pharm-exam-3
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Feb 20, 2024
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Pharm exam 3
pharmacology (Fortis College)
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Pharm exam 3
pharmacology (Fortis College)
Scan to open on Studocu
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NUR 100 Pharmacology Exam 3 Outline
Know about digoxin- Cardiac glycosides- used for heart failure, cardiogenic shock, antarrhythmic, a fb. Assess apical pulse for 1 minute before giving. Therapeutc drug level 0.5-2.0 mg/mL, >2 is TOXIC- caused by DIG: Decreased potassium (hypokalema) Injured kidneys, GFR decreased. Signs of toxicity: Early signs are nausea, vomitng, diarrhea. Then blurred vision, yellow or green vision, halo efect around dark objects. Headache, drowsiness, confusion, disorientaton. Antdote is DIGIBIND. Amiodarone (Cordarone)
Ant arrhythmic drug, used to treat ventricular fbrillaton. cannot give lidocaine if patent is taking ant arrhythmic. Adverse efect of amiodarone is pulmonary fbrosis What do beta adrenergic blockers do?
Acebutolol, metoprolol, propranolol, nadolol- used to treat hypertension, stable angina, chronic heart failure, dysrhythmias. Blocks norepinephrine and epinephrine. Blocks negatve efects of the sympathetc
nervous system. Beta blockers can be selectve or non-selectve, blocking beta 1(heart) or beta 2(lungs) Side efects: Orthostatc hypotension, dizziness, dry cough, elevated potassium. Coumadin and Lopid
Coumadin: Used to prevent new clots, prevents current clots from getng bigger. Does not dissolve clot or thin blood, used for clients who are at increased risk of clot formaton. Interferes with producton of Vit K, which is used in the liver to make clotng factors. Antdote is Vit K.
Therapeutc range INR 2-3 Lopid: Cholesterol lowering medicaton, also known as gemfbrozil- if giving Lopid with with Coumadin, it
can increase bleeding tendency by enhancing the acton of the Coumadin. What should you do if a drug does not have it’s desired efect?
Observe patent for adverse reactons, ABCs, Call physician to administer antdote? Obtain lab order? Isosorbide monottrate
Nitrate drug class, also known as Imdur, is a long actng treatment, used for angina preventon, occurs when too litle blood and oxygen get to the heart. This medicaton relaxes blood vessels, letng more blood and O2 reach the heart. May cause dizziness/orthostatc hypotension- change positons slowly. Teaching about sublingual nitroglycerin
Do not swallow or chew tablets, keep medicaton in the original container (dark, glass botle) and store in a cool, dry place. Do not take with erectle dysfuncton medicaton as it can cause possibly fatally low blood pressure. Why would a heart failure patent take two diferent diuretcs?
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Heart failure causes fuid retenton and is treated with diuretcs, a patent will require 2 diferent diuretcs to keep potassium balanced while stll draining fuid. Lasix is potassium wastng, and and spironolactone is potassium saving. How do you treat adverse efects of Niacin?
Niacin is Vitamin B3, it can be found in meats, fsh, enriched grains, nuts, seeds, and legumes. Niacin is used to lower cholesterol. Can give ASA for fushing and itching. What do you have to check before initatng a statn drug?
Liver functon test LFT- monitor : ALT 7-56 U/L. AST 5-40 U/L. ALP 40-120 U/L.- must be done before statns can be given. Ace inhibitor side efects
Dry and persistent cough could develop. Loop diuretc monitoring
Loop diuretcs are potassium wastng, can cause hypokalemia, monitor level, 3.5-5.0. Obtain baseline vitas, give lasix slowly, rapid administraton can cause ototoxicity. Potassium is an intracellular electrolyte, sodium is an intracellular electrolyte. Nestritde (Natracor) infusion
acutely decompensated HF in hospitalized patents who have dyspnea at rest or with minimal actvity; has been used with digoxin, diuretcs, and ACE inhibitors. Should not be used for intermitent outpatent infusion, scheduled repettve use, as a diuretc or to improve renal functon.
Monitor BUN and serum creatnine. May cause ↑ in serum creatnine; ↑ serum creatnine may be dose-
related
High Alert: Intravenous vasoactve medicatons have an increased potental for causing harm. Have second practtoner independently check original order, dose calculatons, and infusion pump setngs. Administer only in setngs where BP can be closely monitored.
Adenosine (Adenocard)
slows supraventricular tachycardias by decreasing electrical conducton through the av node without causing negatve inotropic efects
- acts directly on sinus pacemaker cells and vagal nerve terminals to decrease chronotropic (heart rate) actvity
place patent in mild reverse trendelenburg positon before administraton of drug
- inital bolus of 6 mg given rapidly over 1 to 3 sec followed by NS bolus of 20 mL; then elevate the extrimity
a second dose (12 mg) may be fven in 1 to 2 minutes if needed.
Warfarin (Coumadin)
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Lab Test Consideratons: Monitor PT, INR and other clotng factors frequently during therapy. Therapeutc PT ranges 1.3-1.5 tmes greater than control; however, the INR, a standardized system that provides a common basis for communicatng and interpretng PT results, is usually referenced. Normal INR (not on antcoagulants) is 0.8-1.2. An INR of 2.5-3.5 is recommended for patents at very high risk of embolizaton
Enoxaparin (Lovonox) teaching
Administer deep into subcutaneous tssue. Alternate injecton sites daily between the lef and right anterolateral and lef and right posterolateral abdominal wall Inject entre length of needle at a 45° or 90° angle into a skin fold held between thumb and forefnger; hold skin fold throughout injecton. Do not
aspirate or massage. Rotate sites frequently. Do not administer IM because of danger of hematoma formaton.
Antdotes for heparin and coumadin
Vitamin K (antdote for warfarin)
(antdote for Heparin)protamine sulfate
Antcoagulants versus antplatelets
Antcoagulants, such as heparin or warfarin (also called Coumadin), slow down your body's process of making clots. Antplatelets, such as aspirin and clopidogrel, prevent blood cells called platelets from clumping together to form a clot. Antplatelets are mainly taken by people who have had a heart atack or stroke
Hydrochlorothiazide
Give hydrochlorothiazide in the morning and early in the evening to avoid nocturia.
Monitor fuid intake and output, daily weight, blood pressure, and serum levels of electrolytes, especially
potassium.
Assess for signs of hypokalemia, such as muscle spasms and weakness.
Monitor BUN and serum creatnine levels.
Frequently monitor blood glucose level as ordered in diabetc patents, and expect to increase antdiabetc drug dosage, as needed.
If patent has gouty arthrits, expect an increased risk of gout atacks during therapy.
Nifedipine (Procardia)
selectvely blocks calcium channels in myocardial and vascular smooth muscle, resultng in less oxygen utlizaton by the heart, an increase in cardiac output, and fall in BP. grapefruit juice enhances absorpton
- melatonin may increase BP and HR
Teaching for sustained released medicaton
Do not crush or chew, must take medicaton whole. Pernicious anemia
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vitamin B12 is not absorbed in a patent with pernicious anemia, another name for B12 is extrinsic factor
What happens when patents with pernicious anemia don't absorb Vitamin B12?
Their RBC's do not mature and they become seriously anemic. Patent will receive monthly IM injectons for treatment. What drug helps producton of red blood cells
Epoetn alfa induces erythropoiesis by stmulatng erythroid progenitor cells. This causes the release of retculocytes from the bone marrow, leading to an increase in hemoglobin and hematocrit levels. The medicaton does not assist with supplying either WBCs or platelets.
Types of anemia
Anemia
is a lower than normal number of erythrocytes in the blood.
Aplastc anemia
an absence of all formed blood elements caused by the failure of blood cell producton in the bone marrow.
Hemolytc anemia
an inadequate number of circulatng red blood cells due to the premature destructon of red blood cells by spleen
Iron-defciency Anemia
the most common form of anemia. Iorn, an essental component of hemoglobin, is normally obtained through food intake and by recycling iorn from old red blood cells.
Megaloblastc anemia
red blood cells are larger than normal. Usually results from a defciency of folic acid or vitamin b12.
Pernicious anemia
a lack of proten intrinsic factor (IF) that helps the body absorb vitamin B12 from the gastrointestnal tract.
Sickle Cell anemia
geneic disorder that causes abnormal hemoglobin, resultng in some red blood cells assuming an abnormal sickle shape, the shape interferes with normal blood fow resuling in damage to most body systems.
thalassemia
inherited blood disorder that causes mild or severe anemia due to reduced hemoglobin and fewer red blood cells
Iron
May cause black, tarry stool Folic acid
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Water soluble B vitamin. Folic Acid Food Sources: Green leafy vegetables, Oranges, Fortfed grains, Fortfed breakfast cereals
What is albumin used for?
used to treat or prevent shock following serious injury, bleeding, surgery, or burns by increasing the volume of blood plasma. This medicine can also replace low blood protein.
Only fuid compatble with a blood transfusion
Normal saline Isotonic, hypertonic, osmotc hypotonic fuids
Hypertonic (saline 3% NaCl) – occurs when water loss is greater than sodium loss, which results in a concentraton of solutes outside the cells and caused the fuid inside the cell to move to the extracellular space, thus dehydratng the cells. Example: elevated temperature resultng in perspiraton
o
Causes fuid to move from ISF into the veins
Hypotonic (0.45% NaCl) – occurs when sodium loss is greater than water loss, which results in higher concentratons of solute inside the cells and causes fuid to be pulled from outside the cells (plasma and intersttal spaces) into the cells. Example: renal insufciency and inadequate aldosterone secreton
o
Causes fuid to move out of the vein and into the tssues
Isotonic (0.9% NaCl) – caused by a loss of both sodium and water from the body, which results in
a decrease in the volume of extracellular fuid. Examples: diarrhea and vomitng
o
Most commonly seen in humans
Osmotc o
In osmotc dehydraton, equilibrium conditons are maintained on both sides of the membrane by evacuatng water from a lower solute concentraton to a higher concentraton
Whole blood, packed red blood cells, fresh frozen plasma and albumin
Albumin (5%) – brown, clear, and viscous)
o
It is metabolized by the retculoendothelial system and excreted by the kidneys and the intestnes.
o
Is a natural protein that is normally produced by the liver
o
Responsible for generatng approx. 70% of the colloid oncotc pressure
o
Human albumin is a sterile soluton of serum albumin that is prepared from the pooled blood, plasma, serum, or placentas obtained from healthy human donors.
o
Contraindicated: known hypersensitvity to it and in those with heart failure, severe anemia, or renal insufciency
o
Available only in parenteral form in concentratons of 5% and 25%.
o
Classifed as a category C drug
Whole blood
o
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and plasma proteins, the chief osmotc component, which help draw fuid back into blood vessels from surrounding tssues
o
BLOOD MUST NOT BE ADMINISTERED WITH ANY SOLUTION OTHER THAN NORMAL SALINE
o
Amount of blood loss – over 50% (slow loss) or 20% (acutely)
Packed red blood cells
o
Obtained by the centrifugaton of whole blood and the separaton of RBCs from plasma and the other cellular elements
o
The advantage of PRBCs is that their oxygen-carrying capacity is beter than that of the other blood products, and they are less likely to cause cardiac fuid overload.
o
Disadvantages: high cost, limited shelf life, and fuctuatng availability, as well as their ability to transmit viruses, trigger allergic reactons, and cause bleeding abnormalites
o
Amount of blood loss – over 50% (slow loss) or 20% (acutely)
Fresh frozen plasma
o
Obtained by centrifuging whole blood and thereby removing the cellular elements. The resultng plasma is then frozen
o
FFP is not recommended for routne fuid resuscitaton, but it may be used as an adjunct to massive blood transfusion in the treatment of pt’s with underlying coagulaton disorders
o
The plasma-expanding capability of FFP is similar to that of dextran but slightly less than that of hetastarch
Teaching for nitro patch
Instruct the patent on how to periodically check on its placement.
Must apply the patch at the same tme each day and be sure to have only one patch in place at a
tme, cleansing all residue of the skin before applying a new patch
Advise to avoid skin folds, hairy areas, and any area distal to the knees or elbows as applicaton sites
Transdermal patch must never be applied to irritated or open skin, and it the patch becomes loose, the pt. needs to remove it and gently wash of the residue with lukewarm soap and water, pat the area dry, and place another patch in another area
Encourage rotaton of sites to prevent irritaton
Emphasize all directons/informaton with both writen and verbal instructons
Side efects of statn drugs
Muscle soreness and liver abnormalites refected in high transaminase levels (serum glutamic-
oxaloacetc transaminase and serum glutamic pyruvic transaminase) on a blood test
Rash/prurits, constpaton, diarrhea, headache, dizziness, blurred vision, fatgue, insomnia
Adverse reactons of statn drugs
Myopathy (muscle pain), which may progress into a serious conditon known as rhabdomyolysis. This is the breakdown of muscle protein accompanied by myoglobinuria, which is the urinary eliminaton of the muscle protein myoglobin. Rhabdomyolysis can lead to acute renal failure and Downloaded by Jasmine Smith (Smithjasmine159@gmail.com)
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even death. When recognized reasonably early, rhabdomyolysis is usually reversible with discontnuaton of the statn drug
Why would a doctor prescribe both heparin and warfarin on the same patent?
Because it takes tme to get a therapeutc level on a pill form
Cholestyramine (Questran) side efects
Bile acid sequestrants
Constpaton is the most common and may be accompanied by heart burn, nausea, belching, bloatng, headache, tnnitus, burnt odor of urine
What is iron dextran?
Is a colloidal soluton of iron and dextran
It is intended for IV or IM form when oral iron is insufcient or not tolerated and is used for the treatment of iron defciency anemia
o
If given IM may have persistent pain and discoloraton – give Z track method
Anaphylactc reactons to iron dextran, including major orthostatc hypotension
and fatal anaphylaxis
, have been reported in 0.3% of pts.
Because of this, a test dose of 25 mg of iron dextran is administered before injecton of the full dose
Although anaphylactc reactons usually occur within a few minutes afer the test dose, it is recommended that a period of at least 1hour elapse before the remaining porton of the inital dose is given
Because of the potental of iron dextran to cause anaphylaxis, it has been replaced by the newer product’s ferric gluconate and iron sucrose.
Have emergency drugs available (epinephrine)
Available for injecton only
o
Pt’s remain recumbent for at least 30 min afer IV administraton
Know normal for BUN, Sodium, Potassium and Magnesium
BUN level – 10-20 (normal range, 8 to 25 mg/100 mL)
Sodium – 135-145
Potassium – 3.5-5
Magnesium – 1.7-2.4
Calcium – 9-11
Pounds to kg
Mg to g
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Intake problem
Give a drug how many grams over 48 hours
Desired over have tmes vehicle.
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