Hematologic Pharmacology (M5)

What blood thinning medications in this unit can you take with NSAIDs?

NONE

Why would you not want to take NSAIDs with any blood thinners?

NSAIDs impair platelet aggregation and thus prolong bleeding time. If you take with a blood thinner, the body will have a very hard time forming clots to stop blood flood with a cut, etc due to the stacking effect

What is Clopidogrel used for?

Inhibition of platelet aggregation (MI, ischemic CVA, TIA, coronary stents)

What is Alteplase used for? (5)

-Acute MI -Deep vein thrombosis -Massive pulmonary emboli -Ischemic CVA -Reestablishing patency of IV catheters (special form)

What would you do for a patient taking Alteplase?

-Administer IV within 3 hours of onset symptoms -administer aminocaproic acid for uncontrolled severe bleeding -monitor aPTT, PT, INR, Hgb, Hct, bleeding time

What drugs in this unit are antiplatelet? (2)

-Aspirin -Clopidogrel

Heparin and Enoxaparin adverse effects? (2)

-Bleeding -Thrombocytopenia (low platelet/thrombocyte count)

Clopidogrel adverse effects? (2)

-Bleeding -Thrombotic thrombocytopenic purpura (rare) (clots forming in small vessels throughout body, resulting in low platelet and low RBC and often kidney, heart, and brain disfunction)

What would you do for a patient taking Enoxaparin? (4)

-DO NOT expel air bubble in the syringe -administer deep subcutaenous in abdomen -administer protamine sulfate for OD -Monitor for black stools, easy bruising, excessive bleeding

What would you tell a patient taking Alteplase? (3)

-Do not take with NSAIDs -Report headache or unilateral weakness -report signs of bleeding

What would you tell a patient taking Warfarin? (5)

-Do not take with NSAIDs -Use an electric razor for shaving and a soft toothbrush -report signs of bleeding -it may take 3-5 days for full therapeutic effect -do not take during pregnancy

What would you tell a patient taking Clopidogrel? (4)

-Do not take with NSAIDs -discontinue 1 week before surgery -report signs of bleeding -take with food to minimize GI effects

What would you tell a patient that is taking Heparin or Enoxaparin? (3)

-Do not take with NSAIDs (non steroidal anti inflammatory drugs) -Use an electric razor for shaving and a soft toothbrush -report signs of bleeding

What two meds would you use protamine sulfate to remedy a patient overdose?

-Heparin -Enoxaparin

What meds would the nurse need to monitor for black stools, easy bruising, petechiae, and excessive bleeding?

-Heparin -Enoxaparin -Warfarin -Clopidogrel

What drugs in this unit are anticoagulants? (3)

-Heparin -Enoxaparin -Warfarin

What would you do for a patient taking Warfarin? (4)

-Monitor PT (therapeutic level 18-24 sec) and INR (2-3) (this is what we did at clinicals last week) -Administer vitamin K for overdose -administer orally -monitor for black stools, easy bruising, petechiae, excessive bleeding

What would you do for a patient taking Heparin? (4)

-Monitor aPTT (therapeutic level one and one half to two times the baseline) -Administer protamine sulfate for OD -Administer subcutaneously or IV -Monitor for black stools, easy bruising, petechiae (purple brown spots that occur under skin due to bleeding), excessive bleeding

What would you do for a patient taking Clopidogrel? (3)

-Monitor platelet count -administer orally -monitor for black stools, easy bruising, petechiae, excessive bleeding

What values would you monitor for a patient taking Alteplase? (6)

-aPTT -PT (prothrombin time, liquid portion of blood clotting time) -INR -Hgb -Hct -bleeding time

Warfarin adverse effects? (2)

-bleeding -toxicity

The nurse is educating the client on anticoagulant therapy about adverse effects. Which adverse effect of anticoagulant therapy is the most serious? A) Abnormal hemorrhage B) Electrolyte depletion C) Severe headache D) Cardiac arrhythmia

A) bleeding bad

A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which medication should the nurse plan to administer for DVT prophylaxis? A) enoxaparin subcutaneous B) heparin infusion C) enoxaparin subcutaneous D) warfarin PO E) aspirin PO

A) Aspirin and heparin primarily used for existing DVT to prevent further thrombosis, not as a preventative (prophylaxis). This is kind of a hoe ass question though because it is used in prevention, just once they already have/had them forming. Enoxaparin is used more for preventing them from forming in the first place i.e. in this case because the only risk factor for clotting is caused by the recent surgery. Enoxaparin is preferred for these cases bc dosage is low and doesn't require PT or PTT monitoring, making it the preferred treatment for DVT prophylaxis following ortho surgery. Warfarin is started after dosing with Enoxaparin and both are given until warfarin reaches therapeutic levels. Think about clinicals at the rehab center where almost everyone who was post op there was taking Coumadin (warfarin) and needed an INR. They probably took Enoxaparin and got started on warfarin while still at inpatient (IMMEDIATELY is the key word in the question when deciding between warfarin and enoxaparin) then once they reached rehab they were just taking warfarin (Coumadin).

A client has had a recent prosthetic heart valve surgery and is receiving anticoagulant therapy. While monitoring the client's laboratory work, the nurse interprets the INR results. What does an INR of 1.5 indicate? A) The client is not receiving enough warfarin to have a therapeutic effect. B) The client's warfarin dose is at therapeutic levels. C) The client's intravenous heparin dose is at therapeutic levels. D) The client's intravenous heparin dose is dangerously high.

A) Range is 2-3. Above three means slow clot time. Below 2 means fast clot time. if it was working too well it would be above 3. Since it is below not enough is in system to slow clot time effectively.

A nurse is providing teaching to a client who is taking warfarin about monitoring the therapeutic effects. Which explanation should the nurse provide about the international normalized ratio (INR) test? A) The INR is a standardized test that eliminates the variations between laboratory reports in prothrombin times. B) The INR is the only test available for anticoagulant therapy monitoring. C) You will only need the test twice per month. D) The INR also monitors heparin therapy if the provider switches the medication prescription.

A) its a standardized test, results will be the same no matter what lab performs the test. PTT is used for Heparin, not INR.

What drug in this unit is a thrombolytic?

Alteplase

A nurse is teaching a client who has a new prescription for clopidogrel. Which instruction will the nurse include? A) "Take this medication three times daily." B) "You might have to stop taking this medication 1 week before any planned surgeries." C) "Take this medication on an empty stomach." D) "Expect to have black-colored stools while taking this medication."

B)

What do Heparin and Enoxaparin do?

Bind with antithrombin to inactivate factor Xa and thrombin

What does Clopidogrel do?

Blocks ADP receptors

What dose Warfarin do?

Blocks activation of vitamin K

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A) If a dose of the medication is missed, double the dose at the next scheduled time. B) Mild nosebleeds are common during initial treatment. C) Use an electric razor while on this medication. D) Increase fiber intake to reduce the adverse effect of constipation.

C) A increases risk for bleeding. B you should stop meds immediately and notify provider. D warfarin does not cause constipation

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which statement will the nurse make? A) "The IV heparin increases the effectiveness of the warfarin and will decrease your stay." B) "I will call the provider to get a prescription for discontinuing the heparin today." C) "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches therapeutic level." D) "Both heparin and warfarin work together to dissolve the clot."

C) Like the other question, warfarin takes time to reach therapeutic levels so a place holder is inserted in the form of alternative blood thinning medication (heparin). Heparin will be d/c'd once INR and PT are within the therapeutic range from warfarin.

What does Alteplase do?

Converts plasminogen to plasmin (dissolves clots)

The nurse notes in the client's medication prescriptions that the client will be starting heparin therapy followed by warfarin. What is the primary goal of heparin and warfarin therapy? A)To dissolve an existing thrombus. B) To stabilize an existing thrombus. C) To dilate the vessel around a clot. D) To prevent further thrombus formation.

D)

A client will be receiving alteplase for an acute myocrdial infarction. The nurse explains to the client that this medication is used for which purpose? A) To relieve chest pain. B) To prevent further clot formation. C) To control bleeding in the coronary vessel. D) To dissolve the clot in the coronary artery.

D) Alteplase is used during acute MI to dissolve the clot that is causing the MI. Heparin and Warfarin are preventative to further clots.

A client is receiving heparin therapy as part of the treatment for a pulmonary embolism.The nurse monitors the results of which laboratory test to check the medication's effectiveness? A)Vitamin K levels B) Prothrombin time/international normalized ratio (PT/INR) C) Bleeding times D) Activated partial thromboplastin time (aPTT)

D) Vitamin K is antidote for Warfarin. PT/INR are for Warfarin. Bleeding time is for Clopidogrel.

(T/F) You can take blood thinners with aspirin and ibuprofen

False; Both of those are NSAIDs

What are Enoxaparin and Warfarin used for?

Prevention of venous thrombosis

What is Heparin used for?

Prevention of venous thrombosis, DIC

A patient is displaying S/S of a Warfarin overdose. What would you administer?

Vitamin K

Alteplase adverse effects?

bleeding

What is the common adverse effect among all medications that prevent and dissolve thrombi?

bleeding