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Health Studies > Pharm Roop > Flashcards

Pharm Roop Flashcards

1
Q

What is angina?

A

-chest pain caused by reduced blood flow to the heart muscle
-blockages are usually called plaque

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2
Q

What is it called if angina is caused from fatty streaks? What is the pt at great risk for?

A

atheroscleortic plaque or atheroma

MI

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3
Q

Which artery is the most common artery to get a blockage and cause MI?

A

Left anterior descending (LAD) artery, also known as the “widow maker”

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4
Q

What do pts usually take for angina?

A

Nitroglycerin (metabolizes to NO, which vasodilates the vessels)

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5
Q

A 62 year old man with a history of angina calls 911 complaining of crushing chest pain. The 911 operator sends an ambulance and instructs the patient to chew an aspirin while waiting for the ambulance. Why did the 911 operator have the pt take an aspirin?

A

-Thins the blood to break up clot
-Blocks COX1 pathway (Inhibits thromboxane A2)

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6
Q

T/F:

With angina, there had to be some type of injury to the blood vessel

A

true!

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7
Q

What does angina damage specifically?

A

the endothelium

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8
Q

How does angina damage the endothelium?

A

-Once it starts to expose the collagen, it also exposes prothrombotic mediators such as vWF
-Blood is flowing through and platelets will be attracted towards the area
-Once platelets bind, they become activated and start to release mediators like thromboxane A2
-Thromboxane A2 activates more platelets and then they will all come together and aggregate/stick = clot formation

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9
Q

A pt w/ angina will have symptoms of a MI. Why?

A

MI is caused by blockage

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10
Q

Platelet disruption is caused by…

A

tissue factor, collagen and vWF

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11
Q

_________ and _________ will cause platelet adhesion and secretion using COX1 pathway

A

Collagen, vWF

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12
Q

__________ blocks production of thromboxane A2 to decrease the platelet recruitment/activation

A

Aspirin

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13
Q

A 62 year old man with a history of angina calls 911 complaining of crushing chest pain. The 911 operator sends an ambulance and instructs the patient to chew an aspirin while waiting for the ambulance. Why was pt told to chew the aspirin instead of swallowing with water?

A

-Faster delivery
-To bypass the liver and get into bloodstream directly
-Increases GI absorption

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14
Q

When the pt. arrives at the hospital, he is diagnosed as having an MI and undergoes percutaneous angioplasty to clear the clot in his coronary artery. He also receives a stent to keep the vessel open. What drugs will this patient likely receive while in the hospital to prevent recurrence of a thrombus in the stented coronary vessel?

A

2 classes of drugs
-Anticoagulants (Heparin)
-Antiplatelets (Continue pt on aspirin, put on Plavix)

This is to ensure that nothing will collect around the stent

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15
Q

What are the antiplatelet drug classes and give some examples

A

1) ASA Anti Thromboxane
-Aspirin

2) ADP receptor antagonists/inhibitors
-Plavix

3) GPIIb/IIIa inhibitors (glycoprotein 2b/3a)
-Clopidogrel
-Prasugrel
-Abciximab
-Eptifibatide
-Tirofiban

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16
Q

What is the anticoagulant drug class we talked about?

A

-Heparin- accelerates interaction of antithrombin w/ thrombin and factor Xa
-LMWH → low molecular weight heparin
»Selectively accelerates interaction of antithrombin w/ factor Xa

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17
Q

Heparin and LMWH prevents the formation of ______ clots

A

fibrin

18
Q

What lab tests are used to monitor anticoagulant therapy?

A

PT → prothrombin time
-Monitors warfarin

aPTT → activated Partial thromboplastin time
-Monitors high dose heparin

Coagulation time
-Monitors high dose heparin

Anti-factor X Assay
-Monitors heparin and LMWH (low molecular weight heparin)

19
Q

A 62 year old man with a history of angina calls 911 complaining of crushing chest pain. The 911 operator sends an ambulance and instructs the patient to chew an aspirin while waiting for the ambulance. When the pt. arrives at the hospital, he is diagnosed as having an MI and undergoes percutaneous angioplasty to clear the clot in his coronary artery. He also receives a stent to keep the vessel open. What drugs will this pt. be prescribed upon discharge?

A

Antiplatelets
-Switch to low dose aspirin
-Keep pt on Plavix

Anticoagulant
-Oral warfarin (switch from heparin)

Beta blockers (dilator of the vessels, parasympathetic)
-metoprolol or propranolol

20
Q

A 78 year old man receives a total knee replacement. He lives by himself about an hour drive from the nearest hospital. Upon discharge, he is given a prescription for lovenox (Enoxaparin). What is lovenox? Why was he put on this?

A

LMWH

-At risk for blood clots in legs
-In hospital he’s immobile → blood stasis (clotting agents sitting around)
-Surgery = bleeding (body sets up clotting cascade)
-Drug binds and accelerates the activity of antithrombin III, an enzyme which causes blood to clot by acting on a blood protein called fibrinogen
-Binds and accelerates antithrombin (our own endogenous protein that is an anticoagulant)

21
Q

What is the mechanism of action (MOA) of lovenox?

A

-Activates antithrombin
-Blocks prothrombin to thrombin and then blocks fibrinogen to fibrin

22
Q

What drug toxicities are associated with the LMWH; lovenox?

A

-Bleeding out
-Heparin induced thrombocytopenia (decrease in platelets/hepatocytes)
»There is a much lower risk when you use LMWH compared to the regular heparin

23
Q

A 32 year old woman in good health is discovered to have atrial fibrillation during a routine wellness visit. She does not recall having any symptoms of arrhythmia such as dizziness or fainting, although she is not able to exercise for as long as she could a few years ago. A
cardiologist prescribes warfarin. What is the reason for using warfarin in this patient? What is the difference between warfarin and heparin?

A

-Coagulation factors: 2, 7, 9, 10 → produced by liver to make clotting factors
»coagulation factors have a LONG half life → so it takes warfarin a long time to kick in
-also takes a longer time for it to act because it has to go through the liver
»Heparin = faster because its intravenous

24
Q

What kinds of lab studies are required for warfarin therapy? What factors can alter the anticoagulant activity of warfarin?

A

PT (prothrombin time)

-Diet
»Anything high in vitamin K (leafy green vegetables), or acidic
»Will have to increase your dose of warfarin otherwise
-Grapefruit
-Alcohol
-Antibiotics
-Antifungals
-NSAIDs
-Aspirin

25
Q

What are some of the risks and toxicities associated with warfarin?

A

-Bleeding
-Birth defects and miscarriage

26
Q

What is Arixtra? Why is it being used more than warfarin?

A

-Synthetic anticoagulant
-Part of heparin that binds to antithrombin III (AT)
-Lower evidence for fetal risk → can give to pregnant women
-Lower incidence of HIT (heparin induced thrombocytopenia)

27
Q

A 32 year old woman in good health is discovered to have atrial fibrillation during a routine wellness visit. She does not recall having any symptoms of arrhythmia such as dizziness or fainting, although she is not able to exercise for as long as she could a few years ago. A cardiologist prescribes warfarin. What counselling would you give this patient?

A

-Are you trying to conceive? Or do you plan to?
»If you DO plan to, come back and see me so that medication can be changed
-Diet

28
Q

While shopping in the grocery, a 61-year-old man develops symptoms of weakness on one side of his body and his wife notices that he has trouble speaking. Suspecting that he is having a stroke, they drive to the nearest hospital which is 20 minutes away. At the hospital it is determined that the patient has had an ischemic stroke and alteplase is administered. What is alteplase and why was it administered to pt?

A

-Thrombolytic drug
-Breaks up clots
-Synthetic Tpa
-Trying to prevent irreversible damage

29
Q

What is the MOA of alteplase?

A

-Alteplase converts plasminogen to the proteolytic enzyme plasmin, which lyses fibrin as well as fibrinogen.
-Dissolves clot

30
Q

What must you determine before administering alteplase to a patient with the symptoms of a stroke?

A

-Time → must take within 2-4 hours of symptom onset
-Age
-HTN
-Diabetes
-Determine whether or not its ischemic or hemorrhagic
»CT/MRI to determine this

31
Q

What is the most common toxicity of alteplase?

A

bleeding

32
Q

Besides stroke, what other scenario could you use alteplase?

A

pulmonary embolism

33
Q

A 24-year-old woman has seasonal allergies in the summer due to various pollens and grasses. Her symptoms include a runny nose and itchy, watery eyes. At the beginning of summer she takes OTC diphenhydramine (Benadryl) for relief of her symptoms. What is diphenhydramine?

A

-Antihistamine that crosses BBB
-H1 receptor antagonist (GPCR)

34
Q

A 24-year-old woman has seasonal allergies in the summer due to various pollens and grasses. Her symptoms include a runny nose and itchy, watery eyes. At the beginning of summer she takes OTC diphenhydramine (Benadryl) for relief of her symptoms. What is the MOA of diphenhydramine in treating this patient’s symptoms?

A

-Acts as an inverse agonist at the H1 receptor, thereby reversing the effects of histamine on capillaries, reducing allergic reaction symptoms
-Histamine stabilizes active state of GPCR
-Blocks it in inactive state so doesn’t go to active state
-Decreases vascular permeability and vasodilation

35
Q

What is the molecular basis of action of histamine and antihistamine?

A
36
Q

What are the direct effects of histamine release?

A

Increase itching, vasodilation, and vascular permeability

37
Q

A 24-year-old woman has seasonal allergies in the summer due to various pollens and grasses. Her symptoms include a runny nose and itchy, watery eyes. At the beginning of summer she takes OTC diphenhydramine (Benadryl) for relief of her symptoms. The patient realizes that the diphenhydramine makes her drowsy. Why does it have this effect?

A

drowsy symptoms bc it crosses BBB

issue is that this can cause depression in some pts, or others can experience restlessness, anxiety, or wakefulness

38
Q

A 24-year-old woman has seasonal allergies in the summer due to various pollens and grasses. Her symptoms include a runny nose and itchy, watery eyes. At the beginning of summer she takes OTC diphenhydramine (Benadryl) for relief of her symptoms. What are her alternatives in treatment without the side effect of drowsiness?

A

H2 drugs (second generation)
-New set of antihistamines
-Ex:
»Cetirizine = Zyrtec
»Fexofenadine = Allegra
»Loratadine = Claritin

39
Q

A 32-year-old man visits his dermatologist because he is very sensitive to mosquito bites. When bitten by a mosquito, he immediately experiences redness at the site which spreads to about the size of a dime, and then a small, itchy bump appears. What is causing this progression of symptoms?

A

-Release of histamine underneath the skin causes itchy, bumpy areas
-Histamine causes vasodilation and capillary permeability

40
Q

What is the triple response of Lewis?

A

Health Studies (14 decks)

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