Perfusion Flashcards
Thiazide Diuretic
Hydrochlorothiazide
- don’t work as fast as loop diuretic
- don’t use on a patient with high calcium level ! Because it retains calcium which can cause kidney stones
- front line therapy for hypertension
• use when lifestyle changes don’t work
Potassium Sparing Diuretic
Spironolactone
- alter aldosterone to increase urine output
- affect the liver
• patient with liver disorder will react better to this than other diuretic
ACE inhibitors
Enalopril
Antihypertension
stop conversion of angiotensin 1 to angiotensin 2
(angiotensin 2 constricts blood vessels, so if you block it, it stops vasoconstriction and stop increase of BP)
- STOPS vasoconstriction
Calcium channel blocker
nifedipine, diltiziem, amlodipine
Block muscle contraction in the calcium channel in smooth muscle
• block calcium -> vasodilation
Beta blocker
Propranolol, metoprolol, atenolol
calm down sympathetic nervous system
1) decrease heart rate
2) increase vasodilation
- parameters must be check (hold for HR <60, SBP <100)
- are not typically used in AA males
1) non selective: both heart and lungs
* propranolol
* not safe for patients with asthma or other respiratory difficulties
* use cautiously in diabetics - mask symptoms
2) selective:
A) cardio selective: “beta 1”
- almost all are oral
- metroprolol, antenolol * Safe for patient with respiratory disorders
B) pulmonary selective “beta 2”
- inhal used for broncodialation
- albuterol(rapid) , salmeterol (long acting) * some may induce anxiety or tachycardia
Process of formation of RBC
1) kidneys make erythropoietin
2) erythropoietin goes into blood and travels to bone marrow
3) in bone marrow it activates the stem cells to produce RBC
In order for bone marrow to make RBC it needs
1) erythropoietin
2) vitamin B-12
3) folic acid
4) iron
5) intrinsic factor
What is the intrinsic factor
In the lining of the gut
It allows vitamin B-12 to be absorbed
- w/o it we can’t make RBC bc we don’t have B-12 if we only get it orally !!
By pass the intrinsic factor
Give B-12 IM
Muscle will absorb it so it doesn’t have to be absorbed by the intestine
How to bypass kidney failure and not producing erythropoietin
Give synthetic erythropoietin
Epoietin Alfa
Epoietin Alfa
Give in shot IM
Given to replace erythropoietin when kidneys can’t produce it ( people on dialysis)
Iron replaced by
Oral, IM or IV
If given ORAL: give w/ orange juice bc it depends on an acidic environment
- IM not used a lot bc if done wrong can stain skin
- can cook with an iron skillet, food will absorb some of the iron
Food to replace iron, folic acid and B-12
1) greens - don’t over cook/raw
2) red meat- blood
3) liver- stores all 3
4) whole grains
5) asparagus- folic acid, also removes free radicals
6) legumes
Rally pack
“Banana pack”
IV fluid containing a lot of minerals
Given to alcoholics
Heparin
- Unfractionated ( is a protein)
- Stop production of fibrin
- drawl up in syringe then change needle (don’t want to give with a dull needle/ or use a need the gas heparin on it)
This causes more trauma to the skin (bruising) - can’t shake or drop it !!!
No oral form only sub-q or IV
Measure therapeutic level
Low molecular weight heparin
Enoxaparin
Fractionated!
Less potential for bleeding or allergic reaction to the heparin
Given sub-q
Do not require blood monitoring
Half life 3-5hr
Useful in prevention of post-operative thrombus formation
Heparin normal and therapeutic levels
Normal level: PTT 25-35
Therapeutic level: PTT 1.5-2.5 X base line (norm)
Warfarin
Stop formation of clot dependent on vitamin K
Inhibit thrombin from being produced !!!
Has long half life (5-7days)
Warfarin is measured by
PT or INR
PT= pro time
INR= international normalized ratio
Loop diuretics
-semide
Furosemide, torsemide
- work fast in the kidney (loop of henel)
- flush out fluid fast, K waistline
- need K replacement
- IV -> assess BP bc they can lose fluid so fast BP drops
- check K levels and BP
Replace K by eating banana, nuts dried fruit
Warfarin normal and therapeutic levels
Normal:
INR 2-3 ( ❤️ valve replacement 3-4)
PT 10-13 (not reliable)
Therapeutic:
PT 1.5 -2 X norm
What do Statin drugs do
Lower cholesterol levels in the blood
Statin drug side effects
Muscle pains / weakness
Sleep problems
Digestive problems
Dizziness/ headache
In order to form a stable clot one must have …
Clotting factors
Platelets
Adequate perfusion
Medications to prevent or treat clotting
- Anticoagulants
- Antiplatelet drugs
- Thrombolytic Agents
Heparin is best to use when you need..
Rapid onset of action
Short half life
Immediate anticoagulant
Rapid reversal
Heparin is safe for use in
Prevention and treatment of venous thrombosis
Pulmonary embolism
Acute coronary syndrome
Pregnant women
Unfractionated heparin is used to prevent
thrombosis formation
(DVT that already exist)
Doesn’t destroy existing clots- keeps it from getting worse til body natural get rid of clot
Warfarin is used to prevent or treat
- Venous thrombosis
- Pulmonary embolism
- Thromboembolic disorders
- Atrial fibrillation associated embolism development
- MI associated embolisms
- Valve replacements
- Hypercoagulable states
Heparin warfarin bridge
When warfarin therapy is begun, additional anticoagulant therapy is needed until the therapeutic level of warfarin is reached.
Often, this is done with subcutaneous injections of heparin.
Once a therapeutic level of warfarin is reached, the heparin is discontinued.
Warfarin antagonist
VIT K:
- doesn’t work quickly (24hr)
FRESH FROZEN PLASMA:
- when need rapid reversal
PCC: prothrombin complex concentrate
Factor complicating warfarin usage
- Increased risk for bleeding (GI, stroke)
- Reliance on patient compliance with complex medication regimen
- Need for frequent monitoring
- Need for dietary modifications
- Multiple food, vitamin, herbal and drug interactions
- Long T1/2
Warfarin food interactions
- foods rich in VIT K ⬇️ effects ( green tea, Brussels spouts, kale, turnip, mustard/collard greens, liver, asparagus, avocado)
- cranberry / grapefruit juice ⬆️ effects
- Oils including canola, olive, soybean and margarine and mayonnaise may⬇️ effectiveness
Warfarin antibiotics interactions
Antibiotics that destroy normal intestinal flora increase the action of warfarin. Intestinal flora are needed to produce Vitamin K.
Why are oral form of warfarin better
- No monitoring is needed
- Few drug-drug interactions
- No special dietary considerations
- Short half life
- Rapid onset of action – do not require bridge
- Easily reversed by holding doses
Aspirin
an antiplatelet that blocks the mechanisms for platelet aggregation. This prevents the formation of a platelet
Risk of aspirin
- Bleeding
- Allergies
- Reacts with many herbal supplements
- Limited use in children or the elderly
- Can become toxic
Anti platelets medications
Clopidogrel (Plavix)
Ticlopidine (Ticlid)
Dipyridamole
Generally, these are tolerated well with few adverse affects
Clopidogrel
•Alternative to aspirin
First choice for aspirin intolerance
- Adverse effects
- GI upset
- Bleeding
- Blood dyscrasias
Thrombolytics
clot busters” to dissolve blood clots
- Streptokinase
- Urokinase
- Alteplase
- Reteplase
Tissue Plasminogen Activator (t-PA)
Breaks down blood clots
- Intrinsic compound (max affect)
- Non-antigenic
- Short half-life
- Higher fibrin specificity
- Expensive
If risk of bleeding from heparin give
Protamine sulfate
Heparin stop clots by
preventing the conversion of prothrombin to thrombin and inactivating Factor X
Common non warfarin anticoagulant
1) DabiGATRAN etexilate
is an oral direct thrombin
2) RivaroxABAN and Apixaban
oral direct coagulation factor Xa inhibitors.
Digoxin
Antiarrhythmic and Blood pressure support
It can treat heart failure and heart rhythm problems.
Toxicity= confusion, loss of appetite, nausea, vomiting, diarrhea, or vision problems
Digoxin
Increase contractility
Reduce HR
Toxixity= fatigue, blurred vision, changes in mental status, PVCs,
