8.1: Blood (Anticoagulant/anemic/lipidemia/angina) - Exam 2

heparin class

anticoagulant

heparin dynamics

act on intrinsic and common pathways, blocks factor X

heparin nursing interventions

target lab aPPT Q6H (should be 60-80 sec). antidote protamine sulfate

heparin indications

DVT, PE, a-fib, patiency of central lines, cardiac cath, disseminated intravascular coagulation (DIC)

heparin adverse effects

low platelets

enoxaparin class

anticoagulant, low molecular weight

enoxaparin dynamics

stop IIa and Xa, reduce clot formation and blocks clot growth. bruising is common side effect

enoxaparin nursing interventions

does not cross placenta, monitor aPTT if variable response is anticipated. safe, given outpatient

warfarin class

anticoagulant

warfarin dynamics

inhibit vitamin K dependent clotting factors, no effect on platelet function.

warfarin nursing interventions

monitor PT (prothrombin time) for therapeutic levels + INR. bleeding adverse effect. watch vit K intake

warfarin indications

prevent clotting in DVT, PE (pulm. embolism), afib, valve

rivaroxaban class

anticoagulant

rivaroxaban dynamics + kinetics

block Xa, long acting, hard to reverse

rivaroxaban nursing interventions

does not require frequent testing, watch in liver and renal disease, watch for thrombocytopenia, target lab platelets

rivaroxaban interactions

few food/alc, lots of drug interactions

clopidogrel class

antiplatelet

clopidogrel dynamics + kinetics

inhibit platelet aggregation, daily dosing.

clopidogrel indications

stent patients

clopidogrel nursing interventions

give with food, harder to reverse than warfarin

clopidogrel effect risks

bleeding, neutropenia

clopidogrel interactions

warfarin, fluvastatin, NSAIDS, tamoxifen, tolbutamide, torsemide (uh. three t’s)

alteplase class

recombinant thrombolytic

alteplase dynamics

act as endogenous tPA (tissue plasminogen activator), converts plasminogen to plasmin (plays part in fibrinolysis)

alteplase indications

acute MI, acute cerebrovascular accident

alteplase contraindications

recent surgery, active internal bleeding, severe uncontrolled HTN

thrombolytic drug examples

alteplase, urokinase, streptokinase, reteplase (enzymes!)

alteplase nursing interventions

monitor bleeding, should be connected to cardiac monitor

erythropoietin (epogen, procrit) class

anti-anemic hormone

erythropoietin dynamics

stem cell stimulator, stimulate bone marrow to produce RBC

erythropoietin indications

anemia from chemo, renal failure, AZT use (HIV)

erythropoietin adverse effects

can increase risk of MI. can cause fever, headache, cough, rash, edema, vomiting, diarrhea, nausea.

iron class

anti-anemic

iron interactions

vit C aids absorption. Antacids, H2 blockers, PPI reduce absorption. blocks gabapentin, cefdinir, synthroid

iron side effect

constipation

cholestyramine class

bile acid sequestrant antihyperlipidemic

cholestyramine dynamics

stop bile salt reabsorption, body produces more bile salt

cholestyramine kinetics

blocks absorption of other meds, acts in the gut

cholestyramine SE

GI, bleeding w/ long use, lowers glucose, interfere vit A, D, E, K absorption

niacin class

nicotinic acid antihyperlipidemic, water soluble vitamin

niacin dynamics

increase HDL, lower LDL + triglycerides

niacin SE

flushing, altered liver function, increase uric acid, GI, dizzy + nervous, pruritus (itchy)

statin drug class

Hmg-CoA reductase inhibitors

statin dynamics

inhibits HmgCoA → limits cholesterol synthesis

statin SE

GI, muscle aches (myalgia), hepatic dysfunction, lens opacities, rhabdomyolysis (muscle breakdown, sx. myoglobin in blood → renal failure, dark urine, muscle swelling)

statin nursing interventions

monitor liver function ALT/AST, CK serum for rhabdomyolysis

statin interactions

grapefruit, itraconazole, erythromycin, warfarin

statin contraindications

active liver disease, pregnancy

fenofibrate/gemfibrozil classes

fibrinic acid derivative

fenofibrate/gemfibrozil dynamics

increase lipolysis, drop triglyceride (TG) production

fenofibrate/gemfibrozil indications

high TG

fenofibrate nursing interventions

daily dosing, watch with severe renal disease, could cause liver damage + gallstones

evolocumab class

PCSK9 inhibitor antihyperlipidemic, Mab

evolocumab dynamics

inactivate PCSK9 enzyme in liver, more LDL breakdown, very effective but expensive

nitroglycerin class

nitrate antianginal

nitroglycerin dynamic

potent vasodilator, lowers myocardial oxygen demand + decreases preload, relax arteries and veins

nitroglycerin nursing interventions

SL or spray used in acute episodes, sustained released, tolerance - need 10-12 hour drug free period daily if patches, do not take SL if recent viagra dosing

nitroglycerin adverse reactions

vasodilation → flushing, headache, hTN, weakness, vertico, syncope, reflex tachycardia, skin irritations

nitroglycerin contraindications

SL → recent viagra dosing, hypersensitivity, severe anemia, hTN, hypovolemia

other treatments for angina

beta blockers, Ca+ channel blockers