🩸 Module 9 · Cardiovascular Part 1

What “cardiac rules” should be followed when administering an antihypertensive medication?🚨 DANGER

Check the BLOOD PRESSURE and APICAL HEART RATE before every dose, and HOLD and notify the provider if they are below the ordered parameters (commonly hold a beta blocker for an apical rate under 60, or systolic BP under 90 to 100). Never stop an antihypertensive abruptly. Teach orthostatic precautions.

• Take an APICAL pulse for a FULL MINUTE, not a radial pulse for 15 seconds. The textbook's rule: assess the apical pulse before metoprolol; if under 60, withhold the drug and call the provider immediately unless other parameters are provided.
• If BP or HR is below parameters, HOLD the dose and notify the provider. Do not give it and then chart it.
• REBOUND HYPERTENSION: abrupt discontinuation of a beta blocker or clonidine causes rebound tachycardia, hypertension, angina, and MI. Teach the patient never to run out and never to stop on their own.
• ORTHOSTATIC HYPOTENSION: change positions slowly, dangle the legs before standing, get up slowly from bed, and use fall precautions. Especially the first dose and after any dose increase.
• Timing considerations: give diuretics in the MORNING so the patient is not up all night, and avoid giving a diuretic right before a diagnostic test or procedure. Take doses at the SAME TIME each day.
• Teach the patient to monitor BP at home and to keep a log, to weigh daily and report a gain over 2 to 3 pounds in a day or new ankle edema, to avoid alcohol and CNS depressants, and to avoid OTC decongestants and NSAIDs. Class-specific: ACE inhibitors and ARBs cause hyperkalemia and require avoiding salt substitutes and high-potassium foods; ACE inhibitors cause a dry cough and angiedema. Extended-release formulations are NEVER crushed. Beta blockers mask hypoglycemia in diabetics.

Apical pulse for a full minute, hold under 60, never stop cold, and stand up slowly.

Describe the first dose phenomenon.🚨 DANGER

First-dose phenomenon is severe ORTHOSTATIC HYPOTENSION, dizziness, and sometimes SYNCOPE occurring 30 to 90 minutes after the FIRST dose of an ALPHA-1 BLOCKER (prazosin, terazosin, doxazosin, tamsulosin). It also occurs after a dose increase or after restarting the drug.

• PREVENTION: give the first dose AT BEDTIME, start with the LOWEST dose, and titrate slowly. Tell the patient to take it when they can lie down and not drive.
• The textbook's version: assess and monitor blood pressure, especially after the first dose, because tamsulosin may cause orthostatic hypotension, and advise the patient to change positions slowly.
• Mechanism: blocking alpha-1 receptors on vascular smooth muscle removes vasoconstrictor tone. On the first dose the baroreceptor reflex has not yet adapted, so blood pools in the legs when the patient stands.
• Nursing: fall precautions, assist with the first ambulation, take orthostatic vital signs (lying, sitting, standing), and teach dangling the legs before standing.
• It resolves with continued therapy as the body compensates, usually within days. But it returns if doses are missed for several days and the drug is restarted at full dose.
• Higher risk with concurrent diuretics, other antihypertensives, PDE-5 inhibitors (sildenafil - separate by at least 4 hours), volume depletion, and in older adults. These drugs treat both hypertension and BPH. Tamsulosin is the most uroselective, so it drops blood pressure the least, but it still causes it.

First alpha blocker dose: bedtime, lowest dose, and do not let them get up fast.

What are the reversal agents for heparin and warfarin?🚨 DANGER

HEPARIN is reversed by PROTAMINE SULFATE, given by slow IV infusion. WARFARIN is reversed by VITAMIN K (phytonadione); for urgent reversal add FRESH FROZEN PLASMA or 4-factor prothrombin complex concentrate.

• Monitoring goes with the antidote: heparin is monitored by aPTT (therapeutic is 1.5 to 2 times the control) and warfarin by PT/INR (therapeutic 2.0 to 3.5 depending on the indication).
• Protamine works within about 5 minutes. Give it SLOWLY - rapid infusion causes hypotension, bradycardia, flushing, and anaphylaxis. Highest anaphylaxis risk in patients with fish allergy, prior protamine exposure, or a vasectomy.
• Protamine only PARTIALLY reverses low-molecular-weight heparin (enoxaparin), about 60%, and does not reverse fondaparinux at all.
• Vitamin K is SLOW: hours to days for full effect, because the liver has to synthesize new clotting factors. That is why FFP or PCC is added when the patient is actively bleeding and you need reversal NOW.
• Vitamin K route matters: oral or IV. IV must be given slowly and diluted because of anaphylaxis risk. Avoid IM in an anticoagulated patient because of hematoma.
• Teach warfarin patients to keep vitamin K intake CONSISTENT (green leafy vegetables) rather than avoiding it entirely, and to report bleeding, bruising, dark stools, or blood in urine. Warfarin's boxed warning is major or fatal bleeding. Newer anticoagulants have their own agents: IDARUCIZUMAB (Praxbind) for dabigatran, and ANDEXANET ALFA (Andexxa) for apixaban and rivaroxaban. Activated charcoal is used for a recent oral overdose.

PROtamine for the PRO-drug of bleeding, heParin. Vitamin K for the K-oumadin.

Apheresed granulocytes🚨 DANGER

Apheresed granulocytes are a blood product: neutrophils collected from a single donor by apheresis and transfused to a patient with SEVERE NEUTROPENIA and a documented bacterial or fungal infection that is NOT responding to antimicrobials. It is a rescue therapy, not a routine transfusion.

• They must be transfused AS SOON AS POSSIBLE, ideally within 6 hours and no later than 24 hours after collection, because granulocytes have an extremely short shelf life and do not store.
• They must be ABO/Rh compatible and CROSSMATCHED (the product contains many red cells), and they must be IRRADIATED to prevent transfusion-associated graft-versus-host disease. Do NOT use a leukocyte-reduction filter - that would remove the entire therapeutic product.
• Reaction rate is HIGH: expect fever, chills, and rigors. Premedication is common. Monitor closely for PULMONARY reactions - dyspnea, hypoxia, and infiltrates (TRALI-like pictures) - and stop the infusion for respiratory compromise.
• DO NOT INFUSE CONCURRENTLY WITH AMPHOTERICIN B. Separate the two by several hours because of the risk of severe pulmonary reactions.
• Use CMV-negative or leukoreduced-equivalent products for CMV-seronegative at-risk recipients per policy.
• Its use has declined because filgrastim (G-CSF) and better antifungals work better in most patients. Nursing role is standard transfusion protocol plus very close respiratory monitoring.

Borrowed neutrophils for a patient with none. Fresh, irradiated, no leukocyte filter, and never with amphotericin.

Erythropoietin🚨 DANGER

Erythropoietin (epoetin alfa, Procrit/Epogen; darbepoetin alfa, Aranesp) is an erythropoiesis-stimulating agent that tells the bone marrow to make RED BLOOD CELLS. Used for anemia of CHRONIC KIDNEY DISEASE, chemotherapy-induced anemia, and zidovudine-related anemia, to reduce the need for transfusion.

• BOXED WARNING: ESAs increase the risk of DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, and thrombosis of vascular access, and they shorten survival and hasten tumor progression in some cancers.
• THE TARGET IS DELIBERATELY LOW. Use the lowest dose needed to avoid transfusion. In CKD, do not start unless hemoglobin is under 10 g/dL, and reduce or hold the dose if hemoglobin exceeds 11 g/dL or rises more than 1 g/dL in 2 weeks. Chasing a normal hemoglobin is what kills people.
• In cancer, use ONLY for chemotherapy-induced anemia, only when the planned chemotherapy is palliative rather than curative, and STOP after the chemotherapy course ends.
• MONITOR: hemoglobin at least weekly at first, BLOOD PRESSURE (hypertension is very common and seizures can occur), and IRON STUDIES. Iron deficiency is the most common reason an ESA 'fails' - the marrow cannot build cells without iron, so transferrin saturation and ferritin must be adequate.
• Route is subcutaneous or IV. Do NOT shake the vial (it denatures the protein). Rotate subcutaneous sites.
• Teach the patient to report chest pain, shortness of breath, one-sided weakness or slurred speech, calf pain or swelling, severe headache, or a seizure. Report a missed dialysis access clot promptly. Filgrastim (WBCs) and romiplostim/oprelvekin (platelets) are the parallel growth factors for the other two cell lines.

EPO builds red cells but builds clots too. Keep hemoglobin UNDER 11 and give them iron.

Oprelvekin🚨 DANGER

Oprelvekin (Neumega) is recombinant INTERLEUKIN-11, a thrombopoietic growth factor that stimulates the bone marrow to produce PLATELETS. It is given subcutaneously to prevent severe thrombocytopenia and reduce the need for platelet transfusions after myelosuppressive chemotherapy.

• BOXED WARNING: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS. Permanently discontinue it in any patient who has an anaphylactic reaction.
• The signature adverse effect is FLUID RETENTION: peripheral edema, dyspnea on exertion, pleural effusion, weight gain, and worsening of pre-existing heart failure. Monitor daily weights, intake and output, lung sounds, and edema. Use with caution in heart failure and in anyone on diuretics.
• It causes a DILUTIONAL ANEMIA from plasma volume expansion - the hemoglobin falls without any actual red cell loss. Do not misread this as bleeding.
• Also causes ATRIAL ARRHYTHMIAS (especially atrial fibrillation and flutter), tachycardia, palpitations, conjunctival injection/redness of the eye, headache, dizziness, and blurred vision. Report palpitations or an irregular pulse.
• Timing: started 6 to 24 hours AFTER the chemotherapy dose is completed and continued until the platelet count recovers, then stopped at least 2 days before the next chemotherapy cycle. Monitor CBC with platelet count regularly.
• It is a growth factor, not a platelet transfusion. It takes days to work, so it PREVENTS thrombocytopenia rather than treating an acute bleed. Practical note: this product was withdrawn from the US market and is not in common clinical use, but it is still tested as the interleukin-11 platelet growth factor. Romiplostim and eltrombopag are the agents used today.

OPRELvekin = platelets (think 'PLatelets'). IL-11 for the 11 letters. Fluid retention and atrial fib are the price.

Packed red blood cells🚨 DANGER

Packed red blood cells are red cells with most of the plasma removed, transfused to treat SYMPTOMATIC ANEMIA or acute blood loss by increasing oxygen-carrying capacity. One unit raises hemoglobin by about 1 g/dL and hematocrit by about 3%.

• TWO-NURSE VERIFICATION at the bedside before starting: patient identifiers, blood type and Rh, unit number, product type, and expiration. This is the single highest-risk moment in transfusion nursing, because an ABO mismatch causes fatal acute hemolysis.
• ONLY 0.9% NORMAL SALINE may hang with blood. Lactated Ringer's contains calcium and will clot the line; dextrose solutions cause hemolysis. Use a Y-type blood administration set with an in-line FILTER and large-bore access (18 to 20 gauge in adults).
• STAY WITH THE PATIENT FOR THE FIRST 15 MINUTES and run it slowly, because most severe reactions appear in that window. Take vital signs at baseline, at 15 minutes, and per policy thereafter, and at completion.
• COMPLETE THE INFUSION WITHIN 4 HOURS of removing it from the blood bank (usually over 2 to 4 hours per unit), because of bacterial growth risk. Blood must never be stored in a unit refrigerator.
• REACTIONS: STOP THE TRANSFUSION IMMEDIATELY, disconnect the tubing at the hub, keep the line open with normal saline using NEW tubing, take vital signs, notify the provider and the blood bank, and send the unit and tubing back with a post-transfusion specimen. Acute hemolytic: fever, chills, flank or back pain, dark urine, hypotension, sense of doom. Febrile non-hemolytic: fever and chills alone. Allergic: hives and itching. TACO: dyspnea, crackles, hypertension, jugular distention.
• Typical trigger is hemoglobin under 7 g/dL (under 8 in cardiac disease or active symptoms). Transfuse ONE unit at a time and reassess. Verify consent and check for prior reactions. Special products: leukoreduced (fewer febrile reactions and less CMV risk), irradiated (prevents graft-versus-host disease in immunocompromised recipients), and washed (for repeated severe allergic reactions or IgA deficiency).

One unit, one gram. Normal saline only. Two nurses, first 15 minutes at the bedside, done in 4 hours.

💉 AliskirenBLACK BOX

Antihypertensive, Direct renin inhibitor

Hypertension, alone or in combination with other antihypertensives

⚠️ Pregnancy

Renin inhibitor that acts on the renin-angiotensin system (RAS)

• CV Orthostatic hypotension, hypotension
• CNS Headache, dizziness, seizures
• GI Diarrhea
• GU Renal stones, increased uric acid
• INTEG Rash
• META Hyperkalemia
• MISC Angiedema, cough

• About the importance of complying with dosage schedule even if feeling better; that if dose is missed, take as soon as possible; that if it is almost time for the next do …
• How to take B/P and normal reading for age group
• Not to use OTC products including herbs, supplements unless approved by prescriber
• To report to prescriber immediately: dizziness, faintness, chest pain, palpitations, uneven or rapid heartbeat, headache, severe diarrhea, swelling of tongue or lips, tro …

💉 ClonidineBLACK BOX

Antihypertensive, Central alpha-adrenergic agonist

Mild to moderate hypertension, used alone or in combination; severe pain in cancer patients (epidural), attention-deficit/hyperactivity disorder (ADHD)

Inhibits sympathetic vasomotor center in CNS, which reduces impulses in sympathetic nervous system; B/P, pulse rate, cardiac output are decreased …

• CNS Drowsiness, nightmares, anxiety, depression, hallucinations, syncope, dizziness
• CV Orthostatic hypotension, HF, ECG abnormalities, sinus tachycardia
• EENT Taste change, dry eyes
• ENDO Hyperglycemia
• GI Nausea, vomiting, constipation, dry mouth
• GU Impotence, urinary retention …

• To avoid hazardous activities and driving until response is known, product may cause drowsiness
• To notify all health care providers of medication use
• Not to discontinue product abruptly or withdrawal symptoms may occur: anxiety, increased B/P, headache, insomnia, increased pulse, tremors, nausea, sweating; to comply wi …
• Not to use OTC (cough, cold, or allergy), alcohol, or CNS depressant products unless directed by prescriber

Antidote / reversal: 1

💉 MetoprololHIGH ALERTBLACK BOX

Antihypertensive, antianginal, β1-Blocker

Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure, cardiomyopathy

Lowers B/P by β-blocking effects; reduces elevated renin plasma levels; blocks β2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect

• CNS Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue, weakness
• CV Hypotension, bradycardia, HF, palpitations, dysrhythmias, cardiac arrest, AV block, pulmonary/peripheral edema, chest pain
• EENT Blurred vision
• GI Nausea …

• To take immediately after meals; to take medication at bedtime to prevent effect of orthostatic hypotension

Antidote / reversal: 1

💉 PropranololHIGH ALERTBLACK BOX

Antihypertensive, antianginal, antidysrhythmic (class II), β-Adrenergic blocker

Chronic stable angina pectoris, hypertension, supraventricular dysrhythmias, migraine prophylaxis, pheochromocytoma, cyanotic spells related to hypertrophic subaortic stenosis, essential tremor, acute MI, vascular headache prophylaxis Unlabeled: Anxiety …

Nonselective β-blocker with negative inotropic, chronotropic, dromotropic properties

• CNS Depression, hallucinations, dizziness, fatigue, lethargy, paresthesias, bizarre dreams, disorientation
• CV Bradycardia, hypotension, HF, palpitations, AV block, peripheral vascular insufficiency, vasodilation, cold extremities, pulmonary edema, dysrhythmias
• EENT Sore throat, laryngospasm …

• Not to discontinue abruptly; may precipitate life-threatening dysrhythmias, exacerbation of angina, MI; to take product at same time each day, either with or without food …
• To avoid OTC products unless approved by prescriber; to avoid alcohol
• To avoid hazardous activities if dizzy
• About the importance of compliance with complete medical regimen; to monitor blood glucose, may mask symptoms of hypoglycemia

💉 NitroprussideHIGH ALERTBLACK BOX

Antihypertensive, vasodilator

Hypertensive crisis/urgency/induction; to decrease bleeding by creating hypotension during surgery; acute HF

Directly relaxes arteriolar, venous smooth muscle, thereby resulting in reduction in cardiac preload and afterload

• CNS Dizziness, headache, agitation, twitching, decreased reflexes, restlessness
• CV Bradycardia, ECG changes, tachycardia, hypotension
• GI Nausea, vomiting, abdominal pain
• INTEG Pain, irritation at inj site, sweating
• MISC Cyanide, thiocyanate toxicity, flushing, hypothyroidism

• To report headache, dizziness, loss of hearing, blurred vision, dyspnea, faintness, pain at IV site
• About the reason for giving product and expected results

💉 FilgrastimHIGH ALERT

Biologic modifier, Granulocyte colony-stimulating factor

To decrease infection in patients receiving antineoplastics that are myelosuppressive; to increase WBC in patients with product-induced neutropenia …

Stimulates proliferation and differentiation of neutrophils

• CNS Fever, headache
• GI Nausea, vomiting, diarrhea, mucositis, anorexia, splenic rupture
• HEMA Thrombocytopenia, excessive leukocytosis
• INTEG Alopecia, exacerbation of skin conditions, urticaria, cutaneous vasculitis, allergic reactions
• MS Osteoporosis, skeletal pain
• OTHER Chest pain …

• About the technique for self-administration: dose, side effects, disposal of containers and needles; provide instruction sheet
• That bone pain is common

💉 AlteplaseHIGH ALERT

Thrombolytic enzyme, Tissue plasminogen activator (TPA)

Lysis of obstructing thrombi associated with acute MI, ischemic conditions that require thrombolysis (i.e., PE, unclotting arteriovenous shunts, acute ischemic CVA) …

Produces fibrin conversion of plasminogen to plasmin; able to bind to fibrin, convert plasminogen in thrombus to plasmin, which leads to local fibrinolysis, limited systemic proteolysis

• INTEG Urticaria, rash
• SYST GI, GU, intracranial, retroperitoneal bleeding, anaphylaxis, fever

• The purpose and expected results of the treatment; to report adverse reactions, bleeding

💉 AspirinHIGH ALERTBLACK BOX

Opiate analgesic, Semisynthetic derivative

Moderate to severe pain Unlabeled: Postherpetic neuralgic (cont rel)

Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception

• CNS Drowsiness, dizziness, confusion, headache, sedation, euphoria, fatigue, abnormal dreams/thoughts, hallucinations
• CV Palpitations, bradycardia, change in B/P
• EENT Tinnitus, blurred vision, miosis, diplopia
• GI Nausea, vomiting, anorexia, constipation, cramps, gastritis, dyspepsia …

• To report any symptoms of CNS changes, allergic reactions
• That physical dependency may result from extended use
• That withdrawal symptoms may occur after long-term use: nausea, vomiting, cramps, fever, faintness, anorexia
• To avoid CNS depressants, alcohol

Antidote / reversal: 1

💉 ClopidogrelHIGH ALERTBLACK BOX

Platelet aggregation inhibitor, Thienopyridine derivative

Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina

Inhibits ADP-induced platelet aggregation

• CNS Headache, dizziness, depression
• CV Edema, hypertension, chest pain
• GI Diarrhea, constipation, GI discomfort
• HEMA Bleeding (major/minor from any site), neutropenia, aplastic anemia, agranulocytosis, thrombotic thrombocytopenic purpura
• INTEG Rash, pruritus, anaphylaxis
• MISC Fatigue …

• That blood work will be necessary during treatment (CBC, LFTs)
• To report any unusual bruising, bleeding to prescriber; that it may take longer to stop bleeding
• To take without regard to food
• To tell all health care providers that clopidogrel is being used; may be held for 5 days before surgery, restart as soon as possible

💉 DabigatranBLACK BOX

Anticoagulant, Direct thrombin inhibitor

Stroke/systemic embolism prophylaxis with nonvalvular atrial fibrillation, DVT, pulmonary embolism in hip replacement

Direct thrombin inhibitor that inhibits both free and clot-bound thrombin; prevents thrombin-induced platelet aggregation and thrombus formation by preventing conversion of fibrinogen to fibrin

• GI Abdominal pain, dyspepsia, esophagitis, gastritis, diarrhea
• HEMA Bleeding (any site)
• SYST Anaphylaxis (rare), angiedema

• About the purpose and expected results; to take at same time of day; not to skip or double doses; if dose is missed, to take as soon as remembered if on the same day; do …
• To take without regard to food; to swallow capsule whole, not to open; to take with a full glass of water, mix pellets/granules with 2 tsp of soft foods, do not mix with …
• To notify all providers that this product is being used; to check with prescriber about when to discontinue
• Bleeding: to report any bleeding or bruising, including blood in stool, emesis, urine; nosebleeds

💉 Enoxaparin (How is this medication administered?)HIGH ALERTBLACK BOX

Anticoagulant, antithrombotic, Low-molecular-weight heparin (LMWH)

Prevention of DVT (inpatient or outpatient), PE (inpatient) in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina, acute MI, coronary artery thrombosis

Binds to antithrombin III inactivating factors Xa/IIa, thereby resulting in a higher ratio of anti–factor Xa to IIa

• CNS Fever, confusion, dizziness, headache
• GI Nausea, vomiting, constipation
• HEMA Hemorrhage from any site, hypochromic anemia, thrombocytopenia, bleeding
• INTEG Ecchymosis, injection site hematoma, alopecia, pruritus, rash
• META Hyperkalemia in renal failure
• MS Osteoporosis
• SYST Edema …

• Black Box Warning: Spinal anesthesia: to report numbness, weakness in lower extremities
• To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor
• To report any signs of bleeding: gums, under skin, urine, stools; do not rub injection site, easy bruising
• To report dizziness, rash, breathing changes

💉 FondaparinuxHIGH ALERTBLACK BOX

Anticoagulant, antithrombotic, Synthetic, selective factor Xa inhibitor

Prevention/treatment of deep venous thrombosis, PE in hip and knee replacement, hip fracture or abdominal surgery Unlabeled: Acute MI NSTEMI/STEMI, PCI, unstable angina

Inhibits factor Xa, binds ATIII; neutralization of factor Xa interrupts blood coagulation and thrombin formation

• CNS Confusion, headache, dizziness, insomnia
• HEMA Anemia, hematoma, thrombocytopenia, major bleeding (intracranial, cerebral, retroperitoneal hemorrhage), postoperative hemorrhage, heparin-induced thrombocytopenia
• INTEG Increased wound drainage, bullous eruption, local reaction—rash, pruritus …

• To use soft-bristle toothbrush to avoid bleeding gums; to use electric razor
• To report any signs of bleeding: gums, under skin, urine, stools
• To avoid OTC products containing aspirin, NSAIDs
• Method for SUBCUT injection if needed

💉 HeparinHIGH ALERT

Anticoagulant, antithrombotic, Unfractionated heparin

Prevention and treatment of DVT and pulmonary embolism; acute coronary syndrome and MI; atrial fibrillation with embolism; keeping lines, dialysis circuits and cardiopulmonary bypass from clotting; disseminated intravascular coagulation.

Boosts the body’s own antithrombin III many times over. The heparin–antithrombin complex then shuts down thrombin (IIa) and factor Xa, so fibrin cannot form. It does not dissolve a clot that is already there — it stops it from growing while the body breaks it down.

• HEMA Bleeding from any site, heparin-induced thrombocytopenia (HIT), anemia.
• INTEG Injection-site bruising, hematoma, rarely skin necrosis.
• MS Osteoporosis with long-term use.
• SYST Hypersensitivity, chills, fever.
• META Hyperkalemia (it suppresses aldosterone).

• Monitored with aPTT, kept roughly one and a half to two and a half times the control value — not INR. INR belongs to warfarin.
• The antidote is protamine sulfate. Know that pairing cold.
• A platelet count that drops by about half, especially on day 5 to 10, is heparin-induced thrombocytopenia. Stop the heparin and call — HIT causes clotting, not bleeding, and it is dangerous.
• Report bleeding gums, nosebleeds, blood in urine or stool, bruising, or a headache that will not quit.

Antidote / reversal: 1

💉 RivaroxabanHIGH ALERTBLACK BOX

Anticoagulant, Factor Xa inhibitor

For deep venous thrombosis (DVT) prophylaxis/treatment, pulmonary embolism (PE), in patients undergoing knee or hip replacement surgery; for stroke prophylaxis and systemic embolism prophylaxis in patients with nonvalvular atrial fibrillation

A novel oral anticoagulant that selectively and potently inhibits coagulation factor Xa

• GI Increased hepatic enzymes, hyperbilirubinemia, jaundice, nausea, cholestasis, cytolytic hepatitis
• HEMA Bleeding, intracranial bleeding, epidural hematoma, GI bleeding, retinal hemorrhage, adrenal bleeding, retroperitoneal hemorrhage, cerebral hemorrhage, subdural hematoma, epidural hematoma …

• To report if pregnancy is planned or suspected; not to breastfeed

💉 Warfarin (How long does it take for warfarin to reach a therapeutic effect?)HIGH ALERTBLACK BOX

Anticoagulant, vitamin K antagonist, Coumarin derivative

Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT, MI prophylaxis, after MI, stroke prophylaxis, thrombosis prophylaxis, pulmonary embolism

Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit K–dependent coagulation factors (II, VII, IX, X)

• GI Nausea, cramps
• GU Hematuria, calciphylaxis
• HEMA Hemorrhage, agranulocytosis, leukopenia, eosinophilia, anemia, ecchymosis, petechiae
• INTEG Rash, dermal necrosis
• MISC Fever
• MS Bone fractures

• To avoid OTC preparations that may cause serious product interactions unless directed by prescriber; to avoid alcohol, herbs, supplements
• To carry emergency ID identifying product taken
• About the importance of compliance with exams and doses