Anti-coagulants, Thyroid, GI

Question 1

how many units of heparin are in a typical bag mix?

Answer 1

25,000 units/ 500ml
-50units/ml

Question 2

with is the MOA of heparin?

Answer 2

-INACTIVATES 2 factors: → Thrombin, Factor Xa
-Inhibits thrombin indirectly

Question 3

is heparin okay for those who are pregnant?

Answer 3

yes

Question 4

what are some adverse rxn for heparin?

Answer 4

-bleeding
-heparin induced thrombocytopenia (HIT)

Question 5

what needs to be monitored when giving heparin?

Answer 5

-aptt
-anti-XA
-ALWAYS check platlets

Question 6

what is the antidote for heparin?

Answer 6

protamine sulfate

Question 7

what do the low molecular weight heparins end in? some examples?

Answer 7

-parin
enoxaparin (Lovenox)
dalteparin (Fragmin)
tinzaparin (Innohep)
fondaparinux (Arixtra)

Question 8

how do low-molecular weight heparins work?

Answer 8

Inhibit thrombus and clot
formation by blocking:
-Factor Xa and 2a

Question 9

what are low molecular weight heparins used to treat?

Answer 9

prophylactic and first line of treatment for DVT’s

Question 10

do you need to monitor plasma levels of low molecular weight heparins?

Answer 10

no

Question 11

what are some adverse effects of low molecular weight heparins

Answer 11

HIT
bleeding

Question 12

what classifies as HIT?

Answer 12

-heparin induced thrombocytopenia
-an allergic response to heparin
-decrease in 50% of platelets or more in 1 day
-can never have heparin again

Question 13

what do you need to monitor when giving low molecular weight heparins?

Answer 13

platelets (150-450)

Question 14

what is the antidote for low molecular weight heparins

Answer 14

protamine sulfate

Question 15

what medication is a vitamin K antagonist?

Answer 15

warfarin

Question 16

how does warfarin work?

Answer 16

interferes with the formation of vitamin k dependent clotting factors in the liver

Question 17

what dont we like about warfarin?

Answer 17

-highly protein bound
-3-5 days to work
-hemorrhage
-many drug interactions
-not useful in emergancy

Question 18

who shouldn’t take warfarin?

Answer 18

pregnant or breastfeeding women

Question 19

when would you hold warfarin?

Answer 19

INR > 3.5

Question 20

what is the antidote to warfarin?

Answer 20

vitamin k

Question 21

what medication is a direct thrombin inhibitor?

Answer 21

dabigatran etexilate

Question 22

how does dabigatran etexilate work?

Answer 22

it directly inhibits thrombin =

Question 23

what is ab adverse effect of dabigatran etexilate?

Answer 23

bleeding

Question 24

how is dabigatran etexilate taken?

Answer 24

orally

Question 25

what is the antidote of dabigatran etexilate?

Answer 25

idarucizumab -very expensive

Question 26

what medications are the Hirudin Analogs?

Answer 26

bivalirudin (Angiomax) lepirudin (Refludan) desirudin (Iprivask) argatroban

Question 27

how do Hirudin Analogs work?

Answer 27

Direct thrombin inhibitor

Question 28

where do Hirudin Analogs occur naturally?

Answer 28

in leech saliva as anticoagulant

Question 29

what is an adverse effect of Hirudin Analogs?

Answer 29

Angiomax ↓ bleeding (compared to heparin)

Question 30

what medications are Direct Factor Xa Inhibitors, what do they end in?

Answer 30

-apixaban (eliquis) -rivaroxaban (xarelto) end in -ban

Question 31

how do Direct Factor Xa Inhibitors work?

Answer 31

Selective inhibition of factor Xa -Directly inhibits thrombin

Question 32

what is the antidote for Direct Factor Xa Inhibitors?

Answer 32

adexanet -expensive! $25,000-50,0000

Question 33

what medications are P2Y12ADP Receptor Antagonists?

Answer 33

clopidogrel (Plavix) prasugrel (Effient) ticagrelor (Brilinta) ticlopidine (Ticlid)

Question 34

how do P2Y12ADP Receptor Antagonists work/

Answer 34

they block the receptor site on platelet surfaces

Question 35

what are the adverse effects of P2Y12ADP Receptor Antagonists?

Answer 35

-bleeding -TTS (thrombotic thrombocytopenic purpura)

Question 36

what medications are GP2b/3a Receptor Antagonists?

Answer 36

abciximab (ReoPro) eptifibatide (Integrillin) tirofiban (Aggrastat)

Question 37

how doe GP2b/3a Receptor Antagonists work?

Answer 37

Prevent platelet aggregation  “Super aspirins”  Cause reversible blockage of this receptor (inhibits final step of platelet aggregation)

Question 38

which medications are Thrombolytics (Fibrinolytic)?

Answer 38

alteplase (tPA) tennecteplase (TNKase) reteplase (Retavase)

Question 39

how does alteplase (tPA) work?

Answer 39

Binds w/plasminogen to convert to plasmin  Plasmin breaks down fibrin (clot)

Question 40

what are the adverse effects of alteplase (tPA)?

Answer 40

-bleeding -intercranial pressure

Question 41

what would you give if someone taking alteplase (tPA) is having severe bleeding that cannot be controlled?

Answer 41

-aminocaproic acid

Question 42

how does tennecteplase (TNKase) work?

Answer 42

Tissue plasminogen activators  Plasmin breaks down fibrin (clot)

Question 43

what has a longer half life tPA or TNKase?

Answer 43

TNKase

Question 44

how is tennecteplase (TNKase) given

Answer 44

-single IV bolis

Question 45

how should reteplase (Retavase) not be given?

Answer 45

in a heparin line

Question 46

what is reteplase (Retavase) used only for?

Answer 46

acute MI

Question 47

what is TNKase used for?

Answer 47

MI and also CVA

Question 48

what is tPA used for?

Answer 48

stroke, acute massive pulmonary emboli

Question 49

what are some s/sx of hypothyroidism?

Answer 49

sluggish, brittle hair, weight gain, high TSH, low T3, low T4 -hashimoto's disease

Question 50

what would be given to treat hypothyroidism?

Answer 50

levothyroxine

Question 51

what are some s/sx of hyperthyroidism?

Answer 51

exothalamus (buldging eyes), thyroid storm (200bpm hr, low bp) -give a beta blocker ^

Question 52

what drug classification is ondansetron?

Answer 52

serotonin 5-HT3 receptor blocker

Question 53

what should be monitored when taking ondansetron?

Answer 53

EKG -lengthen Q-T interval

Question 54

name a H2 blocker and what do they all end in?

Answer 54

famotidine nizatidine -dine

Question 55

how do h2 blockers work?

Answer 55

they decrease the production of gastric acids

Question 56

name a proton-pump inhibitor and what do they all end in?

Answer 56

omprazole pantoprazole -prazole

Question 57

how do proton-pump inhibitors work?

Answer 57

decrease the production of gastric acids

Question 58

how does sulcralfate work?

Answer 58

this is a "bandaid" for the stomach, provides a protective layer

Question 59

how do misprostol and asprin work?

Answer 59

they coat the stomach, and decrease the prostaglandins

Question 60

what is a side effect of bismuth?

Answer 60

-pepto bismol can turn the tounge black like the color of tar

Question 61

what should we know about antiacids?

Answer 61

-liquid is best -can contain Na (harmful for CHF)

Question 62

what drug classification is metaclopramide?

Answer 62

pro-kinetic drug serotonin 5-HT3 blocker

Question 63

how does metaclopramide work?

Answer 63

increases the movement of gastric secretions (diarrhea)