Cholesterol/Peripheral Vasodilators, Anticoagulants, Antiplatelets, Thrombolytics Flashcards
HMG-COA Reductase Inhibitors
-statins
rosuvastatin (Crestor)
inhibits enzyme responsible for cholesterol synthesis in liver; reduces LDL levels
HMG-COA Reductase Inhibitors SE
constipation
muscle aches
abdominal cramps
HMG-COA Reductase Inhibitors ADE
liver impairment
rhabdomyolysis (skeletal muscle disorder that can lead to kidney damage)
cataracts (annual eye exam!)
severe myopathy
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; lifetime commitment
no pregnant women and CI in liver disease
changes in vision/eye exams
AVOID ALCH and GRAPEFRUIT JUICE cause it increases drug lvls
take with food if experiencing GI upset
Cholesterol Absorption Inhibitors
ezetimibe (Zetia)
blocks receptors in small intestine, reducing absorption of dietary and biliary cholesterol and lowering LDLs
Cholesterol Absorption Inhibitors SE/ADE
stomach pain
diarrhea
angioedema
Cholesterol Absorption Inhibitors Nursing Interventions
take drug same time everyday once a day with or without food
assess for liver disease and muscle disorders
monitor liver labs when used with statins and use caution for liver issues
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)
measures time for blood to clot (intrinsic pathway)
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)
standardized PT (prothrombin time) value for 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)
directly measures heparins effect on factor Xa; more accurate than aPTT for heparin dosing
normal is 0.1 1 units/mL (TR is 0.5-1; pt with LMWH is .3-.7)
used in obese, pregnant or renal pts
Anticoagulants
stop blood from clotting
stop existing clots from getting bigger
don’t break up existing clots!!
watch for decreased BP and increased HR (hemorrhage)
Thrombin Inhibitors (Anticoagulant)
Heparin (high alert med! requires double verification) prevent VTE; rapid onset for initial short term therapy
Low-molecular weight heparin/enoxaparin sodium (Lovenox) for pts unable to do routine labs
activates antithrombin which inactivates thrombin, slows clotting by preventing fibrin formation
prevention/treatment of DVT, PE, stroke, AFib
SQ or IV
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
watch for signs of bleeding (bruising, dark stools (guaiac or fecal occult blood), hematuria
avoid IM injections to prevent hematoma formation (use smallest needle possible and hold for 5 min); decrease needle sticks
careful aPTT monitoring or Anti Xa (0.5-1)
use soft toothbrush and electric razor to prevent bleeding
don’t take NSAIDs or aspirin
wear med alert bracelet
Thrombin Inhibitors Labs
every 2 days!
platelets values (below 100,000)
hgb
hct
BP/VS (hypotension and tachycardia)
aPTT
Heparin Antidote
protamine sulfate given if aPTT exceeds therapeutic level or signs of bleeding
LMWH Nursing Interventions
give SQ in abdomen, rotate sites!
don’t expel air bubble and don’t aspirate or rub skin afterward
don’t need intense lab monitoring like with heparin
90° angle, 2 in from umbilicus
Selective Factor Xa Inhibitors
apixaban (Eliquis)
directly inhibits factor Xa which prevents thrombin formation and reduces clot formation
SQ or PO
Selective Factor Xa Inhibitors ADE
anemia
bleeding (hematuria, epistaxis)
anaphylaxis
Selective Factor Xa Inhibitors Nursing Interventions
CI in active bleeding
use caution with pregnancy, breastfeeding or pts in surgery
lab monitoring not necessary
monitor VS and signs of bleeding (Hgb, Hct, platelet count)
don’t discontinue abruptly and use same time everyday with or without food
avoid NSAIDs/aspirin
wear med tag
Selective Factor Xa Inhibitors Antidote
andexa
Oral Anticoagulants
warfarin (Coumadin)
antagonizes vitamin K prevents clot formation
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 and signs of bleeding
wear med alert tag
ask female pts if pregnant or planning
determine if pt is taking any drugs by avoid IM injections (hold pressure at site for 5 min. and use smallest needle possible)
notify dentists and other doctors about therapy
avoid NSAIDs/aspirin
veggies rich in vitamin K can decrease warfarin action and certain drugs; don’t drastically change diet
CI in active bleeding, pregnancy, recent surgery and uncontrolled HTN
Oral Anticoagulants Labs
INR monitoring (0.8-1.1 but goal is 2-3)
full therapeutic effect takes 3-7 days, so bridging with heparin is often needed
Oral Anticoagulants Antidote
vitamin K (phytonadione)
give if PT/INR is high or signs of bleeding
Antiplatelet Drugs
aspirin (baby dose of 81 mg)
reduce risk of clot formation in arteries by blocking platelet activation and aggregation
can have effect for 7 days
Antiplatelet Drugs SE
bleeding
n/v
upset stomach (enteric coated!)
gas
loss of appetite
diarrhea
HA
rash and itching
Antiplatelet Drugs ADE
excessive bleeding (hemorrhage)
GI bleeds
allergic reactions
tinnitus (early sign of toxicity) + hyperventilation
salicylate poisoning (aspirin)
bronchospasm
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
avoid use of NSAIDs/anticoagulants
ADP Receptor Blockers
clopidogrel (Plavix)
inhibits platelet aggregation
ADP Receptor Blockers SE/ADE
bleeding
prolonged bleeding, nausea, rash, neutropenia, hepatotoxicity
ADP Receptor Blockers Nursing Interventions
monitor CBCs and signs of bleeding
LFTs at baseline and every 2 weeks for first 3 months of Tx
reversible within 1-3 weeks after tx stopped
high bleeding risk with NSAIDs, aspirin, alcohol
take at same time daily with meals
avoid use with antacids (take 1 hr or 2 hrs after)
wear med alert bracelet if long term therapy
Thrombolytic Drugs
alteplase (tpa) activase
ONLY ONE THAT BREAKS DOWN EXISTING CLOTS (FIBRIN), CLOT BUSTERS
given within 3 hrs of symptom onset for ischemic stroke, give within 4 hrs for MI
Thrombolytic Drugs SE/ADE
bleeding (check wounds, injection sites, gums and cuts)
life threatening hemorrhage, allergic reaction
hypotension
Thrombolytic Drugs Nursing Interventions
monitor for bleeding (especially intracranial hemorrhage), 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, history of hemorrhage stroke, internal bleeding, trauma, surgery, and uncontrolled HTN, recent GI bleed
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
Total Cholesterol
<150-200 mg/dL
higher levels increase heart disease risk
LDLs
<100 mg/dL
elevated lvls can lead to arterial plaque buildup
HDLs
> 60 Or >40 mg/dL
higher HDL clears LDLs
Triglycerides
<40-150 mg/dL
elevated lvls can cause atherosclerosis
