Exam 4

Question 1

Atorvastatin MOA

Answer 1

• Inhibits cholesterol synthesis by the liver
• HMG-CoA Reductase inhibitor
• Decreases LDL, raises HDL, stabilizes plaques within vessels

Question 2

Atorvastatin ADEs

Answer 2

• Mild GI disturbances
• Rhabdomyolysis (breakdown of muscle tissue)
• Hepatotoxicity
• Myopathy (muscle pain)
• New onset- diabetes

Question 3

Atorvastatin PT teaching

Answer 3

• Avoid NSAIDs and tylenol; use warm compresses for pain
• Avoid grapefruit & alcohol intake
• increase fluid intake to reduce renal stress
• contraindicated for pregnancy
• Take at night (cholesterol synthesis occurs at night)

Question 4

Atorvastatin MONITORing

Answer 4

• Obtain baseline LFTs then monitor LFTs
• Watch for tea colored urine
• Watch for proteins and RBCs in urine
• Lipid panel

Question 5

Bile Acid sequestrants (Colesevelam) MOA

Answer 5

• Used in adjunct to statins
• Binds to bile acids to prevent LDL absorption
• Increases LDL excretion
• Creates positive feedback loop –> Body makes more bile salts due to increases excretion which also increases LDL excretion

Question 6

Bile Acid Sequestrants ADEs

Answer 6

• Constipation

Question 7

Bile Acid Sequestrants PT Teaching

Answer 7

• Increase fluid, fiber, and exercise to counter constipation
• Must space other drugs to not disrupt absorption: take other drugs either 1 hour before BAS, or take other drugs 4 hours after BAS taken

Question 8

Ezetimibe MOA

Answer 8

• Acts of brush border of small intestine to block cholesterol absorption and bile reabsorption
• Used if pt is on high dose statin with little effect on LDL levels

Question 9

Nitroglycerin MOA

Answer 9

• Vasodilation of vascular smooth muscle
• Decrease in venous return –> Decrease in ventricular filling –> decrease in preload = eases stress on heart
• Decreases o2 demand
• Prevents vasospasm

Question 10

Nitroglycerin ADEs

Answer 10

• Reflex tachycardia
• Hypotension, orthostatic hypotension
• Lots of drug interactions

Question 11

Nitroglycerin PT Teaching

Answer 11

• Cannot chew or swallow = must dissolve sublingually
• Stop activity, rest, take a seat while dosing
• Keep in dry environment, no sunlight or moisture exposure
• Take at first sign of angina pain
• If first dose does not relieve pain, call 911 and take another dose (can take up to 3)
• Take frequent breaks with drug to minimize tolerance build up

Question 12

Other Nitro Notes

Answer 12

• Routes: sublingual, transdermal patch, topical ointment
• Sublingual fastest, patch 30-60 min onset
• Need to be off of drug for 8 hours daily to avoid tolerance build up
• Erectile dysfunction drugs can cause life-threatening hypotension interaction

Question 13

Heparin MOA

Answer 13

• Anticoagulant - prevention of clots
• Inhibits thrombin and factor Xa, inhibits fibrin production, enhances antithrombin activity
• Allows time for body to breakdown clot on it’s own, prevents clot from getting bigger
• Useful with venous thrombus

Question 14

Heparin ADEs

Answer 14

• Bleeding risk
• Heparin induced thrombocytopenia (HIT)
• Spinal or epidural hematoma
• Monitor platelet count (less than 100,000 is bad)

Question 15

Heparin PT Teaching

Answer 15

• Know signs and symptoms of hemorrhage
• Monitor for changes in urine and stool color
• Avoid NSAIDs including aspirin
• Use soft toothbrush and electric razor
• Avoid airplanes
• Change position and walk around often
• Wear compression socks and elevate legs often

Question 16

Other Heparin Notes

Answer 16

• Dosage is weight based
• Antidote: protamine sulfate
• Monitoring: PT and INR, platelet count
• Heparin elongates PT and INR (PT to 60-80 seconds, INR goal is 2-3)
• Only used IV in hospital
• Initial dose weight based, then based on aPTT time

Question 17

Enoxaparin

Answer 17

• Low molecular weight heparin
• Same as heparin, same ADEs as heparin
• Pt needs to be taught how to give at-home injection and risks associated
• Used for DVT prevention

Question 18

Warfarin MOA

Answer 18

• Anticoagulant; Vitamin K antagonist, suppresses clotting factors
• Used for long-term anticoagulant management, TIA prevention, Afib and stroke prevention, prevention of recurrent MI, thromboembolism
• Highly protein bound, take a long time to begin working, takes a long time to leave system
• Often used with pt’s with artificial heart valves

Question 19

Warfarin ADEs

Answer 19

• Bleeding risk
• Contraindicated for pregnancy
• MANY drug interactions

Question 20

Warfarin MONITORing

Answer 20

• Treatment objective is to raise INR to 2-3 (higher for heart valve pt’s)
• PT/INR
• Antidote: Vitamin K

Question 21

Warfarin PT Teaching

Answer 21

• Keep vitamin K dietary habits stable
• No grapefruit
• Know s&s of bleeding, hemorrhage
• Can remain in system even if stopped

Question 22

Dabigatran MOA

Answer 22

• Direct thrombin inhibitor
• Used for Afib, DVT, PE
• Preferred over warfarin as of recently
• Has rapid onset, no labs to monitor, more predictable than warfarin
• Antidote : Idarucizumab (Praxbind)

Question 23

Dabigatran ADEs

Answer 23

• Bleeding

- GI Disturbance - dyspepsia

Question 24

Rivaroxiban

Answer 24

• Direct factor Xa inhibitor
• First line drug for AFib
• Highly protein bound
• Contraindicated in pt’s with renal impairment, hepatic impairment, pregnancy

Question 25

Alteplase (tPA)

Answer 25

• Thrombolytic “clot buster”
• binds to plasminogen, promotes synthesis of plasmin to digest clot
• Used in acute MI, acute ischemic stroke, acute massive PE
• Contraindicated in pt’s with active internal bleed, cerebral vascular lesion, recent ischemic stroke
• Antidote : Aminocaproic Acid (Amicar)

Question 26

Aspirin MOA

Answer 26

• Antiplatelet; Suppresses platelet aggregation by irreversible inhibition of cyclooxygenase
• Only works in arterial vessels; prevents arterial thrombosis
• Used to prevent stroke, TIA, angina, and MI

Question 27

Aspirin ADEs

Answer 27

• Bleeding, especially GI

- Hemorrhagic stroke

Question 28

Clopidorgel (Plavix)

Answer 28

• P2Y12 ADP receptors on platelets
• Reduces MI and stroke risk, reduces stenosis in coronary arteries, used in PCI therapy
• ADEs: Hemolytic anemia, neuro dysfunction, Thrombotic thrombocytopenic purpura, bleeding
• Monitor platelets

Question 29

IV abciximab (ReoPro)

Answer 29

• Monoclonal antibody
• Reversibly blocks platelets, inhibits final step of aggregation
• Can be used with acute coronary syndrome, used in PCI therapy
• ADEs: Doubles the risk of bleeding at injury site, general bleeding

Question 30

Sacubitril / Valsartan (Enestro)

Answer 30

• Angiotensin receptor Neprilysin inhibitor (ARNI)
• Decreases BNP levels, suppresses negative RAAS effects
• Used for HF after diuretic
• ADEs: Angioedema, hyperkalemia, hypotension,
• Cannot be given within 36 hours of ACEi

Question 31

Digoxin MOA

Answer 31

• Cardiac glycoside; inhibits Na+/K+ ATP-ase pump in cardiac cells
• Suppresses AV node, increases contractility, increases cardiac output
• Second line agent for HF
• Check pulse before administration (hold if below 60)
• Antidote : Digibind

Question 32

Digoxin ADEs

Answer 32

• Cardiac dysrhythmias
• GI issues (n/v)
• CNS effects (fatigue)
• Changes in vision
• Narrow therapeutic range
• Monitor potassium levels. Hypokalemia can cause toxicity

Question 33

Drug treatment for stable angina

Answer 33

• Beta blockers
• Nitrates
• CCBs

Question 34

Drug treatment for unstable angina

Answer 34

• Nitrates

- CCBs