Coagulation Drugs Flashcards
heparin MOA
activates antithrombin which indirectly inactivates thrombin (factor IIa) and factor Xa
inhibits fibrin formation
low molecular wt heparin MOA
inactivates factor Xa
heparin and low molecular wt heparin class
heparin
heparin route/dose
SQ or IV
- 5000 units 2-3x a day
- IV drip w bolus (wt based protocol–>kg)
heparin indication
conditions necessitating PROMPT anti activity
- stroke, PE, massive DVT
- open heart surgery or dialysis
- low dose therapy for prophylaxis against post op DVT
- treat disseminated intravascular coagulation
heparin nursing considerations
- starts working vv quick (SQ, 20-30 mins, IV immediately)
- use caution if pt has spinal or epidural anesthesia (typically wont even use)
- high risk med, check w other RN
heparin antidote
protamine sulfate
- given slowly through IV to prevent bottoming out BP
how does antidote for heparin work
protamine binds to the heparin making a complex that stops the heparin from working
adverse effects of heparin
- bleeding
- hematoma
- anemia
- thrombocytopenia
signs of bleeding
- change in vs
- bruising
- petechiae (red spots)
- hematomas
- black tarry stools
heparin induced thrombocytopenia (HIT)
low platelet count and inc development of thrombi cause by antibody development
- purple finger tip and toes
nursing consideration for HIT
- monitor platelet counts
- stop heparin if below 100,000
- non heparin anticoags can be used instead
how do we dose IV heparin
clotting time labs
- anti Xa
- aPTT (activated partial thromboplastin time)
draw before and after heparin to determine if any changes in dose are needed
low molecular wt heparin medication
enoxaparin
enoxaparin moa
inhibits factor Xa
- large unfractionated molecules and cleaves them into smaller fragments which inc affinity for Xa and bioavailability, half life
enoxaparin route
SQ
enoxaparin indications
given prophylaxis and treatment
- can be given at home because already dosed out
enoxaparin adverse effects
- bleeding
- thrombocytopenia–> can also cause HIT
enoxaparin antidote
protamine
enoxaparin nursing consideration
- dont give w heparin or other anticoags EXCEPT oral warfarin oral when treating PE/DVT
- black box: potential spinal hematoma if pt has epidural catheter
- given in pre filled syringe so easy to admin (at home too)
- do not expel air bubble
- slow onset of action bc longer half life
- rotate injection site
warfarin moa
inhibit vitamin K dependent clotting factors
- prevents the synthesis of four coagulation factors (VII, IX, X, prothrombin)
warfarin indications
prevention of
- PE, DVT, VTE
- thrombotic events for pts w afib or heart valves
- reduce occurrence of TIA or MI
warfarin route
- ONLY PO
- usually at 5pm
- onset not for 24 hrs
- duration 2-5 days (the half life)
warfarin adverse effects
- bleeding
- lethargy
- muscle pain
- purple toes
- teratogenic effects (no for breast feeding, pregnant)
warfarin antidote
vitamin K (IV)
- fresh frozen plasma or whole blood if vitamin k doesnt work
warfarin nursing considerations
- monitor and teach for signs of bleeding
- HOLD before surgery
- monitor labs –> prothrombin time, international normalized ratio (monitor monthly)
- normal INR w/out warfarin: 1 or less
- normal INR w warfarin: 2-3.5
- many drug interactions (lots of abx)
- food interactions
- no alc
- we med alert bracelet, use soft tissue toothbrush, electric toothbrush
what foods to avoid if taking warfarin
foods with vitamin K will reduce warfarin ability to prevent clots
- kale, broccoli, brussell sprouts, cabbage, pickled cucumber, asparagus kiwi fruit, okra, green beans, lettuce
apixaban and rivaroxaban moa
inhibit factor Xa
apixaban and rivaroxaban indications
- prevents strokes in pt w afib
- post op thrombo-prophylaxis
- treat DVT, PE
apixaban and rivaroxaban adverse effects
- bleeding
- hematoma
- dizziness
- rash
- gastrointestinal distress
- peripheral edema
apixaban and rivaroxaban black box warning
- spinal hematomas if pts has epidural cath
- risk of thrombosis if drug abruptly stops
apixaban and rivaroxaban nursing consideration
- drug interactions
– dec effects of pheytonin, carbamazepine, rifampin, st johns wort
– inc effects of CYP3A4 inihibitors, grapefruit - no routine monitoring
- do not give w other anticoags
- watch liver functions (ALT, AST, GGT)
apixaban and rivaroxaban antidote
andexxa
- recombinant factor Xa, inactivated-zhzo)
aspirin MOA
blocks prostaglandin synthesis through COX enzyme pathway
- blocks platelet aggregation and prevents platelets from clumping together
aspirin indication
- prevent or treat MI
- prevent ischemic stroke
aspirin route
PO
- if acute accident, chew baby aspirin (chew white)
aspirin side effects
- GI (N/V)
- drowsiness/confusion
- bleeding
aspirin nursing considerations
- dont crush enteric
- OTC option but if need anti platelet then typically prescribed
- no for children bc Reyes syndrome
aspirin nursing considerations
- thrombocytopenia
- active bleeding
- blood cancers
- traumatic injury
- GI ulcers
- vitamin K deficiency
- recent hemorrhagic stroke
aspirin antidote
DDAVP (desmopressin)
clopidogrel and ticagrelor moa
antiplatelet ADP inhibitor
- ADP works w/in the platelet adhesion/accumulation process
- alters platelet membrane so it doesn’t receive the signal to aggregate
clopidogrel and ticagrelor indications
- reduce risk of stroke
- prophylaxis of TIAs
- post MI
clopidogrel and ticagrelor contraindications
- thrombocytopenia
- active bleeding
- blood cancer
- traumatic injuries
- GI ulcers
- vitamin K deficiency
- recent hemorrhagic stroke
clopidogrel and ticagrelor side effects
- chest pain
- edema
- flu-like symptoms
- abdominal pain
- D/N
- epistaxis (nose bleed)
- rash
- pruritus
clopidogrel and ticagrelor route
PO
clopidogrel black box
- pt w certain genetic abnormalities
- higher rate of CV events due to reduced conversion to its active metabolite
clopidogrel nursing considerations
effectiveness reduced by amiodarone, Ca channel blockers, NSAIDS, PPIs
ticagelor black box
inc bleeding risk w aspirin doses over 100 mg
clopidogrel and ticagrelor antidote
DDAVP or platelet transfusion
argatroban moa
inhibit thrombin (factor IIa)
argatroban class
direct thrombin inhibitor
argatroban indications
treat HIT
- pt undergoing procedures at high risk for HIT
argatroban route
IV only
argatroban adverse effects
bleeding
argatroban nursing considerations
- used for pts w hepatic dysfunction
- monitor labs (anti Xa, h&h, platelets)
glucocorticoid steroids often used
- hydrocortisone
- prednisone
- dexamethasone
acute side effects of glucocorticoids
- inc ocular pressure (problem for ppl w glaucoma)
- fluid retention
- HTN
- mood swings
- wt gain in ab, face, back of neck –> hunger
long term side effects of corticosteriods
- clouded lens
- high blood sugar
- inc risk of infections
- thinning bones
- suppressed adrenal gland hormone production
- thin skin, bruising, slow wound healing
nursing implications for corticosteroids
- must taper
- take at same time
- wear medical alert bracelet
- monitor blood sugar and wt
mineralcorticoid med
fludrocortisone
fludrocortisone moa
mineralcorticoid replacement
fludrocortisone info
- may be needed with GCC replacement
- salt wasting (unable to maintain Na levels, K levels remain high)
