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Lexicomp Medications Test 1
Terms in this set (24)
Folic acid mechanism of action?
Folic acid is necessary for formation of a number of coenzymes in many metabolic systems, particularly for purine and pyrimidine synthesis; required for nucleoprotein synthesis and maintenance in erythropoiesis; stimulates WBC and platelet production in folate deficiency anemia.
Folic acid use?
Megaloblastic and macrocytic anemias due to folate deficiency: Treatment of megaloblastic and macrocytic anemias due to folate deficiency
Pradaxa Pharmacologic category?
Anticoagulant; Anticoagulant, Direct Thrombin Inhibitor; Direct Oral Anticoagulant (DOAC)
Xarelto pharmacologic category?
Anticoagulant; Anticoagulant, Factor Xa Inhibitor; Direct Oral Anticoagulant (DOAC)
Xarelto dental health professional considerations?
Medical consult is suggested prior to dental invasive procedures. At this time there are no coagulation parameters for rivaroxaban to predict the extent of bleeding. Increased bleeding may occur during invasive dental procedures in patients taking rivaroxaban. Currently, postsurgical treatment with rivaroxaban is ~12 days for knee replacement patients and ~35 days for hip replacement patients. There are no reports of interactions between the anticoagulant and amoxicillin, cephalexin, cefazolin, ampicillin, or clindamycin; therefore, any of these preprocedural antibiotics can safely be used in patients taking rivaroxaban. Routine coagulation testing (INR) is not required, or necessary, for Direct-Acting Oral Anticoagulants (DOAC).
Warfarin pharmacologic category?
Anticoagulant; Anticoagulant, Vitamin K Antagonist
Warfarin mechanism of action?
Hepatic synthesis of coagulation factors II (half-life 42 to 72 hours), VII (half-life 4 to 6 hours), IX, and X (half-life 27 to 48 hours), as well as proteins C and S, requires the presence of vitamin K. These clotting factors are biologically activated by the addition of carboxyl groups to key glutamic acid residues within the proteins' structure. In the process, "active" vitamin K is oxidatively converted to an "inactive" form, which is then subsequently reactivated by vitamin K epoxide reductase complex 1 (VKORC1). Warfarin competitively inhibits the subunit 1 of the multi-unit VKOR complex, thus depleting functional vitamin K reserves and hence reduces synthesis of active clotting factors
Warfarin effects on bleeding? Tooth extraction
A recent study assessed the amount of bleeding during a single tooth extraction in patients who remained on warfarin during the procedure versus those who discontinued warfarin (Karsli 2011). All patients had coronary artery disease. There was no significant difference in bleeding with or without warfarin. The mean blood loss was 2486 ± 1408 g in the warfarin group, compared to 1736 ± 876 g in the patients who stopped warfarin. The mean INR value in the warfarin group was 2.6 ± 0.7. Hemostasis was successfully established locally by packing the extraction sockets with oxidized cellulose (Surgicel) and suturing with 3-0 silk sutures.
Warfarin effects on bleeding? Concurrent antibiotic use?
A retrospective study evaluating over 38,000 patients ≥65 years of age showed exposure to any antibiotic agent was associated with at least a 2-fold increased risk of bleeding that required hospitalization among continuous warfarin users (Baillargeon 2012). All five antibiotic drug classes examined (macrolides, quinolones, cotrimoxazole, penicillins, and cephalosporins) were associated with an increased risk of bleeding. Exposure to an azole antifungal (fluconazole, ketoconazole, or miconazole) while on warfarin was associated with a 4-fold increased risk of bleeding.
Warfarin dental health professions considerations?
It is important to discuss patient with physician or to ask for recent INR result to ensure that patient is within a reasonable range prior to an invasive dental procedure. One clue to determine how stable a patient is on warfarin therapy is to assess how often the patient gets INRs drawn. Recent frequent blood draws may suggest poor control on the patient's warfarin regimen. Surgery is generally acceptable for patients on warfarin with an INR between 2 to 3. Assess potential interactions when prescribing an antibiotic in patients on warfarin. Educate patients, who may require significant acetaminophen doses for multiple consecutive days to control dental pain, on the effects on warfarin (increased INR). NSAIDs do not have effects on INR but may increase the risk of bleeding while on warfarin.
Plavix generic name?
Plavix pharmacologic category?
antiplatelet agent, thienopyridine
Plavix effects on dental tx?
Aspirin in combination with clopidogrel (Plavix®), prasugrel (Effient®), or ticagrelor (Brilinta™) is the primary prevention strategy against stent thrombosis after placement of drug-eluting metal stents in coronary patients. Premature discontinuation of combination antiplatelet therapy (ie, dual antiplatelet therapy) strongly increases the risk of a catastrophic event of stent thrombosis leading to myocardial infarction and/or death, so says a science advisory issued in January 2007 from the American Heart Association in collaboration with the American Dental Association and other professional healthcare organizations. The advisory stresses a 12-month therapy of dual antiplatelet therapy after placement of a drug-eluting stent in order to prevent thrombosis at the stent site. Any elective surgery should be postponed for 1 year after stent implantation, and if surgery must be performed, consideration should be given to continuing the antiplatelet therapy during the perioperative period in high-risk patients with drug-eluting stents.
Meloxicam pharmacologic category?
Analgesic, Nonopioid; Nonsteroidal Anti-inflammatory Drug (NSAID), Oral
Meloxicam mechanism of action?
Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties
Osteoarthritis: Relief of the signs and symptoms of osteoarthritis (OA); management of OA pain.
Rheumatoid arthritis (tablet and suspension only): Relief of signs and symptoms of rheumatoid arthritis (RA); relief of the signs and symptoms of pauciarticular or polyarticular course juvenile RA in patients ≥2 years (suspension) and in patients weighing ≥60 kg (tablet).
Meloxicam effects on dental tx?
Key adverse event(s) related to dental treatment: Taste perversion, ulcerative stomatitis, and xerostomia (normal salivary flow resumes upon discontinuation). The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®). See Effects on Bleeding.
Humira generic name?
Humira pharmacologic category?
Humira use in rheumatoid arthritis?
Rheumatoid arthritis: Treatment (to reduce signs/symptoms, induce major clinical response, inhibit progression of structural damage, and improve physical function) of active rheumatoid arthritis (moderate to severe) in adults; may be used alone or in combination with methotrexate or other nonbiologic DMARDs
Humira effects on bleeding?
Rare reports of pancytopenia (including aplastic anemia), as well as medically significant thrombocytopenia, have been reported with tumor necrosis factor-alpha therapy; in patients undergoing active treatment, a medical consult is recommended
Methotrexate pharmacologic category?
Antineoplastic Agent, Antimetabolite (Antifolate); Antirheumatic, Disease Modifying; Immunosuppressant Agent
Methotrexate nononcology uses related to rheumatoid arthritis?
Oncology uses: Acute lymphoblastic leukemia (ALL) maintenance treatment, ALL meningeal leukemia (preservative-free only; prophylaxis and treatment); treatment of trophoblastic neoplasms (gestational choriocarcinoma, chorioadenoma destruens and hydatidiform mole), breast cancer, head and neck cancer (epidermoid), cutaneous T-Cell lymphoma (advanced mycosis fungoides), lung cancer (squamous cell and small cell), advanced non-Hodgkin lymphomas (NHL), osteosarcoma (preservative-free only).
Methotrexate effects in dental tx?
Key adverse event(s) related to dental treatment: Ulcerative stomatitis, gingivitis, glossitis, and mucositis (dose dependent; appears 3-7 days post-therapy and resolves within 2 weeks). Dental professionals should note before prescribing NSAIDS that concurrent administration with methotrexate may cause severe bone marrow suppression, aplastic anemia, and GI toxicity (see Warnings/Precautions). Although the risk is lower at the methotrexate dosages used for rheumatoid conditions/psoriasis, the addition of an NSAID or salicylate may still lead to unexpected toxicities; caution is warranted.
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