Chamberlain College of Nursing:NR 566 Week 5 final study guide Latest,100% CORRECT
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NR 566
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NR 566
Chamberlain College of Nursing:NR 566 Week 5 final study guide Latest
Chapter 18: Drugs Affecting the Hematopoietic System
• Know the pharmacodynamics, pharmacotherapeutics clinical use, drug interactions and adverse drug reactions for:
Anticoagulants
• Pharmacodynamics
• Oral an...
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Chamberlain College of Nursing:NR 566 Week 5 final study guide Latest
Chapter 18: Drugs Affecting the Hematopoietic System
• Know the pharmacodynamics, pharmacotherapeutics clinical use, drug interactions
and adverse drug reactions for:
Anticoagulants
• Pharmacodynamics
• Oral anticoagulants such as warfarin (Coumadin) inhibit the hepatic synthesis of several
clotting factors, including factor X.
• Heparin inhibits the activity of several activated clotting factors by accelerating
the activity of antithrombin III.
• LMWH enoxaparin (Lovenox) potentiates the activity of antithrombin III and inactivates
factors Xa and IIa (thrombin).
• Dabigatran (Pradaxa) is a direct thrombin inhibitor.
• Thrombin is required for the conversion of fibrinogen to fibrin in the
clotting cascade, thus dabigatran's inhibition of thrombin prevents
thrombi from forming.
• Fondaparinux (Arixtra) is a selective inhibitor of antithrombin III and a factor Xa inhibitor.
• Rivaroxaban (Xarelto) an anticoagulant, is a highly selective factor Xa inhibitor that inhibits
thrombin
formation and the development of thrombi.
• Apixaban (Eliquis) is a selective inhibitor of factor Xa.
• Aspirin antagonizes the cyclooxygenase pathway and interferes with platelet aggregation.
• NSAIDs have this same action.
• NSAIDs are not used as antiplatelet drugs, but this explains why
concurrent use with anticoagulants is contraindicated
• Ticlopidine (Ticlid) and clopidogrel (Plavix) reduce platelet aggregation by inhibiting the
ADP pathway of platelets.
• Unlike aspirin, they have no effect on prostaglandin metabolism.
• Ticagrelor (Brilinta) reversibly interacts with the platelet P2Y12 ADP-receptor to
prevent platelet activation.
• Vorapaxar (Zontivity) is a protease-activated receptor-1 (PAR-1) antagonist, inhibiting
thrombin-induced and thrombin receptor agonist peptide-induced platelet aggregation
• Pharmacotherapeutics:
• Precautions and Contraindications
• All anticoagulants are contraindicated for patients who are hypersensitive to the drug
, or actively bleeding or who have hemophilia, thrombocytopenia, severe HTN,
intracranial hemorrhage, infective endocarditis, active tuberculosis, or ulcerative
lesions of the GI tract.
• Heparins are contraindicated in advanced hepatic or renal disease.
• They may be used in patients who are actively bleeding to treat DIC
• Heparin is Pregnancy Category C: stillbirth, prematurity
• Some heparin preparations contain benzyl alcohol: known to cause “gasping
syndrome”:
• fatal toxicity in neonates
• Hyperkalemia may develop
, • Use for patient with DM or renal insufficiency requires care and frequent monitoring o
aPTT
• Has been associated with fatal medication errors r/t different strengths of preparation
• JCo: anticoagulant therapy is a National patient Safety Goal: plan in place at
each facility to reduce patient harm
• LMWHs are contraindicated for patients with allergies to pork, sulfites, or benzyl
alcohol; uncontrolled bleeding; and in patients who have antiplatelet antibodies
• Renal impairment: cautious use
• Body weight less than 50 kg associated with increased r/f bleeding:
• enoxaparin dose adjustment
• Cautious use: untreated HTN, retinopathy (HTN or DM caused), severe liver
disease, recent Hx of ulcer, or malignancy
• Not used for thromboprophylaxis in patients with mechanical heart values:
especially pregnant (r/f heart value thrombosis)
• Enoxaparin: Preg Cat B, tinzaparin: teratogenicity and fetal death, fondaparinux: Preg
• First line drug for women who require antithrombotic therapy during pregnancy:
LMWH
• Pharmacokinetics of LMWH is altered during pregnancy
• Warfarin
• Hepatic dysfunction potentiates response through impaired synthesis of coagulation
factors
• Use with caution: Hypermetabolic states produced by fever or
hyperthyroidism increase responsiveness to warfarin:
• r/t increased catabolism of vit K dependent coagulation factors
• Increased r/f bleeding in older adults
• Caution use based on balance between potential for decreased r/f
thromboembolism and the risk for bleeding especially in those with
dementia or severe cognitive impairment: Hx of three falls in the previous
year or recurrent injurious falls, uncontrolled HTN, or non-adherent or
unreliable
• Warfarin is Pregnancy Category X: Crosses placenta and can cause hemorrhagic
disorders in the fetus and serious birth defects
• Safe during lactation
• Rivaroxaban (Xarelto): Black-Box Warning: premature discontinuation of
anticoagulants including rivaroxaban may lead to thrombotic events.
• An increased risk of stroke is seen in patients with atrial fibrillation when
transitioning to warfarin
• Rivaroxaban is Pregnancy Category C and is not recommended for use in pregnant
women.
• Apixaban (Eliquis): Black Box warning premature discontinuation leading to thrombotic
events
• Although there are no well-controlled studies: Pregnancy Category B
• Hypersensitivity to aspirin and cross-sensitivity with NSAIDs may occur, contraindicating the
, drug
• Aspirin hypersensitivity is more prevalent in patients with asthma, nasal
polyps, or chronic urticaria.
• Reye syndrome has been associated with its use in children and teenagers who
have influenza or chickenpox.
• Reversible hepatotoxicity has occurred
• Use with caution in liver damage, preexisting hypoprothrombinemia, or vit K deficienc
• Preg Cat C and Cat D in third trimester
• Avoid during lactation
• Clopidogrel and ticlopidine: severe hepatic disease (r/f bleeding d/o), do not use in these
patients
• Not recommended for patients with GI d/o
• Preg Category B
• Ticlopidine: clearance increased with age, older adults increased sensitivity to
this drug (closely monitor or ADRs)
• Older adults: increased levels of clopidogrel: no dosage adjustments
• In older adults clopidogrel is a safer drug
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