NUR 117: Unit 3

Anticoags, Antiplatelets, antihypertensives, antilipidemics, iron, herbal meds

Heparin Sodium

Class: Anticoagulant

Mode of action: Inactivates thrombin molecule and fibrinogen to fibrin

Why?: Tx: Arterial or venous clot, Prevention: DVT, PE; Tx: Arterial or venous clot

Side effects: Bleeding

Labs to monitor: aPTT, PTT, platelets, AntiXa, HIT

Reversal: Protamine Sulfate

Teaching: Look for signs of bleeding, or injury, some herbal meds increase the risk for bleeding, do not stop without an HCP order

Given: Can be given IV/SUBQ

Enoxaparin (Lovenox)

Prevention dose: 30-40mg

Treatment dose: 1mg/kg

Class: Anticoagulant

Action: Inactivates thrombin molecule and fibrinogen to fibrin

Why?: 40 mg Prevention: DVT, PE; 1 mg/kg Tx: DVT, PE

Side effects: Bleeding

Labs: Platelets

Reversal: Protamine Sulfate

Teach: May need to teach pt to self inject, and risk for bleeding

Give: In anterior “love-handles”, 2 inches from the umbilicus, leave the air bubble, using a pre-filled syringe

Warfarin (Coumadin + Jantoven)

Class: anticoagulant

Action: Stops liver from making Vitamin K clotting factors and anticoagulant proteins

Why?: Prevention: DVT, PE; Tx: DVT, PE, A-fib, post valve replacement

Side effects: Bleeding

Labs: INR

Reversal: Phytonadione (Vitamin K)

Teaching: Long half-life, highly protein bound, avoid aspirin and anti-inflammatories

Dabigatran (Pradaxa)

Class: anticoagulant

Action: Directly inhibits thrombin from connecting to fibrinogen

Why?: Prevention: DVT, PE after hip surgery: Tx: DVT, PE, A-fib

Side effects: Bleeding

No labs

Reversal: Idarucizumab (Praxbind)

Teach: Leave in original bottle

Fondaparinux (Arixtra)

Class: anticoagulant

Action: Works on antithrombin III and factor Xa

Why? Prevention: DVT, PE post abd/hip surgery; Tx: DVT, PE

Side Effects: Bleeding

No labs

No reversal

Teaching: Instruct on how to give injection, educate for signs of bleeding

Rivaroxaban (Xarelto)

Class: anticoagulant

Action: Blocks active site of Xa

Why?: Prevention: DVT, PE after hip/knee surgery; Tx: DVT, PE

Side Effects: Bleeding

Labs: Creatinine

Reversal: Adexant alfa

Teaching: Looking for signs of bleeding, change in urine output, weight loss

Apixaban (Eliquis)

Class: Anticoagulant

Action: Blocks active site of Xa

Why?: Prevention: DVT, PE after hip/knee surgery: Tx: DVT, PE, CVA, A-fib

Side effects: Bleeding

Labs: Creatinine

Reversal: Andexant alfa

Teaching: Signs of bleeding, mark urine output changes, and weight loss changes

Acetlysalicylic acid (aspirin)

Class: Antiplatelet

Action: Prevents platelet aggregation on cyclooxygenase (cox)

Why?: Prevention: MI, CVA, DVT post surgery; Tx: MI, CVA, CABG, PCI

Side Effects: Bleeding

Labs: Salicylate level

No reversal

Teaching: 7-10 days stop prior to surgery

Clopidogrel (Plavix)

Class: Antiplatelet

Action: Stops ADP from attaching to platelet, prevent platelet aggregation in arteries

Why?: MI, Stroke, treat Peripheral Artery Disease

Side Effects: Bleeding

No labs

No reversal

Teaching: Teach about safety with risk for bleeding, no grapefruit

aPTT/pTT normal value

24-35 secs

Antixa Therapeutic value

0.3-0.7

INR normal value

0.8-1.1

INR therapeutic value

2-3, 2.5-3.5 if have mechanical valve

Platelets (Plt)

150,000-450,000

Hemoglobin (Hgb)

12-18 gldl

Red Blood Cell (RBC)

4-6 cells/ml

Hematocrit (HCT)

36-54%

Antilipidemias

Why? Need to lower cholestrol, can lower triglycerides, cholestrole, HDL, LDL, treats hyperlipidemia

Contraindications? Statin intolerant

Suffix: -Statins

Assess liver function: INR, PT, ALT, AST

This inhibits HMG-COA

Iron

Iron is an essential mineral for a healthy blood production

Why? Treats iron deficiency anemia

Absorbed in small intestines

Absorption consideration- If iron is given IV it absorbs faster, should stay with pt for 15 mins

What foods are rich in iron? Eggs, Spinach, green leafy

Iron Dietary Education

Do not take iron with antacids or calcium supplements (take 1-2 hours apart)

Iron can be taken with Vitamin C (helps with body absorbing more iron)

Erythropoiesis Stimulating Agents

This medication is given to help the body produce red blood cells

Given to dialysis clients or with CKD and chemotherapy clients

Iron Education

Iron daily (1-3 doses daily): take 1hr before meals

Take with foods only if it causes upset stomach

Iron can cause constipation so increase fiber intake

Don’t double up your iron pill

Keep out of reach of children because it looks like candy

Enteric coated, do not crush or chew

Beta Blockers

Beta-1: Is for heart

Beta-2: Is for lungs

suffixes: -olol, -alol, -ilol

Ex: Metoprolol, can be given IV or PO

Treats: Hypertension + Tachycardia, but can also treat migraines, anxiety, chest pain, and heart failure

Action: Vasodilates, works on Beta 1 and Beta 2 by binding and stopping the sympathetic nervous system to decrease HR and BP, to reduce the workload of the heart

Priority Assessments: BP and HR, also monitor glucose with diabetes pts

When to hold? Hold med if HR less than 60 or SBP less than 90

Side effects: BADFISH, Bradycardia, AV block, dizziness, fatigue, Impotence, Signs of hypoglycemia, hypertension: ALSO, depression, and insomnia

Education: Taper off med, if it is ER do not crush or chew, teach to take pulse and bp, stand slowly, compliance

Calcium Channel Blockers

Has no specific suffix

Ex: Amlodipine, diltiazem

Treats: Hypertension, angina, and supraventricular tachycardia

Action: Decrease myocardial contractility, easing the workload. Relaxes smooth muscles and causes vasodilation. It inhibits calcium from entering the heart cells causing decreased HR and BP

Assess: HR and BP

When to hold? If HR is less than 60 or SBP is less than 90

Side effects: SHRED, Slow HR, Hypotension+ Headaches, Reflex tachycardia, Edema, Dizzy

Education: Stand/Sit slowly, teach how to take a pulse and check BP, compliance, change positions slowly, avoid grapefruit juice, photosensitivity, good oral hygiene b/c less calcium in the body

Angiotensin Converting Enzyme Inhibitor (ACE)

suffix: -prils

Ex: lisinopril

Treats: Hypertension and heart failure

Action: Dilates the BV to improve the amount of pumped blood, vasodilation leads to sodium and water excretion by blocking aldosterone

Assess: Monitor BP and labs: Potassium, BUN, creatinine

When to hold? If SBP is less than 90

Side effects: Angioedema (face swelling), hyperkalemia, cough, may have allergy

Education: Teach how to take BP, compliance, avoid salt sub, moderation of high potassium food, change positions slowly, take same time every day, do not stop abruptly

Rebound Effect

If I stop taking abruptly, BP skyrockets, sometimes higher than original

Angiotensin II Receptor Blocker (ARB)

suffix: -sartan

Ex: Losartan

Treats: Hypertension, and prevents neuropathy in diabetic pts

Assess: Check BP Monitor for hyperkalemia

Side effects: TOPCARD, Teratogenic, Orthostatic Hypotension, potassium increase, cough (dry), angioedema (face swelling), renal impairment, dizziness

Education: Pregnant women CAN NOT take this medication, so their HCP must be aware of this and they need to notify HCP if they plan on becoming pregnant. Take BP, compliance, avoid salt sub., moderation of high potassium food, change positions slowly, take same time everyday, do not stop abruptly.

Nitrates, Nitroglycerin

suffix: -ate

Ways it can be administered: Creams, Sublingual, PO, Extended Release, transdermal patches, IV

Treat: Angina Pectoris (chest pain)

Action: Promotes vasodilation to coronary arteries and veins

When to hold? If SBP is less than 90

Assess: BP and HR

Side effects: Headaches, hypotension, weakness, nausea, vomiting

Education: Do not take until 24 hrs after taking Viagra, no eating or smoking during administration of sublingual tablets. If taken at home and still experiencing chest pain after one call 911.

Nursing considerations: Give one, assess pain and BP and HR after 5 mins, then give another, reassess, and give another after 5 mins. Can give up to 3 with 15 mins SL to relieve angina pectoris.

Digoxin (lanoxin)

Cardiac glycoside: Positice inotrope + negative chronotrope (has a strong contractility and slows rate)

Allows the heart muscles to contract more efficiently and increase cardiac ouutput

Treats: Hypertension, congestive heart failure, and AFIB

Assess: Apical pulse, and digoxin levels (0.8-2) and potassium levels (3.5-5.0), monitor clients with decreased hepatic (liver) function

Hold: If HR is less than 60

Digoxin Toxicity

Too much digoxin level, can cause bradycardia, nausea, vomiting, headached, arrhythmias, sensitivity to light, visual changes

Treatment: Digibind

Chamomile

Soothes the nervous system, relieving muscle tension, promotes digestion, healing properties, promotes sleep

Cinnamon

benefits type 2 diabetes, supplement for IBS and GI problems, lowers cholestrol

Echinacea

Promotes prevention of cold and flu. Stimulates the immune system

Elderberry

Promote relief from cold and flu symptoms. Take at first sign of cold or flu symptoms. Consult HCP before taking with other medication

Fish Oil

Effective triglycerides, lower BP, promotes healthy skin

Garlic

Promote reduction of total cholestrol. Effective in decreasing BP, reducing heart disease. Antinflammatory properly. Boost metabolism.

Ginger

Helpful for mild nausea and motion sickness. May help with osteoarthiritis and rheumatoid arthiristis. Supports digestive health.

Ginkgo Biloba

Improves Memory, but can not take with anticoagulants because it causes adverse reactions

Melatonin

Helps with sleep

St. John’s Wort

Reduce depression/anxiety

aPTT/pTT

A patient is receiving Heparin therapy for the prevention of deep vein thrombosis (DVT). Which lab value should the nurse monitor to ensure the patient’s safety?

SUBQ tissue in abdomen, in the anterior love handles

A patient is prescribed Enoxaparin (Lovenox) for DVT prevention. The nurse knows to administer the injection in which location?

Increase the Warfarin dosage per provider orders. 1.2 is below the Therapeutic range which is 2-3.

A patient on Warfarin (Coumadin) therapy has an INR of 1.2. What is the nurse’s best action?

Idarucizumab (Praxbind)

A patient taking Dabigatran (Pradaxa) presents with signs of bleeding. Which reversal agent should the nurse prepare to administer?

Vitamin C enhances the absorption of iron. Iron should not be taken with calcium or antacids, and doses should not be doubled.

A patient with iron-deficiency anemia is prescribed oral iron supplements. What should the nurse teach the patient regarding iron supplementation dietary-wise?

Beta-blockers should be held if the patient’s heart rate is less than 60 beats per minute due to the risk of severe bradycardia. Or should be held if SBP is 90 or less

What is a contraindication for administering a beta-blocker such as Metoprolol?

Yellow halos around lights are a sign of digoxin toxicity. The nurse should check the digoxin level before taking further actions.

A patient receiving digoxin reports seeing yellow halos around lights. What is the nurse’s priority action?

"I should eat a small snack before taking Nitroglycerin to avoid nausea."
Rationale: Nitroglycerin should be taken on an empty stomach, and food can interfere with the absorption of sublingual tablets.

A nurse is teaching a patient taking Nitroglycerin sublingual tablets. What is a statement by the patient indicates the need for further teaching?

Statins like Atorvastatin can affect liver function, so it’s important to monitor liver enzymes, including ALT and AST.

A patient is taking Atorvastatin to manage hyperlipidemia. Which lab results should the nurse monitor closely?

Peripheral edema is a common side effect of calcium channel blockers and may require dose adjustment or a change in therapy. While the other findings may also occur, peripheral edema is a significant concern.

A nurse is assessing a patient taking a calcium channel blocker, Amlodipine. Which finding would require immediate intervention?

Dizziness can be a result of orthostatic hypotension caused by beta-blockers. Encouraging the patient to rise slowly can help prevent dizziness and falls.

A patient on a beta-blocker for hypertension reports feeling dizzy when standing. What is the most appropriate nursing intervention?

Digoxin should be held if the apical pulse is less than 60 beats per minute, as it may cause further bradycardia.

The nurse is caring for a patient who has been prescribed Digoxin. The nurse assesses the patient’s apical pulse at 55 beats per minute. What is the most appropriate action?

Stop taking aspirin 7-10 days before. Aspirin inhibits platelet aggregation, and it takes about 7 to 10 days for platelet function to return to normal after stopping aspirin.

A patient taking aspirin for stroke prevention is preparing for surgery in a week. What should the nurse include in the preoperative instructions?

"Salt substitutes often contain potassium, which can increase your potassium levels."
Rationale: Losartan, an ARB, can increase potassium levels, and salt substitutes often contain potassium, which can lead to hyperkalemia.

A patient on Losartan for hypertension asks why they cannot take salt substitutes. What is the nurse’s best response?

If chest pain persists after one dose of Nitroglycerin, the patient should call 911, as it could indicate a heart attack. Nitroglycerin can be taken up to three times in 15 minutes, but emergency care is necessary if the first dose is ineffective.

A nurse is educating a patient about taking Nitroglycerin for chest pain. Which instruction is most important for the nurse to include?