NURS 1950Pharmacology I

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Objective 1: identify general reasons anticoagulants are given

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Objective 2: identify the cells in the body that release heparin

Objective 3: describe the actions of heparin

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Objective 4: list the appropriate routes to administer heparin

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Heparin: only parenteral administration Warfarin: oral Heparin

◦ Low doses: inhibit clotting factor Xa◦ High doses: inhibits all clotting factors◦ Effects occur immediately

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Preferred during pregnancy, PE, DVT Required for open heart surgery, renal

dialysis

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Side Effects Hemorrhage: observe hypotension,

tachycardia, petechiae, bruises May see bloody stools, pelvic pain,

headache Hypersensitivity: chills, fever, rash Antidote: protamine sulfate

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Administration◦ IV or subq◦ IM causes hematoma◦ Monitor PTT above 1.5-2 X normal is therapeutic◦ Monitor INR: between 2-3

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Enoxaparin (Lovenox): low molecular weight◦ Acts so has less potential for hemorrhage, longer

duration of action Subq administration Does not affect PT or APTT Do not give to clients allergic to pork by-

products

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Do not inject IM Do not expel air bubble from syringe before

injection Do not rub injection site

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SE to expect: hematoma with improper injection technique

SE to report: bleeding, thrombocytopenia Drug interactions: no clinically significant

interactions◦ Caution: antiplatelet or warfarin therapy

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Warfarin (Coumarin)◦ 1st oral ◦ Antidote: Vitamin K◦ Monitor protime

Needs to be 1.5 to 2X normal Monitor INR: 2-3

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Interactions◦ Heparin◦ ASA◦ Butazoladin◦ Barbiturates

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Objective 5: identify the antidote for heparin

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Objective 6: name the lab tests that are the basis to determine the effectiveness and dosage of heparin◦ PTT 60-80◦ PT 2.5-3.5◦ INR 2-3◦ APTT 25-35 is normal

2-3x baseline= therapeutic ; measured daily

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Objective 7: describe the important points regarding subcutaneous administration of heparin◦ Dose/strength◦ Injection site◦ Needle/syringe◦ Aspiration ◦ Pressure

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Objective 8: list the signs of heparin overdose◦ Bleeding ◦ VS changes◦ Thrombocytopenia ◦ White clot formation is a toxic reaction

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Objective 9: identify drugs that enhance the action of heparin◦ NSAIDs◦ ASA◦ Ginkgo biloba◦ Dipyridamole◦ Clopidogrel◦ Ticlopidine

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Objective 10: describe the action of Coumadin◦ Inhibits the activity of vitamin K—needed for

activation of clotting factors II, VII, IX and X

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Objective 11: name the lab tests done to determine the effectiveness and dosage of Coumadin

◦ 12-15 sec = Normal PT

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Objective 12: identify drugs that increase and decrease the effectiveness of Coumadin

Drugs that can increase Coumadin effects: Tylenol, ASA, dong quai, ginkgo biloba, oil of wintergreen, omeprazole

Drugs that can decrease the effects: St. John’s Wort, rose hip, barbiturates, griseofulvin, vitamin C, vitamin K

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Objective 13: discuss other select anticoagulant agents◦ Fibrinolytic agents◦ Antiplatelet drugs

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Suppress aggregation platelets Prevent arterial thrombus ASA single dose; 5 gr or less

◦ Doubles bleeding time for 4-7 days◦ Reduces MI, TIAs, CVAs

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Amicar◦ Inactivates plasminogen ◦ USE: given IV to reduce hemorrhage in 1-2 hrs

◦ Precaution: no ASA ; DIC is likely problem

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Streptokinase◦ Promotes plasminogen to plasmin◦ Uses

Acute coronary thrombi DVT Massive pulmonary emboli

◦ Nursing interventions: Monitor ECG q 15 min during 1st hr of infusion Monitor LOC (intercranial hemorrhage)

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MI: must give within 6 hours DVT: give within 3 days PE: no more than 5-7 days

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Side Effects Hemorrhage: use Amicar Fever, allergic reaction

Drug given IV

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Urokinase◦ Promotes plasminogen to plasmin

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TPA: tissue type plasminogen activator (Activase)◦ Synthetic◦ Clears coronary artery◦ SE: bleeding

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Objective 14: discuss the indications for antiplatelet drugs◦ Previous MI, CVA, TIA◦ Conditions that predispose to clot formation

Some used in combination post cardiac valve replacement

Peripheral arterial disease Atrial fibrillation Unstable angina

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Objective 15: describe the nursing responsibilities associated with a client receiving an anticoagulant, including specific safety considerations

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Dosage schedules Hydration Lab data Preventing clot formation Patient teaching

◦ Follow-up◦ Safety

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◦ Medic alert bracelet◦ Symptoms to report◦ Do not take OTC meds without consulting MD

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