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pharm 2 > test 2 > Flashcards

test 2 Flashcards

1
Q

nonpharm therapies for dysrhythmias

A

pacemaker, ablation, ICD, cardioversion, defibrillator

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2
Q

what does sodium ions do to the heart

A

cause depolarization

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3
Q

what does calcium ions do to heart

A

stimulate cardiac muscle cells

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4
Q

issue of antidyrthmics

A

they can worsen or create new dysrhthmias

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5
Q

what do class I sodium channel blockers do

A

delay or accelerate repolarization; slow conduction velocity, may alter duration of action potential

monitor LOC

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6
Q

what do class II beta adrenergics antagonist do

A

slow conduction velocity through AV node, decrease automaticity, prolong refractory period

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7
Q

what do class III potassium channel blockers do

A

delay repolarization, increase duration of action potential, lengthen refractory period-stabilize dysrhythmias

Monitor for Jaundice

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8
Q

what do class IV calcium channel blockers do

A

slow conduction velocity, decrease contractility, prolong refractory period

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9
Q

procainamide ther class, pharm class, preg category

A

ther- Class IA antidysrhythmic
pharm -sodium channel blocker
preg cat C

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10
Q

Procainamide action and uses

A

suppress dysrhythmias
Blocks sodium ion channels in myocardial cells, reducing automaticity and slowing conduction of the action potential across the myocardium, prolongs refractory period.

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11
Q

procainamide contraindications, adverse effects, admin concerns

A

contraindications- AV block, severe HF, blood dyscrasias, MG

adverse effects- GI complaints, hypotension, headache. High doses can produce CNS effects like confusion. Black box- lupus like syndrome may occur if token over a year

may increase liver values.

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12
Q

Propranolol (Inderal, InnoPran XL) ther class, pharm class, preg cat

A

ther- Class II antidysrhythmic
pharm- Beta-adrenergic antagonist
preg cat- C

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13
Q

Propranolol (Inderal, InnoPran XL) action and uses

A

Treating tachycardia from sympathetic stimulation, HTN, migraines, prevention of MI, helps panic attacks, PTSD, tremors

Nonselective beta adrenergic antagonist that affects beta 1 and beta 2. reduces HR, slows myocardial conduction velocity, and lowers BP

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14
Q

Propranolol (Inderal, InnoPran XL) contraindications, adverse effects, admin concerns

A

contraindications- Cardiogenic shock, sinus bradycardia, copd, asthma

adverse- Common; Fatigue, hypotension, bradycardia.
Diminished libido. Black box- abrupt stop worsen symptoms, causing MI, HTN, ventricular dysrhythmias

admin concerns- call dr if heart beat less than 60

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15
Q

amiodarone (pacerone) ther class, pharm class, preg cat

A

ther-Class III antidysrhythmic
pharm-Potassium channel blocker

preg cat D

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16
Q

amiodarone (pacerone) action and uses

A

Approved for treatment of resistant ventricular tachycardia and atrial dysrhythmias

Blocks K+ ion channels, blockage of some sodium channels

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17
Q

amiodarone (pacerone) contraindications, adverse effects, admin concerns

A

contraindications -Severe bradycardia, cardiogenic shock, sick sinus, sinus node dysfunction, 3rd degree AV block

adverse effects-Black box- pneumonia like syndrome in lungs- pulm toxicity.
May be elevated liver enzymes, thyroid dysfunction, bluish skin, blurred vision, rashes, anorexia, hypotension

admin concerns- Hypokalemia and hypomagnesemia needs to be corrected before giving this
may increase liver and thyroid values

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18
Q

verapamil (Calan, covera-hs, isoptin SR, verelan) pharm class, ther class, preg cat

A

ther- Class IV antidysrhythmic, antihypertensive, antianginal

pharm- Calcium channel blocker

preg cat C

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19
Q

verapamil (Calan, covera-hs, isoptin SR, verelan) action and uses

A

Inhibiting flow of calcium ions into myocardial cells and in vascular smooth muscle. Stabilizes dysthymias. Decreases cardiac workload, lowering bp. Dilates coronary arteries, Decreasing agina

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20
Q

verapamil (Calan, covera-hs, isoptin SR, verelan) contraindications, adverse effects, admin concerns

A

contraindications- AV heart block, sick sinus, severe hypotension, bleeding aneurysm, or those undergoing intracranial surgery. Use w caution in ckd or hepatic impairment

adverse effects- Headache, flushed skin, constipation, hypotension, bradycardia, pedal edema

avoid grapefruit and caffeine

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21
Q

adenosine (adenocard)

A

decreases automaticity of SA node and sloes conduction thru AV node: slows HR
for serious atrial tachycardia or SVT

Adverse effects-facial flushing, dyspnea

metabolized by RBC. only in IV form for emergency

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22
Q

digoxin (lanoxin)

A

decreases automaticity of SA node and sloes conduction thru AV node: slows HR
mostly seen in HF, but can help atrial dysrhythmias

adverse- dig toxicity. nausea, vomiting, headache, vision disturbances

don’t let HR get under 60

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23
Q

roles of nurse for dysrhythmias

A

monitor for BP changes, changes in consciousness, vision changes, jauncidce
vital signs
ECG

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24
Q

good cholesterol

A

HDL

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25
Q

Bad cholesterol

A

LDL, VLDL

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26
Q

atorvastatin (Lipitor) ther class, pharm class, preg cat

A

ther- antihyperlipidemic
pharm- HMG-CoA reductase inhibitor, statin

preg cat x. dont breastfeed

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27
Q

atorvastatin (Lipitor) uses and actions

A

reducing serum-lipid levels, reducing risk of stroke and MI. also prevent CVA in patients with risk factors

statins act by Inhibiting HMG CoA reductase. As the liver makes less cholesterol it responds by making more LDL. interferes with synthesis of cholesterol

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28
Q

atorvastatin (Lipitor) contraindications, adverse effects, admin concerns

A

contraindications- Prior hypersensitivity, elevated serum transaminases, liver disease

adverse effects-GI complaints, headaches, possible people experience hepatotoxicity. Most serious adverse effect is rhabdomyolysis

admin concerns- no grapefruit juice, admin with food to avoid GI irritation

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29
Q

cholestyramine (questran) ther class, pharm class, preg cat

A

ther- Antihyperlipidemic
pharm- Bile acid sequestrant

preg cat c

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30
Q

cholestyramine (questran) action and uses

A

Cholestyramine is a powder that is mixed with fluid token once-twice daily. Not absorbed or metabolized in intestine, doesn’t produce any systemic effects. May need at least a month to get maximum effect. Binds with bile acids in an insoluble complex that excretes thru feces, lowering cholesterol

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31
Q

cholestyramine (questran) contraindications, adverse effects, admin concerns

A

contraindications- Patients with biliary obstruction and prior hypersensitivity

adverse effects- constipation, nausea, gas

admin concerns- Give other drugs 2 hours before or 4 hours after
Increase in AST, ALP, chloride, decrease in serum calcium, sodium, and potassium

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32
Q

Niacin (nicotinic)

A

B complex vitamin
- decreases VLDL levels, but produce more side effects than statins
adverse effects- hot flashes, flushing, diarrhea, nausea, gout, hepatotoxicity

monitor blood sugar, liver function, uric acid levels

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33
Q

gemfibrozil (lopid) ther class, pharm class, preg cat

A

ther class- antihyperlipidemic
pharm class- Fibric acid drug

preg cat B

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34
Q

gemfibrozil (lopid) action and uses

A

for treatment of hypertriglyceridemia and hypercholesterolemia

Mech of action unknown, is less effective than statins so not 1st choice drug

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35
Q

gemfibrozil (lopid) contraindications, adverse effects, admin concerns

A

contraindications- Hepatic impairment, kidney disease, gallbladder disease, prior hypersensitivity

adverse- Gallstones, may affect liver function. GI symptoms

no fatty foods, admin with meals
monitor labs

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36
Q

ezetimibe (Zetia)

A

inhibits absorption of cholesterol
slightly reduces LDL

Adverse effects- nasopharyngitis, myalgia, upper resp tract infection, arthralgia

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37
Q

left sided HF

A

Fluid in lungs

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38
Q

right sided HF

A

Fluid in body- edema

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39
Q

relationship between heart and kidney issues

A

If kidneys don’t get enough blood and oxygen they secrete renin and aldosterone, vasoconstricting, elevating blood flow. They think we’re loosing blood flow somewhere.
so in HF, kidneys sense low o2, raising bp

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40
Q

ace inhibitors and K+

A

ace inhibitor causes body to retain K+, could lead to hyperkalemia

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41
Q

lisinopril (prinivil, zestril) ther class, pharm class, preg cat

A

ther-Drug for HF and HTN
pharm-ACE inhibitor
preg cat C first sem, D second

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42
Q

lisinopril (prinivil, zestril) action and uses

A

Inhibits ACE and decreases aldosterone secretion

-Treatment for HF, HTN. BP decreased, cardiac output increases

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43
Q

lisinopril (prinivil, zestril) contraindications, adverse effects, and admin concerns

A

contraindications- Hyperkalemia, if had angioedema by ace inhibitor. Don’t use if pregnant

adverse- Cough, headache, dizziness, orthostatic hypotension, rash

admin concerns- NSAIDs may interact decreasing antiHTN effect.
2-3 weeks to reach effect, assess BP
Avoid high intake of potassium

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44
Q

metoprolol (lopressor, toprol) ther class, pharm class, and preg cat

A

ther-Drug for HF and HTN
pharm-Beta 1 adrenergic blocker

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45
Q

metoprolol (lopressor, toprol) action and uses

A

Selective adrenergic, beta 1 blocker. Reduces sympathetic stimulation of heart decreasing cardiac workload. Slows progression of HF, usually combined w ACE inhibitor

used in HF, HTN, agina

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46
Q

metoprolol (lopressor, toprol) contraindications, adverse effects, and admin concerns

A

contraindications-Cardiogenic shock, sinus brady, hypotension, heart block above 1st degree. Use w caution w asthma

adverse-Abnormal sexual function, hypotension, bradycardia, dizziness, fatigue, insomnia. Black box- gradually reduce over 1-2 weeks. No abrupt withdrawal

admin-High doses may affect beta 2 receptors in bronchial smooth muscle.
Hold if pulse below 60
May increase uric acid, lipids, potassium, bilirubin, creatine, ANA, alk phosphate.
monitor blood sugar

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47
Q

diuretics

A

increase urine flow, reduce blood volume and edema.
Assess renal function, I&Os, and electrolytes

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48
Q

digoxin (Lanoxin, lanoxicaps) ther class, pharm class, preg cat

A

ther-Drug for HF
pharm-Cardiac glycoside

preg cat A

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49
Q

digoxin (Lanoxin, lanoxicaps) action and uses

A

Inhibits Na+- K+ ATPase, the critical enzyme responsible for pumping sodium ions out of the myocardial cell in exchange for potassium. This action increases the contractility or strength of myocardial contraction, increasing cardiac output. Increases urine production and reduces blood volume, distressing edema. Also suppresses SA node, and slow conduction in AV helping dysrhythmias

Alleviate symptoms of HF and improving exercise tolerance - increases force of heartbeat, slows rate

50
Q

digoxin (Lanoxin, lanoxicaps) contraindications, adverse effects and admin concerns

A

contraindications- Dysrhythmias, use w caution in hypothyroidism, MI, cor pulmonale

adverse- Could create dysrhythmias, nausea, vomiting, fatigue, anorexia, visual disturbances

admin concerns- Take apical pulse for full minute, check digoxin levels before administering, use w caution in peds and geriatrics
No potassium
carefully monitor w diuretics
don’t take w antidiarrheals

51
Q

digoxin toxicity

A

blue and yellow halos, bradycardia

52
Q

milrinone (primacor) ther class, pharm class, preg cat

A

ther- drug for HF
pharm-Phosphodiesterase inhibitor
preg cat c

53
Q

milrinone (primacor) action and uses

A

block enzyme phosphodiesterase. increases calcium for myocardial contraction, increases cardiac output.

Short term therapy for advanced HF. Only IV

54
Q

milrinone (primacor) contraindications, adverse effects, admin concens

A

contraindications-Previous hypersensitivity. Use w caution if dysrhythmia

adverse- Ventricular dysrhythmia (1 out of 10 chance), headache, nausea, vomiting

admin concerns- Monitor BP and ECG

55
Q

what causes changes in BP

A

Blood volume
peripheral resistance/dilation of arterioles
cardiac output

56
Q

amount of blood in system

A

blood volume

57
Q

friction in arteries as blood flows through

A

peripheral resistance

58
Q

volume of blood pumped per minute

A

cardiac output

59
Q

hormones that affect BP

A

epinephrine and norepinephrine, antidiuretic , all raise blood volume

aldosterone regulates

60
Q

what can HTN cause

A

HF, TIA or CVA, renal failure, visual disturbances

61
Q

first line antihypertensives

A

diuretics, ACE inhibitors, ARBs, CCBs, direct renin inhibitors

62
Q

second line antihypertensive drugs

A

beta blockers (commonly used), alpha 1 adrenergic blockers, alpha 2 adrenergic agonist, direct acting vasodilators, peripherally acting adrenergic neuron blockers

63
Q

decrease fluid, increase urine

A

diuretic

64
Q

thiazide diuretic

A

block Na+ reabsorption and get rid of water and potassium

65
Q

hydrochlorothiazide (microzide) ther class, pharm class, preg cat

A

ther-Drug for HTN and edema
pharm- thiazide diuretic

preg cat B

66
Q

hydrochlorothiazide (microzide) action and uses

A

Reduces bp by 10-20 mmHg for HTN, ascites, edema, HF

Acts on kidney tubule to decrease the reabsorption of Na (normally 99% Na reabsorbed by body) when given drug, more Na sent to urine, water moves with Na, decreasing blood volume and pressure

67
Q

hydrochlorothiazide (microzide) contraindications, adverse effects, admin concerns

A

Contraindications- Prior hypersensitivity, anuria, pre-eclampsia

adverse- Electrolyte imbalances due to loss of K+ and Na+, gout attacks

admin concerns- Admin early in day to prevent nocturia
May increase serum glucose, cholesterol, bilirubin, triglyceride, and calcium. May decrease magnesium , potassium, and sodium

68
Q

spironolactone (aldactone) ther class, pharm class, preg cat

A

ther- Antihypertensive, drug for reducing edema
pharm- Potassium sparing diuretic, aldosterone antagonist
preg cat C

69
Q

spironolactone (aldactone) action and uses

A

Treating mild HTN, reduce edema, slow progression of HF, and primary hyper aldosterone

Inhibits aldosterone, the hormone responsible for increasing renal absorption of Na in exchange for K+, Causing water absorption. This drug excretes water and Na, and body retains K+

70
Q

spironolactone (aldactone) adverse effects, admin concerns

A

adverse- Hyperkalemia (muscle weakness, bradycardia). Diminished libido, menstrual irregularities. Black box- found to cause tumors in animals
admin concerns- Give w food to increase absorption of drug
No K+ supplements

71
Q

what to assess in patients taking diuretics

A

edema, JVD, electrolyte levels, daily weights, glucose levels, uric acid

72
Q

nifedipine (Adalat cc, Procardia XL) ther class, pharm class, preg cat

A

ther- drug for HTN and angina
pharm- calcium channel blocker
preg cat C

73
Q

nifedipine (Adalat cc, Procardia XL) action and uses

A

HTN or vasospastic anemia. Off label treat Raynaud’s

Selectively blocking calcium channels in myocardial and vascular smooth muscle. Results in coronary artery dilation, less oxygen use by heart, increase in cardiac output, and fall in BP

74
Q

nifedipine (Adalat cc, Procardia XL) contraindications, adverse effects, admin concerns

A

contraindications-Prior hypersensitivity
adverse- Headache, dizziness, peripheral edema, heartburn, nausea, flushing.
admin concerns- Discontinue drug gradually, No grapefruit juice

75
Q

ace inhibitor

A

blocks angiotensin II
lowers peripheral resistance and decreasing blood volume
monitor for cough and angioedema
since drug gets rid of volume, monitor low K

76
Q

beta blocker

A

decrease HR and contractility. blocks beta 1 receptors in juxtaglomerular apparatus, inhibiting renin secretion
- reduces cardiac output and BP

77
Q

Doxazosin (Cardura) ther class, pharm class, preg cat

A

ther- drug for HTN and benign prostatic hyperplasia
pharm-Alpha 1 adrenergic blocker
preg cat B

78
Q

Doxazosin (Cardura) action and uses

A

selective alpha 1 adrenergic blocker. dilates arteries in veins causing a fall in blood pressure. also relaxes smooth muscle around prostate gland

79
Q

Doxazosin (Cardura) contraindications, adverse effects, admin concerns

A

contraindications- prior hypersensitivity
adverse- dizziness, dyspnea, headache, orthostatic hypotension

admin concerns- first dose phenomenon can occur, monitor BP incase hypotension

80
Q

alpha 2 adrenergic agonist

A

decrease outflow of sympathetic nerve and impulses from CNS to heart and arteries
causes vasodilation by relaxing arterial smooth muscle
serious adverse effects- reflect tachycardia, sodium and fluid retention

only for severe HTN or HTN crisis

81
Q

hydralazine ther class, pharm class, preg cat

A

ther- Drug for HTN and HF
pharm- direct acting vasodilator
preg cat C

82
Q

hydralazine action and uses

A

Direct acting vasodilation of arterial smooth muscle, has no effects on veins. begins with low doses, gradually increases until desires result. Was the first HTN marketed in US

83
Q

hydralazine contraindications, adverse effects, admin concerns

A

contraindications- angina, rheumatic mitral valve disease, lupus

adverse- reflex tachycardia, palpitations, flushing, diarrhea, lupus like syndrome

admin concerns- abrupt stop can cause rebound HTN

84
Q

local anesthesia

A

affecting a limited part of the body

85
Q

general anesthesia

A

resulting in loss of consciousness

86
Q

infiltration anesthesia

A

direct injection into tissue immediate to surgical site, blocks groups of nerves near by

87
Q

nerve block anesthesia

A

direct injection into tissues that may be distant from surgical site, affects nerve bundles supplying surgical area. used to block sensation in limb ot large area od face

88
Q

spinal anesthesia

A

injected into CSF. Affects large areas like abdomen and legs

89
Q

epidural anesthesia

A

injected into epidural space of spinal canal, used in L&d

90
Q

how do local anesthetics work

A

by blocking sodium channels. prevents pain signals from reaching CNS

sometimes combined w epinephrine, sodium bicarbonate

91
Q

why are anesthetics sometimes combined w epinephrine

A

it constricts blood vessels and increases duration of anesthetic

92
Q

why are anesthetics sometimes combined w sodium bicarbonate

A

it neutralizes infected area, allowing anesthetic to work better

93
Q

lidocaine (xylocaine) ther class, pharm class, preg cat

A

ther- Anesthetic (local/topical); antidysrhythmic (class IB)
pharm- Sodium channel blocker; amide

preg cat B

94
Q

lidocaine (xylocaine) action, uses, adverse effects

A

for Dental procedures, postherpetic neuralgia. mouth was for sores. IV/IM/Subq for dysrhythmias

Most frequently used injectable local anesthetic, blocks neuronal pain impulses. Blocks sodium channels within neuronal membranes

adverse-Anesthesia- uncommon, CNS excitement and confusion. Serious- convulsions, resp depression, cardiac arrest. Black box-too much in children may lead to seizures, brain injury, cardiac abnormalities or death

esters and amides end in caine

95
Q

common adverse effects of local anesthetics

A

early- CNS stimulation
later- CNS depression
cardio effects

96
Q

stages of general anesthetics

A

I- loss of pain
II- excitement and hyperactivity. patient may be delirious
III- surgical anesthesia- skeletal muscles paralyzed, this is what is desired
IV- resp and cardio paralysis. could result in death- bad

97
Q

opioids

A

tricks CNS, causing patients to be insensitive to pain

common one is fentanyl

98
Q

benzodiazepines

A

general anesthetic, ends in -pam

99
Q

nitrous oxide (lauging gas)

A

ther- General anesthetic
pharm-Inhalation gaseous drug

action- Caused by suppression of pain mechanisms in CNS. This agent has low potency and doesn’t produce full loss of consciousness. Ideal for short surgical or dental procedures. Always combined with oxygen

adverse-Possible excitement, anxiety at high doses. Nausea and vomiting, liver damage

contraindications-In patients w impaired LOC, decompression sickness, air embolism, undiagnosed stomach pain, bowel ob, shock, hypotension, pneumothorax

Establish IV in case of emergency

100
Q

propofol (diprivan)

A

ther-General anesthetic
pharm-N- methyl- D- aspartate (NMDA) receptor agonist
preg cat B

Widely used IV anesthetic. Almost an immediate onset of action and is used effectively for conscious sedation. Has antiemetic affect that prevents nausea and vomiting

ADVERSE-Pain at injection site, apnea, resp depression, hypotension, metabolic issues such as hyperkalemia, organ system failures, rhabdomyolysis

has fast onset, deep sedation
dont use on expecting mothers, or allergy to soybean/egg

101
Q

isoflurane (forane)

A

ther- Inhaled general anesthetic
pharm-GABA and glutamate receptor agonist
preg cat C

Potent level of general anesthesia at rapid onset. Low degree of metabolism by body, muscle relaxation

Contraindications: Potent level of general anesthesia at rapid onset. Low degree of metabolism by body, muscle relaxation

adverse- Nausea, vomiting, tremor. Reduces BP, resp depression, malignant hyperthermia

102
Q

neuromuscular blockers

A

depolarizing- binds w acetylcholine receptors at neuromuscular joints

nondepolarizing- competes w acetylcholine for cholinergic receptors at neuromuscular junction

103
Q

succinylcholine (Anectine, quelicin)

A

ther-Skeletal muscle paralytic drug; neuromuscular blocker
pharm-Depolarizing blocker; acetylcholine receptor blocker
preg cat C

Acts on cholinergic receptor sites at neuromuscular junctions. At first, depolarization occurs, skeletal muscles contract, eventually membrane unable to attach to receptor. Drug is rapidly broken down by cholinesterase. This drug reduces amount of anesthetic needed in procedures
IV drug, peaks w in mins

adverse- Paralysis of diaphragm and intercostal muscles (mechanical vent may be needed), bradycardia, resp depression. High doses cause tachycardia and hypotension. Genetic defects - high fever and muscle rigidity, black box- cardiac arrest, hyperkalemic rhabdomyolysis

104
Q

stable angina

A

fairly predictable frequency, itensity, duration. usually relieved by rest

105
Q

unstable angina

A

more frequent, intense, and during periods of rest

106
Q

vasospastic angina (prinzmetal’s)

A

caused by spasm of coronary arteries

107
Q

silent angina

A

absence of angina; Dangerous

108
Q

Nitroglycerin (Nitrostat, nitro-bid)

A

ther- antianginal
pharm- organic nitrate, vasodilator
preg cat C

for Acute angina episode or just prior to phys. activity
action- relaxed arterial and venous smooth muscle, dilates coronary arteries
adverse- hypotension, headache, flushing

if chest pain doesn’t disappear in 10-15 mins, notify ems

if IV admin- in glass

don’t use w phos-5 inhibitors like viagra, could cause severe hypotension and cardiovascular collapse

monitor BP

109
Q

atenolol (tenormin)

A

ther- drug for angina, MI, hypertension
pharm- beta adrenergic blocker
action -Selectively blocks beta 1 adrenergic receptors in heart, slows HR and reduce contractility, lower o2 demand. For HF, HTN, MI, angina

adverse- bradycardia, hypotension

hold if pulse below 60, monitor BP
do not abruptly stop
may increase K, lipids, uric acid

110
Q

Diltiazem (Cardizem, cardia XT, dilacor XT)

A

ther- Drug for angina, hypertension, dysrhythmias
pharm- CCB
Preg cat C

PO- angina and HTN, IV- dysrhythmias
action-Inhibits transport of calcium into myocardial cells. Relaxes coronary and peripheral blood vessels, bringing more o2 to myocardium, reducing cardiac workload

adverse- headache, dizziness, edema

don’t use if bleeding aneurysm, hypotension, cranial surgery

111
Q

reteplase (retavase)

A

ther-Drug for dissolving blood clots
pharm-thrombolytic
preg cat C

For Onset MI. off label- deep vein thrombosis and occluded catheters
action- Prepared thru recombinant DNA technology, reteplase acts by cleaving plasminogen to form plasmin, then this degrades the fibrin matrix of thrombi. Given in bolus

adverse- abnormal bleeding, possible dysrhythmias

reconstitute prior to use
don’t use w heparin

112
Q

monitoring warfarin

A

PT (Prothrombin time)
INR (International normalized ratio)

113
Q

monitoring heparin

A

aPTT (advanced partial thromboplastin time)

114
Q

prevents clots

A

anticoagulants, antiplatelets

115
Q

dissolves clots

A

thrombolytics

116
Q

promotes clots

A

hemostatics

117
Q

heparin

A

ther-Anticoagulant (parenteral)
pharm- Indirect thrombin inhibitor
preg cat C

Prevent thromboembolic events, dialysis, unstable angina, or in acute stages of MI
Heparin typically found in liver and lining of blood vessels, prolongs coagulation, preventing excessive clotting. Doesn’t dissolve clots. Binding of heparin to antithrombin III inactivates several clotting factors, inhibits thrombin activity

Adverse- Bleeding, heparin thrombocytopenia,- causing thrombus. Black box- epidural or spinal hematoma may occur in spinal anesthesia or lumbar puncture

usually weight based
monitor aPTT

don’t give IM shots (increases risk for bleeding)

118
Q

heparin

A

ther-Anticoagulant (parenteral)
pharm- Indirect thrombin inhibitor
preg cat C

Prevent thromboembolic events, dialysis, unstable angina, or in acute stages of MI
Heparin typically found in liver and lining of blood vessels, prolongs coagulation, preventing excessive clotting. Doesn’t dissolve clots. Binding of heparin to antithrombin III inactivates several clotting factors, inhibits thrombin activity

Adverse- Bleeding, heparin thrombocytopenia,- causing thrombus. Black box- epidural or spinal hematoma may occur in spinal anesthesia or lumbar puncture

usually weight based
monitor aPTT

don’t give IM shots (increases risk for bleeding)

antagonist- protamine sulfate

119
Q

warfarin (coumadin)

A

ther- Anticoagulant (oral)
pharm- Vitamin K antagonist
preg cat X

prevention of stroke, MI, DVT, and pulm embolism
anticoagulant, can take several days to reach effect

Vitamin K is the antagonist

120
Q

clopidogrel (Plavix)

A

ther-Antiplatelet drug
pharm- ADP receptor blocker
preg cat B

Reduce rate of MI/Stroke w acute ST elevation MI, non ST elevation, or unstable angina
Action- Inhibits platelet aggression, directly inhibiting ADP binding to its receptor. This binding is irreversible. Drug is usually given along side of aspirin

adverse- Flu like symptoms, bruising, dizziness, rash
Black box- based on CYP450 enzymes, poor metabolizers inhibit less affect

don’t use in bleeding patients
discontinue drug 5 days before surgery

121
Q

alteplase (activase)

A

ther- Drug for dissolving clots
pharm-Thrombolytic
preg cat C

Converts plasminogen to plasmin, dissolving fibrin clots

Maximum affect- within 12 hours of MI, within 3 of stroke

adverse- bleeding

122
Q

Aminocaproic acid (Amicar)

A

ther-Clot stabilizer
pharm- Hemostatic/antifibrinolytic
Preg cat C

Used for Excessive bleeding due to clots being dissolves prematurely, after surgery to prevent post-op bleeding, patients w hemophilia A

action-Inactivates plasminogen, the precursor of the enzyme plasmin that digest fibrin clot, promoting clots

adverse- hypotension, bradycardia

assess vitals, place on cardiac monitor

may elevate K

pharm 2 (4 decks)

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