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NURS 424 > Hematology/acne > Flashcards

Hematology/acne Flashcards

1
Q

Virchow’s triad

A

Thrombophilic abnormalities, vascular endothelial injury, stasis

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2
Q

Warfarin: MOA

A

Inhibits synthesis of vitamin K dependent clotting factors (e.g. factor X, IX, VII, II)

Decline of clotting factors is function of long half lives (can be as long as 3-4 days until see Warfarin effects)

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3
Q

Heparin: MOA

A

Accelerates activity of antithrombin III –> inactivates thrombin and other anticoagulation factors (factor Xa)

Prevents conversion of fibrinogen to fibrin

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4
Q

Warfarin: indications

A

Thrombosis, embolism, afib, prosthetic heart valves

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5
Q

LMWH: MOA

A

Accelerates activity of antithrombin III and inactivates factors Xa and IIa (thrombin)

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6
Q

Heparin: indications

A

Prevention of postoperative thromboembolism

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7
Q

LMWH: indications

A

DVT and/or pulmonary embolism, prophylaxis

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8
Q

Dabigatran (Pradaxa): indications

A

Reducing risk of stroke and systemic embolism in patients with nonvalvular afib

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9
Q

Dabigatran (Pradaxa): MOA

A

Direct thrombin inhibitor

Thrombin required for the conversion of fibrinogen to fibrin in clotting cascade

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10
Q

Rivaroxaban, Apixaban, Edoxaban, Betrixaban: indications

A

Treatment of DVT and/or pulmonary embolism, reduction of stroke and systemic embolism in nonvalvular afib

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11
Q

Rivaroxaban, Apixaban, Edoxaban, Betrixaban: MOA

A

Direct factor Xa inhibitors

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12
Q

What are the steps to platelet adhesion?

A

1) Platelet receptor binds to von Willebrand factor, bridging platelet to injury site
2) Mediators are released - serotonin and histamine–> immediate vasoconstriction
3) Reduction in blood flow and bleeding
4) Vasodilation to permit inflammatory process to occur

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13
Q

Aspirin: indications

A

MI and stroke prevention, acute coronary syndrome

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14
Q

Aspirin: MOA

A

Irreversibly antagonizes COX pathway which interferes with platelet aggregation

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15
Q

Concurrent use with what medication is contraindicated with anticoagulant therapy?

A

NSAIDS (also act on the cyclooxyrgenase pathway like ASA)

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16
Q

Clopidrogel (Plavix): indications

A

Unstable angina, recent MI, acute coronary syndrome

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17
Q

Clopidrogel (Plavix): MOA

A

Reduces platelet aggregation by inhibiting the ADP pathway

Unlike ASA, has no effect on prostaglandins

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18
Q

What medication can be used as a substitute if ASA is contraindicated?

A

Clopidrogel (Plavix)

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19
Q

Heparin: absorption and distribution

A

Not absorbed by the GI tract –> must be given IV or SC

Distributed in plasma and highly protein bound

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20
Q

LMWH: absorption and distribution

A

Not absorbed by the GI tract –> must be given IV or SC

Distributed in plasma and have limited or no protein binding

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21
Q

Warfarin: absorption and distribution

A

Rapidly and completely absorbed orally

Serum levels found in 1-2 hours but anticoagulant effects dependent on depletion of clotting factors (factor II has a half-life of 72 hours) –> full effect does not occur for 3-4 days

Highly bound to plasma protein

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22
Q

Aspirin: absorption and distribution

A

Rapidly and completely absorbed after oral administration

Protein binding highest with low plasma concentrations and lower with high concentrations

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23
Q

Heparin: contraindications

A

Advanced hepatic/renal impairment, pregnancy

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24
Q

Heparin: cautions

A

When combining with conditions that may predispose to hyperkalemia or drug regimens

Compatible with lactation

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25
Q

Heparin: adverse effects

A

Thrombocytopenia, anemia, hyperkalemia

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26
Q

LMWH: contraindications

A

Allergies to pork, sulfites, or benzyl alcohol

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27
Q

LMWH: cautions

A

Renal impairment, untreated hypertension, retinopathy, severe liver disease

Compatible with pregnancy and lactation

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28
Q

LMWH: adverse effects

A

Anemia, hemorrhage, peripheral edema

Monitor platelet levels, hematocrit, aPTT

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29
Q

Warfarin: contraindications

A

BLACK BOX WARNING: fetal bleeding

Avoid in pregnancy (safe in lactation)

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30
Q

Warfarin: cautions

A

Hepatic impairment that may enhance response

Maintain stable intake of foods high in vitamin K

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31
Q

Warfarin: adverse effects

A

Hemorrhagic skin necrosis and cyanotic toes, rare allergic reactions with maculopapular rash eruption

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32
Q

Dabigatran (Pradaxa): contraindications

A

BLACK BOX WARNING: discontinuation may cause increase in thrombotic events (antidote: idarucizumab)

BLACK BOX WARNING: spinal interventions (e.g. epidural) may cause spinal hematomas

Not safe in pregnancy and lactation

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33
Q

Dabigatran (Pradaxa): adverse effects

A

Dyspepsia, gastritis, hemorrhage (rare)

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34
Q

Rivaroxaban, Apixaban, Edoxaban, Betrixaban: contraindications

A

BLACK BOX WARNING: discontinuation may cause increase in thrombotic events

BLACK BOX WARNING: spinal interventions (e.g. epidural) may cause spinal hematomas

Not safe in pregnancy and lactation

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35
Q

Rivaroxaban, Apixaban, Edoxaban, Betrixaban: adverse effects

A

Hemorrhage common among all

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36
Q

Rivaroxaban: adverse effects

A

Back pain, abdominal pain, osteoarthritis, dyspepsia

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37
Q

Rivaroxaban: contraindications

A

Patients with moderate/severe liver impairment, creatinine clearance <30

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38
Q

Apixaban and Edoxaban: cautions

A

Moderate liver impairment

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39
Q

Edoxaban: contraindications

A

Severe liver impairment or creatinine clearance <15

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40
Q

Edoxaban antidote

A

Andexanet alpha (Andexxa)

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41
Q

Apixaban: cautions

A

Moderate liver impairment

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42
Q

Apixaban: contraindications

A

Severe renal impairment

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43
Q

Aspirin: cautions

A

Prevent preeclampsia in pregnancy, low-dose aspirin safe in lactation

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44
Q

Aspirin: contraindications

A

Children who have influenza or chicken pox, creatinine clearance <10, severe liver disease

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45
Q

Aspirin: adverse effects

A

Bleeding, GI ulcer, angioedema, Steven Johnson syndrome

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46
Q

Clopidrogel (Plavix): cautions

A

Use in pregnancy and lactation ONLY if indicated

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47
Q

Clopidrogel (Plavix): contraindications

A

Severe hepatic disease or patients with GI ulcers

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48
Q

Clopidrogel (Plavix): adverse effects

A

Bleeding, Steven Johnson syndrome (rare)

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49
Q

ASA may enhance the effectiveness and increase risk of bleeding with what anticoagulant?

A

Clopidrogel (Plavix)

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50
Q

When is the best time to check patient INR levels?

A

In the morning (patient should take warfarin in the evening)

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51
Q

Patient education: anticoagulants

A

Taken at the same time each day (even if feeling well), missed doses should be taken as soon as remembered the same day, doses should NOT be doubled, HCP should be informed of missed doses, maintain stable vitamin K diet (no increase/decrease), avoid OTC drugs (NSAIDS, ASA, cold remedies)

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52
Q

What can enhance/inhibit the absorption of iron?

A

Enhance: vitamin C
Inhibit: eggs and milk

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53
Q

True/False

The body has no mechanism for excretion of iron

A

True - iron balance achieved through control of the amount of iron absorbed in the gut

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54
Q

Ferrous sulfate (20% elemental iron): MOA

A

Replaces iron found in hemoglobin, myoglobin, and other enzymes

Most easily absorbed and cost-effective

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55
Q

Ferrous sulfate is based on ___

A

Elemental iron

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56
Q

Ferrous sulfate: adverse effects

A

Constipation, dark green/black stools

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57
Q

Common causes of folic acid deficiency

A

Inadequate dietary intake of green vegetables or excessive boiling

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58
Q

Folic acid: MOA

A

Required for nucleoprotein synthesis and maintenance of normal erythropoiesis

Within three months of inadequate folate intake, megaloblastic change and anemia develop

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59
Q

Folic acid: contraindications

A

Administration when vitamin B12 is deficient

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60
Q

Vitamin B12: MOA

A

1) cofactor in metabolism of methylmalonyl-CoA –> when metabolism doesn’t happen there is a buildup of fatty acids –> neurologic manifestations
2) vitamin B12 deficiency prevents the final steps of folate metabolism (causes megaloblastic anemia) –> corrected with folic acid supplementation

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61
Q

Vitamin B12: indications

A

Pernicious anemia (lifetime admin), vitamin B12 deficiency

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62
Q

Vitamin B12: adverse effects

A

Hypokalemia, diarrhea, pruritic, urticaria, anaphylactic shock

63
Q

Pathophysiology of acne

A

Sebaceous glands produce too much sebum which mixes with dead skin cells –> both substances form a plug in the follicle

64
Q

Whiteheads

A

If plugged follicle is close to the surface of the skin, will bulge outwards

65
Q

Blackheads

A

If plugged follicle is open to the skin

66
Q

Papules, pustules, cyst (acne)

A

When harmless bacteria that live on the skin contaminate and infect plugged follicles

67
Q

Mild comedonal acne

A

Open blackheads and closed whiteheads

68
Q

Mild to moderate inflammatory acne

A

Papules, pustules, or both

69
Q

Moderate to severe acne

A

Nodules and cysts (painful)

70
Q

What are the types of medications that are used to treat acne?

A

Topical retinoids or antibiotics, oral antibiotics

71
Q

Examples of topical retinoids

A

Tretinoin (Retin-A), Adapalene (Differin), Tazarotene

72
Q

Tretinoin (Retin-A): MOA

A

Reduce cohesion between keratinized cells –> fragmentation and expulsion of the micro plug, expulsion of comedones, conversion of closed to open comedones

Prevention of new comedone formation with continued use

Act specifically on microcomedones

73
Q

Tretinoin (Retin-A): patient education

A

Has NO antibacterial properties against P. acnes

Enhances penetration of other topical agents (e.g. topical antibiotics, benzoyl peroxide)

May cause hypo/hyperpigmentation

74
Q

Adapalene: MOA

A

For mild/moderate acne

Binds to specific retinoic acid receptors –> normalizes the differentiation of follicular epithelial cells –> decreased microcomedone formation

Modulator of cellular differentiation, keratinization, and inflammatory process

75
Q

Tazarotene: MOA

A

Normalizes epidermal differentiation and reducing influx of inflammatory cells into the skin

76
Q

Tazarotene: patient education

A

DO NOT use in pregnancy

77
Q

Examples of topical antibiotics used to treat acne

A

Benzoyl peroxide, erythromycin, clindamycin, azelaic acid, salicylic acid

78
Q

First line therapy for mild acne

A

Benzoyl peroxide

79
Q

Benzoyl peroxide: MOA

A

Release of active or free-radical oxygen capable of oxidizing bacterial proteins, removes excess sebum

80
Q

Benzoyl peroxide: side effects

A

Drying effect, mild desquamation, photosensitivity

81
Q

Benzoyl peroxide: patient education

A

Can bleach clothing/towels, safe in pregnancy and children >12 years old

DO NOT apply at the same time as topical retinoids

82
Q

Erythromycin + Clindamycin: MOA

A

Interrupts bacterial protein synthesis at the 50S ribosomal subunit

83
Q

What medications can be used in combination with benzoyl peroxide?

A

Erythromycin and clindamycin when used separately

84
Q

True/False

Erythromycin and clindamycin can be used together to treat acne

A

True - reduces bacterial resistance

85
Q

Clindamycin: patient education

A

Monitor for diarrhea (sign of colitis) –> discontinuation

86
Q

Clindamycin: contraindications

A

Crohn’s, ulcerative colitis, antibiotic associated colitis

87
Q

Azelaic acid: MOA

A

Inhibition of microbial cellular protein synthesis

Decreases inflammation associated with acne lesions by reducing the concentration of bacteria present in the skin

Normalization of keratinization –> anticomedonal effect

88
Q

What is first line OTC therapy for mild acne?

A

Salicylic acid

89
Q

Salicylic acid: MOA

A

Exfoliant used to clear comedones, has mild anti-inflammatory effects

90
Q

General topical retinoid precautions and contraindications

A

Avoided in patients with eczema, sunburn, skin abrasions at site of application, lactating women

Should NOT be used at the same time as topical antibiotics (can cause skin irritation)

91
Q

Topical retinoid adverse effects

A

Burning/pruritus after application common

Scaling, erythema, xerosis, peeling

92
Q

Topical antibiotic adverse effects

A

Dryness, erythema, burning, peeling, itching

93
Q

General patient education (topical retinoids/antibiotics)

A

Acne may be worse in the beginning, may take 6-8 weeks before effects are seen, wear sunscreen

94
Q

True/False

Topical retinoids should not be applied to the same area as topical antibiotics and/or benzoyl peroxide

A

True

95
Q

Example of a systemic retinoid to treat acne

A

Isotretinoin (Accutane)

96
Q

Isotretinoin (Accutane): MOA

A

Reduces sebum production by reducing sebaceous gland size, normalizing follicular keratinization and indirectly reducing P. acnes and its inflammatory sequela

97
Q

Isotretinoin (Accutane): adverse effects

A

Chelitis, dry skin and fragility, hypertriglyceridemia, elevation of glucose levels, HA, lethargy, fatigue, arthralgia/myalgia, visual disturbances, GI reactions

98
Q

What medications would you prescribe to treat: noninflammatory comedonal acne?

A

Topical retinoid OR benzoyl peroxide

99
Q

What medications would you prescribe to treat: inflammatory papulopustular acne?

A

Topical combination therapy of topical antibiotic OR retinoid + benzoyl peroxide

100
Q

What medications would you prescribe to treat: severe inflammatory acne?

A

Oral antibiotic + topical combination therapy of topical antibiotic/retinoid + benzoyl peroxide (OR all three agents at once)

Oral isotretinoin (prescribed by dermatologist)

101
Q

Why are topical corticosteroids prescribed?

A

Utilized for their anti-inflammatory, antimitotic (for psoriasis), immunosuppressive, and vasoconstrictive properties

102
Q

Topical corticosteroids: indications

A

Dermatitis, psoriasis

103
Q

What is the least potent topical corticosteroid?

A

Hydrocortisone 2.5%

104
Q

Which topical corticosteroid formulation has the greatest amount of absorption: cream, gel, ointment, solution?

A

Ointments - provide the most occlusive barrier

Most potent

105
Q

Ways to enhance absorption of topical corticosteroids

A

Increase skin temperature, hydration, and application to denuded areas, intertriginous areas, or skin surfaces with a thin stratum corner

106
Q

Topical corticosteroids: MOA

A

Inhibit formation, release, and activity of endogenous mediators of inflammation (e.g. prostaglandins, histamines)

Inhibit migration of macrophages and leukocytes into the skin area by reversing vascular dilation and permeability –> decreased edema, erythema, pruritus

107
Q

Parts of the body with a thin stratum corneum

A

Face, scrotum, axilla, skin folds (use low potency formulations like lotions)

108
Q

True/False

Occlusions (with a dressing) decrease skin penetration

A

False - increase skin penetration 10 to 100 fold, but can lead to more adverse effects

109
Q

Which topical corticosteroid formulation is least potent?

A

Lotions

110
Q

Topical corticosteroid: caution and contraindications

A

Caution with pregnant patients (only use if benefits outweigh the risks)

Children more susceptible to effects and require lowest effective strength to be used

111
Q

Topical corticosteroids: adverse effects

A

May cause local skin irritation and increase risk of secondary infections

Tolerance may occur with prolonged use

Adrenal function/growth should be monitored in children who require moderate to high potency steroids (growth can be stunted)

112
Q

Examples of topical calcineurin inhibitors

A

Pimecrolimus (Elidel) and Tacrolimus (Protopic)

113
Q

Topical calcineurin inhibitors: indications

A

Atopic dermatitis (short or intermittent long-term treatment)

In patients with resistance to steroids, application to sensitive areas (e.g. face, skin folds), steroid induced atrophy, long-term or uninterrupted topical steroid use

114
Q

Topical calcineurin inhibitors: MOA

A

Suppresses cellular immunity through inhibiting T-cell activation by binding to intracellular proteins (e.g. calcineurin dependent proteins) –> inhibition of inflammatory cytokines and mediators of mast cells

115
Q

Which topical calcineurin inhibitor would be prescribed for mild/moderate atopic dermatitis?

A

Pimecrolimus (Elidel)

116
Q

Which topical calcineurin inhibitor would be prescribed for moderate/severe atopic dermatitis?

A

Tacrolimus (Protopic)

117
Q

Topical calcineurin inhibitors: caution and contraindications

A

BLACK BOX WARNING: rare cases of malignancy

DO NOT apply to site of active cutaneous viral infection, lactation, pregnancy

Avoided in children younger than 2 years and immunosuppressed

118
Q

Topical calcineurin inhibitors: adverse effects

A

Local reaction at site of application: burning, pruritus, tingling

HA, fever, flu-like symptoms, acne, folliculitis

119
Q

Example of topical antihistamine

A

Diphenhydramine (Benadryl)

120
Q

Example of topical antipruritic

A

Doxepin (Zonalon)

121
Q

Diphenhydramine (Benadryl): MOA

A

Provides local relief from pruritus and edema b/c local effect on H1 receptors suppresses formation of edema, flare, and pruritus

Provide local anesthetic activity be decreasing permeability of nerve cell membrane to sodium ions –> block transmission of nerve impulses

122
Q

Doxepin (Zonalon): MOA

A

Histamine-blocking action of H1 and H2 receptors, inhibiting the activation of histamine receptors

123
Q

Diphenhydramine (Benadryl): cautions and contraindications

A

Not used to treat chicken pox, measles, poison ivy, sunburn, blistering/oozing skin

Applying to large surface areas increases potential for toxic psychosis, especially in children

Can be used in children 2+ years

Avoid use >7 days

124
Q

Doxepin (Zonalon): cautions and contraindications

A

Drowsiness

Anticholinergic effect –> caution in elderly, untreated narrow angle glaucoma, urinary retention

NOT for children or lactating women

125
Q

Diphenhydramine (Benadryl): indications

A

Local reactions to insect bites, stings, minor cuts, burns or rashes (poison ivy, oak, sumac)

Mild symptoms

126
Q

Doxepin (Zonalon): indications

A

Short term management of moderate to severe pruritus

127
Q

Pyrethrins (RID): indications

A

Head, body, and pubic lice

128
Q

Pyrethrins (RID): MOA

A

Absorbed through the exoskeletal of arthropods, causing paralysis and death

129
Q

Pyrethrins (RID): caution and contraindications

A

Avoid in chrysanthemum or ragweed allergy, children younger than 2 years

Compatible with pregnancy and lactation

130
Q

Pyrethrins (RID): adverse effects

A

Localized burning, pruritus, skin irritation

131
Q

Pyrethrins (RID): patient education

A
  • No residual activity after rinsing

- Works best on dry hair

132
Q

Permethrin: indications

A

Head lice

133
Q

Permethrin: MOA

A

Absorbed through the exoskeleton of arthropods, causing paralysis and death

134
Q

How long is permethrin effective for in treating head lice?

A

Has residual activity against lice for up to 10 days

135
Q

What is first line treatment for head lice?

A

Permethrin

136
Q

What is first line treatment for scabies?

A

Permethrin

137
Q

Permethrin: caution and contraindications

A

Should not be used in infants younger than 2 months

Compatible with pregnancy and lactation

138
Q

Permethrin: patient education

A

Avoid use near the eyes

139
Q

Would you prophylactically treat patients with head lice or scabies?

A

Scabies

140
Q

Permethrin: adverse effects

A

Localized burning, pruritus, skin irritation

141
Q

Malathione (Ovide): indications

A

Head lice

142
Q

Malathione (Ovide): MOA

A

Acts as a pediculicide by inhibiting cholinesterase activity in vivo

Both pediculicidal and ovicidal

143
Q

How long is malathione effective for in the treatment of head lice?

A

Some residual activity for up to seven days

144
Q

Malathione (Ovide): caution and contraindications

A

Flammable –> do not use hair dryers

Avoid in children younger than 6 years, pregnancy, and lactating women

145
Q

Malathione (Ovide): adverse effects

A

Organophosphate poisoning and severe respiratory distress if ingested

Localized burning, skin irritation

146
Q

Benzyl alcohol (Ulesifa): indications

A

Head lice

147
Q

Benzyl alcohol (Ulesifa): MOA

A

Stuns the lice, leading to the ability to penetrate their respiratory mechanism which leads to asphyxiation

Effective against LIVE lice

148
Q

Benzyl alcohol (Ulesifa): caution and contraindications

A

Avoid in infants younger than 6 months

Compatible with pregnancy and lactation

149
Q

Benzyl alcohol (Ulesifa): adverse effects

A

Pruritus, erythema

150
Q

Ivermectin (Sklice): indications

A

Head lice

151
Q

Ivermectin (Sklice): MOA

A

Interferes with the function of the nerve and muscle cells, resulting in parasite paralysis and death

Single application is effective for eradication of head lice

152
Q

Ivermectin (Sklice): caution and contraindication

A

Avoid in pregnancy and/or lactation

Approved for infants older than 6 months

153
Q

Ivermectin (Sklice): adverse effects

A

Dry skin, burning sensation, eye irritation

NURS 424 (35 decks)

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