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Pharmacology > Exam 8: Anticoag/Psych > Flashcards

Exam 8: Anticoag/Psych Flashcards

1
Q

anticoagulant

A

works against the formation of a clot - disrupt coag cascade

most effective on venous thrombosis (damage occurs at distant site like PE)

contra: risk of bleeding (uncontrolled hemorrhage, recent surgery, lumbar puncture, etc.)

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2
Q

antiplatelets

A

inhibit the platelet clumping/aggregation (clotting)

most effective on arterial thrombosis (localized damage)

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3
Q

thrombolytic

A

destroys existing clot - promote lysis of fibrin

tPA - speeds up the conversion of plasminogen to plasmin that degrades the fibrin mesh and breaks up a clot

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4
Q

indications for all

A

DVT, CVA, PE, procedures

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5
Q

ADRs for all

A

bleeding/hemorrhage, spinal/edidural hematoma, hemorrhagic stroke

always #1 concerned for hemorrhage (intracranial bleed)
AMS and projectile vomitting -> increased ICP

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6
Q

contras for all

A

uncontrolled bleeding, recent procedure/puncture

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7
Q

heparin

A

anticoagulant - high risk med
enhance antithrombin - prevent clots, doesn’t break down

rapid acting, SQ/IV

contra: thrombocytopenia

preferred during pregnancy

ADR: HIT, hypersensitivity, local irritation/ecchymosis

labs: antifactor Xa (0.3-0.7), aPTT (60-80 secs), platelet counts - every 6 hrs until stable and then less often and will titrate

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8
Q

HIT

A

immune - decreased platelet counts (occurs 2-5% of pts) -> monitor platelets closely (30% loss or more)
and worry about bleeding -> blue/purple fingers/toes

antibody formation -> lab = HIT immunoassay to detect

promotes thrombosis and loss of circulating platelets

immediately dc and notify provider

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9
Q

aPTT normal

A

40 secs

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10
Q

enoxaparin/dalteparin

A

anticoagulant - LMWH

MOA: inactivates factor Xa and thrombin

SQ/IV

comes in fixed (weight-based) dosing/does not require lab monitoring (at home)

same ADRs

more expensive than heparin

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11
Q

warfarin

A

anticoagulant - Vit K antagonist

PO - delayed onset (not for emerg), prevents activation of vit K (needed for VII, IX, X, and prothrombin)

preventative for Afib, DVT, MI/TIA

ADR: teratogenic, similar to heparin

many interactions - heparins, antiplatelets (bleeding), seizure meds, oral contraceptives, rifampin (decrease), antifungals, cimetidine, amiodarone (increase)

vitamin K foods -> don’t need to avoid, just need to make sure no spikes in vitamin K (steady)

labs: PT/INR (goal 2-3)

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12
Q

dabigatran

A

anticoagulant - direct thrombin inhibitor

PO -> empty stomach, compares to warfarin (less risk of bleeding, labs less often, faster onset, fixed dose, fewer interactions)

ADR: lower risk of bleeding than warfarin, GI

don’t need to check labs as often, stop 1-3 days prior to surgery

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13
Q

argatroban

A

anticoagulant - direct thrombin inhibitor

IV, used in place of heparin when HIT occurs

hypersensitivity w/thrombolytics or contrast media

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14
Q

rivaroxaban

A

anticoagulant - factor Xa inhibitor -> “xa” in the word (Xarelto)

PO, DVT/PE prophylaxis, check renal function, teratogenic, cannot use with hepatic issues

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15
Q

apixaban

A

anticoagulant - factor Xa inhibitor -> “xa” in the word

(Eliquis)

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16
Q

ASA

A

antiplatelet - aspirin

MOA: irreversibly inhibits COX enzyme 1 -> blocks synthesis of TXA2 so no platelet activation and no vasoconstrict

uses: stroke/TIA, angina, MI, bypass/stent

ADR: risk for GI bleed

**doubles bleeding for 7-10 days (lifetime of platelet), stop 1 wk before surg

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17
Q

clopidogrel/ticagrelor

A

antiplatelet - alone or w/ASA (for ACS)

MOA: ADP receptor antagonist - stops ADP stimulated platelet aggregation

uses: stents, CVA, ACS, PAD

ADR: TTP, GI, less bleeding than ASA

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18
Q

tirofiban

A

antiplatelet - GP IIa/IIIb antagonist **highlighted this drug in class

IV, most effective - “super ASA”, used w/ASA and heparin

use w/ACS during cath lab -> prevent reocclusion

reversible block of receptors, effects last 24 - 48 hours

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19
Q

alteplase/reteplase/tenecteplase

A

thrombolytics

dissolve existing thrombi -> convert plasminogen back to plasmin

acute use for MI/CVA/PE (low dose for central line)

alteplase = tPA

give blood products when ADR of bleeding

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20
Q

protamine sulfate

A

antidote to heparin, neutralizes

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21
Q

phytonadione

A

vitamin K antidote to warfarin, PO or IV= dilute first and infuse slow (anaphylaxis risk)

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22
Q

idarucizumab

A

antidote to dabigatran

23
Q

andexnet

A

antidote to rivaroxaban

24
Q

schizophrenia s/s

A

positive symptoms - hallucinations, delusions, agitation, and paranoia

negative symptoms - lack of motivation, blunt affect, social withdrawal

cognitive symptoms - disordered thinking, memory and learning difficulties, inattentiveness

25
Q

schizophrenia theory

A

excessive activation of CNS receptors for dopamine
insufficient activation of CNS receptors for glutamate

26
Q

FGA

A

“typical”, stronger block for dopamine

serious movement disorders (EPS) -> late sign = tardive dyskinesia (irreversible at this point)

ADRs: adrenergic block (hypoten, dizzy, drowsy), muscarinic block (constipation, blurred vision, dry mouth), histamine 1 block (sedation, drowsy, antiemetic), NMS (muscle rigid, fever, seizures, rhabdo), ortho hypotension, prolonged QT, sedation, sexual dysfunction, neuroendocrine (dec prolactin), agranulocytosis, addiction in neonates exposed

selected based off tolerability

27
Q

EPS

A

extrapyramidal symptoms

starts w/ dystonia (face grimacing and involuntary movements) and akathisia (restless)

late (irreversible) sign = tardive dyskinesia -> chewing motion, rolling tongue, involuntary movements

28
Q

EPS tx

A

decrease anticholinergics and decrease dose of FGA
Administer Benzodiazepines and switch to 2nd generation agent

29
Q

NMS

A

fever, encephalopathy, elevated creatinine kinase -> rhabdo, rigidity of muscles

tx: dc meds, cooling measures and benzos

30
Q

SGA

A

atypical, stronger block for serotonin, also approved for bipolar

ADRs: metabolic disorders (gain weight and inc cholesterol, DM), teratogenic, lower risk for EPS, agranulocytosis (clozapine), ortho hypo

31
Q

antipsychotics

A

primary = schizophrenia

SGA = also bipolar
inc in mortality for dementia related psychosis (CV death and pneumonia)

tourette’s, chemo N/V, behavioral problems, ETOH withdrawal, intractable hiccups

32
Q

haloperidol

A

typical antipsychotic (FGA) butyrophenones

other uses: in Tourette’s, ETOH withdrawal, behavior issue, CINV, agitation

ADRs: ortho hypo, prolong QT -> ventric, EPA, MORE

33
Q

chlorpromazine

A

FGA, low potency, prolong QT, tx intractable hiccups

34
Q

clozapine

A

SGA, most effective but greatest metabolic ADRs

**agranulocytosis - monitor CBC

35
Q

quetiapine

A

atypical antipsychotic

uses: sleep, agitation in acute settings

ADR: weight gain, dyslipidemia, DM

avoid getting out of bed quickly or drinking ETOH

36
Q

risperidone

A

SGA - schizo, bipolar, autism tx (sometimes dementia related psychosis)

ADRs: NMS, SI, mood changes

highest risk of EPS

37
Q

theory of depression

A

caused by functional deficiency of monamine neurotransmitters:

norepinephrine (alertness, concentration, energy)

serotonin (obsessions,compulsions, memory)

dopamine (pleasure/reward, motivation/drive)
or combination therein

38
Q

antidepressants

A

slow response (1 - 3 weeks for onset, 6 - 12 for peak)

4-8 weeks to assess efficacy, all equally effective, risk for suicide at beginning of tx, DC slowly -> withdrawal

39
Q

1st line antidepressants

A

SSRIs, SNRIs, buproprion, mirtazipine

more ADRs and less use: TCAs and MAOIs

40
Q

benzodiazepines

A

reactive depression -> following an event, short term

41
Q

SSRI

A

fluoxetine, sertraline, citalopram

MOA: Selectively block the reuptake of serotonin (5HT)

can gradually decrease the dose when symptoms improve

ADR: weight gain, SSSS (stomach upset, sexual dys, serotonin syndrome, suicidal thoughts), teratogenic

^why would someone not take?

42
Q

“effective for sadness, panic, compulsion”

A

escitalopram
fluoxetine
sertraline
paroxetine
citalopram

remember SSRIs

43
Q

SNRI

A

duloxetine, venlafaxine

MOA: Block neuronal reuptake of serotonin and NorEpinephrine (NE),
with minimal/weak effects on other transmitters or receptors

ADRs: same as SSRI, plus HTN

also tx diabetic neuropathy, fibromyalgia

44
Q

TCA

A

amitriptyline, imipramine

MOA: Blocks the uptake of norepinephrine & serotonin (5HT)

blocks Alpha 1 (ortho hypo), histam 1 (sedation), muscarinic (anticholinergic effects), diaphoresis, cardiac tox, seizures, hypomania, SI

toxicity can be lethal, cannot combine with other serotonin agents, w/MAOIs = HTN crisis

45
Q

MAOIs

A

selegiline - transdermal (also used for Parkinson’s in lower dose)

MOA: inhibit the enzyme (MAO) that inactivates the neurotransmitters so more of them in brain; nonselective A & B

inactivates tyramine

older med, don’t use anymore, need to wait 2 weeks between switching from another drug

HTN crisis w/dietary tyramine -> ask to list the foods from last week; serotonin synd w/ other meds

46
Q

tyramine rich foods

A

dairy (cheese, cream), bananas, avo, caffeine, liver, cured meats, soy sauce, wine, beer, overripe fruit

47
Q

Atypical

A

Buproprion

MOA unclear, maybe blocks reuptake -> increases dopamine and norepi

less ADRs than SSRIs but seizures (contra: eating disorders)

can be used for smoking cessation

no sexual dysf and weight loss instead of gain

CNS stim and sim to meth, can test positive on UA

48
Q

St. Johns Wort

A

drug interactions w/ other meds -> serotonin syndrome

49
Q

serotonin syndrome

A

combo of any: SSRIs, MAOIs, tricyclics, St. Johns wort, lithium

excess accumulation of serotonin

fever, tachy, mydriasis, agitation -> AMS, rhabdo, shivering, hyperreflexia & myoclonus, seizures, coma, can cause death

50
Q

lithium

A

narrow thera range (0.5 - 1.0 mEq/L) -> serum levels (tox above 1.5; 2.5 = death)

most concerned about sodium levels -> lithium not excreted as much when sodium is low (retains lithium to compensate)

ADRs: dry mouth, thirst, polyuria (antagonizes ADH), weight gain, distal edema, metallic taste, muscle weakness and tremors w/tox

interactions: diuretics, ACEis (sodium loss), NSAIDs (increase reabsorption up to 60%), anticholinergics (urinary hesitancy)

51
Q

valproate/carbamezapine/lamictal

A

AEDs - antiepileptic drugs

effective mood stabilizers -> valproate is 1st line now for bipolar

52
Q

methylphenidate

A

(ritalin) CNS stimulant for ADD/ADHD; many routes and ER/SR (concerta/daytrana patch - long release)

MOA:?

increase attention span, heighten alertness, and increase focus

can lose effect after 2-3 years but gives window for therapy

ADRs: initially insomnia and growth suppression, anorexia and weight loss

instruct to take early in the day to minimize interference w/meals
no coffee
high abuse potential (sch 2)

53
Q

Atomoxetine

A

nonstimulant

black box for SI

ADRs: SI, HTN, tachy, appetite suppression

54
Q

guanfacine & clonidine

A

alpha 2 adrenergic agonists

originally for HTN

ADRs: somnolence, weight gain, hypotension

Pharmacology (12 decks)

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