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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
contraindications and major adverse reactions of statins
acute liver disease, intracerebral hemorrhage *check LFTs prior to starting
26
what drugs increase risk of rhabdomylosis
if reductase inhibitors and bile sequestrants are taken together it increases the risk!
27
med instructions of reductase inhibitors
usually taken in PM
28
how do bile acid sequestrants/cholestyramine work?
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%
29
common uses of cholestyramine
reduce LDL- best for patients with low CV risk and cant reduce LDL by diet
30
pharmacokinetics of cholestyramine
not absorbed- works in GI tract by binding bile acids
31
side effects of cholestyramine
constipation-- use of laxative N/V
32
ADRs of cholestyramine
can reduce folate levels
33
what drug is a fibric acid derivatives
gemfibrozil
34
what class is gemfibrozil
fibric acid derivative
35
how does gemfibrozil work?
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?
36
use of gemfibrozil
reduce VLDL, best at increasing HDL
37
major ADRs of gemfibrozil
may increase cholesterol excretion into the bile, D/C if gallstones found.. may also cause anemia
38
med instructions for gemfibrozil
must be taken before meals
39
how does ezetimibe work?
Blocks absorption of cholesterol across intestinal border (LDL reduction) Binds with cholesterol in intestine
40
what is ezetimibe used for
first line for kids with familial hypercholesteremia
41
how does evolocumab work?
Monocolonal antibody PCSK9 inhibitor. Alter protein activity that transport LDL into the liver
42
important things to know about evolocumab
super expensive- used with other statins when desired outcome isn't met
43
which drugs are anticoagulants
warfarin, heparin, enoxaparin, apixaban, dabigatran
44
what class is warfarin
anticoagulant
45
how does warfarin work
Inhibit hepatic synthesis of clotting factors including factor X
46
what is warfarin used for
Mechanical valve AFIB (second line for VTE/PE)
47
common side effects of warfarin
bleeding, hemorrhagic necrosis of skin, ** hard to DOSE!!!
48
black box warning of warfarin
do not give to pregnant people, also can cause hyper coagulable state
49
DDI of warfarin
Do not give with NSAIDs MANY drug interactions with CYP2C9 inhibitors.. Specifically Amiodarone and Metronidazole
50
what is antidote of warfarin
vitamin K
51
what is an important diet teaching of warfarin
watch leafy greens
52
what drug class is heparin
anticoagulant
53
how does heparin work
accelerate antithrombin 3 activity
54
what is heparin used for
DVT, PE, STEMI, NSTEMI, ischemic CVA and DIC
55
common side effects of heparin
can cause hyperkalemia, caution w/ renal insufficiency or DM
56
major ADRs/ CI of heparin
Contraindicated in hepatic and renal diseases (advanced) **can cause HITT**
57
antidote of heparin
protamine sulfate
58
DDI of heparin
PCN IV and cephalosporins increase bleeding risk
59
what is enoxaparin
low molecular weight heparin (anticoag)
60
how does enoxaparin work
accelerate antithrombin 3 activity
61
what is lovenox used for
DVT prophy and/or PE, post-op thromboembolism preention
62
how is heparin and lovenox given
SC/IV
63
side effects of lovenox
Bleeding (higher risk for renal patients)... also given SC
64
ADRs of lovenox
CrCl cut off for lovenox use
65
what does lovenox interact with
Interacts w/ salicylates, NSAIDs, dipyridamole, sulfinpyrazone, ticlopidine
66
notable differences between lovenox and heparin
heparin requires more frequent lab monitoring!!!!!!!
67
what drug class is apixaban?
eliquis- direct factor Xa inhibitor
68
what is apixaban used for
a.fib
69
side effects of apixaban
bleeding
70
BBW of apixaban
increased risk of thrombolytic events upon discontinuation & transitioning to warfarin from direct Xa inhibitor increases the risk of CVA
71
drug interactions of apixaban
can give without regard to food watch for ketoconazole, ritonavir and st john's wort
72
how is apixaban metabolized
CYP3A4 metabolism :(
73
what drug class is dabigatran?
anti-coag
74
how does dabigatran work
direct thrombin inhibitor
75
what is dabigatran used for
Prevention and treatment of thromboembolism (DVT), stroke/embolism prevention in a fib peeps
76
pharmacokinetic considerations of dabigatran
absorbed in GI tract, avoid high fat foods, eliminated in urine
77
side effects of dabigatran
bleeding, GI side effects, angioedma and thrombocytopenia
78
black box warning of dabigatran and apixaban
BBW: Increased risk of thrombotic events upon discontinuation
79
DDI of dabigatran
Rifampin, ketoconzaole, verapamil (CCB), plavix, amiodarone, all bleed-y meds
80
CI of all anticoagulants
Contraindications: Hypersensitivity, active bleeding, hemophilia, thrombocytopenia, severe HTN, intracranial hemorrhage, infective endocarditis, active TB, ulcerative lesions of GI tract
81
which drugs are antiplatelets
ASA and clopidogrel
82
what class is aspirin
antiplatelet
83
what class is clopidogrel (plavix)
antiplatelet
84
how does aspirin work
Blocks an enzyme called cyclooxygenase, interferes w/ platelet aggregation AKA ~antiplatelet~ *impact prostaglandin metabolism*
85
how does clopidogrel work
Reduces platelet aggregation by inhibiting the pathway of platelets
86
what is aspirin used for
MI and stroke prevention, antithrombotic therapy for ischemic stroke
87
what is clopidogrel used for
Prevention of new ischemic event (CVS or MI), ACS
88
pharmacokinetics about clopidogrel
PRODRUG babyyyyyy, converted in the liver to a metabolite that works
89
side effects of clopidogrel
bleeding (bleeding precautions in place)
90
side effects of ASA
Normalish ones: GI upset, unusual bleeding (bleeding precautions) Scary ones:REYE SYNDROME, upper GI bleeding, tinnitis
91
signs of ASA toxicity
HA, hyperventilation, agitation, confusion, lethargy, diarrhea, sweating
92
do ASA and clopidogrel require routine labs
no
93
when is ASA sensitivity higher
in people with asthma
94
when is clopidogrel contraindicated
hepatic disease, patient should NOT have GI ulcers
95
DDI of clopidogrel
Other bleed-y meds (anti-coags), PPIs, antiacids, digoxin, theophylline, phenytoin ~drugs that inhibit CYP2C19~, caution w/ natural supplements
96
DDI with aspirin
Hypersensitivity and cross-sensitivity with NSAIDs, increase bleeding risk w/ anticoagu/antiplatelets, etc
97
how does oral iron work
supplement- iron makes up hemoglobin
98
when is oral iron used
Blood loss iron deficiency anemia (BUT balanced diet is best way to prevent iron deficiency)
99
side effects of PO iron
GI symptoms better to give with food even through it decreases absorption, can cause dark stool and teeth staining
100
when is PO iron c/i
Contraindicated in hemochromatosis and hemolytic anemia
101
DDI of PO iron supplement
Chelation with levodopa penicillamine and quinolones, competitive absorption with antacids, cimetidine, tetracyclines
102
folic acid mechanism
a supplement- Deficiency related to poor diet, ileal disease or phenytoin use Increased demand in pregnancy
103
who is deficiency of folic acid common in
pregnant peeps, alcoholics, liver disease
104
pharmacokinetics of folate
Folate= nucleoprotein synthesis and erythropoiesis Produces WBC platelets
105
side effects of folate
GI side effects
106
when is folic acid contraindicated
when B12 is low-- fix low B12 first
107
common DDI of folic acid
Sulfonamides, methotrexate and triamterene interfere ith activation
108
what is vitamin b 12
Necessary for fatty acid synthesis Necessary for folate synthesis
109
when is b12 commonly used
malabsorption Pregnancy
110
side effects of b12
GI side effects
111
c/i of b12
hypersensitivity to cobalt
112

APRN A. Pharm- Test 2 (3 decks)

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