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NUR 325 Patho > Coagulation Meds > Flashcards

Coagulation Meds Flashcards

(92 cards)

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1
Q

What is the biggest concern in anti-coagulant medications

A

most common S/E is bleeding

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2
Q

What 3 things do nurses want to monitor for bleeding

A

Hemoglobin
hematocrit
Vital Signs

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3
Q

what 2 considerations should nurses know about their patient on anti-coagulant medications

A

Know why your patient is on an anti-coagulant

know what sites they may be at risk for bleeding

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4
Q

What are the 2 types of coagulation drugs

A

Anticoagulants

Anti platelet

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5
Q

What are anticoagulants

A

Inhibit the action or formation of the clotting factors

PREVENT clots

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6
Q

What are antiplatelets

A

Prevent platelet plugs from forming by inhibiting platelet aggregation

Best for preventing heart attacks and stroke

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7
Q

MOA of heparin

A

Prevents clotting by activating ANTITHROMBIN -> indirectly inactivates thrombin & factor Xa

Inhibits FIBRIN formation

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8
Q

What is the MOA of Enoxaparin or Low molecular weight heparin

A

Prevents clotting by activating ANTITHROMBIN

ONLY inactivates factor Xa (not thrombin)

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9
Q

What is the first sign of fluid volume deficit ?

A

tachycardia

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10
Q

Signs of internal bleeding

A

tachycardia
skin pallor
low BP
respiration Increasing

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11
Q

T/F Bruising can be a late sign of internal bleeding?

A

True

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12
Q

What is the class for Heparin and LMWH (Enoxaparin)

A

Heparins

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13
Q

Route of Heparin

A

Only given parental (IV or SQ)

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14
Q

Indications for Heparin

A

conditions necessitating PROMPT anticoagulant activity

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15
Q

Examples of when to give Heparin (4)

A

Evolving stroke, PE, massive DVT

Adjunct for patients having open heart surgery or dialysis

Low-dose therapy for prophylaxis against post-op DVT

Treat disseminated intravascular coagulation

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16
Q

What amount and frequency can Heparin be given

A

5000u injection 2-3x a day or as an IV drip with a bolus

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17
Q

what protocol is heparin given

A

weight-based in kg

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18
Q

When Does IV heparin start working

A

Immediately

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19
Q

when does SQ heparin start working

A

20-30 minutes

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20
Q

what is the anti-dote for Heparin

A

Protamine Sulfate

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21
Q

how is protamine given

A

IV
slowly
pushing can drop BP

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22
Q

What patients do we use caution when giving Heparin

A

patients with spinal or epidural anesthesia

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23
Q

T/F Heparin is a HIGH-RISK MED

A

True - must double check with other RN prior to rate changes and boluses

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24
Q

Adverse effects of Heparin (4)

A

bleeding
hematoma
anemia
thrombocytopenia

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25
What 5 things do we monitor for when giving heparin
vital signs, bruising, petechiae, hematomas, black tarry stools
26
What is Heparin induced thrombocytopenia (HIT)
Low platelet count and increased development of thrombi caused by antibody development
27
What are the nursing consideratoins for Heparin induced thrombocytopenia (HIT)
Monitor platelet counts Stop heparin immediately if platelet count \<100,000/mm3 Non-heparin anticoagulants can be used as substitute if anticoagulation still needed
28
What 2 labs do we monitor with Heparin
Anti-Xa OR aPTT (activated partial thromboplastin time)
29
How do we dose IV heparin
based on clotting time labs
30
What is Enoxaparin (Lovenox)
Low-molecular weight heparin
31
What route is Enoxaparin available
SQ injectable
32
Are labs necessary for Enoxaparin
No
33
What are the indications for Enoxaparin
given prophylaxis & treatment
34
What is the advantage of Enoxaparin
can be given at home
35
what are the adverse effects on enoxaparin
bleeding thromboxytopenia Can also cause HIT
36
What is the antidote for Enoxaparin
protamine
37
what patients do we use caution when giving enoxaparin
patients with spinal or epidural anesthesia
38
Reason for low molecular weight heparin
takes large unfractionated heparin moleculaes and cleaves them into smaller fragments and this makes them have greater affinity to factor X-a making them bioavailable and have a longer half life
39
Can you give Enoxaparin and heparin together
No
40
what is the black box warning for Enoxaparin
potential spinal hematoma if patient has epidural catheter
41
5 Nursing considerations for Enoxaparin
Don’t give with really any other anticoagulants except oral warfarin when treating PE or DVT Given in pre-filled syringes easy to administer and teach to give at home Do not expel the air bubble: will remain in plunger to ensure whole dose is given Slower onset of action compared to heparin but LONGER half-life Rotate injection sites
42
MOA of warfarin
Vitamin-K inhibitor -prevents the synthesis of four coagulation factors (VII, IX, X, prothrombin)
43
indications of Warfarin (3)
prevention VTE/DVT/PE, thrombotic events for patients with afib or heart valves, reduce recurrence of TIA or MI
44
route of Warfarin
only given PO, Once daily
45
What is the onset of warfarin
24 hrs
46
what is the duration of warfarin
2-5 days
47
Adverse effects of Warfarin
bleeding lethargy muscle pain purple toes
48
Antidote of warfarin
Vitamin K (IV) If that doesn't work Fresh frozen plasma or whole blood
49
Can you give warfarin to pregnant women or breastfeeding
NO
50
Warfarin nursing considerations
Monitor and teach signs of bleeding hold before surgeries monitor labs MANY drug interactions Food interactions Avoid alcohol Weat medic alert bracelet, use soft toothbrush,
51
What Labs do we monitor for Warfarin
PT- prothrombin time INR- International normalize ratio
52
Normal INR value without warfarin
about 1
53
Therapeutic value with warfarin
2-3.5
54
How frequently do we monitor patients on warfarin for therapeutic effect
MONTHLY
55
What foods should be monitored when taking warfarin
Avoid foods High in Vitamin K green, leafy vegetables
56
MOA of Apixaban (Eliquis) & Rivaroxaban (Xarelto
Direct inhibitor of factor Xa
57
Indications of Apixaban (Eliquis) & Rivaroxaban (Xarelto
prevent strokes in patients with afib, post-op thrombo-prophylaxis, treat DVT & PE
58
Adverse effects of Apixaban (Eliquis) & Rivaroxaban (Xarelto
bleeding, hematoma, dizziness, rash, gastrointestinal distress, peripheral edema
59
Black box warnings for Apixaban (Eliquis) & Rivaroxaban (Xarelto
Spinal hematomas if patient has epidural catheter Risk of thrombosis if drugs ABRUPTLY stopped
60
Drug interactions with Apixaban (Eliquis) & Rivaroxaban (Xarelto
Decreased effects: phenytoin, carbamazepine, rifampin, and st. johns wort Increased effects: CYP3A4 inhibitors (amiodarone, erythromycin, ketonazole, HIV meds, diltiazem, verapamil, grapefruit juice)
61
Do you have to routine monitor Apixaban (Eliquis) & Rivaroxaban (Xarelto
NO
62
antidote for Apixaban (Eliquis) & Rivaroxaban (Xarelto
andexxa (recombinant factor Xa, inactivated-zhzo)
63
can you give Apixaban & rivaroxaban in conjunction with other anticoagulants
NO
64
What organ function and levels do we need to monitor with Apixaban & rivaroxaban
Liver function ALT AST GGT
65
2 types of antiplatelet drugs
``` Aspirin Clopidogrel (plavix) ```
66
S/E of Aspirin
GI (n/v), drowsiness/confusion, bleeding
67
nursing considerations for aspirin
Don’t crush enteric coated OTC medication considerations Reye’s syndrome: children with a virus NO ASPIRIN
68
contraindications for aspirin
thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vitamin K deficiency, recent hemorrhagic stroke
69
What is the antidote for Aspirin
DDAVP (Desmopressin)
70
MOA of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
Antiplatelet ADP inhibitor Alters the platelet membrane so it doesn’t receive the signal to aggregate
71
Indications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
reduce risk of stroke, prophylaxis of TIAs, post-MI
72
Contraindications of Clopidogrel (Plavix) & Ticagrelor (Brilinta)
thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vitamin K deficiency, recent hemorrhagic stroke
73
Side effects of Clopidogrel & Ticagrelor
chest pain, edema, flu-like symptoms, abdominal pain, diarrhea, nausea, epistaxis, rash,pruritus
74
Route of Clopidogrel & Ticagrelor
PO
75
Clopidogrel Black Box Warning
patients with certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite
76
Ticagelor Black Box Warning
Increased bleeding risk risk with aspirin doses over 100mg
77
Antidote for Clopidogrel & Ticagrelor
DDAVP or platelet transfusion
78
What reduces the effectiveness of Clopidogrel
amiodarone, calcium channel blockers, NSAIDS, PPIs
79
2 Thrombin Inhibitors
argatroban bivalrudin
80
class of argatroban and bivalrudin
Direct Thrombin Inhibitors
81
MOA of Direct Thrombin Inhibitors
Inhibit thrombin (factor IIa)
82
indications of argatroban and bivalrudin
treat HIT, and for patients undergoing procedures (PCI) who are at high risk for HIT
83
route of argatroban and bivalrudin
IV only
84
Adverse effects of argatroban and bivalrudin
bleeding
85
Argatroban should be cautioned in patients with what
hepatic dysfunction
86
What labs do we monitor with Direct thrombin inhibitors
Anti-Xa H&H platelets
87
What is aspirin
NSAID - Blocks prostaglandin synthesis through the COX enzyme pathways
88
What does aspirin block
Platelet aggregation
89
what does aspirin prevent
platelets from clumping together
90
What are the indications of aspirin
prevent/treat MI, prevent ischemic stroke
91
Route of aspirin
PO
92
What can you do in an acute event with aspirin
Chew a baby aspirin but cannot be enteric coated

NUR 325 Patho (18 decks)

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