Coagulation And Hyperlipidemia Drugs Flashcards
Vitamin K antagonist - anticoagulant/anti-platelet, example and MOA
Anticoagulant
Ex. Warfarin (Coumadin)
Inhibits vitamin K dependent clotting factors
Vitamin K antagonist - clinical utility, SE
Clinical: a-fib, DVT/PE prevention and tx, valve replacement
SE: bleeding, skin necrosis (rare), teratogenic
Direct thrombin inhibitors - anticoagulant/anti-platelet, example, MOA
Anticoagulant
Dabigatran (Pradaxa)
MOA: inhibits thrombin directly
Dabigatran - clinical utility, SE
Clinical: a-fib, DVT/PE tx
SE: bleeding, GI symptoms
Apixaban MOA
inhibit factor Xa, preventing prothrombin conversion to thrombin
Apixaban SE
SE: bleeding, elevated liver enzymes
Heparin MOA
Enhance activity of antithrombin, inhibiting thrombin and Factor Xa
Heparin SE
Bleeding, heparin-induced thrombocytopenia (HIT)
Aspirin MOA
Irreversibly inhibit COX-1, reducing thromboxane A2 production leading to decreased platelet aggregation
Aspirin SE
bleeding, gastric ulceration, tinnitus
Clopidogrel MOA
Inhibits platelet P2Y12 ADP receptor reducing platelet activation and aggregation
Clopidogrel SE
bleeding, dyspnea (ticagrelor)
Alteplase MOA
Activate plasminogen to plasmin, which digests fibrin and dissolves clots
Alteplase SE
bleeding (including intracranial hemorrhage), allergic reactions (streptokinase)
4 main indications for anticoagulation therapy
Main adverse effect
Indications: DVT, PE, atrial fibrillation, MI
AE: bleeding
Statins SE
myalgia, increased liver enzymes, rhabdomyolysis (rare)
Statins (HMG-CoA reductase inhibitors) MOA
inhibit HMG-CoA reductase enzyme which plays a role in cholesterol production
Bile acid sequestrants - examples, MOA
Cholestyramine, colestipol, colesevelam
Bind bile acids in the intestines, promoting their excretion and reducing circulating cholesterol
Bile acid sequestrants - clinical indications, SE
Hypercholesterolemia
SE: constipation, bloating, indigestion
Ezetimibe MOA
Inhibits cholesterol, absorption in small intestine
Ezetimibe SE
diarrhea, joint pain, sinusitis, fatigue
PCSK9 inhibitors - examples, MOA (not on study guide)
Evolocumab, alirocumab
MOA: monoclonal antibodies that inhibit PCSK9, increasing LDL receptor availability and reducing LDL cholesterol
PCSK9 inhibitors - clinical indications, SE (not on study guide)
HeFH, ASCVD requiring additional LDL-C lowering
SE: nasopharyngitis, injection site reactions
Fenofibrate MOA
activate PPAR alpha, reducing triglyceride synthesis and enhancing triglyceride clearance
Fenofibrate SE
dyspepsia, gallstones, myopathy (when combined with statins)
Omega-3 fatty acids - examples, MOA (not on study guide)
Fish oil, icosapent ethyl
MOA: reduce hepatic triglyceride production and increase triglyceride clearance
Omega-3 fatty acids - clinical indications, SE (not on study guide)
Hypertriglyceridemia
SE: fishy aftertaste, diarrhea, nausea
Niacin - examples, MOA (not on study guide)
Nicotinic acid
Reduces free fatty acid release, decreases VLDL and LDL synthesis, raises HDL levels
Niacin - clinical indications, SE (not on study guide)
Hypercholesterolemia, mixed dyslipidemia
SE: flushing, itching, elevated glucose levels
Define blood clotting
coagulation; prevents excessive bleeding when vessel is damaged
5 stages of blood clotting
1 - vasoconstriction
2 - formation of platelet plug (primary hemostasis)
3 - activation of coagulation cascade (2ndary hemostasis)
4 - clot retraction and repair
5 - fibrinolysis
PT tx consideration for pt on warfarin
gentle w/ MT b/c pts bruise more easily
What sign would a PT check for pt on antigcoags? What causes this sign?
bleeding; INR may be too high
PT consideration for pts on heparin (3)
-gentle during MT to avoid bruising
-padding during ex/act w/ fall risks to avoid internal bleeding
-modalities like deep heat –> increase BF –> increase risk of bleeding
PT edu for anticoags
signs of excessive bleeding (prolonged nose bleeds, bloody urine, lg bruises)
What 4 symptoms might suggest internal bleeding
unusual pain, swelling, headache, dizziness
What 3 tx techniques increase the risk of hematoma formation
dry needling, electroacupuncture, deep tissue mob
3 signs of DVT
unilateral calf pain, swelling, warmth
When is the most beneficial time to schedule sessions for anticoag pt?
when drug’s effect is moderate, NOT peak or trough
What are the 3 statin-associated mus symps (SAMS)
mus pain, tenderness, weakness (different from MSK pain d/t ex)
Hyperlipidemia meds can affect what vitals
BP or HR
What 3 symps of hyperlipidemia meds indicate immediate medical attention is needed
severe mus pain, tea colored urine, unexplained fatigue
