12/7/23, 6:37 AM NR293 Pharmacology for Nursing Practice Week 4 Edapt
Week 4 Concepts: Clotting
Coagulation Modifiers
Prepare: Coagulation Modifiers
Coagulation Modifiers
Coagulation modifiers are a group of medications that both promote and prevent clot formation as well as lysing a preformed
clot and reversing the action of anticoagulants.
Warfarin
Warfarin is an anticoagulant medication whose mechanism of action is to prevent clot formation by inhibiting particular clotting
factors.
Coagulation Modifier Drugs
Coagulation modifier drugs is a class of medication that includes medications?
heparin
aspirin
acetaminophen
warfarin
Self Check: Hemostasis Review
Coagulation Cascade System
The coagulation cascade system is triggered by an injury to a blood vessel, which then triggers either an intrinsic or an
extrinsic pathway of intricate steps, each step triggering the next when clotting factors are/is activated. The ultimate result of
this system is a large concentration of fibrin.
Reverse of the Coagulation Process
The reverse of the coagulation process is the fibrinolytic system. Fibrinolysis is the breakdown of thrombi. This is an important
part of hemostasis in order to prevent excessive coagulation, blocked blood vessels, or mobilized thrombi called an embolus.
Self Check: Coagulation Modifier Drugs
Coagulation Modifiers
The coagulation modifier drugs are broken down into several subclasses or categories based on their hemostasis
reversal or promotion action. Which items are mechanisms of action for this class of drug? Select all that apply.
Thrombus prevention
Thrombus mobilization
Lysing of a preformed thrombus
Anticoagulation reversal
Thrombus promotion
Antiplatelet reversal
Self Check: Mechanism of Action
Mechanism of Action
Which one of these coagulation modifier drugs has a mechanism of action that is to lyse a thrombus that has
already formed? Match it to its subclass.
Medication Subclass
Mechanism of Action Alteplase Thrombolytic
Reversal Drug
Which of these medications is a coagulation modifier whose subclass is a reversal drug? Select all that apply.
aminocaproic acid
apixaban
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protamine sulfate
vitamin K
Reflect: Coagulation Modifiers
Antifibrinolytics
What is another term for antifibrinolytics?
Antithrombotics
Antiplatelets
Hemorheologics
Hemostatics
Promoting Coagulation
A coagulation modifier drug whose mechanism of action is to promote coagulation of the blood is called a(n)
___________ and is used to _________.
antifibrinolytic, manage excessive bleeding
anticoagulant, prevent clot formation
thrombolytic, lyse clots that have already formed
antiplatelet, interfere with platelet function
Anticoagulants
What is another term for anticoagulant?
Hemostatics
Antiplatelets
Hemorheologics
Antithrombotics
Antifibrinolytics
Coagulation Modifier Drugs and Subclasses
Match the coagulation modifier drug’s subclass to the correct medications. Note: Several of the subclasses have
more than one medication listed as correct choices.
Anticoagulants ● Enoxaparin
● Heparin
● Warfarin
● Dabigatran
● etexilateapixaban
Antiplatelets ● clopidogrel bisulfate
● abciximab
Thrombolytics ● alteplase
Antifibrinolytics ● aminocaproic acid
Hemorheologics ● pentoxifylline
Reversal Drugs ● coagulation factor Xa (recombinant)
● idarucizumab
● protamine sulfate
● phytonadione
Reversal and Coagulation Modifier Drugs
Choose the correct word(s) from the drop-down list to complete the following statements regarding reversal drugs.
Protamine sulfate is the reversal drug for heparin.
Phytonadione is the reversal drug for warfarin.
Idarucizumab is the reversal drug for dabigatran etexilate.
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Coagulation factor Xa (recombinant) is the reversal drug for rivaroxaban.
Indications for Use
Match the indications for use of coagulation modifying drugs by dragging the class on the right to the correct
description.
Antiplatelet drugs inhibit platelet aggregation and formation of platelet plugs, which are helpful in preventing heart attacks and
strokes.
Hemorrhagic drugs alter platelet function without interfering with normal platelet activity.
Thrombolytic drugs are a classification of drugs that are used to break down clots or thrombi that have formed.
Antifibrinolytic drugs are hemostatic drugs that promote blood coagulation for conditions of excessive bleeding.
Hemostasis Vocabulary
From the drop-down menu, select the term that best fits the definition.
The process of thrombi formation – Coagulation
A clot forming substance that is the result of the coagulation system, which also triggers the fibrinolysis system – Fibrin
The process of thrombi breakdown – Fibrinolysis
A rare genetic disorder in which certain factors needed for coagulation and hemostasis are inadequate or nonexistent –
Hemophilia
Any process that stops bleeding – Hemostasis
Use of compression to achieve hemostasis – xxxMechanical means of hemostasis
Use of clamping or cauterization to achieve hemostasis – xxxSurgical means of hemostasis
Use of coagulation modifier drugs to achieve hemostasis – xxxPharmacologic means of hemostasis
A mobilized thrombus – Embolus
Blood clot – Thrombus
Subclasses
Match the coagulation modifier drug’s subclass to its mechanism of action.
Prevent clot formation by inhibiting particular clotting factors Anticoagulants
Prevent clot formation by interfering with platelet function Antiplatelets
Lyse clots that have already formed Thrombolytics
Promote the coagulation of blood Antifibrinolytics
Reduce blood viscosity Hemorheologics
Act as antagonists to the other medications Reversal drugs
Anticoagulants (warfarin; heparin)
Prepare: Anticoagulants
Actions of Anticoagulants
Anticoagulants perform which of the following actions?
Act directly on platelet aggregation
Prevent thrombosis
Breakdown fibrin
Lyse pre-formed clots
Anticoagulant Subclasses
Which of these anticoagulants belongs to the subclass heparins?
clopidogrel
warfarin
rivaroxaban
enoxaparin
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Coumarins
How do coumarins prevent thrombus formation?
Working with other drug classes to decrease the thickness of blood
Inhibiting vitamin K-dependent clotting factors
Directly impacting platelet aggregation
Breaking down the fibrin in clots
Self Check: Thromboembolic Event
Which of the following patients is least at risk of a thromboembolic event?
Someone on a direct flight from Detroit, Michigan to Sydney, Australia
Someone who has been in a coma for a week following a stroke
Someone who has a broken foot and is learning to walk with an orthopedic boot
Someone who has a mechanical heart valve
Someone recovering from a bilateral knee replacement
Self Check: Heparin
Heparin Toxicity
Which of the following statements are correct regarding heparin toxicity? Select all that apply.
Heparin toxicity may be treated intravenously with the reversal drug protamine sulfate in severe cases
Because of heparin’s long half life, the toxic effects of heparin cannot reversed by discontinuing heparin alone
The heparin must be stopped immediately
The toxic effects of heparin may be reversed by discontinuing heparin alone
Increased Anticoagulants
Which of the following medications when taken with heparins, can cause an increased anticoagulant effect (bleeding
risk)?
Aspirin and other NSAIDs, oral anticoagulants, antiplatelets, and thrombolytics
Antithrombotics, oral antibiotics, and prothrombins
Acetaminophen, oral anticoagulants, and antithrombotics
Aspirin and other NSAIDs, oral antibiotics, and antithrombotics
Self Check: Warfarin (Coumandin)
Warfarin
Which of the following statements regarding warfarin are accurate? Select all that apply.
It takes several days to reach therapeutic levels
It is the most commonly prescribed parenteral anticoagulant
There is a black box warning regarding bleeding risk specific to warfarin
To treat warfarin toxicity, high doses of diluted vitamin K intravenously can reverse the effects within 6 hours
Self Check: Black Box Warnings
Match the following anticoagulants with its black box warning.
Premature discontinuation of the medication because it can lead to dabigatran
increased thrombi
For patients with an epidural catheter (may cause spinal hematomas) Apixaban / Rivaroxaban / Enoxaparin
Serious bleeding risk warfarin
Reflect: Anticoagulants
Adverse Effects
Which of the following are medications used for treatment of adverse effects associated with heparin? Select all that
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Week 4 Concepts: Clotting
Coagulation Modifiers
Prepare: Coagulation Modifiers
Coagulation Modifiers
Coagulation modifiers are a group of medications that both promote and prevent clot formation as well as lysing a preformed
clot and reversing the action of anticoagulants.
Warfarin
Warfarin is an anticoagulant medication whose mechanism of action is to prevent clot formation by inhibiting particular clotting
factors.
Coagulation Modifier Drugs
Coagulation modifier drugs is a class of medication that includes medications?
heparin
aspirin
acetaminophen
warfarin
Self Check: Hemostasis Review
Coagulation Cascade System
The coagulation cascade system is triggered by an injury to a blood vessel, which then triggers either an intrinsic or an
extrinsic pathway of intricate steps, each step triggering the next when clotting factors are/is activated. The ultimate result of
this system is a large concentration of fibrin.
Reverse of the Coagulation Process
The reverse of the coagulation process is the fibrinolytic system. Fibrinolysis is the breakdown of thrombi. This is an important
part of hemostasis in order to prevent excessive coagulation, blocked blood vessels, or mobilized thrombi called an embolus.
Self Check: Coagulation Modifier Drugs
Coagulation Modifiers
The coagulation modifier drugs are broken down into several subclasses or categories based on their hemostasis
reversal or promotion action. Which items are mechanisms of action for this class of drug? Select all that apply.
Thrombus prevention
Thrombus mobilization
Lysing of a preformed thrombus
Anticoagulation reversal
Thrombus promotion
Antiplatelet reversal
Self Check: Mechanism of Action
Mechanism of Action
Which one of these coagulation modifier drugs has a mechanism of action that is to lyse a thrombus that has
already formed? Match it to its subclass.
Medication Subclass
Mechanism of Action Alteplase Thrombolytic
Reversal Drug
Which of these medications is a coagulation modifier whose subclass is a reversal drug? Select all that apply.
aminocaproic acid
apixaban
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,12/7/23, 6:37 AM NR293 Pharmacology for Nursing Practice Week 4 Edapt
protamine sulfate
vitamin K
Reflect: Coagulation Modifiers
Antifibrinolytics
What is another term for antifibrinolytics?
Antithrombotics
Antiplatelets
Hemorheologics
Hemostatics
Promoting Coagulation
A coagulation modifier drug whose mechanism of action is to promote coagulation of the blood is called a(n)
___________ and is used to _________.
antifibrinolytic, manage excessive bleeding
anticoagulant, prevent clot formation
thrombolytic, lyse clots that have already formed
antiplatelet, interfere with platelet function
Anticoagulants
What is another term for anticoagulant?
Hemostatics
Antiplatelets
Hemorheologics
Antithrombotics
Antifibrinolytics
Coagulation Modifier Drugs and Subclasses
Match the coagulation modifier drug’s subclass to the correct medications. Note: Several of the subclasses have
more than one medication listed as correct choices.
Anticoagulants ● Enoxaparin
● Heparin
● Warfarin
● Dabigatran
● etexilateapixaban
Antiplatelets ● clopidogrel bisulfate
● abciximab
Thrombolytics ● alteplase
Antifibrinolytics ● aminocaproic acid
Hemorheologics ● pentoxifylline
Reversal Drugs ● coagulation factor Xa (recombinant)
● idarucizumab
● protamine sulfate
● phytonadione
Reversal and Coagulation Modifier Drugs
Choose the correct word(s) from the drop-down list to complete the following statements regarding reversal drugs.
Protamine sulfate is the reversal drug for heparin.
Phytonadione is the reversal drug for warfarin.
Idarucizumab is the reversal drug for dabigatran etexilate.
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,12/7/23, 6:37 AM NR293 Pharmacology for Nursing Practice Week 4 Edapt
Coagulation factor Xa (recombinant) is the reversal drug for rivaroxaban.
Indications for Use
Match the indications for use of coagulation modifying drugs by dragging the class on the right to the correct
description.
Antiplatelet drugs inhibit platelet aggregation and formation of platelet plugs, which are helpful in preventing heart attacks and
strokes.
Hemorrhagic drugs alter platelet function without interfering with normal platelet activity.
Thrombolytic drugs are a classification of drugs that are used to break down clots or thrombi that have formed.
Antifibrinolytic drugs are hemostatic drugs that promote blood coagulation for conditions of excessive bleeding.
Hemostasis Vocabulary
From the drop-down menu, select the term that best fits the definition.
The process of thrombi formation – Coagulation
A clot forming substance that is the result of the coagulation system, which also triggers the fibrinolysis system – Fibrin
The process of thrombi breakdown – Fibrinolysis
A rare genetic disorder in which certain factors needed for coagulation and hemostasis are inadequate or nonexistent –
Hemophilia
Any process that stops bleeding – Hemostasis
Use of compression to achieve hemostasis – xxxMechanical means of hemostasis
Use of clamping or cauterization to achieve hemostasis – xxxSurgical means of hemostasis
Use of coagulation modifier drugs to achieve hemostasis – xxxPharmacologic means of hemostasis
A mobilized thrombus – Embolus
Blood clot – Thrombus
Subclasses
Match the coagulation modifier drug’s subclass to its mechanism of action.
Prevent clot formation by inhibiting particular clotting factors Anticoagulants
Prevent clot formation by interfering with platelet function Antiplatelets
Lyse clots that have already formed Thrombolytics
Promote the coagulation of blood Antifibrinolytics
Reduce blood viscosity Hemorheologics
Act as antagonists to the other medications Reversal drugs
Anticoagulants (warfarin; heparin)
Prepare: Anticoagulants
Actions of Anticoagulants
Anticoagulants perform which of the following actions?
Act directly on platelet aggregation
Prevent thrombosis
Breakdown fibrin
Lyse pre-formed clots
Anticoagulant Subclasses
Which of these anticoagulants belongs to the subclass heparins?
clopidogrel
warfarin
rivaroxaban
enoxaparin
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, 12/7/23, 6:37 AM NR293 Pharmacology for Nursing Practice Week 4 Edapt
Coumarins
How do coumarins prevent thrombus formation?
Working with other drug classes to decrease the thickness of blood
Inhibiting vitamin K-dependent clotting factors
Directly impacting platelet aggregation
Breaking down the fibrin in clots
Self Check: Thromboembolic Event
Which of the following patients is least at risk of a thromboembolic event?
Someone on a direct flight from Detroit, Michigan to Sydney, Australia
Someone who has been in a coma for a week following a stroke
Someone who has a broken foot and is learning to walk with an orthopedic boot
Someone who has a mechanical heart valve
Someone recovering from a bilateral knee replacement
Self Check: Heparin
Heparin Toxicity
Which of the following statements are correct regarding heparin toxicity? Select all that apply.
Heparin toxicity may be treated intravenously with the reversal drug protamine sulfate in severe cases
Because of heparin’s long half life, the toxic effects of heparin cannot reversed by discontinuing heparin alone
The heparin must be stopped immediately
The toxic effects of heparin may be reversed by discontinuing heparin alone
Increased Anticoagulants
Which of the following medications when taken with heparins, can cause an increased anticoagulant effect (bleeding
risk)?
Aspirin and other NSAIDs, oral anticoagulants, antiplatelets, and thrombolytics
Antithrombotics, oral antibiotics, and prothrombins
Acetaminophen, oral anticoagulants, and antithrombotics
Aspirin and other NSAIDs, oral antibiotics, and antithrombotics
Self Check: Warfarin (Coumandin)
Warfarin
Which of the following statements regarding warfarin are accurate? Select all that apply.
It takes several days to reach therapeutic levels
It is the most commonly prescribed parenteral anticoagulant
There is a black box warning regarding bleeding risk specific to warfarin
To treat warfarin toxicity, high doses of diluted vitamin K intravenously can reverse the effects within 6 hours
Self Check: Black Box Warnings
Match the following anticoagulants with its black box warning.
Premature discontinuation of the medication because it can lead to dabigatran
increased thrombi
For patients with an epidural catheter (may cause spinal hematomas) Apixaban / Rivaroxaban / Enoxaparin
Serious bleeding risk warfarin
Reflect: Anticoagulants
Adverse Effects
Which of the following are medications used for treatment of adverse effects associated with heparin? Select all that
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