Med Administration Ircc Coagulation Modifiers

Front 1

What is the primary action of anticoagulants?

Back 1

Prevents clots by affecting clotting factors

Front 2

What is the primary action of antiplatelets?

Back 2

Inhibit platelet aggregation

Front 3

What is the primary action of thrombolytics?

Back 3

To break down exhisting clots.

Front 4

What is the primary action of anti fibirinolytics?

Back 4

To promote clot formation.

Front 5

Name the three kinds of anticoagulants.

Back 5

Heparin
LMWH's
Warfarin

Front 6

How is Heparin administered?

Back 6

Heprin is in a vial, you draw it up and give it sub-q 2 inches from umbillicus or iliac crest, inject at a 90-45 degree angle, depends on amount of fat present, or when giving an IV push do not dilute.

Front 7

How does LMWH come, in what form?

Back 7

In a prefilled syringe.

Front 8

What is the other name for Warfarin and how is it administered?

Back 8

Coumadin
Oral

Front 9

Binds to antithrombin II which turns off 3 activating factors (activated II(thrombin) activated X and activated IX)

Back 9

the anticoagulant Heparin

Front 10

Similar to heparin but action is more specific for activated factor X than II

Back 10

LMWH's

Front 11

Inhibits clotting factors II, VII, IX, and X

Back 11

Warfarin (coumadin)

Front 12

Actions/indications of anticoagulants

Back 12

prevent clot formation
MI
unstable angina
atrial fibrillation
mechanical heart valves
slowed blood flow as in post knee surgery or high risk surgery

Front 13

adverse effects of anticoagulants

Back 13

overdose/toxicity
bleeding: hematuria, melena, petechiae, ecchymosis and bleeding of musous membranes

Front 14

Interventions for the side effects of anticoagulants

Back 14

stop the drug
give the antidote
administer blood/plasma replacement

Front 15

how is the onset and what is the half life of heparin?

Back 15

has a rapid onset and a half life of 1-2 hours

Front 16

If a patient goes to surgery in 1 hour after heparin has been administered is this safe? Why or why not?

Back 16

yes, due to the short half life of 1-2 hours it will be half out of the system by the time they get to the actual surgery.

Front 17

best site for Heparin

Back 17

2 inches away from umbillicus or an area around the iliac crest

Front 18

to aspirate or not to aspirate heparin, that is the question?

Back 18

DO NOT ASPIRATE

Front 19

Upon injection what 2 steps must the nurse always do when giving heparin?

Back 19

count to 10 seconds before with drawing the needle
do not rub/massage the skin

Front 20

what anticoagulant must be verified with a second nurse

Back 20

heparin

Front 21

On a standard heparin drip you have 25,000 units heparin in 250 or 500 mL D5W. What is the stock?____ units/mL

Back 21

stock is the concentration
100 units/mL
50 units/mL

Front 22

what other medication can be administered in the heparin IV line?

Back 22

none, no other medication can be administered through the heparin IV line?

Front 23

Give four examples of LMWH's.

Back 23

Oenoxaparin (lovenox)
Odalteparin (Fragmin)
Otinzaparin (Innohep)
Ofondaparinux (Arixtra)

Front 24

the O-parin's are what type of anticoagulant

Back 24

LMWH's

Front 25

what is the half life of Lovenox

Back 25

4.5 hours

Front 26

how do you the Nurse administer LMWH's

Back 26

they come in prefilles syringes and are only given sub-q (as in heparin)

Front 27

what is the onset and half life if warfain (Coumadin)

Back 27

It has a delayed onset and a half life of up to 3-5 days.

Front 28

what labs determine the maintenence dose of coumadin

Back 28

PT and INR (theraputic goal of INR is between 2-3)

Front 29

If the patients labs for their INR come back as 1.2 than what should be done

Back 29

give more coumadin (notify physician or follow protocol)

Front 30

If the patients labs for INR come back as 3.2 than what should be done.

Back 30

hold coumadin

Front 31

antidote for coumadin

Back 31

vitamin K

Front 32

what foods are high in vitamin K

Back 32

green leafy veggies, tomatoe, fish

Front 33

What patient teaching should you do with a patient taking coumadin? (diatery)

Back 33

avoid foods high in vitamin K as it is the antidote to the coumadin therapy and will interfere with the theraputic goals, also keep vit K on hand if there is an acidental over dose

Front 34

what pregnancy category is warfarin (coumadin)?

Back 34

Pregnancy category X

Front 35

Why is overlaping of heparin with coumadin necessary?

Back 35

Heparin is only given in the hospital or other such clinic and has a half life of 1-2 hours so coumadin with it's slow onset and half life of 4-5 days must be given, overlaped, with heparin per doctor's orders or institution policy

Front 36

what serious adverse reaction can result in warfarin toxicity

Back 36

warfarin induced skin necrosis
remember coumadin is rat poison war--it just sounds dangerous

Front 37

What are the nursing implications (what must the nurse look for) for anticoagulants?

Back 37

assess for hypersensitivity reactions
bleeding is the primary side effect
monitor laboratory values closely
watch for drug interactions

Front 38

What should the patient do and/or not do when on anticoagulants?

Back 38

do to increased bleeding and low coagulation of the blood they should only use electric razors, a soft bristle tooth brush
urine and stool should be tested for occult blood
avoid IM/SQ injections
wear medic alert bracelet

Front 39

common name for platelet aggregration inhibitors

Back 39

Antiplatelets

Front 40

ginko with anticoagulants have what effect?

Back 40

promotes bleeding

Front 41

what drug and what administration should be given to the post-op bed ridden client, the client with poulmonary embolism?

Back 41

Heparin, sub-q to the post-op bed ridden client, and IV drip to client with pulmonary embolism.

Front 42

What two coagulation modifiers should not be combined?

Back 42

anticoagulants with antiplatelets

Front 43

names of common antiplatelets

Back 43

salicylates (asprin)
ADP (adenosine diphosphate) inhibitors (plavix)

Front 44

Used to prevent thrombus formation during acute episodes of unstable angina/MI

Back 44

GP IIb/IIa inhibitors
examples are Aggrastat and Persantin (combined with asprin is Aggrenox

Front 45

Aggrenox (persantin/asprin combination) used in what situation?

Back 45

For patients with a history of chest pain

Front 46

Some antiplatelets have what effect on patients what history of chest pain?

Back 46

prevents thrombus formation during acute episodes of unstable angina/MI

Front 47

Primary nursing diagnosis

Back 47

Risk for bleeding

Front 48

What is the theraputic dose range for asprin

Back 48

81 mg-325 mg/day

Front 49

Used to prevent thrombus formation during acute episodes of unstable angina/MI

Back 49

GP IIb/IIa inhibitors
examples are Aggrastat and Persantin (combined with asprin is Aggrenox

Front 50

Aggrenox (persantin/asprin combination) used in what situation?

Back 50

For patients with a history of chest pain

Front 51

Some antiplatelets have what effect on patients wiht history of chest pain?

Back 51

prevents thrombus formation during acute episodes of unstable angina/MI

Front 52

Primary nursing diagnosis

Back 52

Risk for bleeding

Front 53

What is the theraputic dose range for asprin

Back 53

81 mg-325 mg/day

Front 54

asprin is used for prophylaxis of what two conditions?

Back 54

MI/TIA

Front 55

What dose and what rout is plavix given?

Back 55

75 mg daily po

Front 56

when should platelet aggregation inhibitors be stopped before surgery?

Back 56

10-14 days, some surgeons say one week

Front 57

This class of drug breaks down existing thrombus in coronary arterys (vessles that supply the heart with blood)

Back 57

Thrombolytics or Fibrinolytics

Front 58

Indications for thrombolytics/fibrinolytics (what kinds of problems are these drugs good for?)

Back 58

acute MI, arterial thrombosis, DVT, occlusion of AV shunts/ catheters

Front 59

asprin is used for prophylaxis of what two conditions?

Back 59

MI/TIA

Front 60

What dose and what rout is plavix given?

Back 60

75 mg daily po

Front 61

when should platelet aggregation inhibitors be stopped before surgery?

Back 61

10-14 days, some surgeons say one week

Front 62

This class of drug breaks down existing thrombus in coronary arterys (vessles that supply the heart with blood)

Back 62

Thrombolytics or Fibrinolytics

Front 63

Indications for thrombolytics/fibrinolytics

Back 63

acute MI, arterial thrombosis, DVT, occlusion of AV shunts/ catheters, pulmonary embolus

Front 64

Thrombolytic enzymes

Back 64

streptase (strip tease!) streptokinase
activase (activate)alteplase

Front 65

antidote of streptokinase and alteplase

Back 65

Amicar (aminocaproic acid)

Front 66

side effect of thrombolytic enzymes

Back 66

bleeding

Front 67

thrombolytics/fibrinolytics contraindications

Back 67

internal bleeding, recent stroke, severe uncontrolled HTN

Front 68

cannot be used in deseminated intravascular clotting (DIC), new burns, urinary tract bleeding, postpartum bleeding, intravascular clotting

Back 68

antifibrinolytics

Front 69

aPPT

Back 69

lab for heparin

Front 70

PT/INR

Back 70

warfarin (one article says INR is more accurate, PT riskier value to go by)