Anticoagulants Answers – Flashcards
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Heparin Nursing Considerations
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Don't give with Low Molecular Weight Heparin check dosage with second RN Abd deep SQ (5/8" needle, 25 gauge) in the lower abd 2" away from umbilicus. Grasp skin and inject into skin fold (90 degree angle!) *electric razor*
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PTT
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normal 22-32 know lab! Tx 1.5-2.5 times the normal
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Heparin
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given SQ, IV push or IV infusion
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Heparin MOA
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Turns off coagulation pathway, PREVENTING clots from forming (prophylactic). Binds to antithrombin II, inhibits the conversion of prothrombin to thrombin
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Heparin Uses
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Prophylaxis and treatment of thromboemolic disorders: DVT, PE, A-fig, low doses used to maintain patency of IV catheters (keeps lines OPEN)
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Heparin SE
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Main: BLEEDING, thrombocytopenia LT: alopecia/osteoporosis Other: rashes, anemia, fever, allergy
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Heparin toxicity:
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Protamine Sulfate (5 minutes) KNOW OD: IV faster, 30 sec -1 min lasts 2 hours - monitor PTT (nl 22-32)
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LMWH Low Molecular Weight Heparin Dalteparin (Fragmin) Enoxaparin (Lovenox)
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Inject in abdomen (almost to love handles) - within 2" of belly button may cause hematoma to develop; BID or QD orders; Factor X - predictable response
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LMWH Uses: Dose.
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Prevention of thromboembolic disorders: DVT, PE after abd surgery, THR, TKR. Lovenox Dose for DVT/PE/MI: 1mg/kg q 12 hr or 1.5 mg/kg q 24 hours
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Warfarin (Coumadin) Can give with Heparin
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Inhibits clooting factors (II, VII, IX, and X) that rely on vitamin K (blood coagulation)
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Oral Dose of Warfarin
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2.5-10mg/day fro 2-4 days, then based on INR/PT 1.5-2.5 normal
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Warfarin Tx Uses
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Prophylaxis and tx of DVT, PE, A-fib, management of MI, prevent thrombus formation with valve replacement (open heart surgery) Common in aortic or?
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Danger in mechanical valve placement
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foreign object clots - warfarin for the rest of patients life - should hear mechanical click (otherwise might be clot forming)
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#1 SE warfarin
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BLEEDING! (all anticoagulants)
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PT/INR Levels international ratio
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2-3 Valve 2.5-3.5 PT normal 10-13
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Warfarin (Coumadin) Toxicity Teaching
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Vitamin K - 6 hr; a large dose of Vit K will maintain its reversal effects for up to 1 week; Pregnancy CATEGORY X! (totally contraindicated) FFP - fresh frozen plasma (given for antidote)
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Other anticoagulant considerations
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hold skin fold throughout (helps prevent bruising/bleeding after administration) Do not expel air bubble; Never aspirate (pull back on plunger; Never massage area - increase internal bleeding at site (potentially cause abdominal hematoma); Rotate sites
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no lab levels to check with:
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LMWH
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Contraindications for LMWH
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spinal puncture or epidural (less severe than heparin); anesthesia Do NOT administer until 24-48 hours after surgery (patient may experience bleeding - is the bleeding from heparin or from the surgery?)
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Warfarin (Coumadin) considerations rat poisoning
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Increase risk of BLEEDING with other anticoagulants, NSAIDs onset 12-24 hrs. May give with Heparin until tx level reached; KEEP VITAMIN K IN DIET @ STEADY LEVEL (steady state vital, amount not critical)
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Vitamin K sources
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green leafy vegetables, tomatoes, bananas, fish, GREEN TEA (very high); Don't confuse with Potassium (K) sources
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Clot formation travels
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heart (MI), brain (stroke/cerebrovascular accident), lung (pulmonary embolism)
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Dont give Heparin with LMWH
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cranial bleeding
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Sign of abnormal bleeding
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black tarry stools or bloody urine
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Coagulation Cascade
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extrinsic/intrinsic gunshot - extrinsic Know general cycle
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Antiplatelets
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Inhibits cyclooxygenase and prevents the formation of thromboxane. This decreases platelet aggregation - decreased incidence of TIA and MI
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Antiplatelet SE
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dyspepsia, epigastric distress, heartburn, N/V GI bleeding (risk vs benefit), allergic reactions
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antiplatelet Dose
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81-325 mg/qd for prevention TIA/CVA: 325-1300 mg/qd
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Antiplatelet toxicity
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Early sign: tinnitus HA, hyperventilation, agitation, confusion, lethargy, diarrhea, sweating.
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Antiplatelet considerations
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avoid used of ETOH to decrease GI distress don't give to children/teens for varicella, influenza, or viral illness because of potential Reye's syndrome - causes encephalopathy
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Dipyridamole (persantine
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Inhibits platelet aggregation Post-op prevention of thromboembolism Bleeding
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Contraindications (antiplatelets, persantine, Plavix/Ticlid, and Trental/Pletal)
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active bleeding, traumatic injury, recent hemorrhagic stroke, thrombocytopenia
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Stent
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seen as antigen - treat 1-3 months with Plavix (PAD, PVD)
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Clopidogrel (Plavix) Ticlopidine (Ticlid)
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ADP inhibitors. Inhibit platelet aggregation by altering the platelet membrane Use: Decreases risk of thrombotic stroke in patient swith stroke or TIA (Plavix reduces MI , stroke, or vascular death with PAD (stent placement 1-3 months)
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Ticlid can cause
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life threatening neutropenia and agranulociytosis
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Plavix dose
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75 mg/qd
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Pentoxifylline (Trental - breakdown of clots) Cilostazol (Pletal)
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Methylaxine derivative. Increases the flexibility of RBCs and decreases platelet aggregation Use: Intermittent claudication caused by PAD
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SE of Trental/Pletal
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bleeding, angina, CP, dysrhythmia, HA, dizziness, N/V, bloating
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Trental dose
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400 mg tid with meals
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Antifibrinolytic Aminocaprocic Acid (Amicar)
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Prevents lysis of fibrin & promotes clot formation Use: Antidote for thromboylitic OD, excessive bleeding SE: could cause thrombosis Max qd dose: 30 g
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Aminocaproic Acid (Amicar)
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Promotes clot formation only works if a clot has been formed Contraindicated with postpartum bleeding, DIC?
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Thrombolytic Streptokinase (Streptase)
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oldest not clot specific, allergic reactions
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Thrombolytic Retivase, Alteplace (Activase)
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Activates conversion of plasminogen to plasmin, this breaks down clots. Give within 4-6 hours of onset of symptoms Retivase more common used - better SE
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Thrombolytic
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Use: Acute MI, arterial thrombosis, DVT, PE, occluded shunts or catheters SE: internal intracranial and superficial bleeding N/V, hypotension, dysrhythmias
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ANTIDOTE for thrombolytic
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aminocaproic acid (Amicar)
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Thrombolytic Contraindicated with:
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recent surgery, trauma, GI bleeding, delivery (post-partum), uncontrolled HTN, CVA, increased ICP (risk to bleed anyway), NO IM INJECTION - ASSESS FOR BLEEDING
