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Hematologic 1 & 2
| Question | Answer |
|---|---|
| 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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