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 Hypersensitivity reaction (chills, fever, %rticaria) Hemorrhage )* heparin +" (treat , protamine sulfate) Heparin-ind%ced thrombocytopenia (stop if .$ / 011,1112cc) 3I: .$ or %ncontrollable bleeding 3I: 4%rgery of eye, brain, spinal cord5 regional anesthesia5 l%mbar p%nct%re &nti-platelet agent additive risk of bleeding !onitor a $$ levels 67-8h and then 6" (81-91 sec)

Adverse Effects:

Contraindications/Precautions: Interactions: Education:

Treatment of He arin !"

N203 ATI (Unit 7) Hematologic System -

Proto: rotamine s%lfate :inds ;ith heparin and forms a non-coag%lating complex &ntidote to severe heparin overdose Therapeutic Uses: <eversal of heparin administered d%ring proced%res Adverse Effects: Contraindications/Precautions: Interactions: &dminister slo;ly ()1 mg2min or =1 mg in 01 min) Education: a $$ levels of 81-91 sec Expected Action:

Anticoagulant
(!ral)

N203 ATI (Unit 7) Hematologic System -

Proto: ;arfarin (3o%madin) &ntagonizes vitamin > 2 prevents synthesis of 7 intrinsic factors ? prothrombin revention of veno%s thrombosis Therapeutic Uses: revention of thrombi in &-fib and ;ith prosthetic heart valves Hemorrhage ($x ;ith vitamin >) Adverse Effects: Pregnancy (X) Contraindications/Precautions: 3I: 4%rgery of eye, brain, spinal cord5 regional anesthesia5 l%mbar p%nct%re 3I: .$ co%nts, %ncontrolled bleeding, vit@ > A, liver problems, alcoholism Heparin, aspirin, glucocorticoids bleeding Interactions: Acetaminophen, sulfonamides, parenteral cephalosporins, ASA B;arfarinC Phenobarbital, carbamazepine, phenytoin, OC, vitamin K ;arfarin effects $ therape%tic level D 09-)7 sec (normal D 00-0)@= sec) Education: +nset takes 9-0) hrs, f%ll effect takes E-= days Expected Action:

Treatment of #arfarin !"

N203 ATI (Unit 7) Hematologic System -

Expected Action:

Proto: #itamin > ( hytonadione)

romote synthesis of intrinsic factors and prothrombin

Therapeutic Uses: Adverse Effects:

#itamin > deficiency <eversal of hypoprothrombinemia and bleeding d2t warfarin +" &naphylactoid reaction (inf%se slo;ly in dil%ted sol%tion)

Contraindications/Precautions:

Interactions:

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

Education:

Anti latelets

N203 ATI (Unit 7) Hematologic System -

dipyridamole ( ersantine), abciximab (<eo ro) revent platelet cl%mping by inhibiting arterial clotting enzymes and factors rimary prevention of ac%te !I revention of stroke Therapeutic Uses: revention of reinfarction &c%te coronary syndromes (abci imab and tirofiban !Aggrastat") FI effects (conc%rrent I 2 enteric-coated 2 take , food) Adverse Effects: Hemorrhagic stroke regnancy (") Contraindications/Precautions: 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

Expected Action:

Proto: &spirin Others: ticlopidine ($iclid), clopidogrel ( lavix),

T$rom%olytic &e'ications

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses:

Proto: streptokinase Others: alteplase (t &), tenecteplase, reteplase

3lot dissol%tion by plasminogenplasmin ;hich destroys fibrinogen &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 Hx of intracranial hemorrhage Contraindications/Precautions: :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 &dmin ;ithin 7-8 ho%rs of onset Education: 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 Pre arations

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: Adverse Effects:

$reat and prevent iron-deficiency anemia $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 $ake on empty stomach to absorption

&ntacids or tetracyclines absorption

Education:

&nticipate dark green or black stool

(itamin )12
(*yanoco%alamin)

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses: Adverse Effects:

Proto: #itamin :12 (cyanocobalamin)

Lecessary to convert folate (reH%ired for "L& prod%ction) from inactive form $reatment of :12 deficiency !egaloblastic (macrocytic) anemia related to :12 deficiency Hypokalemia )* <:3 prod%ction
Interactions:

Contraindications/Precautions:

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 Lone

revention of ne%ral t%be defects in pregnancy

Adverse Effects:

Contraindications/Precautions:

Interactions:

Sulfonamides, sulfasalazine, methotre ate folate levels , conc%rrent %se

Education:

Hemato oietic ,ro-t$ +actors

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses:

Proto: Epoetin alfa (Epogen, rocrit) Others: darbepoetin alfa

&ct on bone marro; to <:3 prod%ction &nemia of chronic renal fail%re or chemotherapy HI# patients taking zidovudine &nemia in patients sched%le for $'etrovir& elective s%rgery Hypertension )* Hct Adverse Effects: 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: Adverse Effects:

infection risk ;ith ne%tropenia (e@g@ cancer)

:one pain .e%kocytosis: dose 2 interr%pt treatment if M:3 N =1,1112cc, &L3 N )1,1112cc, or platelets N =11,1112cc@ 3I: 4ensitive to () coli proteins Contraindications/Precautions:
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:

"iarrhea, ;eakness, rash, malaise, and bone pain (call) 3I: &llergic to yeast prod%cts

Gacilitates recovery of bone marro; after marro; transplant@

Adverse Effects:

.e%kocytosis, thrombocytosis: O if M:3N=1,111, &L3N)1,111, .$N=11,111

Contraindications/Precautions:

3a%tion , ( disease, hypoxia, peripheral edema, ple%ral2pericardial eff%sion@

Interactions:

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

Education:

T$rom%o oietic ,ro-t$ +actors

N203 ATI (Unit 7) Hematologic System -

Expected Action:

Proto: oprelvekin (Interle%kin 00, Le%mega)

Increases prod%ction of platelets@

Therapeutic Uses: Adverse Effects:

thrombocytopenia , myelos%ppressive chemotherapy Gl%id retention (peripheral edema, dyspnea on exertion) 3on'%nctival in'ection, transient bl%rring, and papilledema

"ysrhythmias
Interactions:

Contraindications/Precautions:

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

Education:

#$ole )loo'

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses: Adverse Effects:

Increases circ%lating blood vol%me &c%te blood loss, extensive b%rns, dehydration, shock 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 Lo !ix Hgb 0-) g2d. per %nit

&ssess site ? patency Qse R0S ga, filter, T-t%bing 3omplete in )-7 ho%rs

Pac.e' /)*s

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses:

U of <:3s Erythroblastosis fetalis Hemoglobinopathies !ed-ind%ced hemolytic anemia

4evere symptomatic anemia (Hgb/8 g2d.)

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 Lo !ix Hgb 0-) g2d. per %nit

&ssess site ? patency 3omplete in )-7 ho%rs

Qse R0S ga, filter, T-t%bing

Platelet *oncentrate

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses:

platelet co%nt $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: Therapeutic Uses:

<eplaces coag%lation factors !assive hemorrhage Extensive b%rns 4hock &ntithrombin III deficiency <everse warfarin effects

"isseminated intravasc%lar coag%lation $hrombotic thrombocytopenic p%rp%ra

Adverse Effects:

<eplacement therapy for factors II, #, #II, IV, V, ? VI 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 Lo !ix

&ssess site ? patency

P$erese' ,ranulocytes

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses:

<eplace ne%trophils 2 gran%locytes Leonatal sepsis 4evere ne%tropenia (&L3 / =11) Lonresponsive life-threatening infection

Le%trophil dysf%nction
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 Lo !ix

&ssess site ? patency

Al%umin

N203 ATI (Unit 7) Hematologic System -

Expected Action: Therapeutic Uses:

Expands circ%lating blood vol%me by oncotic press%re Hypovolemia :%rns &d%lt respiratory distress

Hypoalb%minemia Hemolytic disease of the ne;born

Adverse Effects:

3ardiop%lmonary bypass s%rgery

<isk for fl%id vol%me excess s%ch as p%lmonary edema

Contraindications: Education:

3HG or renal ins%fficiency

!%st administer I#: 4lo;ly %sing an inf%sion p%mp

3an be administered , ;hole blood, plasma, saline, or gl%cose@