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Pharm 2: EXAM 1 > Antianginal, coagulation Modifier, Antilipemic > Flashcards

Antianginal, coagulation Modifier, Antilipemic Flashcards

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1
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
MOA

A

Works through a series of enzyme reactions causing dilated coronary veins, decreased venous return to the
heart, and reduced spasm in coronary arteries

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2
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
INDICATIONS

A

 Treatment and prophylaxis of angina pectoris
 Rapid-acting forms treat angina attacks
 Long-acting forms prevent attacks from occurring

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3
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
CONTRAINDICATIONS

A
  • Allergy,
  • severe anemia,
  • closed-angle glaucoma,
  • hypotension,
  • severe head injury
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4
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
AEs

A
  • HA (severe at first; usually resolves 20-30min)
  • orthostatic hypotension,
  • tachycardia,
  • tolerance develops quickly (within 1 day)
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5
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
INTERACTIONS

A
  • Antihypertensive drugs,
  • alcohol,
  • sildenafil (Viagra) all increase risk for hypotension;
  • anticholinergics may decrease absorption of sublingual nitroglycerin (DUE TO DRY MOUTH)
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6
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
What is the difference between rapid-acting & long-acting forms?

A
  • Rapid-acting treats acute angina attacks (sublingual & IV)

- Long-acting for prevention (Patch)

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7
Q

Nitroglycerin Sublingual

A

Place sublingual tab under tongue when chest pain starts
If NOT relieved in 5 minutes, call 911, then take a second tab
If no relief after 5 minutes, take a third tablet
Patient should sit or lie down after taking the FIRST tablet
-No More than 3 tabs!

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8
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
ADMINISTRATION FORMULATIONS

A
  1. Sublingual (rapid)
  2. Ointment (wear gloves; measure inches from tube)
  3. Patch (long-acting, hairless, no rash/wounds; rotate sites; remove for 10-12 hrs a day)
  4. IV (Rapid; special tubing, tele, infusion pump
  5. Spray (nasal- blow nose first)
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9
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
PROPER STORAGE

A
  1. Tablets come in glass bottle
  2. Protect from heat & light
  3. Room temp needs to be less than 86
  4. IV nitro-protect from heat &light
  5. IV- uses special tubing to protect
  6. Lasts 24 months if stored properly
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10
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
INTERVENTIONS

A
  • Monitor baseline orthostatic BP & pulse
  • Monitor HR (tachycardia)
  • Monitor for drug tolerance (occurs quickly)
  • check med list for interactions (Viagra)
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11
Q

Antianginal Drugs: Nitrates
Prototype: Nitroglycerin (Nitro-Bid, Nitrostat)
EDUCATION

A
  1. HA usually go away in 20-30 minutes
  2. Report dizziness or syncope (hypotension)
  3. Slow position changes
  4. Monitor HR & report tachycardia
  5. Remove transdermal patch each day
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12
Q

Coagulation Modifier Drugs: Prototypes

A 
Anticoagulants: Prevent clot formation
    -Heparin (Heparin sodium)
    -Enoxaparin (Lovenox)
    -Warfarin (Coumadin) 
Antiplatelets: Prevent platelet plugs
    -Clopidogrel (Plavix) 
 Thrombolytics: Break down existing clots
     -Alteplase (Activase)
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13
Q

Anticoagulants: Heparin (Heparin Sodium)

MOA

A

Inhibit clotting factors & prevents development of fibrin; heparin is both a factor Xa & thrombin inhibitor

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14
Q

Anticoagulants: Heparin (Heparin Sodium)

INDICATIONS

A

DVT & pulmonary embolism prophylaxis, a-fib with embolization

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15
Q

Anticoagulants: Heparin (Heparin Sodium)

CONTRAINDICATIONS

A
  • Uncontrolled bleeding,
  • severe thrombocytopenia,
  • lumbar puncture, pregnancy,
  • brain or spinal cord surgery
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16
Q

Anticoagulants: Heparin (Heparin Sodium)

AES

A

-Thrombocytopenia,
-heparin-induced thrombocytopenia,
-bleeding,
-hematoma,
anemia

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17
Q

Anticoagulants: Heparin (Heparin Sodium)

INTERACTIONS

A

-NSAIDs,
-aspirin,
-antiplatelet drugs increase bleeding risk;
-Herbals: ginger, ginkgo biloba, feverfew, evening
primrose oil (all increase bleeding risk);
-IV nitroglycerin reduces heparin’s anticoagulant properties

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18
Q

Heparin Toxicity antidote

A

IV protamine sulfate

  • 1mg of protamine can reverse the effects of 100 units of heparin
  • Stop drug immediately!
  • S/S: hematuria, melena, petechiae, ecchymoses, gum bleeding
  • MONITOR aPPT TIMES; Goal 1.5 to 2 times baseline
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19
Q

Anticoagulants: Heparin (Heparin Sodium) Interventions

ADMINISTRATION

A 
Assess:
Baseline VS & blood values. 
Goal: aPTT at 1½ to 2 times baseline.
Double-check all doses!
Inject:
SubQ deep in abdomen at least 2 inches from umbilicus. 
Do not aspirate or massage.
Apply mod. pressure for 1-2 min. after injection.
Rotate sites
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20
Q

Heparin-Induced Thrombocytopenia

A

Type I
-Gradual reduction in platelets
-Heparin therapy can generally be continued.
Type II
- Acute fall in number of platelets (more than 50% reduction from baseline)
-Discontinue heparin.
Clinical manifestations
-Thrombosis that can be fatal.
-Treatment: thrombin inhibitors such as lepirudin & argatroban
-Warfarin: can cause skin necrosis & “purple toes” syndrome

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21
Q

Anticoagulants: Enoxaparin (Lovenox)

MOA

A

Inhibits clotting factors and prevents development of clots; specifically inhibits factor Xa in
the clotting process

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22
Q

Anticoagulants: Enoxaparin (Lovenox)

INDICATIONS

A

Prophylaxis and treatment of DVT/PE, anticoagulant bridge therapy

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23
Q

Anticoagulants: Enoxaparin (Lovenox)

CONTRAINDICATIONS

A
  • Allergy,
  • uncontrolled bleeding,
  • use of an epidural
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24
Q

enoxaparin (lovenox)

AEs

Study These Flashcards
A
  • Bleeding,
  • thrombocytopenia,
  • hematoma,
  • anemia
25
enoxaparin (Lovenox) | INTERACTIONS
Other anticoagulants increase the risk for bleeding; NSAIDs, aspirin, & antiplatelet drugs also increase the risk for bleeding
26
Key Points: Coagulation Modifiers | ENOXAPARIN (LOVENOX)
Enoxaparin (Lovenox) is administered subcutaneously •Does not require frequent labs like heparin and warfarin •Often used as anticoagulant bridge therapy •Administer the air bubble in the pre-filled syringe • Important to teach patient this if they will be self-administering enoxaparin at home! •Teach to report s/s of excessive bleeding with ALL anticoagulants!!
27
Anticoagulants: Warfarin (Coumadin) | MOA
Inhibit vitamin K dependent clotting factors and prevent clot formation
28
Anticoagulants: Warfarin (Coumadin) | INDICATIONS
Prevention of venous thrombosis and PE, ischemic CVAs secondary to atrial fibrillation, thromboembolism in pts w/prosthetic heart valves, recurrent MI and TIAs
29
Anticoagulants: Warfarin (Coumadin) | CONTRAINDICATIONS
- Allergy, - pregnancy (teratogenic drug), - uncontrolled bleeding, - liver disease, - alcoholism, - vitamin K deficiency, - clients preparing to undergo lumbar puncture, brain, or spinal surgery
30
Anticoagulants: Warfarin (Coumadin) | AEs
Bleeding, lethargy, muscle pain, purple toes
31
Anticoagulants: Warfarin (Coumadin) | INTERACTIONS
Heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides & cephalosporins increase anticoagulation effects; phenobarbital, carbamazepine, phenytoin, & vitamin K decreases anticoagulation effects; excessive intake of foods high in vitamin K decreases anticoagulation effects  Foods high in vitamin K: dark green leafy veggies such as cabbage, Brussel sprouts, & broccoli; mayonnaise, canola and soybean oils GINKO
32
Anticoagulants: Warfarin (Coumadin) | TOXICITY
Discontinue the warfarin FIRST! May take 36 to 42 hours before liver can resynthesize enough clotting factors to reverse warfarin effects Vitamin K1 (phytonadione) can hasten the return to normal coagulation. High doses of vitamin K (10 mg) given IV will reverse the anticoagulation within 6 hours.
33
Know normal and therapeutic ranges of PT/INR | WARFARIN
• PT Normal Levels: 11-13 seconds • PT Therapeutic Levels: target is about 1.5 times the normal value or about 18 seconds • INR Normal Levels: 1.1 or below • INR Therapeutic Levels: 2.0-3.0 with average of 2.5 • For those with recurring clots 2.5-3.5 with an average of 3.0
34
Antiplatelets: Clopidogrel (Plavix) | MOA
Inhibit platelet aggregation
35
Antiplatelets: Clopidogrel (Plavix) | INDICATIONS
Reduce risk for: MI, ischemic CVA (thrombotic stroke), angina; Prevent reocclusion of coronary stents
36
Antiplatelets: Clopidogrel (Plavix) | CONTRAINDICATIONS
Peptic ulcer disease, bleeding disorders, thrombocytopenia, and intracranial bleeding
37
Antiplatelets: Clopidogrel (Plavix) | AEs
Gastric upset, abdominal cramping, nausea, diarrhea, small risk for gastric ulceration and bleeding; risk for thrombotic thrombocytopenic purpura (TTP) > causes blood clots to form in small blood vessels > impairs blood supply to major organs
38
Antiplatelets: Clopidogrel (Plavix) | INTERACTIONS
-Anticoagulants, -NSAIDs, -glucocorticoids, and alcohol increase risk for bleeding; -ginger, gingko biloba, feverfew, & evening primrose oil increase risk for bleeding; -proton pump inhibitors (PPI’s) decrease effects of clopidogrel
39
Antiplatelets: Clopidogrel (Plavix) | KEYPOINTS
- Teach patients to report s/s of excessive bleeding - Can take with food, 8 oz of water, or milk to reduce GI adverse effects - Patients should avoid alcohol while taking this drug!
40
Antiplatelets: Interventions
``` Teach: Report: -gastric irritation -easy bruising, bleeding gums, pinpoint purplish (petechial) rash -sudden, severe headache -weakness, numbness, paralysis -vision changes -N/V -seizures Take w/food, milk, or 8 oz water to minimize GI effects. Avoid alcohol ```
41
Thrombolytics: Alteplase (Activase) | MOA
Activates fibrinolytic system: quickly breaks down clot > Activates plasminogen & converts it to plasmin, which can digest fibrin
42
Thrombolytics: Alteplase (Activase) | INDICATIONS
DVT, massive pulmonary emboli (PE), arterial thrombolysis, reestablish patency of occluded central IV catheters
43
Thrombolytics: Alteplase (Activase) | CONTRAINDICATIONS
-Intracranial hemorrhage, -hemorrhagic CVA, known cerebrovascular lesion such as arteriovenous malformation or aneurysm, -active internal bleeding, -suspected aortic dissection, -facial/head trauma within 3 months, -brain tumor, -pericarditis
44
Thrombolytics: Alteplase (Activase) | AEs
Internal bleeding (intracranial, GI); Superficial (needle puncture sites, wounds)
45
Thrombolytics: Alteplase (Activase) | INTERACTIONS
- Anticoagulants, - NSAIDs, - heparin, - warfarin, - antiplatelets, and other thrombolytics all increase the risk for bleeding
46
Key Points: Coagulation Modifiers •Alteplase (Activase) is a thrombolytic drug meaning it breaks down clots to prevent them from becoming emboli
•Useful for treatment of DVT and PE •Can be used to reestablish patency in an occluded central line •Also used to reverse the s/s of an ischemic CVA (stroke) • Must be given within 3 hours of the onset of stroke s/s for maximum effectiveness •Typically given IV infusion •Teach patient to watch for abnormal bleeding
47
Antilipemics: Prototype Drugs
HMG-CoA Reductase Inhibitors: Atorvastatin (Lipitor) Fibric Acid Derivative/Fibrates: Gemfibrozil (Lopid)
48
HMG-CoA Reductase Inhibitors (statins): Atorvastatin (Lipitor) MOA
Lower blood cholesterol level by decreasing rate of cholesterol production
49
HMG-CoA Reductase Inhibitors (statins): Atorvastatin (Lipitor) INDICATIONS
Recommended first line therapy for hypercholesterolemia; helps reduce LDL and triglyceride levels & increase HDL levels
50
HMG-CoA Reductase Inhibitors (statins): Atorvastatin (Lipitor) CONTRAINDICATIONS
Drug allergy, pregnancy, liver disease, elevated liver enzymes, children less than 8
51
HMG-CoA Reductase Inhibitors (statins): Atorvastatin (Lipitor) AEs
- Myopathy (rhabdomyolysis), - GI disturbances, - headache, - rash, - dizziness, - blurred vision, - fatigue, - insomnia, - hepatotoxicity (less than 2% of patients)
52
HMG-CoA Reductase Inhibitors (statins): Atorvastatin (Lipitor) INTERACTIONS
-Concurrent use of fibrates or other drugs to lower cholesterol increase risk of myopathy or liver toxicity; -erythromycin, azole antifungal drugs & protease inhibitors increase blood levels of statins; grapefruit juice in large amounts increases risk for AE’s; warfarin increases risk for bleeding
53
Fibrates: Gemfibrozil (Lopid) | MOA
Activate lipoprotein lipase, an enzyme responsible for breakdown of cholesterol
54
Fibrates: Gemfibrozil (Lopid) | INDICATIONS
Treatment of type III, IV, and V hyperlipidemia; reduce high levels of plasma triglycerides & increase HDL cholesterol
55
Fibrates: Gemfibrozil (Lopid) | CONTRAINDICATIONS
Drug allergy, severe liver or kidney disease, cirrhosis, and gallbladder disease
56
Fibrates: Gemfibrozil (Lopid) | AEs
GI: abdominal pain, nausea, diarrhea, increase risk for gallstone development; liver toxicity; myopathy
57
Fibrates: Gemfibrozil (Lopid) | INTERACTIONS
Warfarin increases the risk for bleeding; taking both a statin and a fibrate increases the risk for myopathy
58
Nursing Implications for Antilipemics
``` Monitor for and teach to report AE/SE’s:  S/S of liver dysfunction Increased liver enzyme studies Yellow discoloration of skin or sclera Dark urine or pale stool Fatigue N/V, anorexia Excessive bruising Pruritus  Muscle or joint pain  Abdominal pain  Fatigue ```
59
Nursing Implications for Antilipemics: Teach
Teach: Lifestyle, diet changes How to administer each prototype Atorvastatin (Lipitor): PO, take in evening with or without food Gemfibrozil (Lopid): PO, take twice daily; 30 mins before breakfast & evening meal Importance of periodic liver function lab draws Monitor for therapeutic effects: Reduced cholesterol and triglyceride levels

Pharm 2: EXAM 1 (3 decks)

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