Anticoagulant & Anti-arrhythmic Medications Flashcards
What’s the difference between the intrinsic clotting cascade vs. the extrinsic clotting cascade?
Intrinsic = clotting r/t spontaneous internal damage of the blood vessels
Extrinsic = secondary activation d/t injury or trauma
- Ex: knife wound
Is blood clotting (coagulation) good or bad?
It’s both
- Good because we need our blood to clot
- Bad because too much clotting can cause occlusions in the blood vessels
Most often we are giving medications to __________?
Prevent a clot from occurring or clots from worsening i.e., prophylactically
What are the three classes of coagulation modifiers?
- What does each one do?
- In what situations (for what purpose) would we use either categories of medication?
- What’s the difference between the first 2 categories?
- Anti-platelets (Ex: Aspirin)
- Prevents platelet aggregation (RBC from “sticking”)
- Reduces MI/stroke risk - Anticoagulants (Ex: Heparin, Warfarin)
- Prevents blood clotting/slows down blood clotting
- Reduces MI/stroke risk - Thrombolytic Clot Busters
- Breaks up blood clots
- Used if we think someone is having a stroke
*Difference between Anti-platelets vs. Anti-coagulants = they’re acting at different parts in the cascade
Aspirin
- Class?
- Prevention or Buster?
- MOA?
- Therapeutic action?
- Nursing considerations?
- Side effects?
Class = Anti-platelet
Clot PREVENTION
MOA:
- Binds to COX-1 & COX-2
- Decreases inflammatory response
- Inhibits platelet aggregation
Therapeutic action (at higher doses):
- Analgesic
- Antipyretic
Side effects:
- bleeding
- Nausea, vomiting, diarrhea
- Tinnitus (ear ringing)
Nursing considerations:
- Monitor platelet labs i.e., pts ability to clot blood
- Monitor for bleeding
*NEVER give aspirin to children or babies d/t Reye’s syndrome
Clopidogrel (Plavix)
- Class?
- MOA?
- Side effects?
- Contraindications?
- Nursing considerations?
Class = Anti-platelet
More effective than Aspirin at preventing platelet aggregation, but carries higher risk for bleeding
MOA:
- Blocks adenosine diphosphate (ADP) receptor
- Prevents platelet aggregation
Side effects:
- Bleeding
Contraindications:
- Amiodarone –> reduces effectiveness (anti-arrhythmic drug)
- Calcium channel blockers –> reduces effectiveness
- NSAIDS –> increases risk for GI bleeding
Nursing considerations:
- Monitor platelet labs –> pt’s ability to clot
- Monitor for bleeding
Eptifibatide (Integrilin)
- Class?
- MOA?
- Given in which environment?
- Side effects?
- Nursing considerations?
Class = Anti-platelet
MOA:
- Inhibits glycoprotein llb/lla, inhibiting aggregation
Environment:
- ICU environment (IV form)
Side effects:
- Thrombocytopenia (low platelet count)
- Bleeding
Nursing considerations:
- Monitor platelet count
- Monitor Hgb/HCT levels –> low levels indicate loss of blood/RBCs i.e., bleeding
Hemoglobin = protein within RBC that is responsible for carrying oxygen (i.e., performing essential function)
Hematocrit = ratio of RBC to total blood volume (% RBC in blood)
*Both usually correlate/flow together
Tirofiban (Aggrastat)
- Class?
- MOA?
- Given in which environment?
- Side effects?
- Nursing considerations?
Class = Anti-platelet
MOA:
- Inhibits glycoprotein llb/lla, inhibiting aggregation
Environment:
- ICU environment (IV form)
Side effects:
- Thrombocytopenia (low platelet count)
- Bleeding
Nursing considerations:
- Monitor platelet count
- Monitor Hgb/HCT levels –> low levels indicate loss of blood/RBCs i.e., bleeding
Hemoglobin = protein within RBC that is responsible for carrying oxygen (i.e., performing essential function)
Hematocrit = ratio of RBC to total blood volume (% RBC in blood)
*Both usually correlate/flow together
Heparin
- Class?
- Route?
- Side effects?
- Nursing considerations?
- Medication interactions?
- What is the reversal agent?
Class = Anticoagulant
- ZERO effect on clots that have already formed
- Parenteral (IV/SC) –> much quicker onset
Side effects:
- Bleeding
- HIT - Heparin Induced Thrombosis –> medication has opposite effect it is supposed to (this can happen with some medications!)
Medication interactions/contraindications:
- Grapefruit/fruit juice –> can increase risk of bleeding
Nursing considerations:
- Careful administration
- Assessment for bleeding (especially around IV site) –> ask patient of any bleeding in the gums, shaving, stool/urine
- Monitor blood levels often, including aPTT test –> Time it takes for a clot to form
- Monitor therapeutic blood levels and adjust dose if needed
Antidote = Protamine sulfate
Enoxaprin (Lovenox)
- Class?
- Differences from other medications in the same class?
- Side effects?
- Medication interactions?
- Nursing considerations?
Class = Anticoagulant
- Low molecular weight heparin
Lower risk for bleeding; don’t need to monitor aPTT. However, Heparin is more effective at preventing clotting
Can be sent home with patient!
Side effects: Not life-threatening
- Bleeding
- Anemia
Medication interactions/contraindications:
- Grapefruit/fruit juice –> can increase risk of bleeding
Nursing considerations:
- Monitor labs pertinent to bleeding risk –> HCT, HgB, platelets
- Careful assessment for bleeding
- Educate patient that if they fall and hit their head, they need to call provider immediately –> will also bruise easily
Dalteparin (Fragmin)
- Class?
- Differences from other medications in the same class?
- Side effects?
- Medication interactions?
- Nursing considerations?
Class = Anticoagulant
- Low molecular weight heparin
Lower risk for bleeding; don’t need to monitor aPTT. However, Heparin is more effective at preventing clotting
Can be sent home with patient!
Side effects: Not life-threatening
- Bleeding
- Anemia
Medication interactions/contraindications:
- Grapefruit/fruit juice –> can increase risk of bleeding
Nursing considerations:
- Monitor labs pertinent to bleeding risk –> HCT, HgB, platelets
- Careful assessment for bleeding
- Educate patient that if they fall and hit their head, they need to call provider immediately –> will also bruise easily
- Educate patient to look out for signs of bleeding
Warfarin (Coumadin)
- Class? Route?
- Most common medication for?
- Side effects?
- Antidote?
- Drug interactions/contraindications?
- Nursing considerations (monitoring/education)?
Class = Anticoagulant
- PO
Most common medication for atrial fibrillation i.e., clot forming and going out into circulation
Side effects:
- Bleeding
- Muscle pain
Antidote = Vitamin K –> natural coagulant
Drug interactions/contraindications:
- Amiodarone –> reduces effectiveness (anti-arrhythmic drug)
- Erythromycin
- Sulfa drugs
- Grapefruit/cranberry juice
- No alcohol
- Overconsumption of Vitamin K –> can reverse therapeutic effects
Nursing considerations:
- Draw and monitor frequent labs –> blood levels
- Monitor INR (international normalized ratio) –> how long it takes for blood to clot –> should be 2-3.5 times the “normal value” to be considered safe (bridge therapy)
- Educate patient regarding vitamin K intake and what foods are high in vitamin K (Leafy greens, animal liver products, nutritional supplement drinks, vitamins)
Rivaroxaban (Xarelto)
- Class?
- Side effects?
- Reversal agent?
- Nursing implications?
- Benefits of newer drug?
Class = Anticoagulant
- PO
Side effects:
- Bleeding
Reversal agent = Andexanet
Nursing implications:
- Monitor labs pertinent to bleeding
Benefits of newer drug (compared to Warfarin):
- No CLOTTING labs to monitor
- No dietary restrictions
Apixaban (Eliquis)
- Class?
- Side effects?
- Reversal agent?
- Nursing implications?
- Benefits of newer drug?
Class = Anticoagulant
- PO
Side effects:
- Bleeding
Reversal agent = Andexanet
Nursing implications:
- Monitor for labs pertinent to bleeding
Benefits of newer drug (compared to Warfarin):
- No CLOTTING labs to monitor
- No dietary restrictions
Dabigatran (Pradaxa)
- Class?
- Side effects?
- Nursing implications?
Class = Anticoagulant
- Thrombin inhibitor
Side effects:
- Bleeding
- NO dietary restrictions
- NO specific clotting labs to monitor
Nursing implications:
- Review labs pertinent to bleeding (Hgb/HCT)
