Week 1 Flashcards
What are the pharmacotherapy review steps?
- Gather relevant patient information
- Interpret information to identify actual or potential problems
- Develop a prioritised problem list
- Consider possible treatments and their appropriateness for the individual patient and individual patient goals
- Make a plan for treatment
- Describe the required follow up
What are the types of patient information?
- demographic
- ability to communicate
- presenting complaint & diagnosis
- past medical history
- social/lifestyle history
- allergies
- lab and diagnostic tests
- physical exam
- medication history
Medication related problems - DOCUMENT
D - drug selection
O - over or underdose prescribed
C - compliance
U - undertreated
M - monitoring
E - education or information
N - not classifiable
T - toxicity or adverse reaction
What are some key reasons for testing?
- assess the appropriateness of drug therapy
- assess drug adverse effects/toxicity
- monitor therapeutic effect
- compliance
Why is it not appropriate to give pure water in IV?
As the cells contain lower levels of ions, the water will move into the cell more and cause it burst
How to treat water imbalance - Depletion
- oral water if possible
- if oral is not possible then IV with glucose 5% or with sodium 0.9%
How to treat water imbalance due to Excess
- remove the cause
- consider fluid restriction
- some diuretic drugs
What are some symptoms of hyponatraemia (135-145mmol/L)
- usually asymptomatic until <125mmol/L
- Nausea
- headache
- hypervolaemia = oedema
- lethargy
- confusion
- muscle cramps
How is hyponatraemia classified?
according to Extra-Cellular Fluid status
What are the 3 ECF status?
- Hypovolaemic
- Euvolaemic
- Hypervolaemic
Causes of Reduced ECF = Hypovolaemic
- GIT loss = diarrhoea, vomiting
- Poor water intake
Causes of normal ECF = Euvolemic
- SIADH
- adrenal insuff.
Causes of increased ECF = hypervolemic
- congestive cardiac failure
- cirrhosis
- drugs = NSAIDs or corticosteroids
What are some medications can cause SIADH?
SSRIs, SNRIs and carbamazepine
What is an important consideration when treating Chronic Hyponatraemia?
can produce permanent CNS injury due to osmotic demeythlination
Describe the features of Hypernatraemia
- mild to moderate 145-159mmol/L
- rare occurance of sodium gain
What are some symptoms of Hypernatraemia?
- thirst
- restlessness
- confusion
- muscle twitching
- seizures
- coma
What are some treatment options for Hypernatraemia?
- correct cause
- oral fluid replacement with water
- IV fluid without sodium = may require 5% glucose
- If SEVERE = medical emergency + ICU
- If CHRONIC = replace water GRADUALLY as this can be a risk for cerebral oedema
Describe the features of Hyperkalaemia
MILD = 5.1 - 5.9mmol/L
MODERATE = 6.0-6.4mmol/L
- most serious electrolyte emergency
How is true excess of Hyperkalaemia caused?
drug induced, increased input or decreased output
How is apparent excess of Hyperkalaemia caused?
- metabolic acidosis
- insulin deficiency
- digoxin toxicity
- cell lysis
What are some signs and symptoms of Hyperkalaemia?
- muscles weakness
- paraesthesia
- palpitations
- dyspneoa
- bradycardia
- ECG changes
- cardiac arrest is possible
What is the treatment for Hyperkalaemia?
- If Asymptomatic consider = pseudohyperkalaemia
- remove or withhold drugs that contain potassium or causing this hyperkalaemia
- low potassium diet
- increase in renal potassium elimination = diuretic
How to treat severe or life-threatening Hyperkalaemia?
- protect heart
- reduce serum potassium level
- IV insulin and glucose infusion - remove potassium from the body
- oral sodium = removes potassium from the bowel lumen
- haemodialysis
Describe the features of Hypomagnesaemia
Mild = <0.9mmol/L
Moderate = 0.41 - <0.7mmol/L
- Magnesium is a key electrolyte in cellular metabolic reactions
- is common
How to treat mild hypomagnesaemia?
- if mild treat = oral supplementation (500mg tabs)
How to treat severe or symptomatic Hypomagnesaemia?
- tremors
- weakness
- swallowing difficulties
- cardiac arrhythmias
- seizures
IV mag
What is a major side-effect to taking mag supplements?
diarrhoea
What is an important point to remember about the relationship between hypomagnesaemia and hypokalaemia?
- cause it to be refractory to K+ supplementation
Hypokalaemia signs and symptoms
True deficit = excessive loss and decreased intake
Apparent Deficit = metabolic alkalosis, cardiac arrhythmias, hyporeflexia, shallow resp, lethargy and confusion
Describe the cause for Metabolic ACIDOSIS
- ketoacidosis
- lactic acidosis
- diarrhoea
Describe the cause for Metabolic ALKALOSIS
- loss of gastric acid
- potassium deficiency
Describe the cause for Respiratory ACIDOSIS
- airway obstruction (COPD)
- Respiratory centre depression
Describe the cause for respiratory ALKALOSIS
- hysterical over-breathing
- mechanical over-ventilation (ICU)
Describe the compensatory mechanisms
It may restore pH close to normal. If the pH is significantly out of range, it means the body’s ability to compensate is failing
What are the key functions of the Kidney
- excretion of waste products of metabolism
- regulation of water, electrolyte, acid-base balance
- Synthesise hormones/vitamins that can regulate BP, make RBCs and maintain healthy bones
Define Glomerular Filtrate
hydrostatic pressure produced by heart which then pushes water and small solutes through the filtration membrane
Define GFR
Rate at which both kidneys filtrate the blood
What two markers can help us estimate GFR?
creatinine and urea
Define Serum Creatinine (Cr)
- synthesised in the liver
- stored in muscle cells as creatine phosphate
If there is an increase in Cr what happens to GFR
decreases
If Cr is normal then what does that mean for GFR?
it may not be normal
Why is UREA not an indeal marker for GFR?
- diet affects levels
- influenced by protein break down
- partial re-absorption in tubules
What is estimated GFR (eGFR) used for?
- classifying chronic renal impairment
What markers are used in an urinalysis
- albumin - very little passes into the urine normally
Is macroabiluminuria (>300mg/day) reversible?
no it is irreversible nephropathy
Why is microalbuminuria an early marker of nephropathy?
- reversible with good control of hypertension and hyperglycaemia
What is the Cockcroft-Gault equation for males?
What is the Cockcroft-gault equation for Females?
What are the common clinical uses of Creatinine Clearance CrCl
- assessing kidney function in patients with chronic renal failure
- monitoring patients on nephrotoxic drugs
- determining dosage adjustments for renally eliminated drugs
what are the three causes for Acute Kidney Injury?
- Prorenal
- Intrarenal
- Postrenal
How is serum uric acid (URATE) produced?
through catabolism of purines
If serum uric acid is high what does that signify?
- gout
- infections
- renal failure
- high protein diet
- alcoholism
If serum uric acid is Low what does that signify?
- tubular defects
- malabsorption
- por diet
- liver damage
What is the main use for serum uric acid
diagnosing/monitoring gout
