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Pharmacology > Respiratory, ASCVD, prophylaxis, anticoagulant, antiplatelet, thrombolytic agents > Flashcards

Respiratory, ASCVD, prophylaxis, anticoagulant, antiplatelet, thrombolytic agents Flashcards

1
Q

metered-dose inhaler (MDI)

A

one dose per actuation
1 minute between doses
pacers increase delivery to lungs

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2
Q

nebulizers

A

converts solution into mist
admin through mask or mouthpiece over several minutes

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3
Q

respimats

A

delivers fine mist that gives greater delivery of drug
less deposition into mouth and oropharynx

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4
Q

dry-powder inhalers (DPI)

A

delivers dry micro powder to lungs
breath-activated

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5
Q

Albuterol (ventonlin) MOA

A

activate beta2 receptors to cause bronchodilators

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6
Q

albuterol (ventonlin) indications

A

-relief of acute bronchospasm in asthma
-prevention of exercise-induced breathing
-combination inhaled corticosteroids for COPD

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7
Q

Albuterol (Ventolin) adverse effects

A

SABA: tachycardia, angina, and tremor
LABA: sever asthma and asthma-related death

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8
Q

Albuterol (Ventolin) nursing considerations

A

only for symptomatic treatment
LABA never used as monotherapy for asthma
LABA for stable COPD
assess use of SABA for control

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9
Q

Theophylline (Theo-24) MOA

A

unclear, for symptomatic relief

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10
Q

Theophylline (Theo-24) indications

A

PO for maintenance of asthma & COPD
IV for asthma emergencies

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11
Q

Theophylline (Theo-24) adverse effects

A

mild NVD to serious ventricular fib and convulsions

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12
Q

Theophylline (Theo-24) nursing considerations

A

narrow therapeutic range
do not double dose if dose is missed
lidocaine for v fib and diazepam for convulsions

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13
Q

Tiotropium (spiriva) MOA

A

long term, muscarinic antagonist

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14
Q

Tiotropium (spiriva) indications

A

Maintenance therapy of bronchospasm in COPD
Off-label use in asthma

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15
Q

Tiotropium (spiriva) adverse effects

A

Minimal- limited to dry mouth and irritation of pharynx

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16
Q

Tiotropium (spiriva) nursing considerations

A

Often combined with albuterol nebulizer (duo-nebs) as PRN medication to use both mechanisms for maximal relief

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17
Q

Budesonide (Pulmicort) MOA

A

suppress inflammation

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18
Q

Budesonide (Pulmicort) indication

A

Prophylaxis for asthma
Combination ICS/LABA in COPD

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19
Q

Budesonide (Pulmicort) adverse effects

A

Inhaled: candidiasis and dysphonia
PO: acute use only when symptoms are uncontrolled
adrenal suppression, hyperglycemia, osteoporosis with prolonged use

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20
Q

Budesonide (Pulmicort) nursing consideration

A

Patient education on inhalation drug delivery, administration with SABA, and post administration instructions
Tapering with long time PO use and monitoring for adrenal suppression

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21
Q

Cromolyn MOA

A

prevents release of histamine

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22
Q

Cromolyn indications

A

prophylaxis for mild-mod asthma
prevention of EIB
relief from seasonal allergies and before allergen

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23
Q

Cromolyn adverse effects

A

occasional cough or bronchospasm due to inhalation

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24
Q

Cromolyn nursing considerations

A

not used as a quick relief for acute attack (not used as abortive therapy)
Use 15 minutes before exposure to precipitating factors (e.g. exercise, cold, environmental factors, etc.)

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25
Q

Montelukast (Singulair) MOA

A

occupies leukotriene receptors

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26
Q

Montelukast (Singulair) indications

A

Asthma maintenance & prophylaxis
Prevention of EIB
Relief of allergic rhinitis

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27
Q

Montelukast (Singulair) adverse effects

A

Generally well-tolerated

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28
Q

Montelukast (Singulair) nursing considerations

A

Patient education- not used as abortive therapy
Cheaper than most inhalers  may increase patient adherence

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29
Q

Fluticasone (Flonase) MOA

A
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30
Q

Fluticasone (Flonase)

A
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31
Q

Fluticasone (Flonase) adverse effects

A

drying of nasal mucosa and burning or itching sensation
adrenal suppression and slowed growth in children- rare

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32
Q

Fluticasone (Flonase) nursing consideration

A

Patient education on relief is greatest if administered daily than PRN
Relief may take a week or longer to develop

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33
Q

Loratadine (Claritin) MOA

A

block histamine receptors, decreases itching, sneezing, and rhinorrhea (not congestion)

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34
Q

Loratadine (Claritin) indications

A

prevent or suppress major symptoms due to their actions against histamines

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35
Q

Loratadine (Claritin) adverse effects

A

generally mild
sedation and anticholinergic effects seen more with 1st gen antihistamine

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36
Q

Loratadine (Claritin) nursing cosniderations

A

avoid 1st gen antihistamines if you wanna stay up
educate patient that med is most effective if taken daily
intranasal doses can cause somnolence with sufficient systemic absorption

37
Q

Phenylephrine (Sudafed PE) MOA

A

activates alpha 1 receptors

38
Q

Phenylephrine (Sudafed PE) indications

A

allergic rhinitis, congestion with sinusitis and colds

39
Q

Phenylephrine (Sudafed PE) adverse effects

A

Rebound nasal congestion if topical agents are used for more than a few days
CNS excitation (restlessness, irritability, anxiety, and insomnia)
CV effects with PO formulations

40
Q

Phenylephrine (Sudafed PE) nursing consideration

A

Monitor vital signs due to potential for increased BP, particularly in those with CV disorders
Patient education that topical should not be used for more than 3-5 consecutive days
Commonly confused with pseudoephedrine, which can be converted into methamphetamine; placed behind counter in pharmacy

41
Q

Atorvastatin (lipitor) MOA

A

inhibits cholesterol synthesis within liver

42
Q

Atorvastatin (lipitor) indications

A

Hypercholesterolemia
Primary & Secondary CV prevention
Post MI Therapy
DM/DMII

43
Q

Atorvastatin (lipitor) adverse effects

A

Myopathy/rhabdomyolysis
Hepatotoxicity
New onset DM (rare)

Teratogenicity (Category X)

44
Q

Atorvastatin (lipitor) nursing considerations

A

Administer in evening
Monitor LF and CK
Pt education on contraception and myopathy

45
Q

Colesevelam (Welchol) MOA

A

binds to bile acids to prevent absorption and promote excretion

46
Q

Colesevelam (Welchol) adverse effects

A

GI tract- primarily constipation, bloating, indigestion, & nausea

47
Q

Colesevelam (Welchol) nursing considerations

A

Drug interactions resulting in insoluble complexes (such as meds- thiazides, digoxin, & warfarin)
Administer other oral meds 1 hr before or 4 hr after bile-acid sequestrant administration
Increase fluids & fiber prior to administering laxatives
Take with food and water

48
Q

Colesevelam (Welchol) Indications

A

Adjunctive therapy in hypercholesterolemia, often with statin medications

49
Q

Gemfibrozil (Lopid) MOA

A

lowers VLDLd levels to reduce TG levels, raises HDL, little to no effect on LDL

50
Q

Gemfibrozil (Lopid) indications

A

Hypertriglyceridemia
Mixed dyslipidemia

51
Q

Gemfibrozil (Lopid) adverse effects

A

Most common: rash and GI disturbance (nausea, ab pain, diarrhea)
Risk of gallstones
Myopathy/rhabdomyolysis
Hepatotoxicity

52
Q

Gemfibrozil (Lopid) nursing considerations

A

Can increase anticoagulant effects in patients on warfarin
Monitor for bleeding and INR
Periodic liver function test (LFT)
Patient education on myopathy and gallstones

53
Q

Aspirin (ASA) MOA

A

Irreversibly inhibits cyclooxygenase to prevent TXA2 synthesis needed to promote platelet activation

54
Q

Aspirin (ASA) indications

A

Primary & secondary prevention of-
Ischemic CVA and TIA
Angina and MI-related events

55
Q

Aspirin (ASA) adverse effects

A

Bleeding, especially in GI
Hemorrhagic stroke
Salicylism
Renal impairment

56
Q

Aspirin (ASA) nursing consideration

A

Dosing
81 mg helps to prevent CV events
325 mg helps in initial treatment of CV events
Educate & monitor for signs of bleeding
Educate on other sources of aspirin (Excedrin, BC powder, Alka-seltzer)
Give PPI if GI bleeding occurs
Education on medication use in setting of elective surgery (stopped 7- 10 days before)

57
Q

Clopidogrel (Plavix) MOA

A

Irreversibly prevents ADP-stimulated platelet aggregation and blood clot formation

58
Q

Clopidogrel (Plavix) indications

A

Combined with ASA, helps to reduce thrombotic events in patients with acute coronary syndrome
Prevent blockage of coronary artery stents

59
Q

Clopidogrel (Plavix) adverse effects

A

Bleeding
Thrombotic Thrombocytopenic Purpura (TTP)

60
Q

Clopidogrel (Plavix) nursing consideration

A

Educate & monitor for signs of bleeding and directions for continuing medication
Education on medication use in setting of surgery (Hold 5 days before elective surgery)
Give PPI if GI bleed occurs

61
Q

Abciximab (ReoPro) MOA

A

reversible blockade of platelet receptors to inhibit final step of platelet aggregation

62
Q

Abciximab (ReoPro) indications

A

Prevent ischemic events with those who with ACS
Non-STEMI and Unstable Angina
Percutaneous Coronary Intervention (PCI)

63
Q

Abciximab (ReoPro) adverse effects

A

Bleeding, particularly PCI insertion site

64
Q

Abciximab (ReoPro) nursing considerations

A

post procedure cardiac cath monitoring
monitor for s/s bleeding

65
Q

Heparin MOA

A

helps antithrombin inactivate thrombin and factor Xa

66
Q

Heparin indications

A

DVT and PE
Open heart surgery and renal dialysis
Low dose for DVT prophylaxis
Disseminated Intravascular Coagulation (DIC)
Adjunct to thrombolytic therapy of acute MI

67
Q

heparin adverse effects

A

Bleeding
Heparin-induced thrombocytopenia (HIT)
Severe neuro injury if given to spinal puncture/epidural anesthesia

68
Q

heparin nursing considerations

A

Educate & monitor for signs of bleeding
Monitor aPTT/anti-Xa (4 to 6 hours) & CBC during therapy
Protamine sulfate antidote

69
Q

enoxaparin (Lovenox) MOA

A

enhance activity of antithrombin to preferentially indirectly inhibit activity of thrombin and factor Xa

70
Q

enoxaparin (Lovenox) indications

A

DVT and PE
DVT prophylaxis following THA, TKA, & abdominal sx
Off label use for DVT prophylaxis after general sx and in patients with multiple trauma and acute spinal injury

71
Q

enoxaparin (Lovenox) adverse effects

A

Bleeding
Heparin-induced thrombocytopenia (HIT)
Severe neuro injury if given to spinal puncture/epidural anesthesia

72
Q

enoxaparin (Lovenox) nursing considerations

A

Educate & monitor for signs of bleeding
Monitor CBC during therapy
Protamine sulfate antidote

73
Q

Warfarin (Coumadin) MOA

A

Suppresses production of factors VII, IX, X, and prothrombin

74
Q

Warfarin (Coumadin) indications

A

Long-term prophylaxis of thrombosis:
DVT and PE
In prosthetic heart valves
In atrial fibrillation
Reduce risk of recurrent stroke and MI

75
Q

Warfarin (Coumadin) adverse effects

A

Bleeding
Teratogenic

76
Q

Warfarin (Coumadin) nursing consideration

A

Educate & monitor for signs of bleeding
Monitor PT & INR during therapy
Vitamin K antidote and intake of green leafy vegetables
Numerous medication interactions
Much longer half-life than heparin (days vs hours)

77
Q

Dabigatran (Pradaxa) MOA

A

direct, reversible inhibitor of free and bound thrombin

78
Q

Dabigatran (Pradaxa) indications

A

Treatment of DVT and PE
Prevention of VTE in THA and TKA
Prevention of thrombosis in patients with atrial fibrillation

79
Q

Dabigatran (Pradaxa) adverse effects

A

Bleeding
GI disturbances- dyspepsia and/or gastritis-like symptoms

80
Q

Dabigatran (Pradaxa) nursing consideration

A

Educate & monitor for signs of bleeding
No need for monitoring PT/INR
Caution for those with renal impairment
Antidote: idarucizumab (Praxbind)

81
Q

Rivaroxaban (Xarelto) MOA

A

Directly inhibits Xa, interfering with thrombin production

82
Q

Rivaroxaban (Xarelto) indications

A

For DVT and PE
In THA and TKA
In non-orthopedic sx
For Recurrent DVT and PE
Prevention of thrombosis in patients with afib

83
Q

Rivaroxaban (Xarelto) adverse effects

A

Bleeding, especially with pre-existing renal impairment
Spinal/epidural hematoma
Unsafe in pregnancy, only use if benefits outweighs risk

84
Q

Rivaroxaban (Xarelto) nursing consideration

A

Educate & monitor for signs of bleeding
No need for monitoring PT/INR
Caution with renal and/or hepatic impairment (dosage adjustment)
Antidote for Apixaban: Andexxa

85
Q

Alteplase (tPA) MOA

A

Forms complexes with plasminogen to convert into plasmin, an enzyme that digests fibrin, as well as degrade fibrinogen and other clotting factors

86
Q

Alteplase (tPA) indications

A

Acute MI, acute ischemic stroke, and acute massive PE
Low doses for blocked central venous catheter (CVC)

87
Q

Alteplase (tPA) adverse effects

A

Bleeding, particularly ICH

88
Q

Alteplase (tPA) nursing consideration

A

Many contraindications and precautions, so obtain thorough history
Monitor closely for bleeding during administration and limit potential sources for bleeding
Efficacy seen if administered within 2-4 h of symptom onset

Pharmacology (10 decks)

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