pharm 2 anticoagulants

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pharm 2 anticoagulants
2013-06-16 14:16:30
pharmacology nursing

anticoagulants - vickers
Show Answers:

  1. What is the major AE for all anticoagulants?
  2. What 2 things can cause rebound hypertension with anti-hypertensive drug therapy?
    • 1. abruptly stopping the med
    • 2. becoming tolerant to the med
  3. What should be done prior to administering any anticoagulant med?
    double check with another nurse
  4. 4 uses for heparin?
    • 1. prevent DVT & PE
    • 2. maintain patency of venous access devices (IV, central lines)
    • 3. acute MI
    • 4. DIC
  5. Antidote for warfarin?
    vitamin K/AquaMephyton
  6. Action of heparin?
    inactivates factor X -> prevents conversion of prothrombin to thrombin
  7. How does heparin affect existing clots?
    does not affect existing clots - prevents new clots while body dissolves existing clots
  8. 2 routes of admin for heparin?
    IV & SQ
  9. Imp consideration when admin heparin SQ?
    do not massage or aspirate - can cause bleeding/hematomas
  10. 2 AE of heparin?
    • 1. bleeding
    • 2. heparin - induced thrombocytopenia (HIT)
  11. Antidote for heparin overdose?
    protamine sulfate
  12. 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
  13. 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!!
  14. 2 tests that need to be monitored closely with anticoagulant therapy besides clotting tests?
    platelets and CBC
  15. 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
  16. 2 ways to tell morphine toxicity?
    • 1. depressed RR
    • 2. decreased LOC
  17. What type of drug will be given if an ACE inhibitor causes ACE cough or other adverse effects?
    ARB like cozaar
  18. 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
  19. 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
  20. What can the nurse do to make sure all caregivers know a pt is on heparin?
    put a sign above the bed
  21. How is heparin admin IV?
    ALWAYS admin on a pump
  22. What should the nurse do if a pt is on heparin and has just come back from a procedure?
    check the IV pump
  23. ASA is used to prevent ____ & _____.
    MI & stroke
  24. Pt education with heparin therapy?
    teach the pt to report any s/s of bleeding
  25. Why should a pt on heparin be given humidified O2?
    to prevent nose bleeds r/t drying of nose
  26. 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
  27. 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
  28. How is the therapeutic range for heparin calculated?
    multiply the control aPTT by 1.5 & then 2
  29. 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
  30. 4 low molecular weight heparin drugs?
    • 1. lovenox
    • 2. fragmin
    • 3. innohep
    • 4. atrixtra
  31. Route for lovenox and other low molecular weight heparins?
  32. 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
  33. 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
  34. What drug will be used in heparin induced thrombocytopenia?
  35. Route of admin for warfarin?
  36. 2 uses for warfarin?
    • 1. Tx for thrombus/embolism
    • 2. long-term for pt with risk for thrombus
  37. 3 EX of pt at risk for thrombus?
    • 1. valve replacement pt
    • 2. atrial fibrillation
    • 3. pt with Hx of thrombus
  38. INR for prophylaxis of a thrombus or embolus?

    for mechanical heart valves?
    2 to 3

    2.5 to 3.5
  39. PT for standardized exams?
    should be 1.5 to 2 times the control time or 18 to 24 seconds
  40. Action of warfarin?
    blocks vitamin K & prevents activation of factors II (prothrombin), Vii, IX, & X
  41. 2 contraindications for warfarin?
    • 1. active bleed
    • 2. thrombocytopenia
  42. 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
  43. Drug/food interaction with warfarin?
    foods high in vitamin K decrease effectiveness (green leafy vegetables)
  44. Antidote for warfarin?

    When is it given?
    vitamin K/AquaMephyton

    if PT gets very high
  45. Clotting lab that should be monitored with warfarin?

    warfarin - PT & INR

    heparin - aPTT
  46. When should clotting labs be looked at with heparin or warfarin therapy?
    q am
  47. When are warfarin doses usually given to prevent skewed PT & INR results in am?
    at 1600
  48. 4 pt teaching for warfarin?
    • 1. no alcohol
    • 2. risk for bleeding
    • 3. prevent injuries
    • 4. avoid increased vitamin K intake
  49. What is the most important AE associated with statins?
    liver toxicity
  50. What is the most imp SE of bile acid sequestrants?
    severe constipation or diarrhea & risk for impaction
  51. If the QT interval is prolonged with an antiarrhythmic drug what should be done?
    stop the med
  52. EX of an antiplatelet drug?
  53. OTC antiplatelet drug?
  54. Use for plavix?
    decreases the occurence of atherosclerotic events:  MI, stroke, etc
  55. Action of clopidogrel/Plavix?
    inhibits platelet aggregation -> prolongs bleeding time
  56. Can plavix be given with ASA?
    yes, but need to watch platelet count
  57. 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
  58. What will be done if a pt on plavix needs to have surgery?
    will stop 7 days prior to surgery
  59. AE effects of plavix?
    • 1. GI distress
    • 2. bleeding
  60. What type of drug is ASA?
  61. 3 uses for ASA?
    • 1. stroke
    • 2. MI
    • 3. vascular death (PAD)
  62. Serious AE of ASA?
    bleeding esp GI bleeding
  63. EX of hemorheologic drug?
  64. Use for pentoxigylline/Trental?
    used to decrease pain ass. with intermittent claudication ass. with slight blockage with PVD
  65. Action of pentoxigylline/Trental?
    increases flexibility of RBC to get through narrow BV
  66. Common AE of pentoxigylline/Trental?

    Serious SE?
    HA, dizziness, tremor, dyspepsia, NV

  67. When should dose of pentoxygylline/Trentanl be held?
    if HR is high
  68. Suffix for thrombolytic drugs?
  69. alteplase uses?
    give in  med emergency for MI or ischemic stroke
  70. 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
  71. What must be done prior to giving alteplase for stroke emergency?
    must have a brain CT to rule out hemorrhagic stroke
  72. 4 contraindications for thrombolytics / alteplase?
    • 1. active bleed esp intracranial
    • 2. recent injury or surgery
    • 3. severe uncontrolled BP
    • 4. seizures
  73. What is the risk ass. with HTN & use of thrombolytics / alteplase?
    can cause intracranial bleed
  74. Why is it contraindicated to give thrombolytics / alteplase to a seizure pt?
    risk for injury if the pt seizes
  75. What is the most important thing to do before giving a thrombolytic / alteplase?
    ask if the pt has any recent injuries, surgeries, or procedures
  76. 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
  77. Pt education with thrombolytics?
    limits on activity
  78. A pt on thrombolytics should be assessed frequently for ______.
    change in LOC r/t intracranial bleed
  79. Hemostatic drug?
    aminocaproic acid
  80. Use for aminocaproic acid?
    increases clotting for bleeding
  81. 4 AE of aminocaproic acid?
    • 1. renal failure
    • 2. rhabdomylysis
    • 3. thromboembolism
    • 4. arrhythmias
  82. What are antihemophillic factors?
    factor replacement for hemophillic ppl
  83. AE of antihemophillic factors?
    hemolytic anemia

    transmission of hepatitis or HIV
  84. What test should be monitored with antihemophillic factors?
    hematocrit and Coombs test (hemolytic anemia)