Chamberlain College of Nursing - NR 566 WEEK 5 REVIEW / NR 566 WEEK 5 REVIEW _ Latest Summer 2020/2021 (complete)

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Warfarin (Coumadin): Inhibits synthesis of vitamin K-dependent clotting factors X, IX, VII, and II (prothrombin) Pharmacokinetics Well-absorbed when taken orally Metabolized by CYP 1A2 and 2C9 Hal... f-life of 3 to 4 days Precautions and contraindications Pregnancy category X Use cautiously in patients with fall risk, dementia, or uncontrolled hypertension. Avoid in hypermetabolic state. Adverse drug reactions Bleeding (Antidote is vitamin K) Drug interactions: Many Antiplatelet drugs Thrombolytic drugs Anticoagulant effect may be decreased by Oral contraceptives, carbamazepine, Vitamin K-containing foods, etc. Clinical use and dosing Drug of choice for deep vein thrombosis (DVT) and pulmonary embolism (PE) Start at 5 mg per day (7.5 mg/d if weight greater than 80 kg). Consider lower dose if Older than 75 years Multiple comorbid conditions Elevated liver enzymes Changing thyroid status Dose to maintain international normalized ratio (INR) between 2 and 3. Monitoring INR daily until in therapeutic range for 2 consecutive days Then two or three times weekly for 1 to 2 weeks Then less frequently but at least every 6 weeks Rivaroxaban (Xarelto): Factor Xa inhibitor Apixaban (Eliquis): Factor Xa inhibitor Reduction of risk of stroke and systemic embolism in nonvalvular atrial fibrillation Prophylaxis of DVT following knee replacement surgery Treatment of DVT and PE Parenteral Anticoagulants Heparin Binds with the antithrombin III Inactivates factors IXa, Xa, XIIa, XIII Pharmacokinetics Given IV or subcutaneously (SC) Extensively protein-bound Metabolized by liver and renally eliminated Precautions and contraindications Pregnancy category C Avoid in advanced hepatic or renal disease. Avoid in bleeding disorders or active bleeding. Adverse drug reactions (ADRs) May cause thrombocytopenia Life-threatening bleeding Pain at injection site (SC) Antidote is protamine sulfate Drug interactions Cephalosporins and penicillins; Warfarin, antiplatelets and thrombolytics; Valproic acid Clinical use and dosing Given 2 hours pre-operatively Maintenance every 8 to 12 hours for 7 days after surgery Heparin is processed into smaller molecules  low molecular-weight heparins (LMWH) Inactivates factor Xa Enoxaparin DVT or PE Given 2 hours before surgery Fondaparinux - Selective inhibitor of antithrombin III and factor Xa inhibitor DVT Hip fracture surgery or knee replacement [Show More]

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