“Heparin” – Pulmonary embolism

Heparin, otherwise known as Hep-Lock, Hep-Lock U/P, or Monoject Prefill, is an anticoagulant and an antithrombotic drug. According to Linda Skidmore-Roth’s book entitled Mosby’s Drug Guide for Nursing Students (2013), heparin is used to prevent deep vein thrombosis (DVT) and pulmonary emboli (PE), myocardial infarction, open heart surgery, disseminated intravascular clotting syndrome, and atrial fibrillation with embolization. It is also used as an anticoagulant in transfusion and dialysis procedures, to maintain patency of indwelling venipuncture devices, and diagnosis and treatment of disseminated intravascular coagulation (DIC) (p.517).

In Pharmacology and the Nursing Process (2013), Pharmaceutics is defined as the study of how various dosage forms influence the way in which the drug affects the body. The dosage forms of heparin are intravenous (IV) and/or subcutaneous. Dosages of heparin vary depending on the age of the patient. Patient teaching is essential when using heparin. They should be taught how to manage their medication and how significant it is to administer the correct dosage prescribed, as well as which route is to be used.

Patients must understand the importance of telling their doctor if they have high blood pressure, an infection involving the heart, hemophilia, a stomach or intestinal disorder, liver disease, or if you are on experiencing your menstrual cycle. It is important to advise the patient to avoid over the counter preparations that may cause serious product interactions (Roth, 2013). The study of what the body does to the drug is known as Pharmacokinetics (Lilley, Rainforth Collins, Snyder, 2013, p. 20). The body absorbs a subcutaneous injection well.

Although the distribution and protein binding in the body are unknown, it is recognized that heparin is metabolized partially in the kidneys, and in the liver. The excretion of heparin from the body takes place in the lymph, spleen, and in the urine. The half-life of this medication is one and one-half hours. The onset of heparin through an IV is five minutes; whereas subcutaneously the onset is half an hour to one hour. Peak times for IV heparin is said to be around 10 minutes and subcutaneous is approximately two hours.

The duration times for this drug also vary where IV heparin lasts 2-6 hours and subcutaneous lasts from 8-12 hours (Roth, 2013). Pharmacodynamics is known as the study of what the drug does to the body. Because heparin is an anticoagulant, it is also called antithrombotic because it works to prevent the formation of a clot or thrombus. All anticoagulants work in the clotting cascade but so at different points. This specific drug prevents conversion of fibrinogen to fibrin and prothrombin by enhancing inhibitory effects of antithrombin III.

Heparin works by binding to antithrombin III, turning off three main activating factors. The overall effect of heparin is that it turns off the coagulation pathway and prevents clots from forming (Lilley, Rainforth Collins, Snyder, 2013, p. 422). The therapeutic outcome for a patient on heparin is prevention of thrombi. Monitoring of the intensity of the anticoagulant effect of heparin has been considered desirable, especially in the treatment of acute Venous Thromboembolism, in an attempt to secure maximal anti-thrombotic effect without excessive risk of bleeding through over-anticoagulation.

Accurate laboratory monitoring has proven to be difficult to achieve for both unfractionated heparin and low-molecular-weight heparin. There are numerous interactions of heparin and other drugs noted in Mosby’s Drug Guide for Nursing Students (2013). For instance: Dextran, dipyridole, ticlopidine, clopidogrel, and presgrel increase the action of heparin, while Digoxin and Nicotine decrease the action. Lab results show an increased ALT, AST, INR, pro-time, PTT, and potassium. It also shows a decrease in platelets, triglycerides, cholesterol, and plasma free fatty acids.

Though some patients may not experience an interaction with another drug, some may encounter some unpleasant side effects. Some of the adverse effects of this medication can be life-threatening such as Hematuria of the genitourinary system, as well as hemorrhage, thrombocytopenia, anemia, and anaphylaxis in other parts of the body. Some of the more common events include fever, rash, chills, and headaches (p. 519). Upon educating the patient on the drug, it is imperative to instruct that the product may be withheld during active bleeding (menstruation), depending on condition.

Caution the patient to use a soft-bristle toothbrush to avoid bleeding gums; avoid contact sports or the use of an electric razor. Advise patient to report any signs of bleeding: gums, under skin, urine, stools; or unusual bruising even after discontinuing product (Roth, 2013). References Skidmore-Roth, Linda. Mosby’s Drug Guide for Nursing Students. Tenth ed. St. Louis, MO:Mosby, 2013. Print. Lilley, L. L. , Collins, S. R. , & Snyder, J. S.. Pharmacology and the Nursing Process. 7th ed. St. Louis, MO: Mosby, 2013. Print.

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