Week 5: Antiplatelets, Iron, Folic Acid, and Vitamin B12 Flashcards

1
Q

Aspirin MOA

A
  • inhibits thromboxane A2 in the cyclooxygenase pathway thus interfering with platelet aggregation
  • COX 1 and COX 2 inhibitor
  • salicylated NSAIDs
  • inhibits prostaglandins
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2
Q

Aspirin ADRs

A
  • GI ulcer
  • angioedema
  • Steven Johnson syndrome
  • Reye’s syndrome
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3
Q

Aspirin cautions/contraindications

A
  • do not use in pediatrics w/ influenza or chickenpox
  • low dose used to prevent preeclampsia in pregnancy
  • low dose is safe in lactation
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4
Q

Aspirin pharmacokinetics

A
  • well absorbed with oral intake
  • is affected by food
  • metabolized in the liver
  • renally excreted (pH affects excretion)
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5
Q

Clopidogrel (Plavix) MOA

A
  • reduces platelet aggregation by inhibiting adenosine diphosphate pathway
  • blocks the ADP receptor so that platelets cannot adhere to one another at that receptor
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6
Q

Plavix Pharmacokinectics

A
  • Prodrug
  • metabolized by CYP2C19
  • Excreted in urine and feces
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7
Q

Clopidogrel (Plavix) Cautions/precautions

A
  • avoid in pts with GI ulcers (anti-prostaglandin- prostaglandins are GI protective
  • severe hepatic dysfuction - unable to metabolize into active form
  • use with PPIs can attenuate (weaken) the antiplatelet effect of Plavix
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8
Q

Clopidogrel (Plavix) ADRs

A
  • bleeding
  • Steven Johnson syndrome (rare)
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9
Q

What is the most common iron preparation given because it contains the highest amount of elemental iron?

A

Ferrous sulfate (20% elemental iron) - 65mg of elemental iron in a 325mg tablet - dosing is based on the amount of elemental iron

Ferrous Gluconate - 32mg of elemental iron in a 324mg tablet

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10
Q

Iron preparations pharmacokinetics

A
  • food affects absorption
  • take on an empty stomach
  • take with vitamin C to help with absorption
  • avoid taking with dairy products, eggs, antacids, calcium which may inhibit absorption
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11
Q

Iron preparations ADRs

A
  • GI symptoms - constipation, GI upset
  • acute iron toxicity with overdose
  • keep away from children
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12
Q

Iron preparations - monitoring

A
  • check reticulocyte count (immature RBCs) 7 to 10 days after starting iron therapy - if this is not back to normal, there is something else wrong
  • check and Hgb and Hct at 2 weeks then Hgb, Hct , and ferritin at 3 months
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13
Q

Folic acid deficiency - causes

A
  • poor dietary intake - absorption issues - increased demand - impaired utilization
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14
Q

Folic acid pharmacokinetics

A
  • oral, IM, SC are well absorbed
  • metabolized by the liver
  • excreted in urine and feces
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15
Q

Folic acid supplementation indications

A
  • treatment of megaloblastic anemia
  • prevention of folic acid deficiency
  • increased demand during pregnancy, ETOH abuse, hypothyroidism, hemolytic anemia, or malignancy
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16
Q

Vitamin B12 deficiency causes/indications

A
  • decreased absorption due to lack on intrinsic factor (made from parietal cells in the stomach)
  • can be caused by GI surgery, diseases of the ilium, constipation - pernicious anemia d/t malabsorption issues
  • Vitamin B12 is needed for the final steps of folate metabolism
17
Q

Vitamin B12 ADRs

A

hypokalemia

headache

pain @ injection site

transient diarrhea

urticaria

pruritis