NCM 106 SY 2020-2021

DRUG STUDY
 NCM 106 SY 2020-2021

DRUGS MECHANIS INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

M OF
ACTION
Low Prevention of Patients with active major Body as a Assessment & Drug Effects
GENERIC NAME molecular deep vein bleeding, GI bleeding, Whole: Allergic
ENOXAPARIN weight thrombosis hemophilia, heparin reactions (rash,  Lab tests: Baseline coagulation studies;
heparin with (DVT) after hypersensitivity, heparin- urticaria), periodic CBC, platelet count, urine and
BRAND NAME antithromboti hip, knee, or induced thrombocytopenia fever, angioedema arthr stool for occult blood.
Lovenox c properties. abdominal (HIT), thrombocytopenia algia, pain and  Monitor platelet count closely.
Does not surgery, associated with an inflammation at Withhold drug and notify physician if
CLASSIFICATION affect PT. treatment of antiplatelet antibody in the injection site, peripheral platelet count less than 100,000/mm3.
BLOOD FORMERS Does affect DVT and presence of enoxaparin, edema, arthralgia,  Monitor closely patients with renal
COAGULATORS thrombin time pulmonary bleeding disorders, fever.  insufficiency and older adults who are
ANTICOAGULANTS; (TT) and embolism, idiopathic at higher risk for thrombocytopenia.
Low Molecular Weight activated management of thrombocytopenia purpura Digestive: Abnormal  Monitor for and report immediately
Heparin thromboplasti acute coronary (ITP), hypersensitivity to liver function tests.  any sign or symptom of unexplained
n time (aPTT) syndrome. enoxaparin; porcine bleeding.
DOSAGE up to 1.8 protein hypersensitivity, Hematologic:
Prevention of DVT times the neonates. Hemorrhage , thromboc Patient & Family Education
after Hip or Knee control value. ytopenia, ecchymoses,
Surgery anemia.   Report to physician promptly signs of
Adult: SC 30 mg b.i.d. Antithromboti Cautious Use unexplained bleeding such as: pink,
for 10–14 d starting c properties Respiratory: Dyspnea red, or dark brown urine; red or dark
12–24 h post-surgery are due to its Uncontrolled arterial brown vomitus; bleeding gums or
antifactor Xa hypertension, recent Skin: Rash, pruritus. bloody sputum; dark, tarry stools.
Prevention of DVT and history of GI disease,  Do not take any OTC drugs without
after Abdominal antithrombin benzyl alcohol first consulting physician.
Surgery (antifactor hypersensitivity,  Do not breast feed while taking this
Adult: SC 40 mg q.d. IIa) in the conditions or surgery with drug without consulting physician.
starting 2 h before coagulation increased risk of bleeding,
 NCM 106 SY 2020-2021

surgery and continuing activities. An

for 7–10 d (max: 12 d) effective hepatic disease,
anticoagulatio hypertension,
Treatment of DVT n agent; used coagulopathy,
and Pulmonary for thrombolytic therapy,
Embolus prophylactic thrombocytopenia, dental
Adult: SC 1 mg/kg treatment as disease, dental work,
q12h or 1.5 mg/kg/d; an diabetic retinopathy,
monitor anti-Xa antithromboti dialysis, diverticulitis,
activity to determine c agent inflammatory bowel
appropriate dose following disease, intramuscular
certain types injections, lumbar
Acute Coronary of surgery. puncture, menstruation,
Syndrome obesity, peptic ulcer
Adult: SC 1 mg/kg disease, older adults,
q12h for 2–8 d, give endocarditis, renal disease,
concurrently with renal impairment, spinal
aspirin 100–325 mg/d anesthesia, stroke, surgery,
pregnancy (category B),
Adjustment for Renal lactation. Safety and
Impairment effectiveness in children
Clcr <30 mL/min: 30 are not established.
mg or 1 mg/kg q24h
 NCM 106 SY 2020-2021

DRUGS MECHANISM OF INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

ACTION
Derivative of the Acute extensive Active internal bleeding; Body as a Assessment & Drug Effects
GENERIC NAME beta-hemolytic deep venous very recent Whole: Allergic
STREPTOKINASE streptococci. thrombosis, cardiopulmonary reactions (bronchospa  Lab tests: Discontinue heparin
Promotes acute arterial resuscitation; recent sm, periorbital and obtain baseline control levels
BRAND NAME thrombolysis by thrombosis or (within 2 mo) intraspinal, swelling, for TT, aPTT, PT, INR, Hct, and
Kabikinase activating the embolism, acute intracranial, intraarterial angioneurotic platelet count prior to treatment.
Streptase conversion of pulmonary procedures; intracranial edema, anaphylaxis); Treatment is delayed until TT
plasminogen to embolus, neoplasm; CVA, severe urticaria, itching, and aPTT are less than 2 times
CLASSIFICATION plasmin, the enzyme coronary artery uncontrolled hypertension; headache, the normal control level. During
BLOOD FORMERS that degrades fibrin, thrombosis, MI, history of allergic response musculoskeletal pain, treatment with SK, TT is
COAGULATORS fibrinogen, and other and to SK, recent streptococcal flushing, nausea, generally kept at about 2 times or
ANTICOAGULANTS procoagulant arteriovenous infection; obstetrical pyrexia.  more baseline value and checked
Thrombolytic Enzyme proteins into soluble cannula delivery; diabetic q3–4h.
fragments. occlusion. hemorrhagic retinopathy; Hematologic: Phlebiti  Protect patient from invasive
DOSAGE Decreases blood and ulcerative colitis, s, bleeding or oozing procedures: IM injections are
Coronary Artery plasma viscosity and diverticulitis; any at sites of contraindicated. Also prevent
Thrombosis, MI erythrocyte condition in which percutaneous undue manipulation during
Adult: IV 1.5 million aggregation bleeding presents a hazard trauma; prolonged thrombolytic therapy to prevent
IU infused over 60 min  tendency, thus or would be difficult to systemic bruising. Spontaneous bleeding
Intracoronary 15,000– increasing perfusion manage because of hypocoagulability; occurs about twice as often with
20,000 IU bolus, of collateral blood location; pregnancy spontaneous bleeding SK as with heparin.
followed by 2000–4000 vessels. (category C). Safety and (GI, urogenital,  Monitor for excessive bleeding
IU/min for 60 min efficacy in children are not retroperitoneal).  q15min for the first hour of
established. therapy, q30min for second to
Deep Vein CV: Unstable blood eighth hour, then q8h.
Thrombosis, CAUTIOUS USE pressure; reperfusion  Be aware that patient is at risk for
Pulmonary Patient with preexisting atrial or ventricular postthrombolytic bleeding for 2–
Embolism, Arterial hemostatic deficits; dysrhythmias. 4 d after intracoronary SK
 NCM 106 SY 2020-2021

Embolism conditions accompanied treatment. Continue monitoring

Adult: IV 250,000 IU by risk of cerebral vital signs until laboratory tests
over 30 min loading embolism; septic confirm anticoagulant control.
dose, then 100,000 thrombophlebitis; uremia;  Report signs of potential serious
IU/h for 48–72 h liver failure; lactation. bleeding; gum bleeding,
epistaxis, hematoma,
Occluded Cannula spontaneous ecchymoses, oozing
Adult: IV 250,000 IU at catheter site, increased pulse,
in 2 mL over 25–35 pain from internal bleeding. SK
min; clamp for 2 h, infusion should be interrupted,
then aspirate cannula then resumed when bleeding
stops.
 Report promptly symptoms of a
major allergic reaction; therapy
will be discontinued and
emergency treatment instituted.
Minor symptoms (e.g., itching,
nausea) respond to concurrent
antihistamine or corticosteroid
treatment or both without
interruption of SK
administration.
 Check cardiac monitor
frequently. Be alert to changes in
cardiac rhythm, especially during
intracoronary instillation.
Dysrhythmias signal need to stop
therapy at once.
 Monitor BP. Mild changes can be
expected, but report substantial
NCM 106 SY 2020-2021

changes (greater than ±25 mm

Hg). Therapy may be
discontinued.
 Check patient's temperature
during treatment. A slight
elevation, 0.8° C (1.5° F),
perhaps with chills, occurs in
about one third of the patients.
Higher elevations may be treated
with acetaminophen.
 Avoid giving aspirin because of
its antiplatelet action if an
analgesic-antipyretic is indicated.

Patient & Family Education

 Report immediately to physician

symptoms of hypersensitivity
(e.g., labored, difficult breathing;
hives; itching skin).
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE NURSING RESPONSIBILITIES

OF ACTION EFFECT
Indirectly Prophylaxis and Hemorrhagic tendencies, Body as a Assessment & Drug Effects
GENERIC NAME interferes with treatment of deep vitamin C or K deficiency, Whole: Major or
WARFARIN SODIUM blood clotting by vein thrombosis hemophilia, coagulation minor  Determine PT/INP prior to initiation
depressing hepatic and its extension, factor deficiencies, hemorrhage from of therapy and then daily until
BRAND NAME synthesis of pulmonary dyscrasias; active any tissue or maintenance dosage is established.
Coumadin Sodium vitamin K- embolism; bleeding; open wounds, organ;  Obtain a CAREFUL medication history
Panwarfin dependent treatment of atrial active peptic ulcer, hypersensitivity prior to start of therapy and whenever
coagulation fibrillation with visceral carcinoma, (dermatitis, altered responses to therapy require
CLASSIFICATION factors: II, VII, IX, embolization. esophageal varices, urticaria, pruritus, interpretation;
BLOOD FORMERS and X. Also used as malabsorption syndrome; fever).  extremely IMPORTANT since many
COAGULATORS adjunct in hypertension (diastolic BP drugs interfere with the activity of
ANTICOAGULANTS;  treatment of >110 mm Hg), cerebral GI: Anorexia, anticoagulant drugs
Oral Anticoagulant coronary vascular disease; heparin- nausea, vomiting, (see INTERACTIONS).
occlusion, induced thrombocytopenia abdominal  Adjust dose to maintain PT at 1½–2½
DOSAGE cerebral transient (HIT); pericarditis with cramps, diarrhea, times the control (12–15 sec), or 15–
Anticoagulant ischemic attacks acute MI; severe hepatic or steatorrhea, 35% of normal prothrombin activity,
Adult: PO/IV 10–15 (TIAs), and as a renal disease; continuous stomatitis.  or an INR of 2–4 depending on
mg/d for 2–5 d, then 2– prophylactic in tube drainage of any diagnosis.
10 mg once/d with dose patients with orifice; subacute bacterial Other: Increased  Lab tests: For maintenance dosage,
adjusted to maintain a prosthetic cardiac endocarditis; recent serum PT/INR determinations at 1–4-wk
PT 1.2–2 times control valves. Used surgery of brain, spinal transaminase intervals depending on patient's
or INR of 2–3 extensively as cord, or eye; regional or levels, hepatitis, response; periodic urinalyses, stool
rodenticide. lumbar block anesthesia; jaundice, burning guaiac, and liver function tests. Blood
Child: PO 0.1–0.3 threatened abortion; sensation of feet, samples should be drawn at 12–18 h
mg/kg/d, adjust to unreliable patients; transient hair after last dose (optimum).
maintain INR of 2–3 pregnancy (category X). loss.   Monitor closely older adult,
psychotic, or alcoholic patients
Overdosage: Inte because they present serious
NCM 106 SY 2020-2021

rnal or external noncompliance problems.

Cautious Use bleeding,  Note: Patients at greatest risk of
paralytic ileus; hemorrhage include those whose
Alcoholism, allergic skin necrosis of PT/INR are difficult to regulate, who
disorders, during toes (purple toes have an aortic valve prosthesis, who
menstruation, older adults, syndrome), tip of are receiving long-term anticoagulant
senility, psychosis; nose, buttocks, therapy, and older adult and
debilitated patients. thighs, calves, debilitated patients.
Endogenous factors that female breast,
may increase prothrombin abdomen, and Patient & Family Education
time response (enhance other fat-rich
anticoagulant effect): areas.  Understand that bleeding can occur
carcinoma, CHF, collagen even though PT/INR are within
diseases, hepatic and renal therapeutic range. Stop drug and
insufficiency, diarrhea, notify physician immediately if
fever, pancreatic disorders, bleeding or signs of bleeding appear:
malnutrition, vitamin K Blood in urine, bright red or black
deficiency. Endogenous tarry stools, vomiting of blood,
factors that may decrease bleeding with tooth brushing, blue or
prothrombin time response purple spots on skin or mucous
(decrease anticoagulant membrane, round pinpoint purplish
response): edema, red spots (often occur in ankle areas),
hypothyroidism, nosebleed, bloody sputum; chest pain;
hyperlipidemia, abdominal or lumbar pain or swelling,
hypercholesterolemia, profuse menstrual bleeding, pelvic
chronic alcoholism, pain; severe or continuous headache,
hereditary resistance to faintness or dizziness; prolonged
coumarin therapy. oozing from any minor injury (e.g.,
nicks from shaving).
 Stop drug and report immediately any
NCM 106 SY 2020-2021

symptoms of hepatitis (dark urine,

itchy skin, jaundice, abdominal pain,
light stools) or hypersensitivity
reaction (see Appendix F).
 Avoid brand interchange, take drug at
same time each day, and do NOT alter
dose.
 Notify physician if there is an unusual
increase in menstrual bleeding
(slightly increased or prolonged).
Note: PT/INR are checked at least
monthly in menstruating women.
 Risk of bleeding is increased for up to
1 mo after receiving the influenza
vaccine.
 Fever, prolonged hot weather,
malnutrition, and diarrhea lengthen
PT/INR (enhanced anticoagulant
effect).
 A high-fat diet, sudden increase in
vitamin K–rich foods (cabbage,
cauliflower, broccoli, asparagus,
lettuce, turnip greens, onions,
spinach, kale, fish, liver), coffee or
green tea (caffeine), or by tube
feedings with high vitamin K content
shorten PT/INR.
 Maintain a well-balanced diet and
avoid excess intake of alcohol.
 Inform dentist or any new physician
NCM 106 SY 2020-2021

about anticoagulant therapy and

duration of treatment.
 Use a soft toothbrush and floss teeth
gently with waxed floss.
 Use barrier contraceptive measures; if
you become pregnant while on
anticoagulant therapy the fetus is at
great potential risk of congenital
malformations.
 Do not take any other prescription or
OTC drug unless specifically
approved by physician or pharmacist.
Carry medical identification at all
times. It needs to indicate medical
diagnosis, medication(s), physician's
name, address, and telephone number.
 Do not breast feed while taking this
drug without consulting physician.
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

OF ACTION
Exerts direct Prophylaxis and History of hypersensitivity Hematologic: Spontaneo Assessment & Drug Effects
GENERIC NAME effect on the treatment of to heparin (white clot us bleeding, transient
HEPARIN SODIUM cascade of blood venous syndrome); active thrombocytopenia, hypo-  Lab tests: Baseline blood
coagulation thrombosis and bleeding, bleeding fibrinogenemia, "white coagulation tests, Hct, Hgb,
BRAND NAME (clotting) by pulmonary tendencies (hemophilia, clot syndrome."  RBC, and platelet counts prior
Hepalean enhancing the embolism and to purpura, to initiation of therapy and at
Heparin Sodium Lock inhibitory actions prevent thrombocytopenia); Body as a Whole: Fever, regular intervals throughout
Flush Solution of antithrombin III thromboembolic jaundice; ascorbic acid chills, urticaria, pruritus, therapy.
Hep-Lock (heparin cofactor) complications deficiency; inaccessible skin rashes, itching and  Monitor APTT levels closely.
Lipo-Hepin on several factors arising from ulcerative lesions; visceral burning sensations of  Note: In general, dosage is
Liquaemin Sodium essential to normal cardiac and carcinoma; open wounds, feet, numbness and adjusted to keep APTT
blood clotting, vascular surgery, extensive denudation of tingling of hands and feet, between 1.5–2.5 times normal
CLASSIFICATION thereby blocking frostbite, and skin, suppurative elevated BP, headache, control level.
BLOOD FORMERS the conversion of during acute stage thrombophlebitis; nasal congestion,  Draw blood for coagulation
COAGULATORS prothrombin to of MI. Also used advanced kidney, liver, or lacrimation, test 30 min before each
ANTICOAGULANTS thrombin and in treatment of biliary disease; active conjunctivitis, chest scheduled SC or intermittent
fibrinogen to disseminated tuberculosis; bacterial pains, IV dose and approximately
DOSAGE fibrin. intravascular endocarditis; continuous arthralgia, bronchospasm, q4h for patients receiving
Treatment of coagulation tube drainage of stomach anaphylactoid reactions.  continuous IV heparin during
Thromboembolism (DIC), atrial or small intestines; dosage adjustment period.
Adult: IV 5000-U bolus fibrillation with threatened abortion; Endocrine: Osteoporosis, After dosage is established,
dose, then 20,000– embolization, and suspected intracranial hypoaldosteronism, tests may be done once daily.
40,000 U infused over as anticoagulant hemorrhage, severe suppressed renal function,  Patients vary widely in their
24 h, dose adjusted to in blood hypertension; recent hyperkalemia; rebound reaction to heparin; risk of
maintain desired APTT transfusions, surgery of eye, brain, or hyperlipidemia (following hemorrhage appears greatest
or 5000–10,000 U IV extracorporeal spinal cord; spinal tap; termination of heparin in women, all patients >60 y,
piggyback q4– circulation, and shock. therapy).  and patients with liver disease
6h SC 10,000–20,000 dialysis or renal insufficiency.
 NCM 106 SY 2020-2021

U followed by 8000– procedures. GI: increased AST,  Monitor vital signs. Report

20,000 U q8–12h Cautious Use ALT.  fever, drop in BP, rapid pulse,
Child: IV 50 U/kg and other S&S of hemorrhage.
bolus, then 20,000 Unlabeled Alcoholism; history of Urogenital: Priapism  Observe all needle sites daily
U/m2/24 h or 50–100 (rare).  for hematoma and signs of
U/kg q4h or 15–25
Uses allergy (asthma, hives, hay
inflammation (swelling, heat,
fever, eczema); during
U/kg/h Skin: Injection site redness, pain).
Prophylaxis in hip menstruation; pregnancy
reactions: pain, itching,  Antidote: Have on hand
and knee surgery. (category C) especially the
Open Heart Surgery last trimester, and ecchymoses, tissue protamine sulfate (1%
Heparin Sodium
Adult: IV 150–300 immediate postpartum irritation and sloughing; solution), specific heparin
Lock Flush
U/kg cyanosis and pains in antagonist.
Solution is used to period; patients with
arms or legs (vasospasm),
maintain potency indwelling catheters; older
Prophylaxis of adults; use of acid-citrate- reversible transient Patient & Family Education
of indwelling IV
Embolism dextrose (ACD)-converted alopecia (usually around
catheters in
Adult: SC 5000 U q8– blood (may contain temporal area).  Protect from injury and notify
intermittent IV
12h heparin); patients in physician of pink, red, dark
therapy or blood
brown, or cloudy urine; red or
sampling. It is not hazardous occupations;
cerebral embolism. dark brown vomitus; red or
intended for
black stools; bleeding gums or
anticoagulant
oral mucosa; ecchymoses,
therapy.
hematoma, epistaxis, bloody
sputum; chest pain; abdominal
or lumbar pain or swelling;
unusual increase in menstrual
flow; pelvic pain; severe or
continuous headache,
faintness, or dizziness.
 Note: Menstruation may be
somewhat increased and
prolonged; usually, this is not
NCM 106 SY 2020-2021

a contraindication to
continued therapy if bleeding
is not excessive.
 Learn correct technique for
SC administration if
discharged from hospital on
heparin.
 Engage in normal activities
such as shaving with a safety
razor in the absence of a low
platelet (thrombocyte) count.
Usually, heparin does not
affect bleeding time.
 Caution: Smoking and alcohol
consumption may alter
response to heparin and are
not advised.
 Do not take aspirin or any
other OTC medication without
physician's approval.
 NCM 106 SY 2020-2021

DRUGS MECHANISM INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING RESPONSIBILITIES

OF ACTION
Enzyme produced Lysis of acute Pregnancy (category B), Body as a Assessment & Drug Effects
GENERIC NAME by kidneys and massive pulmonary lactation, and in children; Whole: Hypersensi-
UROKINASE isolated from emboli and active internal bleeding; tivity (bronchospasm,  Monitor for therapeutic
human kidney peripheral emboli very recent CPR; recent periorbital swelling, effectiveness: Measurable
BRAND NAME tissue cultures. and restoration of (within two months) angioneurotic edema, signs of clinical response
Abbokinase Promotes patency in occluded intraspinal, intracranial, or anaphylaxis); may not occur for 6–8 h after
Open-Cath thrombolysis by IV catheters intraarterial procedures; headache, therapy is started.
acting directly on (including central intracranial neoplasm, musculoskeletal pain,  Note: Anticoagulant therapy
CLASSIFICATION the endogenous venous catheter); CVA, severe uncontrolled flushing, pyrexia.  with heparin is reinstituted at
BLOOD FORMERS fibrinolytic system acute MI, retinal hypertension; history of end of urokinase therapy and
COAGULATORS, to convert vessel occlusion, allergic response to Hematologic: Phlebi- when thrombin time has
ANTICOAGULANTS; plasminogen to the lysis of clot-occluded thrombolytic agent, recent tis, bleeding or oozing decreased to less than twice
Thrombolytic Enzyme enzyme plasmin. arteriovenous streptococcal infection; at sites of normal control value
cannulas, and obstetrical delivery; percutaneous (usually within 3–4 h).
DOSAGE various other diabetic hemorrhagic trauma; prolonged  Be aware that severe
Pulmonary Embolus conditions associated retinopathy; ulcerative systemic spontaneous bleeding,
Adult: IV 4400 IU/kg with colitis, diverticulitis; any hypocoagulability; including fatality from
diluted in 0.9% NaCl or thromboembolizatio condition in which spontaneous bleeding cerebral hemorrhage, has
5% dextrose infused over n phenomenon. bleeding presents a hazard (GU, GI, occurred during urokinase
10 min, followed by or would be difficult to retroperitoneal);  treatment. Risk is estimated
continuous infusion of manage because of to be twice that associated
4400 IU/kg/h for 12 h location. CV: Unstable blood with heparin therapy.
pressure; reperfusion  See streptokinase for
Occluded Coronary Cautious Use atrial or ventricular additional nursing
Artery dysrhythmias.  implications.
Adult: IV Precede Patient with preexisting
urokinase with bolus of hemostatic deficits, Skin: Urticaria, Patient & Family Education
heparin (2500–10,000 U conditions accompanied itching. 
 NCM 106 SY 2020-2021

IV), then instill GI: Nausea.

urokinase 6000 IU/min by risk of cerebral  Report any of the following
for periods up to 2 h, embolism, septic to physician immediately:
continue until artery is thrombophlebitis; uremia, evidence or suspicion of
maximally opened hepatic failure. bleeding, fever, chills,
(usually 15–30 min using itching, difficulty breathing,
about 500,000 IU) back or chest pain.
 Do not breast feed while
Central Venous taking this drug.
Catheter Clearance
Adult: IV Instill 5000
IU/mL solution into
catheter port, after 5 min
attempt to aspirate
urokinase and clot, if no
success after 30 min, cap
port and wait 30–60 min
and try again (instruct
patient to exhale and
hold breath any time
catheter is disconnected
from syringe or IV
tubing and avoid
excessive pressure of
instillation to prevent
rupture of catheter or
forcing clot into
circulation)