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54 Cards in this Set

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anticoagulants - parenteral
proto: heparin
low molecular weight heparins
proto: enoxaparin (Lovenox)
dalteparin (Fragmin), tinzaparin (Innohep)
activated factor x (Xa) inhibitor
proto: fondaparinux (Atrixtra)
parenteral anticoagulant MOA
prevent clotting by activating antithrombin, thus indirectly inactivating both thrombin and factor Xa.
This inhibits fibrin formation
parenteral anticoagulant use
prompt anticoagulant activity (evolving stroke, pulmonary embolism, massive deep-vein thrombosis)
adjunct for clients having open heart surgery or renal dialysis
low-dose therapy for prophylaxis against postoperative venous thrombosis
treatment of disseminated intravascular coagulation (DIC)
low molecular weight heparins use (parenteral anticoagulant)
prevent deep vein thrombosis
treat DVT and pulmonary embolism
prevent complications in certain types of MI
activated Factor Xa inhibitor use (parenteral anticoagulant)
prevent DVT and pulmonary embolism
treat acute DVT or pulmonary embolism in conjunction with warfarin
parenteral anticoagulant admin
cannot be absorbed by intestinal tract and must be given subQ or IV infusion
parenteral anticoagulant adverse
hemorrhage- observe for bleeding, bruising, decreased BP, administer protamine and avoid aspirin if overdose
thormbocytopenia- discontinue if platelet count is less than 100,000 mm3
hypersensitivity
toxicity- protamine should be administered slowly IV, no faster than 20 mg/min or 50 mg/10 min, do not exceed 100 mg in a 2 hr period
neurologic damage from hematoma formed during spinal or epidural anesthesia- observe for hematoma formation (redness, swelling)
parenteral anticoagulant contraindications
low platelet counts or uncontrollable bleeding
should not be used following surgery of eyes, brain, or spinal cord, lumbar puncture, or regional anesthesia
hemophillia, increased capillary permeability, dissecting aneurysm, PUD, hypertension, hepatic, renal disease, threatened abortion
parenteral anticoagulant interactions
aspirin, NSAIDS, and other anticoagulants
parenteral anticoagulant effectivenss
Heparin- client aPTT levels of 60-80 seconds
no development or no further development of venous thrombi or emboli
oral anticoagulants
Proto: warfarin (Coumadin)
oral anticoagulant MOA
antagonize vit. K, prevents synthesis of four coagulation factors- VII, IX, X and prothrombin
oral anticoagulant USE
venous thrombosis
thrombus formation in clients with afib or prosthetic heart valves
prevention of recurrent MI, TIA, PE, and DVT
oral anticoagulant adverse
hemorrhage
hepatitis
toxicity- administer Vit. K
if vitamin K cannot control bleeding, administer fresh frozen plasma or whole blood
oral anticoagulant contraindications
pregnancy risk X
low platelet counts
uncontrollable bleeding
Vitamin K deficiencies
surgery of eye, brain, spinal cord, lumbar puncture, regional anesthesia
hemophilia
PUD
dissecting aneurysm
hypertension
threatened abortion
oral anticoagulant interactions
concurrent use of: heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, parenteral cephalosporin- increases effects of warfarin

concurrent use of phenobarbital, carmazepine, phenytoin, and oral contraceptives
vitamin k decreases anticoagulant effects

foods high in Vit k-decrease anticoagulant effects

multiple meds interact with warfarin
oral anticoagulant Admin
monitor platelet, CBC, and Hct
administer vit K for warfarin overdose
oral anticoagulant effectiveness
PT 1.5-2 times control
INR of 2-3 for treatment of acute MI, a-fib, PE, DVT, and or tissue heart valves
INR of 3 to 4.5 for mechanical heart valve or recurrent systemic embolism
no further development of venous thrombi
direct thrombin inhibitors
proto: dabigatran (Pradaxa)
Other: hirudin analogs : ivalirudin (angiomax), iepiruden (Refludan)
argatroban (Acova)
direct thrombin action
work by inhibiting thrombin, thus inhibiting a thrombus from developing
direct thrombin use
prevents stroke and embolism in clients who have had a-fib not caused by valvular heart disease
bivaliruden is given concurrently with aspirin for bivaliruden is used for clients who undergo coronary angioplasty
argatroban is used to prevent or treat thrombosis in clients who cannot take heparin due to heparin induced thrombocytopenia
direct thrombin adverse
bleeding (GI, GU, cranial)
GI discomfort- may need PPI for these symptoms
bivaliruden may cause hypotension and headache
direct thrombin interventions
for severe bleeding no antidote for dabigatran is available- dialysis may be used or injections of recombinant factor Vlla
stop taking dabigatran before surgery
take with food
direct thrombin inhibitors contraindications
active bleeding or allergy to med
liver impairment or who are at risk for bleeding
renal impairment
direct thrombin inhibitors interactions
rifampin- decreases levels of dabigatran
other thrombolytics and anticoagulants may increase risk for bleeding with argatroban- monitor with concurrent use
direct thrombin inhibitor admin
discontinue other anticoagulants with dabigatran
bivalirudin and lipurdin are administered IV by direct bolus or continuing infusion
argatroban is administered IV to treat thrombus formation
direct inhibitor of factor XA
proto: rivaroxaban (Xarelto)
direct inhibitor of factor XA MOA
provides anticoagulation selectively and directly by inhibiting factor xa
direct inhibitor of factor XA use
prevents DVT and pulmonary embolism in clients who are undergoing hip and knee surgery
direct inhibitor of factor XA adverse
bleeding (GI, GU)
elevated liver enzymes
direct inhibitor of factor XA interventions
report bleeding, bruising, headache, eye pain
wait at least 18 hours following last dose to remove and epidural catheter and wait 6 hours after removal before starting rivaroxaban again
no antidote for severe bleeding
direct inhibitor of factor XA contraindications
previous allergy to rivaroxaban, clients with active bleeding, severe renal impairment, moderate to severe liver impairment

caution to those using anticoagulants, antiplatelet meds, fibronolytics
direct inhibitor of factor XA interactions
erythromycin, dilitiazem, verapamil, quinidine, amiodarone- increases bleeding risk

rifampin, carbamazepine, phenytoin, st. john's wort- decrease rivaroxaban levels
direct inhibitor of factor XA admin
with or without food
monitor hemoglobin, hematocrit, liver and kidney function periodically during treatment
antiplatelet/ salicyclic
aspirin (Ecotrin)
adverse: GI effects, hemorrhagic stroke, prolonged bleeding time, thrombocytopenia, GI bleed tinnitus
antiplatelet glycoprotein inhibitor
abciximab (ReoPro)
eptifibatide (Integrillin), tirofiban (Aggrastat)

Adverse: hypotension, bradycardia
prolonged bleeding time, thrombocytopenia
antiplatelet ADP inhibitors
prototype: clopidogrel (Plavix)
ticlopidine (Ticlid)

adverse: gastric bleed, thrombocytopenia
prolonged bleeding time, GI effects
antiplatelet arterial vasodilator
prototype: pentoxifylline (Trental)
dipyridamole (Persantine), cilostazol (Pletal)

adverse: dyspepsia, nausea, vomiting
antiplatelets MOA
prevent platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting
inhibit platelet aggregation on the onset of the clotting process- alter bleeding time
antiplatelet use
prevention of MI
prevention of reinfarction following acute MI
prevention of ischemic stroke
acute coronary syndromes
intermittent claudication
antiplatelet contraindications
bleeding disorders, thrombocytopenia, PUD, renal or hepatic disorders, major surgery, hypertension, av malformation, retinal or cranial bleeds
antiplatelet interactions
concurrent use of other meds that enhance bleeding
urine acidifiers may increase levels
concurrent use of aspirin with beta blockers may reduce hypertensive action of beta blockers
corticosteroids
carffeine
PPI decreases effectiveness of clopidogrel
pentoxifylline may increase levels of theophylline
antiplatelet interventions
monitor for aspirin toxicity
monitor BP
monitor for gastric bleed
monitor for toxicity
GI effects: pantoprazole (Protonix) interferes least with platelet inhibition
monitor theophylline level
antiplatelet admin
aspirin 325 mg should be taken during initial episode of MI
clopidogrel should be discontinued 7 days prior to surgery
thrombolytic meds
alteplase (Activase, Cathflo Activase)- often called TPA (tissue plasminogen activator)
thrombolytic meds suffix
-plase
thrombolytic meds use
treat acute MI
treat pulmonary embolism
treat acute ischemic stroke
restore patency to central IV catheters

IV only ROA
thrombolytic meds MOA
dissolve clots that have already formed
thrombolytic meds adverse
serious risk of bleeding from different sites as well as superficial bleeding
thrombolytic meds contraindications
intracranial hemorrhage, known structural cerbrovascular lesion, active internal bleeding, significant closed head or spinal trauma within the past 2 months
pericarditis or bacterial endocarditis
brain tumors
hepatic or renal disorder
caution: clients with severe hypertension, cerebro vascular disorders recent GU or GI bleed, major surgery
thrombolytic meds interactions
other meds that enhance bleeding
thrombolytic meds admin
should be taken asap after onset of manifestations, 3 hr is best
obtain baseline platelet counts
do not mix medications in IV with thrombolytic agents
Hold direct pressure to injection site or ABG site for up to 30 min until any oozing stops
discontinue thrombolytic therapy if life-threatening bleeding occurs