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13 terms

Pharm 32-Anticoagulation

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anticoagulant drugs
interfere with the clotting cascade and prolong blood clotting time; vary by route and method of action: parenteral (prevent fibrinogen to fibrin) and oral (prevent synthesis of factors that need vitamin K); prototype: heparin
heparin
anticoagulant; promotes factor X to prevent conversion of prothrombin to thrombin so no clot forms; can be IV or SC (SC is low molec weight); adv: bleeding and thrombocytopenia; safe in pregnancy; monitor for high aPTT; antidote is protamine sulfate
warfarin
used prophylactically for long term risk of thrombus after mitral valve replacement or venous stasis; blocks vitamin K; adv: bleeding and hemorrhage; fetal warfarin syndrome may occur; P-450 variations alter it; Vitamin K is antidote; monitor PT and INR
antiplatelet drugs
used when overactive platelets pose risk for hypercoagulation; reduce platelet aggregation to prolong bleeding time; prototype: clopidogrel
clopidogrel
used to reduce atherosclerotic events; NO active bleeding disorders; adv: bleeding, GI distress most common, neutropenia; caution younger than 18; for pts who can't tolerate aspirin
hemorheologic drugs
act on RBCs to reduce blood viscosity and increase RBC flexibility; helps prevent thrombus and allows RBCs to enter microcirculation; treat peripheral vascular disease; prototype: pentoxifylline
pentoxifylline
hemorheologic drug; manage intermittent claudication from PVD, can walk longer without pain, full effects seen 4 to 8 weeks, smoking limits effectiveness; adv: CNS, CV, GI; NO hypersensitive to methylxanthines
Thrombolytic drugs
assist in breaking down formed blood clots in pts with MI, PE, ischemic stroke; unclog central venous caths; prototype: alteplase, recombinant
alteplase recombinant
thrombolytic drug; given IV; converts plasminogen to plasmin; NO active internal bleeding; adv: internal or superficial bleeding; reconstitute in sterile water; monitor vital signs for signs of bleeding; cardiac monitor
Clotting factors
deficiencies of normal clotting factors are associated with prolonged bleeding and clot formation, so these replace them; prototype: antihemophilic factor
antihemophilic factor
clotting factor VIII; treats bleeding in hemophilia; slight risk of hepatitis and HIV since made from human factors; reconstitute and administer IV; NO hypersensitivity to mouse protein; adv: anaphylaxis, urticaria, nausea, chills; refrigerate then warm to room temp; don't use aspirin or ibuprofen
hemostatic drugs
stop blood loss by enhancing coagulation; can be systemic (breakdown of clots) or topical (control small bleeding or oozing following surgery); prototype: aminocaproic acid
aminocaproic acid
systemic hemostatic drug; treats life threatening hemorrhage; IV; adv: GI DISTRESS, headache, dizzy, seizure, hypo, tinnitus, nasal congestion, vomiting, cramps, diarrhea, diuresis, thrombophlebitis; place on cardiac monitor; inxs: oral contraceptives