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Pharmacology > Exam 8: Anticoag/Psych > Flashcards

Exam 8: Anticoag/Psych Flashcards

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1
Q

anticoagulant

A

works against the formation of a clot - disrupt coag cascade

most effective on venous thrombosis (damage occurs at distant site like PE)

contra: risk of bleeding (uncontrolled hemorrhage, recent surgery, lumbar puncture, etc.)

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2
Q

antiplatelets

A

inhibit the platelet clumping/aggregation (clotting)

most effective on arterial thrombosis (localized damage)

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3
Q

thrombolytic

A

destroys existing clot - promote lysis of fibrin

tPA - speeds up the conversion of plasminogen to plasmin that degrades the fibrin mesh and breaks up a clot

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4
Q

indications for all

A

DVT, CVA, PE, procedures

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5
Q

ADRs for all

A

bleeding/hemorrhage, spinal/edidural hematoma, hemorrhagic stroke

always #1 concerned for hemorrhage (intracranial bleed)
AMS and projectile vomitting -> increased ICP

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6
Q

contras for all

A

uncontrolled bleeding, recent procedure/puncture

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7
Q

heparin

A

anticoagulant - high risk med
enhance antithrombin - prevent clots, doesn’t break down

rapid acting, SQ/IV

contra: thrombocytopenia

preferred during pregnancy

ADR: HIT, hypersensitivity, local irritation/ecchymosis

labs: antifactor Xa (0.3-0.7), aPTT (60-80 secs), platelet counts - every 6 hrs until stable and then less often and will titrate

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8
Q

HIT

A

immune - decreased platelet counts (occurs 2-5% of pts) -> monitor platelets closely (30% loss or more)
and worry about bleeding -> blue/purple fingers/toes

antibody formation -> lab = HIT immunoassay to detect

promotes thrombosis and loss of circulating platelets

immediately dc and notify provider

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9
Q

aPTT normal

A

40 secs

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10
Q

enoxaparin/dalteparin

A

anticoagulant - LMWH

MOA: inactivates factor Xa and thrombin

SQ/IV

comes in fixed (weight-based) dosing/does not require lab monitoring (at home)

same ADRs

more expensive than heparin

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11
Q

warfarin

A

anticoagulant - Vit K antagonist

PO - delayed onset (not for emerg), prevents activation of vit K (needed for VII, IX, X, and prothrombin)

preventative for Afib, DVT, MI/TIA

ADR: teratogenic, similar to heparin

many interactions - heparins, antiplatelets (bleeding), seizure meds, oral contraceptives, rifampin (decrease), antifungals, cimetidine, amiodarone (increase)

vitamin K foods -> don’t need to avoid, just need to make sure no spikes in vitamin K (steady)

labs: PT/INR (goal 2-3)

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12
Q

dabigatran

A

anticoagulant - direct thrombin inhibitor

PO -> empty stomach, compares to warfarin (less risk of bleeding, labs less often, faster onset, fixed dose, fewer interactions)

ADR: lower risk of bleeding than warfarin, GI

don’t need to check labs as often, stop 1-3 days prior to surgery

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13
Q

argatroban

A

anticoagulant - direct thrombin inhibitor

IV, used in place of heparin when HIT occurs

hypersensitivity w/thrombolytics or contrast media

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14
Q

rivaroxaban

A

anticoagulant - factor Xa inhibitor -> “xa” in the word (Xarelto)

PO, DVT/PE prophylaxis, check renal function, teratogenic, cannot use with hepatic issues

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15
Q

apixaban

A

anticoagulant - factor Xa inhibitor -> “xa” in the word

(Eliquis)

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16
Q

ASA

A

antiplatelet - aspirin

MOA: irreversibly inhibits COX enzyme 1 -> blocks synthesis of TXA2 so no platelet activation and no vasoconstrict

uses: stroke/TIA, angina, MI, bypass/stent

ADR: risk for GI bleed

**doubles bleeding for 7-10 days (lifetime of platelet), stop 1 wk before surg

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17
Q

clopidogrel/ticagrelor

A

antiplatelet - alone or w/ASA (for ACS)

MOA: ADP receptor antagonist - stops ADP stimulated platelet aggregation

uses: stents, CVA, ACS, PAD

ADR: TTP, GI, less bleeding than ASA

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18
Q

tirofiban

A

antiplatelet - GP IIa/IIIb antagonist **highlighted this drug in class

IV, most effective - “super ASA”, used w/ASA and heparin

use w/ACS during cath lab -> prevent reocclusion

reversible block of receptors, effects last 24 - 48 hours

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19
Q

alteplase/reteplase/tenecteplase

A

thrombolytics

dissolve existing thrombi -> convert plasminogen back to plasmin

acute use for MI/CVA/PE (low dose for central line)

alteplase = tPA

give blood products when ADR of bleeding

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20
Q

protamine sulfate

A

antidote to heparin, neutralizes

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21
Q

phytonadione

A

vitamin K antidote to warfarin, PO or IV= dilute first and infuse slow (anaphylaxis risk)

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22
Q

idarucizumab

Study These Flashcards
A

antidote to dabigatran

23
Q

andexnet

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A

antidote to rivaroxaban

24
Q

schizophrenia s/s

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A

positive symptoms - hallucinations, delusions, agitation, and paranoia

negative symptoms - lack of motivation, blunt affect, social withdrawal

cognitive symptoms - disordered thinking, memory and learning difficulties, inattentiveness

25
schizophrenia theory
excessive activation of CNS receptors for dopamine insufficient activation of CNS receptors for glutamate
26
FGA
"typical", stronger block for dopamine serious movement disorders (EPS) -> late sign = tardive dyskinesia (irreversible at this point) ADRs: adrenergic block (hypoten, dizzy, drowsy), muscarinic block (constipation, blurred vision, dry mouth), histamine 1 block (sedation, drowsy, antiemetic), NMS (muscle rigid, fever, seizures, rhabdo), ortho hypotension, prolonged QT, sedation, sexual dysfunction, neuroendocrine (dec prolactin), agranulocytosis, addiction in neonates exposed selected based off tolerability
27
EPS
extrapyramidal symptoms starts w/ dystonia (face grimacing and involuntary movements) and akathisia (restless) late (irreversible) sign = tardive dyskinesia -> chewing motion, rolling tongue, involuntary movements
28
EPS tx
decrease anticholinergics and decrease dose of FGA Administer Benzodiazepines and switch to 2nd generation agent
29
NMS
fever, encephalopathy, elevated creatinine kinase -> rhabdo, rigidity of muscles tx: dc meds, cooling measures and benzos
30
SGA
atypical, stronger block for serotonin, also approved for bipolar ADRs: metabolic disorders (gain weight and inc cholesterol, DM), teratogenic, lower risk for EPS, agranulocytosis (clozapine), ortho hypo
31
antipsychotics
primary = schizophrenia SGA = also bipolar inc in mortality for dementia related psychosis (CV death and pneumonia) tourette's, chemo N/V, behavioral problems, ETOH withdrawal, intractable hiccups
32
haloperidol
typical antipsychotic (FGA) butyrophenones other uses: in Tourette's, ETOH withdrawal, behavior issue, CINV, agitation ADRs: ortho hypo, prolong QT -> ventric, EPA, MORE
33
chlorpromazine
FGA, low potency, prolong QT, tx intractable hiccups
34
clozapine
SGA, most effective but greatest metabolic ADRs **agranulocytosis - monitor CBC
35
quetiapine
atypical antipsychotic uses: sleep, agitation in acute settings ADR: weight gain, dyslipidemia, DM avoid getting out of bed quickly or drinking ETOH
36
risperidone
SGA - schizo, bipolar, autism tx (sometimes dementia related psychosis) ADRs: NMS, SI, mood changes highest risk of EPS
37
theory of depression
caused by functional deficiency of monamine neurotransmitters: norepinephrine (alertness, concentration, energy) serotonin (obsessions,compulsions, memory) dopamine (pleasure/reward, motivation/drive) or combination therein
38
antidepressants
slow response (1 - 3 weeks for onset, 6 - 12 for peak) 4-8 weeks to assess efficacy, all equally effective, risk for suicide at beginning of tx, DC slowly -> withdrawal
39
1st line antidepressants
SSRIs, SNRIs, buproprion, mirtazipine more ADRs and less use: TCAs and MAOIs
40
benzodiazepines
reactive depression -> following an event, short term
41
SSRI
fluoxetine, sertraline, citalopram MOA: Selectively block the reuptake of serotonin (5HT) can gradually decrease the dose when symptoms improve ADR: weight gain, SSSS (stomach upset, sexual dys, serotonin syndrome, suicidal thoughts), teratogenic ^why would someone not take?
42
"effective for sadness, panic, compulsion"
escitalopram fluoxetine sertraline paroxetine citalopram remember SSRIs
43
SNRI
duloxetine, venlafaxine MOA: Block neuronal reuptake of serotonin and NorEpinephrine (NE), with minimal/weak effects on other transmitters or receptors ADRs: same as SSRI, plus HTN also tx diabetic neuropathy, fibromyalgia
44
TCA
amitriptyline, imipramine MOA: Blocks the uptake of norepinephrine & serotonin (5HT) blocks Alpha 1 (ortho hypo), histam 1 (sedation), muscarinic (anticholinergic effects), diaphoresis, cardiac tox, seizures, hypomania, SI toxicity can be lethal, cannot combine with other serotonin agents, w/MAOIs = HTN crisis
45
MAOIs
selegiline - transdermal (also used for Parkinson's in lower dose) MOA: inhibit the enzyme (MAO) that inactivates the neurotransmitters so more of them in brain; nonselective A & B inactivates tyramine older med, don't use anymore, need to wait 2 weeks between switching from another drug HTN crisis w/dietary tyramine -> ask to list the foods from last week; serotonin synd w/ other meds
46
tyramine rich foods
dairy (cheese, cream), bananas, avo, caffeine, liver, cured meats, soy sauce, wine, beer, overripe fruit
47
Atypical
Buproprion MOA unclear, maybe blocks reuptake -> increases dopamine and norepi less ADRs than SSRIs but seizures (contra: eating disorders) can be used for smoking cessation no sexual dysf and weight loss instead of gain CNS stim and sim to meth, can test positive on UA
48
St. Johns Wort
drug interactions w/ other meds -> serotonin syndrome
49
serotonin syndrome
combo of any: SSRIs, MAOIs, tricyclics, St. Johns wort, lithium excess accumulation of serotonin fever, tachy, mydriasis, agitation -> AMS, rhabdo, shivering, hyperreflexia & myoclonus, seizures, coma, can cause death
50
lithium
narrow thera range (0.5 - 1.0 mEq/L) -> serum levels (tox above 1.5; 2.5 = death) most concerned about sodium levels -> lithium not excreted as much when sodium is low (retains lithium to compensate) ADRs: dry mouth, thirst, polyuria (antagonizes ADH), weight gain, distal edema, metallic taste, muscle weakness and tremors w/tox interactions: diuretics, ACEis (sodium loss), NSAIDs (increase reabsorption up to 60%), anticholinergics (urinary hesitancy)
51
valproate/carbamezapine/lamictal
AEDs - antiepileptic drugs effective mood stabilizers -> valproate is 1st line now for bipolar
52
methylphenidate
(ritalin) CNS stimulant for ADD/ADHD; many routes and ER/SR (concerta/daytrana patch - long release) MOA:? increase attention span, heighten alertness, and increase focus can lose effect after 2-3 years but gives window for therapy ADRs: initially insomnia and growth suppression, anorexia and weight loss instruct to take early in the day to minimize interference w/meals no coffee high abuse potential (sch 2)
53
Atomoxetine
nonstimulant black box for SI ADRs: SI, HTN, tachy, appetite suppression
54
guanfacine & clonidine
alpha 2 adrenergic agonists originally for HTN ADRs: somnolence, weight gain, hypotension

Pharmacology (12 decks)

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