anticoagulants

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created 5 months ago by Akosua_Ruby
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Pharmacology
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updated 5 months ago by Akosua_Ruby
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1

arterial v. venous thrombosis

card image
2

atherosclerosis can affect arteries supplying

  • heart (thrombus may precipitate MI)
  • brain (stoke)
  • legs (DVT)
3

anticoagulants

used in thrombotic disorder to prevent new clots

  • does not dissolve formed clots
  • improve blood flow in tissue around clot
  • prevent ischemic damage beyond clot
4

indications for use of anticoagulants

prevention and management of thromboembolic disorders

  • thrombophlebitis, DVT, PE
5

main AE of anticoagulants

bleeding

6

MOA of heparin

prevent formation of clots

7

use of heparin

  • DVT
  • PE
  • unstable angina
  • evolving MI
  • prevention of thrombosis in high risk patients
8

AE of heparin

abnormal bleeding, HIT

9

administration of heparin

  • poorly absorbed in GI tract
  • given subq or IV, weight based
10

nursing care and patient teaching of heparin

  • never draw back plunger on syringe or massage site (bruises)
  • teach patient not to massage IV site, inform them it will sting
  • heparin leaves body quickly
11

what to monitor while administering heparin and antidote

  • aPTT
  • protamine sulfate (slow over 10 minutes)
12

MOA of low molecular weight heparins: enoxaparin (lovenox)

inactivates coagulation factor Xa and produces anticoagulation

13

use of enoxaparin (lovenox)

  • DVT prophylaxis
  • ACS
  • unstable angina
  • acute DVT
14

AE of enoxaparin (lovenox)

  • injection site hematoma
  • Peripheral edema
15

administration of enoxaprin (lovenox)

  • peaks 3-5hrs, lasts 12 hrs.
  • inject air bubble last
  • do not rub injection site
16

enoxaparin (lovenox) antidote

protamine sulfate

17

heparin induced thrombocytopenia (HIT)

  • potentially life-threatening complication
  • antibodies develop against drug
  • platelet decrease by 30-50% of baseline
  • may develop with LMWH
  • discontinue medication immediately
  • can use direct thrombin inhibitors
18

MOA of warfarin (Coumadin)

inhibit hepatic synthesis of vitamin K, affecting multiple clotting factors

19

use of warfarin

  • prophylaxis of thrombosis
  • PE
  • A-fib
20

AE of warfarin

  • bleeding
  • pregnancy category X
21

administration of warfarin and antidote

  • take at same time of day (usually evening)
  • takes about 3-5 days to see effect
  • vitamin K
22

warfarin contraindications and lab monitoring

  • do not start green leafy vegetable diet
  • call and ask HCP before stopping Coumadin
  • PT/INR
23

MOA of argatroban

directly inhibits thrombin from converting fibrinogen to fibrin

24

use of argatroban

  • ACS
  • HIT
  • prophylaxis and treatment of VTE, A-FIB, DVT, PE
25

administration of argatroban and antidote

  • IV only
  • no antidote. considered a high risk drug
26

AE of argatroban

  • bleeding
  • hypotension
  • chest pain
  • cardiac arrest
  • injection site reaction
27

doses for prevention of MI and stroke

  • stroke: 50-325mg/day
  • MI: 75-162mg/day (must discontinue 7 days before surgery)
28

MOA of clopidogrel (Plavix)

inhibits platelet aggregation

29

use of clopidogrel (plavix)

prevent formation of thrombi after stroke or MI

30

AE of clopidogrel (plavix)

  • abnormal bleeding
  • flu-like syndrome
  • acid reflux
31

life-threatening AE of clopidogrel (plavix)

  • agranulocytosis
  • aplastic anemia
  • thrombocytopenia
32

MOA of abciximab

inhibits platelet from forming clots

33

use of abciximab

  • ACS
  • percutaneous coronary intervention
34

AE of abciximab

  • bleeding
  • hypotension
  • dizziness
35

administration of abciximab

  • antiplatelet effects persist for 24-48hrs. after stopping infusion
  • given IV only
  • patient is bleeding risk!!!
36

lab draws for warfarin

  • lab drawn daily until therapeutic range
  • once therapeutic, lab draws every 2-4wks for duration of therapy unless dose is adjusted