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Heparin
- Classification: anticoagulant
- Given IV or Sub-Q
- Action: interfere with the activation of fibrin and fibrinogen from thrombin that keeps the clots from forming
- Uses: prevents and treats deep vein thrombosis, pulmonary embolism, and emboli in atrial fibrillation
- preferred anticoagulant during pregnancy
- Contraindications:
- bleeding tendencies-hemophillia, dissecting aneurysm, peptic ulcer
- thrombocytopenia, uncontrollable bleeding
- postoperative clients, especially eye, brain, spinal cord surgery, lumbar puncture, and regional anesthesia
- Side effects:
- injection site reactions; heparin-induced thrombocytopenia
- large doses may suppress renal function
- spontaneous bleeding at mucous membranes
- Nursing implications:
- monitor the Partial thromboplastin time (PTT) and activated PTT (aPTT)-should be 1 1/2 to 2 times normal range; watch for bleeding
- protamine sulfate is the antidote
- low-molecular-weight heprins (e.g., enoxaparin (lovenox)) do not require PTT or aPTT monitoring; used most often for preventing and treating deep vein thrombosis (DVT)
- administered either intravenously (IV) or subcutaneously
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Warfarin Sodium (coumadin)
- Classification: Anticoagulant
- Given IV, PO
- Action:Vitman K antagonist blocks the use of vitamin K for the synthesis of clotting factors which disrupts the coagulation cascade
- Uses: prevents venous thrombosis and thromboembolism associated with atrial fibrillation and prosthetic heart valves
- decreases risk of recurrent transient ischemic attack (TIA), cerebrovascular accisent (stroke), and myocardial infarction
- Contraindications:
- bleeding disorders (hemophillia, thrombocytopenia)
- vitamin K deficiency; severe hypertension
- Pregnancy-category X, breastfeeding (crosses into breast milk)
- Percautions:
- renal or liver disease, alcoholism
- Side effects:
- spontaneous bleeding
- hypersensitivity reactions (e.g., dermatitis, fever, pruitus, urtcaria)
- red-orange discoloration of urine (not to be confused with hematuria); weakening of bones with long-term use
- Nursing implications
- monitor prothrombintim (PT) and international normalized ratio (INR) as ordered (2 to 3 is usually and acceptable INR)
- interacts with a large number of medications; consequently, monitor for drug interactions before initating therapy
- monitor for bleeding tendencies
- vitamin K is the antidote
- teach client to decrease intake of green, leafy vegetables
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Epoetin Alfa (Procrit)
- Classification: Erythropoietic growth factor
- Given IV
- Action: stimulates red blood cell production
- Uses:
- anemia
- chronic renal failure
- chemotherapy
- HIV-infected clients taking zidovudine (AZT)
- Contraindications:
- uncontrolled hypertension
- hypersensitivity to albumin
- precautions:
- clients with cancers of the myeloid origin (rapid growth of white blood cells example Leukemia)
- Side effects:
- Hypertension
- cardiovascular events-cardiac arrest, heart failure, thrombotic events (stroke, myocardial infarction (MI))
- autoimmune pure red-cell aplasia, severe anemia, red blood cell production ceases
- Nursing implications:
- monitor blood pressure befor erythropoietin therapy
- do not shake solution because it may denature the glycoprotein. do not mix with other medications
- discard remaining contents because erythropoietin does not contain a preservative
- monitor hematocrit (Hct), hemoglobin (Hgb), serum iron and fluid and electrolyte balance
- monitor for seizures (rapid increase in Hct increasis risk of hypertensive encephalopathy)
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Iron Supplements
- Classification: Hematinics
- Given PO, IV, Via tube feedings
- Action: production of notmal hemoglobin and red blood cells for transportation and utilization of oxygen
- Uses:
- Iron deficiency anemia
- prophylactic use in pregnancy and child hood
- Contraindications and precautions:
- all anemias other than iron deficiency anemia
- peptic ulcers, regional enteritis, colitis
- Side effects:
- gastrointestinal disturbances-nausea, heartburn, bloating, constipation
- tarry stools or dark green discoloration
- anaphylaxis (parenteral preparation only)
- Nursing implications:
- do not give with antacids or tetracyclines
- do not crush or chew sustained released medication
- take between meals to maximize uptake
- take vitamin C to promote absorption of the iron
- liquid preperations stain teeth, so use a straw or dilute, follow with rinsing the mouth
- teach client that oral iron supplements differ form one another and should not be interchanged
- diet teaching to include iron-rich food-liver, eggs, meat, fish, fowl
- assess for anaphylaxis with parenteral iron (dextran), as well as hypotension, headache, fever, urtcaria, arthralgia
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Thrombolytics:
Streptokinase
Tenecteplase
Activase
(tPA)
- Clot busters
- Action: convert plasminogen to plasmin, and digest matrix of clots
- Uses: treatment of acute myocardial infarction, pulmonary embolism. thrombotic strokes, and deep vein thrombosis
- Contraindications and precautions:
- cerebrovascular disease and pregnancy
- active bleeding, aortic dissection, pericarditis
- history of intracranial hemorrhage
- recent major surgery
- history of gastrointestinal (GI) bleeding
- Side effects:
- Streptokinase:
- hemorrhage (intracranial of greatest concern) and anemia
- hypotension and fever
- allergic reactions-itching, urticaria, headache, anaphylaxis
- alteplase (tPA) and tenecteplase:
- risk of intracranial hemorrhage is higher
- does not cause hypotension
- Nursing implications:
- administer immediately after the event for better outcome, preferably within 4 to 6 hours
- monitor intake and output and hematocrit during treatment
- monitor client for bleeding and anaphylactic reactions
- while receiving the medication maintain client on bed rest
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Clopidogrel (Plavix)
- Classification: antiplatelet
- Action: inhibits platelet aggregation, action occures within 2 hours of administration
- uses: secondary prevention of myocardial infarction (MI), ischemic stroke, and other vascular events
- Contraindications and precautions:
- active bleeding
- concomittant use of anticoaugulant drugs and non steroidal antinflammatory drugs (NSAID's) can cause bleeding
- Side effects:
- abdominal pain
- dyspepsia
- diarrhea
- rash
- Nursing implications:
- administer with food to diminish gastrointestinal upset
- teach client to report an unusual bleeding or brusing
- teach client that if surgery is scheduled, medication may be held 3 to 7 days before surgery
- platelet counts may be monitored
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