Cholesterol
Balanced diet, weight loss, exercise 30 in/day, reduce sat fat, consume plant sterol, increase soluble/total fiber, total calories to maintain/lose weight. Minimize risk factors (hyperglycemia, smoking, high fat diet),
Warfarin MOA
MOA: inhibit hepatic synthesis of factor X (& “other factors”)
MOA facto Xa inhibitor (xeralto, Eliquis)
Inhibit factor Xa
Causes and treatment of Iron Deficiency anemia
Iron Supp ADR
Causes: GI Bleed, PUD, GI CA, prego, menses
TX Mild: increase dietary iron rich food
Severe: iron supp, IV/IM iron if can't take PO
ADR: constipation, toxicity
MOA and ADE of Statins
MOA: Block synthesis of cholesterol in liver by inhibiting HMG coA reductase activity.
*Check Lipid panel before starting
ADE: Interact w/ CYP, HA, myalgia, fatigue, GI intolerance, flu-like symptoms
MOA and ADR LMwH
Labs to check?
inactivates factor III to influence factor X
ADR: renal problems can extend halflife
Ok in prego
check PT and aPPT
ADE of factor Xa inhibitors
ADE: Can be CYP3A4 inhibitors and inducers
BBW: increased risk of thrombotic events if DC of anticoagulant, & spinal/epidural hematoma
Pernicious cause, tx, ADR
Cause: B12 deficiency (usually inflam disease of SI or gastric resection)
Tx: B12
ADR: uncommon
Hypokalemia, rash, itch, NA retention
How do statins affect lipid panels
Decrease LDL by 25-65%
Decrease TG's by 10-40%
Increase HDL by 5-17%
Warfarin: Indication, ADE, Dose, Testing
Indication: DVT, PT
ADE: bleeding, allergic, many CYP interactions
Dose: Start @5mg/day (7.5 if >80kg)
Testing: INR daily until therapeutic (2-3) x2 days
2-3x/week x 1-2 weeks
then Q 6 weeks
MOA of thrombin inhibitors
Pradaxa: dabigatran prodrug inhibits clot-bound and circulating thrombin
thrombin required to convert fibrinogen to fibrin
Folate Deficiency causes and treatment
Cause: GI disorders, chronic ETOH, poor diet
Tx: FA
ADR:
MOA of Cholesterol absorption inhibitor
MOA Zetia: inhibits intestinal absorption of cholesterol and related phytosterols. Most effective in combo w/ statin.
Advantages and disadvantages of Warfarin
Disadvantages: pt education diet limitations, CYP highly interactive, frequent labs
Advantages: reversible (Vit K, FFP, PCC) PO, once daily dosing (or less)
Thrombin inhibitors: Indications, Contraindications, and ADE
Indication: prevention/management of VTE, stroke prevention in AFib or ischemic heart disease
CI: prosthetic heart valves, prego
Most common SE: GI
Anemia of chronic disease (cause, tx)
Tx: Epoetin alpha
Indication of LMWH
Bridging, joint replacement
Describe the 3 morphologies of Anemia
Pernicious (-B12) anemia, Folic acid deficiency anemia: macrocytic normochromic
Iron deficiency anemia, Thalassemia: microcytic hypochromic
Aplastic, hemorrhagic, sickle cell: normocytic normochromic