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NCLEX > Coagulation Modifier Drugs > Flashcards

Coagulation Modifier Drugs Flashcards

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0
Q

Alteplase (tissue plasminogen activator, t-Pa)

Chemical Classification

A

Tissue plasminogen activator (TPA)

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1
Q

Alteplase (tissue plasminogen activator, t-Pa)

Functional Classification

A

Thrombolytic enzyme

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2
Q

Alteplase (tissue plasminogen activator t-Pa)

Mechanism of Action

A

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

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3
Q

Alteplase (tissue plasminogen activator t-Pa)

Uses

A

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)

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4
Q

Alteplase (tissue plasminogen activator, t-Pa)

Contraindications

A

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

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5
Q

Alteplase (tissue plasminogen activator, t-Pa)

Side Effect

A

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

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6
Q

Alteplase (tissue plasminogen activator, t-Pa)

Nursing Considerations

A

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
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7
Q

Aspirin

Functional Classification

A

Nonopioid analgesic, non-steroidal anti-inflammatory, antipyretic, antiplatelet

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8
Q

Aspirin

Chemical Classification

A

Salicylate

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9
Q

Aspirin

Mechanism of Action

A

Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation

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10
Q

Aspirin

Uses

A

Mild to moderate pain or fever including RA, osteoarthritis, thromboembolic disorders; TIAs, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI

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11
Q

Aspirin

Contraindications

A

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

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12
Q

Aspirin

Side Effects

A

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

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13
Q

Aspirin

Nursing Considerations

A

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
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14
Q

Aspirin

Overdose Treatment

A

Lavage, activated charcoal, monitor electrolytes, VS

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15
Q

Clopidogrel (Plavix)

Functional Classification

A

Platelet aggregation inhibitor

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16
Q

Clopidogrel (Plavix)

Chemical Classification

A

Thienopyridine derivative

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17
Q

Clopidogrel (Plavix)

Mechanism of Action

A

Inhibits ADP-induced platelet aggregation

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18
Q

Clopidogrel (Plavix)

Uses

A

Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina

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19
Q

Clopidogrel (Plavix)

Contraindications

A

hypersensitivity, active bleeding

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20
Q

Clopidogrel (Plavix)

Side Effects

A

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

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21
Q

Clopidogrel (Plavix)

Nursing Considerations

A

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)
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22
Q

Dabigatran (Pradaxa)

Functional Classification

A

Anticoagulant-thrombin inhibitor

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23
Q

Dabigatran (Pradaxa)

Mechanism of Action

A

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

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24
Q

Dabigatran (Pradaxa)

Uses

A

Stroke/systemic embolism prophylaxis with nonvalvular atrial fibrillation

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25
Q

Dabigatran (Pradaxa)

Contraindications

A

Hypersensitivity, bleeding

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26
Q

Dabigatran (Pradaxa)

Side Effects

A 
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)
27
Q

Dabigatran (Pradaxa)

Nursing Considerations

A

ASSESS:

  • BLEEDING: blood in urine or emesis, dark tarry stools, lower back pain; caution with arterial/venous punctures, catheters, NG tubes; monitor vital signs frequently; elderly more prone to serious bleeding
  • THROMBOSIS/MI/EMBOLI: swelling, pain, redness, difficulty breathing, chest pain, tachypnea, cough, coughing up blood, cyanosis
  • POST-THROMBOTIC SYNDROME: pain, heaviness, itching/tingling, swelling, varicose veins, brownish/reddish skin discoloration, ulcers; use of ambulation, compression stockings, adequate anticoagulation can prevent this syndrome
  • Serum Creatinine
28
Q

Enoxaparin (Lovenox)

Functional Classification

A

anticoagulant, antithrombotic

29
Q

Enoxaparin (Lovenox)

Chemical Classification

A

Low-molecular-weight heparin (LMWH)

30
Q

Enoxaparin (Lovenox)

Mechanism of Action

A

Binds to antithrombin III inactivating factors Xa/IIa, thereby resulting in a higher ratio of anti-factor Xa to IIa

31
Q

Enoxaparin (Lovenox)

Uses

A

Prevention of DVT (inpatient or outpatinet), PE (inpatient in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non-Q-wave MI

32
Q

Enoxaparin (Lovenox)

Contraindications

A

Hypersensitivity to this product, benzyl alcohol, heparin, pork; active major bleeding, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, heparin-induced thrombocytopenia

33
Q

Enoxaparin (Lovenox)

Side Effects

A 
CNS: fever, confusion
GI: nausea
HEMA: HEMORRHAGE, HYPOCHROMIC ANEMIA, THROMBOCYTOPENIA, BLEEDING
INTEG: ecchymosis, inj site hematoma 
META: hyperkalemia in renal failure 
SYST: edema, peripheral edema
34
Q

Enoxaparin (Lovenox)

Nursing Considerations

A

ASSESS:

  • Blood studies (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stools), anti-factor Xa (should be checked 4 hr after inj); thrombocytopenia may occur
  • Renal studies: BUN/creatinine baseline and periodically
  • BLEEDING: gums, petechiae, ecchymosis, black tarry stools, hematuria; notify prescriber
  • NEUROLOGIC SYMPTOMS in patients who have received spinal anesthesia
35
Q

Enoxaparin (Lovenox)

Overdose Treatment

A

Protamine SO4 1% sol; dose should equal dose of enoxaparin

36
Q

Eptfibatide

Functional Classification

A

Antiplatelet agent

37
Q

Eptifibatide

Chemical Classification

A

Glycoprotein IIb/IIIa inhibitor

38
Q

Eptifibatide

Mechanism of Action

A

Platelet glycoprotein antagonist; this agent reversibly prevents fibrinogen, von Willebrand’s factor from binding to the glycoprotein IIb/IIIa receptor, thus inhibiting platelet aggregation

39
Q

Eptifibatide

Uses

A

Acute coronary syndrome including those undergoing percutaneous coronary intervention (PCI)

40
Q

Eptifibatide

Contraindications

A

Hypersensitivity, active internal bleeding; history of bleeding, stroke within 2 yr; major surgery with severe trauma, severe hypertension, history of intracranial bleeding, current or planned use of another parenteral GP IIb/IIIa inhibitor, dependence on renal dialysis, coagulopathy, AV malformation, aneurysm

41
Q

Eptifibatide

Side Effects

A

CV: STROKE, hypotension
GU: hematuria
HEMA: THROMBOCYTOPENIA
SYST: BLEEDING, ANAPHYLAXIS

42
Q

Eptifibatide

Nursing Considerations

A

ASSESS:

  • THROMBOCYTOPENIA: platelets, Hgb, Hct, creatinine, PT/APTT baseline INR within 6 hr of loading dose, daily thereafter, patients undergoing PCI should have ACT monitored; maintain APTT 50-70 sec unless PCI to be performed; during PCI, ACT should be 200-300 sec; if platelets drop <100,000mm3, obtain additional platelet counts; if thrombocytopenia is confirmed, discontinue product; draw Hct, Hgb, serum creatinine
  • BLEEDING: gums, bruising, ecchymosis, petechiae; from GI, GU tract, cardiac cath sites, IM inj sites

PERFORM/PROVIDE:

  • Discontinue product prior to CABG
  • All medications PO if possible; avoid IM inj, all catheters
43
Q

Fondaparinux (Arixtra)

Functional Classification

A

Anticoagulant, antithrombotic

44
Q

Fondaparinux (Arixtra)

Chemical Classification

A

Synthetic, selective factor Xa inhibitor

45
Q

Fondaparinux (Arixtra)

Mechanism of Action

A

Acts by antithrombin III (ATIII)-mediated selective inhibition of factor Xa; neutralization of factor Xa interrupts blood coagulation and inhibits thrombin formation; does not inactivate thrombin (activated factor II) or affect platelets

46
Q

Fondaparinux (Arixtra)

Uses

A

Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery

47
Q

Fondaparinux (Arixtra)

Contraindications

A

Hypersensitivity to this product; hemophilia, leukemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocytopenic purpura, weight <30 ml/min), active major bleeding, bacterial endocarditis

48
Q

Fondaparinux (Arixtra)

Side Effects

A

CNS: Fever, confusion, headache, dizziness, Insomnia
GI: Nausea, Vomiting, diarrhea, dyspepsia, Constipation, increased AST, ALT
GU: UTI, urinary retention
HEMA: Anemia, minor bleeding, purpura, hematoma, THROMBOCYTOPENIA, MAJOR BLEEDING (INTRACRANIAL, CEREBRAL, RETROPERITONEAL HEMORRHAGE), POSTOPERATIVE HEMORRHAGE, HEPARIN-INDUCED THROMBOCYTOPENIA
INTEG: increased wound drainage, bullous eruption, local reaction-Rash, pruritus, inj site bleeding
META: hypokalemia
OTHER: hypotension, pain, Edema

49
Q

Fondaparinux (Arixtra)

Nursing Considerations

A

ASSESS:

  • Monitor patients who have received epidural/spinal anesthesia or lumbar puncture for neurological impairment
  • Blood studies (CBC, anti-Xa, Hgb/Hct, prothrombin time, platelets, occult blood in stools), thrombocytopenia may occur; if platelets <100,000/mm3, treatment should be discontinued; renal studies: BUN, creatinine
  • For bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria; decreased Hct, notify prescriber
  • For risk of hemorrhage if coadministering with other products that may cause bleeding
  • For hypersensitivity: rash, fever, chills; notify prescriber
50
Q

Heparin

Functional Classification

A

Anticoagulant, Antithrombotic

51
Q

Heparin

Mechanism of Action

A

Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III

52
Q

Heparin

Uses

A

Prevention of deep venous thrombosis, PE, MI, open heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with emoblization, as an anticoagulant in transfusion and dialysis procedures, prevention of DVT/PE, to maintain patency of indwelling venipuncture devices; diagnosis, treatment of DIC

53
Q

Heparin

Contraindications

A

hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, severe thrombocytopenic purpura, severe renal/hepatic disease, blood dyscrasias, severe hypertension, subacute bacterial endocarditis, acute nephritis; benzyl alcohol products in neonates/infants/pregnancy/lactation

54
Q

Heparin

Side Effects

A

CNS: Fever, chills, headache
GU: HEMATURIA
HEMA: HEMORRHAGE, THROMBOCYTOPENIA, ANEMIA
INTEG: Rash, dermatitis, urticaria, pruritus, delayed transient alopecia, hematoma, cutaneous necrosis (SUBCUT)
META: hyperkalemia, hypoaldosteronism
SYST: ANAPHYLAXIS

55
Q

Heparin

Nursing Considerations

A

ASSESS:

  • Bleeding, hemorrhage: gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, BP; HIT may occur after product discontinuation
  • Blood studies (Hct, occult blood in stools) q3mo
  • Partial prothrombin time, which should be 1.5-2.5x control; for continuous IV inf, check aPTT baseline 6hr after initiation and 6hr after any dose change; use aPTT for dosing adjustments; after therapeutic aPTT has been measured 2x, check aPTT daily
  • Platelet count q2-3days; thrombocytopenia may occur on 4th day of treatment
  • HYPERSENSITIVITY: rash, chills, fever, itching; report to prescriber
56
Q

Heparin

Overdose Treatment

A

Withdraw product, protamine 1mg protamine/100 units heparin

57
Q

Warfarin (Coumadin)

Functional Classification

A

Anticoagulant

58
Q

Warfarin (Coumadin)

Chemical Classification

A

Coumarin derivative

59
Q

Warfarin (Coumadin)

Mechanism of Action

A

Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit-K-dependent coagulation factors (II, VII, IX, X)

60
Q

Warfarin (Coumadin)

Uses

A

Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, thrombosis prophylaxis

61
Q

Warfarin (Coumadin)

Contraindications

A

Pregnancy (X), breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, hepatic disease (severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatic surgery with large open surface, bleeding tendencies of GI/GU/respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar anesthesia
Bleeding

62
Q

Warfarin (Coumadin)

Side Effects

A

CNS: Fever, dizziness, fatigue, headache, lethargy
CV: angina, chest pain, edema, hypotension, syncope
GI: Diarrhea, nausea, vomiting, anorexia, stomatitis, cramps, HEPATITIS, cholestatic jaundice
GU: HEMATURIA
HEMA: HEMORRHAGE, AGRANULOCYTOSIS, LEUKOPENIA, EOSINOPHILIA, anemia, ecchymosis, petechiae
INTEG: Rash, dermatitis, urticaria, alopecia, pruritus
MISC: epistaxis, hemoptysis, mouth ulcers, taste disturbances, priapism, dyspnea
MS: bone fractures
SYST: ANAPHYLAXIS, coma, cholesterol, microembolism, EXFOLIATIVE DERMATITIS, PURPLE TOE SYNDROME

63
Q

Warfarin (Coumadin)

Nursing Considerations

A

ASSESS:

  • Blood studies (Hct, PT, platelets, occult blood in stools) q3mo; INR: in hospital daily after 2nd or 3rd dose; when in therapeutic range for 2 consecutive days, monitor 2-3x wk for 1-2wk then less frequently, depending on stability of INR results; Outpatient: monitor every few days until stable doses then periodically thereafter, depending on stability of INR results
  • Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria; fatal hemorrhage can occur
  • Fever, skin rash, urticaria
64
Q

Warfarin (Coumadin)

Overdose Treatment

A

Administer vit K

NCLEX (40 decks)

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