Pharm 36 Flashcards
Prevent the formation and exhaustion of a thrombus and are used prophylactically in clients who are at high risk for clot formation
Anticoagulants
Have no direct effect on an existing thrombus and do not reverse damage cause from the thrombus
Anticoagulants
Once the presence of a thrombus has been established ___ can prevent additional clots from forming
Anticoagulant therapy
People leaving the hospital will have __ therapy
Po anticoagulant therapy
Anticoagulants are contraindicated in clients with
SATA (6)
Known hypersensitivity
Active bleeding
Hemorrhagic disease
Tuberculosis
Leukemia
GI ulcers
Anticoagulants are used in caution in all clients with
A potential site for bleeding or hemorrhage
Anticoagulation effect with NSAIDS
Increased risk of bleeding
Anticoagulation effect with oral contraceptives
Decrease effectiveness of the anticoagulant
Warfarin should never be combined with __ & __
Ginkgo
Biloba
Anticoagulants prevent thrombosis in the ___
Venous system
Anti-platelet drugs are used to prevent thrombus formation in the
Arterial system
Antiplatelet drugs are use cautiously in clients with
Pancytopenic
Renal impairment
Hepatic impairment
Dissolves blood clots that have already formed within the walls of a blood vessel
Thrombolytic drugs
Activase (streptokinase)
Theombolytic drugs
Bleeding may be internal and involve areas such as __ __ __
GI tract
GU tract
Brain
Bleeding may also be superficial (external) and seen at areas of broken skin such as __ __
Venipuncture sites
Recent surgical wounds
When a thrombolytic is administered with __ ___ ___ the client is at increased risk of bleeding
Aspirin
Dipyridamole
Anticoagulant
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
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
