Coagulation Meds Flashcards
What is the biggest concern in anti-coagulant medications
most common S/E is bleeding
What 3 things do nurses want to monitor for bleeding
Hemoglobin
hematocrit
Vital Signs
what 2 considerations should nurses know about their patient on anti-coagulant medications
Know why your patient is on an anti-coagulant
know what sites they may be at risk for bleeding
What are the 2 types of coagulation drugs
Anticoagulants
Anti platelet
What are anticoagulants
Inhibit the action or formation of the clotting factors
PREVENT clots
What are antiplatelets
Prevent platelet plugs from forming by inhibiting platelet aggregation
Best for preventing heart attacks and stroke
MOA of heparin
Prevents clotting by activating ANTITHROMBIN -> indirectly inactivates thrombin & factor Xa
Inhibits FIBRIN formation
What is the MOA of Enoxaparin or Low molecular weight heparin
Prevents clotting by activating ANTITHROMBIN
ONLY inactivates factor Xa (not thrombin)
What is the first sign of fluid volume deficit ?
tachycardia
Signs of internal bleeding
tachycardia
skin pallor
low BP
respiration Increasing
T/F Bruising can be a late sign of internal bleeding?
True
What is the class for Heparin and LMWH (Enoxaparin)
Heparins
Route of Heparin
Only given parental (IV or SQ)
Indications for Heparin
conditions necessitating PROMPT anticoagulant activity
Examples of when to give Heparin (4)
Evolving stroke, PE, massive DVT
Adjunct for patients having open heart surgery or dialysis
Low-dose therapy for prophylaxis against post-op DVT
Treat disseminated intravascular coagulation
What amount and frequency can Heparin be given
5000u injection 2-3x a day or as an IV drip with a bolus
what protocol is heparin given
weight-based in kg
When Does IV heparin start working
Immediately
when does SQ heparin start working
20-30 minutes
what is the anti-dote for Heparin
Protamine Sulfate
how is protamine given
IV
slowly
pushing can drop BP
What patients do we use caution when giving Heparin
patients with spinal or epidural anesthesia
T/F Heparin is a HIGH-RISK MED
True - must double check with other RN prior to rate changes and boluses
Adverse effects of Heparin (4)
bleeding
hematoma
anemia
thrombocytopenia
What 5 things do we monitor for when giving heparin
vital signs,
bruising,
petechiae,
hematomas,
black tarry stools
What is Heparin induced thrombocytopenia (HIT)
Low platelet count and increased development of thrombi
caused by antibody development
What are the nursing consideratoins for Heparin induced thrombocytopenia (HIT)
Monitor platelet counts
Stop heparin immediately if platelet count <100,000/mm3
Non-heparin anticoagulants can be used as substitute if anticoagulation still needed
What 2 labs do we monitor with Heparin
Anti-Xa OR aPTT (activated partial thromboplastin time)
How do we dose IV heparin
based on clotting time labs
What is Enoxaparin (Lovenox)
Low-molecular weight heparin
What route is Enoxaparin available
SQ injectable
Are labs necessary for Enoxaparin
No
What are the indications for Enoxaparin
given prophylaxis & treatment
What is the advantage of Enoxaparin
can be given at home
what are the adverse effects on enoxaparin
bleeding
thromboxytopenia
Can also cause HIT
What is the antidote for Enoxaparin
protamine
what patients do we use caution when giving enoxaparin
patients with spinal or epidural anesthesia
Reason for low molecular weight heparin
takes large unfractionated heparin moleculaes and cleaves them into smaller fragments and this makes them have greater affinity to factor X-a making them bioavailable and have a longer half life
Can you give Enoxaparin and heparin together
No
what is the black box warning for Enoxaparin
potential spinal hematoma if patient has epidural catheter
5 Nursing considerations for Enoxaparin
Don’t give with really any other anticoagulants except oral warfarin when treating PE or DVT
Given in pre-filled syringes easy to administer and teach to give at home
Do not expel the air bubble: will remain in plunger to ensure whole dose is given
Slower onset of action
compared to heparin but LONGER half-life
Rotate injection sites
MOA of warfarin
Vitamin-K inhibitor
-prevents the synthesis of four coagulation factors (VII, IX, X, prothrombin)
indications of Warfarin (3)
prevention VTE/DVT/PE,
thrombotic events for patients with afib or heart valves,
reduce recurrence of TIA or MI
route of Warfarin
only given PO, Once daily
What is the onset of warfarin
24 hrs
what is the duration of warfarin
2-5 days
Adverse effects of Warfarin
bleeding
lethargy
muscle pain
purple toes
Antidote of warfarin
Vitamin K (IV)
If that doesn’t work
Fresh frozen plasma or whole blood
Can you give warfarin to pregnant women or breastfeeding
NO
Warfarin nursing considerations
Monitor and teach signs of bleeding
hold before surgeries
monitor labs
MANY drug interactions
Food interactions
Avoid alcohol
Weat medic alert bracelet, use soft toothbrush,
What Labs do we monitor for Warfarin
PT- prothrombin time
INR- International normalize ratio
Normal INR value without warfarin
about 1
Therapeutic value with warfarin
2-3.5
How frequently do we monitor patients on warfarin for therapeutic effect
MONTHLY
What foods should be monitored when taking warfarin
Avoid foods High in Vitamin K
green, leafy vegetables
MOA of Apixaban (Eliquis) & Rivaroxaban (Xarelto
Direct inhibitor of factor Xa
Indications of Apixaban (Eliquis) & Rivaroxaban (Xarelto
prevent strokes in patients with afib,
post-op thrombo-prophylaxis, treat DVT & PE
Adverse effects of Apixaban (Eliquis) & Rivaroxaban (Xarelto
bleeding,
hematoma,
dizziness,
rash,
gastrointestinal distress, peripheral edema
Black box warnings for Apixaban (Eliquis) & Rivaroxaban (Xarelto
Spinal hematomas if patient has epidural catheter
Risk of thrombosis if drugs ABRUPTLY stopped
Drug interactions with Apixaban (Eliquis) & Rivaroxaban (Xarelto
Decreased effects: phenytoin, carbamazepine, rifampin, and st. johns wort
Increased effects: CYP3A4 inhibitors (amiodarone, erythromycin, ketonazole, HIV meds, diltiazem, verapamil, grapefruit juice)
Do you have to routine monitor Apixaban (Eliquis) & Rivaroxaban (Xarelto
NO
antidote for Apixaban (Eliquis) & Rivaroxaban (Xarelto
andexxa
(recombinant factor Xa, inactivated-zhzo)
can you give Apixaban & rivaroxaban in conjunction with other anticoagulants
NO
What organ function and levels do we need to monitor with Apixaban & rivaroxaban
Liver function
ALT
AST
GGT
2 types of antiplatelet drugs
Aspirin Clopidogrel (plavix)
S/E of Aspirin
GI (n/v),
drowsiness/confusion,
bleeding
nursing considerations for aspirin
Don’t crush enteric coated
OTC medication considerations
Reye’s syndrome: children with a virus NO ASPIRIN
contraindications for aspirin
thrombocytopenia,
active bleeding,
blood cancers,
traumatic injuries,
GI ulcers,
vitamin K deficiency,
recent hemorrhagic stroke
What is the antidote for Aspirin
DDAVP (Desmopressin)
MOA of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
Antiplatelet ADP inhibitor
Alters the platelet membrane so it doesn’t receive the signal to aggregate
Indications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
reduce risk of stroke, prophylaxis of TIAs,
post-MI
Contraindications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
thrombocytopenia,
active bleeding,
blood cancers,
traumatic injuries,
GI ulcers,
vitamin K deficiency,
recent hemorrhagic stroke
Side effects of Clopidogrel & Ticagrelor
chest pain,
edema,
flu-like symptoms,
abdominal pain,
diarrhea,
nausea,
epistaxis,
rash,pruritus
Route of Clopidogrel & Ticagrelor
PO
Clopidogrel Black Box Warning
patients with certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite
Ticagelor Black Box Warning
Increased bleeding risk risk with aspirin doses over 100mg
Antidote for Clopidogrel & Ticagrelor
DDAVP or platelet transfusion
What reduces the effectiveness of Clopidogrel
amiodarone,
calcium channel blockers, NSAIDS,
PPIs
2 Thrombin Inhibitors
argatroban
bivalrudin
class of argatroban and bivalrudin
Direct Thrombin Inhibitors
MOA of Direct Thrombin Inhibitors
Inhibit thrombin (factor IIa)
indications of argatroban and bivalrudin
treat HIT, and for patients undergoing procedures (PCI) who are at high risk for HIT
route of argatroban and bivalrudin
IV only
Adverse effects of argatroban and bivalrudin
bleeding
Argatroban should be cautioned in patients with what
hepatic dysfunction
What labs do we monitor with Direct thrombin inhibitors
Anti-Xa
H&H
platelets
What is aspirin
NSAID -
Blocks prostaglandin synthesis through the COX enzyme pathways
What does aspirin block
Platelet aggregation
what does aspirin prevent
platelets from clumping together
What are the indications of aspirin
prevent/treat MI,
prevent ischemic stroke
Route of aspirin
PO
What can you do in an acute event with aspirin
Chew a baby aspirin but cannot be enteric coated
