Drugs: Lipidemics, Coagulants, Lax/Carth, Vit/Min, Opthal, Immun, AD, Wt. Mgmt
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| 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)
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| 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
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| 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
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| 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/
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| 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 ⇓
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| 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
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| 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
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| ANTICOAGULANTS: Thrombolytics -Use/Prototypes | Use: to restore blood flow via dissolving clots
Prototypes: streptokinase/urokinase
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| 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
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| 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
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| LAXATIVES/CATHARTICS: Surfactants | Allows water & fat to penetrate/soften stool. Little true laxative effect.
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| LAXATIVES/CATHARTICS: Saline | Osmotic; distends bowel and stimulates peristalsis. May cause F&E d/o's.
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| LAXATIVES/CATHARTICS: Bulk-Forming | Adds mass to feces -> stim. peristalsis/defecation. Best for Long-term use.
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| LAXATIVES/CATHARTICS: Stimulant | Irritates GI mucosa, draws water, stimulates peristalsis. May cause electrolyte imbalances.
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| LAXATIVES/CATHARTICS: Polyethelene Glycol | Distends the bowel causing rapid emptying. Used for bowel cleansing/GI procedures.
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| LAXATIVES/CATHARTICS: Lubriprostone (Amitiza) | ⇑ intestinal fluid; used for chronic idiopathic constipation.
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| LAXATIVES/CATHARTICS: Lactulose | Osmotic; draws water into colon. Softens stool/stimulates peristalsis. Used to treat hepatic encephalopathy.
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| LAXATIVES/CATHARTICS: Sorbitol | Promotes expulsion of potassium-resin complex. Used w/ Kayexelate to tx hyperkalemia.
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| LAXATIVES/CATHARTICS: Lubricant | Lubricates fecal mass. Can ⇓ absorption of fat-soluble vitamins.
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| ANTICOAGULANTS: Direct-Thrombin Inhibitors Use/Feature/Prototype | -Newest anticoagulants!!
-Short-term use (i.e., venous TE, AF)
-Prototype: lepirudin
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| 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.
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| 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
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| 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
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| 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
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| DERMATOLOGIC DRUGS: Types | * Treats skin/mucous membranes
-Antimicrobials
-Antiseptics
-Corticosteroids
-Emollients/Moisterizers
-Enzymes
-Immunosuppressants
-Keratolytics
-Retinoids
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| 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.
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| DERMATOLOGIC DRUGS: Antiseptics | kills/inhibits growth of microbes; MOST PREVENTATIVE.
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| DERMATOLOGIC DRUGS: Corticosteroids | Tx inflammation
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| DERMATOLOGIC DRUGS: Antimicrobials | Tx infections
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| DERMATOLOGIC DRUGS: Emollients/Moisturizers | Tx dry skin/pruritis
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| DERMATOLOGIC DRUGS: Enzymes | To debride necrotic tissue
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| DERMATOLOGIC DRUGS: Immunosuppressants | Tx inlammatory conditions (i.e., sun damage)
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| DERMATOLOGIC DRUGS: Keratolytics | Tx keratin containing conditions
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| 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
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| 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
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| IMMUNIZING AGENTS: Older Adult Immunizations | Include:
-Tetanus-diptheria booster (DPT): q 10 yrs
-Annual influenza vaccine
-Pneumococcal vaccine (usu. one time)
-Shingles prevention vaccine
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| 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!
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| 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
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| ANTIDIARRHEALS: Specific Tx | - Addresses the CAUSE of the sx (i.e., diarrhea)
*Enzymatic replacements
*Antimicrobial Agents
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| 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'
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| 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.
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| 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
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| 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)
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| 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
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| DYSLIPIDEMIAS: Cholesterol Absorption Inhibitor (ezetimibe) | - Inhibits absorption of cholesterol
- AE: allergy, rash, nausea
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| 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
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| Why is mineral oil NOT advised to be administered w/ fat-soluble vitamins? | Mineral oil absorbs vitamins, prev. systemic absorption.
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| VITAMINS/MINERALS (ELECTROLYTES) |
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| VITAMINS/MINERALS (ELECTROLYTES) |
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| VITAMINS/MINERALS (ELECTROLYTES) |
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| VITAMINS/MINERALS (ELECTROLYTES) |
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| Why is mineral oil NOT advised to be administered w/ fat-soluble vitamins? | Mineral oil absorbs vitamins, prev. systemic absorption.
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| Why should undiluted Potassium (K+) never be administered intravenously (IV)? |
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| VITAMINS/MINERALS (ELECTROLYTES) | Oral Niacin causes vasodilation ⇒ may result in injury.
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| The Z-tecnique is used to give iron dextran to prevent...? | -Discomfort/staining of subQ tissue/skin
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| Nutrients can be obtained orally, enterally, parenterally or is best obtained...? | -From diet (food)
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| Nutrient deficiencies are common in people with...? | -Health problems
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| Who can benefit from daily vitamins? | -Most people
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| Large doses of vitamins can be dangerous, therefore.... | -DO NOT EXCEED MAXIMUM RECOMMENDED DOSE.
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| What difference is there between synthetic and natural vitamins? | None
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| Nutrient deficiencies are common in people with...? | -Health problems
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| Who can benefit from daily vitamins? | -Most people
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| Large doses of vitamins can be dangerous, therefore.... | -DO NOT EXCEED MAXIMUM RECOMMENDED DOSE.
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| What difference is there between synthetic and natural vitamins? | None
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