Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

heparin

#1. ________

Inactivates clotting factors thrombin and factor Xa through the increased activity of antithrombin

Critical adverse effect:

#2. __________________

**Critical Allergic reaction**

#3. _____________

Monitor(labs): #4. ____________

Reversal/antidote:

#5. _____________

Administered Route:

#6. (2 answers)_______________

Apixaban (Eliquis)

Anticoagulant

inhibits platelet aggregation (factor Xa) induced by thrombin. 

Critical adverse effect:

#7. ________________

1. Increased risk of hemorrhage in pregnant patients

2. Increased risk of bleeding in patients with renal impairment

Warfarin (Coumadin)

#8. ___________

Decreases the production of vitamin K-dependent clotting factors. (Vit K synthesis)

· bruising

· ____#9_______ (after long term use)

Monitor(labs): INR (2-3 is normal)

Reversal/antidote:

#10. ____________

Nursing Implications:

Avoid in pregnancy or breast feeding

Frequent monitoring of PT and INR

enoxaparin (Lovenox)

anticoagulant

#11. _____________

· Critical adverse effect is hemorrhage

· Critical allergic:

· #12 ________ (induced by**hint)

Monitor(labs): #13 __________

Antidote: #14 _______________

fondaparinux

#15 ______________

#16 ______________

1. Can cause epidural bleeds.

Labs to monitor: None

Nursing Implications:

· Avoid giving in patients with decrease level of consciousness, complains of back pain or is paralyzed.

· Do not administer to patients for at least 6 hours after #17_______or with a #18__________ epidural

Rivaroxaban (Xarelto)

Apixiban (Eliquis)

Edoxanban (Savaysa)

Anticoagulants

Inhibits factor Xa

Risk for neurological impairment

Lab monitoring: No routine clot studies

Nursing Implications:

· Avoid over the counter medications (Vit E, ginkgo biloba, fish oils, garlic, NSAIDS)

· Teach patients to avoid bleeding by doing the following: (3 examples)___#19______

Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

Aspirin (Acetylsalicylic Acid)

Indication: Reduce risk of CVA, TIA, prevent of MI

Treatment during episodes of unstable angina and MI

Prevention: occlusion of stents

#20. __________

Decrease platelet aggregation

Side effect:

· #21_________(given in high doses)

· Bruising

· Gastric upset

Adverse reaction:

· GI bleed

· hemorrhagic stroke (uncontrolled HTN)

Monitor(labs): platelets

Antidote for ASA toxicity: #22 _______(There are 2 optional answers that will be accepted.

Monitor for signs of: ***toxicity – tinnitus, hyperventilation,

Clopidogrel (Plavix)

Antiplatelet

#23 _________

Side effect:

· diarrhea

· gastric discomfort

Adverse Reaction:

· bleeding

· #24 ________

Monitor (labs):

#25 __________

Administered: po

Abciximab

Indicated: after cardiac procedures

Antiplatelet

(Glycoprotein (GP) receptor inhibitors)

Blocks GP IIB/IIIa receptors that stop platelet aggregation

Critical adverse reaction:

· hemorrhage

· Thrombocytopenia

Monitor: hgb & Platelets

***Assess for bleeding in

1. #26 _____

2. #27_______

3. IV insertion sites

Nursing Implications

4. ECG changes

5. No needle sticks or new IV injections

Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

tPA

Alteplase

Streptokinase

Thrombolytics

Break down, or lyse or existing clots

1. Bleeding

Severe Effect:

1. Severe bleeding

Administered: #28 _(route)_ ONLY

Nursing Implications:

1. Monitor for mental status changes

2. No new IV, ABGS

3. Never give through a (route) #29 _________.

4. Do not give within 2 weeks of surgery

5. Do not give to patients with active #30 _______

6. Can only be administered from #31______ hours from onset of symptoms

7. Monitor for cardiac changes/dysrhythmias

8. Uncontrolled hypertension or b/p (180/110)

Drug

Drug Class

Mechanism of Action

Adverse Effects

Nursing Implications

Erythropoietin Alfa

Hematopoietic Agents

#32_____________

· #33 ________

· Cardiovascular events- MI, CVA, DVT

Monitor (labs):

#34 _____ & _______

***Iron levels- key ingredient with the production of RBCs

Nurse Implications:

1. Monitor: #35 (hint: which main vital sign) during therapy

2. Do not administer if hemoglobin 10-11

Filgrastim

Indicated for Neutropenia

Hematopoietic Agents

Increase production of neutrophils (in the bone marrow)

· Enlarge spleen

· __#36___ pain

· Leukocytosis

Monitor baseline (labs):

CBC and platelet counts

Administered: IV & subQ

Oprelvekin

Hematopoietic Agents

Simulate platelet production

· #37_______ (sign of fluid overload)

· anemia

· Cardiac dysrhythmias

Severe Reaction:

· Anaphylaxis

Administered: #38 _____

Monitor (labs): platelet counts, electrolyte status

Nursing Implications:

· Fluid retention: Teach patient to contact provider if symptoms worsen.

· Use with caution in patients with cardiac history- a-fib, a-flutter

Iron Sulfate

Iron deficiency anemia, dietary supplement (prevention)

Hematinic Agents

Replacement of iron which is critical for hemoglobin function

Adverse Reaction

· #39_______**

· Nausea

· Dark Tarry stools

Serious Side effect with IV route:

#40_______

Patient Teaching

1. Take with vitamin

#41_______ source.

2. Infusion: Give a test dose when administering #42 (which route). Keep epinephrine on h and for anaphylaxis.

3. Teach patient to increase fiber and drink plenty of fluids to reduce constipation

Folic Acid

Indicated:

Folic acid anemia, dietary supplement

Hematinic Agents

Replacement for folic acid

1. Nausea

2. Flatulence

3. Rash

1. Teach patient dietary/lifestyle changes:

– Increase consumption of foods high in #43_______ (e.g., green vegetables, liver).

2. If alcoholism underlies dietary deficiency, offer counseling for alcoholism, as well as dietary advice. “

Vitamin B12

Hematinic Agents

Replacement Vitamin B12 anemia,

Dietary supplement, absence of intrinsic factor

1. Headache

2. Nausea

Serious Adverse Reaction

1. #44________** (low lab value)

2. Pulmonary edema

3. Anaphylaxis

1. Labs to Monitor: ***Serum ___#45___

Teach patient s/s of hypokalemia and instruct them to contact provider immediate.

2. Treatment duration- is #46 (how long)