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Hematologic System

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs Anticoagulants/Parenteral Prevent bleeding by inactivation of thrombin formation, inhibition of formation of fibrin Anticoagulation for purposes of stroke, PE, deep venous thrombosis, prophylaxis for venous thrombosis, acute MI Hemorrhage, thrombocytopenia (low platelet count), should not be used for surgeries for the eye, brain, spinal cord, or lumbar puncture Antiplatelets such as ASA, NSAIDS and other anticoagulants increase risk of bleeding Protamine sulfate is antidote, monitor PTT (therapeutic levels should be 60 80sec), can be IV or SubQ, Heparin, low weight heparins: enoxaparin (Lovenox)

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions

Nursing/Patient Teaching

Common Drugs

Anticoagulants/ Oral Antagonize vitamin K, preventing synthesis of coagulation factors Treatment for venous thrombosis/formation, recurrent MI, TIAs Hemorrhage, hepatitis, pregnancy risk X, thrombocytopenia, vitamin K deficiencies Use of heparin, ASA, Tylenol, glucocorticoids, sulfonamides, cephalosporins increase effects of warfarin. Phenobarbital, tegrtol, dilantin, oral contraceptives decreases anticoagulation effects. Monitor PT levels (therapeutic level is 1.5 to 2 times control: 18 to 24 seconds), Monitor INR (2 to 3 for treatment of MI, Afib, PE, thrombosis. 3 to 4.5 for heart valve) Vitamin K is antidote. Warfarin (Coumadin)

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Antiplatelets Prevent platelets from clumping together by inhibiting enzymes and factors that lead to clotting Prevention of acute MI, prevention of reinfarction following MI, stroke, claudication GI upset, hemorrhagic stroke, prolonged bleeding, Tinnitus (hearing loss) Caution with other anticoagulants, Urine acidifiers increase ASA levels, Corticosteriods increase ASA excretion, caffeine may increase ASA absorption, 325mg should be taken during initial acute episode of MI, ASA, clopidogrel (Plavix)

Name Mechanism of Action Therapeutic Uses Side Effects/Precautions Interactions Nursing/Patient Teaching Common Drugs

Thrombolytics Dissolve clots that have already formed by converting plasminogen to plasmin which destroys fibrinogen Acute MI, DVT, massive PE, ischemic stroke Serious risk of bleeding, hypotension, NEVER for hemorrhagic stroke Caution with other anticoagulants, Obtain baseline platelet, hgb, hct, PTT, PT, INR, and fibrinogen levels Streptokinase (Streptase),