Misc Cardiac Cont'd Flashcards
List potential side effects of ticlopidine
Neutropenia and thrombocytopenia
What is a common interaction of clopidogrel?
PPI interaction (reduced efficacy)
When are patients routinely put on ADP receptor inhibitors?
When they undergo stent placements
Name two second generation ADP receptor inhibitors
Prasugrel (Effient) and ticagrelor (Brilinta)
List benefits and drawbacks of second-generation ADP receptor inhibitors
Benefit: no PPI interactions, taken QD (Effient) or BID (Brilinta), less bleeding in emergent situations (quicker reversibility)
Drawback: expensive, shorter acting
When would you use unfractionated heparin?
Venous thrombosis, PE, bridge to oral anticoagulation, other CV diseases
How does unfractionated heparin work?
Activates anti-thrombin III (a plasma protease inhibitor of thrombin) and inhibits three clotting factors
What is the antidote for unfractionated heparin?
IV protamine- 1 mg for every 100 units of heparin
Protamine derived from salmon semen
What is unfractionated heparin’s standard dose?
80 units/kilogram bolus, 18 units/kg/hour
What is unfractionated heparin dosing based on?
aPTT monitoring
Half-life is dose-dependent
What is one major risk of unfractionated heparin?
Heparin induced thrombocytopenia (HIT): immune system considers heparin-platelet complex to be an antigen and destroys it
At what number of platelets should you be concerned?
Less than 100,000
Name three first generation ADP receptor inhibitors
Aspirin, ticlopidine , clopidogrel
Which type of heparin is safe in pregnancy?
Unfractionated heparin-won’t cross placenta
How is LMWH (Lovenox) administered?
SQ
Is it reasonable to administer LMWH to a patient who HIT with heparin?
No – both can cause HIT
why would LMW HB chosen over unfractionated heparin?
Predictable (Standard) dosing
What is nesiritide and when is it used?
Purified preparation of human BNP
Used during acute decompensated CHF with dyspnea at rest
How is nesiritide administered?
IV only-never shaken (peptide)
List the three actions of dopamine
Renal bloodflow (increases secondary to vasodilation), beta-1 (positive inotropy), alpha-1 (vasoconstriction)
(RBA)
What determines the action of dopamine at a given time?
The dose given
When is dopamine used?
Used to treat CHF
Can dopamine be used to treat Parkinson’s disease?
No – does not cross blood brain barrier
What is dobutamine and when is it used?
Beta-1 agonist used to treat CHF
What are glycoprotein IIB and IIIA agonists?
IV anticoagulants that block the final common pathway to platelet aggregation
(most potent antiplatelet therapy)
When are glycoprotein IIB and IIIA agonists used?
Acute coronary syndrome and in PCTA (angioplasty)
What is considered the atomic bomb of anticoagulation treatment?
glycoprotein IIB and IIIA
When are plasminogen activators used?
Dissolve acute thrombi – can be an alternative to angioplasty
What is a TPA?
Tissue plasminogen activator
When should plasminogen activators be administered?
As early as possible (within four hours of onset is ideal)
List contraindications of plasminogen activators
ICH, intracranial trauma, brain tumors, major surgeries of thorax or abdomen, major G.I. bleed
What do plasminogen activator drugs typically end in?
“eplace” (alteplase, reteplase, tenecteplase)
And streptokinase
List two precautions (in addition to contraindications) of taking plasminogen activators
Pregnancy and hypertension
Which plasminogen activator is derived from bacteria?
Streptokinase
