Ch. 45 - Anticoagulants Flashcards Preview

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Flashcards in Ch. 45 - Anticoagulants Deck (31):
1

Heparin (1):

VERY STRONG potent inhibitor of clotting process

2

Heparin (2):

Use:
-Prevent & treat clotting disorders r/t:

Venous problems:
-Deep vein thrombosis (DVT)
-Pulmonary embolism (PE)

3

Heparin (3):

Arterial problems:
-Coronary thrombosis (myocardial infarction)

Cerebral vascular accidents (CVA) = strokes

4

Heparin (4):

Indirectly interferes with conversion of prothrombin to thrombin --->

Prevents conversion of fibrinogen to fibrin
= inhibits clot formation

5

Heparin (5):

SC or IV only!

DO NOT massage site after injection

6

Heparin (6):

Initiation of anticoagulant therapy

Once desired prothrombin time is achieved -->
-Oral anticoagulant for maintenance therapy

7

Potency of Heparin: Units --

Heparin lock (flush):
-100 units/mL
-10 units/mL
Heparin soln:
-10,000 units/mL
-5,000 units/mL
-1,000 units/mL

8

Heparin --- Use with Caution:

Diseases with increase risk of hemorrhage

Surgery!

Other drugs that may induce bleeding

9

Heparin --- Monitor:

1.) Activated partial thromboplastin time (aPTT)

2.) Keep aPTT  1 ½ to 2 ½ times normal value

Normal = (25-35 sec)
Heparin = (30-50 sec)

10

Heparin --- Overdosage:

(antidote):
-Protamine Sulfate

11

Do Not Confuse!

-Heparin soln

-Heparin lock (flush)

12

Low-Molecular-Weight Heparins (LMWH):

Extraction of low-molecular-weight fractions of standard heparin --->

Same amt of anticoagulation ability w/ decreased risk of bleeding

aPTT not needed

13

LMWH --- enoxaparin (Lovenox):

1.) SQ
2.) Pre-filled syringe
3.) Abd ~ 5cm away from umbilicus
4.) Avoid scars
5.) Keep air bubble in syringe!
6.) Do not rub injection site

14

enoxaparin (Lovenox) - Use:

Prevent DVT or PE:
-Hip/knee replacement (after surgery)
-Abd surgery (before and/or after surgery)

15

Oral Anticoagulants (1):

Inhibit blood clotting:
-Interferes with synthesis of vitamin-K dependent clotting factors in liver

16

Oral Anticoagulants (2):

Action:
-12-24 hrs after first dose

Depresses Prothrombin -->

Monitor: Prothrombin time (PT)

17

Oral Anticoagulants -- warfarin sodium (Coumadin) (1):

1.) Initial dose: 10 mg/day

2.) Daily maintenance dose:
-2 – 10 mg/day

3.) Duration of action:
-2 – 5 days

18

warfarin sodium (Coumadin) (2):

Dosage:
-Individualized on pt bloodwork
-Based on INR results

19

International Normalized Ratio (INR):

Values:
-Normal = 1.3 - 2

warfarin (Coumadin) therapy:
-Desired INR = 2-3

20

Oral Anticoagulants (3):

* Greater potential for significant drug interactions than any other pharmacological class of drugs *

21

Oral Anticoagulants --- Overdosage:

1.) Bleeding

2.) Excessive hypoprothrombinemia:
-Omit one or more dose
-Vitamin K = (antagonist / antidote)

22

Nursing Process:

Monitor labs:
Heparin = aPTT

warfarin (Coumadin) = INR (prothrombin)

MONITOR FOR BLEEDING

23

Keep antagonists available:

Heparin = protamine sulfate


warfarin (Coumadin) = Vitamin K

24

Nursing Process:

Teach:
-Inform dentist
-Soft toothbrush
-Electric razor
-Do not smoke
-NO ASA!!

25

Nursing Process -- cont....

Diet ---- Avoid:
-Large amts green, leafy veg, broccoli
-Excessive alcohol
-Caffeine

26

clopidogrel (Plavix):

prevention of secondary MI/stroke

-Used alone or with ASA
***More effective if used together

27

Thromobolytics (1):

Enzymes dissolve fibrin clots

Thrombus disintegrates within 4 hrs after acute MI

should give within 3 hrs of thrombolytic stroke

28

Thromobolytics (2):

Also used for:
- PE
- DVT

29

Thromobolytics --- end in....

-ase enzyme

30

Thromobolytics -- complications:

allergic reaction: ---- anaphylaxis

31

Thromobolytics --- major complications:

hemorrhage