Cholesterol/Peripheral Vasodilators, Anticoagulants, Antiplatelets, Thrombolytics

Question 1

HMG-COA Reductase Inhibitors

Answer 1

-statins

rosuvastatin (Crestor)

inhibits enzyme responsible for cholesterol synthesis in liver; reduces LDL levels

Question 2

HMG-COA Reductase Inhibitors SE

Answer 2

constipation
muscle aches
abdominal cramps

Question 3

HMG-COA Reductase Inhibitors ADE

Answer 3

liver impairment
rhabdomyolysis (skeletal muscle disorder that can lead to kidney damage)
cataracts (annual eye exam!)
severe myopathy

Question 4

HMG-COA Reductase Inhibitors Nursing Interventions

Answer 4

monitor lipid levels/LSTs
observe for s/s of GI upset
may take several weeks before lipid levels decrease
take at bedtime (body makes most cholesterol at night)
report any unexplained muscle tenderness, weakness, fever and malaise
don’t stop suddenly! rebound effect; lifetime commitment
no pregnant women and CI in liver disease
changes in vision/eye exams
AVOID ALCH and GRAPEFRUIT JUICE cause it increases drug lvls
take with food if experiencing GI upset

Question 5

Cholesterol Absorption Inhibitors

Answer 5

ezetimibe (Zetia)

blocks receptors in small intestine, reducing absorption of dietary and biliary cholesterol and lowering LDLs

Question 6

Cholesterol Absorption Inhibitors SE/ADE

Answer 6

stomach pain
diarrhea

angioedema

Question 7

Cholesterol Absorption Inhibitors Nursing Interventions

Answer 7

take drug same time everyday once a day with or without food
assess for liver disease and muscle disorders
monitor liver labs when used with statins and use caution for liver issues
report any unexplained muscle tenderness, weakness, fever and malaise

Question 8

Peripheral Vasodilators (Antiplatelet)

Answer 8

cilostazol (Pletal)

Question 9

Peripheral Vasodilators SE

Answer 9

HA
dizziness
peripheral edema
GI upset

Question 10

Peripheral Vasodilators ADE

Answer 10

tachycardia
dysrhythmias
palpitations
blood dycrasias

Question 11

Peripheral Vasodilators Nursing Interventions

Answer 11

obtain baseline vitals for future comparisons
assess for s/s of inadequate blood flow to extremities
plan for reduction of symptoms of intermittent claudication (pain during activity)
monitor vitals (BP and HR)
desired TR may take 1.5-3 months
don’t smoke or drink
tell pt to change position slowly but frequently to avoid OH

Question 12

aPTT (heparin)

Answer 12

measures time for blood to clot (intrinsic pathway)

consider normal as 1.5-2 times the control

ex. normal is 30-40s; therapeutic is 45-80s

hospital protocol for monitoring; baseline and every 6h x2 then every 24 hr

Question 13

INR (Warfarin)

Answer 13

standardized PT (prothrombin time) value for warfarin

normal range 0.8-1.1 (TR is 2-3 or 2.5-3.5 w/mechanical valve or to prevent arterial thrombosis)

Question 14

Anti-activated factor X (Anti Xa) (heparin)

Answer 14

directly measures heparins effect on factor Xa; more accurate than aPTT for heparin dosing

normal is 0.1 1 units/mL (TR is 0.5-1; pt with LMWH is .3-.7)

used in obese, pregnant or renal pts

Question 15

Anticoagulants

Answer 15

stop blood from clotting
stop existing clots from getting bigger
don’t break up existing clots!!

watch for decreased BP and increased HR (hemorrhage)

Question 16

Thrombin Inhibitors (Anticoagulant)

Answer 16

Heparin (high alert med! requires double verification) prevent VTE; rapid onset for initial short term therapy

Low-molecular weight heparin/enoxaparin sodium (Lovenox) for pts unable to do routine labs

activates antithrombin which inactivates thrombin, slows clotting by preventing fibrin formation

prevention/treatment of DVT, PE, stroke, AFib

SQ or IV

Question 17

Thrombin Inhibitors SE

Answer 17

bleeding
abdominal pain (peptic ulcers)
constipation
n/v

Question 18

Thrombin Inhibitors ADE

Answer 18

hemorrhage
thrombocytopenia
heparin induced thrombocytopenia (HIT)
allergic reaction
hyperkalemia
osteoporosis/osteopenia (chronic use)

Question 19

Thrombin Inhibitors Nursing Interventions

Answer 19

CI in stroke, peptic ulcer disease, surgery of the eye, brain or spine and blood abnormalities

ok for mothers to use since it doesn’t cross placenta

DEXA scan for osteoporosis

watch for signs of bleeding (bruising, dark stools (guaiac or fecal occult blood), hematuria

avoid IM injections to prevent hematoma formation (use smallest needle possible and hold for 5 min); decrease needle sticks

careful aPTT monitoring or Anti Xa (0.5-1)

use soft toothbrush and electric razor to prevent bleeding

don’t take NSAIDs or aspirin

wear med alert bracelet

Question 20

Thrombin Inhibitors Labs

Answer 20

every 2 days!

platelets values (below 100,000)
hgb
hct
BP/VS (hypotension and tachycardia)
aPTT

Question 21

Heparin Antidote

Answer 21

protamine sulfate given if aPTT exceeds therapeutic level or signs of bleeding

Question 22

LMWH Nursing Interventions

Answer 22

give SQ in abdomen, rotate sites!
don’t expel air bubble and don’t aspirate or rub skin afterward
don’t need intense lab monitoring like with heparin

90° angle, 2 in from umbilicus

Question 23

Selective Factor Xa Inhibitors

Answer 23

apixaban (Eliquis)

directly inhibits factor Xa which prevents thrombin formation and reduces clot formation

SQ or PO

Question 24

Selective Factor Xa Inhibitors ADE

Answer 24

anemia
bleeding (hematuria, epistaxis)
anaphylaxis

Question 25

Selective Factor Xa Inhibitors Nursing Interventions

Answer 25

CI in active bleeding use caution with pregnancy, breastfeeding or pts in surgery lab monitoring not necessary monitor VS and signs of bleeding (Hgb, Hct, platelet count) don’t discontinue abruptly and use same time everyday with or without food avoid NSAIDs/aspirin wear med tag

Question 26

Selective Factor Xa Inhibitors Antidote

Answer 26

andexa

Question 27

Oral Anticoagulants

Answer 27

warfarin (Coumadin) antagonizes vitamin K prevents clot formation

Question 28

Oral Anticoagulants SE

Answer 28

**bleeding** GI upset fever rash

Question 29

Oral Anticoagulants ADE

Answer 29

teratogenesis ocular hemorrhage warfarin induced skin necrosis

Question 30

Oral Anticoagulants Nursing Interventions

Answer 30

monitor CBC, lumbar pain, abdominal bulging and guaiac tests on stool and signs of bleeding wear med alert tag ask female pts if pregnant or planning determine if pt is taking any drugs by avoid IM injections (hold pressure at site for 5 min. and use smallest needle possible) notify dentists and other doctors about therapy avoid NSAIDs/aspirin veggies rich in vitamin K can decrease warfarin action and certain drugs; don’t drastically change diet CI in active bleeding, pregnancy, recent surgery and uncontrolled HTN

Question 31

Oral Anticoagulants Labs

Answer 31

INR monitoring (0.8-1.1 but goal is 2-3) full therapeutic effect takes 3-7 days, so bridging with heparin is often needed

Question 32

Oral Anticoagulants Antidote

Answer 32

vitamin K (phytonadione) give if PT/INR is high or signs of bleeding

Question 33

Antiplatelet Drugs

Answer 33

aspirin (baby dose of 81 mg) reduce risk of clot formation in arteries by blocking platelet activation and aggregation can have effect for 7 days

Question 34

Antiplatelet Drugs SE

Answer 34

bleeding n/v upset stomach (enteric coated!) gas loss of appetite diarrhea HA rash and itching

Question 35

Antiplatelet Drugs ADE

Answer 35

excessive bleeding (hemorrhage) GI bleeds allergic reactions tinnitus (early sign of toxicity) + hyperventilation salicylate poisoning (aspirin) bronchospasm

Question 36

Antiplatelet Drugs Nursing Interventions

Answer 36

single dose can inhibit platelet aggregation for 7 days; stop aspirin at least 7 days before surgery enteric coated aspirin may reduce GI irritation assess pt for allergy to aspirin/NSAIDs and whether they take antacids monitor platelet lvl and observe for bleeding take with meals to decrease nausea give drugs 2 hrs or 1 hr before antacids treatment may be life long avoid alcohol for risk of stomach bleeding children shouldn’t take aspirin (Reyes syndrome) not safe during last trimester of pregnancy avoid use of NSAIDs/anticoagulants

Question 37

ADP Receptor Blockers

Answer 37

clopidogrel (Plavix) inhibits platelet aggregation

Question 38

ADP Receptor Blockers SE/ADE

Answer 38

bleeding **prolonged bleeding, nausea, rash, neutropenia, hepatotoxicity**

Question 39

ADP Receptor Blockers Nursing Interventions

Answer 39

monitor CBCs and signs of bleeding LFTs at baseline and every 2 weeks for first 3 months of Tx reversible within 1-3 weeks after tx stopped high bleeding risk with NSAIDs, aspirin, alcohol take at same time daily with meals avoid use with antacids (take 1 hr or 2 hrs after) wear med alert bracelet if long term therapy

Question 40

Thrombolytic Drugs

Answer 40

alteplase (tpa) activase **ONLY ONE THAT BREAKS DOWN EXISTING CLOTS (FIBRIN), CLOT BUSTERS** given within 3 hrs of symptom onset for ischemic stroke, give within 4 hrs for MI

Question 41

Thrombolytic Drugs SE/ADE

Answer 41

bleeding (check wounds, injection sites, gums and cuts) **life threatening hemorrhage, allergic reaction** hypotension

Question 42

Thrombolytic Drugs Nursing Interventions

Answer 42

monitor for bleeding (especially intracranial hemorrhage), coagulation lab tests observe for s/s of allergic reaction avoid NSAIDs and aspirin don’t give any injectable drugs, start/remove IVs no heavy lifting for 10 days have pt report unusual symptoms at once like arm/leg pain that worsens time matters chance of miscarriage during first 5 months CI if mother has given birth within 24 hrs, history of hemorrhage stroke, internal bleeding, trauma, surgery, and uncontrolled HTN, recent GI bleed

Question 43

Hemostatic Agents (Amicar)

Answer 43

promote formation of clots by preventing excess bleeding from surgical sites may cause hypercoagulation with use of estrogen/oral contraceptive can be given during acute hemorrhage via IV monitor very closely

Question 44

Total Cholesterol

Answer 44

<150-200 mg/dL higher levels increase heart disease risk

Question 45

LDLs

Answer 45

<100 mg/dL elevated lvls can lead to arterial plaque buildup

Question 46

HDLs

Answer 46

>60 Or >40 mg/dL higher HDL clears LDLs

Question 47

Triglycerides

Answer 47

<40-150 mg/dL elevated lvls can cause atherosclerosis