Ch. 45 - Anticoagulants

Question 1

Heparin (1):

Answer 1

VERY STRONG potent inhibitor of clotting process

Question 2

Heparin (2):

Answer 2

Use:
-Prevent & treat clotting disorders r/t:

Venous problems:

  - Deep vein thrombosis (DVT)
  - Pulmonary embolism (PE)

Question 3

Heparin (3):

Answer 3

Arterial problems:
-Coronary thrombosis (myocardial infarction)

Cerebral vascular accidents (CVA) = strokes

Question 4

Heparin (4):

Answer 4

Indirectly interferes with conversion of prothrombin to thrombin —>

Prevents conversion of fibrinogen to fibrin
= inhibits clot formation

Question 5

Heparin (5):

Answer 5

SC or IV only!

DO NOT massage site after injection

Question 6

Heparin (6):

Answer 6

Initiation of anticoagulant therapy

Once desired prothrombin time is achieved –>
-Oral anticoagulant for maintenance therapy

Question 7

Potency of Heparin: Units –

Answer 7

Heparin lock (flush):
-100 units/mL
-10 units/mL
Heparin soln:
-10,000 units/mL
-5,000 units/mL
-1,000 units/mL

Question 8

Heparin — Use with Caution:

Answer 8

Diseases with increase risk of hemorrhage

Surgery!

Other drugs that may induce bleeding

Question 9

Heparin — Monitor:

Answer 9

1. ) Activated partial thromboplastin time (aPTT)
2. ) Keep aPTT  1 ½ to 2 ½ times normal value

Normal = (25-35 sec)
Heparin = (30-50 sec)

Question 10

Heparin — Overdosage:

Answer 10

(antidote) :

- Protamine Sulfate

Question 11

Do Not Confuse!

Answer 11

• Heparin soln

- Heparin lock (flush)

Question 12

Low-Molecular-Weight Heparins (LMWH):

Answer 12

Extraction of low-molecular-weight fractions of standard heparin —>

Same amt of anticoagulation ability w/ decreased risk of bleeding

aPTT not needed

Question 13

LMWH — enoxaparin (Lovenox):

Answer 13

1. ) SQ
2. ) Pre-filled syringe
3. ) Abd ~ 5cm away from umbilicus
4. ) Avoid scars
5. ) Keep air bubble in syringe!
6. ) Do not rub injection site

Question 14

enoxaparin (Lovenox) - Use:

Answer 14

Prevent DVT or PE:

- Hip/knee replacement (after surgery)
- Abd surgery (before and/or after surgery)

Question 15

Oral Anticoagulants (1):

Answer 15

Inhibit blood clotting:

-Interferes with synthesis of vitamin-K dependent clotting factors in liver

Question 16

Oral Anticoagulants (2):

Answer 16

Action:
-12-24 hrs after first dose

Depresses Prothrombin –>

Monitor: Prothrombin time (PT)

Question 17

Oral Anticoagulants – warfarin sodium (Coumadin) (1):

Answer 17

1.) Initial dose: 10 mg/day

2. ) Daily maintenance dose:
   - 2 – 10 mg/day
3. ) Duration of action:
   - 2 – 5 days

Question 18

warfarin sodium (Coumadin) (2):

Answer 18

Dosage:

 - Individualized on pt bloodwork
 - Based on INR results

Question 19

International Normalized Ratio (INR):

Answer 19

Values:
-Normal = 1.3 - 2

warfarin (Coumadin) therapy:
-Desired INR = 2-3

Question 20

Oral Anticoagulants (3):

Answer 20

• Greater potential for significant drug interactions than any other pharmacological class of drugs *

Question 21

Oral Anticoagulants — Overdosage:

Answer 21

1.) Bleeding

2. ) Excessive hypoprothrombinemia:
   
   • Omit one or more dose
   • Vitamin K = (antagonist / antidote)

Question 22

Nursing Process:

Answer 22

Monitor labs:
Heparin = aPTT

warfarin (Coumadin) = INR (prothrombin)

MONITOR FOR BLEEDING

Question 23

Keep antagonists available:

Answer 23

Heparin = protamine sulfate

warfarin (Coumadin) = Vitamin K

Question 24

Nursing Process:

Answer 24

Teach:

• Inform dentist
• Soft toothbrush
• Electric razor
• Do not smoke
• NO ASA!!

Question 25

Nursing Process – cont….

Answer 25

Diet —- Avoid:

- Large amts green, leafy veg, broccoli
- Excessive alcohol
- Caffeine

Question 26

clopidogrel (Plavix):

Answer 26

prevention of secondary MI/stroke

• Used alone or with ASA
  
  • **More effective if used together

Question 27

Thromobolytics (1):

Answer 27

Enzymes dissolve fibrin clots

Thrombus disintegrates within 4 hrs after acute MI

should give within 3 hrs of thrombolytic stroke

Question 28

Thromobolytics (2):

Answer 28

Also used for:

• PE
• DVT

Question 29

Thromobolytics — end in….

Answer 29

-ase enzyme

Question 30

Thromobolytics – complications:

Answer 30

allergic reaction: —- anaphylaxis

Question 31

Thromobolytics — major complications:

Answer 31

hemorrhage