Final test Pharm UTA Fall 2010 (part 2)
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| Side effects of Hematopoietic drugs | Bone pain (bigest)
Gastrointestinal
Fever
Hypertension, thrombosis (with epoetin alpha)
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| DMARDS disease-modifying antirheumatoid drugs | Inmunomodulators
decrease progression of disease
Bone marrow suppression (SE * know)
Methotrexate
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| Methotrexate (DMARDS) | Cause severe pain after second day
Given once a week
can depress bone marrow leading to
anemia
low WBCs
low platelets
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| Hematopoietic drugs | decrease duration of anemia, neutropenia, and thrombocitopenia in those receiving chemotherapy
enable hygher doses of chemo to be given
No direct effect on cancer cells
Improbe recovery on those patients having bone marrow transplant
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| Positive inotropic agents | Digixin
ACE inhibitors
ARB inhibitors
B-blockers
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| Drugs for stable heart failure | B-blockers
ACE inhibitors
not congested state of HF
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| Drugs for congestive heart failure | Digoxin
Diuretics
Possitive inotropic drugs
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| Digoxin mechanism of action | inhibit the sodium/potassium ATPase pump
leaving K+ out of cell
Can cause bradicardia & AV blocks
positive inotrope
negative chronotrope and dromotrope
Used only to improve quality of life
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| uses of digoxin | tachirhythmias
A-fib
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| Digoxin Side effects | Narrow therapeutic index
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| Digoxin drug interactions | Food decrease bioavailability ginseng increase dix 75% Black licorite 4x
NonK+ sparing diuretics increase Dix toxicity
antiacids bile acids sques limit absorption
lethal if given with B-bloker nonhydropiridine
St. worth decrease dix levels
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| Digoxing formulations | diferent forulations have different bioavailabilities.
tablets: 65%
capsules 90-100% takes 7 hours to see effect
if patient is Dix toxic ask if they had change formulations recently
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| Digoxin IV | push slowly over 5 min b/c bradicardia and hyputension
half life of 2 days
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| Before giving Digoxin | check renal insuficiency BUN and creatine
Check K+ level if high do not give
Give on empty stomach
check apical heart rate
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| Major reason for Digoxin toxicity | hypokalemia related diuretic therapy
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| S&S of digoxin toxicity | child= upset tummy
fatigue, headache, dizziness,anorexia, seizure if extreme
CARDIAC RHYTHM CHANGES
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| Digoxin antidote | Dilantin "phenotoin" DIGIBIND
Give K+
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| HOLD digoxin | if Heart Rate is below 60
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| measurement of digoxin | measured in mcg need to be converted to mg for calculations
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| Therapeutic digoxin level | 0.5-0.8
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| Thrombus | clot that stays where is originated
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| Embolus | clot that moves from its original position
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| Heparin mechanism of action "unfractionated heparin" | Inactivates thrombin preventing clot formation
It only prevents new clot formation and keep existing clots from growing
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| when IV heparin is given | higher doses only to keep clot from enlarging
post MI, during, and after
treatment of DVT
Stroke
A-fib
hemodialysis
heart-lung bypass
keep central cateter clear of clots
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| Administration of heparin | Bolus dose no more than 50-100 units x kg BOLUS
between 1,500-2,500 units/hour INFUSION
20-30 units x min X KG
flushing lines 10-100 units
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| Most severe side effect of heparin | Hemorrage
Osteoporosis with long term
HIT
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| heparin and HIT | usually after 4 days of therapy
suspect hit if platelet count drop to less than 100,000
assess limbs, rash, fever, chills
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| Heparin drug interactions | ETOH increase risk of bleeding
Aspirin will increase risk of bleeding
Nitroglycerin and nicotine speed up metabolism less effect
administer in a separate IV line
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| Antidote to heparin | Protamine sulfate
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| PTT Partial thromboplatin | Lab result for heparin patient
normal PTT 30-40 seconds
ideal with heparin 60-80 seconds
check PTT every 24 hours
if PTT over 100 stop for 1 hours and restart at lower dose
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| LMWH ow molecular weigh hepatin or fractionated heparin | can be used by patients at home
inhibits factor Xa
less binding issues
PTT is not required
All doses are give subcutaneously
fewer problems than unfractionated
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| Coumadin "Warfarin" | Only PO
Inhibits K depending cloting factors
only prevention
99% protein bound low affinity
patient usually start with heparin and go home with warfarin
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| Uses of warfarin | DTV
A-fib "most common reason"
Clotting dissorders
Discontinued when PT/INR is in therapeutic range
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| side effects of Warfarin | bleeding under skin,or echymosis
chills, rash, itching skin necrosis, GI distress
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| Warfarin drug interactions | glucocorticoids and aspirin increase bleeding Cold medications contain aspirin, Vit K " avoid on foods" Grape juice
Estrogens and barbiturates decrease effectiveness "increase metabolism"
BASs and antacids decrease absorption and level in the bod
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| Antidote for Warfarin toxicity | Vitamin K
Give if INR over 20 and bleeding
only on life-threatening situations as anaphylaxis can occur
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| PT and INR | PTprothrombin time "time it takes to get activated"
INR international normalized ration universal standart of reporting pt results
Patients in warfarin should be on a 2-3 INR
Patients with liver failure will have an abnormal INR
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| wear medic alert device | patients on warfarin "coumadin"
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| antiplatelets | Aspirin the most common works by inhibiting TXA which decrease stickiness of platelets
plavix used by CAD patients
taken for prevention
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| Patients that should not receive thrombolitics | patients with intracraneal pathology,
3-6 moths prior of GI bleeding or surgery
uncontrolled HTN
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| While giving thrombolitics | Coagulation labs, PT/INR, PTT
CBCs look for anemia
Check CBCs often
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| Herbs that increase risk of bleeding | Herbs that start with letter G
Gingo
Garlic
Ginseng
Ginser
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| PF4 antigen | Patients that test positive for this antigen will develop HIT if heparin is given
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| hepatin therapeutic range | 60-80
if high stop or reduce drip
if low increase drip
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| Teach patient on warfarin | limit alcohol to 2 drinks x day
be consistand with vit K foods
atkin's/southbeach/green tea
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