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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
 Warfarin (oral)  CHF  Warfarin Activated Tgromboplastin Time
- Decreases prodxn of  Throtoxicosis - Alopecia (CV/APTT)
Vit K-dependent  Senility - Dermatitis
clotting factors in the  Psychosis - Less frequent, 2. Evaluate for signs of bleeding
liver Rationale: alteration of the normal prolonged, painful  Petechiae
clotting process by loss of Vit K from erections  Bleeding gums
 Heparin, Desirudin, the intestine/ activation of - Bone marrow  Dark colored stool
Argatroban, Bivalirudin plasminogen depression  Dark colored urine
(IV)
- Blocks thrombin DRUG-DRUG INTERACTION: 3. Suggest safety measures (e.e
formation from  Heparin + Oral anticoagulants, caution with electric razor, avoid
prothrombin salicylates, penicillin, contact sports)
Heparin: cephalosporin Rationale: decrease risk of bleeding
- does not cross the = INCREASED BLEEDING
placenta 4. Provide precautions against
- route: IV / Sub-Q  Heparin + Nitroglycerin bleeding during invasive
- antidote: protamine = DECREASED COAGULATION procedures; use pressure dressings
sulfate Rationale: decrease excessive blood
- not the DOC for loss by coagulation
outpatients
5. Mark chart of pt. receiving this
 Antithrombin drug
- Interferes with the Rationale: to alert medical staff of
formation of potential bleeding
thrombin from
prothrombin 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

3. Low-Molecular Weight Heparin  Inhibit thrombin and clot  Given before or just after
formation by blocking factors surgery, then continued for 7-14
a. Dalteparin Xa and IIa days during postoperative
b. Enoxaparin  Blocks angiogenesis recovery process
c. Tinzaparin  Prevents formation of clots and
emboli after surgeries or
prolonged bed rest
4. Thrombolytic Agents  Activates plasminogen to  ACUTE MI  Allergy  BLEEDING 1. Discontinue heparin if it is given
plasmin, which breaks frown to  Pregnancy  Cardiac Arrhythmias before administration of a
a. Alteplase fibrin threads in a clot to Remember:  Hypotension thrombolytic agent
b. Reteplase dissolve a formed clot  Dissolves clot and prevent  Recent Surgery  HYPERSENSITIVITY IS Rationale: To prevent excessive
c. Streptokinase further tissue damage if  CVA w/in the last 2 mos UNCOMMON blood loss
d. Tenecteplase used w/in 6 hrs. after  Aneurysm
e. Urokinase onset of symptoms to  OB Delivery DRUG-DRUG INTERACTION: 2. Institute treatment w/in 6 hrs.
treat pulmonary emboli,  Organ Biopsy  Thrombolytic Agents + after the onset of symptoms of
ischemic stroke, and open  Recent serious GI bleeding Anticoagulant/Antiplatelet acute MI
clotted IV catheters  Recent Major Trauma (CPR) Drug Rationale: To achieve optimum
 Blood Clotting Defects = INCREASED BLEEDING therapeutic effect
 Must be injected and  CVD
removed from the body  Uncontrolled HPTN 3. Arrange to type and cross-match
after liver metabolism  Liver Dse blood
Rationale: could be worsened by Rationale: In case of serious blood
 Only effective if the pt has dissolution of clots loss that would need blood
plasminogen in the transfusion
plasma
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  Replace clotting factors that  Used to prevent blood loss from  Allergy  Related to blood producs 1. Administer by IV route only
are genetically missing or low injury or surgery (Hepa/AIDS) Rationale:to ensure therapeutic
a. Antihemophilic Factor in that particular type of  Used to treat bleeding episodes CNS: effectiveness
b. Coagulation Factor VIIa hemophilia  Headache
c. Factor IX Complex  Antihemophilic Factor  Factor IX Complex  Flushing 2. Monitor for signs of thrombosis
- Classic Hemophilia A - Presence of liver  Fever Rationale:to arrange use of comfort
disease  Lethargy and support measures (e.g. support
 Coagulation Factor VIIa  Coagulation Factor hose, positioning, ambulation,
- From mouse, - Known allergies to GI: exercise)
hamster & bovine mouse, hamster and  Nausea
proteins bovine products  Vomiting 3. Decrease infusion if headache,
- Used to treat chills, fever or tingling occurs
bleeding episodes in Dermatologic (at the site of Rationale:prevent severe drug rxn
Hemophilia A or B injection):
 Itching 4. Monitor clinical response to
 Factor IX Complex  Burning clotting factor levels regularly
- Increases blood levels  Stinging Rationale:in order to adjust dosage
of Factors II, VII, IX, X 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


6. Topical Hemostatic Agents  Used to stop bleeding  Some injuries involve so much Rationale:to arrange use of comfort
 Blocks activation of damage to the small vessels in and support measures (e.g. support
a. Absorbable Gelatin plasminogen system the area that clotting does not hose, positioning, ambulation,
b. Thrombin occur and blood is slowly exercise)
continually lost so we use 2. Decrease infusion if headache,
topical hemostatic agents chills, fever or tingling occurs
 Absorbable Gelatin Rationale:prevent severe drug rxn
- Sponge form
- Pose risk for infection 4. Monitor clinical response to
Rationale: bacteria can become clotting factor levels regularly
trapped in the vascular area when Rationale:in order to adjust dosage
the sponge is applied needed

 Thrombin 3. Arrange to type and cross-match


- From bovine sources blood
- Applied topically and Rationale: In case of serious blood
mixed w/ blood loss that would need blood
- May precipitate transfusion
allergic response
Rationale: because the drug is 4. Mark chart of pt. receiving this
derived from animal sources 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


7. Systemic Hemostatic Agents  Used to stop bleeding  Repeat Coronary Artery  Allergy Rationale:to arrange use of comfort
 Stop the natural plasminogen Bypass Graft (CABG)  Cardiac Dse and support measures (e.g. support
a. Aprotrinin clot-dissolving mechanism by Rationale: risk of arrhythmias hose, positioning, ambulation,
b. Aminocaproic Acid blocking its activation or  Aminocaproic Acid exercise)
directly inhibiting plasmin - Take 10 tabs in the
first hour, then  Renal and Hepatic Dysfxn 2. Decrease infusion if headache,
continue taking, Rationale: could alter secretion of chills, fever or tingling occurs
around the clock drug Rationale:prevent severe drug rxn

 Pregnancy and Lactation 4. Monitor clinical response to


Rationale: 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