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APRN A. Pharm- Test 2 > Week 6- Bleedy meds > Flashcards

Week 6- Bleedy meds Flashcards

1
Q

what drug class is nitroglycerine?

A

nitrate

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2
Q

what drug class is isosorbide dinitrate?

A

nitrate

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3
Q

what is the mechanism of action of nitroglycerin and isosorbide dinitrate?

A

Provides nitric oxide to vascular endothelium

Decrease preload and afterload

Increase cGMP = decrease platelet aggregation

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4
Q

what drugs are in the nitrate class?

A

nitroglycerine and isosorbide dinitrate

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5
Q

common uses of nitroglycerine

A

Angina
Dilates coronaries to bring more blood flow (less so with atherosclerosis)

Short acting

HF (not 1st line)

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6
Q

which is a short acting nitrate?

A

nitroglycerine

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7
Q

best route of nitrates and why

A

sublingual d/t significant first pass effect

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8
Q

which is long-acting nitrate?

A

isosorbide ninitrate- better sustained nitrate activity and better anginal propy

AKA long acting

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9
Q

side effects of nitrates

A

headache, N/V, orthostatic hypotension

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10
Q

major adverse effects/warnings with nitrates

A

Vasodilation increases ICP:

Do not use in head trauma or cerebral hemorrhage

Postural hypotension + syncope

Not used in pregnancy

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11
Q

medication instructions with nitrates

A

Tabs lose potency with air heat and moisture

also tolerance can occur so start low and go slow

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12
Q

drug interactions w/ nitrates

A

anti-HTNs. Etoh, CCBs. haldol (anything that decreases BP)

Sildenafil/ Viagra: Profound Hypotension ***

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13
Q

what drugs are reductase inhibitors?

A

atorvastatin and rosuvastatin

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14
Q

what drugs are bile acid sequestrants?

A

cholestyramine

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15
Q

what drug class is atorvastatin

A

reductase inhibitor

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16
Q

what drug class is rosuvastatin

A

reductase inhibitor

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17
Q

what drug class is cholestyramine

A

bile acid sequestarant

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18
Q

how do reductase inhibitors work?

A

Block synthesis of cholesterol in the liver by competitively inhibiting HMG-CoA reductase activity.
Increase catabolism of LDL and increase in liver’s extraction of LDL reductase.

Also has anti-inflammatory properties (moreso for CV rather than cholesterol)

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19
Q

how does cholestyramine work?

A

Exchange chloride ions for negatively charged bile acids by the liver. Increases uptake of LDL from plasma results in the upregulation of high-infinity of LDL receptors on cell membranes

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20
Q

what are common uses of atorvastatin and rosuvastatin?

A

Reduce LDL

First-line in monotherapy and in combos

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21
Q

which reductase inhibitor is most potent

A

rosuvastatin

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22
Q

which statin is most readily absorbed?

A

atorvastatin

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23
Q

common side effects of reductase inhibitors

A

headache and myalgias

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24
Q

black box warning of reductase inhibitors (statins)

A

possible BG increases along with concentration and memory issues

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25
Q

contraindications and major adverse reactions of statins

A

acute liver disease, intracerebral hemorrhage

*check LFTs prior to starting

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26
Q

what drugs increase risk of rhabdomylosis

A

if reductase inhibitors and bile sequestrants are taken together it increases the risk!

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27
Q

med instructions of reductase inhibitors

A

usually taken in PM

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28
Q

how do bile acid sequestrants/cholestyramine work?

A

Exchange chloride ions for negatively charged bile acids by the liver. Increases uptake of LDL from plasma results in the upregulation of high-infinity of LDL receptors on cell membranes.

LDL reduced by 10-35%

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29
Q

common uses of cholestyramine

A

reduce LDL- best for patients with low CV risk and cant reduce LDL by diet

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30
Q

pharmacokinetics of cholestyramine

A

not absorbed- works in GI tract by binding bile acids

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31
Q

side effects of cholestyramine

A

constipation– use of laxative

N/V

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32
Q

ADRs of cholestyramine

A

can reduce folate levels

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33
Q

what drug is a fibric acid derivatives

A

gemfibrozil

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34
Q

what class is gemfibrozil

A

fibric acid derivative

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35
Q

how does gemfibrozil work?

A

Increase lipolysis of triglycerides via lipoprotein lipase (decrease in 50+% of triglyceride levels)
Also decrease in LDL
HLD increased by 15%-25%

First line for elevated triglycerides in women?

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36
Q

use of gemfibrozil

A

reduce VLDL, best at increasing HDL

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37
Q

major ADRs of gemfibrozil

A

may increase cholesterol excretion into the bile, D/C if gallstones found.. may also cause anemia

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38
Q

med instructions for gemfibrozil

A

must be taken before meals

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39
Q

how does ezetimibe work?

A

Blocks absorption of cholesterol across intestinal border (LDL reduction) Binds with cholesterol in intestine

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40
Q

what is ezetimibe used for

A

first line for kids with familial hypercholesteremia

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41
Q

how does evolocumab work?

A

Monocolonal antibody PCSK9 inhibitor. Alter protein activity that transport LDL into the liver

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42
Q

important things to know about evolocumab

A

super expensive- used with other statins when desired outcome isn’t met

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43
Q

which drugs are anticoagulants

A

warfarin, heparin, enoxaparin, apixaban, dabigatran

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44
Q

what class is warfarin

A

anticoagulant

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45
Q

how does warfarin work

A

Inhibit hepatic synthesis of clotting factors including factor X

46
Q

what is warfarin used for

A

Mechanical valve
AFIB
(second line for VTE/PE)

47
Q

common side effects of warfarin

A

bleeding, hemorrhagic necrosis of skin, ** hard to DOSE!!!

48
Q

black box warning of warfarin

A

do not give to pregnant people, also can cause hyper coagulable state

49
Q

DDI of warfarin

A

Do not give with NSAIDs
MANY drug interactions with CYP2C9 inhibitors.. Specifically Amiodarone and Metronidazole

50
Q

what is antidote of warfarin

A

vitamin K

51
Q

what is an important diet teaching of warfarin

A

watch leafy greens

52
Q

what drug class is heparin

A

anticoagulant

53
Q

how does heparin work

A

accelerate antithrombin 3 activity

54
Q

what is heparin used for

A

DVT, PE, STEMI, NSTEMI, ischemic CVA and DIC

55
Q

common side effects of heparin

A

can cause hyperkalemia, caution w/ renal insufficiency or DM

56
Q

major ADRs/ CI of heparin

A

Contraindicated in hepatic and renal diseases (advanced)

can cause HITT

57
Q

antidote of heparin

A

protamine sulfate

58
Q

DDI of heparin

A

PCN IV and cephalosporins increase bleeding risk

59
Q

what is enoxaparin

A

low molecular weight heparin (anticoag)

60
Q

how does enoxaparin work

A

accelerate antithrombin 3 activity

61
Q

what is lovenox used for

A

DVT prophy and/or PE, post-op thromboembolism preention

62
Q

how is heparin and lovenox given

A

SC/IV

63
Q

side effects of lovenox

A

Bleeding (higher risk for renal patients)… also given SC

64
Q

ADRs of lovenox

A

CrCl cut off for lovenox use

65
Q

what does lovenox interact with

A

Interacts w/ salicylates, NSAIDs, dipyridamole, sulfinpyrazone, ticlopidine

66
Q

notable differences between lovenox and heparin

A

heparin requires more frequent lab monitoring!!!!!!!

67
Q

what drug class is apixaban?

A

eliquis- direct factor Xa inhibitor

68
Q

what is apixaban used for

A

a.fib

69
Q

side effects of apixaban

A

bleeding

70
Q

BBW of apixaban

A

increased risk of thrombolytic events upon discontinuation & transitioning to warfarin from direct Xa inhibitor increases the risk of CVA

71
Q

drug interactions of apixaban

A

can give without regard to food

watch for ketoconazole, ritonavir and st john’s wort

72
Q

how is apixaban metabolized

A

CYP3A4 metabolism :(

73
Q

what drug class is dabigatran?

A

anti-coag

74
Q

how does dabigatran work

A

direct thrombin inhibitor

75
Q

what is dabigatran used for

A

Prevention and treatment of thromboembolism (DVT), stroke/embolism prevention in a fib peeps

76
Q

pharmacokinetic considerations of dabigatran

A

absorbed in GI tract, avoid high fat foods, eliminated in urine

77
Q

side effects of dabigatran

A

bleeding, GI side effects, angioedma and thrombocytopenia

78
Q

black box warning of dabigatran and apixaban

A

BBW: Increased risk of thrombotic events upon discontinuation

79
Q

DDI of dabigatran

A

Rifampin, ketoconzaole, verapamil (CCB), plavix, amiodarone, all bleed-y meds

80
Q

CI of all anticoagulants

A

Contraindications: Hypersensitivity, active bleeding, hemophilia, thrombocytopenia, severe HTN, intracranial hemorrhage, infective endocarditis, active TB, ulcerative lesions of GI tract

81
Q

which drugs are antiplatelets

A

ASA and clopidogrel

82
Q

what class is aspirin

A

antiplatelet

83
Q

what class is clopidogrel (plavix)

A

antiplatelet

84
Q

how does aspirin work

A

Blocks an enzyme called cyclooxygenase, interferes w/ platelet aggregation AKA ~antiplatelet~
impact prostaglandin metabolism

85
Q

how does clopidogrel work

A

Reduces platelet aggregation by inhibiting the pathway of platelets

86
Q

what is aspirin used for

A

MI and stroke prevention, antithrombotic therapy for ischemic stroke

87
Q

what is clopidogrel used for

A

Prevention of new ischemic event (CVS or MI), ACS

88
Q

pharmacokinetics about clopidogrel

A

PRODRUG babyyyyyy, converted in the liver to a metabolite that works

89
Q

side effects of clopidogrel

A

bleeding (bleeding precautions in place)

90
Q

side effects of ASA

A

Normalish ones: GI upset, unusual bleeding (bleeding precautions)

Scary ones:REYE SYNDROME, upper GI bleeding, tinnitis

91
Q

signs of ASA toxicity

A

HA, hyperventilation, agitation, confusion, lethargy, diarrhea, sweating

92
Q

do ASA and clopidogrel require routine labs

A

no

93
Q

when is ASA sensitivity higher

A

in people with asthma

94
Q

when is clopidogrel contraindicated

A

hepatic disease, patient should NOT have GI ulcers

95
Q

DDI of clopidogrel

A

Other bleed-y meds (anti-coags), PPIs, antiacids, digoxin, theophylline, phenytoin ~drugs that inhibit CYP2C19~, caution w/ natural supplements

96
Q

DDI with aspirin

A

Hypersensitivity and cross-sensitivity with NSAIDs, increase bleeding risk w/ anticoagu/antiplatelets, etc

97
Q

how does oral iron work

A

supplement- iron makes up hemoglobin

98
Q

when is oral iron used

A

Blood loss iron deficiency anemia

(BUT balanced diet is best way to prevent iron deficiency)

99
Q

side effects of PO iron

A

GI symptoms better to give with food even through it decreases absorption, can cause dark stool and teeth staining

100
Q

when is PO iron c/i

A

Contraindicated in hemochromatosis and hemolytic anemia

101
Q

DDI of PO iron supplement

A

Chelation with levodopa penicillamine and quinolones, competitive absorption with antacids, cimetidine, tetracyclines

102
Q

folic acid mechanism

A

a supplement- Deficiency related to poor diet, ileal disease or phenytoin use

Increased demand in pregnancy

103
Q

who is deficiency of folic acid common in

A

pregnant peeps, alcoholics, liver disease

104
Q

pharmacokinetics of folate

A

Folate= nucleoprotein synthesis and erythropoiesis

Produces WBC platelets

105
Q

side effects of folate

A

GI side effects

106
Q

when is folic acid contraindicated

A

when B12 is low– fix low B12 first

107
Q

common DDI of folic acid

A

Sulfonamides, methotrexate and triamterene interfere ith activation

108
Q

what is vitamin b 12

A

Necessary for fatty acid synthesis

Necessary for folate synthesis

109
Q

when is b12 commonly used

A

malabsorption

Pregnancy

110
Q

side effects of b12

A

GI side effects

111
Q

c/i of b12

A

hypersensitivity to cobalt

112
Q
A

APRN A. Pharm- Test 2 (3 decks)

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