Nurs 2501 Exam 3

Front 1

Colony-Stimulating Factors: Erythropoietin (EPO, Procrit)

Back 1

Stimulates production of erythrocytes

Used in iron deficiency anemia and ESRD (kidneys produce erythropoietin)

SE: bone pain, muscle aches, HA, elevated BP, N/V

Front 2

Colony-Stimulating Factors: Filgrastim (Neupogen)

Back 2

Stimulates production of granulocytes

Used to treat neutropenia, aplastic anemia, and leukemia and to increase leukapheresis following chemotherapy

SE: bone pain, muscle aches, rash, HA, elevated BP, N/V

Front 3

Colony-Stimulating Factors: Sargramostim (Leukine)

Back 3

Supports survival, clonal expansion, and differentiation of hematopoietic progenitor cells (neutrophils, monocytes/macrophages and myeloid-derived dendritic cells)

Used to treat AML and to increase leukapheresis following bone marrow transplant and chemotherapy

SE: bone pain, muscle aches, HA, rash, elevated BP, N/V

Front 4

Colony-Stimulating Factors: Oprelvekin (Neumega)

Back 4

Thrombopoietic growth factor that principally affects megakaryocytopoiesis (PLT formation)

Used to increase PLT production during chemotherapy

SE: can cause severe allergic reaction, bone pain, muscle aches, HA, elevated BP, N/V, rash

Front 5

Antineoplastic Agent: Imatinib Mesylate (Gleevec)

Back 5

Competitively inhibits Bcr-Abl tyrosine kinase, the constitutive abnormal tyrosine kinase created by the Philadelphia chromosome abnormality in CML

Used as treatment of Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia (CML)

SE: N/V/D, muscle cramps, bone pain, rash, fluid retention/edema, hepatotoxicity, CHF, hypophosphatemia

Front 6

Antiplatelets: Dipyridamole (Persantine)

Back 6

Non-nitrate coronary vasodilator and platelet aggregation inhibitor

Used with coumarin anticoagulants for the prevention of postoperative thromboembolic complications of heart valve replacement or in combination with aspirin for secondary prevention of stroke in patients who have had TIAs or completed thrombotic stroke

SE: HA, dizziness, GI upset, vomiting, diarrhea, flushing, rash, pruritis (EKG changes with injection)

Front 7

Antiplatelets: Pentoxifylline (Trental)

Back 7

Improves blood flow blood by decreasing its viscosity

Used to treat intermittent claudication in PAD; improves function and symptoms, but is not curative

SE: HA, dizziness, blurred vision, flushing, GI upset, N/V/D

Front 8

Antiplatelets: Clopidogrel (Plavix)

Back 8

Platelet-aggregation inhibitor

Used to prevent heart attacks, strokes, and other clot-related diseases

SE: Chest pain,influenza-like symptoms, HA, dizziness, GI upset, dyspepsia, diarrhea, nausea, arthralgia, back pain, purpura, upper respiratory tract infection, rash, pruritus

Front 9

Anticoagulants: Dabigatran etexilate (Pradaxa)

Back 9

Action: Inhibits thrombin preventing the development of thrombus.

Indications: For patients with atrial fibrillation to reduce risk of stroke, treatment and prevention of DVT and pulmonary emboli.

Side effects: Most common side effects relate to increased risk of bleeding, including symptoms of GERD, gastritis and GI bleeding. Monitor patient for signs and symptoms of bleeding.

Nursing care: Assess renal function. No monitoring of blood work is needed but this medication does effect the aPTT. Do not chew or break tablets and take with a full glass of water. Teach patient to take as prescribed; do not stop taking. Teach patient to assess for signs and symptoms of bleeding.

Concomitant use of other drugs that effect bleeding will increase the risk of bleeding. Contraindicated with active bleeding, history of allergy to this medication, and mechanical heart valves. Use of neuraxial spinal anesthesia, spinal puncture or epidural catheters increases risk for spinal or epidural bleeding and paralysis.

There is no current antidote. Note: Half-life is 12-17 hours.

Front 10

Anticoagulants: Rivaroxaban (Xarelto)

Back 10

Action: Inhibits clotting factor Xa

Indications: Stroke reduction for patients with nonvalvular atrial fibrillation, treatment of and reduction of risk for DVT and pulmonary emboli.

Side effects: Most common side effects relate to increased risk for bleeding. Monitor patient for signs and symptoms of bleeding.

Nursing care: 10 mg tablet can be taken with or without food, take 15 and 20 mg tablets with food. This tablet may be crushed and mixed with applesauce immediately prior to giving. No monitoring of blood work is needed. Monitor renal function. Teach patient to take as prescribed, do not stop taking. Teach patient to asses for signs and symptoms of bleeding. Concomitant use of other drugs that effect bleeding will increase the risk of bleeding.

Contraindications: This drug has the same risk related to spinal anesthesia and spinal tap as Pradaxa.

There is no current antidote. Note: Half-life is 2-4 hours.

Front 11

Anticoagulants: Apixaban (Eliquis)

Back 11

Action: Inhibits clotting factor Xa

Indications: For patients with nonvalvular atrial fibrillation to reduce risk of stroke. In August 2014 Eliquis was approved for treatment and prevention of DVT and pulmonary emboli.

Side effects: Most common side effects relate to increased risk for bleeding. Monitor patient for signs and symptoms of bleeding.

Nursing care: No monitoring of blood work is needed. Monitor renal function. This drug may be crushed immediately before administration. Teach patient to take as prescribed, do not stop taking. Teach patient to asses for signs and symptoms of bleeding. Concomitant use of other drugs that effect bleeding will increase the risk of bleeding.

Contraindications: This drug has the same risk related to spinal anesthesia and spinal tap as Pradaxa.

There is no current antidote. Note: Half-life is 12 hours

Front 12

Anticoagulant Antagonist: Protamine sulfate

Back 12

Antidote for Heparin

Front 13

Anticoagulant Antagonist: Vitamin K (Mephyton)

Back 13

Antidote for warfarin (Coumadin)

Front 14

Glycoprotein IIb/IIIa Inhibitor: Abciximab (Reopro)

Back 14

Inhibit glycoprotein IIb/IIIa (also referred to as integrin-αIIbβ3). Activation of the integrin complex enables the binding of fibrinogen, platelet–platelet adhesion, and endothelial adherence.

Used to treat unstable angina and following PTCA

There are no reversal agents currently indicated for glyocoprotein IIb/IIIa inhibitors. Platelet transfusions may be offered in adjunct to supportive management.

Front 15

Fast-Acting Anticoagulants

Back 15

Heparin, Lovenox (LMWH-enoxaaparin)

Half-life 60 - 90 minutes

Monitor PTT/aPTT

Therapeutic aPTT: 1.5 - 2.5 times control (normal is 30 - 40 sec)

Front 16

Long-Term Anticoagulants

Back 16

warfarin (Coumadin)

Monitor PT/INR

Normal PT: 11 - 12.5

Therapeutic INR: 2-3.5

Front 17

Bleeding Precautions

Back 17

• Use an electric shaver.

• Use a soft-bristled toothbrush, and do not floss.

• Do not have dental work performed without consulting your health care provider.

• Do not take aspirin or any aspirin-containing products. Read the label to be sure that the product does not contain aspirin or salicylates.

• Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped.

• If you are bumped, apply ice to the site for at least 1 hour.

• Avoid hard foods that would scrape the inside of your mouth.

• Eat warm, cool, or cold foods to avoid burning your mouth.

• Check your skin and mouth daily for bruises, swelling, or areas with small, reddish purple marks that may indicate bleeding.

• Notify your health care provider if you are injured and persistent bleeding results, have excessive menstrual bleeding, see blood in your urine or bowel movement

• Avoid anal intercourse.

• Take a stool softener to prevent straining during a bowel movement.

• Do not use enemas or rectal suppositories.

• Do not wear clothing or shoes that are tight or that rub.

• Avoid blowing your nose forcefully or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage.

• Avoid playing musical instruments that raise the pressure inside your head, such as brass wind instruments and woodwinds or reed instruments.

• Keep all appointments for laboratory tests