325 Patho 1 drugs mod 6 (E4)

Question 1

class: heparins

Answer 1

-heparin
-enoxaparin (low molecular wt heparin)

Question 2

heparins MOA

Answer 2

prevents clotting by activating antithrombin -> indirectly inactivates thrombin & factor Xa (we inactive factor VII, X and thrombin in the extrinsic pathway & IX, X, XI, XII and thrombin in intrinsic pathway ) inhibits fibrin formation (LMWH only inactivates factor Xa, not thrombin)

Question 3

how is heparin given

Answer 3

IV or sub q injections

Question 4

heparin indications

Answer 4

conditions necessitating prompt anti coagulant activity like stroke, PE, massive DVT, MI

Question 5

LMWH indication

Answer 5

prophylaxis against post op DVT

Question 6

how is heparin dosed

Answer 6

wt based always in KG & labs: aPPT or anti Xa

Question 7

heparin nursing considerations

Answer 7

-rapid onset
-use cautiously in pt w/ spinal or epidural anesthesia bc increased risk for hematoma
-high risk med
-monitor signs for bleeding
must double check w/ another RN for rate changes or boluses

Question 8

heparin SE

Answer 8

-bleeding
-hematoma
-anemia
-thrombocytopenia

Question 9

heparin antidote

Answer 9

protamine sulfate (SE: hypotension)

Question 10

do you need to do all the lab monitoring for LMWH

Answer 10

no

Question 11

LMWH SE

Answer 11

-bleeding
-thrombocytopenia
-HIT

Question 12

LMWH antidote

Answer 12

protamine

Question 13

LMWH nursing considerations

Answer 13

-only injectable, no IV
-can be given at home, pre dosed
-use cautiously in pts w/ spinal or epidural anesthesia
do not give w/ heparin
BBW: potential spinal hematoma if pt has epidural catheter

Question 14

warfarin MOA

Answer 14

vitamin K inhibitor -> prevents the synthesis of factors VII, IX, X & prothrombin

Question 15

warfarin indications

Answer 15

prevention VTE/DVT/PE, thrombotic events for pt w/ Afib or heart valves, reduce recurrence of TIA or MI

Question 16

warfarin SE

Answer 16

-bleeding
-lethargy
-muscle pain
-purple toes

Question 17

warfarin antidote

Answer 17

vitamin K

Question 18

warfarin nursing considerations

Answer 18

-can’t give to pregnant or breast feeding women
-hold before surgeries
-lab monitoring
-many drug & foods interactions (dark leafy greens)
-avoid alcohol
-once a day @5pm

Question 19

apixaban & rivaroxaban MOA

Answer 19

direct inhibitor of factor Xa

Question 20

apixaban & rivaroxaban indications

Answer 20

prevent strokes in pt w/ afib, post op thrombo-prophylaxis, treat DVT & PE

Question 21

apixaban & rivaroxaban SE

Answer 21

-bleeding
-hematoma
-dizziness
-rash
GI distress
-peripheral edema

Question 22

apixaban & rivaroxaban nursing considerations

Answer 22

BBW: spinal hematomas if pt has epidural catheter
-risk of thrombosis if drugs abruptly stopped
-CYP inhibitor, dont have grapefruit & lots of interactions
-do not give w/ other anticoags
-watch liver function (ALT, AST, GGT)

Question 23

apixaban & rivaroxaban antidote

Answer 23

andexxa

Question 24

aspirin MOA

Answer 24

blocks prostaglandin synthesis through the COX enzyme pathways (+blocks platelet aggregation)

Question 25

aspirin indications

Answer 25

prevent/treat MI, prevent ischemic stroke

Question 26

aspirin SE

Answer 26

-GI distress -bleeding -drowsiness/confusion

Question 27

aspirin nursing considerations

Answer 27

-can be bought OTC -reye's syndrome so can't give to children

Question 28

aspirin contraindications

Answer 28

thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vit K deficiency, recent hemorrhagic stroke

Question 29

aspirin antidote

Answer 29

desmopressin (DDAVP)

Question 30

clopidogrel & ticagrelor MOA

Answer 30

anti-platelet ADP inhibitor (alters the platelet membrane so it doesn't receive the signal to aggregate)

Question 31

clopidogrel & ticagrelor indication

Answer 31

reduce risk of stroke, prophylaxis of TIAs, post MI

Question 32

clopidogrel & ticagrelor contraindications

Answer 32

thrombocytopenia, active bleeding, blood cancers, traumatic injuries, GI ulcers, vit K deficiency, recent hemorrhagic stroke

Question 33

clopidogrel & ticagrelor SE

Answer 33

-chest pain -edema -flu like symptoms -abdominal pain -diarrhea -nausea -epistaxis -rash -pruritus (nose bleed)

Question 34

clopidogrel & ticagrelor nursing considerations

Answer 34

**BBW (clopid): pt w/ certain genetic abnormalities, who may have higher rate of CV events due to reduced conversion to its active metabolite** **BBW (tica): increased bleeding risk w/ aspirin doses over 100mg (so can give w/ baby aspirin)** -clopid effectiveness is reduced by amiodarone, CCB, NSAIDS and PPIs

Question 35

clopidogrel & ticagrelor antidote

Answer 35

DDAVP or platelet transfusion

Question 36

direct thrombin inhibitors (argatroban & bivalrudin) MOA

Answer 36

inhibit thrombin (factor IIa)

Question 37

direct thrombin inhibitors indications

Answer 37

treat HIT, and for pts undergoing procedures (PCI) who are at high risk for HIT

Question 38

direct thrombin inhibitors SE

Answer 38

bleeding

Question 39

direct thrombin inhibitors nursing considerations

Answer 39

-only IV -labs (anti Xa and H&H, platelets)

Question 40

class: glucocorticoids

Answer 40

-hydrocortisone -prednisone -dexamethasone

Question 41

hydrocortisone

Answer 41

synthetic, identical to cortisol w/ some aldosterone activity

Question 42

hydrocortisone SE

Answer 42

large amounts = toxic

Question 43

what disease is prednisone usually given for

Answer 43

COPD

Question 44

glucocorticoids MOA

Answer 44

mimics glucocorticoid burst by adrenals at dawn

Question 45

glucocorticoids SE

Answer 45

-increased intraocular pressure -fluid retention -high BP -mood swings -wt gain (centralized)

Question 46

long term side effects corticosteroid use

Answer 46

-clouded eyes -high BS -increased risk of infections -thinning bones -suppressed adrenal gland hormone production -thin skin, bruising, slow wound healing

Question 47

nursing considerations for glucocorticoids

Answer 47

**do not stop abruptly** -take at same time -monitor wt and BS

Question 48

class: mineral-corticoids

Answer 48

fludrocortisone

Question 49

fludrocortisone indication

Answer 49

combat salt wasting (inability to maintain Na+ levels high despite adequate renal function)

Question 50

class: anti platelet

Answer 50

-clopidogrel -ticagrelor -aspirin

Question 51

class: coumarin

Answer 51

warfarin

Question 52

class: anti coag

Answer 52

-apixaban -rivaroxaban