ANTICOAGULANTS UNIT 6 CHPT 40 ORAL ANTICOAG , LOW MOLECULAR WEIGHT HEPARIN

Question 1

Which of the following drugs are Anticoagulants ? SELECT ALL THAT APPLY

A. aspirin
B. celecoxib
C. warfarin
D. Morphine
E. Heparin
F. Enoxaparin
G. Acetominophen

Answer 1

F. Enoxaparin
C. warfarin
E. Heparin

Anticoagulants
 Prevent the formation of clots that inhibit circulation – warfarin,
heparin,
and enoxaparin

Question 2

Action of Heparin

Answer 2

To prevent thromboembolism associated with PE, MI, unstable angina, prosthetic heart valves and PCI; and to treat DVT, DIC, and acute coronary syndrome.
Mechanism of Action: Inactivates thrombin, which prevents conversion of fibrinogen to fibrin.

Question 3

Side effects of Heparin

Answer 3

Itching, chills, headache, epistaxis, erythema, hematoma, hematemesis, hematuria, alopecia, elevated hepatic enzymes, nausea, vomiting, injection-site reaction, priapism

Question 4

Adverse effects of Heparin

Answer 4

Bleeding, intracranial bleeding, ocular hemorrhage, anemia, bone fractures, osteoporosis, hyperkalemia, vitamin D deficiency, GI bleeding, hyperlipidemia, stroke,
Life-threatening: Anaphylaxis, HIT,

Question 5

What is Route of administration for Heparin?

Answer 5

Action
Inhibit action of thrombin
Inhibit conversion of fibrinogen to fibrin
Inhibit clot formation
Use
 Most commonly to prevent or treat venous
thrombosis
 Administration of heparin
 Subcutaneously, intravenously
 Think of quick in/quick out

Question 6

What Laboratory results would you monitor if a patient is on Heparin?

A.INR
B. PTT
C.PT
D. aPTT

Answer 6

B, C

Heparin
 Frequent lab monitoring is needed.
 Heparin laboratory values
 PTT 1.5 to 2.5 times normal clotting time of 20-30 seconds
 aPTT 1.5 to 2.5 times normal time for this test of 30-40
seconds. Done a little differently – depends on facility
 Side effects
 Bleeding
 Injection site irritation – don’t massage
 Antidote
 Protamine sulfate

Question 7

What is the Antidote for Heparin

Answer 7

Protamine Sulfate

Question 8

Containindications / Interactions of Heparin

Answer 8

Increased effect with aspirin, NSAIDs, thrombolytics, probenecid, antibiotics, SSRIs; decreased effect with nitroglycerin, protamine sulfate

Contraindications
 Stroke
 Peptic ulcer
 Bleeding issues

 Interactions
 Other drugs or herbs that cause bleeding

Question 9

2. A patient who received heparin begins to bleed. The nurse anticipates that the health care provider will order which antidote?
   a. Protamine sulfate
   b. Phytonadione
   c. Aminocaproic acid
   d. Potassium chloride

Answer 9

a. Protamine sulfate

Question 10

3. A patient is prescribed enoxaparin. The nurse knows that low-molecular-weight heparin has what kind of half-life?
   a. A longer half-life than heparin
   b. A shorter half-life than heparin
   c. The same half-life as heparin
   d. A four-times shorter half-life than heparin

Answer 10

a. A longer half-life than heparin

Warfarin is long in and takes along time to come out

Heparin is fast in and fast out due to the route of administration, which is IV AND SUBQ

Question 11

What drug class is Warfarin?

A. Oral Anticoagulant
B. Centrally Acting Muscle Relaxant
C. Low Molecular Weight heparin
D. NSAID Antiplatelet

Answer 11

A. Oral Anticoagulant

Question 12

What is the action of Heparin

Answer 12

Warfarin
 Action
 Inhibit hepatic synthesis of vitamin K, affecting the clotting
factors II, VII, IX, and X

 Use
 Prevents and treats blood clotting. Used for treatment and
prevention of DVT, pulmonary embolism and stroke
 Monitor therapeutic range
 PT
 INR – Value 2-3

 Think of warfarin as slow in/slow out

Question 13

What is the Antidote for Warfarin

A. Vitamin B12
B. Vitamin K
C. Potassium Chloride
D. Protamine Sulfate

Answer 13

B. Vitamin K

Vitamin K
Antidote for warfarin overdose
24 to 48 hours to be effective
For acute bleeding, fresh frozen plasma or platelets
is indicated.

Question 14

7. A patient is taking warfarin 5 mg/day for atrial fibrillation. The patient’s international normalized ratio is 3.8. The nurse would consider the international normalized ratio to be what?
   a. Within normal range
   b. Elevated range
   c. Low range
   d. Low-average range

Answer 14

b. Elevated range

Normal range 0.9-1.2

Question 15

6. A patient is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally?
   a. Enoxaparin
   b. Warfarin
   c. Bivalirudin
   d. Dalteparin

Answer 15

b. Warfarin

Question 16

Should a. patient steer eating more vitamin k rich foods on Warfarin?

A. Yes
B. No

Answer 16

B. No

Question 17

Warfarin Contraindications

Answer 17

Contraindications
 Blood dyscrasias (bleeding issues)
 Alcoholism
 Head trauma

 Caution
 Diabetes mellitus – can lower blood glucose
 Interactions

 Other drugs and herbs that cause bleeding
 Interacts with many medications to increase effect of warfarin
 Vitamin K foods – remain consistent

Question 18

What is the use for Enoxaparin

Answer 18

Low-molecular-weight heparin (LMWH)
 Lower risk of bleeding
 Frequent lab monitoring is not required.

 Action
 Inactivates Xa factor

 Use
 Prevent DVT and acute PE after orthopedic or
abdominal surgery – usually started 24 hours post-op

 Precautions
 Don’t take aspirin concurrently or 4 G’s
 Administered once or twice daily - SubQ
ANTICOAGULANTS
ENOXAPARIN

Question 19

Which information will the nurse include when teaching a
patient about warfarin therapy?
A. Increase the amount of green, leafy vegetables in
your diet.
B. Rinse your mouth instead of brushing your teeth.
C. Follow up with laboratory tests such as PT or INR to
regulate warfarin dose.
D. Use a new razor blade each time you shave.

Answer 19

C. Follow up with laboratory tests such as PT or INR to
regulate warfarin dose.

Laboratory tests such as PT or INR are performed to
regulate warfarin (Coumadin) dose. The patient should
avoid consuming large amounts of green, leafy vegetables;
broccoli; legumes; soybean oil; coffee; tea; cola; excessive
alcohol, and certain nutritional supplements such as
coenzyme Q10. Patients are encouraged to perform oral
hygiene and use a soft tooth brush to prevent gums from
bleeding. Patients should be instructed to use an electric
razor when shaving.