coagulation modifiers Flashcards
(21 cards)
COAGULATION THERAPY GOALS
prevent _______
break apart _______
help increase ____ & _____
decrease _____
prevent further _______
indicate need for anti-coag therapy:
prevent CLOT FORMATION
break apart EXISTING CLOT
help increase CIRCULATION & PERFUSION
decrease PAIN
prevent further TISSUE DAMAGE
a. fib, heart disease, HF, hx DVT, immobile for extended period of time, hx stroke
BIGGEST CONCERN: ________
_____ anti-coags most common side effect.
can be _____ or _____.
know ___ pt is on anti-coag & _____ they may be at risk for bleeding.
monitor what labs?
monitor VS:
BLEEDING
ALL
can be INTRINSIC (GI or brain bleed) or EXTRINSIC (cut on hand)
know WHY pt is on anti-coag & WHAT SITES they may be at risk for bleeding
- common for pt in hospitals to be on anti-coags d/t immobility and increased risk of DVT
monitor H&H
VS: first sign is normally tachycardia
later signs: drop in BP, increased RR & WOB, pale
TYPES OF DRUGS:
anticoagulants:
antiplatelets:
anticoagulants: inhibit the action or formation of clotting factors, PREVENT clots; do not do anything once clot is formed
anti-platelets: prevent platelet plugs from forming by inhibiting platelet aggregation, best for preventing heart attacks and stroke; impedes formation of clot
HEPARIN
prevents clotting by activating ______ which indirectly inactivates _____ & ______.
inhibits _____ formation.
prevents clotting by activating ANTITHROMBIN which indirectly inactivates THROMBIN & FACTOR Xa.
inhibits FIBRIN formation.
ENOXAPARIN
prevents clotting by activating antithrombin.
ONLY inactivates ____.
FACTOR Xa
HEPARIN
only given _____.
indications: conditions necessitating _____ ant-thrombotic activity.
can be given _____ injection ____/day or as an ______ with a bolus (usually a ____ protocol).
only given PARENTERAL: SUBQ or IV
indications: conditions necessitating PROMPT activity.
- evolving stroke, PE, massive DVT
- adjunct for pt having open heart surgery or dialysis
- low-dose therapy for prophylaxis against post-op DVT
- treatment disseminated intravascular coagulation (DIC)
can be given 5000u injection 2-3/day or as an IV DRIP with a bolus (usually a WEIGHT-BASED protocol).
HEPARIN
NC:
starts working _____
sub-q:
IV:
antidote:
use cautiously in pt with _____ or ______.
_____-_____ medication!! must ____ with other RN prior to rate changes and boluses.
AE:
monitor for bleeding:
QUICKLY
20-30 mins
IMMEDIATE
protamine sulfate
spinal or epidural anesthesia
HIGH-ALERT, double check
AE: bleeding, hematoma, anemia, thrombocytopenia
monitor for bleeding: VS, bruising, petechiae, hematomas, black tarry stools
HEPARIN INDUCED THROMBOCYTOPENIA (HIT)
___ platelet count and ____ development of thrombi = caused by _______.
NC for HIT:
monitor _____
stop immediately if platelet count < _____.
______ can be used as a substitute if anticoagulation still needed.
LOW platelet count and INCREASED development of thrombi = caused by ANTIBODY DEVELOPMENT.
monitor PLATELET COUNTS
< 100,000
NON-HEPARIN anticoagulants
LABS ASSOCIATED WITH HEPARIN
we dose IV heparin based on ______.
_____ or _____.
therapeutic ranges for each:
considerations for drawing labs:
we dose IV heparin based on CLOTTING TIME LABS
anti-Xa or aPTT
anti-Xa: 0.3-0.7
aPTT: >60-80
use a stick or peripheral IV, flush with 2-3 10mL of NS before drawing labs
ENOXAPARIN
aka:
labs ____ necessary
only given ______.
indications:
advantage:
AE:
antidote:
use cautiously in pt with _____ or _____.
aka: low molecular weight heparin
labs NOT necessary
only given SQ injectable form
indications: given prophylaxis & treatment
advantage: can be given at home
AE: bleeding, thrombocytopenia, can cause HIT
antidote: protamine
spinal or epidural anesthesia
ENOXPARIN
NC:
DO NOT give with _____.
do not give with other ______ except oral ______ when treating PE or DVT.
BBW:
given in ______ syringes = ___ to administer and ____ to give at home.
do not ___ air bubble; remains in plunger to ____.
_____ onset of action compared to heparin but ______ half-life.
____ injection sites.
do not ____ injection sites.
is safe for _____.
do not give with HEPARIN.
do not give with other ANTICOAGULANTS excepts oral WARFARIN when treating PE or DVT.
BBW: potential spinal hematoma if pt has epidural catheter.
given in PRE-FILLED syringes = EASY to administer & TEACH to give at home.
do not EXPEL air bubbles; remains in plunger to ENSURE WHOLE DOSE IS GIVEN.
SLOWER onset of action compared to heparin but LONGER half-life.
ROTATE injection sites.
do not RUB injection sites.
is safe for PREGNANT.
WARFARIN
vitamin K _____ = prevents synthesis of 4 coagulation factors
1.
2.
3.
4.
indications:
only given ____, __/day, usually at ____pm.
AE:
antidote:
teratogenic:
vitamin K INHIBITOR = prevents synthesis of:
1. VII
2. IX
3. X
4. prothrombin
indications: prevention of DVT/VTE/PE; thrombotic events for pt with a. fib or heart valves, reduce recurrence of TIA or MI
only given PO, ONCE/day, usually at 5pm.
AE: bleeding, lethargy, muscle plain, purple toes
antidote: vitamin K (if doesn’t work, given fresh frozen plasma) or whole blood
teratogenic: cannot give to pt who are pregnant or breastfeeding
WARFARIN
NC:
monitor & _____ for signs of bleeding
_____ before surgeries.
lab monitoring:
___ drug interactions:
_____ interactions
avoid _____
wear ____, use _____ toothbrush, _____ toothbrush/razor
monitor & TEACH for signs of bleeding: check stools, look at gums
HOLD before surgeries
lab monitoring:
- PT/INR = prothrombin time, international normalized ratio
- normal INR without warfarin ~ 1
- therapeutic with warfarin = want # to double
- must monitor MONTHLY after pt are therapeutic
MANY drug interactions: amiodarone, fluconazole, erythromycin, metronidazole, sulfonamide antibiotics, cimetidine
FOOD interactions
avoid ALCOHOL
wear MED ALERT BRACELET, use SOFT BRISTLE toothbrush, ELECTRIC toothbrush/razor
WARFARIN
must AVOID FOODS HIGH IN _______ bc they will _____ warfarin’s ability to ______.
ex:
must avoid foods high in VITAMIN K bc they will REDUCE warfarin’s ability to PREVENT CLOTS.
ex: kale, broccoli, brussels sprouts, cabbage, pickled cucumber
APIXABAN & RIVAROXABAN
direct inhibitor of _______.
indications:
AE:
BBW:
director inhibitor of FACTOR Xa.
indications: prevent strokes in pt with afib, post-op thrombo-prophylaxis, treat DVT & PE.
AE: bleeding, hematoma, dizzy, rash, GI distress, peripheral edema
BBW: spinal hematomas if pt has epidural catheter, risk of thrombosis if drugs ABRUPTLY stopped
APIXABAN & RIVAROXABAN
NC:
drug interactions: decreased and increased effects
___ routine monitoring required.
do not give in combo with other ______.
watch _____.
labs:
antidote:
decreased effects: phenytoin, carbamazepine, rifampin, st. john’s wort.
increased effects: CYP3A4 inhibitors (amiodarone, eythromycin, ketonazole, HIV meds, diltiazem, verapamil, grapefruit juice)
NO routine monitoring required.
do not give in combo with other ANTICOAGS.
watch LIVER FX
labs: AST, ALT, GGT
antidote: Andexxa (recombinant factor Xa)
ASPIRIN (as an anti-platelet)
NSAID: blocks _____ synthesis through COX enzyme pathways
- through this mech also blocks ______.
prevents platelets from ______ together.
indications:
given ____.
- if an acute event, give ____.
NSAID: blocks PROSTAGLANDIN synthesis through COX enzyme pathways.
- through this mech also blocks PLATELET AGGREGATION.
prevents platelets from CLUMPING together.
indications: prevent/treat MI, prevent ISCHEMIC stoke.
given PO.
- if an acute event, give BABY ASPIRIN (chewable) - cannot be EC
ASPIRIN
SE:
NC: _______
- do not crush ____
- ____ medication considerations
- reye’s syndrome: children with a virus _______.
contraindications:
antidote:
SE: GI (n/v), drowsy, confusion, bleeding
NC: bleeding
- do not crush EC
- OTC medication considerations
- reye’s syndrome: children with a virus NO ASPIRIN
contraindications: thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vitamin K deficiency, recent hemorrhagic stroke
antidote: DDVAP
CLOPIDOGREL & TICAGRELOR
MOA: antiplatelet _______
- alters ______ so it doesn’t receive the signal to ______.
indications:
contraindications:
MOA: antiplatelet ADP INHIBITOR
- alters PLATELET MEMBRANE so it doesn’t receive the signal to AGGREGATE.
indications: reduce risk of stroke, prophylaxis of TIAs, post-MI
contraindications: thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vitamin K deficiency, recent hemorrhagic stroke
CLOPIDOGREL & TICAGRELOR
SE:
given _____.
CLOPIDOGREL BBW:
clopidogrel effectiveness reduced by ______, ______, _____, & ______.
TICAGRELOR BBW:
antidote:
SE: chest pain, edema, flu-like symptoms, abdominal pain, diarrhea, nausea, epistaxis, rash, pruritus
given PO.
CLOPIDOGREL BBW: pt with certain genetic abnormalities who may have higher rate of CV events d/t reduced conversion to its active metabolite.
clopidogrel effectiveness reduced by AMIODARONE, CCBs, NSAIDS, PPIs.
TICAGRELOR BBW: increased bleeding risk with aspirin doses over 100 mg.
antidote: DDVAP or platelet transfusion
ARGATROBAN & BIVALRUDIN
class:
MOA: inhibit _____.
indications:
given ___ only.
argatroban: careful in pt with ______.
AE:
nursing implications:
class: direct thrombin inhibitors
MOA: inhibit thrombin (IIa)
indications: treat HIT, pt undergoing procedures who are at high risk for HIT.
given IV only.
argatroban: careful in pt with HEPATIC DYSFX
AE: bleeding
nursing implications: labs = anti-Xa, H&H, platelets
