Quiz 4 Flashcards
Heparin
Action
Use
Administration
Antidote
Bind with antithrombin III (inhibit clot formation, stops coagulation cascade)
Prevent venous thrombosis
SubQ: prevention
IV: treatment
Protamine sulfate
Adverse effects of heparin
Nosebleeds, blood urine and stool, bloody gums
Heparin-induced thrombocytopenia (low platelets caused by heparin)
Antidote of warfarin
Vitamin K
Direct Factor Xa
Antagonist
Prototype
Action
Use
Rivaroxaban (Xarelto)
Inhibits platelet activation
Prevention of VTE and stroke
Adverse reactions of alteplase
Antidote
Hemorrhage
Aminocaproic acid
3 factors the predispose pts to thrombosis
Stasis: blood slow = > cot
Vascular damage
Hypercoagulability: > chance of coagulation
Arterial clot formation vs venous clot formation
Arterial: damaged vessels
Venous: caused by circulatory stasis
Heparin lab (what is it)
Therapeutic
apTT: how long it takes for a clot to form (activated thromboplastin time)
45-70 sec
Enoxaparin (lovenox)
What is it?
Administration
Labs
Low-molecular-weight heparin (having a low molecular weight)
SubQ
Frequent lab monitoring not required
Contraindication of enoxaparin
renal impairment
Side effects of enoxaparin
lower risk of bleeding
Vitamin K antagonist
Prototype
Action
Use
Warfarin (Coumadin)
Inhibits hepatic synthesis of Vitamin K
Prevent thromboembolic events
Labs for warfarin
INR (international normalized ratio). Time it takes to clot
Therapeutic range: 2-3
(calculated from PT (prothrombin time))
Antiplatelet
Prototype
Action
Use
OTC
Clopidogrel (plavix)
Action: irreversibly suppresses platelets (platelet lifespan is 7-10 days)
Prevents new clots or prevent them from getting bigger
Aspirin
Thrombolytic
Prototype
Action
Use
Alteplase (Activase)
Bind to fibrin promoting conversion of plasminogen to plasmin (plasmin digests fibrin)
Disintegrates clots
When do we give alteplase
Severe cases where leg isn’t being perfused
Ischemic stroke
Erythropoiesis-stimulating agents
Prototype
MOA
Use
Epoetin alfa (procrit)
Mimics hormone erythropoietin. Only give if benefits > risk
Anemia secondary to chemotherapy or kidney disease
Granulocyte colony stimulating factor
Prototype
MOA
Use
Administration
Filgrastim (neupogen)
Tell bone marrow to make more neutrophils
Neutropenia secondary to marrow transplant or chemo
SubQ or IV
Adverse effects of filgrastim
Flu-like symptoms
Arthralgia (joint stiffness)
Splenomegaly
Interferons
Prototype
MOA
Use
Administration
Interferon alfa 2B
Antiviral, destroys viruses
Antineoplastic, boost immune response
SubQ or IM (3 times a week)
What are interferons
Functions
Proteins naturally occurring in the body (alpha, beta, gamma)
Slow growth of cancer cells, stimulate certain WBCs to fight cancer, antiviral effects
Black box warning on Epoetin alfa
Hemoglobin must be < 10 g/dl
Avoid if hemoglobin > 12g/dl = > blood clots
Epoetin alfa
Administration
SubQ, IV
Nursing interventions of filgrastim
Palpating abdominal in case of splenomegaly
Function of triglycerides
Store unused calories and provide your body with energy
Nonpharmacological methods for cholesterol reduction
< saturate fats and cholesterol
< total fat intake to 30% or less of caloric intake
< cholesterol intake to 300mg/day or less
Exercise
Stop smoking
HMG CoA Reductase Inhibitors
Prototype
Action
Use
Atorvastatin
Inhibit enzyme HMG CoA reductase (responsible for cholesterol biosynthesis)
Reduce amount of cholesterol the body makes. < LDLs, > HDL
Side effects of HMG CoA reductase inhibitors
GI distress, constipation, fatigue, cataracts, liver impairment, muscle cramps, rhabdomyolysis (skeletal muscle destruction)
brown colored pee
Bile acid sequestrants
Prototype
Action
Use
Cholestyramine
Binds with bile acids in the intestine to be excreted out
Remove bile (cholesterol) from the body. Causes cholesterol to be pooped out
Side effects of bile acid sequestrants
Constipation, flatulance, cramping
Fibrates
Prototype
Action
Use
Fenofibrate
Increases breakdown of fatty acids
Reduces triglycerides
Adverse effects of fibrates
GI upset, liver dysfunction, gallstones
Intervention of fibrates
Get liver checked out, labs
Cholesterol Absorption inhibitor
Prototype
Action
Adverse effects
Ezetimibe
acts on the cells in the small intestine to inhibit cholesterol absorption
Diarrhea
Misc. Antihyperlipidemics
Prototype
Action
Nicotinic acid/ Niacin/ Vitamin B
Reduces VLDL and LDL
Side effects of Misc. Antihyperlipidemics
GI distress, flushing, hepatic dysfunction, hyperglycemia, hyperuricemia
Nursing interventions for dyslipidemia medications
Blood lipid levels
Monitor lab values for liver function
Take several weeks before blood lipid levels decline
Instruct pt to have annual eye exams and report changes in visual acuity
Function of cholesterol
Cell membrane
Steroid hormones
Bile salts: digestion of fats
HDL vs LDL
High-density lipoprotein: removes cholesterol from blood–>liver for elimination
Low-density lipoprotein: Fat leaks out into bloodstream = plaque buildup
Should you suddenly stop taking HMG CoA reductase inhibitors?
No, taper
Abrupt discontinuation may lead to rebound effect
Interventions for bile acid sequestrants
Drink with water
Stay hydrate
Eat more fiber
Why do we not want to administer antihyperlipidemics
Large doses are required
Leads to bad reactions/toxicity
Nursing responsibilities for immunosuppressants
Monitor for infection
Autoimmune disorders
Crohn’s Disease: bowel inflammation
Rheumatoid arthritis
Psoriasis: plaque lesions
Myasthenia Gravis
Function of antigens
recognize self vs pathogens
What happens after an organ transplant
Graft rejection reaction: fight the organ and rejecting it
Can lead to organ failure
Why do clients that receive transplanted tissue require immunosuppressants?
So body doesn’t deny it
Anti-rejection therapy
Drugs
MOA
Adverse effects
How long?
Mycophenolate Mofetil (CellCept), Cyclosporine
Suppress the immune system
Increase risk for infection
For life
contraindications of cyclosporine
Grapefruit juice
Cause toxicity
Administration of cyclosporine
Mix cyclosporine with juice to make it palatable
Corticosteroids
Drugs
Use
How long?
Prednisone, hydrocortisone
Asthma, COPD, joint pain
Short term, Tapered
Side effects of corticosteroids
Anti-inflammatory effects, immunosuppressive effects, moodswings, increased appetite
Long term: moon face, weight gain
Antibody (immunoglobulin) preparations
Route
MOA
Drugs
Parenterally
Block cell receptors or inhibit inflammatory cytokines
Monoclonal antibodies
Polyclonal antibodies. Muromonab-CD3, infliximab, basiliximab
Antibody (immunoglobulin)
preparations
Use
Side effects
Reduces damage caused by inflammation
Prevent rejection
Risk for infection
How is antibody preparations preapred?
Make multiple antigens, put in a bottle, and given to redirect their immune system
Side/Adverse effects of chemotherapy
Affects normal cells (rapidly growth tissues)
Alopecia, infertility, anemia, myelosuppression (< in WBC, platelets, RBC), dry/flaky skin, nosebleeds
How long till the body starts feeling the effects of chemotherapy?
7-10 days
Try to avoid people because immunocompromised
Anticancer drugs
Alkylating agents (prevent DNA replication)
Antitumor antibiotics
Hormones
Antimetabolites
Vinca alkaloids
Function of combination chemotherapy
Enhances tumoricidal activity (destroys tumor cells)
> chance of affecting cancer cells in all phases of cell cycle
> synergestic effects to kill cancer cells
< drug resistance
Why are 2 anticancer drugs used instead of just 1?
Synergistic effect when combined
