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Week 4 Concepts: Clotting
d d d
Coagulationd Modifiers
Prepare:dCoagulationdModifiers
Coagulationd Modifiers
Coagulationdmodifiersdaredadgroupdofdmedicationsdthatdbothdpromotedanddpreventdclotdformationdasdwelldasdlysingdadpref
ormedd clotdanddreversingdthedactiondofdanticoagulants.
Warfarin
Warfarindisdandanticoagulantdmedicationdwhosedmechanismdofdactiondisdtodpreventdclotdformationdbydinhibitingdparticulardclott
ingd factors.
Coagulation d Modifierd Drugs
Coagulation dmodifier ddrugs dis dadclass dofdmedication dthatdincludes dmedications?
heparin
d aspiri
n
acetaminophend w
arfarin
Selfd Check: dHemostasisd Review
Coagulationd Cascaded System
Thedcoagulationdcascadedsystemdisdtriggereddbydandinjurydtodadblooddvessel,dwhichdthendtriggersdeitherdandintrinsicdorda
nd extrinsicdpathwaydofdintricatedsteps,deachdstepdtriggeringdthednextdwhendclottingdfactorsdare/isdactivated.dThedultimated
resultdofd thisdsystemdisdadlargedconcentrationdofdfibrin.
Reversed ofd thed Coagulationd Process
Thedreversedofdthedcoagulationdprocessdisdthedfibrinolyticdsystem.dFibrinolysisdisdthedbreakdowndofdthrombi.dThisdisdandimpor
tantd partdofdhemostasisdindorderdtodpreventdexcessivedcoagulation,dblockeddblooddvessels,dordmobilizeddthrombidcalleddande
mbolus.
Selfd Check:d Coagulationd Modifierd Drugs
Coagulationd Modifiers
The dcoagulation dmodifier ddrugs dare dbrokenddown dintodseveraldsubclassesdordcategories dbased dondtheir dhemostasis
d reversal dor dpromotion daction.dWhich ditems dare dmechanisms dofdaction dfor d this dclass dofddrug? dSelectdalldthatdapp
ly.
Thrombusdprevention
Thrombusdmobilization
Lysingdofdadpreformeddthrombu
sd Anticoagulationdreversald Th
rombusdpromotiond Antiplatelet
dreversal
SelfdCheck:dMechanismd ofdAction
Mechanismd ofd Action
Which donedofdthese dcoagulation dmodifier ddrugs dhas dadmechanism dofdaction dthatdis dtodlyse dadthrombus dthatdhas
d already dformed? dMatch ditdto dits dsubclass.
Medication Subclass
MechanismdofdAction Alteplase Thrombolytic
ReversaldDrug
Which dofdthese dmedications dis dadcoagulation dmodifier dwhose dsubclass dis dadreversalddrug? dSelectdalldthatdapply.
aminocaproicdaci
dd apixaban
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protaminedsulfat
ed vitamindK
Reflect:d Coagulationd Modifiers
Antifibrinolytics
Whatdis danother dtermdfor dantifibrinolytics?
Antithromboticsd A
ntiplateletsd Hemo
rheologicsd Hemo
statics
Promoting dCoagulation
Adcoagulation dmodifier ddrugdwhose dmechanism dofdaction dis dto dpromote dcoagulation dofdthe dblood dis dcalled da(n)
anddisduseddtod
.d antifibrinolytic,dmanagedexcessivedble
edingd anticoagulant,dpreventdclotdformationd th
rombolytic,dlysedclotsdthatdhavedalreadydformed
d antiplatelet,dinterferedwithdplateletdfunction
Anticoagulants
Whatdis danother dtermdfor danticoagulant?
Hemostaticsd Anti
plateletsd Hemorh
eologicsd Antithro
mboticsd Antifibrin
olytics
Coagulationd Modifierd Drugsd andd Subclasses
Match dthedcoagulation dmodifier ddrug’s dsubclassdtodthedcorrectdmedications.dNote:dSeveraldofdthedsubclassesdha
ved more dthandonedmedication dlisted dasdcorrectdchoices.
Anticoagulants ●d Enoxaparin
● Heparin
● Warfarin
● Dabigatran
● etexilateapixaban
Antiplatelets ●d d clopidogreldbisulfate
● abciximab
Thrombolytics
● d alteplase d Antifibr
inolytics
●d aminocaproic daci
dd Hemorheologics ● d pentoxifylline
ReversaldDrugs ●d d coagulationd factord Xad (recombinant)
● idarucizumab
● protamined sulfate
● phytonadione
Reversald andd Coagulationd Modifierd Drugs
Choose dthedcorrectdword(s) dfromdtheddrop-
down dlistdtodcomplete dthedfollowing dstatements dregarding dreversalddrugs.
Protaminedsulfatedisdthedreversalddrugdfordheparin.d Ph
ytonadionedisdthedreversalddrugdfordwarfarin.
Idarucizumabdisdthedreversalddrugdforddabigatrandetexilate.
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CoagulationdfactordXad(recombinant)disdthedreversalddrugdfordrivaroxaban.
Indications dfordUse
Match dthedindications dfordusedofdcoagulation dmodifying ddrugs dby ddragging dthedclass dondthe drightdtodthedcorrectd d
escription.
Antiplateletddrugsdinhibitdplateletdaggregationdanddformationdofdplateletdplugs,dwhichdaredhelpfuldindpreventingdheartdattacksd
andd strokes.
Hemorrhagicddrugsdalterdplateletdfunctiondwithoutdinterferingdwithdnormaldplateletdactivity.
Thrombolyticddrugsdaredadclassificationdofddrugsdthatdareduseddtodbreakddowndclotsdordthrombidthatdhavedformed.d Ant
ifibrinolyticddrugsdaredhemostaticddrugsdthatdpromotedblooddcoagulationdfordconditionsdofdexcessivedbleeding.
Hemostasisd Vocabulary
From dtheddrop-down dmenu,dselectdthedtermdthatdbestdfits dtheddefinition.
Thed processd ofd thrombid formationd –d Coagulation
Adclotdformingdsubstancedthatdisdthedresultdofdthedcoagulationdsystem,dwhichdalsodtriggersdthedfibrinolysisdsystemd–
d Fibrind Thedprocessdofdthrombidbreakdown d–dFibrinolysis
Adraredgeneticddisorderdindwhichdcertaindfactorsdneededdfordcoagulationdanddhemostasisdaredinadequatedordnonexistentd–
Hemophilia
Anyd processd thatd stopsd bleedingd –d Hemostasis
Used ofd compressiond todachieved hemostasisd –d xxxMechanicald meansd ofd hemostasis
Usedofd clampingdord cauterizationd todachieved hemostasisd –d xxxSurgicald meansdofd hemostasis
Usedofdcoagulationdmodifierddrugsdtodachievedhemostasisd–
dxxxPharmacologicdmeansdofdhemostasisd Admobilized dthrombus d–d Embolus
Blood dclotd–dThrombus
Subclasses
Match dthedcoagulation dmodifier ddrug’s dsubclass dtodits dmechanism dofdaction.
Preventdclotdformationdbydinhibitingdparticulardclottingdfactorsd Anticoagulan
tsd Preventdclotdformationdbydinterferingdwithdplateletdfunction
Antiplateletsd L
ysedclotsdthatdhavedalreadydformed Thrombolytics
Promotedthedcoagulationdofdblood Antifibrinolytics
Reducedblooddviscosity Hemorheologics
Actdasdantagonistsdtodthedotherdmedications Reversalddrugs
Anticoagulantsd (warfarin;d heparin)
Prepare:d Anticoagulants
Actions dofdAnticoagulants
Anticoagulants dperformdwhich dofdthedfollowing dactions?
Actddirectlydondplateletdaggregationd
Preventdthrombosis
Breakdowndfibrin
Lysedpre-formeddclots
AnticoagulantdSubclasses
Which dofdthese danticoagulants dbelongs dtodthedsubclass dheparins?
clopidogreld warf
arind rivaroxaban
d enoxaparin
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Coumarins
How ddodcoumarins dpreventdthrombus dformation?
Workingdwithdotherddrugdclassesdtoddecreasedthedthicknessdofdblood
d InhibitingdvitamindK-dependentdclottingdfactors
Directlydimpactingdplateletdaggregationd
Breakingddowndthedfibrindindclots
Selfd Check:d Thromboembolicd Event
Which dofdthedfollowing dpatients dis dleastdatdrisk dofdadthromboembolic devent?
SomeonedondaddirectdflightdfromdDetroit,dMichigandtodSydney,dAustra
liad Someonedwhodhasdbeendindadcomadfordadweekdfollowingdadstro
ke
Someonedwhodhasdadbrokendfootdanddisdlearningdtodwalkdwithdandorthopedicdboot
Someonedwhodhasdadmechanicaldheartdvalve
Someonedrecoveringdfromdadbilateraldkneedreplacement
SelfdCheck:dHeparin
HeparindToxicity
Which dofdthedfollowing dstatements daredcorrectdregarding dheparin dtoxicity? dSelectdalldthatdapply.
Heparindtoxicitydmaydbedtreateddintravenouslydwithdthedreversalddrugdprotaminedsulfatedindseveredcasesd B
ecausedofdheparin’sdlongdhalfdlife,dthedtoxicdeffectsdofdheparindcannotdreverseddbyddiscontinuingdheparindal
oned Thedheparindmustdbedstoppeddimmediately
Thedtoxicdeffectsdofdheparindmaydbedreverseddbyddiscontinuingdheparindalone
IncreaseddAnticoagulants
Which dofdthedfollowing dmedications dwhen dtaken dwithdheparins,dcandcause dandincreased danticoagulant deffectd(bleedi
ngd risk)?
AspirindanddotherdNSAIDs,doraldanticoagulants,dantiplatelets,danddthrombolytics
Antithrombotics,doraldantibiotics,danddprothrombinsd Acetamin
ophen,doraldanticoagulants,danddantithromboticsd Aspirindandd
otherdNSAIDs,doraldantibiotics,danddantithrombotics
SelfdCheck:dWarfarind(Coumandin)
Warfarin
Which dofdthedfollowing dstatements dregarding dwarfarin daredaccurate? dSelectdalldthatdapply.
Itdtakesdseveralddaysdtodreachdtherapeuticdlevels
Itdisdthedmostdcommonlydprescribeddparenteraldanticoagulant
Theredisdadblackdboxdwarningdregardingdbleedingdriskdspecificdtodwarfarin
Todtreatdwarfarindtoxicity,dhighddosesdofddiluteddvitamindKdintravenouslydcandreversedthedeffectsdwithind6dhours
Selfd Check:d Blackd Boxd Warnings
Match dthedfollowing danticoagulants dwithdits dblack dbox dwarning.
Premature ddiscontinuation dofdthedmedication dbecause ditdcandlea dabigatran
ddtod increased dthrombi
Ford patientsd withd and epidurald catheterd (mayd caused spinald hematomas) Apixaband/dRivaroxaband/dEnoxaparin
Seriousd bleedingd risk warfarin
Reflect:dAnticoagulants
Adversed Effects
Which dofdthedfollowing daredmedicationsdused dfordtreatmentdofdadverse deffectsdassociated dwithdheparin? dSelectdalldt
hat
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Week 4 Concepts: Clotting
d d d
Coagulationd Modifiers
Prepare:dCoagulationdModifiers
Coagulationd Modifiers
Coagulationdmodifiersdaredadgroupdofdmedicationsdthatdbothdpromotedanddpreventdclotdformationdasdwelldasdlysingdadpref
ormedd clotdanddreversingdthedactiondofdanticoagulants.
Warfarin
Warfarindisdandanticoagulantdmedicationdwhosedmechanismdofdactiondisdtodpreventdclotdformationdbydinhibitingdparticulardclott
ingd factors.
Coagulation d Modifierd Drugs
Coagulation dmodifier ddrugs dis dadclass dofdmedication dthatdincludes dmedications?
heparin
d aspiri
n
acetaminophend w
arfarin
Selfd Check: dHemostasisd Review
Coagulationd Cascaded System
Thedcoagulationdcascadedsystemdisdtriggereddbydandinjurydtodadblooddvessel,dwhichdthendtriggersdeitherdandintrinsicdorda
nd extrinsicdpathwaydofdintricatedsteps,deachdstepdtriggeringdthednextdwhendclottingdfactorsdare/isdactivated.dThedultimated
resultdofd thisdsystemdisdadlargedconcentrationdofdfibrin.
Reversed ofd thed Coagulationd Process
Thedreversedofdthedcoagulationdprocessdisdthedfibrinolyticdsystem.dFibrinolysisdisdthedbreakdowndofdthrombi.dThisdisdandimpor
tantd partdofdhemostasisdindorderdtodpreventdexcessivedcoagulation,dblockeddblooddvessels,dordmobilizeddthrombidcalleddande
mbolus.
Selfd Check:d Coagulationd Modifierd Drugs
Coagulationd Modifiers
The dcoagulation dmodifier ddrugs dare dbrokenddown dintodseveraldsubclassesdordcategories dbased dondtheir dhemostasis
d reversal dor dpromotion daction.dWhich ditems dare dmechanisms dofdaction dfor d this dclass dofddrug? dSelectdalldthatdapp
ly.
Thrombusdprevention
Thrombusdmobilization
Lysingdofdadpreformeddthrombu
sd Anticoagulationdreversald Th
rombusdpromotiond Antiplatelet
dreversal
SelfdCheck:dMechanismd ofdAction
Mechanismd ofd Action
Which donedofdthese dcoagulation dmodifier ddrugs dhas dadmechanism dofdaction dthatdis dtodlyse dadthrombus dthatdhas
d already dformed? dMatch ditdto dits dsubclass.
Medication Subclass
MechanismdofdAction Alteplase Thrombolytic
ReversaldDrug
Which dofdthese dmedications dis dadcoagulation dmodifier dwhose dsubclass dis dadreversalddrug? dSelectdalldthatdapply.
aminocaproicdaci
dd apixaban
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pt
protaminedsulfat
ed vitamindK
Reflect:d Coagulationd Modifiers
Antifibrinolytics
Whatdis danother dtermdfor dantifibrinolytics?
Antithromboticsd A
ntiplateletsd Hemo
rheologicsd Hemo
statics
Promoting dCoagulation
Adcoagulation dmodifier ddrugdwhose dmechanism dofdaction dis dto dpromote dcoagulation dofdthe dblood dis dcalled da(n)
anddisduseddtod
.d antifibrinolytic,dmanagedexcessivedble
edingd anticoagulant,dpreventdclotdformationd th
rombolytic,dlysedclotsdthatdhavedalreadydformed
d antiplatelet,dinterferedwithdplateletdfunction
Anticoagulants
Whatdis danother dtermdfor danticoagulant?
Hemostaticsd Anti
plateletsd Hemorh
eologicsd Antithro
mboticsd Antifibrin
olytics
Coagulationd Modifierd Drugsd andd Subclasses
Match dthedcoagulation dmodifier ddrug’s dsubclassdtodthedcorrectdmedications.dNote:dSeveraldofdthedsubclassesdha
ved more dthandonedmedication dlisted dasdcorrectdchoices.
Anticoagulants ●d Enoxaparin
● Heparin
● Warfarin
● Dabigatran
● etexilateapixaban
Antiplatelets ●d d clopidogreldbisulfate
● abciximab
Thrombolytics
● d alteplase d Antifibr
inolytics
●d aminocaproic daci
dd Hemorheologics ● d pentoxifylline
ReversaldDrugs ●d d coagulationd factord Xad (recombinant)
● idarucizumab
● protamined sulfate
● phytonadione
Reversald andd Coagulationd Modifierd Drugs
Choose dthedcorrectdword(s) dfromdtheddrop-
down dlistdtodcomplete dthedfollowing dstatements dregarding dreversalddrugs.
Protaminedsulfatedisdthedreversalddrugdfordheparin.d Ph
ytonadionedisdthedreversalddrugdfordwarfarin.
Idarucizumabdisdthedreversalddrugdforddabigatrandetexilate.
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CoagulationdfactordXad(recombinant)disdthedreversalddrugdfordrivaroxaban.
Indications dfordUse
Match dthedindications dfordusedofdcoagulation dmodifying ddrugs dby ddragging dthedclass dondthe drightdtodthedcorrectd d
escription.
Antiplateletddrugsdinhibitdplateletdaggregationdanddformationdofdplateletdplugs,dwhichdaredhelpfuldindpreventingdheartdattacksd
andd strokes.
Hemorrhagicddrugsdalterdplateletdfunctiondwithoutdinterferingdwithdnormaldplateletdactivity.
Thrombolyticddrugsdaredadclassificationdofddrugsdthatdareduseddtodbreakddowndclotsdordthrombidthatdhavedformed.d Ant
ifibrinolyticddrugsdaredhemostaticddrugsdthatdpromotedblooddcoagulationdfordconditionsdofdexcessivedbleeding.
Hemostasisd Vocabulary
From dtheddrop-down dmenu,dselectdthedtermdthatdbestdfits dtheddefinition.
Thed processd ofd thrombid formationd –d Coagulation
Adclotdformingdsubstancedthatdisdthedresultdofdthedcoagulationdsystem,dwhichdalsodtriggersdthedfibrinolysisdsystemd–
d Fibrind Thedprocessdofdthrombidbreakdown d–dFibrinolysis
Adraredgeneticddisorderdindwhichdcertaindfactorsdneededdfordcoagulationdanddhemostasisdaredinadequatedordnonexistentd–
Hemophilia
Anyd processd thatd stopsd bleedingd –d Hemostasis
Used ofd compressiond todachieved hemostasisd –d xxxMechanicald meansd ofd hemostasis
Usedofd clampingdord cauterizationd todachieved hemostasisd –d xxxSurgicald meansdofd hemostasis
Usedofdcoagulationdmodifierddrugsdtodachievedhemostasisd–
dxxxPharmacologicdmeansdofdhemostasisd Admobilized dthrombus d–d Embolus
Blood dclotd–dThrombus
Subclasses
Match dthedcoagulation dmodifier ddrug’s dsubclass dtodits dmechanism dofdaction.
Preventdclotdformationdbydinhibitingdparticulardclottingdfactorsd Anticoagulan
tsd Preventdclotdformationdbydinterferingdwithdplateletdfunction
Antiplateletsd L
ysedclotsdthatdhavedalreadydformed Thrombolytics
Promotedthedcoagulationdofdblood Antifibrinolytics
Reducedblooddviscosity Hemorheologics
Actdasdantagonistsdtodthedotherdmedications Reversalddrugs
Anticoagulantsd (warfarin;d heparin)
Prepare:d Anticoagulants
Actions dofdAnticoagulants
Anticoagulants dperformdwhich dofdthedfollowing dactions?
Actddirectlydondplateletdaggregationd
Preventdthrombosis
Breakdowndfibrin
Lysedpre-formeddclots
AnticoagulantdSubclasses
Which dofdthese danticoagulants dbelongs dtodthedsubclass dheparins?
clopidogreld warf
arind rivaroxaban
d enoxaparin
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Coumarins
How ddodcoumarins dpreventdthrombus dformation?
Workingdwithdotherddrugdclassesdtoddecreasedthedthicknessdofdblood
d InhibitingdvitamindK-dependentdclottingdfactors
Directlydimpactingdplateletdaggregationd
Breakingddowndthedfibrindindclots
Selfd Check:d Thromboembolicd Event
Which dofdthedfollowing dpatients dis dleastdatdrisk dofdadthromboembolic devent?
SomeonedondaddirectdflightdfromdDetroit,dMichigandtodSydney,dAustra
liad Someonedwhodhasdbeendindadcomadfordadweekdfollowingdadstro
ke
Someonedwhodhasdadbrokendfootdanddisdlearningdtodwalkdwithdandorthopedicdboot
Someonedwhodhasdadmechanicaldheartdvalve
Someonedrecoveringdfromdadbilateraldkneedreplacement
SelfdCheck:dHeparin
HeparindToxicity
Which dofdthedfollowing dstatements daredcorrectdregarding dheparin dtoxicity? dSelectdalldthatdapply.
Heparindtoxicitydmaydbedtreateddintravenouslydwithdthedreversalddrugdprotaminedsulfatedindseveredcasesd B
ecausedofdheparin’sdlongdhalfdlife,dthedtoxicdeffectsdofdheparindcannotdreverseddbyddiscontinuingdheparindal
oned Thedheparindmustdbedstoppeddimmediately
Thedtoxicdeffectsdofdheparindmaydbedreverseddbyddiscontinuingdheparindalone
IncreaseddAnticoagulants
Which dofdthedfollowing dmedications dwhen dtaken dwithdheparins,dcandcause dandincreased danticoagulant deffectd(bleedi
ngd risk)?
AspirindanddotherdNSAIDs,doraldanticoagulants,dantiplatelets,danddthrombolytics
Antithrombotics,doraldantibiotics,danddprothrombinsd Acetamin
ophen,doraldanticoagulants,danddantithromboticsd Aspirindandd
otherdNSAIDs,doraldantibiotics,danddantithrombotics
SelfdCheck:dWarfarind(Coumandin)
Warfarin
Which dofdthedfollowing dstatements dregarding dwarfarin daredaccurate? dSelectdalldthatdapply.
Itdtakesdseveralddaysdtodreachdtherapeuticdlevels
Itdisdthedmostdcommonlydprescribeddparenteraldanticoagulant
Theredisdadblackdboxdwarningdregardingdbleedingdriskdspecificdtodwarfarin
Todtreatdwarfarindtoxicity,dhighddosesdofddiluteddvitamindKdintravenouslydcandreversedthedeffectsdwithind6dhours
Selfd Check:d Blackd Boxd Warnings
Match dthedfollowing danticoagulants dwithdits dblack dbox dwarning.
Premature ddiscontinuation dofdthedmedication dbecause ditdcandlea dabigatran
ddtod increased dthrombi
Ford patientsd withd and epidurald catheterd (mayd caused spinald hematomas) Apixaband/dRivaroxaband/dEnoxaparin
Seriousd bleedingd risk warfarin
Reflect:dAnticoagulants
Adversed Effects
Which dofdthedfollowing daredmedicationsdused dfordtreatmentdofdadverse deffectsdassociated dwithdheparin? dSelectdalldt
hat
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