Anticoagulants and anemia Flashcards
Thrombolytics are also know as?
**fibrinolytics **
-Alteplase (tPa).
-Tenecteplase (TNK-tPa).
What do thrombolytics do?
dissolve bonds that hold existing thrombi together
aminocaproic acid & tranexamic acid
Antifibrinolytics mechanism of action and what are they used for?
-Inhibit the activation of plasminogen to plasmin, prevent the break-up of fibrin and maintain clot stability.
-used to prevent excessive bleeding.
-used to stablilze post surgical bleeds
What is preferred route for anticoagulant tmt if needed long-term
Oral
What anticoagulants are given parenterally?
-Heparin
-Low-molecular-weight heparins (subcut)
-Fondaparinuxn (chemically r/t LMWH)
-Direct thrombin inhibitors
What anticoagulants are given orally
Warfarin
Dabigatran
What is the antidote for heparin
protamine sulfate
When should aPTT be monitored
monitor every 6 hours when adjusting dose
when giving anticoagulants via needle stick, how long should the nurse hold pressure on the site
venous: 5 min
arterial: 10 minutes
What shoulf the nurse consider when a patient is taking anticoagulants?
-baseline blood test.
-monitor aPTT q6h when adjusting dose.
-monitor for bleeding.
-pressure after needle sticks.
-reduce trauma.
-have antidote available.
What patient education should be provided to patients taking anticoagulants?
-no razors, use wax or electric razor instead.
-soft bristled toothbrush.
-no high impact activities.
-if bleeding proceeds 30 mins, go to hospital.
-if GI bleed present (coffee ground emesis or melena) go to hospital.
What considerations should the nurse take when patient is on warfarin
-assess risk of thromboemboli.
-monitor PT/INR.
-monitor urine, stool, liver function and blood.
-monitor risk groups for non-adherence.
-teach pts to avoid, foods which in vitamin K (broccoli, leafy greens etc.)
Heparin :
Therapeutic classification?
Pharmacological classification?
Therapeutic classification:
anticoagulant
Pharmacological classification:
**indirect thrombin inhibitor **
Therapeutic effects and uses of Heparin
-Acute thromboembolic disorders
-DVT/PE
-Unstable angina/evolving MI
-Prophylaxis
Heparin mechanism of action
Activates antithrombin III, which inhibits thrombin and to lesser extent factor Xa – prevents the formation of clots
ADP receptor blockers do what to the blood.
-irreversibly inhibit platelet ADP receptors (for platelet’s life-8D).
-inhibit aggregation (decrease body’s ability to clot).
-Make the blood less “sticky”.
What agents are ADP receptor blockers and how often do they need to be administered.
-Ticlopidine (Ticlid) BID- stroke prophylaxis (reversible).
-Clopidogrel (Plavix) OD- MI and stroke (irreversible).
ADP receptor blocker, adverse effects.
-Bleeding.
-Neutropenia/ agranulocytosis.
-Thrombotic thrombocytopenic purpura.
Clopidogrel (Plavix)
Therapeutic classification?
Pharmacologic classification?
Therapeutic classification:
Antiplatelet agent
Pharmacologic classification:
ADP receptor blocker
Clopidogrel (Plavix) therapeutic effects and uses
Reduce risk of CVA/MI
Reducing thrombolytic events post‒CVA/MI
Prevent DVT
Prevent thrombi formation unstable angina/coronary stents
Clopidogrel (Plavix) mechanism of action
-Inhibits ADP receptors on platelets and prolongs bleeding time by irreversibly inhibiting platelet aggregation
-CYP450 interaction
What should be watched for in regards to thrombolytics?
watch for S+S of hemorrhagic stroke. (LOC)
What is Streptokinase (SK) and Urokinase (UK) used for?
PE, MI, DVT
Which thrombolytics have fewer side effects and are newer?
Tenecteplase (TNK-tPA)
Alteplase (tPA)
