Warfarin
Nursing assessments for bleeding
What is... assess for signs of bleeding, unusual bruising, tarry black stools, decrease in hematocrit, monitor stool and urine.
Therapeutic uses of heparin
What is...evolving stroke, pulmonary embolism, massive DVT, tx for disseminated intravascular coagulation, low dose therapy for prophylaxis against post-op DVT
Indications
What is... DVT's, PE after joint surgery?
Mechanism of Action
Acts as a selective factor X inhibitor that blocks the active site of factor Xa, inactivating the cascade of coagulation.
Mechanism of Action
What is... Irreversibly prevents ADP platelet aggregation.
Antidote to warfarin
What is... Vitamin K
Expected pharmacological outcome
What is... prevents clotting by activating antithrombin, thus indirectly inactivating both thrombin and factor Xa. This inhibits fibrin formation.
Mechanism of action
What is...reversible inhibitor of thrombin?
Lab test considerations?
What is...no specific labs to monitor.
Most common use of Clopidogrel
What is...post cardiac stenting?
Contraindications
What is... Uncontrolled bleeding, open wounds, active ulcer disease, recent brain/eye/spinal cord sx, severe liver or kidney disease, uncontrolled HTN, pregnancy (due to crossing placenta and causing fatal hemorrhage in fetus.)
Antidote for overdose
What is... protamine sulfate?
Brand name
What is Pradaxa
Treatment for overdose
What is... charcoal to supress GI absorbtion? No specific antidote.
Clopidogrel side effects
what is... GI bleeding, Thrombotic thrombocytopenic purpura (TTP), abdominal pain, rash .
Mechanism of Action
What is... Interferes with synthesis of vitamin K dependent clotting factors. (Factors VII, IX,X, and prothrombin)
lab test considerations
What is... Monitor aPTT and hematocrit prior to and throughout therapy.
Side effects
What is... bleeding, GI upset.
*take with food
Brand name
What is... Eliquis?
Labs to review
What is... CBC-plts
Labs to consider
What is... Monitor PT, INR and other clotting factors frequently during therapy.
*Therapeutic PT range: 1.3-1.5 times greater than control, INR: 2.0-3.0.
Patient population that is high alert
What is... Pediatric patients
*(fatal hemorrhages have occurred due to errors in which heparin sodium injection vials were confused with heparin flush vials.)
Dosing
What is....same dose for all patients? (not weight based)
Desired outcome of therapy
What is... Prevention of blood clots AFib and following DVT, PE.
Drug-drug interactions
What is... PPI proton pump inhibitors? Best choice pantoprazole (Protonix) if needed.