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					                        BLUE HILL MEMORIAL HOSPITAL
                     ADULT CRITICAL CARE DRUG REFERENCE

                                        HEPARIN

I.     INDICATIONS:

       Anticoagulant used for prophylaxis and treatment of thromboembolic disorders.


II.    ACTIONS:

       Potentiates the action of antithrombin III and thereby inactivates thrombin (as
       well as activated coagulation factors IX, X, XI, XII, and plasmin) and prevents the
       conversion of fibrinogen to fibrin; heparin also stimulates release of lipoprotein
       lipase (lipoprotein lipase hydrolyzes triglyceride to glycerol and free fatty acids).


III.   DOSAGE AND ADMINISTRATION:

       Blue Hill Memorial Hospital has a heparin infusion orderset for cardiac, neuro,
       and venous thromboembolic disorders. Refer to these pre-printed order sheets
       for dosing information.




 BRAND          GENERIC        STANDARD         DOUBLE        MAX
 HEPARIN        HEPARIN        25,000 UNITS/    NONE          NONE
                               500 ML D5W
                               PREMIX BAG
                                Concentration
                                =50 units/mL




IV.    NURSING CONSIDERATIONS:

       A.     Antidote: Protamine sulfate 1 mg neutralizes 115 U.S.P. units of heparin.
       B.     Use Blue Hill Memorial Hospital’s Pre-printed Ordersheet when ordering
              Heparin infusion.
       C.     Discontinue use with a positive AHAT.
       D.     Monitor platelets, Hgb, Hct, aPTT.
       E.     Monitor closely for signs of bleeding.



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                    BLUE HILL MEMORIAL HOSPITAL
                 ADULT CRITICAL CARE DRUG REFERENCE

                                     HEPARIN


V.    CONTRAINDICATIONS:

      A.   Severe thrombocytopenia
      B.   Uncontrolled active bleeding, except when due to D.I.C.
           (Disseminated Intravascular Coagulation).
      C.   Suspected intracranial hemorrhage
      D.   Not for I.M. use
      E.   Not for use when appropriate monitoring parameters cannot be
           obtained.




VI.   DRUG INTERACTIONS:

      A.   Cephalosporins which contain the MTT side chain (Cefotetan,
           Cefoxitin) may increase the risk of hemorrhage.
      B.   Aspirin, NSAIDS, Dipyridamole, Ticlopidine, Clopidogrel, IIb/IIIa
           Antagonists all affect platelet function and may potentiate the risk
           of hemorrhage.
      C.   Nitroglycerin (I.V.) may decrease heparin’s anticoagulant effect.
           This interaction has not been validated in some studies, and may
           only occur at high nitroglycerin doses.
      D.   Penicillins (parenteral) may prolong bleeding time via inhibition of
           platelet aggregation, potentially increasing the risk of hemorrhage.
      E.   Thrombolytic agents increase the risk of hemorrhage.
      F.   Warfarin – concurrent therapy increases risk of bleeding, but it is
           common to continue Heparin during initiation of warfarin to assure
           anticoagulation and to protect against possible transient
           hypercoagulability.
      G.   Antihistamines, tetracycline, quinine, nicotine, and cardiac
           glycosides (digoxin) have all been reported to increase heparin’s
           anticoagulant effect.




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                         BLUE HILL MEMORIAL HOSPITAL
                      ADULT CRITICAL CARE DRUG REFERENCE

                                      HEPARIN




VII.   SIDE EFFECTS AND ADVERSE DRUG REACTIONS:

       A.     Cardiovascular – chest pain, hemorrhagic shock, thrombosis,
              vasospasm (possibly related to thrombosis)
       B.     Central Nervous System – fever, headache, chills
       C.     Dermatologic – unexplained bruising, urticaria, alopecia,
              dysesthesia pedis, purpura, eczema, cutaneous necrosis (following
                     deep subcutaneous injection), erythematous plaques.
       D.     Endocrine and Metabolic – hyperkalemia (suppression of
              aldosterone), rebound hyperlipidemia on discontinuation.
       E.     Gastrointestinal – nausea, vomiting, constipation, hematemesis
       F.     Genitourinary – frequent or persistent erection
       G.     Hematologic – hemorrhage, blood in urine, bleeding from gums,
              Epistaxis, adrenal hemorrhage, ovarian hemorrhage,
              Retroperitoneal hemorrhage, thrombocytopenia
       H.     Hepatic – elevated liver enzymes (AST/ALT)
       I.     Local – irritation, ulceration, and cutaneous necrosis have been
              rely reported with deep subcutaneous and I.M. injections (which is
              contraindicated).
       J.     Neuromuscular and Skeletal – peripheral neuropathy, osteoporosis
              (with chronic therapy)
       K.     Ocular – conjunctivitis (allergic reaction)
       L.     Respiratory – hemoptysis, pulmonary hemorrhage, asthma, rhinitis,
              bronchospasms
       M.     Miscellaneous – allergic and anaphylactoid reactions




Original: 10/07 cgd




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