Anticoagulant Meds

Question 1

Heparin

Adverse Effects

Answer 1

Can produce hemorrhage from any body site ( 10%). Tissue irritation/pain at injection site. Anemia. Thrombocytopenia, Fever, Dose dependant on aPTT

Question 2

Heparin

Nursing Considerations

Answer 2

Monitor therapeutic partial thromboplastin time (PTT) at 1.5-2.5 times the control without signs of hemorrhage. Lower limit of normal 20-25 sec; upper limit of normal 32-39 sec.
For IV admin: use infusion pump, peak 5 minutes, duration 2-6 hrs
For injection: give deep SQ; NEVER IM (danger of hematoma) onset 20-60 min, duration 8-12 hr
ANTIDOTE: PROTAMINE SULFATE w/in 30 min
Can be allergenic

Question 3

Low molecular-weight heparin
Enoxaparin
Adverse Effects

Answer 3

Bleeding, Minimal Widespread affect, fixed dose

Question 4

Low molecular-weight heparin
Enoxaparin
Nursing Considerations

Answer 4

Les allergenic than heparin
Must be given deep SQ, NEVER IV or IM
Does not require lab test monitoring

Question 5

Warfarin

Adverse Effects

Answer 5

Hemorrhage, Diarrhea, Rash, Fever

Question 6

Warfarin

Nursing Considerations

Answer 6

Monitor therapeutic prothrombin time (PT) at 1.5-2.5 times the control, or monitor international normalized ratio (INR)
Normal PT 9.5-12 sec; normal INR 2.0-3.5 days
Onset: 12-24 hrs, peak 1.5-3 days, duration 3-5 days
ANTIDOTE: Phytonadione ( vit K), whole blood, pasma
Teach measures to avoid venous stasis
Emphasize importance of regular testing. Client should avoid foods high in vit K, many green vegetables, pork, rice, yogurt, cheeses, fish, milk

Question 7

Dabigatran

Adverse Effects

Answer 7

Directly inhibits thrombin

ANTIDOTE: Idarucizumab

Question 8

Dabigatran

Nursing Considerations

Answer 8

Thrombin used to treat atrial fibrillation. Increased risk bleeding age greater than 75, kidney disease, gastrointestinal bleeding, use of NSAIDs

Question 9

Anticoagulant Medication:

Action

Answer 9

Inhibits synthesis of clotting factors
Heparin blocks conversion of fibrinogen to fibrin
Warfarin interferes with liver synthesis to vitamin K dependent clotting factors

Question 10

Anticoagulant Medication:

Indications

Answer 10

For heparin: prophylaxis and treatment of thromboembolic disorders, in very low doses ( 10-100 units) to maintain patency of IV ( heparin flush) -D/C
For warfarin: MGMT of pulmonary emboli, venous thromboembolism, MI, atrial dysrhythmias, post cardiac valve replacement.
For dipyridamole: as an adjunct to warfarin in post-op cardiac valve replacement, as an adjunct to aspirin to reduce the risk of repeat stroke or TIAs. (Reversal: aminophylline or caffeine).

Question 11

Anticoagulant Medication:

Adverse Effects

Answer 11

Nausea, Alopecia, Urticaria, Hemorrhage, Bleeding/heparin-induced thrombocytopenia ( HIT)

Question 12

Anticoagulant Medication:

Nursing Consideration:

Answer 12

Check for signs of hemorrhage: bleeding gums, nosebleed, unusual bleeding, black/tarry stools, hematuria, fall in hematocrit or blood pressure, guaiac -positive stools.
Client should avoid IM injections, ASA-containing products, and NSAIDs.
Client should wear medical info tag. Instruct client to use soft toothbrush, electric razor, to report bleeding gums, petechiae or bruising, epistaxis, black tarry stools. Monitor platelet counts and s/s of thrombosis during heparin therapy; if HIT is suspected, heparin discontinued and non-heparin anticoagulant given.

Question 13

Anticoagulant Medication:

Herbal Interactions:

Answer 13

Garlis, giger, ginkgo may increase bleeding when taken with warfarin. Large doses of anise may interfere with anticoagulants. Ginseng and alfalfa may decrease anticoagulant activity. Black haw increases action of anticoagulant. Chamomile may interfere with anticoagulants.

Question 14

Anticoagulant Medication:

Vitamin Intercations:

Answer 14

Vitamin C may slightly prolong PT

Vitamin E will increase warfarin’s effect