Anticoagulant & Anti-arrhythmic Medications Flashcards
What’s the difference between the intrinsic clotting cascade vs. the extrinsic clotting cascade?
Intrinsic = clotting r/t spontaneous internal damage of the blood vessels
Extrinsic = secondary activation d/t injury or trauma
- Ex: knife wound
Is blood clotting (coagulation) good or bad?
It’s both
- Good because we need our blood to clot
- Bad because too much clotting can cause occlusions in the blood vessels
Most often we are giving medications to __________?
Prevent a clot from occurring or clots from worsening i.e., prophylactically
What are the three classes of coagulation modifiers?
- What does each one do?
- In what situations (for what purpose) would we use either categories of medication?
- What’s the difference between the first 2 categories?
- Anti-platelets (Ex: Aspirin)
- Prevents platelet aggregation (RBC from “sticking”)
- Reduces MI/stroke risk - Anticoagulants (Ex: Heparin, Warfarin)
- Prevents blood clotting/slows down blood clotting
- Reduces MI/stroke risk - Thrombolytic Clot Busters
- Breaks up blood clots
- Used if we think someone is having a stroke
*Difference between Anti-platelets vs. Anti-coagulants = they’re acting at different parts in the cascade
Aspirin
- Class?
- Prevention or Buster?
- MOA?
- Therapeutic action?
- Nursing considerations?
- Side effects?
Class = Anti-platelet
Clot PREVENTION
MOA:
- Binds to COX-1 & COX-2
- Decreases inflammatory response
- Inhibits platelet aggregation
Therapeutic action (at higher doses):
- Analgesic
- Antipyretic
Side effects:
- bleeding
- Nausea, vomiting, diarrhea
- Tinnitus (ear ringing)
Nursing considerations:
- Monitor platelet labs i.e., pts ability to clot blood
- Monitor for bleeding
*NEVER give aspirin to children or babies d/t Reye’s syndrome
Clopidogrel (Plavix)
- Class?
- MOA?
- Side effects?
- Contraindications?
- Nursing considerations?
Class = Anti-platelet
More effective than Aspirin at preventing platelet aggregation, but carries higher risk for bleeding
MOA:
- Blocks adenosine diphosphate (ADP) receptor
- Prevents platelet aggregation
Side effects:
- Bleeding
Contraindications:
- Amiodarone –> reduces effectiveness (anti-arrhythmic drug)
- Calcium channel blockers –> reduces effectiveness
- NSAIDS –> increases risk for GI bleeding
Nursing considerations:
- Monitor platelet labs –> pt’s ability to clot
- Monitor for bleeding
Eptifibatide (Integrilin)
- Class?
- MOA?
- Given in which environment?
- Side effects?
- Nursing considerations?
Class = Anti-platelet
MOA:
- Inhibits glycoprotein llb/lla, inhibiting aggregation
Environment:
- ICU environment (IV form)
Side effects:
- Thrombocytopenia (low platelet count)
- Bleeding
Nursing considerations:
- Monitor platelet count
- Monitor Hgb/HCT levels –> low levels indicate loss of blood/RBCs i.e., bleeding
Hemoglobin = protein within RBC that is responsible for carrying oxygen (i.e., performing essential function)
Hematocrit = ratio of RBC to total blood volume (% RBC in blood)
*Both usually correlate/flow together
Tirofiban (Aggrastat)
- Class?
- MOA?
- Given in which environment?
- Side effects?
- Nursing considerations?
Class = Anti-platelet
MOA:
- Inhibits glycoprotein llb/lla, inhibiting aggregation
Environment:
- ICU environment (IV form)
Side effects:
- Thrombocytopenia (low platelet count)
- Bleeding
Nursing considerations:
- Monitor platelet count
- Monitor Hgb/HCT levels –> low levels indicate loss of blood/RBCs i.e., bleeding
Hemoglobin = protein within RBC that is responsible for carrying oxygen (i.e., performing essential function)
Hematocrit = ratio of RBC to total blood volume (% RBC in blood)
*Both usually correlate/flow together
Heparin
- Class?
- Route?
- Side effects?
- Nursing considerations?
- Medication interactions?
- What is the reversal agent?
Class = Anticoagulant
- ZERO effect on clots that have already formed
- Parenteral (IV/SC) –> much quicker onset
Side effects:
- Bleeding
- HIT - Heparin Induced Thrombosis –> medication has opposite effect it is supposed to (this can happen with some medications!)
Medication interactions/contraindications:
- Grapefruit/fruit juice –> can increase risk of bleeding
Nursing considerations:
- Careful administration
- Assessment for bleeding (especially around IV site) –> ask patient of any bleeding in the gums, shaving, stool/urine
- Monitor blood levels often, including aPTT test –> Time it takes for a clot to form
- Monitor therapeutic blood levels and adjust dose if needed
Antidote = Protamine sulfate
Enoxaprin (Lovenox)
- Class?
- Differences from other medications in the same class?
- Side effects?
- Medication interactions?
- Nursing considerations?
Class = Anticoagulant
- Low molecular weight heparin
Lower risk for bleeding; don’t need to monitor aPTT. However, Heparin is more effective at preventing clotting
Can be sent home with patient!
Side effects: Not life-threatening
- Bleeding
- Anemia
Medication interactions/contraindications:
- Grapefruit/fruit juice –> can increase risk of bleeding
Nursing considerations:
- Monitor labs pertinent to bleeding risk –> HCT, HgB, platelets
- Careful assessment for bleeding
- Educate patient that if they fall and hit their head, they need to call provider immediately –> will also bruise easily
Dalteparin (Fragmin)
- Class?
- Differences from other medications in the same class?
- Side effects?
- Medication interactions?
- Nursing considerations?
Class = Anticoagulant
- Low molecular weight heparin
Lower risk for bleeding; don’t need to monitor aPTT. However, Heparin is more effective at preventing clotting
Can be sent home with patient!
Side effects: Not life-threatening
- Bleeding
- Anemia
Medication interactions/contraindications:
- Grapefruit/fruit juice –> can increase risk of bleeding
Nursing considerations:
- Monitor labs pertinent to bleeding risk –> HCT, HgB, platelets
- Careful assessment for bleeding
- Educate patient that if they fall and hit their head, they need to call provider immediately –> will also bruise easily
- Educate patient to look out for signs of bleeding
Warfarin (Coumadin)
- Class? Route?
- Most common medication for?
- Side effects?
- Antidote?
- Drug interactions/contraindications?
- Nursing considerations (monitoring/education)?
Class = Anticoagulant
- PO
Most common medication for atrial fibrillation i.e., clot forming and going out into circulation
Side effects:
- Bleeding
- Muscle pain
Antidote = Vitamin K –> natural coagulant
Drug interactions/contraindications:
- Amiodarone –> reduces effectiveness (anti-arrhythmic drug)
- Erythromycin
- Sulfa drugs
- Grapefruit/cranberry juice
- No alcohol
- Overconsumption of Vitamin K –> can reverse therapeutic effects
Nursing considerations:
- Draw and monitor frequent labs –> blood levels
- Monitor INR (international normalized ratio) –> how long it takes for blood to clot –> should be 2-3.5 times the “normal value” to be considered safe (bridge therapy)
- Educate patient regarding vitamin K intake and what foods are high in vitamin K (Leafy greens, animal liver products, nutritional supplement drinks, vitamins)
Rivaroxaban (Xarelto)
- Class?
- Side effects?
- Reversal agent?
- Nursing implications?
- Benefits of newer drug?
Class = Anticoagulant
- PO
Side effects:
- Bleeding
Reversal agent = Andexanet
Nursing implications:
- Monitor labs pertinent to bleeding
Benefits of newer drug (compared to Warfarin):
- No CLOTTING labs to monitor
- No dietary restrictions
Apixaban (Eliquis)
- Class?
- Side effects?
- Reversal agent?
- Nursing implications?
- Benefits of newer drug?
Class = Anticoagulant
- PO
Side effects:
- Bleeding
Reversal agent = Andexanet
Nursing implications:
- Monitor for labs pertinent to bleeding
Benefits of newer drug (compared to Warfarin):
- No CLOTTING labs to monitor
- No dietary restrictions
Dabigatran (Pradaxa)
- Class?
- Side effects?
- Nursing implications?
Class = Anticoagulant
- Thrombin inhibitor
Side effects:
- Bleeding
- NO dietary restrictions
- NO specific clotting labs to monitor
Nursing implications:
- Review labs pertinent to bleeding (Hgb/HCT)
Alteplase (Activase)
- Class?
- Action?
- Side effects?
- Nursing considerations?
Class = Thrombolytic clot buster
- Breaks down/dissolves blood clots
*VERY strong drug –> can have very negative side effects
Side effects:
- Ecchymoses (bruising)
- Bleeding (internally, intracranial, superficial)
- Drug toxicity
Nursing considerations:
- Very short half-life (5 minutes)
- NO antidote
- Monitor labs for signs of bleeding
- Respiratory/cardiac assessment
Reteplase (Retavase)
- Class?
- Action?
- Side effects?
- Nursing considerations?
Class = Thrombolytic clot buster
- Breaks down/dissolves blood clots
*VERY strong drug –> can have very negative side effects
Side effects:
- Ecchymoses (bruising)
- Bleeding (internally, intracranial, superficial)
- Drug toxicity
Nursing considerations:
- Very short half-life (5 minutes)
- NO antidote
- Monitor labs for signs of bleeding
- Respiratory/cardiac assessment
Streptokinase
- Class?
- Action?
- Side effects?
- Nursing considerations?
Class = Thrombolytic clot buster
- Breaks down/dissolves blood clots
*VERY strong drug –> can have very negative side effects
Side effects:
- Ecchymoses (bruising)
- Bleeding (internally, intracranial, superficial)
- Drug toxicity
Nursing considerations:
- Very short half-life (5 minutes)
- NO antidote
- Monitor labs for signs of bleeding
- Respiratory/cardiac assessment
What do anti-arrhythmic drugs do?
Medications that get the HR back to “normal.”
- Trying to stop irregular heart beats from occurring.
What’s a Non-pharmacological method for dysrhythmias?
- What does it aim to do?
- Who can we not use this intervention on?
Delivering small amounts of shock therapy to the patient via cardioversion pads/paddles
- Not the same amount of shock delivered as if the patient were actually coding
Aims to stop the heart long enough as to “reset” it back to it’s normal rhythm
Contraindication:
- do NOT want to deliver small shocks to a patient at risk for clots d/t potential of sending clot into circulation and causing thrombus
Amiodarone (Pacerone/Cordarone)
- Class?
- MOA?
- Side effects?
- Nursing implications?
Class = Potassium channel blocker
MOA:
- blocks potassium channels
- works to return heart rhythm back to “normal”
Side effects:
- Multiple ocular (vision) issues
- Bradycardia
- Hypotension
- Photosensitivity
- Hyper/or Hypothyroidism
- Multiple respiratory issues i.e., Blue Man Syndrome (Blue/graying of the face)
- Pulmonary fibrosis (lung tissue develops thick or “fibrous” scar tissue)
- Pulmonary toxicity (lung damage)
Nursing implications:
- Cardiac assessment
- Vision assessment
- Respiratory assessment
- Potassium levels
