Lepirudin (Refludan)

Question 1

• Therapeutic classification

Answer 1

anticoagulant

Question 2

• Pharmacologic Classification

Answer 2

Direct Thrombin Inhibitor

Question 3

Pregnancy Category

Answer 3

B

Question 4

• Mechanism of Action

Answer 4

o Directly inhibits action of thrombin without requiring intermediate step of antithrombin III inhibition

Question 5

• Indications:

Answer 5

HIT - heparin induced thrombocytopenia

Question 6

• Contraindictions

Answer 6

o Active bleeding

o aPTT ratio >2.5 (should be 1.5-2.5x laboratory control)

Question 7

• Precautions:

Answer 7

o	Severe HTN
o	Recent trauma
o	Recent surgery
o	Intracranial hemorrhage
o	Bacterial endocarditis
o	Renal impairment

Question 8

• Drug Interactions

Answer 8

o Potentiated effect with oral anticoags
o Bleeding with drugs that inhibit platelet aggregation
o Ginger, garlic, green tea, feverfew, gingko

Question 9

• Adverse Effects

Answer 9

o	Bleeding from puncture/wound site
o	Epistaxis
o	Hematuria
o	Vag bleeding
o	GI bleeding
o	Hypersensitivity

Question 10

• Serious Adverse Effects

Answer 10

o Abnormal Bleeding

Question 11

• Nursing Responsibilities

Answer 11

o	Complete health history
o	Baseline blood tests
o	Monitor aPTT
o	Collect blood for testing 30 minutes prior to dose
o	Monitor for signs of bleeding
o	Do not give oral anticoagulants

Question 12

• Patient/family teaching

Answer 12

o	Immediately report unusual bleeding
o	Avoid activities that may result in injury
o	Do not take other drugs supplements
o	Immediately report suspected pregnancy
o	Do not breast feed

Question 13

• Drugs Similar to Lepirudin

Answer 13

o	Argatroban (Acova, Novastan)
o	Bivalirudin (Angiomax)
o	Dabigatran (pradaxa)
o	Desirudin (Iprivask)