Coagulation Modifier Drugs Flashcards Preview

NCLEX > Coagulation Modifier Drugs > Flashcards

Flashcards in Coagulation Modifier Drugs Deck (65):
0

Alteplase (tissue plasminogen activator, t-Pa)
(Functional Classification)

Thrombolytic enzyme

1

Alteplase (tissue plasminogen activator, t-Pa)
(Chemical Classification)

Tissue plasminogen activator (TPA)

2

Alteplase (tissue plasminogen activator t-Pa)
(Mechanism of Action)

Produces fibrin conversion of plasminogen to plasmin; able to bind to fibrin, convert plasminogen in thrombus to plasmin, which leads to local fibrinolysis, limited systemic proteolysis

3

Alteplase (tissue plasminogen activator t-Pa)
(Uses)

Lysis of obstructing thrombi associated with acute MI, ischemic conditions that require thrombolysis (i.e., PE, unclotting arteriovenous shunts, acute ischemic CVA), central venous catheter occlusion (Cathflo)

4

Alteplase (tissue plasminogen activator, t-Pa)
(Contraindications)

Active internal bleeding, history of CVA, severe uncontrolled hypertension, intracranial/intraspinal surgery/trauma (within 3 mo), aneurysm, brain tumor, platelets 1.7 or PR >15 sec, arteriovenous malformation, subarachnoid hemorrhage, intracranial hemorrhage, uncontrolled hypertension, seizure at onset of stroke

5

Alteplase (tissue plasminogen activator, t-Pa)
(Side Effect)

CV: SINUS BRADYCARDIA, CHOLESTEROL MICROEMBOLIZATION, VENTRICULAR TACHYCARDIA, ACCELERATED IDIOVENTRICULAR RHYTHM, BRADYCARDIA, RECURRENT ISCHEMIC STROKE, hypotension
EENT: OROLINGUAL ANGIOEDEMA
INTEG: urticaria, rash
SYST: GI, GU, INTRACRANIAL, RETROPERITONEAL BLEEDING, Surface Bleeding, ANAPHYLAXIS, fever

6

Alteplase (tissue plasminogen activator, t-Pa)
(Nursing Considerations)

ASSESS:
-Treatment is not recommended for patients with acute ischemic stroke >3hr after symptom onset or with minor neurologic deficits or rapidly improving symptoms
-VS, BP, pulse, respirations, neurologic signs, temp at least q4hr; temp >104 degree F (40 degree C) indicates internal bleeding; monitor rhythm closely; ventricular dysrhythmias may occur with hyperfusion; monitor heart, breath sounds, neurologic status, peripheral pulses; assess neurologic status, neurologic change may indicate intracranial bleeding; those with severe neurologic deficit (NIH SS>22) at presentation have increased risk of hemorrhage
-FOR BLEEDING during 1st hour of treatment and 24hr after procedure: hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis; guaiac all body fluids, stools; do not use 150mg or more total dose because intracranial bleeding may occur
-HYPERSENSITIVITY: fever, rash, itching, chills, facial swelling, dyspnea, notify prescriber immediately; stop product, keep resuscitative equipment nearby; mild reaction may be treated with antihistamines
-Previous allergic reactions or streptococcal infection; alteplase may be less effective
-BLOOD STUDIES (Hct, PLATELETS, PTT, PT, TT, APTT) BEFORE STARTING THERAPY; PT or APTT MUST BE LESS THAN 2x CONTROL BEFORE STARTING THERAPY TT OR PT q3-4hr DURING TREATMENT
-MI: ECG CONTINUOUSLY, CARDIAC ENZYMES, RADIONUCLIDE MYOCARDIAL SCANNING/CORONARY ANGIOGRAPHY; CHEST PAIN INTENSITY, CHARACTER; MONITOR THOSE WITH MAJOR EARLY INFARCT SIGNS ON CT SCAN WITH SUBSTANTIAL EDEMA, MASS EFFECT, MIDLINE SHIFT
-PE: PULSE, BP, ABGs, RATE/RHYTHM of RESPIRATIONS
-OCCLUSION: have patient exhale then hold breath when connecting/disconnecting syringe to prevent air embolism
-CHOLESTEROL EMBOLISM: purple toe syndrome, acute renal failure, gangrenous digits, hypertension, livedo reticularis, pancreatitis, MI, cerebral infarction, spinal cord infarction, retinal artery occlusion, bowel infarction, rhabdomyolysis

PERFORM/PROVIDE:
-Avoidance of invasive procedures, inj, rectal temp
-Pressure for 30 sec to minor bleeding sites; 30 min to sites of atrial puncture followed by pressure dressing; inform prescriber if this does not attain hemostasis; apply pressure dressing

7

Aspirin
(Functional Classification)

Nonopioid analgesic, non-steroidal anti-inflammatory, antipyretic, antiplatelet

8

Aspirin
(Chemical Classification)

Salicylate

9

Aspirin
(Mechanism of Action)

Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation

10

Aspirin
(Uses)

Mild to moderate pain or fever including RA, osteoarthritis, thromboembolic disorders; TIAs, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI

11

Aspirin
(Contraindications)

Pregnancy (D) 3rd trimester, breastfeeding, children <12yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine (FDC yellow dye #5), GI bleeding disorders, vit K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure intracranial bleeding, nasal polyps, urticaria

12

Aspirin
(Side Effects)

CNS: stimulation, drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, COMA
CV: rapid pulse, pulmonary edema
EENT: tinnitus, hearing loss
ENDO: hypoglycemia, hyponatremia, hypokalemia
GI: Nausea, Vomiting, GI BLEEDING, diarrhea, heartburn, anorexia, HEPATITIS
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA, increased PT, aPTT, bleeding time
INTEG: Rash, urticaria, bruising
RESP: wheezing, hyperpnea
SYST: REYE'S SYNDROME (CHILDREN), ANAPHYLAXIS, LARYNGEAL EDEMA

13

Aspirin
(Nursing Considerations)

ASSESS:
-PAIN: character, location, intensity; ROM before and 1 hr after administration
-FEVER: temp before and 1 hr after administration
-Hepatic studies: AST, ALT, bilirubin, creatinine if patient is receiving long-term therapy
-Renal studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure (long-term therapy)
-Blood studies: CBC, Hct, Hgb, PT if patient is receiving long-term therapy
-HEPATOTOXICITY: dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy
-ALLERGIC REACTIONS: rash, urticaria; if these occur, product may have to be discontinued; patients with asthma, nasal polyps, allergies: severe allergic reaction may occur
-OTOTOXICITY: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
-SALICYLATE LEVEL: therapeutic level 150-300mcg/ml for chronic inflammation
-Edema in feet, ankles, legs
-Product history; many product interactions

14

Aspirin
(Overdose Treatment)

Lavage, activated charcoal, monitor electrolytes, VS

15

Clopidogrel (Plavix)
(Functional Classification)

Platelet aggregation inhibitor

16

Clopidogrel (Plavix)
(Chemical Classification)

Thienopyridine derivative

17

Clopidogrel (Plavix)
(Mechanism of Action)

Inhibits ADP-induced platelet aggregation

18

Clopidogrel (Plavix)
(Uses)

Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina

19

Clopidogrel (Plavix)
(Contraindications)

hypersensitivity, active bleeding

20

Clopidogrel (Plavix)
(Side Effects)

CNS: headache, dizziness, depression, syncope, hypesthesia, neuralgia
CV: edema, hypertension, chest pain
GI: nausea, vomiting, diarrhea, constipation, GI discomfort, GI BLEEDING, PANCREATITIS, HEPATIC FAILURE
GU: GLOMERULONEPHRITIS
HEMA: epistaxis, purpura, BLEEDING, NEUTROPENIA, APLASTIC ANEMIA, AGRANULOCYTOSIS, THROMBOTIC THROMBOCYTOPENIC PURPURA
INTEG: rashm pruritus, ANAPHYLAXIS
MISC: UTI, hypercholesterolemia, chest pain, fatigue, INTRACRANIAL HEMORRHAGE, TOXIC EPIDERMAL NECROLYSIS, STEVENS-JOHNSON SYNDROME, flulike syndrome
MS: arthralgia, back pain
RESP: upper respiratory tract infection, dyspnea, rhinitis, bronchitis, cough, BRONCHOSPASM

21

Clopidogrel (Plavix)
(Nursing Considerations)

ASSESS:
-THROMBOTIC/ THROMBOCYTIC PURPURA, fever, thrombocytopenia, neurolytic anemia
-Symptoms of stroke, MI during treatment
-Hepatic studies: AST, ALT, bilirubin, creatinine (long-term therapy)
-Blood studies: CBC, differential, Hct, Hgb, PT, cholesterol (long-term therapy)

22

Dabigatran (Pradaxa)
(Functional Classification)

Anticoagulant-thrombin inhibitor

23

Dabigatran (Pradaxa)
(Mechanism of Action)

Direct thrombin inhibitor that inhibits both free and clot-bound thrombin, prevents thrombin-induced platelet aggregation and thrombus formation by preventing conversion of fibrinogen to fibrin

24

Dabigatran (Pradaxa)
(Uses)

Stroke/systemic embolism prophylaxis with nonvalvular atrial fibrillation

25

Dabigatran (Pradaxa)
(Contraindications)

Hypersensitivity, bleeding

26

Dabigatran (Pradaxa)
(Side Effects)

CNS: INTRACRANIAL BLEEDING
CV: MYOCARDIAL INFARCTION
GI: abdominal pain, dyspepsia, peptic ulcer, esophagitis, GERD, gastritis, GI BLEEDING
HEMA: BLEEDING
INTEG: rash, pruritus
SYST: ANAPHYLAXIS (RARE)

27

Dabigatran (Pradaxa)
(Nursing Considerations)

ASSESS:
-BLEEDING: blood in urine or emesis, dark tarry stools, lower back pain; caution with arterial/venous punctures, catheters, NG tubes; monitor vital signs frequently; elderly more prone to serious bleeding
-THROMBOSIS/MI/EMBOLI: swelling, pain, redness, difficulty breathing, chest pain, tachypnea, cough, coughing up blood, cyanosis
-POST-THROMBOTIC SYNDROME: pain, heaviness, itching/tingling, swelling, varicose veins, brownish/reddish skin discoloration, ulcers; use of ambulation, compression stockings, adequate anticoagulation can prevent this syndrome
-Serum Creatinine

28

Enoxaparin (Lovenox)
(Functional Classification)

anticoagulant, antithrombotic

29

Enoxaparin (Lovenox)
(Chemical Classification)

Low-molecular-weight heparin (LMWH)

30

Enoxaparin (Lovenox)
(Mechanism of Action)

Binds to antithrombin III inactivating factors Xa/IIa, thereby resulting in a higher ratio of anti-factor Xa to IIa

31

Enoxaparin (Lovenox)
(Uses)

Prevention of DVT (inpatient or outpatinet), PE (inpatient in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non-Q-wave MI

32

Enoxaparin (Lovenox)
(Contraindications)

Hypersensitivity to this product, benzyl alcohol, heparin, pork; active major bleeding, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, heparin-induced thrombocytopenia

33

Enoxaparin (Lovenox)
(Side Effects)

CNS: fever, confusion
GI: nausea
HEMA: HEMORRHAGE, HYPOCHROMIC ANEMIA, THROMBOCYTOPENIA, BLEEDING
INTEG: ecchymosis, inj site hematoma
META: hyperkalemia in renal failure
SYST: edema, peripheral edema

34

Enoxaparin (Lovenox)
(Nursing Considerations)

ASSESS:
-Blood studies (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stools), anti-factor Xa (should be checked 4 hr after inj); thrombocytopenia may occur
-Renal studies: BUN/creatinine baseline and periodically
-BLEEDING: gums, petechiae, ecchymosis, black tarry stools, hematuria; notify prescriber
-NEUROLOGIC SYMPTOMS in patients who have received spinal anesthesia

35

Enoxaparin (Lovenox)
(Overdose Treatment)

Protamine SO4 1% sol; dose should equal dose of enoxaparin

36

Eptfibatide
(Functional Classification)

Antiplatelet agent

37

Eptifibatide
(Chemical Classification)

Glycoprotein IIb/IIIa inhibitor

38

Eptifibatide
(Mechanism of Action)

Platelet glycoprotein antagonist; this agent reversibly prevents fibrinogen, von Willebrand's factor from binding to the glycoprotein IIb/IIIa receptor, thus inhibiting platelet aggregation

39

Eptifibatide
(Uses)

Acute coronary syndrome including those undergoing percutaneous coronary intervention (PCI)

40

Eptifibatide
(Contraindications)

Hypersensitivity, active internal bleeding; history of bleeding, stroke within 2 yr; major surgery with severe trauma, severe hypertension, history of intracranial bleeding, current or planned use of another parenteral GP IIb/IIIa inhibitor, dependence on renal dialysis, coagulopathy, AV malformation, aneurysm

41

Eptifibatide
(Side Effects)

CV: STROKE, hypotension
GU: hematuria
HEMA: THROMBOCYTOPENIA
SYST: BLEEDING, ANAPHYLAXIS

42

Eptifibatide
(Nursing Considerations)

ASSESS:
-THROMBOCYTOPENIA: platelets, Hgb, Hct, creatinine, PT/APTT baseline INR within 6 hr of loading dose, daily thereafter, patients undergoing PCI should have ACT monitored; maintain APTT 50-70 sec unless PCI to be performed; during PCI, ACT should be 200-300 sec; if platelets drop <100,000mm3, obtain additional platelet counts; if thrombocytopenia is confirmed, discontinue product; draw Hct, Hgb, serum creatinine
-BLEEDING: gums, bruising, ecchymosis, petechiae; from GI, GU tract, cardiac cath sites, IM inj sites

PERFORM/PROVIDE:
-Discontinue product prior to CABG
-All medications PO if possible; avoid IM inj, all catheters

43

Fondaparinux (Arixtra)
(Functional Classification)

Anticoagulant, antithrombotic

44

Fondaparinux (Arixtra)
(Chemical Classification)

Synthetic, selective factor Xa inhibitor

45

Fondaparinux (Arixtra)
(Mechanism of Action)

Acts by antithrombin III (ATIII)-mediated selective inhibition of factor Xa; neutralization of factor Xa interrupts blood coagulation and inhibits thrombin formation; does not inactivate thrombin (activated factor II) or affect platelets

46

Fondaparinux (Arixtra)
(Uses)

Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery

47

Fondaparinux (Arixtra)
(Contraindications)

Hypersensitivity to this product; hemophilia, leukemia with bleeding, peptic ulcer disease, hemorrhagic stroke, surgery, thrombocytopenic purpura, weight <30 ml/min), active major bleeding, bacterial endocarditis

48

Fondaparinux (Arixtra)
(Side Effects)

CNS: Fever, confusion, headache, dizziness, Insomnia
GI: Nausea, Vomiting, diarrhea, dyspepsia, Constipation, increased AST, ALT
GU: UTI, urinary retention
HEMA: Anemia, minor bleeding, purpura, hematoma, THROMBOCYTOPENIA, MAJOR BLEEDING (INTRACRANIAL, CEREBRAL, RETROPERITONEAL HEMORRHAGE), POSTOPERATIVE HEMORRHAGE, HEPARIN-INDUCED THROMBOCYTOPENIA
INTEG: increased wound drainage, bullous eruption, local reaction-Rash, pruritus, inj site bleeding
META: hypokalemia
OTHER: hypotension, pain, Edema

49

Fondaparinux (Arixtra)
(Nursing Considerations)

ASSESS:
-Monitor patients who have received epidural/spinal anesthesia or lumbar puncture for neurological impairment
-Blood studies (CBC, anti-Xa, Hgb/Hct, prothrombin time, platelets, occult blood in stools), thrombocytopenia may occur; if platelets <100,000/mm3, treatment should be discontinued; renal studies: BUN, creatinine
-For bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria; decreased Hct, notify prescriber
-For risk of hemorrhage if coadministering with other products that may cause bleeding
-For hypersensitivity: rash, fever, chills; notify prescriber

50

Heparin
(Functional Classification)

Anticoagulant, Antithrombotic

51

Heparin
(Mechanism of Action)

Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III

52

Heparin
(Uses)

Prevention of deep venous thrombosis, PE, MI, open heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with emoblization, as an anticoagulant in transfusion and dialysis procedures, prevention of DVT/PE, to maintain patency of indwelling venipuncture devices; diagnosis, treatment of DIC

53

Heparin
(Contraindications)

hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, severe thrombocytopenic purpura, severe renal/hepatic disease, blood dyscrasias, severe hypertension, subacute bacterial endocarditis, acute nephritis; benzyl alcohol products in neonates/infants/pregnancy/lactation

54

Heparin
(Side Effects)

CNS: Fever, chills, headache
GU: HEMATURIA
HEMA: HEMORRHAGE, THROMBOCYTOPENIA, ANEMIA
INTEG: Rash, dermatitis, urticaria, pruritus, delayed transient alopecia, hematoma, cutaneous necrosis (SUBCUT)
META: hyperkalemia, hypoaldosteronism
SYST: ANAPHYLAXIS

55

Heparin
(Nursing Considerations)

ASSESS:
-Bleeding, hemorrhage: gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, BP; HIT may occur after product discontinuation
-Blood studies (Hct, occult blood in stools) q3mo
-Partial prothrombin time, which should be 1.5-2.5x control; for continuous IV inf, check aPTT baseline 6hr after initiation and 6hr after any dose change; use aPTT for dosing adjustments; after therapeutic aPTT has been measured 2x, check aPTT daily
-Platelet count q2-3days; thrombocytopenia may occur on 4th day of treatment
-HYPERSENSITIVITY: rash, chills, fever, itching; report to prescriber

56

Heparin
(Overdose Treatment)

Withdraw product, protamine 1mg protamine/100 units heparin

57

Warfarin (Coumadin)
(Functional Classification)

Anticoagulant

58

Warfarin (Coumadin)
(Chemical Classification)

Coumarin derivative

59

Warfarin (Coumadin)
(Mechanism of Action)

Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit-K-dependent coagulation factors (II, VII, IX, X)

60

Warfarin (Coumadin)
(Uses)

Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, thrombosis prophylaxis

61

Warfarin (Coumadin)
(Contraindications)

Pregnancy (X), breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, thrombocytopenic purpura, hepatic disease (severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhagic tendencies; surgery of CNS, eye; traumatic surgery with large open surface, bleeding tendencies of GI/GU/respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar anesthesia
Bleeding

62

Warfarin (Coumadin)
(Side Effects)

CNS: Fever, dizziness, fatigue, headache, lethargy
CV: angina, chest pain, edema, hypotension, syncope
GI: Diarrhea, nausea, vomiting, anorexia, stomatitis, cramps, HEPATITIS, cholestatic jaundice
GU: HEMATURIA
HEMA: HEMORRHAGE, AGRANULOCYTOSIS, LEUKOPENIA, EOSINOPHILIA, anemia, ecchymosis, petechiae
INTEG: Rash, dermatitis, urticaria, alopecia, pruritus
MISC: epistaxis, hemoptysis, mouth ulcers, taste disturbances, priapism, dyspnea
MS: bone fractures
SYST: ANAPHYLAXIS, coma, cholesterol, microembolism, EXFOLIATIVE DERMATITIS, PURPLE TOE SYNDROME

63

Warfarin (Coumadin)
(Nursing Considerations)

ASSESS:
-Blood studies (Hct, PT, platelets, occult blood in stools) q3mo; INR: in hospital daily after 2nd or 3rd dose; when in therapeutic range for 2 consecutive days, monitor 2-3x wk for 1-2wk then less frequently, depending on stability of INR results; Outpatient: monitor every few days until stable doses then periodically thereafter, depending on stability of INR results
-Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria; fatal hemorrhage can occur
-Fever, skin rash, urticaria

64

Warfarin (Coumadin)
(Overdose Treatment)

Administer vit K