HEPARIN 1. Name & class of drug – generic and trade name.

GENERIC NAME: Heparin Sodium BRAND NAME: Hepalean, Heparin Sodium Lock flush solution, Hep-Lock, Lipo-Hepin, Liquaemin Sodium CLASSIFICATION: Blood formers, coagulators, and anticoagulants 2. Dose range and routes for adult & geriatric client. PREPARATIONS: IV/SC – (10, 100, 1000, 2000, 5000, 10,000, 20000, 40000) units/ml injections DOSING: Thromboembolism – IV – 5000 U bolus dose, then 20,000 – 40,000 U infused over 24 h, dose adjusted to maintain desired APTT or 5000 – 10,000 U IV piggyback q 4 – 6 h SC – 10,000 – 20,000 U followed by 8000 – 20,000 U q 8 – 12h Open heart surgery – IV – 150 – 300 U/kg Prophylaxis of Embolism – SC – 5000 U q 8 – 12 h 3. Purpose prescribed. Underline reason your client is prescribed drug. THERAPEUTIC EFFECTS: exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. USES: prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporeal circulation, and dialysis precedures 4. Major side effects & drug interactions. DRUG INTERACTIONS: may prolong PT, which is used to monitor therapy with oral anticoagulants; aspirin, NSAIDs increase risk of bleeding; nitroglycerin IV may decrease anticoagulant activity; protamine antagonizes effects of heparin.

HERBAL INTERACTIONS: feverfew, ginkgo, ginger, valerian may potentiate bleeding SIDE EFFECTS: transient thrombocytopenia, fever, chills, urticaria, pruritus, skin rashes, itching and burning sensation of feet, numbness, tingling of hands and feet, elevated BP

5. Nursing Implications & teaching. IMPLICATIONS: • Baseline blood coagulation tests, Hct, Hgb, RBC and platelet counts prior to initiation or therapy and at regular intervals throughout therapy • Monitor APTT levels closely • Draw blood for coagulation tests 30 min before each scheduled SC or intermittent IV dose and approximately q4h for pts receiving continuous IV heparin during dosage adjustments period. After dosage is established, tests may be done once daily • Pts vary widely in their reaction to heparin; risk of hemorrhage appears greatest in women, all patients > 60 y, and patients with liver disease or renal insufficiency. • Monitor vitals, report fever, drop in BP, rapid pulse and other S&S of hemorrhage • Observe all needle sites daily for hematoma and signs of inflammation • Have on hand protamine sulfate, specific heparin antagonist TEACHING: • Protect from injury and notify Dr of pink, red, dark brown or cloudy urine, red or dark brown vomitus; red or black stools, bleeding gums or oral mucosa; ecchymoses, hematoma, epistaxis, bloody sputum; chest pain; abdominal or lumbar pain or swelling; unusual increase in menstrual flow; pelvic pain; severe or continuous headache, faintness, or dizziness • Menstruation may be somewhat increased and prolonged; • Learn correct technique for SC admin if discharged from hospital on heparin • Engage in normal activities such as shaving with a safety razor in the absence of a low platelet count. • Alcohol and smoking may alter the response to heparin and are not advised • Do not take aspirin or any other OTC meds without the Dr approval