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Anticoagulants

Anticoagulants. NURS 1950 Pharmacology I. Objective 1: identify general reasons anticoagulants are given. Objective 2: identify the cells in the body that release heparin Objective 3: describe the actions of heparin. Objective 4: list the appropriate routes to administer heparin.

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Anticoagulants

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  1. Anticoagulants NURS 1950 Pharmacology I

  2. Objective 1: identify general reasons anticoagulants are given

  3. Objective 2: identify the cells in the body that release heparin • Objective 3: describe the actions of heparin

  4. Objective 4: list the appropriate routes to administer heparin

  5. Heparin: only parenteral administration • Warfarin: oral • Heparin • Low doses: inhibit clotting factor Xa • High doses: inhibits all clotting factors • Effects occur immediately

  6. Preferred during pregnancy, PE, DVT • Required for open heart surgery, renal dialysis

  7. Side Effects • Hemorrhage: observe hypotension, tachycardia, petechiae, bruises • May see bloody stools, pelvic pain, headache • Hypersensitivity: chills, fever, rash • Antidote: protamine sulfate

  8. Administration • IV or subq • IM causes hematoma • Monitor PTT above 1.5-2 X normal is therapeutic • Monitor INR: between 2-3

  9. 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 by-products

  10. Do not inject IM • Do not expel air bubble from syringe before injection • Do not rub injection site

  11. SE to expect: hematoma with improper injection technique • SE to report: bleeding, thrombocytopenia • Drug interactions: no clinically significant interactions • Caution: antiplatelet or warfarin therapy

  12. Warfarin (Coumarin) • 1st oral • Antidote: Vitamin K • Monitor protime • Needs to be 1.5 to 2X normal • Monitor INR: 2-3

  13. Interactions • Heparin • ASA • Butazoladin • Barbiturates

  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 • PTT 60-80 • PT 2.5-3.5 • INR 2-3 • APTT 25-35 is normal • 2-3x baseline= therapeutic ; measured daily

  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 • 12-15 sec = Normal PT

  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. Antiplatelet Drugs • 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. Hemostatics • Amicar • Inactivates plasminogen • USE: given IV to reduce hemorrhage in 1-2 hrs • Precaution: no ASA ; DIC is likely problem

  25. Thrombolytic Drugs • Streptokinase • Promotes plasminogen to plasmin • Uses • Acute coronary thrombi • DVT • Massive pulmonary emboli • Nursing interventions: • Monitor ECG q 15 min during 1st hr of infusion • Monitor LOC (intercranial hemorrhage)

  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 (Activase) • 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

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