ppt chapter 32

67
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 32 Drugs Affecting Coagulation

Upload: stanbridge

Post on 30-Nov-2014

136 views

Category:

Documents


4 download

DESCRIPTION

 

TRANSCRIPT

Page 1: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 32

Drugs Affecting Coagulation

Chapter 32

Drugs Affecting Coagulation

Page 2: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physiology of Coagulation Physiology of Coagulation • Normal circulation requires blood to circulate freely

through large and small blood vessels.

• However, blood must also be able to form clots to prevent excessive blood loss from injuries.

• Blood is composed of various cells and substances, each with a specific purpose that assists in maintaining a balance of coagulation and anticoagulation.

• The cascade is initiated by the tissue damage and platelet activation, which mobilize the clotting factors circulating in the blood.

• The clotting cascade occurs over two pathways, intrinsic and extrinsic.

Page 3: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pathophysiology Pathophysiology

• When blood flow is impeded and slowed in an area, coagulation occurs, leading to formation of a thrombus.

• Any excessive action from the coagulating factors may also produce a thrombus that obstructs blood flow.

• Arterial thrombosis is the most common cause of MI, stroke, and limb gangrene.

• Venous thrombosis leads to pulmonary embolism (PE) and postphlebitic syndrome.

Page 4: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pathophysiology (cont.)Pathophysiology (cont.)

• When clotting factors are deficient, blood clotting does not occur in a timely manner.

• A minor injury or trauma can cause prolonged bleeding.

• Inherited deficiencies of specific clotting factors produce three major hemophilic conditions.

• Fibrinolysis normally occurs in balance with blood coagulation.

Page 5: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drug Therapy for Hypercoagulation Drug Therapy for Hypercoagulation

Page 6: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anticoagulant Drugs Anticoagulant Drugs • Heparin, a naturally occurring anticoagulant, is produced

by mast cells located in connective tissue throughout the body.

• All anticoagulants interfere with the clotting cascade and prolong blood clotting time.

• They vary by their route and their method of action.

• There are two types of anticoagulants: parenteral and oral.

• The parenteral anticoagulants work by preventing the conversion of fibrinogen to fibrin.

• The oral anticoagulants work by preventing the synthesis of factors dependent on vitamin K for synthesis.

• Prototype drug: heparin and warfarin (Coumadin)

Page 7: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Heparin: Core Drug Knowledge Heparin: Core Drug Knowledge

• Pharmacotherapeutics

– Parenteral anticoagulant. It interferes with the final steps of the clotting cascade.

• Pharmacokinetics

– Route: IV or SC. Onset depends on route of administration. Metabolism: liver. Excreted: kidneys.

• Pharmacodynamics

– Rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin.

Page 8: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Heparin: Core Drug Knowledge (cont.)Heparin: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Hypersensitive

• Adverse effects

– Bleeding and thrombocytopenia

• Drug interactions

– Several different drugs affect the action of heparin

Page 9: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Heparin: Core Patient Variables Heparin: Core Patient Variables

• Health status

– Review history for allergies or prolonged bleeding times.

• Life span and gender

– Heparin is safe for pregnant women.

• Lifestyle, diet, and habits

– Assess activity level.

• Environment

– Assess environment where drug will be given.

Page 10: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Heparin: Nursing Diagnoses and Outcomes Heparin: Nursing Diagnoses and Outcomes

• Risk for Injury, Hemorrhage, related to heparin therapy

– Desired outcome: hemorrhage will not occur.

• Risk for Injury, Heparin-induced thrombocytopenia, related to heparin therapy

– Desired outcome: heparin-induced thrombocytopenia will not occur.

Page 11: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Heparin: Planning and InterventionsHeparin: Planning and Interventions

• Maximizing therapeutic effects

– Monitor laboratory values.

– Heparin levels should be allowed to reach steady state before aPTT is measured.

• Minimizing adverse effects

– If the aPTT during treatment exceeds the desired range, the dosage should be decreased.

– Use an IV controller or pump for continuous IV drip heparin.

Page 12: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Heparin: Teaching, Assessment, and EvaluationsHeparin: Teaching, Assessment, and Evaluations

• Patient and family education

– Inform patients why the drug is needed and what it is expected to accomplish.

– Instruct patients to report any bleeding.

• Ongoing assessment and evaluation

– Monitor for signs of bleeding and review aPTT values to maintain heparin levels in the therapeutic range.

Page 13: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• What is the antidote for heparin?

– A. Vitamin K

– B. Clotting factor XII

– C. Sodium sulfate

– D. Protamine sulfate

Page 14: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• D. Protamine sulfate

• Rationale: Protamine sulfate is the antidote for heparin.

Page 15: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Warfarin: Core Drug Knowledge Warfarin: Core Drug Knowledge

• Pharmacotherapeutics

– Used prophylactically for patients with a long-term risk for thrombus formation

• Pharmacokinetics

– Administered: oral. Highly protein bound. Metabolism: liver. Excreted: bile

• Pharmacodynamics

– Competitively blocks vitamin K at its sites of action

Page 16: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Warfarin: Core Drug Knowledge (cont.)Warfarin: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Active bleeding or bleeding disorders

• Adverse effects

– Bleeding and hemorrhage

• Drug interactions

– Several drug–drug and drug–food interactions

Page 17: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Warfarin: Core Patient Variables Warfarin: Core Patient Variables

• Health status

– Assess the availability of vitamin K.

• Life span and gender

– Consider the patient’s age before therapy begins.

• Lifestyle, diet, and habits

– Obtain information about the patient’s dietary habits.

• Environment

– Assess environment where drug will be given.

• Culture and inherited traits

– Inherited variations of P-450 may alter drug response

Page 18: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Warfarin: Nursing Diagnoses and Outcomes Warfarin: Nursing Diagnoses and Outcomes

• Risk for Injury, Bleeding, related to adverse effects of warfarin

– Desired outcome: The patient will not experience bleeding.

Page 19: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Warfarin: Planning and InterventionsWarfarin: Planning and Interventions

• Maximizing therapeutic effects

– Warfarin dosage should be individualized until PT or the INR is in therapeutic range.

• Minimizing adverse effects

– Assess the patient’s response to warfarin therapy.

– Antidote is vitamin K (phytonadione)

Page 20: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Warfarin: Teaching, Assessment, and EvaluationsWarfarin: Teaching, Assessment, and Evaluations

• Patient and family education

– Teach patients the signs of bleeding and methods to prevent bleeding.

– Take the drug at the same time every day.

• Ongoing assessment and evaluation

– Monitor the patient’s PT or INR to determine the therapeutic effects of warfarin.

– Therapy is effective when a thrombus is prevented and bleeding does not occur.

Page 21: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• Warfarin dose is titrated based on what lab value?

– A. aPTT

– B. PT and INR

– C. Platelet count

– D. CBC

Page 22: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• B. PT and INR

• Rationale: Dosage is based on achieving a therapeutic level as measured by changes in the prothrombin time (PT) and International Normalized Ratio (INR).

Page 23: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antiplatelet Drugs Antiplatelet Drugs

• They are used when overactive platelets pose long-term risks for hypercoagulability.

• Platelet aggregation is important in hemostasis.

• Antiplatelet drugs reduce platelet aggregation.

• Antiplatelet drugs differ in their modes of action and adverse effects.

• Prototype drug: clopidogrel (Plavix)

Page 24: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clopidogrel: Core Drug Knowledge Clopidogrel: Core Drug Knowledge

• Pharmacotherapeutics

– Used to reduce atherosclerotic events

• Pharmacokinetics

– Administered: oral. Metabolism: liver. Protein bound

• Pharmacodynamics

– Inhibits the binding of adenosine diphosphate (ADP) to its platelet receptor and the subsequent ADP-mediated activation of the glycoprotein IIb/IIIa complex and thus inhibits platelet aggregation

Page 25: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clopidogrel: Core Drug Knowledge (cont.)Clopidogrel: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Hypersensitivity and active bleeding disorders

• Adverse effects

– Bleeding, GI distress, and neutropenia

• Drug interactions

– Tamoxifen, tolbutamide, warfarin, torsemide, fluvastatin, and many NSAIDs

Page 26: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clopidogrel: Core Patient Variables Clopidogrel: Core Patient Variables • Health status

– Assess for any contraindications to therapy.

• Life span and gender

– Use caution in children younger than 18 years.

• Lifestyle, diet, and habits

– Assess for behaviors that would increased bleeding.

• Environment

– Be aware of the environment in which the drug will be administered.

Page 27: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clopidogrel: Nursing Diagnoses and Outcomes Clopidogrel: Nursing Diagnoses and Outcomes

• Risk for Injury: Increased Risk for Bleeding related to decreased platelet aggregation from drug therapy

– Desired outcome: The patient will suffer no injury related to bleeding while on clopidogrel.

• Risk for Nausea related to adverse effects of clopidogrel

– Desired outcome: Nausea and GI distress will not be extreme enough to warrant stopping clopidogrel therapy.

Page 28: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clopidogrel: Planning and InterventionsClopidogrel: Planning and Interventions

• Maximizing therapeutic effects

– Ensure that clopidogrel is administered routinely to achieve its maximum therapeutic effects.

• Minimizing adverse effects

– Take clopidogrel with food to decrease GI problems.

– Remember that severe neutropenia is a potential risk.

Page 29: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clopidogrel: Teaching, Assessment, and EvaluationsClopidogrel: Teaching, Assessment, and Evaluations

• Patient and family education

– Inform patients and families about laboratory tests that are needed on a regular basis.

– Emphasize to patients that behaviors that may lead to injury should be avoided.

• Ongoing assessment and evaluation

– Periodic measurement of bleeding time and platelet function is needed throughout clopidogrel therapy.

Page 30: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• What is the most serious adverse effect of clopidogrel?

– A. Bleeding

– B. Neutropenia

– C. Arrhythmia

– D. Seizure

Page 31: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• B. Neutropenia

• Rationale: Neutropenia is a potential risk of therapy.

Page 32: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hemorheologic Drugs Hemorheologic Drugs

• The hemorheologic drugs act on RBCs to reduce blood viscosity and increase the flexibility of RBCs.

• This effect helps prevent thrombus formation and allows the RBCs to enter the microcirculation.

• These effects are helpful in treating peripheral vascular disease.

• Prototype drug: pentoxifylline (Trental)

Page 33: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pentoxifylline: Core Drug Knowledge Pentoxifylline: Core Drug Knowledge

• Pharmacotherapeutics

– Manage symptoms of intermittent claudication.

• Pharmacokinetics

– Administered: oral. Distribution: wide. Metabolism: liver. Excreted: kidneys. Onset: 2 to 4 weeks

• Pharmacodynamics

– Increases cAMP levels and increases cellular adenosine triphosphate levels

Page 34: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pentoxifylline: Core Drug Knowledge (cont.)Pentoxifylline: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Intolerance to methylxanthines

• Adverse effects

– Effects occur in central nervous, CV, and GI systems

• Drug interactions

– Interact with a few drugs

Page 35: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pentoxifylline: Core Patient Variables Pentoxifylline: Core Patient Variables

• Health status

– Hypersensitive to the drug or to methylxanthines

• Life span and gender

– Determine if pregnant or breast-feeding.

• Lifestyle, diet, and habits

– Document occupation and daily activities.

• Environment

– Assess environment where drug will be given.

Page 36: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pentoxifylline: Nursing Diagnoses and Outcomes Pentoxifylline: Nursing Diagnoses and Outcomes

• Risk for Injury related to adverse pentoxifylline effects (dizziness, drowsiness, and blurred vision)

– Desired outcome: The patient will remain injury free while on pentoxifylline.

Page 37: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pentoxifylline: Planning and InterventionsPentoxifylline: Planning and Interventions

• Maximizing therapeutic effects

– Pentoxifylline must be taken for several weeks before the full therapeutic effects are evident.

• Minimizing adverse effects

– Give pentoxifylline with food to minimize GI upset.

Page 38: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pentoxifylline: Teaching, Assessment, and EvaluationsPentoxifylline: Teaching, Assessment, and Evaluations

• Patient and family education

– Inform patients that pentoxifylline does not have an immediate effect.

– Instruct patients to keep all follow-up visits with the prescriber.

• Ongoing assessment and evaluation

– Peripheral circulation should be reassessed periodically to measure improvement.

Page 39: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• The full therapeutic effects of pentoxifylline are usually evident after

– A. One hour

– B. One day

– C. One week

– D. Several weeks

Page 40: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• D. Several weeks

• Rationale: Patients must be instructed to continue pentoxifylline as prescribed because it must be taken for several weeks before the full therapeutic effects are evident.

Page 41: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Thrombolytic Drugs Thrombolytic Drugs • Thrombolytic drugs assist in breaking down formed blood

clots.

• These drugs are used for patients who are diagnosed with an evolving, acute MI; a PE; or acute ischemic stroke.

• They may also be given to unclog central venous catheters.

• These drugs may be given systemically or directly at the site of the blood clot.

• Although these drugs are given during emergency situations and can save lives, their adverse effects can be life threatening.

• Prototype drug: alteplase, recombinant (Activase; Cathflo Activase)

Page 42: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alteplase, Recombinant: Core Drug Knowledge Alteplase, Recombinant: Core Drug Knowledge

• Pharmacotherapeutics

– Thromboembolic conditions

• Pharmacokinetics

– Administered: IV. Rapidly cleared from the plasma

• Pharmacodynamics

– Acts in the same way as endogenous tPA

– Converts plasminogen to plasmin

Page 43: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alteplase, Recombinant: Core Drug Knowledge (cont.)Alteplase, Recombinant: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Hypersensitivity and active internal bleeding

• Adverse effects

– Internal or superficial bleeding

• Drug interactions

– Interacts with anticoagulants and antiplatelet drugs

Page 44: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alteplase, Recombinant: Core Patient Variables Alteplase, Recombinant: Core Patient Variables

• Health status

– Assess conditions that contraindicate administering.

• Life span and gender

– Determine the patient’s age and pregnancy status.

• Environment

– Assess environment where drug will be given.

Page 45: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alteplase, Recombinant: Nursing Diagnoses and Outcomes Alteplase, Recombinant: Nursing Diagnoses and Outcomes

• Risk for Injury related to drug-induced bleeding from alteplase

– Desired outcome: The patient will not suffer injury from alteplase.

Page 46: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alteplase, Recombinant: Planning and InterventionsAlteplase, Recombinant: Planning and Interventions

• Maximizing therapeutic effects

– Reconstitute alteplase recombinant in sterile water for injection without preservatives.

• Minimizing adverse effects

– Closely and continually monitor vital signs and observe for signs of active bleeding

– The patient should be connected to a cardiac monitor, both during the treatment and afterward.

Page 47: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Alteplase, Recombinant: Teaching, Assessment, and EvaluationsAlteplase, Recombinant: Teaching, Assessment, and Evaluations

• Patient and family education

– Emphasize to patients and families the need for frequent assessment, pressure dressings, and activity limitations.

– Instruct patients to notify their nurse if they experience signs of adverse reactions.

• Ongoing assessment and evaluation

– Vital signs, evidence of bleeding, and laboratory test results should be assessed throughout therapy with alteplase recombinant as described previously.

Page 48: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• Alteplase, recombinant is a pregnancy category ____ drug.

– A. A

– B. B

– C. C

– D. D

– E. X

Page 49: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• C. C

• Rationale: Alteplase, recombinant is a pregnancy category C drug.

Page 50: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Clotting Factors Clotting Factors

• Deficiencies of normal blood clotting factors are associated with prolonged bleeding and clot formation times.

• These deficiencies result from an inherited absence of the factor.

• Replacement of these factors with clotting factors is the treatment of choice.

• Prototype drug: antihemophilic factor

Page 51: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antihemophilic Factor: Core Drug Knowledge Antihemophilic Factor: Core Drug Knowledge

• Pharmacotherapeutics

– Deficiency of clotting factor VIII, hemophilia A

• Pharmacokinetics

– Administered: IV. T½: 4 to 24 hours

• Pharmacodynamics

– Factor VIII is an essential component of blood clotting. It is required for the conversion of prothrombin to thrombin.

Page 52: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antihemophilic Factor: Core Drug Knowledge (cont.)Antihemophilic Factor: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Hypersensitivity to mouse protein

• Adverse effects

– Anaphylaxis, urticaria, nausea, and chills

• Drug interactions

– No important interactions are associated with AHF.

Page 53: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antihemophilic Factor: Core Patient Variables Antihemophilic Factor: Core Patient Variables • Health status

– Assess labs prior to administration.

• Life span and gender

– Assess pregnancy status.

• Lifestyle, diet, and habits

– Assess for behaviors that might result in injury.

• Environment

– Generally self-administered at home

• Culture and inherited traits

– Religious views forbidding receiving blood products

Page 54: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antihemophilic Factor: Nursing Diagnoses and Outcomes Antihemophilic Factor: Nursing Diagnoses and Outcomes

• Risk for Injury, Hemorrhage, related to deficiency of clotting factor VIII

– Desired outcome: the patient will receive enough factor VIII to prevent injury.

Page 55: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antihemophilic Factor: Planning and InterventionsAntihemophilic Factor: Planning and Interventions

• Maximizing therapeutic effects

– Refrigeration is required for AHF until it is used.

– Before reconstitution, warm the concentrate and the diluent to room temperature.

• Minimizing adverse effects

– After dilution, administer AHF within 3 hours to prevent bacterial growth.

– Administer IV route only.

Page 56: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antihemophilic Factor: Teaching, Assessment, and EvaluationsAntihemophilic Factor: Teaching, Assessment, and Evaluations

• Patient and family education

– Instruct patients and families to observe for bleeding from gums, skin, urine, stools, or emesis.

– Caution patients to avoid products containing aspirin or ibuprofen.

• Ongoing assessment and evaluation

– Blood studies are monitored as previously described when AHF is administered.

– Therapy is effective when prolonged bleeding is prevented or stopped.

Page 57: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• Antihemophilic factor is prescribed for patients who demonstrate a deficiency of clotting factor

– A. IV

– B. VII

– C. VIII

– D. XII

Page 58: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• C. VIII

• Rationale: Patient’s with a demonstrated deficiency of clotting factor VIII can be given AHF to prevent and control excessive bleeding.

Page 59: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hemostatic Drugs Hemostatic Drugs

• Hemostatics stop blood loss by enhancing blood coagulation.

• There are two types of hemostatic agents: systemic and topical.

• Systemic agents interfere with the breakdown of clots.

• Topical agents are used to control small amounts of bleeding or oozing, usually following surgery.

• Prototype drug: aminocaproic acid (Amicar)

Page 60: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aminocaproic Acid: Core Drug Knowledge Aminocaproic Acid: Core Drug Knowledge

• Pharmacotherapeutics

– Life-threatening hemorrhage

• Pharmacokinetics

– Administered: oral or IV. Most of the drug is excreted unchanged in the urine

• Pharmacodynamics

– Blocks the action of plasminogen activators

– Interferes with the binding of active plasmin to fibrin

Page 61: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aminocaproic Acid: Core Drug Knowledge (cont.)Aminocaproic Acid: Core Drug Knowledge (cont.)

• Contraindications and precautions

– Active intravascular clotting disorders

• Adverse effects

– GI distress, headache, dizziness, seizures, hypotension, arrhythmias, tinnitus, nasal congestion, vomiting, abdominal cramps, diarrhea, and diuresis

• Drug interactions

– Oral contraceptives or estrogen

Page 62: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aminocaproic Acid: Core Patient Variables Aminocaproic Acid: Core Patient Variables

• Health status

– Identify contraindications to the drug. • Life span and gender

– Assess pregnancy and breast-feeding status.• Environment

– Administered in an acute care setting, such as a hospital

Page 63: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aminocaproic Acid: Nursing Diagnoses and Outcomes Aminocaproic Acid: Nursing Diagnoses and Outcomes

• Risk for Altered Cardiovascular Perfusion related to volume loss secondary to uncontrolled bleeding or thrombophlebitis secondary to adverse effects of aminocaproic acid

– Desired outcome: adequate perfusion will be maintained as evidenced by presence of pulses, normal skin color and warmth, and capillary refill.

Page 64: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aminocaproic Acid: Planning and InterventionsAminocaproic Acid: Planning and Interventions

• Minimizing adverse effects

– Monitor vital signs at start of therapy and throughout therapy.

– Administer drug via IV infusion pump.

– Monitor intake and output and monitoring neurologic status.

Page 65: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aminocaproic Acid: Teaching, Assessment, and EvaluationsAminocaproic Acid: Teaching, Assessment, and Evaluations

• Patient and family education

– Teach patients and families about the role of aminocaproic acid in controlling bleeding.

– Instruct to change position slowly.

• Ongoing assessment and evaluation

– Monitor the patient throughout treatment and recovery for signs and symptoms of bleeding or embolism or any other untoward event.

– Drug therapy is effective if bleeding is controlled.

Page 66: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

QuestionQuestion

• Which of the following class of drugs should be avoided when giving a patient aminocaproic acid?

– A. Oral contraceptives

– B. Antifungals

– C. Antiarrhythmics

– D. Proton pump blockers

Page 67: Ppt chapter 32

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

AnswerAnswer

• A. Oral contraceptives

• Rationale: An increase in clotting factors leading to hypercoagulation may occur if aminocaproic acid is administered concurrently with oral contraceptives or estrogen.