Pharma Test 3 Flashcards
1
Q
Anticoagulant Drugs
A
- Heparin, a naturally occurring anticoagulant, is produced by mast cells located in connective tissue throughout the body.
- All anticoagulants interfere with the clotting cascade and prolong blood clotting time.
- The parenteral anticoagulants work by preventing the conversion of fibrinogen to fibrin.
2
Q
Heparin
A
- Rapidly promotes the inactivation of factor III, which, in turn, prevents the conversion of prothrombin to thrombin and fibrinogen to fibrin. (Stops clots from forming)
- ½ life of 90 min. short-acting!
-SE: Heparin-induced thrombocytopenia, hep is made from pigs and protein produced in body so can develop an allergy to it. - NC: Monitor aPTT(1.5-2.5 x 30-40 secs), give loading dose then infuse, has no effect on clots already formed
- Antidote: protamine sulfate(base anticoagulant)
3
Q
enoxaparin (Lovenox
A
- Low Molecular Weight heparin (Half-life: 4.5 hr)
- no need for serum PTT’s (works on factor X, not thrombin)
- Black Box Warning for spinal procedures
- No antidote! Protamine sulfate has been used with limited success
4
Q
Warfarin (Coumadin)
A
- Oral Anticoagulant and made from natural chemical= Dicoumarol from rotting clover
- Used for decades to kill rodents in food warehouses.
- Work by preventing the synthesis of factors dependent on vitamin K for synthesis.
- Pts with long term risk for thrombus formation
- Long-acting and takes a few days to work and get out of your system. (Half life 0.5 - 3 days)
- Blocks Vitamin K at its sites of action so Pt overloaded with Vitamin K on Warfarin-> blood clots in the legs
- NC: Dose should be individualized until PT or the INR is in the therapeutic range.INR (International Normalized Ratio) therapeutic range for treatment = 2-3(lower 2= blood to thick, 3= blood to thin), No Vitamin K rich foods
- Antidote= Vitamin K (phytonadione)
- When transitioning from heparin to warfarin, the two drugs must be administered concurrently for 2-3 days.
5
Q
Rivaroxaban (Xarelto)
A
- DVT/ PE treatment and prophylaxis, Afib/flutter thrombus prophylaxis
- Inhibits the formation of thrombin by blocking factor Xa
- Half-life: 5–9 hr
- No pts with valvular dysfunction or mechanical valve, epidural/spinal puncture
- NC: Monitor or bleeding, LOC, no antidote, monitor Cr+, must be off for at least 48 hrs prior to surgery, $15/pill, Monitor BUN and Creatinine(Kidney function and clear the drug in a timely manner), DO NOT HAVE TO MONITOR PT, aPPT, OR INR!
6
Q
Antiplatelet Drugs
A
- They are used when overactive platelets pose long-term risks for hypercoagulability.
- Antiplatelet drugs reduce platelet aggregation.
- Prototype drug: clopidogrel (Plavix).
7
Q
Clopidogrel
A
- Used to reduce atherosclerotic events. (post MI or CVA especially)
- Stop the binding of adenosine diphosphate (ADP) binding to its platelet receptor and the subsequent ADP-mediated activation of the glycoprotein IIb/IIIa complex, thus inhibiting platelet aggregation.
- Half-life: 6 hr
- SE: Neutropenia and GI distress, GI bleeding(most serious)
- Many times put on an H2 blocker preventatively and not a PPI bc PPI decrease therapeutic effect
8
Q
Thrombolytic drugs
A
- Break down formed clots
- Pts who are diagnosed with an evolving, acute MI; a PE; or acute ischemic stroke.
- May be given to unclog central venous catheters.
- May be given systemically or directly at the blood clot site.
- Adverse effects can be life threatening.
- Prototype drug: alteplase (Activase; Cathflo Activase)
9
Q
Alteplase Recombinant
A
- Rapidly cleared from the plasma ½ life 5-10 min
- Acts the same as tPA and Converts plasminogen to plasmin, leading to breakdown of the clot.
- Vital signs, evidence of bleeding, and laboratory test results should be assessed throughout therapy
- NC: Monitor for signs and sx of bleeding (petechia, sudden severe HA, LOC, joint swelling, drop in b/p with increase in HR), Know the ½ life of anticoagulants, Monitor platelets , Hmg/Hct, coagulation studies
- Aminocaproic acid (Amicar) may be used as an antidote.
10
Q
Erythropoiesis-stimulating drug
A
- Epoetin alfa is made through recombinant D N A technology and is functionally identical to human erythropoietin.
- Prototype Drug: Epoetin Alfa (Epogen, Procrit)
11
Q
Epoetin Alpha (Epogen, Procrit)
A
-Renal failure(kidneys cant make it anymore), chemotherapy treatments(destroys RBC), blood loss, and anemia
-Stimulates bone marrow to make RBC
-SE:serious cardiovascular and thrombolytic events(clots, strokes, MI) , HTN(increasing volume of blood and osmotic pole of fluids)
-No pts with hypersensitivity to mammalian cell products (rodents; hamsters; mice)
-Interacts with Androgen (hormone) therapy(Increase thrombolic events )
12
Q
Colony-Stimulating Factors (CFS)
A
-Increase the production of new leukocytes and activate existing white blood cells
-Prototype Drug: Filgrastim (Granix, Neupogen)
13
Q
Filgrastim (Granix, Neupogen)
A
- Neutropenia primarily in cancer treatment or after chemotherapy
- Stimulates hematopoietic cells to produce and activate neutrophils
- SE:Bone pain(affecting bone marrow), neutropenic fever(KNOW; Common; give unless fever 105F)
- No pts with hypersensitivity to E. coli proteins because this microbe is used to produce the recombinant drug.
14
Q
Cyanocobalamin (Nascobal)
A
- Vitamin B12 for Anemia(Pernicious anemia, megaloblastic anemia)
- PO if intrinsic factor present to make the B12 active
- Pts with Dumping Syndrome need the med to administered Nasal or SQ
- Few SE but will turn urine a bright yellow
15
Q
Ferrous Sulfate(Feosol)
A
- Iron deficiency anemia
- Provides the iron molecule essential to formation of RBCs and hemoglobin.
- SE: GI upset, constipation and may darken stools(black but not tarry)
- Antidote= Deferoxamine (Desferal)a parenteral agent that binds iron, which is subsequently removed by the kidneys, turning the urine a reddish-brown color(iron coming out).Primarily used in pediatrics bc flinstone vitamins taste good
- NC: Don’t shake vial bc may deactivate the drug for CFS. Dont send via tube system and walk it back if you return it. This drug is expensive. Monitor CBC count(Leukocytes greater than 100,000 can cause respiratory failure, intracranial hemorrhage, retinal hemorrhage, and MI)
- Iron Administration: Use the Z-track method (deep muscle) when giving IM(if not will come oozing out and can stain the skin where it looks like a bruise), Do not crush tablets or empty contents of capsules when administering, Do not give tablets or capsules within 1 hour of bedtime bc can cause GI upset, PO Give on empty stomach or with high acid food to help absorb iron better (Vitamin C= Orange juice, Kiwi), MOnitor for toxicity and local tissue irritation if IV(SOB, seizures, hypotension)
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16
Q
Hydrochlorothiazide
A
- Thiazide Diuretics
- Used in the treatment of HTN (decrease blood volume) and edema
- Acts in the distal tubule by ncreasesing excretion of sodium and chloride in the distal convoluted tubule thereby taking water with it (trades it out with potassium). Weaker diuretic(Water goes with it bc water goes with sodium)
- SE:Hypokalemia, hyponatremia, hypochloremia, and hypercalcemia
- Wont be on potassium supplements
- watch electrolytes bc sometime pts wont hold on to their sodium and most of the time they do
17
Q
Loop Diuretics
A
- The loop diuretics work in the loop of Henle to inhibit reabsorption of sodium and chloride.
- Exert a powerful effect on fluid and electrolyte balance.
- Referred to as high-ceiling(more you give, the more it works) diuretics because the maximum diuretic effect that can be achieved is higher than with other diuretics.
- Prototype drug: furosemide (Lasix)
- Bumetide (Bumex)- more potent; Torsemide (Demadex)- longer duration
18
Q
Furosemide
A
- Used to treat peripheral & pulmonary edema & HTN.
- Highly protein-bound drug so If pts are malnourished-> can have toxic effects-> make sure to have albumin on board
- Inhibits the reabsorption of sodium-, chloride, and water in the ascending loop of Henle.(Trades potassium out for sodium)
- SE: Electrolyte imbalance (especially K+ and Mg), alterations in glucose
- NC:Doses over 80 mg IVP can be ototoxic. Pushing too fast can cause subclavian pain and ototoxicity, Damage to the nerve to the inner ear if given too much or too fast, Ear ringing on the side of the IV that ur pushing med in
