Exam 3-1 Flashcards
Heparin
Thrombin inhibitor
Rapid active, short half-life.
High risk drug always
Used for prompt anticoagulant activity
Monitor with aPTT (normal 30-40 seconds, 1.5-2.5 times normal range is 60-80)
Subcutaneous & IV drip. NOT IM.
Protamine sulfate antidote.
Adverse is heparin induced thrombocytopenia (not enough platelets) and bleeding
Dabigatran
Thrombin inhibitor
Direct fibrin inhibitor at the liver
Monitor for signs of Gl upset and FALL risk
No blood levels or routine monitoring available, just avoid vitamin K foods
Contradicted by liver and kidney issues. Many interactions. Don’t take if valve replacement
Praxbind antidote
Observe for bleeding gums, bruises, epistaxis, hematemesis, hematuria, occult blood in stool, petechiae
Warfarin
Vitamin K antagonists
PT & INR, and liver function
long-term and slow thrombosis prevention
Orally, same time daily
Reduce bleeding risks
Clopidogrel bisulfate
ADP Clot Blocker
Oral 300mg then 75 mg daily
Monitor for signs of bleeding
Contradicted in CVD
tPA (Alteplase)
Thrombolytics - Clot buster
MI, ischemic strokes
5 min half life
Given through peripheral site that can be pinched
Monitor CARDIAC dysrhythmias and bleeding
Enoxaparin sodium
Factor Xa Inhibitor for DVT/PE prevention
No monitoring needed, but only anticoag
Air bubble needed
Bridge to warfarin
Spinal hematoma/epidural catheter
Apixaban & Rivaroxaban
Factor Xa Inhibitor - preventor
Oral dose on renal function, age, weight
Monitor all bleeding and renal (creatinine, GFR, BUN)
Spinal hematoma/epidural catheter
Vitamin K
Warfarin antidote
Deficiency state, antibiotic therapy, melabsorp, infants
Ferrous Sulfate
Prevent anemia
pediatric poisoning deaths
Toxic Levels: Suction and maintenance of the airway; correction of acidosis; control of shock and dehydration with IV fluids or blood, oxygen, and vasopressors
Contradicted by GI and Liver issue
Cyanocobalamin
B12
Many cell functions, like nerve speed
Should improve energy in deficiency
IM Delivery
Contradiction: COBALT, optic nerve atrophy, hypokalemia, diarrhea
Epoetin Alfa
Anemia of chronic disease (like dailysis)
Usually given with iron, stimulates red blood cell production
Side effect is HTN and related.
Thromboembolic events and bleeding is adverse
Acetaminophen
Non-opioid analgesic Tylenol
Ibuprofen
First generation NSAIDs
Monitor for bleeding, stop week before surgery. Use tylenol when bleeding concern
DNE 1200 mg day or 800 mg at one dose
Contradicted by GI bleed, HTN, heart failure, Renal impairment, Vitamin K deficiency
Naproxen
Aleve First generation NSAIDs
Monitor for bleeding, stop week before surgery. Use tylenol when bleeding concern
Contradicted by aspirin allergy, GI bleed, HTN, heart failure, Renal impairment
Vitamin K deficiency and Peptic ulcer disease place pt at risk for bleeding
1-2 dose per day
Less side effects/interactions then Advil, esp with ACE inhibitors and HTN
Aspirin
Other NSAIDs lack its antiplatelet effects, bleeding
Can be used in Lupus: anti-rheumatic effects
Only for 18 and up Reye’s syndrome
toxicity with tinnitus, hearing loss, dimness of vision
Celecoxib
Second generation NSAIDs
Used for pain/inflammation, esp OA, RA
Less side effects
Avoid in patients with Sulfa allergy
Black box warning: Double the risk for heart attack
Adverse effects include headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema, and hypertension
Nitroglycerin
Both rapid and long acting - Sublingual and IV infusion rapid
Contradicted only by Phosphodiesterase inhibitors
Contradicted by anemia, closed-angle glaucoma, hypotension, and head injury
Headaches usually subside with time, tolerance can develop, reflex tachycardia and postural hypotension side effect
potency is lost in about 3 months
Isosorbide mononitrate
Prevention and (long) treatment of angina
Can make someone dizzy, lightheaded. Teach slow position changes.
Contradicted only by Phosphodiesterase inhibitors
Contradicted by anemia, closed-angle glaucoma, hypotension, and head injury
Atorvastatin
Lower the rate of cholesterol production in the liver
LDL >190, or diabetes or CVD
Adverse effects: Rhabdomyolysis and renal failure. Muscle pain first, may cause jaundice and liver issue, which can lead to N/V
Interactions with oral anticoagulants
All statins are generally dosed once daily (late)
Gemfibrozil
Primarily affect the triglyceride levels, some positive effect on HDL/LDL
Contraindicated in liver or kidney disease (like Cirrhosis and Gallbladder disease)
Usually GI side effects. Risk for gallstone, blurry vision, headache
Interactions with oral anticoagulants and statins
Ezetimibe
Inhibits absorption of cholesterol. Reduces total cholesterol, LDL, and triglycerides
Can be used alone but often with statin
Cholestyramine
Bile Acid Sequestrants, second line choice after statins
Adverse: Constipation and GI blockage (HIGH Fiber)
Contradicted by PKU, Pregnancy and lactation, or loose bowel movements
Heartburn, nausea, belching, bloating usually relieved with time.
Can cause angioedema (call provider), rash and nassau.
All other drugs must be taken at least 1 hour before or 4 to 6 hours after
Niacin
Often used in combination as supplement
Effective in lowering triglyceride, total serum cholesterol, and LDL. Increases HDL
Side Effects: Flushing, itching/Pruritus and rash (antihistamine helps), GI distress
Start small and then increase dose size
Ginkgo biloba
Antioxidant and platelet inhibitor. Increases blood flow
Used to prevent memory loss, vertigo, tinnitus, peripheral arterial occlusion
Adverse effects: GI issues, Headache, Bleeding, Allergies, Allergic skin allergies
MANY potential interactions like anticoagulants including warfarin and NSAIDS.
St. John’s Wart
Herbal equivalent to Prozac for Depression, Anxiety, Sleep disorders, Nervousness
Contradicted: Bipolar depression, Schizophrenia, Alzheimer’s Disease, Dementia
Many interactions and many side effects, like upset GI, photosensitivity.
