Blood Thinners & Diuretics Study Guide

ANTICOAGULANTS

Overview

How does blood clot (Coagulation Cascade)?
Blood clotting begins with platelet activation and continues through the intrinsic and extrinsic pathways, leading to fibrin formation and a stable clot.

Three Main Types of Blood Thinners

• Anticoagulants: Inhibit specific clotting factors in the coagulation cascade (e.g. Heparin, Warfarin).
• Antiplatelets: Prevent platelets from aggregating (e.g. Aspirin, Clopidogrel).
• Thrombolytics: Dissolve existing clots (e.g. Alteplase).

Type	Mechanism	When Prescribed	Medications	Adverse Effects
Anticoagulants	Block or reduce the formation/activity of clotting factors	AFib, DVT, PE prophylaxis/treatment	Heparin, Warfarin, LMWH	Bleeding, bruising, thrombocytopenia
Antiplatelets	Decrease platelet aggregation	Stroke, MI prophylaxis	Aspirin, Clopidogrel	Bleeding, GI upset
Thrombolytics	Dissolve fibrin clots	Acute MI, Ischemic stroke	Alteplase (tPA), Streptokinase	Severe bleeding, hemorrhage

Reversal Agents

• Heparin: Protamine sulfate
• Warfarin: Vitamin K (phytonadione)
• Thrombolytics: Aminocaproic acid

Patient Education & Key Points

• Monitor for signs of bleeding (unusual bruising, bloody stools).
• Maintain consistent Vitamin K intake if on Warfarin.
• All blood thinners increase bleeding risk; monitor INR, PTT regularly.

DIURETICS

Overview

Diuretics increase urine output, manage hypertension, and reduce edema. They vary in potency and effects on electrolytes.

Concept Map: Diuretics

(Scroll or pinch to view the entire map.)

Types of Diuretics

Class	Action & Site	K+ Effect	Examples
Loop Diuretics	Blocks Na+ & Cl- reabsorption in ascending Loop of Henle	Potassium-Wasting	Furosemide, Torsemide
Thiazide Diuretics	Blocks reabsorption in distal convoluted tubule	Potassium-Wasting	HCTZ, Chlorthalidone
Potassium-Sparing	Aldosterone antagonist or Na+/K+ exchange inhibition	Potassium-Sparing	Spironolactone, Triamterene
Osmotic Diuretics	Inhibits passive reabsorption of water in the nephron	Minimal effect	Mannitol

Key Points & Patient Education

• Take in the morning to prevent nocturia.
• Monitor electrolytes (especially K+), daily weights, and signs of dehydration.
• Use caution changing positions (orthostatic hypotension).
• For potassium-sparing diuretics: Avoid high K+ foods or salt substitutes if K+ levels are high.
• Loop diuretics can cause ototoxicity when pushed IV too quickly; do not exceed 20 mg/min of IV furosemide.

Practice Quiz

1. Which of the following best describes the coagulation cascade?

A series of steps that dissolve fibrin clots. The process of antibody production during infection. Activation of platelets and clotting factors leading to fibrin formation. The destruction of platelets by macrophages.

2. What do all blood thinners have in common?

They prevent platelet production. They increase red blood cell count. They reduce clot formation and increase bleeding risk. They dissolve clots by increasing fibrin levels.

3. A nurse is caring for a patient on warfarin. Which of the following should be included in patient teaching?

Avoid leafy greens entirely. Routine INR checks are not needed after stabilization. Maintain a consistent intake of vitamin K-containing foods. Increase vitamin K to reduce bleeding risk.

4. Which diuretic is used to reduce intracranial pressure?

Furosemide Spironolactone Hydrochlorothiazide Mannitol

5. Which finding would require intervention in a patient taking spironolactone?

Serum potassium level of 5.8 mEq/L Sodium level of 135 mEq/L Daily weight gain of 0.5 lbs Potassium level of 3.8 mEq/L

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