Cholesterol/Peripheral Vasodilators, Anticoagulants, Antiplatelets, Thrombolytics Flashcards
HMG-COA Reductase Inhibitors
-statins
rosuvastatin (Crestor)
HMG-COA Reductase Inhibitors SE
constipation
muscle aches
abdominal cramps
HMG-COA Reductase Inhibitors ADE
liver impairment
rhabdomyolysis (skeletal muscle disorder)
cataracts
HMG-COA Reductase Inhibitors Nursing Interventions
monitor lipid levels/LSTs
observe for s/s of GI upset
may take several weeks before lipid levels decrease
take at bedtime (body makes most cholesterol at night)
report any unexplained muscle tenderness, weakness, fever and malaise
don’t stop suddenly! rebound effect
no pregnant women
changes in vision/eye exams
Cholesterol Absorption Inhibitors
ezetimibe (Zetia)
Cholesterol Absorption Inhibitors SE/ADE
stomach pain
diarrhea
angioedema
Cholesterol Absorption Inhibitors Nursing Interventions
take drug same time everyday once a day
assess for liver disease and muscle disorders
monitor liver labs
report any unexplained muscle tenderness, weakness, fever and malaise
Peripheral Vasodilators (Antiplatelet)
cilostazol (Pletal)
Peripheral Vasodilators SE
HA
dizziness
peripheral edema
GI upset
Peripheral Vasodilators ADE
tachycardia
dysrhythmias
palpitations
blood dycrasias
Peripheral Vasodilators Nursing Interventions
obtain baseline vitals for future comparisons
assess for s/s of inadequate blood flow to extremities
plan for reduction of symptoms of intermittent claudication (pain during activity)
monitor vitals (BP and HR)
desired TR may take 1.5-3 months
don’t smoke or drink
tell pt to change position slowly but frequently to avoid OH
aPTT (heparin)
consider normal as 1.5-2 times the control
ex. normal is 30-40s; therapeutic is 45-80s
hospital protocol for monitoring; baseline and every 6h x2 then every 24 hr
INR (Warfarin)
normal range 0.8-1.1 (TR is 2-3 or 2.5-3.5 w/mechanical valve or to prevent arterial thrombosis)
Anti-activated factor X (Anti Xa) (heparin)
normal is 0.1 1 units/mL (TR is 0.5-1; pt with LMWH is .3-.7)
Anticoagulants
stop blood from clotting
stop existing clots from getting bigger
Thrombin Inhibitors
Heparin (high alert med!)
Low-molecular weight heparin/enoxaparin sodium (Lovenox)
Thrombin Inhibitors SE
bleeding
abdominal pain (peptic ulcers)
constipation
n/v
Thrombin Inhibitors ADE
hemorrhage
thrombocytopenia
heparin induced thrombocytopenia (HIT)
allergic reaction
hyperkalemia
osteoporosis/osteopenia (chronic use)
Thrombin Inhibitors Nursing Interventions
CI in stroke, peptic ulcer disease, surgery of the eye, brain or spine and blood abnormalities
ok for mothers to use since it doesn’t cross placenta
DEXA scan for osteoporosis
Thrombin Inhibitors Labs
every 2 days!
platelets values (below 100,000)
hgb
hct
BP/VS
aPTT
Heparin Antidote
protamine sulfate
LMWH Nursing Interventions
give SQ in abdomen
don’t expel air bubble and don’t aspirate or rub skin afterward
don’t need intense lab monitoring like with heparin
Selective Factor Xa Inhibitors
apixaban (Eliquis)
Selective Factor Xa Inhibitors ADE
anemia
bleeding (hematuria, epistaxis)
anaphylaxis
Selective Factor Xa Inhibitors Nursing Interventions
CI in bleeding
use caution with pregnancy, breastfeeding or pts in surgery
lab monitoring not necessary
monitor VS and signs of bleeding
don’t discontinue abruptly and use same time everyday
Selective Factor Xa Inhibitors Antidote
andexa
Oral Anticoagulants
warfarin (Coumadin)
Oral Anticoagulants SE
bleeding
GI upset
fever
rash
Oral Anticoagulants ADE
teratogenesis
ocular hemorrhage
warfarin induced skin necrosis
Oral Anticoagulants Nursing Interventions
monitor CBC, lumbar pain, abdominal bulging and guaiac tests on stool
wear med alert tag
ask female pts if pregnant or planning
determine if pt is taking any drugs by injection (hold pressure at site for 5 min. and use smallest needle possible)
notify dentists and other doctors about therapy
veggies rich in vitamin K can decrease warfarin action and certain drugs; don’t drastically change diet
Oral Anticoagulants Labs
INR values (2-3; 2.5-3.5)
Oral Anticoagulants Antidote
vitamin K (phytonadione)
Antiplatelet Drugs
aspirin
Antiplatelet Drugs SE
bleeding
n/v
upset stomach
gas
loss of appetite
diarrhea
HA
rash and itching
Antiplatelet Drugs ADE
excessive bleeding (hemorrhage)
GI bleeds
allergic reactions
tinnitus
salicylate poisoning (aspirin)
Antiplatelet Drugs Nursing Interventions
single dose can inhibit platelet aggregation for 7 days; stop aspirin at least 7 days before surgery
enteric coated aspirin may reduce GI irritation
assess pt for allergy to aspirin/NSAIDs and whether they take antacids
monitor platelet lvl and observe for bleeding
take with meals to decrease nausea
give drugs 2 hrs or 1 hr before antacids
treatment may be life long
avoid alcohol for risk of stomach bleeding
children shouldn’t take aspirin (Reyes syndrome)
not safe during last trimester of pregnancy
ADP Receptor Blockers
clopidogrel (Plavix)
ADP Receptor Blockers SE/ADE
bleeding
prolonged bleeding, nausea, rash, neutropenia, hepatotoxicity
ADP Receptor Blockers Nursing Interventions
monitor CBCs
LFTs at baseline and every 2 weeks for first 3 months of Tx
reversible within 1-3 weeks after tx stopped
Thrombolytic Drugs
alteplase (tpa) activase
ONLY ONE THAG BREAKS DOWN EXISTING CLOTS, CLOT BUSTERS
Thrombolytic Drugs SE/ADE
bleeding (check wounds, injection sites, gums and cuts)
life threatening hemorrhage, allergic reaction
Thrombolytic Drugs Nursing Interventions
monitor for bleeding, coagulation lab tests
observe for s/s of allergic reaction
avoid NSAIDs and aspirin
don’t give any injectable drugs, start/remove IVs
no heavy lifting for 10 days
have pt report unusual symptoms at once like arm/leg pain that worsens
time matters
chance of miscarriage during first 5 months
CI if mother has given birth within 24 hrs
Hemostatic Agents (Amicar)
promote formation of clots by preventing excess bleeding from surgical sites
may cause hypercoagulation with use of estrogen/oral contraceptive
can be given during acute hemorrhage via IV
monitor very closely
