Lewis 62 - Stroke Flashcards
MOA/Class
Aspirin (ASA)
Inhibits the synthesis of prostaglandin (pain)
Inhibits platelet aggregation by inhibiting the synthesis of thromboxane A2 and prostacyclin.
Salicylate
Tucker 16
Side Effects
Aspirin (ASA)
GI upset, bleeding, salicylism
Tucker 16
Nursing Considerations
Aspirin (ASA)
Risk for Reye’s syndrome when given to children or with concurrent chicken pox or influenza.
Salicylism manifestations - tinnitus, sweating, headache, dizziness, acidosis. Give activated charcoal and/or bicarbonate.
Dose of 81 mg is typically for antiplatelet activity. May give larger dose for antiplatelet effect in acute situations (i.e., active MI).
Risk for hypersensitivity in patients with asthma and/or nasal polyps.
Tucker 16
Indications
Aspirin (ASA)
Mild-moderate pain/fever
Inflammatory conditions (IBD, RA, etc.)
MI/TIA prevention
Tucker 16
MOA/Class
alteplase
Activates tissue plasminogen to break down fibrin threads in formed clots
Thrombolytic / Tissue plasminogen activator
Tucker 48
Side Effects
alteplase
Bleeding!
Tucker 48
Nursing Considerations
alteplase
Contraindications may include: recent surgery, active internal bleeding, CVC within 3 months (unless symptoms started in the last few hours), aneurysm, OB delivery, organ biopsy, recent serious GI bleed, rupture of noncompressible blood vessel, recent major trauma (including CPR), blood clotting disorder, cerbrovascular disease, uncontrolled hypertension, liver disease.
Monitor for signs of bleeding including alterations in mental status.
Avoid IM injections, invasive procedures, etc.
Tucker 48
indications
alteplase
Treatment of active MI, PE, ischemic stroke (under specific circumstances)
Restoration of function in occluded central venous catheters (CVCs)
Tucker 48
MOA/Class
heparin, enoxaparin
Block the formation of thrombin to prothrombin
Anticoagulant - heparin
Tucker 48
Side Effects
heparin, enoxaparin
Bleeding
Tucker 48
Nursing Considerations
heparin, enoxaparin
Enoxaparin has longer half-life and more predictable effects than heparin. Since effects are more predictable, PTT monitoring is not needed. (Enoxaparin is a low-molecular weight heparin).
Protamine sulfate may be used for toxicity if necessary.
Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)
Monitor for heparin-induced thrombocytopenia.
Tucker 48
Indications
heparin, enoxaparin
DVT prevention
Tucker 48
MOA/Class
warfarin
Inhibits hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, & X)
Anticoagulant
Tucker 48
Side Effects
warfarin
Bleeding
Tucker 48
Nursing Considerations
warfarin
Monitor PT/INR
Therapeutic INR typical 2-3 (2.5-3.5 for high-risk patients)
May need bridge therapy with heparin or enoxaparin until INR is therapeutic
Need consistent intake of vitamin K-rich foods
Administer vitamin K to reverse anticoagulation (effective up to 7 days)
Monitor for abnormal bleeding (bleeding gums, blood in stool or urine, epistaxis, heavy menstrual cycles, mental status changes)
Tucker 48
