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The Macstrak Project Medication Classification. The Macstrak Project Issues Macstrak follows drug interventions by drug class rather than the specific.

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Presentation on theme: "The Macstrak Project Medication Classification. The Macstrak Project Issues Macstrak follows drug interventions by drug class rather than the specific."— Presentation transcript:

1 The Macstrak Project Medication Classification

2 The Macstrak Project Issues Macstrak follows drug interventions by drug class rather than the specific agent (e.g. B blocker po rather than metoprolol) to get reliable data first need to ensure understanding of where data captured on Macstrak form need to know proper drug classes need to know the generic as well as trade names accuracy in form completion improves as staff become more comfortable with knowing the drug classes teaching resources available for staff on Macstrak website

3 The Macstrak Project In this presentation 1.Review – where data collected on Macstrak forms 2.Understand – description of each drug class 3.Review– tables of generic versus brand name 4.Learn – resources available for on-going support

4 The Macstrak Project Yes Thrombolysis Here EMS Other Hosp Dose: (mg/units) Duration: (min) Pt.Weight: (kg) Reperfusion Therapy: No Not Indicated: ECG Not Diag. ST Up Transient Too Late Given (Other Hosp) Risk: Risk of ICB Risk Other Bleed Other: ……………...... Drug:TNK/rtPA SK r-PA ( reteplase ) Other Adjuvant: ASA Heparin GP2b/3a Inhibitor blocker IV Clopidogrel Other............................... and/or Primary/Rescue PCI Here Transfer Reperfusion Therapy Decided by:EP Consultant Yes Thrombolysis Here EMS Other Hosp Dose: (mg/units) Duration: (min) Pt.Weight: (kg) Review - Macstrak Form Three sections where medications tracked on the CCU form: 1. ACS Initial Management – Adjuvant Therapy

5 The Macstrak Project Acuity: Shift: Diuretics……………………… Inotropes IV………………….. ETT/Vent…………………….. PA Line………………………. TTVP………………………… IABP…………………………. ACS: RSCP - Ischemia – Definite…. – Probable… CK (+ve)………………...…… Troponin (+ve)……………….. NTG IV………………………. Heparin – UFH……………..... – LMWH……………. Other Antithrombin………...… GP 2b/3a Inhibitor IV……...… Clopidogrel (or thienopyridne)..… Cardiac Cath……………….... PCI…………………………... Outcomes: VF/Sustained VT………….… Infarction (new/repeat) *(1) …... Thrombolysis (new/repeat) *(2).. Stroke *(3) ……………………. Major Bleed *(4) ……………… Transfusion………………….. Crs1: ……………………….... Crs2: ……………………..….. None of the Above……….….. RN Initials ………………..…. Date: DNDNN D Review - Macstrak Form Three sections where medications tracked on the CCU form: 1.ACS Initial Management – Adjuvant Therapy 2.Course in CCU None of the Above needs to be marked if no medication/treatments are given – lets us know that the information is not missing.

6 The Macstrak Project Discharge Meds: ASA Clopidogrel (thienopyridine) Heparin (UF or LMW) Nitrates (po/top) B Blocker ACEI A2 Blocker Statin None of the Above Review - Macstrak Form Three sections where medications are tracked on the CCU form: 1.ACS Initial Management – Adjuvant Therapy 2.Course in CCU 3.CCU Discharge None of the Above needs to be marked if no medication is given – lets us know that the information is not missing.

7 The Macstrak Project Review - Macstrak Form One section where medications are tracked on the ER form: 1.Course in ER ACS Management: (all) ASA Heparin UFH Heparin LMWH Clopidogrel (thienopyridine) GP2b/3a Inhibitor IV Other Antithrombin NTG IV NTG topical/po Blocker IV Blocker po Calcium Antagonist (any) ACEI A2 Blocker Research Protocol None of the Above None of the Above needs to be marked if no medication is given – lets us know that the information is not missing. Optional fields are available to track specific medications if your unit wishes.

8 The Macstrak Project Review - Macstrak Form One section where medications are tracked on the Ward form: 1.Course in Ward None of the Above needs to be marked if no medication is given – lets us know that the information is not missing. Optional fields are available to track specific medications if your unit wishes.

9 The Macstrak Project Thienopyridines - What & How oral anti platelet therapy indications: – ACS – stents – aspirin is not tolerated – dual anti platelet therapy desired ADP-receptor antagonist binds irreversibly to P2Y 12 receptors, modify the platelet P2Y 12 receptor therefore ADP cant bind to it reduces platelet aggregation that persists for the life of the platelets

10 The Macstrak Project Thienopyridines -Who Generic NameBrand Name clopidogrelPlavix ® ticlopidineTiclid ® prasugrelEffient * * Drug has not yet come to market.

11 The Macstrak Project GP2b/3a inhibitors -What anti platelet therapy IV indications: – ACS – PCI final step in platelet aggregation - binding of fibrinogen between two platelets at the GP2b/3a receptor, inhibitors block this final pathway, decreasing platelet aggregation regardless of the mechanism by which the platelets are activated issue for all these therapies has been determining effective dosing

12 The Macstrak Project GP2b/3a inhibitors - How

13 The Macstrak Project GP2b/3a inhibitors - Who Generic NameBrand Name abciximabReopro ® eptifibatideIntegrillin ® tirofibanAggrastat ®

14 The Macstrak Project UF Heparin - What & How antithrombin indications: –ACS –atrial fibrillation –deep vein thrombosis –pulmonary embolism UF Heparin binds to the enzyme inhibitor antithrombin (AT) causing a conformational change that results in its activation through an increase in the flexibility of its reactive site loop activated AT then inactivates thrombin, with also a lesser effect on factor Xa

15 The Macstrak Project LMW Heparins - What & How antithrombin indications: –ACS –atrial fibrillation –deep vein thrombosis –pulmonary embolism sub group of proteins included in UFH although all different protein groups - they have a greater effect on anti factor Xa PT/PTT cannot be used to follow they are not bound to acute phase reactants therefore dose response is more predictable

16 The Macstrak Project Heparins - Who Generic NameBrand Name heparin (unfractionated)Hepalean ® enoxaparinLovenox ® dalteparinFragmin ® tinzaparinInnohep ®

17 The Macstrak Project mostly direct thrombin inhibitors but a variety of targets indications: –heparin-induced thrombocytopenia (HIT) –PCI –ACS most are intravenous only exception coumadin new oral agents in development Other Antithrombins–What & How

18 The Macstrak Project Generic NameBrand Name argatrobanArgatroban ® bivalirudinAngiomax ® lepirudinRefludan ® danaparoidOrganon ® fondaparinuxArixtra ® warfarinCoumadin ® dabigatranPradaxa * Other Antithrombins - Who * Drug has not yet come to market.

19 The Macstrak Project β-blockers - What & How beta (alpha) adrenergic receptor antagonists indications: –arrhythmias –AMI cardioprotection –decrease incidence of occlusion events fight or flight block the action of endogenous catecholamines (epinephrine – adrenalin and norepinephrine – noradrenaline) on β- adrenergic receptors part of the sympathetic nervous system cardioprotection, management of cardiac arrhythmias, blocks activation of clotting system reduces the sympathetic activation of platelets, and the clotting system (PAI-1)

20 The Macstrak Project β-blockers - Who Generic NameBrand Name acebutalolSectral ® atenololTenormin ® carvedilolCoreg ® labetalolTrandate ® metoprololLopresor ® nadololCorgard ® propanololInderal ® sotalolSotacor ® bisoprololMonocor ®

21 The Macstrak Project ACE inhibitors - What Angiotensin-Converting Enzyme inhibitor decreasing the activation of the renin/angiotensin system indications: –prevention of cardiovascular events –CHF –hypertension –left ventricular dysfunction Reduces PAI-1 levels to decrease clot formation reduces afterload, lowers arteriolar resistance, decreases cardiac work and oxygen demand lowers renovascular resistance, increases natriuresis (excretion of sodium in urine)

22 The Macstrak Project ACE inhibitors - How

23 The Macstrak Project ACE inhibitors - Who Generic NameBrand Name benazeprilLotensin ® captoprilCapoten ® cilazaprilInhibace ® enalaprilVasotec ® fosinoprilMonopril ® lisinoprilPrinivil ®, Zestril ® quiniprilAccupril ® ramiprilAltace ®

24 The Macstrak Project A2 blockers - What & How angiotensin receptor blocker indications: –hypertension - intolerance to ACE inhibitors modulate the renin-angiotensin-aldosterone system by blocking activation of angiotensin II AT 1 receptors causes vasodilation effects are similar to ACEI but no cough as do not inhibit the breakdown of bradykinin or other kinins

25 The Macstrak Project A2 blockers - Who Generic NameBrand Name candesartanAtacand ® irbesartanAvapro ® losartanCozaar ® telmisartanMicardis ® valsartanDiovan ®

26 The Macstrak Project Statins - What & How cholesterol lowering agent - reduces inflammation indications: – reducing LDL cholesterol – ACS secondary prevention – CAD primary prevention high-risk groups statins block an enzyme (HMG-CoA reductase) involved in producing cholesterol within liver cells stimulates LDL receptor results in an increased clearance of low- density lipoprotein (LDL) from the bloodstream and a decrease in blood cholesterol levels

27 The Macstrak Project Statins - Who Generic NameBrand Name fluvastatinLescol ® lovastatinMevacor ® pravastatinPravachol ® simvastatinZocor ® atorvastatinLipitor ®

28 The Macstrak Project Diuretics - What & How Increase natriuresis – renal excretion of sodium indications: –heart failure –hypertension act at a variety of targets within the nephron each class has a different specific mechanism of action, but typically share outcome of changing the way the kidneys handle salt - inhibit sodium re-absorption lowering blood pressure and cardiac workload

29 The Macstrak Project Diuretics - Who Generic NameBrand Name furosemideLasix ® ethacrynic acidEdecrin ® bumetanideBurinex ® chlorothiazideDiuril ® hydrochlorothiazideHydroDiuril ®, Esidrix ® indampimideLozol ® metolazoneZaroxolyn ® chlorthalidoneHygroton ® spironolactoneAldactone ®

30 The Macstrak Project Nitrates - What vasodilation - venous indications: –AMI –ischaemic heart disease –heart failure –pulmonary edema –hypertension increase venous capacitance reduces venous return, reducing preload dilate coronary blood vessels improves O2 supply to the myocardium dilate peripheral arteries reduces afterload and work done by the heart

31 The Macstrak Project Nitrates - How

32 The Macstrak Project Nitrates - Who Generic NameBrand Name nitroglycerin IVNitroglycerin IV ® isosorbide dinitrate SLIsordil ® nitroglycerin ointmentNitrobid ®, Nitiol ® nitroglycerin patchesTransderm-Nitro ®, Nitro-Dur ®,Nitrodisc ® isosorbide dinitrate poIsordil ®

33 The Macstrak Project Inotropes - What & How positive inotropic agents increase myocardial contractility indications: –cardiogenic shock - hypotension –AMI –CHF effects are dose-dependant increases cardiac output and blood pressure

34 The Macstrak Project Inotropes - Who Generic NameBrand Name dopamineIntropin ® dobutamineDobutrex ® epinephrineEpinephrine ® norepinephrineLevophed ® milrinonePrimacor ® isoproterenolIsuprel ®

35 The Macstrak Project Calcium Antagonists - What & How negative inotropic effect - decreases myocardial contractility, increases vasodilation indications: –hypertension –angina –atrial fibrillation/flutter block volt-gated calcium channels in muscle cells – calcium levels drop – less muscle contraction Decrease blood pressure, reduces afterload decreasing amount of oxygen required by heart does not decrease the responsiveness of the heart to input from the sympathetic nervous system

36 The Macstrak Project Generic NameBrand Name amlodipineNorvasc ® diltiazemCardizem ® nicardipineCardene ® nifedipineProcardia ® verapamilIsoptin ® felodipinePlendil ® Calcium Antagonists - Who

37 The Macstrak Project Resources The following are ways to ensure staff knowledge of drug classifications and drug penetrance is at suggested guideline levels: Macstrak unit manual – make available at nursing station – available on website Medication List – post in rooms or nursing station – available on website Macstrak Quarterly or Macstrak Nursing News – available on website Reports – review penetrance Audits – Project Office will notify coordinator if on-going issues


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