Pharm Exam 3: GI, Neurological, Reproductive, GU, and Hematologic

histamine H2 antagonists: cimetidine

treats GI ulcers, heartburn, and GERD, blocks H2, decreases stomach acid secretion

side effects: hepatotoxicity, reduced libido, pneumonia risk, agranulocytosis, aplastic anemia

-tidine ending, multiple drug interactions, inhibits liver metabolism, give IV slowly (bradycardia), give at night, increases theophylline levels

proton pump inhibitors (PPI): omeprazole

treats/prevents GI ulcers, heartburn, and GERD, suppresses stomach acid production

side effects: bone loss, GI issues, hypomagnesemia, risk of C. diff, pneumonia

-prazole ending, bone health, short-term, 1 h before food, don’t give w/ rilpivirine, take in the morning on empty stomach

mucosal protectants: sucralfate

treats/prevents acute ulcers, creates gel coating over stomach, not absorbed

side effects: constipation

decreases absorption of PO meds, don’t give with other meds, take on empty stomach, 1 hr before meals, and at night

antacids: aluminum hydroxide, calcium carbonate, magnesium hydroxide, sodium bicarbonate

treats peptic ulcer disease and GERD, neutralizes stomach acid

side effects: constipation w/ Ca and Al, diarrhea w/ Mg

monitor sodium, electrolytes and fluid retention, chew w/ 8 oz of water, take 2 h before/after other meds

serotonin 5-HT3 antagonists: ondansetron

treats n/v from post-op and chemo, serotonin antagonists for brain and stomach

side effects: serotonin syndrome, Steven Johnson syndrome, HA, prolonged QT, hypotension, dizziness

give IV slowly, monitor heart w/ existing issues, interacts w/ apomorphine, SSRI’s, fentanyl

antihistamine/anticholinergic: dimenhydrinate (Dramamine)

treats vertigo, n/v, and motion sickness, blocks histamine release in the ear

side effects: sedation, anticholinergic effects (drying out)

monitor bowels and ambulation, MAOI’s increase side effects

dopamine antagonists/prokinetic agents: metoclopramide

treats gastroparesis, GERD, and n/v, blocks dopamine receptors, increases esophageal sphincter and peristalsis

side effects: EPS (esp tardive dyskinesia), sedation, anticholinergic effects, hypotension

no alcohol or other CNS depressants, drink fluids, med absorption affected

osmotic laxatives (laxative salts): polyethylene glycol

treats constipation, brings water into intestines, increases softening and peristalsis

side effects: electrolyte imbalance, dehydration

monitor Mg, careful w/ dysphagia (can’t thicken), interacts w/ laxatives and loop diuretics

bulk-forming/fiber supplements: psyllium (Metamucil)

treats constipation, IBS, and diverticulosis, non-digestible, absorbs water and softens feces, forms glutinous mass

side effects: GI obstruction, diarrhea

take w/ 8 oz of water, monitor for retrosternal pain, decreases absorption of PO meds

surfactant laxatives/stool softeners: docusate sodium

treats constipation and straining/painful elimination, changes surface tension, increases water in stool, softens

side effects: diarrhea, cramping, throat irritation (bitter taste)

take w/ glass of water and empty stomach, don’t give w/ mineral oil or within 2 h of other laxatives

stimulant laxatives: bisacodyl

treats constipation and colon evacuation for surgery, increases colon peristalsis by drawing water into intestines

side effects: cramping, burning and proctitis, dependence

don’t use long-term (fluid/electrolyte imbalances), don’t give w/ obstructions or impactions

opioids: diphenoxylate w/ atropine and loperamide

treats diarrhea but not underlying cause, decreases GI motility

side effects: drowsiness, anticholinergic effects, arrhythmias, euphoria, dizziness

lowest dose, give antibiotics w/ infections

probiotics

nutritional supplement, treats diarrhea, can be preventative or curative, restores normal flora of intestines

side effects: not common but n/v, bloating, abd pain, HA, appetite or stool changes

5-HT3 blocker: alosetron

treats IBS, blocks serotonin receptors, decreases peristalsis, increases Na and water absorption

side effects: constipation (must sign an agreement), obstruction, perforation, ischemic colitis

monitor for LLQ pain, bloody stool, many drugs decrease effects

5-HT4 receptor agonist: lubiprostone

treats constipation from IBS, increases peristalsis and secretion of fluids/electrolytes

side effects: GI issues, flatulence

take w/ food or water, opioids decrease effects, lactulose is additive

5-aminosalicylates: sulfasalazine

treats mild-moderate IBD, sulfonamide antibiotic, anti-inflammatory

side effects: allergic reaction, crystalluria, expected orange urine and skin, photosensitivity, Steven Johnson syndrome, agranulocytosis

can cause folate deficiency (eat leafy greens), drink fluids, avoid sun, take w/ food, report infxn s/sx

immunosuppressants: azathioprine

treats IBD off-label, approved for RA and organ rejection, immunosuppressant

side effects: bone marrow suppression (pancytopenia), n/v, fatigue, hepatotoxicity

monitor CBC and report low counts, monitor LFT’s, don’t give live vaccines (increased infxn risk)

antibiotics for peptic ulcers w/ H. pylori: clarithromycin

treats whooping cough, diphtheria, chlamydia, PNA, eye prophylaxis, and bronchitis

side effects: prolonged QT, GI upset, hepatotoxicity, ototoxicity

ends w/ -thromycin, avoid antacids, monitor LFT’s

antibiotics for peptic ulcers w/ H. pylori: amoxicillin

antibiotic, treats soft tissue infections and UTI’s

side effects: most common allergy, cross sensitivity w/ cephalosporins

-cillin ending

antibiotics for peptic ulcers w/ H. pylori: metronidazole

treats C. diff, trichomoniasis, amebiasis, and giardiasis

side effects: expected metallic taste, expected red/brown urine, seizures

no alcohol, increases lithium

antibiotics for peptic ulcers w/ H. pylori: tetracycline

antibiotic, treats bacterial infections, acne, lots of resistance

side effects: photosensitivity, tooth discoloration

end w/ -cycline, avoid sun, contraindication = kids < 8 yrs, avoid taking w/ Ca, or antacids, teratogenic

phenothiazine derivative: promethazine

treats n/v and motion sickness, antidopaminergic, antihistamine, and anticholinergic

side effects: drowsiness, anticholinergic effects, orthostatic hypotension, n/v, constipation, IV burns veins

increases pain meds, don’t drive, no alcohol or other CNS depressants, monitor Parkinson’s s/sx, don’t give w/ glaucoma, no anticholinergics or MAOI’s

centrally acting muscle relaxants: baclofen

treats muscle spasms from spinal cord injury, CP, MS, injury, or musculoskeletal disorders, inhibits GABA, decreases spasticity

side effects: orthostatic hypotension, drowsiness, weakness, n/v, urinary retention, constipation, withdrawal

start low, give w/ food, taper off, fluid/fiber/fitness, don’t give w/ glaucoma, MAOI’s, alcohol, other CNS depressants, SSRI’s, and SNRI’s

peripherally acting muscle relaxants: dantrolene (Dantrium)

relaxes muscle spasms from CP, spinal injuries, and MS, treats NMS, antidote for malignant hyperthermia, stops calcium release

side effects: hepatotoxicity, expected sedation

watch LFT’s, avoid alcohol, don’t give w/ cirrhosis and liver failure, no estrogen or calcium channel blockers

hydantoins: phenytoin

treats a wide range of seizures, stops influx of sodium and repetitive neuron firing

side effects: toxicity (ataxia, slurred speech, nystagmus), expected gingival hyperplasia, withdrawal, IV: bradycardia and hypotension

therapeutic at 10-20 mcg/mL, vesicant, monitor CBC, taper dose, teratogenic, don’t give w/ heart block, several incompatibilities

anticonvulsants: carbamazepine (Tegretol)

treats tonic-clonic and partial seizures, bipolar, and trigeminal neuralgia pain, stops influx of sodium

side effects: agranulocytosis, Steven-Johnson syndrome

increased infection risk, report fever, rash, or sore throat, monitor CBC monthly, avoid grapefruit juice, MAOI’s and benzos

anticonvulsants: valproic acid (Depakene)

treats seizures, mood stabilizer, stops influx of sodium, calcium and effects of GABA

side effects: hepatotoxicity, pancreatitis, neural tube defects

monitor LFT’s, report anorexia, n/v, and abd pain, teratogenic

other anticonvulsants: phenobarbital (Luminal)

breaks a seizure, enhances GABA, slows nerve signaling

side effects: somnolence, insomnia, vertigo, hallucinations, GI or CV issues, tolerance

interferes w/ vit K clotting factors, no alcohol, taper dose off, watch for abuse

other anticonvulsants: levetiracetam (Keppra)

treats general and partial seizures (first line), decreases excitatory neurotransmitters by binding to SV2A, broad spectrum

side effects: sedation, dizziness, psychosis, increases suicide risk, agitation

used w/ epilepsy preventatively, therapeutic range

other anticonvulsants: gabapentin (Neurontin)

treats epilepsy, neuropathic pain, and RLS, blocks calcium channels, increases GABA, decreases excitatory neurotransmitters

side effects: respiratory depression, DRESS, sedation, dizziness, ataxia, weight gain

local anesthetics: lidocaine (Xylocaine)

local anesthetic for small areas, treats arrhythmias (IV), stops sodium and action potentials, stops nerve and cardiac activity

side effects: mostly from systemic/IV, HA, dizziness, tremors, hypotension, bradycardia

-caine ending, interacts w/ beta-blockers and phenytoin

short-acting barbiturates: methohexital-sodium (Brevital)

rapid induction of anesthesia and hypnosis, CNS depression, enhances GABA

side effects: sedation, respiratory depression, bradycardia, hypotension, overdose/death, dependence

-barbital ending, no CNS depressants, take at bedtime, monitor vitals, constant supervision, resuscitation equipment close, vesicant, multiple incompatibilities

benzodiazepines: midazolam (Versed)

for conscious sedation for short procedures or general, enhances GABA, promotes faster sleep

side effects: cardiac/respiratory arrest, hypoxia, amnesia, sedation, dependence,

-lam ending, controlled, no other CNS depressants or herbals, antidote = flumazenil, resuscitation equipment nearby, awake but won’t remember, teratogenic, cimetidine causes toxicity

opioids: fentanyl (Duragesic)

supplements general anesthesia, narcotic agonists, gives analgesic and sedative effects

side effects: highly addictive, dependence, respiratory depression, drowsiness, n/v, circulatory collapse

monitor RR, no MAOI’s or other CNS depressants, antidote = Narcan, antiemetics, resuscitation equipment nearby, don’t give w/ hx of abuse or pregnancy, careful w/ increased ICP

amphetamines: dextroamphetamine sulfate (Adderall)

treats ADD/ADHD and narcolepsy, increases norepinephrine and dopamine, CNS stimulation

side effects: insomnia, HTN, tachycardia, suppresses appetite and growth, weight loss, dependence - schedule 2, withdrawal, toxicity

end in -amphetamine, take early in the day, monitor BP, height and weight, avoid caffeine, taper off, don’t give w/ hyperthyroidism, no MAOI’s, other stimulants, or vitamin C

amphetamine-like: methylphenidate (Ritalin)

treats ADD/ADHD and narcolepsy, increases dopamine and norepinephrine by stopping reuptake

side effects: insomnia, anorexia, dysrhythmias, HTN, tachycardia, weight loss, dependence, n/v, dry mouth

lower abuse, take before 4pm, taper dose, avoid caffeine, no MAOI’s or other sitmulants

non-amphetamine stimulant: modafinil (Provigil)

promotes wakefulness w/ narcolepsy, shift work tiredness, OSA, and jet-lag, works related to norepinephrine

side effects: n/v/d, CNS stimulant effects, Steven-Johnson syndrome

give w/ food, take 1 hr before work, monitor for dependence, teratogenic, decreases oral contraceptive effects, several med interactions

dopamine replacement: levodopa-carbidopa

treats Parkinson’s, crosses blood-brain barrier, taken up by dopamine neurons, converts to dopamine

side effects: akinetic crisis if d/c, psychiatric disturbances, ortho hypo, expected dark urine and sweat, tremors/twitches, agranulocytosis

short half-life, taper off, avoid high protein, don’t give w/ glaucoma or suicidal ideation, no MAOI’s or anticholinergics

dopamine receptor agonists: pramipexole (Mirapex)

treats Parkinson’s and restless leg syndrome, binds to dopamine receptors, mimics dopamine response

side effects: GI issues, ortho hypo, dyskinesia, sleep attacks, muscle weakness

taper dose, take w/ food, avoid alcohol and other CNS depressants, teratogenic, cimetidine increases levels

monoamine oxidase type B (MAOI’s): selegiline (Eldepryl)

treats Parkinson’s and depression, inhibits MAO-B’s, increases dopamine, slows deterioration of dopamine

side effects: insomnia, acts like MAO-A’s @ high doses (HTN crisis), irritates oral mucous membranes

check BP w/ HA, take last dose before noon, avoid caffeine and tyramine, don’t eat/drink for 5 mins, don’t give w/ meperidine, no MAOI’s, SSRI’s, or St. John’s wort

cholinesterase inhibitors: donepezil (Aricept)

treats mild-moderate Alzheimer’s, increases acetylcholine, improves cognitive function

side effects: GI issues, CNS effects, bradycardia, frequent urination

give w/ food at bedtime, monitor weight/bleeding, fall risk, report LOC changes, don’t give to kids, no NSAID’s, anticholinergics reduce effects

NMDA receptor agonists: memantine (Ebixa)

treats moderate-severe Alzheimer’s, blocks glutamate from NMDA receptors, decreases calcium, restores brain function, slows damage

side effects: CNS effects, confusion

assess for diarrhea or constipation, monitor dizziness, antacids/drugs that increase urine pH can cause toxicity

immunomodulators: interferon beta-1a (Avonex)

treats MS, inhibits leukocytes across blood-brain barrier, protects myelin sheath

side effects: flu-like symptoms, myelosuppression, hepatotoxicity

start low, pre-medicate w/ acetaminophen, monitor LFTs, careful w/ suicidal ideation and kids < 18, don’t give other immunosuppressors

serotonin agonists: sumatriptan (Imigran)

treats migraines and cluster headaches, binds to serotonin receptors, mimics natural serotonin, inhibits other neurotransmitters, vasoconstriction of arteries

side effects: chest pressure/heaviness, CNS effects (vertigo, tingling)

report jaw pain, don’t give w/ CAD, PVD, older adults, stroke, or MAOI use within 2 wks, no St. John’s wort (toxicity), no other serotonin agonists

benzodiazepines: diazepam

treats anxiety, muscle spasms, seizures, and alcohol withdrawal, CNS depressant, enhances GABA

side effects: sedation, respiratory depression (IV), dependence, amnesia, confusion, anxiety, hypotension, hepatotoxicity

-lam or -pam ending, controlled substance, take in the evening, don’t drive, taper dose, careful w/ alcohol, opioids and elderly, teratogenic, don’t give w/ OSA and COPD, no cimetidine or smoking, monitor LFT’s

antidote = flumazenil

non-benzodiazepines: buspirone

short-term treatment for anxiety, increases serotonin and dopamine, non-sedating, no abuse risk, atypical antianxiolytic

side effects: dizziness, insomnia, anxiety, n/v

take 2 weeks for effects (not PRN), give w/ food, no grapefruit juice, erythromycin, or MAOI’s

tricyclic antidepressants (TCA’s): amitriptyline

treats depression, insomnia, neuropathic pain, and OCD, increases norepinephrine and serotonin

side effects: sedation, arrhythmias, increased suicide risk, lethal in overdose, orthostatic hypotension, anticholinergic effects, withdrawal potential, seizures

takes 2 weeks to show effects, take at bedtime, taper off, fiber/fluids/fitness, careful w/ elderly and CV issues, no alcohol, MAOI’s, St. John’s wort, or levodopa

selective serotonin reuptake inhibitors (SSRI’s): fluoxetine

treats depression/anxiety (first line), PTSD, panic disorder, bulimia, and OCD, increases serotonin, CNS excitation

side effects: dizziness, n/v, sexual dysfunction, insomnia, dry mouth, serotonin syndrome, increases suicide risk, weight gain, hyponatremia

takes 4-6 weeks to show effects, don’t drive, take in the morning, taper off, no MAOI’s, TCA’s, St. John’s wort, or alcohol

selective norepinephrine reuptake inhibitors (SNRI’s): venlafaxine (Effexor)

treats MDD, social anxiety disorder, panic disorder, neuropathic pain, and GAD, blocks reuptake of serotonin and norepinephrine

side effects: sexual dysfunction, n/v, HTN, insomnia, serotonin syndrome, hyponatremia, withdrawal potential, increased suicide

taper off for 2-4 wks, take w/ food, no MAOIs, St. John’s wort, alcohol, herbals, cimetidine, or grapefruit juice

monoamine oxidase inhibitors (MAOIs): phenelzine

treats depression and anxiety (last resort), blocks MAOI receptors, increases serotonin, norepinephrine, and dopamine

side effects: CNS stimulation, insomnia, HTN crisis, anticholinergic effects, ortho hypo, serotonin syndrome, n/v, weight gain, increased suicidal ideation

take in the morning, takes 2 wks to get out of system, no tyramine, no SSRI’s, TCA’s, or OTC meds

atypical antidepressants: bupropion

treats depression and smoking cessation, increases dopamine and norepinephrine, no serotonin

side effects: seizures, insomnia, CNS stimulation, weight loss, anorexia, increased suicidal ideation, less sexual effects

take w/ food, no MAOI’s, don’t give w/ anorexia, bulimia or alcohol use

mood stabilizers: lithium carbonate

controls manic episodes, mood stabilizer (first line), alters electrical activity in the brain

side effects: weight gain, n/v, arrhythmias, hypothyroidism, polydipsia, fine motor tremors, kidney damage

takes 2 wks to show effects, therapeutic range = 0.6-1.2 mEq/L, monitor I&Os, take w/ food, maintain sodium and fluids, avoid caffeine, draw lithium levels in the morning, teratogenic, several toxicity risks

typical antipsychotics: chlorpromazine

treats psychosis, schizophrenia, and agitation, decreases norepinephrine, acetylcholine, dopamine, and histamine, positive symptoms only

side effects: EPS, NMS, sedation, anticholinergic effects, QT prolongation, photosensitivity, ortho hypo

hold for EPS and NMS, wear gloves, mouth checks, teratogenic, no alcohol or CNS depressants

non-traditional/atypical antipsychotics (2nd gen): risperidone (Risperdal)

treats psychosis, schizophrenia, and bipolar, blocks dopamine and serotonin receptors, fewer EPS symptoms and adverse effects, negative and positive symptoms

side effects: EPS, metabolic syndrome (weight gain, hyperglycemia, hyperlipidemia), sedation, anticholinergic effects, agranulocytosis, NMS, QT prolongation, heat stroke

monitor for infxn, fall precautions, mix w/ milk/juice/water, fiber/fluids/fitness, low carb and fat diet, don’t give w/ kids < 13, Parkinson’s, or demenia, no antihypertensives, several med interactions

combination therapy oral contraceptives (E+P): ethinyl estradiol and drospirenone (Yasmin)

used for oral contraception, menstrual regulation, hormone HA’s, reduces female cancer, PID, breast disease, and ovarian cysts, stops thickening of uterine wall, prevents implantation

side effects: thromboembolism, hyperkalemia

report DVT, PE, MI, and stroke s/sx, don’t give w/ breast cancer, altered liver, or over 35, don’t smoke, careful w/ HTN, get mammograms, take at same time, no St. John’s wort, miss 1 = take 2, miss 2 = take 2 for 2 days, miss 3 = start over in 7 days

estrogen hormone replacement therapy (HRT): conjugated equine estrogen (Premarin)

adds estrogen in pre/perimenopausal women, relieves menopausal symptoms, prevents postmenopausal osteoporosis, binds to estrogen receptors, maintains/promotes feminization

side effects: n/v, clotting events, HTN, endometrial hyperplasia, ovarian cancer

effects diminish over time, no more than 3-4 yrs, yearly pelvic exam, take w/ food, don’t smoke, stop 4 wks before surgery, topical at night, don’t give w/ feminine cancer, liver disease, or vaginal bleeding, no warfarin

estrogen + progesterone hormone replacement therapy (HRT): conjugated equine estrogen + medroxyprogesterone (Prempro)

same use as estrogen, suppresses tissue growth in uterus, better for women w/ a uterus

side effects: clotting events, HTN, breast cancer, n/v, edema, breakthrough bleeding

effects diminish over time, no more than 3-4 yrs, yearly pelvic exam, take w/ food, don’t smoke, stop 4 wks before surgery, topical at night, don’t give w/ feminine cancer, liver disease, or vaginal bleeding, no warfarin

GnRH agonists: leuprolide (Lupron)

treats endometriosis, uterine fibroids, and prostate cancer, increases estrogen and progesterone, body thinks its in menopause, overgrown tissue shrinks and relieves symptoms

side effects: hot flashes, bone loss, vaginal dryness, HA, typical menopause s/sx

only take for 6 mths, lubricants, weight-bearing exercise, OTC analgesics, teratogenic, careful w/ older age, no SSRI’s or bupropion

progesterone: medroxyprogesterone acetate (Provera)

used as contraceptive, protective from uterine cancer and endometriosis, palliative care, antagonizes estrogen tissue growth in uterus

side effects: clotting events, breast cancer, breakthrough bleeding, n/v, edema

monitor weight, breast self exams, give w/ food, teratogenic, don’t give w/ vaginal bleeding or feminine cancers, no rifampin, St. John’s wort, or dilantin

testosterone hormone replacement therapy: androderm (Delatestryl)

treats male hypogonadism, delayed puberty, and testicular function, increases muscle mass illegally, hypoactive sexual desire disorder and gender-affirming, binds and produces androgenic/anabolic effects

side effects: virilization, growth of prostate cancer, edema, weight gain, gynecomastia, fetal death, hepatotoxicity

d/c to reverse virilization, I&O’s, bone x-rays, report sexual fxn changes and breast enlargement, teratogenic, don’t give w/ BPH, breast cancer, HTN, and CV/hepatic/renal issues, reduces insulin needed, no anticoags or cyclosporin

5-alpha reductase inhibitor: finasteride

treats urinary disorders and male hair loss, decreases testosterone in prostate, regression of prostate tissue, reduces cancer risk

side effects: reduced libido, seminal volume, and PSA levels, gynecomastia

lifelong therapy, effects take 6-12 mths, regular prostate screenings, teratogenic

alpha-adrenergic receptor agonists: tamsulosin

treats urinary disorders esp. BPH, makes smooth muscle and bladder relax, increases urine flow, works on prostate

side effects: reduced semen production, retrograde ejaculation, ortho hypo, fainting

take at night and same time, lifelong therapy, don’t give w/ Viagra!, no hypotensives or Tagamet

PDE-5 inhibitor: sildenafil

treats erectile dysfunction, blocks erection ending enzyme, no effects if there’s no arousal, vasodilates

side effects: priapism, hypotension, vision/hearing loss, fainting, dizziness

take 1 hr before sex, NEVER take w/ nitro, high fat foods delay effects, lasts 4 hrs, no grapefruit juice, BPH drugs, or rifampin, careful w/ CV issues

anticholinergics: oxybutynin

treats overactive bladders and incontinence, blocks acetylcholine, relaxes bladder, contracts sphincter, keeps urine in

side effects: dryness, constipation, blurry vision, dilated pupils, heat exhaustion, urinary retention, tachycardia, confusion

monitor I&Os, UTI, and elderly, give 2x/day, no grapefruit juice

cholinergics: bethanechol

treats urinary retention from delayed/absent bladder emptying, can be PRN, increases acetylcholine, contracts bladder, relaxes sphincter, pushes urine out

side effects: hypotension, bradycardia, increased stomach acid (secretions), incontinence, bronchoconstriction, dizziness

increase fluids, no cholinesterase inhibitors

iron preparations: ferrous sulfate

treats iron deficiency anemia, increases Hgb and oxygen transport

side effects: constipation, dark stools (expected), tooth discoloration, n/v, metallic taste

dilute if oral, drink w/ straw, rinse mouth, take w/ food if GI issues, no Ca, vit C increases absorption, no antacids

antidote = deferoxamine

vitamin B12, cyanocobalamin (Cobex)

treats pernicious anemia and vitamin B12 deficiency, provides coenzyme for absorption and utilization of B12

side effects: erythema, HTN, hypokalemia

monitor for muscle weakness, n/v, palpitations, careful w other anemias and folic acid, vit C makes unstable, no alcohol or cimetidine

folic acid (Folvite)

treats megaloblastic anemia, folate deficiency, and prevents neural tube defects, folic acid needed for DNA and erythropoiesis

side effects: yellowed urine, masks B12 deficiency, prostate/colorectal cancer, toxicity risk

high folic acid diet, careful w/ neonates, other anemias, and B12 deficiencies, birth control, corticosteriods, and methotrexate will have s/sx of folic acid deficiency but meds don’t work

antihemophilic factors (factors 8 and 9)

prophylaxis to stop bleeding and for hemophilia A (8) and hemophilia B (9), cofactors for factor 10a, skips/helps steps that are missing in coag cascade

side effects: allergic reaction, Creutzfeldt-Jakob disease

monitor for anaphylaxis, rash, and itching, careful w/ previous allergy

antidiuretic hormones: desmopressin (DDVAP)

treats mild hemophilia A, releases stored factor 8, only effective for patients who already make factor 8

side effects: fluid retention, hyponatremia, seizures, drowsiness, GI issues

might need diuretic, daily weights, no alcohol, careful w/ severe HF and HTN, don’t give w/ nephrogenic DI or vWB, interacts w/ loop diuretics, glucocorticoids, NSAIDs, SSRIs, and TCAs

factor 10a/thrombin inhibitors: heparin

anticoagulant, stops blood clotting, enhances antithrombin, doesn’t break up existing clots

side effects: bleeding, thrombocytopenia, neuro injury

high alert, monitor PTT (1.5-2x more), report black stools, no NSAID’s, interacts w/ nitro and herbals

antidote = protamine

vitamin K antagonist anticoagulants: warfarin

prevents clotting events and blood clots, blocks vitamin K in clotting cascade

side effects: bleeding, toxicity

monitor PT/INR (between 2-3) and bleeding, teratogenic, avoid leafy greens, many drug interactions

antidote = vitamin K

non-vitamin K antagonist anticoagulants: dabigatran

prevents blood clots, direct thrombin inhibitor, blocks fibrin conversion

side effects: bleeding

rapid onset, short life, take w/ food, keep in original packaging, don’t give w/ prosthetic valves, several drug interactions

antidote = praxbind

salicylic antiplatelet agent: aspirin

blood thinner, prevents blood clots and angina, stops platelet aggregation, inhibits cyclooxygenase, lasts 7-10 days

side effects: ototoxicity, GI ulcers, bleeding, Reye Syndrome

take w/ food, report tarry stools and bruising, stop 7 days before surgery, don’t give to kids, no alcohol

ADP receptor inhibitor antiplatelet agent: clopidogrel

prevents platelet aggregation and occlusion of arteries, blocks ADP receptors

side effects: bleeding, thrombocytopenia, GI upset/bleed, hypotension, preferred over aspirin

don’t give w/ active bleeding, stop 1 wk before surgery, no other anticoags, PPI’s, or herbals

antidote = platelets

thrombolytics: alteplase (tPA)

“clot buster”, dissolves existing clots, keeps central IV’s patent, breaks up clot by converting to plasmin, breaks down clotting factors

side effects: bleeding

-teplase ending, give within 3 hrs of ischemic stroke s/sx, no other anticoags or NSAIDs

antidote = aminocaproic acid

erythropoiesis stimulating agents (ESA): epoetin alfa

treats anemia, mimics erythropoietin, stimulates production of RBCs, increases Hgb and blood viscosity

side effects: increases blood clot risk, seizures, CV events, malignancy progression

monitor CBC, and BP, keep Hgb < 11, don’t give w/ uncontrolled HTN, MI, or stroke, increase heparin in dialysis

leukopoietic growth factors: filgrastim (Neupogen)

treats patients w/ neutropenia and myelosuppressive chemo, increases production of mature neutrophils

side effects: bone pain, fever, splenomegaly, leukocytosis

monitor pain, and abd, don’t give w/ acute respiratory distress and current chemo, lithium increases neutrophil release, OTC analgesics