Term
| Mechanism of action for Heparin. |
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Definition
| Binds to antithrombin, enhancing its ability to inactivate both thrombin and factor Xa. This suppresses formation of fibrin. Heparin's effects are fairly quick and duration of action is brief. Protamine sulfate is used for overdose. |
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Term
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Definition
| Preferred for situations w/ pulmonary embolism (PE), evolving stroke, and deep vein thrombosis (DVT). Used in pts having open heart surgery and renal dialysis. Low dose therapy for post-op prevention of venous thrombosis. Treatment for disseminated intravascular coagulation and after a MI. |
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Term
| Contraindications for Heparin. |
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Definition
| Use with caution in all pts that have a high likelihood of bleeding (peptic ulcer, hemophilia, aneurysm); those w/liver or kidney damage; those w/thrombocytopenia and uncontrollable bleeding; and those who are using drugs like asprin. |
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Term
| Serious adverse effects for Heparin. |
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Definition
| Hemorrhage, heparin-induced thrombocytopenia (HIT)- development of antibodies for heparin; hypersensitivity rxns b/c heparin is extracted from animal tissues. Severe neuro injury to pts during and immediately after surgery of eye, brain, and spinal cord. |
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Term
| Preadministration assessment for Heparin. |
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Definition
| Undergoes hepatic metabolism and renal excretion, so in pts w/ hepatic or renal insuffciency, half life is prolonged. Obtain baseline values of BP, HR, blood cell counts, platelet counts, platelet counts, hematocrit and aPTT. |
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Term
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Definition
| Signs of hemorrhage (reduced BP, increased HR, discolored urine/stool, bruising, hematomas, headache, faintness). Monitor hematocrit, blood cell, and platelet count for HIT prevention. Labs for aPTT: normal is 40 seconds, therapeutic levels increases to 60-80 seconds. |
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Term
| Patient Education for Heparin. |
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Definition
| Avoid antiplatelet drugs like aspirin. Administered only through injections (in units). Highly polar, so doesn't cross membranes easily- best to be used during pregnancy because least likely to cross placenta. |
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Term
| Generic name for low molecular weight heparin. |
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Definition
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Term
| Mechanism of action for LMW heparin. |
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Definition
| Anticoagulative activity is mediated by the same active pentasaccharide sequence that mediates anticoagulant action of standard heparin. Preferential inactivation of factor Xa (much less able to inactivate thrombin b/c chain is not long enough to provide a bonding site for thrombin. Protamine sulfate is used for overdose. |
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Term
| Indications for LMW heparin. |
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Definition
| Prevention of DVT following abdominal surgery, hip or knee replacement surgery. Treatment of DVT w/ or w/out PE. Prevention of ischemic complications in pts w/unstable angina. |
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Term
| Contranindications for LMW heparin. |
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Definition
| Same as for heparin: Use with caution in all pts that have a high likelihood of bleeding (peptic ulcer, hemophilia, aneurysm); those w/liver or kidney damage; those w/thrombocytopenia and uncontrollable bleeding; and those who are using drugs like asprin. |
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Term
| Serious adverse effects for LMW heparin. |
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Definition
| Can cause immune-mediated thrombocytopenia or severe neurologic injury. |
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Term
| Common adverse effects for LMW heparin. |
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Definition
| Bleeding complications arel less than w/unfractionated heparin and are therefore safe for outpatient use. |
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Term
| Preadministration assesment for LMW heparin. |
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Definition
| Smae as heparin: Undergoes hepatic metabolism and renal excretion, so in pts w/ hepatic or renal insuffciency, half life is prolonged. Obtain baseline values of BP, HR, blood cell counts, platelet counts, platelet counts, and hematocrit. |
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Term
| Monitoring for LMW heparin. |
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Definition
| Watch for signs of neurologic impairment, do not need aPTT test. |
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Term
| Patient Education for LMW heparin. |
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Definition
| Adminsterd by SubQ injection. Avoid antiplatelet drugs like aspirin. At least as effective as unfractioned heparin, maybe moreso. |
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Term
| Generic name for Warfarin. |
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Definition
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Term
| Mechanism of action for Warfarin. |
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Definition
| Decreases production of vitamin K-dependant clotting factors (VII, IX, X, and prothrombin). Vitamin K is needed to make them and warfarin inhibits the enzyme that converts vitamin K to its active form; therefore, vitamin K is antidote. |
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Term
| Indications for Warfarin. |
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Definition
| Treats/prevents venous thrombosis and pulmonary embolisms, prevention of thromboembolism, and prevention of thrombosis during atrial fibrilation. Suitable for prophylactic use; not used in emergencies b/c onset is delayed. |
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Term
| Contraindications for Warfarin. |
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Definition
| Thrombocytopenia or uncontrolled bleeding; vitamin K deficiency; liver disease or alcoholism; pregnancy and lactation; pts undergoing lumbar puncture, anesthesia, or surgery of the eye, brain, or spinal cord. Use caution in pts w/high risk of bleeding, i.e. those w/GI ulcers, hemophilia, severe hypertension, aneurysms, etc. |
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Term
| Serious adverse effects for warfarin. |
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Definition
| Hemorrhage; Fetal hemorrhage and teratogeneses during pregnancy. |
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Term
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Definition
| Obtain a thorough medical hx, identify possible drug interactions, obtain baseline vitals and PT, genetic testing to identify high risk pts. |
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Term
| Preadministration assessment for Warfarin. |
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Definition
| PT/INR (Prothrombin Time/International Ratio) INR should be between 2-3 (PT varies lab to lab, but INR is same internationally). Monitor lab results for hematocrit and blood cell #s. LOTS of drugs interact with it! |
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Term
| Patient education for warfarin. |
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Definition
| Important to stay on dosing schedule. Avoid drugs not approved by prescriber. Keep vitamin K intake constant day to day. Stop taking if you become pregnant or if you are breastfeeding. warn pts about the danger of hemorrhage, inform them of signs of bleeding; avoid excessive alcohol consumption. Use soft toothbrush and electric razor. |
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Term
| Example of Adenosine Diphosphate Receptor Agonists. |
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Definition
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Term
| Mechanism of action for adenosine diphosphate receptor agonists. |
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Definition
| Blocks ADP receptors on platelets, so it prevents ADP stimulated aggregation, prolongs bleeding time. Similar to asprin; antiplatelet drug. |
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Term
| Indications for adenosine diphosphate receptor agonists. |
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Definition
| Prevent blockage of coronary artery stents, reduces the risk of thrombotic/atherosclerotic events (MI, ischemic stroke, and vascular death), prevents these events in patients who have already had them. |
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Term
| Contraindications for adenosine dephosphate receptor agonists. |
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Definition
| Pts taking other drugs that promote bleeding (heparin, warfarin, aspirin, and other NSAIDs) should use caution, pts w/active bleeding disorders. |
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Term
| Serious advese effects for adenosine diphosphate receptor agonists. |
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Definition
| Thrombotic thrombocytopenic purpura (TTP)- decrease in platelets; GI bleeding. |
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Term
| Common adverse effects for adenosine diphosphate receptor agonists. |
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Definition
| GI distress (N?V, diarrhea, abdominal pain). |
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Term
| Preadministration assessment for adenosine diphosphate receptor agonists. |
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Definition
| Check bleeding time, look for active bleeding. |
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Term
| Monitoring for adenosine diphosphate receptor agonists. |
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Definition
| Unusual bleeding, bruising, rash |
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Term
| Patient education for adenosine diphosphate receptor agonists. |
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Definition
| Apply pressure to any bleeding cut, avoid any activity and remove hazards that could cause any injury or fall, look for GI bleed (black tarry schools), hematuria (blood in urine), coffee ground emesis. Administered orally. |
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Term
| Example of a thrombolytic drug. |
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Definition
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Term
| Mechanism of action for thrombolytic drugs. |
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Definition
| Indirect action, drug binds to plasminogen to form active complex, then breaks down remaining plasminogen into plasmin. Plasmin is an enzyme that breaks down the fibrin mesh is an enzyme that breaks down the fibrin mesh work of clots. Plasmin will also degrade fibrinogen and other clotting factors. |
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Term
| Indications for thrombolytic drugs. |
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Definition
| Acute MI, massive pulmonary emboli, ischemic stroke, DVT |
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Term
| Contraindications for thrombolytic drugs. |
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Definition
| Prior intercranial hemorrhage, known cerebral vascular lesion, ischemic stroke w/in the last 3 months but not w/in the last 3 hours, known intercranial neoplasm, active internal bleeding (excluding menses), suspected aortic dissection, acute pericarditis. |
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Term
| Serious adverse effects for thrombolytic drugs. |
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Definition
| bronchospasms, reperfusion arrhythmias, hemoptysis, hemorrhage at injection sites. |
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Term
| Common adverse reactions for thrombolytic drugs. |
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Definition
| Epitaxis, gingival bleeding, hypotension, N/V, ecchymoses, flushing, urticaria, phlebitis at IV site, musculoskeletal pain, allergic reactions including fever. |
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Term
| Monitoring for thrombolytic drugs. |
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Definition
| Vital signs, assess for bleeding every 15 min for 1st hr and 15-30 min for remaining 8 hrs. Monitor for hypersensitivity- keep epinephrine, antihistamine, and resuscitation close by for anaphylactic reaction. |
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Term
| Patient education for thrombolytic drugs. |
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Definition
| Report bleeding from orifices (or gums), abdominal pain, coffee ground emesis, black or tarry stools, hematuria, or joint pain. |
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