anti-coagulant
What lab will you need to monitor for in patients taking warfarin? What is the normal level for this lab, what is the therapeutic value for this lab, and what would a critical value be for this lab?
INR
normal-0.8 to 1.1
therapeutic- 2-4
critical- > 5.5
what are two selective factor Xa inhibitors?
rivaroxaban and apixaban
What are the most common side effects of statin medications?
abdominal pain, headache, rash, elevated liver enzymes, elevated serum creatinine phosphokinase (CPK)
What lipid lowering agent is available over the counter and is also a vitamin?
Niacin (Vitamin B3)
What are the adverse effects of fibric acid derivatives?
GI symptoms, headache, blurred vision, increased risk of gall stones, prolonged prothrombin time, Elevated liver enzymes
What is a low molecular weight heparin?
True or false: This medication come in an oral and injectable form
Enoxaparin
False
it has recently been approved for use in patients with _____, and used in ______ prevention
Dabigatran
A-fib, stroke
what is the first line drug therapy for hypercholestremia?
True or False: A person with liver disease or elevated liver enzymes should not receive this medication?
Statins
True
What are the 2 bile acid sequestrants that we need to know?
Cholestyramine, colesevelam
What are the 2 medications in the fibric acid derivatives?
Gemfibrozil, Fenofibrate
What do you need to monitor for in patients taking heparin?
What is heparin commonly used for? how is administered
Frequent aPTT or anti-Xa monitoring
Administered for DVT prophylaxis, and subcutaneously
What are the side effects of aspirin?
dizziness, confusion, tinnitus, GI upset, GI bleed, pancytopenia,
What is given intravenously prior to surgery to reduce intraoperative bleeding?
Why should a person taking oral contraceptives not receive this medication?
Tranexamic Acid
increased coagulation
what are the nursing implications for bile acid sequestrants?
support patients when initially starting treatment, assure them GI symptoms will improve
Teach patients to take the medication with meals to reduce the adverse GI effects
teach patients to increase dietary fiber and fluid intake to relieve constipation and bloating
Assess lipid labs at baseline and periodically throughout treatment
Assess alcohol intake
What medication is a cholesterol absorption inhibitor and can be taken concurrently with statins to increase effectiveness?
Ezetimibe
What are the nursing implications for anticoagulants?
Must double check concentration of heparin before administering
DO NOT give LMWH with oral factor Xa inhibitors, heparin, or direct thrombin inhibitors
Teach patients taking warfarin to consume consistent amounts of foods high in vitamin K: Leafy green vegetables
Selective factor Xa inhibitors and dabigatran should not be given with any other anticoagulants
Teach patients to avoid grapefruit juice when taking selective factor Xa inhibitors and dabigatran
What are the side effects of clopidogrel?
Chest pain, edema, GI upset, epistaxis, dizziness, fatigue, flulike symptoms
anticoagulant/ antiplatelet nursing implications
Assess injection sites and rotate injection sites (heparin and LMWH)
Avoid giving injections within 2 inches of umbilicus and in/near non-intact skin, drains, stomas, and bruising
consult with provider and STOP anticoagulant/antiplatelet medications prior to any invasive or surgical procedures
Monitor necessary labs (INR, platelet count, aPTT, anti-Xa)
patient education: Use a soft bristle toothbrush, electric razor, and fall prevention strategies
heartburn, nausea, belching, bloating, colesevelam is reported to have few GI effects
What is preferred medication class used to treat hypertension and heart failure in diabetic patients?
ACE inhibitors
What medication is given to patients taking Heparin or Low molecular weight heparins? Should it be given to patients that have not taken a large dose of this medication?
What is given to patients who have overdosed on Warfarin?
What medication is given to patients who have overdosed on Rivaroxaban or apixaban?
What medication is given to patients who have overdosed on Dabigatran?
Protamine sulfate, no only when large doses of LMWH has been given
Vitamin K
Andexxa
Idarucizumab
what are the drugs in the antiplatelets class
HALF points only if you can name the word they have in them
aspirin, clopidogrel, prasurgrel, ticagrelor
What are the nursing implications for anticoagulants/ antiplatelets medications
Assess current medications, including herbal supplements
thorough medical history, especially pertaining to factors that increase bleeding or clotting risk and/or a history of bleeding or blood clots
Assess for S/S of bleeding: bruising, gums, urine, stool, epistaxis, incisions, wounds, and lab tests
Assess for S/S of thrombosis: chest pain, stroke s/s, DVT and PE s/s
What are the nursing implications for statins?
it may take 6-8 weeks for lipid levels to be lowered to their maximum extent
teach patients to limit their consumption of grapefruit juice to 1 quart or less daily
Once daily dosage, typically in the evening
Lovastatin and simvastatin have the highest risk of myopathy
Assess lipid labs at baseline and periodically throughout treatment
Assess alcohol intake
what are the adverse effects of ACE inhibitors?
fatigue, dizziness, mood changes, headaches, hypotension, dry, non-productive cough-encourage patients to report and then are commonly switched to an ARB, loss of taste, hyperkalemia, angioedema, renal impairment