Transcript Anticoagulants - Faculty Sites

NURS 1950
Pharmacology I
1

Objective 1: identify general reasons
anticoagulants are given
2


Objective 2: identify the cells in the body that
release heparin
Objective 3: describe the actions of heparin
3

Objective 4: list the appropriate routes to
administer heparin
4



Heparin: only parenteral administration
Warfarin: oral
Heparin
◦ Low doses: inhibit clotting factor Xa
◦ High doses: inhibits all clotting factors
◦ Effects occur immediately
5


Preferred during pregnancy, PE, DVT
Required for open heart surgery, renal
dialysis
6





Side Effects
Hemorrhage: observe hypotension,
tachycardia, petechiae, bruises
May see bloody stools, pelvic pain, headache
Hypersensitivity: chills, fever, rash
Antidote: protamine sulfate
7

Administration
◦
◦
◦
◦
IV or subq
IM causes hematoma
Monitor PTT above 1.5-2 X normal is therapeutic
Monitor INR: between 2-3
8

Enoxaparin (Lovenox): low molecular weight
◦ Acts so has less potential for hemorrhage, longer
duration of action



Subq administration
Does not affect PT or APTT
Do not give to clients allergic to pork byproducts
9



Do not inject IM
Do not expel air bubble from syringe before
injection
Do not rub injection site
10



SE to expect: hematoma with improper
injection technique
SE to report: bleeding, thrombocytopenia
Drug interactions: no clinically significant
interactions
◦ Caution: antiplatelet or warfarin therapy
11

Warfarin (Coumarin)
◦ 1st oral
◦ Antidote: Vitamin K
◦ Monitor protime
 Needs to be 1.5 to 2X normal
 Monitor INR: 2-3
12





Interactions
Heparin
ASA
Butazoladin
Barbiturates
13



Dicumerol: derived from Coumarin
Erratic absorption
Prevents thrombi in veins
14

Objective 5: identify the antidote for heparin
15

Objective 6: name the lab tests that are the
basis to determine the effectiveness and
dosage of heparin
16

Objective 7: describe the important points
regarding subcutaneous administration of
heparin
◦
◦
◦
◦
◦
Dose/strength
Injection site
Needle/syringe
Aspiration
Pressure
17

Objective 8: list the signs of heparin overdose
◦
◦
◦
◦
Bleeding
VS changes
Thrombocytopenia
White clot formation is a toxic reaction
18

Objective 9: identify drugs that enhance the
action of heparin
◦
◦
◦
◦
◦
◦
NSAIDs
ASA
Ginkgo biloba
Dipyridamole
Clopidogrel
Ticlopidine
19

Objective 10: describe the action of
Coumadin
◦ Inhibits the activity of vitamin K—needed for
activation of clotting factors II, VII, IX and X
20

Objective 11: name the lab tests done to
determine the effectiveness and dosage of
Coumadin
21



Objective 12: identify drugs that increase and
decrease the effectiveness of Coumadin
Drugs that can increase Coumadin effects:
Tylenol, ASA, dong quai, ginkgo biloba, oil
of wintergreen, omeprazole
Drugs that can decrease the effects: St.
John’s Wort, rose hip, barbiturates,
griseofulvin, vitamin C, vitamin K
22

Objective 13: discuss other select
anticoagulant agents
◦ Fibrinolytic agents
◦ Antiplatelet drugs
23



Suppress aggregation platelets
Prevent arterial thrombus
ASA single dose; 5 gr or less
◦ Doubles bleeding time for 4-7 days
◦ Reduces MI, TIAs, CVAs
24

Persantine
◦ Enhances effect of ASA
◦ No significant effect used alone
◦ With warfarin: clients with prosthetic heart valves
25

Streptokinase
◦ Promotes plasminogen to plasmin
◦ Uses
 Acute coronary thrombi
 DVT
 Massive pulmonary emboli
26



MI: must give within 6 hours
DVT: give within 3 days
PE: no more than 5-7 days
27



Side Effects
Hemorrhage: use Amicar
Fever, allergic reaction
Drug given IV
28

Urokinase
◦ Promotes plasminogen to plasmin
29

TPA: tissue type plasminogen activator
◦ Synthetic
◦ Clears coronary artery
◦ SE: bleeding
30

Objective 14: discuss the indications for
antiplatelet drugs
◦ Previous MI, CVA, TIA
◦ Conditions that predispose to clot formation
 Some used in combination post cardiac valve
replacement
 Peripheral arterial disease
 Atrial fibrillation
 Unstable angina
31

Objective 15: describe the nursing
responsibilities associated with a client
receiving an anticoagulant, including specific
safety considerations
32





Dosage schedules
Hydration
Lab data
Preventing clot formation
Patient teaching
◦ Follow-up
◦ Safety
33
◦ Medic alert bracelet
◦ Symptoms to report
◦ Do not take OTC meds without consulting MD
34