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?

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.

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.

Reversal Drug

• Which of these medications is a coagulation modifier whose subclass is a reversal drug? Select all that apply.

Reflect: Coagulation Modifiers

Antifibrinolytics

• What is another term for antifibrinolytics?

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 _________.

Anticoagulants

• What is another term for anticoagulant?

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.

Reversal and Coagulation Modifier Drugs

• Choose the correct word(s) from the drop-down list to complete the following statements regarding reversal drugs.

Indications for Use

• Match the indications for use of coagulation modifying drugs by dragging the class on the right to the correct description.

Hemostasis Vocabulary

• From the drop-down menu, select the term that best fits the definition.

Subclasses

• Match the coagulation modifier drug’s subclass to its mechanism of action.

Anticoagulants (warfarin; heparin)

Prepare: Anticoagulants

Actions of Anticoagulants

• Anticoagulants perform which of the following actions?

Anticoagulant Subclasses

• Which of these anticoagulants belongs to the subclass heparins?

Coumarins

• How do coumarins prevent thrombus formation?

Self Check: Thromboembolic Event

• Which of the following patients is least at risk of a thromboembolic event?

Self Check: Heparin

Heparin Toxicity

• Which of the following statements are correct regarding heparin toxicity? Select all that apply.

Increased Anticoagulants

• Which of the following medications when taken with heparins, can cause an increased anticoagulant effect (bleeding risk)?

Self Check: Warfarin (Coumandin)

Warfarin

• Which of the following statements regarding warfarin are accurate? Select all that apply.

Self Check: Black Box Warnings

• Match the following anticoagulants with its black box warning.

Reflect: Anticoagulants

Adverse Effects

• Which of the following are medications used for treatment of adverse effects associated with heparin? Select all that apply.

About Anticoagulant Medications

• Match each anticoagulant medication or subclass/category to its true statement.

Adverse Effects

• What are the most common adverse effects for anticoagulants in general? Select all that apply.

Statements About Heparin

• Drag the below statements into the correct column, indicating which are true and which are false, regarding the subclass of anticoagulants known as heparins?

Selective Xa Inhibitors

• Which of these medications is an oral selective Xa inhibitor that is used for prevention of strokes in patients with atrial fibrillation (a-fib)?

Indications of Use

• Given their general mechanism of action, anticoagulants are indicated for which of these uses? Select all that apply.

Categories of Heparins

• Which of the following are categories of heparins? Select all that apply.

Antiplatelets (clopidogrel)

Prepare: Antiplatelets

Antiplatelets

• How do antiplatelets prevent clot formation?

Mechanism of Action

• Which of the following statements is true regarding acetylsalicylic acid’s antiplatelet mechanism of action? Select all that apply.

Indications of Use for clopidogrel

• Which of the following are indications for use of clopidogrel? Select all that apply.

Self Check: Mechanism of Action

• Which of the following is true regarding the mechanism of action of antiplatelets?

Self Check: Aspirin

Acetylsalicylic acid

Self Check: Antiplatelet Subclass

Antiplatelet Subclass

• Which of the following statements are accurate regarding the antiplatelet subclass glycoprotein (GP) IIb/IIIa inhibitors? Select all that apply.

Self Check: clopidogrel (Plavix)

Clopidogrel

• Which of the following statements is true regarding clopidogrel?

Adverse Effects

• Which of the following are common adverse effects of clopidogrel? Select all that apply.

Reflect: Antiplatelets

Adenosine Diphosphate (ADP) Receptor Inhibitor Medications

• Which of the following statements are true regarding ADP Inhibitor medications clopidogrel, prasugrel, and ticagrelor? Select all that apply

Platelet Adhesion and Aggregation

• Place the steps of the platelet aggregation process in order, from the point of the damaged blood vessel to the point of clot formation.

Dipyridamole

• Which of the following statements is true regarding dipyridamole? Select all that apply.

Clopidogrel

• Clopidogrel is a(n) oral medication in the adenosine diphosphate (ADP) receptor inhibitor subclass whose mechanism of action is to alter the platelet membrane preventing it from receiving the signal to aggregate.

Antiplatelet

• Choose which antiplatelet corresponds with each statement.

Effectiveness of clopidogrel

• Which of the following medications can reduce the effectiveness of clopidogrel? Select all that apply.

Adverse Effects

• Antiplatelets are contraindicated in patients with which of the following? Select all that apply.

Contraindications for acetylsalicylic acid

• Acetylsalicylic acid is contraindicated in which of the following scenarios? Select all that apply.

Nursing Application: Coagulation Modifiers

Prepare: Nursing Application for Coagulation Modifiers

Black Box Warnings

• The nurse should be aware that black box warnings are present for which antiplatelet medications? Select all that apply.

Therapeutic Effects

• Which assessment findings indicate a therapeutic response to coagulation modifying drugs? Select all that apply.

Main Complication

• Which of the following is a main complication of all anticoagulant and antiplatelet therapy that the nurse caring for a patient receiving coagulation modifier drugs should assess for?

Self Check: Indications of Use

• Anticoagulants are prescribed to prevent or treat which conditions? Select all that apply.

Self Check: Nursing Assessment for Coagulation Modifiers

Thromboembolic Events

• Which assessment finding is an unreliable measure of thrombosis?

Physical Assessment Results

• The nurse is assessing a client who has been taking anticoagulant medication for the past six (6) months. Based on the assessment findings what is the next action the nurse should take?

Self Check: Regular Lab Tests

• A client who recently began anticoagulation medication asks the nurse why they need to get their laboratory values checked so often. What is the best response by the nurse? Select all that apply.

Self Check: Warfarin

• What information should be included on a teaching plan for clients taking warfarin?

Reflect: Nursing Assessment for Coagulation Modifiers

Preventing Bruising, Bleeding, and Tissue Injury

• When planning discharge teaching for a client on coagulation modifying drugs, the nurse should include which information? Select all that apply.

Risk Factors and Contraindications

• Match the assessment findings associated assessment criteria with the reason behind it.

Subjective and Objective Data

• The nurse recognizes which assessment findings as contraindications to coagulation modifying drugs? Select all that apply.

Antidote to Heparin

• When caring for a client receiving heparin, the nurse assures that which antidote is readily available?

Safety While Taking warfarin

• Which images below should be provided to a client with low literacy skills to help them remain safe while taking warfarin? Select all that apply.

Main Complication

• Clients taking anticoagulation modifying drugs should immediately report which symptoms to their healthcare provider? Select all that apply

Mechanism of Action and Nursing Implications

• Which statements are true regarding clopidogrel? Select all that apply.

Drug Classes

Match the drug name to its drug class.

If you can’t see the picture well

• Anticoagulants: Prevent clot formation by inhibiting particular clotting factors
• Antiplatelets: Prevent clot formation by interfering with platelet function
• Antifibrinolytics: Promote the coagulation of blood (used in the management of excessive bleeding)
• Hemorheologics: Reduce blood viscosity (thickness)
• Reversal Drugs: Antidotes

Week 4 Concepts: Perfusion

Prepare: Antihypertensives

Medications in Class

• Which medication is used to treat hypertension?

Prevalence of Hypertension

• Which statements about hypertension in the United States are supported by facts? Select all that apply.

Goals of Treatment

• What are the goals of antihypertensive therapy? Select all that apply.

Self Check: Medication Classes and Drugs in the Class

• Complete each sentence by selecting the word or phrase that makes the sentence true from the drop down menu.

Self Check: Life-Threatening Effects of Antihypertensive

• Indicate which listed side/adverse effects may be caused by the listed antihypertensive medication class by placing a check in the appropriate column.

Self Check: Antihypertensive Therapy During Pregnancy

• Which antihypertensive medications are contraindicated during pregnancy and lactation? Select all that apply.

Self Check: Antihypertensive Contraindications

• Which antihypertensive medication is contraindicated for an older adult with an esophageal stricture?

Self Check: Azathioprine Contraindications

Doxazosin Contraindications

• Indicate which listed medication(s) or over the counter product(s) may cause each interaction listed when administered with doxazosin by placing a check in the appropriate column. Select all that apply for the interaction.

Reflect: Antihypertensives

Therapeutic Use

• When counseling a 68-year-old male who is taking doxazosin and denies any history of hypertension, the health care provider asks if he has history of which other condition?

Antihypertensive Drugs and Classes

Drag the medications to the classification in which each belongs.

Complications of Hypertension

• Mr. James, an older adult with hypertension and chronic kidney disease, is talking with a group of young men newly diagnosed with hypertension about coping with the diagnosis of a lifelong alteration in health. When a participant asks Mr. James what he would do differently if he had the chance, which statement from Mr. James reinforces the importance of medication compliance?

Mechanism of Action

• Which effects of angiotensin II do angiotensin II blocking medications (ARBs) stop in order to decrease blood pressure? Select all that apply.

Adverse Effect/Event OR Contraindications

• Indicate which listed medication(s) or over the counter product(s) may cause each interaction listed when administered with losartan by placing a check in the appropriate column. Select all that apply for each interaction.

Safe Administration

• While reviewing the health history of an individual taking an antihypertensive, the health care provider is concerned that which over-the-counter product may interfere with blood pressure medicine? Select all that apply.

Adherence

• An individual diagnosed with hypertension six months ago is frustrated that their blood pressure is still elevated despite having tried several medications. When asked what is taking so long, what is the best response by the health care provider?

Angiotensin II Blockers (ARBs)

• When providing hypertension screening and education a health care professional shares that which medications are in the ARB class? Select all that apply.

Adrenergics (carvedilol, clonidine, doxazosin)

Prepare: Adrenergics

Medications in Class

• Which medications are included in the adrenergic antihypertensives class? Select all that apply.

Adverse Effects of clonidine

• Which condition may result from stopping clonidine therapy abruptly?

Carvedilol Indications

• In addition to hypertension, carvedilol is also prescribed to treat heart failure and impaired left ventricular function after a myocardial infarction (MI).

Self Check: Indications and Interactions

Indications for carvedilol and clonidine

• Select the indications for use of carvedilol and clonidine by placing marks the appropriate column(s). Select all that apply for each medication.

Interactions with carvedilol

• The beta blocking effects of carvedilol are responsible for causing hyperglycemia by interfering with receptors in the pancreas.

Self Check: Classes and Dosing

Classes and Medications of Adrenergic Antihypertensives

• Match the medication to the class in which it belongs.

Dosing for clonidine

• Use the drop down menus to fill in the missing information related to dosing of clonidine.

Dosing for carvedilol

• Use the drop down menus to fill in the missing information related to dosing of carvedilol.

Reflect: Adrenergics

Response to Treatment

• During a follow up visit with the health care provider a person taking carvedilol reports the following information. Which indicates a possible complication due to the medicine?

Safe Administration of clonidine

• In which individual should clonidine be used with caution?

Metabolism of carvedilol

• An individual taking carvedilol for the last three weeks is reporting an increasingly dry mouth, unusual issues with constipation, and becoming extremely dizzy within five minutes of jogging for exercise. When asked, the person confirms that these symptoms started after the medication was prescribed and have been increasing since. The health care provider suspects a genetic enzyme disorder as the reason for the current symptoms and recommends the individual discontinue the dose of carvedilol slowly.

Adverse Effect/Event Or Contraindications

• A client calls the health care provider at 2 p.m. stating, “I forgot to take my daily blood pressure pill at 8 a.m. like I usually do. Should I take it now?” Which of response by the healthcare provider is best?

Linking Side Effects to Medications

• An individual with diabetes and hypertension is seen in urgent care with severe hypoglycemia. She is concerned that her usual symptoms of low blood sugar were not present, allowing her levels to drop to the point she became faint. Which of her current medications may contribute to the masking of her hypoglycemia?

Pharmacokinetics of clonidine

• Use the drop down menus to fill in the missing pharmacokinetic information of clonidine.

Pharmacokinetics of Carvedilol

• Use the drop down menus to fill in the missing pharmacokinetic information of carvedilol.

Side Effects of carvedilol

• While caring for a client with hypertension who has recently started taking carvedilol, the client reports, “This medication seems to give me a rash.” Which of the following statements by the health care provider is best?

Angiotensin-Converting Enzyme (ACE) Inhibitors (enalapril)

Prepare: ACE Inhibitors

Indications for Use – Angiotensin Converting Enzyme Inhibitors

• Which of the angiotensin converting enzyme (ACE) inhibitors have been shown to reduce the risk of death or development of heart failure (HF) following a myocardial infarction (MI)? Select all that apply.

Therapeutic Effects of Angiotensin Converting Enzyme (ACE) Inhibitors

• In addition to hypertension, ACE Inhibitors are also prescribed to prevent left ventricular hypertrophy after a myocardial infarction and decrease the morbidity and mortality associated with heart failure.

Pharmacokinetics of Angiotensin Converting Enzyme (ACE) Inhibitors

• Which of the oral ACE inhibitor medications are ready to be used by the body as soon as they are absorbed? Select all that apply.

Self Check: Indications, Mechanism of Action, and Expected Results

Therapeutic Effects of ACE Inhibitors

• Click on the cells that contain the therapeutic effects of ACE inhibiting medications. Select all that apply.

Mechanism of Action of Angiotensin Converting Enzyme (ACE) Inhibitors

• By which mechanisms do ACE inhibitors cause systemic vasodilation and lower blood pressure? Select all that apply.

Self Check: Contraindications, Adverse Effects, and Interactions

Effectiveness of Angiotensin Converting Enzyme (ACE) Inhibitors

• Indicate which medications will increase or decrease the effectiveness of ACE inhibitors by clicking the radio button in the correct column.

Self Check: Safety Considerations, Routes of Administration, and Other Meds in Class

Contraindications of Angiotensin Converting Enzyme (ACE) Inhibitors

• ACE inhibitors should be used cautiously in individuals with liver disease and those with a family history of angioedema.

Self Check: Pharmacokinetics and Dosing

Dosing for captopril

• Use the drop down menus to fill in the missing information related to dosing of captopril.

Reflect: ACE Inhibitors

Safe Administration of captopril

• Which statement by an individual taking prescribed captopril indicates further teaching is required?

Linking Side Effects to Medications

• A person is prescribed an Angiotensin Converting Enzyme (ACE) Inhibitors after experiencing a myocardial infarction. What effects on the body will this medication achieve? Select all that apply.

Mechanism of Action of Angiotensin Converting Enzyme (ACE) Inhibitors

• How does captopril impact the vasoconstriction, aldosterone secretion, and renin release that occur as a result of the renin-angiotensin-aldosterone system? Select all that apply.

Side Effects of Angiotensin Converting Enzyme (ACE) Inhibitors

• A patient states they are experiencing an annoying, persistent dry cough that started once they begin taking an ACE inhibitor. The patient is not experiencing any other signs and symptoms. What is the best response by the health care provider?

Benefits of Angiotensin Converting Enzyme (ACE) Inhibitors

• Which individual would benefit most from an ACE inhibitor?

Pharmacokinetics of Angiotensin Converting Enzyme (ACE) Inhibitors

• Which ACE inhibitor is not metabolized by the liver and is eliminated unchanged in urine?

Pharmacokinetics of Enalapril

• Use the drop down menus to fill in the missing pharmacokinetic information of enalapril.

Adverse Effects of Angiotensin Converting Enzyme (ACE) Inhibitors

• An individual taking an ACE inhibitor for the last three weeks reports swelling of the lips, eyes, and tongue that started about 30 minutes before they called the prescribing health care provider.

Nursing Application: Antihypertensives

Prepare: Nursing Application for Antihypertensives

Indications

• While reviewing the medication list for a newly admitted patient the nurse notes they are taking a calcium channel blocker. Based on knowledge of the medication, the nurse inquires if the patient has a history of which conditions? Select all that apply. Angina pectori.

Initial Assessment – Hypertension

• The initial nursing assessment of a patient diagnosed with hypertension should including questions about which underlying causes? Select all that apply.

Goals of Treatment

• What teaching point is a priority when the nurse is teaching a client who is taking an angiotensin converting enzyme (ACE) inhibitor?

Self Check: Assessing Risks During Antihypertensive Therapy

• While obtaining subjective assessment data from a patient with hypertension whose blood pressure has not reached goal after three months o