Anticoagulant, Thrombolytics + CHO drugs Flashcards
1
Q
VLDLs are referring to what?
A
triglycerides
2
Q
prototype for HMG-CoA reductase inhibitors
A
atorvastatin (Lipitor)
3
Q
what is the 1st line tx for lipid disorders?
A
statins
4
Q
MOA of statins
A
- inhibit CHO synthesis in liver
- stimulate liver to make more LDL receptors
more receptors = more LDL removed from blood
5
Q
when are statins most effective? why?
A
at NIGHT - b/c CHO is made at night
6
Q
SE of statins
A
HA, rash, memory loss, GI issues
7
Q
what are the rare + serious SE of statins? (3)
A
- hepatotoxicity
- rhabdomyolysis
- increase incidence of cataracts
8
Q
knowing SE of statins (2), what labs need to be monitored?
A
- LFTs - for hepatotoxicity (OK to use in fatty liver disease)
- CK levels - for rhabdo
9
Q
re: the serious SE of statins (2), what s+s should we teach patients to monitor for with statin use?
A
muscle aches, tenderness, weakness (risk of rhabdomyolysis)
RUQ pain, jaundice, anorexia (risk of hepatitis)
10
Q
what drug-food interactions are most important with statin use?
A
grapefruit
11
Q
what are the 5 classes of lipid lowering drugs?
A
- HMG-CoA Reductase inhibitor
- bile acid sequestrants
- cholesterol absorption inhibitor
- fibric acid derivatives (fibrates)
- monoclonal antibodies (PCSK9 inhibitors)
12
Q
what is the prototype for bile acid sequestrants?
A
colesevelam (Welchol)
“cole the horse is 7 and his best friend is a lamb”
13
Q
MOA of colesevelam
A
binds to bile acids –> forms complexes that prevent them from being reabsorbed –> excreted
14
Q
what are the 2 drugs that work ONLY in GI tract?
A
- colesevelam
2. ezetimibe
15
Q
SE of colesevelam
A
GI disturbances (constipation, bloating, indigestion)
“cole the horse ate too much cole slaw”
16
Q
administration points for colesevelam
A
with food + H2O
17
Q
prototype for cholesterol absorption inhibitor
A
ezetimibe
“get ZET outta here!”
18
Q
MOA for ezetimibe
A
prevents CHO from being absorbed in small intestine
19
Q
what do we need to watch for when ezetimibe is paired with statin?
A
hepatotoxicity (DON’T use with liver disease)
20
Q
what is vytorin?
A
ezetimibe + simvastatin
VY = BI = 2 (drugs)
21
Q
prototype for fibric acid derivative (fibrates)
A
gemFIBrozil
22
Q
MOA for gemfibrozil
A
accelerates clearances of VLDLs (triglycerides)
23
Q
what drug is MOST effective to lower triglyceride levels?
A
gemfibrozil
24
Q
SE of gemfibrozil
A
- GI
- gallstone
- hepatotoxicity
25
gemfibrozil + _________ = increased risk of what?
gemfibrozil + STATIN = increased risk of RHABDOMYOLYSIS
26
prototype for PCSK9 monoclonal antibodies
evolocuMAB
"you evolve to have shitty cholesterol like your family"
27
MOA for evolocumab
blocks PCSK9 from binding to LDL receptors --> more LDL receptors made --> LDL removed
28
what is evolocumab used to treat?
familial hypercholesterolemia
29
route for evolocumab
SQ
30
SE of evolocumab
injection site rxns, rash/hives
31
3 examples of other agents to reduce CHO
1. red yeast rice
2. plant sterols
3. fish oil
32
what are the 6 lipid-lowering drugs?
1. atorvastatin (HMG-CoA inhibitor)
2. colesevelam (bile acid seq)
3. ezetimibe (CHO absorption inhibitor)
4. vytorin (combo CAI + statin)
5. gemfibrozil (fibrates)
5. evolocumab (MAb)
33
what are the 3 different drug types for clots (broad)? what is their broad MOA?
1. anticoagulants: prevent clot formation (reduce fibrin)
2. antiplatelets: inhibit clot growing (aggregation)
3. thrombolytics: dissolves clots
34
what drug type is best for VENOUS thrombi (ex: DVT)?
anticoagulants
35
what drug type is best for ARTERIAL thrombi (ex: MI, stroke)?
antiplatelets
36
MOA of anticoagulants
1. inhibit synthesis of clotting factors
OR
2. inhibit activity of clotting factors
prevent FUTURE clots
CO = NO!!!
37
prototype for anticoagulants
heparin (unfractionated)
38
MOA for heparin
1. inactivates clotting factors
| 2. suppresses formation of fibrin
39
heparin is measured in _____
UNITS
40
route of admin for heparin; indicate their use based on the route
SQ or IV only!
SQ: prophylaxis
IV: emergency anticoagulation
41
onset for IV heparin
immediate
42
onset for SQ heparin
up to 1 hr
43
what is the DOC for rapid anticoagulation (PE, stroke, massive DVT)?
IV infusion heparin
44
half life of heparin
90 mins
45
antidote for heparin + its onset
| NCLEX
protamine sulfate - 5 min onset
46
what lab do we monitor with heparin use?
aPTT (INtrinsic pathway)
47
what is therapeutic level of aPTT for heparin use?
1. 5-2x baseline = 60-80 seconds
| normal: 40
48
how often should aPTT be measured with IV heparin?
q6h
49
SE of heparin
1. bleeding
| 2. HIT (heparin-induced thrombocytopenia)
50
re: HIT, when should heparin be stopped?
if platelets reduce by 50% or get <100,000
51
what procedure should be avoided with heparin use?
epidural/spinal tap (hematoma / paralysis risk)
52
LMWH prototype
enoxaparin (Lovenox)
"it's NOXA much as regular heparin"
"LOvenox = LOW"
53
MOA for enoxaparin
inhibits clotting factors: inactivates Xa + thrombin
54
enoxaparin dosing is based on what?
weight
low molecular WEIGHT heparin dosing is based on WEIGHT
55
route of LMWH
SQ only (abdomen only)
*don't expel bubble*
56
SE of LMWH (enoxaparin)
1. bleeding
| 2. HIT
57
why is enoxaparin preferred over heparin?
safer, no blood tests + more bioavailability
58
antidote for enoxaparin
protamine sulfate
59
vitamin K antagonist prototype
warfarin (Coumadin)
60
route of admin for warfarin (Coumadin)
PO
SQ
IV
61
re: IV vitamin K, what is important to know?
can cause anaphylaxis -- small dose + DILUTE!
62
MOA of warfarin
1. inhibits clotting factors that depend on Vit K
| 2. inhibits prothrombin
63
antidote for warfarin
Vitamin K
64
which drug is 99% protein bound and causes a LOT of drug-drug interactions?
warfarin (Coumadin)
65
what are the drug-food interactions with warfarin?
vitamin K - green leafy veg
*recommended to get a "steady state" of vitamin K and not suddenly decrease or increase the levels consumed*
66
SE of warfarin
hemorrhage
67
half life of warfarin
1.5-2 days
68
what labs are we monitoring with warfarin (Coumadin) use?
PT/INR (focus on this one)
waR = inR
69
what is therapeutic INR for warfarin use?
2.0-3.0
70
what things should we teach our patients on warfarin?
1. same time everyday
2. balance vit K consumption
3. watch for s+s of bleeding
4. avoid things that could cause bleeding (hard toothbrush, straight razors, ibuprofen or ASA, venipuncture, procedures, the "G" natural supps)
71
what pain reliever is considered safe and recommended to use with warfarin? what should be avoided?
safe: tylenol
avoid: ASA + ibuprofen
72
prototype for direct thrombin inhibitor
dabigatran (Pradaxa)
73
route for dabigatran
ORAL
74
MOA of dabigatran
direct, reversible inhibition of thrombin
75
AE of dabigatran
1. bleeding (less than other anticoagulants)
2. GI issues (take with food, PPI or H2 blocker)
*GI issues b/c taken orally*
76
why do we like dabigatran?
```
no lab monitoring
lower risk of bleeding***
few drug-drug / drug-food interactions
no titrations (Set dose)
rapid onset
```
77
antidote for dabigatran
idarucizuMAB (Praxbind)
"i DAR the DAB to CRUZ by me"
78
prototype (2) for direct factor Xa inhibitors
apixaban (Eliquis)
rivaroxaban (Xarelto)
"Xa is BANned"
79
MOA of direct factor Xa inhibitor
binds to Xa + inhibits thrombin
80
route for apixaban + rivaroxaban
ORAL
81
why do we like the direct factor Xa inhibitors?
```
no lab monitoring
lower bleeding risk
fixed dose
fewer drug-interactions
rapid onset
```
*similar to dabigatran*
82
direct factor Xa inhibitors are contraindicated in which 2 scenarios?
1. liver disease
| 2. pregnancy
83
antidote for apixaban + rivaroxaban
andeXanet alfa
84
if on IV heparin in emergency situation and need to switch to oral agent (Xa inhibitors), what's the protocol?
stop heparin
immediately start oral dose
double doses for 2ish days, then move to once daily
85
if on IV heparin in emergency situation and need to switch to oral agent (warfarin), what's the protocol?
2-3 days administer both heparin + warfarin
* warfarin takes a couple days for full effect*
* increased risk of bleeding:
- monitor pTT (heparin) + INR (warfarin)
86
what are the 6 anticoagulant drugs names?
1. heparin
2. enoxaparin (LMWH)
3. warfarin (Coumadin)
4. dabigatran
5. apixaban
6. rivaroxaban
87
what are the 4 antiplatelet drug names?
1. ASA
2. clopidogrel
3. vorapaxar
4. abciximab
88
MOA of ASA
irreversible inhibition of COX (blocks platelet aggregation - not sticky)
89
how long will you see single dose effects of ASA?
one week (why we have patients stop ASA 7 days before surgery)
90
ASA is used to prevent clot formation in __________
ARTERIES (prevent MI, TIA, CVA)
91
SE/risk of ASA use + how we can combat this
GI bleeding --> take with PPI or food/milk
92
prototype for ADP antagonist
clopidogrel (Plavix)
93
MOA of clopidogrel (Plavix)
blocks ADP receptors on platelet surfaces
94
dual platelet therapy is often seen with which 2 drugs?
ASA + clopidogrel (Plavix)
95
if we see s+s of bleeding with clopidogrel (Plavix) use, what's the protocol?
check with provider 1st before stopping - risk of MI or CVA could increase if stopped!!!
96
prototype for PAR-1 Antagonists
vorapaxar
97
MOA of vorapaxar
block PAR on platelets
98
route of vorapaxar
oral (lasts 7-10 days after last dose)
99
what 3 antiplatelet drugs are often given together in some combination to prevent CV events in high risk patients (MI, CVA, PAD hx)
vorapaxar + clopidogrel or ASA
100
prototype for glycoprotein 2B/3A receptor antagonist
abciximab
"easy as ABC, easy as 1, 2, 3"
101
MOA of abciximab
reversible inhibition of ALL platelet aggregation factors!!!!!
102
when would abciximab be used?
IV when someone is unstable (non STEMI, unstable angina, cardiac cath, stents, ACS)
103
main goal of abciximab
SAVE CARDIAC TISSUE in procedures
"ABC = emergency!"
104
how long can antiplatelet effects be seen after dose of abciximab?
~24 hours
105
prototype for thrombolytics
alteplase (tPa)
106
MOA of alteplase (tPa)
breakdown of [all] clots in the body!
107
this drug is used for acute MI, PE, ischemic stroke
alteplase (tPa)
108
when should we give alteplase?
best if given EARLY!
MI: 6 hours of onset (30 mins ideal)
CVA: 3 hours
*all patients should be evaluated for alteplase use*
109
if you see any s+s of bleeding with alteplase (tPa), what should you do?
STOP!!!
| esp. cerebral - might see mental status change
110
half life of alteplase (tPa)
5 minutes
111
contraindications for alteplase
1. recent pregnancy
2. internal bleeding
3. other anticoagulants
4. severe HTN
5. PUD
