Direct Thrombin Inhibitors – Anticoagulant Drugs (Nursing)

by Prof. Lawes

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    00:01 Okay, now we're gonna talk about kind of a fancy one, dabigatran etexilate.

    00:06 That is another mouthful, but it’s a direct thrombin inhibitor.

    00:11 You already know what thrombin does, right? That stickiness likes keeps things together.

    00:15 And this is an oral drug, it’s a prodrug, that means that once you get this drug with two words into your body it becomes dabigatran, okay, so it converts it -- super cool that your body does it.

    00:29 How it works is, this drug, once it becomes the prodrug, prodrug becomes the drug, it binds with and inhibits prothrombin in the blood -- sweet! So it has a really fast onset and it doesn’t require lab work to monitor anticoagulation.

    00:45 So you may see more and more of this medication in your practice.

    00:49 So cool part about this, it goes in as two names, our body turns it into the one name, and it binds with and inhibits prothrombin in the blood, starts in really quick and we don’t have to do lab work for it.

    01:02 Now, here’s another one that’s approved for reversible, so these means if this drug, you get too much of it or you're starting to show a signs that, wow, you're really bleeding, this is the name of the drug that’s approved for reversal.

    01:15 So underlying that drug and I'd like you to write the word antidote, okay, antidote for overdose.

    01:22 Now, there's no major dietary restriction with the medication -- this is awesome.

    01:28 Do you remember what medication have we talked about that has significant dietary restrictions? Right, warfarin -- nothing with Vitamin K. This drug has lower risk of serious bleeding and it's not weight dependent.

    01:45 See, low molecular weight heparin is weight dependent. So you can write, dosage is not weight dependent unlike LMW heparin, yeah, at that point I was so overweight I had to give two shots with each dosage, that was a real encouragement.

    02:02 Okay, let’s look at the therapeutic uses of this magic drug, dabigatran.

    02:07 We can use it for atrial fib, for someone who has a knee or hip replacement, and DVTs/PE, you should just put my name by that one, alright! Now, let’s walk through the why? Why would I want to use atrial fib to be treated by this medication? Well, atrial fib is when your atrium’s kinda quivering, right, just -- just like that.

    02:30 Instead of your atrium going atrium, ventricle, atrium, ventricle, atrium, ventricle - your atrium goes -- ventricle -- ventricle.

    02:36 Okay, so when your atrium is doing this -- it’s not squishing out all the blood.

    02:43 The problem with that is when you let this blood kinda hang out for awhile, it makes clots.

    02:49 So people who are in atrial fib -- atrial fibrillation -- that’s a cardiac dysrhythmia, that’s an atrium that instead of following the way it’s supposed to it does this -- and anytime it does that, it doesn’t empty out, your patient has a risk for developing clots, this medication can help treat that.

    03:08 Now, if I have a knee or a hip replacement, what's really good about that is I'm gonna be immobile and I'm pretty good at making clots after something like that? So this medication will make sure that now I'm having a procedure that I know puts a patient at risk for clots so they’ll start me on this medication to make sure I don’t develop one.

    03:28 And the last one, we already talked about multiple times, right? Deep vein thrombosis, mine likely happen in my leg traveled up to my lungs and became a pulmonary embolus -- DVT/PE.

    03:42 This direct thrombin inhibitors we already talked about our oral prodrug.

    03:48 Make sure you remember what a prodrug is, that means the medication is changed in the body so what we want is not the actual drug we're giving but a prodrug means it’s the substance that will turn into the drug that we want. It blocks the clotting protein thrombin super group, it’s a newer group of anticoagulants so it’s more expensive but it’s pretty cool that it’s out there, you'll start seeing it.

    04:14 Then you also might see DOACs, if you see that on the literature it just means - direct oral anticoagulants, and they call them DOACs.

    04:24 So I wanted you to have those letters there so you'd know that.

    04:27 The mechanism of action is it binds with and inhibits prothrombin in the blood and it has a fast onset, so this is a really good summary slide for you.

    04:35 Go back and look at those key points.

    04:38 What notes do you need to write in the margin that helped it stand out for your brain?

    About the Lecture

    The lecture Direct Thrombin Inhibitors – Anticoagulant Drugs (Nursing) by Prof. Lawes is from the course Cardiovascular Medications (Nursing).

    Included Quiz Questions

    1. It is converted to dabigatran.
    2. It has a slow onset.
    3. It requires a lab to monitor anticoagulation.
    4. It binds with and releases thrombin into the blood.
    1. Thrombin
    2. Hemoglobin
    3. Plastocyanin
    4. Rubredoxin

    Author of lecture Direct Thrombin Inhibitors – Anticoagulant Drugs (Nursing)

     Prof. Lawes

    Prof. Lawes

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