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PAT20A/B Chapter N/A: (2)PAT20 Fall Week 6 Drug Classifications (Stroke)


Department
Pathotherapeutics
Course Code
PAT 20A/B
Professor
Audrey Kenmir
Chapter
N/A

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(2)PAT20 Fall Week 6 Drug Classifications ( Stroke)
1. Anti-Coagulant
a) Coumarins (Antidote: vitamin K) *Coagulation Modifying Agent* (Anti- clot factor)
Warfarin drugs: warfarin sodium (Coumadin)
Action: works in the liver to inhibit vitamin K-dependent clotting factors 2, 7, 9, 10.
Use: prevents and treats thromboembolic disorders (ex. pulmonary emboli, deep vein
thrombosis, disseminated intravascular coagulation), and in combination with
thrombolytic and/or antiplatelet to manage myocardial infractions.
Pharmacokinetics (Warfarin sodium):
Onset- PO/IV: 37-72 hrs
Peak- PO/IV: 5-7 days
Duration- PO/IV: 2-5 days
Side/Adverse Effects:
Anorexia, nausea, vomiting, alopecia (long-term use), dermatitis, fever, urticarial,
tissue necrosis or gangrene, agranulocytosis.
Contraindications/Precautions:
Underlying coagulation disorders, ulcer disease, malignancy, recent surgery, or active
bleeding.
Interactions:
-Drugs that are highly protein bound may displace or be displaced by warfarin.
-There is an increase in bleeding when aspirin or large doses of cefoperazone,
cefotetan, NSAIDs, penicillin or penicillin-like drugs, or valproic acid is used
concurrently.
Dosages (Warfarin sodium):
Tablets = 1-2.5, 3- 6, 7.5, 10 mg; Injection (IV) = 50 mg/vial
Nursing Management Proprieties:
Assess: hypersensitivity, hepatic and renal impairment.
Dietary management: monitor intake of green leafy vegetables.
Lab test evaluation: INR.

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b) Direct Thrombin Inhibitor *Coagulation Modifying Agent* (Anti- blood clot)
Direct thrombin inhibitor drugs: dabigantran etexilate (Pradaxa*), argatroban
(Argatroban), clopidogrel (Plavix)
Action: binds directly to thrombin to prevent platelets in your blood from sticking
together and forming a blood clot.
Use: prevents and treats thromboembolic disorders (ex. pulmonary emboli, deep vein
thrombosis, disseminated intravascular coagulation), and in combination with
thrombolytic and/or antiplatelet to manage myocardial infractions.
Pharmacokinetics (Clopidogrel):
Onset- PO: within 24 hrs
Peak-PO: 3-7 days
Duration- PO: 5 days
Side/Adverse Effects:
Hypotension, bradycardia, nausea, back pain.
Contraindications/Precautions:
Underlying coagulation disorders, ulcer disease, malignancy, recent surgery, or active
bleeding.
Interactions:
-Drugs that are highly protein bound may displace or be displaced by warfarin.
-There is an increase in bleeding when aspirin or large doses of cefoperazone,
cefotetan, NSAIDs, penicillin or penicillin-like drugs, or valproic acid is used
concurrently.
Dosages (Clopidogrel):
Tablets = 75, 300 mg
Nursing Management Proprieties:
Assess: hypersensitivity, hepatic and renal impairment.
Dietary management: monitor intake of green leafy vegetables.
Lab test evaluation: PTT.
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a) Low Molecular Weight Heparin "parin" *Coagulation Modifying Agent* (Anti-
thrombi) (Antidote: protamine)
Low molecular weight heparin drugs: dalteparin sodium (Fragmin), enoxaparin
(Lovenox), tinzaparin (Innohep)
Action: works circulating clotting factors to accelerate formation of an antithrombin
3-thrombin complex, inactivate thrombin and prevent conversion of fibrinogen to
fibrin.
Use: prevents and treats thromboembolic disorders (ex. pulmonary emboli, deep vein
thrombosis, disseminated intravascular coagulation), and in combination with
thrombolytic and/or antiplatelet to manage myocardial infractions.
Pharmacokinetics (Dalteparin sodium):
Onset- SUBCUT: dalteparin= rapid
Peak- SUBCUT: dalteparin= 4 hrs
Duration- SUBCUT: dalteparin= up to 24 hrs
Side/Adverse Effects:
Hypersensitivity reactions, bleeding, thrombocytopenia and elevated liver enzyme
levels.
Contraindications/Precautions:
Underlying coagulation disorders, ulcer disease, malignancy, recent surgery, or active
bleeding.
Interactions:
-Drugs that are highly protein bound may displace or be displaced by warfarin.
-There is an increase in bleeding when aspirin or large doses of cefoperazone,
cefotetan, NSAIDs, penicillin or penicillin-like drugs, or valproic acid is used
concurrently.
Dosages (Dalteparin sodium):
Dalteparin: Prefilled syringes= 2500, 5000, 7500, 10000 units; Multidose vials=
10000, 25000/ mL
Nursing Management Proprieties:
Assess: hypersensitivity, hepatic and renal impairment.
Dietary management: monitor intake of green leafy vegetables.
Lab test evaluation: PTT.
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