anticoagulant and thrombolic drugs Flashcards
anticoagulant
- used to prevent formation and extension of a THROMBUS (blood clot)
- Referred to as blood thinners, but do not actually “thin blood”
–Oral drug = Coumadin
–Parenteral drug = Heparin, Lovenox, Fragmin
- Have no effect on existing thrombus
- Do not reverse damage from the thrombus
- Can prevent additional clots from forming
- So therefore anticoagulants prevent thrombus formation
anticoagulants
- Dissolve clots that have already formed within the walls of a blood vessel
- Reopen blood vessels after occlusion
- Known as “Clot busters”
Fibrolytics
- Oral anticoagulant
- Drug of choice for long term therapy
- Peak activity in 1.5 to 3 days after therapy initiated
Warfarin (Coumadin)
- Interferes with manufacture of clotting factors by the liver.
- It is the depletion of prothrombin, a substance essential for the clotting of blood, that accounts for most of the action of the Coumadin
action of coumadin
coumadin uses
- Prevention and Treatment of Deep Vein Thrombosis (DVT)
- Prevention and treatment of pulmonary embolism, coronary occlusion
adverse reactions of coumadin
- Principle adverse reaction is bleeding, which can range from mild to severe
- Effects of Coumadin may be influenced by many drugs, either increasing or decreasing the effects, so letting MD know about all meds patient is taking is important.
nursing process coumadin
- Prothrombin Time (Pro Time) is lab test drawn to determine patient’s response to Coumadin
- Lab result will have a control value and the patient’s value
- Optimal results: PT of 1.2 to 1.5 times the control value
Most DVT’s occur in
lower extremities.
-Examine for color, and temp, swelling
Check for pedal pulse (bilaterally)
Evaluate for Homan’s sign
Some Labs report INR (International Normalized Ratio) along with
PT
-Level should be between 2-3.
Diet low in Vit K =
increase risk of Hemorrhage
Diet High in Vit K =
risk for clot formation
monitor for bleeding;
-Urine, NG drainage, skin
-Care after injections, shaving, brushing teeth
If bleeding occurs:
–MD may stop med
–MD may order Vitamin K (oral anticoagulant antagonist)
pt teaching
- Follow dosage schedule
- Lab will be periodically monitored
- Inform Dentist or other providers before any treatment or procedure
- Notify MD if bleeding noticed
- Medic –Alert identification
- Use soft toothbrush
- Inhibit the formation of fibrin clots
- Inhibits conversion of fibrinogen to fibrin
- Inactivate several factors necessary for the clotting of blood
- Cannot be taken orally as it is inactivated by acid in stomach, so it is given by injection
- Prevents formation of new clots
Heparin
Heparin uses
- Prevention and treatment of venous thrombosis
- Prevention of post op venous thrombosis
- Prevention of clotting in arterial and heart surgery
- Prevention of repeat cerebral thrombosis
heparin adverse reactiions
- Hemorrhage
- Thrombocytopenia
- Local irritation from injections
nursing process heparin
- PTT (Partial Thromboplastin Time) is lab drawn before first dose
- Heparin doseage is based on PTT being 1.5 to 2.5 times normal
- Dose of Heparin is measured in units per ml (U/ml)
- Usually given Sub Q, 5,000 u in 1 ml
- Also given by IV infusion by IV pump
PTT
Heparin+PTT= 10letters
7+3
PT
Coumadin+PT=10letters
8+2
MANAGING A HEPARIN OD
- Discontinue Heparin may suffice
- Severe hemorrhaging give Heparin Antagonist = Protamine Sulfate
- Observe for signs of bleeding, hypotension
- Monitor BP & Pulse q15-30 min for 2 hrs after administration of antagonist
pt teaching heparin
Similar to Coumadin
- Report signs of bleeding
- Lab tests
- Med as directed
- Advise Providers before treatments
- Med-alert band
Used to dissolve blood clots and reopen vessels after occlusion
- Activase
- Streptokinase
- Urokinase
Thrombolytic drugs
actions of thrombolytic drugs
Break down fibrin clots by converting plasminogen to plasmin (which breaks down fibrin of a blood clot, thus reopening blood vessels after an occlusion
uses of thrombolytic drugs
- In MI’s by lysing (dissolving) a blood clot in a coronary artery
- To treat pulmonary emboli
- To treat DVT’s
adverse reactions of thrombolytic drugs
Bleeding is most frequent reaction
- May be internal as in GI,GU and brain
- May be seen at venipuncture sites and recent surgical wounds
nursing process thrombolytic drugs
- Any history of bleeding tendencies
- During therapy, must monitor for bleeding q 15-30 minutes during the first 8 hours
- For best results, meds must be used as soon as possible (within 4-6 hours) after s/s of blockage
~Observe for s/s of internal bleeding
- -Coffee ground emesis
- -Black tarry stools
- -Hematuria
- -Coughing up blood
- -Joint pain
