Pharm Exam 2

Primary Hemostasis

formation of platelet plug, platelet activation and aggregation

Secondary Hemostasis

activation of clotting factors

Tertiary hemostasis

activates tPA, plasmin breaks down fibrin

What does Asprin affect?

Primary hemostasis

What does Plavix affect

Primary hemostasis

What does brilinta affect

Primary hemostasis

What does Effient affect

Primary hemostasis

What does aggrastat affect

Primary hemostasis

MOA asprin

Irreversibly inhibits COX-1, inhibits platelets during the whole time

What dosage of asprin should you question

>81mg

Secondary prevention usage asprin

stroke, angina, primary MI, coronary stent

What is important with Asprin (when should it not be taken)

Do not take 7 days before elective surgery

What is a inotrope drug

influences the strength of contraction of cardiac muscle

What is a chronotrope drug

influences the heart rate

Stage 1 HTN

130-139/80-89

Stage 2 HTN

140>/90

Severe HTN

>180/>120

HTN emergency

>180/>120

3 goals of HTN treatment

prevent rise in BP, meet Bp target, prevent complications

what are the 4 chatagories of first line treatment for HTN

calcium channel blockers, thiazide diuretics, ACE inhibitors, ARBs

What do calcium channel blockers primarly treat

arrhythmia, HTN, angina

MOA calcium channel blockers

block calcium going into cell, vasodialates, dec HR and dec contractability

What do Non-dihydropryidines act on

vasular smooth muscle AND the heart

What do dihydropryidines work on

Vascular smooth muscle ONLY

What calcium channel blocker catagory are verapamil and diltiazem

Non-dihydropryidines

What calcium channel blocker catagory are procardia, norvasc

dihydropryidines

Used Non-dihydropryidines

angina, cardiac arrhythmias (A-fib/SVT)

Pharmokinetics Non-dihydropryidines

extensive 1st pass metabolism, hepatic metabolizm, highly protein bound

Side effects Non-dihydropryidines

bradycardia and heart block, constipation, peripheral edema

Contradiction Non-dihydropryidines

LV systolic dysfunction (HF), significant conduction system disease (bradycardia)

Pt. Education Non-dihydropryidines

advise to report s/s, counsel on constipation, DO not stop

Uses dihydropryidines

HTN!, angina, subarachnoid hemmorrhage vasospasm prophylaxis

Pharmocokinetics dihydropryidines

rapid absorbtion, metabolized hepatically

What is the half life of amlodipine

30-50hrs

dihydropryidines side effects

Peripheral EDEMA, flushing, headace, hypotension

Caution dihydropryidines

hepatic disease

What is the most common reason people stop dihydropryidines

peripheral edema

PT. education dihydropryidines

monitor for leg swelling, orthostatic hypo risk, swallow sustained-release whole, DONT stop

What drug/food interactions should be worried about with calcium channel blockers?

grapefruit juice can exaggerate drug effect

Nursing implications calcium channel blockers

know when to hold, know PO or IV

When to hold for a dihydropyridine (amlodipine)

hold for symptomatic hypotension

When to hold non-dihydropyridine (diltiazem)

hold for HR <50

What are the 2 areas beta blocks affect

beta-1 receptors in the heart and kidneys

Affects of beta blockers

dec HR, and BP

Primary location and activation of B1 receptors

herat, inc HR and contractability

Primary location and activation of B2 receptors

bronchioles + smooth muscle, bronchodialate and vasodialate

Cardioselective beta blockers primarly block …

B1

Nonselective beta blockers primarly block …

B1 + B2

What do 1st gen beta blockers primary affect

B1 and B2 (nonselective) can affect heart and lungs

What do 2nd gen beta blockers primary affect

B1 (cardio-selective) primarily affect heart

What do 3rd gen beta blockers primary affect

B1 OR B2 (non-selective OR cardio-selective) can have additional vasodialating effects

MOA beta blockers

block beta receptors, dec contractility and slowing of conduction

Do beta blockers have reflex tachycardia

No

How can propranolol be given

PO only

What category is propranolol

1st gen beta blocker

Distribution of propranolol

highly lipid soluable, cross BBB and to featus

What category is metoprolol

2nd gen beta blocker

What form is metoprolol given?

PO or IV

How are propranolol and metoprolol metabolized and excreted

have first pass metabolism, metabolized by liver, excreted in urine

Clinical indications 1st gen BB

migraine prophylaxis, anxiety, HTN (not first line), ischemic heart disease

Name the 1st gen BB

propranolol/ nadolol

Adverse effects 1st gen BB

broncho constriction, hypoglycemia, peripheral vasoconstriction, ED

What patients should not take a 1st gen BB

Pts. with asthma or COPD

What are the names of 2nd gen BB

Metoprolol, atenolol, disoprolol, esomolol

What category is metoprolol

2nd gen BB

What category is atenolol

2nd gen BB

What category is bisoprolol

2nd gen BB

What category is esmolol

2nd gen BB

What category is propranolol

1st gen BB

What category is nadolol

1st gen BB

Clinical indications 2nd gen BB

post MI, ischemic heart disease, HFrEF, HTN

Adverse effects 2nd gen BB

fatigue, bradycardia, hypotension, dizzy

Caveats 2nd gen BB

proven mortality benifits in HFrEF, perfered over non-selective agents in pts. with mild asthma or COPD

What is the difference between metoprolol tartrate/ metoprolol succinate

immediate release / extended release

Should metoprolol tartrate or metoprolol succinate be for a pt with HFrEF

metoprolol succinate

What are the names of the 3rd gen BB

carvedilol, labetalol, bebivolol

What category is nebiviolol

3rd gen BB

What category is carvedilol

3rd gen BB

What category is labetalol

3rd gen BB

clinical indications 3rd gen BB

HRrEF, HTN, ischemic heart disease

What 3rd gen BB has proven mortality benifit in HFrEF

carvedilol and nebivolol

When should carvedilol be held

systolic <90/ HR <50

Contraindications carvedilol

bronchial asthma/ COPD, severe bradycardia, severe hepatic disease

Clinical indications labetalol

perfered for HTN emergency, severe HTN in pregnancy*

Side effects labetalol

dizzy, bradycardia, hepatic dysfunction, bronchospasm

Contraindications labetalol

bronchial asthma, heart block, hypotension

Adverse side affects beta 1 specific BB

bradycardia/ reduced CO/ heart block

Adverse side affects non-beta 1 specific BB

bronchoconstriction, hypoglycemia

NC BB

never stop abruptly, risk of bronchiconstriciton, understand parameters to hold

What is a risk of stopping BB suddenly

rebound HTN and tachycardia

Drug name direct-acting vasodialator

hydralazine

MOA hydralazine

direct relaxation of arteriolar smooth muscle + Dec BP

Clinical indications Hydralazine

severe HTN/ Hypertensive emergencies

What forms can hydralazine be given

PO/ IV/ IM

Adverse affects hydralazine

reflex tachycardia, edema, lupus like syndrome

What is lupus-like syndrome

common with high doses of hydralazine, joint pain fever malaise

Important caveats hydralazine

often paired with BB or diuretic, NOT first line

What type of med is sodium nitroprusside

Direct acting vasodilator

MOA sodium nitroprusside

direct relaxation arteriolar and venous smooth muscle, reduced pre and afterload

What form is sodium nitroprusside given

IV only