Misc Cardiac Cont'd

Question 1

List potential side effects of ticlopidine

Answer 1

Neutropenia and thrombocytopenia

Question 2

What is a common interaction of clopidogrel?

Answer 2

PPI interaction (reduced efficacy)

Question 3

When are patients routinely put on ADP receptor inhibitors?

Answer 3

When they undergo stent placements

Question 4

Name two second generation ADP receptor inhibitors

Answer 4

Prasugrel (Effient) and ticagrelor (Brilinta)

Question 5

List benefits and drawbacks of second-generation ADP receptor inhibitors

Answer 5

Benefit: no PPI interactions, taken QD (Effient) or BID (Brilinta), less bleeding in emergent situations (quicker reversibility)

Drawback: expensive, shorter acting

Question 6

When would you use unfractionated heparin?

Answer 6

Venous thrombosis, PE, bridge to oral anticoagulation, other CV diseases

Question 7

How does unfractionated heparin work?

Answer 7

Activates anti-thrombin III (a plasma protease inhibitor of thrombin) and inhibits three clotting factors

Question 8

What is the antidote for unfractionated heparin?

Answer 8

IV protamine- 1 mg for every 100 units of heparin

Protamine derived from salmon semen

Question 9

What is unfractionated heparin’s standard dose?

Answer 9

80 units/kilogram bolus, 18 units/kg/hour

Question 10

What is unfractionated heparin dosing based on?

Answer 10

aPTT monitoring

Half-life is dose-dependent

Question 11

What is one major risk of unfractionated heparin?

Answer 11

Heparin induced thrombocytopenia (HIT): immune system considers heparin-platelet complex to be an antigen and destroys it

Question 12

At what number of platelets should you be concerned?

Answer 12

Less than 100,000

Question 13

Name three first generation ADP receptor inhibitors

Answer 13

Aspirin, ticlopidine , clopidogrel

Question 14

Which type of heparin is safe in pregnancy?

Answer 14

Unfractionated heparin-won’t cross placenta

Question 15

How is LMWH (Lovenox) administered?

Answer 15

SQ

Question 16

Is it reasonable to administer LMWH to a patient who HIT with heparin?

Answer 16

No – both can cause HIT

Question 17

why would LMW HB chosen over unfractionated heparin?

Answer 17

Predictable (Standard) dosing

Question 18

What is nesiritide and when is it used?

Answer 18

Purified preparation of human BNP

Used during acute decompensated CHF with dyspnea at rest

Question 19

How is nesiritide administered?

Answer 19

IV only-never shaken (peptide)

Question 20

List the three actions of dopamine

Answer 20

Renal bloodflow (increases secondary to vasodilation), beta-1 (positive inotropy), alpha-1 (vasoconstriction)

(RBA)

Question 21

What determines the action of dopamine at a given time?

Answer 21

The dose given

Question 22

When is dopamine used?

Answer 22

Used to treat CHF

Question 23

Can dopamine be used to treat Parkinson’s disease?

Answer 23

No – does not cross blood brain barrier

Question 24

What is dobutamine and when is it used?

Answer 24

Beta-1 agonist used to treat CHF

Question 25

What are glycoprotein IIB and IIIA agonists?

Answer 25

IV anticoagulants that block the final common pathway to platelet aggregation
(most potent antiplatelet therapy)

Question 26

When are glycoprotein IIB and IIIA agonists used?

Answer 26

Acute coronary syndrome and in PCTA (angioplasty)

Question 27

What is considered the atomic bomb of anticoagulation treatment?

Answer 27

glycoprotein IIB and IIIA

Question 28

When are plasminogen activators used?

Answer 28

Dissolve acute thrombi – can be an alternative to angioplasty

Question 29

What is a TPA?

Answer 29

Tissue plasminogen activator

Question 30

When should plasminogen activators be administered?

Answer 30

As early as possible (within four hours of onset is ideal)

Question 31

List contraindications of plasminogen activators

Answer 31

ICH, intracranial trauma, brain tumors, major surgeries of thorax or abdomen, major G.I. bleed

Question 32

What do plasminogen activator drugs typically end in?

Answer 32

“eplace” (alteplase, reteplase, tenecteplase)

And streptokinase

Question 33

List two precautions (in addition to contraindications) of taking plasminogen activators

Answer 33

Pregnancy and hypertension

Question 34

Which plasminogen activator is derived from bacteria?

Answer 34

Streptokinase