NR 526 Week 2 Comparing Classes of Medication
NR526
NR 526
Comparing Classes of Medication
NR 526 Week 2: Comparing Classes of Medication
In this
... [Show More] first discussion, we will be taking a very close look at two different classes of medications and how we can explore the three Ps through this very in- depth exploration.
Compare and contrast an antiplatelet drug to an anticoagulant drug. Be sure to contrast them based on the pharmacokinetics of their action. Integrate their pharmacokinetics with the related pathophysiology. Also, include the related physical assessments that will apply. Be sure to include which patients would be a candidate to receive each of these therapies independently include classic examples of each.
ANSWER
When looking at medications, it is important to study and understand how they impact pathophysiology, pharmacology, and physical assessment, or the 3Ps. Not only is it important for us, as nurses, to understand this, but it’s important for us to understand how to explain this to nurses in training, and break it down for patients, as well. For the purposes of this threaded discussion, I will be exploring an oldie but goodie antiplatelet medication, aspirin (ASA), and the anticoagulant medication, Xarelto. Patients like my father, with risk factors such as heart disease, deep vein thrombosis (DVT), and a factor V Leiden r506q mutation, are candidates for taking both Xarelto and ASA, and the reason these two medications have been chosen (Bardal, Waechter, & Martin, 2011; Janssen, 2018).
Some medications like ASA fall under multiple classifications, in this case, antiplatelet, anti-inflammatory, and antipyretic (Bardal et al., 2011). The antiplatelet properties of ASA stem from the anti-inflammatory action, through blockage of the cyclooxygenase (COX) enzyme, which in turn impedes the formation of cyclic endoperoxide and subsequent conversion to thromboxane A2(TXA2) within platelets, thus interfering with platelet aggregation, and prostaglandin E2 (PGE2), which decreases inflammation, fever, pain, and secretions (Bardal et al., 2011). The end result of blocking platelet aggregation is the reason ASA is essential for heart disease, peripheral vascular disease, post-operative blood clot prevention, and congenital heart disease, while the anti- inflammatory effects of ASA are vital for arthritis control, pain relief, and fever reduction (Bardal et al., 2011).
The anticoagulant medication, Xarelto, directly targets the Xafactor in the clotting cascade and blocks it (Bardal et al., 2011; Janssen, 2018). In doing so, Xarelto blocks the conversion of prothrombin to thrombin, an enzyme that prompts fibrinogen to convert to fibrin, a protein that gives clots strength; and the disruption of thrombin formation also blocks the activation of factors V, VIII, and XI, and blocks platelet clumping (Bardal et al., 2011; Janssen, 2018). All of these effects interfere with the clotting process, and similar to ASA, can be vital for individuals with blood clots such as DVT, those predisposed to blood clots, heart and peripheral vascular disease, atrial fibrillation, and post-operative blood clot prevention (Bardal et al., 2011; Janssen, 2018).
An important difference between ASA and Xarelto is the half-life of effects. For example, Xarelto has an elimination half-life of nine hours, whereas ASA’s is two hours, however, the antiplatelet effect from ASA cannot be reversed and lasts for the life of the platelet cell, meaning, five to seven days, hence the need to stop ASA at least seven days prior to surgery (Bardal et al., 2011; Janssen, 2018). This is a vital aspect to include in patient education.
Physical assessment of patients taking anticoagulants and/or antiplatelet medications must include a bleeding assessment, including an assessment for bruising, bleeding gums, nose bleeds, rectal bleeding, hematemesis or vomiting coffee grounds, blood in the urine, stomach upset, or petechiae (Bardal et al., 2011; Dains, Baumann, & Scheibel, 2012; Janssen, 2018). In
addition to a thorough physical assessment, a medication, supplement, and over-the-counter medication reconciliation must take place as well, to ensure no drug interactions are occurring (Bardal et al., 2011; Dains et al., 2012; Janssen, 2018).
References
Bardal, S. K., Waechter, J. E., & Martin, D. S. (2011). Applied pharmacology. St. Louis, MO: Elsevier Saunders.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Elsevier Mosby.
Janssen. (2018). Xarelto. Retrieved from http://www.janssenlabels.com/package-insert/product-monograph/prescribing- information/XARELTO-pi.pdf [Show Less]