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Pharm test 5
chapters 16, 20, 22
| Question | Answer |
|---|---|
| chapter 16-drugs affecting the hematologic system | |
| normal (blood) clotting mechanisms | cellular damage results in the formation of thromboplastin, thromboplastin acts on prothrombin to form thrombin, thrombin acts on fibrinogen to produce fibrin |
| anticoagulants | platelet inhibitors, direct thrombin inhibitors, indirect thrombin inhibitors, vitamin k antagonists |
| platelet inhibitors (actions/uses) | prevent clotting in blood vessels, block ability of platelets to stick & aggregate (group together) to form a platelet plug |
| platelet inhibitors include | aspirin, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, tirofiban, cilostazol |
| platelet inhibitors (expected side effects) | bleeding, easy bruising, diarrhea, nausea, dyspepsia, vomiting, flatulence, anorexia, rash, pruritus |
| platelet inhibitors (adverse effects) | excessive and sudden bleeding, allergic reaction |
| platelet inhibitors (drug/food interactions) | excessive bleeding when taken with other drugs, green leafy vegetables contain vitamin k which decrease effectiveness, alcohol increases risk of bleeding |
| platelet inhibitors (nurse implications/teaching) | drug hx, bleeding/bruising, signs of internal bleeding, monitor vitals |
| direct thrombin inhibitors (5 categories) | heparin sodium, coumarin, platelet aggregation inhibitors, direct thrombin inhibitors, protease activated receptor-1 antagonist |
| heparin sodium (direct thrombin inhibitor) | increases the action of antithrombin III (heparin cofactor) on several other coagulation factors to slow new clot development |
| coumarin (direct thrombin inhibitors) | limit the formation of blood coagulation factors II, VII, IX, and X in the liver by interfering with vitamin K |
| direct thrombin inhibitors | act much like warfarin but act to stop the coagulation process |
| protease-activated receptor-1 antagonist (direct thrombin inhibitor) | used on people w/ myocardial infarction or peripheral arterial disease. should lower heart attack /stroke/ fatal cardiac event |
| direct thrombin inhibitors (actions/uses) | prevent new thrombus formation, do not dissolve clots, after surgery involving heart (prophylactic), pt at risk for stroke or systemic embolism |
| direct thrombin inhibitors (expected side effects) | bleeding, easy bruising |
| direct thrombin inhibitors (adverse reactions) | excessive bleeding/thrombocytopenia |
| direct thrombin inhibitors (overdose or internal bleeding symptoms) | bleeding gums, excessive bleeding from cuts, unexplained bruising, nosebleeds, unusually heavy menstrual cycle |
| direct thrombin inhibitors (drug interactions) | many common drugs, some increased risk of bleeding, others reduce effectiveness |
| direct thrombin inhibitors (nursing implications/teaching) | asses signs of bleeding/bruising, evaluate signs of overdose (bleeding gums, excessive bleeding etc) |
| indirect thrombin inhibitors (actions/uses) | reduce clot formation by increasing amount of protein antithrombin III, prevents new clot formation, stops existing clots from growing in size |
| indirect thrombin inhibitors (expected side effects) | easy bleeding/bruising, pain, redness, warmth, irritation, skin changes at injection site |
| indirect thrombin inhibitors (adverse reactions) | hemorrhage, thrombocytopenia, shortness of breath, chills, fever, hypersensitivity |
| indirect thrombin inhibitors (serious reactions) | heparin induced thrombocytopenia, thrombosis |
| indirect thrombin inhibitors (drug interactions) | aspirin, NSAIDs, glucocorticoids, other anticoagulants, effects reduced by antihistamines, digoxin, nicotine, tetracycline |
| indirect thrombin inhibitors (nurse implications/teaching) | caution with liver/kidney disease or hypertension, caution use during menses, after deliver, & pt with indwelling catheters, monitor for signs of allergy/overdose |
| indirect thrombin inhibitors (nursing implication how to administer) | give intravenous injection, infusion, or subcutaneous injection (NEVER by intramuscular route), do not shake bottle, cannot be piggybacked/mixed with other drugs in syringe |
| vitamin k antagonists (action/uses) | inhibits the enzyme needed for final activation of vitamin k: prevents blood clots and emboli |
| vitamin k antagonists (expected side fx) | bleeding, easy bruising |
| vitamin k antagonists (adverse reactions) | excessive bleeding, frank blood or dark, tarry stools, coffee colored vomitus with high dosage |
| vitamin k antagonists (drug/food interactions) | many common drugs lengthen the bleeding time, others shorten it |
| vitamin k antagonists (nurse implications/teaching) | asses health/drug hx, contraindications, monitor bleeding risk and for adverse effects |
| fibrinolytic drugs (action) | convert plasminogen to the enzyme plasmin which breaks down fibrin clots, fibrinogen, and other plasma proteins |
| fibrinolytic drugs (uses) | acute myocardial infarctions, acute pulmonary emboli, acute ischemic stroke, acute arterial occlusion |
| fibrinolytic drugs (expected side fx) | bleeding |
| fibrinolytic drugs (adverse reactions) | severe bleeding, shortness of breath, wheezing, chest tightness, facial swelling, rash/hives, increase stroke risk |
| fibrinolytic drugs (drug interactions) | other anticoagulants mat increase the potential for bleeding |
| fibrinolytic drugs (nurse implications/teaching) | given in life threatening situations of stroke or myocardial infarction, assess for other drugs taken, monitor bleeding risk/adverse effects |
| erythropoiesis-stimulating agents (ESAs): uses | reduces need for transfusions & reduces the complications of transfusions such as fluid overload |
| erythropoiesis-stimulating agents (ESAs): expected side fx | pain at injections site. body aches/pain/rash/redness/warmth at injection site |
| erythropoiesis-stimulating agents (ESAs): adverse reactions | hypertension, blood clots, stroke, heart attack, severe allergic reaction |
| erythropoiesis-stimulating agents (ESAs): nurse implications/teaching | asses vitals/weight, health hx/allergies, monitor for allergic reaction, signs of stroke, chest pain, shortness of breath, & increased bp |
| ferrous sulfate (action/uses) | treatment of iron deficiency anemia |
| Ferrous sulfate (expected side fx) | constipation, dark stool color, gastrointestinal irritation, nausea |
| Ferrous sulfate (adverse reactions) | hypersensitivity reaction, iron, overdose |
| Ferrous sulfate (nurse implications/teaching) | asses health hx, bleeding, vitals, monitor for allergic reaction, difficulty breathing, signs of anemia, chest pain, shortness of breath |
| iron dextran (actions & uses) | treatment of iron deficiency anemia in pt for whom oral iron is not effective/feasible |
| iron dextran (expected side fx) | pain & brown colored pigmentation at injection site, constipation |
| iron dextran (adverse reactions) | BLACK box warning for allergic reaction, severe low bp, diarrhea/vomiting, sterile abscess at injection site |
| iron dextran (nurse implications/teaching) | assess health hx, bleeding, vitals. monitor for allergic reaction & signs of anemia (tachycardia/chest pain/shortness of breath) |
Created by:
gabulous