Anticoagulants / Antiplatelets / Thrombolytics Flashcards
anticoagulants (3) and the reversal (3)
- heparin
- enoxaprin
reversal: protamine sulfate - warfarin
reversal: vit K and FFP
antiplatelets (3) and reversal (1)
- ASA
- clopidogrel
- eptifibatide
reversal: platelet infusion
thrombolytics (1) and reversal (1)
- alteplase
reversal: aminocaproic acid
thrombus/embolus risk factors
- dysrhythmia
- unstable plaque (atherosclerosis and HLD)
- blood pooling (bedrest) =>
- Deep Venous Thrombosis (DVT)
- Endocarditis (infectious/inflammatory)
- Invasive procedures, acute diseases, bedrest: perioperative, hemodialysis, angioplasty
thrombus/embolus can disrupt circulation and create what? (6)
- Angina
- myocardial infarction (MI)
- Cerebrovascular accident (CVA)
- Venous thromboembolism (VTE) => pulmonary embolism (PE)
- ischemic bowel
- intermittent claudication
anticoagulants (warfarin, enoxaprin, heparin) prevent…
- prevent clot formation/enlargement
- prophylactic to prevent thrombosis
- therapeutic to prevent worsening (enlarged) of the present thrombosis
heparin, warfarin, and enoxaparin
antiplatelets (ASA, clopidogrel, eptifibatide) prevent…
- prevent platelet aggregation
- prophylactic to prevent thrombosis
- therapeutic to prevent worsening (enlarged) of the present thrombosis
aspirin, clpidogrel, and eptifibatide
thrombolytics (alteplase) prevent…
- clots, they dissolve blood clots
alteplae (tPA)
anticoagulant heparin route (2)
parenteral
- IV
- SubQ
measured in units
anticoagulant heparin MOA
inhibits activation of vit K (factor X)
anticoagulant heparin indication
- prophylactic: pts at high risk for thromboembolism
- therapeutic: prevents clot enlargement
- while waiting for warfarin onset of action; therapeutic INR
anticoagulant warfarin onset of action
3-5 days
risks of all anticoagulants
risk of bleeding with fall and injuries
anticoagulant heparin onset of action and duration of action
20 minutes
duration: 8 hrs
anticoagulant heparin labs to monitor (nursing)
- aPTT
- platelet count for thrombocytopenia (HIT)
anticoagulant heparin reversal
- FFP
- protamine sulfate IV
- or wait 6-8 hours
anticoagulant heparin adverse effects
- heparin-induced thrombocytopenia (HIT)
- bleeding w/ OD
anticoagulant enoxaparin route
parenteral
- SubQ only in prefilled syringes, measured in mg
avoid massaging the area
anticoagulant enoxaparin MOA
inhibits activation of vit K (factor X)
anticoagulant enoxaparin side effect
stinging for a few minutes after injection
anticoagulant enoxaparin labs?
no labs to monitor
anticoagulant enoxaparin duration of action
12 hours
anticoagulant enoxaparin reversal
- FFP
- protamine sulfate IV
- or wait 12-24 hours
anticoagulant warfarin route
enteral
- PO
anticoagulant warfarin MOA
inhibits activation of vit K (factor X)
anticoagulant warfarin nursing
monitor:
- PT (therapeutic 18-24 sec[not important])
- INR (therapeutic 2-3 days)
- takes 3-5 for therapeutic effects, bridging w/ heparin
- long half life = takes 5 days for INR to return to normal after discontinuing the drug
education:
- consistent amount of green leafy vegetables in the diet
- frequent PT/INR monitoring; keep a diet/dose log
anticoagulant warfarin side effect
bleeding
anticoagulant warfarin reversal
- phytonadoine
- FFP transfusion
anticoagulant warfarin drug interactions
ETOH b/c it increases the INR
anticoagulant warfarin contraindication
- pregnancy (use heparin instead)
- thrombocytopenia
- chronic liver disease
- ETOH abuse
antiplatelet aspirin, clpidogrel, and eptifibatide MOA
prevents platelet aggregation
antiplatelet aspirin, clpidogrel, and eptifibatide indication
prophylactic for pts at high risk for thromboembolism
antiplatelet aspirin, clpidogrel, and eptifibatide contraindication
- pregnancy
- history of bleeding disorders
- retinal/cerebral hemorrhage
- thrombocytopenia
- PUD
- aneurysm
- uncontrolled HTN
antiplatelet aspirin and clpidogrel route
PO
- 7 days to clear system
antiplatelet aspirin and clpidogrel contraindication
- NEVER to children under 19 yo
= risk of Reye’s syndrome - NEVER while breastfeeding
antiplatelet eptifibatide route and duration of action
IV
- duration of action: lasts 4 hours
antiplatelet aspirin, clpidogrel, and eptifibatide nursing
- Take with food to minimize GI upset/ GIB
- for Hx. of GIB, PUD:
- Enteric-coated aspirin!! don’t crush
- Buffered aspirin!! (mixed with calcium carbonate)
- Avoid NSAIDs (increased risk of GI bleed)
- Avoid alcohol (increased risk of GI bleed)
- Monitor for adverse reactions:
- Hemorrhage: (see code phrases), particularly GI bleed!!
antiplatelet aspirin, clpidogrel, and eptifibatide reversal agent
platelet transfusion
thrombolytics: alteplase (tPA) MOA
dissolve the clots by fibrinolysis (only drug that does this!!)
naturally it takes 1-2wks
thrombolytics: alteplase (tPA) indications
- within 4 hours of the onset of MI or ischemic CVA s/s
- PE
- DVT
- restore patency of IV catheters
thrombolytics: alteplase (tPA) route
IV bolus followed by gtt for 60 min
- taper the dose!
thrombolytics: alteplase (tPA) goal
- resolution of s/s
- half life of 35 min
- given in ICU and ED
thrombolytics: alteplase (tPA) drug interactions
avoid all AC and antiplatelet drugs until thrombolytic effects are cleared (3 hours)
thrombolytics: alteplase (tPA) adverse reactions
- bleeding
- hemorrhagic CVA
- spinal cord infarction
- N/V
- fever
- angioedema
- anaphylactic shock
rhabdomyolysis - dysrhythmias
- pulmonary edema
thrombolytics: alteplase (tPA) reversal agent
- aminocaproid acid (PO/IV)
- FFP
- PRBC
thrombolytics: alteplase (tPA) contraindications
- BP greater than 180/110
- hemorrhagic diseases (PUD)
- neoplasm
- recent CNS trauma
- aneurism
- recent CVA
- AC use
- thrombocytopenia
- ASA
- NSAIDs
- pregnancy
thrombolytics: alteplase (tPA) nursing
Monitor:
- trend of VS and assessment (q 15 min)
- resolution of symptoms (CP, neurological deficit)
- active bleeding, allergic reaction (hives, angioedema, & dyspnea, anaphylaxis)
cardiac monitoring (risk of reperfusion dysrhythmia treated with beta-blockers)
Avoid venipuncture/arterial sticks, injections (SubQ/IM) as possible
- hold pressure for 30 min
