TCC Pharm #1 Hodges
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| FFP | Fresh Frozen Plasma / unconcentrated/ NOT for SVE/
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| HCP Pain Management | Understand pain, listen to Pt., treat appropriately, stay in front of the pain curve.
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| Post-surgical pain managment | PCA, opioids,agonists help, antagonists block receptors, check for resp. depression, ortho. hypotsn, ICP, urinary retention.
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| Morphine Sulfate (PTD) Use for | narcotic, mod-severe pain, no upper dose limit.
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| Morphine Sulfate MOA | Occupies receptors, alters perception of pain
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| Morphine Sulfate Adverse Effects | Respiratory depression, pruritis,increased ICP
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| MS - Contras/ Precautions | Not for preg, or premies/ Caution with elderly, hep or renal impairment, CNS depression, head injury, increased ICP, COPD
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| Overdose of Morphine Sulfate | Naxalone
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| MS Nursing Implications | Assess for pain, allergies, VS. / Monitor VS, esp. with elderly / Monitor I/O, constipation and O.H. (orthostatic hypotension)
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| Tramadol (PTD) | Prototype of NSAIDS that act on the CNS. Also acts as an SRRI.
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| Gate Control | Well-supported theory that you can flood the receptors with stimuli and this will shut the gate in the dorsal horn to further pain transmission.
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| Pain Perception | impacted by many factors. Pain is transmitted through nociceptors. NSAIDS work at the peripheral level, opiates work on the CNS.
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| Sumatriptan (PTD) | Migraine management. Cranial vessel constriction. Reduces transmission in tregiminal pain pathways.
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| Sumatriptan: Contra/ Precautions | Any cardiac issue, HTN, cholesterol or renal/hep impairment
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| Sumatriptan: Drug Interactions | Do NOT use within 2 weeks of MAOIs or SRRIs.
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| Sumatriptan: Nursing Implications | Administer at first symptom/ Labs for liver functions/ Chest and Jaw monitoring for pain.
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| Serum osmolality | Number of particles in 1kG/L of water. In body fluids, talking about sodium, glucose, urea.
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| Normal range for serum osmolality | 275-295 mml/kg
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| Fluid resuscitation | Keeping fluid levels balanced. Replace fluids. Lost H20? Use hypotonic. Loss of blood? Use blood products. Salt? Hypertonic.
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| What causes thirst? | Osmoreceptors in hypothalamus sens ECF is hypertonic. Pit. releases ADH to retain water via distal kidneys.
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| Hypertonic IV | Fluids being introduced are compared to body fluids. More solvent in IV, it is hyper to body. Less in IV, it is hypo to body.
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| T2Diab. Mellitus | Majority of all diabetics. Capable of producing insulin, target cells are unresponsive. Life style impacts greatly. Obesity raises resistance to insulin.
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| Tx of T2 Dm | Most do NOT require insulin. 3 classes of oral antidiabetics (1. Sulfyonureas - secretagogues 2. Biaguinides - stop liver from prod. glucose 3. Thiaz - increase uptake on cell.
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| Diagnosis of T2DM | Primarily use FPG (fasting plasma glucose) now >100. OGTT (oral glucose tolerance test) saved for pregnancies.
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| Insulin drugs | Rapid - Aspart, Lispro, Glulisine/ Short - Regular/ Interm - Isophane NPH/ Long - Demeter, Glargine
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| DKA | Fatty acid metabolism ~ normally T1. Acidic ketones. 3 Ps. Hyerglycemia. Kussmauls Resp (deep and labored)
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| Glyburide (PTD) | PTD of sulfonylurea (stim. secretion of insulin from pancreatic beta cells). Increases sensitivity of surrounding tissues.
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| Glyburide contras | Allergies to sulfa or thiazide diuretics.
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| Beta B1 Adrenergic Antagonist | HTN, more specific, fewer non-cardiac effects (safer for COPD and asthma),(less effect on glucose). Dec. HR, MC contraction, cardiac cond. Inh. sec. of renin and form. of AT2.
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| Verapamil with amlodipine | Verapamil is a calcium channel blocker. So is amlodipine. Cumulative effect.
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| Verapamil with digoxin | Vera. decreases dist/excret of digoxin. Risk of toxicity. Digoxin used for heart failure. Together can cause bradycardia as both affect AV node.
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| Verapamil with simvastatin | Simvastatin is an inactive prodrug until changed to an active metabolite via the liver. Lowers cholesterol. RISK of myopathy increases greatly.
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| Calcium Channel Blockers (CCBs) | CCBs. C.Channels facilitate card. contractions. Blocking it impacts smooth heart muscle. Some affect arteriolar smooth muscle. None affect serum level. Don't affect veins. Reduce force of myocardial contractions. 2 big classes - dihydropyridies and non.
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| RAAS | Renin Angiotensin Aldosterone system.
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| ACE | Angiotensin converting enzyme I to II (instantly).Also breaks down kinase (sometimes called kinase II)
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| ACE inhibitors | Lower BP. Can cause increase in bradykinins due to blocking the breakdown. Increase in BK can cause angioedema and cough.
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| ARBS | Angiotensin II receptor blockers. After AII created, stop it from activating target receptors.
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| ARBS MOA | Cause vasodilation, drops BP. Work like ACE inhib. but no cough, angioedema, no accum of bradyk.MOre $, but prevent cardiac remodeling.
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| Cardiac remodeling | hypertrophy of myocardial cells from AII. Collagen deposits in cardiac matrix like scar tissue. Increased morbidity/mortality.
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| Lisinoprol (PTD)(active, not a prodrug) | PTD for ACE inhibitor. Heart Failure, Acute MI, HTN. 2-3 to achieve max. ther. benefit.
Watch for hyperkalemia. Orthostatic hyper.NO ETOH, NSAIDS, drink 6-8 H2O daily.
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| HCTZ | Most common thiazide type diuretic. Lowers reab. of NaCl, BVD, BP falls.
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| HCTZ adverse effects | May precipitate gout attacks. Elect. imbal. Low chlor, mag, pot, sodium.
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| HCTZ drug interactions | Increased risk of toxicity from NSAIDS and digoxin. Lowered excretion of lithium and Ca.
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| HCTZ Nursing Responsibilities | Baseline/periodic serum electrolytes. CBC. BUN. Uric Acid.
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| HCTZ Pt teaching | Eat K+ rich food. (green, leafy, vegetables - kale, collards, spinach, and turnip greens are the highest), Avoid direct sun 10-14 days.
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| Classification of microorganisms | Stain, Shape, Oxygen preference.
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| 2 Classification of Anti-Infectives | Chemical Class - fundamental chem structure of a group/ Pharm Class refers to MOA. Predicts similar action, similar adverse effects.
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| Prophy ABx | Stab wounds, HIV, heart valves, some surgeries, antimalarials, anti TB, antiretrovirals for infected HCP.
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| 1 generation Cephalosporins | Beta lactam ring like Penicillins. Good for Staph and strep. Don't cross BBB.
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| Cephalosporin Allergy | most common adverse effect. 5-10 % of those allergic to pen. also allergic. Contra in pt. with anaphylaxis to peni.
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| Carbapenems | largest group of cell wall inhibitin, bacteriocidal. Broadest spectrum. Resistant to beta lactamese. Parenteral. Low adverse effects.
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| Tetracyclines - | Antibiotics that inhibit protein SYNTHESIS of the bacteria. Cycle around and ruin RNA/DNA. EMPTY stomach. Watch for pseudomembranous colitis.Hpylori and acne. Superinfections. Empty stomach and water.
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| Tetracycline - PTD | Sumycin
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| Macrolide | ABx Safe alternative to penicillin for many gram + infections. Whooping cough, diptheria, legionnaires. Inhibits synthesis of ribosomes.
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| Erythromycin - PTD macrolide. | Destroys ribosomes, gram pos.
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| Aminoglycosides - effective against | gram negative. . Mostly saved now for TB due to safer alternatives. Destroys ribosomes PTD - Gentamicin
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| Gentacimin - PTD | Aminoglycosides. Gram neg. Ototoxic and nephrotoxic. Avoid anything else that interferes with 8th CN.
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| Minocycline | 1-2 day dosing, w/or w/out food. Watch lab values for hepatoxicity.
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| Ciprofloxacin - PTD fluoroquinolones | inhibits DNA replica. Anthrax. Tendonitis and tendon rupture.
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| Metronidazole - PTD | antiprotozoan. Rosacea, trichomoniasis, parasites in colon.
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