Ch 25 Coagulation

Question 1

What is the expected pharmalogical action of anticoagulants

Answer 1

Prevent clotting by activating anti thrombin and factor xa. This inhibits fibrin formation

Question 2

What are the therapeutic uses of heparin

Answer 2

Stroke
Pulmonary embolism
Massive DVT
treatment for dissiminated intravascular coagulation (DIC)

Question 3

What is the use of LMWH

Answer 3

Prevent DVT in post op patients
Treat DVT and PE
PRevemt complications in certain types of myocardial infarctions

Question 4

What are activated X ( Xa) inhibitors used for

Fondaparinux

Answer 4

Prevents DVT & PE in post op clients

Treats DVT & PE in conjunction with warfarin

Question 5

What is true of heparin and LMWH

Answer 5

These meds cannot be absorbed by the intestinal tract

They use be given SC or IV

Question 6

What are possible complications of heparin

Answer 6

HEMMORRHAGE, secondary to heparin overdose
Heparin induced thrombocytopenia AEB low platelet counts and increased development of thrombi
Hypersensitivity reactions ( chills, fever, urticaria)
Toxicity, overdose

Question 7

For heparin toxicity what drug should be administered

Answer 7

Administer protamine. Administer is slowly Intravenously no faster than 20mg/min or 50mg/ 10 min.
Do not exceed 100 mg in a. 2 hr period

Question 8

What platelet counts indicated that heparin needs to be discontinued

Answer 8

Less than 100,000

Question 9

Adverse effects of enoxaparin

Answer 9

HEMMORRHAGE
Neurological damage from hematoma formed during spinal or epidural anesthesia.
Thrombocytopenia AEB platelet count less than 100,000
Toxicity/ overdose

Question 10

What are adverse effects of fondaparinux

Answer 10

HEMMORRHAGE
Neurological damage from hematoma formed during spinal or epidural anesthesia
Thrombocytopenia

Question 11

What are contraindications and precautions of parenteral anticoagulants

Answer 11

Contraindicated in ppl with low platelet counts
These meds should not be used during or following surgeries of the eye, brain, spinal cord; lumbar puncture, or regional anesthesia.
Uses cautiously in ppl who have hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, heparin and renal disease or threatened abortion

Question 12

What are nursing considerations for heparin

Answer 12

Obtain baseline vitals
Obtain & monitor CBC, HCT, and platelet count
Monitor rate of infusion Q 30-60 min
Monitor aPTT Q 4-6 hr until appropriate dose Is determined
For sc injections, use a 20-22 guage to withdraw med from vial, then switch to a smaller 25-26 guage.
Do not aspirate
Instruct client to avoid OTC NSAIDS, aspirin or meds containing salicylates

Question 13

What is true of enoxaparin/ fondaparinux

Answer 13

Monitoring is not required

Acceptable for home use

Question 14

How can one determine the effectiveness of heparin

Answer 14

aPTT levels of 60-80 seconds

Question 15

Name a oral anticoagulant

Answer 15

Warfarin ( Coumadin)

Question 16

What does warfarin do

Answer 16

It antagonizes vitamin K, thereby preventing the synthesis of 4 coagulation factors: factor VII,IS,X and prothrombin.

It treats venous thrombosis
It treats thrombus formation in ppl who have atrial fibrillation or prosthetic heart valves
It prevents recurrent MI, TIA, PE & DVT

Question 17

What are complications of warfarin

Answer 17

HEMMORRHAGE
Hepatitis
Toxicity overdose

Question 18

For toxicity or overdose of warfarin what should be administered

Answer 18

Vitamin k to promote synthesis of coagulation factors VII, IX, X and prothrombin
If vitamin k can’t control the bleeding administer fresh frozen plasma or whole blood

Question 19

What are contraindications and precautions of warfarin

Answer 19

Pregnancy category X, due to the high risk of fetal HEMMORRHAGE, fetal death and CNS defects
Contraindicated in ppl with low platelet counts or uncontrolled bleeding
Contraindicated in surgeries of the eyes, brain or spinal cord; lumbar puncture or regional anesthesia.
Contraindicated in ppl with vitamin k deficiencies, liver disorders, and alcohol use disorders due to the additive risk of bleeding
Contraindicated in ppl with hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension, or threatened abortion

Question 20

What are medication interactions of warfarin

Answer 20

Concurrent use of heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins increases the effects of warfari, which increases the risk for bleeding.

Question 21

What are medication Interactions of warfarin

Answer 21

Concurrent use of Phenobarbitol, carbamazepine ( Tegetrol) phenytoin ( Dilantin), oral contraceptives and vitamin k decreases anti coagulation effects
If used concurrently monitor carefully for reduced PT and INR levels

Question 22

What are food interactions of warfarin

Answer 22

Foods high in vitamin K, such a dark green leafy vegetables ( lettuce, cooked spinach) cabbage, broccoli, Brussels sprouts, mayonnaise, canola!and soybean oil,decrease anticoagulant effects with excessive intake.

Question 23

What are therapeutic levels of PT

Answer 23

18-24 seconds

Question 24

What are nursing considerations for the administration of warfarin

Answer 24

administration is usually orally, once daily at the same time each day
Obtain baseline vital signs
Monitor PT levels and INR levels ( INR levels are the most accurate)
Obtain baseline and monitor CBC, platelet count, and HCT levels

Question 25

What are therapeutic levels of INR

Answer 25

2-3

Question 26

How can one tell that warfarin is effective

Answer 26

PTT is 1.5-2 times the control
INR of 2-3 for treatment of acute MI, atrial fibrillation, PE venous thrombosis and or tissue heart valves
INR of 3-4.5 for mechanical heart valve or recurrent systemic embolism
No development of venous thrombi.

Question 27

What are anticoagulants (PARENTERAL)

Answer 27

Heparin

LoW molecular weight heparins (LMWH)
Prototype: enoxaparin (Lovenox)
Other meds; dalteparin (Fragmin),
Tinzaparin ( Inmohep)

Activated factor x ( xa) inhibitor
Prototype: fondaparinux ( Arixtra)