DVE, DVT, PE Pharmacology

Contraindications for heparin/enoxaparin/apixaban:

Antiplatelets, antihistamines, smoking, pork allergy, bleeding risk, anticoagulants, SSRIs, spinal punctures.

MOA of heparin/enoxaparin/apixaban:

Accelerates formation of antithrombin III-thrombin complex and deactivates thrombin, preventing conversion fibrinogen to fibrin.

What is the drug class for enoxaparin and heparin?

Anticoagulants

Nursing interventions for anticoagulants:

Monitor bone mineral density, bleeding precautions, monitor coagulation studies.

What is the antidote for heparin?

protamine sulfate

Contraindications for warfarin:

Tylenol, alcohol use, grapefruit juice, St. johns wort, bleeding risk, infection, 

HTN, kidney disease, diabetes, SSRIs, oral contraceptives, excess dark leafy greens

MOA of warfarin:

Inhibits vitamin K-dependent activation of clotting factors formed in liver.

Nursing interventions for warfarin:

Verify pregnancy status, monitor INR (and other anticoagulation labs), bleeding precautions, labs every 1-4 weeks.

What is the antidote for warfarin?

Vitamin K

MOA of protamine sulfate:

Forms a physiologically inert complex with heparin sodium.

When is protamine sulfate contraindicated?

When the patient is not bleeding due to overdose.

Nursing interventions for protamine sulfate:

Monitor for heparin rebound, have vasopressors and resuscitation equipment immediately available in case of a severe reaction to protamine.

Vitamin K contraindications:

neonates, patients with hereditary hypoprothrombinemia, renal impairment, cases of over anticoagulation due to heparins, and hypersensitivity to vitamin K.

What is the drug class for apixaban?

Factor Xa inhibitor (anticoagulant variant)

apixaban MOA:

Selectively inhibits factor Xa, decreasing thrombin generation and thrombus development.