Developed by: Dawn Johnson, RN, MSN, Ed

 Internally and externally  Prevent bleeding from wounds which could lead to shock or even death

 Injured vessel constricts to slow blood flow  Platelets adhere to injured area and aggregate, plugging damaged vessel  Coagulation cascade occurs thus forming insoluble fibrin strands which slows blood flow more

 Injured cells release prothrombin activator  Prothrombin activator changes prothrombin to thrombin  Thrombin changes fibrinogen to fibrin  Fibrin forms an insoluble web over injured area which stops blood flow

 Anticoagulants  Thrombolytics  Hemostatics

 Inhibiting specific clotting factors in the coagulation cascade  Diminishing the clotting action of platelets  Both ways increase the time to form clots

 Dissolve life-threatening clots

 Promote formation of clots  Inhibit removal of fibrin

 Examples - heparin (Heplock), warfarin (Coumadin)  Mechanism of action - inhibit specific clotting factors which interfere with coagulation cascade in order to prevent formation or enlargement of clot  Primary use - thromboembolic disease; prevent formation of clots in veins  Adverse effects - abnormal bleeding

 Example - ticlopidine (Ticlid)  Mechanism of actions  Aspirin: inhibits thromboxane2, which prevents aggregation of platelets  ADP receptor blockers: interfere with platelet plasma membrane, which prevents platelet aggregation  Glycoprotein IIb/IIIa inhibitors: glycoprotein IIb/IIIa enzyme inhibited which prevents platelet aggregation

 Primary uses - prevent clot formation in arteries  Adverse effects - abnormal bleeding; reduce number of neutrophils

 Example - alteplase (Activase)  Mechanism of action - convert plasminogen to plasmin which causes fibrin to degrade, then preexisting clot dissolves  Primary uses - acute MI, pulmonary embolism, acute ischemic CVA, DVT, arterial thrombosis, coronary thrombosis, clear thrombi in arteriovenous cannulas and blocked IV catheters  Adverse effects - abnormal bleeding; contraindicated in patients with active bleeding or recent trauma

 Example - aminocaproic (Amicar)  Mechanism of action - prevent fibrin from dissolving, which enhances stability of the clot  Primary use - prevent and treat excessive bleeding from surgical sites  Adverse effects - none listed

 Provide essential building blocks for RBC production.  They do so by increasing hemoglobin which is necessary for oxygen transportation

 Iron  Vitamin B12  Folic Acid

 Used to treat the most common form of anemia-iron defieciency.  One function of iron-production of hemoglobin.  Treatment is usually 6 months  Parenteral iron therapy is used for patients who can’t absorb oral preparations, aren’t compliant with oral treatment, or have bowel d/o

 Iron is reduced by antacids as well as foods such as coffee, tea, eggs, and milk.  Other drug interactions are: Tetracycline or any of the cycline drugs, methlydopa, ciprofloxacin, oloxacin, chloramphenicol, and pencillamine may be reduced.  Cimetidine and other histamine2-receptor antagonists may decrease GI absorption of iron.