rbeck911 ivy tech advanced pharm - week 2 drugs

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clopidogrel, Plavix

Antiplatelet drug that prolongs bleeding time by inhibiting platelet aggregation directly inhibiting ADP binding to its receptor. This binding is irreversible and the platelet will be affected for the remainder of it's lifespan. Overdose requires platelet transfusion to prevent hemorrhage. Pharm class: ADP receptor blocker. seen in patients with recent hx of MI, CVA, or PAD. ALso for unstable angina.

heparin, Heplock

anticoagulant (parenteral) A natural substance found in the liver and lining of blood vessels. Normal function is to prolong bleeding coagulation time, thereby preventing excessive clotting within blood vessels. It prevents enlargement of existing clots and formation of new ones.It binds to antithrombin III, inactivating several clotting factors and inhibits thrombin activity. IV Onset of action is immediate, subcu onset may take up to 1 hour. Used to treat DVT, pulmonary embolism, unstable angina, evolving MI, and prevention of thrombosis. For overdose or hemorrhage, administer protamine sulfate. Pharm class is indirect thrombin inhibitor.

warfarin, Coumadin

An oral anticoagulant. It's indications include CVA, MI, DVT, and pulmonary embolism in surgery patients. Also used to prevent thromboembolic events in high risk patients (following MI, or a-fib). Unlike heparin, this anticoagulant can take several days to reach it's max effect. This explains why the use of this and heparin are overlapped. This drug inhibits the action of vitamin K, and synthesis of clotting factors II, VII, and X are diminished. Because these clotting factors are normally circulating in the blood, it takes several days for their plasma levels to fall and for this drug to take effect. Another reason for the slow onset is that 99% of the drug is bound to plasma proteins and is thus unavailable to produce it's effect. For overdose, treat with Vit. K.Pharm class: Vit. K antagonist.

epoetin alfa, Epogen

This drug for anemia is made through recombinant DNA technology and is functionally identical to erythropoietin. Because of its ability to stimulate erythropoiesis, it is effective in treating disorders caused by a deficiency in RBC formation. Drug is used for chronic renal failure (lack of erythropoietin secretion), cancer treatments (anemia caused by antineoplastic agents), given prior blood transfusions or surgery, and anemia in HIV patients. Usually subcu. May increase risk of serious cardiac events, increased risk of DVT, and may promote tumor progression. Contraindicated in patients with uncontrolled HTN. Overdose may lead to polycythemia, which may be corrected by phlebotomy. Pharm class: Hematopoietic growth factor, erythropoietin.

filgrastim, Nepogen

This drug for increasing neutrophil production is produced through recombinant DNA technology. It's two primary actions are to increase neutrophil production in the bone marrow and to enhance the phagocytic and cytotoxic functions of exisitng neutrophils. Used for patients with neutropenia, cancer patients (neutropenia from antineoplastic agents damaging bone marrow), bone marrow or stem cell transplant patients, and Aids patients with immunosuppression. Subcu or IV. May cause bone pain, development of allergic reaction, and is contraindicated in patients allergic to E. coli (used to make drug). There is no treatments of overdose. Pharm class: Colony stimulating factor

cyanocobalamin, Calomist

This drug for anemia is a vit. B12 supplement and indicated in patients with pernicious anemia. Given IM or subcu. Parenteral administration rapidly reverses most S&S of pernicious anemia. Patients must take it the rest of their lives. May cause hypokalemia, rashes, itching, or anaphylaxis. Contraindicated in patients with cobalt of folic acid anemia, severe pulmonary disease, and used cautiously in patients with heart disease because of the potential of sodium retention. No overdosage has been reported. Pharm class: Vitamin supplement.

ferrous sulfate, Feosol

This agent for anemia is an iron supplement containing 20-30% of elemental iron. The dose of these various preperations are based on their iron content. Patients with iron deficiency respond rapidly to the administration of this drug. Response usually achieved in 48 hours, but therapy may continue for several months to replenish iron storage depots. Hgb and HCT are monitored regularly as excess iron is toxic. Adverse affects are GI upset, constipation. Dairy slows absoprtion, Vit. C increases it. Overdose treament with deferoxamone as it binds iron and is removed by kidneys. Pharm class: Iron supplement.

atorvastatin, Lipitor

This antihyperlipidemic's primary indication is high cholesterol. The statins act by inhibiting HMG-CoA reductase. As the liver makes less cholesterol, it responds by making more LDL receptors on liver cells. This results in increased removal of LDL from blood. Therapeutic level takes 2 weeks to reach. Patients should be placed on a low cholesterol diet to increase the actions. Ruduces risk of MI and CVA. Prengancy catagory X. Adverse affects is GI upset, diarrhea, constipation, liver damage, and most serious is rhabdomyolysis. Contraindicated in pations with serious liver disease, elevated serum transaminases. risk of rhabdo increases with concurrent administration of macrolide antibiotics. Drug may increase digoxin levels by 20%, and erythromycin may increase this drugs levels by 40%. Patients should not drink grapefruit juice! There is not treatment for overdose. Pharm class: HMG-CoA reductase inhibitor, statin.

Cholestyramine, Questran

This antihyperlipidemic is a powder that is mixed with fluid before being taken. It is not absorbed or metabolized once it reaches the intestine, so it won't exert systemic effects. Therapeutic range takes 30 days or more. It binds with bile acids containing cholesterol in a insoluble complex that is excreted in feces, and the cholesterol levels decrease with fecal loss. May cause constipation, bloating, gas, and nausea. Contraindicated in patients with total biliary obstruction. No treatment for overdose. Pharm class: Bile acid resin.

Niacin

This drug is a B vitamin supplement that occurs naturally in plants and animals. Mech of action: Decrease VLDL levels. It's primary use is to lower triglycerides and increase HDL levels. Adverse effects are flushing, hot flashes, nausea, excess gas, diarrhea. More seriously, hepatotoxicity, and gout.

gemfibrozil, Lopid

This antihyperlipidemic causes a 50% reduction in VLDL with an increase in HDL. The mechanism is unknown. It is less effective than statins at lowering LDL, thus not the first drug of choice for LDL levels. Contraindicated in pt's with hepatic impairment, severe renal dysfunction, or pre-existing gallbladder disease. Concurrent use with anticoagulants may potentiate anticoagulant effect. Concurrent use with statins increases the risk of myopathy and Rhabdomyolysis. No treatment for overdose. Pharm class: Fibric acid agent.

Vitamin K

This supplement plays a vital role in blood clotting. It is found in green leafy vegetables. So it is used to reverse the effects of "blood thinning" medications when too much is given; to prevent clotting problems in newborns who don't have enough of this; and to treat bleeding caused by medications including salicylates, sulfonamides, quinine, quinidine, or antibiotics. Healthcare providers also give this med by injection to treat clotting problems.

Retavase

Thrombolytic drug used for Improving heart function and reducing long-term effects of a heart attack. It may also be used for other conditions as determined by your doctor. It is a tissue plasminogen activator. It works by activating a substance that helps to break up blood clots. Blood clots can prevent oxygen and nutrients from getting to the heart, which causes tissue death and long-term damage to the heart.

Protamine sulfate

a sterile, non-pyrogenic, isotonic solution that is a heparin antagonist. It is also a weak anticoagulant. IV drug. Neutralizes heparin by forming heparin-protamine complex.May be partially metabolized or may be cleaved by fibrinolysin, thus freeing heparin. Treatment of heparin overdose.

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