this is Professor Hoffman and we're are now ready for topic 6 e in the cardiovascular drugs uh discussion for pharmacology for nursing and we're in this topic we're looking at drugs that interfere with coagulation so we're looking at clotting or anti clotting type drugs um so as we look at those and you're looking at your reading guide we're looking at antiplatelets anti-coagulants and thrombolytics would be the three classes of drugs that we want to focus on so as we look at these three classes I want to keep in mind that anti-coagulants are going to interfere with the clotting Cascade and thrombin formation so we're really looking at not developing large clots or helping break down early early developing clots in the bloodstream so we're going to be using these when we're have risk for developing dvts or there is a presence of a DVT that is not um caused major issues yet to help break it down second class of drugs we going to look at are the antiplatelets so they are part of early stages of developing clots and some accumulation of some of the clotting factors along the wall of the blood vessels so we'll be looking at those in terms of preventative type drug especially and then finally we'll look at thrombolytic drugs where we actually do a very quick and effective breakdown of a thrombus um or a clot that is um has caused major issues either cardiovascular or uh neurologically in the brain so again starting with anti-coagulants uh morphine or cumin Hein anox parin or Lenox are all examples uh the warin is um an oral drug the Hein is given either by injection or IV uh the enoxaparin is given subq they work slightly different on the coagulation Cascade but the same general response is they're going to interfere with that Cascade EV events that is involved with developing clots or forming clots to keep those clots from happening or to start breaking them down once they have so again we're using them as blocking clot development by interfering with clotting function so as we look at side effects or reactions bleeding is the number one concern again we're blocking the effects not only at the site of clot development but everywhere in the body so we want to watch for any signs of excess bleeding or abnormal bleeding we're going to monitor the clotting Labs the inrs um the pts ptts and you'll talk about that in your clinical classes specifically which ones you want to be focusing on uh some teaching that we want to focus on is again that awareness of potential for increased bleeding so if we have bleeding G gums any uh small Cuts or things that have trouble controlling bleeding that sort of thing they need to report U they also need to avoid the use of n sets like ibuprofen because those drugs have a secondary effect of um on the platelets they also interfere they are a form of an antiplatelet which interferes with a clotting Factor so they're just going to increase the risk for bleeding if they're taken along with the anti-coagulants okay antiplatelets uh ibuprofen as far as n says is a key one as well as aspirin are going to be very common ones uh but then we get into the uh prescription level of drugs um that are listed here you're going to be familiar with some of the generic or trade names possibly like Plavix pantin uh you may not see quite as often anymore but what they're doing is they inhibit platelets from adhering to the vascular wall as a sight of injury and starting to aggregate or Clump together as part of the part of the process of um that will eventually lead on to clot formation or that repair type things that's going on uh normally where we want to see a clot developed it's going to inhibit that essentially you're going to hear it usually described it's going to thin the blood um and again we're going to use it mainly as a preventative drug if someone has had a a stroke related to clots or it's had an MI related to potential clots they're going to be put on antiplatelet to reduce the chances of that happening in the future if people are at risk for a heart attack related to potential atherosclerosis and cl development they may be put on the anti platelet as a prophylaxis so again the anti-coagulants are treating a real or very high potential development of clot antiplatelets are going to be used more as a preventative measure particularly in the areas of stroke and Mi patients again what we're looking at with u reactions is primarily bleeding uh some of them will cause some GI distress and a few CNS type side effects as well uh we want to be very cautious if they have any sort of bleeding disorder is going to increase that risk if they've had any recent surgery or a close hit injury where there's potential bleeding or potential for bleeding um at the site or in the brain antiplatelets are going to increase that risk by blocking naturally occurring um measures in the bloodstream so we want to be very aware that that is a potential contraindication the thrombolytics um are you'll notice they all in an ASE they're all enzymes which means they tear things down and the things that the thrombolytics tear down are fibrin in a clot so a formed clot especially one that is gone to um a section of the heart's circulatory system and blocked off blood flow to that part of the heart or it's gone to the lungs and blocked off the blood flow to a section of lungs or a clot that's going into the brain and it's causing stroke symptoms because of the clot blocking blood flow thrombolytics are going to be effective at going to those sites breaking those clots down and opening up those blood vessels so they're emergency drug they're given IV they're very effective they're very strong and because of that they have risks um again bleeding is extremely high risk they're going to block those clots they're also going to break down clots anywhere else they find them so if an individual had multiple IV attempts in emergency situation um prior to getting to the point of being eligible for the stics we have to be aware that all those IV sticks sites are going to start bleeding as well probably because the clots that may have formed to close them off are going to be um broken down by the drug as well there is a response by the heart muscle um there are some cardiac arrhythmias that when you get into critical care you will be focusing on those and identifying those as expected arrhythmias they are normally temporary very short-lived and then cardiac Rhythm goes back to normal um the potential for hypotension some individuals do have a hyper sensitive response to these as well so I just need to be aware of that main concern most emerging concern is watch for bleeding so that U covers the coagulation related classes of drugs that I want you to focus on for the course