MOA/functions
Statins
Inhibits an enzyme essential for cholesterol synthesis
- Lowers LDL, Triglycerides and increases HDL
Adverse effects of gemfibrozil
Gallstones, hepatotoxicity
What to monitor in patient on warfarin
INR
Normal range= 2-3, 3.4 and above may indicate bleeding
Patient teaching regarding Niacin
May cause flushing, take aspirin 30 minutes before administration of niacin to prevent flushing
Fibrinolysis
1. Clot forms
2. 24-48hrs later fibrinolysis begins
3. tPA converts plasminogen to plasmin
4. Plasmin digests fibrin and clot dissolves
5. Circulation is restored
-Vitamin K antagonists, inhibits clotting factors II, VII, IX, X
Warfarin
Adverse effects of Heparin
HIT, bleeding
Black box warning: Epidural/spinal hematomas lead to paralysis over time
What to monitor with patient on statin
Liver function tests
CK levels
Patient teaching regarding antiplatelets
DON'T STOP ABRUPTLY
Heparin pharmacokinetics
Onset Peak Duration
-O: 30–60 min
-P: 2 h
-D: 8–12 h
Gemfibrozil
- Exact MOA is unknown
- Generally lowers VLDL, and increases HDL
Bleeding, Injection site hematomas, lower risk of HIT, spinal/epidural hematoma risk
Enoxaparin
D/dimer
For DVT/PE, will be increased
Contraindications for Heparin
• Thrombocytopenia
• Uncontrollable bleeding
• During and immediately after surgery of the eye, brain, or spinal cord
Characteristics of Left hemisphere stroke
Right-sided hemiparesis (weakness/paralysis)
Vision loss in right visual field of eye
Aphasia
Impaired memory/judgement
Enoxaparin
Hypotension and/or bradycardia (If given rapidly)
Aminocaproic Acid (Amicar)
What to monitor in patient taking Cholestyramine
GI effects, vitamins
What should patients avoid when on warfarin?
-Vitamin K rich foods
- Always consult a doctor when taking any OTC meds when on warfarin
Set of three clinical signs (hypertension, bradycardia, respiratory depression) that indicate increased ICP
Cushing's Triad
Difference in function between Thrombolytic and Hemostatic drugs
Thrombolytic: Converts plasminogen → plasmin, which dissolves fibrin clots
Hemostatic: Inhibits plasminogen activation--> stabilizes clots
Adverse effects of Ezetimibe
Nasopharyngitis, diarrhea, myalgia
Heparin effects on lab tests
Increased free fatty acids, ALT, AST
Decreased Serum cholesterol and triglycerides
Key nursing considerations for Alteplase therapy
- Give within 3 hours
- Monitor neuro status q15
- No antiplatelets for 24h
- Avoid IM injections
Drugs for hyperlipidemia that cause hepatotoxicity/liver dysfunction
Statins, niacin, gemfibrozil