Ch. 26 and 54 Flashcards Preview

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Flashcards in Ch. 26 and 54 Deck (51):
1

The nurse will have many opportunities in practice to give medications that:

Enhance coagulation
Inhibit coagulation
Dissolve existing clots

2

Too much clotting. Starts in venous veins.

Thomboembolic Disorders

3

Types of Thromboembolic Disorders

DVT, Pulmonary Embolism, Cerebral Vascular Accident (Stroke)

4

What lab tests are essential to diagnose a coagulation disorder

PT (prothrombin time)
aPTT (activated partial thromboplastin time)
Platelet count
Specific clotting factor tests depending on disease

5

Mechanisms of action for drugs used to slow clotting/prevent formation

Inhibit clotting factors
Inhibit the clotting action of platelets
Dissolve clots (Clot busters)
(all these lengthens bleeding time)

6

Makes blood cells very flexible. Will help blockages in arteries.

Trentol

7

Acts by indirectly inhibiting thrombin. Prevents formation of fibrin clots. Alongate bleeding time. Stops extension of existing clots is unable to dissolve. Used for thrombosis, MI, strokes etc- blood flow disruption. Stops DVT from getting bigger

Heparin

8

Heparin is the drug of choice for.......

thromboembolic disorders SQ/IV

9

Adverse effects of Heparin

Abnormal bleeding, dose dependent

10

Antidote for too much heparin given

protamine sulfate

11

What labs will be drawn for Heparin

aPTT

12

Therapeutic range of Heparin

1.5-2 (normal: 25-35)

13

Where should we monitor when a pt is on heparin?

s/s of bleeding in urine, stool, bruising, and excessive menstruation

14

What interventions could they do to prevent injury when taking Heparin

soft bristle toothbrush
electric razor for shaving
avoid picking nose

15

Low molecular weight heparin. Safer and more stable than heparin.Produce more predictable responses. Will not need clotting factor labs drawn. Given in the abdomen. Usually given for 5-10 days.

Enoxaparin (Lovenox) SQ

16

Inhibits activated vitamin K. Takes a few days to produce a full therapeutic effect. Will see this taken with Heparin until appropriate levels are reached. Labs are the marker of dosage.

Warfarin (Coumadin)

17

Therapeutic range for Warfarin (Coumadin) (international Normalized Ratio)

2.0-3.0 or up to 3.5

18

Adverse effects of Coumadin

Bleeding

19

Antidote for Coumadin overdose

Vitamin K

20

What Vitamin K foods should we eat in moderation?

spinach, cabbage, cauliflower, brussels sprouts, broccoli

21

What herbs increase herbs of bleeding

Garlic
Ginkgo

22

Approved for prevention of stroke in those with a-fib, post op prophylaxis and treatment of DVT. Factor XA inhibitors

Rivaroxaban (Xarelto)
Apixaban (Eliquis)

23

Also inhibit thrombin directly factor 2A. Prevention of strokes int hose with afib. Has a drying agent in the cap that stops breakdown of medication.

Dabigatran (Pradaxa) PO

24

Interfere with platelet aggregation. Is concerned with stopping formation in arteries. Can still profoundly increase bleeding time.

Antiplatelet Agents

25

Helps platelets go and clup. Prevents platelet aggregation.

Adenosine diphosphate (ADP) receptor blockers

26

Prevents platelet activation and thrombus formation.

Glycoprotein 2b/3a inhibitor

27

Needs to be stopped before surgery. Given to prevent thrombi formation in those at risk for MI and CVA and those that have unstable angina and stent placement. Also given to prevent post op DVT.

Clopidogrel (Plavix) ADP Receptor Blocker

28

Very expensive so not used often. Given in acute situations. Given IV many times concurrently with ASA or heparin for optimal results. Glycoprotein 2b/2a inhibitor.

Epitifbatide (integrilin)
Abciximab (ReoPro)

29

Accelerate the normal process of breaking down clots. Plasmin DIGESTS fibrin breaking it down.

Thrombolytics

30

Given ASAP after clot has formed. Preferably within 4 hours. 6 hours of MI or 3 hours of CVA.

Altepase (Activase) IV

31

Used to promote formation of clots. By preventing digestion of fibrin clots.

Hemostatics

32

Most often prescribed after surgery to stop abnormal bleeding. Also given after acute hemorrhage. In certain instances the incidence of thrombosis is increased.

Aminocaproic Acid (Amicar) PO/IV

33

Amicar adverse effect

wasting and weakness of muscle leading to rhabdomyolysis

34

Anemia can be related too:

Blood loss
Blood cell destruction
Decreased blood cell production

35

Erythopoietin is secreted by what organ?

Kidneys

36

These are meant to ensure proper blood consistency and then of course ensure that are adequate RBC for oxygenaton

Iron

37

Most common reason to get prescribed Epogen

cancer and renal failure

38

Made by recombinant DNA. Stimulates the bone marrow to make RBCs. Hematocrit increases 2%/week.

Epoetin alfa (Epogen, Procrit)

39

Adverse effects of Epogen?

HTN, Thromboembolic events (watch hgb/hct closely)

40

Goal of pharmacotherapy of Anemia

Increase HCT, HGB, O2 and RBC

41

`Effectiveness of Epogen will be much lower when deficient in.....

iron and other vitamins

42

What is a major cause of anemia

iron deficiency

43

Iron Deficient anemia treatments?

Ferrous Fumarate/Sulfate PO (Moderate anemia)
Iron Dextran (Dexferrum) IV/IM (severe anemia)

44

Water soluble B vitamin. Necessary for normal fetal development.

Folic Acid

45

Which condition must be ruled out before giving folic acid?

Perniciious Anemia

46

For Vitamin B12 deficiency Given IM/SQ. Take daily, then every other day, then weekly, then monthly for life.

Cyanocobalamin

47

What must be present to give Cyanocobalamin orally?

intrinsic factor

48

Serious effects that can occur with Cyanocobalamin

Neurovascular Problems: memory loss, unsteadiness and mood disturbances

49

What will we need to assess for reasoning for medication

iron stores, kidney function and bone marrow function

50

Implementation of Iron supplements

Liquid formulations should be taken through a straw
Remain upright min after taking (do not crush)
Can be taken with food/vitamin c
Use Z-track method

51

How long does it take to see improvements in anemia status?

2-6 weeks