NURS 1950
Pharmacology I
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Objective 1: identify general reasons
anticoagulants are given
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Objective 2: identify the cells in the body that
release heparin
Objective 3: describe the actions of heparin
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Objective 4: list the appropriate routes to
administer heparin
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Heparin: only parenteral administration
Warfarin: oral
Heparin
◦ Low doses: inhibit clotting factor Xa
◦ High doses: inhibits all clotting factors
◦ Effects occur immediately
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Preferred during pregnancy, PE, DVT
Required for open heart surgery, renal
dialysis
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Side Effects
Hemorrhage: observe hypotension,
tachycardia, petechiae, bruises
May see bloody stools, pelvic pain, headache
Hypersensitivity: chills, fever, rash
Antidote: protamine sulfate
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Administration
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IV or subq
IM causes hematoma
Monitor PTT above 1.5-2 X normal is therapeutic
Monitor INR: between 2-3
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Enoxaparin (Lovenox): low molecular weight
◦ Acts so has less potential for hemorrhage, longer
duration of action
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Subq administration
Does not affect PT or APTT
Do not give to clients allergic to pork byproducts
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Do not inject IM
Do not expel air bubble from syringe before
injection
Do not rub injection site
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SE to expect: hematoma with improper
injection technique
SE to report: bleeding, thrombocytopenia
Drug interactions: no clinically significant
interactions
◦ Caution: antiplatelet or warfarin therapy
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Warfarin (Coumarin)
◦ 1st oral
◦ Antidote: Vitamin K
◦ Monitor protime
 Needs to be 1.5 to 2X normal
 Monitor INR: 2-3
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Interactions
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Heparin
ASA
Butazoladin
Barbiturates
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Objective 5: identify the antidote for heparin
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Objective 6: name the lab tests that are the
basis to determine the effectiveness and
dosage of heparin
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PTT 60-80
PT
2.5-3.5
INR 2-3
APTT 25-35 is normal
 2-3x baseline= therapeutic ; measured daily
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Objective 7: describe the important points
regarding subcutaneous administration of
heparin
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Dose/strength
Injection site
Needle/syringe
Aspiration
Pressure
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Objective 8: list the signs of heparin overdose
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Bleeding
VS changes
Thrombocytopenia
White clot formation is a toxic reaction
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Objective 9: identify drugs that enhance the
action of heparin
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NSAIDs
ASA
Ginkgo biloba
Dipyridamole
Clopidogrel
Ticlopidine
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Objective 10: describe the action of
Coumadin
◦ Inhibits the activity of vitamin K—needed for
activation of clotting factors II, VII, IX and X
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Objective 11: name the lab tests done to
determine the effectiveness and dosage of
Coumadin
◦ 12-15 sec = Normal PT
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Objective 12: identify drugs that increase and
decrease the effectiveness of Coumadin
Drugs that can increase Coumadin effects:
Tylenol, ASA, dong quai, ginkgo biloba, oil
of wintergreen, omeprazole
Drugs that can decrease the effects: St.
John’s Wort, rose hip, barbiturates,
griseofulvin, vitamin C, vitamin K
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Objective 13: discuss other select
anticoagulant agents
◦ Fibrinolytic agents
◦ Antiplatelet drugs
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Suppress aggregation platelets
Prevent arterial thrombus
ASA single dose; 5 gr or less
◦ Doubles bleeding time for 4-7 days
◦ Reduces MI, TIAs, CVAs
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Amicar
◦ Inactivates plasminogen
◦ USE: given IV to reduce hemorrhage in 1-2 hrs
◦ Precaution: no ASA ; DIC is likely problem
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Streptokinase
◦ Promotes plasminogen to plasmin
◦ Uses
 Acute coronary thrombi
 DVT
 Massive pulmonary emboli
◦ Nursing interventions:
 Monitor ECG q 15 min during 1st hr of infusion
 Monitor LOC (intercranial hemorrhage)
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MI: must give within 6 hours
DVT: give within 3 days
PE: no more than 5-7 days
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Side Effects
Hemorrhage: use Amicar
Fever, allergic reaction
Drug given IV
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Urokinase
◦ Promotes plasminogen to plasmin
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TPA: tissue type plasminogen activator
(Activase)
◦ Synthetic
◦ Clears coronary artery
◦ SE: bleeding
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Objective 14: discuss the indications for
antiplatelet drugs
◦ Previous MI, CVA, TIA
◦ Conditions that predispose to clot formation
 Some used in combination post cardiac valve
replacement
 Peripheral arterial disease
 Atrial fibrillation
 Unstable angina
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Objective 15: describe the nursing
responsibilities associated with a client
receiving an anticoagulant, including specific
safety considerations
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Dosage schedules
Hydration
Lab data
Preventing clot formation
Patient teaching
◦ Follow-up
◦ Safety
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◦ Medic alert bracelet
◦ Symptoms to report
◦ Do not take OTC meds without consulting MD
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