Hemostasis drugs PDF

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Summary

Hemostasis drugs...

Description

Process

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of

Hemostasis

(Factor Xa) Intrinsic Pathway (In response to injury) Extrinsic Pathway (Blood enters tissue spaces)

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Removal of Blood Clots Fibrinolysis: Removal of clot so that tissue can resume its normal activity Fibrinolysis: Removal of clot so that tissue can resume its normal activity

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Diseases of Hemostasis Thromboembolic disorders (MI and CVA) Thromboembolic disorders

(MI and CVA) –Stationary clot (thrombus) grows and deprives specific areas of oxygen Deep Vein Thrombosis (DVT) Deep Vein Thrombosis (DVT) –Formation of clots in large veins (usually legs) Embolus Embolus –Thrombus may break off and be carried by bloodstream to affect other areas

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Diseases of Hemostasis (cont) Thrombocytopenia Thrombocytopenia –Low number of

platelets, cannot properly form clots Hemophilias Hemophilias –Genetic deficiencies of clotting factors

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Mechanisms of Action Anticoagulants Anticoagulants –Inhibition of clotting factors

Antiplatelets Antiplatelets –Inhibition of platelet function Thrombolytics Thrombolytics –Lyse thrombi Hemostatics Hemostatics –Inhibition of fibrinolysis

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Inhibition of Clotting Factors (Anticoagulants)

Heparin Example: Heparin (Heplock®) Example: Heparin (Heplock®) MOA: Enhances

inhibitory effect of antithrombin III (inhibits factor Xa) MOA: Enhances inhibitory effect of antithrombin III (inhibits factor Xa)

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Heparin Enoxaparin (Factor Xa)

Heparin Example: Heparin (Heplock®) Example: Heparin (Heplock®) MOA: Enhances

inhibitory effect of antithrombin III (inhibits factor Xa) MOA: Enhances inhibitory effect of

antithrombin III (inhibits factor Xa) Route: IV (continuous infusion), SC Route: IV (continuous infusion), SC Monitoring: aPTT (25-40 s), platelets, s/sxs of hemorrhage Monitoring: aPTT (25-40 s), platelets, s/sxs of hemorrhage Adverse Effects: Adverse Effects: –Hemorrhage –Anaphylaxis – Thrombocytopenia (HIT)

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Low-Molecular-Weight Heparins Example: Enoxaparin (Lovenox®) Example: Enoxaparin

(Lovenox®) MOA: Enhances inhibitory effect of antithrombin III (inhibits factor Xa) MOA: Enhances inhibitory effect of antithrombin III (inhibits factor Xa) Route: SC Route: SC Monitoring: Anti-factor Xa, SCr, platelets Monitoring: Anti-factor Xa, SCr, platelets Adverse Effects: Adverse Effects: –Hemorrhage –Thrombocytopenia –Hypersensitivity (anaphylaxis)

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Vitamin K-Dependant Clotting Factor Inhibitors Example: Warfarin (Coumadin®) Example:

Warfarin (Coumadin®) MOA: Inhibits enzymes responsible for cyclic conversion of Vitamin K MOA: Inhibits enzymes responsible for cyclic conversion of Vitamin K Route: PO Route: PO Monitoring: PT/INR (12-15 / 2-3.5), s/sxs of hemorrhage Monitoring: PT/INR (12-15 / 2-3.5), s/sxs of hemorrhage Adverse Effects: Adverse Effects: –Hemorrhage –Anemia –Bruising

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Direct Thrombin Inhibitors Examples: Argatroban (Novastan®) Bivalirudin (Angiomax®)

Examples: Argatroban (Novastan®) Bivalirudin (Angiomax®) MOA: Directly inhibit thrombin (preventing formation of fibrin clots) MOA: Directly inhibit thrombin (preventing formation of fibrin clots)

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Argatroban Bivalirudin (Factor Xa)

Direct Thrombin Inhibitors Examples: Argatroban (Novastan®) Bivalirudin (Angiomax®)

Examples: Argatroban (Novastan®) Bivalirudin (Angiomax®) MOA: Directly inhibit thrombin (preventing formation of fibrin clots) MOA: Directly inhibit thrombin (preventing formation of fibrin clots) Route: IV Route: IV Monitoring: aPTT (25-40 s) Monitoring: aPTT (25-40 s) Adverse Effects: Adverse Effects: –Serious internal hemorrhage –Back pain (bivalirudin)

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Nursing Considerations Medication Safety Medication Safety Assess patients for signs of

bleeding Assess patients for signs of bleeding –Bruising –Obvious signs of bleeding (nosebleeds, bleeding from rectum, blood in emesis) –“Coffee Ground” or black, tarry stools / emesis Patient

education Patient education Toxicity: warfarin – vit K administration heparin – protamine sulfate Toxicity: warfarin – vit K administration heparin – protamine sulfate

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Patient Case JR is 55 YOWM recently diagnosed with a DVT and is currently receiving

enoxaparin (Lovenox). JR is 55 YOWM recently diagnosed with a DVT and is currently receiving enoxaparin (Lovenox). Before he can be d/c’ed from the hospital, his MD wants to starts him on chronic anticoagulation to prevent future DVTs Before he can be d/c’ed from the hospital, his MD wants to starts him on chronic anticoagulation to prevent future DVTs

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Inhibition of Platelet Function (Antiplatelets)

GP IIb/IIIa Antagonists Example: Abciximab (ReoPro®) Example: Abciximab (ReoPro®)

MOA: Inhibit GP IIb/IIIa, enzyme necessary for platelet aggregation MOA: Inhibit GP IIb/IIIa, enzyme necessary for platelet aggregation

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GP IIb/IIIa Antagonists Example: Abciximab (ReoPro®) Example: Abciximab (ReoPro®)

MOA: Inhibit GP IIb/IIIa, enzyme necessary for platelet aggregation MOA: Inhibit GP IIb/IIIa, enzyme necessary for platelet aggregation Route: IV Route: IV Monitoring: Platelets Monitoring: Platelets Adverse Effects: Adverse Effects: –Hemorrhage –Thrombocytopenia

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Aspirin (Ecotrin®) Example: Aspirin (Ecotrin®) Example: Aspirin (Ecotrin®) MOA: Irreversibly binds to COX, inhibiting formation of thromboxane A2 MOA: Irreversibly binds to COX, inhibiting formation of thromboxane A2

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Aspirin (Ecotrin®) Example: Aspirin (Ecotrin®) Example: Aspirin (Ecotrin®) MOA: Irreversibly binds to COX, inhibiting formation of thromboxane A2 MOA: Irreversibly binds to COX,

inhibiting formation of thromboxane A2 Route: PO Route: PO Monitoring: S/sxs hemorrhage Monitoring: S/sxs hemorrhage Adverse Effects: Adverse Effects: –Increased clotting times –GI bleeding –Anaphylaxis

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ADP Receptor Blockers Example: Clopidogrel (Plavix®) Example: Clopidogrel (Plavix®) MOA: ADP-receptor blockers MOA: ADP-receptor blockers

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ADP Receptor Blockers Example: Clopidogrel (Plavix®) Example: Clopidogrel (Plavix®) MOA: ADP-receptor blockers MOA: ADP-receptor blockers Route: IV (loading dose), PO Route: IV (loading dose), PO Monitoring: S/sxs hemorrhage Monitoring: S/sxs hemorrhage Adverse Effects: Adverse Effects: –Increased clotting time –GI bleeding –Blood dyscrasias (TTP)

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Agents for Intermittent Claudication Example: Cilostazole (Pletal®) Example: Cilostazole

(Pletal®) MOA: PDE-3 inhibitor MOA: PDE-3 inhibitor Route: PO Route: PO Monitoring: S/sxs hemorrhage, heart Monitoring: S/sxs hemorrhage, heart Adverse Effects: Adverse Effects: – Palpitation, tachycardia, –Nausea, vomitting

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Nursing Considerations Careful monitoring of patient condition (increased risk of bleeding) Careful monitoring of patient condition (increased risk of bleeding) Combination with

anticoagulants – increased risk of bleeding Combination with anticoagulants – increased risk of bleeding Injection / venipuncture sites will require prolonged pressure to control bleeding Injection / venipuncture sites will require prolonged pressure to control bleeding Patient education Patient education

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Pharmacotherapy with Thrombolytics

Thrombolytics Example: Alteplase (Activase®, TPA) Example: Alteplase (Activase®, TPA)

MOA: Fibrin-enhanced conversion of plasminogen to plasmin MOA: Fibrin-enhanced conversion of plasminogen to plasmin

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Thrombolytics Example: Alteplase (Activase®, TPA) Example: Alteplase (Activase®, TPA)

MOA: Fibrin-enhanced conversion of plasminogen to plasmin MOA: Fibrin-enhanced conversion of plasminogen to plasmin Route: IV Route: IV Monitoring: S/sxs hemorrhage, coagulation tests, H/H, platelets, mental status, dysrhythmias (MI) Monitoring: S/sxs hemorrhage, coagulation tests, H/H, platelets, mental status, dysrhythmias (MI) Adverse Effects: Adverse Effects: –Serious internal bleeding –Intracranial hemorrhage

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Nursing Considerations Identify underlying conditions that exclude patient from receiving

thrombolytics Identify underlying conditions that exclude patient from receiving thrombolytics –Recent trauma, surgery, or biopsy –Arterial emboli –Recent cerebral embolism –Hemorrhage – Thrombocytopenia –Childbirth (within 10 days)

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Pharmacotherapy with Hemostatics

Hemostatics Example: Aprotinin (Trasylol®) Example: Aprotinin (Trasylol®) MOA: Inhibits

fibrinolysis (affects multiple mediators) MOA: Inhibits fibrinolysis (affects multiple mediators)

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Hemostatics Example: Aprotinin (Trasylol®) Example: Aprotinin (Trasylol®) MOA: Inhibits

fibrinolysis (affects multiple mediators) MOA: Inhibits fibrinolysis (affects multiple mediators) Route: IV Route: IV Monitoring: Clotting, peripheral pulses, paresthesias, (+) Homans’ sign Monitoring: Clotting, peripheral pulses, paresthesias, (+) Homans’ signHomans’ signHomans’ sign Adverse Effects: Adverse Effects: –Clotting –Extravasation...