Warfarin and Clopidogrel Patient Care

Warfarin Patient Teaching

• Mode of Action: Warfarin is a vitamin K antagonist.
• Patient Teaching: Avoid vitamin K-rich diets.
• INR Range: 2 to 3.
• Oral Administration: 8 to 12 hours for initial response, takes several days to peak.
• Nursing Intervention: If INR is less than 2 or greater than 4, hold and notify provider. Stop 5 days prior to surgery.
• Antidote: Foidon (Fondiparinux).
• Transition from Heparin: Stop heparin when warfarin INR is in therapeutic range; heparin therapeutic levels don't matter.
• Heparin PT Ranges: Heparin is an indirect thrombin inhibitor; therapeutic levels are based on activated partial thromboplastin time (60-80 seconds).
• Heparin Antidote: Protamine sulfate.

DVT Assessment and Prophylaxis

• Prophylactic: Warfarin, Lovenox.
• Assessment: Warmth, edema, swelling, and pain.

Clopidogrel (Plavix) Patient Teaching

• Class: Antiplatelet.
• Patient Teaching: Signs and symptoms include bleeding, petechiae, bruising. Caution with contact sports and avoid other anticoagulants and NSAIDs.

Aspirin Mechanism

• Mechanism: Aspirin (acetylsalicylic acid) suppresses platelet aggregation by irreversibly inhibiting cyclooxygenase.

Epoetin Alfa

• Mechanism: Stimulates red blood cell production in bone marrow.
• Uses: Treats anemia from kidney failure, chemotherapy, HIV/AIDS.
• Pre-Surgery Considerations: Can increase reticulocyte count.

Atorvastatin (Lipitor) Patient Teaching

• Class: Anti-hyperlipidemic, cholesterol absorption inhibitor.
• Contraindications: Gallbladder disease, muscle pain, jaundice, nausea, vomiting.
• Diet Recommendations: Low-fat, low-cholesterol diet.
• Cholesterol Ranges: LDL <100 mg/dL, HDL >60 mg/dL, triglycerides <150 mg/dL, total cholesterol <200 mg/dL.

Iron Sulfate Patient Teaching

• Use: Iron deficiency anemia, prevention.
• Patient Teaching: Avoid antacids, tetracyclines, and vitamin C. Take 2 hours post-meal. Increase fluid and fiber intake.
• Stool Color: Black or green stools are expected.

Nitroglycerin Patient Teaching

• Emergency: Call 911 after the first dose if pain doesn't subside.
• Storage: Protected from light in an airtight container.
• Avoid: Hypotensives, alcohol, phosphodiesterase type 5 inhibitors (Viagra, Cialis).

Hemophilia A Treatment

• Treatment: Factor VII concentrates replace missing clotting factors.
• Monitor: Shortness of breath.

Filgrastim (Neupogen)

• Mechanism of Action: A luecopoetic growth factor that stimulates bone marrow production of neutrophils.
• Use: Reduces risk of infection in patients with neutropenia or undergoing autologous transplants.
• Additional Use: Reduces risk in cancer patients.

Bile Acid Sequestrants (Cholestyramine)

• Class: Anti-hyperlipidemic medication.
• Medications: Cholestyramine, Questran.

ACE Inhibitors

• Contraindications: Hyperkalemic patients, taking potassium supplements, renal failure, pregnancy.
• Adverse Effects: Angioedema, cough, elevated potassium (hyperkalemia).
• Use in Reduced Ejection Fraction (EF): To prevent symptomatic heart failure.
• Use in HTN and Diabetes: Treatment of choice.
• OTC Meds to Avoid: Sympathomimetics (pseudoephedrine, phenylephrine).

Verapamil (Calan) Patient Teaching

• Class: Calcium channel blocker.
• Contraindications: Avoid grapefruit juice, separate from beta-blockers.
• Administration: 2 hours apart from other medications.
• Heart Failure: Avoid with heart failure.
• Heart Block: Non-dihydropyridines (verapamil) can cause heart block in toxic doses.
• Contraindicated Medication Combinations: Avoid grapefruit juice with all calcium channel blockers, non-dihydropyridines, potassium channel blockers, and statins.

Amiodarone Patient Teaching

• General Concerns: Baseline chest X-ray is required, use sunscreen outdoors.
• Adverse Reports: Report shortness of breath, cough promptly, and stop if needed.

Potassium Considerations and Hypokalemia

• Administration: Oral administration.
• Diuresis Onset: Diuresis begins in 60 minutes, lasts 8 hours.
• IV Rapid Onset: Pulmonary edema within 5 minutes, lasts 2 hours.
• Hypokalemia Side Effects: Muscle weakness, threat, irregular pulse.
• Furosemide (Lasix) and Bumetanide: Same class as furosemide, monitor for dehydration and hypokalemia.

Spironolactone (Aldactone) Mechanism

• Mechanism: Blocks aldosterone action in the distal nephron.

Hydrochlorothiazide Patient Teaching

• Administration: Take at the same time daily; avoid before bedtime.
• Contraindications: Pregnancy and breastfeeding.

Antacids and Tagamet Administration

• Administration: Administer 1 hour apart.

Sucralfate (Carafate) Mechanism

• Mechanism: Sticky gel adheres to ulcers, protecting them.
• Use: Acute and maintenance therapy for peptic ulcers.

Misoprostol (Cytotec)

• Use: OTC medication for ulcer prevention. Administer 30 minutes apart from antacids, 2 hours apart from other medications.
• Avoidant: Avoid smoking, alcohol, avoid spicy foods.

Theophylline, Warfarin, Fluoroquinolones

• Use: Antibiotics, steroids, or bronchodilators.

Tiotropium (Spiriva):

• Class: Bronchodilator, muscarinic colinergic antagonist.
• Use: Prophylaxis for exacerbations.

Ipratropium (Atrovent) Mechanism

• Class: Bronchodilator, muscarinic colinergic antagonist.
• Mechanism: Blocks muscarinic receptors decreasing bronco constriction, increasing airway diameter. Management of COPD and asthma.

Albuterol Side Effects

• Common Side Effects: Tachycardia, nervousness, tremors.

Monoclonal Antibodies (zumab)

• Use: Asthma and COPD which do not respond to usual treatment

Asthma and COPD Medications

• Classes: Beta-2 agonists (end in -erol), anticholinergics (end in -ium), methylxanthines (end in -phylline).
• Additional Classes: Steroids (end in -sone), leukotriene modifiers (end in -lukast), and mast cell stabilizers (cromolyn).

Oropharyngeal Candidiasis Prevention

• Prevention: Rinse mouth with water.

Metronidazole (Flagyl) Patient Teaching

• Use: Treatment of H. pylori.
• Avoidances: Alcohol, pregnancy.
• Course: 10-14 days.

PUD Patient Teaching

• General: Decrease stress, eat healthy, avoid NSAIDs and large meals, avoid spicy foods, reduce caffeine.

Bulk-Forming Laxatives

• Types: Methylcellulose, psyllium (Metamucil).
• Administration: With a full glass of water.
• Contraindications: Conditions causing diarrhea or increased peristalsis.

Magnesium Hydroxide (Milk of Magnesia)

• Caution: Renal disease(chronic kidney disease).
• Side Effects: Avoid dehydration and electrolyte imbalance, such as hypermagnesemia.
• Nursing Interactions: Monitor for fluid and electrolyte imbalances, abuse, and encourage water consumption.

Stimulant Laxatives

• Side Effects: Abdominal cramping.
• Proctitis: Long term use may cause.

Treating Diarrhea

• Diet: BRAT diet.
• Dehydration: Avoid dehydration.
• Probiotics: Consider probiotic yogurt.

Bismuth Subsalicylate (Pepto-Bismol)

• Side Effect: Black tongue, dark stools.

Plant-Derived Laxative

• Mechanism: Acts on the colon.
• Duration of Effect: 6-12 hours.
• Monitoring: Increase water intake; monitor for contraindications.

Spacer Use in Medications

• Purpose: Helps medication reach the lungs more effectively.

Beta-Blockers Mechanism and Function

• Mechanism: Decreases heart activity by blocking hormones (like adrenaline).
• Prescription Only.

Pre-Existing Conditions to Question Beta-Blockers

• Conditions: Sinus bradycardia, AV heart block, diabetes.
• Vital Signs Warnings: Hold medication if blood pressure is <90 mmHg or heart rate is <60 bpm

Dextromethorphan (Robitussin DM)

• Mechanism: CNS action to suppress cough.
• Monitoring: Respiratory rate.
• Additional Precautions: Change position slowly, do not use with other opiates or CNS depressants

Ondansetron (Zofran)

• Class Serotonin antagonist
• Side Effect: Prolong QT and heart rhythm. Monitor heart rate.

Promethazine (Phenergan)

• Class: Dopamine antagonist
• Side Effects: Monitor level of consciousness; observe IV site for patency.

Proton Pump Inhibitors (PPIs) (Omeprazole, Pantoprazole)

• Use: Peptic ulcer prevention
• Side effect report to MD if needed.

Antihistamines

• Mechanism of Action: Blocks histamine action, reducing allergic responses.
• Types: H1 and H2 receptor antagonists.
• Uses: Allergies, gastric ulcers.

Rivaroxaban

• Characteristics Rapid onset, fixed dosing, no antidote.
• Precautions: Soft toothbrush, electric razor, take as directed.
• Contraindications: Pregnancy.
• Caution: Avoid with anticoagulants, antiplatelets, and fibrinolytics.

Lovastatin

• Administration: Administer at night.
• LDL reduction: Noticeable within 2 weeks.
• Creatine Kinase (CK): Report muscle aches/weakness. Avoid grapefruit juice

Cromolyn

• Use: Alternative to glucocorticoids; reduces frequency and intensity of asthma attacks.
• Effectiveness: Takes time; safest of asthma medications.

Hyperkalemia Indication

• Sign: Tall T waves on EKG
• Labs: Monitor potassium levels.

Digoxin (Lanoxin)

• Therapeutic Range: 0.5-0.8 ng/mL
• Indications: Heart failure, atrial fibrillation.
• Precautions: Assess GI and CNS, monitor pulse before administration, hold if HR < 60.
• Antidote: Digibind.
• Pulse Monitoring: Apical pulse for a full minute.

Calcium Channel Blockers and Reflex Tachycardia

• Risk Factors: Dihydropyridines (e.g., nifedipine, amlodipine) combined with beta-blockers.

Misoprostol (Cytotec) and Pregnancy

• Contraindications: Avoid during pregnancy.

Theophylline, Antibiotics

• Therapeutic Range: 5-15 mcg/mL
• Toxicity: > 20 mcg/mL
• Antibiotics: Affect metabolism.

Morphine

• Use: MI prevention/treatment.
• Effects: Sedation, modest atrial dilation.
• Administration: 10 mL bolus.
• Additional Considerations: Antiplatelets, anticoagulant, and lipid-lowering medications are often used in combination.

Lactase and Chronic Liver Disease

• Lactose Intolerance: Ammonia levels can be affected by lactose in chronic liver disease.
• Relief: Laxatives may be beneficial.

Glomerular Filtration Rate (GFR)

• Definition: Measures renal function.
• Significance: Used for diagnosing and defining renal disorders and acute/chronic kidney injury (AKI/CKD).

Treatment for Torsades de Pointes

• Treatment: IV magnesium.

Metoclopramide Side effects

• Side effect: Tardive dyskinesia

Steroids for inflammation

• Steroids: Prednisone, short-acting beta-2 agonists (e.g., albuterol, etc), etc.

COPD and Asthma Medications

• Classes: Short-acting beta-2 agonists, long-acting beta-2 agonists, anticholinergics, and methylxanthines.
• Additional Classes: Steroids, leukotriene modifiers, and mast cell stabilizers.

Bibasilar Crackles, Pitting Edema, Jugular Distension (JVD)

• Medication Anticipation: Furosemide (a diuretic)

ACE Inhibitors Indications

• Uses: Hypertension, heart failure, and diabetic neuropathy and MI prevention.

ACE Inhibitors and Potassium Regulation

• Effect: Inhibition of aldosterone release results in potassium retention.

Medication for Atrial Flutter/NSR Anticipation

• Medication: Amiodarone (Amiodarone)

Medication for DM2 and HTN

• Anticipation: ACE inhibitor.