Exam 3-1

Question 1

Heparin

Answer 1

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

Question 2

Dabigatran

Answer 2

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

Question 3

Warfarin

Answer 3

Vitamin K antagonists

PT & INR, and liver function

long-term and slow thrombosis prevention

Orally, same time daily

Reduce bleeding risks

Question 4

Clopidogrel bisulfate

Answer 4

ADP Clot Blocker

Oral 300mg then 75 mg daily

Monitor for signs of bleeding

Contradicted in CVD

Question 5

tPA (Alteplase)

Answer 5

Thrombolytics - Clot buster

MI, ischemic strokes

5 min half life

Given through peripheral site that can be pinched

Monitor CARDIAC dysrhythmias and bleeding

Question 6

Enoxaparin sodium

Answer 6

Factor Xa Inhibitor for DVT/PE prevention

No monitoring needed, but only anticoag

Air bubble needed

Bridge to warfarin

Spinal hematoma/epidural catheter

Question 7

Apixaban & Rivaroxaban

Answer 7

Factor Xa Inhibitor - preventor

Oral dose on renal function, age, weight

Monitor all bleeding and renal (creatinine, GFR, BUN)

Spinal hematoma/epidural catheter

Question 8

Vitamin K

Answer 8

Warfarin antidote

Deficiency state, antibiotic therapy, melabsorp, infants

Question 9

Ferrous Sulfate

Answer 9

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

Question 10

Cyanocobalamin

Answer 10

B12

Many cell functions, like nerve speed

Should improve energy in deficiency

IM Delivery

Contradiction: COBALT, optic nerve atrophy, hypokalemia, diarrhea

Question 11

Epoetin Alfa

Answer 11

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

Question 12

Acetaminophen

Answer 12

Non-opioid analgesic Tylenol

Question 13

Ibuprofen

Answer 13

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

Question 14

Naproxen

Answer 14

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

Question 15

Aspirin

Answer 15

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

Question 16

Celecoxib

Answer 16

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

Question 17

Nitroglycerin

Answer 17

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

Question 18

Isosorbide mononitrate

Answer 18

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

Question 19

Atorvastatin

Answer 19

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)

Question 20

Gemfibrozil

Answer 20

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

Question 21

Ezetimibe

Answer 21

Inhibits absorption of cholesterol. Reduces total cholesterol, LDL, and triglycerides

Can be used alone but often with statin

Question 22

Cholestyramine

Answer 22

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

Question 23

Niacin

Answer 23

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

Question 24

Ginkgo biloba

Answer 24

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.

Question 25

St. John’s Wart

Answer 25

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.