Pharmacology - Exam 3 Flashcards
What kind of a drug is heparin?
Anticoagulant
What are the actions and uses of heparin?
Natural substance found in the liver and lining of blood vessels.
Normal function is to prolong coagulation time, thereby preventing excessive clotting within blood vessels.
Heparin prevents the enlargement of existing clots and the formation of new ones.
It has no ability to dissolve existing clots.
What are the administration alerts related to injections for heparin?
Never draw back the syringe plunger once the needle has entered the skin and never massage the site after injection. Doing either can contribute to bleeding or tissue damage.
What is the black box warning for heparin?
Epidural or spinal hematomas may occur when heparin or LMWHs are used in patients receiving spinal anesthesia or lumbar puncture. Because these can result in LT or permanent paralysis, frequent monitoring for neurologic impairment is essential.
What is the treatment for overdose of heparin?
If serious hemorrhage occurs, a specific antagonist (protamine sulfate) may be administered IV to neutralize heparin’s anticoagulant activity. Protamine sulfate has an onset of action of 5 minutes and is also an antagonist to LMWHs.
Which drug is a vitamin K antagonist?
Warfarin (coumadin) is an anticoagulant and vitamin K antagonist
What are the actions and uses of warfarin?
Indications for warfarin therapy include the prevention of stroke, MI, DVT, and pulmonary embolism in patients undergoing hip/knee surgery, or in those with LT indwelling central venous catheters or prosthetic heart valves.
Warfarin may be given to prevent thromboembolic events in high risk patients following an MI or atrial fibrillation episode.
What are the lab values to monitor throughout Warfarin therapy?
The therapeutic range of serum warfarin levels carries from 1-10 mcg/mL to achieve an INR value of 2-3.
What is the black box warning for Warfarin?
Warfarin can cause major or fatal bleeding, and regular monitoring of INR is required. Patients should be instructed about prevention measures to minimize bleeding risk and to immediately notify healthcare providers of signs and symptoms of bleeding.
What are herbal/food contraindications for Warfarin?
Use of warfarin with herbal supplements such as green tea, ginkgo, feverfew, garlic, cranberry, chamomile, and ginger may increase the risk of bleeding.
Consumption of foods rich in vitamin k (kale/spinach/turnip or mustard greens/ broccoli/ brussels sprouts/ cabbage) may reduce the therapeutic effects of warfarin.
What are the overdose treatments of warfarin?
An overdose of warfarin is treated with vitamin K, given either PO (non-emergency reversal) or IV (emergency reversal). Reversal of anticoagulant effects of warfarin is usually complete within 24 hours.
What is a type of anti-platelet drug?
Clopidogrel (Plavix) is an antiplatelet drug and ADP receptor blocker
What are administration alerts for Clopidogrel (Plavix)?
Clopidogrel tablets should not be crushed or split.
Discontinue drug at least 5 days prior to surgery.
Pregnancy Cat B
What are the Black Box warnings / genetic considerations for Clopidogrel (Plavix)?
Because the effectiveness of Clopidogrel (Plavix) is dependent on its metabolic activation by CY P450 enzymes, poor metabolizers will exhibit less therapeutic effect and more adverse cardiovascular events. Tests are available to identify poor metabolizers of this enzyme. More than 50% of Asians have genetic variants that inhibit clopidogrel metabolism.
Safety statements for coagulation meds?
Anticoagulant use is a high-risk safety concern and is included in the Joint Commission’s National Patient Safety Goals.
Teach the patient/caregiver signs and symptoms of excessive bleeding, including occult bleeding. If external bleeding occurs, pressure of the site should be held up to 15 minutes. If bleeding continues, is severe, or is accompanied by dizziness or syncope, immediate medical attention (911) should be obtained.
What kind of drugs are in the erythropoietin class?
Erythropoietin is one of the hematopoietic growth factor/enhancer drugs. It’s an erythropoiesis stimulating drug.
Epoetin Alfa (Epogen, Procrit)
Epoetin Alfa is an erythropoietin.
Actions and uses of epeotin alfa
Epoetin alfa is made through recombinant DNA technology and is functionally identical to human erythropoietin.
Because of its ability to stimulate erythropoiesis, epoetin alfa is effective in treating disorders caused by a deficiency in RBC formation.
Patients with CKD often cannot secrete enough endogenous erythropoietin and benefit from epoetin alfa administration.
Administrative alerts for epoetin alfa (handling)
The subQ route is generally preferred over IV route because lower doses are needed and absorption is lower. Do not shake the epoetin alfa vial because this may deactivate the drug. Visibly inspect the solution for particulate matter.
Black box warnings for epoetin alfa
The risk of serious cardiovascular and thromboembolic events is increased with epoetin alfa therapy.
TIAs, MIA, and strokes have occurred in patients with CKD who are on dialysis and being treated with epoetin alfa.
Epoetin alfa increased the rate of DVT in patients not receiving concurrent anticoagulation. The lowest dose possible should be used in patients with cancer because the drug can promote tumor progression and shorten overall survival.
What drug is a colony stimulating factor?
Filgrastim (Neupogen) is a colony stimulating factor. This drug increases neutrophil production.
Administration alerts for filgrastim (neupogen)
Do not administer filgrastim within 24 hours before or after chemotherapy with cytotoxic drugs because this will greatly decrease the effectiveness of filgrastim.
Adverse effects of filgrastim
Common adverse effects of filgrastim include fatigue, rash, epistaxis, decreased platelet counts, neurtopenic fever, nausea, and vomiting.
Filgrastim is associated with potentially serious adverse effects and close monitoring is required.
Bone pain occurs in a significant number of patients receiving filgrastim.
A small % of patients may develop an allergic reaction.
Frequent lab tests are necessary to ensure that excessive numbers of neutrophils (leukocytes) do not occur. Leukocyte counts of higher than 100,000 cells/mm3 increase the risk of serious adverse effects, such as respiratory failure, intracranial hemorrhage, retinal hemorrhage, and MI. Fatal rupture of the spleen has occurred in a small number of patients.
What type of drug is cyanocobalamin (B-12)?
Cyanocobalamin (B-12) is a vitamin supplement for anemia.
Intrinsic factor’s role in cyanocobalamin (B-12) administration
Oral vitamin B12 formations are available primarily as vitamin supplementation, although they are only effective in patients who have sufficient amounts of intrinsic factor.
What type of drug is ferrous sulfate (iron)?
Ferrous sulfate (iron) is an iron supplement and anti-anemic drug.
Black box warning for children for ferrous sulfate?
nonintentional overdoses of iron-containing products are a leading cause of fatal poisoning in children.
Herbal/food considerations with ferrous sulfate (iron)
food, especially dairy products, will inhibit absorption of ferrous sulfate. Foods high in vitamin C, such as orange juice and strawberries, can increase the absorption of iron.
Administration alerts with ferrous sulfate (iron)
when administering via IV, be careful to prevent infiltration because iron is highly irritating to tissues.
Use the z-track method (deep muscle) when giving IM.
Do not crush tablets or empty contents of capsules when administrating.
Do not give tablets or capsules within 1 hour of bedtime.
Ibuprofen Administration alerts
give ibuprofen on an empty stomach as tolerated.
If nausea, vomiting, or abdominal pain occurs, give with food.
Be aware that patients with asthma or who have allergies to aspirin are more likely to exhibit a hypersensitivity reaction to ibuprofen.
Ibuprofen adverse effects
when used intermittently at low-moderate doses, the adverse effects of ibuprofen are generally mild and include nausea, heartburn, epigastric pain, and dizziness.
GI ulceration with occult or gross bleeding may occur, especially in patients who are taking high doses for prolonged periods.
Chronic use of ibuprofen may lead to CKD.
Ibuprofen black box warning
NSAIDs may cause an increased risk of serious thrombotic events, MI, and stroke, which can be fatal. This risk may increase with duration of use.
Patients with CV disease or risk factors for CV disease may be at greater risk.
NSAIDs are contraindicated for the treatment of perioperative pain in those undergoing coronary artery bypass graft surgery.
NSAIDs increase the risk of serious GI adverse events, including bleeding, ulceration, and the perforation of the stomach or intestines - which can be fatal.
Ibuprofen maximum daily dose
Max daily dose is 3200/mg/day, or 400-800 TID-QID
Prednisone - type of drug
Prednisone is a corticosteroid
Adverse effects of prednisone
LT therapy may result in cushing syndrome, a condition that includes hyperglycemia, fat redistribution to the shoulders and face, muscle weakness, bruising, and bones that easily fracture.
Because gastric ulcers may occur with LT therapy, an antiulcer medication may be prescribed prophylactically.
Use with caution in patients with peptic ulcer, ulcerative colitis, or diverticulitis.
Contraindications of prednisone
Patients with active viral, bacterial, fungal, or protozoan infections should not take prednisone.
what type of drug is acetaminophen?
Acetaminophen is an antipyretic
Patient safety related to acetaminophen
Lots of OTC medications have acetaminophen in them, so it easy to overdose and should be reviewed in a med rec.
Administration alerts related to acetaminophen
liquid forms are available in varying concentrations. Use the appropriate-strength product in children to avoid toxicity. Never administer to patients who consume alcohol regularly due to the potential for drug-induced hepatotoxicity. Advise patients that acetaminophen is found in many OTC products and that extreme care must be taken to not duplicate doses by taking several of these products concurrently.
adverse effects of acetaminophen
acetaminophen is generally safe, and adverse effects are uncommon at therapeutic doses. The risk of adverse effects is dose related and increases with LT use.
Acute acetaminophen poisoning is very serious. Symptoms include anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, abdominal pain, and diarrhea.
Excessive acetaminophen use is the nuber one cause of acute liver failure in the US.
Black box warning of acetaminophen
Acetaminophen has the potential to cause severe and even fatal liver injury and may cause serious allergic reactions with symptoms of angioedema, difficulty breathing, itching, or rash.
Because of FDA recommendations, drug manufacturers now limit the strength of acetaminophen in prescription combination products to 325 mg/tablet to lower the potential for acetaminophen induced hepatotoxicity.
Hep B Vaccine (HBV)
Given to children: at birth, 1-4 months, and 6-18 months later.
HBV actions and uses
HBV is a highly effective vaccine that provides active immunity for 99-100% of patients. indications include all infants at birth, children <19yo who have not been vaccinated, healthcare workers or caregivers who are at risk for contact with Hep B, individuals with high risk sexual practices etc.
HBV doesn’t provide against exposure to other non-B hep viruses.
HBV is produced through recombinant DNA tech, using yeast cells. It is not prepared from human blood.
HBV administration alerts
in adults, use the deltoid muscle for the injection site, unless contraindicated. Because none of the formulas of Recomivax HB contain a preservative, once the single dose vial has been penetrated, withdrawn vaccine should be used promptly and the vial discarded.
Epinephrine (1:1000) should be immediately available to treat a possible anaphylactic reaction.
Interferon
Interferons are secreted by lymphocytes and macrophages that have been infected with a virus. They slow the spread of viral infections and enhance the activity of leukocytes.
Interferon alfa-2b
used to treat multiple sclerosis, granulomatous disease, and severe osteoporosis
