ANTICOAGULANTS UNIT 6 CHPT 40 ORAL ANTICOAG , LOW MOLECULAR WEIGHT HEPARIN Flashcards
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
F. Enoxaparin
C. warfarin
E. Heparin
Anticoagulants
Prevent the formation of clots that inhibit circulation – warfarin,
heparin,
and enoxaparin
Action of Heparin
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.
Side effects of Heparin
Itching, chills, headache, epistaxis, erythema, hematoma, hematemesis, hematuria, alopecia, elevated hepatic enzymes, nausea, vomiting, injection-site reaction, priapism
Adverse effects of Heparin
Bleeding, intracranial bleeding, ocular hemorrhage, anemia, bone fractures, osteoporosis, hyperkalemia, vitamin D deficiency, GI bleeding, hyperlipidemia, stroke,
Life-threatening: Anaphylaxis, HIT,
What is Route of administration for Heparin?
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
What Laboratory results would you monitor if a patient is on Heparin?
A.INR
B. PTT
C.PT
D. aPTT
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
What is the Antidote for Heparin
Protamine Sulfate
Containindications / Interactions of Heparin
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
- 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
a. Protamine sulfate
- 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
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
What drug class is Warfarin?
A. Oral Anticoagulant
B. Centrally Acting Muscle Relaxant
C. Low Molecular Weight heparin
D. NSAID Antiplatelet
A. Oral Anticoagulant
What is the action of Heparin
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
What is the Antidote for Warfarin
A. Vitamin B12
B. Vitamin K
C. Potassium Chloride
D. Protamine Sulfate
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.
- 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
b. Elevated range
Normal range 0.9-1.2
- 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
b. Warfarin
Should a. patient steer eating more vitamin k rich foods on Warfarin?
A. Yes
B. No
B. No
Warfarin Contraindications
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
What is the use for Enoxaparin
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
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.
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.
