Anticoagulants

(Parenteral)
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: Heparin Others: enoxaparin, tinzaparin (Innohep)
Intrinsic factors and thrombin conversion are inhibited by heparin
Therapeutic Uses:
Evolving stroke, E, !I, "#$ "%ring pregnancy
&d'%nct d%ring ( s%rgery, dialysis, abdominal s%rgery, or 'oint replacement
"isseminated intravasc%lar coag%lation
Adverse Effects:
Hypersensitivity reaction (chills, fever, %rticaria)
Hemorrhage )* heparin +" (treat , protamine sulfate)
Heparin-ind%ced thrombocytopenia (stop if .$ / 011,1112cc)
Contraindications/Precautions:
3I: .$ or %ncontrollable bleeding
3I: 4%rgery of eye, brain, spinal cord5 regional anesthesia5 l%mbar p%nct%re
Interactions:
&nti-platelet agent additive risk of bleeding

Education:
!onitor a$$ levels 67-8h and then 6" (81-91 sec)

Treatment of Hearin !"

N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: rotamine s%lfate
:inds ;ith heparin and forms a non-coag%lating complex
Therapeutic Uses:
&ntidote to severe heparin overdose
<eversal of heparin administered d%ring proced%res
Adverse Effects:

Contraindications/Precautions:

Interactions:

Education:
&dminister slo;ly ()1 mg2min or =1 mg in 01 min)
a$$ levels of 81-91 sec
Anticoagulant
(!ral)
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: ;arfarin (3o%madin)
&ntagonizes vitamin > 2 prevents synthesis of 7 intrinsic factors ? prothrombin
Therapeutic Uses:
revention of veno%s thrombosis
revention of thrombi in &-fib and ;ith prosthetic heart valves
Adverse Effects:
Hemorrhage ($x ;ith vitamin >)

Contraindications/Precautions:
Pregnancy (X)
3I: 4%rgery of eye, brain, spinal cord5 regional anesthesia5 l%mbar p%nct%re
3I: .$ co%nts, %ncontrolled bleeding, vit@ > A, liver problems, alcoholism
Interactions:
Heparin, aspirin, glucocorticoids bleeding
Acetaminophen, sulfonamides, parenteral cephalosporins, ASA B;arfarinC
Phenobarbital, carbamazepine, phenytoin, OC, vitamin K ;arfarin effects
Education:
$ therape%tic level D 09-)7 sec (normal D 00-0)@= sec)
+nset takes 9-0) hrs, f%ll effect takes E-= days
Treatment of #arfarin !"
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: #itamin > (hytonadione)
romote synthesis of intrinsic factors and prothrombin
Therapeutic Uses:
#itamin > deficiency
<eversal of hypoprothrombinemia and bleeding d2t warfarin +"
Adverse Effects:
&naphylactoid reaction (inf%se slo;ly in dil%ted sol%tion)

Contraindications/Precautions:

Interactions:

Education:
&dminister small doses ()@= mg + 2 1@=-0 mg I#) of vitamin > to
prevent development of resistance to warfarin@

Antilatelets
N203
ATI (Unit 7)
Hematologic System -
Expected
Action:
Proto: &spirin Others: ticlopidine ($iclid), clopidogrel (lavix),
dipyridamole (ersantine), abciximab (<eo ro)
revent platelet cl%mping by inhibiting arterial clotting enzymes and factors
Therapeutic Uses:
rimary prevention of ac%te !I revention of stroke
revention of reinfarction
&c%te coronary syndromes (abciimab and tirofiban !Aggrastat")
Adverse
Effects:
FI effects (conc%rrent I 2 enteric-coated 2 take , food)
Hemorrhagic stroke
Contraindications/Precautions:
regnancy (")
Interactions:

!edications that enhance bleeding additive risk for bleeding
Education:

&4& (90 mg) for prevention 2 &4& (E)= mg) d%ring initial ac%te !I episode
T$rom%olytic &e'ications
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: streptokinase
Others: alteplase (t&), tenecteplase, reteplase
3lot dissol%tion by plasminogenplasmin ;hich destroys fibrinogen
Therapeutic Uses:

&c%te !I 2 "#$ 2 !assive E 2 Ischemic stroke (alteplase)
Adverse Effects:

4erio%s risk of bleeding from different sites
Strepto#inase Hypotension (inf%se slo;ly)
&llergic reaction or anaphylaxis
Contraindications/Precautions:
Hx of intracranial hemorrhage
:rain t%mors 2 pericarditis 2 <ecent head or facial tra%ma 2 internal bleeding
Interactions:

!eds that enhance bleeding have additive risk for bleeding
Education:
&dmin ;ithin 7-8 ho%rs of onset
I# aminocaproic acid for excessive fibrinolysis
&dminister H
)
antagonists s%ch as ranitidine $%antec& or I s%ch as
omeprazole $Prilosec& to prevent FI bleeding@
Iron Prearations
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: Gerro%s s%lfate Others: Iron "extran
Increase iron level for <:3 development and oxygen transport capacity
Therapeutic Uses:
$reat and prevent iron-deficiency anemia
Adverse Effects:
$eeth staining (liH%id) I"il%te 2 "rink , stra; 2 <inseJ
FI distress: Itake , food if necessary b%t absorptionJ
&naphylaxis (parenteral): I# is safer 2 "eep I! , K-track 2 Inf%se slo;ly
Contraindications/Precautions:

Interactions:
#itamin 3 absorption b%t side effects
&ntacids or tetracyclines absorption
Education:
$ake on empty stomach to absorption
&nticipate dark green or black stool
(itamin )
12
(*yanoco%alamin)
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: #itamin :
12
(cyanocobalamin)
Lecessary to convert folate (reH%ired for "L& prod%ction) from inactive form
Therapeutic Uses:
$reatment of :
12
deficiency
!egaloblastic (macrocytic) anemia related to :
12
deficiency
Adverse Effects:

Hypokalemia )* <:3 prod%ction
Contraindications/Precautions:

Interactions:
Golic acid s%pplements mask signs of :
12
deficiency

Education:
Intranasal spray 2 oral 2 I! 2 43
In'ections are painf%l5 reserved for red%ced ability to absorb@
+olic Aci'
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: Golic &cid
Golic acid is essential in "L& prod%ction ? erythropoiesis (<:3, M:3, .$)
Therapeutic Uses:
$x of macrocytic anemia
revention of ne%ral t%be defects in pregnancy
Adverse Effects:
Lone

Contraindications/Precautions:

Interactions:

Sulfonamides, sulfasalazine, methotreate folate levels , conc%rrent %se
Education:

Hematooietic ,ro-t$ +actors

N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: Epoetin alfa (Epogen, rocrit) Others: darbepoetin alfa
&ct on bone marro; to <:3 prod%ction
Therapeutic Uses:
&nemia of chronic renal fail%re or chemotherapy
HI# patients taking zidovudine
$'etrovir&
&nemia in patients sched%le for
elective s%rgery
Adverse Effects:
Hypertension )* Hct
risk for 3# event (!I, stroke, arrest) , Hgb N 0) g2d. or N 0 g in ) ;eeks
Contraindications/Precautions:
3I: %ncontrolled hypertension

Interactions:

Education:
<:3 prod%ction reH%ires iron, folate, and vitamin
:0)
!onitor Hgb and Hct )x per ;eek %ntil target range is reached
,ranulocyte *olony
Stimulating +actor
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: filgrastim (Le%pogen) Others: pegfilgrastim (Le%lasta)
!edications stim%late bone marro; to prod%ction of ne%trophils@
Therapeutic Uses:
infection risk ;ith ne%tropenia (e@g@ cancer)
Adverse Effects:
:one pain
.e%kocytosis: dose 2 interr%pt treatment if M:3 N =1,1112cc, &L3 N
)1,1112cc, or platelets N =11,1112cc@
Contraindications/Precautions:
3I: 4ensitive to () coli proteins

Interactions:

Education:
*ilgrastim sho%ld not be agitated nor mixed
!onitor 3:3 )x per ;eek
,ranulocyte &acro$age
*olony Stimulating +actor
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: 4argramostim (.e%kine)
prod%ction of M:3s in bone marro;
Therapeutic Uses:

Gacilitates recovery of bone marro; after marro; transplant@
Adverse Effects:
"iarrhea, ;eakness, rash, malaise, and bone pain (call)
.e%kocytosis, thrombocytosis: O if M:3N=1,111, &L3N)1,111, .$N=11,111
Contraindications/Precautions:
3I: &llergic to yeast prod%cts
3a%tion , ( disease, hypoxia, peripheral edema, ple%ral2pericardial eff%sion@
Interactions:

Education:
Sargramostim sho%ld not be agitated nor mixed ;ith other meds@

T$rom%ooietic ,ro-t$
+actors
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Proto: oprelvekin (Interle%kin 00, Le%mega)
Increases prod%ction of platelets@
Therapeutic Uses: thrombocytopenia , myelos%ppressive chemotherapy
Adverse Effects:
Gl%id retention (peripheral edema, dyspnea on exertion)
"ysrhythmias 3on'%nctival in'ection, transient bl%rring, and papilledema
Contraindications/Precautions:

Interactions:

Education:
$reat for )0 days or %ntil .$ N =1,111

#$ole )loo'
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Increases circ%lating blood vol%me
Therapeutic Uses: &c%te blood loss, extensive b%rns, dehydration, shock
Adverse Effects:
4epsis (c%lt%re, antibiotics, I# fl%ids, vasopressors, steroids)
&c%te hemolytic rxn (fever, tachycardia, hypotension): #4 6=m for 0=m
Gebrile nonhemolytic rxn (most common) (fever, headache): #4 6=m for 0=m
&naphylaxis: #4 6=m for 0=m P I! or I# epinephrine
!ild allergy: If respiration %ncompromised, antihistamines and restart
3irc%latory overload: lace %pright 2 +
)
and di%retics 2 slo;er rate
Education:
<eH%ires co%ntersign &ssess before, d%ring, ? after
&ssess site ? patency Qse R0S ga, filter, T-t%bing Lo !ix
3omplete in )-7 ho%rs Hgb 0-) g2d. per %nit
Pac.e' /)*s
N203
ATI (Unit 7)
Hematologic System -
Expected Action: U of <:3s
Therapeutic Uses: Erythroblastosis fetalis Hemoglobinopathies
4evere symptomatic anemia (Hgb/8 g2d.) !ed-ind%ced hemolytic anemia
Adverse Effects:
4epsis (c%lt%re, antibiotics, I# fl%ids, vasopressors, steroids)
&c%te hemolytic rxn (fever, tachycardia, hypotension): #4 6=m for 0=m
Gebrile nonhemolytic rxn (most common) (fever, headache): #4 6=m for 0=m
&naphylaxis: #4 6=m for 0=m P I! or I# epinephrine
!ild allergy: If respiration %ncompromised, antihistamines and restart
Education:
<eH%ires co%ntersign &ssess before, d%ring, ? after
&ssess site ? patency Qse R0S ga, filter, T-t%bing Lo !ix
3omplete in )-7 ho%rs
Hgb 0-) g2d. per %nit
Platelet *oncentrate
N203
ATI (Unit 7)
Hematologic System -
Expected Action: platelet co%nt
Therapeutic Uses:
$hrombocytopenia (/ )1,1112cc)
&ctive bleeding (platelets / 91,1112cc)
Adverse Effects:
4epsis (c%lt%re, antibiotics, I# fl%ids, vasopressors, steroids)
Gebrile nonhemolytic rxn (most common) (fever, headache): #4 6=m for 0=m
!ild allergy: If respiration %ncompromised, antihistamines and restart
Education:
<eH%ires co%ntersign &ssess before, d%ring, ? after
&ssess site ? patency Qse special platelet kit (smaller filter, shorter t%be
+res$ +ro0en Plasma
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
<eplaces coag%lation factors
Therapeutic Uses: !assive hemorrhage Extensive b%rns 4hock
"isseminated intravasc%lar coag%lation &ntithrombin III deficiency
$hrombotic thrombocytopenic p%rp%ra <everse warfarin effects
<eplacement therapy for factors II, #, #II, IV, V, ? VI
Adverse Effects:
4epsis (c%lt%re, antibiotics, I# fl%ids, vasopressors, steroids)
&c%te hemolytic rxn (fever, tachycardia, hypotension): #4 6=m for 0=m
Gebrile nonhemolytic rxn (most common) (fever, headache): #4 6=m for 0=m
&naphylaxis: #4 6=m for 0=m P I! or I# epinephrine
!ild allergy: If respiration %ncompromised, antihistamines and restart
3irc%latory overload: lace %pright 2 +
)
and di%retics 2 slo;er rate
Education:
<eH%ires co%ntersign &ssess before, d%ring, ? after
&ssess site ? patency

Lo !ix
P$erese' ,ranulocytes
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
<eplace ne%trophils 2 gran%locytes
Therapeutic Uses: Leonatal sepsis 4evere ne%tropenia (&L3 / =11)
Le%trophil dysf%nction Lonresponsive life-threatening infection
Adverse Effects:
4epsis (c%lt%re, antibiotics, I# fl%ids, vasopressors, steroids)
&c%te hemolytic rxn (fever, tachycardia, hypotension): #4 6=m for 0=m
Gebrile nonhemolytic rxn (most common) (fever, headache): #4 6=m for 0=m
&naphylaxis: #4 6=m for 0=m P I! or I# epinephrine
!ild allergy: If respiration %ncompromised, antihistamines and restart
3irc%latory overload: lace %pright 2 +
)
and di%retics 2 slo;er rate
Education:
<eH%ires co%ntersign &ssess before, d%ring, ? after
&ssess site ? patency

Lo !ix
Al%umin
N203
ATI (Unit 7)
Hematologic System -
Expected Action:
Expands circ%lating blood vol%me by oncotic press%re
Therapeutic Uses: Hypovolemia :%rns &d%lt respiratory distress
Hypoalb%minemia 3ardiop%lmonary bypass s%rgery
Hemolytic disease of the ne;born
Adverse Effects:

<isk for fl%id vol%me excess s%ch as p%lmonary edema
Contraindications: 3HG or renal ins%fficiency
Education:
!%st administer I#: 4lo;ly %sing an inf%sion p%mp
3an be administered , ;hole blood, plasma, saline, or gl%cose@