Podcast
Questions and Answers
Which of the following is a key difference between heparin and low molecular weight heparins (LMWH)?
Which of the following is a key difference between heparin and low molecular weight heparins (LMWH)?
- Heparin primarily prevents post-operative DVT and PE, while LMWH is used for acute DVT and PE.
- Heparin has a more stable response and lower bleeding risk compared to LMWH.
- LMWH offer a more stable response and a lower risk of bleeding compared to heparin. (correct)
- LMWH are administered orally, while heparin is given via injection.
A patient is prescribed Arixtra (fondaparinux). What is its primary mechanism of action?
A patient is prescribed Arixtra (fondaparinux). What is its primary mechanism of action?
- Directly inhibits the production of thrombin.
- Selectively inhibits activated factor Xa. (correct)
- Activates antithrombin III to neutralize thrombin.
- Inhibits the formation of fibrin.
Which of the following conditions is commonly treated with heparin?
Which of the following conditions is commonly treated with heparin?
- Non-hemorrhagic stroke (correct)
- Uncontrolled hypertension
- Hemophilia
- Hemorrhagic stroke
A patient undergoing knee replacement surgery is prescribed LMWH post-operatively. What is the primary purpose of this medication in this scenario?
A patient undergoing knee replacement surgery is prescribed LMWH post-operatively. What is the primary purpose of this medication in this scenario?
A patient is receiving Arixtra (fondaparinux) for DVT. What other medication might it be given with?
A patient is receiving Arixtra (fondaparinux) for DVT. What other medication might it be given with?
What is a significant adverse effect associated with heparin administration that requires close monitoring?
What is a significant adverse effect associated with heparin administration that requires close monitoring?
Why is neurological assessment crucial when administering LMWH or Arixtra, particularly in patients undergoing spinal or epidural procedures?
Why is neurological assessment crucial when administering LMWH or Arixtra, particularly in patients undergoing spinal or epidural procedures?
A patient with a known hypersensitivity to heparin is scheduled for an urgent surgery. Which parenteral anticoagulant would be the MOST appropriate alternative?
A patient with a known hypersensitivity to heparin is scheduled for an urgent surgery. Which parenteral anticoagulant would be the MOST appropriate alternative?
Which of the following conditions is a contraindication for the use of parenteral anticoagulants?
Which of the following conditions is a contraindication for the use of parenteral anticoagulants?
A patient with Disseminated Intravascular Coagulation (DIC) is experiencing active bleeding. In what circumstances, if any, might a parenteral anticoagulant be considered?
A patient with Disseminated Intravascular Coagulation (DIC) is experiencing active bleeding. In what circumstances, if any, might a parenteral anticoagulant be considered?
Which pre-existing condition would necessitate cautious use of parenteral anticoagulants due to increased risks?
Which pre-existing condition would necessitate cautious use of parenteral anticoagulants due to increased risks?
A patient is taking warfarin for chronic atrial fibrillation. Which of the following medications, if taken concurrently, would MOST likely decrease the effectiveness of warfarin?
A patient is taking warfarin for chronic atrial fibrillation. Which of the following medications, if taken concurrently, would MOST likely decrease the effectiveness of warfarin?
Before initiating heparin therapy, what baseline vital sign is MOST critical to establish for detecting early signs of bleeding?
Before initiating heparin therapy, what baseline vital sign is MOST critical to establish for detecting early signs of bleeding?
During heparin administration, an increased heart rate and respiratory rate might indicate what?
During heparin administration, an increased heart rate and respiratory rate might indicate what?
How do NSAIDs affect patients taking parenteral anticoagulants like heparin or LMWH?
How do NSAIDs affect patients taking parenteral anticoagulants like heparin or LMWH?
Flashcards
Parenteral Anticoagulants
Parenteral Anticoagulants
Medications given via injection/infusion to prevent blood clot formation, crucial for thromboembolic events.
Heparin
Heparin
A traditional anticoagulant with a higher bleeding risk compared to LMWH.
Low Molecular Weight Heparins (LMWH)
Low Molecular Weight Heparins (LMWH)
Examples include Lovenox and Fragmin; offer more stable responses and lower bleeding risk than heparin.
Arixtra (Fondaparinux)
Arixtra (Fondaparinux)
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Inhibition of Fibrin Formation
Inhibition of Fibrin Formation
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Inactivation of Clotting Factors
Inactivation of Clotting Factors
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Heparin common uses
Heparin common uses
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Low Molecular Weight Heparins (LMWH) Uses
Low Molecular Weight Heparins (LMWH) Uses
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Arixtra (Fondaparinux) Uses
Arixtra (Fondaparinux) Uses
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Hemorrhage (Heparin)
Hemorrhage (Heparin)
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Thrombocytopenia
Thrombocytopenia
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Neurological Damage (LMWH/Arixtra)
Neurological Damage (LMWH/Arixtra)
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Thrombocytopenia (Contraindication)
Thrombocytopenia (Contraindication)
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Active Bleeding (Contraindication)
Active Bleeding (Contraindication)
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Baseline Vital Signs
Baseline Vital Signs
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Study Notes
- Parenteral anticoagulants are administered via injection or infusion.
- These medications prevent blood clot formation.
- They are crucial in managing and preventing thromboembolic events.
Key Parenteral Anticoagulants
- Heparin is a traditional anticoagulant.
- Low Molecular Weight Heparins (LMWH) include Lovenox and Fragmin.
- LMWH offer more stable responses compared to heparin.
- LMWH have a lower risk of bleeding compared to heparin.
- Arixtra (Fondaparinux) is an activated factor Xa inhibitor.
Mechanism of Action
- Parenteral anticoagulants inhibit fibrin formation.
- Fibrin is a key component of blood clots.
- These drugs inactivate factors necessary for blood coagulation.
- They disrupt the coagulation cascade.
Indications and Uses
- Parenteral anticoagulants are used to prevent and treat thromboembolic disorders.
- Heparin is used in cases of:
- Cerebrovascular Accident (CVA), specifically non-hemorrhagic stroke
- Pulmonary Embolism (PE)
- Deep Vein Thrombosis (DVT)
- Myocardial Infarction (MI) or Heart Attack
- Prophylaxis post-operative thrombosis
- During pregnancy for coagulation.
- Low Molecular Weight Heparins (LMWH) are used for:
- Prevention of post-operative DVT and PE
- Prevention of complications from angina and MI
- Arixtra (Fondaparinux) is used for:
- Prevention of DVT and PE post-operatively
- Prevention of acute DVT and PE, often in conjunction with Coumadin (Warfarin)
Adverse Reactions
- Common adverse reactions include bleeding, thrombocytopenia, and neurological complications.
- Heparin can cause:
- Hemorrhage, the most significant risk
- Thrombocytopenia, increasing bleeding risk
- Allergic reactions
- Heparin overdose/toxicity
- Low Molecular Weight Heparins (LMWH) can cause:
- Hemorrhage
- Neurological damage, such as hematoma formation during spinal anesthesia or epidural procedures
- Thrombocytopenia
- Bleeding
- Overdose/toxicity
- Arixtra (Fondaparinux) can cause:
- Hemorrhage
- Neurological damage, such as hematoma formation
- Thrombocytopenia
Contraindications
- Thrombocytopenia: Avoid use in patients with low platelet count.
- Active Bleeding: Contraindicated, except in specific cases like Disseminated Intravascular Coagulation (DIC).
- Disseminated Intravascular Coagulation (DIC) involves simultaneous clotting and bleeding.
- Hemorrhagic Disease: Conditions that increase bleeding risk.
- Uncontrolled Hypertension: High risk of stroke or aneurysm.
- Recent Surgery: Especially of the eye or central nervous system.
- Hemophilia: A bleeding disorder.
Drug Interactions
- Increased Bleeding Risk can occur with concurrent use of:
- Anticoagulants
- Aspirin
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Decreased Effectiveness of Coumadin (Warfarin) can occur with:
- Oral Contraceptives
- Vitamin K
Nursing Administration and Monitoring
- Baseline Vital Signs: Establish baseline blood pressure, heart rate, and respiratory rate.
- Hypotension (low blood pressure) can indicate internal bleeding.
- Tachycardia (increased heart rate) and increased respiratory rate may indicate compensation for blood loss.
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