Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (202 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
HIGH ALERTheparin (Rx)
(hep′a-rin)
Hepalean
, Heparin Leo, Hep-Lock, Hep-Lock U/P, Monoject Prefill
Func. class.:
Anticoagulant, antithrombotic
Do not confuse:
heparin
/Hespan
Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III
Prevention of deep venous thrombosis, PE, MI, open heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with embolization, as an anticoagulant in transfusion and dialysis procedures, prevention of DVT/PE, to maintain patency of indwelling venipuncture devices; diagnosis, treatment of DIC
Hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease, severe thrombocytopenic purpura, severe renal/hepatic disease, blood dyscrasias, severe hypertension, subacute bacterial endocarditis, acute nephritis; benzyl alcohol products in neonates/infants/pregnancy/lactation
Precautions:
Pregnancy (C), children, geriatric patients, alcoholism, hyperlipidemia, diabetes, renal disease
Calculator
• Adult:
IV BOL
80 international units/kg then maintenance
IV INF
18 international units/kg/hr; if aPTT <35 (1.2× normal), increase
IV INF
rate by 4 international units/kg/hr and rebolus with 80 international units/kg; if aPTT 35-45 (1.2-1.5× normal), increase
IV INF
by 2 international units/kg/hr and rebolus with 40 international units/kg; if aPTT 46-70 (1.5-2.3× normal), maintain
IV INF;
if aPTT 71-90 (2.3-3× normal), decrease
IV INF
by 2 international units/kg/hr; if aPTT >90 (>3× normal), hold
IV INF
for 1 hr then decrease rate 3 international units/kg/hr
• Child/infant/neonate:
IV
loading dose 75 international units/kg
• Child >1 yr:
20 international units/kg/hr
• Infant/neonate
<
1 yr:
28 international units/kg/hr as initial maintenance dose
• Adult:
IV
≥150 international units/kg; procedures <60 min, up to 300 international units/kg; procedures >60 min, up to 400 international units/kg based on ACT
• Adult:
IV BOL
weight adjusted with 60-100 international units/kg, maintain ACT within 250-300 sec (HemoTec) or 300-350 sec (Hemochron)
• Child/infant/neonate:
IV BOL
100-150 international units/kg
• Adult:
SUBCUT
5000 units q8-12hr
• Adult/child:
IV
10-100 units/ml
• Infant
<
10 kg:
IV
10 units/ml
Available forms:
Sol for inj 10, 100, 1000, 5000, 7500, 10,000, 20,000, 40,000 units/ml; premixed 1000 units/500 ml, 2000 units/1000 ml, 12,500 units/250 ml, 25,000 units/250 ml, 25,000 units/500 ml; lock flush preparations 10 units/ml
•
Cannot be used interchangeably (unit for unit) with LMWHs or heparinoids
•
At same time each day to maintain steady blood levels
Do not mistake heparin sodium inj 10,000 units/ml and Hep-Lock U/P 10 units/ml; they have similar blue labeling; deaths in pediatric patients have occurred when heparin sodium inj vials were confused with heparin flush vials
•
Give
deeply with 25G 3/8-1/2-in needle; do not massage area or aspirate when giving SUBCUT inj; give in abdomen between pelvic bones, rotate sites; do not pull back on plunger; leave in for 10 sec; apply gentle pressure for 1 min
•
Changing needles is not recommended
•
Avoid all IM inj that may cause bleeding, hematoma
•
Give loading dose undiluted, over ≥1 min, use before continuous inf
•
Dilute 25,000 units/250-500 ml 0.9 NaCl or D
5
W, (50-100 units) solutions are premixed and ready for use
•
When product is added to inf sol for cont IV, invert container at least 6 times to ensure adequate mixing
Additive compatibilities:
Avoid adding to sol, even if compatible; rate of heparin inf times may need to be changed
Y-site compatibilities:
Acyclovir, allopurinol, amifostine, aminophylline, atropine, aztreonam, betamethasone, bleomycin, calcium gluconate, ceFAZolin, cefoTEtan, cefTAZidime, cefTRIAXone, chlordiazepoxide, cimetidine, CISplatin, cladribine, clindamycin, conjugated estrogens, cyanocobalamin, cyclophosphamide, cytarabine, dexamethasone, digoxin, DOPamine, DOXOrubicin liposome, edrophonium, enalaprilat, EPINEPHrine, esmolol, ethacrynate, etoposide, famotidine, fentaNYL, fluconazole, fludarabine, fluorouracil, foscarnet, furosemide, gallium, gemcitabine, granisetron, hydrocortisone, HYDROmorphone, insulin (regular), isoproterenol, kanamycin, leucovorin, linezolid, lidocaine, LORazepam, magnesium sulfate, melphalan, menadiol, meropenem, methotrexate, methoxamine, methyldopate, methylergonovine, metoclopramide, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoMYcin, morphine, nafcillin, neostigmine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, oxytocin, PACLitaxel, pancuronium, penicillin G potassium, phytonadione, piperacillin, piperacillin/tazobactam, potassium chloride, prednisoLONE, procainamide, propofol, propranolol, pyridostigmine, ranitidine, remifentanil, sargramostim, scopolamine, sodium bicarbonate, succinylcholine, tacrolimus, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin/clavulanate, tirofiban, trimethobenzamide, trimethaphan, vecuronium, vinBLAStine, warfarin, zidovudine, zoledronic acid
CNS:
Fever
, chills, headache
GU:
Hematuria
HEMA:
Hemorrhage, thrombocytopenia, anemia
INTEG:
Rash
, dermatitis, urticaria, pruritus, delayed transient alopecia, hematoma, cutaneous necrosis (SUBCUT), inj site reactions
META:
Hyperkalemia, hypoaldosteronism
SYST:
Anaphylaxis
Half-life 1½ hr; excreted in urine; 95% bound to plasma proteins; does not cross placenta or alter breast milk; removed from the system via the lymph and spleen; partially metabolized in kidney, liver; excreted in urine (<50% unchanged)
SUBCUT:
Onset 20-60 min, duration 8-12 hr, well absorbed >35,000 international units/24 hr
IV:
Peak 5 min, duration 2-6 hr
Increase:
heparin action—oral anticoagulants, salicylates, dextran, NSAIDs, platelet inhibitors, cephalosporins, penicillins, ticlopidine, dipyridamole, antineoplastics, clopidogrel, presgrel, SSRIs, SNRIs
Decrease:
heparin action—digoxin, tetracyclines, antihistamines, cardiac glycosides, nicotine, nitroglycerin
Increase:
bleeding risk—garlic, ginger, ginkgo, feverfew, green tea, horse chestnut
Increase:
ALT, AST, INR, PT, PTT, potassium
Decrease:
platelets
Bleeding, hemorrhage: gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, B/P; HIT may occur after product discontinuation
•
Blood studies (Hct, occult blood in stools) q3mo
•
Partial prothrombin time, which should be 1.5-2.5× control; for continuous IV inf, check aPTT baseline 6 hr after initiation and 6 hr after any dose change;
use aPTT for dosing adjustments; after therapeutic aPTT has been measured 2×, check aPTT daily
•
Platelet count q2-3days; thrombocytopenia may occur on 4th day of treatment
•
Hypersensitivity:
rash, chills, fever, itching; report to prescriber
•
Storage at room temp
•
Therapeutic response: decrease of DVT, adequate anticoagulation based on aPTT
•
To avoid OTC preparations that may cause serious product interactions unless directed by prescriber
•
That product may be held during active bleeding (menstruation), depending on condition
•
To use soft-bristle toothbrush to avoid bleeding gums; to avoid contact sports; to use an electric razor, to avoid IM inj
•
To carry emergency ID identifying product taken
•
To report to prescriber any signs of bleeding: gums, under skin, urine, stools
•
To report to prescriber any signs of hypersensitivity: rash, chills, fever, itching
Withdraw product, protamine 1 mg protamine/100 units heparin