Unit 6 Part 2
F. Echezona 1/2026
Pharmacologic
Drug Class Action Drug
Examples
Indication
(Areas of Use)
Adverse
Reactions
Side
Effects
Nursing Implications
&
Patient Education
Oral Anticoagulant
Factor Xa Inhibitor
Review pages
553 & 555-556
Blocks the activity
of clotting factor Xa
to prevent the
formation of blood
clots.
Prevents clots.
Apixaban
(Oral)
Prevention of DVT
and PE
Prevention of A-Fib
related strokes
Ocular hemorrhage
Internal Bleeding
Hypotension
Bradycardia
Headaches
Dizziness
GI Upset
Bruising
Nursing Management:
Monitor CBC and vitals
No coagulation monitoring is required
Assess for internal/excess bleeding (melena),
hemoptysis, hematuria, hematemesis,
epistaxis, V/S changes. Montor for sudden
drop in weight.
Implement bleeding prevention
Contraindications/Cautions – Clients
weighing less than 50 kg; anemia, peptic
ulcers, bleeding disorders, internal bleeding.
Patient Teaching:
Anticoagulant
Review Prototype
pg. 557 &
Clinical Judgement
pg. 556
Interferes with the
clotting cascade to
prevent the
formation of blood
clots.
Prevents clots.
Warfarin (Oral)
Heparin
(IV/SQ)
A-Fib
Prevention and
treatment of
thrombosis
associated with PE,
DVT and unstable
angina.
Warfarin:
Bleeding
Purple toe
syndrome
Elevated liver
enzymes
Heparin:
Anaphylaxis
HIT
Bleeding
Warfarin:
Bleeding
Bruising
GI Upset
Alopecia
Heparin:
Bleeding
Bruising @
injection site
Nursing Management:
Monitor labs - PT/INR: Warfarin (slow)
aPTT/PTT: Heparin (IV-fast);
CBC; LFTs, and Stool for occult blood;
Assess for internal bleeding (see above).
Limit/Avoid needle sticks.
Warfarin Antidote: Vitamin K
Heparin Antidote: Protamine Sulfate
Contraindications/Cautions for both:
Renal or hepatic disorders, alcoholism,
bleeding disorders, anemia, peptic ulcer, CVA,
hemophilia, head trauma
Caution with OTC’s, herbal supplements
(5Gs), ASA, and NSAIDs – page 538.
Patient Teaching (Page 556):
Low Molecular
Weight Heparin
Review pgs.
552 & 553
Interferes with
clotting cascade to
prevent the
formation of blood
clots.
Prevents clots.
Enoxaparin
(SQ)
To prevent venous
thromboembolism,
given after surgery
to prevent DVT or
PE
Bleeding
Elevated liver
enzymes
Bleeding
Bruising @
injection site
Monitor vitals and for therapeutic response.
No lab monitoring required.
May still monitor CBC and LFTs
May use Protamine Sulfate as antidote.
Contraindications – Spinal Surgery or
Epidural Catheters (same as heparin)
Patient Teaching:
Thrombolytic
Review Prototype
pg. 560 &
Clinical Judgment
pg. 561
Promotes conversion
of plasminogen to
plasmin, an enzyme
that digests the fibrin
matrix of clots.
Destroys clots!!
Alteplase
Promotes fibrinolysis
related to thrombus-
“clot buster”
AMI/PE/CVA
**also used to re-establish
patency in occluded central
lines/catheters**
Anaphylaxis
MI
HR/BP Changes
Bleeding
Ecchymosis
Epistaxis
GI Distress
Monitor for bleeding (for up to 24 hrs) and
allergic reactions. Review vitals, ECG, and
CBC levels. Minimize venipuncture or
injections. Assess for resolution of acute
indication.
Contraindications/Cautions - bleeding
disorders, NSAIDs, anticoagulant use, severe
liver dysfunction, internal bleeding,
hemorrhagic strokes, head trauma, recent
surgery, uncontrolled or severe HTN.
Patient Teaching (Page 561):
