Pharmacology

aPTT
Activated partial thromboplastin time
What is aPTT?
The lab test used to monitor heparin levels
What is the normal lab value for aPTT?
(Judy and book)
Book = 40 seconds
Judy = 20-30 seconds
What is the effect of Heparin on aPTT?
(Judy and book)
Heparin increases aPTT by 1.5-2 seconds, making the aPTT:
Book = 60-80 seconds
Judy = 45-75 seconds
Heparin has a ____ onset and ____ duration.
Rapid
Brief
If a patient is on Heparin and his/her aPTT value falls out of therapeutic range what should one expect? (too high? too low?)
Because of Heparin’s rapid onset and brief duration, if the value should be too high then the dosage can be titrated down so that the aPTT value will fall in therapeutic range; if the value is too low to be considered therapeutic then the dosage can be titrated up.
How often should aPTT be evaluated during therapy?
Every 4-6 hours
If the aPTT is >80 seconds what nursing intervention can be done

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immediately?
Titrate the dosage of heparin down, the aPTT falls out of therapeutic range (too high).
PT
Prothrombin time
What is a PT test?
A coagulation test that is especially sensitive to alerations in Vitamin K dependent factors.
What is the average pretreatment value for PT?
12 seconds
How does warfarin affect PT?
It prolongs it.
Why do all labs use INR?
To ensure that test results from different laboratories are comparable. “lab consistency”
True or False:
PT is insignificant during warfarin therapy?
False.
PT must be determined frequently during warfarin therapy.
How often should PT be measured during treatment?
Daily for the first 5 days fo treatment, twice a week for 1-2 weeks thereafter and then once a week for the next 1-2 months
True or False:
Concurrent therapy with heparin can influence PT values.
True.
Because concurrent therapy with heparin can influence PT values, blood for PT determinations should be drawn no sooner than 5 hours after an IV injection of heparin.
INR
International normalized ratio
How is INR determined?
By multiplying the observed PT ratio by a correction factor specific to the particular thromboplastin preparation employed for the test.
What is an normal INR?
What INR value may be preferred for patients with mechanical heart valves or embolism?
Normal INR = 2-3
Other INR = 3-4.5
True or False:
If an INR is above the recommended range, the dosage should be increased.
False.
If an INR is above the recommended range, the dosage should be reduced. It may take a week or more to reach the desired range.
What is the mechanism of action for heparin?
Heparin suppresses coagulation by helping antithrombin inactivate clotting factors, primarily thrombin and factor XA (clotting factor).
How is heparin administered and what is the onset?
Heparin is rapid onset and only given by injection or IV.
Be cautious when giving heparin to a patient with ____.
an active GI bleed
When do you give Protamine Sulfate?
When there is an overdose to heparin
What is the DOC for heparin overdose?
Protamine sulfate
What are the lab test(s) are typically ordered for patients on Coumadin?
PT
INR
What is the PT for a patient on Coumadin?
Normal PT = 12-15 seconds
Coumadin = 1.5-2 x patient’s baseline
What is the INR for a patient on Coumadin?
2.5 is considered therapeutic in most situations
True or False:
A patient can never be put on Coumadin when he/she is also on Heparin.
False.
What lab test(s) are typically ordered for patients on Heparin?
aPTT
How do you take a patient from Heparin to Coumadin?
Decrease the heparin dose and start Coumadin.
How do you figure out fi your patient is being given the correct dosage when transfering from Heparin to Coumadin pharmacotherapy?
PT and INR
What are the side effects of thiazide diuretics?
Hyponatremia, hypochloremia, dehydration
Hypokalemia
Hyperglycemia, hyeruricemia
Dysrhythmias
Metabolic acidosis
Hypotension – headache, dizziness
Serum aldactone
How do you combat hypokalemia for patients taking thiazide diuretics?
Encourage the patietn to take KCl supplements or to eat foods that are high in K
What is the mechanism of action of a diuretic?
Decrease volume by blocking sodium and chloride reabsorption and prevent the reabsorption of water.
What part of the renal system produces the greatest dieresis?
The proximal tubule
Why is diuretic therapy important to a patient with hypertension?
The decrease in volume increases preload
When is the best and worst time to give a diuretic?
Best = with meals early in the day
Worst = at night (nocturia)
What patient education is important regarding diuretics?
Importance of potassiumn supplements (in K-lossing diuretics)
Change positions slowly (orhostatic hypotension)
Thirst is a common side effect
Monitor I&O
Weigh daily and report a +/- 2 lbs
Observe for signs of dehydration
Monitory for signs of fluid retention – swelling, SOB, weight gain
No hot showers
Wear support hose – put them while laying in bed before you rise in the morning
What is the mechanism of action of laxatives?
They increase GI motility, soften the stool, increase stool volume, hasten fecal passage through the intestine, facilitate evacuation from the rectum
Why are laxatives misued so widely?
Misconceptions of wht constitutes normal bowel function
What is Imodium (Loperamide) used to treat?
Used to treat diarrhea OTC
What is the mechanism of action of Imodium?
Decreased peristalsis (tone and contractions) in the bowel.
Type of opioid
What is the mechanism of action of Amphogel?
Decreases destruction of the gut wal by neutralizing acid (hydrochloric acid) in the stomach
What are the side effects of Amphogel?
Constipation (contains aluminum hydroxide)
What are some of the common side effects of atacids?
A common side effect of antacids are constipation (aluminum hydroxide) and diarrhea (magnesium hydroxide).
Cimentidine’s mechanism of action.
Decreases the amout of acid going into the stomach
Why are cell cyclic specific antineoplastic drugs used in chemotherapy?
There is a greater chance of deceased number of cancer cells when you use multiple drugs that affect areas/times during the cell cycle.
What does cell phase specificity mean?
Drugs are only toxic to cells that are in a particular cycle/phase of the cell cycle.
What is stomatitis?
Inflammation of the oral mucosa that usually develops a few days after the onset of chemotherapy.
How is stomatitis care managed?
Good oral hygiene, bland diet, mouthwash containing lidocaine, antihistamine, cold soothing foods, opioid for pain.
That is the DOC for stomatitis?
Nystatin
What at the uses for heparin?
Pulmonary embolism, stoke, DVT, open-heart surgery, renal dialysis, prevention of clot extension, DIC.
What is the DOC for pulmonary embolisms (PE)? What drug would you not give and why?
Heparin is the DOC
You would not give Coumadin because it takes too long (you must give something right away to prevent extensions of the clot).
What is the mechanism of action for histamine-2 antagonists?
Promotes healing by suppressing secretion of gastric acid (hydrochloric acid).
What are histamine-2 antagonists used for?
They are the first line of drugs for treating gastric and dudenal ulcers.
What lab tests must a patient undergoing chemotherapy have done?
Markers
WBC
RBC – Hgb, Hct
MRI or CT scan
BUN and Creatinine (for older adults)
Why must a patient on chemotherapy have their RBC done?
They are at risk for neutropenia, thrombocytopenia, and anemia.
Why must a patient on chemotherapy have a CT scan or MRI?
To observe the size of his/her tumors
What is the preferred for temporary treatment for constipation?
Bulk forming laxatives
What are the different types of laxatives?
Bulk-forming
Lubricant
Surfactant
Osmotic
Stimulant
How do bulk-forming laxatives function?
They function like dietary fiber – they increase bulk, the bulk pushes on the colon, and than in turn, increases peristalsis
How do lubricating laxatives work?
Increases mucosal secretions making it easier for stool to pass through the bowel.
How do surfactant laxatives work?
They keep the stool soft by increasing the amount of water and electrolytes in the intestinal lumen
How do stimulant laxatives work?
They stimulate peristalsis
How do osmotic laxatives work?
They used laxative salts (magnesium and sodium) to draw water into the intestinal lumen. The fecal mass softens and swells, the wall of the bowel stretches, and peristalsis is stimulated.
What is Peri-Colase?
A stimulant laxative
Peri-Colase is not given to patients with a history of/recent ____.
MI
What is the goal of antineoplastic drug therapy?
Decrease the size of the neoplasm so that the immune system can take over.
Goals may also include curing the disease, relieving the symptoms, killing the metastasis cells, and prolonging life.
Relating to GERD and acid suppression:
What kinds of drugs do you give and when do you give them?
Prilosec (proton pump inhibitor) – give before meals to suppress secretion of gastric acid
Antacids – give after meals to help neutralize acid
Relating to GERD and acid suppression:
How long do you want acid suppression to last?
24 hours
What are some considerations for combination drug chemotherapy::
What to attack the cancerous cells at different points during the cell cycle.
Want lower doses of drugs so that the side effects are not are severe.
Why is the nadar of WBC important?
You want each drug to effect the body at a different time (you don’t want the same 2+ drugs all ‘hitting the patient’ at the same time.
When tumors break down they cause _____.
An increase in uric acid
What is the significant of uric acid in the body?
Too much of it (hyperuricemia) can lead to gouty arthritis.
What drug is used to manage hyperuricemia associated with gout and cancer therapy?
Allopurinol
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