Pharm 2 exam 2 Flashcards
1
Q
Heparin
A
Anticoagulant
2
Q
Enoxaparin
A
Anticoagulant
3
Q
Warfarin
A
Anticoagulant
4
Q
Common uses of Anticoagulants
A
- Prevention/treatment of MI & Stroke
- Prevention/treatment of DVT (VTE)
- Atrial fibrillation
- Artificial heart valves
5
Q
Aspirin
A
Antiplatelet
6
Q
Clopidogrel
A
Antiplatelet
7
Q
General themes for antiplatelets and anticoagulants
A
- Watch for signs of bleeding (increase HR, Decrease BP, bruising, petechiae, coffee-ground emesis, black tarry stools)
- Advise clients to use a soft-bristle tooth brush and an electric razor
8
Q
Heparin specific themes
A
- Rapid acting; short half-life
- Requires close monitoring
- Monitor PTT levels:
- Normal: 40 seconds
- Therapeutic: 60-80 seconds - Antidote: protamine
9
Q
Enoxaparin specific themes
A
- Rapid acting; longer half-life
- More predictable (less monitoring)
- Administer correctly
- Antidote: protamine
10
Q
Enoxaparin administration
A
- Route: SubQ
- 2 inches away from umbilicus
- Don’t twist cap, remove air bubble, aspirate, or rub the injection site
- Push real hard to activate the protective sleeve over needle
11
Q
Warfarin specific themes
A
- Takes 5 days to start working
- Must maintain consistent intake of vitamin K (green leafy vegetables & mayonnaise)
- Monitor PT/INR levels:
- Normal: 1
- Therapeutic: 2-3
- Mechanical heart valves: 2-4.5 - Antidote: vitamin K
12
Q
Antiplatelet and anticoagulant high yield
A
- Many herbals increase risk of bleeding (If they start with the letter G)
- Check PTT for heparin
- Check PT/INR for warfarin
13
Q
Red blood cell “Ingredients”
A
- Iron
- Vitamin B12
- Folic Acid
14
Q
erythropoietin anemia medication mechanism of action
A
Erythropoietic medications are synthetic versions of human erythropoietin. Once injected, they trigger the bone marrow to start producing more red blood cells
15
Q
Common uses of Erythropoietics
A
- Anemia of chronic kidney disease
- Chemotherapy-induced anemia (if goal is not cure)
- HIV-infected clients taking ziovudine
16
Q
Epoetin alfa
A
Erythropoietic antianemia
17
Q
Darbepoetin alfa
A
Erythropoietic anemia (long acting)
18
Q
Erythropoietics notable problems
A
- Hypertension (Must fix hypertension first) (Stop treatment if Hgb > 11 gm/dL or an increase > 1 gm/dL in a 2-week period)
- Cardiovascular events (HF, MI, stroke, etc.)
- Tumor progression (cancer patients)
19
Q
Erythropoietic high yield concepts
A
- These medication are very risky (the risks often outweigh the benefits)
- Ensure adequate iron levels
20
Q
Ferrous sulfate
A
Anemia medication for low iron (only PO)
21
Q
Iron dextran
A
Anemia medication for low iron (IV or IM)
22
Q
Iron deficiency
A
- 5% of USA population
- Daily requirements:
- Men: 8 mg
- Women: 15-18 mg
- Infants: 11 mg
- Dietary sources for iron: liver, egg yolks, muscle meat, yeast, grains, leafy vegetables
23
Q
Ferrous sulfate problems
A
- Absorption: Food greatly reduces absorption. Try to take between meals with OJ
- GI problems (nausea, constipation)
- Dark green or black stools (harmless)
- Teeth staining (liquid form) (wash mouth after use)
24
Q
Vitamin B12 deficiency
A
- Leads to anemia and nerve damage
- Caused by poor absorption (e.g., celiac disease or lack of intrinsic factor)
- Pernicious anemia (person doesn’t have intrinsic factor and is the process is slow and not observable)
- Dietary sources vitamin B12: dairy products
25
Vitamin B12 (cyanocobalamin) routes
- PO
- IM
- IV
26
Folic acid deficiency
- Essential to the production of DNA and erythropoiesis (RBCs, WBCs, platelets)
- Caused by malabsorption disorders and alcoholism
- Causes neural tube defects (e.g., spina bifida) if levels are low early in pregnancy
- Dietary sources of folic acid: green leafy vegetables
- Pregnant women need to take 400-800 mcg daily
27
High yield concepts for Iron, vitamin B12, and folic acid
- There's no iron in milk
- Pernicious anemia is caused by low levels of vitamin B12
- Paresthesias often accompany vitamin B12 deficiency anemia
- Take folic acid before and during pregnancy to prevent neural tube defects
- Green leafy vegetables have folic acid, but you must still take supplements if you are pregnant
28
Packed red blood cells (PRBCs)
Blood product
29
Platelets
Blood product
30
Fresh frozen plasma (FFP)
Blood product
31
Albumin
Blood product
32
Types of reactions from blood products
- Acute hemolytic
- Febrile nonhemolytic
- Anaphylactic reactions
- Mild allergic reactions
- Hyperkalemia (PRBCs)
- Volume overload
33
Acute hemolytic reaction
- Chief cause is ABO incompatibility (i.e., the got the wrong blood)
- Most likely to occur in first 20 minutes
- Signs/symptoms: chills, fever, tachycardia, low back pain, red urine
- Stop the transfusion STAT!
34
High yield concepts for blood products
- Transfusing blood products is a high risk procedure (riskier than most medications)
- Verifying the right client gets the right blood product is important
- You only have four hours to infuse PRBCs once the blood leaves the blood bank
- The first step to any reaction is to stop the transfusion
- You also need to change the tubing, start normal saline, double check the right product was given, and call the prescriber
- Normal saline is the only fluid that can transfuse with blood
35
Type 1 diabetes mellitus
- 5% of diabetes cases
- Autoimmune disorder caused by destruction of beta cells of the pancreas
- Sudden onset; usually in childhood
- Insulin replacement is mandatory
- Greater risk for diabetic ketoacidosis (DKA) (Juicy fruit breath)
36
Type 2 diabetes mellitus
- 95% of diabetes cases
- Caused by decreased sensitivity to insulin and inadequate insulin secretions
- Gradual onset; usually in adulthood
- Often treated with oral antidiabetic meds
- Greater risk for hyperglycemic hyperosmolar syndrome (HHS)
37
Metformin
Oral antidiabetic (Biguanides class)
38
Metformin mechanism of action
Decreases the absorption of glucose in the gut, reduces the production of glucose within the liver, and increases insulin sensitivity in the cells
39
Metformin notable problems
- Anorexia, nausea, diarrhea, and flatulence are the most common complaints
- Weight loss (About 7 pounds)
- Vitamin B12 and folic acid deficiency
- Lactic acidosis (rare) (blood pH too low, get rid of CO2 so breath fast. Leads to hyperventilation, myalgia, adn fatigue)
40
Glipizide
Oral antidiabetic (class sulfonylureas)
41
Glyburide
Oral antidiabetic (class sulfonylureas)
42
Glimepiride
Oral antidiabetic (class sulfonylureas)
43
Sulfonylureas oral antidiabetic mechanism of action
Stimulate the pancrease to release more insulin, causing blood glucose to decrease
44
Sulfonylureas oral antidiabetic notable problems
- Hypoglycemia
- Weight gain (5-10 pounds)
- Must avoid alcohol (may cause disulfiram like reaction and increase risk of hypoglycemia)
45
High yield concepts for metformin
- Metformin is the drug of choice fro most clients who have type 2 diabetes
- take metformin with meals
- avoid alcohol while taking metformin
- watch kidney function
46
High yield concepts for sulfonylureas
- Cause the pancreas to secrete more insulin
- Take sulfonylureas with breakfast
- Watch out for hypoglycemia
- Alcohol can cause a disulfiram-like reaction
47
Mixing insulin
1. Start with the intermediate-acting insulin (cloudy) and roll it between your hands to mix
2. Clean the top of the intermediate-acting and rapid/short-acting insulin (clear) bottles with alcohol.
3. Insert the needle into the intermediate-acting insulin (cloudy) and inject air into the bottle
4. Insert the needle into the rapid/short-acting (clear) insulin and inject air into the bottle
5. Invert the bottle with the needle still in place and pull the plunger back until the ordered amount of rapid/short-acting insulin (clear) is in the syringe
6. Carefully pull the plunger back and draw out the ordered amount of intermediate-acting insulin (cloudy). Note: Use caution during this step because you can’t push excess insulin back into the bottle. If you draw out too much insulin, you need to discard the syringe and start over from step 1
48
Rapid-acting insulin
- insulin glulisine
- insulin lispro
- insulin aspart.
49
Short-acting insulin
- insulin regular
50
Intermediate insulin
- insulin NPH
51
Long-acting insulin
- insulin detemir
| - insulin glargin
52
insulin administration sites
- SubQ sites
- abdomen is absorbed fastes
- rotate sites around the site area
- rotate injection areas every week
53
Lipohypertrophy
Giving insulin shots in the same spot over and over again
54
Risk factors for a stomach ulcer
- Helicobacter pylori (70-90% of cases)
- Medications (e.g., NSAIDs, corticosteroids, bisphosphonates, KCl, chemotherapy)
- Stress (e.g., acute illness, ventilator, extensive burns, head injury)
- Tobacco use
- Alcohol use
55
Antiulcer type of medications
- Antibiotics (if H. pylori induced)
- Proton pump inhibitors (PPIs)
- Histamine-2 blockers
56
Omeprazole
Proton pump inhibitor
57
Esomeprazole
Proton pump inhibitor
58
Pantoprazole
Proton pump inhibitor
59
Lansoprazole
Proton pump inhibitor
60
Common uses for Proton pump inhibitors
- Peptic ulcer disease
- Gastroesophageal reflux disease (GERD)
- Heartburn
61
Proton Pump inhibitors mechanism of action
Irreversibly bind to H+, K+ ATPase pumps (AKA proton pumps) in the stomach, causing them to stop producing gastric acid. The effect lasts 1-3 days until the body can produce new pumps
62
Proton pump inhibitors notable problems
- Short half-life & only bind to active pumps (take before breakfast)
- Don't crush or chew
- Rebound symptoms if abruptly stopped
- Rare effects with chronic use:
- Pneumonia
- Osteoporosis
- Hypomagnesemia
63
Ranitidine
Histamine-2 blockers
64
Cimetidine
Histamine-2 blockers
65
Famotidine
Histamine-2 blockers
66
Histamine-2 blocker common uses
- Peptic ulcer disease
- Gastroesophageal reflux disease (GERD)
- Heartburn
67
Histamine-2 blocker mechanism of action
block histamine-2 receptors in the stomach, which reduces the production of gastric acid
68
Histamine-2 blockers notable problems
- Not as potent as PPIs
- Diminished effect over time
- Rebound symptoms if abruptly stopped
- Confusion (if poor renal function)
69
Antiulcer high yield concepts
- H. pylori induced PUD is treated with a PPI plus amoxicillin an clarithromycin
70
Ondansetron
Antiemetic
71
Promethazine
Antiemetic
72
Metoclopramide
Antiemetic
73
Ondansetron mechanism of action
- "Clean" drug
- Blocks serotonin (5-HT3) receptors in the CTZ and vomiting center
- Works better if administered beforehand (e.g., chemotherapy
- PO or IV
74
Ondansetron problems
- Headache
- Diarrhea/constipation
- Dizziness
- Prolonged QT interval (people on Chemo)
75
Promethazine mechanism of action
- "dirty" drug
| - Blocks histamine (H1), dopamine (D2), and adrenergic (alpha 1) receptors in the CTZ and vomiting center
76
Promethazine problems
- Receptors:
- H1 blockade: sedation, dry mouth
- D2 blockade: extrapyramidal symptoms (EPS)
- Alpha 1 blockade: orthostatic hypotension
- Contraindicated for children < 2 yrs (profound respiratory depression)
- Infiltration can lead to gangrene
77
Metoclopramide action
- Blocks dopamine (D2) and serotonin (5-HT3) receptors in the CTZ and vomiting center
- Also promotes gastric motility (great for clients with diabetic gastroparesis)
78
Metaclopramide problems
- Extrapyramidal symptoms (EPS) (do not take longer than three months)
- Drowsiness
79
Nonpharmacologic strategies for constipation
- High fiber foods
- 1-3 L of fluid intake per day
- Regular exercise
80
Docusate sodium
Laxative
81
Polyethylene glycol 3350
Laxative
82
Bisacodyl
Laxative
83
Lactulose
Laxative
84
Docusate sodium themes
- Surfactant laxative (stool softener)
- Great for:
- Prophylaxis
- Prevention of painful elimination
- Prevention of straining
85
Polyethylene glycol 3350 themes
- Osmotic laxative (pulls water into GI tract)
- BM in 2-4 days
- Mix in 4-8 ounces of fluid
86
Bisacodyl themes
- Stimulant laxative (irritates GI tract
| - BM in 12 hrs (PO) or 1 hr (PR)
87
Lactulose themes
- Osmotic laxative
- More expensive and unpleasant (flatulence and cramping) than other laxatives
- Primarily given because it helps the intestines excrete ammonia
88
Laxative overuse
- Dehydration
- Electrolyte imbalances
- Loss of normal defecation reflex
89
High yield concepts for Laxatives
- Stimulant laxatives (e.g., bisacodyl) should be used sparingly
- Laxatives can cause electrolyte imbalances
- Lactulose helps clients with chronic liver disease excrete ammonia
