Hematologic Meds Flashcards
Thrombin/Xa Inhibitor Prototype and Other drug names
heparin
Others: enoxaparin (Lovenox) (Low molecular meight heparins-LMWH)
thrombin/Xa inhibitors therapeutic uses
treat anyone with a blood clot or at risk for a blood clot:
Acute MI
Ischemic stroke
Given prophylactically to clients after major surgery and on bedrest or limited activity to prevent blood clots from forming
thrombin/xa inhibitor administration
IV, subQ
thrombin/xa inhibitor EPA
inhibits factor Xa and thrombin - blocking clotting process
thrombin/xa inhibitor ADRs
bleeding! Heparin-induced thrombocytopenia (HIT)
thrombin/xa inhibitors RN intervention and client education
Watch for bleeding: easy bleeding, black tarry stools
IV heparin is a HIGH ALERT MEDICATION
aPTT of UFH is used to monitor for therapeutic levels of IV heparin (q6hours)
- aPTT: 1.5-2x clients baseline
Monitor platelet count
Pt education: Soft toothbrush, Electric razor
thrombin/xa inhibitor contraindications and interactions
Anyone at risk for uncontrolled bleeding. Thrombocytopenia
NSAIDs
Antidote: Protamine sulfate
vit K antagonist prototype
warfarin (Coumadin)
vit K antagonist therapeutic use
long term management or prevention of venous thromboembolic disorders including:
- DVT
- PE
- Atrial fibrillation
- Mechanical heart valves
vit k antagonist administration
PO - takes 3-5 days to take effect
vit K antagonist EPA
acts on liver to prevent synthesis of vitamin K dependent clotting factors
vit K antagonist ADRs
bleeding!
vit k antagonist RN intervention and client education
Monitor for bleeding
Narrow therapeutic range - monitor the INR
- INR between 2-3
*keep consistent intake of vitamin K (green leafy veggies)
vit K antagonist contraindications and interactions
Teratogenic
Caution w/ clients at high risk for bleeding (ETOH, GI ulcers, thrombocytopenia)
MANY medications and herbs interact with warfarin
Antidote: vitamin K
direct thrombin inhibitors
PO: dabigatran (Pradaxa)
IV: argatroban, bivalrudin
- Anticoagulants given when pt develops heparin-induced thrombocytopenia (HIT)
NO antidote
direct Xa inhibitors
PO: rivaroxaban (Xarelto)
Antidote: Andexxa
antiplatelets: salicylates prototype
Aspirin (ASA)
salicylates therapeutic use
MI, CVA, TIA, coronary stents
salicylates administration
PO, rectal
salicylates EPA
inhibits platelet aggregation via inhibition of cyclooxygenase
salicylates ADRs
gastric upset most common. Risk for bleeding. Renal damage
Toxicity = salicylism: tinnitus, HA, dizziness
salicylates RN intervention and client education
Monitor for bleeding
Monitor kidney function
Avoid ETOH - Increased risk of bleeding
Educate client on s/sx of salicylism - should call provider if they develop
salicylates RN intervention and client education
Monitor for bleeding
Monitor kidney function
Avoid ETOH - Increased risk of bleeding
Educate client on s/sx of salicylism - should call provider if they develop
salicylates RN intervention and client education
Monitor for bleeding
Monitor kidney function
Avoid ETOH - Increased risk of bleeding
Educate client on s/sx of salicylism - should call provider if they develop
salicylates contraindications and interactions
Do not give to children <18 = Reye’s syndrome (vomiting, confusion, loss of consciousness, seizures).
Caution w/ peptic ulcer disease. Caution if given w/ anticoagulants
Ibuprofen decreases anti-plt effect
ACE/ARBs = increased risk of renal damage
Antiplatelets: Adenosine Diphosphate receptor (ADP) Inhibitor Prototype
clopidogrel (Plavix)
ADP inhibitor therapeutic use
MI, CVA, TIA, Coronary stents
ADP inhibitor administration
PO - effects last 7-10 days
ADP inhibitor EPA
inhibits platelet aggregation by blocking ADP receptors on PLTs
ADP inhibitor ADRs
same as ASA - less rare but BAD = thrombotic
ADP inhibitors RN intervention and client education
Monitor for bleeding: GI bleeding (black tarry stool, hematemesis), Bruising. Petechiae - concern for TTP, Check PLT count periodically
Discontinue 5-7 days prior to elective surgeries
Take w/ food to minimize GI upset
Avoid ETOH
ADP inhibitors contraindications and interactions
Caution w/ peptic ulcer disease and other bleeding disorders
Caution with anticoagulants
Herbal. PPIs reduce anti-plt effect
thrombolytics prototype
alteplase - TPA
thrombolytics therapeutic use
dissolves clot!
Systemic: ischemic CVA (w/in 3-4 hrs), MI (w/in 2 hrs)
Local: establish patency of central IV catheter
thrombolytics administration
IV only - ICU/ER only!
thrombolytics EPA
converts plasminogen into plasmin = breaks down fibrin in clot. Plasmin will prevent new clots from forming
thrombolytics ADRs
EXTREME BLEEDING
thrombolytics RN intervention and client education
VERY close monitoring
- Continuous VS
- Neuro checks for 24hrs
- Emergency equipment available
Monitor CBC and coagulation labs
Limited punctures
- Get IV, foley, NGT - before admin
reversal : aminocaproic acid (Amicar)
thrombolytics contraindications and interactions
Very long checklist - recent surgery (2-4 weeks), head trauma, known aneurysm, any active bleeding, HTN
Iron Supplements
Iron = necessary component for RBC
Ferrous sulfate (Feosol) - PO
Iron dextran - IV, IM
- Anaphylactic rxns
ADR: GI disturbances
- Better to take on an empty stomach but can give w/ food to decrease GI upset (will have less absorption)
Antacids reduce absorption
Can cause dark stools!
Iron toxicity - Deferoxamine
B12 Supplements
Cyanocobalamin (Vit B12)
- PO, subQ, IM, intranasal
ADRs: hypokalemia
Folic acid supplements
Folate
- PO, subQ, IM/IV
ETOH abuse, malabsorption, pregnancy
Monitor reticulocyte count to determine effectiveness
erythropoietic growth factor prototype and other drug names
epoetin alfa (Epogen)
Others: darbepoetin alfa - long acting version
erythropoietic growth factor therapeutic use
chronic renal failure, pre-op anemia, w/ chemotherapy, w/ HIV treatment Zidovudine
erythropoietic growth factor adminitration
IV (IV bolus 1-3), SubQ
erythropoietic growth factor EPA
mimics erythropoietin in the bone marrow = production of RBCs
erythropoietic growth factor ADRs
HTN, increased risk of cardiac/CVA events (Hg>11). Can cause progression of certain malignancies
erythropoietic growth factor RN intervention and client education
Monitor Hg levels
- Report if over 12 OR raise more than 1 gram/dc within 2 weeks
- w/ CA pt - Hg over 10
Monitor BP
Lowest dose possible needed
Client: report signs of MI/CVA
Encourage folic acid, B12, iron
erythropoietic growth factor contraindications and interactions
Uncontrolled HTN
Caution in clients w/ cancer due to progression of disease (only when Hg<10)
w/ dialysis: may need more heparin
