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Pharmacology Anticoagulant Agents > Anticoagulant Agents > Flashcards

Anticoagulant Agents Flashcards

1
Q

Heparin (given SQ, IV push/infusion) use pump Iv peak 5 min.

  • Im causes hematoma, so not used.
  • cannot cross membrane, so no PO: does not cross placenta or breast milk.

MOA:

A

Binds to antithrombin 3, Inhibits the conversion of prothrombin to thrombin; inactivates factor Xa. Turns off coagulation pathway and prevents clots from forming.

onset of action within minutes.

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2
Q

Heparin (given SQ, IV push/infusion) use pump Iv peak 5 min.

  • Im causes hematoma, so not used.
  • cannot cross membrane, so no PO: does not cross placenta or breast milk.

Therapeutic Uses:

A

Prophylaxis and treatment of thromboembolic disorders: DVT,PE, a-fib, evolving stroke, acute MI. Open heart surgery and dialysis to prevent clots while blood going through machine.
Low doses used to maintain potency of IV catheters and post for DVT prophylaxis.

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3
Q

Heparin (given SQ, IV push/infusion) use pump Iv peak 5 min.

  • Im causes hematoma, so not used.
  • cannot cross membrane, so no PO: does not cross placenta or breast milk.

SIDE EFFECT:

A

*Bleeding 10% (may be fatal) rashes, anemia, HIT(heparin induced cytopenia), fever, allergy.

LT: alopecia,osteoporosis.

watch for decrease blood pressure, increased HR, HA, monitor platelets,Treat OD with protamine sulfate.

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4
Q

Heparin (given SQ, IV push/infusion) use pump Iv peak 5 min.

  • Im causes hematoma, so not used.
  • cannot cross membrane, so no PO: does not cross placenta or breast milk.

Level:

A

aPTT(for heparin) nl 25-35sec.
TX: dont excede 1.5-2.5x normal(target is 45-70sec.)
Monitor aPTT q. 4-6 hours initially then 1x/day
monitor H/H platelets (150,000-400,000)

aPTT: partial thromboplastin time

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5
Q

Heparin (given SQ, IV push/infusion) use pump Iv peak 5 min.

  • Im causes hematoma, so not used.
  • cannot cross membrane, so no PO: does not cross placenta or breast milk.

Toxicity/ Teaching:

A

protamine sulfate(5 min) lasts 2 hours 1mg protamine for 100units heparin. Slow IV injection (no >20mg/min or 50mg over 10 min).
Report abnormal bleeding such as cuts, or severe HA, blurred vision, bloody urine/sputum. Red/dark brown/ tarry stool.
Heparin is THE anticoagulant of choice during pregnancy.

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6
Q

Heparin (given SQ, IV push/infusion) use pump Iv peak 5 min.

  • Im causes hematoma, so not used.
  • cannot cross membrane, so no PO: does not cross placenta or breast milk.

Nursing consideration:

A

Don’t give with LMWheprin, check with 2nd RN.
Admn deep SQ(5/8” needle, 26-28 gauge) in lower abdomen. inject into skin fold at 90degree angle.
never aspirate or massage. Apply firm mental pressure.
avoid incisions, rotate sites, avoid IM injections. Use soft toothbrush, electric razor. Avoid anti platelet drugs, spinal puncture, and epidurals.

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7
Q

Low molecular weight heparin
Dalteparin
*enoxaparin
-Only SQ based on body wt. Prophylaxis:30-40mg BID or QD
-treatment of DVT/PE/MI: 1mg/kg q 12hr or 1.5mg/kg q 24 hr.

MOA:

A

Works similar to heparin but more specific for activated factor X. More predictable response.

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8
Q

Low molecular weight heparin
Dalteparin
*enoxaparin
-Only SQ based on body wt. Prophylaxis:30-40mg BID or QD
-treatment of DVT/PE/MI: 1mg/kg q 12hr or 1.5mg/kg q 24 hr.

Therapeutic uses:

A

Prevention of thromboembolic disorders: DVT, PE, after abdomen surgery, THR, TKR
* first line therapy for prevention and treatment of DVT, ischemia in unstable angina and STEMI(nasty heart attack).

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9
Q

Low molecular weight heparin
Dalteparin
*enoxaparin
-Only SQ based on body wt. Prophylaxis:30-40mg BID or QD
-treatment of DVT/PE/MI: 1mg/kg q 12hr or 1.5mg/kg q 24 hr.

Side effects:

A

BlEEDING, anemia, thrombocytopenia, dizziness, HA, constipation, N/V, rash, pruritus

safe for outpatient use.

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10
Q

Low molecular weight heparin
Dalteparin
*enoxaparin
-Only SQ based on body wt. Prophylaxis:30-40mg BID or QD
-treatment of DVT/PE/MI: 1mg/kg q 12hr or 1.5mg/kg q 24 hr.

LEVEL:

A

none

but monitor CBC because can cause thrombocytopenia

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11
Q

Low molecular weight heparin
Dalteparin
*enoxaparin
-Only SQ based on body wt. Prophylaxis:30-40mg BID or QD
-treatment of DVT/PE/MI: 1mg/kg q 12hr or 1.5mg/kg q 24 hr.

Toxicity/ teaching:

A

contraindication w/ spinal puncture/epidural. Can cause severe euro injury, permanent paralysis. DO NOT administers until 12 hours after surgery for THR/TKR.

OD:protamine sulfate

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12
Q

Low molecular weight heparin
Dalteparin
*enoxaparin
-Only SQ based on body wt. Prophylaxis:30-40mg BID or QD
-treatment of DVT/PE/MI: 1mg/kg q 12hr or 1.5mg/kg q 24 hr.

Nursing Consideration:

A
  • don’t use w/ heparin

admin. deep SQ in the love handles of abdomen. Never aspirate or massage. Rotate sites (profiled syringe) P.409

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13
Q 
ORAL ANTICOAGULANTS:
warfarin (coumadin) 
dose:2.5-10mg/day for 2-4 days, then based on INR/PT
1.5-2.5 nl 
NEW POTENT ANTICOAGULANTS:
*dabigatran 
*apixaban 
**rivaroxaban

MOA:

A

inhibits clotting factors (2,7,9,and 5)that rely on vitamin K

-onset of action may take days (36-72hr)

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14
Q 
ORAL ANTICOAGULANTS:
warfarin (coumadin) 
dose:2.5-10mg/day for 2-4 days, then based on INR/PT
1.5-2.5 nl 
NEW POTENT ANTICOAGULANTS:
*dabigatran 
*apixaban 
**rivaroxaban

Therapeutic use:

A

Prophylaxis and tx of DVT,PE,A-fib, management of MI, prevention of thrombus w/ valve replacement.

  • Decrease risk of recurrent TIA/MI
  • *prevention of DVTin THR/TKR
  • */**Tx of DVT/ PE
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15
Q 
ORAL ANTICOAGULANTS:
warfarin (coumadin) 
dose:2.5-10mg/day for 2-4 days, then based on INR/PT
1.5-2.5 nl 
NEW POTENT ANTICOAGULANTS:
*dabigatran 
*apixaban 
**rivaroxaban

Side effects:

A

BLEEDING, cramps, Nausea, Diarrhea, rash, fever.

Tx prolonges PT d/c several days before or; if emergency give Vitamin K.

*/** major bleeding

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16
Q 
ORAL ANTICOAGULANTS:
warfarin (coumadin) 
dose:2.5-10mg/day for 2-4 days, then based on INR/PT
1.5-2.5 nl 
NEW POTENT ANTICOAGULANTS:
*dabigatran 
*apixaban 
**rivaroxaban

Level:

A 
PT/INR
PT nl 11-13sec (Tx is 1.5xnl or 18 sec.)
INR 1 w/o tx 
INRof 2-3 is target 
with valve target is 2.5-3.5
17
Q 
ORAL ANTICOAGULANTS:
warfarin (coumadin) 
dose:2.5-10mg/day for 2-4 days, then based on INR/PT
1.5-2.5 nl 
NEW POTENT ANTICOAGULANTS:
*dabigatran 
*apixaban 
**rivaroxaban

Toxicity/ teachings

A

Vitamin K (phytonadione) a large dose of Vit K will maintain its reversal effects for up to 1 week.

  • PO or IV
  • Preg cat. X (warfarin)
  • limit use of alcohol
  • */** DO NOT require therapeutic monitoring
18
Q 
ORAL ANTICOAGULANTS:
warfarin (coumadin) 
dose:2.5-10mg/day for 2-4 days, then based on INR/PT
1.5-2.5 nl 
NEW POTENT ANTICOAGULANTS:
*dabigatran 
*apixaban 
**rivaroxaban

Nursing Considerations:

A
  • Increase risk of bleeding w/ other anticoagulants, NSAIDS.
  • Anti fungal(azole) and sulfonamides increase effects. -May give with heparin until therapeutic level reached.
  • Keep Vit K steady in diet don’t ^ or v .
  • */** don’t use with renal disease/ spinal procedures.

Pharmacology Anticoagulant Agents (1 decks)

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