Med affecting coagulation Flashcards
What is the action of an anticoagulant?
Prevents clotting by activating antithrombin-hence inactivates both thrombin and factor Xa.
Heparin is an anticoagulant-what are some therapeutic uses?/
Stroke, PE, DVT, prophylaxis against post op venous thrombosis ( hip/knee & abd surgery
What are the complications of heparin?
Hemorrhage, the risk of hematoma at a puncture site for spinal or epidural medication is increased while on heparin
What drug is given for heparin toxicity?
Protamine ( binds with heparin & forms a heparin-protamine complex with no anticoagulant properties). Give it IV slowly
What are nursing actions to know about heparin?
Advise clients to observe for bleeding, increased heart rate, decreased B/P, bruising, petechiae, hematomas, black-tarry stools, and labs must be monitored ( aPTT). Teach patients to use an electric razor & soft toothbrush
What is the lab test for heparin?
aPTT ( the lab value should be at 1.5-2 times the baseline
What are the contraindications for Heparin?
Contraindicated for a patient with a low platelet count, it should NOT be used during or after eye, brain, or spinal cord surgery, or lumbar puncture.
What are drug interactions with heparin?
Aspirin, NSAIDs, Garlic, Ginger, Glucosamine, Ginkgo biloba, Resveratrol- ( skin of grapes & blueberries)
What medication is a Vitamin K inhibitor?
Warfarin ( Brand name coumadin)
What is the action of Coumarins?
Antagonizes vitamin K which prevents the synthesis of 4 coagulation factors factor V11, IX, X & prothrombin
When is warfarin used? What conditions?
Prevention of venous thrombosis & PE, Afib, & Prosthetic heart valves
What are the complications of warfarin?
Hemorrhage & Hepatitis
If a patient has bleeding, what is given?
Vitamin K
If vitamin K cannot control the bleeding, what is ordered next?
The provider will order Fresh Frozen Plasma
What is the lab test for Warfarin ( Brand name - Coumadin)?
PT/INR
Enoxaparin- know what this does; Understand the differences between this and heparin
LMW, more effective for lowering the risk of venous thromboembolism ( VTE) in patients with acute stroke- can give it home, unlike heparin
What is enoxaparin?
It is a low molecular weight heparin ( LMW)
How is enoxaparin ( Lovenox) administered what route/
Administer deep subcutaneous injections in the abdomen ensuring a distance of 2 inches from the umbilicus* do not aspirate- Use a 22 or a 20-inch needle from the vial- then change the needle to a smaller needle ( 25-26 inch gauge) 1/2-5/8 inches long- apply gentle pressure for 1-2 minutes after the injection.
What are important actions to teach a patient or client when taking enoxaparin ( Lovenox)?
Advise clients to use an electric razor for shaving and a soft toothbrush, and avoid the use of over-the-counter ( OTC) NSAIDS or aspirin ( ASA). If they are self-administering the Rx at home and using prefilled syringes, do not expel air bubbles,
Monitor for indications of bleeding) gums bleeding, abdominal pain, nose bleeds, or coffee-ground emesis, and monitor for indications of bleeding (black-tarry stools) Unlike heparin there are no regular lab tests required.
What drug is administered for enoxaparin ( Lovenox) toxicity?
Protamine ( heparin antagonist) * administer slowly no faster than 20 mg per minute in 10 minutes
Describe how to administer a subcutaneous injection- the actual injection
Pinch up an area of skin, inject at a 90-degree angle and insert the needle completely. Do not aspirate, do not rub the site for 1-2 minutes after the injection.
What is the expected action of Alteplase often called tPA ( tissue plasminogen activator)
This is a thrombolytic medication that dissolves clots that have already formed. ( clots are dissolved by converting plasminogen to plasmin which actually destroys*** fibrinogen
What conditions is a tpA Alteplase used?
Acute myocardial infarction ( AMI), massive PE ( Pulmonary embolism) Acute ischemic stroke, last to restore patency to central IV catheters
What is the route of administration?
IV only
