exam 3: clotting Flashcards
anticoagulation meds
- heparin
- enoxaparin
- warfarin
- apixaban
antiplatelet meds
- aspirin
- clopidogrel
thrombolytic med
alteplase
heparin action
- prevention of thromboembolism
- inactivated thrombin, thus preventing the fibrinogen converting to fibrin
disorders heparin prevents thromboembolisms with
- PE
- MI
- unstable angina
- artificial heart valves
- DVT
- DIC (disseminated intravascular coagulation)
why is heparin given SQ/IV?
poorly absorbed in the GI system
heparin s/e
- itching
- chills
- hematoma
- epistaxis
- hematuria
major s/e of heparin
- anemia
- bone fractures
- osteoporosis
- GI bleeding
- hemorrhage
- thrombocytopenia
heparin antidote
protamine sulfate
pt education for heparin
avoid large amounts of green leafy vegetables d/t vitamin k
enoxaparin action
- prevention of VTE, DVT, or PE
- treatment of DVT with or without PE
enoxaparin BBW
administering two heparin products concomitantly can result in serious harm or death
common s/e of enoxaparin
- bleeding
- hematoma
- fever
- anemia
- peripheral edema
- elevated liver enzymes
major s/e of enoxaparin
- hemorrhage
- hematuria
enoxaparin contraindications
- stroke
- peptic ulcers
- hypersensitivity to pork
- active bleeding
enoxaparin nursing considerations
- should not be given to eye, brain or spinal surgery pts
- do not expel the air in the syringe
pt education for enoxaparin
avoid large amounts of green leafy vegetables, coffee, tea
warfarin action
inhibits hepatic synthesis of vitamin k clotting factors
warfarin indication
prevention of thrombophlebitis, PE, and embolism formation r/t stroke
common s/e of warfarin
- nausea
- GI cramping
- ecchymosis
- h/a
major s/e of warfarin
- black tarry stool
- hemorrhage
BBW for warfarin
crosses placenta
may cause fetal fatality from hemorrhage
what to monitor during warfarin therapy
- PT/INR
- hematuria and occult blood stool
- hepatic function (AST/ALT)
pt education for warfarin
- eat balanced levels of vitamin k rich foods
- use soft toothbrush, floss carefully, utilize electric razor
- report bleeding
apixaban action
inhibits the conversion of prothrombin to thrombin in the prevention of clot formation
apixaban treats. . .
- DVT
- PE
- stroke prevention
- a-fib
common s/e of apixaban
- hematoma
- anemia
- bleeding
- epistaxis
- hematuria
- menorrhagia
- hemoptysis
major s/e of apixaban
- bleeding (vaginal, GI, intracranial)
- hypotension
contraindications for apixaban
- active bleeding
- severe hypersensitivity
labs to monitor with apixaban
- CBC, platelet count
- PT/INR
aspirin prevents/treats. . .
- MI
- TIA
- a-fib
- prophylaxis for TE
excessive amounts of aspirin can lead to. . .
- SJS
- anaphylaxis
- laryngeal edema
common s/e of aspirin
- tinnitus
- dyspepsia
- GI upset
- nausea
- increased bleeding
- anemia
major s/e of aspirin
toxicity
- tinnitus
- hyperventilation
- confusion
- lethargy
- agitation
labs to monitor with aspirin
- prolonged bleeding time
- hepatic function
pt teaching for aspirin
- avoid alcohol
- inform HCP of med prior to surgery
clopidogrel action
inhibition of platelet aggregation- prevention of ADP bonding with the platelet receptor site
common s/e of clopidogrel
- abdominal pain
- dizziness
- epistaxis
- h/a
- hematoma
- diarrhea
- constipation
- purpura
- peripheral edema
MAJOR s/e of clopidogrel
- bleeding
- peptic ulcer
- intracranial bleeding
life threatening s/e of clopidogrel
- aplastic anemia
- agranulocytosis
- SJS
- pancytopenia
- thrombocytopenia
agranulocytosis
severe neutropenia
contraindications for clopidogrel
- GI bleed
- intracranial hemorrhage
administer clopidogrel with caution in pts with. . .
- hepatic/renal disease
- surgery
- peptic ulcer
- trauma
labs to monitor with clopidogrel
- prolonged bleeding time
- CBC
- platelet count
pt education for clopidogrel
- effects are decreased with grapefruit juice
- call PCP if fever, chills, core throat or unusual bleeding/bruising occur
med that needs to be discontinued a minimum of 5 days prior to surgery
clopidogrel
alteplase action
promotes plasminogen to plasmin —> breakdown of fibrin clots
alteplase treats. . .
- ischemic CVA or PE
- occluded central lines
thromboembolism
occlusion of an artery or vein caused by a thrombus or embolus
thromboembolism results in. . .
ischemia: deficient blood flow possibly causing tissue necrosis in obstructed area
common s/e of alteplase
- epistaxis
- hypotension
- ecchymosis
- rash
major s/e of alteplase
- anaphylaxis
- HTN
- MI
- cerebral edema
life threatening s/e of alteplase
- stroke
- dysrhythmia
- pulmonary edema
- renal failure
contraindications for alteplase
- internal bleeding
- bleeding disorders
- severe liver dysfunction
- head trauma
use caution with these pts if prescribed alteplase
- a-fib
- hepatic/renal disease
- CABG
- PUD
what to monitor when administering alteplase
- PT/aPTT
- H/H, platelets
- neuro status
avoid administering clotting medications concurrently with. . .
- NSAIDs
- SSNRIs
- SSRIs
