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Pharmacology > Vascular Drugs > Flashcards

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
Q

PE complication and treatment goals

A

tissue hypoxia/death
slow cloth growth; inhibit new clots; clot lysis; surgical

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26
Q

Prothrombin time (PT) reference range

A

11-12.5 seconds

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27
Q

International Normalized Ratio (INR) reference range

A

0.7-1.8

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28
Q

International Normalized Ration (INR) therapeutic range

A

2.0-3.0

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29
Q

Activated Partial Thromboplastin Time (aPTT) reference range

A

21-35 seconds

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30
Q

Activated Partial Thromboplastin Time (aPTT) therapeutic range

A

45-70 seconds

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31
Q

General Nursing Considerations for Anticoags and Thrombolytics

A

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

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32
Q

Contraindications of Anticoags and Thrombolytics

A

Pregnancy (except heparin/enoxaparin), bleeding disorders, hx of bleed, thrombocytopenia

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33
Q

Drug-Drug of Anticoags and Thrombolytics

A

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.

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34
Q

Heparin Class

A

indirect thrombin inhibitor- anticoagulant

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35
Q

Heparin MoA

A

disrupts clotting cascade; prolongs bleeding time

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36
Q

Heparin route/dose

A

5000 units SQ q8h (prevention) or IV drip (protocol)

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37
Q

Heparin indications

A

prevent or treat DVT (SQ); treat PE (IV)

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38
Q

Heparin contraindications

A

Porker allergy; Pork abstention religion (Judaism, Muslim)

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39
Q

Heparin AE

A

Bleeding, heparin-induced thrombocytopenia, bruising at injection site

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40
Q

Heparin Nursing considerations

A

rotate/monitor injections site for SQ (do not administer IM), monitor platelet count; monitor aPTT

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41
Q

Heparin reversal agent

A

protamine sulfate (heparin short half life, stop infusion)

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42
Q

Enoxaparin (Lovenox) class

A

low molecular weight heparin- anticoagulant

43
Q

Enoxaparin (Lovenox) MoA

A

disrupts clotting cascade, prolongs bleeding time

44
Q

Enoxaparin (Lovenox) indications

A

prevention or treatment of DVT

45
Q

Enoxaparin (Lovenox) route

A

1mg/kg every 12 hr SQ

46
Q

Enoxaparin (Lovenox) contraindications

A

pork allergy; pork abstention religion (Judaism, Muslim)

47
Q

Enoxaparin (Lovenox) AE

A

bleeding; bruising at injection site

48
Q

Enoxaparin (Lovenox) nursing considerations

A

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
Q

Enoxaparin (Lovenox) reversal agent

A

protamine sulfate

50
Q

Warfarin (Coumadin) class

A

Vitamin K antagonist (anticoagulant)

51
Q

Warfarin (Coumadin) MoA

A

interfere with hepatic synthesis of vitamin K dependent clotting factors; prolongs bleeding time

52
Q

Warfarin (Coumadin) route/dose

A

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
Q

Warfarin (Coumadin) indications

A

chronic Afib, artificial heart valves, prevent/treat DVT, PE

54
Q

Warfarin (Coumadin) AE

A

GI effects (n/v), bleeding

55
Q

Warfarin (Coumadin) drug-drug

A

antibiotics (monitor INR), Amiodarone, herbals

56
Q

Warfarin (Coumadin) nursing considerations

A

Monitor PT/INR; first oral anticoagulant on market

57
Q

Warfarin (Coumadin) reversal agent

A

Vitamin K

58
Q

Warfarin (Coumadin) Lab Draws

A

dose change= next lab in 3 days
long term monitoring= weekly or monthly

59
Q

Warfarin (Coumadin) Diet

A

teach patient to maintain consistent intake (avoid) vitamin K containing foods (increased intake may decrease warfarin effect)

60
Q

Foods High in Vitamin K

A

kale
collard greens
spinach
brussel sprouts
broccoli
asparagus
sauerkraut
soybeans
edamame

61
Q

herbals to avoid with Warfarin

A

St. Johns Wart
Garlic
Gingko
Ginger Root
Chamomile

62
Q

Rivaroxaban (Xarelto) class

A

Factor Xa Inhibitor

63
Q

Rivaroxaban (Xarelto) MoA

A

disrupt clotting cascade; prolongs bleeding time

64
Q

Rivaroxaban (Xarelto) route/dose

A

10 mg PO daily (prevention); 15 mg PO BID (treatment)

65
Q

Rivaroxaban (Xarelto) indications

A

chronic afib; prevent DVT and PE

66
Q

Rivaroxaban (Xarelto) AE

A

bleeding

67
Q

Rivaroxaban (Xarelto) nursing considerations

A

no blood monitoring required

68
Q

Rivaroxaban (Xarelto) reversal agent

A

Andexxa

69
Q

Initial Management of Anticoagulant Overdose

A

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
Q

Alteplase (Activase; tPA) class

A

thrombolytic agent CLOT BUSTER

71
Q

Alteplase (Activase; tPA) MoA

A

Local fibrinolysis (acute clot lysis)

72
Q

Alteplase (Activase; tPA) indications

A

systemic: ischemic (embolic) stroke, PE, coronary thrombosis (MI)
Local: central venous catheter occlusion (small dose to break up clot in line)

73
Q

Alteplase (Activase; tPA) AE

A

bleeding, hypotension, bradycardia, tachycardia

74
Q

Alteplase (Activase; tPA) contraindications

A

MANY. check before administration

75
Q

drug therapy for chronic Afib

A

warfarin, rivaroxaban

76
Q

drug therapy for ischemic stroke (embolus)

A

alteplase

77
Q

drug therapy for DVT

A

SQ heparin, enoxaparin, warfarin, rivaroxaban

78
Q

drug therapy for PE

A

IV heparin drip, alteplase

79
Q

bridging concept

A

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
Q

Epoetin Alfa (Procrit) class

A

erythopoiesis stimulating agent

81
Q

Epoetin Alfa (Procrit) MoA

A

erythropoietin factor controlling rate of RBC production

82
Q

Epoetin Alfa (Procrit) Indications

A

disorders of RBC formation to decrease need for blood transfusions; renal failure, antineoplastic treatments

83
Q

Epoetin Alfa (Procrit) contraindications

A

angina, caution in CHF

84
Q

Epoetin Alfa (Procrit) AE

A

fatigue, bone pain, edema, HTN, headache, fever, DVT, CVA, MI has occured

85
Q

Epoetin Alfa (Procrit) nursing considerations

A

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
Q

Ferrous Sulfate class

A

iron deficiency anemia

87
Q

Ferrous Sulfate MoA

A

replace iron; required for hemoglobin formation

88
Q

Ferrous Sulfate indications

A

iron deficiency, iron-deficiency anemia (heavy periods)

89
Q

Ferrous Sulfate drug-drug/food

A

antacids, dairy reduce absorption

90
Q

Ferrous Sulfate AE

A

GI upset, dark tarry stools, constipation

91
Q

Ferrous Sulfate nursing considerations

A

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
Q

Cyancobalamin (Vitamin B12) class

A

Agents for megaloblastic anemias

93
Q

Cyancobalamin (Vitamin B12) MoA

A

Replace vitamin B12; required for Hgb formation

94
Q

Cyancobalamin (Vitamin B12) indications

A

B12 deficiency anemia, pernicious anemia

95
Q

pernicious anemia

A

lack IF to absorb B12 (only gets injections not oral)

96
Q

Cyancobalamin (Vitamin B12) dose/route

A

monthly SQ/IM

97
Q

Cyancobalamin (Vitamin B12) AE

A

rare

98
Q

Cyancobalamin (Vitamin B12) nursing considerations

A

monitor labs for therapeutic response (HgB, B12)

99
Q

Cyancobalamin (Vitamin B12) Patient Teaching

A

pt. sudden discontinuation can cause anemia to return and irreversible nerve damage/depression; Pernicious anemia will need injections for life

100
Q

Folic Acid class

A

agents for Megaloblastic Anemias

101
Q

Folic Acid MoA

A

required for erythropoiesis

102
Q

Folic Acid indications

A

folic acid deficiency anemia (if diet changes ineffective), alcoholism, pregnancy prevention of neural tube defects

103
Q

Folic Acid AE

A

urine turns bright yellow

104
Q

Folic Acid Nursing considerations

A

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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