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Pharmacology > Ch. 14: Drugs Affecting the Hematologic System > Flashcards

Ch. 14: Drugs Affecting the Hematologic System Flashcards

1
Q

Platelet inhibitors

A

these drugs use a variety of mechanisms to prevent platelets from sticking together (aggregating) to form a platelet plug that starts the blood clotting cascade

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2
Q

Platelet inhibitor drugs

A

aspirin (Ecotrin), cilostazol (Pletal), clopidogrel (Plavix), ticagrelor (Brilinta), ticlopidine (Ticlid)

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3
Q

Direct thrombin inhibitors

A

these drugs bind to prothrombin and prevent its conversion to thrombin, which is needed to convert fibringoen to fibrin. With less thrombin, less fibrin is available to form the network that is the mesh forming the base of a clot

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4
Q

Direct thrombin inhibitor drugs

A

apixaban (Eliquis), desirudin (Iprivask), dabigatran (Pradaxa), rivaroxaban (Xarelto)

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5
Q

Indirect thrombin inhibitors

A

these drugs indirectly prevent the conversion of prothrombin to thrombin by increasing the amount of active antithrombin III. This substance has the action of interfering with the conversion of prothrombin to thrombin

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6
Q

Indirect thrombin inhibitor drugs

A

heparin, heparin sodium (Calcilean, Hepealean), enoxaparin (Lovenox), dalteparin (Fragmin), tinzaparin (Innohep), fondaparinux sodium (Arixtra)

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7
Q

Nursing implications of platelet inhibitors

A

avoid taking OTC drugs, especially those that contain NSAIDs, antacids interfere with antiplatelet drugs, most oral antiplatelet drugs are better tolerated when given with food to prevent nausea, teach patients the symptoms of bleeding and to report any signs of abnormal bleeding to the healthcare provider, teach patients to avoid the foods, herbs, and supplements that can interfere with antiplatelet drugs, teach patients not to stop taking these drugs without talking to their provider. Drugs may need to be held for certain surgical or dental procedures. Antiplatelet drugs should be avoided during the last trimester of pregnancy and should not be taken while breast-feeding

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8
Q

Direct thrombin inhibitor drugs

A

watch for signs of abnormal bleeding and teach patients to report abnormal bleeding, including heavy menses; monitor patients for signs of allergy or hypersensitivity to these drugs. Teach patients to avoid aspirin or NSAIDs while taking thrombin inhibitors because serious hemorrhage or death could occur. Keep the drugs in the original containers; do not place in plastic pill containers

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9
Q

Indirect thrombin inhibitor nursing implications

A

watch for signs of abnormal bleeding and teach patients to report abnormal bleeding, including heavy menses. Monitor patients who are receiving heparin for indications of allergy or hypersensitivity. Teach patients to avoid aspirin or NSAIDs while taking heparin preparations. Assess patients who are receiving heparin for low platelet counts and indications of clot extension

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10
Q

Vitamin K antagonist drugs

A

warfarin (Coumadin)

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11
Q

Vitamin K nursing implications

A

teach patients to limit the amount of green, leafy vegetables they eat because these vegetables are a natural source of vitamin K. Monitor patient’s INR to determine effectiveness. Remind patients to keep all appointments for INR. Stress the importance of not taking aspirin or NSAIDs with this drug. Teach patients the signs of abnormal bleeding to report to the healthcare provider. Caution women of childbearing age who are taking warfarin to avoid pregnancy

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12
Q

Platelet inhibitor drugs work in

A

a patient who might be having reduced blood circulation to the heart before a myocardial infarction
-given prophylactically to reduce blood clots

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13
Q

Platelet inhibitors may be given in adjunct to

A

thrombolytic therapy, to prevent heart attack

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14
Q

Acetylsalicylic acid (ASA)

A

or aspirin, is the most commonly used antiplatelet drug

-reduces the risk for major blood vessel blockage

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15
Q

Aspirin is used in

A

acute myocardial infarction (MI), ischemic stroke, angina, and peripheral arterial disease

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16
Q

Complications of ASA use

A

GI bleeding in older patients, those with a history of peptic ulcer disease, and patients using other NSAIDs

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17
Q

Clopidogrel (Plavix)

A

a drug that is used for patients who have had an MI caused by a clot (thrombus) formed in a coronary artery

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18
Q

Clopidogrel must be taken

A

daily for a year or longer to prevent clots from developing and plugging up the stent

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19
Q

Side effects of platelet inhibitors

A

bleeding, easy bruising, bleeding of the gums, diarrhea, nausea, dyspepsia, vomiting, flatulence, and anorexia
skin rashes, pruritis, and purpura

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20
Q

Adverse reactions of platelet inhibitors

A

excessive bleeding, itching, hives, and runny nose; with more severe reactions include swelling of the lips, tongue, or face or acute cardiovascular events

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21
Q

Thrombocytopenia

A

decrease in platelet counts

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22
Q

Neutropenia

A

white blood cell counts

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23
Q

Drug and food interactions of platelet inhibitors

A

other drugs that reduce coagulation, alcohol, vitamin K, oral contraceptives, antibiotics proton pump inhibitors
green leafy vegetables, St John’s wort

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24
Q

Direct thrombin inhibitors action

A

interferes with factor II, which increases the time it takes for blood to clot; binds to free thrombin in the blood and thrombin that is bound to fibrin

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25
Q

DTIs uses

A

are also used to prevent clots in arteries and veins, such as DVT, PE, clotting from A-fib, abnormal heart rhythm
-used like warfarin and anticoagulants

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26
Q

Side effects of DTIs

A

can cause bleeding, easy bruising, bleeding gums, gastric upset (taken on empty stomach)

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27
Q

Adverse reactions of DTIs

A

excessive bleeding and thrombocytopenia

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28
Q

Early signs of DTI overdose

A

bleeding from the gums while brushing teeth, excessive bleeding or oozing from cuts, unexplained bruising or nosebleeds, and unusually heavy menses in women

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29
Q

Drug interactions with DTIs

A

atorvastatin, azithromycin, carvedilol, clarithromycin, cyclosproine, diltiazem, and St. John’s wort

30
Q

Drugs that decrease the effects of DTIs

A

carbamazepine, dexamethasone, phenobarbital, phenytoin, or rifampin; antacids may as well

31
Q

DTI antidote

A

idarucizumab

32
Q

Instruct patients to keep DTIs in original bottle

A

to protect drug from moisture and light

33
Q

Instruct patients to take DTIs with a

A

full glass of water to prevent stomach irritation and improve absorption

34
Q

Indirect thrombin inhibitor actions

A

inhibits thrombin from clotting

35
Q

Low-molecular-weight heparin (LMWH)

A

more steady anticoagulation effect than heparin, binds to antithrombin and inhibiting factor Xa

36
Q

The half-life of LMWH is longer than

A

heparin sodium

37
Q

LMWH uses

A

anticoagulation therapy with heparin is used to prevent new clot formation or to stop existing clots from growing in size

38
Q

Heparin is used

A

prophylactically, during and after surgeries, patients with heart valve disease, patients with dysrhythmias and in patients receiving hemodialysis

39
Q

Used in the prevention of venous thromboembolism and may be used when PE is present

A

LMWH

40
Q

Expected side effects of heparin sodium

A

easy bleeding, and bruising, pain, redness, warmth, irritation, or skin changes where the drug was injected. Other side effects may include foot itching or bluish-colored skin

41
Q

Adverse reactions of heparin sodium

A

hemorrhage, thrombocytopenia, shortness of breath, wheezing, chills, fever, alopecia, and hypersensitivity reaction

42
Q

In the event of heparin overdose

A

protamine sulfate is given to counteract the effect of heparin

43
Q

Heparin-induced thrombocytopenia (HIT) and heparin-induced thrombocytopenia and thrombosis (HITT)

A

In HIT, antibodies against heparin are formed and activate platelets, which clump together and cause small clots in the bloodstream, and the platelet count falls; if major clots develop and block vessels, the condition is even more serious and is called HITT

44
Q

Drug interactions of heparin sodium

A

aspirin, NSAIDs, glucocorticoids, and other anticoagulants (warfarin) to increase the risk for GI bleeding. Antihistamines, digoxin, nicotine, and tetracycline decrease the anticoagulant effect of heparin

45
Q

For injection of heparin

A

use a small (25-gauge) needle and a tuberculin syringe for the subcutaneous injection (given every 12 hours)

46
Q

Continuous IV therapy with heparin is first started by a bolus of heparin that is based on the weight of the patient

A

usually 5,000 to 10,000 units

47
Q

Vitamin K antagonists actions

A

inhibit the enzyme needed for final activation of the vitamin K

48
Q

Vitamin K antagonists uses

A

for long-term therapy in chronic conditions that might involve problems with clot formation

49
Q

Vitamin K antagonists expected side effects

A

potential for easy bruising and bleeding is common

50
Q

Warfarin may produce

A

GI upset, headache, and skin rash

51
Q

Vitamin K antagonist adverse reactions

A

excessive bleeding, or hemorrhage that can be seen with very heavy menstrual bleeding, frank blood or dark, tarry stools, or coffee-colored vomitus with excessive dosage

52
Q

Warfarin can cause

A

skin necrosis, and birth defects or death to the fetus

53
Q

Vitamin K can be given

A

orally or parenterally to help stimulate the liver to resume manufacture of prothrombin and serve as an anticoagulant antagonist

54
Q

Drug and Food interactions with vitamin k antagoinsts

A

many antibiotics, anti-inflammatory drugs, antidysrhythmics, GI drugs, statins, and steroids can lengthen bleeding time effects of warfarin, whereas antacids, antihistamines, barbiturates, large doses of vitamin C, and oral contraceptives can shorten it

55
Q

Eating excessive amounts of green, leafy vegetables can

A

interfere with the purpose of vitamin K antagonist therapy, decrease bleeding time, and reduce effectiveness of the treatment, leading to new blood clot formation

56
Q

Fibrinolytic drugs

A

formerly called thrombolytic drugs actually do dissolve and break down existing blood clots

57
Q

Fibrinolytic drug actions

A

work by converting plasmingoen to the enzyme plasmin, which breaks down fibrin clots, fibringoen, and other plasma proteins. These products are used only in a critical care setting

58
Q

Fibrinolytic uses

A

used in the acute care setting such as the emergency department or intensive care unit. Acute MI, acute pulmonary emboli, acute ischemic stroke, and acute arterial occlusion. These drugs dissolve clots and emboli, reducing the cellular damage from arterial blockage

59
Q

Most commonly used fibrinolytic drugs are

A

alterplase (Activase), tPA, reteplase (Retavase), and tenecteplase (TNKase)

60
Q

Fibrinolytic drug nursing implications

A

before therapy, ensure the patient has no history of active bleeding disorders, certain surgeries, blood pressure is lower than 200/120, pregnancy or delivery, head trauma prolonged cardiopulmonary resuscitation, or pending aortic dissection (contraindications)
watch for signs of hemorrhage
monitor patients who are taking heparin for wheezing, shortness of breath chest tightness facial swelling, and rash or hives (allergic reaction)
monitor coagulation laboratory tests
monitor for the presence of severe headache or changes in alertness (stroke)
avoid giving IM drugs because of the risk for bleeding

61
Q

Expected side effects of fibrinolytics

A

bleeding or low blood pressure

62
Q

Adverse reaction of fibrinolytics

A

allergic reactions and hypersensitivity, hemorrhage is the most critical adverse reaction that can occur
risk for stroke
contraindications include known bleeding disorders, pregnancy or recent delivery, history of stroke within the past 2 months, hypertension with a blood pressure above 200/120, head trauma, and aortic dissection

63
Q

Drug interactions of fibrinolytics

A

with other anticoagulants increase the potential for bleeding and hemorrhage

64
Q

Erythropoiesis-stimulating agents

A

synthetic forms of the hormone erythropoietin

65
Q

ESAs action

A

oxygenate the body

66
Q

ESAs uses

A

usually given to patients with a condition that causes anemia, and who need to increase the production of RBCs

67
Q

Patients who are anemic from the effects of chemotherapy on the bone marrow or who may be anemic before surgery are often prescribed

A

ESAs

68
Q

ESAs reduce the need for

A

blood transfusions and reduce the complications of transfusions, such as fluid overload

69
Q

Expected side effects of ESAs

A

pain at the injection site, generalized body aches and pain, skin rash, redness or warmth at the injection site can occur

70
Q

Adverse reactions of ESAs

A

hypertension, blood clots, stroke, and MI
in some advanced cancers, increased tumor growth occurred where ESAs were given
risk for severe allergic reaction

71
Q

Nursing implications of ESAs

A

monitor blood pressure for increases due to increased blood viscosity, headache, body aches, fever or chills
monitor blood counts, to help determine drug effectiveness
follow directions for drug mixing and preparation because these vary by product
check for signs or symptoms of allergic reaction
teach patients to immediately report chest pain or shortness of breath, drooping face, or numbness in face or extremities

Pharmacology (10 decks)

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