Exam 4 Flashcards
1
Q
Atorvastatin MOA
A
- Inhibits cholesterol synthesis by the liver
- HMG-CoA Reductase inhibitor
- Decreases LDL, raises HDL, stabilizes plaques within vessels
2
Q
Atorvastatin ADEs
A
- Mild GI disturbances
- Rhabdomyolysis (breakdown of muscle tissue)
- Hepatotoxicity
- Myopathy (muscle pain)
- New onset- diabetes
3
Q
Atorvastatin PT teaching
A
- Avoid NSAIDs and tylenol; use warm compresses for pain
- Avoid grapefruit & alcohol intake
- increase fluid intake to reduce renal stress
- contraindicated for pregnancy
- Take at night (cholesterol synthesis occurs at night)
4
Q
Atorvastatin MONITORing
A
- Obtain baseline LFTs then monitor LFTs
- Watch for tea colored urine
- Watch for proteins and RBCs in urine
- Lipid panel
5
Q
Bile Acid sequestrants (Colesevelam) MOA
A
- Used in adjunct to statins
- Binds to bile acids to prevent LDL absorption
- Increases LDL excretion
- Creates positive feedback loop –> Body makes more bile salts due to increases excretion which also increases LDL excretion
6
Q
Bile Acid Sequestrants ADEs
A
- Constipation
7
Q
Bile Acid Sequestrants PT Teaching
A
- Increase fluid, fiber, and exercise to counter constipation
- Must space other drugs to not disrupt absorption: take other drugs either 1 hour before BAS, or take other drugs 4 hours after BAS taken
8
Q
Ezetimibe MOA
A
- Acts of brush border of small intestine to block cholesterol absorption and bile reabsorption
- Used if pt is on high dose statin with little effect on LDL levels
9
Q
Nitroglycerin MOA
A
- Vasodilation of vascular smooth muscle
- Decrease in venous return –> Decrease in ventricular filling –> decrease in preload = eases stress on heart
- Decreases o2 demand
- Prevents vasospasm
10
Q
Nitroglycerin ADEs
A
- Reflex tachycardia
- Hypotension, orthostatic hypotension
- Lots of drug interactions
11
Q
Nitroglycerin PT Teaching
A
- Cannot chew or swallow = must dissolve sublingually
- Stop activity, rest, take a seat while dosing
- Keep in dry environment, no sunlight or moisture exposure
- Take at first sign of angina pain
- If first dose does not relieve pain, call 911 and take another dose (can take up to 3)
- Take frequent breaks with drug to minimize tolerance build up
12
Q
Other Nitro Notes
A
- Routes: sublingual, transdermal patch, topical ointment
- Sublingual fastest, patch 30-60 min onset
- Need to be off of drug for 8 hours daily to avoid tolerance build up
- Erectile dysfunction drugs can cause life-threatening hypotension interaction
13
Q
Heparin MOA
A
- Anticoagulant - prevention of clots
- Inhibits thrombin and factor Xa, inhibits fibrin production, enhances antithrombin activity
- Allows time for body to breakdown clot on it’s own, prevents clot from getting bigger
- Useful with venous thrombus
14
Q
Heparin ADEs
A
- Bleeding risk
- Heparin induced thrombocytopenia (HIT)
- Spinal or epidural hematoma
- Monitor platelet count (less than 100,000 is bad)
15
Q
Heparin PT Teaching
A
- Know signs and symptoms of hemorrhage
- Monitor for changes in urine and stool color
- Avoid NSAIDs including aspirin
- Use soft toothbrush and electric razor
- Avoid airplanes
- Change position and walk around often
- Wear compression socks and elevate legs often
16
Q
Other Heparin Notes
A
- Dosage is weight based
- Antidote: protamine sulfate
- Monitoring: PT and INR, platelet count
- Heparin elongates PT and INR (PT to 60-80 seconds, INR goal is 2-3)
- Only used IV in hospital
- Initial dose weight based, then based on aPTT time
17
Q
Enoxaparin
A
- Low molecular weight heparin
- Same as heparin, same ADEs as heparin
- Pt needs to be taught how to give at-home injection and risks associated
- Used for DVT prevention
18
Q
Warfarin MOA
A
- Anticoagulant; Vitamin K antagonist, suppresses clotting factors
- Used for long-term anticoagulant management, TIA prevention, Afib and stroke prevention, prevention of recurrent MI, thromboembolism
- Highly protein bound, take a long time to begin working, takes a long time to leave system
- Often used with pt’s with artificial heart valves
19
Q
Warfarin ADEs
A
- Bleeding risk
- Contraindicated for pregnancy
- MANY drug interactions
20
Q
Warfarin MONITORing
A
- Treatment objective is to raise INR to 2-3 (higher for heart valve pt’s)
- PT/INR
- Antidote: Vitamin K
21
Q
Warfarin PT Teaching
A
- Keep vitamin K dietary habits stable
- No grapefruit
- Know s&s of bleeding, hemorrhage
- Can remain in system even if stopped
22
Q
Dabigatran MOA
A
- Direct thrombin inhibitor
- Used for Afib, DVT, PE
- Preferred over warfarin as of recently
- Has rapid onset, no labs to monitor, more predictable than warfarin
- Antidote : Idarucizumab (Praxbind)
23
Q
Dabigatran ADEs
A
- Bleeding
- GI Disturbance - dyspepsia
24
Q
Rivaroxiban
A
- Direct factor Xa inhibitor
- First line drug for AFib
- Highly protein bound
- Contraindicated in pt’s with renal impairment, hepatic impairment, pregnancy
25
Alteplase (tPA)
- Thrombolytic "clot buster"
- binds to plasminogen, promotes synthesis of plasmin to digest clot
- Used in acute MI, acute ischemic stroke, acute massive PE
- Contraindicated in pt's with active internal bleed, cerebral vascular lesion, recent ischemic stroke
- Antidote : Aminocaproic Acid (Amicar)
26
Aspirin MOA
- Antiplatelet; Suppresses platelet aggregation by irreversible inhibition of cyclooxygenase
- Only works in arterial vessels; prevents arterial thrombosis
- Used to prevent stroke, TIA, angina, and MI
27
Aspirin ADEs
- Bleeding, especially GI
| - Hemorrhagic stroke
28
Clopidorgel (Plavix)
- P2Y12 ADP receptors on platelets
- Reduces MI and stroke risk, reduces stenosis in coronary arteries, used in PCI therapy
- ADEs: Hemolytic anemia, neuro dysfunction, Thrombotic thrombocytopenic purpura, bleeding
- Monitor platelets
29
IV abciximab (ReoPro)
- Monoclonal antibody
- Reversibly blocks platelets, inhibits final step of aggregation
- Can be used with acute coronary syndrome, used in PCI therapy
- ADEs: Doubles the risk of bleeding at injury site, general bleeding
30
Sacubitril / Valsartan (Enestro)
- Angiotensin receptor Neprilysin inhibitor (ARNI)
- Decreases BNP levels, suppresses negative RAAS effects
- Used for HF after diuretic
- ADEs: Angioedema, hyperkalemia, hypotension,
- Cannot be given within 36 hours of ACEi
31
Digoxin MOA
- Cardiac glycoside; inhibits Na+/K+ ATP-ase pump in cardiac cells
- Suppresses AV node, increases contractility, increases cardiac output
- Second line agent for HF
- Check pulse before administration (hold if below 60)
- Antidote : Digibind
32
Digoxin ADEs
- Cardiac dysrhythmias
- GI issues (n/v)
- CNS effects (fatigue)
- Changes in vision
- Narrow therapeutic range
- Monitor potassium levels. Hypokalemia can cause toxicity
33
Drug treatment for stable angina
- Beta blockers
- Nitrates
- CCBs
34
Drug treatment for unstable angina
- Nitrates
| - CCBs
