anticoagulants

Question 1

Anticoagulants
Heparin
Goals

Answer 1

accelerates rate at which antithrombin III newtralizeds thrombin and factor X
LOW DOSE: Prevents conversion of prothrombin to thrombin
HIGH DOSE: Prevents conversion of bibrinogen to fibrin

Question 2

Anticoagulants
Heparin
Uses

Answer 2

prophylaxis and treatment of thrombosis
treat pulmonary embolism
prevent clotting in: bypass pump, dialysis, IV lines
Treat disseminated intravascular coagulopahty (DIC)

Question 3

Anticoagulants
Heparin
Adverse effects

Answer 3

1.5 to 20% of pts will have these effects
Bleeding is dose related
causes can be mild to severe
there can also be bleeding in GI or GU

Question 4

Heparin reversal agent:

Answer 4

Protamine Sulfate

Question 5

**Protamine Sulfate **

Reversal agent for Heparin

Answer 5

use in case of Life-threatening hemorrhage
give through Slow IV infusion
RISK OF ANAPHYLAXIS

Question 6

The test for Heparin is?

Answer 6

activated partial thromboplastin time (aPTT)

used for monitoring Heparin

Question 7

Routes for Heparin

Answer 7

HIGH ALERT MED: TWO NURSE VERIFICATION
SQ or IV (never IM!)
IV–immediate onset, short half life (1-2 hours, >with > dose
SQ–rapid onset (20-60 min) given in abdomen

Question 8

aPTT or PTT goal

Answer 8

to be 1/5 to 2x the the control.
these values vary per lab
this would be a test needed daily, when does are changed, OR
if bleeding noted

Question 9

other adverse effects for Heparin

Answer 9

SQ injection can burise or cause pain
elevated liver function tests
resistance–familiar, febrile, other clots
Could burn at site of injection

Question 10

HIT -Heparin-Induced Thrombocytopenia

Answer 10

AKA–White clot syndrome
clots due to platelet aggregation
immune reaction to heparin– can embolize organs
D/C heparin in thrombocytopenia–>esp if PLATLETS DROP BY 50%
Onset usually 5-22 days on Heparin (0.5% of pts)
monitor platelet counts
D/C heparin, may not be able to ever use heparin again find other Rx

Question 11

Low Molcular Eight Heparin
Enoxaparin (Lovenox)
Goal

Answer 11

Less effect on thrombin, predictable pharmacokinetic profile

allows SQ administration, based on weight without lab monitoring

Question 12

Low Molecular Eight Heaprin
Enoxaparin (Lovenox)
Uses

Answer 12

prevent DVT–esp. Postop, orthopedic surgery –doses are usually 1-2x/day SQ
unstable angina
DOSES NOT THE SAME AS HEPARIN

Question 13

Low Molecular Eight Heaprin
Enoxaparin (Lovenox)
adverse effects

Answer 13

bleeding (with no reversal agent)
thrombocytopenia–monitor platelet count
can elevate AST, ALT

Question 14

Low Molecular Eight Heaprin
Enoxaparin (Lovenox)
Nursing implications

Answer 14

given SQ– watch for bruising (on abdomen)
report drop of platelets
teach safety

Question 15

Coumarin Anticoagulants
Coumadin, Warfarin
Goal

Answer 15

interfers with action of vitamin K
inhibits thrombus formation and extension
prolongs prothrombin time and aPTT

takes 72 hours or more to reach adequate anticoagulation
takes 2-7 days to stablize
may overlap heparin therapy

Question 16

Coumarin Anticoagulants
Coumadin, Warfarin
Uses

Answer 16

Usualy PO
prevent and treat thrombosis
reduce risk of stoke or MI
Follow heparin therapy with coumadin

Question 17

Coumarin Anticoagulants
Coumadin, Warfarin
adverse effects

Answer 17

bleeding
usually due to OD but may have existing lesion
~10% of people are very sensative –require low does

Question 18

rare effecrts from coumadin/warfarin

Answer 18

GI–nausea, vomiting, diarrhea, cramps
dermatitis (skin necrosis)
elevate liver function tests

Question 19

Drug interactions with coumadin/warfarin

Answer 19

Herbal agents
highly protein bound (99%)
caution with other drugs causing bleeding
(aspirin, NSAIDS, ETOH, corticosteroids, other anticoagulants)
Antibiotics

Question 20

Coumarin Anticoagulants
Coumadin, Warfarin
Nursing implications

Answer 20

Monitor PT (1.5 to 2x control
INR 2.0-3.0
Teach:
     Safety
     Diet:(caution with Vit K intake
     no meds without MD approval
     Must keep appointments for labs
     monitor for bleeding
     No IM injections
     D/C several days before a surgery
     Not safe in pregnancy

Question 21

Coumadin/warfarin reversal agent

Answer 21

(INR >5) Vitamin K
PO for INR 5-8 or IV infusion VIT K
RISK OF ANAPHYLAXIS GREATER WITH IV–reserve for hemorrhage &INR>8 WITH IV–
severe bleeding–fresh frozen plasma (restore clotting factors)

Question 22

What is aPTT? And its normal values after heparin?

Answer 22

Activated partial thromboplastin time.
20-35 seconds after heparin 40-70seconds
We want to prolong value.