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Pharm2 > Exam2 > Flashcards

Exam2 Flashcards

1
Q

common uses of anticoagulants

A
  • prevention/treatment of MI and stroke
  • prevention/treatment of DVT
  • atrial fibrillation
  • artificial heart valves
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2
Q

antiplatelets to know

A
  • aspirin

- clopidogrel

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3
Q

anticoagulants to know

A
  • heparin
  • enoxaparin
  • warfarin
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4
Q

problem with antiplatelets/anticoagulants?

A
  • watch signs of bleeding
  • increased HR
  • decreased BP (hypovolemia)
  • petechiae
  • coffee-ground emesis
  • black tarry stools (melena)
  • advise clients to use soft brittle brush and electric razor
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5
Q

heparin characteristics

A
  • rapid acting
  • SHORT half-life
  • requires close monitoring
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6
Q

heparin PTT levels

A

normal: 40seconds
Therapeutic: 60-80 secs

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7
Q

antidote for heparin and enoxaparin

A

protamine

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8
Q

enoxaparin characteristics

A
  • rapid acting
  • LONGER half-life
  • more predictable (less monitoring)
  • subcutaneous injection (Lovenox= “love handles”)
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9
Q

warfarin characteristics

A
  • takes 5 days to start working (delay onset)

- must maintain CONSISTENT intake of vitamin K (green leafy veggies and mayo)

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10
Q

PT/INR levels (for warfarin)

A

Normal: 1
Therapeutic: 2-3
Mechanical heart valves: 3-4.5

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11
Q

antidote for warfarin

A

vitamin K

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12
Q

herbals that can increase the risk of bleeding

A
  • garlic
  • ginger root
  • gingko biloba
  • glucosamine
  • feverfew (migraines)
  • saw palmetto
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13
Q

RBC “ingredients”

A
  • iron
  • vitamin B12
  • folic acid
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14
Q

anemia caused by a lack of erythropoietin. mechanism

A

erythropoietic meds are synthetic versions of human erythropoietin. once injected, they trigger the bone marrow to start producing more RBCs

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15
Q

common uses of erythropoietic meds

A
  • anemia of chronic kidney disease
  • chemotherapy-induced anemia
  • HIV-infected clients taking zidovudine (AZT)
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16
Q

erythropoietic meds to know

A
  • epoetin alfa

- darbaepoetin (long-acting)

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17
Q

whats the problem with erythropoietic meds?

A
  • hypertension**
  • cardiovascular events (HF, MI, stroke, etc)
  • tumor progression (cancer patients)

*ensure adequate iron levels

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18
Q

what must you monitor FIRST when clients are taking epoetin alfa and darbapoetin?

A

HYPERTENSION

-stop treatment if HgB > 11 gm/dL or an increase > 1 gm/dL in a 2-week period

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19
Q

Iron meds for anemia

A
  • ferrous sulfate (PO only)

- iron dextran (IV or IM)

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20
Q

iron deficiency

A 
5% of US population
daily Fe requirements:
-men: 8mg
-women: 15-18mg
-infants: 11mg
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21
Q

dietary sources of iron

A
  • red meat
  • liver
  • egg yolks
  • grains
  • yeast
  • green leafy veggies
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22
Q

ferrous sulfate

A
  • food greatly reduces absorption (try to take between meals with OJ)
  • GI problems (nausea, constipation)
  • dark green or black stools (harmless; normal side effect)
  • teeth staining (liquid form)
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23
Q

vitamin b12 deficiency

A
  • leads to anemia and nerve damage
  • caused by poor absorption (celiac disease or lack of intrinsic factor)
  • pernicious anemia (“silent killer”)
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24
Q

dietary sources of vitamin b12

A

dairy products (lots of vitamin b12 but no iron)

-milk baby syndrome (only drinking milk; no iron)

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25
Q

beefy red tongue

A

can happen when a person has pernicious anemia (lack of vitamin b12)
-also paresthesias (“pins and needles”) can be caused from vitamin b12 deficiency anemia

26
Q

folic acid deficiency

A
  • caused by malabsorption, disorders, and alcoholism
  • causes neural tube defects (spina bifida) if levels are low early in pregnancy (must take before and during pregnancy)
  • follic acid is essential to the production of DNA and erythropoeisis (RBCs, WBCs and platelets)
27
Q

dietary sources of follic acid

A

green leafy veggies

28
Q

blood products to know

A
  • packed red blood cells (PRBCs)
  • platelets
  • fresh frozen plasma (FFP)
  • albumin
29
Q

whats the problem with blood products:

A
  • acute hemolytic
  • febrile nonhemolytic
  • anaphylactic reactions
  • mild allergic reactions
  • hyperkalemia (PRBCs)
  • volume overload (pulmonary edema)
30
Q

what is the main cause of acute hemolytic rxn?

A

ABO incompatibility (client got the wrong blood)

  • most likely to occur in the first 20 min
  • STOP TRANSFUSION STAT
  • signs/symptoms: chills, fever, tachycardia, low back pain (kidneys), red urine

-must change the tubing, start normal saline, double check the right product was given and call the prescriber

31
Q

you only have ___ hours to infuse PRBCs once the blood leaves the blood black

A

4

-has to be refrigerated; higher for infection risks

32
Q

whats the ONLY fluid that can be transfused with blood?

A

normal saline

33
Q

T2D is at greater risk for:

A

hyperglycemic hyperosmolar syndrome (HHS)

-t2d is caused by decreased sensitivity to insulin and inadequate insulin secretion

34
Q

oral diabetic classes

A
  • biguanides (metformin)
  • sulfonylureas
  • meglitinides
  • thiazolidinediones
35
Q

mechanism of action of metformin

A
  • decreases the absorption of glucose in the gut
  • reduces the production of glucose within the liver
  • increases insulin sensitivity in the cells
36
Q

notable problems with metformin

A
  • anorexia, N/D, flatulence (take with meals)
  • weight loss (about 7lbs)
  • vitamin b12 and follic acid deficiency
  • lactic acidosis
37
Q

lactic acidosis

A

(rare) (metformin)
- low body pH= body will get rid of co2
- breathing faster= hyperventilation
- myalgia
- taking metformin + alcohol

38
Q

sulfonylureas to know

A

(oral antidiabetic meds)

  • glipizide
  • glyburide
  • glimepiride
39
Q

mechanism of action of sulfonylureas

A

-stimulate the pancreas to release more insulin, causing the blood glucose to decrease

40
Q

notable problems with sulfonylureas

A
  • hypoglycemia! (take with breakfast)
  • weight gain (5-10lbs)
  • must avoid alcohol (may cause disulfiram-like rxn and increases risk of hypoglycemia) - palpitations, emesis
41
Q

mixing insulins instructions

A
  • air in cloudy (nph) then clear

- draw air out from clear then cloudy

42
Q

risk factors for stomach ulcers

A
  • helicobacter pylori (70-90%)– take antibiotics (amoxicillin and clarithromycin)
  • medications (NSAIDS- ketorolac, corticosteroids, potassium, bisphosphonates, KCL, chemo)
  • stress (acute illness, ventilator, extensive burns, head injury)
  • tobacco use
  • alcohol use
  • acidic foods
43
Q

common uses of proton pump inhibitors (PPI)

A
  • peptic ulcer disease
  • gastroesophageal reflux disease (GERD)
  • heartburn
44
Q

PPI to know

A

ending in -prazole

  • omeprazole
  • esomeprazole
  • pantoprazole
  • lansoprazole
45
Q

PPI mechanism of action

A
  • blocks the H+K+ATPase pumps in the stomach, causing them to STOP producing gastric acid
  • effect lasts 1-3days until body can produce new pumps
46
Q

notable problems with PPIs

A
  • short half-life and only bind to ACTIVE pumps (so take before breakfast)
  • dont crush or chew (may become inactivated with stomach acid)
  • rebound symptoms if abruptly stopped
  • rare effects with chronic use (pneumonia, osteoporosis, hypomagnesemia)
47
Q

common uses of H2 blockers

A
  • peptic ulcer disease
  • gastroesophageal reflux disease (GERD)
  • heartburn

SAME AS PPIs

48
Q

h2 blockers to know

A

ending in -tidine

  • ranitidine
  • cimetidine
  • famotidine
49
Q

h2 blocker mechanism of action

A
  • block histamine-2 receptors in the stomach, reduces the production of gastric acid
  • not as strong, work quicker
50
Q

notable problems with h2 blockers

A
  • well-tolerated
  • not as potent as PPIs
  • diminished effect over time
  • rebound symptoms if abruptly stopped
  • confusion (if poor renal function) usually elderly pts
51
Q

antiemetic meds (meds to help not throw up)

A
  • ondansetron
  • promethazine
  • metoclopramide
52
Q

odansetron

A

antiemetic

  • “clean” drug
  • blocks serotonin receptors in the CTZ and vomiting center
  • works better if administered beforehand (chemo)
53
Q

problems with odansetron

A
  • headache
  • diarrhea, constipation
  • dizziness
  • prolonged QT intervals (torsade–>vfib–>rip)
54
Q

promethazine

A

antiemtic

-“dirty” drug
h1 blockade: sedation, dry mouth (anticholinergics)
d2 blockade: extrapyramidal symptoms
a1 blockade: orthostatic hypotension

  • contraindicated for children <2 (stop breathing)
  • infiltration can lead to gangrene
55
Q

metoclopramide

A
  • blocks dopamine (d2) and serotonin receptors in the CTZ and vomiting center
  • also promotes gastric motility (speeds gastric emptying) (great for clients with diabetic gastroparesis–> not passing food thru sphincter)
56
Q

metoclopramide problems

A
  • dizziness

- extrapyramidal symptoms (do not tale longer than 3 monts)

57
Q

laxatives to know

A
  • docusate sodium
  • polyethylene glycol 3350
  • bisacodyl
  • lactulose
58
Q

docusate sodium

A 
(laxative)
-surfactant laxative (stool softener)
great for:
-prophylaxis
-prevention of painful elimination
-prevention of straining
59
Q

polyethylene glycol 3350

A
  • osmotic laxative (pulls water into GI tract)
  • BM in 2-4 days
  • mix in 4-8oz of fluid
60
Q

bisacodyl

A
  • stimulant laxative (irritates GI tract)

- BM in 12hrs (PO) or 1hr (PR)

61
Q

lactulose

A
  • osmotic laxative
  • more expensive and unpleasant (flatulence and cramping) than other laxatives
  • primarily given because it helps the intestines excrete ammonia (for hyperammonia)
62
Q

laxative overuse

A
  • dehydration
  • electrolyte imbalances
  • loss of normal defecation reflux

Pharm2 (7 decks)

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