Hematologic Meds

Question 1

Thrombin/Xa Inhibitor Prototype and Other drug names

Answer 1

heparin
Others: enoxaparin (Lovenox) (Low molecular meight heparins-LMWH)

Question 2

thrombin/Xa inhibitors therapeutic uses

Answer 2

treat anyone with a blood clot or at risk for a blood clot:
Acute MI
Ischemic stroke
Given prophylactically to clients after major surgery and on bedrest or limited activity to prevent blood clots from forming

Question 3

thrombin/xa inhibitor administration

Answer 3

IV, subQ

Question 4

thrombin/xa inhibitor EPA

Answer 4

inhibits factor Xa and thrombin - blocking clotting process

Question 5

thrombin/xa inhibitor ADRs

Answer 5

bleeding! Heparin-induced thrombocytopenia (HIT)

Question 6

thrombin/xa inhibitors RN intervention and client education

Answer 6

Watch for bleeding: easy bleeding, black tarry stools
IV heparin is a HIGH ALERT MEDICATION
aPTT of UFH is used to monitor for therapeutic levels of IV heparin (q6hours)
- aPTT: 1.5-2x clients baseline
Monitor platelet count
Pt education: Soft toothbrush, Electric razor

Question 7

thrombin/xa inhibitor contraindications and interactions

Answer 7

Anyone at risk for uncontrolled bleeding. Thrombocytopenia
NSAIDs
Antidote: Protamine sulfate

Question 8

vit K antagonist prototype

Answer 8

warfarin (Coumadin)

Question 9

vit K antagonist therapeutic use

Answer 9

long term management or prevention of venous thromboembolic disorders including:
- DVT
- PE
- Atrial fibrillation
- Mechanical heart valves

Question 10

vit k antagonist administration

Answer 10

PO - takes 3-5 days to take effect

Question 11

vit K antagonist EPA

Answer 11

acts on liver to prevent synthesis of vitamin K dependent clotting factors

Question 12

vit K antagonist ADRs

Answer 12

bleeding!

Question 13

vit k antagonist RN intervention and client education

Answer 13

Monitor for bleeding
Narrow therapeutic range - monitor the INR
- INR between 2-3
*keep consistent intake of vitamin K (green leafy veggies)

Question 14

vit K antagonist contraindications and interactions

Answer 14

Teratogenic
Caution w/ clients at high risk for bleeding (ETOH, GI ulcers, thrombocytopenia)
MANY medications and herbs interact with warfarin
Antidote: vitamin K

Question 15

direct thrombin inhibitors

Answer 15

PO: dabigatran (Pradaxa)
IV: argatroban, bivalrudin
- Anticoagulants given when pt develops heparin-induced thrombocytopenia (HIT)
NO antidote

Question 16

direct Xa inhibitors

Answer 16

PO: rivaroxaban (Xarelto)
Antidote: Andexxa

Question 17

antiplatelets: salicylates prototype

Answer 17

Aspirin (ASA)

Question 18

salicylates therapeutic use

Answer 18

MI, CVA, TIA, coronary stents

Question 19

salicylates administration

Answer 19

PO, rectal

Question 20

salicylates EPA

Answer 20

inhibits platelet aggregation via inhibition of cyclooxygenase

Question 21

salicylates ADRs

Answer 21

gastric upset most common. Risk for bleeding. Renal damage
Toxicity = salicylism: tinnitus, HA, dizziness

Question 22

salicylates RN intervention and client education

Answer 22

Monitor for bleeding
Monitor kidney function
Avoid ETOH - Increased risk of bleeding
Educate client on s/sx of salicylism - should call provider if they develop

Question 22

salicylates RN intervention and client education

Answer 22

Monitor for bleeding
Monitor kidney function
Avoid ETOH - Increased risk of bleeding
Educate client on s/sx of salicylism - should call provider if they develop

Question 23

salicylates RN intervention and client education

Answer 23

Monitor for bleeding
Monitor kidney function
Avoid ETOH - Increased risk of bleeding
Educate client on s/sx of salicylism - should call provider if they develop

Question 24

salicylates contraindications and interactions

Answer 24

Do not give to children <18 = Reye’s syndrome (vomiting, confusion, loss of consciousness, seizures). Caution w/ peptic ulcer disease. Caution if given w/ anticoagulants Ibuprofen decreases anti-plt effect ACE/ARBs = increased risk of renal damage

Question 25

Antiplatelets: Adenosine Diphosphate receptor (ADP) Inhibitor Prototype

Answer 25

clopidogrel (Plavix)

Question 26

ADP inhibitor therapeutic use

Answer 26

MI, CVA, TIA, Coronary stents

Question 27

ADP inhibitor administration

Answer 27

PO - effects last 7-10 days

Question 28

ADP inhibitor EPA

Answer 28

inhibits platelet aggregation by blocking ADP receptors on PLTs

Question 29

ADP inhibitor ADRs

Answer 29

same as ASA - less rare but BAD = thrombotic

Question 30

ADP inhibitors RN intervention and client education

Answer 30

Monitor for bleeding: GI bleeding (black tarry stool, hematemesis), Bruising. Petechiae - concern for TTP, Check PLT count periodically Discontinue 5-7 days prior to elective surgeries Take w/ food to minimize GI upset Avoid ETOH

Question 31

ADP inhibitors contraindications and interactions

Answer 31

Caution w/ peptic ulcer disease and other bleeding disorders Caution with anticoagulants Herbal. PPIs reduce anti-plt effect

Question 32

thrombolytics prototype

Answer 32

alteplase - TPA

Question 33

thrombolytics therapeutic use

Answer 33

dissolves clot! Systemic: ischemic CVA (w/in 3-4 hrs), MI (w/in 2 hrs) Local: establish patency of central IV catheter

Question 34

thrombolytics administration

Answer 34

IV only - ICU/ER only!

Question 35

thrombolytics EPA

Answer 35

converts plasminogen into plasmin = breaks down fibrin in clot. Plasmin will prevent new clots from forming

Question 36

thrombolytics ADRs

Answer 36

EXTREME BLEEDING

Question 37

thrombolytics RN intervention and client education

Answer 37

VERY close monitoring - Continuous VS - Neuro checks for 24hrs - Emergency equipment available Monitor CBC and coagulation labs Limited punctures - Get IV, foley, NGT - before admin reversal : aminocaproic acid (Amicar)

Question 38

thrombolytics contraindications and interactions

Answer 38

Very long checklist - recent surgery (2-4 weeks), head trauma, known aneurysm, any active bleeding, HTN

Question 39

Iron Supplements

Answer 39

Iron = necessary component for RBC Ferrous sulfate (Feosol) - PO Iron dextran - IV, IM - Anaphylactic rxns ADR: GI disturbances - Better to take on an empty stomach but can give w/ food to decrease GI upset (will have less absorption) Antacids reduce absorption Can cause dark stools! Iron toxicity - Deferoxamine

Question 40

B12 Supplements

Answer 40

Cyanocobalamin (Vit B12) - PO, subQ, IM, intranasal ADRs: hypokalemia

Question 40

Folic acid supplements

Answer 40

Folate - PO, subQ, IM/IV ETOH abuse, malabsorption, pregnancy Monitor reticulocyte count to determine effectiveness

Question 40

erythropoietic growth factor prototype and other drug names

Answer 40

epoetin alfa (Epogen) Others: darbepoetin alfa - long acting version

Question 41

erythropoietic growth factor therapeutic use

Answer 41

chronic renal failure, pre-op anemia, w/ chemotherapy, w/ HIV treatment Zidovudine

Question 42

erythropoietic growth factor adminitration

Answer 42

IV (IV bolus 1-3), SubQ

Question 43

erythropoietic growth factor EPA

Answer 43

mimics erythropoietin in the bone marrow = production of RBCs

Question 44

erythropoietic growth factor ADRs

Answer 44

HTN, increased risk of cardiac/CVA events (Hg>11). Can cause progression of certain malignancies

Question 45

erythropoietic growth factor RN intervention and client education

Answer 45

Monitor Hg levels - Report if over 12 OR raise more than 1 gram/dc within 2 weeks - w/ CA pt - Hg over 10 Monitor BP Lowest dose possible needed Client: report signs of MI/CVA Encourage folic acid, B12, iron

Question 46

erythropoietic growth factor contraindications and interactions

Answer 46

Uncontrolled HTN Caution in clients w/ cancer due to progression of disease (only when Hg<10) w/ dialysis: may need more heparin