Pharm II Exam 2

Warfarin Antidote

Vitamin K

Heparin antidote

Protamine Sulfate

Antiplatelet example

Aspirin

Signs of Excessive bleeding

Blood in urine, blood in stool, bruising, nose bleeds etc.

Low molecular Heparin?

Enoxaprin (Lovenox)

How do you give Hepain?

IV or SC

Warfarin lab value to monitor

INR

Heparin Lab value to monitor?

Ptt

Biggest Heparin concern?

H.I.T. (Heparin Induced Thrombocytopenia)

Warfarin Caution?

CHF, thyrotoxicosis, senility or psychosis

Warfarin adverse effects?

Bleeding, GI upset, hepatic dysfunction, alopecia, dermaittis, bone marrow suppression, long and painful erection

INR optimal range

2.5-3.5

What increases INR?

Alcohol, NSAIDS, Antibiotics, Cough Medicine, Pain medicine

What decreases INR?

Increased green leafy vegetables, missed doses

Rivaroxaban and Apixaban

Andexxa and Andexanet

Apixaban and Rixaroxaban indications

DVT prophylaxis and prevent stroke

Advantages of using Apixaban over warfarin?

Rapid onset

Fixed dosage

Lower bleeding risk

Less drug interactions

No need for INR monitoring

Dabigatram antidote

Idarucizumab

Antiplatelet medications Action

Inhibit platelet adhesion and aggregation by blocking receptors sites on the platelet membrane

Anagrelide – Blocks the production of platelets in the bone marrow

Antiplatelet indications

Reduce risk of recurrent TIAs or strokes

Reduce death or nonfatal MI

MI prophylaxis

Anti-inflammatory, analgesic, and antipyretic effects

Antiplatelet Contraindications

Allergy, pregnancy, and lactation

Bleeding disorder

Recent surgery

Closed-head injury

Antiplatelet adverse effects

Bleeding

Headache, dizziness, and weakness

GI distress

Antiplatelet drug-drug interactions

Another drug that affects blood clotting

CYP3A inhibitors or inducers

ADENOSINE DIPHOSPHATE RECEPTOR ANTAGONISTS

drugs of choice to prevent thrombosis in stented cardiac vessels

What to know about P2Y meds

šOral, give loading dose

šReduction of thrombotic CV events in patients with ACS

šReduces death in MI and CVA

šIncreased risk of bleeding when taken with Coumadin, Heparin, TPA, and NSAIDS

šContraindicated in bleeding disorders or hemorrhagic CVA

Nonpharmacologic control for High Cholesterol

Exercise

Weight Loss

Smoking Cessation

Mediterranean Diet

Fiber

Flax seed, garlic, green tea

HRT

Statins contraindication

Liver disease, hard on liver

What do you monitor for patients on statins

LFTS at 6 and 12 weeks, myopathy and weakness and rhabdomyolysis

Statin Drug-food

Grapefruit juice

what do MTP Inhibitors treat

Treats hypertriglyceridemia, and for people who accumulate LDL

MTP example

Lomitapide

MTP contraindications

Pregnancy or liver dx

MTP side effects

GI issues

PCSK9 Inhibitors examples

alirocumab or evolocumab

PCSK9 Inhibitor MOA

Blocks protein that enters LDL receptors in liver allowing LDL to enter the receptors and get metabolied

PCSK9 Inhibitor indication

For familial hypercholesterolemia, MI, CVA, used along or without statins

Fibrate caution

Increased risk of rhabdomyolysis when taking with statins

Increased risk of bleeding when taking with coumadin

Fibrate benefit

Fibrates may be more appropriate for people with elevated triglyceride levels

May increase HDL

Fibrate examples

Fenofibrate or Gemfibrozil

Metabolic syndrome

Waist circumference increases

High Triglycerides

Low HDL

High BP

High fasting glucose

Nonpharmacologic control of Arrhythmias

Can have tachycardia with

Elevated temperature —> need fever reduction

Dehydration —> Correct fluid balance, provide hydration

Infection —> Tx infection

Hypotension —> tx cause of hypotension

Other treatments for arrhythmias

Implantable device to override arrhythmia

Implantable pacemaker

Surgical ablation of conduction pathways

Class IA SODIUM CHANNEL BLOCKERS

Treat Afib ex. Quindine

Class IB SODIUM CHANNEL BLOCKERS

Treat PVC and VT ex. Lidocaine

Class IC SODIUM CHANNEL BLOCKERS

Use if A and B dont work ex. Flecainide

Class II Beta-Adrenergic Blockers

Treat SVT and slows heart

Class II Beta-Adrenergic Blockers example

Atenolol and Metoprolol

Class III Potassium Channel Blockers

Treat VT, V-Fib

Class III Potassium Channel Blockers example

Amiodarone

CLASS IV CALCIUM CHANNEL BLOCKERS

Treat SVT

CLASS IV CALCIUM CHANNEL BLOCKERS example

Dilitazem and Verapamil

CLASS IV CALCIUM CHANNEL BLOCKERS MOA

Slows cardiac electrical conduction

Unclassified Antiarryhmtics ex and what they treat

Adenosine : SVT

Digoxin: SVT and Afib

Magnesium Sulfate: Torsades de Pointes and can fix dysrhythmias caused by digoxin

Nonpharmacologic Treatment of Shock

Treat Cause

Maintain oxygenation

Positioning

Maintain SBP > 90

Correct electrolites and acidosis

Use Trendelenburg Cautiously**

Adrenergic Drugs example

Dobutamine (Dobutrex)

Dopamine (Intropin)

Epinephrine (Adrenalin)* prototype

Norepinephrine (Levophed)

Phenylephrine (Neosynephrine

Adrenergic Drug Contraindications

Cardiac Dysrhythmias

Angina

HTN

Hyperthyroidism

CVA

Adrenergic Drug MOA

Class of medications that affect Sympathetic nervous system by mimicking or interfering with the actions of epinephrine and norepinephrine.

Bronchodilation

Increased blood pressure

Increased heart rate

Increased cardiac output

Adrenergic Drug Indications

Asthma, Allergic reactions, cardiac arrest and shock

Anaphylaxis medication

Epinephrine: relieves bronchospasm , laryngeal edema and hypotension

what do Positive Inotropic Medications do

Increase strength of muscle contraction, stroke volume and cardiac output

Cardiac Glycoside ex.

Digoxin

Cardiac Glycoside Indication

Treatment of HF

Treatment of A Fib/A Flutter & PAT

Cardiac Glycoside MOA

Increases intracellular calcium allowing more calcium to enter myocardial cells during depolarization

Increases myocardial contraction force (positive inotropic)

Increased cardiac output

Increased renal perfusion

Decreased heart rate

Slowed conduction through AV node

Digoxin toxicity drug level

> 1.2 ng/mL

what increases dig toxicity

Hypokalemia

Signs of dig toxicity

Anorexia, nausea, vomiting

Visual changes, yello halos

Fatigue, weakness, dizziness

Cardiac arrhythmias, bradycardia

Dig antidote

Digifab

Phosphodiesterace Inhibitor (Inotropic) ex

Milrinone

Phosphodiesterace Inhibitor

Smooth muscle relaxant

Phosphodiesterace Inhibitor Caution

Dysrhythmia, thrombocytopenia and jaundice

Drugs for Bradycardia and Lowering blood pressure

Isoproterenol

Dopamine

Epinephrine

Atrophine

Emergency Drugs to Lean on

Lidocaine

Epinephrine

Atropine

Narcan

Antianginal drugs MOA

Improve blood delivery to the heart muscle by dilating blood vessels

Improve blood delivery to the heart muscle by decreasing the work of the heart

Antianginal drug types

Nitrates

Beta-Adrenergic Blockers

Calcium Channel Blockers

Nitrates use?

Used for angina

Stable angina

With increased exhertion

No damage to heart muscle

Basic reflexes surrounding the pain restore blood flow

Unstable angina

Episodes of ischemia occur at rest

Prinzmetal’s Angina

Spasms of coronary arteries

Not due to narrowing of coronary vessels

Nitrate MOA

Act directly on smooth muscle to cause relaxation and depress muscle tone

Nitrate Indication

Prevention and treatment of attacks of angina pectoris

Also used to treat cyanide poisoning

Nitrates contraindication and cautions

Allergy

Severe anemia

Head trauma or cerebral hemorrhage

Pregnancy and lactation

Hepatic or renal disease

Hypotension, hypovolemia, and conditions that limit cardiac output

Nitrate Adverse Effects

Related to the vasodilatation and decreased in blood flow

CNS – Headache, dizziness, and weakness

GI – Nausea, vomiting

CV – Hypotension

Misc. – Flushing, pallor increased perspiration

Nitrate Drug-Drug interactions

Ergot derivatives

Heparin

Drugs for erectile dysfunction

Nursing Interventions for Pt on nitro

Check BP

Adminster tablet

wait

reassess

x3

Antineoplastic therapy targets

Normal cells impacted most are human cells that reproduce rapidly. ex.

Skin, Hair, Lining of GI tract

Adverse Effects of Traditional Cytotoxic Antineoplastic Drugs

Mouth ulcers, Hair loss, N/V/D, Nephrotoxicity, Lung toxicity, Cardiotoxicity, Cystitis, Neurotoxicity: peripheral nerves, Bone marrow suppression

Types of Antineoplastic Agents

Cytotoxic chemo agents

Hormones and hormone modulators

Cancer cell-specific agents

Indications for Use of Antineoplastic drugs

Cure neoplastic disease: induce/ maintain remissions

Relieve neoplastic disease symptoms

treatment of non malignant conditions such as RA, Psoriasis, MS

What is nadir?

Nadir is the lowest point the WBC will go to

If extravasation occurs during chemotherapy what are nursing interventions

Stop infusion

Don’t remove cannula, instead aspirate

Notify MD

Compress

Immobilization and elevate

Alkylating agents adverse effects

Tremors, muscle twitching, Myelosupression, Dose limiting adverse effect, Nausea/Vomiting, Teratogenesis, Gonadal atrophy, Leukemogenesis, Carcinogenesis

Example of Antimetabolite

Methotrexate

Contraindication for all antineoplastic drugs

Pregnancy, lactation, bone marrow suppression and hepatic dysfunction

Antimetabolites adverse effects

N/V

fatigue weakness, myalgias

stomatitis

vision changes or light sensitivity

Folic acid deficiency

Antimetabolite drug-drug interactions

Drugs that are toxic to liver and kidneys

Antimetabolite warning

Impairs folic acid in normal cells and lead to toxicity

Rescue drug for methotrexate?

Leucovorin

Antineoplastic antibodies Adverse effect

Cardiotoxic and can cause red urine. Very big bone marrow suppression

Mitotic Inhibitors adverse effects

GI effects, pancytopenia

Hormone modulator example

Tamoxifen

What kind of drug is Tamoxifen

SERM drug