AFIB – PVD PHARMACOLOGY Study Notes

AFIB – PVD PHARMACOLOGY

Overview

  • Presenter: Penni Merrick, MSN Ed, RN
  • Reviewers: E. Hopson, RN, MSN-Ed, CNE & L. Templeton, DNP

Statins: Hyperlipidemia Lowering Agents

Mechanism of Action

  • Statin medications decrease cholesterol production in the liver.
  • Atorvastatin specifically enhances the number of LDL receptors on hepatic cell surfaces, resulting in decreased LDL levels in the bloodstream.

Medications

  • Atorvastatin is a primary example of a statin used in clinical practice.

Client Education

  • Patients should alert their medical doctor (MD) if they experience:
    • Prolonged muscle aches
    • Joint aches
    • Muscle tenderness
  • Such symptoms may require:
    • Holding the medication
    • Reducing the dosage
    • Switching to another medication
  • Patients taking Warfarin should understand that:
    • Clotting times may be prolonged while on statin drugs.
  • Importance of diet and exercise as adjuncts to pharmacological treatment for hyperlipidemia.

Nursing Implications

  • Monitor Liver Function Tests (LFT) and Lipid Panel:
    • Baseline assessment followed by re-evaluation at 6 weeks.
  • Be aware that rhabdomyolysis has been reported in patients taking atorvastatin.

Anticoagulant Agents

Mechanism of Action

  • These agents deplete functional vitamin K reserves, thereby reducing the synthesis of active clotting factors.

Medications

  • Warfarin is a commonly prescribed anticoagulant.

Client Education

  • Patients should observe for:
    • Signs of bleeding that does not stop.
    • Eliminate risks for falling, which could exacerbate bleeding.

Nursing Implications

  • Monitor for signs of abnormal bleeding, including but not limited to:
    • Gastrointestinal (GI) bleeds
    • Hematemesis (vomiting blood)
    • Intraocular bleeding.
  • Regularly check Prothrombin Time (PT) and International Normalized Ratio (INR) levels at least three times a week, aiming for a therapeutic range of [2,3][2, 3].

Platelet Aggregation Inhibitors

Mechanism of Action

  • These medications prevent activation of glycoprotein IIb/IIIa receptors, reducing platelet aggregation (the clumping together of platelets).

Medications

  • Clopidogrel is a representative platelet aggregation inhibitor.

Client Education

  • Patients should be vigilant about:
    • Signs of bleeding that does not stop.
    • Risks associated with falling.

Nursing Implications

  • Note that there is no reversible agent or antidote for clopidogrel.
  • Monitor for abnormal bleeding including:
    • GI bleeds
    • Hematemesis
    • Intraocular bleeding.
  • Regularly check Hemoglobin and Hematocrit levels to assess for blood loss.

NSAIDs: Aspirin (ASA)

Mechanism of Action

  • Similar to platelet aggregation inhibitors, aspirin prevents activation of glycoprotein IIb/IIIa receptors, thereby reducing platelet aggregation.

Medications

  • Aspirin (ASA) is a prominent NSAID used in this capacity.

Client Education

  • Patients should monitor for:
    • Signs of bleeding that does not stop.
    • Gastrointestinal upset, which can escalate to GI bleeding.
  • Advise patients with an allergy to ibuprofen that they should not take aspirin.

Nursing Implications

  • Monitor for signs of abnormal bleeding, particularly:
    • GI bleeds
    • Hematemesis
    • Intraocular bleeding.
  • Be aware that ASA increases the risk of intracranial bleeding.
  • Symptoms of mild toxicity from aspirin can include:
    • Tinnitus
    • Dizziness
    • Lethargy
    • Nausea
    • Vomiting

Low Molecular Weight Heparin (LMWH)

Mechanism of Action

  • LMWH works by binding to and potentiating antithrombin III, thereby forming a complex that irreversibly inactivates factor Xa.

Medications

  • Enoxaparin is a commonly used LMWH.

Client Education

  • Patients should be vigilant for signs of bleeding that does not stop and report:
    • Gastrointestinal upset leading to GI bleeding.

Nursing Implications

  • Protamine is the antidote for LMWH.
  • Ongoing monitoring for abnormal bleeding events such as:
    • GI bleeds
    • Hematemesis
    • Intraocular bleeding.
  • Additional observations include:
    • Nausea
    • Headache
    • Confusion
    • Injection site irritation or pain.
  • Dose adjustments should be made for:
    • Advanced age
    • Renal insufficiency.
  • Typical therapeutic dosing is 1 mg/kg every 12 hours; adjustments are needed for patients older than 75 years.

Activated Factor Xa Inhibitor

Mechanism of Action

  • This class of medications prevents the progression of the coagulation cascade through the final common pathway, inhibiting thrombin generation and thereby prolonging clotting times.

Medications

  • Rivaroxaban represents this category of anticoagulant.

Client Education

  • Patients should be aware of:
    • Signs of bleeding that does not stop.
    • Gastrointestinal upset leading to GI bleeding.
  • Monitoring of liver enzymes is necessary.

Nursing Implications

  • Andexanet alfa serves as the antidote for rivaroxaban.
  • Monitoring for abnormal bleeding signs:
    • GI bleeds
    • Hematemesis
    • Intraocular bleeding.
  • Before initiating treatment, patients should undergo a screening for:
    • Bleeding disorders
    • Coagulation profiles
    • Hepatic or renal impairments.
  • Routine coagulation testing is not necessary for patients on rivaroxaban.