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Pharm (Test 3)

Drugs: Lipidemics, Coagulants, Lax/Carth, Vit/Min, Opthal, Immun, AD, Wt. Mgmt

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.
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
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
Created by: rprefume
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