Week 7: Anticoags: 10 q

Question 1

If on Heparin check what?

Target level?

What does it mean when value is too high or too low

Answer 1

aPTT and PTT

Target therapeutic level of anticoagulation: 40-70 SECONDS

High: Risk for bleeding (patient will die)
Low: chance of forming clots (clots will grow)

Question 2

If on Warfarin check?

Normal PT level?
Target INR level?

Answer 2

PT and INR

Normal PT: 18 seconds

Target levels of INR range from 2-3 (or an average of 2.5)

Question 3

Anticoagulant
Heparin

How is it given ?

When is aPTT measured and when is it not measured?

What is the antidote for overdose/toxicity?

Answer 3

subQ two or three times a day;

aPTT does not need to be monitored when used for prophylaxis (or IV catheters)

aPTT (usually every 4-6 hours when on continuous IV until therapeutic effects are seen; then daily once achieved)

Antidote for overdose/toxicity is protamine sulfate

Question 4

Heparin

Adverse effects?
What drugs can u not take while on heparin?

Answer 4

BLEEDING!!!!!!!
HIT
thrombocytopenia
hematoma
anemia

Aspirin & NSAIDS (decreased platelet activity)
Oral Anticoagulants
Antiplatelet drugs
Thrombolytics (additive effects)

Question 5

Anticoagulants

Warfarin
How is it taken?

Diet and Antidote for overdose/toxicity?

Adverse effects?
Avoid what juice?

Answer 5

PO ONLY

vitamin K consistent diet

Antidote for overdose/toxicity is Vitamin K

BLEEDING
Purple toes (rare, affects 1 in 5000 clients)

cranberry juice

Question 6

Anticoagulants- LMWH

Enoxaparin

used for?
How do they come?
Do not what?

Answer 6

More predictable anticoagulant response, lab monitoring is not necessary

Used for prophylaxis and treatment
* “Bridge therapy”
* Pre-filled syringes

***Do not massage site and do not expel air bubble!!!!!!

Question 7

Anticoagulants- LMWH

Enoxaparin

CONTRAINDICATION?
When is the only time it is given IV?

Answer 7

**Clients w/ an indwelling epidural catheter!!!!!!!

because it can cause additional bleeding

but can be started 2 hours after the catheter is removed

The ONLY time this medication is given IVP is for a STEMI

Question 8

What is Bridge Therapy?

Answer 8

The use of short-acting anticoagulants (heparin or LMWH) for a period of time during the interruption warfarin

Warfarin is stopped 5-6 days before surgery to allow its anticoagulation effects to wane

Bridging w/ either heparin or LMWH is started 3 days before surgery w/ the last dose given 24 hours before
surgery

Bridging is resumed no earlier than 24 hours after surgery

At this time, warfarin is restarted

Bridging is continued for usually 3-5 days, until the effect of warfarin has resumed and INR is WNL

Question 9

Anticoagulants: Direct Thrombin
Inhibitors

DABIGATRAN

Prevention of what?

Activates in?

Dose dependent on what?

Most common and serious side effect?

Is monitoring required?

**What is the antidote for toxicity?

Answer 9

prevention of strokes and thrombosis in clients with nonvalvular a fib

activates in the liver

Dose dependent on renal function

Most common & most serious side effect is bleeding w/ increased GI bleeding

No coagulation monitoring is required

Antidote of overdose/toxicity is idarucizumab

Question 10

Anticoagulants- Direct Thrombin
Inhibitors

ARGATROBAN (IV)

Used for?
Adverse effect?

Answer 10

Prevention of thrombosis in clients with heparin-induced thrombocytopenia (HIT)

As an anticoagulant in clients with or at risk for HIT who are undergoing percutaneous coronary intervention

BLEEDING

Question 11

Anticoagulants-Selective Inhibitor of
factor Xa

Fondaparinux

Used for?
Cannot use if?
Monitor what?
Black box warning for what?
risk for?

Answer 11

Prevention and/or treatment of DVT and PE

cannot be body weight < 50 kg or CrCl less than 30!!!!

monitor platelet count
Stop if less than 100,000

Potential spinal hematomas with epidural catheters.

BLEEDING

Question 12

Anticoagulants-Selective Inhibitor of
factor Xa

Rivaroxaban

Used for?
Warning for what?
Antidote for toxicity?
How can u take it?
When is it administered?

Answer 12

Prevention and/ or treatment of VTE, DVT, and/or PE

Black box warning-potential spinal hematomas

Antidote for overdose/toxicity is andexanet alfa

OK to crush tablet and mix with applesauce if the client cannot swallow; tablets are stable in applesauce for 4 hours

Administer medication with food at the same time every day

Question 13

Anticoagulants-Selective Inhibitor of
factor Xa

Apixaban

Used for?
Not recommended for?
Antidote?

Answer 13

Decrease risk of stroke associated w/ a-fib

Not recommended for clients w/ prosthetic heart valves

Antidote for overdose/toxicity is andexanet alfa

Question 14

Antiplatelet Drugs

Aspirin

Used for?
Adverse effect?

Answer 14

Decreases platelet aggregation

GI BLEEDING

Question 15

Antiplatelet Drugs

Clopidogrel

used for?
adverse effect?

Answer 15

Antiplatelet drug

used to prevent blood clots, MI, and strokes

GI BLEEDING

Question 16

Thrombolytic Drugs

Alteplase

give to who?

What’s the antidote?

Answer 16

CLOT BUSTER

Give to people with Acute MI, acute ischemic stroke, PE

Very short half life

Aminocaproic acid may be used as an antidote

Question 17

Alteplase

Must be given within what timeframe?

What to do For Catheter occlusion

Answer 17

MUST be given within 3- 4.5 hours of symptom onset

Monitor ability to aspirate blood as an indicator of patency

Question 18

Antifibrinolytic Drugs

Aminocaproic Acid
what does it do?

ADVERSE EFFECTS?

caution for IV administration?

Answer 18

Management of acute, life-threatening hemorrhage and blood oozing from surgical sites

ADVERSE EFFECTS:
dysrhythmias, hypotension (IV only)

IV administration: caution client to make position changes slowly to avoid orthostatic hypotension

Question 19

Antifibrinolytic Drugs

Desmopressin

controls what?
notify HCP when?

ADVERSE EFFECTS?

Answer 19

Controls bleeding in certain types of hemophilia and von Willebrand’s disease

notify HCP if bleeding is not
controlled or if headache, dyspnea occurs

Hyponatremia and Seizures