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NURS 3303 > Anticoagulants and Respiratory > Flashcards

Anticoagulants and Respiratory Flashcards

1
Q

atorvastatin (Lipitor) MOA

A

leads to a fall in hepatic cholesterol levels produces a
compensatory upregulation in the number of LDL
receptors on hepatocytes with increased
clearance of circulating LDL cholesterol

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2
Q

atorvastatin (Lipitor) indications

A
  • hypercholesterolemia
  • primary and secondary CV prevention
  • protection against MI and stroke in DM pts
  • post MI therapy
  • type 2 DM
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3
Q

atorvastatin (Lipitor) AEs

A
  • myopathy
  • rhabdomyolysis
  • hepatotoxicity
  • teratogenicity
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4
Q

atorvastatin (Lipitor) nursing considerations

A
  • evening admin preferred
  • monitor liver function and CK
  • pt education: contraception and myopathy risks
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5
Q

colesevelam (Welchol) MOA

A

binds to bile acids secreted into small intestine to prevent reabsorption, eventually increases # of LDL cholesterol receptors for hepatic uptake

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6
Q

colesevelam (Welchol) indications

A

adjunctive therapy in hypercholesterolemia often with statins

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7
Q

colesevelam (Welchol) AEs

A

nausea, constipation, indigestion, bloating

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8
Q

colesevelam (Welchol) nursing considerations

A
  • administer other meds 1 hours before or 4 hours after
  • increase fluid and fiber intake prior to laxative admin
  • can interact with other common meds (thiazides, digoxin, and warfarin)
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9
Q

gemfibrozil (Lopid) MOA

A

activates PPAR alpha to accelerate clearance of VLDLs to reduce TG levels, raises HDL

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10
Q

gemfibrozil (Lopid) indications

A

hypertriglycerdiemia

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11
Q

gemfibrozil (Lopid) AEs

A
  • rash
  • GI upset
  • gallstones
  • myopathy/rhabdomyolysis
  • hepatotoxicity
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12
Q

gemfibrozil (Lopid) nursing considerations

A
  • can increase anticoagulant effects in pts on warfarin (monitor for bleeding and INR)
  • diet modification
  • administer 30 minutes before morning and evening meals
  • educate pts on myopathy risk
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13
Q

aspirin MOA

A

antiplatelet medication that irreversibly inhibits cyclooxygenase to prevent TXA2 synthesis needed to promote platelet activation

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14
Q

aspirin indications

A
  • ischemic CVA and stroke
  • angina and MI-related events
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15
Q

aspirin AEs

A
  • bleeding
  • salicylism (aspirin toxicity)
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16
Q

aspirin nursing considerations

A
  • educate and monitor for signs of bleeding
  • educate on other sources of aspirin
  • give PPI if GI bleeding occurs
  • stop med 7-10 days before surgery
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17
Q

aspirin dosing

A
  • 81mg = helps prevent CV effects
  • 325mg = helps in initial treatment of CV events
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18
Q

clopidogrel (Plavix) MOA

A

irreversibly prevents ADP- stimulated platelet aggregation and blood clot formation

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19
Q

clopidogrel (Plavix) indications

A
  • helps reduce thrombotic events in pts w/ acute coronary syndrome
  • prevents blockage of coronary artery stents
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20
Q

clopidogrel (Plavix) AEs

A

bleeding and TTP

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21
Q

clopidogrel (Plavix) nursing considerations

A
  • educate and monitor for signs of bleeding
  • give PPI if GI bleeding occurs
  • education on med use in setting of elective surgery
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22
Q

abciximab (ReoPro) MOA

A

glycoprotein Ilb/Illa receptor antagonist med that causes reversible blockade of platelet receptors to inhibit the final step of platelet aggregation

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23
Q

abciximab (ReoPro) indications

A
  • ACS
  • PCI
  • Non-STEMI
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24
Q

abciximab (ReoPro) AEs

A

bleeding

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25
Q

abciximab (ReoPro) nursing considerations

A
  • post-procedure cardiac cath monitoring
  • monitor for s/s of bleeding
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26
Q

heparin MOA

A

antithrombin activating anticoagulant that enhances the activity of antithrombin to indirectly inhibit activity of thrombin and factor Xa

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27
Q

heparin indications

A
  • DVT and PE
  • open heart surgery and renal dialysis
  • low dose = DVT prophylaxis
  • DIC
  • anticoagulation during pregnancy
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28
Q

heparin AEs

A
  • bleeding
  • HIT
  • severe neuro injury if given to spine/epidural pts
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29
Q

heparin nursing considerations

A
  • educate/monitor for s/s of bleeding
  • monitor aPTT and CBC
  • antidote is protamine sulfate
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30
Q

enoxaparin (Lovenox) MOA

A

LMWH that enhances activity of antithrombin to preferentially indirectly inhibit activity of thrombin factor Xa with some inhibition on thrombin

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31
Q

enoxaparin (Lovenox) indications

A
  • DVT and PE
  • DVT prophylaxis after THA, TKA, and abd sx
  • off-label = DVT prophylaxis after surgery and spinal injury
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32
Q

enoxaparin (Lovenox) AEs

A
  • bleeding
  • HIT
  • severe neuro injury if given to spinal/epidural pts
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33
Q

enoxaparin (Lovenox) nursing considerations

A
  • educate and monitor for s/s of bleeding
  • monitor CBC
  • antidote = protamine sulfate
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34
Q

warfarin (Coumadin) MOA

A

vitamin K antagonist med that suppresses production of factors VII, IX, X, and prothrombin

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35
Q

warfarin (Coumadin) indications

A
  • DVT and PE prevention
  • thromboembolism prevention in pts with prosthetic heart valves
  • prevention of thrombosis in pts w/ a-fib
36
Q

warfarin (Coumadin) AEs

A
  • bleeding
  • teratogenic
37
Q

warfarin (Coumadin) nursing considerations

A
  • educate/monitor for s/s bleeding
  • monitor PT and INR
  • numerous med interactions
  • longer half-life than heparin
  • antidote = vitamin K and leafy greens
38
Q

dabigatran (Pradaxa) MOA

A

direct thrombin inhibitor that directly inhibits actions of free and bound thrombin

39
Q

dabigatran (Pradaxa) indications

A
  • DVT and PE treatment
  • VTE prevention in THA and TKA
  • prevention of thrombus in a-fib pts
40
Q

dabigatran (Pradaxa) AEs

A
  • bleeding
  • GI upset
41
Q

dabigatran (Pradaxa) nursing considerations

A
  • monitor and educate on s/s of bleeding
  • antidote = idarucizumab
42
Q

rivaroxaban (Xarelto) MOA

A

direct factor Xa inhibitor that directly inhibits Xa and therefore thrombin production

43
Q

rivaroxaban (Xarelto) indications

A
  • DVT and PE treatment
  • VTE prevention in THA and TKA
  • thrombosis prevention in a-fib pts
44
Q

rivaroxaban (Xarelto) AEs

A
  • bleeding
  • spinal/epidural hematoma
45
Q

rivaroxaban (Xarelto) nursing considerations

A
  • educate/monitor for s/s bleeding
  • caution with renal and/or hepatic impairment
  • antidote = andexxa
46
Q

alteplase (t-PA) MOA

A

thrombolytic class med that forms complexes with plasminogen to convert to plasmin as well as degrade fibrinogen and other clotting factors

47
Q

alteplase (t-PA) indications

A
  • acute MI, stroke, PE
  • low dose for CVC thats blocked
48
Q

alteplase (t-PA) AEs

A

bleeding (particularly ICH)

49
Q

alteplase (t-PA) nursing considerations

A
  • many interactions and contraindications
  • monitor for bleeding
  • efficacy if given within 2-4 hours of symptom onset
50
Q

albuterol (Ventolin) and salmeterol (Serevent) MOA

A

beta-2 adrenergic agonist used for symptomatic relief via bronchodilation

51
Q

albuterol (Ventolin) and salmeterol (Serevent) indications

A
  • relief of acute bronchospasm in asthma
  • prevention of EIB
  • combo of ICS/LABA for COPD
52
Q

albuterol (Ventolin) and salmeterol (Serevent) AEs

A
  • SABA = tachycardia, angina, tremors
  • LABA = severe asthma and asthma-related death
53
Q

albuterol (Ventolin) and salmeterol (Serevent) nursing considerations

A
  • pt education on symptomatic relief from therapy
  • LABA often used with glucocorticoid (never monotherapy!)
  • assess use of SABA for control
54
Q

theophylline (Theo-24) MOA

A

symptomatic relief via bronchodilation due to blockade of receptors for adenosine and anti-inflammatory effects

55
Q

theophylline (Theo-24) indications

A
  • PO for maintenance of asthma and COPD
  • IV for asthma emergencies
56
Q

theophylline (Theo-24) AEs

A

theophylline toxicity (ranges from GI upset to v-fib and convulsions)

57
Q

theophylline (Theo-24) nursing considerations

A
  • narrow therapeutic range
  • lidocaine for v-fib
  • diazepam for convulsions
58
Q

tiotropium (Spiriva) MOA

A

blocks muscarinic cholinergic receptors in bronchi to prevent bronchoconstriction

59
Q

tiotropium (Spiriva) AEs

A

minimal, but usually dry mouth and irritation of pharynx (potential for anticholinergic effects)

60
Q

tiotropium (Spiriva) nursing considerations

A

often combined with albuterol nebulizer as PRN med to use both mechanisms for maximal relief

61
Q

budesonide (Pulmicort) MOA

A

suppresses inflammation by decreased synthesis and release of inflammatory modulators, decreased and activity of inflammatory cells, decreased edema of airway mucosa

62
Q

budesonide (Pulmicort) indications

A
  • maintenance therapy in asthma
  • combination ICS/LABA in COPD
63
Q

budesonide (Pulmicort) AEs

A
  • inhaled = candidiasis and dysphonia
  • PO = rare in acute use; adrenal suppression, hyperglycemia, osteoporosis w/ prolonged use
64
Q

budesonide (Pulmicort) nursing considerations

A
  • pt education on inhaled drug delivery
  • tapering with long-term PO use (monitor for adrenal suppression)
65
Q

Cromolyn MOA

A

mast cell stabilizer that prevents release of histamine and other mediators by stabilizing cytoplasmic membrane of mast cells

66
Q

Cromolyn indications

A
  • maintenance of mild to moderate asthma
  • prevention of EIB
  • relief of allergic rhinitis
67
Q

Cromolyn AEs

A
  • generally well tolerated
  • inhalation can cause cough or bronchospasm
68
Q

Cromolyn nursing considerations

A
  • pt education on place in therapy
  • use 15 minutes prior to precipitating factors
69
Q

montelukast (Singulair) MOA

A

leukotriene receptor blocker that occupied leukotriene receptors in airway and proinflammatory cells to block receptor activation

70
Q

montelukast (Singulair) indications

A
  • asthma maintenance and prophylaxis
  • prevention of EIB
  • allergic rhinitis relief
71
Q

montelukast (Singulair) AEs

A

generally well-tolerated

72
Q

montelukast (Singulair) nursing considerations

A
  • pt education on place in therapy
  • cheaper than inhalers
73
Q

fluticasone (Flonase) MOA

A

glucocorticoid used to prevent or suppress major allergic rhinitis symptoms due to anti-inflammatory actions

74
Q

fluticasone (Flonase) indications

A

prevention of allergic rhinitis

75
Q

fluticasone (Flonase) AEs

A
  • drying of nasal mucosa
  • burning/itching sensation
  • nosebleed
  • systemic effects rare (adrenal suppression)
76
Q

fluticasone (Flonase) nursing considerations

A
  • pt education on greatest relief if given daily rather than PRN
  • relief can take a week+ to develop
77
Q

loratadine (Claritin) MOA

A

antihistamine used to prevent or suppress major symptoms due to their action against histamine

78
Q

loratadine (Claritin) indications

A

allergic rhinitis

79
Q

loratadine (Claritin) AEs

A
  • generally mild
  • possible sedation and anticholinergic effects
80
Q

loratadine (Claritin) nursing considerations

A
  • avoid first gen antihistamine if requiring alertness
  • med most effective if take prophylactically
  • can cause somnolence in intranasal preparations
81
Q

phenylephrine (Sudafed PE) MOA

A

sympathomometric decongestant that activates alpha-1 receptors on nasal blood receptors to cause vasoconstriction

82
Q

phenylephrine (Sudafed PE) nursing considerations

A
  • monitor V/S
  • don’t use for more than 3-5 days
  • commonly confused with pseudoephedrine
83
Q

Non-opioid antitussives MOA

A
  • dextromethorphan = acts on sigma opioid receptors to suppress cough reflex
  • diphenhydramine = unclear
  • benzonatate (Tessalon) = decreases sensitivity of respiratory tract stretch receptors
84
Q

Non-opioid antitussives AEs

A
  • dextromethorphan = high doses have potential for causing euphoria
  • benzonatate = usually mild; can cause seizures, dysrhythmia, and overdose
85
Q

Opioid antitussives MOA

A

poorly understood in context of cough, thought to increase cough threshold in CNS

86
Q

Opioid antitussives AEs

A
  • respiratory depression
  • constipation
  • abuse
87
Q

Opioid antitussives nursing considerations

A
  • monitor respiratory status
  • naloxone is reversal agent

NURS 3303 (10 decks)

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