Misc Cardiac Cont'd Flashcards

1
Q

List potential side effects of ticlopidine

A

Neutropenia and thrombocytopenia

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2
Q

What is a common interaction of clopidogrel?

A

PPI interaction (reduced efficacy)

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3
Q

When are patients routinely put on ADP receptor inhibitors?

A

When they undergo stent placements

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4
Q

Name two second generation ADP receptor inhibitors

A

Prasugrel (Effient) and ticagrelor (Brilinta)

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5
Q

List benefits and drawbacks of second-generation ADP receptor inhibitors

A

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

Drawback: expensive, shorter acting

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6
Q

When would you use unfractionated heparin?

A

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

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7
Q

How does unfractionated heparin work?

A

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

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8
Q

What is the antidote for unfractionated heparin?

A

IV protamine- 1 mg for every 100 units of heparin

Protamine derived from salmon semen

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9
Q

What is unfractionated heparin’s standard dose?

A

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

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10
Q

What is unfractionated heparin dosing based on?

A

aPTT monitoring

Half-life is dose-dependent

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11
Q

What is one major risk of unfractionated heparin?

A

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

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12
Q

At what number of platelets should you be concerned?

A

Less than 100,000

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13
Q

Name three first generation ADP receptor inhibitors

A

Aspirin, ticlopidine , clopidogrel

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14
Q

Which type of heparin is safe in pregnancy?

A

Unfractionated heparin-won’t cross placenta

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15
Q

How is LMWH (Lovenox) administered?

A

SQ

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16
Q

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

A

No – both can cause HIT

17
Q

why would LMW HB chosen over unfractionated heparin?

A

Predictable (Standard) dosing

18
Q

What is nesiritide and when is it used?

A

Purified preparation of human BNP

Used during acute decompensated CHF with dyspnea at rest

19
Q

How is nesiritide administered?

A

IV only-never shaken (peptide)

20
Q

List the three actions of dopamine

A

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

(RBA)

21
Q

What determines the action of dopamine at a given time?

A

The dose given

22
Q

When is dopamine used?

A

Used to treat CHF

23
Q

Can dopamine be used to treat Parkinson’s disease?

A

No – does not cross blood brain barrier

24
Q

What is dobutamine and when is it used?

A

Beta-1 agonist used to treat CHF

25
What are glycoprotein IIB and IIIA agonists?
IV anticoagulants that block the final common pathway to platelet aggregation (most potent antiplatelet therapy)
26
When are glycoprotein IIB and IIIA agonists used?
Acute coronary syndrome and in PCTA (angioplasty)
27
What is considered the atomic bomb of anticoagulation treatment?
glycoprotein IIB and IIIA
28
When are plasminogen activators used?
Dissolve acute thrombi – can be an alternative to angioplasty
29
What is a TPA?
Tissue plasminogen activator
30
When should plasminogen activators be administered?
As early as possible (within four hours of onset is ideal)
31
List contraindications of plasminogen activators
ICH, intracranial trauma, brain tumors, major surgeries of thorax or abdomen, major G.I. bleed
32
What do plasminogen activator drugs typically end in?
"eplace" (alteplase, reteplase, tenecteplase) | And streptokinase
33
List two precautions (in addition to contraindications) of taking plasminogen activators
Pregnancy and hypertension
34
Which plasminogen activator is derived from bacteria?
Streptokinase