Hematologic

Question 1

Anticoagulants: IV

+ heparin

Answer 1

LOW MOLECULAR WEIGHT HEPARIN: Enoxaparin

INDICATIONS: Stroke, PE, DVT, and other conditions requiring fast anticoagulation.

MODE OF ACTION: Activates antithrombin, inhibiting thrombus formation.

SIDE EFFECTS: BLEEDING. Heparin induced thrombocytopenia (HIT), hypersensitivity.

KEY POINTS: Closely monitor aPTT. THERAPEUTIC aPTT IS 1.5-2 TIMES BASELINE. ANTIDOTE IS PROTAMINE! MONITOR FOR BLEEDING ( coffee ground emesis, tarry stools). Use soft toothbrush, electric razor.

Question 2

Anticoagulants: Oral

+ warfarin (Coumadin)

Answer 2

INDICATIONS: Venous thrombosis, AFIB with thrombus. Prevention of Mls, TIAs, Pts, DVTs.

MODE OF ACTION: Antagonizes vitamin K, which prevents formation of several clotting factors.

SIDE EFFECTS: BLEEDING. GI upset, hepatitis.

KEY POINTS: Closely monitor PT/INR levels. THERAPEUTIC INR IS 2-3 (takes 3-5 days to get to therapeutic level). ANTIDOTE IS VITAMIN K! Advise patients to maintain a CONSISTENT intake of foods high in vitamin K. Monitor for bleeding. Use soft toothbrush, electric razor.

Question 3

Anticoagulant: Factor xa inhibitor

+ rivaroxaban (Xarelto)

Answer 3

INDICATIONS: Prevention of DVT, PE, stroke in patients with AFIB.

MODE OF ACTION: Selectively inhibits factor Xa, which blocks the coagulation cascade.

SIDE EFFECTS: BLEEDING, elevated liver enzymes.

KEY POINTS: Monitor liver function, hemoglobin, and hematocrit during therapy.

Question 4

Antiplatelets

+ aspirin

Answer 4

OTHER ANTIPLATELETS: Abciximab, clopidogrel

INDICATIONS: Prevention of MI, stroke.

MODE OF ACTION: Inhibits platelet aggregation.

SIDE EFFECTS: GI upset, BLEEDING, TINNITUS (ASPIRIN).

KEY POINTS: Do not give aspirin to children with fever (due to risk of Reye’s syndrome). Contraindicated in patients with bleeding disorders.

Question 5

Thrombolytic Medication

+ alteplase (Activase)

Answer 5

OTHER THROMBOLYTIC: Reteplase; many end in -ase.

INDICATIONS: MIs, strokes, PEs, and occluded central IVs.

MODE OF ACTION: Converts plasminogen to plasmin, which breaks up fibrinogen.

SIDE EFFECTS: BLEEDING! Contraindicated in patients who have had a hemorrhagic stroke, internal bleeding, recent trauma/surgery, severe hypertension.

KEY POINTS: SHOULD BE TAKEN WITHIN 3 HOURS OF SYMPTOMS. Closely monitor labs, vital signs. Limit venipuncture and IM injection.

Question 6

Erythropoiesis Growth Factors

+ epoetin alfa (Epogen)

Answer 6

INDICATIONS: Anemia; INCREASES PRODUCTION OF RED BLOOD CELLS in patients with anemia r/t chronic kidney disease, HIV, chemotherapy.

MODE OF ACTION: Stimulates bone marrow to increase production of RBCs.

SIDE EFFECTS: HYPERTENSION (due to increase in Hct), increased risk of DVT/stroke/MI.

KEY POINTS: Do not agitate vial. Monitor BP during therapy. Monitor Hgb, Hct twice a week. Ensure sufficient iron levels.

Question 7

Leukopoietic Growth Factors

+ filgrastim (Neupogen)

Answer 7

INDICATIONS: neutropenia; INCREASES PRODUCTION OF NEUTROPHILS and decreases risk of infection in neutropenic patients (r/t chemotherapy).

MODE OF ACTION: Causes bone marrow to increase production of neutrophils.

SIDE EFFECTS: Bone pain, LEUKOCYTOSIS (HIGH WBC LEVELS), splenomegaly.

KEY POINTS: Do not agitate vial. Monitor CBC twice a week.