Hem, MI, hyperlip Flashcards
Process of hemostasis
- Vascular injury/endothelial exposure- vasoconstrictive response- activation of platelets
- Adhesion- Glycoproteins and von willebrand factor-Binds platelets
- Activation- Platelets are activated
- Aggregation- With help from ADP, thrombin, thromboxane A1-Visable clot
- Formation of fibrin plug within blood clot
- CLot retraction and dissolution- fibrinolysis0 destroys clot
Coagulation cascade intrinsic vs extrinsic
I-Activation in response to injury of blood vessel
E- Activation when extravascular injury from surrounding tissue
What is the importance of vit k in clotting and one thing about it
Vit k makes 4 of the clotting factors. It is made from bacteria in the gut.
Where is heparin found and what is it?
IN liver, linning of blood vessles and animal tissue it is a carbohydrate
What is the drug of choice to tx thromboembolic disease
Heparin
MA for Heparin
and what does that do?
and one thing it does not do
Binds to antithrombin 111 inhibits thrombin and inactivates factor Xa
Prevents clots from forming or getting bigger and prolongs coagulation time
Breaks up existing clots
AE for heparin 4
Bleeding thrombocytopenia HIT, hypersensitivity, osteoporosis
Heparin Considerations 4 numbers with one
Appt- activated partial thromboplastin time Normal-25-35 therapy- 1.5-2.5x normal Don't let them fall HIT-< 150.000 Watch for bleeding
Warfarin other name and MA and 3 thing about it
Coumadin inhibits enzymes that form vit k most popular po anticoag Doesn't affect clotting factors that are already present so it take a 3-4 days to work Need to wat h PT/INR
Indications for warfarin 2
Anything that a clot can cause, prosthetic heart valve
PT INR values and what drug what does it stand for?
Warfarin
prothrombin time and international normalized ratio
normal-pt-11-13.5 INR .801.1
Therapy- 2.0-3.0
Warfarin adverse effects 4
Bleeding, osteoporosis, bone fractures, fetal death 1st trimester
What are theNC for warfarin? 3
NSAIDS, ACE, Asprin can increase anticoag effect
no ginkgo, garlic, cranberry, ginger- risk of bleeding
avoid K rich food- greens!
Dabigatran MA
two thing about it
AE-2
1 Consideration
MA-Inhibits the a tion of thrombin directly by binding to it.
No lab and quickly reversed
Bleeding, abrupt stop=Thrombolytic event
Contraindicated in patients with mechanical heart valves because of increased risk of stroke or bleeding
What drug do we use in patients who have a mechanical heart valve?
Warfarin
What are the antiplatelets?
Asprin, Adenosine diphosphate receptor blockers, glycoprotein 11b and 111a receptor blockers
Asprin MA and one two things about it
Binds to cyclooxygenase enzyme in platelets-inhibits formation of thromboxane A2 that is an activator of platelet aggregation
Single dose can last as long as a week and avoid other coag mod
Asprin Adverse effects 3
Hypersensitivity-bronchospasm-anaphylaxis, stomach ulcers, bleeding, pain, tinnitus
Clopidogrel Class and MA
one thing about it
and uses
AE-2ish
Blocks Adenosine diphosphate on platelets-ADP is needed to activate platelet aggregation
Inhibition of platelet function can last several days after drug is d/cd
Profolaxis for arterial thrmboembolism, stroke, MI
Bleeding few AD
ABCIXIMAB class and MA
IN- 2
AE 1
glycoprotein binds to 11b and 11a receptors on platelets prevents fibrinogen, von willi and other procoags
only IV
Coronary angioplasty, revascularization
AEAbnormal bleeding- can last ten days
What do thrombolitics do? what are the names when else do we give them when are they effective How are they given
Dissolve existing clots End in ase MI 20min-12hr IV ER
MA of thrombolytics
uses
AE
Converts plasminogen to plasmin-dissolves fibrin clots
Emergency-open clotted central lines and for other thrombocytes
bleeding
What is aminocaproic acid ma 2 uses Given? One adverse effect
Hemostatic Blocks plasminogen and plasmin- prevents digestion of clots excessive hemorrhage- surg Given IV Clots
Chronotropic, dromotropic, inotropic
Heart rate, Speed/conduction/ myocardial contractility
Chronotropic, dromotropic, inotropic
Heart rate, Speed/conduction/ myocardial contractility
2 things that cause brady
SA node dysfunction AV node block
Tachy problem and bpm
SA node rapid firing, 160-200
Atrial flutter
regular hr but 250-300 bpm
Atrial fib
chaotic firing, quivering, most common
Vent tachy vent fib
High risk of sudden death
cardiac arrest
How do we classify antidysrthmics
vaughn williams class 1 Na+ blockers 2 beta blockers 3 K+ channel blockers 4-Ca+ blockers other-adenosine and dig
Sodium channel blockers about 3
lg group of antidysR
classified 1a 1b 1c
they block the Na channel-prevent depolarization
reduce automaticity and slow impulse conduction so delays repolarization
What is the class anti d class drugs
!A procainamide
Procainamide class?
Tx?
how?
one thing
1A
tx Tachy cardias
suppresses dysR
used in CPR as a last resort
Procainamide AE 4
How is it given?
Bone marrow suppression BLOOD- might be fetal cardiotoxicity- worsen dysr severe hypotn Lupus like syndrome IV quick patient is supine
Lidocaine class MA 3 things it does
Blocks Na+ channels
slows conduction in all heart
reduces automaticity in vents and perkinje
Accelerates repolarization- decreases HR
Lidocaine AE
CNS effcts- drowsy confusion anxiety parethesias
further- convulsions, coma, respiratory arrest
What is the class 11 for antid 3 things it does Tx 2 things
Beta blockers propanolol
Blocks SNS activation, slow heart rate, reduce conduction velocity (speed)
TX- Increased bp and angina
Propanolol Contra and what is it for
Anti D
Severe brady, lung stuff
Class 111 what is it drugs?
Name
MA-2
One advantage
K+ channel blockers amiodarone block k+ from leaving delays repo block na and ca channels
AE of amiodarone 3
and one thing
cardiotoxicity black box- pulm tox-itis and pulm fibrosis need lung tests infant hypothyroidism CNS reactions hypotn Visual disturbances can lead to blindness rashes blue skin atax, dizzy, trem, mood, halucinacions lots of drug interactions effects can last 4-6 weeks
What is class 4 and drugs and what to watch for
nondihydropyridines
vamoamil and diltiazem
hypotn and brady
What is the miscellaneous antid
ma-2
2 things about it
3 things about admin
Adenosine
causes potassium to leave the cell blocks reentry pathways to the SA and AV nodes
causes 1-5 seconds of asystole
SHORT half life
given for PSVT
Need to have doc present, must be supine, risk of severe hypoTN or death
What is the second miscellaneous drug
What is it for
MA
SE- 1
Dig
a fib or flutter PSVT
MA-decreases automotisity of AV node
prodysr effect
What drugs cause prodysrythmic effects? and one thing to remember about it
Class 1, 111, and mis
ben needs to outweigh ben
What is hypertn
BP 130/80
What are the Anti anginal drugs
Organic Nitrates beta blockers ccbs
what is the goal for antiangina 5
decrease frequency and intensity, and increase activity tolerance
reduce workload of the heart by reducing hr and and reducing afterload prevent vasopasm promote dilation reduce pain
What does nitro do? 3
Increases vasodilation of the coronary arts
relaxes art and venous smooth mm
decreases preload
Nitro AE
contraindications
vasodilation s/s
hypotn, shock, head injury, truama
Beta blocker name for MI and 3 MA
one thing about it
s/s
one contraindication
Atenolol decreases cardiac workload by blocking receptors in the heart reduces HR and contractility
Selective for beta 1 so no lungs
All hypotension signs
patients with ischemic heart disease no abrupt stop can worsed angina or cause MI
What do the ccbs do? 4 name? adverse effects?
Vera and dil relax smooth mm and decrease bp reduction in afterload decrease hr dilate coronary arts hypo brady stuff
Tx for MI
Thrombolytics- ase
asprin blood thinner
nitro dilator
betablockers reduce HR BP and contractility
ACE inhib-help prevent remodeling and dysr
Pain meds
How to give asprin for MI
and daily dose?
325mg chew and swallow
81 mg
Explain lipids
Triglycerides
phospholipids
steroids
tri- Stored fat used as energy
make plasma membranes
steroirds-cholesterol- component of all cell membranes produced by the liver found in food but we don’t need an outside source
HDL, LDL, VLDL and levels and total value
H-protein- greater than 60
L-cholesterol less than 100
v-triglycerides less than 150
total- less than 200
5 drug classes for lip
statins, bile acid sequetrants
niacin fibric acid and micellaneous
What are the three statins
Atro-first choice
lova- pm with empty stomach
simva-pm with or without food
Atrovastatin MA and ae 4 teaching 1
inhibit HMG-coa reductase reducing chole being made by the liver the liver will increase LDL receptors and remove more LDL
myopathy/ rhabdomyolysis, GI discomfort, hepatotoxicity, teratogenic cat x
no grapefruit or gj-inhibits metabolism
Off label benefits of statins 4
Enhance ability of blood vessels to dilate, protect against alz, lower colorectal cancer and migraines
Name of bile acid MA 2 three teaching what is it good for? 3 AE one
cholestyramine
Binds to bile acids in intestines forming insuluble complex that contains cholesterol, eliminated in feces
and liver makes more LDL receptors
mix with 60-180ml if water drink right away takes 1month
interferes with vit and minerals
decreases puritis with bil obstruc and is good for cdiff and diarrhea
All gi and steatorrhea
Niacin b complex
MA 3
2 points
AE 6
Decreases production og VLDLS
lowers LDL and triglycerides
Increases HDL kind of
Need high dose 2-3g can take a long time
flushing, paresthesia, Gi issues, gout, hepatotoxicity, raises glucose
Fibric acid drug name MA 3 AE 1 CI 3 2 teaching
Gemfibrozil
activates lipoprot lipase to breakdown and eliminate triglycerides in the plasma
inhibits the breakdown of stored fat
mostly for triglycerides secondline for those who cant use statins
GI discomfort
ci in hepatic impairment and gallbladder disease
take with food
caution in kidneys
what is the other fibric acid drup
fenofibrate
give once a day instead of twice
monitor liver
can cause myopathy and rhabdo when given with a statin
Ezetimibe
MA 2
CHOLESTEROL ABSORB INHIBITOR IN SM INTESTINE lowers LDL in blood First line misc sometimes combined with statins 1x a day not many side effects
What fat is bad?
Saturated fat
