Anticoagulants and Thrombolytic Agents > Pharmacology
Exam Review
Direct thrombin inhibitors (DTIs)
Total Questions : 5
Showing 5 questions, Sign in for moreA nurse is caring for a client who is receiving bivalirudin IV for a PCI procedure. Which of the following laboratory tests should the nurse monitor to evaluate the effectiveness of the drug?
Explanation
ECT.ECT stands for ecarin clotting time, which is a test that measures the anticoagulant effect of bivalirudin, a direct thrombin inhibitor.Bivalirudin is used for patients undergoing percutaneous coronary intervention (PCI) to prevent thrombotic complications.ECT is the most sensitive and specific test for monitoring bivalirudin therapy.
Choice A is wrong because PT stands for prothrombin time, which is a test that measures the extrinsic pathway of coagulation and the effect of warfarin, a vitamin K antagonist.PT is not affected by bivalirudin.
Choice B is wrong because INR stands for international normalized ratio, which is a standardized way of reporting PT results and the effect of warfarin.INR is also not affected by bivalirudin.
Choice C is wrong because aPTT stands for activated partial thromboplastin time, which is a test that measures the intrinsic pathway of coagulation and the effect of heparin, an indirect thrombin inhibitor.aPTT can be used to monitor bivalirudin therapy, but it is less sensitive and specific than ECT.
A nurse is teaching a client who has a new prescription for dabigatran to prevent stroke. Which of the following instructions should the nurse include? (Select all that apply.)
Explanation
Dabigatran is an anticoagulant that prevents blood clots and stroke.It can cause bleeding as a side effect, so the client should report any signs of bleeding, such as bruising, hematuria, or melena.The client should also use a soft toothbrush and an electric razor to prevent injury and bleeding.Dabigatran should be stored in its original container to maintain potency and protect it from moisture.
Choice A is wrong because dabigatran does not need to be taken with food to prevent gastrointestinal upset.It can be taken with or without food.
Choice E is wrong because dabigatran does not require regular blood tests to monitor the drug level.Unlike warfarin, dabigatran has a predictable anticoagulant effect and does not need frequent dose adjustments.
A nurse is reviewing the medication history of a client who is prescribed argatroban for HIT. Which of the following statements by the client indicates a need for further teaching?
Explanation
This statement by the client indicates a need for further teaching because aspirin can increase the risk of bleeding when taken with argatroban, which is an anticoagulant drug used to treat or prevent thrombosis in patients with heparin-induced thrombocytopenia (HIT). The client should avoid taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless prescribed by their health care provider.
Choice A is wrong because avoiding alcohol while taking argatroban is a correct statement.
Alcohol can also increase the risk of bleeding and should be avoided or limited by the client.
Choice C is wrong because notifying the dentist that the client is taking argatroban is a correct statement.
The client should inform their dentist and other health care providers about their medication history before any invasive procedures, as they may need to adjust or stop their argatroban dose to prevent excessive bleeding.
Choice D is wrong because checking the blood pressure regularly at home is a correct statement.
The client should monitor their blood pressure and other signs of bleeding, such as bruising, nosebleeds, blood in urine or stool, or prolonged bleeding from cuts or wounds.
The client should also report any symptoms of thrombosis, such as chest pain, shortness of breath, leg pain or swelling, or stroke-like symptoms.
A nurse is preparing to administer lepirudin IV to a client who has DVT. Which of the following actions should the nurse take?
Explanation
Lepirudin is a direct thrombin inhibitor that is used as an anticoagulant in patients with heparin-induced thrombocytopenia (HIT).It is administered as an initial intravenous bolus dose followed by a continuous intravenous infusion for 2-10 days or longer if clinically needed.The infusion rate should be adjusted to the activated partial thromboplastin time (aPTT), which is a measure of the blood’s clotting ability. An infusion pump can ensure a constant and accurate delivery of the drug at the desired rate.
Choice A is wrong because flushing the IV line with heparin before and after giving lepirudin can increase the risk of bleeding and worsening HIT.Heparin is the cause of HIT and should be avoided in patients with this condition.
Choice C is wrong because administering lepirudin as a bolus injection over 15 seconds can result in a rapid and excessive anticoagulation effect, which can increase the risk of bleeding and hemorrhage.Lepirudin should be given as a bolus injection over 15-20 minutes, followed by a continuous infusion.
Choice D is wrong because monitoring the client’s platelet count daily is not sufficient to assess the efficacy and safety of lepirudin therapy.The platelet count is not affected by lepirudin and does not reflect its anticoagulant activity.The aPTT should be monitored at least once daily and more frequently in patients with renal impairment or increased bleeding risk.The normal platelet count range is 150,000 to 450,000 platelets per microliter of blood.
A nurse is caring for a client who has an overdose of dabigatran and is experiencing life-threatening bleeding. Which of the following drugs should the nurse anticipate administering as an antidote?
Explanation
• Dabigatran is a direct thrombin inhibitor that prevents the formation of blood clots.
It is used to treat atrial fibrillation, deep vein thrombosis, and pulmonary embolism.However, it can also cause bleeding complications, especially in high doses or in clients who have renal impairment, liver disease, or other risk factors.
• Idarucizumab is a monoclonal antibody that binds to dabigatran and reverses its anticoagulant effect.It is the only specific antidote for dabigatran overdose and should be administered intravenously as soon as possible.
• Choice A. Vitamin K is wrong because it is not an antidote for dabigatran.Vitamin K is used to reverse the effect of warfarin, a vitamin K antagonist that inhibits the synthesis of clotting factors.
• Choice B. Protamine sulfate is wrong because it is not an antidote for dabigatran.Protamine sulfate is used to reverse the effect of heparin, an indirect thrombin inhibitor that enhances the activity of antithrombin.
• Choice D. Aminocaproic acid is wrong because it is not an antidote for dabigatran.Aminocaproic acid is used to treat bleeding caused by excessive fibrinolysis, such as in hemophilia or after surgery.
Thrombolytic agents:
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