325 Patho 1 drugs mod 6 (E4) Flashcards
class: heparins
-heparin
-enoxaparin (low molecular wt heparin)
heparins MOA
prevents clotting by activating antithrombin -> indirectly inactivates thrombin & factor Xa (we inactive factor VII, X and thrombin in the extrinsic pathway & IX, X, XI, XII and thrombin in intrinsic pathway ) inhibits fibrin formation (LMWH only inactivates factor Xa, not thrombin)
how is heparin given
IV or sub q injections
heparin indications
conditions necessitating prompt anti coagulant activity like stroke, PE, massive DVT, MI
LMWH indication
prophylaxis against post op DVT
how is heparin dosed
wt based always in KG & labs: aPPT or anti Xa
heparin nursing considerations
-rapid onset
-use cautiously in pt w/ spinal or epidural anesthesia bc increased risk for hematoma
-high risk med
-monitor signs for bleeding
must double check w/ another RN for rate changes or boluses
heparin SE
-bleeding
-hematoma
-anemia
-thrombocytopenia
heparin antidote
protamine sulfate (SE: hypotension)
do you need to do all the lab monitoring for LMWH
no
LMWH SE
-bleeding
-thrombocytopenia
-HIT
LMWH antidote
protamine
LMWH nursing considerations
-only injectable, no IV
-can be given at home, pre dosed
-use cautiously in pts w/ spinal or epidural anesthesia
do not give w/ heparin
BBW: potential spinal hematoma if pt has epidural catheter
warfarin MOA
vitamin K inhibitor -> prevents the synthesis of factors VII, IX, X & prothrombin
warfarin indications
prevention VTE/DVT/PE, thrombotic events for pt w/ Afib or heart valves, reduce recurrence of TIA or MI
warfarin SE
-bleeding
-lethargy
-muscle pain
-purple toes
warfarin antidote
vitamin K
warfarin nursing considerations
-can’t give to pregnant or breast feeding women
-hold before surgeries
-lab monitoring
-many drug & foods interactions (dark leafy greens)
-avoid alcohol
-once a day @5pm
apixaban & rivaroxaban MOA
direct inhibitor of factor Xa
apixaban & rivaroxaban indications
prevent strokes in pt w/ afib, post op thrombo-prophylaxis, treat DVT & PE
apixaban & rivaroxaban SE
-bleeding
-hematoma
-dizziness
-rash
GI distress
-peripheral edema
apixaban & rivaroxaban nursing considerations
BBW: spinal hematomas if pt has epidural catheter
-risk of thrombosis if drugs abruptly stopped
-CYP inhibitor, dont have grapefruit & lots of interactions
-do not give w/ other anticoags
-watch liver function (ALT, AST, GGT)
apixaban & rivaroxaban antidote
andexxa
aspirin MOA
blocks prostaglandin synthesis through the COX enzyme pathways (+blocks platelet aggregation)
aspirin indications
prevent/treat MI, prevent ischemic stroke
aspirin SE
-GI distress
-bleeding
-drowsiness/confusion
aspirin nursing considerations
-can be bought OTC
-reye’s syndrome so can’t give to children
aspirin contraindications
thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vit K deficiency, recent hemorrhagic stroke
aspirin antidote
desmopressin (DDAVP)
clopidogrel & ticagrelor MOA
anti-platelet ADP inhibitor (alters the platelet membrane so it doesn’t receive the signal to aggregate)
clopidogrel & ticagrelor indication
reduce risk of stroke, prophylaxis of TIAs, post MI
clopidogrel & ticagrelor contraindications
thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vit K deficiency, recent hemorrhagic stroke
clopidogrel & ticagrelor SE
-chest pain
-edema
-flu like symptoms
-abdominal pain
-diarrhea
-nausea
-epistaxis
-rash
-pruritus (nose bleed)
clopidogrel & ticagrelor nursing considerations
BBW (clopid): pt w/ certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite
BBW (tica): increased bleeding risk w/ aspirin doses over 100mg (so can give w/ baby aspirin)
-clopid effectiveness is reduced by amiodarone, CCB, NSAIDS and PPIs
clopidogrel & ticagrelor antidote
DDAVP or platelet transfusion
direct thrombin inhibitors (argatroban & bivalrudin) MOA
inhibit thrombin (factor IIa)
direct thrombin inhibitors indications
treat HIT, and for pts undergoing procedures (PCI) who are at high risk for HIT
direct thrombin inhibitors SE
bleeding
direct thrombin inhibitors nursing considerations
-only IV
-labs (anti Xa and H&H, platelets)
class: glucocorticoids
-hydrocortisone
-prednisone
-dexamethasone
hydrocortisone
synthetic, identical to cortisol w/ some aldosterone activity
hydrocortisone SE
large amounts = toxic
what disease is prednisone usually given for
COPD
glucocorticoids MOA
mimics glucocorticoid burst by adrenals at dawn
glucocorticoids SE
-increased intraocular pressure
-fluid retention
-high BP
-mood swings
-wt gain (centralized)
long term side effects corticosteroid use
-clouded eyes
-high BS
-increased risk of infections
-thinning bones
-suppressed adrenal gland hormone production
-thin skin, bruising, slow wound healing
nursing considerations for glucocorticoids
do not stop abruptly
-take at same time
-monitor wt and BS
class: mineral-corticoids
fludrocortisone
fludrocortisone indication
combat salt wasting (inability to maintain Na+ levels high despite adequate renal function)
class: anti platelet
-clopidogrel
-ticagrelor
-aspirin
class: coumarin
warfarin
class: anti coag
-apixaban
-rivaroxaban
