Pharmaport Academy

17/02/2026

14/02/2026

Thrombolytics
Actions
Work to directly or indirectly convert plasminogen to plasmin, an enzyme that acts to digest the
fibrin matrix of clots. Dissolve existing thrombi rather than prevent them from occurring. Also
known as fibrinolytics or informally as clot busters—alteplase (tPA), tenecteplase (TNKase), reteplace
(Retavase).
Uses
• All three medications used in treatment of acute myocardial infarction
• tPA used also for pulmonary embolism, acute ischemic stroke, and restoring patency in a
clogged central venous catheter
Contraindications and Precautions
• Cerebrovascular disease and pregnancy
• Active internal bleeding, aortic dissection, history of poorly controlled hypertension
• Any prior intracranial hemorrhage or recent head injury
• Recent major surgery or trauma within the prior 2 to 4 weeks
• History of gastrointestinal (GI) bleeding
• Ischemic stroke within the prior 6 months
Side Effects
• Hemorrhage (intracranial of greatest concern) and anemia
• Bleeding from recent wounds and needle punctures
• Hypersensitivity reactions—itching, urticaria, headache
• Hypotension, cardiac dysrhythmias
Nursing Implications
1. Administer immediately after the event for better outcome, preferably within 2 to 4 hours.
2. Monitor intake and output and hematocrit levels during treatment.
3. Monitor patient for bleeding and hypersensitivity reactions.
4. While receiving the medication, maintain patient on bed rest; avoid subcutaneous (SQ) and
intramuscular (IM) injections.

14/02/2026

Iron Supplements (Oral Ferrous Iron Salts)
Action
Hematinic agent used in the production of normal hemoglobin and red blood cells for
transportation and utilization of oxygen
Uses
• Iron deficiency anemia (microcytic, hypochromic)
• Prophylactic use in pregnancy and childhood
Contraindications and Precautions
• All anemias other than iron deficiency anemia
• Peptic ulcers, regional enteritis, colitis
• Iron-containing products are leading cause of iron poisoning in young children.
Side Effects
• Gastrointestinal (GI) disturbances—nausea (usually transient), heartburn (pyrosis),
bloating, constipation
• Tarry stools or dark-green discoloration (not associated with bleeding)
• Iron toxicity due to accidental or intentional overdose (usually in children and not with
therapeutic doses)
Nursing Implications
1. Do not give with antacids or tetracyclines, or crush or chew sustained-release medications.
2. Take between meals to maximize uptake.
3. Take vitamin C (ascorbic acid) to promote the absorption of the iron.
4. Because liquid preparations stain teeth, use a straw or dilute; follow with rinsing the mouth.
5. Teach patient that oral iron supplements differ from one another and should not be
interchanged.
6. Diet teaching to include iron-rich foods—liver, eggs, meat, fish, and fowl.
7. Teach to store iron out of reach and in childproof containers; iron poisoning can be fatal to
young children.
8. Parenteral deferoxamine (Desferal) and the oral drug deferasirox (Exjade) are used for
chronic iron overload caused by blood transfusions—drugs absorb iron and prevent toxic
effects.

14/02/2026

Warfarin Sodium (Coumadin)
Actions
Warfarin is an oral anticoagulant that antagonizes vitamin K, which is necessary for the synthesis of
clotting factors VII, IX, X, and prothrombin. As a result, it disrupts the coagulation cascade.
Uses
• Long-term prophylaxis of thrombosis; is not useful in emergency because of delayed onset
of action
• Prevents venous thrombosis and thromboembolism associated with atrial fibrillation and
prosthetic heart valves
• Decreases risk of recurrent transient ischemic attacks (TIAs) and recurrent myocardial
infarction
Contraindications
• Bleeding disorders (hemophilia, thrombocytopenia)
• Lumbar puncture; regional anesthesia; or surgery of the eye, brain, or spinal cord
• Vitamin K deficiency; severe hypertension
• Pregnancy—category X; breast-feeding (crosses into breast milk)
• Liver disease, alcoholism
Side Effects
• Spontaneous bleeding
• Hypersensitivity reactions (e.g., dermatitis, fever, pruritus, urticaria)
• Red-orange discoloration of urine (not to be confused with hematuria); weakening of bones
with long-term use leading to risk of fractures
Nursing Implications
1. Monitor prothrombin time (PT) and international normalized ratio (INR) as ordered (2 to 3
is usually an acceptable INR for anticoagulation).
2. Interacts with a large number of medications; consequently, evaluate medications for
interactions before initiating therapy.
3. Monitor for bleeding tendencies; vitamin K is an antidote.
4. Teach patient to maintain intake of vitamin K (keep constant intake of foods such as green,
leafy vegetables, mayonnaise, and canola oil) and do not abruptly increase or decrease
intake.
5. Patient must advise all health care providers if patient is taking warfarin, because it is very
slow to be excreted from the body.
6. Teach patient to wear a medical alert bracelet.

14/02/2026

Enoxaparin (Lovenox)
Actions
Low–molecular-weight heparin (LMWH) with a great affinity for factor Xa in providing
anticoagulation action; provides a predictable anticoagulant response
Uses
Prevention of postoperative deep vein thrombosis, pulmonary embolism; prevention of ischemic
complications in unstable angina, or non–Q-wave myocardial infarction (MI), and ST-elevation MI
(STEMI)
Contraindications
• Presence of any active bleeding
• Increased risk of hematoma in patients with spinal or epidural anesthesia
• Use with caution with concurrent use of aspirin, clopidogrel, and other antiplatelet
medications
• Not to be used in presence of thrombocytopenia
Side Effects
• Immune-mediated thrombocytopenia
• Bleeding episodes
Nursing Implications
1. Medication is only administered subcutaneously.
2. Protamine sulfate is antidote.
3. Always double-check—cannot be given to a patient receiving heparin.
4. Injections in abdomen should be 2 inches from umbilicus or any incisional area.
5. Advise patient not to take any over-the-counter (OTC) medications, especially aspirin.
6. Check complete blood count (CBC), especially platelet count.
7. Monitor for bleeding:
• Guaiac stools for occult blood
• Hematuria
• Bleeding gums
• Excessive bruising
8. Does not require activated partial thromboplastin time (aPTT) monitoring.

14/02/2026

Heparin
Action
Heparin is an anticoagulant that exerts a direct effect on blood coagulation by enhancing the
inhibitory actions of antithrombin on several factors essential to normal blood clotting, thereby
blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.
Uses
• Rapid acting (within minutes) to prevent and treat deep vein thrombosis (DVT),
pulmonary embolism, and emboli in atrial fibrillation
• Used to treat disseminated intravascular coagulation (DIC)
• Is preferred anticoagulant during pregnancy (doesn
't cross the placenta or enter breast
milk)
• Prevents coagulation in heart-lung machines and dialyzers in patients after open-heart
surgery and dialysis
• Used as an adjunct to thrombolytic therapy of acute myocardial infarction (MI)
Precautions and Contraindications
• Bleeding tendencies—hemophilia, dissecting aneurysm, peptic ulcer
• Thrombocytopenia, uncontrollable bleeding, threatened abortion
• Postoperative patients—especially eye, brain, and spinal cord surgeries; lumbar puncture;
and regional anesthesia
Side Effects
• Injection site reactions and heparin-induced thrombocytopenia may develop.
• May result in spontaneous bleeding.
Nursing Implications
1. Monitor partial thromboplastin time (PTT) and activated PTT (aPTT)—should be 1½ to 2
times the control value. Watch for bleeding.
2. May not be given orally, or by intramuscular (IM) injection; protamine sulfate is the
antidote.
3. Caution patients not to take aspirin or any medication that decreases platelet aggregation
(clopidogrel) unless ordered specifically by health care provider.
4. Administered either intravenously (IV) or subcutaneously; apply firm pressure for 1 to 2
minutes; do not massage site after injection.
5. Dosage is prescribed in units, not milligrams (mg).

14/02/2026

Epoetin Alfa (Procrit)
Action
Erythropoietic growth factor that stimulates red blood cell production in the bone marrow
Uses
• Patients with anemia as a result of chronic renal failure, chemotherapy
• Patients infected with human immunodeficiency virus (HIV) and taking zidovudine
(Retrovir)
• Patients with anemia before elective surgery
Contraindications
• Hemoglobin in excess of 11 mg/dL; hypersensitivity to albumin
Precautions
• Poorly controlled hypertension; hypersensitivity to albumin
• Patients with cancers of myeloid origin
Side Effects
• Hypertension
• Cardiovascular events—cardiac arrest, heart failure, thrombotic events (stroke, myocardial
infarction [MI])
• Patients with cancer—tumor progression and shortened survival
• Autoimmune pure red-cell aplasia (PRCA)—severe anemia, red blood cell (RBC)
production ceases (rarely occurs)
Nursing Implications
1. Monitor blood pressure before erythropoietin therapy.
2. Do not shake solution; it may denature the glycoprotein. Do not mix with other
medications.
3. Discard remaining contents because erythropoietin does not contain a preservative.
4. Monitor hematocrit (Hct), hemoglobin (Hb), and serum iron levels as well as fluid and
electrolyte balance.
5. Monitor for seizures (rapid increase in Hct level increases risk of hypertensive
encephalopathy).
6. Provide patient with required Medication Guide from the Food and Drug Administration
(FDA