Final Exam Overview

Card Set Information

Final Exam Overview
2010-12-17 01:50:41
final exam

521 and 522 Final
Show Answers:

  1. What class of drugs is first line for depression and anxiety in dementia patients?
  2. Use this antipsychotic in treatment refractory patients
  3. This med has the most prolactin elevation of any antipsychotic
  4. Which antipsychotic causes potentially fatal agranulocytosis?
  5. What is the overall cause of Parkinson's Disease?
    Destruction of dopamine neurons in the substantia nigra
  6. Which pathway is more active in Parkinson's?
    The indirect pathway. It inhibits movement.
  7. What effect does decreased dopamine have on gutamate and movement?
    Decr dopamine = decr direct pathway = decr glutamate = decr stimulation of cortex = decr facilitation of movement = incr indirect pathway = decr glutamate = incr inhibition of movement
  8. What are the 4 cardinal symptoms of Parkinson's?
    probable diagnosis if 2 of the 4

    • bradykinesia
    • resting tremor
    • rigidity
    • postural imbalance
  9. AEs of selegiline
    worsens existing psychosis and dyskinesias
  10. Can COMT inhibitors be used as monotherapy in PD?
  11. anticholinergic effects
    • mad as a hatter
    • blind as a bat
    • hot as a hare
    • dry as a bone
    • red as a beet
  12. What is the major advantage of amantadine?
    suppresses levodopa induced dyskinesias
  13. Initial treatment of Parkinson's should be with these agents (top 3)
    • selegiline/rasagiline
    • levodopa
    • DA agonist
  14. Adjunctive treatment for wearing off of L-dopa in PD
    • COMT inhibitors
    • MAOB inhibitors
    • DA agonists
  15. Which type of seizures are bilaterally symmetrical and without local onset?
    • Generalized.
    • Includes: Grand mal, Absence, etc
  16. Which type of seizures begin locally?
    • Partial, or focal.
    • Can be simple (no loss of consciousness) or complex (impaired consciousness).
  17. Which med is best for absence seizures?
    Ethosuximide because it is the narrowest-spectrum
  18. Narrow-spectrum antiepileptic meds should be limited to use in what type of epilepsy?
    Focal epilepsy with partial and secondarily generalized seizures
  19. Which AED can cause dose-related thrombocytopenia?
    valproic acid
  20. Which AEDs cause decreased bone density?
    Phenobarb and phenytoin
  21. What are some main SEs of CBZ?
    • rashes
    • bone marrow suppression (decreased WBC count)
  22. Which AEDs cause hyponatremia?
    CBZ and oxcarbazepine
  23. What meds can be used for chronic (maintenance) treatment of opioid addiction?
    • methadone
    • buprenorphine with naloxone (suboxone)
    • naltrexone
    • clonidine
  24. What endogenous CNS substances does alcohol affect?
    • endogenous opiates
    • GABA
    • dopamine
    • glutamine
  25. Initial management of cocaine-induced chest pain - acute coronary syndrome ACS
    • ASA, BZD
    • IV nitro, nitroprusside or phentolamine (for persistant HTN)
    • Avoid B-blockers (b/c alpha would still be stimulated and could lead to worse coronary vasospasm)
  26. Mgmt of acute cocaine intoxication
    • ABCs
    • Treat hyperthermia, seizures, agitation (e.g. BZD)
    • Manage cardiovascular complications
  27. Which med used for relapse prevention in alcohol abuse disorder is nephrotoxic?
    Acamprosate - CrC must be over 30 to use this
  28. What is the metabolite of cocaine that is looked for in urine testing?
  29. Which alcohol abuse disorder drugs used for relapse prevention are hepatotoxic
    • disulfiram
    • naltrexone
  30. How does clonidine work in treating opioid addiction?
    • It's an alpha-agonist
    • helps with anxiety
    • shortens time of WD sx
    • normalizes neurochemistry to make pt less addicted
  31. Which cholinesterase inhibitor has the most GI SEs?
    Rivastigmine (Exelon)
  32. What SE does Rivastigmine have that the other CIs do not?
    dose-dependent weight loss
  33. How long must you be on 10 mg donepezil before titrating up to 23 mg?
    at least 3 months
  34. SEs of all cholinesterase inhibitors
    • n/v/d
    • dizziness
    • urinary incontinence
    • bradycardia, syncope
    • salivation, sweating
  35. Which 2 meds should not be used in Parkinson's disease (one is for dementia, one is an AP)?
    • Memantine - may worsen psychiatric sx or cognition
    • Olanzapine may exacerbate PD
  36. Which CI comes in a patch formulation?
  37. What are environmental risk factors for AD?
    • age, vascular disease risk factors, head injury, decreased brain reserve capacity
    • diabetes increases risk 3-fold
  38. What medications may have a protective effect against dementia?
    • NSAIDS
    • HMG-CoA reductase inhibitors
  39. What is the effect of estrogen on dementia?
    • Possible protective effect
    • In studies
  40. Which drugs show improvement in neuropsychiatric symptoms of dementia (in studies)?
    • risperidone
    • aripiprazole
  41. What are precautions/relative contraindications for ALL cholinesterase inhibitors?
    • bradycardia
    • sick sinus syndrome
    • supraventricular cardiac conduction abnormalities
    • peptic ulcer disease
    • bladder obstruction
  42. What are precautions when giving Memantine?
    • severe renal or hepatic impairment
    • meds or dietary changes that alkalinize the urine - could decrease renal excretion of the medication
  43. What added SEs does donepezil have that other CIs don't?
    • insomnia
    • musculoskeletal issues
  44. What would be an appropriate med to use for insomnia in AD patients that will not contribute to cognitive impairment?
  45. Nonpharmacologic interventions for treatment of pts with AD
    • minimize environmental triggers
    • redirect patient attention (minimize noise, background distraction, personal discomfort)
  46. What meds should be used in delirium and when are they warranted?
    • neuroleptics (haloperidol is DOC, I think ?)
    • used when sx compromise safety or interfere with medical care
  47. Which anticonvulsant medications may cause cognitive effects? Which 2 cause fewer?
    • CBZ
    • VPA
    • phenytoin
    • phenobarb

    • gabapentin
    • lamotrigine
  48. Which anticonvulsants have the least significant drug interaction potential?
    • gabapentin
    • tiagabine
    • levetiracetam
    • zonisamide
  49. Which anticonvulsants inhibit hepatic metabolism and which induce it?
    • Valproate is an inhibitor
    • Phenytoin, Phenobarb, Primidone, CBZ are inducers
  50. What is the first line drug for primary generalized seizures (absence, myoclonic, tonic-clonic)?
    VPA (but really ethosuximide is best for absence)
  51. Which antiepileptic requires adjustment when contraceptive pills are started or d/c'd? Why?
    • lamotrigine
    • OCs enhance its clearance
    • (pregnancy also increases its clearance)
  52. Which antiepileptic is the worst choice for a pregnant woman?
  53. What is the initial treatment for status epilepticus and what is the DOC?
    • Benzodiazepines
    • lorazepam is DOC
  54. What antiepileptic is a concern because of PEG?
  55. Normal levels
    • Sodium: 136-145
    • Potassium: 3.5-5
    • Chloride: 96-106
    • pCO2: 35-45
    • HCO3: 22-27
    • RR: 18
    • Magnesium: 1.7-2.1
    • Calcium: 8.5-10.5
    • Phosphorus: 2.7-4.5
    • Osmolality: 275-290
    • BUN: 5-20
    • Glucose: 70-110
    • Prealbumin: 20-40
  56. 2 possible causes of metabolic alkalosis
    • loss of acid (vomiting, diuretics)
    • Gain of bicarb
  57. Cause of respiratory alkalosis
  58. causes of respiratory acidosis
    • hypoventilation
    • (depression of resp center, decreased diffusion, loss of bellows action of chest)
  59. causes of metabolic acidosis
    • gain of a strong acid
    • loss of bicarb
  60. What is the normal anion gap and how is this useful?
    12 +/- 4

    • it helps us determine the cause of metabolic acidosis
    • - if it is because of gain of HCl or loss of bicarb, the anion gap is normal
    • - if it is d/t gain of exogenous acid, the anion gap is increased = anion gap acidosis
  61. name causes of anion gap acidosis and non-anion gap acidosis
    • Methanol
    • Uremia
    • Lactate
    • Ethylene glycol
    • Paraldehyde
    • Aspirin
    • Ketoacidosis

    • TPN
    • Renal tubular acidosis
    • diarrhea (loss of bicarb)
  62. What order of metabolism does phenobarbital have?
    First order
  63. What is the equation to calculate serum osmolality?
    2[Na] + Gluc/18 + BUN/2.8
  64. Which hormone controls Na reabsorption? What stimulates its release?
    aldosterone; perfusion pressure in the kidney
  65. What hormone controls reabsorption of water? When is it secreted?
    ADH; when osmolality is high
  66. What is the overall cause of non-anion gap acidosis?
    loss of bicarb or gain of HCl (TPN, renal tubular acidosis, diarrhea)
  67. What is the overall cause of anion gap acidosis?
    Gain of exogenous acid
  68. What does a BUN/Scr > 20 tell us?
    pt is probably dehydrated and could be having kidney problems d/t poor perfusion
  69. What are Dr. Jameson's 2 sodium rules?
    • #1. Salt rules volume. (if you have too much volume, this means you have too much salt) - talking about TOTAL BODY sodium here
    • #2. Water rules tonicity. - talking about SERUM sodium and FREE water
  70. If a pt is on diuretics and you give free water, what happens to sodium? What if you replace the fluid with normal saline?
    • If replace with free water - hyponatremia
    • If replace with NS - hypernatremia
  71. What does a high Na level tell you in terms of free water?
    you have lost free water and must replace it
  72. How do you get free water? How do you get more volume?
    • give D5W
    • secrete ADH
    • drink it
    • pull it in with glucose

    • add sodium
    • secrete aldosterone
  73. What is happening with sodium and water in hypotonic hypovolemic hyponatremia? How do we treat it?
    • Total body sodium is down
    • Free water is low overall (relatively high, though)

    • restore circulating volume (use NS)
    • minimize sodium loss
    • stop diuretics
  74. What is happening with sodium and water in hypotonic isovolemic hyponatremia? How do we treat it?
    • Serum sodium is low
    • Total body sodium is normal
    • Free water is high

    Treat with NS + loop diuretic + ADH inhibitor (because of SIADH)
  75. What is SIADH? What drugs can cause it? What is the long term treatment for it?
    • syndrome of inappropriate antidiuretic hormone
    • too much ADH
    • ADH should be "off" because the osmolality is low, but it isn't

    • Antipsychotics
    • SSRIs
    • TCAs
    • CBZ and oxcarbazepine
    • antineoplastics
    • antidiuretic hormones

    long term tx: demeclocycline
  76. What is happening with sodium and water in hypotonic hypervolemic hyponatremia? What can cause it? How do we treat it?
    • Total body sodium is high
    • Total body H2O is high
    • Serum sodium is low

    Causes: (things that turn on aldosterone leading to hypervolemia) Heart failure, cirrhosis, nephrotic syndrome, renal failure

    Treatment: restrict sodium and water intake (< 1 - 1.5 L/d), give diuretics (lasix)
  77. How much should Na be increased by per day when treating hyponatremia? How quickly should it be decreased when treating hypernatremia?
    • increase by NMT 12 mEq/L/day
    • decrease by 0.5 - 1 mEq/L/day
  78. What must you first correct before you are able to correct low potassium?
    low magnesium
  79. A deficit of what electrolyte causes increased potential for digoxin toxicity?
  80. What level of potassium requires treatment for hypokalemia? What would that treatment be? Rates if given IV?
    • < 3
    • KCl is the only appropriate treatment
    • can give 20 mEq/h if using central line - must monitor ECG
    • can give only 10 mEq/h if using peripheral line
    • NEVER give IV push
  81. What potassium imbalance can acidosis temporarily cause?
    hyperkalemia - goes away when acidosis is corrected, so be careful
  82. What are the steps in treating hyperkalemia, and the treatments used in each step?
    • 1. stabilize the heart - use Calcium Chloride
    • 2. Drive K+ intracellularly - use insulin + glucose
    • 3. Remove from the body - use Kayexelate or Lasix
    • 4. Decrease intake
  83. What is the preferred treatment of hypomagnesemia?
    Magnesium Oxide
  84. What are the effects of magnesium on the CV system?
    relaxant/sedative type actions: dilates veins and arteries, decreases BP, relaxes muscles
  85. How do we rid the body of Magnesium naturally?
  86. What effects do PTH, Vitamin D, and Calcitonin have on serum calcium?
    • PTH increases it
    • Vitamin D increases it
    • Calcitonin decreases it
  87. What is the equation for corrected Calcium?
    [(4 - albumen) x 0.8] + serum Ca
  88. What ECG abnormality can hypocalcemia cause?
    prolonged QT interval
  89. Why must we always check magnesium level in treatment of hypocalcemia?
    Have to treat low Mg before IV Calcium can increase serum calcium levels
  90. Which hypophosphatemia treatment does not contain sodium? Which contains potassium? Which does not contain potassium?
    • K-phos original does not have sodium
    • both K-phos products contain potassium - the original has more than the neutral formulation
    • Fleet phospho-soda and sodium phosphate both do not contain potassium
  91. Treatments for hyperphosphatemia
    • Calcium
    • Sevelamer
  92. What are usually the first choice antipsychotics (3)?
    • Risperidone
    • Quetiapine
    • Olanzapine
  93. Which SGAs have the most risk of metabolic problems such as unmasking of diabetes, hyperlipidemias, and weight gain? The least?
    • Clozapine and olanzapine are the worst
    • Ziprasidone and aripiprazole are the best - they are weight neutral
  94. Which SGA has been FDA approved to reduce the risk of recurrent suicidal behavior in schizophrenia?
  95. What are the 2 major AEs associated with clozapine and how are they treated?
    • Agranulocytosis - stop drug
    • Seizures - if continued tx is indicated, add VPA and keep doses of clozapine to < 900 mg/d
  96. What is the significance of the DI between clozapine and CBZ?
    • both cause agranulocytosis
    • thrombocytopenia
    • worsening of psychosis
  97. What is the interaction between clozapine and fluoxetine?
    increased clozapine concentrations and increased risk of its SEs
  98. Which SGA is approved to treat schizophrenia in children and adolescents?
  99. Risperidone is a substrate of what CYP enzyme? What drugs does this lead to DIs with?
    • CYP 2D6 (it is a substrate)
    • it has DIs with 2D6 inhibitors and inducers, especially SSRIs
  100. What is the metabolite of risperidone that is available as an injectible?
    paliperidone - may have even more prolactin elevation than risperidone
  101. Which first line SGA is the most expensive and has less risk of EPSEs than risperidone?
    • olanzapine
    • (the EPSEs are dose dependent)
  102. What DIs does olanzapine have?
    virtually none
  103. which SGA is tied with clozapine for the highest risk of metabolic problems?
  104. Which SGA is indicated for schizophrenia, acute bipolar mania, and acute bipolar depression?
  105. What CYP enzyme is quetiapine a substrate of?
  106. What is a major SE of quetiapine?
  107. Main advantages of ziprasidone
    • little to no weight gain
    • minimal metabolic effects
    • (note: must give with food to increase bioavailability)
  108. Which SGA has the most risk of QT prolongation? What drugs does this lead to DIs with?
    • ziprasidone
    • Antiarrhythics, Antihistamines, Erythromycin, possibly TCAs
  109. Which SGA is the first drug simultaneously approved for both acute schizophrenia and manic or mixed bipolar disorder in adults? What dosage form does it come in?
    Asenapine - only comes in SL tablets
  110. What receptors does aripiprazole work on?
    • D2 partial agonist
    • 5-HT1A partial agonist
    • 5-HT2A partial antagonist
    • (acts like antagonist in mesolimbic and agonist in mesocortical)
  111. Which SGA may decrease prolactin concentrations?
  112. which SGA is less sedating than other SGAs
  113. Which SGA is approved for adolescents with schizophrenia?
    aripiprazole (and risperidone too)
  114. which SGA is approved as adjunctive treatment of treatment-resistant depression?
  115. What effects are of greatest concern with clozapine?
    • agranulocytosis
    • seizure
  116. What effects are of greatest concern with risperidone?
    • dose-dependent EPSEs
    • prolactin increase
  117. What effects are of greatest concern with olanzapine?
    • weight gain
    • diabetes
    • dose-dependent EPSEs
  118. What effects are of greatest concern with quetiapine?
    lack of effect on negative symptoms of schizophrenia
  119. What effects are of greatest concern with ziprasidone?
    • lack of effect on negative symptoms of schiz
    • dose-dependent EPSEs
    • QTc prolongation
    • (note: little weight gain)
  120. What effects are of greatest concern with aripiprazole?
    • nausea
    • akathisia
  121. Name some Anticholinergic SEs
    • confusion
    • delerium
    • memory dysfxn
    • dry eyes
    • exacerbation of angle closure glaucoma
    • blurred vision
    • tachycardia
    • constipation
    • urinary retention
  122. CIs for clozapine
    • agranulocytosis or granulocytopenia (or hx of it)
    • uncontrolled epilepsy
    • severe renal disease
  123. CIs for ziprasidone
    • recent MI
    • HF
    • Hx of arrhythmias
    • QT prolongation
    • drugs that can prolong QT interval
  124. all SGAs need to be titrated up to effective dose except which one?
  125. Which SGA is the best to use in a pt with diabetes?
  126. What dextrose content and osmolarity is allowed when giving through a peripheral line?
    • dextrose content NMT 10%
    • osmolarity must be less than 900 mOsm/L
  127. Equation for TPN osmolarity
    [grams of dextrose/L x 5] + [grams of amino acid/L x 10] + [mEq cations/L]
  128. What must sodium in a TPN be limited to?
    150 mEq/L
  129. What 2 electrolytes should be avoided together in TPNs? Why?
    Calcium and Phosphorus - can form precipitates
  130. Which calcium salt is preferred in TPN?
    calcium gluconate
  131. Most drugs are incompatible with TPN. Which are commonly added (are compatible)?
    insulin and H2 blockers (ex. ranitidine)
  132. How long is a TPN good for? How often do the tubes need to be changed?
    • good for 24 hours
    • change tubes q24h if fluids have lipids; q72h if only a dextrose and AA sol'n
  133. What rate must dextrose infusion be limited to?
    5 mg/kg/min
  134. How should we correct the TPN in hypercapnia?
    reduce calories and dextrose in TPN
  135. What effect does propofol use have on TPN?
    It is a lipid based emulsion that provides 1.1 kcal/ml of the infusion. Need to reduce lipid in the TPN.
  136. What adjustments should be made to TPN if the BUN is > 50 mg/dL? Which patients would this be a concern in?
    • Reduce the amino acid goal
    • Concern in renal patients
  137. If a TPN patient is acidotic what adjustments should be made? In an alkalotic patient?
    • If acidotic: reduce chloride and increase acetate
    • If alkalotic: reduce acetate and increase chloride
  138. When should a patient receive glutamine and arginine supplementation in TPN?
    intestinal atrophy
  139. In patients with chronic renal insufficiency receiving chronic TPN what vitamin should be reduced?
    Vitamin C
  140. What is refeeding syndrome?
    • characterized by simultaneous hypophosphatemia, hypokalemia, hypomagnesemia and sometimes deficiency in thiamine and sodium
    • Occurs from fat metabolism becoming the main source of energy in starvation, then feeding being begun again and a shift to carbohydrate metabolism occurs. Pt needs ATP and there is a sudden cellular uptake of phosphate leading to severe hypophosphatemia which can lead to neurologic, cardiac, respiratory, and hematologic abnormalities, even death.
  141. If a TPN patient's prealbumin is low, what do we do?
    This means the protein synthesis is low and we must increase carbs and AAs
  142. Where is albumin made, what is its half-life? What are the levels for depletion being considered mild, moderate, severe?
    • It is made in the liver
    • Half life of 20 days
    • Mild depletion = 2.8 - 3.5 g/dl
    • Moderate depl = 2.1-2.7 g/dl
    • Severe depl = < 2.1 g/dl
  143. What is transferrin?
    A blood plasma protein for iron delivery
  144. What are the K+ and Na+ goals for TPN?
    • K+ is 40-100
    • Na+ is 80-150
  145. How do you figure out the calorie goal when formulating TPN?
    BEE x Stress Factor
  146. How do you figure out the fluid goal when formulating TPN?
    1500 ml for the first 20 kg of weight and 20 ml/kg for each add'l kg
  147. How do you figure out the protein goal when formulating TPN?
    • Ranges from 0.6-2.0g/kg/d
    • Common is 1.2-2
    • Renal failure is 0.6-0.8
  148. How do you figure out the lipid goal when formulating TPN?
    • it is approx 1/3 of the non-protein calorie goal
    • usually around 0.7 - 1.1 g/kg
  149. How do you figure out the dextrose goal when formulating TPN?
    it's the difference betw the calorie goal and the AA + lipids (or about 2/3 of the non-protein calorie goal)
  150. What is black cohosh used for?
    PMS, hot flashes
  151. What is cranberry used for?
    Prevention of recurrent UTIs
  152. What is echinacea used for?
    boosts the immune system
  153. What is feverfew used for?
    migraine prophylaxis
  154. What is fish oil used for?
    HTN, hyperlipidemia, mental health, anticoagulant, CHD, stroke
  155. What is flaxseed used for?
    constipation, diarrhea, diabetes, menopause, HTN, CAD, hyperlipidemia
  156. What is garlic used for?
    hyperlipoproteinemia, arteriosclerosis
  157. What is horse chestnut seed used for?
    venous conditions, eczema, leg pains, hemorrhoids, phlebitis, menstruation
  158. What is ginkgo used for?
    • cerebral circulatory disturbances
    • peripheral arterial circulatory disturbances
  159. What is Asian Ginseng used for?
    • "adaptogen" for increasing resistance to environmental stress
    • energy
    • concentration
  160. What is milk thistle used for?
    liver protectant
  161. What is saw palmetto used for?
  162. What is St. John's Wort used for?
    anxiety, depression
  163. What is valerian used for?
    • restlessness
    • nervous disturbance of sleep
  164. What is glucosamine/chondroitin used for?
    osteoarthritis, inhibition of breakdown of cartilage
  165. What is Coenzyme Q-10 used for?
    CHF, HTN, stable angina, ventricular arrhythmias, cancer, heart surgery, periodontal disease
  166. What is melatonin used for?
    • circadian rhythm sleep disorders in the blind
    • jet lag
    • insomnia
    • depression
    • cancer
  167. What type of formula should trauma, burn, head/neck CA, and critically ill/mechanical ventilation patients have for EN?
    • immune-modulating formulation:
    • omega-3s
    • antioxidants
    • arginine
    • glutamine
    • nucleic acids
  168. What type of EN formulation is best for ARDS and severe respiratory failure patients?
    • one that has anti-inflammatory lipids and antioxidants
    • "pulmonary" formulas not recommended
  169. When should a pt with severe acute pancreatitis receive EN?
  170. What EN formula should pts with severe liver disease receive?
    standard polymeric formulations
  171. What product added to EN gives 3 g/L of protein?
  172. What supplement can be added to EN to give 6 g/L of carbohydrate?
  173. What product can be added to EN to give 10 g/L of fat?
  174. What do fructooligosaccharides or FOS do?
    they help stimulate growth of beneficial GI bacteria
  175. Which 2 alpha-agonists are used clinically? When are they typically used?
    • Clonidine- drug addiction
    • Methyldopa- pregnancy/breastfeeding
  176. Which other HTN med may be used in pregnancy (besides methyldopa)?
    labetalol - it has the most data in pregnancy
  177. Best HTN meds to use in Diabetes are
    ACEIs and ARBs
  178. Recommended HTN treatment in migraine
    Beta blockers (especially non-selective such as verapamil)
  179. Which HTN meds should be avoided in asthma/COPD?
  180. Recommended HTN treatment in tachycardia/Afib
    beta-blockers and non-DHP CCBs
  181. HTN meds to avoid in depression
    • beta-blockers
    • alpha-2 agonists
  182. HTN meds to avoid in bradycardia/AV block
    • beta-blockers
    • non-DHP CCBs
  183. HTN meds to avoid in pregnancy
    ACEs and ARBs
  184. Best HTN med to use in osteoporosis
  185. Which HTN meds should be used in renal insufficiency patients? Which should be avoided?
    • use: ACEs, ARBs, loops
    • avoid: K+ sparing, thiazides
  186. Stages of HTN
    • normal <120/<80
    • prehypertension 120-139/80-89
    • stage 1 HTN 140-159/90-99
    • stage 2 HTN >160/>100
  187. Order of potency of statins
    • rosuvastatin
    • atorvastatin
    • simvastatin
    • pitavastatin
    • lovastatin
    • pravastatin
    • fluvastatin
  188. Which hyperlipidemia med is the DOC for high LDL?
  189. Which hyperlipidemia med is the DOC for high LDL and high TG?
  190. Which hyperlipidemia med is the DOC for high LDL, high TG, and low HDL?
  191. Which is the DOC for treating high TG, low HDL, or both?
    fibric acid
  192. What is the DOC for treatment and prevention of DVT and PE in pregnancy?
  193. When is APTT measured?
    When a pt is on treatment doses of unfractionated heparin
  194. What is the dose of UH for prevention?
    5000 units SQ q8-12h
  195. What is the treatment dose for UH?
    • loading dose is 80 units/kg IV
    • maintenance is 18 units/kg IV
  196. What is the length of treatment with UH?
    d/c when INR has been therapeutic for 24 hours for a minimum of 5 days
  197. What is the prophylactic dose of enoxaparin?
    30 mg SQ bid (or 40 mg SQ qd)
  198. What is the treatment dose of enoxaparin?
    1 mg/kg SQ bid
  199. What is the antidote for bleeding caused by heparin?
    protamine sulfate
  200. What drugs can be used to treat clots in a pt with HIT, Heparin-induced thrombocytopenia?
    • Direct thrombin inhibitors (lepirudin, argatroban)
    • fondaparinux
  201. MOA of warfarin
    inhibits vitamin K-epoxide reductase which decreases levels of vitamin K in the body
  202. What is the duration of therapy with warfarin in a pt who is being treated for their first VTE?
    3 months
  203. What is the goal INR for most patients?
  204. How long is warfarin treatment in a patient with recurrent DVT/PE?
  205. For a pt with thrombosis who has had a mechanical valve replacement what is the duration of warfarin therapy and what is the goal INR?
    • lifetime
    • 2.5-3.5
  206. When is warfarin therapy started in a DVT/PE patient?
    as soon as APTT is therapeutic from heparin
  207. How long should heparin and warfarin therapy be overlapped?
    at least 5 days
  208. What is the starting dose of warfarin in treatment of DVT/PE? In prophylaxis?
    • 5-10 mg PO QD for treatment
    • 2.5 - 5 mg PO QD for prophylaxis
  209. For reversal of bleeding and/or high INR what actions do we take and at what INR levels?
    • INR of 3-5 and pt not bleeding, hold 1-2 doses and resume tx at lower dose
    • INR of 6-9 and pt not bleeding, stop therapy, give 2.5 mg PO Vitamin K, recheck in 24 h
    • INR of 10-20 and pt not bleeding, stop therapy, give Vitamin K 5 mg PO, recheck INR in 24 h
    • INR >20 or seriously bleeding, stop therapy, give Vitamin K 10 mg IV infusion, recheck INR q 6-12 h, may repeat Vitamin K IV q 12 h, may supplement with fresh frozen plasma or prothrombin complex concentrates, resume heparin therapy until patient responsive to warfarin
  210. Are warfarin and heparin compatible with pregnancy and breastfeeding?
    • Warfarin not with pregnancy - Category X - ok to use heparin
    • Warfarin ok in breastfeeding - heparin no
  211. The 10A drugs that interfere with warfarin
    • antibiotics
    • azole antifungals
    • antidepressants
    • antiplatelets
    • anti-inflammatory agents
    • amiodarone
    • acetaminophen
    • alternative remedies
    • antileptics
    • alcohol
  212. Why do we tell patients on coumadin to take their medication in the evening?
    Because if they come into the clinic and their INR is high, we can still adjust that day's dose
  213. Which class of antihypertensives should be avoided in patients with severe PAD?
  214. Which receptor on the platelet adheres to the subendothelium?
    GP Ib
  215. What factors/parts of the coagulation cascade does Thrombin (Factor IIa) activate?
    • Protein C
    • Factor VIII
    • Factor V
    • Fibrinogen
  216. At what point in the coagulation cascade do both pathways merge into one?
    At factor X
  217. What receptor on the platelet allows platelets to adhere to each other?
    GP IIb/IIIa