Nr567 Final Exam Study Guide _ Latest 2023-2024

Final Exam Study Guide 1NR567 Final Exam Study GuideTherapeutic dosing and monitoring of warfarin (Coumadin) & Types of anticoagulants- mechanisms of action and indications for useBlood coagulation mechanisms:1. injury exposes subendothelial matrix proteins (i.e. collagen and von Willebrand factor) result in platelet adherence and activation, secretion and synthesis of vasoconstrictors and platelet-recruiting and activating molecules [thromboxane A2 is synthesized from acid within platelets; platelets secrete ADP (a platelet aggregator) and serotonin (stimulates aggregation and vasoconstriction)] = platelet plug2. Coagulation system cascade is activated resulting in thrombin generation and a fibrin clot, which stabilizes the platelet plug*1 & 2 occur simultaneously. Indirect ThrombinInhibitors MOA Dosage Monitoring Clinical Applications Toxicities & ReversalUnfractionated heparin(UFH, HMW) 1. Binds to antithrombin and inhibits clotting factorproteases thrombin, IXa, and Xa Continuous IV infusion bolus: 80-100units/kg followed by 15-22 units/kg per hourLow dose prophylaxis:5000 units subq Q8-12h Activated partialthromboplastin time(aPTT or PTT), CBC w/platelet count Bleeding, hair loss, HIT (heparin induced thrombocytopenia)Long-term: osteoporosis, spontaneous fractures, mineralocorticoid deficiency Protamine Sulfate: for every 100 units heparin remaining in patient, 1mgprotamine sulfate given IVLow-Molecular-WeightHeparinEnoxaparin/LovenoxDalteparinTinzaparin 1. Binds to antithrombin and inhibits clotting factorproteases thrombin and Xa Prophylactic: 30-40mgQ or BIDFull dose: 1mg/kg subq Q12h Unnecessary 1mg protamine sulfate may partially neutralize