pharm 2 anticoagulants
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What is the major AE for all anticoagulants?
What 2 things can cause rebound hypertension with anti-hypertensive drug therapy?
- 1. abruptly stopping the med
- 2. becoming tolerant to the med
What should be done prior to administering any anticoagulant med?
double check with another nurse
4 uses for heparin?
- 1. prevent DVT & PE
- 2. maintain patency of venous access devices (IV, central lines)
- 3. acute MI
- 4. DIC
Antidote for warfarin?
Action of heparin?
inactivates factor X -> prevents conversion of prothrombin to thrombin
How does heparin affect existing clots?
does not affect existing clots - prevents new clots while body dissolves existing clots
2 routes of admin for heparin?
IV & SQ
Imp consideration when admin heparin SQ?
do not massage or aspirate - can cause bleeding/hematomas
2 AE of heparin?
- 1. bleeding
- 2. heparin - induced thrombocytopenia (HIT)
Antidote for heparin overdose?
Why do pt that are taking heparin need to be monitored closely?
decreased LOC/fall risk should be monitored closely r/t risk of bleeding out if injured
What is a sign that HIT has occurred?
Action & teaching?
platelet count will drop drastically
stop the med immediately and tell pt that they can NEVER have haparin again!!
2 tests that need to be monitored closely with anticoagulant therapy besides clotting tests?
platelets and CBC
Why may a pt on anti-hypertensive/drug that lowers CO have crackles/rales?
any drug that decreases BP/CO can cause CHF-like s/s
2 ways to tell morphine toxicity?
- 1. depressed RR
- 2. decreased LOC
What type of drug will be given if an ACE inhibitor causes ACE cough or other adverse effects?
ARB like cozaar
If a pt is taking heparin and experiences CNS s/s such as dizziness & confusion what would be the concern?
- 1. intracranial bleed
- 2. risk for bleeding r/t falls
Important consideration when admin/removing IV lines or shots when pt is on heparin?
- 1. put pressure on IV sites when removing
- 2. avoid IM injections if possible
What can the nurse do to make sure all caregivers know a pt is on heparin?
put a sign above the bed
How is heparin admin IV?
ALWAYS admin on a pump
What should the nurse do if a pt is on heparin and has just come back from a procedure?
check the IV pump
ASA is used to prevent ____ & _____.
MI & stroke
Pt education with heparin therapy?
teach the pt to report any s/s of bleeding
Why should a pt on heparin be given humidified O2?
to prevent nose bleeds r/t drying of nose
How will heparin be initiated at the hospital?
bolus 80u/kg then drip at 18u/kg/h
obtain PTT q 6 h and adjust dosage rate accordingly
How will heparin be adjusted at the hospital?
if PTT is <35 seconds rebolus 80u/kg and increase rate by 2 u/kg/h
if PTT <36 to 44 seconds rebolus with 40 u/kg and increse rate by 2 u/kg/h
if PTT < 45 to 75 seconds cont. current rate
if PTT is 76 to 90 seconds decrease rate by 2u/kg/h
If PTT is > 90 seconds hold heparin for 1 hour and then decrease rate by 3 u/kg/h
How is the therapeutic range for heparin calculated?
multiply the control aPTT by 1.5 & then 2
What will be done if aPTT is lower/higher than therapeutic range?
if lower will bolus or up dose
if higher will decrease or stop dose
4 low molecular weight heparin drugs?
- 1. lovenox
- 2. fragmin
- 3. innohep
- 4. atrixtra
Route for lovenox and other low molecular weight heparins?
What clotting test needs to be checked with lovenox and other low molecular weight heparins?
do not have to check aPTT but need to watch platelets
Pt teaching for SQ injections of lovenox and other low molecular weight heparins?
rotate injection sites and do not eject the air bubble in the syringe
What drug will be used in heparin induced thrombocytopenia?
Route of admin for warfarin?
2 uses for warfarin?
- 1. Tx for thrombus/embolism
- 2. long-term for pt with risk for thrombus
3 EX of pt at risk for thrombus?
- 1. valve replacement pt
- 2. atrial fibrillation
- 3. pt with Hx of thrombus
INR for prophylaxis of a thrombus or embolus?
for mechanical heart valves?
2 to 3
2.5 to 3.5
PT for standardized exams?
should be 1.5 to 2 times the control time or 18 to 24 seconds
Action of warfarin?
blocks vitamin K & prevents activation of factors II (prothrombin), Vii, IX, & X
2 contraindications for warfarin?
- 1. active bleed
- 2. thrombocytopenia
What is done if a warfarin pt is going to have surgery?
med will be stopped 7 days prior to surgery & pt may have to go on heparin temporarily
Drug/food interaction with warfarin?
foods high in vitamin K decrease effectiveness (green leafy vegetables)
Antidote for warfarin?
When is it given?
if PT gets very high
Clotting lab that should be monitored with warfarin?
warfarin - PT & INR
heparin - aPTT
When should clotting labs be looked at with heparin or warfarin therapy?
When are warfarin doses usually given to prevent skewed PT & INR results in am?
4 pt teaching for warfarin?
- 1. no alcohol
- 2. risk for bleeding
- 3. prevent injuries
- 4. avoid increased vitamin K intake
What is the most important AE associated with statins?
What is the most imp SE of bile acid sequestrants?
severe constipation or diarrhea & risk for impaction
If the QT interval is prolonged with an antiarrhythmic drug what should be done?
stop the med
EX of an antiplatelet drug?
OTC antiplatelet drug?
Use for plavix?
decreases the occurence of atherosclerotic events: MI, stroke, etc
Action of clopidogrel/Plavix?
inhibits platelet aggregation -> prolongs bleeding time
Can plavix be given with ASA?
yes, but need to watch platelet count
Teaching for pt on plavix?
- 1. hold pressure to any injury no matter how small
- 2. med alert bracelet
- 3. inform dentist of use
- 4. injury-proof house
What will be done if a pt on plavix needs to have surgery?
will stop 7 days prior to surgery
AE effects of plavix?
- 1. GI distress
- 2. bleeding
What type of drug is ASA?
3 uses for ASA?
- 1. stroke
- 2. MI
- 3. vascular death (PAD)
Serious AE of ASA?
bleeding esp GI bleeding
EX of hemorheologic drug?
Use for pentoxigylline/Trental?
used to decrease pain ass. with intermittent claudication ass. with slight blockage with PVD
Action of pentoxigylline/Trental?
increases flexibility of RBC to get through narrow BV
Common AE of pentoxigylline/Trental?
HA, dizziness, tremor, dyspepsia, NV
When should dose of pentoxygylline/Trentanl be held?
if HR is high
Suffix for thrombolytic drugs?
give in med emergency for MI or ischemic stroke
How much time may pass before it is too late to give alteplase for MI or stroke?
- MI - less than 6 h after onset of s/s
- stroke - less than 3 h after onset of s/s
What must be done prior to giving alteplase for stroke emergency?
must have a brain CT to rule out hemorrhagic stroke
4 contraindications for thrombolytics / alteplase?
- 1. active bleed esp intracranial
- 2. recent injury or surgery
- 3. severe uncontrolled BP
- 4. seizures
What is the risk ass. with HTN & use of thrombolytics / alteplase?
can cause intracranial bleed
Why is it contraindicated to give thrombolytics / alteplase to a seizure pt?
risk for injury if the pt seizes
What is the most important thing to do before giving a thrombolytic / alteplase?
ask if the pt has any recent injuries, surgeries, or procedures
4 ways to minimize risk for bleeding with thrombolytics / alteplase?
- 1. monitor for bleeding
- 2. avoid venipuncture and arterial puncture, & IM meds if possible
- 3. use pressure dressing
- 4. sign on pt door
Pt education with thrombolytics?
limits on activity
A pt on thrombolytics should be assessed frequently for ______.
change in LOC r/t intracranial bleed
Use for aminocaproic acid?
increases clotting for bleeding
4 AE of aminocaproic acid?
- 1. renal failure
- 2. rhabdomylysis
- 3. thromboembolism
- 4. arrhythmias
What are antihemophillic factors?
factor replacement for hemophillic ppl
AE of antihemophillic factors?
transmission of hepatitis or HIV
What test should be monitored with antihemophillic factors?
hematocrit and Coombs test (hemolytic anemia)
What would you like to do?
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