Anticoagulants, antiplatelets, & thrombolytics Flashcards
Prevent the formation of clots that inhibit circulation
Anticoagulants
Prevent platelet aggregation, clumping together of clots platelets to form a clot
Antiplatelets
Anticoagulant used to for preventing or treating blood clots
(VTEs or PEs, stroke, a fib, clot prevention with certain surgeries)
Prolongs clotting time; requires aPTT (titrated drip based on this)
High risk med w/ strict protocol
Heparin
Heparin side effects
excessive bleeding, heparin-induced thrombocytopenia
(HIT), osteoporosis
Antidote for hemorrhage: protamine sulfate
Low molecular weight heparin (LMWH) anticoagulant that does not require aPTT
enoxaparin (Lovenox)
Oral anticoagulant that prolongs clotting time (monitored by prothrombin time) by inhibiting synthesis of Vitamin K; Dosage is based on INR lab test
Used mainly to prevent thromboembolic conditions (thrombophlebitis, PE, and embolism formation caused by a fib, which can lead to stroke)
warfarin (Coumadin)
Side effects of warfarin
bleeding (monitor for signs of bleeding- petechiae, ecchymosis, GI bleeding, ocular hemorrhage, hematuria)
Adverse effects of warfarin
hemorrhage (rare, possibly life-threatening), warfarin induced skin necrosis
Antidote is Vitamin K
True or False
Garlic is a blood thinner
True
Warfarin INR lab test parameters
Normal INR is 1.1 or below
Patients on warfarin therapy are maintained at 2.0 to 3.0
INR value greater than 3 puts patient at risk of bleeding
Warfarin pt teaching points
Medical follow-up to check INR and adjust dosage
Consume consistent amounts of vitamin K-rich foods (no alterations)
Do not take aspirin-containing products without consulting prescriber
Do not drink alcohol
Manage home safety
Used to prevent thrombosis in the arteries by suppressing platelet aggregation
Prophylactic use in:
Prevention of myocardial infarction or stroke for patients with familial history
Prevention of a repeat myocardial infarction or stroke
Prevention of a stroke for patients having transient ischemic attacks
Antiplatelet drugs
Ex: aspirin and clopidrogel
Inhibit COX enzyme to reduce platelet aggregation
- prevent/treat MI & thromboembolism
- stroke
-TIA
-Maintain vascular grafts
Side effects: prolonged bleedings time, GI effects
aspirin
Antiplatelet drug used frequently after MI or stroke to prevent a second event
Side effects: epistaxis, headaches, hematoma, GI distress, purpura, rash, pruritis
Adverse effects: bleeding, peptic ulcers, intracranial bleeding
clopidogrel (Plavix)
It is important for patients to read labels of OTC medications when taking antiplatelet drugs. Why?
They need to avoid products with aspirin and NSAIDs.
DISSOLVE existing clots! Nicknamed “clot busters”; Promotes conversion of plasminogen to plasmin, which destroys the fibrin in the blood clot
Used to treat MI, thrombotic stroke, PE, & DVT
Thrombolytic drugs
Ex: alteplase t-PA (Activase)*
For thrombotic stroke, thrombolytic drugs should be administered within 3 hours. Can these types of drugs be used for hemorrhagic stroke?
No! Must get CT beforehand to determine type of stroke.
Side effects & adverse effects of thrombolytic drugs
Side effects – bleeding! Oozing from cuts, gums, wounds, injection sites
Adverse effects – allergic reaction, life-threatening hemorrhage
Used to promote the formation of clots
Prevent fibrin from dissolving
Used to treat excessive bleeding from surgical sites
May cause hypercoagulation w/concurrent use of estrogen/oral contraceptives
hemostatic agents
Anti-hyperlipidemia that inhibits the enzyme HMG CoA reductase in cholesterol biosynthesis; slows the production of cholesterol
Increases the ability of the liver to remove LDL from blood; No effect on HDL
HMG CoA reductase inhibitors (statins)
Ex: atorvastatin calcium (Lipitor)
Side effects & adverse effects of statins
Side effects: constipation, peptic ulcers, muscle ache
Adverse effects: hepatic/renal failure, vision changes (cataract development), Rhabdo
Nursing interventions for statins
-Monitor pt’s blood lipid levels
-Monitor lab values for liver function
-May take several weeks for blood lipid levels to decline
-Pts must have annual eye exams & report any vision changes
-Instruct pt to take at bedtime
-Teach pt to report any unexplained muscle tenderness weakness, fever, and malaise
Antiplatelet that causes peripheral vasodilation. Used to treat intermittent claudication.
Side effects: Dizziness, headache, peripheral edema, GI distress, orthostatic hypotension
Adverse effects: tachycardia, palpitations, dysrhythmias
Peripheral vasodilators
Ex: cilostazol (Pletal)
Cilostazol must knows
-therapeutic response may take 1.5 to 3 months
-No smoking or drinking alcohol
-change position slowly