Nokea
A patient will be taking dabigatran as part of treatment for chronic atrial fibrillation. Which statements about dabigatran are true?
- A. The dose of dabigatran is reduced in patients with decreased renal function.
- B. Bleeding is the most common adverse effect.
- C. Idarucizumab is given as an antidote in cases of uncontrolled bleeding.
- D. Dabigatran levels are monitored by measuring prothrombin time/international normalized ratio (PT/INR) results.
- E. This drug is a prodrug and becomes activated in the liver.
Correct Answer: A,B,C,E
Rationale: Dabigatran is excreted extensively in the kidneys, and the dose is dependent upon renal function. The normal dose is 150 mg twice daily, but it will be given at reduced dosage if renal impairment is present. The most common and serious side effect is bleeding. Dabigatran is a prodrug that becomes activated in the liver. Idarucizumab (Praxbind) is a specific dabigatran antidote that reverses the anticoagulant effects of dabigatran for emergency surgery or in life-threatening or uncontrolled bleeding. Dabigatran levels are not monitored by PT/INR.
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The nurse is reviewing new medication orders for a patient who has an epidural catheter for administration of pain medications. One of the orders is for enoxaparin, a low-molecular-weight heparin (LMWH). What is the nurse's priority action?
- A. Give the LMWH as ordered.
- B. Double-check the LMWH order with another nurse, and then administer as ordered.
- C. Stop the epidural pain medication, and then administer the LMWH.
- D. Contact the prescriber because the LMWH cannot be given if the patient has an epidural catheter.
Correct Answer: D
Rationale: LMWHs are contraindicated in patients with an indwelling epidural catheter; they can be given 2 hours after the epidural is removed. This is very important to remember, because giving an LMWH with an epidural has been associated with epidural hematoma.
A patient is receiving thrombolytic therapy, and the nurse monitors the patient for adverse effects. What is the most common undesirable effect of thrombolytic therapy?
- A. Dysrhythmias
- B. Nausea and vomiting
- C. Anaphylactic reactions
- D. Internal and superficial bleeding
Correct Answer: D
Rationale: Bleeding, both internal and superficial, as well as intracranial, is the most common undesirable effect of thrombolytic therapy. The other options list possible adverse effects of thrombolytic drugs, but they are not the most common effects.
A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose?
- A. Vitamin E
- B. Vitamin K
- C. Protamine sulfate
- D. Potassium chloride
Correct Answer: C
Rationale: Protamine sulfate is a specific heparin antidote and forms a complex with heparin, completely reversing its anticoagulant properties. Vitamin K is the antidote for warfarin (Coumadin) overdose. The other options are incorrect.
A patient has been prescribed warfarin in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale?
- A. The oral and injection forms work synergistically.
- B. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.
- C. The warfarin is used to reach an adequate level of anticoagulation when heparin alone is unable to do so.
- D. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.
Correct Answer: D
Rationale: This overlap therapy is required in patients who have been receiving heparin for anticoagulation and are to be switched to warfarin so that prevention of clotting is continuous. This overlapping is done purposefully to allow time for the blood levels of warfarin to rise, so that when the heparin is eventually discontinued, therapeutic anticoagulation levels of warfarin will have been achieved. Recommendations are to continue overlap therapy of the heparin and warfarin for at least 5 days; the heparin is stopped after day 5 when the international normalized ratio (INR) is above 2.
An elderly patient has had hip surgery and will be receiving heparin, 4000 units subcutaneously every 12 hours. The heparin is available in vials of 5000 units/mL. Calculate how much heparin the nurse will administer for this dose.
Correct Answer: 0.8 mL
Rationale: 5000 units : 1 mL :: 4000 units : x mL; (5000 * x) = (1 * 4000); 5000x = 4000; x = 4000/5000 = 0.8 mL.