chapter 9 cardiac pharm

adverse effects of heparin

-Bleeding,

- heparin-induced thrombocytopenia (HIT).

nursing implications of heparin

- monitoring platelets

-aPTT and PTT

what is the reveal agent of heparin

protamine sulfate

what is the action of warfarin

- helps us not clot

- keeps blood thin

pharmacokinetics of warfarin

PO med

adverse effects of warfarin

- bleeding

- hemorrhage

black box warning for warfarin

- fetal bleeding

- not given to pregnant women

contraindications of warfarin

- GI ulcers / bleed

- intracranial hemorrhage

- hypertension

- caution with alcoholism

nuring implications of warfarin

- LOTS of drug interactions

- frequent monitoring

(normal INR around 1; Goal with warfarin -> 2-3 )

- diet changes: foods with vitamin k; leafy greens, acts like a reversal of med

when is vitamin k (oral or iv) given to reverse warfarin

in pts with no active bleeding, but INR is greater than 5

If pts INR is 9, what should you do to reverse

-EMERGENT

- give Prothrombin complex concentrate (PCC)

-PCC is expensive

- or Fresh frozen plasma (FFP)

patient education for all anticoagulants

- bleeding

-ecchymosis (increase bruising)

- bleeding gums

- hypotension; lightheadedness

- labs: low hemoglobin, low hematocrit

- bloody / dark urine

-hemoptysis (coughing up blood)

- prolongation of bleeding (nose bleeds)

patient education for all anticoagulants continued

- dyspepsia (heart burn)

- nausea

- upper abdominal pain

- GI hemorrhage

- diarrhea

-NSAID use discourage d/t risk of bleeding

what do anti platelets do

-inhibit platelet aggregation

- adhesion

- activation

- makes platelets more slippery so they don't stick together

what class is clopidogrel

Antiplatelet

what is the pharmacokinetics of clopidogrel

loading oral dose

use of clopidogrel

- atrial fibrillation

- prevention of heart attacks

- after heart attack treatment (stent)

- PATIENT CANT STOP TAKING THIS MED

what class is aspirin

Antiplatelet

what is the pharmacokinetics of aspirin

-DOSE DEPENDENT

- baby aspirin (81 mg) used for anti platelet effects

- higher doses used for inflammation or fevers

use of aspirin

- prevention of heart attack

- after heart attack treatment (stent)

adverse effects of aspirin

bleeding

patient education of aspirin

- teaching the difference between baby aspirin compared to other NSAIDS

what class is eptilfibatride

anti platelet

use of eptilfibatride

- during heart attack treatment (stent)

- usually with aspirin

Dabigatran/Bivalirudin

-direct thrombin inhibitors

- used for unstable angina prior to stent intervention

-less monitoring, more predictable, no risk of heperain induced thrombocytopenia

- less strong than heparin and warfarin

Rivaroxaban and Apixaban

-Factor Xa inhibitors

- inhibits platelets preventing thrombin formation

- less monitoring, more predictable, no risk of heperain induced thrombocytopenia

- less strong than heperain and warfarin

what do thrombolytics do

given to dissolve thrombi

uses of thrombolyitcs

- acute heart attack

- acute pulmonary embolism

- acute ischemia

goals for thrombolytics

-reestablish blood flow as quick as possible

- only given with specially trained nurses

- need baseline labs for this pt to ensure no risk of bleeding; INR, PTT etc

what do thrombolytics end in

- ase

pharmacokinetics of thromblytics

IV

adverse effects of thrombolytics

- bleeding!!

-angioedma

- if given for ischemic stroke'; risk for brain hemorrhage

nursing implications for thrombolytics

- avoid iv sticks, NG tubes

- monitoring: neurological checks, labs, bleeding, angioedma

-TEACHING: pts use soft bristle toothbrush

what are the symptoms of arterial thrombi

- dependent on where the clot is blocking blood flow to

- brain = cerebral vascular accident or stroke

- coronary arteries = myocardial infarction

what is an incomplete blockage

deficient blood flow = ischemia (cold to touch_

what is complete blockage

obstruction = necrosis (tissue death)

when are anticoagulants used

- thrombotic disorders (more effective in preventing venous thrombus)

- does NOT dissolve clots

- concern for bleeding

when are anti platelets used

-used to prevent arterial thrombosis

- concern for bleeding

When are thrombolytics used?

- dissolve thrombi and limit tissue damage in thromboembolic disorders

- concern for bleeding

use of heparin

- prophylactic (5,000 units)

- pulmonary embolism

- DVT

what is heparin included thrombocytopenia

- life threatening

- decrease in patients platelet count

- if you see this trend stop heparin and change drug

- these patients should never use heparin again

contraindications of heparin

- GI ulcers/ bleeding

- intracranial hemorrhage

- hypertension (cause bleeding risk)

- treat HTN before giving heperain

- caution with alcoholism (bleeding risk)

- history of heparin included thrombocytopenia

BLACK BOX WARNING FOR HEPARIN

SLOW IV INFUSION!!!

- 10 minutes

What is enoxaparin?

- similar uses as heparin

- less monitoring

- used prophylactically in pts on bed rest

- still a risk for heparin included thrombocytopenia

- monitor platelets

- given SubQ with air in syringe

uses of warfarin

- LONG term prevention or management of:

1. DVT

2. pulmonary embolism

3. atrial fibrillation

4. prosthetic heart vales

what is an arterial thrombi (clot) associated with

athersosclerosis (plaque), HTN

venous thrombi is associated with what

venous stasis

what can happen with venous stasis

deep vein thrombosis

what are the symptoms of DVT

- could be asymptomatic

- have swelling and pain on that leg

- were are concerned about this traveling to the LUNGS

- can lead to pulmonary emboli

what class is heparin

anticoagulant

what is the action of heparin

prevent clot formation

pharmacokinetics of heparin

only IV or SubQ injection