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pharm 2 > Hemo Drugs > Flashcards

Hemo Drugs Flashcards

1
Q

Anticoagulant Meds and how they work

A

Warfarin (Coumadin)
Heparin
Lovenox
Reduce fibrin formation - prevent clots from forming and growing

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2
Q

Antiplatlet meds and how they work

A

Clopidogrel (Plavix)
Desmopressin
Prevent platelets from clumping - prevent clots from forming and growing

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3
Q

Thrombolytic Meds and how they work

A

Aleteplase
Breaks up or dissolves clots

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4
Q

Warfarin Class/Use

A

Class - Anticoagulant
Use -Prevention of venous thrombosis, pulmonary embolism, during atrial fibrillation
* Prevention of thromboembolism in clients who have prosthetic heart valves
* Prevention of recurrent myocardial infarction

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5
Q

Warfarin Adverse Reactions

A

Hemorrhage
* Toxicity (overdose)

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6
Q

Warfarin Interventions

A

Monitor vital signs, checking for hypotension and tachycardia.
* For warfarin overdose, stop the drug and administer vitamin K parenterally
* If vitamin K cannot control bleeding, administer fresh frozen plasma or whole blood.

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7
Q

Warfarin Administration

A

Administer orally.
* Measure baseline vital signs and prothrombin time (PT), reported as an international normalized ratio (INR).
* Monitor INR; recommend reduced dosage for an INR above 2 to 3,
* Monitor PT/INR daily initially and eventually every 2 to 4 weeks.
* Expect anticoagulant effects to take 8 to 12 hr, with the full therapeutic effect in 3 to 5 days.
*

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8
Q

Warfarin Teaching

A

Report bruising, petechiae, bleeding, hematomas, or black tarry stool immediately.
Wear medical identification indicating warfarin use. Avoid excessive alcohol ingestion.

Tell them not to take over-the-counter NSAIDs, especially aspirin, or drugs containing salicylates.
Advise them to use an electric razor for shaving and a soft toothbrush

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9
Q

Warfarin Contraindications

A

Pregnancy risk - teratogenic
Vitamin K deficiency Thrombocytopenia
Liver disease
Alcoholism

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10
Q

Warfarin Precautions

A

Peptic ulcer disease
Severe hypertension
Severe hepatic or renal disease

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11
Q

Warfarin Interactions

A

Heparin, aspirin, acetaminophen (Tylenol), glucocorticoids, sulfonamides, and parenteral cephalosporins increase anticoagulation.
Phenobarbital (Luminal), carbamazepine (Tegretol), phenytoin (Dilantin), oral contraceptives, and vitamin K decrease anticoagulation.
Excessive intake of foods high in vitamin K, such as dark green leafy vegetables including cabbage, broccoli, and Brussels sprouts, mayonnaise, canola, and soybean oils decrease anticoagulation.

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12
Q

Heparin/enoxaparin (lovenox) Class/use

A

Anticoagulant
Prophylaxis for postoperative venous thrombosis and pulmonary emboli
* Acute myocardial infarction (with thrombolytic therapy)
* Ischemic complications of unstable angina and some dysrhythmias
* Disseminated intravascular coagulation

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13
Q

Heparin/enoxaparin (lovenox) Adverse Reactions

A

Bleeding/hemorrhage
* Thrombocytopenia (low platelet count)
* Hypersensitivity reactions

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14
Q

Heparin/enoxaparin (lovenox) Interventions

A

Monitor vital signs, checking for hypotension and tachycardia.
* Monitor activated partial thromboplastin time (aPTT), making sure it is no higher than twice the baseline value.
* For heparin overdose, stop heparin and administer protamine
* Stop heparin for platelet counts below 100,000/mm3
* Monitor for itching and rash or hives

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15
Q

Heparin/enoxaparin (lovenox) Administration

A

Measure baseline vital signs, CBC, platelet count, and hematocrit.
* Administer subcutaneously or IV, usually every 12 hr.
* Use an infusion pump for continuous IV administration; monitor rate of infusion every 30 to 60 min.
* Monitor aPTT every 4 to 6 hr initially, then monitor daily. (Enoxaparin does not require aPTT monitoring.)
* Administer deep subcutaneous injections in the abdomen at least 2 inches from the umbilicus and rotating sites; apply moderate pressure for 1 to 2 min after injection, do not rub.

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16
Q

Heparin/enoxaparin (lovenox) Teaching

A

Report bruising, petechiae, hematomas, or black tarry stools. Report calf pain, tenderness, or swelling immediately. Report shortness of breath.
Report itching, rash or hives.
Avoid use of OTC NSAIDs and aspirin
Advise them to use an electric razor for shaving and a soft toothbrush.

17
Q

Heparin/enoxaparin (lovenox) Precautions

A

Peptic ulcer disease
Severe hypertension
Severe hepatic or renal disease

18
Q

Heparin/enoxaparin (lovenox) Interactions

A

NSAIDs, aspirin and antiplatelet drugs increase bleeding risk.
IV nitroglycerin reduces anticoagulation.
Protamine reverses heparin activity.
Herbals ginger, ginkgo biloba, feverfew, and evening primrose oil increase bleeding risk.

19
Q

Clopidogrel(Plavix) Class/Use

A

Anti platelet
Inhibition of platelet aggregation for risk reduction related to myocardial infarction, transient ischemic attacks, coronary stents

20
Q

Clopidogrel (Plavix) Adverse Drug Reactions

A

Gastric upset, abdominal pain, diarrhea, nausea, gastric ulceration/ bleeding (less than aspirin)
* Bleeding (less likely than with aspirin)
* Thrombotic thrombocytopenic purpura - rare

21
Q

Clopidogrel (Plavix) Interventions

A

Monitor for signs of gastrointestinal bleeding (black or dark-colored stools, abdominal pain, nausea, hematemesis).
* Monitor for signs of bleeding (easy bruising, petechiae, excessive bleeding from minor injuries).
* Monitor for warning signs of hemorrhagic cerebrovascular accidents.
* Monitor for ecchymosis or petechial rash.
* Check platelet counts periodically.

22
Q

Clopidogrel (Plavix) Administration

A

Give daily dose orally, with or without food.
* Check platelet counts periodically.
* Discontinue 1 week before elective surgery.

23
Q

Clopidogrel (Plavix) Teaching

A

If needed, take with food, milk, or 8 oz of water to minimize gastrointestinal effects.
* If diarrhea occurs, drink plenty of clear fluids
* Report persistent gastric Irritation and signs of bleeding.
* Report any unusual or prolonged bleeding.
* Report sudden severe headache, weakness, numbness, paralysis, vision changes, nausea, vomiting, or seizures.
* Report easy bruising, bleeding gums, pinpoint purplish (petechial) rash.

24
Q

Clopidogrel (Plavix) Contraindications

A

Peptic ulcer disease
* Bleeding disorders
* Thrombocytopenia
* Intracranial bleeding

25
Q

Clopidogrel (Plavix) Precautions

A

Gastrointestinal bleeding
* Liver or kidney dysfunction
* High risk for bleeding

26
Q

Clopidogrel (Plavix) Interactions

A

Anticoagulants, NSAIDs, glucocorticoids, and alcohol increase bleeding risk.
* Proton pump inhibitors reduce antiplatelet effects.
* Herbal supplements ginger, ginkgo biloba, feverfew, and evening primrose oil increase bleeding risk.

27
Q

Desmopressin Class/Use

A

Anti platelet
Mild hemophilia A (controls trauma-induced bleeding and maintains hemostasis during surgery). Antidiuretic home - can cause fluid retention and edema

28
Q

Epoetin Class/Use

A

Erythropoietic Growth Factor
Supports production of erythrocytes

29
Q

Alteplase Class/Use

A

Thrombolytics
* Acute myocardial infarction
* Deep-vein thrombosis
* Massive pulmonary emboli

30
Q

Alteplase Adverse Reaction

A

Bleeding

31
Q

Alteplase Interventions

A

Limit venipuncture and injections.
* Apply pressure dressings to recent wounds.
* Monitor vital signs and signs of intracranial bleeding (level of consciousness, headache, unilateral weakness)
* Monitor aPTT, PT, INR, bleeding time, Hgb, and Hct.

32
Q

Alteplase Administration

A
  • Administer via IV infusion.
  • Give thrombolytic agents ASAP within onset of symptoms (less than 2 hr for MI,
  • Obtain baseline platelet counts, Hgb, Hct, aPTT, PT, INR, and fibrinogen levels, and monitor periodically.
  • Obtain baseline vital signs and monitor continuously.
  • Ensure adequate IV access for emergency drugs; have emergency equipment available.
  • Following thrombolytic therapy, administer heparin or aspirin to reduce the risk of repeat thrombosis.
    Aminocaproic acid for severe adverse reaction
33
Q

Alteplase Teaching

A
  • Report any unusual or prolonged bleeding.
  • Report of headache, or unilateral weakness.
34
Q

Alteplase Contratindications

A

Bleeding, head trauma, hemorrhage, closed head injury

35
Q

Alteplase Precautions

A

Severe hypertension
Active peptic ulcer disease

36
Q

Alteplase Interactions

A

Drugs that enhance bleeding (NSAIDs, heparin, warfarin [Coumadin], thrombolytics, and antiplatelets) increase bleeding risk.

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