Ch 25 Coagulation Flashcards Preview

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Flashcards in Ch 25 Coagulation Deck (27)
0

What are anticoagulants (PARENTERAL)

Heparin

LoW molecular weight heparins (LMWH)
Prototype: enoxaparin (Lovenox)
Other meds; dalteparin (Fragmin),
Tinzaparin ( Inmohep)

Activated factor x ( xa) inhibitor
Prototype: fondaparinux ( Arixtra)

1

What is the expected pharmalogical action of anticoagulants

Prevent clotting by activating anti thrombin and factor xa. This inhibits fibrin formation

2

What are the therapeutic uses of heparin

Stroke
Pulmonary embolism
Massive DVT
treatment for dissiminated intravascular coagulation (DIC)

3

What is the use of LMWH

Prevent DVT in post op patients
Treat DVT and PE
PRevemt complications in certain types of myocardial infarctions

4

What are activated X ( Xa) inhibitors used for
Fondaparinux

Prevents DVT & PE in post op clients
Treats DVT & PE in conjunction with warfarin

5

What is true of heparin and LMWH

These meds cannot be absorbed by the intestinal tract
They use be given SC or IV

6

What are possible complications of heparin

HEMMORRHAGE, secondary to heparin overdose
Heparin induced thrombocytopenia AEB low platelet counts and increased development of thrombi
Hypersensitivity reactions ( chills, fever, urticaria)
Toxicity, overdose

7

For heparin toxicity what drug should be administered

Administer protamine. Administer is slowly Intravenously no faster than 20mg/min or 50mg/ 10 min.
Do not exceed 100 mg in a. 2 hr period

8

What platelet counts indicated that heparin needs to be discontinued

Less than 100,000

9

Adverse effects of enoxaparin

HEMMORRHAGE
Neurological damage from hematoma formed during spinal or epidural anesthesia.
Thrombocytopenia AEB platelet count less than 100,000
Toxicity/ overdose

10

What are adverse effects of fondaparinux

HEMMORRHAGE
Neurological damage from hematoma formed during spinal or epidural anesthesia
Thrombocytopenia

11

What are contraindications and precautions of parenteral anticoagulants

Contraindicated in ppl with low platelet counts
These meds should not be used during or following surgeries of the eye, brain, spinal cord; lumbar puncture, or regional anesthesia.
Uses cautiously in ppl who have hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, heparin and renal disease or threatened abortion

12

What are nursing considerations for heparin

Obtain baseline vitals
Obtain & monitor CBC, HCT, and platelet count
Monitor rate of infusion Q 30-60 min
Monitor aPTT Q 4-6 hr until appropriate dose Is determined
For sc injections, use a 20-22 guage to withdraw med from vial, then switch to a smaller 25-26 guage.
Do not aspirate
Instruct client to avoid OTC NSAIDS, aspirin or meds containing salicylates

13

What is true of enoxaparin/ fondaparinux

Monitoring is not required
Acceptable for home use

14

How can one determine the effectiveness of heparin

aPTT levels of 60-80 seconds

15

Name a oral anticoagulant

Warfarin ( Coumadin)

16

What does warfarin do

It antagonizes vitamin K, thereby preventing the synthesis of 4 coagulation factors: factor VII,IS,X and prothrombin.

It treats venous thrombosis
It treats thrombus formation in ppl who have atrial fibrillation or prosthetic heart valves
It prevents recurrent MI, TIA, PE & DVT

17

What are complications of warfarin

HEMMORRHAGE
Hepatitis
Toxicity overdose

18

For toxicity or overdose of warfarin what should be administered

Vitamin k to promote synthesis of coagulation factors VII, IX, X and prothrombin
If vitamin k can't control the bleeding administer fresh frozen plasma or whole blood

19

What are contraindications and precautions of warfarin

Pregnancy category X, due to the high risk of fetal HEMMORRHAGE, fetal death and CNS defects
Contraindicated in ppl with low platelet counts or uncontrolled bleeding
Contraindicated in surgeries of the eyes, brain or spinal cord; lumbar puncture or regional anesthesia.
Contraindicated in ppl with vitamin k deficiencies, liver disorders, and alcohol use disorders due to the additive risk of bleeding
Contraindicated in ppl with hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension, or threatened abortion

20

What are medication interactions of warfarin

Concurrent use of heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins increases the effects of warfari, which increases the risk for bleeding.

21

What are medication Interactions of warfarin

Concurrent use of Phenobarbitol, carbamazepine ( Tegetrol) phenytoin ( Dilantin), oral contraceptives and vitamin k decreases anti coagulation effects
If used concurrently monitor carefully for reduced PT and INR levels

22

What are food interactions of warfarin

Foods high in vitamin K, such a dark green leafy vegetables ( lettuce, cooked spinach) cabbage, broccoli, Brussels sprouts, mayonnaise, canola!and soybean oil,decrease anticoagulant effects with excessive intake.

23

What are therapeutic levels of PT

18-24 seconds

24

What are nursing considerations for the administration of warfarin

administration is usually orally, once daily at the same time each day
Obtain baseline vital signs
Monitor PT levels and INR levels ( INR levels are the most accurate)
Obtain baseline and monitor CBC, platelet count, and HCT levels

25

What are therapeutic levels of INR

2-3

26

How can one tell that warfarin is effective

PTT is 1.5-2 times the control
INR of 2-3 for treatment of acute MI, atrial fibrillation, PE venous thrombosis and or tissue heart valves
INR of 3-4.5 for mechanical heart valve or recurrent systemic embolism
No development of venous thrombi.