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290 Cards in this Set
- Front
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|
most popular anticoagulant; obtained from animal tissue
|
heparin
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hospital use only (IV or subQ)
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heparin
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never given IM due to the risk of local bleeding
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heparin
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heavy acidic molecule; metabolized by the liver and excreted in urine
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heparin
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binds to & activates antitrhombin III (AT III)
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heparin
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inactivates thrombin, fibrin, and clotting factor X
|
heparin
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when combined with heparin, it works
1000x faster |
Antithrombin III
|
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coats the inside of blood vessels making them very slippery to further
reduce clotting ability |
heparin
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rapid effect and is used when anticoagulation is needed immediately
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heparin
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can be used 1-2 weeks post MI (heart attack)
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heparin
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drug of choice in pregnancy because it does not cross the placenta
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heparin
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can be used in cardiac bypass, hemodialysis and orthopedic surgery
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heparin
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effectiveness is measured by ptt (partial thromboplastin time)
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heparin
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a light weight version of heparin
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lovenox/enoxaparin
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enoxaparin
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lovenox
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anticoagulation medication for at home use (injection)
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lovenox/enoxaparin
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longer duration of action than heparin
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lovenox/enoxaparin
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available in pre-prepared syringes
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lovenox/enoxaparin
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warfarin
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coumadin
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anticoagulant and small lipid soluble molecule
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coumadin/warfarin
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interferes with clotting factors dependent on vitamin K produced in the liver
|
coumadin/warfarin
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clotting factors dependent on vitamin K produced in the liver
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II, VII, IX, & X
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duration of action between 8-60 hours
|
coumadin/warfarin
vitamin K |
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used for chronic anticoagulation
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coumadin/warfarin
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can be used 2-6 months post MI
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coumadin/warfarin
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huge problem with drug interactions
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coumadin/warfarin
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alter liver metabolism & influences blood levels of coumadin
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rifampin & tagamet
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very common to overlap _____ & heparin therapies because ____ will take almost 2 days (60 hours) to work
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coumadin
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coumadin overdose is treated with
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plasma transfusion (fresh or frozen)
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simple blood test for coumadin
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pt (prothrombin time)
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PT
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prothrombin time
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blood thinners that block COX enzymes
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aspirin and NSAID’s
|
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#1 drug interaction
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aspirin vs. coumadin
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reduces risk of stroke or the risk of a 2nd stroke
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ticlid/ticlopidine
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ticlopidine
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ticlid
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reduces body’s ability to clot blood and has a very slow onset of action (takes 4-5 days to
work) |
ticlid
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unique side effect: can increase total cholesterol 8-10%
|
ticlid
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anticoagulant for hospital use only
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reopro/abciximab
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abciximab
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reopro
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used to treat acute cardiac ischemia (lack of blood flow to heart)
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reopro/abciximab
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can be used with aspirin or heparin but increases the risk of internal bleeding
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reopro/abciximab
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must monitor the patient’s platelet count and pt (prothrombin time) while on
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reopro/abciximab
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dipyridamole (200) + aspirin (25)
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aggrenox
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both have antiplatelet effects
|
dipyridamole (200) + aspirin (25)
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used post bypass surgery and heart valve replacement
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aggrenox
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can be used as a substitute for patients unable to take coumadin
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aggrenox
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most popular drug for peripheral artery disease (PAD)
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plavix
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used for recent M/I or stroke
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plavix
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works in 2 hours!
|
plavix
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TPA's
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tissue plasminogen activators
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clot dissolvers
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tissue plasminogen activators
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used for emergency treatment of MI or stroke
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tissue plasminogen activators
|
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crushing chest pain, pain in left shoulder and jaw
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symptoms of M/I
|
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droop in mouth, loss of sensation in half of the body
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symptoms of stroke
|
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anticoagulant with a very small window to use (1-4 hours after onset of symptoms)
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tissue plasminogen activators
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TPA approved for acute MI, acute stroke and pulmonary embolism
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alteplase
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TPA approved for acute MI
|
reteplase
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TPA given in 2 IV doses: the second is given 1.5 hours
after the first IV runs out for a longer duration of action |
reteplase
|
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approved for acute MI and pulmonary embolism
|
streptokinase
|
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people may need very high doses of this anticoagulant in order for it to work
|
streptokinase
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depressed mood, lack of interest/pleasure in most or all activities for 2 weeks or
greater are symptoms of |
depression
|
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loss of appetite, weight loss, insomnia, fatigue, loss of energy, feelings of
guilt, thoughts of death/suicide are symptoms of |
depression
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disease cannot be measured
|
depression
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"Brain chemicals are responsible for our moods."
|
amine hypothesis of mood
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5HT3
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serotonin
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NE
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norepinephrine
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when there are a lot of these chemicals, the result is a good mood
|
norepinephrine (NE)
serotonin (5HT3) |
|
|
it takes 2-4 weeks to increase both patients usually feel the side
effects before the actual treatment effects |
norepinephrine (NE)
serotonin (5HT3) |
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|
treatment of depression 1st episode
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9 months
|
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treatment of depression 2nd episode
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5 years
|
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treatment of depression 3rd episode
|
indefinite amount of time
|
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lipid soluble molecules that increase NE & 5HT3
|
tricyclic antidepressants - 1st generation
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have good absorption in GI tract & good distribution throughout the body
|
lipid soluble molecules
|
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these drugs turn off the re-uptake mechanism
|
tricyclic antidepressants - 1st generation
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antidepressants metabolized by the liver
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tricyclic antidepressants - 1st generation
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long duration of action: 8-36 hours
|
tricyclic antidepressants - 1st generation
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antidepressants given 1xday at night
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tricyclic antidepressants - 1st generation
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have side effects of sedation, drying effect, blurry vision, constipation, hypotension
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tricyclic antidepressants - 1st generation
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can treat enuresis (bed wetting)
|
tricyclic antidepressants - 1st generation
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famous for danger with overdose: the 3 C’s: coma, convulsions and cardiac toxicity
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tricyclic antidepressants - 1st generation
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overdose of this drug can occur with as little as a 2 week supply of medication
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tricyclic antidepressants - 1st generation
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can cause death due to depressed cardiac contractility
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tricyclic antidepressants - 1st generation
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tofranil/imipramine
elavil/amitriptyline sinequan/doxepin |
tricyclic antidepressants - 1st generation
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tofranil
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imipramine
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elavil
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amitriptyline
|
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sinequan
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doxepin
|
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desyrel/trazodone
wellbutrin/bupropion |
tricyclic antidepressants - 2nd generation
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desyrel
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trazodone
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wellbutrin
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bupropion
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works on 5HT3 only & causes such drowsiness that it can be used as a sleeping pill
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desyrel/trazodone
|
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the only CNS stimulant antidepressant
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wellbutrin/bupropion
|
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increases dopamine
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wellbutrin/bupropion
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can cause tremors & seizures in high doses because it is a CNS stimulant
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wellbutrin/bupropion
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theophylline, raglan, caffeine and CNS stimulants all increase the risk of
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seizures
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antidepressant taken in AM
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wellbutrin/bupropion
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this drug's secondary use is smoking cessation
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wellbutrin/bupropion
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effexor/venlafaxine
remeron/mirtazipine |
tricyclic antidepressants - 3rd generation
|
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effexor
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venlafaxine
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remeron
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mirtazipine
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works on NE and 5HT3 & increases BP (diastolic) by 7.2mmHG
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effexor/venlafaxine
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works on 5HT3 and histamine 1 receptors causing a drying effect
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remeron/mirtazipine
|
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selective serotonin reuptake inhibitors
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SSRI's
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most widely rx’d drugs for depression due to:
* minimal side effects * safety in overdose * effectiveness in patients unresponsive to other drugs |
SSRI's
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prozac/fluoxetine
celexa/citalopram luvox/fluvoxamine paxil/parozetine zoloft/sertaline |
SSRI's
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prozac
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fluoxetine
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celexa
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citalopram
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luvox
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fluvoxamine
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paxil
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parozetine
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zoloft
|
sertaline
|
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SSRI with longest duration of action
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prozac/fluoxetine
|
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active metabolite
|
when liver breaks down the medication, it causes another active
form of a chemical to be released |
|
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SSRI with an active metabolite which results in long duration of action
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prozac/fluoxetine
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SSRI given 1xday usually in the morning
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prozac/fluoxetine
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may also treat bulimia, OCD, and pre-menstural dysphoric disorder (pmdd)
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prozac/fluoxetine
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SSRI with max dose per day: 80mg
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prozac/fluoxetine
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SSRI with dose range of 10-60mg/day
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celexa/citalopram
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SSRI given in the morning or night
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celexa/citalopram
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SSRI mostly given to the elderly
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celexa/citalopram
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can treat depression, panic disorder, social phopias, OCD, post traumatic stress,
seasonal affective disorder (SAD) |
paxil/paroxetine
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dose range 25-200mg/day usually in the morning
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paxil/paroxetine
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SSRI that must be given 2xday
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luvox/fluvoxamine
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SSRI with starting dose: 50mg/day (25mg in AM, 25 in PM) increased to 50mg every 7 days
|
luvox/fluvoxamine
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can be used in children who suffer from autism (along with vitamin
therapy) |
luvox/fluvoxamine
|
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nausea, headache, anxiety, insomnia, sexual dysfunction, must
start low dose and then titrate upwards |
main side effects of SSRI's
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if discontinued, the dose must be tapered down or withdrawal symptoms may occur
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SSRI's
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monoamine oxidase inhibitors
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MAO's
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nardil/phenelzine
parnate/tranylcypromine marplan/isocarboxazid elderpryl/selegiline |
MAO Inhibitors
|
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an enzyme which exists in 2 states (A & B)
|
monoamine oxidase
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breaks down 5HT3, NE, tyramine (too much tyramine can lead to severe hypertensive crisis: BP so high that it can cause nausea, vomiting, chest pain, intracranial bleeding and death)
|
MAO-A inhibitors
(Nardil/phenelzine, parnate/tranylcypromine, marplan/isocarboxazid) |
|
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MAO-B is inhibited causing dopamine to go up on this drug
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eldepryl/selegiline
|
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these drugs are related to amphetimines
|
MAO's
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never to be given with SSRI's
|
MAOI's or MAO inhibitors
|
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these drugs are very dangerous due to hypotensive side effects
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MAO's
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all inhibit MAO-A & cause NE, 5HT3 and tyramine levels to increase
|
nardil/phenelzine
parnate/tranylcypromine marplan/isocarboxazid |
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inhibits MAO-B causing dopamine to increase
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eldepryl/selegline
|
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these types of drugs produce dose dependent CNS depressant effects
|
sedative hypnotics
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sedation, relief from anxiety, impaired motor function, behavioral disinhibition, hypnosis, anesthesia, amnesia
suppression of reflexes |
actions of sedative hypnotics
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emergency anti convulsion activity
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sedative hypnotics like valium & ativan for seizures
|
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skeletal muscle relaxation
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valium used for 3-4 days
|
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action of sedative hypnotics that leads to hypotension, respiratory depression, cardiovascular collapse
|
medullary depression
|
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cross tolerance can occur with ___
because these drugs are so similar, you may be tolerant to a drug never taken before. |
sedative hypnotics
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occurs with compulsive use of medication
|
psychological dependence
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leads to withdrawals if drug is discontinued
|
physical dependence
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exception to the dependence rule because it is a non addictive anti anxiety medication
|
buspar/buspirone
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must not be mixed with alcohol
|
sedative hypnotics
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general anesthetic used in surgery
|
thiopental
|
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valium/diazepam
ativan/lorazepam serax/oxazepam xanax/alprazolam klonopin/clonazepam |
anti-anxiety medications (PAM drugs)
|
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valium
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diazepam
|
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ativan
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lorazepam
|
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serax
|
oxazepam
|
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xanax
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alprazolam
|
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klonopin
|
clonazepam
|
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act at the benzodiazepene (BZ) receptor site
|
anti-anxiety (PAM) drugs
|
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anti-anxiety drug with long duration of action, produces daytime sedation
|
valium/diazepam
|
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anti-anxiety drug with short duration of action
|
serax/oxazepam
|
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preferred anti-anxiety drugs
|
xanax/alprazolam
klonopin/clonazepam |
|
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chloral hydrate
dalmane/flurazepam restoril/temazepam ambien/zolpidem sonata/zaleplon lunestra rozerem |
sleeping pills/hypnotics
|
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oldest sleeping pill; has 1 active metabolite which is trichloroethanol & comes in a liquid formula used in children prior to dental procedures
|
chloral hydrate
|
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dalmane
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flurazepam
|
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restoril
|
temazepam
|
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ambien
|
zolpidem
|
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sonata
|
zaleplon
|
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sleeping pill with long duration of action that produces “morning hangover effect”
|
dalmane/flurazepam
|
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sleeping pill with short duration of action
|
restoril/temazepam
|
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no morning hangover; very addictive
non BZ sleeping pill that acts on BZ1 receptor. Is not a muscle relaxant or anti-convulsant |
ambien/zolpidem
|
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newer sleeping pill that decreases onset sleep time but doesn't increase total sleep time.
works at Gaba-Bz complex, omega 1 receptor |
sonata/zaleplon
|
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unrelated to other sleeping pills & hypnotics. improves sleep maintainence & works in GABA complex
|
lunesta
|
|
|
more of a natural sleep aid; similar to OTC products like melatonin
stimulates melatonin receptors 1&2 in brain (M1 & M2) maintains normal sleep-wake cycle |
Rozerem
|
|
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used vs. seizures
depresses neuronal activity in the brain same side effects as rifampin |
phenobarbital
|
|
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BZ antagonist used in overdose
reverses CNS depression (like morphine and narcan) |
flumazenil
|
|
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CNS depressants
|
barbiturates
|
|
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buspar
|
busipirone
|
|
|
<200mg/dL
|
total cholesterol
|
|
|
>35mg/dL
|
HDL
|
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<130, but maybe even 100mg/dL
130-159 mg/dL is borderline high >160mg/dL high! |
LDL
|
|
|
major cause of coronary artery disease
|
elevated blood cholesterol
|
|
|
reduces the risk of heart attack
|
lowering LDL
|
|
|
diet
exercise weight reduction |
cholesterol tx starts with
|
|
|
secondary endocrine disorders that must be diagnosed and treated before treating high cholesterol
|
diabetes and hypothyroidism
|
|
|
resin powders
|
Questran/Cholestyraminie Colestid/Colestipol
|
|
|
one of the older cholesterol medications that are mixed with noncarbonated beverages
|
resin powders
|
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|
bind to bile acids (which emulsify or breakdown fats) and removes bile acids from
the body. the body then thinks that it needs to make more bile acid in order for the body to make the bile, it needs cholesterol, so it pulls cholesterol from the bloodstream, |
resin powders reduce blood levels of LDL by
|
|
|
4-7 days
total reduction is seen in 1 month |
cholesterol reduction is seen in
|
|
|
bloating
gas constipation |
side effects of resin powders
|
|
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absorb everything within contact, therefore there must be a 4 hr separation period before taking any other meds
|
resin powders
|
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these drugs have a really bad taste
|
resin powders
|
|
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if this therapy is discontinued, cholesterol levels may rise to levels higher than initial levels
|
resin powders
|
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Resin tablets
|
Welchol
|
|
|
same dosage as resin powders
taken 2x a day |
resin tablets/welchol
|
|
|
decreases total & LDL 10-20%
decreases triglycerides 30-70% increases HDL by 20-35% decreases VLDL |
niacin
|
|
|
reducing VLDL
|
biggest impact on triglycerides
|
|
|
high doses are necessary to achieve above results
(between 1000-2000mg per day) |
niacin
|
|
|
caused by vasodilation which produces edema, dizziness and pruritis
(itchy skin) |
“Niacin Flush”
|
|
|
take 325mg aspirin 30 minutes before Niacin
eat a meal before taking Niacin |
Niacin Flush prevention
|
|
|
if liver enzymes rise to 3x normal levels, the medication must be discontinued
|
niacin
|
|
|
Questran
|
Cholestyraminie
|
|
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Colestid
|
Colestipol
|
|
|
Lipoprotein lipase stimulators
|
Tricor/Fenofibrate & Lopid/Gemfibrozil
|
|
|
inhibit production of and increase removal of VLDL
decrease triglycerides in the body also increases HDL |
Lipoprotein lipase stimulators
|
|
|
cholesterol meds that increase the action of Coumadin and diabetic medication tablets
|
Lipoprotein lipase stimulators
|
|
|
gas
bloating nausea skin rash alopecia (because fats are reduced, and therefore unable to feed hair follicles) |
side effects of Lipoprotein lipase stimulators
|
|
|
Mevacor/Lovastatin, Lipitor/Atorvastatin, Zocor/Simvistatin, Pravachol/Pravastatin, Crestor/Rosuvastatin
|
statins
|
|
|
Mevacor
|
Lovastatin
|
|
|
Lipitor
|
Atorvastatin
|
|
|
Zocor
|
Simvistatin
|
|
|
Pravachol
|
Pravastatin
|
|
|
Crestor
|
Rosuvastatin
|
|
|
following tests are needed prior to this therapy:
full baseline lipid profile baseline liver function test baseline kidney function test |
statin therapy
|
|
|
interrupts conversion of HMGCOa into mevalonate
|
statins
|
|
|
vitamins of tomorrow because they prevent heart attack and may
also prevent stroke. |
statins
|
|
|
they decrease LDL, VLDL and triglycerides
and increase HDL, which is the goal |
statins
|
|
|
results can be seen in 2 weeks
total reduction can be seen in 6weeks and maintained with daily therapy |
statin therapy
|
|
|
take them at bedtime because the liver goes to work while you
are asleep |
statins
|
|
|
myalgia (muscle pain) especially in the legs
if ignored, it can turn into rhabdomyolypis (destruction of skeletal muscle) |
#1 side effect of statin
|
|
|
this cholesterol medication is pregnancy category X-> death to fetus
|
statin
|
|
|
discontinue this drug if if liver tests rise to 3x the normal &
if kidney tests rise to 10x the normal, |
statins
|
|
|
require bloodtests at 6 weeks, 12 weeks, and 12 months after starting therapy
|
statins
|
|
|
cholesterol medication not to be used in patients under age 18
|
statins
|
|
|
bioavailability is only between 5-24%
|
statins
|
|
|
decreases cholesterol absorbed from food consumed
|
Zetia
|
|
|
Zetia + simvastatin
|
Vytorin
|
|
|
combo drug that treats via dietary method and via liver production
|
Vytorin
|
|
|
a condition in which there is a reduction in quantity of the oxygen-carrying protein, hemoglobin
|
anemia
|
|
|
type of anemia caused by iron deficiency
|
microcytic hypochromic anemia
|
|
|
an essential component of heme,
|
iron
|
|
|
is responsible for oxygen transport
|
heme
|
|
|
the form of iron that is absorbed by the body
|
ferrous iron
|
|
|
the form of iron that is stored within the body (specifically in the liver, spleen and bone marrow)
|
ferric iron
|
|
|
iron moves around the body while bound to this protein
|
transferrin
|
|
|
type of anemia caused by lysis of heme which releases iron into the bloodstream
|
hemolytic anemia
|
|
|
body loses iron by
|
sweat, saliva and stool
|
|
|
shock, metabolic acidosis, coma and death are due to
|
iron toxicity
|
|
|
mouth: phosphate and carbonate salt to correct acid base imbalance
IV: deferoxamine, which removes iron from the bloodstream |
iron overdose treated by
|
|
|
GI upset
dark stools |
side effects of iron
|
|
|
IV drug which removes iron from the bloodstream
|
deferoxamine
|
|
|
has drug interaction v. tetracycline
|
iron
|
|
|
type of anemia that results in B12 deficiency
|
pernicious anemia
|
|
|
a protein necessary for the body to
absorb vitamin B12 |
intrinsic factor
|
|
|
produce intrinsic factor
|
parietal cells
|
|
|
caused by a reduction of intrinsic factor
|
B12 deficiency
|
|
|
first sign of B12 deficiency
|
anemia
|
|
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available IM
is a co-factor in the transfer of one-carbon unit, which is a necessary step in the production of DNA. |
B12
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B12 is essential for conversion of metmalonyl COa to ____ which is necessary for lipid metabolism to sustain nerve function
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succinyl COa
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maintains myelin sheath (protective nerve covering)
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B12
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type of anemia caused by a deficiency of folic acid
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megaloblastic anemia
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responsible for red blood cell production and growth
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folic acid
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used in pregnancy to prevent neural tube defects
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folic acid
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can help treat liver disease due to alcohol abuse
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folic acid
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is necessary for the health of rapidly multiplying cells
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folic acid
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is supplemented for patients using methotrexate
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folic acid
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this type of anemia must be identified before treatment is started
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B12 deficient anemia
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the chemical produced by the kidney which stimulates
the bone marrow to produce red blood cells |
erythropoetin
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anemia caused by kidney disease
is treated with |
erythropoetin
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after 100% bone marrow destruction, only treatment is
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bone marrow transplantation
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stimulate production of white blood cells
& used after chemotherapy to prevent infection and strengthen the body’s defense |
sargramostim & filgrastim
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stimulates granulocytes and macrophages
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sargramostim
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stimulates neutrophils
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filgrastim
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side effects include bone pain, which can become crippling
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filgrastim
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condition which increases the body’s need for vitamins, Fe, folic acid and essential fatty acids
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pregnancy
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essential fatty acids
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promote nervous system and brain development
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pregnancy drug that acts as antihistamine (side effects: drowsiness and drying effect)
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meclizine
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pregnancy drug taken 12.5-25 mg 3xday
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meclizine
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used if meclizine does not work under severe circumstances, when well being is endangered
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tigan
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used when tigan fails
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zofran
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#2 complaint of pregnancy
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low back pain
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nonmedical treatment for low back pain
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heat and massage therapy
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Tylenol only (max dose 4000mg)
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medical treatment: for low back pain in pregnancy
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never use this drug during pregnancy
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aspirin
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harmless but uncomfortable complaint during pregnancy
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heartburn
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Mylanta, never sodium bicarbonate
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treatment for heartburn
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regular contractions causing dilation before week 37 of gestation
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Preterm labor
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% of births are premature
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12
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biggest concern with pre-term births (before 34 weeks)
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lung development
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speed up the development of the lungs, brain and intestines
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steroids (IV)
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test is done on the amniotic fluid to measure lung maturity
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L/S ratio (lecithin/sphingomyelin)
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as the baby’s lungs mature, lecithin increases and ____ decreases
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sphingomyelin
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nonselective beta stimulants used to relax uterine muscle.
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yutopar & brethine
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delay labor 24-48 hours to give steroids a chance to work
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yutopar & brethine
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increased heart rate in mother & fetus
( must measure mother’s pulse rate and BP) |
yutopar & brethine
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natural Ca+ channel blocker used when yutopar & brethine do not work to slow down labor
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magnesium
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blood levels of Mg need to be at ____ to take effect
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5-8mg/dL
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causes decreased BP & muscle weakness
must check reflexes and urine output |
magnesium
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baby will be lethargic for 24-48 hours after birth
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magnesium
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Ca+ given to mother when
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BP drops too low, while on magnesium
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condition occurring as a result of premature birth where the baby grunts while trying to breath
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respiratory distress syndrome
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reduce the surface tension in the lungs
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surfactants
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coat air sacs and enable them to expand and fill with oxygen
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surfactants
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this condition must be diagnosed and treated within 15 minutes of birth
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respiratory distress syndrome
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administered endotracheally (right into the lungs) of a baby
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surfactants
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exosurf & survanta
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surfactants
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