Name of Drug Mechanism of Action Indication Contraindication Adverse Effects Nursing Responsibilities

1. Antiplatelet Drugs  Decrease formation of platelet  CARDIOVASCULAR DSE (CVD)  Allergy  BLEEDING 1. Provide small frequent feedings
plug by decreasing  Decreased risk of fatal MI  Pregnancy & Lactation CNS: Rationale: to relieve GI effects
a. Abxicimab responsiveness of platelet to  Prevent reinfarction after MI  Bleeding Disorder  Headache
b. Anagrelide stimuli that would cause them  Prevent thromboembolic Rationale:  Weakness 2. Provide comfort measures &
c. Aspirin to stick together on the vessel stroke Risk of excessive blood loss  Dizziness analgesia for headache
d. Cilostazol wall  Treatment of thromboembolic Rationale: relieve pain and improve
e. Clopidogrel disorders  Recent Surgery GI: pt compliance
f. Dypyrimidole  Inhibit platelet aggregation by  Maintain patency of grafts Rationale:  Nausea
g. Eptifibatide blocking receptor sites on Increased risk of bleeding in  GI Distress 3. Suggest safety measures (e.e
h. Sulfinpyrazone platelet membrane, preventing  Anagrelide unhealed vessels caution with electric razor, avoid
i. Ticlopidine platelet-platelet interaction - blocks the prodxn of Dermatologic: contact sports)
j. Tirofiban platelet in the bone  Skin rash Rationale: decrease risk of bleeding
marrow
- Indicated for: 4. Provide precautions against
THROMBOCYTHEMIA bleeding during invasive
procedures; use pressure dressings
Rationale: decrease excessive blood
loss by coagulation

5. Mark chart of pt. receiving this

drug
Rationale: to alert medical staff of
potential bleeding

6. Provide thorough pt teaching on

drug therapy
Rationale: enhance pt knowledge &
promote compliance

7. Offer support & encouragement

Rationale: heal ppt deal w/ the dx
and drug regimen

2. Anticoagulants  Interfere with the coagulation  ATRIAL FIBRILLATION  Allergy  BLEEDING 1. Evaluate therapeutic effects
process by interfering w/ the  MI  Haemorrhagic Disorders CNS:  Warfarin
a. Warfarin clotting cascade and thrombin  PULMONARY EMBOLUS  Recent surgery  Headache = Prothrombin Time (PT) x
b. Heparin formation  STROKE  Spinal Puncture  Weakness Control Value or International
c. Antithrombin  GI Ulcers  Dizziness Normalized Ration (CV/INR)
d. Agratroban  IUD
e. Bivalirudin  TB GI: = 1.5/2.5 x 2/3
f. Desirudin  Presence of indwelling  Nausea
catheters  Vomiting  Heparin
 Threatened abortion  Hepatic Dysfxn = Whole Blood Clotting Time
Rationale: Increased bleeding  Diarrhea (WBCT) x Control Value/
tendencies

3. Low-Molecular Weight Heparin  Inhibit thrombin and clot
formation by blocking factors
a. Dalteparin Xa and IIa
b. Enoxaparin  Blocks angiogenesis
c. Tinzaparin  Prevents formation of clots and
emboli after surgeries or
prolonged bed rest
 Warfarin (oral)
- Decreases prodxn of
Vit K-dependent
clotting factors in the
liver
 Heparin, Desirudin,
Argatroban, Bivalirudin
(IV)
- Blocks thrombin
formation from
prothrombin
Heparin:
- does not cross the
placenta
- route: IV / Sub-Q
- antidote: protamine
sulfate
- not the DOC for
outpatients
 Antithrombin
- Interferes with the
formation of
thrombin from
prothrombin
 Given before or just after
surgery, then continued for 7-14
days during postoperative
recovery process
 CHF  Warfarin Activated Tgromboplastin Time
 Throtoxicosis - Alopecia (CV/APTT)
 Senility - Dermatitis
 Psychosis - Less frequent, 2. Evaluate for signs of bleeding
Rationale: alteration of the normal prolonged, painful  Petechiae
clotting process by loss of Vit K from erections  Bleeding gums
the intestine/ activation of - Bone marrow  Dark colored stool
plasminogen depression  Dark colored urine
DRUG-DRUG INTERACTION: 3. Suggest safety measures (e.e
 Heparin + Oral anticoagulants, caution with electric razor, avoid
salicylates, penicillin, contact sports)
cephalosporin Rationale: decrease risk of bleeding
= INCREASED BLEEDING
4. Provide precautions against
 Heparin + Nitroglycerin bleeding during invasive
= DECREASED COAGULATION procedures; use pressure dressings
Rationale: decrease excessive blood
loss by coagulation
5. Mark chart of pt. receiving this
drug
Rationale: to alert medical staff of
potential bleeding
6. Provide thorough pt teaching on
drug therapy
Rationale: enhance pt knowledge &
promote compliance
7. Offer support & encouragement
Rationale: heal ppt deal w/ the dx
and drug regimen
4. Thrombolytic Agents  Activates plasminogen to  ACUTE MI
plasmin, which breaks frown to
a. Alteplase fibrin threads in a clot to Remember:
b. Reteplase dissolve a formed clot  Dissolves clot and prevent
c. Streptokinase further tissue damage if
d. Tenecteplase used w/in 6 hrs. after
e. Urokinase onset of symptoms to
treat pulmonary emboli,
ischemic stroke, and open
clotted IV catheters
 Must be injected and
removed from the body
after liver metabolism
 Only effective if the pt has
plasminogen in the
plasma
 Allergy  BLEEDING 1. Discontinue heparin if it is given
 Pregnancy  Cardiac Arrhythmias before administration of a
 Hypotension thrombolytic agent
 Recent Surgery  HYPERSENSITIVITY IS Rationale: To prevent excessive
 CVA w/in the last 2 mos UNCOMMON blood loss
 Aneurysm
 OB Delivery DRUG-DRUG INTERACTION: 2. Institute treatment w/in 6 hrs.
 Organ Biopsy  Thrombolytic Agents + after the onset of symptoms of
 Recent serious GI bleeding Anticoagulant/Antiplatelet acute MI
 Recent Major Trauma (CPR) Drug Rationale: To achieve optimum
 Blood Clotting Defects = INCREASED BLEEDING therapeutic effect
 CVD
 Uncontrolled HPTN 3. Arrange to type and cross-match
 Liver Dse blood
Rationale: could be worsened by Rationale: In case of serious blood
dissolution of clots loss that would need blood
transfusion
4. Monitor cardiac rhythm
continuously if given for acute MI
Rationale: Because of the risk of
alteration of cardiac fxn
5. Evaluate for signs of bleeding
 Petechiae
 Bleeding gums
 Dark colored stool
 Dark colored urine
6. Provide precautions against
bleeding during invasive
procedures; use pressure dressings
Rationale: decrease excessive blood
loss by coagulation
7. Mark chart of pt. receiving this
drug
Rationale: to alert medical staff of
potential bleeding
8. Provide thorough pt teaching on
drug therapy
Rationale: enhance pt knowledge &
promote compliance
9. Offer support & encouragement
Rationale: heal ppt deal w/ the dx
and drug regimen
5. Antihemophilic Agents
a. Antihemophilic Factor
b. Coagulation Factor VIIa
c. Factor IX Complex
6. Topical Hemostatic Agents
a. Absorbable Gelatin
b. Thrombin
 Replace clotting factors that
are genetically missing or low
in that particular type of
hemophilia
 Used to stop bleeding
 Blocks activation of
plasminogen system
 Used to prevent blood loss from
injury or surgery
 Used to treat bleeding episodes
 Antihemophilic Factor
- Classic Hemophilia A
 Coagulation Factor VIIa
- From mouse,
hamster & bovine
proteins
- Used to treat
bleeding episodes in
Hemophilia A or B
 Factor IX Complex
- Increases blood levels
of Factors II, VII, IX, X
 Some injuries involve so much
damage to the small vessels in
the area that clotting does not
occur and blood is slowly
 Allergy  Related to blood producs 1. Administer by IV route only
(Hepa/AIDS) Rationale:to ensure therapeutic
CNS: effectiveness
 Headache
 Factor IX Complex  Flushing 2. Monitor for signs of thrombosis
- Presence of liver  Fever Rationale:to arrange use of comfort
disease  Lethargy and support measures (e.g. support
 Coagulation Factor hose, positioning, ambulation,
- Known allergies to GI: exercise)
mouse, hamster and  Nausea
bovine products  Vomiting 3. Decrease infusion if headache,
chills, fever or tingling occurs
Dermatologic (at the site of Rationale:prevent severe drug rxn
injection):
 Itching 4. Monitor clinical response to
 Burning clotting factor levels regularly
 Stinging Rationale:in order to adjust dosage
needed
5. Arrange to type and cross-match
blood
Rationale: In case of serious blood
loss that would need blood
transfusion
6. Mark chart of pt. receiving this
drug
Rationale: to alert medical staff of
potential bleeding
7. Provide thorough pt teaching on
drug therapy
Rationale: enhance pt knowledge &
promote compliance
8. Offer support & encouragement
Rationale: heal ppt deal w/ the dx
and drug regimen
1. Monitor for signs of thrombosis
Rationale:to arrange use of comfort
and support measures (e.g. support
hose, positioning, ambulation,
exercise)

7. Systemic Hemostatic Agents
a. Aprotrinin
b. Aminocaproic Acid
continually lost so we use
topical hemostatic agents
 Absorbable Gelatin
- Sponge form
- Pose risk for infection
Rationale: bacteria can become
trapped in the vascular area when
the sponge is applied
 Thrombin
- From bovine sources
- Applied topically and
mixed w/ blood
- May precipitate
allergic response
Rationale: because the drug is
derived from animal sources
 Used to stop bleeding  Repeat Coronary Artery
 Stop the natural plasminogen Bypass Graft (CABG)
clot-dissolving mechanism by
blocking its activation or  Aminocaproic Acid
directly inhibiting plasmin - Take 10 tabs in the
first hour, then
continue taking,
around the clock
 Allergy
 Cardiac Dse
Rationale: risk of arrhythmias
 Renal and Hepatic Dysfxn
Rationale: could alter secretion of
drug
 Pregnancy and Lactation
Rationale:
2. Decrease infusion if headache,
chills, fever or tingling occurs
Rationale:prevent severe drug rxn
4. Monitor clinical response to
clotting factor levels regularly
Rationale:in order to adjust dosage
needed
3. Arrange to type and cross-match
blood
Rationale: In case of serious blood
loss that would need blood
transfusion
4. Mark chart of pt. receiving this
drug
Rationale: to alert medical staff of
potential bleeding
5. Provide thorough pt teaching on
drug therapy
Rationale: enhance pt knowledge &
promote compliance
6. Offer support & encouragement
Rationale: heal ppt deal w/ the dx
and drug regimen
1. Monitor for signs of thrombosis
Rationale:to arrange use of comfort
and support measures (e.g. support
hose, positioning, ambulation,
exercise)
2. Decrease infusion if headache,
chills, fever or tingling occurs
Rationale:prevent severe drug rxn
4. Monitor clinical response to
clotting factor levels regularly
Rationale:in order to adjust dosage
needed
3. Arrange to type and cross-match
blood
Rationale: In case of serious blood
loss that would need blood
transfusion

4. Mark chart of pt. receiving this

drug
Rationale: to alert medical staff of
potential bleeding

5. Provide thorough pt teaching on

drug therapy
Rationale: enhance pt knowledge &
promote compliance

6. Offer support & encouragement

Rationale: heal ppt deal w/ the dx
and drug regimen