Drug Mgmt

Question 1

Virchow’s Triangle is?

Answer 1

Trigger for thrombosis:

Hypercoag state
Endothil injury
Circulatory stasis

Question 2

Warfarin indicated for tx of?

Answer 2

Prophy/tx of v thromb, PE, card emboli, thromb complications from a fib or valve placement

Post MI prophy of new MI or thromb events

Question 3

Warfarin mechanism?

Answer 3

inhib vit K activation ->
depleats clotting factors

4-5 day load time

Question 4

Recommended INR?

Answer 4

2 - 3

2.5 -3.5 if heart valve

Question 5

Warfarin + Heparin standards?

Answer 5

Min 5 day overlap

Stop heparin when INR at correct level

Question 6

Warfarin dosing?

Answer 6

Initiate 5mg (2mg if old, etc)
Titrate w/ daily INR until right level

Monitor INR every 1-4wks

Question 7

Warfarin contraindicated for?

Answer 7

Pregnancy
Alchol/drug abuse
Frequent falls
Unreliable behavior

Question 8

Warfarin overdose presents?

Answer 8

Blood in urine/stool
Bruising
Bloody nose/gums
Heavy flow

Question 9

Warfarin drug interactions: cause potentiation (bleeding)?

Answer 9

Alcohol w/ liver dz
Aspirin
Acetaminophen
NSAIDs
Sulfa

Question 10

Warfarin drug interactions: cause inhibition (less effective)?

Answer 10

Barbiturates
Bile sequestrants
Anti-convulsants

Question 11

Tx of warfarin overdose?

Answer 11

Stop warfarin, monitor INR 1-2 days

Oral Vit K1 (takes 6-10 hrs)

IV Vit K1 (take few hrs)

Plasma infusion

Prothrombin Complex Concentrate (PCC)

Question 12

Digoxin toxicity exacerbated by?

Answer 12

hypoK+
hypoxemia
hypothyroid
renal insuff
hypovol
meds

Question 13

Digoxin toxicity presentation?

Answer 13

Arrhythmias, (C) PAT w/ block

N/V/D anorexia

∆d mental state, visual disturbances

Question 14

Digoxin toxicity tx?

Answer 14

Discontinue
Balance K+
Cardiac monitoring
φ cardioversion

Fab antibody fragments

Question 15

Dilantin is?

Answer 15

anticonvulsant

Small ↑ in dose cause large ↑ in serum levels

Question 16

Dilantin toxicity presentation?

Answer 16

(Draw drug level while sxs present)

Nystagmus
Tremor
Ataxia
Dizzy
Slurred speech

Question 17

Digoxin levels peak how long after ingestion?

Plateau?

When do you draw blood to check levels?

Answer 17

30-90 min

6-8 hrs

6-8 hrs

Question 18

Digoxin therapeutic range?

Answer 18

0.5 - 2

Question 19

Digoxin loading dose if faster tx needed?

Answer 19

0.25-0.5mg STAT
w/ 0.25mg Q 6hrs
x max 1.5mg/day

Question 20

Digoxin maint dose?

Answer 20

0.125-0.25 mg/day

Question 21

Dilantin therapeutic level?

Draw to eval levels when?

Answer 21

10-20

Just before next dose

Question 22

Dilantin levels peak when?

Answer 22

4-8 hrs (oral)
15 min (IV)

Question 23

Dilantin S/E?

Answer 23

rash
lethargy
gingival hypertrophy
megaloblastic anemia
benign lymphoid hyperplasia

Question 24

Dilantin toxicity tx?

Answer 24

no antidote