Week 11 Coagulation Flashcards
Children Considerations
- Little research available; if used, monitor closely; calculate the dose based on wt and always perform independent double check
- Need to understand the importance of safety precautions and preventing injuries
Adult considerations
- Instructed in ways to prevent injuries and what to do if bleeding occurs
- Inform provider of any drugs or alternative therapies; many drug interactions
- Carry or wear medicAlert notification
- Understand the importance of regular, periodic blood tests to evaluate the effects of the drugs
Older Adult considerations
- More likely to encounter drug-drug interactions because they typically take more drugs
- More likely to have impaired kidney and liver function which impacts drug metabolism and excretion
- Start therapy at the lowest possible dose and adjust accordingly in response to lab result
Alter platelet aggregation and the formation of the platelet plug
antiplatelets
interfere w/ the clotting cascade and thrombin formation
anticoagulants
break down the thrombus or clot that has been formed by stimulating the plasmin system
thrombolytics
Antiplatelet prototype drug
Aspirin
Anticoagulation prototype drug
Heparin
thrombolytic prototype drug
UROKINASE
Therapeutic Action: Aspirin
- Inhibits platelet aggregation by inhibiting platelet synthesis of thromboxane A2
- Decrease the formation of the platelet plug
indication: Aspirin
- reduction of risks of recurrent TIA/ strokes
- reduction of death or nonfatal MI in pts w/ hx of MI or unstable angina
pharmacokinetics: Aspirin
- Metabolism in liver
- excreted in urine
- enters breastmilk
- oral administration
adverse effects: Aspirin
- Bleeding and bruising
- fever, coma, CV collapse; toxicity
- GI bleed, nausea, occult blood loss, dizziness, tinnitus, difficulty hearing, heartburn
Contraindications: Aspirin
- Allergy
- recent surgery
- presence of known bleeding disorder or active bleeding
- closed head injuries
- hx of thrombocytopenia
Drug-drug interaction: Aspirin
- excessive bleeding risk is increased when combined with another drug that affects blood clotting
Nursing considerations: Aspirin
- Labs; clotting factors, plt count
- pt is more at risk for bleeding; longer pressure to stop, limit contact sports, soft bristle toothbrush, electric razor only
- seek medical care if pt falls
- saftey measures to stop bleeding
- stop taking med if having surgery
- check for bleeding and brusing often
Therapeutic action: heparin
Inhibits thrombus and clot production by blocking the conversation of prothrombin to thrombin and fibrinogen to fibrin
Indication: heparin
- prevention & treatment of venous thrombosis and pulmonary embolism
- treatment of atrial fibrillation w/ embolization\
Pharmacokinetics: heparin
- IV & SubQ as well
- metabolized in the liver and the cells
- excreted in the urine
- DOES NOT ENTER BREASTMILK
Adverse Effects: heparin
- BLEEDING
- loss of hair, bruising, chills, fever, osteoporosis, suppression of renal function
Contraindications: heparin
- Allergy
- any conditions that could be compromised by bleeding tendencies
- Heparin is preferred during pregnancy
Drug-drug interactions: heparin
- Increased bleeding can occur if combined w/ oral anticoags, penicillins, cephalosporins, or salicylates
- decreased anticoag if taken w/ nitroglycerin
Nursing considerations: heparin
- in case of a heparin overdose; the antidote protamine sulfate
- watch for s/s of bleeding
- safety measures to decrease bleeding risks
- know if pt has hx of bleeding disorders
- keep the antidote on standby
- monitor blood test/ clotting times
- any acute bleeds?
Therapeutic Action: UROKINASE
Converts endogenous plasminogen to plasmin, which breaks down fibrin clots, fibrinogen, and other plasma proteins; lyses & emboli
Indication: UROKINASE
- If a thrombus has already formed in a vessel; acute MI, ischemic stroke, PE
- Dissolves the clot to open the vessel and restore blood flow to the tissue
pharmacokinetics: UROKINASE
- IV; onset immediate
- metabolized in the plasma
- excretion unknown
- crosses placenta
Adverse Effect: UROKINASE
BLEEDING
- headache, edema, hypotension, skin rash, bleeding, breathing difficulties, pain, fever, bronchospasms
Contraindications: UROKINASE
- Allergy
- any condition that would be worsened by the dissolution of clots; surgeries, CVA, internal bleeding, ect
- pregnancy & lactation
Drug-drug interactions: UROKINASE
- Risk of hemorrhage increases if thrombolytic agents are used with any anticoag or antiplatelet drug
- stop platelet drips before administering thrombolytics
Nursing considerations: UROKINASE
- check for s/s of bleeding
- if pt has sign of MI/PE give immediately
- only give if clot is already formed
- d/c heparin before giving
- monitor clotting times
- arrange type and cross match blood
A thrombolytic agent would be most indicated for which circumstance?
pulmonary embolism
