Heparins
True or False: fondaparinux is reversed with protamine
False
What is the MoA of alteplase?
it dissolves clots
What is the MoA of antiplatelets?
To reverse either Xa inhibitors or direct thrombin inhibitors, what do you give?
Factor Xa, dialysis or activated charcoal
Why is inhibiting vitamin K helpful for anticoagulation?
without vitamin K, we can't make Factors VII, IX, X, and prothrombin
How is heparin administered?
IV or Subq
What is alteplase indicated for?
Acute MI, CVA, massive PE, opens clotted IV catheters
What is aspirin indicated for and what are the adverse effects
prevent CVA/MI
tinnitus/hearing loss
What are the indications for dibigatran
stroke prevention in a-fib
DVT/PE prevention/treatment
What labs do you need to monitor when giving warfarin?
monitor PT/INR
What is some patient ed you need to give for heparin?
how to inject
use electric razor and soft toothbrush
monitor and report bleeding and bruising
avoid NSAID, OTC, aspirin or meds with salicylates
What do you need to monitor while giving thrombolytics?
aPTT
PT/INR
H&H
What is dipyridamole indicated for and what are the adverse effects
PAD/claudication
N/V - take with food; don't crush or chew
What are the indications of rivaroxaban?
stroke prevention in a-fib
DVT/PE prevention/treatment
What administration techniques do you need to know when giving warfarin?
There are many drug-drug interactions
dosage varies greatly
Which heparins are effected by protamine?
unfractionated heparin - reversed
enoxaparin - partially reversed
fondaparinux - not reversed!
What histories do you need to cautiously give alteplase to?
severe uncontrolled hypertension
fully anticoagulated with another drug (severe bleeding)
active bleeding in the last 2-4 weeks
What is abciximab indicated for and what are the adverse effects
prevents restenosis
bleeding from catheterization site, hypotension and bradycardia
What would you give to reverse dibigatran?
idarucizumab
What patient education do you need to give?
consistent intake of foods high in vitamin K
take at the same time each day
wear a medical alert bracelet
What's the difference between LMW and unfractionated heparin?
LMW - used to prevent
unfractionated - used in emergent situations (active)
What are administration notes for alteplase?
Give ASAP after onset of symptoms
avoid extra sticks
monitor VS and for bleeding
REVERSAL AGENT: aminocaproic
What are the adverse effects for all antiplatelets?
bleeding (for GI bleed, may need enteric coated drug and PPI), hemorrhagic stroke, thrombocytopenia
How does dibigatran work?
binds with thrombin to prevent thrombus formation
What is the reversal agent for warfarin
vitamin K or FFP