Pharmacology 3 Flashcards
What medications are
used for Iron Deficiency
anemia?
Ferrous Sulfate
Iron Dextran
What medications are used for pernicious anemia?
Vitamin B12
Cyancobalamin
What medications are used for megaloblastic anemia?
Folic Acid
B12+Cyanocobalamin
What does iron deficiency anemia cause?
RBCs to be small and pale
What does nuclear (megaloblastic) anemia cause?
RBCs to be longer in shape
missing intrinsic factor
Does does hemolytic anemia cause
RBCs to be destroyed (inside or outside cell)
What is a normal HGB level?
13-18 for males
12-16 for females
What is a normal HCT level?
45-52% for males
37-48% for females
What type of iron is ferrous sulfate given for?
ONLY IRON DEF.
Do not give if pt does not have this specific type or has iron overload
Side effects of Iron Dextran ?
- Stains the skin black and permanently
- orthostatic hypotension
- fatal anaphylaxis
- Elderly responds better to lower doses
What method is used to give Iron Dextran?
Z-track
What can happen with iron dextran?
Anaphylaxis
GIVE A TEST DOSE
What are s/s of iron poisoning?
melena, hematemesis, n/v, diarrhea
shock = hypotension, tachypnea, pallor, coma, acidosis
Treatment of iron poisoning
bowel irrigation, defoxamine (Desferal)
What causes pernicious anemia?
Vitamin B12 deficiency
S/S of pernicious anemia?
- Beefy red tongue
- Skin and mucous membranes affected (GI disturbances)
- Neurological changes (Numbness, tingling hands feet , CNS damage)
Dysrhythmias, heart failure, infection, bleeding - Signs of anemia (Fatigue, pallor)
Cardinal signs of pernicious anemia?
Beefy red tongue, pallor, neuropathy
Side effects of cyancobalamin?
itching, diarrhea, fever, hypokalemia
What causes folic acid (megaloblastic) anemia?
Folate (B9) deficiency
What do you treat this Megaloblastic (Macrocytic) Anemia with?
Folic Acid (B9)
Do not give this with other anemias
Types of bleeding disorders?
hemophilia, genetic disorders, limited/absent coagulation factors
Which factor is hemophilia A missing?
factor VIII
What factor is hemophilia B (Christmas Disease) missing?
Factor IX
S/S of hemophilia
easy bruising, excessive/prolonged bleeding, internal bleeding with “slight” injuries
What lab levels to get for hemophilia?
Coagulation labs
What are examples of anticoagulants ?
Warfarin (coumadin)
Low-molecular-weight heparins (LMWHs)
Heparin
What does heparin help with?
- for quick anticoagulation needs (stroke, pulmonary embolism, massive DVT)
- prevent clots
- prevents post-op venous thrombosis
What needs to be done with admin of heparin?
Check IV doses w/ another nurse
What is an example of a low molecular weight heparin (LMWH)?
Lovenox
When is LMWH
used?
- Emergency anticoagulation therapy
- Situations where clot formation is a risk
- Slowed blood flow
- Prevent AND/OR Treat DVT and PE
- Anticoagulation “Bridge”
Where do you admin Lovenox?
2 inches from umbilicus
Side effects of LMWH
low platelets, hemorrhage, hypersensensity, neurological damage
What is the half-life of heparin and LMWH?
Heparin: 1-2 hours
LMWH: 4.5-7 hours
What to give for heparin/LMWH toxicity?
protamine, replace lost blood
Side effects of warfarin?
bleeding, hepatitis, muscle pain purple toe syndrome
What to do for warfarin overdose?
d/c warfarin
start Vitamin K
What is a normal aPTT time?
45-70 seconds
What is a normal PT time?
18-24 seconds
What is a normal INR while taking warfarin?
2-3
What is an antiplatelet?
aspirin
When to use an antiplatelet?
Prevent acute MI
side effects of aspirin
- n/v
- dyspepsia
- hemorrhagic stroke
- prolonged bleeding
- gastric bleeding
- thrombocytopenia
- tinnitus
What are other examples of antiplatelets?
Antiplatelet ADP inhibitors
- Clopidogrel
- Ticlopidine
Antiplatelet Glypoprotein Inhibitors
- Eptifibatide
- Tirofiban
Side effects of Clopidogrel and Ticlopidine ?
chest pain, bleeding, low platelets, flu-like symptoms
What are glycoprotein inhibitors used for?
unstable angina/MI
Examples of glycoprotein inhibitors?
Eptidibatide (Integrilin)
Tirofiban (Aggrastat)
Examples of centrally acting alpha2 adrenergics?
Clonidine (Catapres)
Methyldopa
What are centrally acting alpha2 adrenergics used for?
decrease HR, decrease force of cardiac contraction, make heart “chill out”
Hypertension
Side effects of CAAAs
bradycardia, orthostatic hypotension, drowsiness, rebound HTN (if d/c’ed too fast)
What do we assess when giving clonidine?
Apical heart rate don’t give if less than 60
When do we not give clonidine?
HR <60
Example of cardiac glycosides?
Digoxin (Lanoxin)
What does Digoxin treat?
heart failure, atrial fibrillation
Side effects of Digoxin?
bradycardia, hypotension
green/purple/yellow vision (toxicity)
halo vision (toxicity)
What is the therapeutic range of Digoxin?
0.5-0.8 ng/mL
How to treat Digoxin overdose?
Atropine
hold next dose
When do we not give Digoxin?
HR <60
Potency of diuretics from most to least potent
Loop diuretics
Mannitol (osmotic) diuretics
Thiazide diuretics
Potassium sparing diuretics
Example of a loop diuretic?
Lasix (furosemide)
When are loop diuretics used?
Rapid diuresis needed
control HTN
Manage edema r/t HF
hepatic or renal disease
Side effects of Lasix?
dehydration, ototoxicity, hypokalemia, hypochloremia, hyponatremia, decrease in HDL, increase in LDL
When to not give loop diuretics?
anuria, severe electrolyte depletion
Lab levels to asses w/ loop diuretics?
BUN & Creatinine
Examples of Thiazide diuretics?
HCTZ
Chlorothiazide
metolazone
Thiazide diuretics used for?
HTN, mild to mod HF, edema, hepatic cirrhosis
Side effects of thiazide diuretics?
decrease sodium & potassium
increase calcium & LDL
decrease libido
Contraindications of thiazide diuretics?
sulfa allergy
anuria/severe renal failure
S/S of hypokalemia?
s/s
- hypotension*
- general weakness/fatigue
- muscle cramps
- n/v
- constipation
- irritable, confused *
- arrhythmia/tachycardia **
- shallow respiration **
- early signs
*** late signs
Examples of osmotic diuretics?
Mannitol (osmotrol)
Osmotic diuretics used for?
Cerebral edema, increased intracranial & intraocular pressure
Contraindications of Mannitol?
Pulmonary edema
severe kidney disease
intracranial bleeding
Normal potassium values?
3.5-5.0
S/S of hyperkalemia?
s/s:
- general weakness
- muscle fatigue, twitches, cramps, paralysis
- abdominal cramps
- distention
- nausea
- diarrhea
- irritable, anxious
- hypotension
- arrhythmias
give kayexalate for hyperkalemia
or IV sodium bicarbonate may be used to help lower hyperkalemia
How is potassium chloride administered?
Orally
Example of potassium sparing diuretic
Spironolactone
Triamterene
What is spironolactone used for?
To decrease loss of K+
edema of multiple etiologies
left ventricular MI
Side effects of spironolactone
endocrine effects, increased urinary frequency
Side effect specific to Triamterene?
Turns urine blue
anemia
low folate
What is important to monitor with K+ sparing diuretics?
LOC
Examples of Nitrates/Nitrites meds?
Nitroglycerin
Isosorbide Dinitrate
Isosorbide Mononitrate
Side effects of nitro?
headache, hypotension, reflex tachycardia
Contraindications of nitro?
Use of ED meds
closed-angle glaucoma
What is the max dose of nitro?
3 - 0.4 mg tabs or sprays
How often should sublingual nitro tabs be replaced?
every 3 months
What are examples of osmotic laxatives?
miralax
milk of mag
what are side effects of osmotic laxatives
rectal bleedings, diarrhea, abdominal cramps
Contraindications of milk of mag?
hypermagnesia
hypocalcemia
Are osmotic laxatives used short or long term?
short term
examples of saline laxatives?
fleets enema
Side effects of a fleets enema?
arrhythmias, cramping, N/V, hypokalemia, sodium retention
Is a fleets enema for short or long term?
short
examples of stimulant laxatives?
Bisacodyl (Ducolax)
Side effects of Ducolax?
abdominal cramps, nausea, diarrhea
w/ long-term use: hypokalemia, muscle weakness
Is ducolax used short or long term?
short term
What laxative can be taken long term?
Metamucil (psyllium)
Other examples of laxatives?
Mag citrate
mineral oil
pericolace
colace
side effects of laxatives?
cramps, diarrhea, n/v, electrolyte imbalances
Examples of antiemetics?
odanestron (Zofran)
promethazine (Phenegran)
prochlorperazine (Compazine)
metoclopramide (Reglan)
Side effects of antiemetics
sedation, neuro issues, heartbeat irregularities, anticholinergic effects
Contraindications of antiemetics
Zofran- long QT interval, phenylketonuria
Phenegran/Compazine- <2 yrs old, allergy to phenothizines
Reglan- GI obstruction, seizures, Parkinson’s
Examples of antidiarrheals?
loperamide hydroxychloride (Imodium)
bismuth-subsalicylate (Peptop-Bismul)
diphenoxylate HCL (Lomotil)
Side effects of antidiarrheals?
constipation, drowsiness, dizziness, cardiac irregularities
Pepto- tinnitus
Side effects of antidiarrheals?
constipation, drowsiness, dizziness, cardiac irregularities
Pepto- tinnitus
Contraindications of antidiarrheals?
hypersensitivity, constipation
Imodium- alcohol intolerance
Pepto- children w/ viral infection
Lomotil- infectious diarrhea
Contraindications of antidiarrheals?
hypersensitivity, constipation
Imodium- alcohol intolerance
Pepto- children w/ viral infection
Lomotil- infectious diarrhea
Examples of anticholinergics/antihistamines
scopolamine (Transderm-Scop)
hydroxyzine hydrochloride (Visteral)
meclizine hydrochloride (Antivert)
dimenhydrinate (Dramamine)
Side effects of anticholinergics/antihistamines
anticholinergic effects, drowsiness, blurred vision, palpitations
Anticholinergics/antihistamines used for….
N/V, motion sickness
Contraindications of anticholinergics/antihistamines?
hypersensitivity, cardiac irregularities, pregnancy/lactation
use caution w/ geriatric pts
