NCLEX Medication Review – Drugs that Affect the Blood Part 1

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We continue our NCLEX Drug review series with a new section Drugs that Affect the Blood – Part 1

Anticoagulants (Parenteral)

Expected Action: Intrinsic factors and thrombin conversion are inhibited by heparin

Example: Heparin — Others: enoxaparin, tinzaparin (Innohep)

Therapeutic Uses: Evolving stroke, PE, MI, DVT, during pregnancy, Adjunct during ♥ surgery, dialysis, abdominal surgery, or joint replacement, Disseminated intravascular coagulation

Adverse Effects Hypersensitivity reaction (chills, fever, urticaria), Hemorrhage 2º heparin OD (treat ĉ protamine sulfate), Heparin-induced thrombocytopenia (stop if PLT < 100,000/cc)


CI: Decreased PLT or uncontrollable bleeding
CI: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture

Interactions: Anti-platelet agent leads to additive risk of bleeding

Education: Monitor aPTT levels Q4-6h and then QD (60-80 sec)


Treatment of Heparin OD

Expected Action: Binds with heparin and forms a non-coagulating complex

Drug: Protamine sulfate

Therapeutic Uses: Antidote to severe heparin overdose, Reversal of heparin administered during procedures

Education: Administer slowly (20 mg/min or 50 mg in 10 min), aPTT levels of 60-80 sec


Anticoagulant (Oral)

Expected Action: Antagonizes vitamin K / prevents synthesis of 4 intrinsic factors & prothrombin

Example: warfarin (Coumadin)

Therapeutic Uses: Prevention of venous thrombosis, Prevention of thrombi in A-fib and with prosthetic heart valves

Adverse Effects: Hemorrhage (Tx with vitamin K)

Pregnancy (X)
CI: Surgery of eye, brain, spinal cord; regional anesthesia; lumbar puncture
CI: decreased PLT counts, uncontrolled bleeding, vit. K δ, liver problems, alcoholism

Heparin, aspirin, glucocorticoids leads to increased bleeding
Acetaminophen, sulfonamides, parenteral cephalosporins, ASA leads to ñ [warfarin]

Phenobarbital, carbamazepine, phenytoin, OC, vitamin K leads to decreased warfarin effects


PT therapeutic level = 18-24 sec (normal = 11-12.5 sec), Onset takes 8-12 hrs, full effect takes 3-5 days


Treatment of Warfarin OD

Expected Action: Promote synthesis of intrinsic factors and prothrombin

Drug name: Vitamin K (Phytonadione)

Therapeutic Uses: Vitamin K deficiency, Reversal of hypoprothrombinemia and bleeding d/t warfarin OD

Adverse Effects: Anaphylactoid reaction (infuse slowly in diluted solution)

Education: Administer small doses (2.5 mg PO / 0.5-1 mg IV) of vitamin K to prevent development of resistance to warfarin.



Expected Action Prevent platelet clumping by inhibiting arterial clotting enzymes and factors

Example: Aspirin — Others: ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), abciximab (Reo Pro)

Therapeutic Uses: Primary prevention of acute MI, Prevention of stroke, Prevention of reinfarction, Acute coronary syndromes (abciximab and tirofiban {Aggrastat})

  • Adverse Effects: GI effects (concurrent PPI / enteric-coated / take ĉ food), Hemorrhagic stroke

Contraindications/Precautions: Pregnancy (D)


Medications that enhance bleeding leads to additive risk for bleeding


ASA (81 mg) for prevention / ASA (325 mg) during initial acute MI episode


Thrombolytic Medications

Expected Action:

Clot dissolution by plasminogen leads to plasmin which destroys fibrinogen

Proto: streptokinase  Others: alteplase (tPA), tenecteplase, reteplase

Therapeutic Uses: Acute MI / DVT / Massive PE / Ischemic stroke (alteplase)

Adverse Effects: Serious risk of bleeding from different sites

Streptokinase Hypotension (infuse slowly), Allergic reaction or anaphylaxis


Hx of intracranial hemorrhage, Brain tumors / pericarditis / Recent head or facial trauma / internal bleeding

Interactions: Meds that enhance bleeding have additive risk for bleeding,

Education: Admin within 4-6 hours of onset, IV aminocaproic acid for excessive fibrinolysis, Administer H2 antagonists such as ranitidine (Zantec) or PPI such as omeprazole (Prilosec) to prevent GI bleeding.


Iron Preparations

Expected Action: Increase iron level for RBC development and oxygen transport capacity

Example: Ferrous sulfate — Others: Iron Dextran

Therapeutic Uses: Treat and prevent iron-deficiency anemia

Adverse Effects: Teeth staining (liquid) {Dilute / Drink ĉ straw / Rinse}, GI distress: {take ĉ food if necessary but greatly decreases absorption}, Anaphylaxis (parenteral): IV is safer / Deep IM ĉ Z-track / Infuse slowly


Vitamin C leads to increased absorption but increases side effects
Antacids or tetracyclines leads to decreased absorption

Education: Take on empty stomach to ñ absorption, Anticipate dark green or black stool


Vitamin B12 – (Cyanocobalamin)

Expected Action: Necessary to convert folate (required for DNA production) from inactive form

Therapeutic Uses: Treatment of B12 deficiency, Megaloblastic (macrocytic) anemia related to B12 deficiency

Adverse Effects: Hypokalemia 2º increased RBC production

Interactions: Folic acid supplements mask signs of B12 deficiency

Education: Intranasal spray / oral / IM / SC, Injections are painful; reserved for reduced ability to absorb.


Folic Acid

Expected Action: Folic acid is essential in DNA production & erythropoiesis (RBC, WBC, PLT)

Therapeutic Uses: Tx of macrocytic anemia, Prevention of neural tube defects in pregnancy

Interactions: Sulfonamides, sulfasalazine, methotrexate leads to decreased folate levels ĉ concurrent use


Past Medication posts –


Nervous System Meds (4 parts)


Cardiac Medications

Part 1 –
Part 2 –
Part 3-

Pain Meds and Inflammation –

Immunity and Chemo –

Anti Infective Drugs –

More information can be found on our blog –


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