Name the Coagulation Modifier Drugs.
What is the action of Anticoagulants?
- Inhibit the action/formation of clotting factors
- Prevent clot formation
What is the action of Antiplatelet drugs?
- Inhibit platelet aggregation
- Prevent platelet plugs
What is the action of Thrombolytic drugs?
Lyse (break down) existing clots
What is Hemostasis?
The process that halts bleeding after injury to a blood vessel
Why would a client be prescribed an Anticoagulant?
- for prophylactic Tx: prevent Thrombus (clot formation)
- prevent embolus (dislodged clot)
How does Heparin & LMWH work?
Prevent clot formation by turning off coagulation pathway.
How does Warfarin work as an Anticoagulant?
Inhibiting Vitamin K synthesis by bacteria in intestinal tract -> inhibits clotting factors.
Due to the Anticoagulants ability to prevent clot formation it helps prevent what health conditions?
- MI (myocardial infarction)
- DVT (deep vein thrombosis)
- PE (pulmonary embolism)
What should a client starting on Warfarin be taught to watch for with this drug?
What are the Anticoagulant drugs?
- Low-molecular-weight heparin
What is the antidote for Heparin?
What is the antidote for Warfarin?
What lab tests are used to monitor Heparin?
Activated Partial Thromboplastin Time (aPTT)
What are the names of the two LMWH drugs?
Lovenox & Fragmin
LMWH like Lovenox don't require frequent lab tests like regular Heparin. But what test is used to monitor Lovenox?
aPTT & PLATELET COUNT
What is the critical assessment for administration of Heparin?
aPTT, platelet count
What labs are monitored when a client is taking Warfarin?
PT & INR
What is the normal INR range for a client NOT taking Warfarin?
INR of 1.0
What is the Therapeutic IRN range for a client on Warfarin?
INR of 2-3.5 (depending on indication)
Warfarin has a long duration of action and half-life. What are they?
- Duration of action: 2-5 days
- Half-life: 1/2-3days
Can a client on Heparin start taking Warfarin as well?
Yes, until PT-INR levels indicate adequate anticoagulation.
What should a client taking an Anticoagulant be taught?
- Labs are important!!
- s/s of abnormal bleeding
- measures to prevent bruising, bleeding, or tissue injury
- Medic alert bracelet
- Avoid: foods ^in Vit K (tomatoes, greens)
Which drugs have Antiplatelet properties?
- Plavix & Ticlid
- Aggrastat & Itegrilin
What are the a/e with Antiplatelet drugs?
ASA: bleeding, heartburn, <platelets
What is the purpose of using Antiplatelet drugs?
reduce risk of fatal & nonfatal strokes
What are the patients taught when started on an Antiplatelet drug?
- Monitor for abnormal bleeding
- drug-drug interactions
- medic alert bracelet
Name the Thrombolytic drugs.
Streptase, t-PA, Activase, Eminase, Retavase, TNKase, Xigris
What is the mechanism of action for the Thrombolytic drugs?
- Activate the fibrinolytic system to break down the clot in the blood vessel quickly.
- Activate plasminogen & convert it to plasmin, which can digest fibrin.
What is the reason for prescribing a client a Thrombolytic drug?
- Reestablish blood flow to the heart muscle via coronary arteries, preventing tissue destruction.
- Acute MI, Arterial thrombolysis, DVT, Occlusion of shunts or catheters, PE, Acute ischemic stroke.
What are the A/E of Thrombolytic drugs?
- Bleeding: internal, intracranial, superficial
- Other: N/V, hypotension, anaphylactic, cardiac dysrhythmias
What are the nursing implications in general for the Coagulation Modifier Drug goups?
- Monitor for therapeutic effects
- s/s of bleeding
- ^BP, HA, hematoma formation, hemorrhage, SOB, chills, fever
What are Antilipemic drugs used for?
to lower lipid levels
Name the drugs in the Antilipemic group HMG-Coa Reductase Inhibitors (HMGs, or Statins).
Lovastatin, pravastatin, simvastatin, atrovastatin
What is the mechanism of action with the HMG-CoA Reductase Inhibitor drugs?
- Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol.
- Lower the rate of cholesterol production
What are the A/E of the HMG-CoA Reductase Inhibitors?
- mild, transient GI disturbances
- Myopathy (muscle pain), possibly leading to the serious condition Rhabomylosiselevations in liver enzymes or liver disease
What are the nursing implications for Antilipemics?
- Obtain baseline liver fxn tests
- Assess dietary patterns, exercise, Wt, Ht, VS, tobacco, & alcohol, Family Hx
What are special things are taught to a client taking Niacin?
- Started on a LOW dose initially & gradually increased & take w/meals to minimize A/E
- Small doses of ASA or NSAIDs can be taken 30min before niacin to <cutaneous flushing
What are the general nursing implications with Antilipemics?
- instruct pts to report persistan GI upset, constipation, abnormal bleeding, yellow skin
- Monitor: A/E, liver enzyme tests
- Monitor for therapeutic effects
- *<cholesterol & triglyceride levels