Anticoagulation/Antihypertensive Medications
What are the two antiplatelets we've covered?
Aspirin and Clopidogrel (Plavix)
What is the most common type of arrythmia?
Atrial fibrilation
What is the reversal agent for Heparin?
Protamine Sulfate
What is an adverse effect seen with vasodilators?
Reflex tachycardia - a reaction to a sudden drop in BP
How is Enoxaparin (Lovenox) different from Heparin?
Renal toxicity - we should check BUN and creatinine levels AND we do not need to monitor aPPT levels
What are the two oral Factor Xa Inhibitors?
Rivaroxaban (Xarelto) and Apixiban (Eliquis)
Which type of diuretic leads (potentially) to increased Potassium levels?
Spironolactone
What route of administration can we use for Enoxaparin (Lovenox)?
Sub Q
What are the two types of Factor Xa Inhibitors?
Sub Q and Oral
What types of calcium channel blockers affect heart rate and dysrhythmias?
The ones that end in "amil" or "izem" (Verapamil/Calan or Diltiazem/Cardizem)
What is the reversal agent for Factor Xa Inhibitors?
There is none
Why are Factor Xa Inhibitors more convenient than Warfarin (Coumadin)?
They don't require any sort of monitoring or dietary restrictions
How do anticoagulants work?
They work by preventing fibrin formation, which allows the body to breakdown the weaker platelet plug
How many types of Beta Blockers are there?
Three - Cardio selective - Non-cardio selective - Topical for glaucoma
True or False - The side effects/adverse effects for topical beta blockers are the same as non-topical beta blockers?
True
What cardiac adverse effect are we concerned about with calcium channel blockers?
hypotension
What are 2 adverse effects of Alpha 2 Adrenergic Agonists?
hypotension and rebound hypertension
When are two instances where a Direct Thrombin Inhibitor antagonist may be used?
in rare case or during dialysis
What do vasodilators treat?
- HTN - Angina - Heart failure
What are four reasons a patient may be prescribed an ACEI or ARB?
- HTN - Heart failure - MI - Diabetic nephropathy
What are the 3 subcutaneous anticoagulation medications?
- Heparin - enoxaparin (Lovenox) - fondaparinux (Arixtra)
What are the 3 vasodilators we've covered?
- Isosorbide (Isordil) - Hydralazine (Apresoline) - Nitroglycerin (Nitro)
How many types of diuretics are there?
- Loop (Furosemide/"Lasix" and Bumetanide/"Bumex) - Thiazide (Hydrocholorothiazide/"Hydrodiuril") - Potassium sparing (Spironolactone)
For what three diagnoses would we prescribe an antiplatelet?
- MI - PAD - Ischemic stroke
What are three labs you need to monitor when taking Heparin?
- Platelets - H & H - aPPT
What are the three anticoagulant medications used to address atrial fibrilation?
- Warfarin (Coumadin) - Oral Factor Xa Inhibitors - Direct Thrombin Inhibitors
What are the 3 adverse effects associated with diuretics?
- electrolyte imbalance - potassium imbalance (hypo with loop/thiazides and hyper with potassium sparing) - dehydration
What are 3 ways we know diuretics are working?
- increased urination - decreased edema - decreased BP
How do blood clots form?
- vessel damage - platelets go to site and become activated - once activated, platelets bind to RBC's and form a "plug" - fibrin strands strengthen and solidify the plug
What are the 3 oral anticoagulation medications?
- warfarin (Coumadin) - Xa inhibitors like rivaroxaban (Xarelto) and apixaban (Eliquis) - direct thrombin inhibitors like dabigatran (Pradaxa)
Once a clot develops in your left atrial appendage, where does it go?
It drops to the left ventricle, and then travels through the aortic valve into the ascending aorta
What labs do we monitor with patients taking a statin, and how often?
LFT's and Cholesterol every 3-6 months
What kinds of food are rich in vitamin K?
Leafy greens
What diuretic is the most "aggressive" and leads to the most fluid loss?
Loop
What type of heart valve lasts for >20 years and requires lifelong anticoagulation?
Mechanical heart valves
Do Direct Thrombin Inhibitors require a bridge treatment?
No - this is why they work quicker than Warfarin
What are the two types of toxicity we're concerned about with Aspirin?
Ototoxicity and nephrotoxicity
What are the 2 routes Alpha 2 Adrenergic Agonists can be given?
PO or transdermal patch
What specific lab are we concerned about with Warfarin (Coumadin)?
PT/INR
What should patients taking Spironolactone avoid consuming?
Potassium supplements or salt substitutes
What are 4 reasons a patient may be prescribed a beta blocker?
- Angina - HTN - MI/CAD - Heart Failure
With vasodilators, what vital signs should we monitor?
- BP - HR
What 3 things do we want to continually asses with a patient taking calcium channel blockers?
- BP - HR - Bowels
What are the 4 adverse effects of ACEI's and ARB's ("FAJA")
- First dose effect - Angioedema - Hypotension - Hyperkalemia
One in how many strokes is caused by atrial fibrilation?
1 in 7
For slow moving or pooling of blood, we use which of the following?
Anticoagulants
Aspirin is an example of a?
Antiplatelet
What kind of medication is used for smaller arterial thrombi?
Antiplatelets
Which works quicker - anticoagulants or antiplatelets?
Antiplatelets, because anticoagulants work on EXISITING clots and prevents the formation of fibrin. Antiplatelets prevent the formation of clots all together by inhibiting platelet aggregation
What is a major adverse affect of statins?
Apparently just "myopathy"
Why do ACEI's and ARB's lead to hyperkalemia?
Because Aldosterone leads to the release of Potassium in the body. When ACEI's and ARB's prevent the release of Aldosterone, they also prevent the release of potassium. This leads to a build up in our system.
Why are ACEI's and ARBS good for patients diagnosed with diabetic nephropathy?
Because they increase blood flow to the kidneys and improve renal perfusion
What are the two types of topical beta blockers?
Betaxolol (Betoptic S) and Timolol (Timoptic)
What type of heart valve lasts for 8-10 years and requires no anticoagulation?
Biologic heart valves
In non-cardio selective beta blockers, what's an adverse effect we should look out for?
Bronchoconstriction
How do beta blockers work?
By blocking beta receptors, which are responsible for adrenaline. As a result, we experience the opposite effects of adrenaline (decreased HR versus tachycardia, etc.)
How do topical beta blockers work?
By decreasing intraocular pressure
How do antiplatelets work?
By inhibiting platelet aggregation and activation
What is an example of an Alpha 2 Adrenergic Agonist?
Clonidine ("Catapres")
What GI adverse effect are we concerned about with calcium channel blockers?
Constipation, because they can negatively affect the muscle of the intestinal tract.
What is a respiratory symptom commonly seen with ACEI's?
Cough (non-productive)
What two things do all anticoagulants treat and prevent?
DVT and PE
What do anticoagulants look to prevent (and if unsuccessful, treat)?
DVT and the possible pulmonary embolism (PE) that follows
How do you know if Clonidine is working?
Decrease in BP is observed
What type of anticoagulant is Dabigatran (Pradaxa)?
Direct Thrombin Inhibitor
How do we know if a medication is a statin?
Ends in "-statin"
What is similar to Heparin, but lower in molecular weight?
Enoxaparin (Lovenox)
What are the two Warfarin alternatives we've covered?
Factor Xa Inhibitors and Direct Thrombin Inhibitors
(True or False) Do anticoagulants breakdown clots?
False
(True or False) Atrial fibrilation increases your risk of stroke 8x
False - increases your risk of stroke 5x
(True or False) Antiplatelets are reversible?
False - they are non reversible
True or False - Patients taking Warfarin (Coumadin) should avoid consuming Vitamin K?
False - they should continue to eat them in moderation
(True or False) Anticoagulants are used for arterial thrombi?
False - they're used for venous thrombi
What is a phenomenon (adverse effect) we see with ACEI's and ARB's?
First Dose Effect - a hypersensitivity or reaction to the first exposure of a medication (vasodilation).
What routes can vasodilators be given?
Five (total) - sublingual - buccal - transdermal - topical - IV
Which is the Sub Q Factor Xa Inhibitor?
Fondaparinux (Aritrxa)
When are Factor Xa Inhibitors usually used?
For patients with a Heparin allergy
What are two reasons a statin would be prescribed?
For patients with hypertriglyceridemia and dyslipidemia
What are two reasons someone may need long term anticoagulation therapy?
For post-op prosthetic heart valve and atrial fibrilation patients
What are two aspirin-specific adverse effects?
Gastric bleeding/ulcerations and renal imparment
What disease do topical beta blockers treat?
Glaucoma
What type of food should be avoided when taking a statin?
Grapefruit
What do Alpha 2 Adrenergic Agonists treat?
HTN
What is "HIT"
Heparin Induced Thrombocytopenia
What type of toxicity are we concerned about with statins?
Hepatotoxicity
What are the two routes of administration for heparin?
IV and subcutaneous
When should a patient take their statin?
In the evening
When should patients take their Alpha 2 Adrenergic Agonists?
In the evening (due to drowziness)
What type of angina is a medical emergency?
Unstable angina
What is the reversal agent for Warfarin (Coumadin)?
Vitamin K
When are vasodilators contraindicated?
With other vasodilators or erectile dysfunction medications (example: Viagra)
Can anticoagulants be considered a prophylactic?
Yes
What is rebound hypertension?
Your body's reaction to a sudden decrease in BP
What happens during heparin induced thrombocytopenia?
Your platelet count decreases (less than 100,00 or more than or equal to a 50% drop). You're also at a higher risk for blood clots
How do we know if a medication is a Calcium Channel Blocker?
it ends in "-pine" or "amil"/"izem"
How do we know if a medication is an ACEI?
it ends in "-pril"
How do we know if a medication is an ARB?
it ends in "-sartan"
What does prophylaxis mean?
preventative treatment
What happens to your BP, HR, and (potentially) your respiratory rate when taking beta blockers?
they decrease
Do beta blockers lead to vasoconstriction or vasodilation?
vasodilation
