Understanding Blood Thinners

• Blood thinners are generally categorized into three sizes:

  • Small: Antiplatelets (e.g., aspirin, clopidogrel)

  • Medium: Anticoagulants (e.g., heparin, warfarin)

  • Large: Thrombolytics (clot busters like tPA, alteplase)

Antiplatelets (Aspirin and Clopidogrel)

• Purpose: Decrease platelet aggregation to prevent clots.

• Mechanism: Prevent platelets from clumping, akin to spreading plates apart.

• Indications:

  • Prevention of clots in heart (MI) and brain (CVA/TIA)

  • Treating narrowed arteries (e.g., ACS, PAD)

  • Post-surgical prevention (after stent/bypass)

• Important Reminders:

  • HESI Key Term: Post-PCI (Percutaneous Coronary Intervention)

  • Always assess hemoglobin and platelet levels before administering.

    • Hemoglobin < 7 can lead to significant bleeding risk.

    • Platelets levels: Normal range 150-400; < 150 is concerning, < 50 is very dangerous (thrombocytopenia).

• Priority Nursing Action for Low Platelets: Hold the drug, question the prescription, and notify the healthcare provider (HCP).

Aspirin Toxicity

• Initial Treatment: Activated charcoal to bind aspirin and prevent absorption.

• Key Signs:

  • Tinnitus (ringing of the ears)

  • Hyperventilation (indicating salicylate poisoning)

• Important Note: Tachycardia and hypotension are not toxicity signs but indicators of bleeding.

Glycoprotein Receptor Inhibitors (e.g., Eptifibatide)

• Use: Prevention of platelet aggregation post-cardiac procedures.

• Adverse Effects: Similar to aspirin, but risk of severe thrombocytopenia.

Stroke Management

• Key to Stroke Treatment: Time is essential to prevent brain damage; every second counts—"Time is brain."

• Phase Two Goals: Achieve door-to-needle times of under 60 minutes, eventually under 45 minutes.

12 Key Strategies to Improve Stroke Care

1. Pre-notify Hospital: Emergency responders should alert the hospital upon recognizing a stroke.

2. Use a Stroke Toolkit: Streamlines care process and assists physicians.

3. Quick Triage Procedures: Early recognition reduces treatment time.

4. Single Call Activation: Activate the entire stroke team via a single call.

5. Universal Clock: Attach a timer to the patient's chart to monitor time accurately.

6. Direct Transfer to Imaging: If suitable, send the patient directly from triage to CT.

7. Timely CT/MRI: Perform imaging within 25 minutes of arrival.

8. Quick Lab Results: Ensure lab results are available within 30 minutes; use point of care testing if necessary.

9. Prepare Alteplase Ahead of Time: Have the drug mixed and ready for eligible patients.

10. Team Approach: Collaborate for faster decision-making.

11. Feedback and Improvement: Regularly evaluate stroke care processes for enhancements.

Levodopa and Carbidopa (Parkinson's Disease Treatment)

• Primary Purpose: Treatment of Parkinson's by increasing dopamine levels.

• Mechanism:

  • Levodopa: Precursor to dopamine that enters the brain.

  • Carbidopa: Inhibits the breakdown of levodopa, enhancing availability in the brain.

• Side Effects:

  • Dyskinesia (involuntary movements)

  • Orthostatic hypotension (dizziness on standing)

• Patient Education:

  • Start at low doses to avoid toxicity.

  • Monitor for side effects like hallucinations and involuntary movements.

  • Be aware of urinary discoloration (red/brown urine is normal).

  • Avoid high-protein meals which hinder absorption.

Multiple Sclerosis (MS) Overview

• Pathophysiology: MS is an autoimmune disease targeting myelin sheaths (fatty tissue) surrounding nerves, impairing movement.

• Symptoms:

  • Muscle spasms and stiffness

  • Fatigue

  • Muscle weakness

  • Numbness, tingling in limbs

• Management:

  • Balance exercise with rest to combat fatigue.

  • Avoid extreme temperatures and stressors to prevent flare-ups.

• Diagnostics: MRI or CT scans show brain plaque; lumbar puncture reveals elevated antibodies.

Conclusion: Master the detailed mechanisms, indications, and side effects associated with each medication type to effectively manage patient care in clinical scenarios and prepare for examinations. Stay updated on optimal protocols for urgent conditions like stroke, ensuring best practices for time-sensitive interventions.