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Pharm 2: EXAM 1 > Antianginal, coagulation Modifier, Antilipemic > Flashcards

Antianginal, coagulation Modifier, Antilipemic Flashcards

1
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
MOA

A

Works through a series of enzyme reactions causing dilated coronary veins, decreased venous return to the
heart, and reduced spasm in coronary arteries

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2
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
INDICATIONS

A

 Treatment and prophylaxis of angina pectoris
 Rapid-acting forms treat angina attacks
 Long-acting forms prevent attacks from occurring

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3
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
CONTRAINDICATIONS

A
  • Allergy,
  • severe anemia,
  • closed-angle glaucoma,
  • hypotension,
  • severe head injury
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4
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
AEs

A
  • HA (severe at first; usually resolves 20-30min)
  • orthostatic hypotension,
  • tachycardia,
  • tolerance develops quickly (within 1 day)
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5
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
INTERACTIONS

A
  • Antihypertensive drugs,
  • alcohol,
  • sildenafil (Viagra) all increase risk for hypotension;
  • anticholinergics may decrease absorption of sublingual nitroglycerin (DUE TO DRY MOUTH)
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6
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
What is the difference between rapid-acting & long-acting forms?

A
  • Rapid-acting treats acute angina attacks (sublingual & IV)

- Long-acting for prevention (Patch)

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7
Q

Nitroglycerin Sublingual

A

Place sublingual tab under tongue when chest pain starts
If NOT relieved in 5 minutes, call 911, then take a second tab
If no relief after 5 minutes, take a third tablet
Patient should sit or lie down after taking the FIRST tablet
-No More than 3 tabs!

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8
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
ADMINISTRATION FORMULATIONS

A
  1. Sublingual (rapid)
  2. Ointment (wear gloves; measure inches from tube)
  3. Patch (long-acting, hairless, no rash/wounds; rotate sites; remove for 10-12 hrs a day)
  4. IV (Rapid; special tubing, tele, infusion pump
  5. Spray (nasal- blow nose first)
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9
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
PROPER STORAGE

A
  1. Tablets come in glass bottle
  2. Protect from heat & light
  3. Room temp needs to be less than 86
  4. IV nitro-protect from heat &light
  5. IV- uses special tubing to protect
  6. Lasts 24 months if stored properly
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10
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
INTERVENTIONS

A
  • Monitor baseline orthostatic BP & pulse
  • Monitor HR (tachycardia)
  • Monitor for drug tolerance (occurs quickly)
  • check med list for interactions (Viagra)
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11
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
EDUCATION

A
  1. HA usually go away in 20-30 minutes
  2. Report dizziness or syncope (hypotension)
  3. Slow position changes
  4. Monitor HR & report tachycardia
  5. Remove transdermal patch each day
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12
Q

Coagulation Modifier Drugs: Prototypes

A 
Anticoagulants: Prevent clot formation
    -Heparin (Heparin sodium)
    -Enoxaparin (Lovenox)
    -Warfarin (Coumadin) 
Antiplatelets: Prevent platelet plugs
    -Clopidogrel (Plavix) 
 Thrombolytics: Break down existing clots
     -Alteplase (Activase)
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13
Q

Anticoagulants: Heparin (Heparin Sodium)

MOA

A

Inhibit clotting factors & prevents development of fibrin; heparin is both a factor Xa & thrombin inhibitor

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14
Q

Anticoagulants: Heparin (Heparin Sodium)

INDICATIONS

A

DVT & pulmonary embolism prophylaxis, a-fib with embolization

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15
Q

Anticoagulants: Heparin (Heparin Sodium)

CONTRAINDICATIONS

A
  • Uncontrolled bleeding,
  • severe thrombocytopenia,
  • lumbar puncture, pregnancy,
  • brain or spinal cord surgery
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16
Q

Anticoagulants: Heparin (Heparin Sodium)

AES

A

-Thrombocytopenia,
-heparin-induced thrombocytopenia,
-bleeding,
-hematoma,
anemia

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17
Q

Anticoagulants: Heparin (Heparin Sodium)

INTERACTIONS

A

-NSAIDs,
-aspirin,
-antiplatelet drugs increase bleeding risk;
-Herbals: ginger, ginkgo biloba, feverfew, evening
primrose oil (all increase bleeding risk);
-IV nitroglycerin reduces heparin’s anticoagulant properties

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18
Q

Heparin Toxicity antidote

A

IV protamine sulfate

  • 1mg of protamine can reverse the effects of 100 units of heparin
  • Stop drug immediately!
  • S/S: hematuria, melena, petechiae, ecchymoses, gum bleeding
  • MONITOR aPPT TIMES; Goal 1.5 to 2 times baseline
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19
Q

Anticoagulants: Heparin (Heparin Sodium) Interventions

ADMINISTRATION

A 
Assess:
Baseline VS & blood values. 
Goal: aPTT at 1½ to 2 times baseline.
Double-check all doses!
Inject:
SubQ deep in abdomen at least 2 inches from umbilicus. 
Do not aspirate or massage.
Apply mod. pressure for 1-2 min. after injection.
Rotate sites
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20
Q

Heparin-Induced Thrombocytopenia

A

Type I
-Gradual reduction in platelets
-Heparin therapy can generally be continued.
Type II
- Acute fall in number of platelets (more than 50% reduction from baseline)
-Discontinue heparin.
Clinical manifestations
-Thrombosis that can be fatal.
-Treatment: thrombin inhibitors such as lepirudin & argatroban
-Warfarin: can cause skin necrosis & “purple toes” syndrome

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21
Q

Anticoagulants: Enoxaparin (Lovenox)

MOA

A

Inhibits clotting factors and prevents development of clots; specifically inhibits factor Xa in
the clotting process

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22
Q

Anticoagulants: Enoxaparin (Lovenox)

INDICATIONS

A

Prophylaxis and treatment of DVT/PE, anticoagulant bridge therapy

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23
Q

Anticoagulants: Enoxaparin (Lovenox)

CONTRAINDICATIONS

A
  • Allergy,
  • uncontrolled bleeding,
  • use of an epidural
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24
Q

enoxaparin (lovenox)

AEs

A
  • Bleeding,
  • thrombocytopenia,
  • hematoma,
  • anemia
25
Q

enoxaparin (Lovenox)

INTERACTIONS

A

Other anticoagulants increase the risk for bleeding; NSAIDs, aspirin, & antiplatelet drugs
also increase the risk for bleeding

26
Q

Key Points: Coagulation Modifiers

ENOXAPARIN (LOVENOX)

A

Enoxaparin (Lovenox) is administered subcutaneously
•Does not require frequent labs like heparin and warfarin
•Often used as anticoagulant bridge therapy
•Administer the air bubble in the pre-filled syringe
• Important to teach patient this if they will be self-administering enoxaparin at
home!
•Teach to report s/s of excessive bleeding with ALL anticoagulants!!

27
Q

Anticoagulants: Warfarin (Coumadin)

MOA

A

Inhibit vitamin K dependent clotting factors and prevent clot formation

28
Q

Anticoagulants: Warfarin (Coumadin)

INDICATIONS

A

Prevention of venous thrombosis and PE, ischemic CVAs secondary to atrial fibrillation, thromboembolism in pts w/prosthetic heart valves, recurrent MI and TIAs

29
Q

Anticoagulants: Warfarin (Coumadin)

CONTRAINDICATIONS

A
  • Allergy,
  • pregnancy (teratogenic drug),
  • uncontrolled bleeding,
  • liver disease,
  • alcoholism,
  • vitamin K deficiency,
  • clients preparing to undergo lumbar puncture, brain, or spinal surgery
30
Q

Anticoagulants: Warfarin (Coumadin)

AEs

A

Bleeding, lethargy, muscle pain, purple toes

31
Q

Anticoagulants: Warfarin (Coumadin)

INTERACTIONS

A

Heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides & cephalosporins increase anticoagulation effects; phenobarbital, carbamazepine, phenytoin, & vitamin K decreases anticoagulation effects; excessive intake of foods high in vitamin K decreases anticoagulation effects
 Foods high in vitamin K: dark green leafy veggies such as cabbage, Brussel sprouts, & broccoli; mayonnaise, canola and soybean oils
GINKO

32
Q

Anticoagulants: Warfarin (Coumadin)

TOXICITY

A

Discontinue the warfarin FIRST!
May take 36 to 42 hours before liver can resynthesize enough clotting factors
to reverse warfarin effects
Vitamin K1 (phytonadione) can hasten the return to normal coagulation.
High doses of vitamin K (10 mg) given IV will reverse the anticoagulation
within 6 hours.

33
Q

Know normal and therapeutic ranges of PT/INR

WARFARIN

A

• PT Normal Levels: 11-13 seconds
• PT Therapeutic Levels: target is about 1.5 times the normal value or about 18
seconds
• INR Normal Levels: 1.1 or below
• INR Therapeutic Levels: 2.0-3.0 with average of 2.5
• For those with recurring clots 2.5-3.5 with an average of 3.0

34
Q

Antiplatelets: Clopidogrel (Plavix)

MOA

A

Inhibit platelet aggregation

35
Q

Antiplatelets: Clopidogrel (Plavix)

INDICATIONS

A

Reduce risk for: MI, ischemic CVA (thrombotic stroke), angina; Prevent reocclusion of coronary
stents

36
Q

Antiplatelets: Clopidogrel (Plavix)

CONTRAINDICATIONS

A

Peptic ulcer disease, bleeding disorders, thrombocytopenia, and intracranial bleeding

37
Q

Antiplatelets: Clopidogrel (Plavix)

AEs

A

Gastric upset, abdominal cramping, nausea, diarrhea, small risk for gastric ulceration and bleeding;
risk for thrombotic thrombocytopenic purpura (TTP) > causes blood clots to form in small blood
vessels > impairs blood supply to major organs

38
Q

Antiplatelets: Clopidogrel (Plavix)

INTERACTIONS

A

-Anticoagulants,
-NSAIDs,
-glucocorticoids, and alcohol increase risk for bleeding; -ginger, gingko biloba, feverfew, & evening primrose oil increase risk for bleeding;
-proton pump inhibitors (PPI’s)
decrease effects of clopidogrel

39
Q

Antiplatelets: Clopidogrel (Plavix)

KEYPOINTS

A
  • Teach patients to report s/s of excessive bleeding
  • Can take with food, 8 oz of water, or milk to reduce GI adverse effects
  • Patients should avoid alcohol while taking this drug!
40
Q

Antiplatelets: Interventions

A 
Teach:
 Report:
    -gastric irritation
     -easy bruising, bleeding gums, pinpoint purplish (petechial) rash
     -sudden, severe headache
      -weakness, numbness, paralysis
       -vision changes
       -N/V
       -seizures
  Take w/food, milk, or 8 oz water to minimize GI effects.
  Avoid alcohol
41
Q

Thrombolytics: Alteplase (Activase)

MOA

A

Activates fibrinolytic system: quickly breaks down clot > Activates plasminogen & converts it to plasmin, which
can digest fibrin

42
Q

Thrombolytics: Alteplase (Activase)

INDICATIONS

A

DVT, massive pulmonary emboli (PE), arterial thrombolysis, reestablish patency of occluded central IV
catheters

43
Q

Thrombolytics: Alteplase (Activase)

CONTRAINDICATIONS

A

-Intracranial hemorrhage,
-hemorrhagic CVA, known cerebrovascular lesion such as arteriovenous malformation
or aneurysm,
-active internal bleeding,
-suspected aortic dissection,
-facial/head trauma within 3 months,
-brain tumor,
-pericarditis

44
Q

Thrombolytics: Alteplase (Activase)

AEs

A

Internal bleeding (intracranial, GI); Superficial (needle puncture sites, wounds)

45
Q

Thrombolytics: Alteplase (Activase)

INTERACTIONS

A
  • Anticoagulants,
  • NSAIDs,
  • heparin,
  • warfarin,
  • antiplatelets, and other thrombolytics all increase the risk for bleeding
46
Q

Key Points: Coagulation Modifiers
•Alteplase (Activase) is a thrombolytic drug meaning it breaks down
clots to prevent them from becoming emboli

A

•Useful for treatment of DVT and PE
•Can be used to reestablish patency in an occluded central line
•Also used to reverse the s/s of an ischemic CVA (stroke)
• Must be given within 3 hours of the onset of stroke s/s for maximum
effectiveness
•Typically given IV infusion
•Teach patient to watch for abnormal bleeding

47
Q

Antilipemics: Prototype Drugs

A

HMG-CoA Reductase Inhibitors:
Atorvastatin (Lipitor)
Fibric Acid Derivative/Fibrates:
Gemfibrozil (Lopid)

48
Q

HMG-CoA Reductase Inhibitors (statins): Atorvastatin
(Lipitor)
MOA

A

Lower blood cholesterol level by decreasing rate of cholesterol production

49
Q

HMG-CoA Reductase Inhibitors (statins): Atorvastatin
(Lipitor)
INDICATIONS

A

Recommended first line therapy for hypercholesterolemia; helps reduce LDL and triglyceride levels
& increase HDL levels

50
Q

HMG-CoA Reductase Inhibitors (statins): Atorvastatin
(Lipitor)
CONTRAINDICATIONS

A

Drug allergy, pregnancy, liver disease, elevated liver enzymes, children less than 8

51
Q

HMG-CoA Reductase Inhibitors (statins): Atorvastatin
(Lipitor)
AEs

A
  • Myopathy (rhabdomyolysis),
  • GI disturbances,
  • headache,
  • rash,
  • dizziness,
  • blurred vision,
  • fatigue,
  • insomnia,
  • hepatotoxicity (less than 2% of patients)
52
Q

HMG-CoA Reductase Inhibitors (statins): Atorvastatin
(Lipitor)
INTERACTIONS

A

-Concurrent use of fibrates or other drugs to lower cholesterol increase risk of myopathy or liver
toxicity;
-erythromycin, azole antifungal drugs & protease inhibitors increase blood levels of statins;
grapefruit juice in large amounts increases risk for AE’s; warfarin increases risk for bleeding

53
Q

Fibrates: Gemfibrozil (Lopid)

MOA

A

Activate lipoprotein lipase, an enzyme responsible for breakdown of cholesterol

54
Q

Fibrates: Gemfibrozil (Lopid)

INDICATIONS

A

Treatment of type III, IV, and V hyperlipidemia; reduce high levels of plasma triglycerides
& increase HDL cholesterol

55
Q

Fibrates: Gemfibrozil (Lopid)

CONTRAINDICATIONS

A

Drug allergy, severe liver or kidney disease, cirrhosis, and gallbladder disease

56
Q

Fibrates: Gemfibrozil (Lopid)

AEs

A

GI: abdominal pain, nausea, diarrhea, increase risk for gallstone development; liver
toxicity; myopathy

57
Q

Fibrates: Gemfibrozil (Lopid)

INTERACTIONS

A

Warfarin increases the risk for bleeding; taking both a statin and a fibrate increases the
risk for myopathy

58
Q

Nursing Implications for Antilipemics

A 
Monitor for and teach to report AE/SE’s: 
 S/S of liver dysfunction
Increased liver enzyme studies
Yellow discoloration of skin or sclera
Dark urine or pale stool
Fatigue
N/V, anorexia
Excessive bruising
Pruritus 
 Muscle or joint pain
 Abdominal pain
 Fatigue
59
Q

Nursing Implications for Antilipemics: Teach

A

Teach:
Lifestyle, diet changes
How to administer each prototype
Atorvastatin (Lipitor): PO, take in evening with or without food
Gemfibrozil (Lopid): PO, take twice daily; 30 mins before breakfast & evening
meal
Importance of periodic liver function lab draws
Monitor for therapeutic effects:
Reduced cholesterol and triglyceride levels

Pharm 2: EXAM 1 (3 decks)

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