Respiratory, ASCVD, prophylaxis, anticoagulant, antiplatelet, thrombolytic agents Flashcards
metered-dose inhaler (MDI)
one dose per actuation
1 minute between doses
pacers increase delivery to lungs
nebulizers
converts solution into mist
admin through mask or mouthpiece over several minutes
respimats
delivers fine mist that gives greater delivery of drug
less deposition into mouth and oropharynx
dry-powder inhalers (DPI)
delivers dry micro powder to lungs
breath-activated
Albuterol (ventonlin) MOA
activate beta2 receptors to cause bronchodilators
albuterol (ventonlin) indications
-relief of acute bronchospasm in asthma
-prevention of exercise-induced breathing
-combination inhaled corticosteroids for COPD
Albuterol (Ventolin) adverse effects
SABA: tachycardia, angina, and tremor
LABA: sever asthma and asthma-related death
Albuterol (Ventolin) nursing considerations
only for symptomatic treatment
LABA never used as monotherapy for asthma
LABA for stable COPD
assess use of SABA for control
Theophylline (Theo-24) MOA
unclear, for symptomatic relief
Theophylline (Theo-24) indications
PO for maintenance of asthma & COPD
IV for asthma emergencies
Theophylline (Theo-24) adverse effects
mild NVD to serious ventricular fib and convulsions
Theophylline (Theo-24) nursing considerations
narrow therapeutic range
do not double dose if dose is missed
lidocaine for v fib and diazepam for convulsions
Tiotropium (spiriva) MOA
long term, muscarinic antagonist
Tiotropium (spiriva) indications
Maintenance therapy of bronchospasm in COPD
Off-label use in asthma
Tiotropium (spiriva) adverse effects
Minimal- limited to dry mouth and irritation of pharynx
Tiotropium (spiriva) nursing considerations
Often combined with albuterol nebulizer (duo-nebs) as PRN medication to use both mechanisms for maximal relief
Budesonide (Pulmicort) MOA
suppress inflammation
Budesonide (Pulmicort) indication
Prophylaxis for asthma
Combination ICS/LABA in COPD
Budesonide (Pulmicort) adverse effects
Inhaled: candidiasis and dysphonia
PO: acute use only when symptoms are uncontrolled
adrenal suppression, hyperglycemia, osteoporosis with prolonged use
Budesonide (Pulmicort) nursing consideration
Patient education on inhalation drug delivery, administration with SABA, and post administration instructions
Tapering with long time PO use and monitoring for adrenal suppression
Cromolyn MOA
prevents release of histamine
Cromolyn indications
prophylaxis for mild-mod asthma
prevention of EIB
relief from seasonal allergies and before allergen
Cromolyn adverse effects
occasional cough or bronchospasm due to inhalation
Cromolyn nursing considerations
not used as a quick relief for acute attack (not used as abortive therapy)
Use 15 minutes before exposure to precipitating factors (e.g. exercise, cold, environmental factors, etc.)
Montelukast (Singulair) MOA
occupies leukotriene receptors
Montelukast (Singulair) indications
Asthma maintenance & prophylaxis
Prevention of EIB
Relief of allergic rhinitis
Montelukast (Singulair) adverse effects
Generally well-tolerated
Montelukast (Singulair) nursing considerations
Patient education- not used as abortive therapy
Cheaper than most inhalers may increase patient adherence
Fluticasone (Flonase) MOA
Fluticasone (Flonase)
Fluticasone (Flonase) adverse effects
drying of nasal mucosa and burning or itching sensation
adrenal suppression and slowed growth in children- rare
Fluticasone (Flonase) nursing consideration
Patient education on relief is greatest if administered daily than PRN
Relief may take a week or longer to develop
Loratadine (Claritin) MOA
block histamine receptors, decreases itching, sneezing, and rhinorrhea (not congestion)
Loratadine (Claritin) indications
prevent or suppress major symptoms due to their actions against histamines
Loratadine (Claritin) adverse effects
generally mild
sedation and anticholinergic effects seen more with 1st gen antihistamine
Loratadine (Claritin) nursing cosniderations
avoid 1st gen antihistamines if you wanna stay up
educate patient that med is most effective if taken daily
intranasal doses can cause somnolence with sufficient systemic absorption
Phenylephrine (Sudafed PE) MOA
activates alpha 1 receptors
Phenylephrine (Sudafed PE) indications
allergic rhinitis, congestion with sinusitis and colds
Phenylephrine (Sudafed PE) adverse effects
Rebound nasal congestion if topical agents are used for more than a few days
CNS excitation (restlessness, irritability, anxiety, and insomnia)
CV effects with PO formulations
Phenylephrine (Sudafed PE) nursing consideration
Monitor vital signs due to potential for increased BP, particularly in those with CV disorders
Patient education that topical should not be used for more than 3-5 consecutive days
Commonly confused with pseudoephedrine, which can be converted into methamphetamine; placed behind counter in pharmacy
Atorvastatin (lipitor) MOA
inhibits cholesterol synthesis within liver
Atorvastatin (lipitor) indications
Hypercholesterolemia
Primary & Secondary CV prevention
Post MI Therapy
DM/DMII
Atorvastatin (lipitor) adverse effects
Myopathy/rhabdomyolysis
Hepatotoxicity
New onset DM (rare)
Teratogenicity (Category X)
Atorvastatin (lipitor) nursing considerations
Administer in evening
Monitor LF and CK
Pt education on contraception and myopathy
Colesevelam (Welchol) MOA
binds to bile acids to prevent absorption and promote excretion
Colesevelam (Welchol) adverse effects
GI tract- primarily constipation, bloating, indigestion, & nausea
Colesevelam (Welchol) nursing considerations
Drug interactions resulting in insoluble complexes (such as meds- thiazides, digoxin, & warfarin)
Administer other oral meds 1 hr before or 4 hr after bile-acid sequestrant administration
Increase fluids & fiber prior to administering laxatives
Take with food and water
Colesevelam (Welchol) Indications
Adjunctive therapy in hypercholesterolemia, often with statin medications
Gemfibrozil (Lopid) MOA
lowers VLDLd levels to reduce TG levels, raises HDL, little to no effect on LDL
Gemfibrozil (Lopid) indications
Hypertriglyceridemia
Mixed dyslipidemia
Gemfibrozil (Lopid) adverse effects
Most common: rash and GI disturbance (nausea, ab pain, diarrhea)
Risk of gallstones
Myopathy/rhabdomyolysis
Hepatotoxicity
Gemfibrozil (Lopid) nursing considerations
Can increase anticoagulant effects in patients on warfarin
Monitor for bleeding and INR
Periodic liver function test (LFT)
Patient education on myopathy and gallstones
Aspirin (ASA) MOA
Irreversibly inhibits cyclooxygenase to prevent TXA2 synthesis needed to promote platelet activation
Aspirin (ASA) indications
Primary & secondary prevention of-
Ischemic CVA and TIA
Angina and MI-related events
Aspirin (ASA) adverse effects
Bleeding, especially in GI
Hemorrhagic stroke
Salicylism
Renal impairment
Aspirin (ASA) nursing consideration
Dosing
81 mg helps to prevent CV events
325 mg helps in initial treatment of CV events
Educate & monitor for signs of bleeding
Educate on other sources of aspirin (Excedrin, BC powder, Alka-seltzer)
Give PPI if GI bleeding occurs
Education on medication use in setting of elective surgery (stopped 7- 10 days before)
Clopidogrel (Plavix) MOA
Irreversibly prevents ADP-stimulated platelet aggregation and blood clot formation
Clopidogrel (Plavix) indications
Combined with ASA, helps to reduce thrombotic events in patients with acute coronary syndrome
Prevent blockage of coronary artery stents
Clopidogrel (Plavix) adverse effects
Bleeding
Thrombotic Thrombocytopenic Purpura (TTP)
Clopidogrel (Plavix) nursing consideration
Educate & monitor for signs of bleeding and directions for continuing medication
Education on medication use in setting of surgery (Hold 5 days before elective surgery)
Give PPI if GI bleed occurs
Abciximab (ReoPro) MOA
reversible blockade of platelet receptors to inhibit final step of platelet aggregation
Abciximab (ReoPro) indications
Prevent ischemic events with those who with ACS
Non-STEMI and Unstable Angina
Percutaneous Coronary Intervention (PCI)
Abciximab (ReoPro) adverse effects
Bleeding, particularly PCI insertion site
Abciximab (ReoPro) nursing considerations
post procedure cardiac cath monitoring
monitor for s/s bleeding
Heparin MOA
helps antithrombin inactivate thrombin and factor Xa
Heparin indications
DVT and PE
Open heart surgery and renal dialysis
Low dose for DVT prophylaxis
Disseminated Intravascular Coagulation (DIC)
Adjunct to thrombolytic therapy of acute MI
heparin adverse effects
Bleeding
Heparin-induced thrombocytopenia (HIT)
Severe neuro injury if given to spinal puncture/epidural anesthesia
heparin nursing considerations
Educate & monitor for signs of bleeding
Monitor aPTT/anti-Xa (4 to 6 hours) & CBC during therapy
Protamine sulfate antidote
enoxaparin (Lovenox) MOA
enhance activity of antithrombin to preferentially indirectly inhibit activity of thrombin and factor Xa
enoxaparin (Lovenox) indications
DVT and PE
DVT prophylaxis following THA, TKA, & abdominal sx
Off label use for DVT prophylaxis after general sx and in patients with multiple trauma and acute spinal injury
enoxaparin (Lovenox) adverse effects
Bleeding
Heparin-induced thrombocytopenia (HIT)
Severe neuro injury if given to spinal puncture/epidural anesthesia
enoxaparin (Lovenox) nursing considerations
Educate & monitor for signs of bleeding
Monitor CBC during therapy
Protamine sulfate antidote
Warfarin (Coumadin) MOA
Suppresses production of factors VII, IX, X, and prothrombin
Warfarin (Coumadin) indications
Long-term prophylaxis of thrombosis:
DVT and PE
In prosthetic heart valves
In atrial fibrillation
Reduce risk of recurrent stroke and MI
Warfarin (Coumadin) adverse effects
Bleeding
Teratogenic
Warfarin (Coumadin) nursing consideration
Educate & monitor for signs of bleeding
Monitor PT & INR during therapy
Vitamin K antidote and intake of green leafy vegetables
Numerous medication interactions
Much longer half-life than heparin (days vs hours)
Dabigatran (Pradaxa) MOA
direct, reversible inhibitor of free and bound thrombin
Dabigatran (Pradaxa) indications
Treatment of DVT and PE
Prevention of VTE in THA and TKA
Prevention of thrombosis in patients with atrial fibrillation
Dabigatran (Pradaxa) adverse effects
Bleeding
GI disturbances- dyspepsia and/or gastritis-like symptoms
Dabigatran (Pradaxa) nursing consideration
Educate & monitor for signs of bleeding
No need for monitoring PT/INR
Caution for those with renal impairment
Antidote: idarucizumab (Praxbind)
Rivaroxaban (Xarelto) MOA
Directly inhibits Xa, interfering with thrombin production
Rivaroxaban (Xarelto) indications
For DVT and PE
In THA and TKA
In non-orthopedic sx
For Recurrent DVT and PE
Prevention of thrombosis in patients with afib
Rivaroxaban (Xarelto) adverse effects
Bleeding, especially with pre-existing renal impairment
Spinal/epidural hematoma
Unsafe in pregnancy, only use if benefits outweighs risk
Rivaroxaban (Xarelto) nursing consideration
Educate & monitor for signs of bleeding
No need for monitoring PT/INR
Caution with renal and/or hepatic impairment (dosage adjustment)
Antidote for Apixaban: Andexxa
Alteplase (tPA) MOA
Forms complexes with plasminogen to convert into plasmin, an enzyme that digests fibrin, as well as degrade fibrinogen and other clotting factors
Alteplase (tPA) indications
Acute MI, acute ischemic stroke, and acute massive PE
Low doses for blocked central venous catheter (CVC)
Alteplase (tPA) adverse effects
Bleeding, particularly ICH
Alteplase (tPA) nursing consideration
Many contraindications and precautions, so obtain thorough history
Monitor closely for bleeding during administration and limit potential sources for bleeding
Efficacy seen if administered within 2-4 h of symptom onset
