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Pharmacology II > Quiz 3 > Flashcards

Quiz 3 Flashcards

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1
Q

Functions of lipoproteins

A
  1. Energy utilization
  2. Lipid deposition
  3. Steroid hormone production
  4. Bile acid formation
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2
Q

Lipoprotein structure

A
  1. Lipophilic core - esterified cholesterol & triglycerides
  2. Outer layer - phospholipids & unesterified cholesterol
  3. Apolipoproteins - determines lipoprotein function & classification
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3
Q

Classifications of lipoproteins

A
  1. Chylomicrons - large, carry dietary lipids
  2. VLDL - triglycerides
  3. IDL - cholesterol esters & triglycerides
  4. LDL - cholesterol esters
  5. HDL - cholesterol esters to liver
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4
Q

When should you get your cholesterol checked?

A

after 20 then q 5 years
after 9-12 h fast

  1. Total cholesterol
  2. Triglycerides
  3. HDL
  4. LDL & VLDL calculated
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5
Q

What is primary hyperlipidemia?

A

aka familial

  1. Lipid metabolism defect
  2. Fredrickson Classification (Type I-V)
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6
Q

What is secondary hyperlipidemia?

A

aka acquired

  1. Diabetes
  2. Hypothyroidism
  3. Renal failure
  4. Obstructive liver disease
  5. Drug induced
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7
Q

What are major risk factors that modify LDL goals?

A
  1. Smoking
  2. HTN
  3. Low HDL (45, women >55
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8
Q

What are some good Therapeutic Lifestyle Changes w/ hyperlipidemia?

A 
1. Diet
Sat fat <200
Inc fiber & plants
2. Wt mgmt
3. Exercise
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9
Q

Dx metabolic syndrome

A

Any 3 of:

  1. Abdominal obesity
  2. Triglycerides
  3. Low HDL
  4. BP
  5. Fasting glucose >130
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10
Q

Steps of ATP III cholesterol guidelines

A
  1. Evaluate LDL & assess risk factors
  2. Initiate drug therapy
  3. If TG >500 lower 1st
  4. If LDL at goal & HDL below goal consider addition of drug therapy
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11
Q

MOA & benefits of HMG-CoA Reductase inhibitors

A
  1. Reduce hepatic cholesterol biosynthesis
  2. Dec. oxidative stress
  3. Dec. vascular inflammation
  4. Stabilize atherosclerotic lesions
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12
Q

ADRs of HMG-CoA Reductase inhibitors

A
  1. Hepatic dysfunction - don’t use w/ liver disease
  2. Myopathy - inc. CK
    obtain baseline & recheck if Pt Sx
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13
Q

MOA Nicotinic acid

A

Reduces hepatic VLDL secretion & enhances VLDL clearance

aka Vitamin B3

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14
Q

ADRs nicotinic acid

A
  1. Flushing, pruritis, warmth, tingling
  2. Hyperglycemia
  3. Hyperuricemia (gout)
  4. Upper GI distress
  5. Hepatotoxicity
    Obtain LFTs at baseline
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15
Q

MOA fibrates

A
  1. Activate lipoprotein lipase
  2. Promote delivery of TGs to adipose
  3. Interfere w/ VLDL formation in the liver

Adjust for renal function

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16
Q

ADRs fibrates

A
  1. GI Sx
  2. Myopathy
  3. Arrhythmias
  4. Elevated aminotransferases or ALP
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17
Q

What are the indirect thrombin inhibitors?

A
  1. Heparin
  2. Enoxaparin
  3. Fondaparinux
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18
Q

How can you avoid Heparin Induced Thrombocytopenia? (HITT)

A

give arixtra

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19
Q

What are the oral direct factor Xa inhibitors?

A
  1. Rivaroxaban
  2. Apixaban

prevention of DVT/PE
adjust dose renally
CYP3A4 & p-glycoprotein

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20
Q

ADRs oral direct factor Xa inhibitors

A
  1. Peripheral edema
  2. Dizziness
  3. HA
  4. Diarrhea
  5. Bleeding
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21
Q

What are the oral direct thrombin inhibitors?

A

Pradaxa

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22
Q

What are the IV direct thrombin inhibitors?

A
  1. Bivalirudin
  2. Argatroban
    - used if HIT
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23
Q

What are the oral antiplatelets?

A
  1. Ticlodipine
  2. Clopidogrel
  3. Prasugrel
  4. Ticagrelor
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24
Q

What are the Vit K antagonists & a common ADR?

Study These Flashcards
A
  1. Warfarin

common ADR = purple toe

25
What is the 1st lab to respond w/ anemia?
Reticulocyte count
26
Mechanisms of anemia
1. Dec. RBC production 2. Inc. RBC destruction 3. Blood loss
27
Macrocytic anemia & causes
MCV >100 1. Vit B12 deficiency 2. Folic acid deficiency 3. Drug induced 4. Bone marrow toxicity
28
Normocytic anemia & causes
MCV 81-99 1. Acute blood loss 2. Hemolytic anemia 3. Anemia of chronic disease
29
Microcytic anemia & causes
MCV <80 1. Iron deficiency 2. Anemia of chronic disease
30
Common causes of iron deficiency anemia
1. Diet - uncommon except in kids 2. Failure to absorb iron salts 3. Inc. utilization (pregnancy, growth) 4. Atransferrinemia 5. Failure to utilize - lead poisoning, chronic disease 6. Blood loss
31
Lab values to Dx Iron deficiency anemia
``` Decreased 1. Hgb, Hct, RBC 2. MCV 3. MCH 4. MCHC 5. Serum iron 6. Transferrin saturation 7. Ferritin Increased 1. TIBC ```
32
How much elemental iron do you need per day to treat iron deficiency anemia?
200 mg
33
Who needs IV iron transfusions?
Pts who can't tolerate oral iron 1. Chronic kidney disease 2. Malabsorption syndromes 3. IBD
34
Which IV iron do you have to give a test dose?
Iron dextran
35
Why is folate & B12 important for old people?
neurologic dysfunction
36
What are the erythropoiesis stimulating agents?
1. Epoietin | 2. Darbapoietin (longer acting)
37
Problems with sickle cell
1. Low Hct 2. Low Hgb 3. Inc. reticulocyte count 4. Veno-occlusive damage 5. Organ damage
38
How to treat sickle cell?
1. Analgesics 2. Antibiotics 3. Blood transfusions 4. Pneumococcal vaccination 5. Anti-sickling agents
39
MOA Droxia
``` anti-sickling agent inc. RBC Hgb F levels reduction of polymerization of Hgb S reduction of deformed, dense & damaged RBCs inc. RBC water content alters adhesion of RBCs to endothelium ```
40
ADRs Droxia
1. Leukopenia - monitor blood work 2. CNS - dizziness, disorientation, hallucinations 3. Hepatotoxicity 4. Hyperuricemia 5. Dysuria
41
What drugs are used for coagulopathies?
1. Factor VIII inhibitor bypassing activity (FEIBA) 2. Recombinant Factor VIIa (NovoSeven) 3. Prothrombin complex concentrate (Kcentra) 4. Cryoprecipitate
42
What med is given for coagulopathies assoc w/ liver disease?
NovoSeven
43
What are the coagulants?
1. Anti-Inhibitor Coagulant Complex 2. Prothrombin complex concentrate 3. Factor VIIa 4. Aminocaproic acid 5. Tranexamic acid 6. Topical thrombin 7. Cellulose 8. Gelatin absorbable 9. Ferric subsulfate 10. Fibrin sealant 11. Desmopressin
44
Anti-inhibitor coagulant complex
Precursor & activated forms of II, VII, IX & X For hemophilia A&B Pts who will undergo surgery or are bleeding May be used for life-threatening bleeding assoc w/ Pradaxa
45
Prothrombin Complex Concentrate
Factors II, VII, Protein C & S | For Warfarin reversal
46
Factor VIIa
Activates factorc IX & X in assoc. w/ tissue factor injectible until bleeding stops for Hemophilia A & B
47
Aminocaproic acid
Binds competitively to plasminogen preventing breakdown of fibrin Used to stop acute bleeding
48
Tranexamic acid
Displaces plasminogen from fibrin Inhibits fibrinolysis & proteolytic activity of plasma Short-term use in hemophilia Pts to reduce/prevent hemorrhage following tooth extraction Tx of cyclic heavy menstrual bleeding
49
FAST
Face Arm Speech Time Signs of stroke
50
Types of hemorrhagic strokes
1. Intracerebral hemorrhage - small vessels rupture from HTN 2. Subarachnoid hemorrhage 3. Intracerebral aneurysm - vessel rupture 4. Arteriovenous malformation
51
How to Tx intracerebral hemorrhage
1. ABC 2. BP control 3. Analgesia & sedation
52
How to Tx subarachnoid hemorrhage
1. Prophylactic anti-seizure drugs 2. Don't lower BP 3. Nimodipine
53
Nimodipine
CCB used for subarachnoid hemorrhage
54
How to treat ischemic stroke
1. ABC 2. Treat hyper/hypoglycemia 3. STAT emergency noncontrast CT 4. Medical support 5. IV thrombolysis 6. Endovascular techniques 7. Antithrombotic Tx 8. Neuroprotection 9. Rehab
55
Contraindications to alteplase for stroke
1. High BP 2. Low platelets 3. Low Hct 4. Low/high glucose 5. Heparin w/in 48h, long PTT/INR 6. Rapidly improving Sx 7. Prior stroke or head injury w/in 3 months 8. Prior intracranial hemorrhage 9. Major surgery in prior 14 days 10. Minor stroke Sx 11. GI bleeding in prior 21 days 12. Recent MI 13. Coma/stupor
56
Which antiplatelet is used in stroke Pts?
aspirin
57
When do you need to start cholesterol Tx in stroke Pts?
TC >120
58
Good cholesterol levels?
TC 40

Pharmacology II (10 decks)

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