Anticoagulants

Question 1

Dabigatran etexilate

Answer 1

Purpose: prevention of stroke in patients with nonvalvular atrial fibrillation

SE: dyspepsia, abdominal discomfort, epigastric pain, GI hemorrhage, bleeding

Nurs Con: -PO: may take without regard to meals
-do not crush or chew capsules
-closely monitor for signs of bleeding
-increased risk of bleeding when combined with aspirin, other anti-platelets or anticoagulants
stop med 24 hrs before surgery
-RX

Question 2

Enoxaparin

Answer 2

purpose: prevention & tx of deep vein thrombosis

SE: bleeding, bruising, injection site hematoma, injection site echymosis, increase in AST/ALT

• Nurs Con: injection: sub Q, can be given IV during cardiac procedures
• do not use in patients with a history of heparin-induced thrombocytopenia
• use w caution in patients with impaired renal function or morbid obesity
• monitor closely for signs of bleeding or excessive bruising
• stop med 12-24 hrs before surgery

Question 3

Heparin

Answer 3

Purpose: prevention & tx of DVT and PE

SE: spontaneous bleeding, issue irritation/pain at injection site, increased AST/ALT, anemia, thrombocytopenia, fever, rash

Nurs con: therapeutic ptt @ 1.5 - 2.5 times control without signs of hemorrhage

• IV: peak 5 min, duration 2-6 hrs (give over 1 min)
• Injection: give deep subQ, never IM (danger of hematoma) onset 20-60 min, duration 8-12 hours
• antidote: protamine sulfate within 30 min
• asses for signs of hemorrhage
• avoid asa-containing products and NSAIDs
• abrupt wtihdrawal may precipitate increase coagulablity
• Rx

Question 4

Rivaroxaban

Answer 4

purpose: tx & prevention of DVT & PE, prevention of stroke in patients with nonvalvular atrial fibrillation

SE: bleeding, bruising, pruitus, syncope, nausea, hematoma, elevated bilirubin, elevated AST/ALT

Nurs con: -dose reduction required in renal impairment

• PO: give doses greater than 15mg with food, lower doses may be given without regard to food
• stop med 24 hr before surgery
• monitor closely for signs of bleeding or excessive breathing
• Rx

Question 5

Warfarin

Answer 5

purpose: prevention & tx of DVT & PE, Tx of atrial fibrillation

SE: hemorrhage. diarrhea. rash, fever, angina syndrome, anemia, dermatitis, jaundice, elevated liver enzymes, anaphylactic reactions.

Nurs con: therapeutic PT @ 1.5-2.5 times the control, INR 2.0-3.0

• Onset 12-24 hours, peak 1.5-3 days; duration 3-5 days
• avoid foods high in vitamin K; many leafy vegtables
• do not interchange brands; potenices may not be equivalent
• do not take nay drug or herb without provider approval- may change effect
• avoid asa-containing products and NSAIDS
• oral anticoagulants may cause red-orange discoloartion of alkaline urine, interfering with some lab tests
• antidote: vitamin K
• Rx

Question 6

Carbamazepine

Answer 6

Purpose: management of seizures, trigeminal neuralgia and neuropathic pain

-SE: Myelosuppression, dizziness, drowsiness, ataxia, diplopia, rash, photosensitivity, depression, N, V, dyspepsia, aplastic anemia, stevens-johnson syndrome, suicidal thoughts

• Nurs con: -avoid driving & other activities requiring alertness the first 3 days
• monitor blood levels, CBC regularly, esp during first 2 months
• take with food or milk to decrease GI upset
• do not mix with grapefruit juice
• urine may turn pink to brown
• avoid abrupt withdrawal: discontinue gradually
• avoid use with alcohol and CNS depressants
• inform provider before taking any new medication or herbal medication