Drugs for Coagulation Disorders

1. Drugs for Coagulation Disorders

2. Hemostasis

3. Clotting Cascade

4. Clotting Diagnostics Whole Blood clotting time PT INR aPTT Platelets LFTs Do you know the normal values for these? What is the role of Vitamin K?

5. Fibrinolysis

6. Fibrinolysis

7. Thromboembolic Disorders How would you describe a thromboembolic disorder? Explain the difference between thrombus and embolus. Identify conditions that increase the risk of arterial thrombi or emboli. Describe how Atrial Fibrilation contributes to clot formation. Compare and contrast the effects of a right atrial vs. a left atrial embolus.

8. Bleeding Disorders Compare and contrast the following bleeding disorders: Thrombocytopenia Hemophilia von Willebrand�s disease

9. Coagulation Modification Four Mechanisms Prevent clot formation through clotting factor inhibition Prevent clot formation through inhibition of platelet action Removal of existing clot Promotion of clot formation through inhibition of fibrin destruction Table 27.1 p. 381

10. Anticoagulants Prevent clot formation of expansion DO NOT dissolve clots Compare and Contrast the prototype anticoagulants Heparin p. 383 Warfarin p. 384

12. Case Presentation Mr. G., a 72 year-old-male, is four days status post bowel resection. He has experienced increased pain and nausea and has not been able to ambulate. He frequently takes off the pneumatic compression devices. Today he awoke with pain in his left calf. Upon assessment the nurse found the calf to be swollen, reddened, and warm to touch.

13. Case Questions What collaborative problem does the assessment findings indicate? What should the nurse do? What treatment would you anticipate and why?

14. Case Presentation Mrs. L., a 54 year-old-female, has just returned to the floor following a total knee replacement for severe osteoarthritis. Her post-op orders inlcude enoxaparin (Lovenox) 30 mg q 12 hours.

15. Case Questions How does treatment for Mrs. L. differ from that of Mr. G.? What is the rationale for the difference in pharmacotherapy? What route of administration is indicated? What are the benefits to treatment with low molecular weight heparin?

16. Case Study Unfolds Mr. G. has been on IV heparin for 3 days to treat a DVT. The dose of heparin has been increased at intervals in attempt to reach therapeutic coagulation. This morning he is complaining of fatigue and appears pale and pasty. With further questioning he admits to lower back pain and the nurse notes that the abdominal wall is bulging.

17. Questions As the nurse assessing Mr. G., what do you think the problem is? What do his symptoms indicate? What changes would you expect in the vital signs? What would you expect to see on the CBC? What is the significance of the lumbar pain and bulging abdomen?

18. Anticoagulants What are the nursing considerations associated with anticoagulant administration? What would be included in patient teaching? What preventive nursing measures would you include in your plan of care?

19. Antiplatelet Agents How does the mechanism of action of antiplatelet drugs differ from that of anticoagulants? What is the primary indication for pharmacotherapy with antiplatelets?

20. Antiplatelet Agents Four types: Aspirin ADP receptor blockers: clopidogrel (Plavix) Glycoprotein IIb/IIIa receptor antagonists: abcixamab (ReoPro) Agents for intermittent claudication: pentoxifylline (Trental)

21. Case Presentation Mr. N., a 65-year-old male, has known coronary artery disease. While raking his yard he experienced chest pain and shortness of breath. When 3 nitroglycerin tablets did not relieve his pain his son took him to the ED. After telling the triage officer his symptoms, Mr. N. was immediately put into a room and assessed. One of the first things Mr. N. was given was an 80 mg �baby aspirin�.

22. Case Questions What do you think is happening to Mr. N.? What is the purpose of administering aspirin? How long will that specific action of aspirin persist?

23. Additional Questions What is the implication of daily ASA therapy in regards to diagnostic procedures or surgery? What would be the implication of adding another coagulation modifying drug to the regimen of someone on daily ASA therapy?

24. The Case Unfolds ECG and laboratory diagnostics indicate that Mr. N. in having a myocardial infarction. The ED physician orders 60 mg alteplase (TPA) IV to be followed with an infusion of 20 mg/h over next 2 hrs.

25. Case Questions To what class of drug does alteplace belong? How does the action of alteplace differ from that of heparin? What is the primary purpose of administering this drug? What nursing measures are essential during administration of this drug.

26. Hemostatics What is the purpose of hemostatic drugs? When are these medications indicated? What are important nursing responsibilities related to administration of this drug? When is this drug contraindicated? What adverse effects would indicate muscle tissue damage?