test 2 Flashcards
1
Q
nonpharm therapies for dysrhythmias
A
pacemaker, ablation, ICD, cardioversion, defibrillator
2
Q
what does sodium ions do to the heart
A
cause depolarization
3
Q
what does calcium ions do to heart
A
stimulate cardiac muscle cells
4
Q
issue of antidyrthmics
A
they can worsen or create new dysrhthmias
5
Q
what do class I sodium channel blockers do
A
delay or accelerate repolarization; slow conduction velocity, may alter duration of action potential
monitor LOC
6
Q
what do class II beta adrenergics antagonist do
A
slow conduction velocity through AV node, decrease automaticity, prolong refractory period
7
Q
what do class III potassium channel blockers do
A
delay repolarization, increase duration of action potential, lengthen refractory period-stabilize dysrhythmias
Monitor for Jaundice
8
Q
what do class IV calcium channel blockers do
A
slow conduction velocity, decrease contractility, prolong refractory period
9
Q
procainamide ther class, pharm class, preg category
A
ther- Class IA antidysrhythmic
pharm -sodium channel blocker
preg cat C
10
Q
Procainamide action and uses
A
suppress dysrhythmias
Blocks sodium ion channels in myocardial cells, reducing automaticity and slowing conduction of the action potential across the myocardium, prolongs refractory period.
11
Q
procainamide contraindications, adverse effects, admin concerns
A
contraindications- AV block, severe HF, blood dyscrasias, MG
adverse effects- GI complaints, hypotension, headache. High doses can produce CNS effects like confusion. Black box- lupus like syndrome may occur if token over a year
may increase liver values.
12
Q
Propranolol (Inderal, InnoPran XL) ther class, pharm class, preg cat
A
ther- Class II antidysrhythmic
pharm- Beta-adrenergic antagonist
preg cat- C
13
Q
Propranolol (Inderal, InnoPran XL) action and uses
A
Treating tachycardia from sympathetic stimulation, HTN, migraines, prevention of MI, helps panic attacks, PTSD, tremors
Nonselective beta adrenergic antagonist that affects beta 1 and beta 2. reduces HR, slows myocardial conduction velocity, and lowers BP
14
Q
Propranolol (Inderal, InnoPran XL) contraindications, adverse effects, admin concerns
A
contraindications- Cardiogenic shock, sinus bradycardia, copd, asthma
adverse- Common; Fatigue, hypotension, bradycardia.
Diminished libido. Black box- abrupt stop worsen symptoms, causing MI, HTN, ventricular dysrhythmias
admin concerns- call dr if heart beat less than 60
15
Q
amiodarone (pacerone) ther class, pharm class, preg cat
A
ther-Class III antidysrhythmic
pharm-Potassium channel blocker
preg cat D
16
Q
amiodarone (pacerone) action and uses
A
Approved for treatment of resistant ventricular tachycardia and atrial dysrhythmias
Blocks K+ ion channels, blockage of some sodium channels
17
Q
amiodarone (pacerone) contraindications, adverse effects, admin concerns
A
contraindications -Severe bradycardia, cardiogenic shock, sick sinus, sinus node dysfunction, 3rd degree AV block
adverse effects-Black box- pneumonia like syndrome in lungs- pulm toxicity.
May be elevated liver enzymes, thyroid dysfunction, bluish skin, blurred vision, rashes, anorexia, hypotension
admin concerns- Hypokalemia and hypomagnesemia needs to be corrected before giving this
may increase liver and thyroid values
18
Q
verapamil (Calan, covera-hs, isoptin SR, verelan) pharm class, ther class, preg cat
A
ther- Class IV antidysrhythmic, antihypertensive, antianginal
pharm- Calcium channel blocker
preg cat C
19
Q
verapamil (Calan, covera-hs, isoptin SR, verelan) action and uses
A
Inhibiting flow of calcium ions into myocardial cells and in vascular smooth muscle. Stabilizes dysthymias. Decreases cardiac workload, lowering bp. Dilates coronary arteries, Decreasing agina
20
Q
verapamil (Calan, covera-hs, isoptin SR, verelan) contraindications, adverse effects, admin concerns
A
contraindications- AV heart block, sick sinus, severe hypotension, bleeding aneurysm, or those undergoing intracranial surgery. Use w caution in ckd or hepatic impairment
adverse effects- Headache, flushed skin, constipation, hypotension, bradycardia, pedal edema
avoid grapefruit and caffeine
21
Q
adenosine (adenocard)
A
decreases automaticity of SA node and sloes conduction thru AV node: slows HR
for serious atrial tachycardia or SVT
Adverse effects-facial flushing, dyspnea
metabolized by RBC. only in IV form for emergency
22
Q
digoxin (lanoxin)
A
decreases automaticity of SA node and sloes conduction thru AV node: slows HR
mostly seen in HF, but can help atrial dysrhythmias
adverse- dig toxicity. nausea, vomiting, headache, vision disturbances
don’t let HR get under 60
23
Q
roles of nurse for dysrhythmias
A
monitor for BP changes, changes in consciousness, vision changes, jauncidce
vital signs
ECG
24
Q
good cholesterol
A
HDL
25
Bad cholesterol
LDL, VLDL
26
atorvastatin (Lipitor) ther class, pharm class, preg cat
ther- antihyperlipidemic
pharm- HMG-CoA reductase inhibitor, statin
preg cat x. dont breastfeed
27
atorvastatin (Lipitor) uses and actions
reducing serum-lipid levels, reducing risk of stroke and MI. also prevent CVA in patients with risk factors
statins act by Inhibiting HMG CoA reductase. As the liver makes less cholesterol it responds by making more LDL. interferes with synthesis of cholesterol
28
atorvastatin (Lipitor) contraindications, adverse effects, admin concerns
contraindications- Prior hypersensitivity, elevated serum transaminases, liver disease
adverse effects-GI complaints, headaches, possible people experience hepatotoxicity. Most serious adverse effect is rhabdomyolysis
admin concerns- no grapefruit juice, admin with food to avoid GI irritation
29
cholestyramine (questran) ther class, pharm class, preg cat
ther- Antihyperlipidemic
pharm- Bile acid sequestrant
preg cat c
30
cholestyramine (questran) action and uses
Cholestyramine is a powder that is mixed with fluid token once-twice daily. Not absorbed or metabolized in intestine, doesn’t produce any systemic effects. May need at least a month to get maximum effect. Binds with bile acids in an insoluble complex that excretes thru feces, lowering cholesterol
31
cholestyramine (questran) contraindications, adverse effects, admin concerns
contraindications- Patients with biliary obstruction and prior hypersensitivity
adverse effects- constipation, nausea, gas
admin concerns- Give other drugs 2 hours before or 4 hours after
Increase in AST, ALP, chloride, decrease in serum calcium, sodium, and potassium
32
Niacin (nicotinic)
B complex vitamin
- decreases VLDL levels, but produce more side effects than statins
adverse effects- hot flashes, flushing, diarrhea, nausea, gout, hepatotoxicity
monitor blood sugar, liver function, uric acid levels
33
gemfibrozil (lopid) ther class, pharm class, preg cat
ther class- antihyperlipidemic
pharm class- Fibric acid drug
preg cat B
34
gemfibrozil (lopid) action and uses
for treatment of hypertriglyceridemia and hypercholesterolemia
Mech of action unknown, is less effective than statins so not 1st choice drug
35
gemfibrozil (lopid) contraindications, adverse effects, admin concerns
contraindications- Hepatic impairment, kidney disease, gallbladder disease, prior hypersensitivity
adverse- Gallstones, may affect liver function. GI symptoms
no fatty foods, admin with meals
monitor labs
36
ezetimibe (Zetia)
inhibits absorption of cholesterol
slightly reduces LDL
Adverse effects- nasopharyngitis, myalgia, upper resp tract infection, arthralgia
37
left sided HF
Fluid in lungs
38
right sided HF
Fluid in body- edema
39
relationship between heart and kidney issues
If kidneys don’t get enough blood and oxygen they secrete renin and aldosterone, vasoconstricting, elevating blood flow. They think we're loosing blood flow somewhere.
so in HF, kidneys sense low o2, raising bp
40
ace inhibitors and K+
ace inhibitor causes body to retain K+, could lead to hyperkalemia
41
lisinopril (prinivil, zestril) ther class, pharm class, preg cat
ther-Drug for HF and HTN
pharm-ACE inhibitor
preg cat C first sem, D second
42
lisinopril (prinivil, zestril) action and uses
Inhibits ACE and decreases aldosterone secretion
-Treatment for HF, HTN. BP decreased, cardiac output increases
43
lisinopril (prinivil, zestril) contraindications, adverse effects, and admin concerns
contraindications- Hyperkalemia, if had angioedema by ace inhibitor. Don’t use if pregnant
adverse- Cough, headache, dizziness, orthostatic hypotension, rash
admin concerns- NSAIDs may interact decreasing antiHTN effect.
2-3 weeks to reach effect, assess BP
Avoid high intake of potassium
44
metoprolol (lopressor, toprol) ther class, pharm class, and preg cat
ther-Drug for HF and HTN
pharm-Beta 1 adrenergic blocker
45
metoprolol (lopressor, toprol) action and uses
Selective adrenergic, beta 1 blocker. Reduces sympathetic stimulation of heart decreasing cardiac workload. Slows progression of HF, usually combined w ACE inhibitor
used in HF, HTN, agina
46
metoprolol (lopressor, toprol) contraindications, adverse effects, and admin concerns
contraindications-Cardiogenic shock, sinus brady, hypotension, heart block above 1st degree. Use w caution w asthma
adverse-Abnormal sexual function, hypotension, bradycardia, dizziness, fatigue, insomnia. Black box- gradually reduce over 1-2 weeks. No abrupt withdrawal
admin-High doses may affect beta 2 receptors in bronchial smooth muscle.
Hold if pulse below 60
May increase uric acid, lipids, potassium, bilirubin, creatine, ANA, alk phosphate.
monitor blood sugar
47
diuretics
increase urine flow, reduce blood volume and edema.
Assess renal function, I&Os, and electrolytes
48
digoxin (Lanoxin, lanoxicaps) ther class, pharm class, preg cat
ther-Drug for HF
pharm-Cardiac glycoside
preg cat A
49
digoxin (Lanoxin, lanoxicaps) action and uses
Inhibits Na+- K+ ATPase, the critical enzyme responsible for pumping sodium ions out of the myocardial cell in exchange for potassium. This action increases the contractility or strength of myocardial contraction, increasing cardiac output. Increases urine production and reduces blood volume, distressing edema. Also suppresses SA node, and slow conduction in AV helping dysrhythmias
Alleviate symptoms of HF and improving exercise tolerance - increases force of heartbeat, slows rate
50
digoxin (Lanoxin, lanoxicaps) contraindications, adverse effects and admin concerns
contraindications- Dysrhythmias, use w caution in hypothyroidism, MI, cor pulmonale
adverse- Could create dysrhythmias, nausea, vomiting, fatigue, anorexia, visual disturbances
admin concerns- Take apical pulse for full minute, check digoxin levels before administering, use w caution in peds and geriatrics
No potassium
carefully monitor w diuretics
don't take w antidiarrheals
51
digoxin toxicity
blue and yellow halos, bradycardia
52
milrinone (primacor) ther class, pharm class, preg cat
ther- drug for HF
pharm-Phosphodiesterase inhibitor
preg cat c
53
milrinone (primacor) action and uses
block enzyme phosphodiesterase. increases calcium for myocardial contraction, increases cardiac output.
Short term therapy for advanced HF. Only IV
54
milrinone (primacor) contraindications, adverse effects, admin concens
contraindications-Previous hypersensitivity. Use w caution if dysrhythmia
adverse- Ventricular dysrhythmia (1 out of 10 chance), headache, nausea, vomiting
admin concerns- Monitor BP and ECG
55
what causes changes in BP
Blood volume
peripheral resistance/dilation of arterioles
cardiac output
56
amount of blood in system
blood volume
57
friction in arteries as blood flows through
peripheral resistance
58
volume of blood pumped per minute
cardiac output
59
hormones that affect BP
epinephrine and norepinephrine, antidiuretic , all raise blood volume
aldosterone regulates
60
what can HTN cause
HF, TIA or CVA, renal failure, visual disturbances
61
first line antihypertensives
diuretics, ACE inhibitors, ARBs, CCBs, direct renin inhibitors
62
second line antihypertensive drugs
beta blockers (commonly used), alpha 1 adrenergic blockers, alpha 2 adrenergic agonist, direct acting vasodilators, peripherally acting adrenergic neuron blockers
63
decrease fluid, increase urine
diuretic
64
thiazide diuretic
block Na+ reabsorption and get rid of water and potassium
65
hydrochlorothiazide (microzide) ther class, pharm class, preg cat
ther-Drug for HTN and edema
pharm- thiazide diuretic
preg cat B
66
hydrochlorothiazide (microzide) action and uses
Reduces bp by 10-20 mmHg for HTN, ascites, edema, HF
Acts on kidney tubule to decrease the reabsorption of Na (normally 99% Na reabsorbed by body) when given drug, more Na sent to urine, water moves with Na, decreasing blood volume and pressure
67
hydrochlorothiazide (microzide) contraindications, adverse effects, admin concerns
Contraindications- Prior hypersensitivity, anuria, pre-eclampsia
adverse- Electrolyte imbalances due to loss of K+ and Na+, gout attacks
admin concerns- Admin early in day to prevent nocturia
May increase serum glucose, cholesterol, bilirubin, triglyceride, and calcium. May decrease magnesium , potassium, and sodium
68
spironolactone (aldactone) ther class, pharm class, preg cat
ther- Antihypertensive, drug for reducing edema
pharm- Potassium sparing diuretic, aldosterone antagonist
preg cat C
69
spironolactone (aldactone) action and uses
Treating mild HTN, reduce edema, slow progression of HF, and primary hyper aldosterone
Inhibits aldosterone, the hormone responsible for increasing renal absorption of Na in exchange for K+, Causing water absorption. This drug excretes water and Na, and body retains K+
70
spironolactone (aldactone) adverse effects, admin concerns
adverse- Hyperkalemia (muscle weakness, bradycardia). Diminished libido, menstrual irregularities. Black box- found to cause tumors in animals
admin concerns- Give w food to increase absorption of drug
No K+ supplements
71
what to assess in patients taking diuretics
edema, JVD, electrolyte levels, daily weights, glucose levels, uric acid
72
nifedipine (Adalat cc, Procardia XL) ther class, pharm class, preg cat
ther- drug for HTN and angina
pharm- calcium channel blocker
preg cat C
73
nifedipine (Adalat cc, Procardia XL) action and uses
HTN or vasospastic anemia. Off label treat Raynaud's
Selectively blocking calcium channels in myocardial and vascular smooth muscle. Results in coronary artery dilation, less oxygen use by heart, increase in cardiac output, and fall in BP
74
nifedipine (Adalat cc, Procardia XL) contraindications, adverse effects, admin concerns
contraindications-Prior hypersensitivity
adverse- Headache, dizziness, peripheral edema, heartburn, nausea, flushing.
admin concerns- Discontinue drug gradually, No grapefruit juice
75
ace inhibitor
blocks angiotensin II
lowers peripheral resistance and decreasing blood volume
monitor for cough and angioedema
since drug gets rid of volume, monitor low K
76
beta blocker
decrease HR and contractility. blocks beta 1 receptors in juxtaglomerular apparatus, inhibiting renin secretion
- reduces cardiac output and BP
77
Doxazosin (Cardura) ther class, pharm class, preg cat
ther- drug for HTN and benign prostatic hyperplasia
pharm-Alpha 1 adrenergic blocker
preg cat B
78
Doxazosin (Cardura) action and uses
selective alpha 1 adrenergic blocker. dilates arteries in veins causing a fall in blood pressure. also relaxes smooth muscle around prostate gland
79
Doxazosin (Cardura) contraindications, adverse effects, admin concerns
contraindications- prior hypersensitivity
adverse- dizziness, dyspnea, headache, orthostatic hypotension
admin concerns- first dose phenomenon can occur, monitor BP incase hypotension
80
alpha 2 adrenergic agonist
decrease outflow of sympathetic nerve and impulses from CNS to heart and arteries
causes vasodilation by relaxing arterial smooth muscle
serious adverse effects- reflect tachycardia, sodium and fluid retention
only for severe HTN or HTN crisis
81
hydralazine ther class, pharm class, preg cat
ther- Drug for HTN and HF
pharm- direct acting vasodilator
preg cat C
82
hydralazine action and uses
Direct acting vasodilation of arterial smooth muscle, has no effects on veins. begins with low doses, gradually increases until desires result. Was the first HTN marketed in US
83
hydralazine contraindications, adverse effects, admin concerns
contraindications- angina, rheumatic mitral valve disease, lupus
adverse- reflex tachycardia, palpitations, flushing, diarrhea, lupus like syndrome
admin concerns- abrupt stop can cause rebound HTN
84
local anesthesia
affecting a limited part of the body
85
general anesthesia
resulting in loss of consciousness
86
infiltration anesthesia
direct injection into tissue immediate to surgical site, blocks groups of nerves near by
87
nerve block anesthesia
direct injection into tissues that may be distant from surgical site, affects nerve bundles supplying surgical area. used to block sensation in limb ot large area od face
88
spinal anesthesia
injected into CSF. Affects large areas like abdomen and legs
89
epidural anesthesia
injected into epidural space of spinal canal, used in L&d
90
how do local anesthetics work
by blocking sodium channels. prevents pain signals from reaching CNS
sometimes combined w epinephrine, sodium bicarbonate
91
why are anesthetics sometimes combined w epinephrine
it constricts blood vessels and increases duration of anesthetic
92
why are anesthetics sometimes combined w sodium bicarbonate
it neutralizes infected area, allowing anesthetic to work better
93
lidocaine (xylocaine) ther class, pharm class, preg cat
ther- Anesthetic (local/topical); antidysrhythmic (class IB)
pharm- Sodium channel blocker; amide
preg cat B
94
lidocaine (xylocaine) action, uses, adverse effects
for Dental procedures, postherpetic neuralgia. mouth was for sores. IV/IM/Subq for dysrhythmias
Most frequently used injectable local anesthetic, blocks neuronal pain impulses. Blocks sodium channels within neuronal membranes
adverse-Anesthesia- uncommon, CNS excitement and confusion. Serious- convulsions, resp depression, cardiac arrest. Black box-too much in children may lead to seizures, brain injury, cardiac abnormalities or death
esters and amides end in caine
95
common adverse effects of local anesthetics
early- CNS stimulation
later- CNS depression
cardio effects
96
stages of general anesthetics
I- loss of pain
II- excitement and hyperactivity. patient may be delirious
III- surgical anesthesia- skeletal muscles paralyzed, this is what is desired
IV- resp and cardio paralysis. could result in death- bad
97
opioids
tricks CNS, causing patients to be insensitive to pain
common one is fentanyl
98
benzodiazepines
general anesthetic, ends in -pam
99
nitrous oxide (lauging gas)
ther- General anesthetic
pharm-Inhalation gaseous drug
action- Caused by suppression of pain mechanisms in CNS. This agent has low potency and doesn’t produce full loss of consciousness. Ideal for short surgical or dental procedures. Always combined with oxygen
adverse-Possible excitement, anxiety at high doses. Nausea and vomiting, liver damage
contraindications-In patients w impaired LOC, decompression sickness, air embolism, undiagnosed stomach pain, bowel ob, shock, hypotension, pneumothorax
Establish IV in case of emergency
100
propofol (diprivan)
ther-General anesthetic
pharm-N- methyl- D- aspartate (NMDA) receptor agonist
preg cat B
Widely used IV anesthetic. Almost an immediate onset of action and is used effectively for conscious sedation. Has antiemetic affect that prevents nausea and vomiting
ADVERSE-Pain at injection site, apnea, resp depression, hypotension, metabolic issues such as hyperkalemia, organ system failures, rhabdomyolysis
has fast onset, deep sedation
dont use on expecting mothers, or allergy to soybean/egg
101
isoflurane (forane)
ther- Inhaled general anesthetic
pharm-GABA and glutamate receptor agonist
preg cat C
Potent level of general anesthesia at rapid onset. Low degree of metabolism by body, muscle relaxation
Contraindications: Potent level of general anesthesia at rapid onset. Low degree of metabolism by body, muscle relaxation
adverse- Nausea, vomiting, tremor. Reduces BP, resp depression, malignant hyperthermia
102
neuromuscular blockers
depolarizing- binds w acetylcholine receptors at neuromuscular joints
nondepolarizing- competes w acetylcholine for cholinergic receptors at neuromuscular junction
103
succinylcholine (Anectine, quelicin)
ther-Skeletal muscle paralytic drug; neuromuscular blocker
pharm-Depolarizing blocker; acetylcholine receptor blocker
preg cat C
Acts on cholinergic receptor sites at neuromuscular junctions. At first, depolarization occurs, skeletal muscles contract, eventually membrane unable to attach to receptor. Drug is rapidly broken down by cholinesterase. This drug reduces amount of anesthetic needed in procedures
IV drug, peaks w in mins
adverse- Paralysis of diaphragm and intercostal muscles (mechanical vent may be needed), bradycardia, resp depression. High doses cause tachycardia and hypotension. Genetic defects - high fever and muscle rigidity, black box- cardiac arrest, hyperkalemic rhabdomyolysis
104
stable angina
fairly predictable frequency, itensity, duration. usually relieved by rest
105
unstable angina
more frequent, intense, and during periods of rest
106
vasospastic angina (prinzmetal's)
caused by spasm of coronary arteries
107
silent angina
absence of angina; Dangerous
108
Nitroglycerin (Nitrostat, nitro-bid)
ther- antianginal
pharm- organic nitrate, vasodilator
preg cat C
for Acute angina episode or just prior to phys. activity
action- relaxed arterial and venous smooth muscle, dilates coronary arteries
adverse- hypotension, headache, flushing
if chest pain doesn't disappear in 10-15 mins, notify ems
if IV admin- in glass
don't use w phos-5 inhibitors like viagra, could cause severe hypotension and cardiovascular collapse
monitor BP
109
atenolol (tenormin)
ther- drug for angina, MI, hypertension
pharm- beta adrenergic blocker
action -Selectively blocks beta 1 adrenergic receptors in heart, slows HR and reduce contractility, lower o2 demand. For HF, HTN, MI, angina
adverse- bradycardia, hypotension
hold if pulse below 60, monitor BP
do not abruptly stop
may increase K, lipids, uric acid
110
Diltiazem (Cardizem, cardia XT, dilacor XT)
ther- Drug for angina, hypertension, dysrhythmias
pharm- CCB
Preg cat C
PO- angina and HTN, IV- dysrhythmias
action-Inhibits transport of calcium into myocardial cells. Relaxes coronary and peripheral blood vessels, bringing more o2 to myocardium, reducing cardiac workload
adverse- headache, dizziness, edema
don't use if bleeding aneurysm, hypotension, cranial surgery
111
reteplase (retavase)
ther-Drug for dissolving blood clots
pharm-thrombolytic
preg cat C
For Onset MI. off label- deep vein thrombosis and occluded catheters
action- Prepared thru recombinant DNA technology, reteplase acts by cleaving plasminogen to form plasmin, then this degrades the fibrin matrix of thrombi. Given in bolus
adverse- abnormal bleeding, possible dysrhythmias
reconstitute prior to use
don't use w heparin
112
monitoring warfarin
PT (Prothrombin time)
INR (International normalized ratio)
113
monitoring heparin
aPTT (advanced partial thromboplastin time)
114
prevents clots
anticoagulants, antiplatelets
115
dissolves clots
thrombolytics
116
promotes clots
hemostatics
117
heparin
ther-Anticoagulant (parenteral)
pharm- Indirect thrombin inhibitor
preg cat C
Prevent thromboembolic events, dialysis, unstable angina, or in acute stages of MI
Heparin typically found in liver and lining of blood vessels, prolongs coagulation, preventing excessive clotting. Doesn’t dissolve clots. Binding of heparin to antithrombin III inactivates several clotting factors, inhibits thrombin activity
Adverse- Bleeding, heparin thrombocytopenia,- causing thrombus. Black box- epidural or spinal hematoma may occur in spinal anesthesia or lumbar puncture
usually weight based
monitor aPTT
don't give IM shots (increases risk for bleeding)
118
heparin
ther-Anticoagulant (parenteral)
pharm- Indirect thrombin inhibitor
preg cat C
Prevent thromboembolic events, dialysis, unstable angina, or in acute stages of MI
Heparin typically found in liver and lining of blood vessels, prolongs coagulation, preventing excessive clotting. Doesn’t dissolve clots. Binding of heparin to antithrombin III inactivates several clotting factors, inhibits thrombin activity
Adverse- Bleeding, heparin thrombocytopenia,- causing thrombus. Black box- epidural or spinal hematoma may occur in spinal anesthesia or lumbar puncture
usually weight based
monitor aPTT
don't give IM shots (increases risk for bleeding)
antagonist- protamine sulfate
119
warfarin (coumadin)
ther- Anticoagulant (oral)
pharm- Vitamin K antagonist
preg cat X
prevention of stroke, MI, DVT, and pulm embolism
anticoagulant, can take several days to reach effect
Vitamin K is the antagonist
120
clopidogrel (Plavix)
ther-Antiplatelet drug
pharm- ADP receptor blocker
preg cat B
Reduce rate of MI/Stroke w acute ST elevation MI, non ST elevation, or unstable angina
Action- Inhibits platelet aggression, directly inhibiting ADP binding to its receptor. This binding is irreversible. Drug is usually given along side of aspirin
adverse- Flu like symptoms, bruising, dizziness, rash
Black box- based on CYP450 enzymes, poor metabolizers inhibit less affect
don't use in bleeding patients
discontinue drug 5 days before surgery
121
alteplase (activase)
ther- Drug for dissolving clots
pharm-Thrombolytic
preg cat C
Converts plasminogen to plasmin, dissolving fibrin clots
Maximum affect- within 12 hours of MI, within 3 of stroke
adverse- bleeding
122
Aminocaproic acid (Amicar)
ther-Clot stabilizer
pharm- Hemostatic/antifibrinolytic
Preg cat C
Used for Excessive bleeding due to clots being dissolves prematurely, after surgery to prevent post-op bleeding, patients w hemophilia A
action-Inactivates plasminogen, the precursor of the enzyme plasmin that digest fibrin clot, promoting clots
adverse- hypotension, bradycardia
assess vitals, place on cardiac monitor
may elevate K
