Medications Affecting Coagulation Flashcards
What is the therapeutic action of heparin and low molecular weight heparin?
Interfere with the clotting cascade and fibrin formation, which prevents clots from forming or clots from getting any bigger. DO NOT DISSOLVE CLOTS
What is the therapeutic action of heparin and low molecular weight heparin?
Interfere with the clotting cascade and fibrin formation, which prevents clots from forming or clots from getting any bigger.
What is the therapeutic use for heparin and low molecular weight heparin?
Used for condition where developing clots is a problem
For example: CAD, stroke, pulmonary embolism, massive DVTs, dialysis, prophylaxis for post operation or long term bedrest, treatment of DIC
How are the forms of heparin administered?
IV or subcutaneous
With DIC, when is it best to treat this condition with forms of heparin?
during the actual clotting process of DIC, becuase later on in the disease process the body will have used up all of its clotting factors and the patient will be at a very high risk for bleeding.
What are some adverse effects of parenteral anticoagulants like heparin?
Hemorrhage
Heparin-induced thrombocytopenia
What are some nursing considerations for parenteral anticoagulants like heparin?
monitor vitals
look for signs of bleeding (internal and external)
avoid falls! (risk of bleeds)
monitor aPTT (activated partial thromboplastin time)
monitor platelets (throughout and some time after therapy)
What is a medication to reverse an overdose of heparin?
protamine sulfate
administer slowly (no faster than 20mg/minute
What is the therapeutic aPTT range for heparin treatment?
1.5-2 times the baseline (60-80 seconds)
At what platelet count should heparin treatment be stopped?
In what patients is heparin treatment contraindicated?
bleeding disorders
low platelet count
severe HTN (risk for intercranial bleeds)
dont take with aspirin (thins blood)
dont take with NSAIDs (increase risk for gastric ulcers and bleeds
What are some internal and external signs of bleeding?
Increased heart rate (decrease in CO)
BP (late sign, may drop because of loss of volume)
collection from foley bag
GI bleeds (black tarry stool is upper GI and bright red is lower GI)
Changes in loc (intercranial bleed)
INTERCRANIAL BLEED IS MOST CONCERING
What are the two different “types” of heparin-induced throbocytopenia?
one can happen just a few days after exposure and will correct in a few days
the second type doesnt normally happen until 6-10 days into therapy
ANTIBODIES ARE BEING FORMED TO ATTACK OUR PLATELETS IN RESPONSE TO HEPARIN
What are some precautions for IV heparin?
use a IV PUMP for continuous drip
double check dosage with another nurse
monitor infusion and look for bleeding every 30-60 minutes
monitor aPTT every 4-6 hours until therapeutic range is maintained, then monitor daily
monitor VS
get baseline CBC, platelets, and HCT levels (HCT and HGB drop may indicate bleeding)
How do you administer SQ heparin?
withdraw medication with 20-22 gauge needle
change needles to 25-26 1/2 gauge
inject into deep subcutaneous tissue 2 inches from umbilicus (pinch fold of skin) DONT ASPIRATE
Apply pressure for 1-2 minutes, DONT MASSAGE
record and rotate sites
monitor for bleeding
How do you administer SQ heparin?
withdraw medication with 20-22 gauge needle
change needles to 25-26 1/2 gauge
inject into deep subcutaneous tissue 2 inches from umbilicus (pinch fold of skin)
Apply pressure for 1-2 minutes, DONT MASSAGE
record and rotate sites
monitor for bleeding
What is the therapeutic use for heparin and low molecular weight heparin?
Used for condition where developing clots is a problem
For example: CAD, stroke, pulmonary embolism, massive DVTs, dialysis, prophylaxis for post operation or long term bedrest, treatment of DIC
How are the forms of heparin administered?
IV or subcutaneous
With DIC, when is it best to treat this condition with forms of heparin?
during the actual clotting process of DIC, becuase later on in the disease process the body will have used up all of its clotting factors and the patient will be at a very high risk for bleeding.
What are some adverse effects of parenteral anticoagulants like heparin?
Hemorrhage
Heparin-induced thrombocytopenia
What are some nursing considerations for parenteral anticoagulants like heparin?
monitor vitals
look for signs of bleeding (internal and external)
avoid falls! (risk of bleeds)
monitor aPTT (activated partial thromboplastin time)
monitor platelets (throughout and some time after therapy)
What is a medication to reverse an overdose of heparin?
protamine sulfate
administer slowly (no faster than 20mg/minute
What is the therapeutic aPTT range for heparin treatment?
1.5-2 times the baseline (60-80 seconds)
At what platelet count should heparin treatment be stopped?
In what patients is heparin treatment contraindicated?
bleeding disorders
low platelet count
severe HTN (risk for intercranial bleeds)
dont take with aspirin (thins blood)
dont take with NSAIDs (increase risk for gastric ulcers and bleeds
What are some internal and external signs of bleeding?
Increased heart rate (decrease in CO)
BP (late sign, may drop because of loss of volume)
collection from foley bag
GI bleeds (black tarry stool is upper GI and bright red is lower GI)
Changes in loc (intercranial bleed)
INTERCRANIAL BLEED IS MOST CONCERING
What are the two different “types” of heparin-induced throbocytopenia?
one can happen just a few days after exposure and will correct in a few days
the second type doesnt normally happen until 6-10 days into therapy
ANTIBODIES ARE BEING FORMED TO ATTACK OUR PLATELETS IN RESPONSE TO HEPARIN
What are some precautions for IV heparin?
use a IV PUMP for continuous drip
double check dosage with another nurse
monitor infusion and look for bleeding every 30-60 minutes
monitor aPTT every 4-6 hours until therapeutic range is maintained, then monitor daily
monitor VS
get baseline CBC, platelets, and HCT levels (HCT and HGB drop may indicate bleeding)
How would we know when therapeutic range is being maintained with heparin?
when 2-4 labs come back in therapeutic range
How do you administer SQ heparin?
withdraw medication with 20-22 gauge needle
change needles to 25-26 1/2 gauge
inject into deep subcutaneous tissue 2 inches from umbilicus (pinch fold of skin)
Apply pressure for 1-2 minutes, DONT MASSAGE
record and rotate sites
monitor for bleeding
How do you administer enoxaparin (low molecular weight heparin) SQ?
Same as heparin, only difference is lab monitoring isnt required and you can teach the patient to do this at home
DO NOT REMOVE BUBBLE IF IT IS PRE-FILLED BOTTLE (the bubble is injected last and creates a seal when needle is removed, this prevents leak of the medication out of injection site and prevents bruising)
what is enoxaparin usually used for?
prophylaxis and prevention of DVT
Do you need to monitor aPTT with enoxaparin?
NO NO NO
What is some patient education related to anticoagulants?
teach home administration techniques for lovenox
tell patient about adverse effects and about signs of bleeding (be specific) and make sure they know that they are going to bleed easier
advise patient not to take OTC/herbal remedies or other medications, may increase the risk for bleeding so consult with doctor (garlic is known as anticoagulant)
USE AN ELECTRIC RAZOR AND A SOFT TOOTHBRUSH
tell the patient not to take aspirin or other NSAIDs
what is the therapeutic action of warfarin?
prevents the development of coagulation factors, antagonize vitamin K
How is warfarin administered?
PO
What pregnancy category is warfarin?
category X
What are some therpeutic uses for warfarin?
treat DVTs, clot formation in atrial fibrillation (clot can form and stick to heart wall, when heart is cardioverted strong pumps can break clot free) and prosthetic heart valves (rest of life), prevent pulmonary embolus and DVTs.
Describe the anticoagulant therapy of a patient admitted with a PE.
The patient will more than likely be started on a heparin drip, and once they become stable enough to go home but are still at risk for another clot they might be sent home of warfarin.
enoxaparin will not be used in this situation because it isnt strong enough for a situation where a known clot has formed.
What are some adverse effects of warfarin?
hemorrhage
hepatits
What are some nursing considerations for patients taking warfarin?
Same as heparin EXCEPT:
for overdose administer IV vitamin K (phytonadion) and if that isnt effective give patient FFP (fresh frozen plasma) or whole blood
monitor PT (prothrombin time) and INR (international normalized ratio)
Monitor liver function and enzymes
what is the normal PT and INR range for warfarin therapy?
PT - 1.5-2.5 times normal (18-24 seconds)
INR: 2-3
When is warfarin contraindicated?
bleeding disorders, low platelet counts, liver disorders, vitamin k deficiencies, severe HTN (high risk for intracranial bleeds), aspirin or NSAIDs
when is warfarin usually administered during the day?
1700 because PT and INR need to be done prior to dosing, this allows time for them to be done and interpreted.
What are some patient teaching point for warfarin (oral anticoagulant)?
same as IV EXCEPT:
avoid foods high in vitamin K (negates effect) like dark leafy green veggies, cabbage, brussel sprouts, mayo)
many drug-drug interactions (highly protein bound)
Stop 3-5 days before surgery
avoid alcohol (liver damage and increase risk for bleeding)
keep lab appointments
wear medical alert bracelet
monitor PT/INR at home
What is the therapeutic action of antiplatelets?
prevents platelets from clumping together, inhibits platelet aggregation which alters bleeding times
What pregnancy category is aspirin?
Category D
what pregnancy category is clopidogrel?
category C
What are some therapeutic uses for antiplatelet drugs?
prevent MI and stroke (low dose or baby aspirin)
treatment of MI (full 325mg dose)
acute coronary syndrome (clopidogrel)
what are some adverse effects of antiplatelets?
GI effects
hemorrhagic stroke
bleeding
tinnitus (ringing in ears), hearing loss
what are some nursing considerations for antiplatelets?
Give aspirin with food and do not crush or chew if eneteric coated
prevent falls, report signs of hemorrhagic stroke (aspirin)
Monitor for signs of bleeding, stop treatment if bleeding and call physician
If patient experiences hearing loss or tinnitus stop treatment and call physician (just aspirin)
When is aspirin contraindicated?
bleeding disorders
renal/liver dysfunction
severe HTN
Why shouldnt we treat children or teenagers with chickenpox or the flu with aspirin?
There has been a link to the use of aspirin during viral disease and the development of reyes syndrome in children and teenagers.
what is the therapeutic affect of thrombolytics?
dissolve blood clots by converting plaminogen to plasmin which destroys fibrinogen
THESE ACTUALLY DISSOLVE CLOTS
when are thrombolytics primarily used?
used in emergency situations for things like thromboembolic stroke and MI
What is the time frame for administration of thrombolytics?
within 3 hours of symptoms
When are thrombolytics contraindicated?
bleeding disorders, trauma/surgery, recent stroke, severe HTN
What are the primary adverse effects of thrombolytics?
bleeding (internal and external, intracranial most important)
How can the effects of thrombolytics be reversed?
aminocaproic acid
Are thrombolytics serious drugs?
YES YES YES
always weigh the benefits and risks of using
patient has a high risk of bleeding, and can die from it
