Drug Name (Generic & Trade) - Classification - Drug Actions - Therapeutic Effect Clinical Indications - Nursing interventions -

Transcription

1 Drug Name (Generic & Trade) - Ferrous Sulfate Classification - Enzimatic Mineral, Iron Drug Actions - Essential component in formation of Hgb, myoglobin & Enzimes. Therapeutic Effect: Prevents iron deficiency Clinical Indications - Prevention & treatment of Iron deficiency, Anemia Nursing interventions - Assess nutritional status, Assess for constipation, Check CBC Side effects/toxicity - Nausea, Constipation, GI Upset Contraindications - Hemochromatosis, Peptic Ulcers Aging/developmental considerations - Pregnancy Category A, Elderly: None Noted Patient Teaching - Expect stool color to darken Drug Name (Generic & Trade) - Gleevec / imatinib Mesylate Classification - tyrosine-kinase inhibitor used in the treatment of multiple cancers, most notably Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia Drug Actions - preventing a tyrosine kinase enzyme, in this case BCR-Abl, from phosphorylating subsequent proteins and initiating the signaling cascade necessary for cancer development, thus preventing the growth of cancer cells and leading to their death by apoptosis Clinical Indications - Leukimea OFF-LABEL: Treatment of desmoid tumors, Post stem cell transplant Nursing interventions - Assess CBC & BMP Side effects/toxicity - edema and, occasionally, serious fluid retention, Severe congestive heart failure and left ventricular dysfunction have been reported, Nausea, diarrhea, vomiting, headache, rash, musculoskeletal pain, muscle cramps, arthralgia Precautions - Hepatic/renal impairment, thyroidectomy pts, hypothyroidism. Gastric surgery pts Interactions: St. John s wort decreases concentration, Grapefruit products may increase concentration Lab values: May increase serum bilirubin, AST, ALT, creatinine. May decrease platelet count, WBC count, serum potassium, albumin, calcium, RBC. Nursing considerations - Obtain baseline CBC, serum chemistries, renal function. Monitor hepatic function tests before beginning treatment, monthly thereafter Intervention/evaluation - Assess periorbital area, lower extremities for early evidence of fluid retention. Monitor for unexpected, rapid weight gain Patient Teaching - Drink plenty of fluids and ensure a healthy diet, Avoid crowds, those with known infection Drug Name (Generic & Trade) - Lovenox / enoxaparin sodium Classification - Anticoagulant, Low molecular weight heparin Drug Actions - potentiates action of antithrombin III, inactivates coagulation factor Xa Therapeutic Effect: Produces anticoagulation. Does not significantly influence PT, aptt. Clinical Indications - Prevention of postop deep vein thrombosis (DVT) following hip or knee replacement surgery, abdominal surgery. Long-term DVT prevention following hip replacement surgery, nonsurgical acute illness. Treatment of acute coronary syndrome (ACS): unstable angina, non Q-wave MI, acute ST-segment elevation MI (STEMI). Acute DVT (with warfarin). Off-label: Prophylaxis/treatment of thromboembolism in children. DVT prophylaxis following moderate-risk general surgery, Gynecologic surgery; management of venous thromboembolism (vte) during pregnancy. Interactions: Antiplatelet agents, aspirin, NSAIDs, thrombolytics may increase risk of bleeding, Cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, ginseng may increase antiplatelet action Side effects/toxicity - Bleeding complications, Injection site hematoma, nausea, peripheral edema Lab values - Increases serum alkaline phosphatase, AST, ALT. May decrease Hgb, Hct, RBCs Contraindications - Pork products, acute bleeding, hypersensitivity to heparin Antidote - Proramine sulfate Nursing interventions - Periodically monitor CBC, platelet count, stool for occult blood, Assess for any sign of bleeding Nursing considerations - Obtain baseline CBC. Note platelet count. Patient Teaching - May increase bleeding time, may make you bruise more easily

2 Drug Name (Generic & Trade) - dabigatran etexilate / Pradaxa Classification - Thrombin inhibitor Anticoagulant Drug Actions -Direct thrombin inhibitor, preventing the conversion of fibrinogen into fibrin during coagulation cascade. Therapeutic Effect: Produces anticoagulation, preventing development of thrombus Clinical Indications - Indicated to reduce risk of stroke, systemic embolism in pts with nonvalvular atrial fibrillation Precautions: Active major bleeding, patients with mechanical prosthetic heart valves, Renal / Heppatic impairment Interactions: Rifampin may decrease concentration. Antacids, proton pump inhibitors may decrease levels, effect. Antiplatelet agents, NSAIDs, other anticoagulants, thrombolytics may increase risk of bleeding, Feverfew, ginkgo biloba, green tea, red clover may increase risk of bleeding. St. John's wort may decrease concentration/effects, High-fat meal delays absorption approximately 2 hrs Lab Values: May increase aptt, PT, INR Side effects/toxicity - Dyspepsia (heartburn, nausea, indigestion), diarrhea, upper abdominal pain Antidote - Vitamin K. Amount based on INR, significance of bleeding. Nursing interventions - Assess any sign of bleeding (hematuria, stool, bleeding from gums, petechiae, bruising). Nursing considerations - Assess CBC, including platelet count. Check PT, PTT. Determine initial B/P Patient Teaching - Avoid alcohol, salicylates, drastic dietary changes. May increase bleeding time., Use electric razor, soft toothbrush to prevent bleeding Drug Name (Generic & Trade) - Aspirin (ASA) Classification - Nonsteroidal salicylate, Anti-inflammatory, Antipyretic, Anticoagulant Drug Actions - Inhibits prostaglandin synthesis, effects hypothalamus heat regulation, interferes with thromboxane A in platelet aggregation Clinical Indications - Treatment of mild to moderate pain, fever. Reduces inflammation related to rheumatoid arthritis, juvenile arthritis, osteoarthritis, rheumatic fever. As platelet aggregation inhibitor in the prevention of transient ischemic attacks, cerebral thromboembolism, MI or reinfarction. Adjunctive treatment of Kawasaki's disease. OFF-LABEL: Prevention of pre-eclampsia; alternative therapy for preventing thromboembolism associated with atrial fibrillation where warfarin cannot be used; pericarditis associated with MI; prosthetic valve thromboprophylaxis Side effects/toxicity - Toxic over 30mg/dl/day, GI distress (including abdominal distention, cramping, heartburn, mild nausea); allergic reaction (including bronchospasm, pruritus, urticaria). Precautions - Hypersensitivity to salicylates, NSAIDs; asthma; rhinitis; nasal polyps; inherited or acquired bleeding disorders; use in children for viral infections; pregnancy. Interactions: Alcohol, NSAIDs may increase risk of GI effects (e.g., ulceration). Antacids, urinary alkalinizers increase excretion. Anticoagulants, heparin, thrombolytics, rivaroxaban, ticagrelor increase risk of bleeding. Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, ginseng, green tea, horse chestnut, red clover Lab values: May alter serum AST, ALT, alkaline phosphatase, uric acid; prolongs prothrombin time (PT), bleeding time. May decrease serum cholesterol, potassium, T3, T4. Nursing interventions - Assess type, location, duration of pain, inflammation. Inspect appearance of affected joints for Immobility, deformities, skin condition. Intervention/evaluation - Monitor urinary ph (sudden acidification, ph from 6.5 to 5.5, may result in toxicity). Assess skin for evidence of ecchymosis Patient Teaching - Don t drink alcohol while using this drug. Report any ringing in the ears (Tinnitus), Report tinnitus or persistent abdominal GI pain, bleeding

3 Drug Name (Generic & Trade) - Heparin/Hepalean Classification - Anticoagulant Drug Actions - Interferes with blood coagulation by blocking conversion of prothrombin to thrombin to thrombin and fibrinogen to fibrin. Prevents further extension of existing thrombi or new clot formation. No effect on existing clots Clinical Indications - Prophylaxis, treatment of thrombolitic disorders. Dosage and administration - IV units/kg Max 5000 Units, SQ 5000 Units Nursing interventions - Check dose with co-worker, Determine PTT before administration Side effects/toxicity - Bleeding complications, Puritus, Burning by vasospastic reaction Contraindications - Intercranial hemorrhage, severe hypotension, severe thrombocytopenia, uncontrolled bleeding Antidote - Protamine Sulfate Aging/developmental considerations - Pregnancy category C, Elderly more susceptible to hemorrhage Patient Teaching - Use a soft toothbrush and electric razor to prevent bleeding, report signs of dark or red urine Drug Name (Generic & Trade) - filgrastim/neupogen Classification - Biologic modifier CLINICAL: Granulocyte colony-stimulating factor Drug Actions - Stimulates production, maturation, activation of neutrophils. Therapeutic Effect: Increases migration, activation of neutrophils Clinical Indications - Decreases infection incidence in pts with malignancies receiving chemotherapy associated with severe neutropenia, fever OFF-LABEL: Treatment of AIDS-related neutropenia or hepatitis C treatment-associated neutropenia Lab Values: - May increase LDH, leukocyte alkaline phosphatase (LAP) scores, serum alkaline phosphatase, uric acid Nursing interventions - Monitor INR reports diligently. Assess Hct, platelet count, AST, ALT, urine/stool for occult blood. Be alert to complaints of abdominal/back pain, severe headache (may be sign of hemorrhage). Side effects - Nausea/vomiting, mild to severe bone pain, alopecia (18%), diarrhea, fever, fatigue Nursing considerations - CBC, platelet count should be obtained before therapy initiation and twice weekly thereafter. Intervention/evaluation: In septic pts, be alert for adult respiratory distress syndrome Patient Teaching - Report fever, chills, severe bone pain, chest pain, palpitations. Drug Name (Generic & Trade) - clopidogrel/ Plavix Classification - Thienopyridine derivative clinical: Antiplatelet Drug Actions - Inhibits binding of enzyme adenosine phosphate (ADP) to its platelet receptor and subsequent ADP-mediated activation of a glycoprotein complex. Therapeutic Effect: Inhibits platelet aggregation. Clinical Indications - Reduction of atherosclerotic events (e.g., MI, stroke, vascular death) in pts with recent MI or stroke, or established peripheral artery disease (PAD). Treatment of acute coronary syndrome (ACS). Reduces rate of atherothrombotic events in pts with unstable angina (UA), non-st segment elevation MI (non-stemi), ST-segment elevation MI (STEMI), or with percutaneous coronary intervention (PCI) or CABG OFF-LABEL: Graft patency (saphenous vein), stable coronary artery disease (in combination with aspirin). Initial treatment of acute coronary syndrome in pts allergic to aspirin Lab Values: - May increase bilirubin, AST, ALT, serum cholesterol, uric acid. May decrease neutrophil count, platelet count. Side effects - Skin disorders, Upper respiratory tract infection, chest pain, flu-like symptoms, headache, dizziness, arthralgia. Nursing interventions - : Monitor platelet count for evidence of thrombocytopenia. Assess BUN, serum creatinine, bilirubin, AST, ALT, WBC, Hgb, Hct, signs/symptoms of hepatic insufficiency during therapy Nursing considerations - Obtain baseline chemistries, platelet count, PFA level Intervention/evaluation: In septic pts, be alert for adult respiratory distress syndrome Patient Teaching - Inform physicians, dentists if clopidogrel is being taken, esp. before surgery is scheduled or before taking any new drug.

4 Drug Name (Generic & Trade) - Warfarin/ Coumadin Classification - Coumarin derivative clinical: Anticoagulant Drug Actions - Interferes w/ hepatic synthesis of vita K dependent clotting factors, resulting in depletion of coagulation factors Therapeutic Effect: Prevents extension of formed existing clot; prevents new clots, secondary thromboembolic complications Clinical Indications - Prophylaxis, treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. Prophylaxis, treatment of thromboembolic complications associated with cardiac valve replacement or atrial fibrillation. Reduces risk of death, recurrent MI, stroke, embolization after MI. OFF-LABEL: Treatment adjunct in transient ischemic attacks Lab Values: - Watch INR, Therapeudic levela between Precautions: Hemorrhagic tendencies (e.g., cerebral aneurysms), surgery of eye or CNS, neurosurgical procedures, open wounds, severe hypertension, spinal puncture procedures, uncontrolled bleeding, ulcers, unreliable or noncompliant pt, unsupervised senile or psychotic pt, blood dyscrasias, pericarditis or pericardial effusion, pregnancy (except in women with mechanical heart valves at high risk for thromboembolism), bacterial endocarditis, threatened abortion. Interactions - Amiodarone, azole antifungals, cimetidine, disulfiram, fluvoxamine, sulfamethoxazole-trimethoprim, levothyroxine, metronidazole, NSAIDs, omeprazole, platelet aggregation inhibitors, salicylates, thrombolytic agents, thyroid hormones may increase effect. Griseofulvin, hepatic enzyme inducers (e.g., rifampin), vitamin K may decrease effects. Alcohol may enhance anticoagulant effect, Cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo biloba, ginseng possess antiplatelet activity, may increase risk of bleeding. Ginseng, St. John's wort may decrease effect. Side Effects: GI distress Antidote: Vitamin K Nursing interventions - : Monitor INR reports diligently. Assess Hct, platelet count, AST, ALT, urine/stool for occult blood. Be alert to complaints of abdominal/back pain, severe headache (may be sign of hemorrhage). Decrease in B/P, increase in pulse rate may be sign of hemorrhage Nursing considerations - Determine INR before administration and daily following therapy initiation. Patient Teaching - Take medication at same time each day. Do not take, discontinue any other medication except on advice of physician. Avoid alcohol, aspirin, drastic dietary changes. Drug Name (Generic & Trade) - Erythropoietin/EPO/Procrit / epoetin alfa Classification - Glycoprotien clinical: Erythropoietin Drug Actions - Stimulates division, differentiation of erythroid progenitor cells in bone marrow. Therapeutic Effect: Induces erythropoiesis, releases reticulocytes from bone marrow. Clinical Indications - Treatment of anemia in pts receiving or who have received chemotherapy, those with chronic renal failure to decrease need for RBC transfusion, HIV-infected pts on zidovudine (AZT) therapy when endogenous erythropoietin levels 500 munits/ml or less, those scheduled for elective noncardiac, nonvascular surgery, reducing need for allogenic blood transfusions. Off-Label: Anemia in myelodysplastic syndromes. Lab Values: - May increase BUN, serum phosphorus, potassium, creatinine, uric acid, sodium. May decrease bleeding time, iron concentration, serum ferritin. Precautions: Pure red cell aplasia, uncontrolled hypertension. Cautions: History of seizures or hypertension. Cancer pts: Tumor growth, shortened survival may occur when Hgb levels of 11 g/dl or greater are achieved with epoetin alfa. Chronic kidney failure pts: Increased risk for serious cardiovascular reactions (e.g., stroke, MI) when Hgb levels greater than 11 g/dl are achieved with epoetin alfa. Interactions - Heparin, iron supplements dosage may need to be increased Side Effects: Fever, diarrhea, nausea, vomiting, edema, Hypertension, arthralgia Nursing interventions - : Assess CBC routinely. Monitor Hgb, Hct. Monitor aggressively for increased B/P (25% of pts on medication require antihypertensive therapy, dietary restrictions). Monitor temperature, esp. Nursing considerations - Assess B/P before drug initiation (80% of pts with chronic renal failure have history of hypertension). B/P often rises during early therapy in pts with history of hypertension. Patient Teaching - void potentially hazardous activity during first 90 days of therapy (increased risk of seizures in pts with chronic renal failure during first 90 days).

5 Drug Name (Generic & Trade) - Sargramostim/Leukine Classification - Colony stimulating factor clinical: Hematopoietic, antineutropenic Drug Actions - Stimulates proliferation/differentiation of hematopoietic cells to activate mature granulocytes and macrophages Therapeutic Effect: Assists bone marrow in making new WBCs, increases their chemotactic, antifungal, antiparasidic activity. Increases cytoneplastic cells, activates neutrophiles to inhibit tumor cell growth Clinical Indications - Accelerates myloid recovery in Pts undergoing autologous or allogenic bone marrow transplant or in Pts who have undergonehematopoetic stem cell transplant folllowing myeloblative chemotherapy. Prolongs survival in patents that just went under a bone marroe transplant. OFF-LABEL: Treatment of aids-related neutropenia; chronic severe neutropenia, chronic, severe neutropenia, drug induced neutropenis, myledospastic syndrome Lab Values: - May increase serum biliruben, createnan, hepatic enzimes, may decrease serum albumin Precautions: 12hrs before/after radiation therapy, 24hrs before/after chemo therapy, excessive leukemic myeloid blasts in bone marrow or peripheral blood greater than 10% Interactions - None significant Side Effects: GI disturbance, arthalgia, myalgia, HA, malaise, rash, putitus Nursing interventions - : Monitor CBC with Diff, plateletes, rensl/hepatic and pulmonary function, VS, weight Nursing considerations - Baseline PFT, Weights, VS Patient Teaching - Monitor daily weights Drug Name (Generic & Trade) - Dipyridamole/Persantine Classification - Blood modifyer, platelet aggrigation inhibitor, coronary vasodiolator clinical: Antiplatelet, antianginal, diagnostic agent Drug Actions - Inhibits activity of sndenosine deaminase and phosphodiesterase, enzymes cauzing accumulation of adenosine, cyclic adenosen monophosphate (AMP) Therapeutic Effect: Inhibits platelet aggrigation, may cause coronary vasodilation Clinical Indications - Adjunct to warfarin (Coumadin) anticoagulant therapy in prevention of postoperative thromboembolitic complications of cardiac valve replacement OFF-LABEL: Reduces risk of reinfarction in pts recovering from MI, treatment of transient ischemic atacks (TIA) Lab Values: - none. Precautions: Hypertension, coronary artery disease (CAD). Interactions - Anticoagulants, ASA, Heparin, Salicylates, throbolytics may increase risk for bleeding. Cats Claw, Dong quai, Evening primrose, Garlic, Gensing may increase antiplatelet activity. Side Effects: Dizzieness, Abdominal distress, HA, Rash Nursing interventions - : Assist with ambulation, Assess B/P for Hypotension Nursing considerations - Assess for presense of CP, Obtain baseline B/P, Pulse. Patient Teaching - Use caustion when rising from a laying or sitting position Drug Name (Generic & Trade) - Apixaban /Eliquis Classification - Ce clinical: At Drug Actions - Inhibits clotting factor Xa Clinical Indications - For patients wit nonvalvular atrial fibrilation to reduce risk of stroke (CVA), Tx/prevention of DVT and PE Lab Values: - PT/INR, aptt Precautions: Risk related to spinal anesthesia, spinal tap Side Effects: Increased risk of bleeding Nursing interventions - Monitor renal function Nursing considerations - Monitor for S/S of bleeding Patient Teaching - Monitor for S/S of bleeding

6 Drug Name (Generic & Trade) - Heparin Classification - Sulfated polysaccharide, blood modifyer clinical: Anticoagulant Drug Actions - Interfears with blood coagulation by blocking conversion of prothrombin to thrombin and fibrinogen to fibrin. Therapeutic Effect: Prevents further extension of existing thrombi or new clot formation. No effect on existing clots Clinical Indications - Prophylaxis, treatment of thromboembolitic disorders, including venous thrombosis, pulmonary embolism, peripheral artery embolism, atrial fibrilation with embolism OFF-LABEL: Acute MI as adjunct to thrombolysis, percutaneous coronary intervention Lab Values: - May increase free fatty acids, serum AST, ALT, May decrease serum cholesterol Precautions: Intercranial Hemmorhage, severe hypotension, sever thrombocytopenia, subacute bacterial endocarditis, uncontrolled bleeding (unless secondary to DIC) Interactions - Antithyroid medications valproic acid may cause hypoprpthrombinemia. Platelet aggrigation inhibitors, throbolytics may increase risk of bleeding, Probenecid may increase effect Side Effects: Puritus, burning (prticularly on soles of feet) caused by vasospastic reaction Antidote: Protamine Sulfate Nursing interventions - : Monitor aptt (Therapeutic range at times normal) diligently. Assess Hct, platelet count, AST, ALT, Monitor urine and stool for occult blood. Assess B/P Nursing considerations - Crosscheck dose with coworker, determine aptt before administration and 24 hours following initiation of therapy then q24-48hrs for first week untill maintenance dosage is determined Patient Teaching - Use only electric razors to shave Drug Name (Generic & Trade) - Rivaroxaban/Xarelto Classification - Factor Xa inhibitor clinical: Anticoagulant Drug Actions - Selectively blocks active site of factor Xa, a key factor in the intrinsic and extrinsic pathway of blood coagulation cascade. Prevents new clot formation, secondary thromboembolic complications Therapeutic Effect: Inhibits blood coagulation Clinical Indications - Ptophylaxis of deep vein thrombosis (DVT) in pts undergoing knee or hip replacement surgery. Reduces risk of thromboembolism/stroke in pts with nonvalular atrial fibrilation Lab Values: - May decrease platelets. May increase AST, ALT, bilirubin Precautions: Major active bleeding Interactions - Ketoconazole, itraconazole, clarithromycin, erythromycin, fluconazole, ritonavir may increase risk of bleeding. Anticoagulants, antiplatelets, NSAIDs may increase bleeding risk. St Johns Wart may decrease effect Side Effects: Wound secretion/oozing Nursing interventions - : Monitor CBC, CMP, CrCl, occult urine/stool Nursing considerations - Monitor VE, obtain EKG, Comprehensive Pt Hx. Patient Teaching - Do not abruptly stop taking medication, Avoid NSAIDs Drug Name (Generic & Trade) - Protamine Sulfate Classification - Protien clinical: Heparin agonist Antidote Drug Actions - Combines with heparin to form stable salt Therapeutic Effect: Reduces anticoagulation activity of heparin Clinical Indications - Treatment of severe heparin overdose (cauzing hemorrhage) Off-Label: Tx of low molecular weight heparin toxisity Lab Values: - PT/INR, aptt Precautions: Hx of alergy to shelfish Side Effects: Decreased BP, Dyspnea, N/V Nursing interventions - : Baseline assessment, check PT/INR, aptt, Hct, Assess for bleeding

7 Drug Name (Generic & Trade) - Abciximab / Reopro Classification - Glycoprotien IIb/IIIa receptor inhibitor clinical: Antiplatelet, antithrombotic Drug Actions - Rapidly inhibits platelet aggregation by preventing the binding of fibrinogen to GP IIb/IIIa receptor sites on platelets Therapeutic Effect: Prevents occlusion of trated coronary arteries. Prevents acute cardiac ischemic complications Clinical Indications - Adjunct to ASA and heparin therapy to prevent cardiac ischemic complications in patients undergoing percutanious coronary intervention (PCI) and those with unstable angina not responding to conventional medical therepy when PCI is planned within 24 hours OFF-LABEL: Support PCI durring ST-segment elevation, MI (STEMI) as an adjunct to half-dose thrombolytics Lab Values: - Increases activated clotting time (ACT) prothrombin time (PT) activated partial thromboplastin time (aptt), decreases platelet count Precautions: Active internal bleeding, arteriovenous malformation or aneurism, CVA with residual neurologic deficient, Hx of CVA (within 2 years) Interactions - Antiplatelet medications, heparin, thrombolitics, may increase risk of bleeding Side Effects: Nausea, Hypotension, Vomiting Nursing interventions - : Observe for AMS, Monitor for bleeding, Monitor ACT, PT, aptt, Platelet counts, Hgb, Hct Nursing considerations - Heparin should be discontinued 4hrs befor atrial sheeth is removed. Maintain Pt on bedrest 6-8hrs following procedure. Patient Teaching - Assess skin for bruising up to 3 days after infusion, report signs of bleeding Drug Name (Generic & Trade) - Vitamin K Classification - Fat-soluable vitamin clinical: Nutritional suppliment, antidote (drug-induces hypothrombinemia) Antihemmhoragic Drug Actions - Promotes hepatic formation of coagulation factors II, VII, IX, X Therapeutic Effect: Essential for normal clotting of blood Clinical Indications - Prevention, treatment of hemorrhagic states in neonates, antidote for hemorrhagic-induced by oral anticoagulants, hypothtombinemic states due to vitamin K deficiency. Will NOT counteract anticoagulation effects of heparin Lab Values: - INR Precautions: Renal impairment, newborns, Risk of jaundace via hyperbilirubinemia Interactions - Broad-spectrum antibiotics, high-dose salicylates may increase vitamin K requirements. Cholestyramine, coleestipol, minerla oil, sucraflate may decrease absorbtion. May decrease the effects of oral anticoagulants Side Effects: Pain, Soreness, Swelling, Puritic erythemia, facial flushing, altered taste Nursing interventions - : Monitor PT/INR routienly Nursing considerations - Assess for echymosis,petechiae, Bleeding in gums Patient Teaching - Use only an electric razor and soft tooth brush, and monitor for bleeding Drug Name (Generic & Trade) - Pentoxifylline/Trental Classification - Hemorrheologic agent clinical: Hemorrheologic Drug Actions - Alters flexibility of RBCs, inhibits production of tumor necrosis factor (TNF), neutrophil activation, platelet aggregation Therapeutic Effect: Reduces blood viscosity, improves blood flow Clinical Indications - Symptomatic treatment of intermittent claudication associated with occlusive peripheral vascular disease, diabetic angiopathies OFF-LABEL: Venous leg ulcers Lab Values: - None Precautions: Hx of intollerance to xanthine derivitives, such as caffeen, theophylline, thrombromine, recent cerebral/retinal hemorrhage Interactions - May intensify effects of antihypertensives Side Effects: Dizzieness, Nausea, altered taste, dyspepsia (Heartburn, epigastric pain, indigestion) Nursing interventions - : Assist with ambulation if dizzieness occurs. Assess for hand tremmors. Patient Teaching - Limit caffeen, Avoid tasks that require operation of heavy machenery such as driving

8 March 2014 pentoxifylline (pen-tox-i-fi-leen) (Albert, Apo-Pentoxifylline SR, Trental) CLASSIFICATION PHARMACOTHERAPEUTIC: Hemorheologic agent. CLINICAL: Hemorheologic. Copyright 2015, 2014, 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved. ACTION Alters flexibility of RBCs; inhibits production of tumor necrosis factor (TNF), neutrophil activation, platelet aggregation. Therapeutic Effect: Reduces blood viscosity, improves blood flow. PHARMACOKINETICS Well absorbed after PO administration. Undergoes first-pass metabolism in liver. Primarily excreted in urine. Unknown if removed by hemodialysis. USES Symptomatic treatment of intermittent claudication associated with occlusive peripheral vascular disease, diabetic angiopathies. OFF-LABEL: Venous leg ulcers. PRECAUTIONS History of intolerance to xanthine derivatives, such as caffeine, theophylline, theobromine; recent cerebral/retinal hemorrhage. INTERACTIONS DRUG: May increase effects of antihypertensives, warfarin, oral hypoglycemic agents. HERBAL: None significant. FOOD: None known. LAB VALUES: None significant. SIDE EFFECTS Dizziness, nausea, altered taste, dyspepsia (heartburn, epigastric pain, indigestion). INTERVENTION/EVALUATION Assist with ambulation if dizziness occurs. Assess for hand tremor. Monitor for relief of symptoms of intermittent claudication (pain, aching, cramping in calf muscles, buttocks, thigh, feet). PATIENT/FAMILY TEACHING Avoid tasks requiring alertness, motor skills until response to drug is established. Limit caffeine.

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22 DIC underlying disorder systemic activation of coagulation widespread intracellular fibrin deposition consumption of platelets & clotting factors thrombosis and organ failure (severe) bleeding Inflamation Infection Coagulation TF Platelets Thrombin (IIa) PAI-1 Clot TAFI DIC Laboratory Tests tpa Fibrinolysis PT/INR Normal Values Prothrombin Time Seconds Internationalized Ratio PTT/APTT THROMBIN TIME FIBRINOGEN PLATELETS FSP/FDP* Partial Thromboplastin Time Seconds ACT Test Seconds Seconds Factor I X10 9 /L Fibrin Split Products Fibrin Degadation Products CLOTTING FACTOR ASSAYS D-DIMER ELISAs Chromogenic <250 Ecarin Clotting Time (ECT)

23 ANEMIAS Compare Fe, TIBC, Transferrin and Transferrin Saturation DISORDER IRON DEFICIENCY CHRONIC ILLNESS IRON Tx OVERLOAD Serum Fe (Iron) TIBC Trans-ferrin Feren Sat