Ch. 26 and 54 Flashcards
The nurse will have many opportunities in practice to give medications that:
Enhance coagulation
Inhibit coagulation
Dissolve existing clots
Too much clotting. Starts in venous veins.
Thomboembolic Disorders
Types of Thromboembolic Disorders
DVT, Pulmonary Embolism, Cerebral Vascular Accident (Stroke)
What lab tests are essential to diagnose a coagulation disorder
PT (prothrombin time)
aPTT (activated partial thromboplastin time)
Platelet count
Specific clotting factor tests depending on disease
Mechanisms of action for drugs used to slow clotting/prevent formation
Inhibit clotting factors
Inhibit the clotting action of platelets
Dissolve clots (Clot busters)
(all these lengthens bleeding time)
Makes blood cells very flexible. Will help blockages in arteries.
Trentol
Acts by indirectly inhibiting thrombin. Prevents formation of fibrin clots. Alongate bleeding time. Stops extension of existing clots is unable to dissolve. Used for thrombosis, MI, strokes etc- blood flow disruption. Stops DVT from getting bigger
Heparin
Heparin is the drug of choice for…….
thromboembolic disorders SQ/IV
Adverse effects of Heparin
Abnormal bleeding, dose dependent
Antidote for too much heparin given
protamine sulfate
What labs will be drawn for Heparin
aPTT
Therapeutic range of Heparin
1.5-2 (normal: 25-35)
Where should we monitor when a pt is on heparin?
s/s of bleeding in urine, stool, bruising, and excessive menstruation
What interventions could they do to prevent injury when taking Heparin
soft bristle toothbrush
electric razor for shaving
avoid picking nose
Low molecular weight heparin. Safer and more stable than heparin.Produce more predictable responses. Will not need clotting factor labs drawn. Given in the abdomen. Usually given for 5-10 days.
Enoxaparin (Lovenox) SQ
Inhibits activated vitamin K. Takes a few days to produce a full therapeutic effect. Will see this taken with Heparin until appropriate levels are reached. Labs are the marker of dosage.
Warfarin (Coumadin)
Therapeutic range for Warfarin (Coumadin) (international Normalized Ratio)
2.0-3.0 or up to 3.5
Adverse effects of Coumadin
Bleeding
Antidote for Coumadin overdose
Vitamin K
What Vitamin K foods should we eat in moderation?
spinach, cabbage, cauliflower, brussels sprouts, broccoli
What herbs increase herbs of bleeding
Garlic
Ginkgo
Approved for prevention of stroke in those with a-fib, post op prophylaxis and treatment of DVT. Factor XA inhibitors
Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Also inhibit thrombin directly factor 2A. Prevention of strokes int hose with afib. Has a drying agent in the cap that stops breakdown of medication.
Dabigatran (Pradaxa) PO
Interfere with platelet aggregation. Is concerned with stopping formation in arteries. Can still profoundly increase bleeding time.
Antiplatelet Agents
Helps platelets go and clup. Prevents platelet aggregation.
Adenosine diphosphate (ADP) receptor blockers
Prevents platelet activation and thrombus formation.
Glycoprotein 2b/3a inhibitor
Needs to be stopped before surgery. Given to prevent thrombi formation in those at risk for MI and CVA and those that have unstable angina and stent placement. Also given to prevent post op DVT.
Clopidogrel (Plavix) ADP Receptor Blocker
Very expensive so not used often. Given in acute situations. Given IV many times concurrently with ASA or heparin for optimal results. Glycoprotein 2b/2a inhibitor.
Epitifbatide (integrilin)
Abciximab (ReoPro)
Accelerate the normal process of breaking down clots. Plasmin DIGESTS fibrin breaking it down.
Thrombolytics
Given ASAP after clot has formed. Preferably within 4 hours. 6 hours of MI or 3 hours of CVA.
Altepase (Activase) IV
Used to promote formation of clots. By preventing digestion of fibrin clots.
Hemostatics
Most often prescribed after surgery to stop abnormal bleeding. Also given after acute hemorrhage. In certain instances the incidence of thrombosis is increased.
Aminocaproic Acid (Amicar) PO/IV
Amicar adverse effect
wasting and weakness of muscle leading to rhabdomyolysis
Anemia can be related too:
Blood loss
Blood cell destruction
Decreased blood cell production
Erythopoietin is secreted by what organ?
Kidneys
These are meant to ensure proper blood consistency and then of course ensure that are adequate RBC for oxygenaton
Iron
Most common reason to get prescribed Epogen
cancer and renal failure
Made by recombinant DNA. Stimulates the bone marrow to make RBCs. Hematocrit increases 2%/week.
Epoetin alfa (Epogen, Procrit)
Adverse effects of Epogen?
HTN, Thromboembolic events (watch hgb/hct closely)
Goal of pharmacotherapy of Anemia
Increase HCT, HGB, O2 and RBC
`Effectiveness of Epogen will be much lower when deficient in…..
iron and other vitamins
What is a major cause of anemia
iron deficiency
Iron Deficient anemia treatments?
Ferrous Fumarate/Sulfate PO (Moderate anemia) Iron Dextran (Dexferrum) IV/IM (severe anemia)
Water soluble B vitamin. Necessary for normal fetal development.
Folic Acid
Which condition must be ruled out before giving folic acid?
Perniciious Anemia
For Vitamin B12 deficiency Given IM/SQ. Take daily, then every other day, then weekly, then monthly for life.
Cyanocobalamin
What must be present to give Cyanocobalamin orally?
intrinsic factor
Serious effects that can occur with Cyanocobalamin
Neurovascular Problems: memory loss, unsteadiness and mood disturbances
What will we need to assess for reasoning for medication
iron stores, kidney function and bone marrow function
Implementation of Iron supplements
Liquid formulations should be taken through a straw
Remain upright min after taking (do not crush)
Can be taken with food/vitamin c
Use Z-track method
How long does it take to see improvements in anemia status?
2-6 weeks
