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Pharm 2 > Ch. 26 and 54 > Flashcards

Ch. 26 and 54 Flashcards

1
Q

The nurse will have many opportunities in practice to give medications that:

A

Enhance coagulation
Inhibit coagulation
Dissolve existing clots

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2
Q

Too much clotting. Starts in venous veins.

A

Thomboembolic Disorders

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3
Q

Types of Thromboembolic Disorders

A

DVT, Pulmonary Embolism, Cerebral Vascular Accident (Stroke)

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4
Q

What lab tests are essential to diagnose a coagulation disorder

A

PT (prothrombin time)
aPTT (activated partial thromboplastin time)
Platelet count
Specific clotting factor tests depending on disease

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5
Q

Mechanisms of action for drugs used to slow clotting/prevent formation

A

Inhibit clotting factors
Inhibit the clotting action of platelets
Dissolve clots (Clot busters)
(all these lengthens bleeding time)

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6
Q

Makes blood cells very flexible. Will help blockages in arteries.

A

Trentol

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7
Q

Acts by indirectly inhibiting thrombin. Prevents formation of fibrin clots. Alongate bleeding time. Stops extension of existing clots is unable to dissolve. Used for thrombosis, MI, strokes etc- blood flow disruption. Stops DVT from getting bigger

A

Heparin

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8
Q

Heparin is the drug of choice for…….

A

thromboembolic disorders SQ/IV

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9
Q

Adverse effects of Heparin

A

Abnormal bleeding, dose dependent

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10
Q

Antidote for too much heparin given

A

protamine sulfate

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11
Q

What labs will be drawn for Heparin

A

aPTT

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12
Q

Therapeutic range of Heparin

A

1.5-2 (normal: 25-35)

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13
Q

Where should we monitor when a pt is on heparin?

A

s/s of bleeding in urine, stool, bruising, and excessive menstruation

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14
Q

What interventions could they do to prevent injury when taking Heparin

A

soft bristle toothbrush
electric razor for shaving
avoid picking nose

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15
Q

Low molecular weight heparin. Safer and more stable than heparin.Produce more predictable responses. Will not need clotting factor labs drawn. Given in the abdomen. Usually given for 5-10 days.

A

Enoxaparin (Lovenox) SQ

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16
Q

Inhibits activated vitamin K. Takes a few days to produce a full therapeutic effect. Will see this taken with Heparin until appropriate levels are reached. Labs are the marker of dosage.

A

Warfarin (Coumadin)

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17
Q

Therapeutic range for Warfarin (Coumadin) (international Normalized Ratio)

A

2.0-3.0 or up to 3.5

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18
Q

Adverse effects of Coumadin

A

Bleeding

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19
Q

Antidote for Coumadin overdose

A

Vitamin K

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20
Q

What Vitamin K foods should we eat in moderation?

A

spinach, cabbage, cauliflower, brussels sprouts, broccoli

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21
Q

What herbs increase herbs of bleeding

A

Garlic

Ginkgo

22
Q

Approved for prevention of stroke in those with a-fib, post op prophylaxis and treatment of DVT. Factor XA inhibitors

A

Rivaroxaban (Xarelto)

Apixaban (Eliquis)

23
Q

Also inhibit thrombin directly factor 2A. Prevention of strokes int hose with afib. Has a drying agent in the cap that stops breakdown of medication.

A

Dabigatran (Pradaxa) PO

24
Q

Interfere with platelet aggregation. Is concerned with stopping formation in arteries. Can still profoundly increase bleeding time.

A

Antiplatelet Agents

25
Q

Helps platelets go and clup. Prevents platelet aggregation.

A

Adenosine diphosphate (ADP) receptor blockers

26
Q

Prevents platelet activation and thrombus formation.

A

Glycoprotein 2b/3a inhibitor

27
Q

Needs to be stopped before surgery. Given to prevent thrombi formation in those at risk for MI and CVA and those that have unstable angina and stent placement. Also given to prevent post op DVT.

A

Clopidogrel (Plavix) ADP Receptor Blocker

28
Q

Very expensive so not used often. Given in acute situations. Given IV many times concurrently with ASA or heparin for optimal results. Glycoprotein 2b/2a inhibitor.

A

Epitifbatide (integrilin)

Abciximab (ReoPro)

29
Q

Accelerate the normal process of breaking down clots. Plasmin DIGESTS fibrin breaking it down.

A

Thrombolytics

30
Q

Given ASAP after clot has formed. Preferably within 4 hours. 6 hours of MI or 3 hours of CVA.

A

Altepase (Activase) IV

31
Q

Used to promote formation of clots. By preventing digestion of fibrin clots.

A

Hemostatics

32
Q

Most often prescribed after surgery to stop abnormal bleeding. Also given after acute hemorrhage. In certain instances the incidence of thrombosis is increased.

A

Aminocaproic Acid (Amicar) PO/IV

33
Q

Amicar adverse effect

A

wasting and weakness of muscle leading to rhabdomyolysis

34
Q

Anemia can be related too:

A

Blood loss
Blood cell destruction
Decreased blood cell production

35
Q

Erythopoietin is secreted by what organ?

A

Kidneys

36
Q

These are meant to ensure proper blood consistency and then of course ensure that are adequate RBC for oxygenaton

A

Iron

37
Q

Most common reason to get prescribed Epogen

A

cancer and renal failure

38
Q

Made by recombinant DNA. Stimulates the bone marrow to make RBCs. Hematocrit increases 2%/week.

A

Epoetin alfa (Epogen, Procrit)

39
Q

Adverse effects of Epogen?

A

HTN, Thromboembolic events (watch hgb/hct closely)

40
Q

Goal of pharmacotherapy of Anemia

A

Increase HCT, HGB, O2 and RBC

41
Q

`Effectiveness of Epogen will be much lower when deficient in…..

A

iron and other vitamins

42
Q

What is a major cause of anemia

A

iron deficiency

43
Q

Iron Deficient anemia treatments?

A 
Ferrous Fumarate/Sulfate PO (Moderate anemia)
Iron Dextran (Dexferrum) IV/IM (severe anemia)
44
Q

Water soluble B vitamin. Necessary for normal fetal development.

A

Folic Acid

45
Q

Which condition must be ruled out before giving folic acid?

A

Perniciious Anemia

46
Q

For Vitamin B12 deficiency Given IM/SQ. Take daily, then every other day, then weekly, then monthly for life.

A

Cyanocobalamin

47
Q

What must be present to give Cyanocobalamin orally?

A

intrinsic factor

48
Q

Serious effects that can occur with Cyanocobalamin

A

Neurovascular Problems: memory loss, unsteadiness and mood disturbances

49
Q

What will we need to assess for reasoning for medication

A

iron stores, kidney function and bone marrow function

50
Q

Implementation of Iron supplements

A

Liquid formulations should be taken through a straw
Remain upright min after taking (do not crush)
Can be taken with food/vitamin c
Use Z-track method

51
Q

How long does it take to see improvements in anemia status?

A

2-6 weeks

Pharm 2 (4 decks)

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