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Pharm CPR > PAD > Flashcards

PAD Flashcards

1
Q

What is the main cause for PAD?

A

Smoking or DM have greatest risk

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2
Q

What are the 2 complications of PAD?

A
  1. Critical limb ischemia

2. Stroke and Heart Attack

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3
Q

What can pseudoephedrine and OTC meds predispose you to?

A

Vasoconstrict so bad in PAD

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4
Q

What is found on physical exam of PAD?

A

ABI < 0.9
Weak or absent pedal pulses with bruit
Poor wound healing
Tredmill test is positive to assess severity while walking

Note that with DVT we will see swelling, pain, red/discolored skin, warmth

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5
Q

What are the tests to check PAD dx?

A
  1. Ultrasound = identify blocked arteries
  2. Angiography = view blood flow
  3. Blood tests = lipid, fasting glucose
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6
Q

This med is a type 3 PDE inhibitor that prolongs the life of cAMP in platelets and cells to promote aggregation and vasodilate

A

Cilostazol

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7
Q

When is Cilostazol contraindicated?

A

Heart failure patients - especially Class III and IV patients

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8
Q

What imaging can be done for DVT dx?

A

Ultrasound
Blood Test = D-dimer
Venography = visualize via Xray
CT/MRI

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9
Q

What are the only 3 oral drugs for DVT treatment? Rest are parenteral

A

Warfarin, thrombin inhibitor, factor Xa inhibitor

Can also treat with compression stockings, stents, and vena cava filter

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10
Q

Antiplatelet drugs break up

A

white clots

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11
Q

Anticoagulant drugs block. Complication?

A

red clots (fibrin)

Spinal or epidural hematoma

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12
Q

Intrinsic pathway is represented by:

A

aPTT - we mix phospholipids, activator, and Ca2+ in the patient’s plasma and evaluate serine protease factors (2, 9, 10, 11, 12)

HEPARIN

WAR IS OUTSIDE SO HEPARIN MUST BE INSIDE

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13
Q

Extrinsic pathway is represented by:

A

PT - time to coagulation after addition of tissue factor - then normalized to INR

WARFARIN you lose lots of tissue

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14
Q

Use this drug to treat RAPIDLY for PE, Stroke, DVT, DIC, acute MI

A

Heparin

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15
Q

MOA of heparin?

A

Binds to and activates antithrombin III to inhibit factor Xa then thrombin

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16
Q

This drug prevents formation of red clots

A

Heparin

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17
Q

Can heparin be used in pregnancy?

A

yes

18
Q

When is heparin contraindicated?

A
  • Thrombocytopenia
  • Uncontrollable bleeding
  • Avoid using during any surgery or procedure involving CNS or eyes (also enoxaparin)
  • BLEEDING IS HUGEST CONCERN
19
Q

What does enoxaparin and fondiparinaux inhibit?

A

LMWH - inhibits Factor Xa

20
Q

This drug is used for prevention DVT after abdominal surgery or hip/knee replacement

A

Enoxaparin

21
Q

This drug is used for ischemic pcomplications in unstable angina or STEMI

A

Enoxaparin

22
Q

What is the first choice for treatment and prevention of DVT?

A

Enoxaparin, much longer half lives and dosing is predictable

23
Q

What is the antidote to enoxaparin?

A

Protamine

24
Q

This drug is used to treat PE or DVT with warfarin

A

Fondiparinaux

25
Q

This is an anticoagulant that must be stopped 4-5 days before surgery

A

Fondiparinaux

26
Q

What anticoagulant is not reversible by protamine?

A

Fondiparinaux

27
Q

This drug does not cause heparin induced thrombocytopenia

A

Fondiparinaux

28
Q

The benefit to using bivalirudin over heparin?

A

Doesn’t need antithrombin and causes less bleeding, but there’s no antidote

29
Q

This drug is given in combination with aspirin for angioplasty patients

A

Bivalirudin

30
Q

What’s the difference in MOA of bivalirudin and trobin?

A 
Bivalirudin = directly blocks thrombin
Argatroban = directly binds catalytic site of thrombin
31
Q

How do we monitor if argatroban is working?

A

Monitor aPTT

32
Q

What is the challenge associated with warfarin dosing?

A

Genetic variability

Note that the CYP2C9 substrate is S-warfarin and polymorphisms of this in whites lead to lower clearance rates

33
Q

What makes warfarin resistant in blacks but sensitive in asians?

A

VKORC1 haplotype

34
Q

This drug is used for long-term prophylaxis of thrombosis in mechanical heart valves, PE, atrial fibrillation, but cannot be used in emergencies

A

Warfarin

35
Q

How do we monitor warfarin?

A

It’s 100% bioavailable orally but it is eliminated by liver in bile, has slow onset and slow offset
We monitor with PT, INR = 2-3, and check more frequently if you add or subtract a drug

36
Q

What happens when bleeding occurs with warfarin?

A

Discontinue warfarin immediately and administer Vitamin K to reverse

37
Q

Why do we get cutaneous necrosis with warfarin?

A

Protein C has a shorter half life than several other clotting factors so pro-coagulant state initially

38
Q

This drug can be used to prevent DVT and PE after hip/knee replacement and prevent stroke in patients with nonvalvular atrial fibrillation

A

Rivaroxaban

Note that mechanical heart valves are contraindicated in Dabigatran

39
Q

What can we use as an antidote to rivaroxaban?

A

Andaxanet alfa

40
Q

What drug must be kept in a supplied dessicator bottle?

A

Dabigatran

41
Q

General concern with all anticoagulants in terms of adverse effects

A

Bleeding and cranial issues

Pharm CPR (9 decks)

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