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pharm 2 > Hem, MI, hyperlip > Flashcards

Hem, MI, hyperlip Flashcards

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1
Q

Process of hemostasis

A
  1. Vascular injury/endothelial exposure- vasoconstrictive response- activation of platelets
  2. Adhesion- Glycoproteins and von willebrand factor-Binds platelets
  3. Activation- Platelets are activated
  4. Aggregation- With help from ADP, thrombin, thromboxane A1-Visable clot
  5. Formation of fibrin plug within blood clot
  6. CLot retraction and dissolution- fibrinolysis0 destroys clot
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2
Q

Coagulation cascade intrinsic vs extrinsic

A

I-Activation in response to injury of blood vessel

E- Activation when extravascular injury from surrounding tissue

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3
Q

What is the importance of vit k in clotting and one thing about it

A

Vit k makes 4 of the clotting factors. It is made from bacteria in the gut.

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4
Q

Where is heparin found and what is it?

A

IN liver, linning of blood vessles and animal tissue it is a carbohydrate

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5
Q

What is the drug of choice to tx thromboembolic disease

A

Heparin

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6
Q

MA for Heparin
and what does that do?
and one thing it does not do

A

Binds to antithrombin 111 inhibits thrombin and inactivates factor Xa

Prevents clots from forming or getting bigger and prolongs coagulation time
Breaks up existing clots

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7
Q

AE for heparin 4

A

Bleeding thrombocytopenia HIT, hypersensitivity, osteoporosis

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8
Q

Heparin Considerations 4 numbers with one

A 
Appt- activated partial thromboplastin time 
Normal-25-35
therapy- 1.5-2.5x normal 
Don't let them fall
HIT-< 150.000
Watch for bleeding
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9
Q

Warfarin other name and MA and 3 thing about it

A 
Coumadin 
inhibits enzymes that form vit k 
most popular po anticoag 
Doesn't affect clotting factors that are already present so it take a 3-4 days to work
Need to wat h PT/INR
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10
Q

Indications for warfarin 2

A

Anything that a clot can cause, prosthetic heart valve

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11
Q

PT INR values and what drug what does it stand for?

A

Warfarin
prothrombin time and international normalized ratio
normal-pt-11-13.5 INR .801.1
Therapy- 2.0-3.0

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12
Q

Warfarin adverse effects 4

A

Bleeding, osteoporosis, bone fractures, fetal death 1st trimester

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13
Q

What are theNC for warfarin? 3

A

NSAIDS, ACE, Asprin can increase anticoag effect
no ginkgo, garlic, cranberry, ginger- risk of bleeding
avoid K rich food- greens!

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14
Q

Dabigatran MA
two thing about it
AE-2
1 Consideration

A

MA-Inhibits the a tion of thrombin directly by binding to it.
No lab and quickly reversed
Bleeding, abrupt stop=Thrombolytic event
Contraindicated in patients with mechanical heart valves because of increased risk of stroke or bleeding

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15
Q

What drug do we use in patients who have a mechanical heart valve?

A

Warfarin

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16
Q

What are the antiplatelets?

A

Asprin, Adenosine diphosphate receptor blockers, glycoprotein 11b and 111a receptor blockers

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17
Q

Asprin MA and one two things about it

A

Binds to cyclooxygenase enzyme in platelets-inhibits formation of thromboxane A2 that is an activator of platelet aggregation
Single dose can last as long as a week and avoid other coag mod

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18
Q

Asprin Adverse effects 3

A

Hypersensitivity-bronchospasm-anaphylaxis, stomach ulcers, bleeding, pain, tinnitus

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19
Q

Clopidogrel Class and MA
one thing about it
and uses
AE-2ish

A

Blocks Adenosine diphosphate on platelets-ADP is needed to activate platelet aggregation
Inhibition of platelet function can last several days after drug is d/cd
Profolaxis for arterial thrmboembolism, stroke, MI
Bleeding few AD

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20
Q

ABCIXIMAB class and MA
IN- 2
AE 1

A

glycoprotein binds to 11b and 11a receptors on platelets prevents fibrinogen, von willi and other procoags
only IV
Coronary angioplasty, revascularization
AEAbnormal bleeding- can last ten days

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21
Q 
What do thrombolitics do?
 what are the names
when else do we give them 
when are they effective 
How are they given
A 
Dissolve existing clots 
End in ase
MI 
20min-12hr
IV ER
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22
Q

MA of thrombolytics
uses
AE

A

Converts plasminogen to plasmin-dissolves fibrin clots
Emergency-open clotted central lines and for other thrombocytes
bleeding

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23
Q 
What is aminocaproic acid
ma
2 uses
 Given?
One adverse effect
A 
Hemostatic
Blocks plasminogen and plasmin- prevents digestion of clots 
excessive hemorrhage- surg 
Given IV 
Clots
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24
Q

Chronotropic, dromotropic, inotropic

A

Heart rate, Speed/conduction/ myocardial contractility

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25
Chronotropic, dromotropic, inotropic
Heart rate, Speed/conduction/ myocardial contractility
26
2 things that cause brady
SA node dysfunction AV node block
27
Tachy problem and bpm
SA node rapid firing, 160-200
28
Atrial flutter
regular hr but 250-300 bpm
29
Atrial fib
chaotic firing, quivering, most common
30
Vent tachy vent fib
High risk of sudden death | cardiac arrest
31
How do we classify antidysrthmics
``` vaughn williams class 1 Na+ blockers 2 beta blockers 3 K+ channel blockers 4-Ca+ blockers other-adenosine and dig ```
32
Sodium channel blockers about 3
lg group of antidysR classified 1a 1b 1c they block the Na channel-prevent depolarization reduce automaticity and slow impulse conduction so delays repolarization
33
What is the class anti d class drugs
!A procainamide
34
Procainamide class? Tx? how? one thing
1A tx Tachy cardias suppresses dysR used in CPR as a last resort
35
Procainamide AE 4 | How is it given?
``` Bone marrow suppression BLOOD- might be fetal cardiotoxicity- worsen dysr severe hypotn Lupus like syndrome IV quick patient is supine ```
36
``` Lidocaine class MA 3 things it does ```
Blocks Na+ channels slows conduction in all heart reduces automaticity in vents and perkinje Accelerates repolarization- decreases HR
37
Lidocaine AE
CNS effcts- drowsy confusion anxiety parethesias | further- convulsions, coma, respiratory arrest
38
``` What is the class 11 for antid 3 things it does Tx 2 things ```
Beta blockers propanolol Blocks SNS activation, slow heart rate, reduce conduction velocity (speed) TX- Increased bp and angina
39
Propanolol Contra and what is it for
Anti D | Severe brady, lung stuff
40
Class 111 what is it drugs? Name MA-2 One advantage
``` K+ channel blockers amiodarone block k+ from leaving delays repo block na and ca channels ```
41
AE of amiodarone 3 | and one thing
``` cardiotoxicity black box- pulm tox-itis and pulm fibrosis need lung tests infant hypothyroidism CNS reactions hypotn Visual disturbances can lead to blindness rashes blue skin atax, dizzy, trem, mood, halucinacions lots of drug interactions effects can last 4-6 weeks ```
42
What is class 4 and drugs and what to watch for
nondihydropyridines vamoamil and diltiazem hypotn and brady
43
What is the miscellaneous antid ma-2 2 things about it 3 things about admin
Adenosine causes potassium to leave the cell blocks reentry pathways to the SA and AV nodes causes 1-5 seconds of asystole SHORT half life given for PSVT Need to have doc present, must be supine, risk of severe hypoTN or death
44
What is the second miscellaneous drug What is it for MA SE- 1
Dig a fib or flutter PSVT MA-decreases automotisity of AV node prodysr effect
45
What drugs cause prodysrythmic effects? and one thing to remember about it
Class 1, 111, and mis | ben needs to outweigh ben
46
What is hypertn
BP 130/80
47
What are the Anti anginal drugs
Organic Nitrates beta blockers ccbs
48
what is the goal for antiangina 5
decrease frequency and intensity, and increase activity tolerance reduce workload of the heart by reducing hr and and reducing afterload prevent vasopasm promote dilation reduce pain
49
What does nitro do? 3
Increases vasodilation of the coronary arts relaxes art and venous smooth mm decreases preload
50
Nitro AE | contraindications
vasodilation s/s | hypotn, shock, head injury, truama
51
Beta blocker name for MI and 3 MA one thing about it s/s one contraindication
Atenolol decreases cardiac workload by blocking receptors in the heart reduces HR and contractility Selective for beta 1 so no lungs All hypotension signs patients with ischemic heart disease no abrupt stop can worsed angina or cause MI
52
What do the ccbs do? 4 name? adverse effects?
``` Vera and dil relax smooth mm and decrease bp reduction in afterload decrease hr dilate coronary arts hypo brady stuff ```
53
Tx for MI
Thrombolytics- ase asprin blood thinner nitro dilator betablockers reduce HR BP and contractility ACE inhib-help prevent remodeling and dysr Pain meds
54
How to give asprin for MI | and daily dose?
325mg chew and swallow | 81 mg
55
Explain lipids Triglycerides phospholipids steroids
tri- Stored fat used as energy make plasma membranes steroirds-cholesterol- component of all cell membranes produced by the liver found in food but we don't need an outside source
56
HDL, LDL, VLDL and levels and total value
H-protein- greater than 60 L-cholesterol less than 100 v-triglycerides less than 150 total- less than 200
57
5 drug classes for lip
statins, bile acid sequetrants | niacin fibric acid and micellaneous
58
What are the three statins
Atro-first choice lova- pm with empty stomach simva-pm with or without food
59
Atrovastatin MA and ae 4 teaching 1
inhibit HMG-coa reductase reducing chole being made by the liver the liver will increase LDL receptors and remove more LDL myopathy/ rhabdomyolysis, GI discomfort, hepatotoxicity, teratogenic cat x no grapefruit or gj-inhibits metabolism
60
Off label benefits of statins 4
Enhance ability of blood vessels to dilate, protect against alz, lower colorectal cancer and migraines
61
``` Name of bile acid MA 2 three teaching what is it good for? 3 AE one ```
cholestyramine Binds to bile acids in intestines forming insuluble complex that contains cholesterol, eliminated in feces and liver makes more LDL receptors mix with 60-180ml if water drink right away takes 1month interferes with vit and minerals decreases puritis with bil obstruc and is good for cdiff and diarrhea All gi and steatorrhea
62
Niacin b complex MA 3 2 points AE 6
Decreases production og VLDLS lowers LDL and triglycerides Increases HDL kind of Need high dose 2-3g can take a long time flushing, paresthesia, Gi issues, gout, hepatotoxicity, raises glucose
63
``` Fibric acid drug name MA 3 AE 1 CI 3 2 teaching ```
Gemfibrozil activates lipoprot lipase to breakdown and eliminate triglycerides in the plasma inhibits the breakdown of stored fat mostly for triglycerides secondline for those who cant use statins GI discomfort ci in hepatic impairment and gallbladder disease take with food caution in kidneys
64
what is the other fibric acid drup
fenofibrate give once a day instead of twice monitor liver can cause myopathy and rhabdo when given with a statin
65
Ezetimibe | MA 2
``` CHOLESTEROL ABSORB INHIBITOR IN SM INTESTINE lowers LDL in blood First line misc sometimes combined with statins 1x a day not many side effects ```
66
What fat is bad?
Saturated fat

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