NRSG 3100 Exam #6
Most common coagulation disorder - ANS-thrombocytopenia
THERAPEUTIC aPTT - ANS-60-80
MOA of anticoagulants - ANS-Lengthen clotting time and prevent thrombi from forming or
growing larger
They do NOT dissolve clots: prevent growing
Onset for IV heprian - ANS-Immediate
Onset for SQ heprian - ANS-About an hour
AE heprian - ANS-Abnormal bleeding,
possible allergies (animal products), osteoporosis!!!!
caution with renal or hepatic failure
HIT!!!!
HIT - ANS-Heparin-induced thrombocytopenia occurs in up to 5% of patients; markedly
INCREASES platelet aggregation and thrombolytic events
CI for heprian - ANS-Internal bleeding,
intracranial hemorrhage,
severe HTN,
bacterial endocarditis!!!!
, severe thrombocytopenia
BBW for heprian - ANS-Epidural or spinal hematomas may occur in clients with epidural or
lumbar puncture
Onset of protamine sulfate - ANS-5 minutes
DI for heprian - ANS-nicotine,
digoxin,
tetracycline,
antihistamines.
Ginger,
garlic,
green tea,
and gingko.
, Pregnancy and heprian - ANS-Does not cross placental barrier and is not secreted in breast
milk; anticoagulant of choice for pregnancy and lactation. Caution during the peripartum period.
Difference between lovenox and heprian - ANS-Unable to bind thrombin; More selective for
Factor Xa inhibition
Advantages of Enoxaparin (Lovenox) - ANS-More predictable response; dose determined
based on weight!!!
Less frequent monitoring
Half-life is 2-4 times longer than heparin
Once daily dosing, SQ
Why is lovenox typically dosed for 1400 - ANS-Gives dr time to adjust order based off of labs
before nurse gives it
Disadvantage of Enoxaprin (Lovenox) - ANS-More expensive
MOA of antiplatelets - ANS-Antiplatelet agents provide anticoagulation by reducing the
aggregation properties of platelets
3 subtypes of antiplatelets - ANS-Aspirin
Adenosine diphosphate (ADP) receptor blockers
Prototype: Clopidogrel (Plavix)
Glycoprotein IIb/IIIa receptor blockers
Prototype: Abciximab (ReoPro)
Prototype adenosine diposphate receptor blocker - ANS-Clopidogrel (Plavix)
Protype glycoprotein IIb/IIIa receptor blocker - ANS-Abciximab (ReoPro)
Effects of Abciximab (ReoPro) - ANS-Acute coronary syndrome, percutaneous coronary
intervention
Effects of ReoPro - ANS-Platelet function reduced as much as 90% within 2 hours;
effects may persist for up to 10 days
AE of abciximab (ReoPro) - ANS-Hypotension (blood loss),
abnormal bleeding,
back/chest pain,
thrombocytopenia
Most common coagulation disorder - ANS-thrombocytopenia
THERAPEUTIC aPTT - ANS-60-80
MOA of anticoagulants - ANS-Lengthen clotting time and prevent thrombi from forming or
growing larger
They do NOT dissolve clots: prevent growing
Onset for IV heprian - ANS-Immediate
Onset for SQ heprian - ANS-About an hour
AE heprian - ANS-Abnormal bleeding,
possible allergies (animal products), osteoporosis!!!!
caution with renal or hepatic failure
HIT!!!!
HIT - ANS-Heparin-induced thrombocytopenia occurs in up to 5% of patients; markedly
INCREASES platelet aggregation and thrombolytic events
CI for heprian - ANS-Internal bleeding,
intracranial hemorrhage,
severe HTN,
bacterial endocarditis!!!!
, severe thrombocytopenia
BBW for heprian - ANS-Epidural or spinal hematomas may occur in clients with epidural or
lumbar puncture
Onset of protamine sulfate - ANS-5 minutes
DI for heprian - ANS-nicotine,
digoxin,
tetracycline,
antihistamines.
Ginger,
garlic,
green tea,
and gingko.
, Pregnancy and heprian - ANS-Does not cross placental barrier and is not secreted in breast
milk; anticoagulant of choice for pregnancy and lactation. Caution during the peripartum period.
Difference between lovenox and heprian - ANS-Unable to bind thrombin; More selective for
Factor Xa inhibition
Advantages of Enoxaparin (Lovenox) - ANS-More predictable response; dose determined
based on weight!!!
Less frequent monitoring
Half-life is 2-4 times longer than heparin
Once daily dosing, SQ
Why is lovenox typically dosed for 1400 - ANS-Gives dr time to adjust order based off of labs
before nurse gives it
Disadvantage of Enoxaprin (Lovenox) - ANS-More expensive
MOA of antiplatelets - ANS-Antiplatelet agents provide anticoagulation by reducing the
aggregation properties of platelets
3 subtypes of antiplatelets - ANS-Aspirin
Adenosine diphosphate (ADP) receptor blockers
Prototype: Clopidogrel (Plavix)
Glycoprotein IIb/IIIa receptor blockers
Prototype: Abciximab (ReoPro)
Prototype adenosine diposphate receptor blocker - ANS-Clopidogrel (Plavix)
Protype glycoprotein IIb/IIIa receptor blocker - ANS-Abciximab (ReoPro)
Effects of Abciximab (ReoPro) - ANS-Acute coronary syndrome, percutaneous coronary
intervention
Effects of ReoPro - ANS-Platelet function reduced as much as 90% within 2 hours;
effects may persist for up to 10 days
AE of abciximab (ReoPro) - ANS-Hypotension (blood loss),
abnormal bleeding,
back/chest pain,
thrombocytopenia
