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Intro To Drugs > test 3 hematologic agents > Flashcards

test 3 hematologic agents Flashcards

1
Q

INR

A

used to determine the clotting tendency of blood

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2
Q

PT

A

used to determine the clotting tendency of blood

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3
Q

PTT

A

blood clotting disorder test

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4
Q

CVA

A

A stroke, or cerebrovascular accident

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5
Q

PCI

A

a set of procedures used to treat coronary heart disease

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6
Q

CABG

A

Coronary artery bypass surgery

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7
Q

ICH

A

Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding within the brain tissue itself

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8
Q

Embolus

A

traveling clot

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9
Q

Thrombus

A

stationary clot

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10
Q

Anemia

A

a condition in which the body does not have enough healthy red blood cells

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11
Q

Myelosuppression

A

bone marrow suppression

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12
Q

Neutrophils

A

type of white blood cells

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13
Q

Aspirin MOA

A

Inhibition of thromboxane A2 synthesis, a potent mediator of platelet aggregation and vasoconstriction

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14
Q

Asprin indications

A 
Pain
Fever
Inflammatory conditions 
Cardioprotection 
Prevention of in-stent thrombosis following PCI or CABG
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15
Q

aspirin Adverse effects

A

Bleeding
Dyspepsia- upset stomach or indigestion,
GI bleeding
Tinnitus

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16
Q

aspirin- contraindictions

A

Hypersensitivity to NSAIDS
Pregnancy (3rd trimester)
Viral infection in children

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17
Q

aspirin interactions

A

ACE inhibitors
NSAIDs
Lithium

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18
Q

aspirin patient counseling

A

Take with food to avoid GI upset
Monitor for bleeding
Limit alcohol intake

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19
Q

Clopidogrel- used after stent- MOA

A

Selectively blocks adenosine diphosphate (ADP) to its platelet receptor
Irreversibly inhibits platelet aggregation

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20
Q

Clopidogrel- used after stent- indications

A

Reduces thrombotic events in patients with atherosclerosis

Acute coronary syndromes

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21
Q

Clopidogrel- used after stent- Adverse effects

A

Bleeding

Thrombotic Thrombocytopenic Purpura (TTP)

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22
Q

Clopidogrel- used after stent- BB warning

A

patients may hay abnormality that may Lower active metabolite exposure may result in reduced platelet inhibition and, thus, a higher rate of cardiovascular events following MI or stent thrombosis following PCI.

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23
Q

Clopidogrel- used after stent- contraindications

A

Active bleeding (peptic ulcer disease, ICH)
Proton pump inhibitors
NSAIDs
Anticoagulants

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24
Q

Clopidogrel- used after stent- interactions

A

Proton pump inhibitors
NSAIDs
Anticoagulants

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25
Clopidogrel- used after stent- patient counseling
Adherence is crucial! | Monitor for bleeding
26
Heparin MOA
Binds to antithrombin and accelerates antithrombin’s ability to inhibit factors IXa, Xa, XIa, XIIa, and IIa.
27
Heparin indications
Prophylaxis and treatment of thrombosis and embolism Coagulopathies Prophylaxis of DVT and PE in high-risk medical and surgical patients Clotting prevention Prophylaxis of left ventricular thrombi and cerebrovascular accidents post-MI “Bridge” to warfarin therapy to prevent CVA in patients with cardiac valve replacements
28
Heparin adverse effects
Bleeding Heparin induced thrombocytopenia (HIT) Osteoporosis (with prolonged use)
29
Heparin Contraindications
History of HIT Uncontrolled active bleeding except when due to disseminated intravascular coagulation Hypersensitivity to pork products
30
Heparin key points
``` Monitored via the PTT Does not cross the placenta Can be used in severe renal impairment Relatively short t1/2 SUBQ injection has variable absorption Antidote is available “High Alert” drug ```
31
Low molecular weight heparin
Black box warning Spinal or epidural hematomas, including subsequent paralysis, may occur with recent or anticipated neuraxial anesthesia (epidural or spinal anesthesia) or spinal puncture in patients anticoagulated with LMWH or heparinoids.
32
Warfarin MOA
Inhibits the activation of Vitamin K dependent clotting factors
33
Warfarin indications
Inhibits the activation of Vitamin K dependent clotting factors Prophylaxis and treatment of DVT and/or PE Prophylaxis and treatment of stroke in atrial fibrillation Prophylaxis and treatment of thromboembolic complications in cardiac valve replacement Reduces risk of death, recurrent myocardial infarction, and thromboembolic events
34
Warfarin adverse effects
Bleeding Purple toe syndrome Intracranial, Intraocular, retroperitoneal bleeding
35
Warfarin pregnancy cat.
X
36
Warfarin contraindications
``` Active peptic ulcer Active hemorrhage Noncompliance Pregnancy High risk of falls Alcoholism Upcoming surgical procedure ```
37
Warfarin interactions
Aspirin, NSAIDs, anticoagulants | Vitamin K
38
Warfarin counseling
Monitored via the INR Dosing is incredibly individualized Many drug-drug, drug-nutrient, drug-disease state interactions Patients should have a medical alert bracelet or card with them at all times Patients will bleed and bruise easier
39
Warfarin key points
Antidote is available High INR = increased risk of bleeding (blood is too thin) Low INR = increased risk of clotting (blood is too thick)
40
Dabigtran MOA
Direct thrombin inhibitor
41
Dabigtran indications
Prophylaxis of stroke and systemic embolism in atrial fibrillation
42
Dabigtran adverse effects
Bleeding Dyspepsia GI bleeding
43
Dabigtran contraindications
Active bleeding | Pregnancy
44
Dabigtran interactions
P-gp substrate
45
Dabigtran counseling
Report signs and symptoms of bleeding Do not remove from dispensing container Once bottle opened, capsules are good for x days
46
Dabigtran key points
No routine monitoring required Use with caution in significant renal impairment and in the elderly No antidote available
47
Rivaroxaban MOA
Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa (FXa) in both the intrinsic and extrinsic coagulation pathways
48
Rivaroxaban indications
Prophylaxis and treatment of DVT/PE | Prevention of stroke in atrial fibrillation
49
Rivaroxaban adverse effects
Bleeding | Bruising
50
Rivaroxaban contraindications
Active major bleeding
51
Rivaroxaban interactions
CYP3A4/P-gp substrate | Antiplatelets/Anticoagulants
52
Rivaroxaban counseling
Report signs and symptoms of bleeding
53
Rivaroxaban key points
No routine monitoring required
54
Thrombolytics Alteplase, Activase MOA
Stimulates conversion of plasminogen to plasmin | Dissolves fibrin clots
55
Thrombolytics Alteplase, Activase indications
``` Acute MI Acute ischemic stroke Pulmonary embolism Peripheral arterial thromboembolism Central venous catheter occlusion ```
56
Thrombolytics Alteplase, Activase adverse effects
Bleeding | Intracranial hemorrhage
57
Thrombolytics Alteplase, Activase contraindications
``` Active internal bleeding History of CVA Recent intracranial or intraspinal surgery or trauma Intracranial neoplasm Arteriovenous malformation or aneurysm Known bleeding diathesis Severe uncontrolled hypertension Suspected aortic dissection ```
58
Thrombolytics Alteplase, Activase interactions
Anticoagulants | Antiplatelets
59
Thrombolytics Alteplase, Activase key points
Always refer to list of contraindications/relative contraindications prior to administering TPA Patient is at an increased risk of ICH if TPA administered and they have contraindication criteria Monitor patient closely for bleeding Dosing varies depending on indication being used
60
immunosuppressants
``` Used in patients with various immune disorders and those with organ transplants Commonly used agents include: Cyclosporine Tacrolimus Mycophenlate ```
61
Cyclosporine MOA
Inhibits T-lymphocyte activation | Suppresses immune response of T-cells
62
Cyclosporine indications
``` Prevention of organ transplant rejection Rheumatoid Arthritis (RA) ```
63
Cyclosporine adverse effects
Hypertension Hirsutism Gingival Hyperplasia Edema
64
Cyclosporine BB warning
Immunosuppressant agents, including cyclosporine, increase the risk of infection; the risk of developing bacterial, viral (including CMV), fungal, and protozoal infections, including opportunistic infections, is increased. Immunosuppressant agents, including cyclosporine, may be associated with the development of lymphoma and other malignancies (predominantly skin malignancies).
65
Cyclosporine contraindications
Abnormal renal function (RA patients only) Uncontrolled hypertension Malignancies
66
Cyclosporine interactions
3A4 substrate Phenytoin, Rifampin Fluconazole, Amiodarone
67
Cyclosporine key points
Cyclosporine products are not interchangable Drug levels are required Many drug-drug interactions Avoid live vaccines
68
Tacrolimus MOA
Inhibits T-cell differentiation and proliferation | Preventing allograft rejection
69
Tacrolimus indications
Prevention of organ transplant rejection Prevention of graft-versus-host disease Moderate–severe atopic dermatitis
70
Tacrolimus adverse effects
``` Insomnia N/V/D Alopecia New-onset DM Hypertension ```
71
Tacrolimus BB warning
Immunosuppressant agents, including tacrolimus, increase the risk of infection; the risk of developing bacterial, viral (including CMV), fungal, and protozoal infections, including opportunistic infections, is increased. Immunosuppressant agents, including tacrolimus, may be associated with the development of lymphoma and other malignancies (predominantly skin malignancies).
72
Tacrolimus contraindications
Hypersensitivity
73
Tacrolimus interactions
3A4 substrate 3A4 Inducers – Decreases tacrolimus levels 3A4 Inhibitors – Increases tacrolimus levels
74
Tacrolimus counseling
``` Many drug-drug interactions Report any signs/symptoms of infection immediately Drug levels are monitored Avoid live vaccines Avoid grapefruit juice May increase drug levels ```
75
rheumatoid arthritis (RA)
Affects 1% of the population 2-3x more likely to affect women than men Signs and symptoms: Generalized fatigue, multiple joint pain, morning stiffness American College of Rheumatology have clinical practice guidelines to help guide care
76
Drug therapy for RA
``` NSAIDs/COX2 inhibitors Glucocorticoids Disease modifying antirheumatic drugs (DMARDs) Nonbiologic agents Hydroxychloroquine, sulfasalazine, methotrexate, gold, auranofin, azathioprine, penicillamine, minocycline, leflunomide Biologic agents Etanercept Infliximab Adalimumab Anakinra ```
77
Crohns Disease
``` A type of inflammatory bowel disease Can affect any part of the GI tract from mouth to anus Symptoms include: Diarrhea Stomach cramping Blood in stool Ulcers Weight loss ```
78
Tumor Necrosis Factor Inhibitors MOA
Blocks the action of tumor necrosis factor | Allows healing of the affected joints
79
Tumor Necrosis Factor Inhibitors indications
RA | Crohn’s Disease
80
Tumor Necrosis Factor Inhibitors adverse effects
Injection site reactions Rash Mycobacterial, fungal, and opportunistic infections
81
Tumor Necrosis Factor Inhibitors BB warnings
Increased risk of serious infections that may lead to hospitalization or death
82
Tumor Necrosis Factor Inhibitors contraindications
Active infection | Sepsis
83
Tumor Necrosis Factor Inhibitors interactions
Live immunizations | Other biologic products
84
Tumor Necrosis Factor Inhibitors counseling points
Patients should be evaluated for TB before starting therapy | Avoid live immunizations for at least 3 months after therapy
85
Neutropenia
Low amount of neutrophils (white blood cells) Leads to an increased risk of infection (bacterial, viral, and fungal) Causes include: Medications Infection Radiation Bone marrow dysfunction
86
Filgrastim – Neupogen/Neulasta – SUBQ/IV injection indications
Neutropenia
87
Filgrastim – Neupogen/Neulasta – SUBQ/IV injection Adverse effects
``` Splenomegaly Bone/skeletal pain Fever Epistaxis Hypersensitivity Acute respiratory distress syndrome (ARDS) Sickle cell crisis ```
88
Filgrastim – Neupogen/Neulasta – SUBQ/IV injection contraindications
Hypersensitivity to Eschericha coli
89
Filgrastim – Neupogen/Neulasta – SUBQ/IV injection counseling points
If self administering, do not reuse syringes or needles Can use analgesics to treat bone pain Dose can be rounded to nearest syringe size Do NOT give 2 weeks before or 24 hours following chemotherapy
90
Ferrous Sulfate MOA
Replaces iron normally endogenous to the body
91
Ferrous Sulfate indications
Iron deficient anemia
92
Ferrous Sulfate adverse effects
Constipation and stomach cramping Dark stools N/V GI irritation
93
Ferrous Sulfate interactions
Levothyroxine Antibiotics – fluoroquinolones, tetracyclines Food
94
Ferrous Sulfate counseling
If constipation occurs, increase fluid and fiber content of diet Take on empty stomach to ensure absorption Black stool may occur Keep out of reach of children
95
Ferrous Sulfate key points
Product should be dosed on elemental content of iron | Verify mg needed to be dispensed if Rx written only for mLs of liquid
96
Gout
Uric acid crystals deposit in joints causing pain and inflammation Can be caused by overproduction of uric acid or underexcretion of uric acid Risk factors for gout include obesity, male sex, age >40, alcohol consumption, diet, and certain medications
97
Colchicine – Colcrys dosing
tablet
98
Allopurinol – Zyloprim dosing
tablet, injection
99
Colchicine MOA
Decreases deposition of uric acid and inflammatory reaction
100
Colchicine indications
Acute gout attacks Prophylaxis for acute gout attacks Treatment of familial Mediterranean fever
101
Colchicine adverse effects
N/V/D Alopecia Bone marrow suppression Rhabdomyolysis
102
Colchicine contraindications
Concomitant use of p-glycoprotein or strong CYP3A4 inhibitors in the presence of hepatic or renal impairment
103
Colchicine interactions
Enzyme inhibitors Digoxin Cyclosporine Ranolazine
104
Colchicine patient counseling
Take at the first sign of a gout attack Do not drink grapefruit juice Low purine diet and hydration can help reduce gout flares Diarrhea is the most common side effect
105
Allopurinol MOA
Blocks xanthine oxidase | Decreases the production of uric acid
106
Allopurinol indications
Prevention of gout attacks Prevention of tumor lysis syndrome Prevention of recurrent calcium oxalate calculi
107
Allopurinol Adverse effects
Maculopapular rash Pruritis Stevens–Johnson syndrome(SJS)/toxic epidermal necrolysis (TENS) Myelosuppression
108
Allopurinol contraindications
Concomitant use of didanosine
109
Allopurinol interactions
``` Azathioprine Mercaptopurine Cyclosporine Amoxicillin Warfarin ```
110
Allopurinol counseling
Dose must be titrated up for response Drug will not help established gout attack Immediately report any skin rash to physician Maintain adequate hydration while taking allopurinol Take allopurinol with food to minimize GI upset Periodic blood tests may be ordered to monitor for effectiveness and side effects

Intro To Drugs (13 decks)

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