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68 Cards in this Set
- Front
- Back
Identify the 3 anticoagulants discussed in lecture. |
warfarin (Coumadin)
heparin enoxaparin (Lovenox) |
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anticoagulant
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acting to suppress, delay, or nullify blood coagulation
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coagulation
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the process by which blood forms clots
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Identify the mechanism of action(s) for the following drug: heparin.
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Inactivates thrombin and factor Xa => suppression of fibrin
Note: Stops fibrin |
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Is heparin a maintenance med?
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No
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TRUE/FALSE
Blood clot formation is a normal body function. |
True
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Identify the routes of administration for heparin.
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IV
Subcutaneous |
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Identify the half-life of heparin. Is it short or long?
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1.5 hours, short half-life
Note: Half-life may be longer in patients with kidney or liver disease |
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Where is heparin metabolized?
Where is heparin excreted? |
Metabolized in liver
Excreted in kidneys |
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Identify 5 therapeutic use(s) for heparin.
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Massive venous thrombosis (fibrin meshwork of clot) such as DVT (deep vein thrombosis), or post op venous thrombosis
Pulmonary embolism Acute myocardial infarction (AMI) Open heart surgery Renal dialysis |
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Heparin in prescribed in _____.
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units
For adults, 10,000-20,000 USP units SC or 10,000 units IV initially (loading dose) then 5,000-10,000 units q4-6 hrs |
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Identify the adverse effect(s) of heparin. (4)
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Heparin Induced Thrombocytopenia
(monitor platelet count) Hypersensitivity Reactions Osteoporosis (long term tx) Hematoma & Irritation, injection site |
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Why do we monitor platelet count?
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Low platelet count causes bleeding
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Identify the antidote for heparin.
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Protamine sulfate
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Identify the contraindication(s) for heparin. (4)
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Bleeding disorders (esp uncontrollable bleeding)
Thrombocytopenia Immediately post-op After lumbar puncture |
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What lab do you monitor with heparin?
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Partial thrombloplastin time (PTT)
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_______ is a low molecular-weight heparin.
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Enoxaparin (Lovenox)
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Identify the mechanism of action(s) for the following drug: enoxaprin (Lovenox).
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Inactivates factor Xa
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thrombocytopenia
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low platelet count
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Do you give heparin to patients with active bleeding or bleeding disorders?
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No
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Is enoxaparin (Lovenox) given for maintenance?
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Yes
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Is enoxaparin (Lovenox) safe for use during pregnancy?
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Yes
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Identify the antidote for enoxparin.
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Protamine sulfate
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Identify 2 therapeutic use(s) for enoxaparin.
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DVT prophylaxis (prevention of DVT)
Prevention of ischemic complications for non-Q wave MI or unstable angina |
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Which has a longer half-life, heparin or enoxaparin?
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Enoxaparin
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Why would enoxaprin be used during pregnancy?
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Pregnancy thickens blood, which then decreases blood supply from mom to baby. Enoxaparin will thin the blood.
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Identify the adverse effect(s) of enoxaparin.
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Bleeding
Pain or inflammation at injection site |
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Identify the oral anticoagulant discussed in lecture.
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Warfarin (Coumadin)
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Identify the mechanism of action(s) for the following drug: warfarin.
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prevents biosynthesis of clotting factors VII, IX, X, prothrombin
blocks Vitamin K => prevents coagulation |
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Identify the dietary adjustment that needs to be made for patients taking warfarin. Why?
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Eat less food items with Vitamin K, such as green, leafy vegetables
This is important because if there is too much Vitamin K, warfarin will be useless and will be toxic to the body. |
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Identify the antidote for warfarin.
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Vitamin K
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What labs must be monitored for a patient taking warfarin?
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INR (international normalized ratio)
Prothrombin time (PT) |
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Identify the half-life of warfarin.
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6 hours - 2.5 days
Note: Even if the pt stopped taking it 2 days ago, it is still in their system. |
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TRUE/FALSE
A nurse must monitor for signs of bleeding for a few days, even if warfarin has been discontinued. |
TRUE
Because the drug has a long half-life. |
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Identify the level of INR for a therapeutic dose for atrial fibrillation.
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2.0-3.0
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atrial fibrillation
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muscular twitching of the muscles of the atria of the heart
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How is vitamin K involved in blood clotting?
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each form of vitamin K functions as an enzyme that assists in chemically altering proteins involved in the blood clotting
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thrombolytics
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Drug used to break up and dissolving clots
Tip: Clot busters |
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Identify some education that may be useful for patients on anticoagulants.
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Disease process
Reason for taking drug Adverse effects Monitoring and follow-up Avoid vigorous activities (e.g. contact sports) Brush teeth with soft bristles |
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Identify the 2 antiplatelet drugs discussed in lecture.
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aspirin and clopidogrel (Plavix)
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Identify the mechanism of action(s) for the following drug: aspirin.
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Suppresses platelet aggregation
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Identify 2 therapeutic use(s) for aspirin.
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Prevention of MI
Prevention of stroke (pts with hx of TIA) |
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Identify the last step in clot formation.
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fibrinogen → fibrin
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Which drug is most effective to prevent venous thrombosis after surgical procedure?
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Small doses of heparin
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transient ischemic attack (TIA)
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when blood flow to a part of the brain stops for a brief period of time. A person will have stroke-like symptoms for up to 24 hours, but in most cases for 1 - 2 hours.
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Identify the adverse effect(s) of aspirin. (3)
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- Increase risk of GI bleed, peptic ulcer disease (PUD)
- Increase risk of hemorrhagic stroke - Bleeding |
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Identify the mechanism of action(s) for the following drug: streptokinase (Streptase).
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catalyzes conversion of other plasminogen into plasmin
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Identify the other name for alteplase.
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tissue plasminogen activator (tPA)
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Identify the mechanism of action(s) for the following drug: alteplase.
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promotes plasminogen to plasmin (which digests fibrin matrix of clots)
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Identify the 2 thrombolytics discussed in lecture.
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streptokinase (Streptase)
alteplase (tPA) |
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anemia
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condition in which the body does not have enough healthy red blood cells (decrease in the quantity or quality)
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Identify the cause(s) for anemia.
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altered production erythrocytes, blood loss and increased destruction of erythrocytes
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Identify the most common type of anemia.
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iron deficiency anemia (IDA)
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iron deficiency anemia
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insufficient iron available for erythropoiesis resulting in anemia
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erythropoiesis
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formation or production of red blood cells.
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Identify the 3 cause(s) for IDA.
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- Blood loss
- Increased iron requirement (birth to 2, adolescents, pregnancy) - Decreased iron absorption ( gastrectomy, upper small bowel malabsorption issues) |
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Identify the 4 risk factor(s) for IDA.
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Pregnancy
Poverty Children/Adolescent Blood loss |
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Iron is stored in the form of _____ within the body.
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hemoglobin
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TRUE/FALSE
Iron (in the body) can be recycled. |
True
It is in constant use in the body. |
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Identify and describe the 3 stages of IDA.
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Stage I– body’s iron stores for red cell production and hemoglobin synthesis are depleted
Stage II- insufficient amounts of iron are transported to the marrow and then iron deficient red cells are produced (impaired erythropoiesis) Stage III- Clinical manifestations of iron deficiency anemia (IDA) appears = insufficient iron supply & diminished HGB synthesis |
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Evaluation of IDA starts with ______.
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assessment of the labs.
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What labs need to be assessed for IDA? (5)
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- CBC (hemoglobin & hematocrit) - Ferritin
- TIBC (total iron binding capacity) - Transferrin saturation - Stool for occult blood |
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Identify the 2 types of iron replacements available for pts with IDA?
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Oral replacement is the initial treatment
If severe, IV iron replacement |
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Iron replacement has decreased absorption with _______.
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Decreased absorption with antacids, milk, eggs, cheese,
coffee, tea |
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What food helps to absorb iron?
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Orange juice (Vitamin C)
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Identify the mechanism of action(s) for the following drug: clopidogrel (Plavix).
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prevent platelet aggregation, antiplatelet; works like aspirin
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Identify the therapeutic use(s) for the following drug: clopidogrel (Plavix).
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prevention of ischemic stroke
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thrombus vs embolus
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Thrombus is a solid mass of platelets and/or fibrin (and other components of blood) that forms locally in a vessel
Embolus is most often a piece of a thrombus that has broken free and is carried toward the brain by the bloodstream. |