Term
| What are the two primary types of inadequate clotting disorders? |
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Definition
1. Disorders of platelets
2. Disorders of coagulation cascade |
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Term
| What's the major risk associated with inadequate clotting? |
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Definition
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Term
| What are platelet disorders called? What causes it? |
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Definition
*Thrombocytopenia
*Decreased production in bone marrow
*Reduced platelet survival (autoimmune)
*Failure to release from spleen |
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Term
| What causes coagulation disorders? |
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Definition
*Inadequate clotting factors d/t liver disease
*Inadequate Vitamin K
*Nosocomial (leading cause)
*Hereditary |
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Term
| What are the 2 hereditary bleeding disorders? |
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Definition
1. Hemophilia A = X-linked recessive imp. of factor VIII = Tx c extrinsic factor VIII
2. Von Willebrand's = autosomal (Tx c factor VIII w/vWF) |
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Term
| What is pathologic coagulation? Arterial vs. Venous clots? |
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Definition
*Any episode of blood clotting that is at the wrong location or the wrong time
*Arterial = less common = block O2 = Acute MI or non-hemorrhagic CVA
*Venous = more common = risk for PE |
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Term
| What is hypercoagulability? How can it happen? |
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Definition
*Increased platelet function
*Too many = overproduction by marrow
*Disturbances of flow = stasis
*Damage to vascular endothelium = atherosclerosis, DM = starts clotting cascade
*Increased stickiness = tendency of platelets adhering |
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Term
| What accelerates coagulation? |
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Definition
*Estrogen effects = increased hepatic synth of clotting factors
*Cancer, sepsis
*Acquired disorders of unclear etiology = smoking, obesity |
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Term
| What causes vein thrombosis? S/S? Risks? Preventive measures? |
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Definition
*deep vein stasis, endothelial injury, hypercoagulability
*Redness, tenderness, warmth, inflammation
*Risk for PE
*Mobility, Hydration, Venous compression devices |
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Term
| What do Rxs do to prevent clot formation? |
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Definition
*Impede platelet aggregation
*Impair blood coagulation |
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Term
Where do antiplatelet Rxs work best?
What are the three categories of Rx? |
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Definition
*On the arterial "side" of coagulopathies
1. Aspirin
2. ADP receptor antagonists
3. GP IIb and IIIa receptor agonists |
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Term
| How does Aspirin work as an antiplatelet Rx? |
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Definition
*Inhibits synth of prostaglandin, thromboxane A2
*Used for CVA protection |
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Term
| How do ADP antagonists work as antiplatelet Rxs? Uses? |
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Definition
*Ticlopidine (Ticlid) or clopidogrel (Plavix)
*Irreversibly bind ADP to receptor on platelets
*Used when aspirin is contraindicated
*Prevention of stroke & MI, acute coronary syndrome |
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Term
| How does GP IIa and IIIb Receptor Antagonists work as antiplatelet Rxs? |
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Definition
*Integrilin, Aggrastat, ReoPro
*Causes reversible blockade of fibrin receptors on platelets = prevents aggregation
*Given IV
*Short term use
*Expensive |
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Term
| What do anticoagulants do? |
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Definition
*Disrupt coagulation cascade & suppress production of fibrin
*Prevents venous thrombosis
*Prevent formation of new clot |
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Term
| What is Heparin used for? Route? Dosing? |
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Definition
*Used for various thromboembolic disorders = DVT, PE, pre-procedures
*IV/SQ
*Fast-acting
*Dosed in units = wide variation in preparations |
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Term
| What are the ADRs associated with Heparin? What is the antidote to heparin? Drug/drug interactions? |
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Definition
*Bleeding = monitor c PTT (normal value ~40)
*Heparin induced thrombocytopenia = antibody reaction
*Hypersensitivity reactions = allergic
*Protamine sulfate as antidote for bleeding
*Interacts c ASA or other anti-platelet Rxs |
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Term
| What are low molecular weight heparins (LMWH)used for? |
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Definition
*Prevention & Tx for DVT
*unstable angina & MI when combined c ASA
*Longer 1/2 life than heparin
*Less risks
*Expensive |
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Term
| What does Warfarin (Coumadin) do? Used for? Administration? Antidote? |
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Definition
*Inhibits hepatic synthesis of vitamin K-dependent clotting factors
*Long term prevention of DVT, PE
*Atrial fibrillation
*Acute or post MI
*After valve replacement
*Oral only
*Vitamin K Antidote |
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Term
| What are the major risks associated with Warfarin? |
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Definition
*BLEEDING
*Drug/drug interactions = MAOIs, others can increase or decrease effects of coumadin = no Rx w/o MD approval |
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Term
| What do Thrombolytics do? Examples? |
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Definition
*Dissolve clots already present
*Reestablish blood flow & prevent/limit tissue damte = stimulate plasminogen to plasmin; degrade fibrin present; disolve thrombi
*Activase, Streptase, Abbokinase |
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Term
| What are Thrombolytics used for? Administartion? |
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Definition
*AMI
*Lysis of thrombus in coronary arteries
*Lysis of PE or DVT
*Stroke (some types)
*Dissolving clots in intravascular catheters
*IV |
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Term
| Major ADR associated c Thrombolytics? |
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Definition
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