NUR 226 Heme thromboembolics.docx - NUR 226 Patho\/Pharm Blue Print Heme\/Thromboembolics Medications Know therapeutic levels where appropriate adverse

NUR 226 Heme thromboembolics.docx - NUR 226 Patho/Pharm...

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NUR 226 Patho/PharmBlue Print Heme/ThromboembolicsMedications:Know therapeutic levels where appropriate, adverse reactions, implications, how to determine if drug is effective; expected outcome, dietary concerns, when to call the provider: Erythropoietin oStimulates RBC production in response to insufficient oxygen available to cells (hypoxia)oIs a hormone that originates in the kidney, travels to the bone marrow and interacts with receptors on hematopoietic stem cells with the message to increase RBC productionoAlso stimulates production of hemoglobinoSerum levels of erythropoietin may increase as much as 1,000 fold in response to hypoxia.oRequire more ironFilgrastim (neupogen)oAdminister at home – proper disposal oStimulates immature neutrophils to divide and differntiateoUsed primarily to treat chronic neutropenia or neutropenia caused by chemooAsses PT HX of myeloid cancers, like leukemiaoMay stimulate the proliferation of the malignant cellsoDon’t administer concurrently with chemooGet baseline labsoBaseline cardiac assessment… may cause cardiac dsyrhythmias/tachycardiaoAdverse effects: HTN, skeletal pain, ECG changes, ST depression Unfractionated heparinoMOA: binds to antithrombin III which inactivated several clotting factors and inhibits thrombin activityoIndirect thrombin inhibitoroIV – onset is immediate,SC- 1hr for therapeutic effectoShort half life 30-minutes to one houroMonitor PTT/ACToPriority outcome: prevention of DVT and PE, Prolonged partial thromboplastin time (aPTT) of 1.5–2.5 times the control, without signs of hemorrhage.oProtamine Sulfate reverses heparins actionoPatient teaching : it prevents clots from forming, advise to report any s/sx of unusual bleeding/bruising to HCP, don’t take NSAIDs, soft toothbrush and electric razoroIndications: acute coronary syndromes, MI, prophylaxis and treatment of thromboembolic disease, bridge to oral anticoagulation
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oNursing Considerations: monitor for S/Sx of bleeding, PTT/ACT, thrombocytopenia, never rub injection site of SC heparin, never draw back plunger once the syringe has entered the skin – may contribute to tissue damage or bleedingoAdverse reaction: BLEEDING and HITEnoxaparin (Lovenox)oTrade name : LovenoxoADMIN: SQ, 1-2x per day, weight dosedoLow molecular weight heparin (LMWH)oInstruct PT to not take, aspiring, naproxen, or ibuprofen (NSAIDS) witout talking to HCPoMOA: synthesis of fragments from UFH, target specifically factor Xa.oMore predictable anticoagulation effects, longer half life then UFHoIndications: drug of choice for the prophylaxis and treatment of thromboembolic disorders, ACSoNursing Considerations: monitor for signs and symptoms of bleeding, thrombocytopenia, HIT (rare), can monitor factor Xa levelsoAdverse reactions: Hemorrhage, thrombocytopenia, pancytopenia, anaphylaxisWarfarinoProthrombin Time (PT) most often used to dose warfarinoMOA: inhibits synthesis of vitamin K dependent clotting factors (Factors II, VII, IX, X)o
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