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NSG 323 > LL agents, Anticoags, antiplatelets and thrombolytics > Flashcards

LL agents, Anticoags, antiplatelets and thrombolytics Flashcards

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1
Q

HMG-CoA reductase inhibitors are also called

A

statins

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2
Q

1st line therapy for lipid disorders

A

statins

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3
Q

MOA for statins

A

inhibit CL synthesis in the liver
stimulate hepatocytes to produce more LDL receptors
LDL receptors remove the LDL from the blood

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4
Q

prototype for statins

A

Atorvostatin AKA Lipitor

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5
Q

common SE of statins

A

headache, rash, memory loss, GI disturbance

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6
Q

serious SE of statins

A

hepatotoxicity, myopathy/rhabdomyolysis, cataracts

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7
Q

special considerations for statins

A

monitor for increased SE when statins combined with other lipid lowering agents.
no grapefruit
no pregnancy!
d-d interactions!

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8
Q

Bile-acid sequestrants MOA

A

bind to bile acids to form complexes that excreted.

bile acids are made from CL –> liver makes more bile acids using LDL –> increases LDL receptors to uptake more LDL

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9
Q

bile acid sequestrants prototype

A

colesevelam (welchol)

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10
Q

where do bile acid sequestrants work?

A

only in GI tract! so they have GI side effects, like constipation, bloating and indigestion.
admin with food and h2o

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11
Q

Cholesterol absorption inhibitor prototype

A

ezetimibe (zetia)

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12
Q

CL absorption inhibitor MOA

A

blocks CL absorption in the small intestine

also blocks CL secreted in bile

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13
Q

Ezetimibe se

A

equal placebo

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14
Q

what should you watch for with ezetimibe?

A

increased liver toxicity with statin.

no liver disease!

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15
Q

what is vytorin?

A

ezetimibe + simvistatin

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16
Q

Fibric acid derivatives (fibrates) moa

A

accelerates the clearance of VLDLs
little to no effect on LDLs
increases HDLs too

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17
Q

Fibrates prototype

A

gemfibrozil (lopid)

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18
Q

SE of gemfibrozil

A

rash and GI upset
increased risk of gallstones
myopathy
liver toxicity

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19
Q

d-d interactions of gemfibrozil

A

warfarin: increased risk of bleeding
statins: increased risk of rhabdo

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20
Q

MAB PCSK9 inhibitors MOA

A

binds to PCSK9 which blocks PCSK9 binding to LDL receptors. this increases LDL receptors, allowing LDL to bind to the receptors and be removed from the blood.

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21
Q

MAB PCSK9 prototype

A

evolocumab (repatha)

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22
Q

who is evolocumab approved for?

A

those who have familial high CL OR atherosclerotic heart problems who maxed out on statins.

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23
Q

how is evolocumab administered?

A

subq or IV. NO ORAL

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24
Q

SE of MAB PCSK9 inhibitors

A

injection site reactions, vasculitis, rask, urticaria.

antibody production can occur.

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25
Other lipid lowering agents
fish oil plant sterols and sterol esters cholestin: made from rice fermented with red yeast
26
anticoagulants
prevents the formation of clots
27
antiplatelets
inhibits platelet aggregation
28
thrombolytic
dissolves life threatening clots
29
general MOA for anticoagulants
inhibit syn clotting factors (factor X and thrombin) or inhibit the activity of clotting factors (factor Xa, thrombin)
30
general uses of anticoags.
PREVENTION of VENOUS thrombosis
31
Heparin MOA
inactives several clotting factors (factor Xa) as well as inhibits thrombin activity and suppresses formation of fibrin
32
admin of heparin
must be IV or subq
33
half life of heparin
90 mins. | takes 6 hours to become therapeutic!
34
heparin/LMWH antidote
protamine sulfate
35
what sort of monitoring do you need to do with heparin
aPTT | platelets
36
normal aPTT levels
40 secs. with heparin we want to get it to 1.5-2x baseline, 60-80 seconds. with IV heparin, test aPTT every 6 hours
37
se of heparin
bleeding, heparin induced thrombocytopenia (HIT)
38
HIT management
monitor platelets. if <100K, reduce by 50% then stop heparin
39
LWMH characteristics
same MOA but safer! no frequent blood tests can be admined at home dosage based on weight
40
what is the drug of choice for DVT?
LWMH
41
LWMH prototype
enoxaparin (lovenox)
42
Vitamin K antagonist prototype
warfarin (coumadin)
43
MOA of warfarin
acts by inhibiting hepatic syn of vitamin K dependent clotting factors and prothrombin
44
antidote for warfarin
vitamin K, effects in 6 hours
45
uses of warfarin
prevent DVT, PE, clots in patients with afib, prosthetic heart valves, or who had TIA or recurrent MI
46
considerations for warfarin
no pregnancy! highly protein bound lots of d-d interactions narrow therapeutic index genetic testing is recommended (VKORC1 and CYP2C9) variants (increased risk of bleeding ) foods high in vitamin K-- eat consistently
47
monitoring for warfarin
PT or INR, normally look at INR | half-life is 1.5-2 days.
48
direct thrombin inhibitors MOA
direct, reversible inhibitor of thrombin
49
admin of direct thrombin inhibitors?
can be IV, subQ or oral
50
when do you use dabigatran?
afib, hip/knee replacement
51
prototype for direct thrombin inhibitors
dabigatran (pradaxa)
52
AE of dabigatran
bleeding and GI issues
53
considerations for dabigatran
``` no lab monitoring lower risk of bleeding few d-d interactions/d-f interactions rapid onset set dose stop before surgery! ```
54
antidote for dabigatran
idarucizumab (praxbind)
55
direct factor Xa inhibitors MOA
bind with factor Xa and inhibits thrombin
56
considerations for factor Xa inhibitors
``` NO monitoring Oral formulation rapid onset fixed dose lower bleeding risk few drug interactions ```
57
prototype for factor Xa inhibitors (2)
rivaroxaban (xarelto) | apixaban (eliquis)
58
antidote for factor xa inhibitors
andexanet alfa
59
indications for factor xa inhibitors
post hip/knee replacement Afib tx of DVT/PE
60
se of factor xa inhibitors
bleeding; spinal/epidural hematoma | contra in: liver disease and pregnancy
61
Aspirin moa
interfere with platelet aggregation | used to prevent clot formation in ARTERIES
62
what does ASA prevent
MI, TIA and stroke
63
what does COX have to do with ASA
asa irreversibly inhibits COX and COX interferes with TXA 2, which is platelet aggregation
64
dosing for ASA
81 mg 1x/week | give with proton pump inhibitor to protect GI system
65
ADP antagonists prototype
clopidogrel (Plavix)
66
ADP antagonists MOA
irreversible blockade of ADP receptors on platelet surfaces
67
SE of ADP antag
same as ASA
68
ACS pts and ADP
give ASA too!
69
What should you do if there are s/s of bleeding pts taking clopidogrel?
call provider! they'll clot up super quickly, may keep them on.
70
PAR-1 antagonists prototype
vorapaxar (Zontivity)
71
Vorapaxar MOa
reversibly blocks the PAR-1 expressed on platelets
72
admin of PAR-1 antagonists
oral, lasts 7-10 days. given with clopidogrel and/or ASA to prevent CV events. given to high risk patients!
73
glycoprotein IIb/IIIa receptor antagonists prototype
abciximab (ReoPro)
74
admin of abciximab
IV for short term use (like surgery or procedures) given with ASA and heparin stops working in 24-48 hours
75
MOA for abciximab
reversible inhibition of all factors in platelet aggregation
76
Thrombolytics MOA
bust up a clot baby
77
thrombolytics prototype
alteplase (tPa)
78
considerations for tPa
most effective if given early: within 6 hrs of MI or 3 of CVA have to see if they are eligible for tPa, screen for risk of hemorrhage narrow margin of safety, stop if ANY sign/sym of bleeding
79
contraindications for tPa
pregnancy, severe HTN, peptic ulcer, history of MI/CVA.

NSG 323 (12 decks)

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