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Pharm > Hematologic Meds > Flashcards

Hematologic Meds Flashcards

1
Q

Thrombin/Xa Inhibitor Prototype and Other drug names

A

heparin
Others: enoxaparin (Lovenox) (Low molecular meight heparins-LMWH)

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2
Q

thrombin/Xa inhibitors therapeutic uses

A

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

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3
Q

thrombin/xa inhibitor administration

A

IV, subQ

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4
Q

thrombin/xa inhibitor EPA

A

inhibits factor Xa and thrombin - blocking clotting process

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5
Q

thrombin/xa inhibitor ADRs

A

bleeding! Heparin-induced thrombocytopenia (HIT)

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6
Q

thrombin/xa inhibitors RN intervention and client education

A

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

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7
Q

thrombin/xa inhibitor contraindications and interactions

A

Anyone at risk for uncontrolled bleeding. Thrombocytopenia
NSAIDs
Antidote: Protamine sulfate

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8
Q

vit K antagonist prototype

A

warfarin (Coumadin)

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9
Q

vit K antagonist therapeutic use

A

long term management or prevention of venous thromboembolic disorders including:
- DVT
- PE
- Atrial fibrillation
- Mechanical heart valves

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10
Q

vit k antagonist administration

A

PO - takes 3-5 days to take effect

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11
Q

vit K antagonist EPA

A

acts on liver to prevent synthesis of vitamin K dependent clotting factors

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12
Q

vit K antagonist ADRs

A

bleeding!

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13
Q

vit k antagonist RN intervention and client education

A

Monitor for bleeding
Narrow therapeutic range - monitor the INR
- INR between 2-3
*keep consistent intake of vitamin K (green leafy veggies)

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14
Q

vit K antagonist contraindications and interactions

A

Teratogenic
Caution w/ clients at high risk for bleeding (ETOH, GI ulcers, thrombocytopenia)
MANY medications and herbs interact with warfarin
Antidote: vitamin K

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15
Q

direct thrombin inhibitors

A

PO: dabigatran (Pradaxa)
IV: argatroban, bivalrudin
- Anticoagulants given when pt develops heparin-induced thrombocytopenia (HIT)
NO antidote

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16
Q

direct Xa inhibitors

A

PO: rivaroxaban (Xarelto)
Antidote: Andexxa

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17
Q

antiplatelets: salicylates prototype

A

Aspirin (ASA)

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18
Q

salicylates therapeutic use

A

MI, CVA, TIA, coronary stents

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19
Q

salicylates administration

A

PO, rectal

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20
Q

salicylates EPA

A

inhibits platelet aggregation via inhibition of cyclooxygenase

21
Q

salicylates ADRs

A

gastric upset most common. Risk for bleeding. Renal damage
Toxicity = salicylism: tinnitus, HA, dizziness

22
Q

salicylates RN intervention and client education

A

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

22
Q

salicylates RN intervention and client education

A

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

23
Q

salicylates RN intervention and client education

A

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

24
Q

salicylates contraindications and interactions

A

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

25
Q

Antiplatelets: Adenosine Diphosphate receptor (ADP) Inhibitor Prototype

A

clopidogrel (Plavix)

26
Q

ADP inhibitor therapeutic use

A

MI, CVA, TIA, Coronary stents

27
Q

ADP inhibitor administration

A

PO - effects last 7-10 days

28
Q

ADP inhibitor EPA

A

inhibits platelet aggregation by blocking ADP receptors on PLTs

29
Q

ADP inhibitor ADRs

A

same as ASA - less rare but BAD = thrombotic

30
Q

ADP inhibitors RN intervention and client education

A

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

31
Q

ADP inhibitors contraindications and interactions

A

Caution w/ peptic ulcer disease and other bleeding disorders
Caution with anticoagulants
Herbal. PPIs reduce anti-plt effect

32
Q

thrombolytics prototype

A

alteplase - TPA

33
Q

thrombolytics therapeutic use

A

dissolves clot!
Systemic: ischemic CVA (w/in 3-4 hrs), MI (w/in 2 hrs)
Local: establish patency of central IV catheter

34
Q

thrombolytics administration

A

IV only - ICU/ER only!

35
Q

thrombolytics EPA

A

converts plasminogen into plasmin = breaks down fibrin in clot. Plasmin will prevent new clots from forming

36
Q

thrombolytics ADRs

A

EXTREME BLEEDING

37
Q

thrombolytics RN intervention and client education

A

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)

38
Q

thrombolytics contraindications and interactions

A

Very long checklist - recent surgery (2-4 weeks), head trauma, known aneurysm, any active bleeding, HTN

39
Q

Iron Supplements

A

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

40
Q

B12 Supplements

A

Cyanocobalamin (Vit B12)
- PO, subQ, IM, intranasal
ADRs: hypokalemia

40
Q

Folic acid supplements

A

Folate
- PO, subQ, IM/IV
ETOH abuse, malabsorption, pregnancy
Monitor reticulocyte count to determine effectiveness

40
Q

erythropoietic growth factor prototype and other drug names

A

epoetin alfa (Epogen)
Others: darbepoetin alfa - long acting version

41
Q

erythropoietic growth factor therapeutic use

A

chronic renal failure, pre-op anemia, w/ chemotherapy, w/ HIV treatment Zidovudine

42
Q

erythropoietic growth factor adminitration

A

IV (IV bolus 1-3), SubQ

43
Q

erythropoietic growth factor EPA

A

mimics erythropoietin in the bone marrow = production of RBCs

44
Q

erythropoietic growth factor ADRs

A

HTN, increased risk of cardiac/CVA events (Hg>11). Can cause progression of certain malignancies

45
Q

erythropoietic growth factor RN intervention and client education

A

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

46
Q

erythropoietic growth factor contraindications and interactions

A

Uncontrolled HTN
Caution in clients w/ cancer due to progression of disease (only when Hg<10)
w/ dialysis: may need more heparin

Pharm (13 decks)

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