1050: heparin/warfarin, and alteplase
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What is the class and the action of heparin and warfarin?
heparin: inhibits factor X from converting prothrombin to thrombin, therefore, a stable clot is not formed.
warfarin: an oral anticoagulant, hinders the normal clotting effects of vitamin K (blocks).
Which system is used for lab value studies and what is each drug's purpose (use)?
heparin: aPTT (activated partial thromboplastin time)
purpose: prevents extension of blood clot and prevents new clots from forming.
warfarin: iNR (international normalized ratio)
purpose: prevention & treatment of thrombosis (blood clot), PE.
What contraindications are similar in both heparin and warfarin?
What are other contraindications for heparin and warfarin?
heparin: severe kidney & liver disease, 3rd trimester of pregnancy.
warfarin: open wounds, may cause fetal hemorrhage
What are some side effects of heparin and warfarin? (remember HEnRy)
heparin: bruising, balding, decreased RBCs
warfarin: stomach cramps, fever, itching
What similar adverse reaction does heparin and warfarin have that is similar to one of their contraindications?
What are the other adverse reactions for heparin and warfarin?
hep: HIT (Heparin Induced Thrombocytopenia)
What are the interactions for heparin and warfarin?
hep: smoking decreases effects; drugs such NSAIDs, antiplatelets & thrombolytics (clopidogrel & alteplase)
war: vitamin k foods, many drugs and herbals, CRANBERRY JUICE.
/What are the nursing actions for heparin for side effects? What is the antidote for heparin?
What are the nursing actions for warfarin based on its side effects? What is the antiode used for warfarin for increased vitamin K? (remember drawing)
Bruising: check body for bruises; monitor for bleeding (blood tests); give protamine sulfate if HIT overdose; check aPTT platelet count daily.
warfarin: check INR routinely as similar to aPTT for heparin; maintain usual intake of vitamin K, stop 7 days before surgery and give vitamin K (phytonadione) for an antidote.
What is our exemplar for thrombolytics and what is its action?
Action: dissolve (break down) blood clots.
What are the uses of alteplase?
alteplase is used for dissolving blood clots in EMERGENCY situations such as when the Pt shows s/sx of CVA or MI.
It is also used for dissolving clots in catheters placed in large BVs.
What is alteplase contraindicated for that is similar w/ the anticoagulants?
What are the other contraindications for alteplase?
Contraindicated for acute internal bleeding.
Other contraindications include Pts who've had recent surgery and exhibit hemorrhagic stroke.
What are the side effects of alteplase? (remember ALT key)
What are some adverse reactions?
ALTeplase's side effects include: bleeding from the nose, gums, bronchospasms, and hypotension, and fever.
Adverse reactions include bleeding from the stomach (GI), IC bleeding, and retroperitoneal bleeding; anaphylaxis.
What can ALTeplase not have for interactions?
ALT cannot have aspirin, NSAIDs, and AAs (anti-platelets & anticoagulants)
What are some nursing actions involved with ALTeplase? (think about side effects/adverse reactions)
Reconstitute w/ sterile water and monitor continuously during IV: BP, P, T, bleeding.
B/c it is given in EMERGENCY situations, give within 3 hours of onset.
*No IM route.
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