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Questions and Answers
What is coagulation?
What is coagulation?
- The process of blood cell formation
- The process of blood clotting (correct)
- The process of oxygen transport in blood
- The balance of coagulation and anticoagulation (correct)
What do anticoagulant drugs do?
What do anticoagulant drugs do?
Prevent the conversion of fibrinogen to fibrin.
What are the routes for administering Heparin?
What are the routes for administering Heparin?
- Intravenously (IV) (correct)
- Orally
- Subcutaneously (SC) (correct)
- Topically
What is the primary adverse effect of Heparin?
What is the primary adverse effect of Heparin?
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Heparin is contraindicated in pregnant women.
Heparin is contraindicated in pregnant women.
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What should patients be instructed to report when taking Heparin?
What should patients be instructed to report when taking Heparin?
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What is the antidote for Warfarin?
What is the antidote for Warfarin?
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What is the therapeutic range for INR when taking anticoagulants?
What is the therapeutic range for INR when taking anticoagulants?
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What is Clopidogrel used for?
What is Clopidogrel used for?
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Complete the sentence: The normal PT (prothrombin time) is ____ to ____ seconds.
Complete the sentence: The normal PT (prothrombin time) is ____ to ____ seconds.
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Complete the sentence: Antiplatelet drugs are needed when there is a long-term risk for __________.
Complete the sentence: Antiplatelet drugs are needed when there is a long-term risk for __________.
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Study Notes
Coagulation
- Blood consists of various cells and substances, maintaining a balance between coagulation and anticoagulation.
- The clotting cascade is crucial in blood coagulation.
Anticoagulant Drugs
- Parenteral anticoagulants prevent the conversion of fibrinogen to fibrin.
- Oral anticoagulants inhibit the synthesis of vitamin K-dependent clotting factors.
Heparin: Core Drug Knowledge
- Heparin is a parenteral anticoagulant that interferes with the final steps of the clotting cascade.
- Administered via IV or subcutaneously; metabolism occurs in the liver, excretion via kidneys.
- Promotes rapid inactivation of factor X, blocking the conversion of prothrombin to thrombin.
- Contraindicated in patients with hypersensitivity; monitor for bleeding and thrombocytopenia.
- Drug interactions may enhance heparin's effects; antidote is protamine sulfate.
Heparin: Core Patient Variables
- Assess patient’s history for allergies and prolonged bleeding times.
- Safe for pregnant women; evaluate activity level and drug administration environment.
Heparin: Planning and Interventions
- Monitor laboratory values; allow heparin levels to stabilize before measuring PTT.
- Adjust dosage if PTT exceeds desired range; use an IV controller for continuous infusion.
Heparin: Teaching, Assessment, and Evaluations
- Educate patients and families to report any signs of bleeding.
- Ongoing assessments include monitoring for bleeding and reviewing PTT values to maintain therapeutic levels.
Warfarin: Core Drug Knowledge (Coumadin)
- Warfarin is used prophylactically to prevent long-term thrombus formation.
- Administered orally; highly protein-bound; metabolized in the liver and excreted in bile.
- Competitively blocks vitamin K at its action sites; contraindicated in active bleeding scenarios.
- Numerous drug-drug and drug-food interactions occur.
Warfarin: Core Patient Variables
- Assess vitamin K availability as it competes with warfarin.
- Greater safety concerns for patients under 18 years old; assess dietary habits.
- Environment for administration can vary; genetic variations may influence drug response.
Warfarin: Planning and Interventions
- Individualize warfarin dosage based on PT or INR until therapeutic range is achieved.
- Monitor patient response and use vitamin K as an antidote; lab values not required for tests.
Warfarin: Teaching, Assessment, and Evaluation
- Educate patients on bleeding signs and prevention; reinforce taking the drug consistently at the same time each day.
- Ongoing monitoring of PT and INR is essential for ensuring warfarin's therapeutic efficacy.
Normal Lab Values
- Prothrombin Time (PT): 10 to 13.5 seconds.
- Partial Prothrombin Time (PTT): 25 to 35 seconds.
- International Normalized Ratio (INR): 2.0 to 4.0 (if on anticoagulants), 0.8 to 1.2 (if not on anticoagulants).
Antiplatelet Drugs
- Utilized for conditions where overactive platelets increase the risk of hypercoagulability.
- Platelet aggregation is crucial for hemostasis; antiplatelet drugs decrease this aggregation.
- Prototypical drug: Clopidogrel (Plavix) with varying modes of action and side effects.
Clopidogrel: Knowledge
- Oral antiplatelet rapidly absorbs, peaking within two hours of administration.
- Reduces the risk of stroke or vascular death in patients with recent myocardial infarction, stroke, or peripheral artery disease.
- Effects of clopidogrel last approximately five days; intravenous forms provide rapid action.
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