Diuretics and Anticoagulants pharm practice questions 5.2.24

• Cryoprecipitate


  Contains clotting factors important in hemophilia and other anemia
• PT INR


  Lab used for Warfarin (Coumadin)
• aPPT or ACT


  Lab used for Heparin
• Discharge instructions for a patient on Warfarin (Coumadin): Be sure to avoid green leafy vegetables because these will counteract with the medication
• Those who are prescribed a blood thinner, such as Coumadin, are told to avoid foods in high vitamin K because the will counteract the effects of the blood thinner
• Patients are allowed to eat green leafy vegetables with Heparin, NOT Coumadin (Warfarin)
• Foods high in potassium


  • Fruit
  • Fish
  • Vegetables
  • Poultry
  • Meats
  • Dairy products
  • Bananas
  • Cantaloupe
  • Orange juice
  • Oranges
• Signs of low calcium


  • Chvostek's
  • Trousseau
  • Tetany
• Early symptoms of hypokalemia (low potassium)


  • Anorexia
  • Hypotension (low blood pressure)
  • Lethargy
  • Mental confusion
  • Muscle weakness/ muscle cramps
  • Nausea
• Late symptoms of hypokalemia (low potassium)


  • Cardiac dysrhythmias
  • Neuropathy
  • Paralytic ileus
  • Secondary alkalosis
• Thrombus


  Stationary (not moving) blood clot
• Embolus


  Blood clot that breaks loose and travels from one location in the body to another
• Normal range for potassium (K+) is 3.5 to 5.5 mEq/L
• Hypokalemia


  Deficiency of K+ level, less than 3.5 mEq/L
• Hypokalemia is corrected with K+ and potassium-rich foods
• The maximum rate for IV potassium administration is 10 mEq/hr
• Hyperkalemia


  Excessive K+ level, greater than 5.5 mEq/L
• Ways to correct hyperkalemia


  • Hemodialysis (HD)
  • Kayexalate (causes diarrhea)
  • Calcium gluconate
  • Sodium bicarbonate
  • Insulin
• Fibrin is the name of the blood clot
• Fibrinogen is a protein that changes into fibrin to become the blood clot
• Lasix (furosemide) decreases preload and should be given in the morning. Potassium must be monitored and never pushed.
• Cryoprecipitate contains clotting factors important in hemophilia and other anemias
• For patients on diuretic therapy, educate them to walk slowly and monitor blood pressure
• The antidote for heparin is protamine sulfate
• The antidote for Coumadin (warfarin) is vitamin K, and patients should avoid green leafy vegetables and NSAIDs
• Look out for bleeding as a side effect of thrombolytic medications
• Indications for anticoagulant medications


  • DVT
  • MI
  • PE
  • CVA
• Patients on anticoagulant medications should avoid flossing, shaving, and rough sports
• 3 blood proteins


  • Albumin (made by liver)
  • Globulin (immuno)
  • Fibrinogen (clotting)
• Anasarca is the term for whole body swelling
• The important lab tests for heparin are aPTT and ACT
• For Lovenox (enoxaparin), do not heat the injection site
• The antidote for Coumadin (warfarin) is vitamin K
• Potential side effects of thrombolytics


  • Intracranial bleeding
  • Internal bleeding
  • Superficial bleeding
  • Arrhythmias
• 3 signs of low calcium


  • Trousseau
  • Chvostek's
  • Tetany
• Patients on Coumadin should avoid NSAIDs
• Potassium needs to be diluted when given intravenously, do not give pure potassium
• Mannitol is the osmotic diuretic of choice for treating intracranial pressure, but it needs to be filtered as it can crystallize
• Spironolactone is a potassium-sparing diuretic
• When a patient is on diuretics, assess their intake/output, weight, and electrolytes