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Pharmacology and the Nursing Process, 9th Ed., Lilley, Rainforth Collins & Snyder, 2019 | Registered Nurse (RN) School Study Aid

Clotting Overview

Endothelial Cells are Damaged

Platelets Respond to Exposed Collagen and Stick

Platelets Release Recruiting Factors

More Platelets are Attracted

Soluble Fibrinogen Turns to Insoluble Fibrin

Fibrin Seals the Clot

Clot Dissolves

Liver Produces Clotting Factors

2 mins

Coagulation Cascade Overview

Secondary Hemostasis

Intrinsic Pathway

Partial Thromboplastin Time (PTT)

Heparin

Extrinsic Pathway

Prothrombin Time (PT)

Warfarin

Common Pathway

Thrombin

Convert Fibrinogen to Fibrin

Stabilizes the Platelet Plug

2 mins

Pulmonary Embolism Causes

FAT BAT Mnemonic

Fat

Air

Deep Vein Thrombosis (DVT)

Bacteria

Amniotic Fluid

Tumor

Hypercoagulable

Central Venous Lines

Immobilized

1 min

Pulmonary Embolism Assessment

Shortness of Breath (SOB)

Pleuritic Chest Pain

Tachypnea

Hemoptysis

Hypoxemia

Sudden Death

52 secs

Venous Thromboembolism (DVT) Interventions

Anticoagulants

Prevention Education

Frequent Ambulation

Leg Exercises

Compression Stockings or SCD's

Avoid Nicotine and Oral Contraceptives

Surgery

1 min

Venous Thromboembolism (DVT) Assessment

Venous Wall Inflammation caused by Thrombus

Tenderness

Edema

Warmth

Asymmetry

Could be Asymptomatic

Monitor for Pulmonary Embolism

58 secs

Vitamin K1 (Phytonadione)

Synthesizes Clotting Factors II, VII, IX, X

Hypoprothrombinemia

Newborn Prophylaxis

Bleeding from Warfarin Overdose

Shock

Kernicterus

Cardiac Arrest

Bile Salts required for Intestinal Absorption

Increased Risks with IV Administration

2 mins

Alteplase

Tissue Plasminogen Activator

Thrombosis

Bleeding

Intracranial Hemorrhage

Internal Hemorrhaging

Minimize Bleeding

Monitor for Shock

Aminocaproic Acid

2 mins

Warfarin (Coumadin)

Inhibits Clotting Factors

Atrial Fibrillation

Venous Thrombosis

Pulmonary Embolism

PT/INR Levels

Observe for Bleeding

Pregnancy

Vitamin K and Fresh Frozen Plasma

Prolonged Therapeutic Onset

Maintain Same Diet

2 mins

Enoxaparin (Lovenox)

Inhibits Clotting Factors

Factor Xa

Clot Formation Prevention

Heparin Induced Thrombocytopenia (HIT)

Bleeding

Medication Education

Subcutaneous Injection

2 Inches from Umbilicus or Incisions

Protamine Sulfate

2 mins

Heparin Induced Thrombocytopenia (HIT)

5-10 Days After Heparin Exposure

Heparin-Platelet Factor 4 Complex

Autoantibodies Form Against Complex

Heparin-Platelet Factor 4-Antibody Complex Binds Platelets

Platelet Aggregation

Procoagulant Release

Thrombocytopenia

Serotonin Release Assay (SRA)

Stop Heparin, Start Direct Thrombin Inhibitor

2 mins

Heparin (Unfractionated)

Suppresses Coagulation

Deep Vein Thrombosis (DVT)

Pulmonary Embolism

Hemorrhage

Heparin-Induced Thrombocytopenia (HIT)

Monitor aPTT

Preferred (Safe) During Pregnancy

Protamine Sulfate

2 mins

Phenytoin (Dilantin)

Blocks Na+ Channels

Tonic-clonic Seizures

Ataxia

Nystagmus

Sedation

Gingival Hyperplasia

Purple Glove Syndrome

Hirsutism

Rash

Anemia

Individualized Dosing

2 mins

Carbamazepine (Tegretol)

Inactivates Na+ Channels

Seizures

Bipolar Disorder

Trigeminal Neuralgia

Nystagmus

Ataxia

Hepatotoxicity

Blood Dyscrasias

Water Retention

Stevens-Johnson Syndrome

Avoid Grapefruit Juice

2 mins

Omeprazole (Prilosec)

"-prazole" Suffix

Zollinger-Ellison Syndrome

Gastritis

Peptic Ulcer

Gastroesophageal Reflux Disease (GERD)

Proton Pump Inhibitor (PPI)

Inhibit H+/K+/ATPase

Hip Fracture

Pneumonia

2 mins

Phenobarbital (Barbiturates)

Barbiturate

Seizures

Ataxia

Paradoxical Excitement

Fatigue/Drowsiness

Monitor Plasma Levels

High Potential for Abuse

1 min

Azoles (Ketoconazole)

"-azole" suffix

Local and Less Serious Systemic Mycosis

Inhibits Ergosterol Synthesis

Inhibits P450

Liver Dysfunction

Inhibition of Testosterone Synthesis

1 min

NSAIDs

Anti-inflammatory

Analgesic

Fever

Closure of Patent Ductus Arteriosus

Reversible Inhibition of COX-1 and COX-2

Block Prostaglandin Synthesis

Interstitial Nephritis

Gastric Ulcer

Renal Ischemia

1 min

Acetaminophen

Fever

Pain

Reversibly Inhibits COX

Acts Primarily in CNS

Hepatic Necrosis

N-acetylcysteine Antidote

51 secs

Aspirin (Acetylsalicylic Acid)

Inhibits Platelet Aggregation

NSAID

Thrombotic Event Prevention

General Pain

Inflammatory Conditions

Fever

Pancytopenia

GI Ulcers

Bleeding

Withhold Before Surgery 7-10 Days

Reye's Syndrome

2 mins

PT/PTT Lab Values

Prothrombin Time (PT)

10-14 seconds

Activated Partial Thromboplastin Time (PTT or aPTT)

25-35 seconds

1 min

INR Lab Value

0.8-1.2 Normal Range

Warfarin

2.0-3.0

1 min

Bleeding Time Lab Values

2-7 Minutes

41 secs

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