Chapter 4 CV + hematology - lipid disorders and anticoagulants Flashcards
cholestyramine (questran)
colestipol (colestid)
colesevelam (welchol)
- Form insoluble complex with bile salts – excreted in feces
- body compensates by increasing LDL receptors (uptake of cholesterol-carrying lipoprotein particles into cells) and oxidizing cholesterol to bile acids
indication
* LDL (bad) >190 mg/dl (160 for 2 risk factors)
effects
* decrease cholesterol, LDL
* inc triglycerides, vldl (very low density lipoproteins)
lovastatin (mevacor)
pravastatin (pravachol)
simvastatin (zocor)
fluvastatin (lescol)
atorvastatin (lipitor)
rosuvastatin (Crestor)
pitavastatin (livalo)
- inhibit HMG-CoA reductase in liver (catalyzes rate limiting step in cholesterol synethesis)
indication
* LDL >190 mg/dl (160 w/ 2 risk facators)
effect
* decrease cholesterol, LDL, VLDL, triglyc
* inc HDL
Gemfibrozil (lopid)
- inhibits VLDL synthesis
- inc lipoprotein lipase activity => reduce triglyceride levels
indication
* LDL >190 mg/dl (>160)
effects
* decrease cholestrol, triglyceride, vldl, idl
* dec or inc LDL + inc HDL
fenofibrate (tricor)
indication
* hypertriglyceridemia
effect
- dec cholesterol + triglyceride
- inc LDL, HDL
Ezetimibe (zetia)
- inhibits cholesterol GI absorption
indication
hypercholesterolemia
effect
* dec LDL + triglyceride
* inc HDL
evolocumab (repatha)
alirocumab (parulent)
- antibody blocking PCSK9 (reduces low density lipoprotein receptors [LDLR])
- need these receptors!
indication
* familial hypercholesterolemia that needs tx more than statins + diet
effect
* lower LDL-C levels
Heparin
anticoagulant
- Binds to antithrombin III => complex then binds to + inhibits activated clotting factors (factor Xa)
- Large quantities stop thrombin and clotting factors to prevent conversion of fibrinogen to fibrin
indication
1) post op DVT + pulmonar embol
2) Extracorporeal circulation: The diversion of blood flow through a circuit outside the body but continuous with the bodily circulation (open heart surgey and renal hemodialysis
3) immediate coagulation
effects
* bleed
* thrombocytopenia (platelet count low)
* hematoma (blood pool)
* necrosis @ injection site
Subq/IV
Interactions
1) Bleed or hemorrhage — aspirin, ibuprofen, anticoagulants + thrombolytics, dextran (shock med), phenylbutazone (nsaid), indomethacin (nsaid), dipyridamole (antiplatelet), some penicillins + cephalosporins, valprioc acid, plicamycin (antineoplastic antibiotic), methimazole (antithyroid), propylthiouracil (antithyroid), probenecid (gout), hydroxycholoroquine (antimalarial + antirhematic), chloroquine (malaria)
2) Decrease anticoagulation w/ digitalis, tetracylcines, antihistamines, nicotine
Check hematocrit + blood in stool
* Caution with menstruating women, pt w/ subacute bacterial endocarditis, hypotension, liver disease, or blood dyscrasias
PROTAMINE SULFATE inactives heparin and be as an antagonist if severe bleeding occurs
Other lower molecular weight heparins
anticoagulant
- dalteparin (fragmin)
- tinazparin (innohep)
- heparinoids — enoxaprin (lovenox)
- 3 above used for DVT and pulmonary emboli (prophylaxis too)
- Adleparin and enoxparin — ishcemic or MI (non Q)
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All these do not alter pt/ptt — inc risk of spinal or epidural hematoma following lumbar puncture
Direct thrombin inhibitors
- lepirudin (refludan)
- bivalirudin (angiomax)
- argatroban
Warfarin (coumadin)
anticoaugulant
- antagonize vitamin K; interfere w/ synthesis of vitamin K-dependent clotting factors (II, VII, IX, X)
indication
1) DVT
2) ishcemic heart disease
3) rheumatic heart disease (damage to heart valves caused by one or several episodes of rheumatic fever, an autoimmune inflammatory reaction to throat infection with group A streptococci (streptococcal pharyngitis or strep throat)
4) PE
5) Chronc use with artifical heart valves
effects
1) bleeding
2) necrosis
3) GI upset
PO
interaction
1) bleed – urokinase and streptokinase (thrombolytic agent
2) Inc anticoagulation — asprin, phenylbutazone + oxyphenbutzone (NSAID), disulfiram (alcoholism), cimetadine, sulfinpyrzone (gout), metronidazole (AB), trimethoprim-sulfamethoxazole (AB), dextrothyroxine (thyroid hormone), many others, such as heparin
3) Decreased anticoagulation — rifampin (antimycobacterial), cholestryamine (anitcholesterol), high dose vitamin C or vitamin K
**monitor protrombin time — ecchymoses (Bruise), hematuria, uterine and intestinal bleeding may occur even in normal range **
10 to 13 seconds – normal
INR of 0.8 to 1.1 — normal
2-3 INR for taking it warfarin
ticagrelor (brilinta)
prasugrel (effient)
anitcoagulant
- binds to P2Y12 class of adenosine diphosphate (ADP) receptor on platelets
indicatoin
* dec thromboses in ACS
effects
* dyspnea, headache
* contraindicated w/ brain hemorrhage
PO
interaction
* cardiac toxicity w/ digoxin
ONLY prasugrel is irreversible when bind to receptor
aspirin
ibuprofen
antiplatelet
- inhibits cycloxygenase => prevents production thromboxane A2 and prostagladins (needed for platelet aggregation
indication
* aspirin — reduce risk of reccuent TIA or stroke + reduce MI in pts w/ unstable agina or prior infarction
* BOTH analgesic or antiinflammatory
effects
* GI ulceration
* bleeding + hemorrhage
interactions
* bleed — anticoagulants
* GI ulceration — ETOH, corticosteroids, phenylbutazone (NSAID) or oxyphenbutazone
* DEcrease uricosurea (urea in urine) effects of probenecid and sulfinpyrazone
clopidogrel (plavix)
ticlopidine (ticlid)
antiplatelet
- blocks platelet aggregation by inhibiting ADP receptor
indication
* reduce atherosclerotic events
effects
* GI ulceration, bleed
* neutorpenia
* rare — thrombotic thrombocytopenic purpura (blood clots form in small blood vessels throughout your body. The clots can limit or block the flow of blood to your organs, such as your brain, kidneys, and heart.)
increased bleeding risk
consider stopping prior to surgical or dental procedure
cilostazol (pletal)
antiplatelet
- inhibit phoshodiesterase II; dilates lower extremity blood vessels
indication
* intermittent claudication (muscle pain due to lack of oxygen that’s triggered by activity and relieved by rest)
effects
heart palpitations
absorption inc w/ fatty foods
levels inc by omeprazole, macrolides, diltiazem
CONTRAINDICATED in patients w/ CHF
dipyridamole (persantine)
antiplatelet
- inhibits phosphodiesterase
- l/t increased cAMP levels to potentiate PGI2 (platelet aggregation inhibitor)
- inc level of adenosine (coronary artery vasodilator)
- few clinical effects alone
indication
* w/ WARFARIN — prevents emboli from artificial valves
* w/ ASPIRIN — enhance platelet lifespan in thrombotic disae
effects
* worsen angina
* dizziness, syncope
