Coagulation Modifier Drugs Flashcards
Alteplase (tissue plasminogen activator, t-Pa)
Functional Classification
Thrombolytic enzyme
Alteplase (tissue plasminogen activator t-Pa)
Mechanism of Action
Produces fibrin conversion of plasminogen to plasmin; able to bind to fibrin, convert plasminogen in thrombus to plasmin, which leads to local fibrinolysis, limited systemic proteolysis
Alteplase (tissue plasminogen activator t-Pa)
Uses
Lysis of obstructing thrombi associated with acute MI, ischemic conditions that require thrombolysis (i.e., PE, unclotting arteriovenous shunts, acute ischemic CVA), central venous catheter occlusion (Cathflo)
Alteplase (tissue plasminogen activator, t-Pa)
Contraindications
Active internal bleeding, history of CVA, severe uncontrolled hypertension, intracranial/intraspinal surgery/trauma (within 3 mo), aneurysm, brain tumor, platelets 1.7 or PR >15 sec, arteriovenous malformation, subarachnoid hemorrhage, intracranial hemorrhage, uncontrolled hypertension, seizure at onset of stroke
Alteplase (tissue plasminogen activator, t-Pa)
Side Effect
CV: SINUS BRADYCARDIA, CHOLESTEROL MICROEMBOLIZATION, VENTRICULAR TACHYCARDIA, ACCELERATED IDIOVENTRICULAR RHYTHM, BRADYCARDIA, RECURRENT ISCHEMIC STROKE, hypotension
EENT: OROLINGUAL ANGIOEDEMA
INTEG: urticaria, rash
SYST: GI, GU, INTRACRANIAL, RETROPERITONEAL BLEEDING, Surface Bleeding, ANAPHYLAXIS, fever
Alteplase (tissue plasminogen activator, t-Pa)
Nursing Considerations
ASSESS:
- Treatment is not recommended for patients with acute ischemic stroke >3hr after symptom onset or with minor neurologic deficits or rapidly improving symptoms
- VS, BP, pulse, respirations, neurologic signs, temp at least q4hr; temp >104 degree F (40 degree C) indicates internal bleeding; monitor rhythm closely; ventricular dysrhythmias may occur with hyperfusion; monitor heart, breath sounds, neurologic status, peripheral pulses; assess neurologic status, neurologic change may indicate intracranial bleeding; those with severe neurologic deficit (NIH SS>22) at presentation have increased risk of hemorrhage
- FOR BLEEDING during 1st hour of treatment and 24hr after procedure: hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis; guaiac all body fluids, stools; do not use 150mg or more total dose because intracranial bleeding may occur
- HYPERSENSITIVITY: fever, rash, itching, chills, facial swelling, dyspnea, notify prescriber immediately; stop product, keep resuscitative equipment nearby; mild reaction may be treated with antihistamines
- Previous allergic reactions or streptococcal infection; alteplase may be less effective
- BLOOD STUDIES (Hct, PLATELETS, PTT, PT, TT, APTT) BEFORE STARTING THERAPY; PT or APTT MUST BE LESS THAN 2x CONTROL BEFORE STARTING THERAPY TT OR PT q3-4hr DURING TREATMENT
- MI: ECG CONTINUOUSLY, CARDIAC ENZYMES, RADIONUCLIDE MYOCARDIAL SCANNING/CORONARY ANGIOGRAPHY; CHEST PAIN INTENSITY, CHARACTER; MONITOR THOSE WITH MAJOR EARLY INFARCT SIGNS ON CT SCAN WITH SUBSTANTIAL EDEMA, MASS EFFECT, MIDLINE SHIFT
- PE: PULSE, BP, ABGs, RATE/RHYTHM of RESPIRATIONS
- OCCLUSION: have patient exhale then hold breath when connecting/disconnecting syringe to prevent air embolism
- CHOLESTEROL EMBOLISM: purple toe syndrome, acute renal failure, gangrenous digits, hypertension, livedo reticularis, pancreatitis, MI, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, rhabdomyolysis
PERFORM/PROVIDE:
- Avoidance of invasive procedures, inj, rectal temp
- Pressure for 30 sec to minor bleeding sites; 30 min to sites of atrial puncture followed by pressure dressing; inform prescriber if this does not attain hemostasis; apply pressure dressing
Aspirin
Functional Classification
Nonopioid analgesic, non-steroidal anti-inflammatory, antipyretic, antiplatelet
Aspirin
Chemical Classification
Salicylate
Aspirin
Mechanism of Action
Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation
Aspirin
Uses
Mild to moderate pain or fever including RA, osteoarthritis, thromboembolic disorders; TIAs, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI
Aspirin
Contraindications
Pregnancy (D) 3rd trimester, breastfeeding, children <12yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine (FDC yellow dye #5), GI bleeding disorders, vit K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure intracranial bleeding, nasal polyps, urticaria
Aspirin
Side Effects
CNS: stimulation, drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, COMA
CV: rapid pulse, pulmonary edema
EENT: tinnitus, hearing loss
ENDO: hypoglycemia, hyponatremia, hypokalemia
GI: Nausea, Vomiting, GI BLEEDING, diarrhea, heartburn, anorexia, HEPATITIS
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA, increased PT, aPTT, bleeding time
INTEG: Rash, urticaria, bruising
RESP: wheezing, hyperpnea
SYST: REYE’S SYNDROME (CHILDREN), ANAPHYLAXIS, LARYNGEAL EDEMA
Aspirin
Nursing Considerations
ASSESS:
- PAIN: character, location, intensity; ROM before and 1 hr after administration
- FEVER: temp before and 1 hr after administration
- Hepatic studies: AST, ALT, bilirubin, creatinine if patient is receiving long-term therapy
- Renal studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure (long-term therapy)
- Blood studies: CBC, Hct, Hgb, PT if patient is receiving long-term therapy
- HEPATOTOXICITY: dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy
- ALLERGIC REACTIONS: rash, urticaria; if these occur, product may have to be discontinued; patients with asthma, nasal polyps, allergies: severe allergic reaction may occur
- OTOTOXICITY: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
- SALICYLATE LEVEL: therapeutic level 150-300mcg/ml for chronic inflammation
- Edema in feet, ankles, legs
- Product history; many product interactions
Aspirin
Overdose Treatment
Lavage, activated charcoal, monitor electrolytes, VS
Clopidogrel (Plavix)
Functional Classification
Platelet aggregation inhibitor
Clopidogrel (Plavix)
Chemical Classification
Thienopyridine derivative
Clopidogrel (Plavix)
Mechanism of Action
Inhibits ADP-induced platelet aggregation
Clopidogrel (Plavix)
Uses
Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina
Clopidogrel (Plavix)
Contraindications
hypersensitivity, active bleeding
Clopidogrel (Plavix)
Side Effects
CNS: headache, dizziness, depression, syncope, hypesthesia, neuralgia
CV: edema, hypertension, chest pain
GI: nausea, vomiting, diarrhea, constipation, GI discomfort, GI BLEEDING, PANCREATITIS, HEPATIC FAILURE
GU: GLOMERULONEPHRITIS
HEMA: epistaxis, purpura, BLEEDING, NEUTROPENIA, APLASTIC ANEMIA, AGRANULOCYTOSIS, THROMBOTIC THROMBOCYTOPENIC PURPURA
INTEG: rashm pruritus, ANAPHYLAXIS
MISC: UTI, hypercholesterolemia, chest pain, fatigue, INTRACRANIAL HEMORRHAGE, TOXIC EPIDERMAL NECROLYSIS, STEVENS-JOHNSON SYNDROME, flulike syndrome
MS: arthralgia, back pain
RESP: upper respiratory tract infection, dyspnea, rhinitis, bronchitis, cough, BRONCHOSPASM
Clopidogrel (Plavix)
Nursing Considerations
ASSESS:
- THROMBOTIC/ THROMBOCYTIC PURPURA, fever, thrombocytopenia, neurolytic anemia
- Symptoms of stroke, MI during treatment
- Hepatic studies: AST, ALT, bilirubin, creatinine (long-term therapy)
- Blood studies: CBC, differential, Hct, Hgb, PT, cholesterol (long-term therapy)
Dabigatran (Pradaxa)
Functional Classification
Anticoagulant-thrombin inhibitor
Dabigatran (Pradaxa)
Mechanism of Action
Direct thrombin inhibitor that inhibits both free and clot-bound thrombin, prevents thrombin-induced platelet aggregation and thrombus formation by preventing conversion of fibrinogen to fibrin
Dabigatran (Pradaxa)
Uses
Stroke/systemic embolism prophylaxis with nonvalvular atrial fibrillation
Dabigatran (Pradaxa)
Contraindications
Hypersensitivity, bleeding
Dabigatran (Pradaxa)
Side Effects
CNS: INTRACRANIAL BLEEDING CV: MYOCARDIAL INFARCTION GI: abdominal pain, dyspepsia, peptic ulcer, esophagitis, GERD, gastritis, GI BLEEDING HEMA: BLEEDING INTEG: rash, pruritus SYST: ANAPHYLAXIS (RARE)