Nursing

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Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications
heparin #1. ________ Inactivates clotting factors thrombin and factor Xa through the increased activity of antithrombin Critical adverse effect:

#2. __________________

 

**Critical Allergic reaction**

#3. _____________

 

 

 Monitor(labs): #4. ____________

Reversal/antidote:  

#5. _____________

Administered Route:

#6. (2 answers)_______________

 
Apixaban (Eliquis) Anticoagulant inhibits platelet aggregation (factor Xa) induced by thrombin. Critical adverse effect:

#7. ________________

 

 

 1.       Increased risk of hemorrhage in pregnant patients

2.       Increased risk of bleeding in patients with renal impairment
Warfarin (Coumadin) #8. ___________ Decreases the production of vitamin K-dependent clotting factors. (Vit K synthesis) ·         bruising

·         ____#9_______ (after long term use)

 

 

 Monitor(labs): INR (2-3 is normal)

Reversal/antidote:

#10. ____________

 

Nursing Implications:

Avoid in pregnancy or breast feeding

Frequent monitoring of PT and INR
enoxaparin (Lovenox) anticoagulant #11. _____________ ·         Critical adverse effect is hemorrhage

·         Critical allergic:

·          #12 ________ (induced by**hint)

 

 

 Monitor(labs): #13 __________

Antidote: #14 _______________

 
fondaparinux #15 ______________ #16 ______________ 1. Can cause epidural bleeds.

 

 

 Labs to monitor:  None

 

Nursing Implications:

·         Avoid giving in patients with decrease level of consciousness, complains of back pain or is paralyzed.

·         Do not administer to patients for at least 6 hours after #17_______or with a #18__________ epidural

 
Rivaroxaban (Xarelto)

Apixiban (Eliquis)

Edoxanban (Savaysa)

 Anticoagulants Inhibits factor Xa Risk for neurological impairment Lab monitoring: No routine clot studies

 

Nursing Implications:

·         Avoid over the counter medications (Vit E, ginkgo biloba, fish oils, garlic, NSAIDS)

 

·         Teach patients to avoid bleeding by doing the following:                                  (3 examples)___#19______

 

 

 

 

 

 

 

 

Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications
Aspirin (Acetylsalicylic Acid)

 

 

Indication: Reduce risk of CVA, TIA, prevent of MI

 

Treatment during episodes of unstable angina and MI

 

Prevention: occlusion of stents

 #20. __________ Decrease platelet aggregation Side effect:

·         #21_________(given in high doses)

·         Bruising

·         Gastric upset

 

Adverse reaction:

·         GI bleed

·         hemorrhagic stroke (uncontrolled HTN)

 

 Monitor(labs):  platelets

 

Antidote for ASA toxicity:  #22 _______(There are 2 optional answers that will be accepted. 

 

Monitor for signs of:  ***toxicity – tinnitus, hyperventilation,

 
Clopidogrel (Plavix) Antiplatelet #23 _________ Side effect:

·         diarrhea

·         gastric discomfort

 

Adverse Reaction:

·         bleeding

·         #24 ________

 Monitor (labs):

#25 __________

Administered: po

 

 
Abciximab

 

Indicated: after cardiac procedures

 Antiplatelet

(Glycoprotein (GP) receptor inhibitors)

 Blocks GP IIB/IIIa receptors that stop platelet aggregation

 

  

Critical adverse reaction:

·         hemorrhage

·         Thrombocytopenia

 

 Monitor: hgb & Platelets

***Assess for bleeding in

1.       #26 _____

2.       #27_______

3.       IV insertion sites

Nursing Implications

4.       ECG changes

5.       No needle sticks or new IV injections

 

Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications
 

tPA

Alteplase

Streptokinase

 

 

 

 

 Thrombolytics Break down, or lyse or existing clots 1.        Bleeding

 

Severe Effect:

1.       Severe bleeding

 

 Administered:  #28 _(route)_ ONLY

 

Nursing Implications:

1.       Monitor for mental status changes

2.       No new IV, ABGS

3.       Never give through a (route) #29 _________.

4.       Do not give within 2 weeks of surgery

5.       Do not give to patients with active #30 _______

6.       Can only be administered from #31______ hours from onset of symptoms

7.       Monitor for cardiac changes/dysrhythmias

8.       Uncontrolled hypertension or b/p (180/110)

 
         
Drug Drug Class Mechanism of Action Adverse Effects Nursing Implications
Erythropoietin Alfa Hematopoietic Agents #32_____________ ·         #33 ________

·         Cardiovascular events- MI, CVA, DVT

 Monitor (labs):

#34 _____ & _______

***Iron levels- key ingredient with the production of RBCs

Nurse Implications:

1.       Monitor:  #35 (hint: which main vital sign) during therapy

2.       Do not administer if hemoglobin 10-11
Filgrastim

 

Indicated for Neutropenia

 Hematopoietic Agents Increase production of neutrophils (in the bone marrow) ·         Enlarge spleen

·         __#36___ pain

·         Leukocytosis

 Monitor baseline (labs):

CBC and platelet counts

Administered: IV & subQ
Oprelvekin Hematopoietic Agents Simulate platelet production ·         #37_______ (sign of fluid overload)

·         anemia

·         Cardiac dysrhythmias

Severe Reaction:

·         Anaphylaxis

 Administered: #38 _____

Monitor (labs): platelet counts, electrolyte status

Nursing Implications:

·         Fluid retention: Teach patient to contact provider if symptoms worsen.

·         Use with caution in patients with cardiac history- a-fib, a-flutter

 

 

 

Iron Sulfate

 

Iron deficiency anemia, dietary supplement (prevention)

 Hematinic Agents

 

 Replacement of iron which is critical for hemoglobin function Adverse Reaction

·         #39_______**

·         Nausea

·         Dark Tarry stools

 

Serious Side effect with IV route:

#40_______

 

 Patient Teaching

1.  Take with vitamin

#41_______ source.

 

2. Infusion: Give a test dose when administering #42 (which route).  Keep epinephrine on h and for anaphylaxis.

3. Teach patient to increase fiber and drink plenty of fluids  to reduce constipation

 
Folic Acid

 

Indicated:

Folic acid anemia, dietary supplement

 

 Hematinic Agents

 

 Replacement for folic acid 1.       Nausea

2.       Flatulence

3.       Rash

 1. Teach patient dietary/lifestyle changes:

– Increase consumption of foods high in #43_______ (e.g., green vegetables, liver).

2.  If alcoholism underlies dietary deficiency, offer counseling for alcoholism, as well as dietary advice. “
Vitamin B12

 

 

 Hematinic Agents

 

 Replacement Vitamin B12 anemia,

Dietary supplement, absence of intrinsic factor

 1.       Headache

2.       Nausea

 

Serious Adverse Reaction

1.       #44________** (low lab value)

2.       Pulmonary edema

3.       Anaphylaxis

 1.       Labs to Monitor:  ***Serum ___#45___

Teach patient s/s of hypokalemia and instruct them to contact provider immediate.

2.       Treatment duration- is #46 (how long)

 

 

 

 

 

 

 

 

 

Answer Sheet

**Make sure you read the instructions.

  • You must turn BOTH documents in to receive full credit. NO EXCEPTIONS.
  • Provide your answers in the correct order. Make sure your numbers match what is given, or it will be marked incorrect.
  • There is only one answer per blank. If the question indications there is more than one answer, then you must have all correct to receive credit.
  • **You do not have to use this specific format. As long as you submit the answers in the correct order it will be accepted.  However, if you decide to use this format, make sure the answer matches and form it is NEAT.  Written answers will be accepted as long as they are in a pdf form so they can be read and graded.

 

 

 

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