Stroke meds

Question 1

Warfarin (Coumadin): anticoagulant

Answer 1

-adverse reactions: hemorrhage, toxicity (OD)
-monitor VS (hypotension, tachy), CBC
-antidote: vitamin K

-admin: PO, check PT and INR q 2 wks (Coumadin clinics), slow onset- 8-12 hrs, full effect 3-5 days

-ed: stop if signs of hemorrhage, report bleeding, wear id bracelet, avoid excessive alcohol, dose and time different for everybody and can change, no NSAIDS/ASA/ salicylates(pepto), electric razor, soft tooth brush, lots of interactions
-watch vit k foods and keep steady amount of intake (dark leafy greens, mayo, canola/soybean oil)

Question 2

alteplase: thrombolytics

Answer 2

-purpose: dissolves already formed clots
-uses: MI, ischemic stroke, PE, restore patency to central IV

-watch for bleeding: limit sticks, get labs, monitor VS, LOC
-give IV, baseline Hgb, Hct, aPTT, PT, INR, Fibrinogen levels

-Report: Unusual or prolonged bleeding, HA, unilateral weakness
-Contraindications: active bleeding, things that make bleeding worse, things that can bleed (meds, tumors, ulcers, etc)
-Caution: Severe HTN, recent strokes, major surgeries, active PUD

Question 3

heparin, enoxaparin: anticoagulant

Answer 3

heparin: factor Xa/thrombin inhibitor
enoxaparin: Xa inhibitor
-use electric razors and soft tooth brushes
-adverse reactions: bleeding, hemorrhage, thrombocytopenia, hypersensitivity, hematomas with procedures like LP

-antidote: Protamine

interventions: monitor VS for hypotension and tachycardia, LE for sensation/movement, look at aPTT (no greater than 2x baseline)
-admin IV or SubQ (can apply pressure for 1-2 min but don’t rub)

-report: bruising, petechiae, hematomas, black tarry stools, allergic reaction
-avoid NSAIDs and ASA, list herbs due to interactions
-caution in those with bleeding disorders or antiplatelet meds

Question 4

clopidogrel (plavix): antiplatelets

Answer 4

-inhibits platelet aggregation
-adverse: GI upset, ab pain, d/n, ulcers, bleeding
-interventions: monitor bleeding, CVA-hemorrhagic type, check platelet counts
-admin PO: discon 1 wk prior to surgery, take with milk/water/food to avoid GI upset

interactions:
-Anticoags, NSAIDs, ASA, glucocorticoids, alcohol – increase bleeding risk
-PPIs reduce antiplatelet effects
-Herbs and supplements can increase risk of bleeding (ginger, ginkgo, feverfew, fish oil, evening primrose oil)

Question 5

NOACs: anticoagulants

Answer 5

-Non-vitamin K antagonist oral anticoagulants, newest med
-types: Apixaban (Eliquis), Dabigatran
(Pradaxa), Rivaroxaban (Xarelto)

-inhibits specific clotting factors to prevent clots
-advantages: no routine monitoring, predictable effects, fewer interactions
-disadvantages: expensive, increase risk of GI bleed, no good antidote but there are options
-must stop before surgery (timing depends on drug)