Exam 1: Pharm (Anticoagulants) Flashcards
Unfractured heparin
Anticoagulant (IV, SQ)
Enhances the effects of anti-thrombin and inactivation of thrombin& factor Xa
AEs: Bleeding, heparin-induced thrombocytopenia
Contraindication: Active bleeding, preparation for surgery
Antidote: protamine sulfate
Nursing considerations: protein binding, unpredictable bioavailability, short half life
Monitor aPTT to make sure it’s therapeutic
Enoxaparin (Lovenox)
Anticoagulant: LMWH (SQ)
Enhance the effects of anti-thrombin and inactivation of thrombin & factor Xa
AEs: Bleeding, heparin-induced thrombocytopenia
Contraindications: Active bleeding, prep for surgery, Weight >150kg (unknown dosage), renal dysfunction
Antidote: protein sulfate; no protein binding so more predictable bioavailability compared to heparin
Monitoring not required
Warfarin (Coumadin)
Anticoagulant: Vitamin K antagonist (PO)
Inhibits synthesis of vitamin K-dependent clotting factors (VII, IX, X, and Thrombin)
AEs: Bleeding
Contraindication: bleeding, preparation for surgery
Antidote: Phytonadione (vitamin K)
Nursing considerations: tons of food and drug interactions! Long half-life, delayed onset, prolonged effects
Monitoring: PT (Prothrombin time) and INR (international normalized ratio)
Patient ed: monitor for dark stools, bright red blood in stools, injury prevention, unexplained bruising, nosebleeds, increased menstrual cycle flow, lower back pain/bruising. Green leafy vegetables decrease effectiveness (maintain consistant intake) **Flossing/dental hygiene.
Dabigitran (Pradaxa)
Anticoagulant: direct thrombin inhibitor (PO)
Direct thrombin inhibitor
AEs: Bleeding, GI effects (35% abdominal pain, Nausea, dyspepsia)
Contraindications: Bleeding, preparation for surgery
Nursing considerations: some interactions with drugs that inhibit p-glycoprotein (amiodarone); increased bleeding risk
Rivaroxaban (Xarelto)
Anticoagulant: Direct factor Xa inhibitor (PO)
Factor Xa inhibitor
AEs: Bleeding
Contraindications: Bleeding, preparation for surgery
Nursing considerations: No great reversal agent, active immediately; less drug interactions compared to warfarin
Ferrous sulfate
Nutritional supplement
Treatment of iron deficiency anemia
AEs: GI disturbances (Nauseau, heartburn, Constipation**, diarrhea, dark green or black stools); toxic in large doses
Drug interactions: reduced absorption if taken with antacids; increased absorption if taken with vitamin C (asorbic acid) but also increased adverse effects)
Iron dextran
Parenteral iron preparation (IV if bad/need immediate iron)
Treatment of iron deficiency anemia
AEs: Anaphylactic reactions (triggered by the dextran component), hypotension, circulatory failure, cardiac arrest
Nursing considerations: start with test dose (25mg over 5 mins) then watch for reaction at least 15 minutes)
Actively monitor during test dose
Cyanocobalamin
Vitamin B12 product (PO, intranasal, IM, or SC - NEVER IV)
Purified crystalline form of Vitamin B12
AEs: generally safe, may see hypokalemia due to increased erythrocyte production
With initial dose, check B12 and folic acid levels
Folic acid
Nutritional supplement (PO or IV)
Essential factor for DNA synthesis
Nursing considerations: in alcoholism poor intake of folic acid through diet, derangement of enterohepatic recirculation secondary to alcohol-induced liver injury
With initial dose, monitor B12 and folic acid levels
Patient ed: increase dose early in pregnancy for neural tube development
Erythropoietin (procrit)
Erythropoietic growth factor/exogenous erythropoietin (SC or IV)
Stimulates RBC formation, need iron, folic acid, and B12 to make RBCs; used for renal disease, oncologic/hematologic diseases
