Pharm 2 Exam 1 Flashcards
1
Q
Thiazide Diuretic
hydrochlorothiazide (HCTZ) Indications
A
Edema, HF, Diabetes, HTN, Idiopathic Hypercalciuria
2
Q
Loop Diuretic
furosemide (lasix) indications
A
Management of edema in HF, Hepatic or Renal disease, HTN, Hypercalcemia
3
Q
*Potassium-Sparing Diuretic
spironolactone (Aldactone) indications
A
Hyperaldosteronism, HTN,
Reversing of hypokalemia casued by Potassium-Wasting diuretics,
heart failure in pediatric patient.
4
Q
Thiazide Diuretic
hydrochlorothiazide (HCTZ)
Contraindications/Precautions
A
Allergy, Hepatic Coma, Anuria, Severe Renal Failure
5
Q
Loop Diuretic
furosemide (lasix)
Contraindications/Precautions
A
Allergy, hepatic coma, severe electrolyte loss
6
Q
Potassium-Sparing Diuretic
spironolactone (Aldactone)
Contraindications/Precautions
A
Allergy, Hyperkalemia, Renal Failure, Anuria
7
Q
Thiazide Diuretic
hydrochlorothiazide (HCTZ)
Side/Adverse Effects
A
Hypokalemia, Hypercalcemia, Hyperglycemia, Elevated Lipids, Elevatid Uric Acid
8
Q
Loop Diuretic
furosemide (Lasix)
Side/Adverse Effects
A
Hypokalemia, photosensitivity, dizziness, headache
9
Q
Potassium-Sparing Diuretic
spironolactone (Aldactone)
Side/Adverse Effects
A
Gynecomastia, amenorrhea, irregular menses, postmenopausal bleeding, hyperkalemia, dizziness, headache
10
Q
*Thiazide Diuretic
hydrochlorothiazide (HCTZ) Interactions
A
Corticosteroids,
digoxin,
oral hypoglycemics
11
Q
*Loop Diuretic
furosemide (Lasix) interactions
A
*NSAIDs - nephrotoxic - Increased BUN/Creatinine
*Vancomycin: nephrotoxic!!
Corticosteroids
*Digoxin - Increased levels - risk for toxicity
*Lithium - Increased levels - risk for toxicity
Aminoglycoside antibiotics
12
Q
Potassium-Sparing Diuretic
spironolactone (Aldactone) interactions
A
ACE Inhibitors, Lithium, NSAIDs
13
Q
*Thiazide Diuretic - hydrochlorothiazide (HCTZ) & Loop Diuretic
furosemide (Lasix) education
A
Potassium wasting so watch for Hypokalemia symptoms (Alkalosis, Shallow Resp., Irritability, Confuson, Weakness, Arrhythmias, Lethargy, Thready Pulse, Reduced Bowel Sounds
14
Q
*Potassium-Sparing Diuretic
spironolactone (Aldactone) education
A
*watch for Hyperkalemia (muscle twitching -> cramps -> parasthesia, irritability and anxiety, reduced BP, EKG changes, Dysrhythmias & Irregular Rhythm, Abdominal Cramping, Diarrhea)
15
Q
older adults & diuretics
A
Start with lower doses and gradually increase - goal is a lowest effective dose
Monitor for s/s of hyperkalemia, hypokalemia, dehydration, o/s hypotension
Change positions slowly
Have alternate methods for urination available (i.e. bedside commode, urinal)
16
Q
Cardiac Glycoside
digoxin (Lanoxin) indications
A
Systolic heart failure, atrial fibrillation
Action: Positive inotropic, negative chronotropic, negative dromotripic
17
Q
Cardiac Glycoside
digoxin (Lanoxin)
Contraindications/Precautions
A
Allergy, second or third-degree heart block, ventricular tachycardia or vibrilation, diastolic HF, subaortic stenosis
18
Q
Cardiac Glycoside
digoxin (Lanoxin)
Side / Adverse Effects
A
Brady/Tachycardia, Hypotension, Headache, fatigue, confusion, convulsions, colored vision, halo vision, anorexia, nausea, vomiting, diarrhea
19
Q
Cardiac Glycoside
digoxin (Lanoxin) Interactions
A
Amiodarone, quinidine, verapamil, these can increase levels by 50%
20
Q
Cardiac Glycoside
digoxin (Lanoxin) Admin
A
Low therapeutic index, levels are 0.5-2ng/mL
21
Q
Cardiac Glycoside
digoxin (Lanoxin)
Interventions / Considerations
A
*Low K+/Mg+ may increase toxicity
*Admin of Digoxicine immune Fab needed for severe toxicity
*Steps to manage Toxicity:
Discontinue, Begin ECG Monitoring & Give antidysrhythmics as ordered, Determine serum digoxin and electrolyte levels, admin K+ supplements for hypokalemia if indicated, institute supportive therapy for GI symptoms (N/V/D), Admin antidote (digoxin immune Fab) if indicated
22
Q
*digoxin (Lanoxin) s/s toxicity Education
A
Bradycardia, Headache, Dizziness, Confusion, Nausea, Blurred/Yellow Vision
23
Q
Order of Prescription for HF
A
Order of Prescription - ACE Inhibitors -> ARBs -> Beta Blockers -> Loop Diuretics -> Digoxin
24
Q
phosphodiesterase inhibitor
*milrinone (Primacor) indications
A
*ICU Setting for acute heart failure
Action: Positive inotropic, causes vasodilation
25
phosphodiesterase inhibitor
| milrinone (Primacor) Contraindications/Precautions
Allergy, aortic or pulmn. vasc. disease, diastolic HF
26
phosphodiesterase inhibitor
| milrinone (Primacor) Side / Adverse Effects
*Vent. dysrhythmia in 12% of patients, angina, hypokalemia, tremor, thrombocytopenia*
27
phosphodiesterase inhibitor
| milrinone (Primacor) Interactions
Using with diuretics can cause Hypovolemia and reuced cardiac filling
Additive inotropic effects if used with digoxin
28
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Class 1A (sodium channel blocker)
quinidine (Quinidex) Indications
```
Long term treatment of atrial fibrilation and atrial flutter
Action: Blocks sodium entry into cells, slowing impulse conduction
29
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Class 1A (sodium channel blocker)
quinidine (Quinidex) Contraindications/Precautions
```
Allergy, severe heart block, severe HF, asthma, myasthenia gravis, low WBCs
30
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Class 1A (sodium channel blocker)
quinidine (Quinidex) Side / Adverse Effects
```
GI, Hypotension, ventricular dysrhythmias (from toxicity), arterial embolism, cinchonism (tinnitus, visual disturbances, headache, N/V)
31
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Class 1A (sodium channel blocker)
quinidine (Quinidex) interactions
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Anticholinergics, antidysrhythmics, cholinergic, antihypertensives, digoxin, grapefruit juice
32
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Class 1A (sodium channel blocker)
quinidine (Quinidex) interventions/ considerations
```
```
Monitor pulse, bp, and GI
Keep patient supine during IV therapy
Monitor ECG periodically with oral and constantly with IV
Monitor toxicity
Use IV Pump!
Monitor s/s of cinchonism
```
33
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Class 1C (sodium channel blocker)
flecainide (Tambocor) indicaitons
```
Serious uncontrolled superventricular and ventricular tachydysrhythmias
Long-term for some supraventricular dysrhythmias
Action: Blocks sodium into cardiac cells
34
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Class 1C (sodium channel blocker)
flecainide (Tambocor) Contraindications/Precautions
```
Allergy, second or third degree AV block, prolonged QT interval, recent MI, shock, electrolyte imbalance
35
flecainide (Tambocor) Side / Adverse Effects
*Blurry vision/difficulty focusing
edema in lower extremities
widening or prolongation of QT interval
weight increase*
worsening HF, the potential for 1st deg. av block and multple dysrhytmias
36
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Class 1C (sodium channel blocker)
flecainide (Tambocor) interactions
```
digoxin, beta blockers, calcium channel blockers
37
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Class 1C (sodium channel blocker)
flecainide (Tambocor) Admin
```
Oral route only - pill
38
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Class 1C (sodium channel blocker)
flecainide (Tambocor) Interventions / Considerations
```
Montior for visual disturbances/changes in vision
Monitor for crackles in lungs, edema, wt. gain
Periodic ECG monitoring
Monitor blood levels to detect toxicity
Begin with the lowest dose and increase no more than every 4 days
39
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Class III (potassium channel blocker)
amiodarone (Cordarone, Pacerone) Indications
```
Life-threatening ventricular tachycardia or fibrillation that's resistant to other drugs
Treats atrial fibrillation
Action: Block potassium channels, decreases automaticity, decreases contractility, dilates coronary and peripheral vessels
40
```
Class III (potassium channel blocker)
amiodarone (Cordarone, Pacerone) Contraindications/Precautions
```
Pregnancy, lactation, allergy, shock, bradycardia, heart block, sinus node dysfunction, severe hepatic disease
41
*amiodarone (Cordarone)
| Side / Adverse Effects
GI, *pulmonary toxicity*, visual, cardiac, blue-grey discoloration of skin, CNS
42
```
Class III (potassium channel blocker)
amiodarone (Cordarone, Pacerone) Administration
```
PO/IV
During IV, monitor cardiac rhythm constantly
IV needs central line to prevent thrombophlebitis
43
*amiodarone (Cordarone) Interventions / Considerations
Monitor GI Symptoms
*Baseline and periodic chest x-ray and pulm. function tests* - Monitor for cough, dyspnea, difficulty breathing*
Auscultate breath sounds and report changes
Monitor vision or light sensitivity changes
HR/BP
Monitor wt. change, edema, skin discol and CNS effects
44
*verapamil (Calan) Indications
* Rapid ventricular response to atrial flutter
* Convert supraventricular tachycardia to regular sinus rhythm
* slow HR of atrial fibrillation and flutter*
action: Block calcium channels in myocardium, prolong PR interval
45
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Class IV (calcium channel blocker)
verapamil (Calan) Contraindications/Precautions
```
Allergy, severe hypotension, cardiogenic shock, liver or kidney dysfunction
46
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Class IV (calcium channel blocker)
verapamil (Calan) Side / Adverse Effects
```
Hypotension, bradycardia, HF, peripheral edema of ft/legs, lightheadedness, dizziness
47
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Class IV (calcium channel blocker)
verapamil (Calan) Interactions
```
Antihypertensives, lithium, grapefruit juice
48
```
Class IV (calcium channel blocker)
verapamil (Calan) Administration
```
PO with food
| IV - monitor vitals and cardiac rhythm continuously
49
Antidysrhythmics
Class IV (calcium channel blocker)
verapamil (Calan) Interventions / Considerations
Keep pt supine 1h following dose
Monitor BP carefully
Withold dose and notify for: BP < 90mmHg Sys OR pulse <60
Monitor for and report edema, low urine output, crackles in lungs, lightheadedness
Give PO dose with food
50
Unclassified Antidysrhythmic
| adenosine (Adenocard) Indications
Convert PSVT to sinus rhythm
Action: Slows conduction through AV, <10sec half life
51
Unclassified Antidysrhythmic
| adenosine (Adenocard) Contraindications/Precautions
Allergy, 2nd or 3rd degree heart block
52
Unclassified Antidysrhythmic
| adenosine (Adenocard) Side / Adverse Effects
Causes brief period of asystole
| All other s/e minimal due to short half life
53
Unclassified Antidysrhythmic
| adenosine (Adenocard) Interactions
rare
54
*For All Antidysrhythmics
| Contraindications/Cautions
```
* drug Allergy
2nd or 3rd deg AV block
Bundle branch block
Cardiogenic shock
Sick Sinus syndrome
ECG changes based on Cardiologist
other antidysrhythmics
```
55
*For All Antidysrhythmics
| AE/SE
```
ALL antidysrhythmics can cause dysrhythmias!
Hypersensitivity reactions
N/V/D
Dizziness
Headache
Blurred Vision
Prolongation of the QT interval
```
56
*For All Antidysrhythmics
| Therapteutic Response
```
Decreased BP in HTN pts
Decreased Edema
Decreased Fatigue
Regular HR
Improved regularity of rhythm
Improved Cardiac Output
Decreased occurrence of dysrhythmias
```
57
For All Antidysrhythmics
| Assessments (during)
Monitor Cardiac Rhythm, HR, BP, general well-being, skin color, temp, heart & lung sounds
Assess plasma drug levels
Monitor for AE & toxic effects
58
For All Antidysrhythmics Assessments (Pre)
```
Thorough drug&med history
Baseline BP, HR, IO, Cardiac Rhythm
Serum Potassium lvls before starting
Contraindications
Interactions
```
59
For All Antidysrhythmics Education
Take as scheduled
Do not skip or double doses
Contact provider if dose missed
Do not crush/chew sustained-release preps
Notify provider in case of: SOB, Edema, Dizziness, syncope, chest pain, gi distress, blurred vision, edema
60
Nitrate
| nitroglycerin (Nitro-Bid, Nitrostat) Indications
Treatment and prophylaxis of angina pectoris
61
Nitrate
| nitroglycerin (Nitro-Bid, Nitrostat) Contraindications/Precautions
Allergy, severe anemia, closed-angle glaucoma, hypotension, severe head injury
62
*Nitrate
| nitroglycerin Side / Adverse Effects
*Severe headaches (at first), orthostatic hypotension, tachycardia, tolerance*
63
Nitrate
| nitroglycerin (Nitro-Bid, Nitrostat) Interactions
Antihypertensives, alcohol, viagra, anticholinergics may decrease absorption of sublingual
64
*nitroglycerin Administration
*Sublingual - Tab under the tongue, 5 min, 911 then second tab, 5 min, 3rd tab
Sit or lie after taking first tab
*Sublingual spray - no more than 3 doses in 15 min
*Oral - do not swallow, dissolve
*Patches - prevention only - rotate sites, 10-12 hours a day
*Topical - Gloves, administer by inch
*IV - Glass bottle with special tubing. must be protected from heat and light.*
65
Nitrate
| nitroglycerin (Nitro-Bid, Nitrostat) Interventions / Considerations
Avoid touching ointment during application
Monitor baseline orthostatic BP and pulse
Monitor HR
May prescribe beta-blockers or calcium channel blockers to suppress tachycardia
Drug tolerance very fast
Check for interactions esp ED drugs
66
Nitrate
| nitroglycerin (Nitro-Bid, Nitrostat) Education
Take OTC analgesics to relieve headache pain
Report dizziness or syncope
Change positions slowly
Monitor HR and report Tachycardia
Remove patch each day, never more than one patch at a time
67
*Know proper storage of nitroglycerin tablets:
*Comes in a glass bottle
Must be protected from heat and light
Should not be left in a room where the temperature is warmer than 86 degrees Fahrenheit*
68
*Nitrate
| nitroglycerin (Nitro-Bid, Nitrostat) Rapid and long acting
* Rapid acting trats acute angina attacks. SubL/IV
| * Long acting for preventions. PO/TD
69
*Anticoagulant
| heparin (Heparin Sodium) indications
DVT & pulm. embolism prophylaxis, atrial fibrilation with embolization
action: Inhibit clotting factors & prevent dev. of fibrin
70
Anticoagulant
| heparin (Heparin Sodium) Contraindications/Precautions
Uncontrolled bleeding, severe thrombocytopenia, bleeding, hematoma, anemia
71
*Anticoagulant
| heparin (Heparin Sodium) Side / Adverse Effects
*Thrombocytopenia, heparin-induced thrombocytopenia*, bleeding, hematoma, anemia
72
Anticoagulant
| heparin (Heparin Sodium) Interactions
*NSAIDs, aspirin, antiplatelet drugs increase bleeding rist; Herbals: ginger, ginko biloba, feverfew, evening primrose oil; IV nitro reduces anticoag. properties*
73
Anticoagulant
| heparin (Heparin Sodium) Administration
```
*Assess baseline vitals & blood values
Goal: aPTT at 1.5-2x baseline
Doublecheck all doses!*
Injection: Subq in abd 2" from umb.
Do not aspirate or massage, apply pressure for 1-2 min., rotate sites
*IV Bolus - immediate effect
*Antidote = IV protamine sulfate
1 mg can reverse 100 units of heparine
```
74
*Anticoagulant
| heparin (Heparin Sodium) Interventions / Considerations
*Freq. monitor aPTT, doses are adjusted based on the aPTT level, bolus dose admin first*
For toxicity/od - stop drug & admin antidote
Toxicity s/s: Hematuria, melena, petechia, eccymosis, gum/mucus membrane bleed.
75
heparin Education
Report bruising, petechiae, hematomas, black tarry stools, calf pain, tenderness, swelling, shorness of air
76
Heparin-Induced Thrombocytopenia Info type 1 and 2
Type 1: Gradual reduction in platelets, therapy can generally continue
Type 2: Acute fall in number of platelets (more than 50% from baseline, discontinue heparin
77
*Anticoagulants (heparin, enoxaparin, warfarin)
Inhibit the action or formation of clotting factors
| Prevent clot formation
78
*Antiplatelet drugs (clopidogrel)
Inhibit platelet aggregation
| Prevent platelet plugs
79
*Thrombolytic drugs (alteplase)
Lyse (break down) existing clots
80
Anticoagulant
| enoxaparin (Lovenox) indications
* Anticoagulant Bridge Therapy*; Prophylaxis and *treatment of DVT/PE*
action: Inhibits clotting factors and prevents clot dev.
81
Lovenox Contraindications/Precautions
Allergy, uncontrolled *bleeding, use of an *Alcohol
82
lovenox SE/AE
Bleeding, thrombocytopenia, hematoma, anemia
83
lovenox interactions
*Other anticoags. increase risk for bleeding; NSAIDs, asprin & antiplatelets also increase bleed risk*
84
*lovenox Admin
*Subq in prefilled syringe, do not expel air bubble, one-time use syringe - self adminstering at home. (teach pt)*
85
lovenox Interventions / Considerations
No labs needed
| Monitor for bleeding/bruising
86
Anticoagulant
| warfarin (Coumadin) indications
Prevention of venous thrombosis and PE; ischemic CVAs secondary to afib, thromboembolism in pts w/ prosthetic heart valves, recurrent MI and TIA
action: Inhibit vitamin K dependent clotting factors
87
warfarin (Coumadin) Contraindications/Precautions
Allergy, pregnancy (teratogenic), *uncontrolled bleeding, liver disease, *alcoholism, vitamin k deficiency, clients prepping for lumbar puncture, brain, or spinal surgery
88
warfarin Side / Adverse Effects
Bleeding, lethargy, muscle pain, purple toes
89
warfarin interactions
*Heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides & cephalosporins increase anticoag effects; phenobarbital, carbamazepine, phenytoin & vitamin K decreases anticoag effects; excessive intake of foods high in vitamin K decrease anticoag effects*
90
warfarin Admin
PO
Measure baseline PT/INR and continue to monitor through therapy
Target INR 2-3, report outside range
Monitor INR every 2-4wk once the dose is correct
Can take 5 days to reach full effects, use heparin or enoxaparin as a bridge
91
warfarin Interventions / Considerations
*Monitor PT/INR, know normal values and therapeutic ranges
Toxicity: Discontinue warfarin, may take 36-42 hours before liver can resynth enough clotting factors to reverse effects; vitamin K can hasten return, high doses of vitamin K (10mg) given IV will reverese within 6 hrs*
92
warfarin education
Importance of regular labs, signs of abnormal bleeding, bleed prevention, medical alert bracelet, avoid high vitamin K foods,
93
Antiplatelet
| *clopidogrel (Plavix) indicaitons
* Reduce risk for MI, ischemic CVA, angina; prevent reocclusion of coronary stents*
action: Inhibit platelet aggregation
94
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Antiplatelet
clopidogrel (Plavix) Contraindications/Precautions
```
Peptic ulcer disease, *bleeding disorders, thrombocytopenia, intracranial bleeding, *Alcohol
95
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Antiplatelet
clopidogrel (Plavix) Side / Adverse Effects
```
*Gastric upset, abd. cramping, n/v, diarrhea, small risk for *gastric ulcers and bleeding; risk for TTP > causes clots in small vessels > impairs blood supply to vessels
96
```
Antiplatelet
clopidogrel (Plavix) Interactions
```
Anticoagulants, NSAIDs, glucocorticoids, alcohol increase bleed risk; ginger, ginko biloba, feverfew & evening primrose oil increase bleed risk; proton pump inhibitors decrease effectiveness
97
```
Antiplatelet
clopidogrel (Plavix) Administration
```
PO once daily w/ or w/o food
Check platelet counts periodically
*Stop drug 5-7 days before elective surgery*
98
*Antiplatelet
| clopidogrel (Plavix) Education
Report: gastric irritation, *easy bruising/bleeding*, sudden severe headache, weakness/numbness/paralysis, vision changes, N/V, seizures
*Can take with food, milk or water to minimize GI effects, Avoid alcohol*
99
*Thrombolytics
| alteplase (Activase) indications
*DVT, massive PE,*
*reestablish patency of occluded central iv caths*
arterial thrombolysis
actions: Activates fibrinolytic system: bust clots
100
Thrombolytics
| alteplase (Activase) Contraindications/Precautions
Intracranial hemorrhage, hemorrhagic CVA, known cerebrovascular lesion such as arteriovenous malform. or aneurysm, *active internal bleeding*, suspected aortic dissection, facial/head trauma w/in 3 mos, brain tumor, pericarditis
101
Thrombolytics
| alteplase (Activase) Side / Adverse Effects
Internal bleeding (intracranial, GI); superficial (needle puncure sites, wounds)
102
Thrombolytics
| alteplase (Activase) Interactions
Anticoags, NSAIDs, heparin, warfarin, antiplateletes and other thrombolytics increase bleed risk
103
Thrombolytics
| alteplase (Activase) Administration
*IV infusion - typically given
Give w/in 4-6 hours of symptoms or 3-4.5 hours of CVA symptoms*
Assess baseline clotting and vitals
Ensure IV access for emergency drugs
Following ateplase, give heparin or aspirin to avoid re-thrombosis
also used to reverse the s/s of an ischemic CVA (stroke) with 3 hrs of the onset of stroke s/s for max effectiveness
104
alteplase (Activase) education
Report unusual, prolonged bleeding, unilateral weakness, headache, dizziness
105
* Anticoug (warfarin)
| * normal therapeutic ranges of PT/INR
PT Normal Levels: 11-13 seconds
PT Therapeutic Levels: target is about 1.5 times the normal value or about 18 seconds
INR Normal Levels: 1.1 or below
INR Therapeutic Levels: 2.0-3.0 with average of 2.5
For those with recurring clots 2.5-3.5 with an average of 3.0
106
what is one s/s of ALL anticoagulants to report!!
excessive bleeding
107
HMC-CoA Reductase Inhibitor statin
| *atorvastatin (Lipitor) Indications
Elevated blood cholesterol
Elevated triglycerides
hyperlipidemia - 1st therapy,
signs of atherosclerotic cardiovascular disease
108
*atorvastatin Contraindications/Precautions
Allergy, *pregnancy, liver disease, elevated liver enzymes*, children <8
109
*atorvastatin Side / Adverse Effects
Myopathy (muscle pain, aches),
if left untreated (rhabdomyolysis) -kidney failure hepatotoxicity - dark red or cola-colored urine
GI, headache, rash, dizziness, blurred vision, fatigue, insomnia,
110
atorvastatin Administration
PO, in evening w/ or w/o food
111
*atorvastatin Education
*This drug can commonly cause muscle aches and pains (myopathy) - report immediately. - discontinue statin therapy
Grapefruit juice increases the risk for drug toxicity. Frequent evaluation of liver function tests (LFT’s) will need to be completed during drug therapy
Any onset of muscle pain/soreness, changes in urine color, fever, or malaise should be reported immediately!
may take 6-8 weeks to reach max therapeutic outcome.*
*patients with end stage liver disease should not take antilipemics, such as atorvastatin
112
Fibrate
| gemfibrozil (Lopid) indications
Treatment of Type III, IV & V hyperlipidemia; reduce high levels of plasma triglycerides & increase HDL cholestorl
action: Activate lipoprotein lipase, breaking down cholestorl
113
Fibrate
| gemfibrozil Contraindications/Precautions
Allergy, severe liver/kidney disease, cirrhosis, gallbladder disease
114
*gemfibrozil Side / Adverse Effects
* GI discomfort, N/V/D,
| * increase risk for gallstone so avoid fatty foods* dev; liver toxicity; myopathy
115
gemfibrozil Interactions
Warfarin increases risk for bleeding; statn and fibrate increases myopathy risk
116
gemfibrozil Administration
PO twice daily before bfast and evening meal
117
*gemfibrozil Education
Patients may not begin therapy with antilipemic until 6 months of attempting lifestyle changes!
118
Antilipemic Interventions
Monitor and teach to report AE/SE: s/s liver dys (increased liver enzymes, yellow discorloration of skin or sclera, dark urine or pale stool, fatigue, N/V, anorexia, excessive brusiing, pruritus), muscle or joint pain, abd. pain, fatigue
119
Antilipemic Education
Lifestyle&Diet changes, how to admin; liver function labs; monitor chol and triglyceride levels
120
*Coagulation modifiers contraindications
Bleeding
Alcohol especially w/ clopidogrel (plavix) and enoxaparin (lovenox)
Elevated lab levels PT/INR
