Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm Exam 2 > anticoagulants, Ca, Osteoporosis > Flashcards

anticoagulants, Ca, Osteoporosis Flashcards

(89 cards)

Start Studying
1
Q

Heparin MOA

A

Suppresses coagulation by helping antithrombin inactivate clotting factors, mainly thrombin and factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Heparin Use

A

Suppressing massive blood clotting
PE
DVT
DIC
MI
Stroke
Open heart surgery (prevent clots in the machine)
Renal dialysis (prevent clots in the machine)
Prevention of DVT for those in hospital on longterm bed rest
After orthopedic surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Heparin Route

A

IV: titrate to aPTT, 2 RN check
SubQ: abdomen only, does not cross membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Heparin and Pregnancy

A

Does not cross membranes: placenta and breast milk.

Can be used in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Heparin A/E

A

Hemorrhage (most important)
Spinal epidural hematoma
Heparin induced thrombocytopenia (HIT)
Hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

HIT

A

immune mediated disorder where a proximal increase in thrombotic event due to development of antibodies
Starts clotting = Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Heparin Contraindications

A

Thrombocytopenia
Uncontrolled bleeding
Hemophilia
Eye, brain, spinal cord surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Heparin Antidote

A

Protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Heparin Monitoring

A

aPTT: norm: 30-40, therapeutic range: 60-80 (1.5-2x norm)

anti factor Xa: therapeutic range: 0.3-0.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Enoxaparin

A

Lovenox

Low molecular weight heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Enoxaparin MOA

A

Does not inactivate thrombin as well as heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Enoxaparin Use

A 
DVT prophylaxis after surgery
Treatment for established DVT
Prevention of ischemic complications
Stable angina
non-Q wave MI
STEMI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Enoxaparin Dosing

A

Fixed dose, no blood monitoring longer half life than heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Enoxaparin Route

A

Abdominal SubQ, pt must be able to give to themselves at home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Enoxaparin Contraindications

A

Spinal puncture/surgery = paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Enoxaparin A/E

A

HIT

Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Enoxaparin Antidote

A

Protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Warfarin MOA

A

Blocks synthesis of factor VII, IX, X and prothrombin, which need Vit K to be produced
Inhibits the enzyme VKORCI needed to convert Vit K to active form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Warfarin Use

A 
Long term prophylaxis of thrombosis 
Venous thrombosis 
PE
Thromboembolism 
Thrombosis in A fib
Thrombosis in prosthetic heart valves 
Reduce risk of TIA and recurrent MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Warfarin A/E

A 
Hemorrhage
Skin necrosis 
Alopecia
Dermatitis
Fever
Red/orange urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Warfarin Contraindications

A

Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Warfarin Drug interactions

A

Those that promote bleeding or anticoagulation
↓ anticoagulation effects: Heparin, Aspirin, Acetaminophen
Vit K ↓ effects of Warfarin
ETOH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Warfarin Pt edu

A

Maintain same amount of Vit K in diet (foods high in Vit K: Green leafy veggie, soybean oil, canola oil, mayonnaise)
Wear a medical alert bracelet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Warfarin Monitoring

A

PT (changes fast): norm: ∼12, therapeutic range: 18-24
INR (take ∼ 1 wk to change): therapeutic range: 2-3x normal
>INR corrects for thromboplastin variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Warfarin Antidote
Vit K
26
Warfarin Dosing
Adjust depending on PT and INR time
27
Warfarin Nursing considerations
Hold 1-2 wk before surgery | Very slow onset, must use heparin at beginning to prevent clots then stop heparin when warfarin starts working
28
Dabigatran Etexilate Brand
Pradaxa
29
Dabigatran MOA
Reversible direct thrombin inhibitor
30
Dabigatran Use
Non valvular Afib Hip/Knee replacement DVT/PE treatment Prevention of stroke and Afib
31
Dabigatran and Kidneys
1/2 life gets longer with renal impairment, may need to decrease dose
32
Dabigatran A/E
Bleeding | GI disturbance: dyspepsia: give PPI
33
Dabigatran Drug interactions
P-glycoprotein inhibitor ↑ bleeding risk, drug level - Ketoconazole - Amiodarone - Verapamil - Quinidine
34
Dabigatran Nursing considerations
Does not require monitoring Same dose for everyone Swallow whole No real antidote
35
Rivaroxaban Brand name
Xarelto
36
Rivaroxaban MOA
Selective inhibitor of factor Xa (inhibits production of thrombin) Binds directly with factor Xa to cause inactivation
37
Rivaroxaban Use
Prevents DVT, PE after Hip/Knee replacement ONLY Prevents stroke in nonvalvular A.fib Treatment of DVT/PE unrelated to orthopedic surgery
38
Rivaroxaban Renal impairment
Decrease dose
39
Rivaroxaban A/E
Bleeding | Spinal epidural hematoma → paralysis
40
Rivaroxaban Contraindications
Pregnancy | Moderate + renal/hepatic impairment
41
Rivaroxaban Drug interactions
CYP3A4
42
Rivaroxaban Pt edu
Can be taken with or without food
43
Aspirin MOA
・Prevents platelet aggregation by suppressing production of an enzyme necessary for platelets to produce thromboxane A2 (prostaglandin) ・Inhibits synthesis of prostacyclin from endothelium of the atrial cell wall but as long as dosage is kept low this is not a problem ・Inhibits COX
44
Aspirin Use
Prophylaxis: MI (primary prevention <70 y/o), Recurrent MI (secondary prevention), Death from stroke, TIA, ↓r/f sudden death, Reocclusion during coronary stenting (PCI) Ischemic stroke Chronic stable angina Unstable angina
45
Aspirin A/E
GI bleeding/Upset | Hemorrhagic stroke
46
Aspirin Nursing considerations
May need PPI if enteric coated tab does not decrease GI upset
47
Clopidogrel MOA
ADP receptor antagonist P2Y12 adenosine diphosphate receptor blocker on the surface of the platelets Antiplatelet aggregators similar in action to aspirin and frequently given in addition to aspirin after PCI procedure to prevent thrombotic event
48
Clopidogrel Use
Prevents occlusion of coronary stents (PCI) ↓thrombotic events in pt with acute coronary syndromes Prevents stenosis of coronary stents Secondary prevention of MI, Ischemic stroke, and other avascular events ❊Used for up to 2 years after coronary event
49
Clopidogrel A/E
``` Bleeding Bruising Thrombocytopenia (with in first few weeks) Fever (with in first few weeks) Anemia Renal dysfunction ```
50
Clopidogrel Drug interactions
Caution with combo with other drugs that promote bleeding
51
Clopidogrel Nursing considerations
Stop 5 days before surgery | Can be used with PPI
52
Ticagrelor MOA
Inhibits the receptor site on the surface of the platelet, thus preventing aggregation of platelets ❊Reversible blockade and effects wear-off faster
53
Ticagrelor Use
Prevents occlusion of coronary stents | ↳used for about 18-24 mo after procedure
54
Ticagrelor A/E
``` Hemorrhage Dyspnea Cough Diarrhea Dizziness Non cardiac chest pain Bradycardia Ventricular pauses ```
55
Ticagrelor Drug combo
Aspirin is usually given in low dosages along with the drug but high doses >100 mg should not be used due to danger of actually reducing benefits of Ticagrelor
56
Ticagrelor Pt educations
Discontinue 5 days before surgery
57
Abciximab MOA
Reversible blockade of platelet GP IIb/IIIa receptors | Binds to platelets near the GP IIb/IIIa receptors and then prevents the receptors from binding to fibrinogen
58
Abciximab Use
Most effective antiplatelet drug Acute coronary syndromes Percutaneous coronary interventions Acute MI/PCI
59
Abciximab A/E
Major bleeding (oozing)→ stop if occurs GI bleed Urogenital bleeding Retroperitoneal bleeding
60
Abciximab Route
IV only
61
Abciximab Drug interactions
In Conjunction with heparin and aspirin to promote revascularization in patients undergoing thrombolytic therapy, acute MI, PCI
62
Alteplase
tPA
63
Alteplase MOA
Binds to plasminogen to form an active complex then catalyzes the conversion of other plasminogen molecules into plasmin, an enzyme that digests the fibrin meshwork of clots
64
Alteplase Use
MI Ischemic stroke Massive PE ✶Must meet guidelines to give
65
Alteplase Dosing time
With in2-6 hr of onset of symptoms
66
Alteplase A/E
Bleeding (intracranial bleed) | Fever
67
Alteplase Drug interactions
``` Anticoagulants ・heparin ・warfarin ・dabigatran Antiplatelets ・Aspirin ・Clopidogrel ```
68
Alteplase Nursing considerations
No invasive procedures Pt needs to lay still due to increased risk for bleeding All clots good and bad will be dissolved
69
Vit D MOA
Works with PTH to increase GI absorption of Ca Increase osteoclast maturation D2, D3 (active form)
70
Vit D Use
Regulation of Ca and phosphorus homeostasis Osteoporosis Renal osteodystrophy
71
Vit D A/E
``` Toxicity Early s/s: weakness, fatigue, nausea, vomiting, anorexia, abdominal cramping, constipation Late s/s: ↓kidney function, polyuria, nocturia, proteinuria Neurologic: seizures, confusion, ataxia Cardiac dysrhythmias Coma Ca deposition in soft tissue Decalcification of bone ```
72
Vit D Sources
``` Sunlight Fatty fish Egg yolk Cheese Beef liver Mushrooms Some cereals Some OJ ```
73
Calcitonin Salmon
Calcitonin
74
Calcitonin MOA
Decreases bone reabsorption by inhibiting the activity of osteoclasts Inhibits tubular resorption of Ca Increase Ca excretion
75
Calcitonin Use
Osteoporosis treatment Pagets Hypercalcemia
76
Calcitonin Route
Nasal spray: alternating nostrils daily
77
Calcitonin A/E
Nausea: diminishes with time Flushing of face and hands Injection site reaction Can develop antibodies so might stop working after a year
78
Bisphosphonate Drug
Alendronate (Fosamax)
79
Alendronate MOA
Inhibits bone resorption by decreasing activity of osteoclasts
80
Alendronate Use
``` Postmenopausal osteoporosis Osteoporosis in men Glucocorticoid induced osteoporosis Pagets Hypercalcemia of malignancy May help prevent/treat bone metastases in patients with cancer ```
81
Alendronate A/E
``` Ocular inflammation Osteonecrosis of the jaw Atypical femur fracture A fib Esophageal ulceration and cancer Musculoskeletal pain Hyperparathyroidism ```
82
Alendronate Pt education
Take 30 min before other foods and drugs, on empty stomach with a full glass of water Must sit upright for 30 minutes to prevent esophageal problems Take a drug holiday after about 5 years for about 6 mo
83
Selective Estrogen Receptor Modulators drug
Raloxifene
84
Raloxifene MOA
``` Structurally similar to estrogen and binds to estrogen receptors Mimics estrogen (agonist) in bone, lipids, and blood clotting Blocks estrogen in the breast and endometrium ```
85
Raloxifene Use
Prevention/Treatment of postmenopausal osteoporosis | Estrogen receptor breast cancer
86
Raloxifene A/E
Thromboembolism (DVT, PE, Stroke) | Hot flashes
87
Raloxifene Contraindications
Pregnancy
88
Raloxifene Drug interactions
Take with adequate intake of Ca and Vit D
89
Raloxifene Pt education
Take with or without food | ensure adequate intake of Ca and Vit D

Pharm Exam 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions