IV heparin

Question 1

what should be avoided in pt on anticoags

Answer 1

no IM injections and arterial punctures

avoid ADA and NSAIDS if possible (unless cardiac pt)

Question 2

what type of labs would you want if pt is on heparin?

Answer 2

PTT, PT-INR, CBC, platelet count

Question 3

what is a therapeutic PTT and what is normal PTT

Answer 3

55-64 normal is 23-32

Question 4

antidote to heparin

Answer 4

protamine sulfate

Question 5

normal INR

Answer 5

0.9-1.1 seconds

Question 6

which labs are going to be taken q2 days on heparin

Answer 6

CBC and platelets

Question 7

why are platelets taken

why is CBC done

Answer 7

heparin has risk of thrombocytopenia

CBC to look at Hct (concerning if it falls as pt may have bleed..or anemia?)

Question 8

MoA of heparin

Answer 8

potentiates the inhibitory effect of antithrombin of factor Xa and thrombin. This prevents the conversion of fibrinogen to fibrin

Question 9

side effects of heparin

Answer 9

bleeding, anemia, thrombocytopenia

Question 10

assessments for nurse if pt on heparin

Answer 10

bleeding/hemmorhage eg hematuria, dec Hct, dec BP, tarry stol, bruising
thrombosis?
PTT
platelet
CBC for anemia and platelets

may cause hyperkalemia

Question 11

warfarin MoA

which lab do you look at

antidote

Answer 11

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

Question 12

how does clopidogrel work vs ASA

Answer 12

clopidogrel inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors

ASA inhibits prostaglandin synthesis which inhibits platelet aggregation

Question 13

which meds are preferred primary tx of PE or DVT

Answer 13

• Herapin and warfarin sodium (anticoag) are 1’ method for tx PE or acute DVT

Question 14

t or f heparin is used to tx current emboli

Answer 14

• Heparin is used to prevent recurrence of emboli but has no effect on emboli that are already present

Question 15

what is the half life of heparin

Answer 15

its dose dependent which is hwy they do so much monitoring of labs

Question 16

is heparin or warfarin the LT med. how does this switch occur

Answer 16

• 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

Question 17

how long after embolic event must pt use anticoag

Answer 17

• All pts must continue to take anticoag for 3-6mos after embolic event

Question 18

pt is unable to use heparinoid meds. what can they have instead?

Answer 18

• 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

Question 19

if pt needs thrombolytic what meds can you give them

Answer 19

Eg alteplase, urokinase, streptokinase can be used to tx PE esp if v compromised as it resoves the emboli more quickly

Question 20

what must you monitor before giving thrombolytic

Answer 20

• Before starting thrombolytic therapy look at prothrombin time, PTT, HCt, platelet

Question 21

how should you alter their meds before starting thrombolytic

Answer 21

stop heprin

Question 22

contraindications for thrombolytics

Answer 22

• Contra is bleeding intracranial stuff, strokes in past 2 mos, sx in past 10 days, severe HTN, LDR

Question 23

when making transition from warfarin to heparin what is nec

Answer 23

they should overlap for min 5 days or until PT-INR is in therapeutic range for 2 consecutive days before heparin is d/c

Question 24

how is heparin given IV

Answer 24

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??

Question 25

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

Answer 25

liver dysfx

thrombocytopenia, bleeding

Question 26

can you hang heparin without a primary infusion

Answer 26

no. it needs isotonic soln when given piggyback. it should have primary ssoln as emergency precaution

Question 27

if hanging a piggyback and a bolus how would the conc be different

Answer 27

bolus would have stronger []