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Pharm > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Which direct thrombin inhibitor promotes nitric oxide release?

A

argatroban

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2
Q

Pulmonary is to bleomycin, as cardias is to?

A

doxorubicin (adriamycin)

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3
Q

How does ASA work as an antiplatelet medication?

A

inhibits thromboxane synthesis- interferes with COX 1 and 2 enzymes (irreversible- lasts for life of platelet)

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4
Q

Heparin is present endogenously on?

A

basophils and mast cells (as well as liver)

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5
Q

Which antimicrotubule chemo agent causes vascular permeability, peripheral edema, pleural effusion, and ascites?

A

Docetaxel

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6
Q

Heparin characteristics

A
  • binds to antithrombin
  • poorly lipid soluble, high molecular weight
  • given IV or deep SQ
  • prevents clot formation
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7
Q

What lab values evaluate heparin?

A

APTT and ACT

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8
Q

Contraindications for heparin

A

known bleeding tendencies, intracranial or intraocular surgery

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9
Q

Side effects of heparin

A
  • bleeding
  • HIT
  • CV changes (decreased MAP from decreased SVR)
  • altered protein binding (displaces alkaline drugs, increased concentrations of unbound drugs like propofol)
  • decreased antithrombin
  • altered cell morphology (leukocytes and RBCs)
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10
Q

Protamine characteristics

A
  • specific antagonist to heparin
  • strongly alkaline, positively charged
  • cleared by reticuloendothelial system
  • 1.3 mg for every 100 units heparin
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11
Q

Side effects of protamine

A
  • hypotension (rapid injection)
  • pulmonary hypertension (release of thromboxane and serotonin)
  • allergic reactions (fish allergy)
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12
Q

Warfarin characteristics

A
  • prevention of embolic events
  • rapidly and completely absorbed
  • high protein binding
  • does NOT cross into placenta
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13
Q

What lab test evaluates warfarin?

A

PT and INR

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14
Q

Warfarin and surgery

A
  • minor surgery ok
  • d/c 1-3 pre op before majory surgery (bridge with hep)
  • need Vit K and FFP to reverse warfarin for emergent surgery
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15
Q

Alteplase

A
  • thrombolytic

- major risk of spontaneous bleeding (trauma)

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16
Q

What do you treat spontaneous bleeding with from alteplase?

A

FFP, cryo, platelets

17
Q

Very rapid acting insulins and timing

A

lispro, aspart, glulisine
5-15 onset
45-75 peak
2-4 hour duration

18
Q

Rapid acting insulin

A

regular
20 min onset
2-4 h peak
6-8 h duration

19
Q

Intermediate acting insulin

A

NPH
2h onset
4-12 h peak
18-28 hour duration

20
Q

Long acting insulins

A

detemir (2 h onset, 3-9h peak, 6-24h duration)

glargine (1.5 h onset, no peak, 20-24h duration)

21
Q

ultra long acting insulin

A

degludec
2 hour onset
no peak
>40 hour duration

22
Q

Insulin is metabolized by:

A

proteolytic enzymes in the liver and kidneys

23
Q

Pharmacokinetics of heparin

A
  • poorly lipid soluble, high molecular weight
  • poorly absorbed from GI
  • does not cross placenta
  • circulates bound to plasma proteins (may neutralize anticoag effects)
  • non linear dose response relationship
  • elimination 1/2 time increased by low body temp and hepatic and renal dysfunction
24
Q

Regular crystalline zinc insulin

A

onset 0.5-1 hours
peak 2-3 hours
duration 6-8 hours

25
Q

Which 2 drugs have a 10% potential for cardiotoxicity and may enhance myocardial depressant effects of anesthetics?

A

doxorubicin and daunorubicin

26
Q

Consideration with hypoglycemia and anesthetics

A

anesthesia and nonselective beta adrenergic antagonists can mask s/s of hypoglycemia

27
Q

What oral hypoglycemic agent has a risk of lactic acidosis?

A

metformin- avoid use with hepatic dysfunction

28
Q

How does streptokinase work?

A

thrombolytic- act as plasminogen activators; converts proenzyme plasminogen to plasmin and that hydrolyzes fibrin to dissolve clot

29
Q

How does warfarin work?

A

blocks vitamin K from synthesizing clotting factors in the liver

30
Q

What is insulin resistance?

A

cells don’t respond to insulin and can’t use glucose as energy

31
Q

What happens with pancreas removal?

A

patients require exogenous insulin

Pharm (5 decks)

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