Vascular Drugs Flashcards
Atorvastatin (Lipitor) class
HMG-CoA Reductase Inhibitors
Atorvastatin (Lipitor) MoA
Blocks HMG-CoA reductase from completing synthesis of cholesterol in the liver
Atorvastatin (Lipitor) Administration Consideration
At HS (highest rates of cholesterol synthesis at night)
Atorvastatin (Lipitor) Caution
renal impairment, liver disease, heavy alcohol use, pregnancy category X
Atorvastatin (Lipitor) AE
GI affects- cramping, diarrhea, constipation
liver damage
myalgias
toxic rhabdomyolysis with AKI
Atorvastatin (Lipitor) Nursing Considerations
monitor liver kidney function (toxicity); teach to report myalgias, no grapefruit juice (increases levels-toxicity), lifestyle modification.
Aspirin (ASA) class
Anti-platelet Agent/ Salicylate
Aspirin (ASA) MoA
inhibit platelet aggregation (COX inhibitor)
anti-platelets prevent what…
the platelet part of clotting (platelet coags forms platelet plug with anti-platelet)
Aspirin (ASA) Indication
Prevention of MI, TIA, ischemic CVA in high risk populations (primary or secondary prevention)
Aspirin (ASA) Dose
81-325 mg PO daily (81mg is a baby aspirin)
level of dose determines if its prevention or treatment
Aspirin (ASA) AE
GI irritation (N/V, epigastric pain)
bleeding- GI bleeding
hematuria
easy bruising
tinnitus (with toxicity)
Aspirin (ASA) Nursing considerations
take as directed, take with food, hold 1 week prior to procedure, monitor for s/s GI bleed (dark/bloody stools)
Clopidogrel (Plavix) class
anti-platelet agent
Clopidogrel (Plavix) MoA
inhibit platelet aggregation (alters signaling sent to platelets to initiate clotting)
Clopidogrel (Plavix) indications
prevent blood clot w/hx of MI, ischemic stroke, or PAD; prevent blood clot with cardiac stent or graft (blood wants to clot to metal)
Clopidogrel (Plavix) AE
bleeding
flu like syndrome
dizziness
bruising
rash
pruritus
Clopidogrel (Plavix) Nursing
Hold 5 days prior to procedure, bleeding precautions (soft bristle toothbrush, electric razors, etc…)
Nursing assessment for anti-platelet drugs
indication for medication (prevention of blood clots)
clinical manifestations of bleeding
Nursing interventions for anti-platelet drugs
bleeding precautions, avoid injury and falls, hold prior to procedure/surgery, educate patient on medications
anticoagulants prevent what…
disrupt clotting cascade making it difficult for blood to clot
Chronic a fib complication and treatment goals
ischemic stroke (embolus)- when clot is pumped out of atria and into brain
prevent blood clot in atria
ischemic stroke (embolus) complication and treatment goals
tissue hypoxia/death
clot lysis; restore perfusion
DVT complication and treatment goals
pulmonary embolism
slow clot growth; inhibit propagation (movement); inhibit new clots
PE complication and treatment goals
tissue hypoxia/death
slow cloth growth; inhibit new clots; clot lysis; surgical
Prothrombin time (PT) reference range
11-12.5 seconds
International Normalized Ratio (INR) reference range
0.7-1.8
International Normalized Ration (INR) therapeutic range
2.0-3.0
Activated Partial Thromboplastin Time (aPTT) reference range
21-35 seconds
Activated Partial Thromboplastin Time (aPTT) therapeutic range
45-70 seconds
General Nursing Considerations for Anticoags and Thrombolytics
All have a AE of bleeding (fatal and non-fatal), reduce injury and falls, implement bleeding precaution.
Fatal: hemorrhagic stroke, internal bleeding, GI bleeding
Non-Fatal: hematuria, epistaxis, bruising
Contraindications of Anticoags and Thrombolytics
Pregnancy (except heparin/enoxaparin), bleeding disorders, hx of bleed, thrombocytopenia
Drug-Drug of Anticoags and Thrombolytics
anti-platelet, NSAIDs, herbals (all increase bleeding). some patients can be on both anti-platelet and anticoag because of stroke history so they are SUPER high risk of bleeding.
Heparin Class
indirect thrombin inhibitor- anticoagulant
Heparin MoA
disrupts clotting cascade; prolongs bleeding time
Heparin route/dose
5000 units SQ q8h (prevention) or IV drip (protocol)
Heparin indications
prevent or treat DVT (SQ); treat PE (IV)
Heparin contraindications
Porker allergy; Pork abstention religion (Judaism, Muslim)
Heparin AE
Bleeding, heparin-induced thrombocytopenia, bruising at injection site
Heparin Nursing considerations
rotate/monitor injections site for SQ (do not administer IM), monitor platelet count; monitor aPTT
Heparin reversal agent
protamine sulfate (heparin short half life, stop infusion)
Enoxaparin (Lovenox) class
low molecular weight heparin- anticoagulant
Enoxaparin (Lovenox) MoA
disrupts clotting cascade, prolongs bleeding time
Enoxaparin (Lovenox) indications
prevention or treatment of DVT
Enoxaparin (Lovenox) route
1mg/kg every 12 hr SQ
Enoxaparin (Lovenox) contraindications
pork allergy; pork abstention religion (Judaism, Muslim)
Enoxaparin (Lovenox) AE
bleeding; bruising at injection site
Enoxaparin (Lovenox) nursing considerations
Admin in deep SQ; do not aspirate or massage site; do not remove air bubble from prefilled syringe; rotate/monitor injection sites; monitoring of clotting time not necessary
Enoxaparin (Lovenox) reversal agent
protamine sulfate
Warfarin (Coumadin) class
Vitamin K antagonist (anticoagulant)
Warfarin (Coumadin) MoA
interfere with hepatic synthesis of vitamin K dependent clotting factors; prolongs bleeding time
Warfarin (Coumadin) route/dose
2-10 mg/day PO based on INR
Daily in evening or HS
Hold and call PCP if INR is greater than 3.0
Expect Vitamin K order if INR is greater than 4
Warfarin (Coumadin) indications
chronic Afib, artificial heart valves, prevent/treat DVT, PE
Warfarin (Coumadin) AE
GI effects (n/v), bleeding
Warfarin (Coumadin) drug-drug
antibiotics (monitor INR), Amiodarone, herbals
Warfarin (Coumadin) nursing considerations
Monitor PT/INR; first oral anticoagulant on market
Warfarin (Coumadin) reversal agent
Vitamin K
Warfarin (Coumadin) Lab Draws
dose change= next lab in 3 days
long term monitoring= weekly or monthly
Warfarin (Coumadin) Diet
teach patient to maintain consistent intake (avoid) vitamin K containing foods (increased intake may decrease warfarin effect)
Foods High in Vitamin K
kale
collard greens
spinach
brussel sprouts
broccoli
asparagus
sauerkraut
soybeans
edamame
herbals to avoid with Warfarin
St. Johns Wart
Garlic
Gingko
Ginger Root
Chamomile
Rivaroxaban (Xarelto) class
Factor Xa Inhibitor
Rivaroxaban (Xarelto) MoA
disrupt clotting cascade; prolongs bleeding time
Rivaroxaban (Xarelto) route/dose
10 mg PO daily (prevention); 15 mg PO BID (treatment)
Rivaroxaban (Xarelto) indications
chronic afib; prevent DVT and PE
Rivaroxaban (Xarelto) AE
bleeding
Rivaroxaban (Xarelto) nursing considerations
no blood monitoring required
Rivaroxaban (Xarelto) reversal agent
Andexxa
Initial Management of Anticoagulant Overdose
Assess for CM of bleeding and VS
Notify PCP
Draw Labs as ordered H&H, Plts, and clotting times
administer fluids and or packed red blood cells
administer reversal agent as ordered
Alteplase (Activase; tPA) class
thrombolytic agent CLOT BUSTER
Alteplase (Activase; tPA) MoA
Local fibrinolysis (acute clot lysis)
Alteplase (Activase; tPA) indications
systemic: ischemic (embolic) stroke, PE, coronary thrombosis (MI)
Local: central venous catheter occlusion (small dose to break up clot in line)
Alteplase (Activase; tPA) AE
bleeding, hypotension, bradycardia, tachycardia
Alteplase (Activase; tPA) contraindications
MANY. check before administration
drug therapy for chronic Afib
warfarin, rivaroxaban
drug therapy for ischemic stroke (embolus)
alteplase
drug therapy for DVT
SQ heparin, enoxaparin, warfarin, rivaroxaban
drug therapy for PE
IV heparin drip, alteplase
bridging concept
warfarin takes 2-3 days to start so they are also given an instant drug heparin or lovenox until warfarin is in therapeutic levels
Epoetin Alfa (Procrit) class
erythopoiesis stimulating agent
Epoetin Alfa (Procrit) MoA
erythropoietin factor controlling rate of RBC production
Epoetin Alfa (Procrit) Indications
disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments
Epoetin Alfa (Procrit) contraindications
angina, caution in CHF
Epoetin Alfa (Procrit) AE
fatigue, bone pain, edema, HTN, headache, fever, DVT, CVA, MI has occured
Epoetin Alfa (Procrit) nursing considerations
Monitor CBC weekly (dose depends on Hgb and indication), check VS (risk of HTN), analgesia for bone pain, goal Hgb above 10; hold if Hgb is greater than 12
Ferrous Sulfate class
iron deficiency anemia
Ferrous Sulfate MoA
replace iron; required for hemoglobin formation
Ferrous Sulfate indications
iron deficiency, iron-deficiency anemia (heavy periods)
Ferrous Sulfate drug-drug/food
antacids, dairy reduce absorption
Ferrous Sulfate AE
GI upset, dark tarry stools, constipation
Ferrous Sulfate nursing considerations
monitor labs (Hgb, iron); take w/o food for best absorption; take with Vit C to increase absorption; do not take within one hour of bedtime (GERD), do not crush or empty capsules; reassess Hgb after 3 months
KEEP AWAY from children-fatal overdose
Cyancobalamin (Vitamin B12) class
Agents for megaloblastic anemias
Cyancobalamin (Vitamin B12) MoA
Replace vitamin B12; required for Hgb formation
Cyancobalamin (Vitamin B12) indications
B12 deficiency anemia, pernicious anemia
pernicious anemia
lack IF to absorb B12 (only gets injections not oral)
Cyancobalamin (Vitamin B12) dose/route
monthly SQ/IM
Cyancobalamin (Vitamin B12) AE
rare
Cyancobalamin (Vitamin B12) nursing considerations
monitor labs for therapeutic response (HgB, B12)
Cyancobalamin (Vitamin B12) Patient Teaching
pt. sudden discontinuation can cause anemia to return and irreversible nerve damage/depression; Pernicious anemia will need injections for life
Folic Acid class
agents for Megaloblastic Anemias
Folic Acid MoA
required for erythropoiesis
Folic Acid indications
folic acid deficiency anemia (if diet changes ineffective), alcoholism, pregnancy prevention of neural tube defects
Folic Acid AE
urine turns bright yellow
Folic Acid Nursing considerations
monitor H/H, nutritional status, therapeutic response
MOST COMMONLY taken for chronic alcoholism- results in poor diet/ decreases ability to absorb vitamin B12