Pharmacology of Anticoagulants and Antiarrhythmics

Anticoagulants and Antiarrhythmics

• A client taking anticoagulants or DOACs like apixaban should avoid taking NSAIDs due to a significant risk of bleeding.
• Digoxin does not require clients to increase their potassium intake, but this may be necessary when concurrently taking diuretics.
• Calcium channel blockers (Diltiazem), beta blockers (metoprolol), and Digoxin are prescribed to reduce the ventricular rate, improve cardiac output, and convert atrial fibrillation to sinus rhythm.

Medication Contraindications

• Beta blockers (metoprolol), non-dihydropyridine calcium channel blockers (diltiazem, verapamil), and all beta blockers (metoprolol, timolol, atenolol) are contraindicated for patients with bradycardia.
• Medications associated with orthostatic hypotension include beta blockers (metoprolol), alpha blockers (terazosin), antipsychotics, antidepressants, diuretics, vasodilators (nitroglycerine, hydralazine), and narcotics (morphine).

Cardiovascular Medications

• A patient should call emergency medical services if their symptoms persist after taking the first dose of nitroglycerin, and then take up to 2 additional doses if pain persists.
• The normal range for aPTT is 25-35 seconds, and on heparin, aPTT should be 1.5-2 times normal value (46-70 seconds).
• Elevated aPTT puts the client at risk for bleeding, while low aPTT puts the client at risk for blood clot formation.

Administration and Follow-up

• Adenosine should be administered in 1-2 seconds due to its half-life.
• The nurse would not need to follow up with a healthcare provider for 10 units NPH insulin IV push.
• Ace inhibitors and ARBs lead to hyperkalemia by reducing aldosterone production, causing potassium retention.

Symptom Management

• After administering nitroglycerin, headache requires immediate follow-up.
• A patient on a corticosteroid should report immediately if they experience symptoms such as personality changes, abdominal pain, or decreased urination.
• During an asthma attack, the nurse would anticipate medications such as beta2 agonists (salbutamol) and corticosteroids.