Pharm 36 Flashcards by Brandie Alnobani

Prevent the formation and exhaustion of a thrombus and are used prophylactically in clients who are at high risk for clot formation

Anticoagulants

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Have no direct effect on an existing thrombus and do not reverse damage cause from the thrombus

Anticoagulants

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Once the presence of a thrombus has been established ___ can prevent additional clots from forming

Anticoagulant therapy

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People leaving the hospital will have __ therapy

Po anticoagulant therapy

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Anticoagulants are contraindicated in clients with
SATA (6)

Known hypersensitivity
Active bleeding
Hemorrhagic disease
Tuberculosis
Leukemia
GI ulcers

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Anticoagulants are used in caution in all clients with

A potential site for bleeding or hemorrhage

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Anticoagulation effect with NSAIDS

Increased risk of bleeding

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Anticoagulation effect with oral contraceptives

Decrease effectiveness of the anticoagulant

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Warfarin should never be combined with __ & __

Ginkgo
Biloba

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Anticoagulants prevent thrombosis in the ___

Venous system

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Anti-platelet drugs are used to prevent thrombus formation in the

Arterial system

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Antiplatelet drugs are use cautiously in clients with

Pancytopenic
Renal impairment
Hepatic impairment

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Dissolves blood clots that have already formed within the walls of a blood vessel

Thrombolytic drugs

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Activase (streptokinase)

Theombolytic drugs

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Bleeding may be internal and involve areas such as __ __ __

GI tract
GU tract
Brain

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Bleeding may also be superficial (external) and seen at areas of broken skin such as __ __

Venipuncture sites
Recent surgical wounds

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When a thrombolytic is administered with __ ___ ___ the client is at increased risk of bleeding

Aspirin
Dipyridamole
Anticoagulant

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Pre admin assessment when a client is immobilized
SATA (4)

Vital signs
Inspect physical appearance, noting skin color, temp & pain, differences bilaterally
Palpate pedal pulses, noting rate & strength if lower limb is involved
Test for positive Homans sign, pain in calf when the foot is dorsiflexed, suggest DVT

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Ongoing assessment
SATA

Continually assess any signs of bleeding (gums,nose,stool,urine,nasogastric drainage)
Clients on warfarin first time require dose adjustment based on PT/INR

If PT exceeds __ times the control value or INR exceeds __, notify PCP before drug is given

1.2-1.5
3

SATA (3)
Should be performed throughout the corse of heparin therapy

Periodic
Platelet counts
Hematocrit
Tests for occult blood in stool

For those taking heparin by continuous Iv need __ taken periodically (usually every 4 hours)

Blood coagulation tests

Examine the __ and ___ in the client with DVT for signs of improvement

Skin temp
Color

Related to excessive bleeding because of drug therapy

Injury risk

Related to preparing to communicate drug use if incapacitated

Altered health seeking behavior

Related to fear of atypical bleeding during thrombolytic drug therapy

Anxiety

Optimal therapeutic results of warfarin are obtained when the clients PT is __ times the control value

1.2-1.5

Heparin prep unlike warfarin must be given by parental route preferably SATA(4)

Subcutaneous or Iv The onset of anticoagulation is almost immediate after a single dose Max effect occur w in 10 mins of admin Clotting time returns to normal with in 4 hrs unless redosed

Although warfarin is most often admin orally, an ___ form may be given for those who are unable to receive orally

Injectable

The dose of heparin is measured in __ and is available in various doses, EX:

Units 10,000 units/mL

Always have nurse check ___

Heparin

When heparin or other anticoagulants are given by subcu route, admin sites are __ and the site used is ___. The recommended sites for admin are those on the __, but areas w in __ in of the ___ are avoided because of the increased __ of that area

Rotated Documented on clients chart Abdomen 2 Umbilicus Vascularity

Drugs for DVT prevention (lovenox) are available in __, do not ___ they are administered deep __ tissue by __ the skin. Under the needle into the tissue at a __ angle so the __ is injected last. It is not necessary to __; this may aspirate the needle guard

Prefilled syringes Subcut Pinching a fold 90 Air bubble Aspirate

Withhold the drug immediately and contact the pcp if any of the following: SATA (3)

PT exceeds 1.5 times the control value There is evidence of bleeding INR is greater than 3

Be alert to the following indicators of bleeding

Decided drop in BP or a rise in pulse

Platelet count

150,000-350,000

APTT Range w heparin

120-140 seconds

Symptoms of warfarin OD

Melena Petechiae Oozing from superficial injuries Excessive menstruation

Should be readily available when client is receiving warfarin

Vitamin k (phytondadione)

Foods high in vitamin k SATA (8)

Leafy green veggies Beans Broccoli Cabbage Cauliflower Cheese Fish Yogurt

Protamine is a specific antidote for

Heparin or LMWHs

Oral anticoagulants Generic, trade, use

Warfarin (Coumadin) Prophylaxis/treatment of venous thrombosis

Parental anticoagulant Generic, use

Heparin Clotting prevention

Low molecular weight heparins 2 generic, 1 trade

Dalteparin Enoxaparin (lovenox)

Anti platelet agents 2 generic 2 trade 1 adverse reaction

Clopidogrel (plavid ) skin rash, constipastion Dipyridamole (persantine)

Anticoagulant antagonist Generics, trades, uses

Phytonadione (vitamin k) (mephyton) (aqua-k) (aquamephyton) Treatment of warfarin OF, prophylaxis of K deficiency of newborns) Protamine Treatment of heparin OD