Antihyperlipidemic & Vasodilators PDF

Antihyperlipidemic & Vasodilators - Unit 6 AnticoagulantsAnticoagulants, Antiplatelets, and Thrombolytics Unit 5 NUR 210/BLS 101  Antihyperlipidemic & Vasodilators - Unit 6 Thrombus Formation Pathophysiology Formation of clot in artery or vein Caused by decreased circulat...

Antihyperlipidemic & Vasodilators - Unit 6 AnticoagulantsAnticoagulants, Antiplatelets, and Thrombolytics Unit 5 NUR 210/BLS 101  Antihyperlipidemic & Vasodilators - Unit 6 Thrombus Formation Pathophysiology Formation of clot in artery or vein Caused by decreased circulation, platelet aggregation on vessel wall, blood coagulation Arterial clot formation Platelets initiate process. Fibrin formation occurs. RBCs are trapped in fibrin mesh. Venous clot formation Platelet aggregation with fibrin that attaches to RBCs  Antihyperlipidemic & Vasodilators - Unit 6 Drugs Used to Maintain or Restore Circulation Antiplatelets Prevent platelet aggregation ? aspirin and clopidogrel Anticoagulants Prevent the formation of clots that inhibit circulation ? warfarin, heparin, and enoxaparin Thrombolytics Attack and dissolve blood clots that have already formed - alteplase  Antihyperlipidemic & Vasodilators - Unit 6 Antiplatelet Drugs Aspirin Aspirin Effective and inexpensive treatment for suppressing platelet aggregation Low-dose therapy Action Inhibit platelet aggregation by inhibiting COX 1 Use Prevention of MI and stroke Refer to unit 2 to review aspirin  Antihyperlipidemic & Vasodilators - Unit 6 Antiplatelets Clopidogrel Bisulfate Action Suppress platelet aggregation. Used Prevent thrombosis in the arteries Prevention of myocardial infarction or stroke for clients with familial history Prevention of a repeat myocardial infarction or stroke Prevention of a stroke for clients having transient ischemic attacks  Antihyperlipidemic & Vasodilators - Unit 6 Antiplatelets Clopidogrel Bisulfate Side Effects/Adverse reactions Abdominal pain Bleeding Hypotension  Antihyperlipidemic & Vasodilators - Unit 6 Antiplatelets Clopidogrel Bisulfate Contraindications Bleeding Peptic ulcer Caution Liver disease Renal disease Interactions Other drugs that cause bleeding 5 G?s: Ginger, garlic, ginseng, ginko biloba, green tea  Antihyperlipidemic & Vasodilators - Unit 6 Oral AnticoagulantsWarfarin Warfarin Action Inhibit hepatic synthesis of vitamin K, affecting the clotting factors II, VII, IX, and X Use Prevents and treats blood clotting. Used for treatment and prevention of DVT, pulmonary embolism and stroke Monitor therapeutic range PT INR ? Value 2-3 Think of warfarin as slow in/slow out  Antihyperlipidemic & Vasodilators - Unit 6 Oral AnticoagulantsWarfarin Side effects/Adverse reactions GI upset Bleeding Vitamin K Antidote for warfarin overdose 24 to 48 hours to be effective For acute bleeding, fresh frozen plasma or platelets is indicated.  Antihyperlipidemic & Vasodilators - Unit 6 Oral AnticoagulantsWarfarin Contraindications Blood dyscrasias (bleeding issues) Alcoholism Head trauma Caution Diabetes mellitus ? can lower blood glucose Interactions Other drugs and herbs that cause bleeding Interacts with many medications to increase effect of warfarin Vitamin K foods ? remain consistent  Antihyperlipidemic & Vasodilators - Unit 6 Oral Anticoagulants Apixaban Action Selectively block activity of clotting factor Xa to prevent clot formation Use Prevent and treat DVT and PE Prevention of stroke and atrial fibrillation Does not require routine coagulation monitoring Apixaban  Antihyperlipidemic & Vasodilators - Unit 6 Oral AnticoagulantsApixaban Side effects/Adverse reactions Bleeding Hypotension Contraindications Clients weighing less than 50 kg-increased risk of bleeding Interactions Other drugs and herbs that cause bleeding  Antihyperlipidemic & Vasodilators - Unit 6 AnticoagulantsHeparin Action Inhibit action of thrombin Inhibit conversion of fibrinogen to fibrin Inhibit clot formation Use Most commonly to prevent or treat venous thrombosis Administration of heparin Subcutaneously, intravenously Think of quick in/quick out  Antihyperlipidemic & Vasodilators - Unit 6 AnticoagulantsHeparin Heparin Frequent lab monitoring is needed. Heparin laboratory values PTT 1.5 to 2.5 times normal clotting time of 20-30 seconds aPTT 1.5 to 2.5 times normal time for this test of 30-40 seconds. Done a little differently ? depends on facility Side effects Bleeding Injection site irritation ? don?t massage Antidote Protamine sulfate  Antihyperlipidemic & Vasodilators - Unit 6 AnticoagulantsHeparin Contraindications Hemorrhagic stroke Bleeding issues Use caution in clients with peptic ulcer disease Interactions Other drugs or herbs that cause bleeding  Antihyperlipidemic & Vasodilators - Unit 6 Anticoagulants Enoxaparin Low-molecular-weight heparin (LMWH) Lower risk of bleeding Frequent lab monitoring is not required. Action Inactivates Xa factor Use Prevent DVT and acute PE after orthopedic or abdominal surgery ? usually started 24 hours post-op Precautions Don?t take aspirin concurrently or 4 G?s Administered once or twice daily - SubQ  Antihyperlipidemic & Vasodilators - Unit 6 Thrombolytics - Alteplase Action Promotes conversion of plasminogen to plasmin. Degrades fibrinogen, fibrin and other clotting factors, which disintegrates the clot Uses To dissolve clots following acute MI, pulmonary embolism, and ischemic stroke and DVT All end in -ase  Antihyperlipidemic & Vasodilators - Unit 6 Thrombolytics - Alteplase Side effects/adverse reactions Anaphylaxis Hemorrhage Contraindications Bleeding Recent surgery or trauma Severe liver dysfunction Head trauma Interactions Other drugs and herbs that cause bleeding (NSAIDS)  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process Anticoagulants Baseline vital signs CBC, PT, INR, PTT Medical/medical history For thrombolytics Any recent surgeries or trauma When the event started Best results if given with 4 hours of onset of MI or 3 hours of an ischemic stroke Report history of blood ?thinners? including ibuprofen and other drugs that cause bleeding Assessment  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process:Anticoagulants Interventions Monitor vital signs Labs CBC PT/INR ? warfarin PTT ? heparin All ? alteplase Monitor for bleeding-remember the sites from unit 2 Soft toothbrush, electric razor Have antidote available ? heparin, warfarin Monitor for S/S of allergic reaction Avoid any venipuncture as able  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process:Anticoagulants Teaching To signs and symptoms of bleeding to report Use soft toothbrush, electric razor Inform dentist of medication Advise of lab draws and importance Medic alert bracelet Stop smoking No NSAIDS or other drugs that cause bleeding Caution with herbal products How to stop bleeding Diet ? maintain consistent amount of vitamin K for warfarin Evaluation  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #1 A client is prescribed aspirin, 81 mg, and clopidogrel. The nurse identifies the drug classification of clopidogrel as anticoagulant. thrombotic inhibitor. antiplatelet. thrombolytic.  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #2 A client arrived in the emergency department 2 hours after an acute ischemic stroke. The client is given an intravenous (IV) injection of alteplase tPA. It is most important for the nurse to monitor what? (Select all that apply.) Bleeding Vital signs Troponin Allergic reactions Electrocardiogram  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #3 Which information will the nurse include when teaching a client about warfarin therapy? Increase the amount of green, leafy vegetables in your diet. Rinse your mouth instead of brushing your teeth. Follow up with laboratory tests such as PT or INR to regulate warfarin dose. Use a new razor blade each time you shave.  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #4 A client is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote in case it is needed? Vitamin K Protamine sulfate Warfarin Aminocaproic acid  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #5 Four clients are considered as potential candidates for thrombolytic therapy. Which client is most likely to receive thrombolytic therapy? The client who recently used acetaminophen The client with a history of severe hypertension The client who recently had spinal surgery The client with a history of warfarin use  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #6 A client is recovering from surgery to replace her right hip. In the early postoperative phase, the nurse anticipates administration of which drug to prevent deep vein thrombosis? Dipyridamole Low-molecular-weight heparin Abciximab Anagrelide  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #7 The client develops a deep vein thrombosis. The nurse anticipates administration of which medication? Intravenous heparin Clopidogrel Vitamin K Protamine sulfate  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #8 The client is being discharged home on warfarin therapy. Which information will the nurse include when teaching the client? Results of activated partial thromboplastin time (aPTT) will determine if the medication is effective. International normalized ratio (INR) results should be between 2 and 3. A normal response to warfarin is for your stools to look tarry. Increase the amount of green leafy vegetables in your diet.