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Ati flash cards 07, medications affecting the blood

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Ati flash cards 07, medications affecting the blood

  1. 1. Anticoagulants (Parenteral) N203 ATI (Unit 7) Hematologic System -
  2. 2. Expected Action: Proto: Heparin — Others: enoxaparin, tinzaparin (Innohep) · Intrinsic factors and thrombin conversion are inhibited by heparin Therapeutic Uses: · Evolving stroke, PE, MI, DVT · During pregnancy · Adjunct during ♥ surgery, dialysis, abdominal surgery, or joint replacement · Disseminated intravascular coagulation Adverse Effects: · Hypersensitivity reaction (chills, fever, urticaria) · Hemorrhage 2º heparin OD (treat ĉ protamine sulfate) · Heparin-induced thrombocytopenia (stop if PLT < 100,000/cc) Contraindications/Precautions: · CI:  PLT or uncontrollable bleeding · CI: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture Interactions: · Anti-platelet agent  additive risk of bleeding · Education: · Monitor aPTT levels Q4-6h and then QD (60-80 sec) ·
  3. 3. Treatment of Heparin OD N203 ATI (Unit 7) Hematologic System -
  4. 4. Expected Action: Proto: Protamine sulfate · Binds with heparin and forms a non-coagulating complex Therapeutic Uses: · Antidote to severe heparin overdose · Reversal of heparin administered during procedures Adverse Effects: · · Contraindications/Precautions: · · Interactions: · · Education: · Administer slowly (20 mg/min or 50 mg in 10 min) · aPTT levels of 60-80 sec
  5. 5. Anticoagulant (Oral) N203 ATI (Unit 7) Hematologic System -
  6. 6. Expected Action: Proto: warfarin (Coumadin) · Antagonizes vitamin K / prevents synthesis of 4 intrinsic factors & prothrombin Therapeutic Uses: · Prevention of venous thrombosis · Prevention of thrombi in A-fib and with prosthetic heart valves Adverse Effects: · Hemorrhage (Tx with vitamin K) · Contraindications/Precautions: · Pregnancy (X) · CI: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture · CI:  PLT counts, uncontrolled bleeding, vit. K δ, liver problems, alcoholism Interactions: · Heparin, aspirin, glucocorticoids   bleeding · Acetaminophen, sulfonamides, parenteral cephalosporins, ASA   [warfarin] · Phenobarbital, carbamazepine, phenytoin, OC, vitamin K   warfarin effects Education: · PT therapeutic level = 18-24 sec (normal = 11-12.5 sec) · Onset takes 8-12 hrs, full effect takes 3-5 days
  7. 7. Treatment of Warfarin OD N203 ATI (Unit 7) Hematologic System -
  8. 8. Expected Action: Proto: Vitamin K (Phytonadione) · Promote synthesis of intrinsic factors and prothrombin Therapeutic Uses: · Vitamin K deficiency · Reversal of hypoprothrombinemia and bleeding d/t warfarin OD Adverse Effects: · Anaphylactoid reaction (infuse slowly in diluted solution) · Contraindications/Precautions: · · Interactions: · · Education: · Administer small doses (2.5 mg PO / 0.5-1 mg IV) of vitamin K to prevent development of resistance to warfarin. ·
  9. 9. Antiplatelets N203 ATI (Unit 7) Hematologic System -
  10. 10. Expected Action: Proto: Aspirin — Others: ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), abciximab (Reo Pro) · Prevent platelet clumping by inhibiting arterial clotting enzymes and factors Therapeutic Uses: · Primary prevention of acute MI · Prevention of stroke · Prevention of reinfarction · Acute coronary syndromes (abciximab and tirofiban {Aggrastat}) Adverse Effects: · GI effects (concurrent PPI / enteric-coated / take ĉ food) · Hemorrhagic stroke Contraindications/Precautions: · Pregnancy (D) Interactions: · · Medications that enhance bleeding  additive risk for bleeding Education: · · ASA (81 mg) for prevention / ASA (325 mg) during initial acute MI episode
  11. 11. Thrombolytic Medications N203 ATI (Unit 7) Hematologic System -
  12. 12. Expected Action: Proto: streptokinase Others: alteplase (tPA), tenecteplase, reteplase · Clot dissolution by plasminogenplasmin which destroys fibrinogen Therapeutic Uses: · · Acute MI / DVT / Massive PE / Ischemic stroke (alteplase) Adverse Effects: · · Serious risk of bleeding from different sites Streptokinase · Hypotension (infuse slowly) · Allergic reaction or anaphylaxis Contraindications/Precautions: · Hx of intracranial hemorrhage · Brain tumors / pericarditis / Recent head or facial trauma / internal bleeding Interactions: · · Meds that enhance bleeding have additive risk for bleeding Education: · Admin within 4-6 hours of onset · IV aminocaproic acid for excessive fibrinolysis · Administer H2 antagonists such as ranitidine (Zantec) or PPI such as omeprazole (Prilosec) to prevent GI bleeding.
  13. 13. Iron Preparations N203 ATI (Unit 7) Hematologic System -
  14. 14. Expected Action: Proto: Ferrous sulfate — Others: Iron Dextran · Increase iron level for RBC development and oxygen transport capacity Therapeutic Uses: · Treat and prevent iron-deficiency anemia Adverse Effects: · Teeth staining (liquid) {Dilute / Drink ĉ straw / Rinse} · GI distress: {take ĉ food if necessary but  absorption} · Anaphylaxis (parenteral): IV is safer / Deep IM ĉ Z-track / Infuse slowly Contraindications/Precautions: · · Interactions: · Vitamin C   absorption but  side effects · Antacids or tetracyclines   absorption Education: · Take on empty stomach to  absorption · Anticipate dark green or black stool
  15. 15. Vitamin B12 (Cyanocobalamin) N203 ATI (Unit 7) Hematologic System -
  16. 16. Expected Action: Proto: Vitamin B12 (cyanocobalamin) · Necessary to convert folate (required for DNA production) from inactive form Therapeutic Uses: · Treatment of B12 deficiency · Megaloblastic (macrocytic) anemia related to B12 deficiency Adverse Effects: · · Hypokalemia 2º  RBC production Contraindications/Precautions: · · Interactions: · Folic acid supplements mask signs of B12 deficiency · Education: · Intranasal spray / oral / IM / SC · Injections are painful; reserved for reduced ability to absorb.
  17. 17. Folic Acid N203 ATI (Unit 7) Hematologic System -
  18. 18. Expected Action: Proto: Folic Acid · Folic acid is essential in DNA production & erythropoiesis (RBC, WBC, PLT) Therapeutic Uses: · Tx of macrocytic anemia · Prevention of neural tube defects in pregnancy Adverse Effects: · None · Contraindications/Precautions: · · Interactions: · · Sulfonamides, sulfasalazine, methotrexate   folate levels ĉ concurrent use Education: · ·
  19. 19. Hematopoietic Growth Factors N203 ATI (Unit 7) Hematologic System -
  20. 20. Expected Action: Proto: Epoetin alfa (Epogen, Procrit) — Others: darbepoetin alfa · Act on bone marrow to  RBC production Therapeutic Uses: · Anemia of chronic renal failure or chemotherapy · HIV patients taking zidovudine (Retrovir) · Anemia in patients schedule for elective surgery Adverse Effects: · Hypertension 2º  Hct ·  risk for CV event (MI, stroke, arrest) ĉ  Hgb > 12 g/dL or > 1 g in 2 weeks Contraindications/Precautions: · CI: uncontrolled hypertension · Interactions: · · Education: · RBC production requires iron, folate, and vitamin B12 · Monitor Hgb and Hct 2x per week until target range is reached
  21. 21. Granulocyte Colony Stimulating Factor N203 ATI (Unit 7) Hematologic System -
  22. 22. Expected Action: Proto: filgrastim (Neupogen) — Others: pegfilgrastim (Neulasta) · Medications stimulate bone marrow to  production of neutrophils. Therapeutic Uses: ·  infection risk with neutropenia (e.g. cancer) Adverse Effects: · Bone pain · Leukocytosis:  dose / interrupt treatment if WBC > 50,000/cc, ANC > 20,000/cc, or platelets > 500,000/cc. Contraindications/Precautions: · CI: Sensitive to E. coli proteins · Interactions: · · Education: · Filgrastim should not be agitated nor mixed · Monitor CBC 2x per week
  23. 23. Granulocyte Macrophage Colony Stimulating Factor N203 ATI (Unit 7) Hematologic System -
  24. 24. Expected Action: Proto: Sargramostim (Leukine) ·  production of WBCs in bone marrow Therapeutic Uses: · · Facilitates recovery of bone marrow after marrow transplant. Adverse Effects: · Diarrhea, weakness, rash, malaise, and bone pain (call) · Leukocytosis, thrombocytosis: Δ if WBC>50,000, ANC>20,000, PLT>500,000 Contraindications/Precautions: · CI: Allergic to yeast products · Caution ĉ ♥ disease, hypoxia, peripheral edema, pleural/pericardial effusion. Interactions: · · Education: · Sargramostim should not be agitated nor mixed with other meds. ·
  25. 25. Thrombopoietic Growth Factors N203 ATI (Unit 7) Hematologic System -
  26. 26. Expected Action: Proto: oprelvekin (Interleukin 11, Neumega) · Increases production of platelets. Therapeutic Uses: ·  thrombocytopenia ĉ myelosuppressive chemotherapy Adverse Effects: · Fluid retention (peripheral edema, dyspnea on exertion) · Dysrhythmias · Conjunctival injection, transient blurring, and papilledema Contraindications/Precautions: · · Interactions: · · Education: · Treat for 21 days or until PLT  > 50,000 ·
  27. 27. Whole Blood N203 ATI (Unit 7) Hematologic System -
  28. 28. Expected Action: · Increases circulating blood volume Therapeutic Uses: · Acute blood loss, extensive burns, dehydration, shock Adverse Effects: · Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids) · Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m · Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m · Anaphylaxis: VS Q5m for 15m – IM or IV epinephrine · Mild allergy: If respiration uncompromised, antihistamines and restart · Circulatory overload: Place upright / O2 and diuretics / slower rate Education: · Requires countersign · Assess before, during, & after · Assess site & patency · Use ≥19 ga, filter, Y-tubing · No Mix · Complete in 2-4 hours ·  Hgb 1-2 g/dL per unit
  29. 29. Packed RBCs N203 ATI (Unit 7) Hematologic System -
  30. 30. Expected Action: ·  # of RBCs Therapeutic Uses: · Erythroblastosis fetalis · Hemoglobinopathies · Severe symptomatic anemia (Hgb<6 g/dL) · Med-induced hemolytic anemia Adverse Effects: · Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids) · Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m · Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m · Anaphylaxis: VS Q5m for 15m – IM or IV epinephrine · Mild allergy: If respiration uncompromised, antihistamines and restart Education: · Requires countersign · Assess before, during, & after · Assess site & patency · Use ≥19 ga, filter, Y-tubing · No Mix · Complete in 2-4 hours ·  Hgb 1-2 g/dL per unit
  31. 31. Platelet Concentrate N203 ATI (Unit 7) Hematologic System -
  32. 32. Expected Action: ·  platelet count Therapeutic Uses: · Thrombocytopenia (< 20,000/cc) · Active bleeding (platelets < 80,000/cc) Adverse Effects: · Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids) · Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m · Mild allergy: If respiration uncompromised, antihistamines and restart Education: · Requires countersign · Assess before, during, & after · Assess site & patency · Use special platelet kit (smaller filter, shorter tube
  33. 33. Fresh Frozen Plasma N203 ATI (Unit 7) Hematologic System -
  34. 34. Expected Action: · Replaces coagulation factors Therapeutic Uses: · Massive hemorrhage · Extensive burns · Shock · Disseminated intravascular coagulation · Antithrombin III deficiency · Thrombotic thrombocytopenic purpura · Reverse warfarin effects · Replacement therapy for factors II, V, VII, IX, X, & XI Adverse Effects: · Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids) · Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m · Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m · Anaphylaxis: VS Q5m for 15m – IM or IV epinephrine · Mild allergy: If respiration uncompromised, antihistamines and restart · Circulatory overload: Place upright / O2 and diuretics / slower rate Education: · Requires countersign · Assess before, during, & after · Assess site & patency · · No Mix
  35. 35. Pheresed Granulocytes N203 ATI (Unit 7) Hematologic System -
  36. 36. Expected Action: · Replace neutrophils / granulocytes Therapeutic Uses: · Neonatal sepsis · Severe neutropenia (ANC < 500) · Neutrophil dysfunction · Nonresponsive life-threatening infection Adverse Effects: · Sepsis (culture, antibiotics, IV fluids, vasopressors, steroids) · Acute hemolytic rxn (fever, tachycardia, hypotension): VS Q5m for 15m · Febrile nonhemolytic rxn (most common) (fever, headache): VS Q5m for 15m · Anaphylaxis: VS Q5m for 15m – IM or IV epinephrine · Mild allergy: If respiration uncompromised, antihistamines and restart · Circulatory overload: Place upright / O2 and diuretics / slower rate Education: · Requires countersign · Assess before, during, & after · Assess site & patency · · No Mix
  37. 37. Albumin N203 ATI (Unit 7) Hematologic System -
  38. 38. Expected Action: · Expands circulating blood volume by oncotic pressure Therapeutic Uses: · Hypovolemia · Burns · Adult respiratory distress · Hypoalbuminemia · Cardiopulmonary bypass surgery · Hemolytic disease of the newborn Adverse Effects: · · Risk for fluid volume excess such as pulmonary edema Contraindications: CHF or renal insufficiency Education: · Must administer IV: Slowly using an infusion pump · Can be administered ĉ whole blood, plasma, saline, or glucose.

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