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Hematologic 1 & 2

Parenteral anticoagulants meds (2) Heparin & enoxaparin
Parenteral anticoagulants pharmacologic action they inhibit fibrin formation in the blood (the clotting factor)
Heparin & enoxaparin are used for these (4) PE, DVT, MI, & DIC pulmonary embolism, deep vein thrombosis, myocardial infarction, & disseminated intravascular coagulation
The difference between enoxaparin & Heparin enoxaparin is a low-weight heparin, it requires less monitoring since it has a more predictable response
Complications for Heparin/enoxaparin (3) hemorrhage, HIT (heparin-induced thrombocytopenia), & hypersensitivity reactions
We look for these symptoms when monitoring for hemorrhage (2) hypotension & tachycardia
We look for these symptoms when monitoring for hypersensitivity (2) fever & chills
Interaction for heparin/enoxaparin (1) other antiplatelets (like aspirin)
We monitor this lab during heparin/enoxaparin treatment aPTT lab (partial thromboplastin time)
Partial thromboplastin time lab values & "a" explanation Baseline for partial thromboplastin time is usually 40 seconds. We want 1.5-2x the baseline, so we're shooting for 60-80 seconds. The "a" means we're going to add something to the test to make the blood clot faster.
Do you aspirate the air bubble out of the enoxaparin pen? No, we keep it and inject it along with the medication.
How does injecting Heparin/enoxaparin differ from normal subQ injections? We don't aspirate the plunger on the syringe, we insert the needle at a 90 degree angle, fully insert the needle, and inject the air bubble along with the medication.
Why could a patient who is already taking Heparin be able to take warfarin (Coumadin) at the same time? Heparin can be continued until warfarin (Coumadin) reaches its therapeutic level (usually within 3-5 days). They can be taken together for a short period of time.
Antidote for Heparin toxicity (when hemorrhage would occur) protamine
Oral anticoagulant med warfarin (Coumadin)
Oral anticoagulants pharmacologic action prevents clots by antagonizing vitamin K (but doesn't affect the ones already in the system)
Antidote for warfarin vitamin K
Warfarin is used for this (1) to prevent stroke in patients with a-fib
Complications for warfarin (1) hemorrhage
Interactions with warfarin (4) NSAIDs (aspirin & ibuprofen), acetaminophen (and OTC drugs that contain it), foods high in vitamin K (like kale or leafy greens), & alcohol
Client education for warfarin (3) take at the same time each day (usually around 5pm), discontinue 7 days before surgery, & wear a medical alert bracelet
Clients should report signs of bleeding to their provider. What should they be on the lookout for? (3) black tarry stools, coffee-ground emesis, & rectal bleeding
What can a client do to prevent gum bleeding while on an anticoagulant? use a soft toothbrush
We monitor these labs during warfarin treatment (2) PT & INR (prothrombin time & the international normalized ratio)
INR (international normalized ratio) lab values & how often we'd do it range should be 2-3 & we would do the test daily starting out, then we'd do it less often as the body becomes acclimated warfarin
Salicylics pharmacologic action they inhibit platelet aggregation by inhibiting the COX-1 enzyme
Salicylics med (1) aspirin
Aspirin is used for this (besides pain relief) to prevent acute myocardial infarctions
Complications for aspirin (3) GI effects (nausea, vomiting, loss of appetite), GI bleeding, & salicylism (or aspirin toxicity)
If a client is having GI effects as a complication with aspirin, what can they do? They can either take enteric-coated tablets so they bi-pass the stomach altogether or they can take it with food
Primary symptoms of salicylism (aspirin toxicity) (2) tinnitus (ringing in the ear) & hearing loss
Keep in mind the therapeutic effect of salicylism is... irreversible
What should we remember when administering doses of aspirin? Use the lowest dose possible! Increasing the dose won't increase the therapeutic effect, but it WILL increase their risk for severe bleeding!
ADP inhibitors stands for... adenosine diphosphate inhibitors
ADP inhibitors pharmacologic action inhibits platelet aggregation
ADP inhibitors med Plavix (clopidogrel)
Clopidogrel is used for (2) to reduce the risk of myocardial infarction & angina (chest pain)
Clopidogrel complications (3) bleeding, stroke, & thrombocytopenia (low platelets)
What are some signs of a stroke that we can look for as a side effect of clopidogrel (4)? slurred speech, one-sided paralysis, numbness, & weakness
What are some signs of an active bleed that we can look for as a side effect of clopidogrel (4)? weakness, vision changes, numbness, & paralysis
If a client has this, we would use clopidogrel cautiously... peptic ulcer disease, since they're already at risk for bleeding
Client education for clopidogrel (2) report signs of bleeding & discontinue 7 days before surgery
Thrombolytics pharmacologic action they dissolve blood clots that have already been formed
Thrombolytics med Activase (alteplase)
Alteplase is used for this (2) PE & ischemic stroke (pulmonary embolism)
Complications for alteplase (2) bleeding & intracranial bleeding
What would we monitor for, for intracranial bleeding? level of consciousness x3, headache, weakness, & changes in their vitals (specifically blood pressure)
When is the best time to give alteplase? within 3 hours of a pulmonary embolism or ischemic stroke
What would we monitor as a priority with a client taking alteplase? bleeding
What lab would be monitor for alteplase? platelet count
Antidote for alteplase aminocaproic acid (Amicar)
Erythropoietic growth factors pharmacologic action they stimulate RBC production
Erythropoietic growth factors med Epogen (epoetin alfa)
Epoetin alfa is used for (1) anemia
Complications for epoetin alfa HTN, headache, & DVT (hypertension & deep vein thrombosis)
What would we monitor for the complications for epoetin alfa? I&O and BP
Administration considerations with epoetin alfa (4) use the lowest dose possible, it's given either as subQ or IV bolus injection, with subQ: DON'T agitate the vial, use each vial only use (they're single-use vials), & Do NOT dilute or mix the med)
What labs would we monitor for a client taking epoetin alfa and how frequently would we monitor them? Hgb & Hct (hemoglobin & hematocrit) We would monitor them twice a week until the target range is reached. Then, their levels should increase if treatment is effective.
Leukopoietic growth factors pharmacologic action stimulates leukocyte production
Leukopoietic growth factors med Neupogen (filgrastim)
Filgrastim is used for (1) to reduce a patient's risk for infection (specifically after high-dose chemotherapy & bone marrow transplantation)
Filgrastim complications (3) bone pain, leukocytosis, & splenomegaly (enlarged spleen)
What can we do if a client is complaining of bone pain while taking filgrastim? give them acetaminophen or an opioid
What lab would we monitor for, for a client taking filgrastim-and what is the value we're looking for? WBC count, the value should be 10,000 cubic millimeters. If over 10,000, treatment may need to be reduced or stopped.
What would the client complain of that would indicate splenomegaly while taking filgrastim? pain in the left upper quadrant of their abdomen
Contraindication for filgrastim (1) clients who have a sensitivity to E. Coli
What route is filgrastim administered? subQ
Thrombopoietic growth factors pharmacologic action increases platelet production
Thrombopoietic growth factors med Neumega (oprelvekin)
Oprelvekin is used for (1) to decrease thrombocytopenia (primarily for clients undergoing chemotherapy)
Complications for oprelvekin (3) fluid retention, cardiac dysrhythmias, & conjunctivitis (pink eye)
What would we monitor for, for fluid retention with a client taking oprelvekin (3)? peripheral edema/swollen ankles & dyspnea upon exertion
What are some examples of cardiac dysrhythmias (3), & what can be ordered to monitor them? palpitations, a. fib, & atrial flutters An ECG may be ordered to monitor for these side effects.
What lab would we monitor for, for a client taking oprelvekin and what's the value we're looking for? we'd monitor their platelet count & it should be greater than 50,000 cubic millimeters
Administration considerations for oprelvekin (5) SubQ injection once a day, may need to be reconstituted by: adding water or a saline solution to the powder, rolling the vial to mix it together, & administering within 3 hours of mixing
What is microcytic anemia? anemia caused by iron deficiency
What is macrocytic/megaloblastic anemia? anemia caused by either vitamin B12 or folic acid deficiency
Iron deficiency med Feosol (ferrous sulfate)
Ferrous sulfate is used for (2) iron deficiency & blood loss
Complications for ferrous sulfate teeth staining (with liquid form)
Administration considerations for the oral tablet form of ferrous sulfate (1) it's best not to take it with meals, but if GI upset occurs and they have to, they can
Administration considerations & forms for the liquid form of ferrous sulfate (4) dilute it with water, drink through a straw, DON'T swish and swallow, & rinse mouth afterwards
Client education for ferrous sulfate (3) take with orange juice to increase absorption, increase foods high in iron, & expect dark tarry stools
Vitamin B12 deficiency med Nascobal (cyancobalamin)
Cyancobalamin is used for (2) pernicious anemia & vitamin B12 deficiency
Complications for cyancobalamin diarrhea & hypokalemia
Administration considerations for cyancobalamin (3) available in oral, subQ, IM, & intranasal forms, treatment may be lifelong, & encourage foods high in vitamin B12 (like dairy products, shellfish, fruit, & eggs)
Folic acid is used for (3) folic acid deficiency, vitamin B12 deficiency, & to prevent neural tube defects in utero
Administration considerations & forms for folic acid (3) available in oral (preferred form), subQ, IM, or IV injection, expect flushing or warmth following IV administration, & increase foods high in folic acid (like leafy greens, broccoli, & brussel sprouts)
Created by: tiffhales



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