Ch. 45 - Anticoagulants Flashcards Preview

Pharm > Ch. 45 - Anticoagulants > Flashcards

Flashcards in Ch. 45 - Anticoagulants Deck (31)
Loading flashcards...
1
Q

Heparin (1):

A

VERY STRONG potent inhibitor of clotting process

2
Q

Heparin (2):

A

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

Venous problems:

  - Deep vein thrombosis (DVT)
  - Pulmonary embolism (PE)
3
Q

Heparin (3):

A

Arterial problems:
-Coronary thrombosis (myocardial infarction)

Cerebral vascular accidents (CVA) = strokes

4
Q

Heparin (4):

A

Indirectly interferes with conversion of prothrombin to thrombin —>

Prevents conversion of fibrinogen to fibrin
= inhibits clot formation

5
Q

Heparin (5):

A

SC or IV only!

DO NOT massage site after injection

6
Q

Heparin (6):

A

Initiation of anticoagulant therapy

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

7
Q

Potency of Heparin: Units –

A

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

8
Q

Heparin — Use with Caution:

A

Diseases with increase risk of hemorrhage

Surgery!

Other drugs that may induce bleeding

9
Q

Heparin — Monitor:

A
  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
Q

Heparin — Overdosage:

A

(antidote) :

- Protamine Sulfate

11
Q

Do Not Confuse!

A
  • Heparin soln

- Heparin lock (flush)

12
Q

Low-Molecular-Weight Heparins (LMWH):

A

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

Same amt of anticoagulation ability w/ decreased risk of bleeding

aPTT not needed

13
Q

LMWH — enoxaparin (Lovenox):

A
  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
Q

enoxaparin (Lovenox) - Use:

A

Prevent DVT or PE:

- Hip/knee replacement (after surgery)
- Abd surgery (before and/or after surgery)
15
Q

Oral Anticoagulants (1):

A

Inhibit blood clotting:

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

16
Q

Oral Anticoagulants (2):

A

Action:
-12-24 hrs after first dose

Depresses Prothrombin –>

Monitor: Prothrombin time (PT)

17
Q

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

A

1.) Initial dose: 10 mg/day

  1. ) Daily maintenance dose:
    - 2 – 10 mg/day
  2. ) Duration of action:
    - 2 – 5 days
18
Q

warfarin sodium (Coumadin) (2):

A

Dosage:

 - Individualized on pt bloodwork
 - Based on INR results
19
Q

International Normalized Ratio (INR):

A

Values:
-Normal = 1.3 - 2

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

20
Q

Oral Anticoagulants (3):

A
  • Greater potential for significant drug interactions than any other pharmacological class of drugs *
21
Q

Oral Anticoagulants — Overdosage:

A

1.) Bleeding

  1. ) Excessive hypoprothrombinemia:
    • Omit one or more dose
    • Vitamin K = (antagonist / antidote)
22
Q

Nursing Process:

A

Monitor labs:
Heparin = aPTT

warfarin (Coumadin) = INR (prothrombin)

MONITOR FOR BLEEDING

23
Q

Keep antagonists available:

A

Heparin = protamine sulfate

warfarin (Coumadin) = Vitamin K

24
Q

Nursing Process:

A

Teach:

  • Inform dentist
  • Soft toothbrush
  • Electric razor
  • Do not smoke
  • NO ASA!!
25
Q

Nursing Process – cont….

A

Diet —- Avoid:

- Large amts green, leafy veg, broccoli
- Excessive alcohol
- Caffeine
26
Q

clopidogrel (Plavix):

A

prevention of secondary MI/stroke

  • Used alone or with ASA
    • **More effective if used together
27
Q

Thromobolytics (1):

A

Enzymes dissolve fibrin clots

Thrombus disintegrates within 4 hrs after acute MI

should give within 3 hrs of thrombolytic stroke

28
Q

Thromobolytics (2):

A

Also used for:

  • PE
  • DVT
29
Q

Thromobolytics — end in….

A

-ase enzyme

30
Q

Thromobolytics – complications:

A

allergic reaction: —- anaphylaxis

31
Q

Thromobolytics — major complications:

A

hemorrhage