Anticoagulants Flashcards
What is heparins drug class?
Anticoagulant
What is the antidote for heparin?
Protamine sulfate
What is heparin mechanism of action?
It combines with antithrombin 3 to inactivate factors 9-12
True or false:
heparin is a clot buster.
False, it prevents further clotting, but does not dissolve
Is heparin, short, acting, or slow releasing.
Short acting takes about 20 to 30 minutes
What are the therapeutic uses of heparin?
Prevention of management of thromboembolic disorders, such as DVT, PE, and a fib
Is heparin used prophylactically? If so, how?
It is used prophylactically in patients withβ¦
MI heart failure, and stroke
history of thrombophlebitis, major abdominal/thoracic surgery
restrictions of bedrest for 5+ days
Recent gynecologic surgery (especially in patients who take estrogen/oral contraceptive)
What are the two most common side effects of heparin?
Hemorrhaging (drug hypersensitivity, local irritation was subQ administration)
HIT (heparin induced thrombocytopenia)
What does heparin induced thrombocytopenia do?
Lowers platelet counts (low platelets= no clotting factors)
How do we administrate heparin?
We administrate SubQ or IV, does not absorb in G.I.
What are the nursing actions we take when administering heparin?
APTT (activated partial thrombin time)
Levels need to be between 46-70
When aPTT levels are below 70. What are our 3 priority actions?
1.stop the drug
2. Prepare protamine sulfate (antidote)
3. Reassess labs (1 hour)
What are some patient teachings when administering heparin?
Bleeding risk
obtain labs regularly
how to observe signs and symptoms of bleeding
correct self administration
Chamomile, garlic, ginger, ginkgo, ginseng, and high doses of vitamin E can increase the effects of the drug
What pregnancy category is heparin?
C
What is the brand name for warfarin?
Coumadin
What drug class is warfarin?
Anticoagulants (Vit K Antagonist)
What is the most common oral anticoagulant?
Warfarin (Coumadin)
What is warfarin (Coumadin) mechanism of action?
Works in liver to block synthesis of vitamin K dependent factors: 2,7,9 and 10
Warfarin is highly bound to plasma proteins, such asβ¦
Albumin 98%
How many days does warfarin (Coumadin) take to work?
Takes up to five days, PT on Lovenox while on loading dose
What are the therapeutic uses of warfarin (Coumadin)?
prevention and management of venous, thromboembolism disorders:
DVT, PE, and embolization associated with a fib and prosthetic heart valves
Use after MI to: decrease reinfection, stroke, venous, thromboembolism, and death
What are side effects of warfarin (Coumadin)?
Bleeding (more likely pts with a hepatic disease because of decreased synthesis of vitamin K in plasma proteins)
Nausea, vomiting, abdominal pain, alopecia, urticaria, dizziness, joint and muscle pain
What is the antidote for warfarin (Coumadin)?
Vitamin K
What are nursing actions we take when administering warfarin (Coumadin)?
INR (internal national normalized ratio)
What should the levels be of INR?
2 to 3
2.5 to 3.5 (heart valve replacement)
What are patient teaching when administering warfarin (Coumadin)?
Obtain regular lab test
Search for signs and symptoms of bleeding
Prevent blood clots from forming and legs
Do not change vitamin K and take (dark leafy greens) BE CONSISTENT
LET PROVIDER KNOW ABOUT TOBACCO USE
Safe self administrationβs
True or false: warfarin (Coumadin) has a black box warning
True for fatal bleeding
What pregnancy category is warfarin (Coumadin) and why?
Pregnancy category X because it can crossable center and calls fetal hemorrhaging
What is the brand name of clopidogrel?
οΏΌ Plavix
What drug class is clopidogrel (plavix)
Antiplatelet
What is the mechanism of action of clopidogrel (Plavix?)
It irreversibly blocks the ADP receptor on platelets or surface
What are the side effects of clopidogrel (Plavix)?
Pruritus, rash, purpura, and diarrhea
Thrombotic thrombocytopenic Purpera, TTP
Hemorrhage and severe neutropenia
What are the therapeutic uses of clopidogrel (Plavix)?
Reduces MI, stroke and vascular death in pts w/ atherosclerosis, and in those after Coronary artery stent
People with afib who canβt take vitamin K antagonistic, take what drug?
οΏΌ Clopidogrel (Plavix)
What should the lab levels be when taking antiplatelets?
οΏΌ Hemoglobin: > 7 (anything below 7 youβre sending your pts to heaven)
Platelets: 150,000-400k (anything below 150 is always iffy. Anything below 50 is extremely risky!!!)
Nursing actions for clopidogrel (Plavix):
No INR or PTT needed
What patients teachings do we give when administrating clopidogrel (Plavix?)
Report any sign of bleeding (excessive bruising, blood in urine and stool)
TAKE WITHOUT FOOD
Obtain labs regularly
Prevent injury
If superficial bleeding occurs, apply pressure for 3-5 minutes
What are some safety measures when administrating clopidogrel (Plavix?)
This drug may accumulate in patients with hepatic impairment
It may increase your risk of hemorrhagic stroke in elderly
True or false:
Clopidogrel has a black box warning
True that has a black box warning, for patients who are reduce metabolizers of drugs (2-14%)
What pregnancy category is Clopidogrel?
B
What drug class is aspirin
Antiplatelets
What is aspirins mechanisms of action?
Itβs a thromboxane A2 inhibitor
Provides antiplatelet properties it makes red blood cells less sticky
Lower platelets aggregation
What are the therapeutic uses of aspirin?
Prevents am MI, CVA, and TIA (transient ischemic heart attack)
Treats ACS
artificial heart valves; it prevents clots
Used after setting bypassed and used after PCI (percutaneous coronary intervention)
What drug does aspirin interact with?
NSAIDS but not acetaminophen
Side effects of aspirin
Antiplatelet activity reverses after drug is stopped
οΏΌ What are some nursing actions for aspirin?
No, PTT or INR
No new IV or IM after administration
What are some patient teachings with aspirin?
Signs and symptoms of bleeding.
Be careful falling
use electric razor
Report to provider if urine has blood or if youre having black stools.
What are key signs of aspirin toxicity?
What are some key signs of bleeding while taking aspirin?
Tinnitus /hyperventilation = toxicity
Tachycardia and hypertension equals bleeding
What drug class is rivaroxaban (xarelto)?
Anticoagulant (direct factor xa inhibitor)
What is rivaroxaban (xarelto) mechanism of action?
Inhibits platelet activation and fibrin clotting factor of xa
Xarelto is as effective as __________ but associated with ______ ________
War-farin
Less bleeding
True or false (why or why not):
Warfarin (xarelto) is slowly absorbed
False, rapidly absorbed, itβs highly bound to plasma proteins
Warfarin (xarelto) undergoes partial metabolism by _____ and exceeded by ______
Cytochrome P450
Urine
What are the therapeutic uses of Rivaroxaban (xarelto)?
Used in treatment and prevention of Venous thromboembolism
stroke prevention in pts with non valvular afib
At home use following knee and hip surgery for prevention of venous thrombus
What are the side effects of Rivaroxaban (Xarelto) ?
Bleeding (intercranial, GI, and retinal)
-can increase if taken with other drugs that alter hemostasis (NSAIDβs and aspirin)
Can cause spinal epidural hematoma if given while getting epidural for surgery
What Nursing actions done take when administering rivaroxaban (xarelto)?
No labs are necessary
What specific pts do we not give xarelto
Pts w/ creatine clearance less than 15mL
Pts with hepatic disease
Pts who are critically ill
What patients teachings dowe give when administering Rivaroxaban (xarelto)?
Safe use/administration
Prevent bleeding as well as symptoms and signs
Obtain regular labs
What foods increase the effect of xarelto?
What foods decrease?
Increase:
-Grapefruit!!!!!!
-Bilberry, alfalfa, and anise
Decrease:
-St John βS wort
What medication increase serum concentration of xarelto?
Clarithromycin.
What are some safety measures of Rivaroxaban?
Estrogen derivatives decrease effect
On beers criteria list
What drug class is alteplase (TPA)?
Thrombolytic
What are the mechanisms of action of alteplase (rTPA)?
Encourages plasminogen to plasmin, which breaks down clot
Lyses unwanted clot
What does rTPA stand for?
Recombinant tissue plasminogen activator
What are Thera partic uses for alteplase (rTPA)?
Treatment of:
- ischemic stroke, mi, acute PE
Side effects for alteplase areβ¦
Bleeding, symptomatic Brain hemorrhage, increase risk of cerebral embolism
With ptβs who have afib/ aflutter
What are the contraindications with alteplase (tpa)?
Severe hypertension
Aneurysm
Intracranial or intraspinal surgery /trauma/mass
Current use of oral anticoagulants
Arterovenous malformation
What Nursing actions do we take when administering Alteplase?
Minimize IM injections (bruising, bleeding, and hematoma may occur)
Assess pts for cardiac dysthymiaβs such as: (SB, PVCβs, and Vtach)
Check INR, aPTT, platelets count and fibrinogen to establish baseline
True or false? Why or why not?
Only specific nurses are allow to give Alteplase (rTPA)
Only ED/critical care nurses or settings with cardiac and other monitoring available
Patient teachings when administering Alteplase (rTPA)?
Bleeding
Special care brushing teeth (reduce gum bleeding)
Does Alteplase have a black box warning? Why or why not?
Yes!!! HIGHEST RISK FOR BLEEDING
Safety for alteplase?
No iv, no subq, no IM, no ABGs
Avoid giving pt with:
-active bleeding -uncontrolled HTN 180/110+
-recent surgery
What are the 3Aβs when giving Alteplase?
Aneurysm, accident, av malformation
What drug class is Cholestyramine?
Fibrates (bile acid sequestrants)
What is choleStyramineβs mechanism of action?
Binds w/cholesterol in intestine and prevents absorption
What are the therapeutic uses of cholestyramine?
Reduces LDL (15-30%)
little to no effect of HDL (3-5% elevation)
What are these effects of cholestyramine?
GI issues: constipation, abdominal pain/ discomfort, nausea, vomiting, diarrhea, anorexia and flatulence
Contradicted with biliary obstruction
May decrease absorption of oral medications
What Nursing actions are required when giving Cholestyramine?
Observe decreased levels of total term cholesterol, LDL, triglycerides, & HDL
What are the patient teachings when administering Cholestyramine?
Adequacy of fat soluble vitamin: A, D, E and K (supplements may be required)
Oat bran/ pectin increase effects
Take meds with water or other fluids
What safety measures do we take when administering Cholestyramine?
Do not take 4-6 hrs within other medications
What pregnancy category is Cholestyramine?
C
What are the mechanism of action for Fibrates?
Increase oxidation of fatty acids in liver
Decrease hepatic production of Tchol, LDL, triglycerides, and HDL
What are the side effects when taking fenofibrate?
GI discomfort/diarrhea
Increase cholesterol concentration in biliary tract and formation of gallstones
What nursing actions do we take when administering Fenofibrate?
Assess and test Tchol, LDL, triglycerides, HDL
We administer the drug with food to increase absorption
What patient teachings do we follow when administering Fenofibrate?
Pt needs to report symptoms
Periodic blood tests
What pregnancy category is Fenofibrate?
C
