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pharm 2 > Hem, MI, hyperlip > Flashcards

Hem, MI, hyperlip Flashcards

1
Q

Process of hemostasis

A
  1. Vascular injury/endothelial exposure- vasoconstrictive response- activation of platelets
  2. Adhesion- Glycoproteins and von willebrand factor-Binds platelets
  3. Activation- Platelets are activated
  4. Aggregation- With help from ADP, thrombin, thromboxane A1-Visable clot
  5. Formation of fibrin plug within blood clot
  6. CLot retraction and dissolution- fibrinolysis0 destroys clot
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2
Q

Coagulation cascade intrinsic vs extrinsic

A

I-Activation in response to injury of blood vessel

E- Activation when extravascular injury from surrounding tissue

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3
Q

What is the importance of vit k in clotting and one thing about it

A

Vit k makes 4 of the clotting factors. It is made from bacteria in the gut.

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4
Q

Where is heparin found and what is it?

A

IN liver, linning of blood vessles and animal tissue it is a carbohydrate

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5
Q

What is the drug of choice to tx thromboembolic disease

A

Heparin

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6
Q

MA for Heparin
and what does that do?
and one thing it does not do

A

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

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7
Q

AE for heparin 4

A

Bleeding thrombocytopenia HIT, hypersensitivity, osteoporosis

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8
Q

Heparin Considerations 4 numbers with one

A 
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
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9
Q

Warfarin other name and MA and 3 thing about it

A 
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
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10
Q

Indications for warfarin 2

A

Anything that a clot can cause, prosthetic heart valve

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11
Q

PT INR values and what drug what does it stand for?

A

Warfarin
prothrombin time and international normalized ratio
normal-pt-11-13.5 INR .801.1
Therapy- 2.0-3.0

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12
Q

Warfarin adverse effects 4

A

Bleeding, osteoporosis, bone fractures, fetal death 1st trimester

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13
Q

What are theNC for warfarin? 3

A

NSAIDS, ACE, Asprin can increase anticoag effect
no ginkgo, garlic, cranberry, ginger- risk of bleeding
avoid K rich food- greens!

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14
Q

Dabigatran MA
two thing about it
AE-2
1 Consideration

A

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

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15
Q

What drug do we use in patients who have a mechanical heart valve?

A

Warfarin

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16
Q

What are the antiplatelets?

A

Asprin, Adenosine diphosphate receptor blockers, glycoprotein 11b and 111a receptor blockers

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17
Q

Asprin MA and one two things about it

A

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

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18
Q

Asprin Adverse effects 3

A

Hypersensitivity-bronchospasm-anaphylaxis, stomach ulcers, bleeding, pain, tinnitus

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19
Q

Clopidogrel Class and MA
one thing about it
and uses
AE-2ish

A

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

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20
Q

ABCIXIMAB class and MA
IN- 2
AE 1

A

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

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21
Q 
What do thrombolitics do?
 what are the names
when else do we give them 
when are they effective 
How are they given
A 
Dissolve existing clots 
End in ase
MI 
20min-12hr
IV ER
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22
Q

MA of thrombolytics
uses
AE

A

Converts plasminogen to plasmin-dissolves fibrin clots
Emergency-open clotted central lines and for other thrombocytes
bleeding

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23
Q 
What is aminocaproic acid
ma
2 uses
 Given?
One adverse effect
A 
Hemostatic
Blocks plasminogen and plasmin- prevents digestion of clots 
excessive hemorrhage- surg 
Given IV 
Clots
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24
Q

Chronotropic, dromotropic, inotropic

A

Heart rate, Speed/conduction/ myocardial contractility

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25
Q

Chronotropic, dromotropic, inotropic

A

Heart rate, Speed/conduction/ myocardial contractility

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26
Q

2 things that cause brady

A

SA node dysfunction AV node block

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27
Q

Tachy problem and bpm

A

SA node rapid firing, 160-200

28
Q

Atrial flutter

A

regular hr but 250-300 bpm

29
Q

Atrial fib

A

chaotic firing, quivering, most common

30
Q

Vent tachy vent fib

A

High risk of sudden death

cardiac arrest

31
Q

How do we classify antidysrthmics

A 
vaughn williams class
1 Na+ blockers 
2 beta blockers 
3 K+ channel blockers 
4-Ca+ blockers
other-adenosine and dig
32
Q

Sodium channel blockers about 3

A

lg group of antidysR
classified 1a 1b 1c
they block the Na channel-prevent depolarization
reduce automaticity and slow impulse conduction so delays repolarization

33
Q

What is the class anti d class drugs

A

!A procainamide

34
Q

Procainamide class?
Tx?
how?
one thing

A

1A
tx Tachy cardias
suppresses dysR
used in CPR as a last resort

35
Q

Procainamide AE 4

How is it given?

A 
Bone marrow suppression BLOOD- might be fetal 
cardiotoxicity- worsen dysr 
severe hypotn 
Lupus like syndrome 
IV quick patient is supine
36
Q 
Lidocaine 
class
MA 
3 things it does
A

Blocks Na+ channels
slows conduction in all heart
reduces automaticity in vents and perkinje
Accelerates repolarization- decreases HR

37
Q

Lidocaine AE

A

CNS effcts- drowsy confusion anxiety parethesias

further- convulsions, coma, respiratory arrest

38
Q 
What is the class 11 for antid 
3 things it does 
Tx 2 things
A

Beta blockers propanolol
Blocks SNS activation, slow heart rate, reduce conduction velocity (speed)
TX- Increased bp and angina

39
Q

Propanolol Contra and what is it for

A

Anti D

Severe brady, lung stuff

40
Q

Class 111 what is it drugs?
Name
MA-2
One advantage

A 
K+ channel blockers 
amiodarone 
block k+ from leaving 
delays repo
block na and ca channels
41
Q

AE of amiodarone 3

and one thing

A 
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
42
Q

What is class 4 and drugs and what to watch for

A

nondihydropyridines
vamoamil and diltiazem
hypotn and brady

43
Q

What is the miscellaneous antid
ma-2
2 things about it
3 things about admin

A

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

44
Q

What is the second miscellaneous drug
What is it for
MA
SE- 1

A

Dig
a fib or flutter PSVT
MA-decreases automotisity of AV node
prodysr effect

45
Q

What drugs cause prodysrythmic effects? and one thing to remember about it

A

Class 1, 111, and mis

ben needs to outweigh ben

46
Q

What is hypertn

A

BP 130/80

47
Q

What are the Anti anginal drugs

A

Organic Nitrates beta blockers ccbs

48
Q

what is the goal for antiangina 5

A

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

49
Q

What does nitro do? 3

A

Increases vasodilation of the coronary arts
relaxes art and venous smooth mm
decreases preload

50
Q

Nitro AE

contraindications

A

vasodilation s/s

hypotn, shock, head injury, truama

51
Q

Beta blocker name for MI and 3 MA
one thing about it
s/s
one contraindication

A

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

52
Q

What do the ccbs do? 4 name? adverse effects?

A 
Vera and dil
relax smooth mm and decrease bp
reduction in afterload
decrease hr 
dilate coronary arts 
hypo brady stuff
53
Q

Tx for MI

A

Thrombolytics- ase
asprin blood thinner
nitro dilator
betablockers reduce HR BP and contractility
ACE inhib-help prevent remodeling and dysr
Pain meds

54
Q

How to give asprin for MI

and daily dose?

A

325mg chew and swallow

81 mg

55
Q

Explain lipids
Triglycerides
phospholipids
steroids

A

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

56
Q

HDL, LDL, VLDL and levels and total value

A

H-protein- greater than 60
L-cholesterol less than 100
v-triglycerides less than 150
total- less than 200

57
Q

5 drug classes for lip

A

statins, bile acid sequetrants

niacin fibric acid and micellaneous

58
Q

What are the three statins

A

Atro-first choice
lova- pm with empty stomach
simva-pm with or without food

59
Q

Atrovastatin MA and ae 4 teaching 1

A

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

60
Q

Off label benefits of statins 4

A

Enhance ability of blood vessels to dilate, protect against alz, lower colorectal cancer and migraines

61
Q 
Name of bile acid 
MA 2
three teaching 
what is it good for? 3
AE one
A

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

62
Q

Niacin b complex
MA 3
2 points
AE 6

A

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

63
Q 
Fibric acid drug 
name
MA 3
AE 1
CI 3
2 teaching
A

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

64
Q

what is the other fibric acid drup

A

fenofibrate
give once a day instead of twice
monitor liver
can cause myopathy and rhabdo when given with a statin

65
Q

Ezetimibe

MA 2

A 
CHOLESTEROL ABSORB INHIBITOR IN SM INTESTINE 
lowers LDL in blood
First line misc 
sometimes combined with statins 
1x a day 
not many side effects
66
Q

What fat is bad?

A

Saturated fat

pharm 2 (8 decks)

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