IV heparin Flashcards
what should be avoided in pt on anticoags
no IM injections and arterial punctures
avoid ADA and NSAIDS if possible (unless cardiac pt)
what type of labs would you want if pt is on heparin?
PTT, PT-INR, CBC, platelet count
what is a therapeutic PTT and what is normal PTT
55-64 normal is 23-32
antidote to heparin
protamine sulfate
normal INR
0.9-1.1 seconds
which labs are going to be taken q2 days on heparin
CBC and platelets
why are platelets taken
why is CBC done
heparin has risk of thrombocytopenia
CBC to look at Hct (concerning if it falls as pt may have bleed..or anemia?)
MoA of heparin
potentiates the inhibitory effect of antithrombin of factor Xa and thrombin. This prevents the conversion of fibrinogen to fibrin
side effects of heparin
bleeding, anemia, thrombocytopenia
assessments for nurse if pt on heparin
bleeding/hemmorhage eg hematuria, dec Hct, dec BP, tarry stol, bruising thrombosis? PTT platelet CBC for anemia and platelets
may cause hyperkalemia
warfarin MoA
which lab do you look at
antidote
Interferes w hepatic synthesis of vitamin k dependent clotting factors (II, VII, IX, X).
looks like maybe more INR. they say PT-INR (which i think means INR?)
antidote is vitamin K
how does clopidogrel work vs ASA
clopidogrel inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors
ASA inhibits prostaglandin synthesis which inhibits platelet aggregation
which meds are preferred primary tx of PE or DVT
• Herapin and warfarin sodium (anticoag) are 1’ method for tx PE or acute DVT
t or f heparin is used to tx current emboli
• Heparin is used to prevent recurrence of emboli but has no effect on emboli that are already present
what is the half life of heparin
its dose dependent which is hwy they do so much monitoring of labs
is heparin or warfarin the LT med. how does this switch occur
- May change to oral therapy eg warfarin
- Continue heparin until INR is therapeutic (typically 2.0-2.5)
- High dose of subcut LMWH can be used to maint therapeutic PTT while oral therapy is adjusted
how long after embolic event must pt use anticoag
• All pts must continue to take anticoag for 3-6mos after embolic event
pt is unable to use heparinoid meds. what can they have instead?
• If pt cant have heparinoids they can have lepirudin and argatroban (direct thrombin inhibitors that need less freq monitoring). Same as heparin for contra and side other than side e of fever, abn liver fx, allergic skin rxn
if pt needs thrombolytic what meds can you give them
Eg alteplase, urokinase, streptokinase can be used to tx PE esp if v compromised as it resoves the emboli more quickly
what must you monitor before giving thrombolytic
• Before starting thrombolytic therapy look at prothrombin time, PTT, HCt, platelet
how should you alter their meds before starting thrombolytic
stop heprin
contraindications for thrombolytics
• Contra is bleeding intracranial stuff, strokes in past 2 mos, sx in past 10 days, severe HTN, LDR
when making transition from warfarin to heparin what is nec
they should overlap for min 5 days or until PT-INR is in therapeutic range for 2 consecutive days before heparin is d/c
how is heparin given IV
25000 units heparin in 500ml D5W= 50U/ml
then look at their weight and set the rate of infusion based on this…as well as give bolus??
judging by iv monograph which organ fx should you look at as its contraindicated if you have this
what are the main two side effects
liver dysfx
thrombocytopenia, bleeding
can you hang heparin without a primary infusion
no. it needs isotonic soln when given piggyback. it should have primary ssoln as emergency precaution
if hanging a piggyback and a bolus how would the conc be different
bolus would have stronger []
