Pharmacology Module 3

Heparin (unfractionated) Pharm Class
Antithrombotics

Heparin (unfractionated) Therapeutic Class
Anticoagulants

Heparin (unfractionated) Use Indication
Can be used during pregnancy, does not cross placenta or enter breast milk.
Situations that require rapid onset of anticoagulant effects: PE, evolving stroke, DVT, open heart surgery, renal dialysis.
Low dose therapy to prevent post-op venous thrombosis.
Very low dose to maintain patency of IV catheters.

Heparin (unfractionated) Nursing Implications
Assess for signs of bleeding or thrombosis, notify HCP if these occur.
Monitor aPTT and HCT, long term – monitor platelet count. This is cheap.
Protamine Sulfate is the antidote.

LMW Heparin Enoxaparin (Lovenox) Pharm Class
antithrombotics

LMW Heparin Enoxaparin (Lovenox) Therapeutic Class
anticoagulants

LMW Heparin Enoxaparin (Lovenox) Use Indication
Prevention of DVT s/p abdominal sx, hip & knee replacement sx
Treatment of established DVT with or without PE
Prevention of ischemic complications

LMW Heparin Enoxaparin (Lovenox) Nursing Implications
Assess for bleeding and hemorrhage, notify HCP if these occur
Assess for thrombosis
Monitor CBC, platelet count, stools for occult blood
Antidote is protamine sulfate

LMW Heparin Dalteparin (Fragmin) Pharm Class
Antithrombotics

LMW Heparin Dalteparin (Fragmin) Therapeutic Class
Anticoagulants

LMW Heparin Dalteparin (Fragmin) Use Indication
Prevention of DVT s/p abdominal sx, hip & knee replacement sx
Extended treatment of symptomatic DVT and/or PE in pt’s with cancer (CA)
Prevention of ischemic complications

LMW Heparin Dalteparin (Fragmin) Nursing Implications
Assess for bleeding and hemorrhage, notify HCP if these occur
Assess for thrombosis
Monitor CBC, platelet count, stools for occult blood
Antidote is protamine sulfate

Warfarin (Coumadin) Pharm Class
Coumarins

Warfarin (Coumadin) Therapeutic Class
Anticoagulants

Warfarin (Coumadin) Pregnancy Class
X

Warfarin (Coumadin) Use Indication
Prevention of venous thrombosis and associated PE
Prevention of thromboembolism in pt’s with prosthetic heart valves
Prevention of thrombosis in pt’s with atrial fibrillation

Warfarin (Coumadin) Nursing Implications
Assess for bleeding and hemorrhage, notify HCP if these occur
Assess for thrombosis
Pt’s >60 exhibit greater than expected PT/INR response
Pediatrics assess PT/INR rates more frequently
Monitor PT, INR, clotting factors, hepatic function and CBC, stool and urine for occult blood
Someone not on Warfarin should have an INR of 1.
Someone on Warfarin should have an INR of 2.0-4.0
Antidote is Vit K

dabigatran (Pradaxa)
Pharm Class
Thrombin Inhibitors

dabigatran (Pradaxa)
Therapeutic class
Anticoagulants

dabigatran (Pradaxa)
Use/ Indication
A-fib – In US, approved for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

dabigatran (Pradaxa)
Nursing Implications
Assess for symptoms of stroke or peripheral vascular disease. Assess for bleeding.
Potential nursing dx: Activity Intolerance
Patient/ family teaching: Take medication as directed; may bleed more easily or longer, notify health care provider if unusual signs occur. Very expensive.

rivaroxaban (Xarelto)
Pharm Class
Antithrombotics, factor Xa inhibitors

rivaroxaban (Xarelto)
Therapeutic Class
Anticoagulants

rivaroxaban (Xarelto)
Use/ Indication
Prevention of DVT and PE s/p knee or hip replacement surgery, and prevention of stroke in patients with atrial fibrillation. Lecture- currently for A-Fib only

rivaroxaban (Xarelto)
Nursing implications
Assess for bleeding and hemorrhage, notify HCP if this occurs. Monitor patients with epidural catheters for s&s of neurologic impairment.
Potential nursing dx: Ineffective tissue perfusion (indications)
Risk for injury (side effects)
Patient/ family teaching: Take medication as directed; advise patient to report symptoms or unusual bleeding, or s&s of spinal or epidural hematoma, to HCP immediately. Very expensive. Currently for A-Fib only.

Aspirin
Pharm Class
Salicylates (Anti-platelets)

Aspirin
Therapeutic Class
Antipyretics, nonopioid analgesics

Aspirin
Use/ Indication
Inflammatory disorders – Rheumatoid arthritis, Osteoarthritis
Mild to moderate pain
Fever
Prophylaxis of transient ischemic attacks and MI

Aspirin
Nursing Implications
Monitor for hypersensitivity in pt’s with asthma, allergies, nasal polyps
Assess for rash, pain, limitation of movement, fever
Monitor hepatic function
Prolongs bleeding time, monitor for GI bleeds

1. The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin? A. Complete blood count (CBC) B. Activated partial thromboplastin time (aPTT) C. Prothrombin time (PT) D. Blood urea nitrogen (BUN) B. Activated partial thromboplastin time …

Atropine Pharm Class anticholinergics; antimuscarinics Atropine Therapeutic Class antiarrhythmics WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Atropine Use Indication Decrease oral and respiratory secretions Increased heart rate, reversal …

Anticoagulants or Enoxaparin Pt/Family teaching -Avoid activities that can lead to bleeding -Carry/Wear med ID, report any unusual signs of bleeding and bruising to HCP -Instruct not to take OTC meds, especially those containing AsA or NSAIDS -May require nutritional …

Coumadin (warfarin) Class Anticoagulant Coumadin (warfarin) Action Inhibits the clotting of blood WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample Coumadin (warfarin) Indications Treatment of venous thrombosis, pulmonary embolism, …

Heparin uses -Prevents DVT’s, pulmonary embolism and emboli in atrial febrillation -Preferred anticoagulant during pregnancy Heparin precautions and contraindications -Bleeding tendencies- Hemaphilia, aneurysm, peptic ulcer -Thrombocytopenia -Postop patients WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR …

morphine sulfate/naltrexone HCl (Embeda) Pharm Class opioid agonists morphine sulfate/naltrexone HCl (Embeda) Ther Class opioid analgesics WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample morphine sulfate/naltrexone HCl (Embeda) Use …

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