w15 Lipidedma and Coag

LDL (BAD) - HDL (GOOD)

We don’t know the causes of ASCVD but what is it linked to and what is the treatment?

linked to hyperlidemia (metabolic syndrome)

Tx -> 3-6 months diet change

What are the 5 major factors that increase the risk of ASCVD

Abdominal obesity

high blood pressure

high blood triglycerides

low levels of HDL

cholesterol and insulin resistance.

Fats are broken down into smaller parts in the “blank“ and the “blank“. The “blank“ stimulates (via the high cholesterol content) the “blank“ to release bile salts, which break them down into smaller parts the fat molecules

Fats are broken down into smaller parts in the stomach and the duodenum. The duodenum stimulates (via the high cholesterol content) the gallbladder to release bile salts, which break them down into smaller parts the fat molecules

Which class of fats is HDL and LDL apart of and are they lipoprotiens?

A) Triglycerides

B) Phospholipids

C) Cholesterol

C) Cholesterol and YES

Define and what are some causes (5)

Rhabdomyolysis

muscle damge releases proteins like myoglobin and electrolytes into the bloodstream, which can harm the kidneys and heart

causes: not moving,drugs, toxins, infections, and genetics

What are the 3 steps in Blood coag process? elaborate on the last step and what’s included in that step.

1. Vasoconstriction

2. Platelet Aggregation (Platelet Plug Formation)

3. Clotting factors

• Intrinsic Pathway (damage within the blood vessel)

  • trigger by exposed collage

• Extrinsic Pathway (damage within the tissues)

  • Tiggered by Tissue factor (TF)

Which clotting factor and vitamin are involved just before activation of the common pathway, and do the intrinsic and extrinsic pathways both lead into the common pathway?

factor X and Vitamin K (VIII)

YES

What happens in the common pathway

conversion of prothrombin → thrombin, and then fibrinogen → fibrin (stablizes the clot)

Where is vit.K made and what drug OD is it used for?

Liver and Warfarin

Define this bleeding disorders and what speific info she talked about them for each

Hemophilia

Vitamin K deficiency

von Willebrand Disease (vWD)

Disseminated Intravascular Coagulation (DIC)

Hemophilia – A Recessive genetic missing or defective clotting factor

• Hemo A (VIII) Hemo B Hemo C

• IT ONLY AFFECTS THE INTRINSIC PATHWAY

Vitamin K deficiency – affects production of clotting factors (II, VII, IX, and X )

• EFFECTS ALL 3 PATHWAYS

• Please eat dark leafy greens; spinach

• Vit. K is administered to newborns, b.c immature livers

von Willebrand Disease (vWD) - dominant genetic dysfunction of von Willebrand factor (vWF).

• Affects Platelet Aggregation (Platelet Plug Formation)

Disseminated Intravascular Coagulation (DIC)

• Abnormal clots + bleeding, thus using up the clotting factors

• Tx. -> Heparin - Plasma - IV blood

Define

Thrombocytopenia

Immune thrombocytopenic purpura (ITP)

Thromboembolic Disorders and what are the s/sx of this one

Thrombocytopenia

• Low platelet count.

Immune Thrombocytopenic Purpura (ITP)

• Autoimmune destruction of platelets.

Thromboembolic Disorders

• Conditions where abnormal blood clots form and block vessels.

• Hypoxia -> Anoxia -> Tissue necrosis

What are 2 natural plasma proteins that are used to breakdown clots?

Antithrombin III

• Inhibits thrombin, preventing fibrin formation, helps control excessive clotting

Plasmin

• The main enzyme responsible for breaking down fibrin

define

PT & INR

PTT

PT (Prothrombin Time) & INR (International Normalized Ratio)\

• Test Extrinsic pathway and vit K lvl (liver fxn)

• Monitor warfarin therapy

PTT (Partial Thromboplastin Time)

• Measures clotting via the intrinsic pathway

• Monitor heparin therapy

• screen for many bleeding disorders

Class

Action

Adverse

D2D

Cholestyramine

Class → Bile Acid Sequestrants

Action → The bile acids pull the LDL from the bloodstream to bind to it in the intestine, thus dec the LDL lvl

Adverse:

• Fatigue, HA 

• GI- constipation,  hemorrhoids, GI upset. 

• Musculoskeletal-muscle aches and pains

D2D:

• delay absorption- thiazide diuretics, digoxin, OCPs

• Administer 1 hour prior to or 4-6 hours after the bile sequestrant

Class

Action

Tx

Adverse

D2D

Atorvastatin

Class → HMG-CoA Reductase Inhibitors

Action → blocks enzyme HMG-CoA reductase, dec LDL and Inc HDL lvls

Tx:

• high cholesterol and LDL as an adjunct to diet and exercise

• prophylaxis for MI in at-risk CAD patients

Adverse:

• CNS- insomnia, HA

• GI flatulence, abdominal cramp

D2D:

• Erythromycin- increased risk of rhabdomyolysis 

• Digoxin and grapefruit juice - increase the risk of toxicity

Class

Action

Adverse

D2D

Ezetimibe

Class → Cholesterol Absorption Inhibitors

Action → Dec the absorption of cholesterol, used with stains ot HMG-CoA

Adverse → mild abdominal pain, diarrhea, muscle aches/pains 

D2D:

• admin 2 hours before or 4 after bile sequestrant, 

• With statins, myopathy, liver issues

• With warfarin, increase levels, monitor- PT, PTT, INR

Class

Action

Tx

Adverse

Evolocumab

Class → PCSK9 Inhibitors

Action → stops PCSK9 from destroying liver LDL receptors, so your liver can clear more LDL from the blood.

Tx:

• short term HF if no response to (digoxin, vasodilators, diuretics)

• Emergent situations

Adverse → Flu-like s/sx

Class

Tx

Adverse

Contraindications

Aspirin (ASA)

Class → Antiplatelets

Tx → CV diseases (PVD, MI ….)

Adverse → bleeding, ASA-GI irritation, risk of ulcers, and tinnitus 

Contraindications → known bleeding disorder, closed head injuries

Class

Adverse

Contraindications

D2D

Heparin

Class → Anticoagulants

Adverse:

• Heparin-induced thrombocytopenia 

• bleeding

Contraindications

• Known bleeding disorder, recent trauma, and or surgery, GI ulcers

D2D:

• Salicylates, cephalosporin/ PCN inc bleeding risk 

• Decreased anticoagulation with nitroglycerin

Antidote for herparin OD is…

Protamine sulfate

Class

Tx

Adverse

Contraindications

D2D

Alteplase

Class → Thrombolytics

tx → MI, PE, clear IV and CVP lines

Adverse:

• Bleeding (monitor Hgb and Hct)

• arrythmias

Contraindications:

•  Known bleeding disorder, recent trauma, and or surgery, GI ulcers

D2D

• anticoagulants, antiplatelets, watch for  increased risk of bleeding 

Class

Adverse

Contraindications

D2D

Aminocaproic acid

Class → Hemostatic Agents

Adverse → Prevent systemic clot breakdown, prevent blood loss

Contraindications:

• dizziness, hallucinations (from changes in brain blood flow)

• nausea, cramping

D2D

• OCP

Action

Adverse

Antihemophilic Factor

Action → Replaces the missing VIII clotting factor in hemophilia A (classic)

Adverse → Risk use with blood products causing allergic rx s/sx