ati flash cards 07, medications affecting the blood
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ATI Flash Cards 07, Medications Affecting the BloodTRANSCRIPT
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Anticoagulants(Parenteral)
N203ATI (Unit 7)
Hematologic System -
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Expected Action: Proto: Heparin — Others: enoxaparin, tinzaparin (Innohep)
Intrinsic factors and thrombin conversion are inhibited by heparinTherapeutic 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)
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Treatment of Heparin OD
N203ATI (Unit 7)
Hematologic System -
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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
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Anticoagulant(Oral)
N203ATI (Unit 7)
Hematologic System -
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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
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Treatment of Warfarin OD
N203ATI (Unit 7)
Hematologic System -
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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.
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Antiplatelets
N203ATI (Unit 7)
Hematologic System -
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Expected Action:
Proto: Aspirin — Others: ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), abciximab (Reo Pro)
Prevent platelet clumping by inhibiting arterial clotting enzymes and factorsTherapeutic 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
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Thrombolytic Medications
N203ATI (Unit 7)
Hematologic System -
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Expected Action:Proto: streptokinase
Others: alteplase (tPA), tenecteplase, reteplase Clot dissolution by plasminogenplasmin which destroys fibrinogen
Therapeutic Uses: Acute MI / DVT / Massive PE / Ischemic stroke (alteplase)
Adverse Effects: Serious risk of bleeding from different sitesStreptokinase 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.
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Iron Preparations
N203ATI (Unit 7)
Hematologic System -
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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
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Vitamin B12(Cyanocobalamin)
N203ATI (Unit 7)
Hematologic System -
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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.
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Folic Acid
N203ATI (Unit 7)
Hematologic System -
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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:
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Hematopoietic Growth Factors
N203ATI (Unit 7)
Hematologic System -
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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 surgeryAdverse 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
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Granulocyte ColonyStimulating Factor
N203ATI (Unit 7)
Hematologic System -
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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
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Granulocyte Macrophage Colony Stimulating Factor
N203ATI (Unit 7)
Hematologic System -
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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.
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Thrombopoietic Growth Factors
N203ATI (Unit 7)
Hematologic System -
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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
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Whole Blood
N203ATI (Unit 7)
Hematologic System -
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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
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Packed RBCs
N203ATI (Unit 7)
Hematologic System -
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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
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Platelet Concentrate
N203ATI (Unit 7)
Hematologic System -
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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
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Fresh Frozen Plasma
N203ATI (Unit 7)
Hematologic System -
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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
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Pheresed Granulocytes
N203ATI (Unit 7)
Hematologic System -
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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
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Albumin
N203ATI (Unit 7)
Hematologic System -
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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.