1. NURS 1950 Pharmacology I 1

2.  Objective 1: identify general reasons anticoagulants are given 2

3.  Objective 2: identify the cells in the body that release heparin  Objective 3: describe the actions of heparin 3

4.  Objective 4: list the appropriate routes to administer heparin 4

5.  Heparin: only parenteral administration  Warfarin: oral  Heparin ◦ Low doses: inhibit clotting factor Xa ◦ High doses: inhibits all clotting factors ◦ Effects occur immediately 5

6.  Preferred during pregnancy, PE, DVT  Required for open heart surgery, renal dialysis 6

7.  Side Effects  Hemorrhage: observe hypotension, tachycardia, petechiae, bruises  May see bloody stools, pelvic pain, headache  Hypersensitivity: chills, fever, rash  Antidote: protamine sulfate 7

8.  Administration ◦ IV or subq ◦ IM causes hematoma ◦ Monitor PTT above 1.5-2 X normal is therapeutic ◦ Monitor INR: between 2-3 8

9.  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 9

10.  Do not inject IM  Do not expel air bubble from syringe before injection  Do not rub injection site 10

11.  SE to expect: hematoma with improper injection technique  SE to report: bleeding, thrombocytopenia  Drug interactions: no clinically significant interactions ◦ Caution: antiplatelet or warfarin therapy 11

12.  Warfarin (Coumarin) ◦ 1 st oral ◦ Antidote: Vitamin K ◦ Monitor protime  Needs to be 1.5 to 2X normal  Monitor INR: 2-3 12

13.  Interactions ◦ Heparin ◦ ASA ◦ Butazoladin ◦ Barbiturates 13

14.  Objective 5: identify the antidote for heparin 14

15.  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 15

16.  Objective 7: describe the important points regarding subcutaneous administration of heparin ◦ Dose/strength ◦ Injection site ◦ Needle/syringe ◦ Aspiration ◦ Pressure 16

17.  Objective 8: list the signs of heparin overdose ◦ Bleeding ◦ VS changes ◦ Thrombocytopenia ◦ White clot formation is a toxic reaction 17

18.  Objective 9: identify drugs that enhance the action of heparin ◦ NSAIDs ◦ ASA ◦ Ginkgo biloba ◦ Dipyridamole ◦ Clopidogrel ◦ Ticlopidine 18

19.  Objective 10: describe the action of Coumadin ◦ Inhibits the activity of vitamin K—needed for activation of clotting factors II, VII, IX and X 19

20.  Objective 11: name the lab tests done to determine the effectiveness and dosage of Coumadin ◦ 12-15 sec = Normal PT 20

21.  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 21

22.  Objective 13: discuss other select anticoagulant agents ◦ Fibrinolytic agents ◦ Antiplatelet drugs 22

23.  Suppress aggregation platelets  Prevent arterial thrombus  ASA single dose; 5 gr or less ◦ Doubles bleeding time for 4-7 days ◦ Reduces MI, TIAs, CVAs 23

24.  Amicar ◦ Inactivates plasminogen ◦ USE: given IV to reduce hemorrhage in 1-2 hrs ◦ Precaution: no ASA ; DIC is likely problem 24

25.  Streptokinase ◦ Promotes plasminogen to plasmin ◦ Uses  Acute coronary thrombi  DVT  Massive pulmonary emboli ◦ Nursing interventions:  Monitor ECG q 15 min during 1 st hr of infusion  Monitor LOC (intercranial hemorrhage) 25

26.  MI: must give within 6 hours  DVT: give within 3 days  PE: no more than 5-7 days 26

27.  Side Effects  Hemorrhage: use Amicar  Fever, allergic reaction Drug given IV 27

28.  Urokinase ◦ Promotes plasminogen to plasmin 28

29.  TPA: tissue type plasminogen activator (Activase) ◦ Synthetic ◦ Clears coronary artery ◦ SE: bleeding 29

30.  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 30

31.  Objective 15: describe the nursing responsibilities associated with a client receiving an anticoagulant, including specific safety considerations 31

32.  Dosage schedules  Hydration  Lab data  Preventing clot formation  Patient teaching ◦ Follow-up ◦ Safety 32

33. ◦ Medic alert bracelet ◦ Symptoms to report ◦ Do not take OTC meds without consulting MD 33