Pharm part 3 Flashcards
Common indications for Coumadin
Prophylaxis or tx of pulmonary embolism or venous thrombosis
Treatment of a fib with embolization
Adjunct in tx of coronary occlusion
MOA of Coumadin
Antagonizes synthesis of vit K dependent clotting factors II, VII, IX, and X, as well as proteins C and S
Adverse effects of Coumadin
Bleeding
Bruising
Nausea
Diarrhea
Renal or hepatic adjustments for Coumadin
No definitive adjustments- monitor INR closely in renal and hepatic impairment
BBW for Coumadin
May cause major or fatal bleeding
Drug interactions of Coumadin
Enhanced anticoag effects with alcohol, allopurinol, amiodarine, adrenocortical steroids, cimetidine, disulfiram, erythromycin, metronidazole, salicylates, Bactrim/Septra, and thyroid medications
Decreased anticoag effects with carbamazepine, cholesyramine, rifampin, and vit K
Counseling of Coumadin
Take only as directed
Avoid alcohol and aspirin-containing drugs
Do not begin or d/c other medications without first consulting your physician
Store in a cool dry place away from kids and sunlight
If dose is missed, take it as soon as possible
If it is closer to the time of your next dose, skip the missed dose and resume nl dosing schedule- do not double doses
Be consistent with the amount of green leafy vegetables eaten
Monitoring of Coumadin
INR
Bruising
S/sx of bleeding
Common indications for atenolol
HTN
Angina pectoris
MOA of atenolol
Cardioselective beta-1 adrenergic receptor blocker which results in decreased HR and CO
Common SEs of atenolol
Drowsiness Dizziness Bradycardia Hypotension Fatigue
Renal or hepatic dosage adjustments for atenolol
Renal: CrCl 15-35: max dose 50 mg/day
CrCl <15: max dose 25 mg/day
BBW for atenolol
Withdrawn abruptly can cause acute tachycardia, HTN, and/or ischemia
Clinically significant drug interactions for atenolol
May decrease effect of clonidine
Verapamil increases toxicity effect of atenolol
Major counseling points of atenolol
May mask hypoglycemic sx in pt with DM.
Use caution while operating machinery or when mental alertness is required.
Rise slowly when standing up from sitting and lying position.
Do not abruptly d/c
Monitoring parameters of atenolol
BP
HR
Common indications for clonazepam
Lennox-Gastaut syndrome Akinetic and myoclonic seizures Absence seizures with succinimide failure Panic disorder GAD
MOA of clonazepam
Binds to and enhances activity of GABA receptors
Common AEs of clonazepam
Drowsiness
Ataxia
Fatigue
Dizziness
Clinically significant drug interactions of clonazepam
Increased CNS depression with EtOH and other CNS depressants
Caution in pts taking opioids d/t increased risk of sedation and resp depression
Major counseling points of clonazepam
May cause drowsiness
Avoid EtOH while taking this medication
May be habit-forming
Do not stop taking this med abruptly
Store in a cool dry place away from kids and sunlight
If a dose is missed, take it ASAP
If it is closer to the time of your next dose, skip the missed dose and return to nl dosing schedule- do not double doses
Monitoring parameters of clonazepam
Improvement in sx of anxiety
Misuse, abuse, decreased seizure activity
Common indications of penicillin
Various infections
MOA of penicillin
Inhibits cell wall mucopeptide biosynthesis
Common AEs of penicillin
Black tongue
Diarrhea
Vomiting
Renal or hepatic dose adjustments for penicillin
Consider dose adjustments with either renal or liver failure
Clinically sig drug interactions with penicillin
May result in an increased INR when taken by a warfarin pt
Major counseling points for penicillin
Take till empty
May effect the effectiveness of contraceptives
Monitoring parameters of penicillin
Improvement in S/Sx of infection, WBC
Common indications of Augmentin
Tx of OM, sinusitis, and infections caused by susceptible organisms involving the lower resp tract, skin and skin structure, and urinary tract
Common AEs of Augmentin
Diarrhea
GI upset
Vomiting
Renal or hepatic dose adjustments for Augmentin
Renal- CrCl 10-30: dose every 12 hrs, CrCl <10: dose every 24 hrs.
Do not use ER tablets in pts with hemodialysis
Major counseling points of Augmentin
Do not skip any doses Take with food Refrigerate suspension If a rash develops contact physician Ask for PCN allergy
Monitoring parameters of Augmentin
Improvement of S/sx of infection, WBC
Common indications of Bactrim
Susceptible infections
MOA of Bactrim
Trimethoprim blocks production of tetrahydrofolic acid by inhibiting dihydrofolate reductase
Sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competitively antagonizing PABA
Common AEs of Bactrim
Increased sensitivity to sunlight, diarrhea, rash, GI upset, increased potassium
Renal or hepatic dose adjustments of Bactrim
CrCl 15-30 mL/min: administer 50% recommended dose
CrCl <15 mL/min: use not recommended
Clinically significant drug interactions with Bactrim
May increase effects of cyclosporine
May increase serum levels of phenytoin
May increase effects of oral anticoagulants and sulfonylureas
Major counseling points of Bactrim
Preferably taken on an empty stomach one hour before or two hours after meals with a full glass of water
Complete full course of therapy unless otherwise directed
Avoid prolonged exposure to sunlight
Shake suspension well before using
Store in a cool dry place away from kids and sunlight
If a dose is missed, take it ASAP
Monitoring parameters of Bactrim
Improvement of S/Sx of infection, WBC
Common indications of Plavix
Reduction of atherosclerotic events in pt with h/o stroke, MI, established peripheral artery disease, or acute coronary syndrome
MOA of Plavix
Converted to active metabolite via CYP2C19, which irreversibly modifies platelet receptors, selectively inhibiting binding of ADP to the platelet receptors, thereby inhibiting platelet aggregation
Common AEs of Plavix
CP HA Flu-like sx Arthralgia Dizziness GI bleed
BBW for Plavix
Diminished effectiveness in poor CYP2C19 metabolizers
Clinically sig drug interactions with Plavix
Predisposition of occult blood loss with NSAIDs
May interfere with metabolism of CYP2C9 substrates
Omeprazole and esomeprazole may decrease effects of clopidogrel
Major counseling points of Plavix
Contact physician if you notice any sign of infection
Can be taken with or without food
Do not take PPIs with this
Bleeding time will be increased while taking this
Tell physicians and dentists about therapy prior to surgery
Take only as prescribed
Store in cool dry place away from kids and sunlight
If dose is missed, take it ASAP
If it is closer to the time of the next dose, skip the missed dose and return to nl dosing schedule- do not double doses
Monitoring parameters of Plavix
Bruising/bleeding
Common indications of PPIs
Duodenal/gastric ulcer Erosive esophagitis GERD H. pylori infection Heartburn (hypersecretory conditions)
MOA of PPIs
Supresses H+/K ATPase (proton pump) at the gastric parietal cells decreasing production of acid
Common AEs of PPIs
Cough
Constipation
Rash
Dizziness
Clinically sig drug interactions of PPIs
Increase gastric pH
Inhibits activation of clopidogrel
Increases levels of diazepam, phenytoin, and warfarin
Major counseling points of PPIs
Take 30 mins prior to a meal
Contents of capsule may be added to applesauce for administration
Monitoring parameters of PPIs
Improvement in GI sx
Mg if used long term
