Anticoagulants | Coconote

All right, anticoagulants. This is in chapter 26, page 403. We have a clotting cascade. These particular drugs actually do affect the clotting cascade. So the clotting cascade, I believe it's on page 404, figure 26.2, I believe. You don't have to have the clotting cascade memorized, but just understanding it will help you with learning these medications. Therapeutic effects, what we're trying to do, sorry, mechanism of action exerts action in the clotting cascades. I think I already mentioned that. And then therapeutic effects, it's preventing clot formation, right? It's going to prevent that clot from forming. So that's important to remember for this particular class. So you call them antithrombotic, so we're preventing clot or thrombus formation. Indications would be coronary artery disease. In my heart failure, if a patient had a heart valve replacement, it'll help, again, from an ischemic event occurring. History of thrombotic strokes, that would be an ischemic stroke. Deep vein thrombosis, or DVT, and we've talked about that before in immobility, so hopefully you remember that. So we might administer this type of treatment for prophylaxis, preventative. And then pulmonary embolism, that was also mentioned in your immobility lecture as well, where that... clot or thrombus if it gets dislodged from an extremity it can actually land in a pulmonary artery precautions would be blood dyscrasia that's basically just different clotting disorders an example would be like hemophilia where a patient will just profusely bleed they don't really have any clotting factors recent surgery right we wouldn't want that surgical incision to bleed out and then concurrent use of other drugs that can also affect clotting Contraindications would be pregnancy, but it's really depending on the agent. Active bleeding, visible and occult. Remember those things that you can see and those you cannot. You might need a microscope to see it. Side effects would be bleeding. That's important to remember, right? If I'm going to give something that's an antithrombotic, then I want to remember that I can also increase the risk of bleeding. Nausea, vomiting, hypotension. Mainly only see that in really extremely high doses. Cardiac dysrhythmias, thrombocytopenia, right? That's low platelets. And then heparin-induced thrombocytopenia, otherwise known as HIT. That's mainly a complication of heparin therapy. It's caused by antibodies the patient may have. Nursing actions, we want to make sure we are continually assessing our patient, assessing for active bleeding, visible anacolt, appropriate drug dosing, following their labs. We can have that CBC, hemoglobin, and hematocrit, including their platelets. We need to be assessing that. And then patient education. Treatment, dosing, labs, safety issues, and when to call the doctor. So as we're starting to go through all of these drugs, you're going to see how the dosing might be different, what labs might be different that we're looking at, and some safety issues. Examples of drugs in class. The first one here is warfarin. Warfarin is a prototype that you need to remember. It's a coumarin derivative. This starts on page 411 if you wanted to look up this drug. What this particular drug... does is it inhibits vitamin K synthesis. Okay, so inhibits vitamin K dependent clotting factors, right? So the patient cannot clot or reduces clotting factors. So oral route, we want to think about dietary considerations. So patients who are on warfarin, we want to tell them to avoid green leafy vegetables. Why? Because they're rich in vitamin K. So we're trying to inhibit vitamin K dependent clotting factors. So we would in turn reverse that if they were eating foods that are rich in vitamin K. So it's going to interfere basically with the effects of warfarin if they consume those foods in large amounts. Dosages adjusting, what we utilize, I don't want to block this off too much, what we utilize for dosage adjusting is the INR. Okay, INR is the international normalized ratio, it's abbreviated as INR, and we also look at prothombin time. PT okay so always remember INR and PT together right what we're looking at is how long it takes a blood to clot okay we have different pathways of coagulation extrinsic intrinsic you don't have to remember the pathways this actually works on the extrinsic pathway just food for thought but um always remember INR and PT so one of the ways I remembered how what labs go with what anticoagulant drugs that I'm looking at is if you use your hands and you spell out warfarin on your hands right w-a-r-f-a-r-i-n right how many fingers do you have left you have two fingers left right so remember PT right two fingers left PT and always remember that PT INR go together so you'd be assessing both PT INR even if you spelt out cumin in the trade name on your hand you'd get the same okay so spell them out on your fingers whatever you have left that's the lob you're looking for okay so for goal INR INR normal is one right that's normal they're not on medication so you're gonna want to memorize this okay so INR oops INR normal is one okay but therapeutically this is what you really want to remember INR therapeutic meaning the patient is on treatment right they're on Warfarin. So INR therapeutic is 2 to 3.5. You have to remember that. Okay, 2 to 3.5. That's what you want to remember as therapeutic. My patients on warfarin, so generally the provider wants to keep their INR between 2 and 3.5. So the provider will give you the specific number, but you want to remember therapeutic range is generally 2 to 3.5. Why do we want to remember this? We monitor and adjust warfarin label levels. We monitor and adjust warfarin levels based on the INR level. So if the INR level is high, then we're probably going to look at how we're going to adjust treatment. So what we're looking at is how long it actually takes the blood to clot. So if they're on therapy and they're on 2 to 3.5, then that's a normal clotting, or not a normal, but it's a therapeutic clotting time. for their particular treatment. If they are clotting too quickly, right, then they were probably going to need adjustment in drug, right, so they might need to go up in their dosaging. If it's taking way too long for them to clot, so they're way out of that therapeutic range of a 3.5, then what do you think we might need to do with the drug dosaging? They might need to stop it, right, if it's taking them way too long to clot. So just utilize that or re-utilize that. to therapeutically adjust the dosages of warfarin okay and we monitor the patient that way reversal agent you want to remember the reversal reversal agement agent is vitamin k vitamin k is your reversal agent for warfarin all right heparin farm class anticoagulant we can give this drug ivy and subcutaneous iv dosages are based on the ptt Right? So we monitor the PTT for drug effectiveness for heparin. Unlike warfarin, we're looking at the PTINR. So remember how we spelt out warfarin on our fingers? Do the same with heparin. If you spelt out heparin on your fingers, H-E-P-A-R-I-N, how many fingers do you have left? We have three. P-T-T. Okay, so that's how you're going to remember which lab you'd be utilizing therapeutically to assess and monitor heparin therapeutic effectiveness. Okay? So monitor PTT for drug effectiveness of heparin. Goal PTT level is determined by indication, protocol, and response. So your provider is going to give you that number. Effective, oh so PTT is partial thromboplastin time, in case you were curious as to what that is. And then PTT is proton thrombin. And... Oh, reversal agent. So reversal agent for heparin is protamine sulfate. And I will spell that out for you. Protamine sulfate. Okay. So you're going to want to remember the reversal agent for heparin as well. Okay. All right, Lobanox or anoxaparin. Anoxaparin is actually the generic name of the prototype that you need to remember. Okay, so its farm class is a low molecular weight heparin or LMWH. Dosing is basically we dose it, it's weight based and also based on indication. Typically, we utilize this as prophylaxis, right, to prevent clot formation or DVTs. So if it is a low molecular weight heparin, we know with heparin our reversal agent is protop... protamine sulfate so it's the same so lovinox reversal agent is also protamine sulfate Okay, and then these next couple drugs that you see here, these aren't drugs that you need to memorize, but they're on here because they've become so much more common that you're gonna see patients are on these at home. So, apixaban and or Eliquis or Xeralto or whatever Oxaban, River Oxaban, that are, those are drugs that you commonly see patients coming to the hospital with because they take them at home. These are just different types of antithrombotics. And then Pradaxa is another type. So they're not on here that you have to memorize for testing, but just so that if you see them, which you probably will see them in the acute care setting, you know what they are.

You don't have to have the clotting cascade memorized, but just understanding it will help you with learning these medications. Therapeutic effects, what we're trying to do, sorry, mechanism of action exerts action in the clotting cascades. I think I already mentioned that. And then therapeutic effects, it's preventing clot formation, right?

It's going to prevent that clot from forming. So that's important to remember for this particular class. So you call them antithrombotic, so we're preventing clot or thrombus formation.

Indications would be coronary artery disease. In my heart failure, if a patient had a heart valve replacement, it'll help, again, from an ischemic event occurring. History of thrombotic strokes, that would be an ischemic stroke. Deep vein thrombosis, or DVT, and we've talked about that before in immobility, so hopefully you remember that. So we might administer this type of treatment for prophylaxis, preventative.

And then pulmonary embolism, that was also mentioned in your immobility lecture as well, where that... clot or thrombus if it gets dislodged from an extremity it can actually land in a pulmonary artery precautions would be blood dyscrasia that's basically just different clotting disorders an example would be like hemophilia where a patient will just profusely bleed they don't really have any clotting factors recent surgery right we wouldn't want that surgical incision to bleed out and then concurrent use of other drugs that can also affect clotting Contraindications would be pregnancy, but it's really depending on the agent. Active bleeding, visible and occult. Remember those things that you can see and those you cannot. You might need a microscope to see it.

Side effects would be bleeding. That's important to remember, right? If I'm going to give something that's an antithrombotic, then I want to remember that I can also increase the risk of bleeding.

Nausea, vomiting, hypotension. Mainly only see that in really extremely high doses. Cardiac dysrhythmias, thrombocytopenia, right?

That's low platelets. And then heparin-induced thrombocytopenia, otherwise known as HIT. That's mainly a complication of heparin therapy.

It's caused by antibodies the patient may have. Nursing actions, we want to make sure we are continually assessing our patient, assessing for active bleeding, visible anacolt, appropriate drug dosing, following their labs. We can have that CBC, hemoglobin, and hematocrit, including their platelets. We need to be assessing that. And then patient education.

Treatment, dosing, labs, safety issues, and when to call the doctor. So as we're starting to go through all of these drugs, you're going to see how the dosing might be different, what labs might be different that we're looking at, and some safety issues. Examples of drugs in class. The first one here is warfarin. Warfarin is a prototype that you need to remember.

It's a coumarin derivative. This starts on page 411 if you wanted to look up this drug. What this particular drug... does is it inhibits vitamin K synthesis.

Okay, so inhibits vitamin K dependent clotting factors, right? So the patient cannot clot or reduces clotting factors. So oral route, we want to think about dietary considerations. So patients who are on warfarin, we want to tell them to avoid green leafy vegetables.

Why? Because they're rich in vitamin K. So we're trying to inhibit vitamin K dependent clotting factors.

So we would in turn reverse that if they were eating foods that are rich in vitamin K. So it's going to interfere basically with the effects of warfarin if they consume those foods in large amounts. Dosages adjusting, what we utilize, I don't want to block this off too much, what we utilize for dosage adjusting is the INR. Okay, INR is the international normalized ratio, it's abbreviated as INR, and we also look at prothombin time. PT okay so always remember INR and PT together right what we're looking at is how long it takes a blood to clot okay we have different pathways of coagulation extrinsic intrinsic you don't have to remember the pathways this actually works on the extrinsic pathway just food for thought but um always remember INR and PT so one of the ways I remembered how what labs go with what anticoagulant drugs that I'm looking at is if you use your hands and you spell out warfarin on your hands right w-a-r-f-a-r-i-n right how many fingers do you have left you have two fingers left right so remember PT right two fingers left PT and always remember that PT INR go together so you'd be assessing both PT INR even if you spelt out cumin in the trade name on your hand you'd get the same okay so spell them out on your fingers whatever you have left that's the lob you're looking for okay so for goal INR INR normal is one right that's normal they're not on medication so you're gonna want to memorize this okay so INR oops INR normal is one okay but therapeutically this is what you really want to remember INR therapeutic meaning the patient is on treatment right they're on Warfarin.

So INR therapeutic is 2 to 3.5. You have to remember that. Okay, 2 to 3.5.

That's what you want to remember as therapeutic. My patients on warfarin, so generally the provider wants to keep their INR between 2 and 3.5. So the provider will give you the specific number, but you want to remember therapeutic range is generally 2 to 3.5.

Why do we want to remember this? We monitor and adjust warfarin label levels. We monitor and adjust warfarin levels based on the INR level.

So if the INR level is high, then we're probably going to look at how we're going to adjust treatment. So what we're looking at is how long it actually takes the blood to clot. So if they're on therapy and they're on 2 to 3.5, then that's a normal clotting, or not a normal, but it's a therapeutic clotting time.

for their particular treatment. If they are clotting too quickly, right, then they were probably going to need adjustment in drug, right, so they might need to go up in their dosaging. If it's taking way too long for them to clot, so they're way out of that therapeutic range of a 3.5, then what do you think we might need to do with the drug dosaging?

They might need to stop it, right, if it's taking them way too long to clot. So just utilize that or re-utilize that. to therapeutically adjust the dosages of warfarin okay and we monitor the patient that way reversal agent you want to remember the reversal reversal agement agent is vitamin k vitamin k is your reversal agent for warfarin all right heparin farm class anticoagulant we can give this drug ivy and subcutaneous iv dosages are based on the ptt Right?

So we monitor the PTT for drug effectiveness for heparin. Unlike warfarin, we're looking at the PTINR. So remember how we spelt out warfarin on our fingers? Do the same with heparin.

If you spelt out heparin on your fingers, H-E-P-A-R-I-N, how many fingers do you have left? We have three. P-T-T.

Okay, so that's how you're going to remember which lab you'd be utilizing therapeutically to assess and monitor heparin therapeutic effectiveness. Okay? So monitor PTT for drug effectiveness of heparin. Goal PTT level is determined by indication, protocol, and response.

So your provider is going to give you that number. Effective, oh so PTT is partial thromboplastin time, in case you were curious as to what that is. And then PTT is proton thrombin. And... Oh, reversal agent.

So reversal agent for heparin is protamine sulfate. And I will spell that out for you. Protamine sulfate.

Okay. So you're going to want to remember the reversal agent for heparin as well. Okay.

All right, Lobanox or anoxaparin. Anoxaparin is actually the generic name of the prototype that you need to remember. Okay, so its farm class is a low molecular weight heparin or LMWH.

Dosing is basically we dose it, it's weight based and also based on indication. Typically, we utilize this as prophylaxis, right, to prevent clot formation or DVTs. So if it is a low molecular weight heparin, we know with heparin our reversal agent is protop... protamine sulfate so it's the same so lovinox reversal agent is also protamine sulfate Okay, and then these next couple drugs that you see here, these aren't drugs that you need to memorize, but they're on here because they've become so much more common that you're gonna see patients are on these at home. So, apixaban and or Eliquis or Xeralto or whatever Oxaban, River Oxaban, that are, those are drugs that you commonly see patients coming to the hospital with because they take them at home.

These are just different types of antithrombotics. And then Pradaxa is another type. So they're not on here that you have to memorize for testing, but just so that if you see them, which you probably will see them in the acute care setting, you know what they are.

Transcript for:Anticoagulants

Transcript for:
Anticoagulants