NUR112 Pharmacology: Cardiovascular Drugs; Anticoagulants, Antiplatelet

Nursing Actions/Teaching for bleeding (general)

1.Monitor for signs of bleeding 2.Hold medication if signs of active bleeding 3.Hold medication if labs are ELEVATED above therapeutic range. 4.Educate patient to avoid injury, use an electric razor, and use soft toothbrush 5.Report any usual bleeding or bruising to MD(hematuria, bloody stools, etc....) 6.Need to carry a card or med alert bracelet 7.Avoid ASA, NSAIDS or alcohol 8.If bleeding occurs apply pressure for 5-10 minutes

Anticoagulants Precaution / Contradictions

- Avoid if active bleeding - Caution with other medications that can cause bleeding.

Nursing Actions/Teaching for aspirin

-Aspirin for cardiac disease patient: Daily low-dose aspirin tablets typically contain 81 mg. -Also listed as a nonopioid analgesic and antipyretic -Not used in children (can lead to Reye syndrome) -Can prolong bleeding time for 4-7 days

The nurse identifies which anticoagulant medications as safe to administer during pregnancy for treatment of thrombophlebitis? Select all that apply 1. Heparin 2. Warfarin 3. Enoxaparin 4. Clopidogrel 5. Acetylsalicylic acid

1. Heparin 3. Enoxaparin

When teaching a client with atrial fibrillation about a new prescription for warfarin, the nurse will include information about which vitamin? 1. Vitamin K 2. Vitamin D 3. Vitamin B1 4. Vitamin B12

1. Vitamin K Warfarin causes inhibition of vitamin K-dependent clotting factors, and use of vitamin K would affect the therapeutic effect of warfarin.

To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ? 1. Administer the injection via the Z-track technique 2. Avoid massaging the injection site after the injection 3. Use 2 mL of sterile normal saline to dilute the heparin 4. Inject the medication into the vastus lateralis muscle in the thigh

2. Avoid massaging the injection site after the injection The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subcutaneous bleeding into the area.

When the international normalized ratio (INR) for a client receiving warfarin for venous thrombosis 4.6, which action will the nurse taken? 1. Administer the scheduled dose of warfarin 2. Offer the client foods that are high in vitamin K 3. Notify the health care provider of the laboratory results 4. Warn the client about risk for spontaneous hemorrhage

3. Notify the health care provider of the laboratory results The therapeutic level for INR when treating a venous thrombosis is 2 to 3, so the nurse would notify the health care provider and anticipate a decrease in warfarin dosage. Higher INR can lead bleeding but not hemorrhage.

Which laboratory value would the nurse use to determine whether a client is receiving a therapeutic dose of intravenous heparin? 1. International normalized ratio (INR) is between 2 and 3 2. Prothrombin time (PT) is 2.5 times the control value 3. Activated partial thromboplastin time (APTT) is 70 seconds 4. Activated clotting time (ACT) is in the range of 70 to 120 seconds

3. Activated partial thromboplastin time (APTT) is 70 seconds When a client is receiving intravenous heparin, the APTT should be 1.5 to 2 times the normal APTT of 40 seconds, or 60 to 80 seconds.

Which food will the nurse discuss when teaching a client who has a new prescription for warfarin? 1. Dairy products 2. High-fiber fruits 3. Green leafy vegetables 4. Whole-grain breads and cereals

3. Green leafy vegetables Green leafy vegetable are high in vitamin K, which will affect the effectiveness of warfarin because warfarin works by reducing the synthesis of vitamin K-dependent clotting factors. Clients taking warfarin are taught to try to eat about the same amount of vitamin K-rich foods daily to help stabilize the needed warfarin dose.

Warfarin is prescribed for a client who has been receiving intravenous (IV) heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both medications are needed at the same time. Which rationale would the nurse include to address the client's concern? 1. This permits the administration of smaller doses of each medication 2. Giving both medication allows clot dissolution while preventing new clot formation 3. Heparin provides anticoagulant effects until warfarin reaches therapeutic levels. 4. Administration of heparin with warfarin provides immediate and maximum protection against clot formation.

3. Heparin provides anticoagulant effects until warfarin reaches therapeutic levels. Warfarin is administered orally for 2 to 3 days to achieve the desired effect on the international normalized ratio (INR) level before heparin is discontinued. These medication do not dissolve clots already present.

Which medication is often contraindicated when taking warfarin? 1) Atenolol 2) Ferrous sulfate 3) Chlorpromazine 4) Acetylsalicylic acid

4) Acetylsalicylic acid Acetylsalicylic acid can cause decreased platelet aggregation.

A client is admitted to the hospital with a diagnosis of deep vein thrombosis, and intravenous (IV) heparin sodium is prescribed. If the client experience bleeding which medication will the nurse be prepared to administer? 1. Vitamin K 2. Oprelvekin 3. Warfarin sodium 4. Protamine sulfate

4. Protamine sulfate Protamine sulfate binds with heparin sodium to form a physiologically inert complex; it corrects clotting deficits.

What are external bleeding?

External bleeding refers to bleeding that flows out of the body. Examples include nosebleeds and bleeding from a minor skin cut. Excessive bruising, blood in stool, vomitting blood

Antiplatelet drugs

ASA (aspirin) Plavix (clopidogrel)

What are internal bleeding?

Abdominal bleeding, low blood pressure, abdominal pain, vomiting blood, fainting, nausea, blood in the urine, abdominal bruising, high heart rate, low BP

Anticoagulants Oral General Information

General Information Slow Onset Crosses Placenta (tetrogenic) Hepatic Excretion

Anticoagulants Parenteral Antidote

Antidote: Protamine Sulfate

Anticoagulants side effect

Bleeding!

Antiplatelet Precautions/Contraindications

Caution with history or GI bleeding/ulcer Hold if active bleeding noted

Anticoagulants Oral drugs

Coumadin (warfarin) Given PO Monitor PT/INR Avoid changes in amount of Vitamin K consumed

Wafarin use

Coumadin (warfarin) stay longer in system. If patient will have a surgery, the patient must stop taking Coumadin about 7-10 days before surgery

Antiplatelet side effects

Decreased platelet count BLEEDING

Antiplatelet action

Exert an anticoagulant effect by interfering with platelet aggregation

Anticoagulants Parenteral drugs

Heparin Given Sub-Q (abdomen) Can be given IV Monitor PTT level Lovenox (enoxaparin) Given sub-Q (lateral aspect of abdomen) PTT is usually not monitored

Heparin use

Heparin-May be used to prevent DVT after surgery or prolonged periods of bed rest

Nursing Actions/Teaching for active bleeding

Obvious sign of bleeding, excessive of bleeding report HCP Active bleeding solve with medication and report HCP Hidden signs of bleeding

Anticoagulants Oral labs

PT (prothrombin time)- Control 11-13.5 seconds -TR: 1.5-2 times normal INR (international normalized ratio) - TR: 2-3

Antiplatelet uses

Prevention of clots in vessels Often used with MI (myocardial infarction) or CVA (cerebral vascular accident) patients

Anticoagulants Parenteral drugs General Information

Rapid Onset Does not cross placenta Renal excretion

Plavix (clopidogrel) serious side effect

Serious side effect: thrombocytopenic purpura (anemia, low platelet, fever, changes in LOC (Level of consciousness))

What is Sub-Q injection?

Subcutaneous (SQ or Sub-Q) injection means the injection is given in the fatty tissue, just under the skin.

Antiplatelet interactions

Use caution if other medications that can cause bleeding Avoid alcohol

Anticoagulants Oral Antidote

Vitamin K (phytonadione)

Anticoagulants Parenteral lab

aPTT (activated partial thromboplastin time) Control range 30-40 seconds TR: 1.5-2 times normal

Lab tests for Anticoagulant

complete blood count (CBC). "H&H", is a popular shorthand for hemoglobin and hematocrit, blooding H&H are decreased H&H = hemoglobin and hematocrit

Anticoagulants Use/ Indication

prevention and treatment of thromboembolic disorders including deep vein thrombosis, atrial fibrillation, pulmonary embolism. May also be used in the management of MI possibly in combination with other medications

Anticoagulants action

prevents clot extension and formation. IT DOES NOT DISSOLVE THE CLOT!!

Aspirin toxicity symptoms

tinnitus, HA, confusion, lethargy, tachypnea, tachycardia, fever