*Medication (Dose/Frequency/Route) (Recommendation Dose)

*Reason for Medication: *Classification: *Action of Med Ther. class. anticoagulants Pharm. class. Antithrombotics

*Labs pertinent to Med

*Food/Drug Interactions & *Drug/Drug Interactions

*Pt Teaching Related to Medication

*Nursing Implications

Side Effects

Evaluation: Client Response

Heparin
50units IV daily
Recommendation Dose Line Flushing IV (Adults and Children): 10100 units/mL (10 units/mL for infants <10 kg, 100 units/mL for all others) solution to fill heparin lock set to needle hub; replace after each use.

Action Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin In low doses, prevents the conversion of prothrombin to SC (Adults): 5000 units IV, thrombin by its followed by initial subcut effects on factor dose of 10,00020,000 Xa units, then 800010,000 Higher doses units q 8 hr or 15,000 neutralize 20,000 units q 12 hr. thrombin, preventing the conversion of fibrinogen to High Alert Medication: This fibrin medication bears a Therapeutic heightened risk of causing Effect(s): significant pt harm when it Prevention of is used in error. thrombus formation Prevention of extension of existing thrombi (full dose)

Monitor activated partial thromboplastin time (aPTT) and hematocrit prior to and periodically during therapy. When intermittent IV therapy is used, draw aPTT levels 30 min before each dose during initial therapy and then periodically. During continuous administration, monitor aPTT levels every 4 hr during early therapy. For Subcut therapy, draw blood 46 hr after injection Monitor platelet count every 23 days throughout therapy. May cause mild thrombocytopenia, which appears on 4th day and resolves despite continued heparin therapy. Heparin-induced thrombocytopenia (HIT), a more severe form which necessitates discontinuing medication, may develop on 8th day of therapy; may reduce platelet count to as low as 5000/mm3 and lead to increased resistance to heparin therapy. HIT may progress to development of venous and arterial thrombosis (HITT) and may occur up to several wk after discontinuation. Pts who have received a previous course of heparin may be at higher risk for severe thrombocytopenia for several months after the initial course May cause hyperkalemia and AST and ALT levels

Drug-Drug Advise pt to report Risk of bleeding may be any symptoms of by concurrent use of unusual bleeding drugs that affect platelet or bruising to function, including health care aspirin, NSAIDs, professional clopidogrel, immediately dipyridamole, some Instruct pt not to penicillins, ticlopidine, take medications abciximab, eptifibitide, containing aspirin tirofiban, and dextran or NSAIDs while Risk of bleeding may be on heparin therapy by concurrent use of Caution pt to avoid drugs that cause IM injections and hypoprothrombinemia, activities leading to including quinidine, injury and to use a cefoperazone, cefotetan, soft toothbrush and andvalproic acid electric razor Concurrent use of during heparin thrombolytics risk of therapy bleeding Advise pt to Heparins affect the inform health care prothrombin time used professional of in assessing the medication response towarfarin regimen prior to Digoxin, tetracyclines, treatment or nicotine, and surgery antihistamines may Pts on anticoagulant effect of anticoagulant heparin therapy should Streptokinase may be carry an followed by relative identification card resistance to heparin with this Drug-Natural Products information at all risk of bleeding with times arnica, anise, chamomile, clove, dong quai, fever few, garlic, ginger, and Panax ginseng

Assess for signs of bleeding and GI: drughemorrhage (bleeding gums; nosebleed; induced unusual bruising; black, tarry stools; hepatitis. hematuria; fall in hematocrit or blood pressure; guaiac-positive stools). Notify Derm: alopecia health care professional if these occur Assess pt for evidence of additional or (long-term use), rashes, increased thrombosis. Symptoms will urticaria. depend on area of involvement Monitor pt for hypersensitivity reactions (chills, fever, urticaria) Hemat: SC BLEEDING, Observe injection sites for hematomas, anemia, ecchymosis, or inflammation

Inform all personnel caring for pt of anticoagulant therapy. Venipunctures and injection sites require application of pressure to prevent bleeding or hematoma formation. Avoid IM injections of other medications; hematomas may develop In pts requiring long-term Local: pain at anticoagulation, oral anticoagulant injection site. therapy should be instituted 45 days prior to discontinuing heparin therapy Solution is colorless to slightly yellow MS: SC: osteoporosis Administer deep into subcut tissue. (long-term Alternate injection sites between arm use). and the left and right abdominal wall above the iliac crest. Inject entire length Misc: fever, of needle at a 45- or 90-angle into a hypersensitivity skin fold held between thumb and forefinger; hold skin fold throughout injection. Do not aspirate or massage. Rotate sites frequently. Do not administer IM because of danger of hematoma formation. Solution should be clear; do not inject solution containing particulate matter

thrombocytop enia (can occur up to several weeks after discontinuatio n of therapy).