Exam 2 Chapter 26 drugs used to treat thromboembolic disease

Term Definition
Thromboembolic Diseases ? Diseases associated with abnormal clotting within blood vessels which form a clot or thrombus
An embolus is created when fragments of a thrombus break off and circulate until trapped in a capillary
Clotting cascade is activated when a blood vessel is injured, or with increased viscosity
?Intrinsic clotting pathway is activated when there is damage to the blood vessel.
Extrinsic clotting pathway is activated when there is damage outside of the blood vessels, usually to tissues
Examples and Risk Factors for Thromboembolic Disorders ?MI/ DVT / Embolic Stroke / Pulmonary Emboli / Knee or Hip Surgery / Trauma / Long Automobile or Plane Rides / Pregnancy or Oral Contraceptives
Laboratory Tests for Thromboembolic Diseases PT (prothrombin time) – evaluates extrinsic system – Monitors warfarin therapy / aPTT (activated partial thromboplastin time)- evaluates intrinsic coagulation – Monitors heparin therapy / INR (International Normalized Ratio) – Monitors warfarin therapy
Nonpharmacologic Treatment of Thromboembolic Diseases ? Prevention of conditions that cause clots to form:: Immobilization with venous stasis / Surgery, trauma to lower limbs / Heart failure, vasospasm / Cancers of the lung, prostate, stomach, pancreas / Pregnancy, oral contraceptives
Ways to prevent stasis: leg exercises, wearing stockings, leg elevation, sequential, compression devices
Drug Class: Platelet Inhibitors Actions ?Inhibit platelet aggregation
Drug Class: Platelet Inhibitors Uses ? Primary prevention of MIs and stroke; prevent blood clots from forming
Drug Class: Platelet Inhibitors Common adverse effects ? effects include Abdominal distress, hypotension
Drug Class: Platelet Inhibitors Serious adverse effects ? Neutropenia, agranulocytosis, bleeding ?With clopidogrel: Thrombotic thrombocytopenic purpura ( T T P )
dipyridamole (Persantine), specifically Platelet inhibitor. Drug Class: Platelet Inhibitors.
clopidogrel (Plavix), Drug Class: Platelet Inhibitors. severely reduces platelets – T h r o m b o tic t h r o m b o c y t o p e nic p u r p u r a ( T T P )
fondaparinux (Arixtra) Drug Class: Anticoagulants (LMWH) prototype
Drug Class: Anticoagulants (LMWH) Actions ? Low-molecular–weight heparin (LMWH)
Drug Class: Anticoagulants (LMWH) Uses ? Prevent deep vein thrombosis after hip replacements or abdominal surgery; prevent MIs, combined with aspirin
Drug Class: Anticoagulants (LMWH) Common adverse effects ? effects include Hematoma formation, (inject slowly and alternate sites Q 24 hours) bleeding at injection site . do not rub.
Drug Class: Anticoagulants (LMWH) Serious adverse effects ? effects include Bleeding, thrombocytopenia
Contraindications Anticoagulants do not give to anyone with low platelets or uncontrolled bleeding.
enoxaparin (Lovenox) Anticoagulant.. Subq into anterolateral or posterolateral abdominal wall q 12-24 h / Don’t expel air bubble in the prefilled syringe prior to injection/ Inject entire needle into skinfold leaving needle in place for 10 sec after injection ? Don’t rub ?
Anticoagulants heparin – Actions ? antithrombin III neutralizes thrombin, factors IXa, Xa, XI, and XII, as well as plasmin
Anticoagulants – Heparin Uses ?Treat deep vein thrombosis, pulmonary embolism, cerebral embolism
Anticoagulants – Heparin nursing implications Can be given subcutaneously, IV push, IV infusion ?Dosages vary depending on route ?Monitor aPTT, platelets, hematocrit
Anticoagulants – Heparin Common adverse effect ? effects include Bleeding or hematoma at injection site
Anticoagulants – Heparin ?Serious adverse effects effects include ?Bleeding ?Mucous membranes, skin, urine and stools, thrombocytopenia, internal bleeding
Protamine Sulfate Heparin's Reversal agent is
Heparin Administration ? Therapeutic range: aPTT is 1.5-2.5 times control. Subq injection into abdomen, don’t massage site, alternate sites, use 90-degree angle, apply gentle pressure after
Heparin administration Confirm calculation with another nurse ?Be certain dose strength is correct/ Monitor ecchymotic areas ?Monitor VS (if HR up or BP low, may be clue that pt is bleeding ?Remember that PTT is used to monitor Heparin given IV, not sq.
Drug Class: Anticoagulants ?Drug: warfarin (Coumadin Action: ) inhibit activity of vitamin K, which activates certain clotting factors
Drug Class: Anticoagulants ?Drug: warfarin (Coumadin) Uses: treatment/prophylaxis of DVT, embolization from atrial fibrillation or heart valve replacement, pulmonary embolism
Drug Class: Anticoagulants ?Drug: warfarin (Coumadin) Target: INR of 2-3 for patients with atrial fibrillation, stroke, MI, and DVT ?INR of 2.5-3.5 for patients with mechanical heart valve device
Drug Class: Anticoagulants ?Drug: warfarin (Coumadin) Adverse effects: ? bleeding, Skin, mucous membranes ?Internal bleeding ?Urine and stools ?Menstrual flow ?Surgical dressings and drains
Drug Class: Anticoagulants ?Drug: warfarin (Coumadin) Contraindicated in pregnancy . Antidote: discontinue use, vitamin K . many drug interactions
Drug Class: Anticoagulants ?Drug: warfarin (Coumadin)
Important Use of Persantine and Coumadin for mechanical valves
Patient Education for Anticoagulation Therapy Diet and nutrition – Limit or maintain same intake of leafy green veg/ Drink 8-oz of fluid daily/ activity to prevent venous stasis / May use soft toothbrush, avoid aspirin products /Do not flex knees or place pressure under knees/ move around?
Factor Xa inhibitors ? Knee surgery (give for 12 days post op), Hip replacement (give for 35 days post op) , Can’t give if Creatinine Clearance is less than 30 ml/min
Factor Xa inhibitors Revaroxaban (Xarelto) ?and st johnswart work against it
Drug Class: Thrombin Inhibitor
?Drug: dabigatran (Pradaxa) Action:
direct thrombin inhibitor, prevents conversion of fibrinogen to fibrin
Drug Class: Thrombin Inhibitor
?Drug: dabigatran (Pradaxa) Uses:
reduce risk of stroke with non-valvular atrial fibrillation
Drug Class: Thrombin Inhibitor
?Drug: dabigatran (Pradaxa) Premedication assessment
: assess for bleeding, monitor labs, assess for pregnancy ?Safety alert ?Capsules must be swallowed whole and are sensitive to moisture ?Bottle must be used within 30 days
Drug Class: Glycoprotein IIb/IIIa Inhibitors ?Actions ?Block receptors on platelets, preventing aggregation and clot formation
Drug Class: Glycoprotein IIb/IIIa Inhibitors Uses ? Prevent clots forming from the debris often released during percutaneous coronary intervention (PCI) procedures
Drug Class: Glycoprotein IIb/IIIa Inhibitors Serious adverse effects ?effects include Bleeding, thrombocytopenia
Drug Class: Fibrinolytic Agents ?Actions ?Stimulate the body’s own clot-dissolving mechanism, converting plasminogen to plasmin, which digests fibrin
Drug Class: Fibrinolytic Agents Uses ? Dissolve fibrin clots secondary to coronary artery occlusion (MI), pulmonary emboli, cerebral emboli, deep venous thrombosis/ ?Works best on lysing recently formed thrombi
Drug Class: Fibrinolytic Agents Drugs: streptokinase, alteplase (Activase), reteplase (Retavase), tenecteplase (TNKase)