PC 707 Module 4 Exam - Cardiac Q & A Coenzyme Q-10 in the treatment of lipids: -potential link with decrease in coenzyme Q10 & heart failure--may be a predictor of mortality* -statins decrease conenzyme-Q10 levels--whi
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PC 707 Module 4 Exam - Cardiac Q & A Coenzyme Q-10 in the treatment of lipids: -potential link with decrease in coenzyme Q10 & heart failure--may be a predictor of mortality* -statins decrease conenzyme-Q10 levels--which are also in muscle tissue--could be a casual link to statin induced myopathy* -could benefit patients with heart failure* Use of turmeric for lipid and inflammation treatment? -anti-inflammatory -if used daily for 3 months can decrease total cholesterol, LDL, VLDL, and triglycerides* -blocks inflammatory cytokines & enzymes including COX2 -same target as celecoxib (Celebrex) -AVOID using anticoagulants--may potentiate effects* -AVOID if about to have surgery, pregnant*, gallbladder disease What can green tea do? -may decrease blood pressure if drink 600 mL/day -associated with decreased risk of CAD* Yoga & Meditation in the treatment of HTN? -decreases blood pressure* -can be used as natural alternative -Meditation has a greater effect on those >60 years old -Yoga has a greater effect on those <60 years old When do we screen for dyslipidemia in children? -around ages 9-11 & 17-21 or sooner if significant risk factors are present* -lifestyle first--strict diet, refer to dietician, dash diet, exercise--can decrease LDL & increase HDL within 8 weeks* -Statins are usually only for children 10 years and older -Bile acid sequestrants may not be the best option as it increases triglycerides and DEPLETE folate, carotenoids, vitamin D -Niacin has limited safety & efficacy in children When would bile acid sequestrants be used in pregnancy? -can be used to treat intrahepatic cholestasis--accumulation of bile acids in liver & skin -A/E of this condition include severe priuritis, preterm birth, still birth, fetal death. -delivery is the cure -ursodeoxycholic acid (Actigall) can be used to manage symptoms until delivery is appropriate* What are anticoagulants? -disrupts the coagulation cascade or suppresses production of fibrin -warfarin (Coumadin), Heparin, vitamin K antagonists, direct factor Xa inhibitors, direct thrombin inhibitors* What are anti platelets? -inhibits platelet aggregation -prevents thrombosis in the arteries -aspirin (ASA), NSAIDs, anti-platelets (Plavix) Warfarin (Coumadin): -anticoagulant--suppresses coagulation by decreasing the production of 4 vitamin K dependent factors* -vitamin K antagonist* -oral -long half-life; can be used long-term prophylaxis -used to prevent thrombosis* -dosing is based on comorbidities, other medications used, genetics/metabolism -a small dose can have a greater effect than expected* -Monitored with PT and/or INR* -lab values can be effected quickly as warfarin effects aren't immediate/delayed onset--8-12 hours* Black box warning for warfarin (Coumadin)? -may cause major or fatal bleeding* Warfarin use in pregnancy & lactation? -contraindicated in pregnancy--category X--can cross placenta and could cause fetal malformations or CNS defects--fetal warfarin syndrome* -use lovenox (low-molecular weight heparin) or heparin unfractionated in pregnancy* -use cautiously with breastfeeding--make sure to monitor infants for bleeding or bruising* S/E & special considerations with warfarin (Coumadin)? -S/E--->bleeding, long term therapy may weaken bones, risk for hemorrhage -Many potential drug to drug interactions--use caution with other drugs that could increase risk of bleeding (Heparin, ASA, non-aspirin platelet drugs, acetaminophen (APAP), antibiotics)* Contraindications with warfarin (Coumadin)? -recent hemorrhagic stroke -risk of or active major bleeding -recent trauma -any situation which increases risk of bleeding Patient teaching regarding warfarin (Coumadin)? -greens, green tea, canola oil, soybean oil, mayo can impact bleeding time* -use electric razor -do not use aspirin (ASA) or other NSAIDS* -monitor for bleeding (nose, stools, bruises) -wear med alert bracelet and card in wallet What is the typical starting dose for warfarin (Coumadin)? Who would need a lower dose? -typical starting dose is 5mg/day -lowered dose is usually necessary with elderly, CHF, malnourished, liver disease, recent major surgery, fever, hyperthyroidism, if using other medications that can impact bleeding times* Why would genetic testing be helpful before starting a patient on warfarin (Coumadin)? -it could test for genetic variations in metabolism to determine how each individual person metabolizes warfarin -this can determine how low or high of dose is given -can decrease the risk of bleeding/hemorrhage (dose too high) or the risk of clots (dose too low)* What is fetal warfarin syndrome? When is it most likely to occur? -facial abnormalities, respiratory difficulties, airway obstruction -could cause spontaneous miscarriage, still birth, neonatal death -the most critical period for which this occurs is the 1st trimester (6-9 weeks)* What can be used to antagonize warfarin effects? -vitamin K Heparin (unfractionated): -anticoagulant -suppresses coagulation by enhancing anti-thrombin--which inactivates two major clotting factors (thrombin & factor Xa) -used in prophylaxis for DVT & thrombosis* -rapid-acting* -injection only -does NOT cross placenta or enter breastmilk -aPTT is used to monitor therapeutic levels* -normal aPTT is 40 seconds (heparin prolongs it to 60-80 seconds)* -heparin levels are variable--intensive monitoring is required* Low molecular weight heparin: -also enhances anti-thrombin--which inactivates two major clotting factors (thrombin & factor Xa) -fixed doses -injection--but can be used at home--no monitoring needed*
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