Card Set Information

2011-06-29 07:48:20
Anticoagulants Hematinics

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  1. Heparin
    • Classification: anticoagulant
    • Given IV or Sub-Q
    • Action: interfere with the activation of fibrin and fibrinogen from thrombin that keeps the clots from forming
    • Uses: prevents and treats deep vein thrombosis, pulmonary embolism, and emboli in atrial fibrillation
    • preferred anticoagulant during pregnancy
    • Contraindications:
    • bleeding tendencies-hemophillia, dissecting aneurysm, peptic ulcer
    • thrombocytopenia, uncontrollable bleeding
    • postoperative clients, especially eye, brain, spinal cord surgery, lumbar puncture, and regional anesthesia
    • Side effects:
    • injection site reactions; heparin-induced thrombocytopenia
    • large doses may suppress renal function
    • spontaneous bleeding at mucous membranes
    • Nursing implications:
    • monitor the Partial thromboplastin time (PTT) and activated PTT (aPTT)-should be 1 1/2 to 2 times normal range; watch for bleeding
    • protamine sulfate is the antidote
    • low-molecular-weight heprins (e.g., enoxaparin (lovenox)) do not require PTT or aPTT monitoring; used most often for preventing and treating deep vein thrombosis (DVT)
    • administered either intravenously (IV) or subcutaneously
  2. Warfarin Sodium (coumadin)
    • Classification: Anticoagulant
    • Given IV, PO
    • Action:Vitman K antagonist blocks the use of vitamin K for the synthesis of clotting factors which disrupts the coagulation cascade
    • Uses: prevents venous thrombosis and thromboembolism associated with atrial fibrillation and prosthetic heart valves
    • decreases risk of recurrent transient ischemic attack (TIA), cerebrovascular accisent (stroke), and myocardial infarction
    • Contraindications:
    • bleeding disorders (hemophillia, thrombocytopenia)
    • vitamin K deficiency; severe hypertension
    • Pregnancy-category X, breastfeeding (crosses into breast milk)
    • Percautions:
    • renal or liver disease, alcoholism
    • Side effects:
    • spontaneous bleeding
    • hypersensitivity reactions (e.g., dermatitis, fever, pruitus, urtcaria)
    • red-orange discoloration of urine (not to be confused with hematuria); weakening of bones with long-term use
    • Nursing implications
    • monitor prothrombintim (PT) and international normalized ratio (INR) as ordered (2 to 3 is usually and acceptable INR)
    • interacts with a large number of medications; consequently, monitor for drug interactions before initating therapy
    • monitor for bleeding tendencies
    • vitamin K is the antidote
    • teach client to decrease intake of green, leafy vegetables
  3. Epoetin Alfa (Procrit)
    • Classification: Erythropoietic growth factor
    • Given IV
    • Action: stimulates red blood cell production
    • Uses:
    • anemia
    • chronic renal failure
    • chemotherapy
    • HIV-infected clients taking zidovudine (AZT)
    • Contraindications:
    • uncontrolled hypertension
    • hypersensitivity to albumin
    • precautions:
    • clients with cancers of the myeloid origin (rapid growth of white blood cells example Leukemia)
    • Side effects:
    • Hypertension
    • cardiovascular events-cardiac arrest, heart failure, thrombotic events (stroke, myocardial infarction (MI))
    • autoimmune pure red-cell aplasia, severe anemia, red blood cell production ceases
    • Nursing implications:
    • monitor blood pressure befor erythropoietin therapy
    • do not shake solution because it may denature the glycoprotein. do not mix with other medications
    • discard remaining contents because erythropoietin does not contain a preservative
    • monitor hematocrit (Hct), hemoglobin (Hgb), serum iron and fluid and electrolyte balance
    • monitor for seizures (rapid increase in Hct increasis risk of hypertensive encephalopathy)
  4. Iron Supplements
    • Classification: Hematinics
    • Given PO, IV, Via tube feedings
    • Action: production of notmal hemoglobin and red blood cells for transportation and utilization of oxygen
    • Uses:
    • Iron deficiency anemia
    • prophylactic use in pregnancy and child hood
    • Contraindications and precautions:
    • all anemias other than iron deficiency anemia
    • peptic ulcers, regional enteritis, colitis
    • Side effects:
    • gastrointestinal disturbances-nausea, heartburn, bloating, constipation
    • tarry stools or dark green discoloration
    • anaphylaxis (parenteral preparation only)
    • Nursing implications:
    • do not give with antacids or tetracyclines
    • do not crush or chew sustained released medication
    • take between meals to maximize uptake
    • take vitamin C to promote absorption of the iron
    • liquid preperations stain teeth, so use a straw or dilute, follow with rinsing the mouth
    • teach client that oral iron supplements differ form one another and should not be interchanged
    • diet teaching to include iron-rich food-liver, eggs, meat, fish, fowl
    • assess for anaphylaxis with parenteral iron (dextran), as well as hypotension, headache, fever, urtcaria, arthralgia
  5. Thrombolytics:
    • Clot busters
    • Action: convert plasminogen to plasmin, and digest matrix of clots
    • Uses: treatment of acute myocardial infarction, pulmonary embolism. thrombotic strokes, and deep vein thrombosis
    • Contraindications and precautions:
    • cerebrovascular disease and pregnancy
    • active bleeding, aortic dissection, pericarditis
    • history of intracranial hemorrhage
    • recent major surgery
    • history of gastrointestinal (GI) bleeding
    • Side effects:
    • Streptokinase:
    • hemorrhage (intracranial of greatest concern) and anemia
    • hypotension and fever
    • allergic reactions-itching, urticaria, headache, anaphylaxis
    • alteplase (tPA) and tenecteplase:
    • risk of intracranial hemorrhage is higher
    • does not cause hypotension
    • Nursing implications:
    • administer immediately after the event for better outcome, preferably within 4 to 6 hours
    • monitor intake and output and hematocrit during treatment
    • monitor client for bleeding and anaphylactic reactions
    • while receiving the medication maintain client on bed rest
  6. Clopidogrel (Plavix)
    • Classification: antiplatelet
    • Action: inhibits platelet aggregation, action occures within 2 hours of administration
    • uses: secondary prevention of myocardial infarction (MI), ischemic stroke, and other vascular events
    • Contraindications and precautions:
    • active bleeding
    • concomittant use of anticoaugulant drugs and non steroidal antinflammatory drugs (NSAID's) can cause bleeding
    • Side effects:
    • abdominal pain
    • dyspepsia
    • diarrhea
    • rash
    • Nursing implications:
    • administer with food to diminish gastrointestinal upset
    • teach client to report an unusual bleeding or brusing
    • teach client that if surgery is scheduled, medication may be held 3 to 7 days before surgery
    • platelet counts may be monitored