Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm Exam 2 > anticoagulants, Ca, Osteoporosis > Flashcards

anticoagulants, Ca, Osteoporosis Flashcards

1
Q

Heparin MOA

A

Suppresses coagulation by helping antithrombin inactivate clotting factors, mainly thrombin and factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Heparin Use

A

Suppressing massive blood clotting
PE
DVT
DIC
MI
Stroke
Open heart surgery (prevent clots in the machine)
Renal dialysis (prevent clots in the machine)
Prevention of DVT for those in hospital on longterm bed rest
After orthopedic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Heparin Route

A

IV: titrate to aPTT, 2 RN check
SubQ: abdomen only, does not cross membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Heparin and Pregnancy

A

Does not cross membranes: placenta and breast milk.

Can be used in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Heparin A/E

A

Hemorrhage (most important)
Spinal epidural hematoma
Heparin induced thrombocytopenia (HIT)
Hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HIT

A

immune mediated disorder where a proximal increase in thrombotic event due to development of antibodies
Starts clotting = Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Heparin Contraindications

A

Thrombocytopenia
Uncontrolled bleeding
Hemophilia
Eye, brain, spinal cord surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Heparin Antidote

A

Protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Heparin Monitoring

A

aPTT: norm: 30-40, therapeutic range: 60-80 (1.5-2x norm)

anti factor Xa: therapeutic range: 0.3-0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Enoxaparin

A

Lovenox

Low molecular weight heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Enoxaparin MOA

A

Does not inactivate thrombin as well as heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Enoxaparin Use

A 
DVT prophylaxis after surgery
Treatment for established DVT
Prevention of ischemic complications
Stable angina
non-Q wave MI
STEMI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Enoxaparin Dosing

A

Fixed dose, no blood monitoring longer half life than heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Enoxaparin Route

A

Abdominal SubQ, pt must be able to give to themselves at home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Enoxaparin Contraindications

A

Spinal puncture/surgery = paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Enoxaparin A/E

A

HIT

Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Enoxaparin Antidote

A

Protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Warfarin MOA

A

Blocks synthesis of factor VII, IX, X and prothrombin, which need Vit K to be produced
Inhibits the enzyme VKORCI needed to convert Vit K to active form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Warfarin Use

A 
Long term prophylaxis of thrombosis 
Venous thrombosis 
PE
Thromboembolism 
Thrombosis in A fib
Thrombosis in prosthetic heart valves 
Reduce risk of TIA and recurrent MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Warfarin A/E

A 
Hemorrhage
Skin necrosis 
Alopecia
Dermatitis
Fever
Red/orange urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Warfarin Contraindications

A

Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Warfarin Drug interactions

A

Those that promote bleeding or anticoagulation
↓ anticoagulation effects: Heparin, Aspirin, Acetaminophen
Vit K ↓ effects of Warfarin
ETOH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Warfarin Pt edu

A

Maintain same amount of Vit K in diet (foods high in Vit K: Green leafy veggie, soybean oil, canola oil, mayonnaise)
Wear a medical alert bracelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Warfarin Monitoring

A

PT (changes fast): norm: ∼12, therapeutic range: 18-24
INR (take ∼ 1 wk to change): therapeutic range: 2-3x normal
>INR corrects for thromboplastin variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Warfarin Antidote

A

Vit K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Warfarin Dosing

A

Adjust depending on PT and INR time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Warfarin Nursing considerations

A

Hold 1-2 wk before surgery

Very slow onset, must use heparin at beginning to prevent clots then stop heparin when warfarin starts working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Dabigatran Etexilate Brand

A

Pradaxa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Dabigatran MOA

A

Reversible direct thrombin inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dabigatran Use

A

Non valvular Afib
Hip/Knee replacement
DVT/PE treatment
Prevention of stroke and Afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Dabigatran and Kidneys

A

1/2 life gets longer with renal impairment, may need to decrease dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Dabigatran A/E

A

Bleeding

GI disturbance: dyspepsia: give PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Dabigatran Drug interactions

A

P-glycoprotein inhibitor ↑ bleeding risk, drug level

  • Ketoconazole
  • Amiodarone
  • Verapamil
  • Quinidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Dabigatran Nursing considerations

A

Does not require monitoring
Same dose for everyone
Swallow whole
No real antidote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Rivaroxaban Brand name

A

Xarelto

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Rivaroxaban MOA

A

Selective inhibitor of factor Xa (inhibits production of thrombin)
Binds directly with factor Xa to cause inactivation

37
Q

Rivaroxaban Use

A

Prevents DVT, PE after Hip/Knee replacement ONLY
Prevents stroke in nonvalvular A.fib
Treatment of DVT/PE unrelated to orthopedic surgery

38
Q

Rivaroxaban Renal impairment

A

Decrease dose

39
Q

Rivaroxaban A/E

A

Bleeding

Spinal epidural hematoma → paralysis

40
Q

Rivaroxaban Contraindications

A

Pregnancy

Moderate + renal/hepatic impairment

41
Q

Rivaroxaban Drug interactions

A

CYP3A4

42
Q

Rivaroxaban Pt edu

A

Can be taken with or without food

43
Q

Aspirin MOA

A

・Prevents platelet aggregation by suppressing production of an enzyme necessary for platelets to produce thromboxane A2 (prostaglandin)
・Inhibits synthesis of prostacyclin from endothelium of the atrial cell wall but as long as dosage is kept low this is not a problem
・Inhibits COX

44
Q

Aspirin Use

A

Prophylaxis: MI (primary prevention <70 y/o), Recurrent MI (secondary prevention), Death from stroke, TIA, ↓r/f sudden death, Reocclusion during coronary stenting (PCI)
Ischemic stroke
Chronic stable angina
Unstable angina

45
Q

Aspirin A/E

A

GI bleeding/Upset

Hemorrhagic stroke

46
Q

Aspirin Nursing considerations

A

May need PPI if enteric coated tab does not decrease GI upset

47
Q

Clopidogrel MOA

A

ADP receptor antagonist
P2Y12 adenosine diphosphate receptor blocker on the surface of the platelets
Antiplatelet aggregators similar in action to aspirin and frequently given in addition to aspirin after PCI procedure to prevent thrombotic event

48
Q

Clopidogrel Use

A

Prevents occlusion of coronary stents (PCI)
↓thrombotic events in pt with acute coronary syndromes
Prevents stenosis of coronary stents
Secondary prevention of MI, Ischemic stroke, and other avascular events
❊Used for up to 2 years after coronary event

49
Q

Clopidogrel A/E

A 
Bleeding
Bruising 
Thrombocytopenia (with in first few weeks)
Fever (with in first few weeks) 
Anemia
Renal dysfunction
50
Q

Clopidogrel Drug interactions

A

Caution with combo with other drugs that promote bleeding

51
Q

Clopidogrel Nursing considerations

A

Stop 5 days before surgery

Can be used with PPI

52
Q

Ticagrelor MOA

A

Inhibits the receptor site on the surface of the platelet, thus preventing aggregation of platelets
❊Reversible blockade and effects wear-off faster

53
Q

Ticagrelor Use

A

Prevents occlusion of coronary stents

↳used for about 18-24 mo after procedure

54
Q

Ticagrelor A/E

A 
Hemorrhage
Dyspnea
Cough
Diarrhea
Dizziness
Non cardiac chest pain
Bradycardia 
Ventricular pauses
55
Q

Ticagrelor Drug combo

A

Aspirin is usually given in low dosages along with the drug but high doses >100 mg should not be used due to danger of actually reducing benefits of Ticagrelor

56
Q

Ticagrelor Pt educations

A

Discontinue 5 days before surgery

57
Q

Abciximab MOA

A

Reversible blockade of platelet GP IIb/IIIa receptors

Binds to platelets near the GP IIb/IIIa receptors and then prevents the receptors from binding to fibrinogen

58
Q

Abciximab Use

A

Most effective antiplatelet drug
Acute coronary syndromes
Percutaneous coronary interventions
Acute MI/PCI

59
Q

Abciximab A/E

A

Major bleeding (oozing)→ stop if occurs
GI bleed
Urogenital bleeding
Retroperitoneal bleeding

60
Q

Abciximab Route

A

IV only

61
Q

Abciximab Drug interactions

A

In Conjunction with heparin and aspirin to promote revascularization in patients undergoing thrombolytic therapy, acute MI, PCI

62
Q

Alteplase

A

tPA

63
Q

Alteplase MOA

A

Binds to plasminogen to form an active complex then catalyzes the conversion of other plasminogen molecules into plasmin, an enzyme that digests the fibrin meshwork of clots

64
Q

Alteplase Use

A

MI
Ischemic stroke
Massive PE
✶Must meet guidelines to give

65
Q

Alteplase Dosing time

A

With in2-6 hr of onset of symptoms

66
Q

Alteplase A/E

A

Bleeding (intracranial bleed)

Fever

67
Q

Alteplase Drug interactions

A 
Anticoagulants
・heparin
・warfarin
・dabigatran 
Antiplatelets 
・Aspirin
・Clopidogrel
68
Q

Alteplase Nursing considerations

A

No invasive procedures
Pt needs to lay still due to increased risk for bleeding
All clots good and bad will be dissolved

69
Q

Vit D MOA

A

Works with PTH to increase GI absorption of Ca
Increase osteoclast maturation
D2, D3 (active form)

70
Q

Vit D Use

A

Regulation of Ca and phosphorus homeostasis
Osteoporosis
Renal osteodystrophy

71
Q

Vit D A/E

A 
Toxicity 
Early s/s: weakness, fatigue, nausea, vomiting, anorexia, abdominal cramping, constipation 
Late s/s: ↓kidney function, polyuria, nocturia, proteinuria
Neurologic: seizures, confusion, ataxia
Cardiac dysrhythmias
Coma
Ca deposition in soft tissue
Decalcification of bone
72
Q

Vit D Sources

A 
Sunlight 
Fatty fish
Egg yolk
Cheese
Beef liver
Mushrooms 
Some cereals 
Some OJ
73
Q

Calcitonin Salmon

A

Calcitonin

74
Q

Calcitonin MOA

A

Decreases bone reabsorption by inhibiting the activity of osteoclasts
Inhibits tubular resorption of Ca
Increase Ca excretion

75
Q

Calcitonin Use

A

Osteoporosis treatment
Pagets
Hypercalcemia

76
Q

Calcitonin Route

A

Nasal spray: alternating nostrils daily

77
Q

Calcitonin A/E

A

Nausea: diminishes with time
Flushing of face and hands
Injection site reaction
Can develop antibodies so might stop working after a year

78
Q

Bisphosphonate Drug

A

Alendronate (Fosamax)

79
Q

Alendronate MOA

A

Inhibits bone resorption by decreasing activity of osteoclasts

80
Q

Alendronate Use

A 
Postmenopausal osteoporosis 
Osteoporosis in men 
Glucocorticoid induced osteoporosis
Pagets
Hypercalcemia of malignancy 
May help prevent/treat bone metastases in patients with cancer
81
Q

Alendronate A/E

A 
Ocular inflammation 
Osteonecrosis of the jaw
Atypical femur fracture 
A fib
Esophageal ulceration and cancer 
Musculoskeletal pain 
Hyperparathyroidism
82
Q

Alendronate Pt education

A

Take 30 min before other foods and drugs, on empty stomach with a full glass of water
Must sit upright for 30 minutes to prevent esophageal problems
Take a drug holiday after about 5 years for about 6 mo

83
Q

Selective Estrogen Receptor Modulators drug

A

Raloxifene

84
Q

Raloxifene MOA

A 
Structurally similar to estrogen and binds to estrogen receptors 
Mimics estrogen (agonist) in bone, lipids, and blood clotting 
Blocks estrogen in the breast and endometrium
85
Q

Raloxifene Use

A

Prevention/Treatment of postmenopausal osteoporosis

Estrogen receptor breast cancer

86
Q

Raloxifene A/E

A

Thromboembolism (DVT, PE, Stroke)

Hot flashes

87
Q

Raloxifene Contraindications

A

Pregnancy

88
Q

Raloxifene Drug interactions

A

Take with adequate intake of Ca and Vit D

89
Q

Raloxifene Pt education

A

Take with or without food

ensure adequate intake of Ca and Vit D

Pharm Exam 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions