pharm 3 set 3

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kbryant86
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241025
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pharm 3 set 3
Updated:
2013-10-17 09:11:15
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pharm 3
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  1. IV Nitro needs special tubing b/c it sticks to plastic
    IV Nitro needs special tubing b/c it sticks to plastic
  2. Anginal Prophylaxis
    • Stable angina
    • used preventative, not for acute setting

    • Pt. will be given Ca++ blockers (arteriole dilation and relax cornary spasm
    • Pt will also be given Beta Blocks (slow HR, Inc. coronary flow time, and reduce atrial pressure)
  3. Ranolazine / Ranexa
    • Reduces accumulation of Na+ and Ca+ in muscle cells
    • Not sure how, but does help muscle cells use energy more efficiently

    SE=dysrrhythm, HTN, GI

    Reserved for refactory cases when all other drugs fail
  4. Heparin
    • anti-coag
    • Inactivates Thrombin and Factor 10a
    • -fibrin production is reduced, clotting suppressed
    • -short 1/2

    Used for PE, Embolic stroke, MI, DIC

    Monitor aPTT (22-34 sec.)

    Risk for Bleeding
  5. Protamine Sulfate
    Antidote for heparin induced bleeding
  6. Heparin routes
    • IV intermittent - during cath procedure or the like
    • - Not done often

    • IV continuous - given by weight and managed protocol
    • - Q6h after dose given or change made

    Low dose therapy - to prevent DVT's
  7. Enoxaparin / Lovenox

    Dalteparin / Fragmin
    low molecular weight heparin 

    • Fractionated - use part of long hep chain
    • Does NOT affect aPTT so don't need t monitor
    • -only affects Factor 10a (not thrombin)
    • can be done at home
  8. Warfarin / Coumadin
    • oral anti-coag
    • Vit K antagonist

    Monnitor PT and INR

    • risk for bleeding
    • many drug reactions
  9. Dabigatren / Pradaxa
    • Direct Thrombin Inhibitor
    • non-valvular A-Fib clot prevention
    • Thromboembolism
    • Inc. incidence of bleeding
    • GI SE
    • Unstable
    • No blood monitoring
  10. ASA / Aspirin
    • Anti-platelet
    • prevent platelet aggregation
    • prevent thromboses in arteries

    • Interrupts clotting by interfering with Thromboxane
    • SE= GI bleed
  11. Ticlopidine / Ticlid

    Clopidogrel / Plavix

    Prasugrel / Effient
    • Anti-platelet drugs
    • More specifically, ADP Receptor Antagonists
    •  - Irreversible blockage of platelet ADP (prevent aggregation)

    • T= 1st but hematologic SE
    • P= 2nd gen
    •  = less side effects, very popular
    • E= 3rd gen
    •  = less clotting, but more major bleeding
  12. Abciximab / Reopro

    Eptifibatide / Integrillin
    • Anti-platelet
    • *Glycoprotein receptor antagonist
    • -reversible blocking of receptor to prevent agg

    Given IV short term for ACS and PCI ONLY
  13. Dipyridamoloe / Persantin

    Aggrenox
    • Anti-platelete
    • used ONLY for prevention of thromboembolism AFTER heart valve replacement
    • used in conjunction with coumadin

    A= Persantin combined with ASA to reduce incidence of strokes
  14. Cilostazol / PLetal
    Anti-platelet

    Platelet inhibitor and vasodilator

    DOC for intermittent Claudication
  15. Thrombolytics
    • remove thrombi that have formed
    • convert plasminogen to plamin
    • -plasmin degrades the fibrin cap
    • Indication: acute MI, DVT, PE; lead to ischemic stroke

    this drug has risk of bleeding
  16. Streptokinase


    Alteplase (tPA)
    Thrombolytics

    S= 1st drug, but allergic rxns b/c is made from strptococci

    • A= 2nd gen.
    •  = Short 1/2
  17. Diuretics
    increase urine output

    • -Tx of HTN
    • -Mobilization of edematous fluid
    • -Prevent renal failure
    •   =when fluids are low on this pt. we give fluids and diuretics to flush kindeys out
  18. 3 compenents of urine formation
    • filtration
    • reabsorption
    • secretion
  19. Adverse effects of diuretics
    • Hypovolemia
    • -dehydration, orthostatic hypoTN, thirst
    • Acid/Base imbalance
    • Disturbances of electrolyte levels
  20. Furosemide / Lasix
    • Loop (high ceiling) Diuretic
    • Works in the Ascending loop of Henle
    • -depends on prostaglandin availability (which dec. with ibuprofen use)
    • Blocks Na+ and Cl- reabsoprtion
    • DOC for fluid overload

    SE= Hypokalemia
  21. Hydochlothiazide
    • Thaizide diuretic
    • Blocks Na and CL reabsorption
    •  ->much LESS h2o and electrolyte loss than loops
    • Doesn't work well with low GFR rate, so not given for Renal Failure
    • Used for HTN and Edema
    • BAD for Gout (uric acid build up)

    Paradoxical (reverse) effects on Diabetes Insipidus (decreases urine in a disease that increases urine
  22. Spironolactone / Aldactone
    • K+ sparing diuretic
    • -used with other diurs.

    • Aldosterone Antagonist
    • Inc. Na+ excretion so Kidney saves K+

    Limited urine production but dec. K+ loss
  23. Trimaterene / Dyrenium

    Amiloride / Midamore
    K+ sparing diuretic

    • Non Aldosterone Antagonist
    • Inc. Na+ (h2o) loss
    • Directly blocks K+ loss
    •  ->given with loops b/c of blocking effect
  24. Manntiol / Osmotorol
    • Creates an osmotic effect in the nephron
    • -inhibits passive reabsorption of h2o
    • NO Metab effect, just a big molecule that attracts h2o
    • Moves fuild from tissue into vascular space
    • MUST be given IV and use a filter needle
    • Given mainly to Dec. ICP, also used for edema
  25. Cholesterol

    lipoproteins
    • C= part of cell membran
    • = essential for bile production
    • =made in liver

    • L= carry cholest
    • -LDL= carry chol to body (bad chol)
    • -HDL= carry excess chol to liver for metab
  26. HMG-CoA Reductase and their Inhibitors
    HMG reductase provides for cholest product

    Inhibitors are called Statins -> DOC for dec. LDL and inc. HDL
  27. Statins
    • Dec. LDL
    • INc. HDL
    • Promote plaque stability
    • Also, an Inc in Hepatic LDL receptors

    take drug at night b/c most chol production is done at night

    create risk for liver failure and muscle breakdown
  28. SE of Statins
    Headache, rash, GI

    Hepatotoxicity major SE, monitor every 6 months

    Muscle inflamm and breakdown

    Grapefruit juice
  29. Atrovastatin / Lipitor
    Statin
  30. Simvastatin / Zocor
    • statin
    • NEVER more than 80mg
  31. Lovastatin / Mevacor
    statin
  32. Risuvastatin / Crestor
    • 2nd gen statin
    • very potent (dec dose, dec SE in theory)
    • Rhabdomyolysis is big issue with Crestor
  33. ways to deal with Statin SE's
    • try every other day statin dosing
    • check thyroid imbalances
    • check Vit. D status
    • Consider Coenzyme Q10
    • -studies suggest it can help prevent muscle issues
  34. Nicotinic Acid / Niacin

    Niaspan
    • Dec. triglycerides and LDL production
    • Inc HDL better than any other drug
    • Reduces coronary risk and mortality

    SE= skin flushing, GI, hepatotoxicity, hyperglycemia

    Niacin= slow release form
  35. Cholestyramine / Questran
    Bile Acid Sequestrant

    • Binds with bile acids in gut to prevent reabsorption
    • Dec. bile acid creates demand for more production
    • Choilesterol is used to make bile acids, so liver creates more LDL receptors

    SE= constipation, indigetion, nausea (with food)

    Dec uptake of fat soluble drugs, so take Coumadin 1 hr before Questran
  36. Colesevelam / WelChol
    • new Bile Acid Sequestrant
    • 2nd gen
    • Better tolerated, less constipation and nausea
    • does NOT afftect fat soluble drugs/vit.s
    • $$$
  37. Ezetimibe / Zetia
    • Cholesterol Absorption Blocking
    • Block absoption in sm. intestine
    • Affects dietary and cholesterol secreted in bile (which is often reabsorbed)
    • well tolerated, careful in liver failure
  38. Gemfibrozil / Lopid

    Fenofibrate / Tricor
    Fibric Acid Derivative  "Fibrates"

    • Most effective for lowering triglycerides
    • can Inc HDL, NO affect on LDL
    • accelerated breakdown of triglys

    SE= gall stones, myopathy

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