4. anticoagulants drug table PDF

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1. ANTICOAGULANTS Prototype: heparin sodium (unfractionated)

Mechanism of Action: Short-term use acts to inactivate thrombin (prolong clotting time). prevents clot formation, but does not break down clot o

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Use(s) stroke, coronary artery disease, dysrhythmias, DVT, cancer, prevention for bedridden or after major surgery

Side effects bleeding, thrombocytopenia, allergic reaction

Nursing Implications monitor aPTT (30-40sec) Heparin 1.5-2.5 x normal = 60-100 administer subq (abdomen) No aspiration or massage

Antagonist (antidote): protamine sulfate (1mg/100 units) and/or stop heparin

Step one: heparin binds with antithrombin III Step two: antithrombin III inactivates thrombin Step three: thrombin inhibits conversion of fibrinogen to fibrin Step four: clot is prevented due to inhibition of fibrin

Check with nurse

Anticoagulant: Low-molecular-weight heparin (LMWH) Prototype: enoxaparin (Lovenox) (parin)

Mechanism of Action: similar to heparin, but specific to active factor X

Use(s)

Side effects

2-4x longer, fewer lab tests needed, give SQ at home

Nursing Implications don’t take antiplatelet drugs (aspirin) Don’t need aPTT monitoring Antagonist: (antidote) Protamine sulfate 1mg/1mg LMWH

Anticoagulant Prototype: warfarin (Coumadin)

Mechanism of Action: inhibit synthesis of clotting factors II, IV, IX, X (those dependent on vitamin K)

Use(s) valve replacement surgery, thromboembolic disease

Side effects bleeding microemboli (purple toe syndrome)

Nursing Implications Monitor: PT (prothrombin) normal: 11 to 13.5 seconds INR Normal =1 Taking warfarin: INR 2-3.5

Prevents clotting by prolonging prothrombin time (PT)

petechiae Contraindication in allergy and pregnancy

Avoid High vitamin K food [leafy green veggies, liver, cranberry, etc] Limit garlic: increases bleeding

Drug interactions: CYP2C9: aspirin, oral contraceptives, barbiturates Antidote: phytonadion [vitamin K]; takes 6 hours Human prothrombin complex (Kcentra) IV rapid response Give over 30 minutes

Anticoagulant: dabigatran Prototype: dabigatran etexilate mesylate (Pradaxa)

Mechanism of Action: Direct thrombin inhibitor

Use(s) Same as warfarin (don’t give to pt.

Side effects Bleeding

Nursing Implications Antagonist (Antidote): idarucizumab (Praxbind)

Administration: oral

with artificial heart valve)

Caution: liver damage, open wounds, surgery Cannot take aspirin or NSAIDs, ONLY TYLENOL Assess for bleeding signs. Monitor lab values [aPTT, INR] Shave with an electric razor and use a soft toothbrush

2. Antiplatelet Prototype: Aspirin

Mechanism of Action:

Use(s) prevent thrombosis in arteries prevent stroke (TIA) or MI (prophylaxis)

alters platelet aggregation [clustering or coming together]

Side effects bleeding, stomach ulcers, tinnitus

Kinetics: oral (low dose 81 mg) 162 or 325 mg

Nursing Implications NC: active bleeding, receiving other anticoagulation, children under 16 with flu-like symptoms, ulcers, pregnancy

**If Acute Coronary symptoms: take aspirin

81mg “heart protectant” [heart attack]

Discontinue at least 7 days before surgery

Antiplatelets: ADP Receptor Blockers Prototype: clopidogrel (Plavix), ticlopidine (Ticlid),

Mechanism of Action: Prolong bleeding time inhibiting platelet aggregation ADP Receptor blocker

Use(s) prevent/risk MI, stroke (thromboembolic)

Side effects abdominal pain, diarrhea, dyspepsia, rash

Nursing Implications Given PO

(alter platelet plasma membrane)

Antiplatelet: Glycoprotein (GP) IIb/IIIa Receptor Antagonist Prototype:

epifibatide (Integrilin)

Mechanism of Action: block binding of fibrinogen to platelet (GP) receptors

Use(s) acute cardiac syndrome, prior to angioplasty, or PTCA

Side effects

Nursing Implications Kinetics: IV bolus, then continuous infusion. Antiplatelet from 24-48 hrs

bleeding (Give platelets)

Assess: petechiae (thrombocytopenia), bleeding Intervention/Education: Take oral drugs with food, water, milk Monitor IV site for oozing, urine output

3. Thrombolytic- clot busters Prototype:

alteplase tPA

Mechanism of Action: break or lyses preformed clots in blood vessels Identical to human tissues plasminogen activator (tPA)

Use(s) chest pain (myocardial infarction), stroke caused by clots (brain attack), pulmonary

Side effects bleeding, nausea/vomiting , dysrhythmias, neurological problems

Nursing Implications Thrombolytics are nonspecific – dissolve whatever clots they encounter. Half life 5-7 min o

Duration: 3 hrs.

Monitor vital signs every 15-30 minutes

(changes plasminogen to plasmin, which then dissolves fibrin clots)

embolism

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Monitor lab values: aPTT, bleeding time, and INR

Contradictions: (do not give)  Active bleeding: Hemorrhagic stroke, trauma or recent surgery (last 10 day  Cranial neoplasm Caution: Narrow margin of safety  Pregnancy or recent delivery  Older adults>65-80  Taking anticoagulants & HTN

4. Antifibrinolytic (Hemostasis) Prototype: aminocaproic acid (Amicar)

Mechanism of Action: prevents lyses of fibrin by plasminogen – promotes clot formation

Use(s)

Side effects

prevent and treat Rare excessive bleeding from surgery, oozing around chest tubes

Nursing Implications may cause hypotension and bradycardia when given IV= need cardiac monitor and frequent VS

Local Hemostatic [only for a local effect, not a systemic]     

Control capillary bleeding; slow down the bleeding/hemorrhage

Mechanical: Absorbable gelatin or foam: moisten and insert Dissolve in 4-6 weeks After surgery 2-5 days: skin, vagina, rectum, ear [can be inserted anywhere]...