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
Heparin: only parenteral administration • Warfarin: oral • Heparin • Low doses: inhibit clotting factor Xa • High doses: inhibits all clotting factors • Effects occur immediately
Preferred during pregnancy, PE, DVT • Required for open heart surgery, renal dialysis
Side Effects • Hemorrhage: observe hypotension, tachycardia, petechiae, bruises • May see bloody stools, pelvic pain, headache • Hypersensitivity: chills, fever, rash • Antidote: protamine sulfate
Administration • IV or subq • IM causes hematoma • Monitor PTT above 1.5-2 X normal is therapeutic • Monitor INR: between 2-3
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
Do not inject IM • Do not expel air bubble from syringe before injection • Do not rub injection site
SE to expect: hematoma with improper injection technique • SE to report: bleeding, thrombocytopenia • Drug interactions: no clinically significant interactions • Caution: antiplatelet or warfarin therapy
Warfarin (Coumarin) • 1st oral • Antidote: Vitamin K • Monitor protime • Needs to be 1.5 to 2X normal • Monitor INR: 2-3
Interactions • Heparin • ASA • Butazoladin • Barbiturates
Dicumerol: derived from Coumarin • Erratic absorption • Prevents thrombi in veins
Objective 5: identify the antidote for heparin
Objective 6: name the lab tests that are the basis to determine the effectiveness and dosage of heparin
Objective 7: describe the important points regarding subcutaneous administration of heparin • Dose/strength • Injection site • Needle/syringe • Aspiration • Pressure
Objective 8: list the signs of heparin overdose • Bleeding • VS changes • Thrombocytopenia • White clot formation is a toxic reaction
Objective 9: identify drugs that enhance the action of heparin • NSAIDs • ASA • Ginkgo biloba • Dipyridamole • Clopidogrel • Ticlopidine
Objective 10: describe the action of Coumadin • Inhibits the activity of vitamin K—needed for activation of clotting factors II, VII, IX and X
Objective 11: name the lab tests done to determine the effectiveness and dosage of Coumadin
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
Objective 13: discuss other select anticoagulant agents • Fibrinolytic agents • Antiplatelet drugs
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
Persantine • Enhances effect of ASA • No significant effect used alone • With warfarin: clients with prosthetic heart valves
Thrombolytic Drugs • Streptokinase • Promotes plasminogen to plasmin • Uses • Acute coronary thrombi • DVT • Massive pulmonary emboli
MI: must give within 6 hours • DVT: give within 3 days • PE: no more than 5-7 days
Side Effects • Hemorrhage: use Amicar • Fever, allergic reaction Drug given IV
Urokinase • Promotes plasminogen to plasmin
TPA: tissue type plasminogen activator • Synthetic • Clears coronary artery • SE: bleeding
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
Objective 15: describe the nursing responsibilities associated with a client receiving an anticoagulant, including specific safety considerations
Dosage schedules • Hydration • Lab data • Preventing clot formation • Patient teaching • Follow-up • Safety
Medic alert bracelet • Symptoms to report • Do not take OTC meds without consulting MD
