09 Meds: Anticoagulants

Front 1

3 anticoagulant meds?

Back 1

1. Heparin
2. Lovenox (Enoxaparin, low-molecular weight heparin)
3. Warfarin (Coumadin

Front 2

How does Heparin work?

Back 2

it blocks the conversion of fibrinogen to fibrin

Front 3

What is the test used to monitor for therapeutic levels of Heparin?

Back 3

the PTT (partial thromboplastin time) at 1.5-2.5 x the control WITHOUT signs of hemorrhage

Front 4

What are the limits of normal for PTT?

Back 4

lower limit of normal: 20-25 sec

upper limit of normal: 32-39 sec

Front 5

Heparin considerations during IV administration?

Back 5

1. use an infusion pump
2. peak at 5 minutes
3. duration of action is 2-6 hr

Front 6

How do you inject heparin?

Back 6

deep SubQ ONLY

Front 7

Why should you NEVER give heparin IM?

Back 7

danger of hematoma

Front 8

What is the onset & DOA for heparin SubQ?

Back 8

onset: 20-60 min

doa: 8-12 hr

Front 9

What is the ANTIDOTE for heparin?

Back 9

antidote for heparin:

PROTAMINE SULFATE if given within 30 min

Front 10

Can heparin be allergenic?

Back 10

yes

Front 11

Is enoxaparin more or less allergenic than heparin?

Back 11

enoxaparin is less allergenic than heparin

Front 12

How must enoxaprin be administered?

Back 12

deep SUBQ ONLY,

do NOT give IV or IM

Front 13

Does enoxaparin require lab testing to monitor therapeutic levels?

Back 13

NO

Front 14

Potential side effects of enoxaparin?

Back 14

same as heparin:
1. hemorrhage from any body site (10%)
2. tissue irritation/pain at injection
3. anemia
4. thrombocytopenia
5. fever

Front 15

What is the moa of Coumadin?

Back 15

coumadin: interferes w/ liver synthesis of vitamin k-dependent clotting factors

Front 16

Which test monitors the therapeutic levels of Coumadin?

Back 16

PT: prothrombin time at 1.5-2.5 x the control OR

INR

Front 17

Normal PT?

Back 17

9.5-12 sec

Front 18

Normal INR?

Back 18

2.0-3.5

Front 19

Coumadin's onset, peak, and doa?

Back 19

coumadin:
onset: 12-24 h
peak: 1.5-3 da
doa: 3-5 da

Front 20

Antidotes for coumadin? (3)

Back 20

1. vitamin K
2. whole blood
3. plasma

Front 21

What should you teach the pt receiving coumadin?

Back 21

1. to avoid venous stasis
2. to get regular lab testing
3. to avoid foods high in vitamin k

Front 22

7 foods high in vitamin k?

Back 22

1. green veggies
2. pork
3. rice
4. yogurt
5. cheeses
6. fish
7. milk

Front 23

4 potential side effects for Coumadin?

Back 23

1. hemorrhage
2. D
3. rash
4. fever

Front 24

Indications for heparin? (2)

Back 24

1. prophylaxis of thromboembolic disorders
2. maintain patency of IV catheters (heparin flush)

Front 25

typical dosage of a heparin flush?

Back 25

very low dose: 10-100 units

Front 26

Indications for coumadin (5)

Back 26

1. management of pulmonary emboli
2. DVT
3. MI
4. atrial dysrhythmias
5. poast cardiac valve replacement

Front 27

5 general side effects of anticoagulants?

Back 27

1. N
2. alopecia
3. urticaria
4. hemorrhage
5. bleeding

Front 28

What is HIT?

Back 28

heparin induced thrombocytopenia

Front 29

What is persantine?

Back 29

an adjunct to COUMADIN in postop cardiac valve replacement

an adjunct to ASPIRIN to reduce the risk of repeat strokes or TIAs

Front 30

6 signs of hemorrhage?

Back 30

1. bleeding gums
2. nosebleed
3. unusual bleeding
4. black/tarry stools
5. hematuria
6. fall in BP or Hct
7. guaiac-positive stools

Front 31

If a pt is on an anticoagulant, which meds should the pt avoid?

Back 31

1. IM injections
2. ASA-containing products
3. NSAIDs

Front 32

What should the pt wear if he is on anticoagulants?

Back 32

medical information tag

Front 33

Which instructions should you give a pt on anticoagulant meds?

Back 33

1. use a soft toothbrush
2. electric razor
3. report bleeding gums, petechiae or bruising, epistaxis, black tarry stools

Front 34

What should the nurse monitor in a pt during heparin therapy?

Back 34

1. platelet counts
2. S&S of thrombosis

Front 35

If HIT is suspected, what should the nurse do?

Back 35

d/c heparin and start lepirudin (non-heparin anticoagulant)

Front 36

Which substances might increase bleeding when taken w/ coumadin? 3

Back 36

1. garlic
2. gingko
3. ginger

Front 37

Large doses of ___ or ___may interfere w/ anticoagulants

Back 37

anise, chamomile

Front 38

Which 2 substances might decrease anticoagulant activity

Back 38

1. ginseng
2. alfalfa

Front 39

What herb might increase the action of an anticoagulant?

Back 39

black haw

Front 40

Which vitamin might slightly prolong PT?

Back 40

Vitamin c

Front 41

Which vitamin might increase warfarin's effect?

Back 41

vitamin e