Click “Check answer” or click inside the card to see the answer to each card.

Click “Mark for review”, and that card will go to the bottom of the stack so you can practice it again.

Click “Next card” to proceed.

[qdeck align=”center” style=”border:4px solid green;” card_back_image=”https://applern.com/wp-content/uploads/2022/01/flashcard.png”]

[start]

[h]

Anticoagulants

[q] Heparin Overview

[a] Prevent Clotting, prophylaxis against postoperative venous thrombosis, Given IV or subcutaneous

[q] Heparin side effect 1

[a] “Hemorrhage -Monitor vital signs, observe for increased heart rate,
decreased blood pressure, bruising, petechiae, hematomas,
black tarry stools, Monitor activated partial thromboplastin time (aPTT). Keep
value at 1.5 to 2 times the baseline, bleeding precautions”

[q] Antidot for Heparin

[a] protamine

[q] Heparin side effect 2

[a] “Thrombocytopenia – Monitor platelet count periodically throughout treatment,
especially in the first month. Stop heparin if platelet count is less than 100,000/mm3.”

[q] Heparin side effect 3

[a] Hypersensitivity reactions (chills, fever, urticaria)- Administer a small test dose first

[q] Heparin Toxicity/overdose

[a] Administer protamine – Slow IV

[q] Heparin Contraindication

[a] “clients who have low platelet counts (thrombocytopenia) uncontrollable bleeding, hemophilia,dissecting aneurysm,
peptic ulcer disease, severe hypertension, hepatic or renal disease, or threatened abortion. Should not be used during or following surgeries of the eye(s), brain, or spinal cord; lumbar puncture; or regional anesthesia (Neurologic damage may happen from if hematoma is formed during spinal or epidural anesthesia.”

[q] Enoxaparin/fondaparinux injection

[a] Do not expel the air bubble from the prefilled syringe, Do not aspirate. Do not rub the site for 1 to 2 min after the injection. Rotate and record injection sites.

[q] Heparin Medication Effectiveness

[a] Client aPTT levels of 60 to 80 seconds, No Blood cclot

[q] Warfarin Overview

[a] Work against vitamin K, prevent synthesis of clotting factor, anticoagulant

[q] Warfarin Side effect

[a] “Hemorrhage -Monitor vital signs, observe for increased heart rate,
decreased blood pressure, bruising, petechiae, hematomas,
black tarry stools, Monitor PT/INR, bleeding precautions”

[q] Warfarin Side effect

[a] Hepatotoxic – Monitor liver enzymes. Assess for jaundice

[q] Warfarin antidot

[a] Vitamin K

[q] Warfarin Contraindication/concern

[a] Pregnancy, clients who have low platelet counts (thrombocytopenia) uncontrollable bleeding, vitamin K deficiencies, liver disorders, and alcohol use disorder due to the additive risk of bleeding, hemophilia,dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic or renal disease, or threatened abortion. Should not be used during or following surgeries of the eye(s), brain, or spinal cord; lumbar puncture; or regional anesthesia (Neurologic damage may happen from if hematoma is formed during spinal or epidural anesthesia.

[q] Warfarin and other meds

[a] Concurrent use of phenobarbital, carbamazepine , phenytoin, oral contraceptives, and vitamin K decreases anticoagulant effects.

[q] Warfarin and food

[a] “Foods high in vitamin K, such as dark green leafy vegetables (lettuce, cooked spinach), cabbage, broccoli, Brussels sprouts, mayonnaise, canola, and soybean oil, may decrease anticoagulant effects with excessive intake. Instruct clients to maintain a consistent intake of
vitamin K to avoid sudden fluctuations that could affect the action of warfarin.”

[q] Warfarin Teaching

[a] Bleeding precautions, full therapeutic effect may not be achieved for 3 to 5 days. Avoid alcohol and over-the-counter meds, PT/INR montoring, use soft-bristle toothbrush,use electric razor for shaving

[q] Warfarin and INR

[a] INR of 2 to 3 for treatment of acute myocardial infarction, atrial fibrillation, pulmonary embolism, venous thrombosis, and/or tissue heart valves. Mechanical heart valve need INR above 3

[q] Dabigatran Overview

[a] inhibiting thrombin, preventing a thrombus from developing

[q] Dabigatran Side effect

[a] Bleeding (GI, GU, cranial and other sites) : Teach clients to report manifestations of bleeding to provider, no antidote to dabigatran is available

[q] Dabigatran Side effect

[a] GI discomfort, nausea, vomiting, esophageal reflux,ulcer formation : Take dabigatran with food, antacids

[q] Rivaroxaban Overview

[a] “Anticoagulation, Prevents DVT and pulmonary embolism in clients who are undergoing total hip or
knee arthroplasty surgery”

[q] Rivaroxaban Adverse effects

[a] Bleeding (GI, GU, cranial retinal, epidural following removal of epidural catheter) : Wait at least 18 hr following last dose to remove an epidural catheter

[q] Rivaroxaban Adverse effects

[a] Elevated liver enzymes, Bleeding risk is increased when taking erythromycin, diltiazem, verapamil, quinidine, amiodarone. Monitor hemoglobin, hematocrit, and liver and kidney function periodically during treatment.

[q] Rivaroxaban therapeutic effect affected by

[a] Rifampin, carbamazepine, phenytoin, and St. John’s wort may decrease rivaroxaban levels

[q] Antiplatelets common meds

[a] Aspirin (Acetyle Salicylic Acid), Abciximab, Eptifibatide, Tirofiban, Clopidogrel, Ticlopidine, For imtermittent claudication (Pentoxifylline, Dipyridamole, Cilostazol)

[q] Aspirin Side Effect

[a] GI effects : Use enteric-coated tablets, take aspirin with food.

[q] Aspirin Side Effect

[a] Hemorrhagic stroke, bleeding, thrombocytopenia : Bbserve for weakness, dizziness, and headache (?Stroke), Monitor bleeding time. Monitor for gastric bleed, bruising, petechiae, and bleeding gums

[q] Aspirin Side Effect

[a] Tinnitus, hearing loss

[q] Abciximab Side Effect

[a] Hypotension and bradycardia, bleeding : Monitor vitals, bleeding precautions, Apply pressure to cardiac catheter access site

[q] Clopidogrel Side Effect

[a] Bleeding, GI effects – diarrhea, dyspepsia, pain

[q] Pentoxifylline Side Effect

[a] Dyspepsia, nausea, vomiting : Take with food.Do not crush or chew medication. Monitor hydration if GI upset occurs

[q] Thrombolytic Overview

[a] Alteplase (tPA), Tenecteplase, Reteplase. Dissolve clots, Given IV

[q] Thrombolytics Nursing Care

[a] Giving within 3 hr is best, continuous hemodynamic monitoring, Obtain baseline vital signs, platelet counts, hemoglobin (Hgb), hematocrit (Hct), aPTT, PT, INR, and fibrinogen level. Do not mix any medications in IV with thrombolytic agents. Minimize bruising or bleeding by limiting venipunctures and subcutaneous/intramuscular injections. Hold direct pressure to injection site or ABG site for up to 30 min until any oozing stops.

[x] [restart][/qdeck]