pharm exam 2 anticoagulants and blood products
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
