Unit 6.2 Anticoagulants PDF

Anticoagulants Anticoagulants, Antiplatelets, and Thrombolytics NUR 210/BLS 101 Unit 5  Pathophysiology Formation of clot in artery or vein ◦ Caused by decreased circulation, platelet aggregatio...

Anticoagulants Anticoagulants, Antiplatelets, and Thrombolytics NUR 210/BLS 101 Unit 5  Pathophysiology Formation of clot in artery or vein ◦ Caused by decreased circulation, platelet aggregation on vessel wall, Thrombus blood coagulation Formation 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  Antiplatelets Drugs Used to Prevent platelet aggregation – aspirin Maintain or and clopidogrel Restore Anticoagulants Circulation Prevent the formation of clots that inhibit circulation – warfarin, heparin, and enoxaparin Thrombolytics Attack and dissolve blood clots that have already formed - alteplase  Aspirin Effective and inexpensive treatment for suppressing platelet aggregation Antiplatelet Drugs Low-dose therapy Aspirin Action Inhibit platelet aggregation by inhibiting COX 1 Use Prevention of MI and stroke Refer to unit 2 to review aspirin  Action Antiplatelets Suppress platelet aggregation. Clopidogrel Used Prevent thrombosis in the arteries Bisulfate Prevention of myocardial infarction or stroke for 1 clients with familial history Prevention of a repeat myocardial infarction or stroke Prevention of a stroke for clients having transient ischemic attacks  Antiplatelets Clopidogrel Side Effects/Adverse reactions Bisulfate Abdominal pain 1 Bleeding Hypotension  Contraindications Bleeding Antiplatelets Peptic ulcer Clopidogrel Caution Bisulfate Liver disease 1 Renal disease Interactions Other drugs that cause bleeding 5 G’s: Ginger, garlic, ginseng, ginko biloba, green tea  Warfarin Action Inhibit hepatic synthesis of vitamin K, affecting the clotting factors II, VII, IX, and X Oral Anticoagulants Use Warfarin 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  Side effects/Adverse reactions GI upset Bleeding Oral Anticoagulants Warfarin Vitamin K Antidote for warfarin overdose 24 to 48 hours to be effective For acute bleeding, fresh frozen plasma or platelets is indicated.  Contraindications Blood dyscrasias (bleeding issues) Alcoholism Head trauma Oral Anticoagulants Caution Warfarin 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  Apixaban Action Oral Anticoagulants Selectively block activity of clotting factor Xa to prevent Apixaban clot formation Use Prevent and treat DVT and PE Prevention of stroke and atrial fibrillation Does not require routine coagulation monitoring  Side effects/Adverse reactions Bleeding Hypotension Oral Anticoagulants Apixaban Contraindications Clients weighing less than 50 kg-increased risk of bleeding Interactions Other drugs and herbs that cause bleeding  Action Inhibit action of thrombin Inhibit conversion of fibrinogen to fibrin Anticoagulants Inhibit clot formation Heparin Use Most commonly to prevent or treat venous thrombosis Administration of heparin Subcutaneously, intravenously Think of quick in/quick out  Heparin Frequent lab monitoring is needed. Heparin laboratory values PTT 1.5 to 2.5 times normal clotting Anticoagulants time of 20-30 seconds Heparin 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  Contraindications Anticoagulants Hemorrhagic stroke Bleeding issues Heparin Use caution in clients with peptic ulcer disease Interactions Other drugs or herbs that cause bleeding  Low-molecular-weight heparin (LMWH) Lower risk of bleeding Frequent lab monitoring is not required. Action Anticoagulants Inactivates Xa factor Enoxaparin 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  Action Promotes conversion of plasminogen to plasmin. Degrades fibrinogen, fibrin and other clotting factors, which Thrombolytics - disintegrates the clot Alteplase 1 Uses To dissolve clots following acute MI, pulmonary embolism, and ischemic stroke and DVT All end in -ase  Side effects/adverse reactions Anaphylaxis Hemorrhage Thrombolytics - Contraindications Alteplase Bleeding 1 Recent surgery or trauma Severe liver dysfunction Head trauma Interactions Other drugs and herbs that cause bleeding (NSAIDS)  Assessment Baseline vital signs CBC, PT, INR, PTT Medical/medical history Nursing Process Anticoagulants 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  Interventions Monitor vital signs Labs ◦ CBC ◦ PT/INR – warfarin Nursing Process: ◦ PTT – heparin Anticoagulants ◦ 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  Teaching To signs and symptoms of bleeding to report Use soft toothbrush, electric razor Inform dentist of medication Nursing Process: Advise of lab draws and importance Medic alert bracelet Anticoagulants 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  A client is prescribed aspirin, 81 mg, and clopidogrel. The nurse identifies the drug Practice Question classification of clopidogrel as #1 A. anticoagulant. B. thrombotic inhibitor. C. antiplatelet. D. thrombolytic.  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 Practice Question nurse to monitor what? (Select all that apply.) #2 A. Bleeding B. Vital signs C. Troponin D. Allergic reactions E. Electrocardiogram  Which information will the nurse include when teaching a client about warfarin therapy? Practice Question A. Increase the amount of green, leafy #3 vegetables in your diet. B. Rinse your mouth instead of brushing your teeth. C. Follow up with laboratory tests such as PT or INR to regulate warfarin dose. D. Use a new razor blade each time you shave.  A client is on heparin therapy secondary to deep vein thromboses. The nurse has which medication on hand as an antidote Practice Question in case it is needed? #4 A. Vitamin K B. Protamine sulfate C. Warfarin D. Aminocaproic acid  Four clients are considered as potential candidates for thrombolytic therapy. Which client is most likely to receive thrombolytic therapy? Practice Question #5 A. The client who recently used acetaminophen B. The client with a history of severe hypertension C. The client who recently had spinal surgery D. The client with a history of warfarin use  A client is recovering from surgery to replace her right hip. In the early postoperative phase, the nurse Practice Question anticipates administration of which drug #6 to prevent deep vein thrombosis? A. Dipyridamole B. Low-molecular-weight heparin C. Abciximab D. Anagrelide  The client develops a deep vein thrombosis. The nurse anticipates administration of which Practice Question medication? #7 A. Intravenous heparin B. Clopidogrel C. Vitamin K D. Protamine sulfate  The client is being discharged home on warfarin therapy. Which information will the nurse include when teaching the client? Practice Question A. Results of activated partial thromboplastin #8 time (aPTT) will determine if the medication is effective. B. International normalized ratio (INR) results should be between 2 and 3. C. A normal response to warfarin is for your stools to look tarry. D. Increase the amount of green leafy vegetables in your diet.