Name /bks 53161 deglins md disk/heparin 02/14/2014 02: 22pm plate # 0-Composite
Yüklə 53,24 Kb. Pdf görüntüsü
|
|
Name /bks_53161_deglins_md_disk/heparin 02/14/2014 02:22PM Plate # 0-Composite pg 1 # 1 PDF Page #1 ϭ Canadian drug name. ϭ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ϭ Discontinued. 1 High Alert heparin (hep-a-rin) Hepalean, Hep-Lock, Hep-Lock U/P
Prophylaxis and treatment of various thromboembolic disorders including: Venous thromboembolism, Pulmonary emboli, Atrial fibrillation with embolization, Acute and chronic consumptive coagulopathies, Peripheral arterial thromboembolism. Used in very low doses (10– 100 units) to maintain patency of IV catheters (heparin flush).
Action Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin. In low doses, prevents the conversion of prothrombin to thrombin by its effects on factor Xa. Higher doses neutralize thrombin, preventing the conversion of fibrinogen to fibrin. Therapeutic Effects: Prevention of thrombus formation. Prevention of extension of existing thrombi (full dose).
Erratically absorbed following subcut or IM administration. Distribution: Does not cross the placenta or enter breast milk. Protein Binding: Very high (to low-density lipoproteins, globulins, and fibrino- gen).
Probably removed by the reticuloendothelial sys- tem (lymph nodes, spleen).
1– 2 hr (qwith increasing dose); affected by obesity, renal and hepatic function, malignancy, presence of pulmonary embolism, and infections. TIME/ACTION PROFILE (anticoagulant effect) ROUTE ONSET PEAK DURATION Heparin subcut 20–60 min 2 hr
8–12 hr Heparin IV immediate 5–10 min
2–6 hr Contraindications/Precautions Contraindicated in: Hypersensitivity; Uncontrolled bleeding; Severe thrombocy- topenia; Open wounds (full dose); Avoid use of products containing benzyl alcohol in premature infants. Use Cautiously in: Severe liver or kidney disease; Retinopathy (hypertensive or diabetic); Untreated hypertension; Ulcer disease; Spinal cord or brain injury; History of congenital or acquired bleeding disorder; Malignancy; OB: May be used during pregnancy, but use with caution during the last trimester and in the immediate post- partum period; Geri: Women Ͼ 60 yr haveqrisk of bleeding. Exercise Extreme Caution in: Severe uncontrolled hypertension; Bacterial en- docarditis, bleeding disorders; GI bleeding/ulceration/pathology; Hemorrhagic stroke; Recent CNS or ophthalmologic surgery; Active GI bleeding/ulceration; History of thrombocytopenia related to heparin.
drug-induced hepatitis. Derm: alopecia (long-term use), rashes, urticaria. He- mat: BLEEDING
, HEPARIN
- INDUCED THROMBOCYTOPENIA (HIT) ( WITH OR WITHOUT THROMBOSIS ), anemia. Local: pain at injection site. MS: osteoporosis (long-term use).
fever, hypersensitivity. Interactions Heparin is frequently used concurrently or sequentially with other agents affecting coagulation. The risk of potentially seri- ous interactions is greatest with full anticoagulation Drug-Drug: Risk of bleeding may beqby concurrent use of drugs that affect platelet function, including aspirin, NSAIDs, clopidogrel, dipyridamole, some penicillins, ticlopidine, abciximab, eptifibitide, tirofiban, and dextran. Risk of bleeding may beqby concurrent use of drugs that cause hypoprothrom-
Concurrent use of thrombolyticsqrisk of bleeding. Heparins affect the prothrom- bin time used in assessing the response to warfarin. Digoxin, tetracyclines, nico-
may be followed by relative resistance to heparin. Drug-Natural Products: q risk of bleeding with arnica, anise, chamomile, clove, dong quai, fever few, garlic, ginger, and Panax ginseng. Name /bks_53161_deglins_md_disk/heparin 02/14/2014 02:22PM Plate # 0-Composite pg 2 # 2 ᭧ 2015 F.A. Davis Company
PDF Page #2 2 Route/Dosage Therapeutic Anticoagulation IV (Adults): Intermittent bolus— 10,000 units, followed by 5000– 10,000 units q 4– 6 hr. Continuous infusion— 5000 units (35– 70 units/kg), followed by 20,000– 40,000 units infused over 24 hr (approx. 1000 units/hr or 15– 18 units/kg/ hr).
IV (Children Ͼ
100 units/kg q 4 hr. Continuous infusion— Loading dose 75 units/kg, followed by 20 units/kg/hr, adjust to maintain aPTT of 60– 85 sec. IV (Neonates and Infants Ͻ
units/kg, followed by 28 units/kg/hr, adjust to maintain aPTT of 60– 85 sec.
units, then 8000– 10,000 units q 8 hr or 15,000– 20,000 units q 12 hr. Prophylaxis of Thromboembolism Subcut (Adults): 5000 units q 8– 12 hr (may be started 2 hr prior to surgery). Cardiovascular Surgery IV (Adults): At least 150 units/kg (300 units/kg if procedure Ͻ 60 min; 400 units/kg if Ͼ 60 min). Intraarterial (Neonates , Infants, and Children): 100– 150 units/kg via an ar- tery prior to cardiac catheterization. Line Flushing IV (Adults and Children): 10– 100 units/mL (10 units/mL for infants Ͻ 10 kg, 100 units/mL for all others) solution to fill heparin lock set to needle hub; replace after each use. Total Parenteral Nutrition IV (Adults and Children): 0.5– 1 units/mL (final solution concentration) to main- tain line patency. Arterial Line Patency Intraarterial (Neonates): 0.5– 2 units/mL. NURSING IMPLICATIONS Assessment ● Assess for signs of bleeding and hemorrhage (bleeding gums; nose- bleed; unusual bruising; black, tarry stools; hematuria; fall in hemato- crit or BP; guaiac-positive stools). Notify health care professional if these occur. ● Assess patient for evidence of additional or increased thrombosis. Symptoms will depend on area of involvement. ● Monitor patient for hypersensitivity reactions (chills, fever, urticaria). ● Subcut: Observe injection sites for hematomas, ecchymosis, or inflammation. ● Lab Test Considerations: Monitor activated partial thromboplastin time (aPTT) and hematocrit prior to and periodically during therapy. When intermit-
therapy and then periodically. During continuous administration, monitor aPTT levels every 4 hr during early therapy. For Subcut therapy, draw blood 4– 6 hr af- ter injection. ● Monitor platelet count every 2–3 days throughout therapy. May cause
3 and lead to increased resistance to heparin therapy. HIT may pro- gress to development of venous and arterial thrombosis (HITT) and may occur up to several wk after discontinuation. Patients 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 andqAST and ALT levels. ● Toxicity and Overdose: Protamine sulfate is the antidote. Due to short half-life, overdose can often be treated by withdrawing the drug.
Ineffective tissue perfusion (Indications) Risk for injury (Side Effects)
● High Alert: Fatal hemorrhages have occurred in pediatric patients due to errors in which heparin sodium injection vials were confused with heparin flush vials.
Name /bks_53161_deglins_md_disk/heparin 02/14/2014 02:22PM Plate # 0-Composite pg 3 # 3 ϭ Canadian drug name. ϭ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ϭ Discontinued. 3 CONTINUED heparin PDF Page #3 Carefully examine all heparin sodium injection vials to confirm the correct vial choice prior to administration. Have second practitioner independently check original order, dose calculation, and infusion pump settings. Unintended con- comitant use of two heparin products (unfractionated heparin and LMW hepa- rins) has resulted in serious harm or death. Review patients’ recent (emergency department, operating room) and current medication administration records be- fore administering any heparin or LMW heparin product. Do not confuse heparin with Hespan (hetastarch in sodium chloride). Do not confuse vials of heparin with vials of insulin. ● Inform all personnel caring for patient of anticoagulant therapy. Venipunctures and injection sites require application of pressure to prevent bleeding or hema- toma formation. Avoid IM injections of other medications; hematomas may de- velop. ● In patients requiring long-term anticoagulation, oral anticoagulant therapyshould be instituted 4– 5 days prior to discontinuing heparin therapy. ● Solution is colorless to slightly yellow. IV Administration ● pH: 5.0–8.0. ● Subcut: Administer deep into subcut tissue. Alternate injection sites between arm and the left and right abdominal wall above the iliac crest. Inject entire length of needle at a 45 Њ- or 90Њ-angle into a skin fold held between thumb and forefinger; hold skin fold throughout injection. Do not aspirate or massage. Rotate sites fre- quently. Do not administer IM because of danger of hematoma formation. Solu- tion should be clear; do not inject solution containing particulate matter. ● Direct IV: Diluent: Administer loading dose undiluted. Concentration: Var- ies depending upon vial used. Rate: Administer over at least 1 min. Loading dose given before continuous infusion. ● Continuous Infusion: Diluent: Dilute 25,000 units of heparin in 250–500 mL of 0.9% NaCl or D5W. Premixed infusions are already diluted and ready to use. Ad- mixed solutions stable for 24 hr at room temperature or if refrigerated. Premixed infusion stable for 30 days once overwrap removed. Concentration: 50– 100 units/mL. Rate: See Route/Dosage section. Adjust to maintain therapeutic aPTT. Use an infusion pump to ensure accuracy. ● Flush: To prevent clot formation in intermittent infusion (heparin lock) sets, in- ject dilute heparin solution of 10– 100 units/0.5– 1 mL after each medication in- jection or every 8– 12 hr. To prevent incompatibility of heparin with medication, flush lock set with sterile water or 0.9% NaCl for injection before and after medica- tion is administered. ● Y-Site Compatibility: acyclovir, alemtuzumab, alfentanil, allopurinol, amifos- tine, aminocaproic acid, aminophylline, amphotericin B lipid complex, ampho- tericin B liposome, anidulafungin, argatroban, ascorbic acid, atropine, azathio- prine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftaroline, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cisplatin, cladribine, clindamycin, cyanocobalamin, cyclosporine, cytarabine, dactinomycin, daptomy- cin, dexamethasone, dexmedetomidine, digoxin, docetaxel, dopamine, doripe- nem, doxacurium, doxapram, doxorubicin liposome, edrophonium, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, ertapenem, estrogens, conju- gated, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, flucon- azole, fludarabine, flumazenil, fluorouracil, folic acid, foscarnet, ganciclovir, gemcitabine, glycopyrrolate, granisetron, hydrocortisone, hydromorphone, ifos- famide, imipenem/cilastatin, indomethacin, irinotecan, isoproterenol, ketorolac, leucovorin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mech- lorethamine, melphalan, meropenem, metaraminol, methotrexate, methoxamine, methyldopate, methylergonovine, metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone, mitomycin, morphine, multiple vitamins, naf- cillin, nalbuphine, naloxone, neostigmine, nitroglycerin, nitroprusside, norepi- nephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, pa- lonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, penicillin G, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, pi- peracillin/tazobactam, potassium acetate, potassium chloride, procainamide, propofol, propranolol, pyridostigmine, pyridoxime, ranitidine, remifentanil, ri- tuximab, rocuronium, sargramostim, scopolamine, sodium acetate, sodium bi- carbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, theophylline, thiamine, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolaz- oline, tranexamic acid, trastuzumab, trimetaphan, vasopressin, vecuronium, vera- pamil, vinblastine, vincristine, voriconazole, warfarin, zidovudine, zoledronic acid.
Name /bks_53161_deglins_md_disk/heparin 02/14/2014 02:22PM Plate # 0-Composite pg 4 # 4 ᭧ 2015 F.A. Davis Company PDF Page #4 4 ● Y-Site Incompatibility: alteplase, amikacin, amiodarone, amphotericin B cho- lesteryl, amsacrine, caspofungin, ciprofloxacin, dantrolene, diazepam, diazoxide, doxycycline, epirubicin, filgrastim, gentamicin, haloperidol, hydroxyzine, idaru- bicin, ketamine, levofloxacin, mitoxandrone, mycophenolate, palifermin, papav- erine, pentamidine, phenytoin, protamine, quinupristin/dalfopristin, reteplase, tobramycin, trimethoprim/sulfamethoxazole, vancomycin. ● Additive Compatibility: It is recommended that heparin not be mixed in solu- tion with other medications when given for anticoagulation, even those that are compatible, because changes in rate of heparin infusion may be required that would also affect admixtures.
● Advise patient to report any symptoms of unusual bleeding or bruising to health care professional immediately. ● Instruct patient not to take medications containing aspirin or NSAIDs while on heparin therapy. ● Caution patient to avoid IM injections and activities leading to injury and to use a soft toothbrush and electric razor during heparin therapy. ● Advise patient to inform health care professional of medication regimen prior to treatment or surgery. ● Patients on anticoagulant therapy should carry an identification card with this in- formation at all times.
● Prolonged partial thromboplastin time (PTT) of 1.5–2.5 times the control, with- out signs of hemorrhage. ● Prevention of deep vein thrombosis and pulmonary emboli. ● Patency of IV catheters. Why was this drug prescribed for your patient? Yüklə 53,24 Kb. Dostları ilə paylaş:
|