MedicationsthatTreatBloodDisordersWeek2recorded.pptx

Drugs Affecting the Blood

NSG 220

by Unknown Author is licensed under

Types of Drugs

Thrombolytics

“Clot Busters”

Highest Bleed Risks

Anticoagulants

Treat and prevent thrombosis “clot”

MOA (mechanism of action)- Inhibits Vit. K in the liver that interferes with the blood clotting mechanism by blocking thrombin

Antiplatelets

Lower platelet aggregation

Mechanism of action- prevent platelets from clogging up

Antiplatelets

Indicated for: Ischemic strokes, TIA (transient ischemic attacks), unstable angina, coronary stenting, Acute MI, previous MI & prevention of MI

Aspirin “salicylic acid” ASA

PO, IV and rectal preparations

Too much “ASA toxicity”

Tinnitus- ringing in ears- high doses or long-term use

Elevated blood pressure and tachycardia –possible bleed

Contraindicated for patients with thrombocytopenia

Clopidogrel (Plavix)- po only

Indicated for: Strokes (CVA), prevent stenosis of coronary stents

Takes effect with 2 hrs. of the first dose, peak effect 3-7 days of treatment

Administered with PPI (proton-pump inhibitors) such as Omeprazole to prevent GI bleeding, however, can also reduce the efficacy of Clopidogrel

Discontinue at least 5 days before surgery d/t bleeding risk

Dipyridamole (po & IV)

Indicated for prevention of thromboembolism following heart valve replacement

given w/other antiplatelets- Aspirin

Aside effects- headache, dizziness, & GI disturbances

Ticlopidine (po)

Indication: CVA prevention and coronary artery occlusion

Can be given with aspirin or for patients who can not take aspirin

Platelets (thrombocytes) are cells in the blood that clump together to begin the clotting process. They are the first responders when there is injury. They also initiate the inflammatory response of the innate immune system. The four main platelet functions are:

Antiplatelets

Prevent platelets from forming clots, DO NOT decrease the number of clots

Indication: post MI/ACS or to prevent MI, CVA, TIA, PAD (peripheral artery disease) & prevent re-occlusion of vessels

Before you administer the medication

Monitor labs

Hemoglobin- if less than 7

Platelets – (150,000-400,000)

***less than 150K- Call the provider, *less than 50K- Urgent

Hold the medication for abnormal labs, Notify the provider

Anticoagulants

Drugs used to prevent and treat “thrombosis”

Venous thrombi “stagnate” develop when blood flow is slow – when blood settles, fibrin is produced causing the red blood cells and platelets to form a thrombus.

Thrombosis- 2 types

Venous-blood clot in the vein

Venous thrombus has a tail that can break off causing an embolus

Embolus can travel to the lungs causing a pulmonary embolism

Arterial- blood clot in the artery.

Harmful effects are local causing blockage and decrease perfusion to area or organ(s)

Anticoagulants

Used for: prevention growth of “existing clots and/or new clots”

Do not dissolve clots

Indicated for: prevention of DVT

MOA: blocks the formation of fibrin (forms seals on clots)

Administration: IV or subcutaneous

Monitor Labs: pTT (46-70)

(the lower the number the thicker the blood, the higher the number the thinner the blood)

**Dosage of medication will be based on these labs.

Anticoagulant Drugs

Heparin (Administered IV or subcutaneous

MOA: Activation of antithrombin, resulting in the activation of factor Xa and thrombin

Prescribed short-term (days to weeks)

Works quickly within minutes (usually 20mins)

Usually given for DVTs or after MI (heart attack) to prevent clots from growing

Low Molecular Weight heparin (Enoxaparin and Dalteparin)

MOA: Activation of antithrombin, resulting in the activation of factor Xa and thrombin and some activation of thrombin

Administered subcutaneous only (never aspirate or rub the site)

Patient can administer this medication at home

Assess H & H (hemoglobin and hematocrit) and blood pressures that drop by 20 points

Monitor platelets – ***HIT**

Warfarin (po only)

MOA: Activation of antithrombin, resulting in selective inactivation of factor Xa

Takes days to take effect (usually 5 days) but last a long time once taken

Life-long therapy – Most patients have to take it rest of their life was started

Monitor labs for frequently (daily for 5 days) for therapeutic ranges (INR, but also Prothrombin time (PT)

Clinical Pearl- A patient who is started on heparin in the hospital can start taking coumadin. They CAN be taken at the same time.

Patients who take warfarin will often be referred to coumadin clinics. Where there labs are monitored frequently

Monitor for HIT (half of the platelets are decreased with 24 hours after starting heparin/low molecular heparin

Monitor

Labs

Heparin – monitor aPTT

If ptt is over 70 stop the heparin drip

Any signs of bleeding (iv site, urine) stop the infusion- notify provider

Antidote – protamine sulfate

Warfarin- monitor INR

Antidote – Vitamin K ***do not give Vit K unless the patient has had warfarin for 5 days (after switching from IV Hep)

Teach patient to eat vit K in moderation when eating.

Eat leafy green vegetables and foods such as liver.

Bacteria in the intestine produces vitamin K. When antibiotics are taken, they kill the bacteria and

Antibiotics increase INR.

Thrombolytics

Used to treat emergency conditions: CVA (cerebral vascular accident), MI (myocardial infarction, PE (pulmonary embolism) & other conditions (i.e., clot removal from central line or dialysis catheter)

Medications: Alteplase, Reteplase, Tenecteplase

MOA: break down, or lyse of fibrin in thrombi (usually dissolve newly formed clots)

Administration: IV only

**only drug that dissolves clot**

Usually given within 3-4.5 hours from onset of symptoms

No new injections at all. The IV’s (usually 2) is what you will use. No other injections. Never through central lines

If you make the H for heparin it looks like 2 tt’s crossed. You can use this to remember which lab to watch

Memory Tricks

Anticoagulants

Platelets 150K-400K

<150 K

<50 K critical low = “Thrombocytopenia”

Heparin

pTT – “2 t’s make the letter H”

46-70 pTT

Warfarin (in=“IN”r)

INR 2-3 Therapeutic Range

Antiplatelets – monitor “platelets”

clopidogrel

Aspirin

Abciximab

Memory Tricks (cont.)

AVOID any patients with active bleeding

with liver problems because liver makes coagulation factors (vitamin K). No vitamin K (clotting factor= risk of bleeding)

Peptic ulcers (bleeding)

Think about any situations that can cause or a concern for bleeding (i.e., medications, disease process, sign or symptoms of bleeding)

Patient teaching

Safety

Environment (situations in which patient can injure themselves) rugs, dim rooms

Patient care

Soft bristle toothbrushes, no razors, no flossing, avoid constipation, no alcohol-based mouth wash,

Always wear a medical alert bracelet

Avoid trauma where injuries can occur

MedicationsthatTreatBloodDisordersWeek2recorded.pptx

MedicationsthatTreatBloodDisordersWeek2recorded.pptx

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