Clinical Medications WorksheetsGeneric Nameenoxaparin

Trade NameLovenox

ClassificationAnticoagulants, antithrombotics

Dose40 mg

RouteSQ

Time/frequencyqid

PeakUnknown

Onsetunknown

Duration12 hrs

Normal dosage range40mg SQ daily

Why is your patient getting this medicationPrevention of thrombus formation. Systemic anticoagulation for prevention of ischemic or thrombotic events (e.g., MI, stroke)

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Systemic anticoagulation Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity, uncontrolled bleeding, GI bleeding/ulceration/pathology. Geriatric patients (enoxaparin elimination prolonged). Retinopathy (hypertensive or diabetic). Untreated hypertension. History of congenital or acquired bleeding disorder. Recent history of ulcer disease. Hemorrhagic stroke. Common side effectsDizziness, headache, insomnia, constipation, N/V, urinary retention, bleeding, anemia, thrombocytopenia

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Plavix: Drugs that can affect hemostasis such as dextran, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or other anticoagulants may potentiate the risk of bleeding complications associated with the use of a low molecular weight heparin (LMWH), heparinoid, or fondaparinux. In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during LMWH, heparinoid, or fondaparinux therapy may also be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.ASA: In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during low molecular weight heparin (LMWH) or heparinoid therapy may be increased by the concomitant use of other drugs that affect coagulation, including nonsteroidal anti-inflammatory drugs (NSAIDs). The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.

Lab value alterations caused by medicineReversible increase in liver enzymes, monitor CBC, platelet count and , monitor closely if thrombocytopenia occurs, if decrease in hematocrit occurs, assess for hemorrhageBe sure to teach the patient the following about this medicationAdvise patient to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care professional immediately. Instruct patient not to take aspirin, naproxen, or ibuprofen without consulting health care professional while on enoxaparin therapy.

Nursing Process- Assessment(Pre-administration assessment)Assess for signs and symptoms of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools), assess for signs and symptoms of thrombosis, observe injection sites for hematomas.

AssessmentWhy would you hold or not give this med?Hypersensitivity (chills, fever, urticaria). Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools); bleeding from surgical site. Notify physician or other health care professional if these occur.

EvaluationCheck after givingUnusual bleeding or hemorrhage. Prevent DVT/clot formation. Observe injection sites for hematomas, ecchymosis, or inflammation.