Question | Answer |
COAGULANTS
-AE/Antidotes/Monitoring/Considerations | AE: Bleeding
Antidotes:
-Warfarin: potassium (K+)
-Heparin: protamine sulfate*
*adv effect: incl. serious CV/Pulm. effects
Monitor Blood Levels:
-Warfarin: INR
-Heparin: aPTT
*exc.⇓mol.wt.heparins (enoxaparin/Lovenox) |
CLOT FORMATION
-Risk factors/Effects of ABNORMAL clot formation | Arterial (Thrombi):
Atherosclerosis: obstruct BV -> tissue necr.
Venous (Thrombi):
-Stasis of blood flow: local swelling
-If clot brks loose => Lungs(PE) => sud. death |
ANTICOAGULANTS: General
-Action/Uses/Prototypes | Action:
- to prevent formation of new clots and ext. of existing clots
Uses:
- to prevent/tx thrombophlebitis, DVT & PE
Prototypes: Warfarin, Heparin |
DYSLIPIDEMIAS: Bile Acid Sequesterants (cholecystramine)
-Action/AE/Pt. Teaching/Other | Action:
- ⇑ brkdwn of cholesterol
Adverse Effects:
- GI
- Interferes w/ absorp. of many po meds
Pt. Teaching:
- take other meds 1 hr a or 4 hr p cholestyramine
** Often Rx w/ |
DYSLIPIDEMIAS: Fibrates
-Action/Use/AE/Caution | Action:
-⇓ hepatic prod of TG/VLDL's; ⇑HDL's
Use:
- to ⇓ TG
Adverse Effects:
- GI
CAUTION:
⇑serum Warfarin levels ⇒ Warfarin must be ⇓ |
DYSLIPIDEMIAS: HMG-CoA Reductase Inhibitors (Statins)
-Action/Adverse Effects/Pt. Teaching | Action:
⇓ synth. of cholesterol
Adverse Effects:
-GI*
-serious, but rare: hepatotoxicity/myopathy
Pt. Teaching:
-promptly report muscle/tenderness |
ANTICOAGULANTS: Anti-Platelet Drugs
-Action/Protypes | Action: Inhib. platelet activation, adhesion aggregation or procoagulant activity.
Prototypes:
- Aspirin: used to prevent MI, CVA & tx inflammation.
- clopidogrel (Plavix): prev. platelet aggreg.; prevent MI, CVA & vascular |
ANTICOAGULANTS: Thrombolytics
-Use/Prototypes | Use: to restore blood flow via dissolving clots
Prototypes: streptokinase/urokinase |
BLOOD COAGULATION
-Thrombus/Embolus/Hemostasis/Plasmin | Thrombus: blood clot
Embolus: an unattached thrombus in bloodstream
Hemostasis: cessation of bleeding via an injured BV.
Plasmin: enzyme that dissolves blood clots p bleeding ceases |
LAXATIVES/CATHARTICS:
-How do they differ? | Laxatives: mild effects; elim. of soft, formed stool
Cathartic: strong effects and elim. of liquid or semi-liquid stool
* Diff. depends more on dose, so may be used interchangable |
LAXATIVES/CATHARTICS:
Surfactants | Allows water & fat to penetrate/soften stool. Little true laxative effect. |
LAXATIVES/CATHARTICS:
Saline | Osmotic; distends bowel and stimulates peristalsis. May cause F&E d/o's. |
LAXATIVES/CATHARTICS:
Bulk-Forming | Adds mass to feces -> stim. peristalsis/defecation. Best for Long-term use. |
LAXATIVES/CATHARTICS:
Stimulant | Irritates GI mucosa, draws water, stimulates peristalsis. May cause electrolyte imbalances. |
LAXATIVES/CATHARTICS:
Polyethelene Glycol | Distends the bowel causing rapid emptying. Used for bowel cleansing/GI procedures. |
LAXATIVES/CATHARTICS:
Lubriprostone (Amitiza) | ⇑ intestinal fluid; used for chronic idiopathic constipation. |
LAXATIVES/CATHARTICS:
Lactulose | Osmotic; draws water into colon. Softens stool/stimulates peristalsis. Used to treat hepatic encephalopathy. |
LAXATIVES/CATHARTICS:
Sorbitol | Promotes expulsion of potassium-resin complex. Used w/ Kayexelate to tx hyperkalemia. |
LAXATIVES/CATHARTICS:
Lubricant | Lubricates fecal mass. Can ⇓ absorption of fat-soluble vitamins. |
ANTICOAGULANTS: Direct-Thrombin Inhibitors
Use/Feature/Prototype | -Newest anticoagulants!!
-Short-term use (i.e., venous TE, AF)
-Prototype: lepirudin |
ANTICOAGULANTS:
Implementation/Teaching | -use electric razor
-avoid trauma incl. invasive procedures
-watch for bleeding
-carry a MedicAlert card and/or bracelet
-avoid large amts. of K+-Rich veggies
-check INR a each dose; withold warfarin if INR >3. |
OPTHALMIC DRUGS:
Uses/Forms/Labels/Other | Uses: tx d/o of eye; dilate/constrict pupils
Forms: solutions, suspensions, ointments
*Wait > 5 min b/t drugs when >1 eye Rx ordered
Labels: color-coded
-some pts. take >1 opth. drug; adhere closely to scheduled time for ea |
OPTHALMIC DRUGS:
Classes | -Anesthetics
-Anti-inflammatory agents
-Anti-microbials
-ANS drugs
-Diuretics
-Lubricants
* Opthalmic Beta-blockers** => Glaucoma
* some opth. drugs absorb.⇒system effects
* some pts >1 opth. drg; adh. clos 2 sched time |
OPTHALMIC DRUGS:
Administration of topical drops | -Confirm exp. date
-Tilt head back; look up
-Pull lower lid down ⇒ create pch conjunctiva
-Admin drops/thin line oint ⇒pouch w/o ->med cont ⇒eye/skin
-Look ⇓(sevl secs)
-⇓syst ⇒cls eye p instill; ap pres tear dct,3-5m |
DERMATOLOGIC DRUGS:
Types | * Treats skin/mucous membranes
-Antimicrobials
-Antiseptics
-Corticosteroids
-Emollients/Moisterizers
-Enzymes
-Immunosuppressants
-Keratolytics
-Retinoids |
DERMATOLOGIC DRUGS:
Features | -Sign. absorption can occur esp. if covered w/ occlusive dressing
- Do NOT cover w/ an occlusive dressing topical steroids unless specifically ordered.
-Acne is tx w/ topical/systemic ANTIMICROBIALS and RETINOIDS. |
DERMATOLOGIC DRUGS:
Antiseptics | kills/inhibits growth of microbes; MOST PREVENTATIVE. |
DERMATOLOGIC DRUGS:
Corticosteroids | Tx inflammation |
DERMATOLOGIC DRUGS:
Antimicrobials | Tx infections |
DERMATOLOGIC DRUGS:
Emollients/Moisturizers | Tx dry skin/pruritis |
DERMATOLOGIC DRUGS:
Enzymes | To debride necrotic tissue |
DERMATOLOGIC DRUGS:
Immunosuppressants | Tx inlammatory conditions (i.e., sun damage) |
DERMATOLOGIC DRUGS:
Keratolytics | Tx keratin containing conditions |
DERMATOLOGIC DRUGS:
Retinoids | Retinoids such as Accutane, acne initially becomes worse, than improves.
*isotretinoin (Accutane):
-teratogenic
-female pt must use contracepion during and a use
-Liver fx mst b mnitrd
-Advised to report depression/suicidal th |
IMMUNIZING AGENTS:
Features | -Used to protect against infectious dz
-Active immunity req admin of an antigen to induce pts immune serum (contains antibodies) from people who are immune to the antigen.
-Depending on vaccines rec'd in childhood, young/middle adults hav dif vacc needs |
IMMUNIZING AGENTS:
Older Adult Immunizations | Include:
-Tetanus-diptheria booster (DPT): q 10 yrs
-Annual influenza vaccine
-Pneumococcal vaccine (usu. one time)
-Shingles prevention vaccine |
IMMUNIZING AGENTS:
Adverse Effects | -Pain, tenderness @ inj site
-Fever, muscle aches
-Anaphylaxis: when giving immunizations, have epi avail for subcutaneous use for STAT tx.
* LIVE VACC SHOULD NOT BE GIVEN TO PTS W/ ACTIVE MALIGNANT DX! |
ANTIDIARRHEALS:
Non-Specific Tx | -addresses the sx
Most Effective Prototypes:
-opiates/opiate derivatives
*diphenoxylate w/atropine (Lomotril)
*loperamide (Imodium)
*both above: contraindicated in kids under age 2 |
ANTIDIARRHEALS:
Specific Tx | - Addresses the CAUSE of the sx (i.e., diarrhea)
*Enzymatic replacements
*Antimicrobial Agents |
ANTIDIARRHEALS:
When to administer anti-diarrheals | -Main AE: constipation
-Prototype:
* Alsoetron (Lotronex)- used in women w/ severe diarrhea predominant IBS.
-Serious AE include:
*GI obstruction, perf, hemmorage, ischemic colitis
*Contraind. w/ numerous d/o
*A pt-physician agreement req' |
DRUGS ASSOC W/ WEIGHT GAIN: | -Antidepressants
-Antidiabetic drugs
-Antiepileptic Drugs
-Statins
-Corticosteroids
-PPI's
-Lithium
**Drug therapy for obesity should be part of a program diet, physical activity and behavior modification. |
DRUGS ASSOC W/ WEIGHT GAIN:
Approved for Long-Term Use | *Sibutramine (Merida)
-ACTION: ⇑ serotonin/epinephrine
-EFFECTS: ⇑satiety, ⇓food intake, ⇑metabolic rate
-AE: ⇑HR, ⇑BP
-CONTRA: CVD, Renal or Liver Dz
-Many drug interactions |
DRUGS ASSOC W/ WEIGHT GAIN:
Approved for Long-Term Use | *orlistat (Xenical, Alli)
-ACTION: ⇑ serotonin/epinephrine
-EFFECTS: ⇑satiety, ⇓food int, ⇑metab. rate
-AE: flatulance, fecal urgency/incont., fatty stools
-usu. subside p few weeks
-Interf. w/absorp. fat-soluble vit; multi-vits needed (2hrs a/p use) |
DYSLIPIDEMIAS:
Niacin | - Most effective drug: ⇑ HDL levels
- ⇓ serum TG/LDL's
- AE: itching, hepatoxcity, flushing
* Flushing can be ⇓ via:
- starting w/ ⇓ dose, and gradually ⇑
- taking w/ meals
- taking aspirin (325mg), 30 min a niacin |
DYSLIPIDEMIAS:
Cholesterol Absorption Inhibitor (ezetimibe) | - Inhibits absorption of cholesterol
- AE: allergy, rash, nausea |
DYSLIPIDEMIAS:
Key Points | - Works via inhibiting absorption of dietary lipids/⇓ cholesterol synthesis via the liver
- Most common SE: GI
- Niacin causes flushing
- Statins cn cause dmg
- Drg Interactions:
*Admin cholestyramine 1hr a/4hrs p othr drgs
*Fibrates enhance Warfa |
Why is mineral oil NOT advised to be administered w/ fat-soluble vitamins? | Mineral oil absorbs vitamins, prev. systemic absorption. |
VITAMINS/MINERALS (ELECTROLYTES) | |
VITAMINS/MINERALS (ELECTROLYTES) | |
VITAMINS/MINERALS (ELECTROLYTES) | |
VITAMINS/MINERALS (ELECTROLYTES) | |
Why is mineral oil NOT advised to be administered w/ fat-soluble vitamins? | Mineral oil absorbs vitamins, prev. systemic absorption. |
Why should undiluted Potassium (K+) never be administered intravenously (IV)? | |
VITAMINS/MINERALS (ELECTROLYTES) | Oral Niacin causes vasodilation ⇒ may result in injury. |
The Z-tecnique is used to give iron dextran to prevent...? | -Discomfort/staining of subQ tissue/skin |
Nutrients can be obtained orally, enterally, parenterally or is best obtained...? | -From diet (food) |
Nutrient deficiencies are common in people with...? | -Health problems |
Who can benefit from daily vitamins? | -Most people |
Large doses of vitamins can be dangerous, therefore.... | -DO NOT EXCEED MAXIMUM RECOMMENDED DOSE. |
What difference is there between synthetic and natural vitamins? | None |
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Nutrient deficiencies are common in people with...? | -Health problems |
Who can benefit from daily vitamins? | -Most people |
Large doses of vitamins can be dangerous, therefore.... | -DO NOT EXCEED MAXIMUM RECOMMENDED DOSE. |
What difference is there between synthetic and natural vitamins? | None |
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