Unit 10 Cardiovasular Pt. 1 Flashcards
What baseline lab tests does the provider order when initiating statin therapy?
Baseline lipid panel
Baseline LFTs
Most statin drugs are part of which CYP enzyme class?
CYP3A4
What lab tests will the provider run to assess adherence to statin therapy?
Follow up lipid panel every 3-12 months for “ongoing monitoring”
Statin drugs and CYP3A4 inhibitors such as Cipro, Clarithromycin, azole antifungals, CCBs, and Fibrates such as Gemfibrozil will increase the risk of
Statin-induced myopathy, with rhabdomyolysis and acute renal failure.
A CYP2C9 inhibitor that will increase the anticoagulant effect of warfarin is :
Alcohol.
Avoid with warfarin for increased risk of bleeding.
Also avoid certain azoles: fluconazole(Diflucan) and miclonazole(Monistat); Bactrim, Septra, Prozac, Flagyl.
When using statins and/or anticoagulant meds, sometimes it takes _______or so to see an important interaction with muscle pain or bleeding.
2 weeks
If a patient has gastritis or other structural bowel problems, avoid :
NSAIDs, Aspirin, and Warfarin
Can instigate or increase bleeding from these sources. Judicious attention is important in early detection of bleeding.
CYP3A4 inducers decrease drug concentration and reduce the anticoagulant effect :
Antiseizure meds: Tegretol, Phenytoin HIV meds St. John's wort Corticosteroid: dexamethasone (Decadron) rifampin
If a patient has an ASCVD risk of >7.5% what initial therapy is indicated?
High dose therapy. statin drug
Patient is recommended for high dose statin therapy if their LDL is greater than _____.
> 190 mg/dL
High dose treatment options for statin therapy:
Atorvastatin (Lipitor) 40-80mg
Rosuvastatin (Crestor) 20-40mg
Rather. Than a targeted number for the LDL treatment focuses on:
A percentage reduction in the level of LDL.
Patient centered treatment target.
Niacin and fenofibrate therapy offer no benefit and should be considered in patients:
Who do not respond as expected to statins or
Are unable to tolerate recommended statin dose intensity or
Experience statin intolerance.
Mechanism of action: Heparin
Prevents of slows formation of new thrombi.
Has no effect on existing clots.
Monitored by PTT.
(LMWH can’t be monitored by PTT but has a more predictable anticoagulant effect)
Mechanism of action: Wafarin
Competitively blocks vitamin K binding sites.
Inhibits synthesis of vit K dependent coagulation factors: VII, IX, X, II.
Prevents extension of existing thrombus and formation of new thrombi. Does not reverse ischemic damage to already established thrombus.
Mechanism of action: aspirin
Platelet inhibitor.
Prevents platelet aggregation through inhibiting cyclooxygenase in platelets and endothelial cells.
Mechanism of action: Clopidogrel
Platelet inhibitor.
Inhibits binding of ADP to its platelet receptor and ADP mediated activation of IIb/IIa complex.
To prevent venous thromboembolism treatment is :
Compression stockings, intermittent compression devices, or UFH or LMWH. Especially important in post op pts.
Aspirin not recommended !!!
If a patient has had a previous TIA and/or ischemic stroke preventative therapy is :
Aspirin and warfarin
If pt. had recent TIA INR goal is 2-3
To prevent atrial fibrillation in persistent AF the patient will be prescribed:
Warfarin with INR goal 2-3
Unless pt is <65 then patient will take ASA 325mg/day.
Pt takes both warfarin and ASA if they have a hx of rheumatic mitral valve disease, prosthetic heart valve, or hx of systemic emboli.
Women requiring long term warfarin anticoagulation who are considering pregnancy should
Substitute with UFH or LMWH as soon as pregnancy is achieved.
Maintained for at least 6 wks postpartum.
Low dose unfractionated heparin or low molecular weight heparin is used for prophylaxis of
DVT
Patients should not use generic interchangeably with brand name Coumadin because of the decreased
Bioavailability
Warfarin therapy should be stopped temporarily and a source of over anticoagulation should be assessed if the INR is greater than:
> 5
5-10 mg Vitamin K should be given to prevent life-threatening bleeding, or emergent surgery for an INR greater than:
> 9
A patient is treated with a platelet inhibitor such as Aspirin daily for primary prevention of :
MI, cerebrovascular disease, indicate in men >50yo
81mg daily
What tests monitor heparin therapy and which tests monitor warfarin therapy ?
PTT: monitors heparin therapy
PT and INR: monitors warfarin therapy
Initial dose of warfarin to be prescribed :
5-10 mg
( 2.5mg for elderly)
Give 3 doses subsequently before monitoring.
Monitor INR q3-4 days until goal is reached then weekly decreasing dose every 2 weeks.
Warfarin is a pregnancy category :
X
Placental transfer of medication: LBW, growth retardation, spontaneous abortion,stillbirth, high risk OBGYN referral of pt is already on Warfarin and became pregnant.
