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pharmacology > Chapter 43 and 37 > Flashcards

Chapter 43 and 37 Flashcards

1
Q

What causes a blood clot?

A

decreased circulation, platelet aggregation, blood coagulation

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2
Q

Antiplatelets affect the arteries or veins?

A

arteries

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3
Q

anticoagulants affect the arteries or veins

A

both

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4
Q

What are the two types of anti platelet drugs?

A

NSAIDs (aspirin) and P2Y12 receptor blockers

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5
Q

If a patient shows to ED with signs of myocardial infarction or CVA, what can we give them immediately?

A

4 81mg CHEWABLE aspirin (acetylsalicylic acid) tablets

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6
Q

Antiplatelets suppress what?

A

platelet aggregation

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7
Q

What is long term-low dose ASA therapy?

A

81 mg ENTERIC COATED tablet taken daily to prevent MI, stroke, DVT

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8
Q

Why do we prescribe enteric coated tablets for daily aspirin use?

A

reduce risk to GI lining

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9
Q

Side and adverse effects of aspirin?

A

stroke, increase bleeding, GI ulcers/bleeding, thrombocytopenia, tinnitus and hearing loss (could indicate overdose)

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10
Q

What are the P2Y12 receptor blockers?

A

clopidogrel, prasugrel, ticlopidine, ticagrelor

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11
Q

When taken with NSAIDS clopidogrel can cause?

A

greater effects of bleeding

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12
Q

What herbs need to be avoided when taking anti platelet and anticoagulation medication

A

garlic, gensing, ginko, feverfew

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13
Q

Contraindications of taking anti platelet meds?

A

surgery (stop 7 days before) , bleeding, signs of hearing loss

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14
Q

What are the signs and symptoms of bleeding we can monitor in all medications?

A

bleeding gums, tarry stool (melena), coffee ground emesis, petechiae, increased bruising, pallor, fatigue, pink urine, decreased BP, increased HR, hematoma

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15
Q

Can aspirin and clopidogrel be taken together?

A

yes

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16
Q

Nursing interventions for anti platelet drugs?

A

monitor VS (indicators of bleeding), S&S of stroke (blood thinners can cause hemorrhagic stroke) stop taking 7 days before surgery, platelet count should be 150-400k and no less, electric razor and soft bristled toothbrush, herbs

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17
Q

What do anticoagulants do?

A

prevent current clot from growing and new ones from forming

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18
Q

Heparin and LWMH inhibit?

A

thrombin and factor Xa

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19
Q

Which anticoagulant is a Vitamin K inhibitor?

A

warfarin

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20
Q

What do we use anticoagulants for?

A

treatment for A-fib, MI, CVA, artificial heart valves, preventing DVT and PE

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21
Q

Adverse Effects of anticoagulants?

A

increased bleeding, hemorrhage

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22
Q

When do we administer heparin?

A

those on bed rest (prevent DVT), DVT from turning into PE and CVA, open heart surgery, DIC (disseminated intravascular coagulation)

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23
Q

can you take anti platelet drugs with heparin?

A

NO

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24
Q

Adverse effects of Heparin?

A

bleeding, hemorrhage (can mean overdose/toxicity), thrombocytopenia, hypersensitivities,

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25
Q

What is the LMWH drug we discussed?

A

enoxaparin

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26
Q

How is enoxaparin administered?

A

umbilicus subcutaneously in pre-filled syringe *remember we do not expel air-bubble, rub site, and we must rotate sites

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27
Q

Do we monitor aPTT with enoxaparin? Why?

A

No ; decrease risk of bleeding and longer half life

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28
Q

Patient teaching for heparin?

A

use electric razors, soft. bristled toothbrush, do not take anti platelets, teach back and return demonstration if self administering enoxaparin

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29
Q

Heparin is contraindicated in?

A

those with bleeding disorders (hemophilia), thrombocytopenia, hemorrhagic strokes, peptic ulcers, eye/brain/ spinal surgery

30
Q

Heparin is what pregnancy category?

A

c

31
Q

If heparin is given via IV, what are the nursing considerations?

A

use IV pump, take vital signs/new weight/ verify aPTT/labs and dose with another nurse before administering, monitor q4-6h, continuous infusion, has its own line

32
Q

Heparin Labs?

A

aPTT and pTT (monitor time it takes to clot)

33
Q

when is aPTT therapeutic?

A

60-80 seconds (70 seconds @ risk of bleeding, if > hold administration and contact provider)

34
Q

when is PTT therapeutic?

A

100-140 seconds (100 seconds @ risk of bleeding, if >140 hold administration and contact provider)

35
Q

Platelet count on heparin should be?

A

> 100,000 (if not contact provider and hold)

36
Q

Nursing interventions for heparin?

A

monitor signs of bleeding, monitor labs

37
Q

Antidote for heparin?

A

protamine sulfate (monitor 5-15 mins after administration and 2-8 hours after)

38
Q

What is warfarin used for?

A

treating DVT, prevent thrombus formation with those in A-fib or have prosthetic heart valves, prevent MI, TIA, PE, and DVT

39
Q

Adverse effects of warfarin

A

hemorrhage, hepatitis

40
Q

Drug interactions with warfarin

A

highly protein bound (check other drugs in case we need to fix dosages), pregnancy category X (teratogenic)

41
Q

What are the labs we monitor with warfarin

A

PT and INR

42
Q

therapeutic range for INR?

A

2-3 (3-4.5 if they have mechanical heart valve or recurrent systemic embolism)

43
Q

therapeutic range for PT?

A

18-24 seconds

44
Q

Can aspirin/ other NSAIDs be taken with warfarin?

A

No; teach patient to take acetaminophen

45
Q

Nursing considerations with warfarin

A

medication reconciliation, monitor VS/labs/bleeding, keep on heparin/enoxaparin until INR therapeutic, vitamin K is antidote

46
Q

patient teaching with warfarin?

A

notify dentist, wear medic alert bracelet, do not smoke, stay consistent with intake of vitamin k foods, do not sit or stand for prolonged periods, avoid crossing legs

47
Q

How long does it take warfarin to work?

A

feel effects after 8-12 hours ; 3-5 days to work (why we administer fast acting heparin first) , can feel effects of warfarin up to 5 days after stopping

48
Q

What are thrombolytic drugs used for?

A

clot busters, clearing out central lines

49
Q

What are the thrombolytic drugs?

A

streptokinase, cathfloactivase (goes in central lines) alteplase, t-PA

50
Q

thrombolytic drugs need to be administered within how many hours of symptoms?

A

within 3 hours of symptoms of stroke or MI

51
Q

Adverse effects of thrombolytics?

A

bleeding, reperfusion arrhythmias

52
Q

Nursing considerations of thrombolytic drugs?

A

CONTINUOUS CARDIAC MONITORING, VS, CT scan needs to be done to determine hemorrhagic vs ischemic stroke, labs, make sure patients know signs of MI and CVA so they get to ED on time

53
Q

What does epoetin alfa do?

A

increase production of red blood cells

54
Q

How is warfarin administered?

A

PO

55
Q

Indications of erythropoietin alfa?

A

CKD, chemo, HIV/AIDs meds

56
Q

Darbapoetin is? What is it used for?

A

long acting erythropoietin; used in CKD and anemia caused by chemo

57
Q

Side and Adverse effects of epoetin alfa?

A

HTN, risk for thrombolytic events, DVT, headaches and body aches

58
Q

Contraindications of epoetin alfa?

A

HTN

59
Q

Nursing considerations of epoetin alfa?

A

increase iron, monitor BP, H&H (heme should be 10-11 and HCT: 33%), S&S of stroke and MI

60
Q

Why should clients taking epoetin alfa report headaches?

A

could indicate stroke

61
Q

How is epoetin alfa administered?

A

subcutaneously and IV

62
Q

What does Filgrastim do?

A

increase production of neutrophils

63
Q

What are indications of filgrastim?

A

those with cancer, leukcytopenia,

64
Q

side and adverse effects of filgrastim

A

bone pain (take acetaminophen), leukocytosis, splenomegaly, risk of splenic rupture (long term use)

65
Q

Nursing considerations of filgrastim

A

CBC (WBC -100,000 & ANC- 10,000 hold medication), bone pain

66
Q

What does oprelvekin do

A

increase platelet production

67
Q

Indications of oprelvekin

A

treat thrombocytopenia, decrease need for platelet transfusion

68
Q

Side and adverse effects of oprelvekin

A

fluid retention, arrhythmias, eye effects, allergic reactions, anaphylaxis , dyspnea on exertion, edema

69
Q

Nursing considerations for oprelvekin

A

monitor for A-fib, tachycardia , AV flutter, conjunctival infections, papilledema, labs

70
Q

We know oprelvekin is effective when platelet count reaches what level?

A

50,000

71
Q
A

pharmacology (12 decks)

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