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Coagulation modifier drugs - Coggle Diagram
Coagulation modifier drugs
Anticoagulants:
suffix: -arin
Heparin
MOA:
prevents clotting by activating antithrombin. inhibits thrombin and works on different points of the clotting cascade
Side effects:
hemorrhage, heparin induced thrombocytopenia, hypersensitivity reactions, toxicity
interactions:
other anticoagulants
PT teaching:
baseline vital sings; labs - CBC, PLT; APTT - used for monitoring of heparin every 4-6 hours until stable levels are reached.
therapeutic APTT = 1.5-2.5X normal value; antidote: Protamine sulfate
contraindications:
any conditions that predispose the pt to bleeding
enoxaparin
indication:
prevent DVT in post-op pts, prevent complications in certain types of MI, treat DVT/PE
MOA:
acts on coagulation factor XA, limiting thrombin needed for production of fibrin
Side effects:
hemorrhage, neurologic damage from hematoma formation in those who are receiving spinal or epidural anesthesia, thrombocytopenia
PT. teaching:
most syringes come pre-filled (do not expel air bubble), inject in abdomen (without aspirating), rotate injection sites,
monitor for signs of bleeding
contraindications:
pts with bleeding disorders
Warfarin
MOA:
antagonize Vitamin K preventing synthesis of additional coagulation factors
Side effects:
bleeding, brusing
interactions:
many herbal products have potential interactions - increased bleeding may occur
PT teaching:
signs of abnormal bleeding.
to be started while the pt is still on heparin until PT-INR levels indicate adequate anticoagulation
. full therapeutic effect takes several days. Monitor PT-INR regularly - keep follow up appointments.
Therapeutic PT-INR = 2-3x's normal value.
avoiding foods high in vitamin K (tomatoes, dark leafy green vegetables).
Antidote: Vitamin K
contraindications:
bleeding
Direct thrombin inhibitors:
dabigatran
Indication:
prevent stroke or embolism in pts who have afib not caused by valvular heart disease
MOA:
work directly by inhibiting thrombin, preventing a thrombus from developing
side effects:
bleeding, GI discomfort
Interactions:
other anticoagulants
PT teaching:
given orally (should not be crushed), can be taken with or without food. discontinue other anticoagulants when starting dabigatran
contraindications:
bleeding disorders
Direct inhibitors of Factor XA:
ribaroxaban
Indication:
prevents DVT and PE in clients who are undergoing joint replacements
MOA:
anticoagulation by inhibiting factor Xa
side effects:
bleeding and elevated liver enzymes
interactions:
other anticoagulants
PT teaching:
administer tablets orally once a day with or without food at the same time everyday.
monitor Hgb, HCT, and liver and kidney function during treatment
contraindications:
bleeding disorders
Antiplatelets:
MOA:
inhibit platelet aggregation, prevent platelet adhesion, reduce risk of stroke, treat unstable angina and MI
Aspirin:
oral and suppository, cardioprotective
clopidogrel (Plavix):
oral, used after coronary artery stent placement
Eptifibatide:
intravenous, used in ICU or cardiac cath lab
thrombolytics/fibrinolytics:
anistreplase, alteplae, reteplase, tenecteplase
Suffix: -plase
MOA:
activate the fibrinolytic system to break down the clot in the blood vessel quickly. activate plasminogen and convert it to plasmin, which can digest fibrin
Side effects:
bleeding (internal, intracranial - altered LOC, superficial); nausea/vomiting; hypotension; anaphylactic reactions; cardiac dysrhythmias
PT teaching:
treatment of acute MI- MUST be initiated within 6 hours of onset of symptoms. Treatment of acute ischemic stroke- MUST be initiated within 3 hours of onset of symptoms.
must have informed conset
Contraindications:
bleeding