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Vascular Drugs Flashcards

1
Q

Atorvastatin (Lipitor) class

A

HMG-CoA Reductase Inhibitors

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2
Q

Atorvastatin (Lipitor) MoA

A

Blocks HMG-CoA reductase from completing synthesis of cholesterol in the liver

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3
Q

Atorvastatin (Lipitor) Administration Consideration

A

At HS (highest rates of cholesterol synthesis at night)

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4
Q

Atorvastatin (Lipitor) Caution

A

renal impairment, liver disease, heavy alcohol use, pregnancy category X

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5
Q

Atorvastatin (Lipitor) AE

A

GI affects- cramping, diarrhea, constipation
liver damage
myalgias
toxic rhabdomyolysis with AKI

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6
Q

Atorvastatin (Lipitor) Nursing Considerations

A

monitor liver kidney function (toxicity); teach to report myalgias, no grapefruit juice (increases levels-toxicity), lifestyle modification.

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7
Q

Aspirin (ASA) class

A

Anti-platelet Agent/ Salicylate

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8
Q

Aspirin (ASA) MoA

A

inhibit platelet aggregation (COX inhibitor)

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9
Q

anti-platelets prevent what…

A

the platelet part of clotting (platelet coags forms platelet plug with anti-platelet)

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10
Q

Aspirin (ASA) Indication

A

Prevention of MI, TIA, ischemic CVA in high risk populations (primary or secondary prevention)

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11
Q

Aspirin (ASA) Dose

A

81-325 mg PO daily (81mg is a baby aspirin)
level of dose determines if its prevention or treatment

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12
Q

Aspirin (ASA) AE

A

GI irritation (N/V, epigastric pain)
bleeding- GI bleeding
hematuria
easy bruising
tinnitus (with toxicity)

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13
Q

Aspirin (ASA) Nursing considerations

A

take as directed, take with food, hold 1 week prior to procedure, monitor for s/s GI bleed (dark/bloody stools)

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14
Q

Clopidogrel (Plavix) class

A

anti-platelet agent

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15
Q

Clopidogrel (Plavix) MoA

A

inhibit platelet aggregation (alters signaling sent to platelets to initiate clotting)

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16
Q

Clopidogrel (Plavix) indications

A

prevent blood clot w/hx of MI, ischemic stroke, or PAD; prevent blood clot with cardiac stent or graft (blood wants to clot to metal)

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17
Q

Clopidogrel (Plavix) AE

A

bleeding
flu like syndrome
dizziness
bruising
rash
pruritus

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18
Q

Clopidogrel (Plavix) Nursing

A

Hold 5 days prior to procedure, bleeding precautions (soft bristle toothbrush, electric razors, etc…)

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19
Q

Nursing assessment for anti-platelet drugs

A

indication for medication (prevention of blood clots)
clinical manifestations of bleeding

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20
Q

Nursing interventions for anti-platelet drugs

A

bleeding precautions, avoid injury and falls, hold prior to procedure/surgery, educate patient on medications

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21
Q

anticoagulants prevent what…

A

disrupt clotting cascade making it difficult for blood to clot

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22
Q

Chronic a fib complication and treatment goals

A

ischemic stroke (embolus)- when clot is pumped out of atria and into brain
prevent blood clot in atria

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23
Q

ischemic stroke (embolus) complication and treatment goals

A

tissue hypoxia/death
clot lysis; restore perfusion

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24
Q

DVT complication and treatment goals

A

pulmonary embolism
slow clot growth; inhibit propagation (movement); inhibit new clots

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25
PE complication and treatment goals
tissue hypoxia/death slow cloth growth; inhibit new clots; clot lysis; surgical
26
Prothrombin time (PT) reference range
11-12.5 seconds
27
International Normalized Ratio (INR) reference range
0.7-1.8
28
International Normalized Ration (INR) therapeutic range
2.0-3.0
29
Activated Partial Thromboplastin Time (aPTT) reference range
21-35 seconds
30
Activated Partial Thromboplastin Time (aPTT) therapeutic range
45-70 seconds
31
General Nursing Considerations for Anticoags and Thrombolytics
All have a AE of bleeding (fatal and non-fatal), reduce injury and falls, implement bleeding precaution. Fatal: hemorrhagic stroke, internal bleeding, GI bleeding Non-Fatal: hematuria, epistaxis, bruising
32
Contraindications of Anticoags and Thrombolytics
Pregnancy (except heparin/enoxaparin), bleeding disorders, hx of bleed, thrombocytopenia
33
Drug-Drug of Anticoags and Thrombolytics
anti-platelet, NSAIDs, herbals (all increase bleeding). some patients can be on both anti-platelet and anticoag because of stroke history so they are SUPER high risk of bleeding.
34
Heparin Class
indirect thrombin inhibitor- anticoagulant
35
Heparin MoA
disrupts clotting cascade; prolongs bleeding time
36
Heparin route/dose
5000 units SQ q8h (prevention) or IV drip (protocol)
37
Heparin indications
prevent or treat DVT (SQ); treat PE (IV)
38
Heparin contraindications
Porker allergy; Pork abstention religion (Judaism, Muslim)
39
Heparin AE
Bleeding, heparin-induced thrombocytopenia, bruising at injection site
40
Heparin Nursing considerations
rotate/monitor injections site for SQ (do not administer IM), monitor platelet count; monitor aPTT
41
Heparin reversal agent
protamine sulfate (heparin short half life, stop infusion)
42
Enoxaparin (Lovenox) class
low molecular weight heparin- anticoagulant
43
Enoxaparin (Lovenox) MoA
disrupts clotting cascade, prolongs bleeding time
44
Enoxaparin (Lovenox) indications
prevention or treatment of DVT
45
Enoxaparin (Lovenox) route
1mg/kg every 12 hr SQ
46
Enoxaparin (Lovenox) contraindications
pork allergy; pork abstention religion (Judaism, Muslim)
47
Enoxaparin (Lovenox) AE
bleeding; bruising at injection site
48
Enoxaparin (Lovenox) nursing considerations
Admin in deep SQ; do not aspirate or massage site; do not remove air bubble from prefilled syringe; rotate/monitor injection sites; monitoring of clotting time not necessary
49
Enoxaparin (Lovenox) reversal agent
protamine sulfate
50
Warfarin (Coumadin) class
Vitamin K antagonist (anticoagulant)
51
Warfarin (Coumadin) MoA
interfere with hepatic synthesis of vitamin K dependent clotting factors; prolongs bleeding time
52
Warfarin (Coumadin) route/dose
2-10 mg/day PO based on INR Daily in evening or HS Hold and call PCP if INR is greater than 3.0 Expect Vitamin K order if INR is greater than 4
53
Warfarin (Coumadin) indications
chronic Afib, artificial heart valves, prevent/treat DVT, PE
54
Warfarin (Coumadin) AE
GI effects (n/v), bleeding
55
Warfarin (Coumadin) drug-drug
antibiotics (monitor INR), Amiodarone, herbals
56
Warfarin (Coumadin) nursing considerations
Monitor PT/INR; first oral anticoagulant on market
57
Warfarin (Coumadin) reversal agent
Vitamin K
58
Warfarin (Coumadin) Lab Draws
dose change= next lab in 3 days long term monitoring= weekly or monthly
59
Warfarin (Coumadin) Diet
teach patient to maintain consistent intake (avoid) vitamin K containing foods (increased intake may decrease warfarin effect)
60
Foods High in Vitamin K
kale collard greens spinach brussel sprouts broccoli asparagus sauerkraut soybeans edamame
61
herbals to avoid with Warfarin
St. Johns Wart Garlic Gingko Ginger Root Chamomile
62
Rivaroxaban (Xarelto) class
Factor Xa Inhibitor
63
Rivaroxaban (Xarelto) MoA
disrupt clotting cascade; prolongs bleeding time
64
Rivaroxaban (Xarelto) route/dose
10 mg PO daily (prevention); 15 mg PO BID (treatment)
65
Rivaroxaban (Xarelto) indications
chronic afib; prevent DVT and PE
66
Rivaroxaban (Xarelto) AE
bleeding
67
Rivaroxaban (Xarelto) nursing considerations
no blood monitoring required
68
Rivaroxaban (Xarelto) reversal agent
Andexxa
69
Initial Management of Anticoagulant Overdose
Assess for CM of bleeding and VS Notify PCP Draw Labs as ordered H&H, Plts, and clotting times administer fluids and or packed red blood cells administer reversal agent as ordered
70
Alteplase (Activase; tPA) class
thrombolytic agent CLOT BUSTER
71
Alteplase (Activase; tPA) MoA
Local fibrinolysis (acute clot lysis)
72
Alteplase (Activase; tPA) indications
systemic: ischemic (embolic) stroke, PE, coronary thrombosis (MI) Local: central venous catheter occlusion (small dose to break up clot in line)
73
Alteplase (Activase; tPA) AE
bleeding, hypotension, bradycardia, tachycardia
74
Alteplase (Activase; tPA) contraindications
MANY. check before administration
75
drug therapy for chronic Afib
warfarin, rivaroxaban
76
drug therapy for ischemic stroke (embolus)
alteplase
77
drug therapy for DVT
SQ heparin, enoxaparin, warfarin, rivaroxaban
78
drug therapy for PE
IV heparin drip, alteplase
79
bridging concept
warfarin takes 2-3 days to start so they are also given an instant drug heparin or lovenox until warfarin is in therapeutic levels
80
Epoetin Alfa (Procrit) class
erythopoiesis stimulating agent
81
Epoetin Alfa (Procrit) MoA
erythropoietin factor controlling rate of RBC production
82
Epoetin Alfa (Procrit) Indications
disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments
83
Epoetin Alfa (Procrit) contraindications
angina, caution in CHF
84
Epoetin Alfa (Procrit) AE
fatigue, bone pain, edema, HTN, headache, fever, DVT, CVA, MI has occured
85
Epoetin Alfa (Procrit) nursing considerations
Monitor CBC weekly (dose depends on Hgb and indication), check VS (risk of HTN), analgesia for bone pain, goal Hgb above 10; hold if Hgb is greater than 12
86
Ferrous Sulfate class
iron deficiency anemia
87
Ferrous Sulfate MoA
replace iron; required for hemoglobin formation
88
Ferrous Sulfate indications
iron deficiency, iron-deficiency anemia (heavy periods)
89
Ferrous Sulfate drug-drug/food
antacids, dairy reduce absorption
90
Ferrous Sulfate AE
GI upset, dark tarry stools, constipation
91
Ferrous Sulfate nursing considerations
monitor labs (Hgb, iron); take w/o food for best absorption; take with Vit C to increase absorption; do not take within one hour of bedtime (GERD), do not crush or empty capsules; reassess Hgb after 3 months KEEP AWAY from children-fatal overdose
92
Cyancobalamin (Vitamin B12) class
Agents for megaloblastic anemias
93
Cyancobalamin (Vitamin B12) MoA
Replace vitamin B12; required for Hgb formation
94
Cyancobalamin (Vitamin B12) indications
B12 deficiency anemia, pernicious anemia
95
pernicious anemia
lack IF to absorb B12 (only gets injections not oral)
96
Cyancobalamin (Vitamin B12) dose/route
monthly SQ/IM
97
Cyancobalamin (Vitamin B12) AE
rare
98
Cyancobalamin (Vitamin B12) nursing considerations
monitor labs for therapeutic response (HgB, B12)
99
Cyancobalamin (Vitamin B12) Patient Teaching
pt. sudden discontinuation can cause anemia to return and irreversible nerve damage/depression; Pernicious anemia will need injections for life
100
Folic Acid class
agents for Megaloblastic Anemias
101
Folic Acid MoA
required for erythropoiesis
102
Folic Acid indications
folic acid deficiency anemia (if diet changes ineffective), alcoholism, pregnancy prevention of neural tube defects
103
Folic Acid AE
urine turns bright yellow
104
Folic Acid Nursing considerations
monitor H/H, nutritional status, therapeutic response MOST COMMONLY taken for chronic alcoholism- results in poor diet/ decreases ability to absorb vitamin B12

Pharmacology (6 decks)

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