Anticoagulants
Black box warning for newer anticoagulants?
Risk of rebound thromboembolic events when suddenly stopped.
Aspirin and clopidogrel (Plavix)
Antidote for heparin overdose?
Protamine Sulfate
Indication for thrombolytic
Dissolves formed clots-Treat MI, PE, ischemic CVA
Drug-food interactions with ferrous sulfate
antacids, eggs, milk, other calcium-containing substances, coffee, tea
Types of anticoagulant medications
Heparin and derivatives
Enoxaparin
Warfarin
Inhibit platelet adhesion and aggregation
How is Lovenox (enoxaparin) given?
Subcutaneously. Rotate sites. Bruising is common, do not give over a bruise.
Indications for Anticoagulants
Used to reduce the ability of the blood to clot
Prevention of PE,DVT, Embolism
Therapeutic action of epoeitin alfo (Epogen)
acts like natural glycoprotein erythropoietin to stimulate production of RBCs in bone marrow
Side effects/Adverse effects
Bleeding/hemorrhage
Monitor for: Nasal bleeding, gingival bleeding, rectal bleeding, large bleeding
Side/Adverse Effects of aspirin?
GI bleeding/stomach pain, Thrombocytopenia platelets <150,000/mm3
Toxicity- Tinnitus/hearing loss, N/V, Tachypnea, increased temp
Which labs should be monitored while on Heparin?
aPTT (activated partial thromboplastin time) or anti-Xa assay
Indications for enoxaparin?
Prevent clots and emboli in certain surgeries or prolonged bedrest
Adverse effects of ferrous sulfate?
GI irritation-GI upset, nausea, vomiting, dark green stools, constipation
Which lab do we monitor while on warfarin?
INR
Side/Adverse effects of clopidogrel?
Hemorrhage, bleeding, thrombocytopenia (platelets <150,000/mm3)
How is protamine sulfate IV administered?
Administer slowly, not to exceed 50 mg IV in 10 minutes
Have life support equipment available
Indications for antiplatelet medication
CV diseases that are prone to occluding vessels, maintenance of grafts; adjunct in MI, prevention of reinfarction after MI
Used to treat pernicious anemia
Vitamin B12
How does warfarin work?
Decreases vitamin-K dependent clotting factors in the liver (extends clotting time)
Nursing to monitor
Signs of bleeding-bruising, bleeding when brushing teeth, dark, tarry stools
Bleeding precautions
Gentle oral care-use a soft-bristled toothbrush, use an electric razor instead of a straight razor, observe and report evidence of bleeding, avoid other medications that increase risk of bleeding.
How many days does it take for warfarin to take full effect?
3-7 days
Can take 2-3 weeks for improvement, and 6-10 months for stable levels