PHARMA- LAB

    avatar
    Created by
    yeon

    Subdecks (11)

    Cards (453)

    • Hemostatis (stopping of blood flow) 

      is an essential mechanism in our body to it from both external and internal injuries.
    • Without the efficient hemostasis - bleeding or internal injuries would lead to shock or death
    • Hemostasis - is a complex process involving the clotting factors that are activated in a series of sequential steps, known as, "cascade"
    • Diseases affecting hemostasis:
      • MI
      • CVA
      • Venous Thrombus
      • Valvular Heart Disease
    • Achieved hemostasis = blood clot is formed, protecting the body from excessive hemorrhage
    • Clot - may restrict blood flow to the area and must be restored for blood flow to continue.
    • Fibrinolysis - is a process of clot removal initiated within 24-48 hours of clot formation until clot dissolves.
    • Disorders that affect coagulation process are divided into two categories:
      • Overproduction of clots or Thromboembolic disorders
      • Clotting factor is ineffective resulting to risk for bleeding and hemorrhagic disorders
    • Three major groups used to maintain or restore circulation:
      • Anticoagulants
      • Antiplatelets
      • Thrombolytics
    • Anticoagulants 

      also called as "blood thinners" that prolongs bleeding time to prevent formation of blood clots
    • Anti-coagulants

      acts to prevent the formation of new clots
    • Anticoagulants - are used to patients at high risk for clot formation
    • Conditions at high risk for clot formation:
      • Venous problems: Thrombosis and Pulmonary Embolism
      • Arterial problems: Coronary thrombosis and MI
    • Side effects of Anti-coagulants (bleeding) 

      • Hemorrhage
      • Hematuria
      • Epistaxis
      • Ecchymosis - large bruise / bleeding underneath the skin
      • Gum bleeding
      • Thrombocytopenia - low platelet count
    • Contraindications of Anti-coagulants (Presence of Bleeding) 

      • Active bleeding
      • Bleeding disorders
      • Blood dyscrasias
      • Disease: Ulcer, liver, kidney
    • Drugs under anti-coagulants:
      • Warfarin (Coumadin)
      • Dabigatran (Praxada)
      • Rivaroxaban (Xarelto)
      • Heparin
    • Warfarin (Coumadin) 

      is an oral drug that works to interfere the formation of Vitamin K clotting factors in the liver.
    • Vitamin K

      used to reverse the effects of warfarin
    • Prothrombin time - measure the time it takes for a blood to clot
    • Warfarin (Prothrombin Time) 

      • Normal lab value: 11 - 12.5 secs
      • Therapeutic lab value: 15.5 to 35 secs
    • Warfarin (International Normalized Ratio: INR) 

      • Normal lab value: 0.8 - 1.1 secs
      • Therapeutic lab value: 2-3 secs
    • Longer than normal PT - may indicate: 

      • lack of clotting factors (I, II, V, VII, X)
      • lack of vit. k due to liver disease (cirrhosis) or liver injury
      • due to disseminated intravascular coagulation (DIC)
      • caused by treatment of blood thinning medications (Warfarin and Heparin)
    • Dabigatran (Praxada) 

      directly inhibits thrombin, blocking the last step of clot formation
    • Dabigatran is indicated to patients with non-valvular atrial fibrillation

      • approved to reduce the risk for stroke and systemic embolism
      • drug of choice than warfarin
    • Rivaroxaban (Xarelto) 

      is a factor Xa inhibitor that stops the coagulation cascade in early step.
    • Rivaroxaban is indicated to:

      • patients undergoing knee or hip replacement surgery
      • approved to prevent DVT, which may cause pulmonary embolism.
    • Heparin

      a naturally occurring substance that inhibits the conversion of prothrombin to thrombin, blocking the conversion of fibrinogen to fibrin which is the last step of clot formation.
    • Onset of action for heparin is immediate in IV and SC
    • Enoxaparin 

      is a low molecular weight heparin that does not need intense monitoring.
    • Protamine Sulfate 

      antidote for Heparin overdose
    • Activated Partial Thromboplastin Time - is a screening test to evaluate a person's ability to form blood clot; the secs it takes to form a clot. It also assesses the amount of certain proteins in a blood.
    • aPTT for Heparin

      • Normal lab value: 30-40 secs
      • Therapeutic lab value: 45-100 secs
    • Warfarin therapeutic effects evaluation

      Prothrombin Time (PT) 1.5-2.5 times control value or International Normalized Ratio (INR) 2-3
    • Heparin therapeutic effects evaluation

      Activated Partial Thromboplastin Time (aPTT) 1.5-3 times control value
    • For anticoagulants, evaluate signs of blood loss 

      • petechiae
      • bleeding gums
      • bruises
      • dark colored: stools and urine
    • for anticoagulants, during invasive procedures. Provide increase precautions against bleeding
      • use of pressure dressing
      • avoid IM injections
      • avoid rubbing the SC injection sites
    • Thrombolytic medications

      selectively degrades formed fibrin clot with minimal effect on clot formation.
    • Thrombolytic medications are administered to patients with disorders where intravascular clot has already formed:
      • Acute MI
      • Pulmonary Embolism
      • Acute CVA
      • DVT
    • Thrombolytics for MI: Usage 

      are used within 4-6 hours of infarct inset to restore blood flow.
    • Thrombolytic agents can break down clots older than 6 hours, but tissue that are already anoxic over 6 hours may not benefit from the treatment.