Hematology Flashcards
What are anti platelet drugs
Clopidogrel (Plavix)
Aspirin
What are factor inbibitord
○ Apixaban (Eliquis)
○ Fondaparinux (Arixtra)
○ Rivaroxaban (Xarelto)
● Classification: Indirect Thrombin Inhibitor
○ Anticoagulant!
● How it works
○ Thrombin → converts fibrinogen to fibrin → Fibrin forms clots!
○ Antithrombin III inhibits Thrombin
○ Heparin ENHANCES antithrombin III
○ This stops thrombin from being activated, which therefore prevents clots from forming.
● This is the intrinsic coagulation pathway
*it slows down clotting
HEPARIN
What is the normal aPTT level?
Therapeutic aPTT (w/ Heparin):
Normal aPTT: 30-40 seconds
Therapeutic aPTT: 1.5-2x normal
Antidote for HEPARIN
PROTAMINE SULFATE
● Complication of Heparin therapy
● Usually occurs 5-10 days after Heparin exposure
● Suspect in any client on Heparin who has an unexplained platelet drop
● Clinical manifestations:
○ Skin lesions at heparin injection sites
○ Chills
○ Fever
○ Dyspnea
○ Chest pain
● Complications - clotting!
○ DVT
○ PE
● Treatment
○ Discontinue ALL heparin and start a different anticoagulant!
Heparin Induced Thrombocytopenia and Thrombosis (HITT)
Therapeutic class: Anticoagulant
Indication: Prevent Clots (hx of DVT, PE, CVA, etc.) Nursing
Considerations:
● Always given SC
● Not interchangeable with heparin
● Porcine derived, may have cultural or religious implications
● No need for anticoagulation tests/monitoring, dose is based on body size
● DO monitor platelets
● Only anticoagulants that CAN be used in pregnancy
Enoxaparin, dalteparin, tinzapatin
(low molecular weight heparins)
Therapeutic class: Anticoagulant
Indication: venous thrombosis, pulmonary embolism, A-fib
Action: disrupts liver synthesis of Vitamin K dependent clotting factors
Nursing Considerations:
● Monitor for bleeding
● Monitor PT and INR
○ PT ■ Normal: 10-12 seconds
○ INR ■ Normal: 0.9-1.2 ■ Therapeutic INR: 2-3
● Antidote: Vitamin K
● Contraindicated during pregnancy
Warfarin
What is the antidote for WARFARIN
VITAMIN K
Action: Inhibits prostaglandins production to tx fever and inflammation, decreases platelet aggregation leading to decrease clotting
Indication: mild to moderate pain, Stroke and MI prophylaxis
Nursing considerations:
1. Risk of bleeding - dont administer with other anticoagulants, d/c 5-7 days prior surgery
2. Caution with pediatric clients - Reye’s syndrome can occur with viral infections like the flu or chickenpox: causes vimiting, delirium, coma, and death (ONLY TIME IT IS USED IN PEDS IS IN KAWASAKI DISEASE)
Aspirin: Acetylsalicylic acid
Therapeutic class: Antipyretic, non-opioid analgesic, NSAID/salicylate
What is ASA (aspirin/ acetylsalicylic acid) toxicity called?
SALICYLISM
ASA toxicity that causes nausea, tinnitus, headache, delirium, hyperventilation, pulmonary
edema then OD causes respiratory depression and acidosis leading to coma and death. Sodium bicarbonate is treatment for acidosis and fluid resuscitation.
Indication: To break up an existing clot. “Clot buster.” PE, MI, Ischemic stroke, clotted off central line.
Action: Enzyme that converts plasminogen to plasmin, destroying a clot.
Nursing Considerations:
● Must be given ASAP to work (door to TPA for a stroke - 60 min)
● Bleeding risk - do NOT give with other anticoagulants
Fibrinolytics/Thrombolytics
Urokinase, streptokinase, alteplase (tissue plasminogen activator ((tPA))
Increases production of fetal hemoglobin to reduce crises
Indicated for Sickle Cell Anemia
Hydroxyurea
It is a phosphate binder indicated in the treatment of hyperphosphatemia associated with chronic kidney disease. This medication is purported to decrease serum phosphorus levels by binding to food. this, this medication is given with meals. Combined with a low phosphorus diet, the goal of this medication is to decrease serum phosphate levels.
It must be administed with meals and not with hemodialysis. If a client is taking PPI, they should not consume other medications at the same time as the PPI dosing because of the PPI’s bility to decrease the absorption of htose medications.
SEVELAMER
