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1
Q

Signs and symptoms of hypertension

A

Flushed face

Headache*

Vision changes

Strong bounding pulses

Dizziness

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2
Q

How do we tell when the hypertension medications are working?

A

Lower HTN around 120/80

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3
Q

What are some common adverse effects of most blood pressure medications?

A

Hypotension

Orthostatic hypotension

If systolic is less than 100.. we hold medication

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4
Q

Signs of hypotension?

A

Dizzy

Pale

Nauseous

Syncope

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5
Q

Patient education for hypertension medications

A

Get up slowly

Don’t stop taking abruptly because it can cause rebound hypertension which can cause hypertension crisis

Taken everyday

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6
Q

Adverse effects of ace inhibitors

A

Angioedema- EMERGENCY

Hypotension

Cough- report so we can switch

Hyperkalemia- avoid salt substitutes

Very nephrotoxic

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7
Q

Interactions for ACE inhibitors

A

Other anti HTN

NSAIDS- also nephrotoxic

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8
Q

What do ARBs end with

A

Sartan

Losartan and valsartan

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9
Q

Benefits of arb over ace

A

No cough

Lower risk of Angioedema- but hold if history with ace

Lower risk of hyperkalemia

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10
Q

Adverse effects of beta blockers

A

Bradycardia- hold if HR is < 60

Hypotension- hold if < 100

Rebound tachycardia (don’t stop suddenly)

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11
Q

Signs and symptoms of bradycardia?

A

Fatigue

Dizziness

Treat with atropine

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12
Q

What are the calcium channel blockers?

A

Verapamil, diltiazem, amlodipine

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13
Q

What do Verapamil, diltiazem, amlodipine treat

A

Hypertension, angina, and dysrhythmias

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14
Q

Which calcium channel blocker is used for hypertension

A

Amlodipine

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15
Q

Which calcium channel blocker is used for dysrhythmias

A

Verapamil, diltiazem

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16
Q

Adverse effects of the calcium channel blockers

A

Cardio suppression (bradycardia/hf)

Orthostatic hypotension

Constipation, especially verapamil, so moving around/exercise, drink fluids, dietary fiber

Rebound tachycardia/hypertension

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17
Q

Interactions of Verapamil, diltiazem, amlodipine

A

Anything that lowers heart rate

Digoxin, beta blockers and grape fruit juice

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18
Q

What is angina?

A

Chest pain that is caused by the heart due to lack of oxygen and blood flow

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19
Q

Difference between angina and heart attack?

A

In angina some blood can still get by, but with heart attack there is a total blockage of the artery so no blood gets by

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20
Q

What is the main medication used to treat angina?

A

Nitroglycerine and isosorbide

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21
Q

How do nitrates work?

A

Vasodilation of the coronary arteries

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22
Q

Adverse effects of nitroglycerine and isosorbide

A

Headache (normal) due to vasodilation

Hypotension

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23
Q

What would we give for acute angina

A

Sublingual because it’s rapid treatment

And if they are having a heart attack right now.. we give IV

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24
Q

Cautions for nitroglycerine and isosorbide

A

ED medications like slidenafil. They cannot have nitro within 24 hours of the last time they took this medication because it causes life threatening hypotension that’s irreversible

Anti HTN meds

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25
Education for nitroglycerine and isosorbide
Store in a dark, cool, and dry place. The medication will degrade if there is light, heat or moisture. Angina attack: stop, sit, take 1 tablet and rest for 5 mins. If not improved, call 911. Can take 3 total doses 5 mins apart
26
What is heart failure
The heart is not pumping enough blood. It can’t fill.. and it can’t pump.. It can be caused by chronic hypertension, heart attack, coronary artery disease, etc.
27
What’s the main drug to treat heart failure
Digoxin
28
What is digoxin
It’s a positive inotropic (increase force of contraction of heart) Negative chronotropic (slows the heart rate by slowing the signals that start in the SA node) Negative dromotropic (slows speed.. by slowing the travel of the impulse through the conduction system)
29
Before giving digoxin what should we asses for
Heart rate.. hold if less than 60 Check apical heart rate for 1 full min.
30
Adverse effects for digoxin
Bradycardia **toxicity** It has a narrow therapeutic window 0.5-2.0 ng/ml… greater than 2=toxicity
31
What are signs of early toxicity of digoxin
GI effects: anorexia, NV, & abdominal pain
32
What are late or severe signs of toxicity from digoxin
Yellow or green halos in vision Brady dysrhythmia Hypokalemia can increase risk of toxicity
33
Education for digoxin
Take apical HR for 1 full min Report & hold if HR less than 60 Report changes in HR and rhythm Take same time each day Report signs of toxicity If a dose is missed, don’t double it
34
If toxic from digoxin what do we give
Digoxin immuno fab
35
Adverse effects of statins
Hepatotoxic (monitor ast and alt labs, look out for anorexia, NV, abdominal distention, jaundice) avoid other hepatotoxic medication like acetaminophen and alcohol Myopathy (muscle pain) Rhabdomyolysis
36
Signs of Rhabdomyolysis
Myopathy Dark urine Flank pain
37
Contraindications for statins
Pregnancy Sever liver disease
38
Interactions for statins
Grapefruit juice
39
Education for statins
Report muscle pain, jaundice, dark coloured urine, or kidney pain
40
When do we swab for cultures
Before any antibiotic is given
41
Normal white blood cell range
11.2 - 4.1
42
Why do we monitor WBC during antibiotic therapy?
It lets us know if the antibiotic is working
43
What should a patient do if taken contraceptives and is prescribed antibiotics
Stop taking them and use non hormonal form of contraception like a barrier
44
Signs and symptoms of c diff
Bad diarrhea Mucus, pus and blood in the diarrhea Abdominal pain
45
What are the 3 Supra infections
Thrush (fungus in mouth) C.diff Yeast infection
46
What are signs and symptoms of an allergic reaction to penicillin
Rashes/hives urticaria (itching) Anaphylaxis- swelling in the airway,face, bright red skin colour, low BP
47
If someone is having an allergic reaction what do we do?
Stop giving medication Give epi IM
48
Averse effects for penicillins?
Renal impairments so monitor BUN, creatine, GFR
49
If someone has anaphylaxis with penicillin, will you give a cephalosporin?
No because of cross sensitivity to penicillin Now you could still give if they had a minor infection
50
When do we use vancomycin
Reserved for serious infections Treatment of systemic infections by IV Treatment of c diff by PO
51
Adverse effects of vancomycin
Red man syndrome- extreme flushing.. so slow the infusion by at least 60 mins.. because if you give vancomycin to fast.. it causes red man syndrome Nephrotoxic- so draw a trough just prior to the next dose
52
Main drugs to treat TB
Ribampin Isoniazid
53
What is the difference between active TB and latent TB
Latent: they are not showing any symptoms and they are not infectious. Active: the infection is actively destroying the lungs, coughing up blood
54
Main adverse effects of rifampin and isoniazid
Hepatotoxic so patients should avoid other hepatotoxic drugs
55
What is the big main adverse affects for all anticoagulant
Hemorrhage
56
What are signs of bleeding
Bleeding gums, or small wounds Excessive bruising, petechiae, or hematomas Frank blood (bright red) in emesis or stool Coffee ground emesis or black tarry stool “melena” Nose bleeds Fatigue and pallor Tachycardia Occult bleeds (slow GI bleed)
57
What labs tell you if your patient is bleeding?
H&H When it’s low that means they are bleeding.
58
What are the 2 types of heparins
Heparin Enoxaparin which is like a weaker heparin
59
What does IV heparin treat?
Acute treatment of ischemic stroke, PE, MI, or DVT
60
What is enoxaparin used for
Prevent DVT and PE It’s a bridge to oral therapy. So while we wait for the PO therapy to reach its therapeutic effects, we can give enoxaparin
61
Adverse effects of heparin and enoxaparin
Hemorrhage and the antidote is protamine sulfate.. it binds and inactivates heparins Heparin induced thrombocytopenia (HIT)… so hold medication if platelets are less than 100,000. Don’t give to a patient with low platelets or who is actively hemorrhaging
62
Adverse effects of warfarin
Hemorrhage- highest risk when starting or adjusting dose.. and the antidote is vitamin k Liver damage- so monitor AST/ALT/Bilirubin Jaundice
63
Patient education for warfarin
Taken daily PO at the same time Will have to get frequent lab monitoring Know what foods are high in vitamin K like green leafy vegetables so that they can keep there vitamin K levels consistent
64
What is warfarin contraindicated in?
Pregnancy! It will cause fetal demise
65
What is alteplase used for?
To dissolve every blood clot in your body So if someone is having a stroke or a heart attack, and we don’t have a cath lab.. they have a massive PE and they are dying on the table.. well give them alteplase
66
Adverse effects for alteplase
Hemorrhage Spontaneous bleeding Hemorrhagic stroke
67
What are the anti platelets
Clopidogrel and aspirin
68
Adverse effects for clopidogrel and ASA
GI bleed- coffee ground emesis, black tarry stool Hemorrhage Thrombocytopenia- unusual bruising, bleeding that won’t stop
69
Adverse effects just got aspirin
Nephrotoxicity Salicylism - tinnitus Reye’s syndrome- don’t give to children especially if they just had a viral infection
70
What is the dose for aspirin to prevent cardiac events
81 mg
71
What are the types of anemia
Pernicious B12 deficiency Iron deficiency Megaloblastic CKD
72
What is the difference between pernicious and B12 anemia
With both of these, you’re not getting enough B12, but with pernicious you’re not able to absorb the B12 in your diet because you lack intrinsic factor B12 deficiency just means you’re not eating enough B12
73
What route do you give b12 to someone with pernicious anemia
Injection IM
74
What route of administration of b12 for people with b12 deficiency anemia
PO
75
What causes iron deficiency anemia
Not eating enough iron or heavy menstruation
76
What causes megaloblastic anemia
Not enough folic acid
77
What is CKD anemia?
The kidneys can no longer secrete it’s hormone erythropoietin to notify bone marrow to create more red blood cells

Pharm Exam 3 (6 decks)

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