Pharm is AWESOME! Flashcards
Warfarin aka, and medication class
Aka Coumadin. Oral anticoagulant, specifically a Vitamin K antagonist.
Warfarin route
Route: usually oral
Warfarin use
Use: Reduces ability to clot. Used in patients with A Fib, history of thrombosis, artificial valves. Prevention of recurrent MI, transient ischemic attacks, pulmonary emboli, DVT.
Warfarin teaching
Teaching: Excessive Vitamin K rich foods should be avoided, but more importantly, Vitamin K foods (broccoli, spinach, liver) should be CONSISTENT –don’t add a lot or subtract a lot from usual diet. Monitor for signs of internal bleeding/vital signs.
what increases risk of bleeding on warfarin
Increased risk of bleeding (increased efficacy) when on warfarin: acetaminophen, NSAIDS, antibiotics, antifungals, amiodarone, cranberry juice, gingko biloba, vitamin E, omeprazole, thyroid hormine, SSRIS
What increases risk of clots on warfarin
Increased risk of clotting (decreased efficacy of warfarin): rifampin, carbamezapine, oral contraceptives, ginseng, st johns wort, vitamin K rich foods.
Warfarin monitor
Monitor: PT/INR, monitor for medication induce hepatitis –look at liver enzymes, signs of jaundice.
Warfarin overdose interventions
In overdose, D/C warfarin and administer Vitamin K. If bleeding not controlled by Vit K, administer fresh frozen plasma or whole blood.
Warfarin category
Category X –not safe in pregnancy. If anti-coagulation in pregnancy is needed, heparin can be used.
Warfarin therapeutic level time and range
Takes 3-5 days to reach therapeutic levels, can be taken indefinitely. Therapeutic INR is 2-3. Maybe up to 3.5 in heart valve disease. Level over 4 is concerning but not emergent.
Lithium medication class
Lithium carbonate is a mood stabilizer used in the manic phase of bipolar disorder.
Lithium therapeutic range
Lithium has a narrow therapeutic range 0.6 - 1.2 is generally considered therapeutic. 1.3 - 1.9 is no-mans land and maybe toxic or maybe fine. Over 2 is considered toxic.
Lithium toxicity warning signs
Early: Diarrhea, n/v, excessive thirst, polyuria, muscle weakness, fine hand tremor, slurred speech, lethargy.
Advanced: ongoing GI distress, mental confusion, poor coordination, coarse tremor, sedation
Sever: extreme polyuria of dilute urine, tinnitus, EPS, blurred vision, ataxia, seizure, severe hypotension –coma, respiratory failure, death.
Expected side effects of lithium and teaching
Some effects resolve within a few weeks.
Nausea, diarrhea, abdominal pain –take lithium with milk.
Fine hand tremors –can be made worse with caffeine and stress.
Polyuria and mild thirst. Important to maintain adequate fluid intake 2-3 L per day.
Maintain normal sodium intake.
Do NOT take with NSAIDs or anticholinergics.
Weight gain.
Renal toxicity, dose should be as low as can be effective. Renal function should be monitored periodically.
Goiter and hypothyroidism with long term treatment.
Bradydysrythmia, hypotension, electrolyte imbalance
Magnesium sulfate use in preeclampsia
Prophylactic for seizures
Magnesium toxicity signs
Nausea, flushing, headache, hypotension, abdominal pain, respiratory distress, absent or reduced deep tendon reflexes, hypocalcemia, somnolence, cardiac arrest, decreased urine output.
Magnesium sulfate therapeutic range
4-7
Intervention in magnesium toxicity
Stop mag, administer IV calcium gluconate bolus
Magensium contraindications
Not for use in pts with myasthenia gravis
Magnesium use in preterm labor
Tocolytic –mag sulfate is a CNS depressant and relaxes smooth muscle. It is a last-line drug for preterm labor as it has significant maternal side effects and incrases fetal mortality.
Thrombolytic vs Anti-thrombotics
Thrombolytics help dissolve existing clots by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors.
Anti-Thrombotics like antiplatelets and anticoagulants, affect the body’s ability to aggregate platelets or form clots.
Common thrombolytics
–plase suffix. Alteplase (aka tPA), tenecteplase, reteplase.
Therapeutic uses of thrombolytics
Treat:
acute MI (all)
Massive pulmonary emboli (alteplase only)
Acute ischemic stroke (alteplase only)
Restore patency to central lines (alteplase only)
Complications and monitoring of thrombolytics
Bleeding –both internal and superficial. Must monitor wounds, limit pokes, monitor vitals and signs of intracranial bleeding (change in LOC, weakness), monitor H&H, aPTT and PT.
Contraindications for thrombolytics
active bleeding, recent trauma, aneurysm, AV malformation, peptic ulcer disease, hx hemorrhagic stroke, uncontrolled hypertension,
Carbamezapine medication class and common useage
Anticonvulsant, used to treat epilepsy as well as bipolar disorder, and trigeminal and glossopharyngeal neuralgias, diabetic neuropathy.
Carbamezapine common side effects
Can affect vision and balance, headahce.
Carbamezapine monitoring/teaching
Associated with leukopenia due to agranulocytosis, and increased infection risk. Teach prevention and s/sx of infection.
Promotes secretion of ADH and risk of fluid volume overload and hyponatremia.
Dermatitis, rash, stevens-johnson syndrome.
Vancomycin medication class
Cell wall synthesis inhibitor. Destroys bacterial cell wasll.
Vancomycin uses/routes
IV –MRSA, MRSE, and other streptococcoal infections
PO –C. Diff
Vancomycin monitoring
Vanco has risk of renal and ototoxicity. Run vancomycin trough prior to administration to ensure within therapeutic level, monitor BUN and creatinine levels, monitor for hearing loss
Vancomycin reaction
Red man syndrome –a rash over neck and chest, flushing, tachycardia. Can be confused for allergic reaction but no respiratory involvement. Is a rate issue –run slowly, at minimum over 60 minutes.
Vancomycin precautions
Do not use in pts with corn allergies, use caution in pts with renal impariment or hearing loss.
Vancomycin therapeutic range
10-20
Prototype NSAIDS
1st gen Cox-1 and Cox-2 inhibitors Ibuprofin Aspirin Meloxicam Naproxen Diclofenac Indomethacin Ketorolac
2nd gen Cox-2 inhibitor
Celecoxib
NSAIDs and inhibition of cyclooxygenase
Cox-1 inhibition can result in decreased platelet aggregation (do not use in bleeding risk pts) and kidney damage (do not use in renal pts).
Cox-2 inhibition can result in decreased inflammation, fever, pain, does not decrease platelet aggregation.
Consideration re: prescription of NSAIDs
Do not prescribe/administer more than 1 at a time
Albumin medication class
Blood product
Albumin action
Expands circulating blood volume by exerting oncotic pressure –stablizes vital signs, prevents hypotension and tachycardia.
Albumin risk
Fluid volume excess, pulmonary edema
Methotrexate medication class, use
Disease-modifying antirheumatic drug (DMARD). DMARD 1 = Non-biologic DMARD. Cytotoxic agent/immunomodulator. It is a chemo-ish drug. Used in rheumatoid arthritis and breast cancer tx.
Methotrexate monitoring
Monitor for s/sx infection, such as fever/sore throat.
Monitor liver function. Observe for anorexia, abdominal fullness, jaundice.
Monitor renal function. –elevated uric acid, BUN, creatinine, 2-3 L fluid daily. Allopurinol if uric acid level elevated.
Monitor for bone marrow suppression –CBC and platelets q3-6 months
Monitor for mouth and stomach ulcers. Coffee-ground emesis, tarry black stools. Frequent oral hygeine .
Avoid in pregnancy. Avoid becoming pregnant for 6 months after taking.
Amiodarone
Antidysthymic medication –Class III. Potassium channel blockers, prolong action potential and refractory period of cardiac cycle. Last line –used only when other treatments have failed due to toxic adverse effects.
Amiodardone toxicity
pulmonary toxicity –dry cough, pleuritic chest pain, dypnea.
Sulfonamides and trimethoprim usage
Inhibit bacterial growth, used for UTIs (usually due to E. choli), otitis media, chancroid (chancre sores), pertussis, shigellosis, and pneumocystis jiroveci pneumonia (fungal pneumonia).
Common Sulfonamides and trimethoprim drugs
trimethoprim-sulfamethoxazole
sulfadiazine
trimethoprim
Considerations/teaching of sulfonamides and trimethoprim drugs
Can cause kidney damage –adequate water intake
Can cause photosenstivity –wear sunscreen
Can cause folic acid deficiency (interrupts folic acid synthesis in bacteria) –take folate
Can cause agranulocytosis –teach prevention and s/sx of infection, bleeding, report sore throat and pallor. Obtain baseline CBC and follow up periodically.
Can cause skin/urine to turn orange/yellow. Do not give to pregnant people in 1st tri or at term, breastfeeding people, infants under 2 months due to risk of kernicterus.
Hyperkalemia –monitor potassium levels.
Stevens-Johnson syndrome –discontinue and contact HCP if rash appears.
Tumor necrosis factor inhibitors
Targeted anti-neoplastic medications.
etanercept, -ximab, -mumab, -zumab
Tumor necrosis factor inhibitor common SE
Rash, hypotension, wheezing, GI upset Flu-like symptoms Pulmonary emboli Thromboembolism Alopecia Tumor lysis syndrome Hemorrhage Neutropenia
Tumor necrosis factor inhibitor consideration prior to administrator
must be tested to confirm no TB infection
Action of lactulose
Reduces serum ammonia levels by decreasing absorption of ammonia in the intestines –laxative.
Loop diuretics common use
In emergent need of rapid mobilization of fluid –pulmonary edema in HF pts even with renal impairment. Liver, kidney disease, hypertension. Also used in hypercalcemia.
Loop diuretics considerations
May cause: Dehydration, hyponatremia, hypochloremia, hypocalcemia, hypotension, ototoxicity, hypokalemia –NOT K SPARING.
Common loop diuretics
furosemide
Ethacrynic acid
Bumetanide
Torsemide
Thiazide diuretics common use
First line in essential hypertension if renal function NOT impaired
Edema of mild to moderate HF and liver, kidney disease.
Often used in combo with antihypertensives for BP control
Reduce urine production in DI patients
Promote absorption of calcium and can reduce postmenopausal osteoperosis risk.
