pharm exam 2 anticoagulants and blood products

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adverse effects for antiplatelets

-GI upsets and bleeds

low molecular weight heparin (LMWH)

-Lovenox and Fragmin -smaller molecular structure than normal heparin -more predictable response -Subcutaneous administration

antidote for heparin

-Protamine Sulfate

antidote for warfarin

-Vitamin K

contraindication for antiplatelets

-allergy, NSAIDs

antiplatlet agents

-aspirin and Clopidogrel (Plavix)

thrombolytic agents

-can dissolve clots -older: Streptokinase, Urokinase -new: Alteplase (Activase), Reteplase (Retavase), Tenecteplase (TNKase)

albumin

-considered a blood product -used to treat shock and severe hypovolemia -do not give if fluid overload

fresh frozen plasma (FFP)

-indicated with multiple factor deficiencies, bleeding, reversal of anticoagulants

heparin

-inhibits thrombin -monitor aPTT (normal is 30-40 seconds, theraputic is 45-90 seconds) -can cause heparin-induced thrombocytopenia -subcutaneous or IV administration -can be used to flush catheters (don't need to monitor labs)

Warfarin (Coumadin)

-inhibits vitamin K synthesis, prevents clot formation -monitor PT and INR labs -long-half life, will exert effects for 2-3 months after stopping -PO administration, cheap

nursing implications for anti-coags

-monitor for therapeutic effects -monitor for bleeding -educate patients about bleeding and fall prevention -do not massage injection area (heparin) -coumadin (eat lots of leafy greens)

high points of blood products

-must cross match to prevent a hemolytic reaction -if reaction occurs: turn off transfusion, call health care provider, send blood and tubing to the blood bank -need a large IV, can only hang with normal saline

adverse effects of albumin

-no clotting factors or oxygen-carrying capacity, more expensive than crystalloids

transfusion-related acute lung injury (TRALI)

-noncardiogenic pulmonary edema: causes acute hypoxemia, occurs within 6 hours of transfusion -presents with: rapid, onset dyspnea and tachypnea, maybe fever, cynosis, hypotension, pulmonary crackles

indications for antiplatlets

-past medical history of CAD, MI, angina, PAD, TIA

whole blood

-prevents hemorrhage, thrombocytopenia -replace when platelets <50,000

contraindication of blood products

-religion may not allow for blood product replacement

blood products adverse effects

-hemolytic reactions, transfusions reactions, TRALI

anticoagulant drugs

-heparin, LMWH (Lovenox), warfarin (Coumadin), Direct Thromin Inhibitors, Selective factor Xa inhibitors

packed red blood cells (PRBCs)

-increases oxygen carrying capacity, 1 unit raises hematocrit by about 3% -replace why hemoglobin is <7

cryoprecipitate

-indicated for bleeding disorder (Von Willebrands)

nursing implications for blood transfusions

-stay in your patient's room for at least the first 15 minutes, take vitals every 15 minutes for the first hour of transfusion -blood can only hang for 4 hours

how do anticoagulants work?

-they inferese with the clotting cascade which decreases the ability for the blood to clot

why do patients with Afib need anticoags?

-to prevent stroke

ways to prevent bleeding...

-use a soft toothbrush, avoid using sharp tools, not a good candidate if they have a history of falls, avoid NSAIDs, avoid blowing nose too hard

indication for anticoagulants

-used to prevent thrombus, has NO effect on existing clots, prevents extension of preexisting clots


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