Week 9 Medications for Coagulation, Lipids, anemia medications

Question 1

Examples of anticoagulants

Answer 1

Warfarin/Coumadin PO

Heparin IV SQ
-low molecular weigh heparin: Enoxaparin-Lovenox SQ

Question 2

Enoxaparin med admin:

Answer 2

deep SQ in abd 2” from umbilicus,
don’t aspirate,
rotate sites,
Don’t expel air if giving whole prefilled syringe, inject at 90deg, don’t rub site.
½- 5/8”
25-28 gauge needle

Question 3

warfarin indication

Answer 3

Thrombosis prophylaxis (tx for a-fib)

Question 4

heparin indication

Answer 4

Thrombosis prophylaxis (usually in hospital only following ortho surgery, MI, PE..)

Question 5

note on indication for heparin and warfarin

Answer 5

has no effect on blood clots which have already formed

Question 6

SE AE of heparin and warfarin

Answer 6

Heparin-thrombocytopenia
Bleeding

Question 7

Heparin and warfarin interactions

Answer 7

Interaction: NSAID’s, ASA, PCN, Cephalosporin, Ginkgo

Question 8

heparin and warfarin Contraindication

Answer 8

Contraindication:
acute bleeding,
warfarin-Pregnancy

Question 9

heparin and warfarin pt edu and nsg implications

Answer 9

Pt Ed:
Coumadin/warfarin- monitor foods high in vit K (green leafy veggies)

All-monitor for bleeding (pt INR)
ALL Monitor for:
Bruising, gums, abd pain, coffee ground emesis, tarry stool (internal bleeding)
Use electric razor and soft toothbrush.
Doses can be adjusted if pt regularly eats high K+

Question 10

what is the antidote for a heparin and warfarin OD

Answer 10

Warfarin- vit K
Heparin protamine

Question 11

lab monitoring for dose titration of warfarin and heparin

Answer 11

Warfarin pt/INR (2-3)
Heparin aPTT (30-45sec?)
Enoxaparin-Lovenox – no labs needed

Question 12

Antiplatelet ex

Answer 12

Aspirin 81 or 325mg PO
Clopidogrel (Plavix) 75mg PO

Question 13

Antiplatelet Aspirin and clopidogrel indication

Answer 13

Reduce risk of recurrent (transient ischemic attack) TIAs or strokes, PE, and MI prophylaxis

Question 14

SE AE of aspirin and clopidrogrel

Answer 14

bleeding, dyspepsia, abd pain, N/V

Question 15

clopidogrel and aspirin interactions and nursing implications

Answer 15

Interaction:
* NSAIDs, heparin, warfarin

Nursing Implications: Pt ed: monitor for bleeding, hold med 5-7 days before surgery

Question 16

Thrombopoetic Growth Factors

Answer 16

Oprelvekin

Question 17

Oprelvekin indication

Answer 17

decreases thrombocytopenia and need for platelet transfusion in patients receiving chemo.

Question 18

Oprelvekin SE AE

Answer 18

allergic reaction or anaphylaxis

Question 19

Thrombolytic agents

Answer 19

alteplase

Question 20

alteplase indication

Answer 20

acute MI, PE, acute ischemic stroke, DVT

Question 21

SE AE of alteplase

Answer 21

SE/AE:
bleeding,
cardiac arrhythmias,
hypersensitivity (rash, flushing, bronchospasm, anaphylaxis)

Question 22

nsg implications of thrombolytic agent alteplase

Answer 22

Nursing Implications:
monitor for bleeding,
strictly follow med admin guidelines.

Question 23

antilipemic drugs

Answer 23

HMG-COA inhibitors
Atorvastatin (Lipitor) PO 10-80mg
Simvastatin (Zocor) PO 10-40mg

-statin

Question 24

antilipemic drug
Atorvastatin (Lipitor) PO 10-80mg
Simvastatin
indication

Answer 24

treat elevated cholesterol by lowering cholesterol production

Question 25

SE AE of atorvastatin and simvastatin

Answer 25

hepatotoxicity, rhabdomyolysis, muscle pain + weakness, Rhabdo: painful/decrease in urine, onset of muscle pain, tea discolored urine

Question 26

antilipemic drug atorvastatin and simvastatin interaction and contraindication

Answer 26

Interaction: Grapefruit juice Contraindication: Pregnancy X

Question 27

nsg implication of antilipemic drug atorvastatin and simvastatin

Answer 27

Will be life long treatment for cholesterol Report muscle pain and all rhabdo Sx Avoid grapefruit Will need monitoring of creatinine kinase Contraception and pregnancy

Question 28

Bile Acid Sequestrants

Answer 28

Colesevelam can be PO 3 times a day twice daily 6QD or 1 powder packet daily

Question 29

Colesevelam

Answer 29

reduce elevated cholesterol through excretion in feces

Question 30

colesevelam/ Welchol SEAE -bile acid sequestrants

Answer 30

Constipation (elimated through excretion)

Question 31

colesevelam/ Welchol nsg implications: pt ed

Answer 31

take with 8oz of water cannot be taken with other meds powder form must be mixed with a liquid and never taken dry all drugs should be taken at least 1 hr before or 4-6 hours after bile sequestrant

Question 32

Niacin MOA and indication

Answer 32

vitamin B3 lipid lowering properties in high doses

Question 33

SEAE of niacin

Answer 33

flushing of the face and feeling of warmth report sensations of tingling in the feet to HCP

Question 34

Omega 3 fatty acids indication and SE

Answer 34

reduce cholesterol belching may be fishy

Question 35

Fibrates

Answer 35

Fenofibrate Tricor Gemfibrozil Lopid -fibr

Question 36

Fenofibrate and gemfibrozil and indication

Answer 36

lowers cholesterol and increase HDL by stopping the breakdown of lipids to lower LDL and raise HDL

Question 37

SE AE of fenofibrate and gemfibrozil

Answer 37

SE AE diarrhea, hepatotoxicity

Question 38

fenofibrate and gemfibrozil interaction

Answer 38

warfarin

Question 39

Cholesterol Absorption inhibitor

Answer 39

ezetimibe Zetia

Question 40

Exetimibe indication

Answer 40

lower LDL cholesterol and increase HDL by inhibiting absorption of cholesterol in the small intestine brush border

Question 41

Exetimbe (cholesterol absorption inhibitor) Nsg implications

Answer 41

report persistent GI upset constipation bleeding yellowing of the skin (indicates liver damage) monitor liver function

Question 42

Epoetin alfa (erythropoiesis stimulating agent) indication

Answer 42

treats anemia due to end-stage-renal disease and chemo therapy by stimulating bone marrow to produce RBC its a synthetic hormone of natural hormone

Question 43

epoetin alfa SE AE

Answer 43

hypertension MI Stroke DVT EDEMA headache

Question 44

epoetin contraindication

Answer 44

uncontrolled hypertension high hgb

Question 45

nsg implication of epoetin alfa

Answer 45

assess for pregnancy and last menses lab (Hgb and Hct)

Question 46

Iron medications

Answer 46

ferrous sulfate FeSO4 PO ferrous Gluconate PO Iron dextran IV (only for iron deficient anemia)

Question 47

iron indiciation

Answer 47

anemia

Question 48

iron SE AE

Answer 48

Constipation (may increase fluids and use stool softner) it is normal to have black tarry stool stains teeth IV- anaphylactic response, stains tissue, Z-track

Question 49

what can iron interact with

Answer 49

antacids tetracyline diary affect absorption

Question 50

what is iron contraindicated by

Answer 50

ulcerative colitis and peptic ulcer disease

Question 51

iron nsg implications and pt ed

Answer 51

avoid caffeine avoid dairy avoid antacids and tetracyclines when taking the med by 2 hrs take with orange juice to improve absorbtion can be taken with food to improve GI upset stool may be tarry/black (normal) liquid forms should be taken with a straw to avoid stains patients should sit upright 15-30 after oral iron doses to avoid corrosion to the esophagous admin of iron injections using z track

Question 52

Folic acid indication

Answer 52

megoblastic anemia pregnancy

Question 53

what cause folic acid deficiency

Answer 53

absorption issues in the small intestine malnutrition and alcoholism

Question 54

Cyanocobalamin Vit B12

Answer 54

is needed for essential cell growth and division production of RBC

Question 55

cyanobalamin B12 indication and what it is caused by

Answer 55

pernicious anemia caused by lack of intrinsic factor in the stomach unable to absorb oral B12