pharm

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erinarnold
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117489
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pharm
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2011-11-17 16:13:24
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pharm
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pharm
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  1. vitamins
    laxatives/antibiotics lower fat soluble absorption
  2. Iron Prep
    FEOSOL (ferrous sulfate)
    INFED (iron dextran) IV
    • prevent/treat iron deficiency anemia
    • w/ or after meals -> full glass of fluid
    • can cause GI upset & discolored stools
    • caffeine decreases absorption
    • liquid prep thru straw
  3. Iron Excess
    DESFERAL (deforaxamine)
    • chelating agents (metal antagonists)
    • removes iron from GI or parentally excreted thru kidneys
    • causes reddish-brown urine
  4. Potassium
    KCL (potassium chloride)
    • potassium/chloride deficiencies often occur together
    • replaced K+ lost thru diuretics
    • IV diluted to avoid cardiotoxicity, hyPERkalemia, site irritation
    • oral po powder or effervescent tabs taken w/ 4 oz. H20
    • absorbed best on empty stomach
  5. HypERkalemia
    KAYEXALATE (sodium polystrryene sulfate)
    • cation exchange resin
    • oral/rectal
    • acts in colon to release soldium & combine w/ potassium & eliminate in feces
    • STOP all potassium
    • cardiac monitoring
    • insulin IV moves K+ into cells
    • each gram of resin combines w/ 1 meq. K+
    • retain enema for 1- several hrs
    • dialysis
  6. Magnesium Preps
    MAGNESIUM OXIDE (po)
    MAGNESIUM SULFATE (im/iv)
    • treats decreased magnesium levels
    • used to control eclampsia induced convulsions
  7. peptic ulcer disease
    imbalance of cell-destructive (gastric acid, H. pylori, NSAID'S), & cell-protective
  8. Antacids (OTC)
    MAGNESIUM
    • can cause diarrhea
    • not given w/ renal insufficiency
    • acts rapidly
    • highly neutralizing
    • long duration
  9. Antacids (OTC)
    ALUMINUM
    • can cause constipation
    • most common combine aluminum & magnesium -> decreased adverse GI effects
    • chew
    • assess pain
  10. Antacids (OTC)
    CALCIUM
    • cause cause gas, constipation, acid rebound
    • most effective for heartburn
    • frequent, low dose
    • check sugar content w/ diabetes
  11. Heliobacter pylori
    • gram- bacteria
    • seen in 75% peptic ulcers
    • seen in 90% duodenal ulcers
    • eradicates H. pylori and heals ulcers
    • 2 antimicrobials (amxycln, clrthrmycn, metrdzl, tetrcycln) & 1 proton pump inhibitor
    • &/or
    • 1 histamine - 2 receptor antagonists
    • PREVPAC- amxycln, clrthrmycn, lansprzl
  12. Histamine 2 receptor agonist (scrip & OTC)
    - suppress gastric acid secretions & decr pepsin in stomach
    TAGAMET(cimetidine)
    not used as much -> causes mental confusion
  13. Histamine 2 recpetor agonist
    - suppress gastric acid & decr pepsin in stomach
    PEPCID(famotidine)
    ZANTAC(ranitidine)
    • standard for most admitted patients -> prevent ulcers/ will not go home on them
    • full dose until ulcers heal-> 50% for prevention
  14. Proton Pump Inhibitors
    - inhibits gastric acid secretions
    - prevent pumping of gastric acid from parietal cells
    PRILOSEC(omeprazole)
    swallow whole before food
  15. Proton Pump Inhibitors
    - inhibits gastric acid secretions
    - prevent pumping of gastric acid from parietal cells
    PROTONIX(pantoprazole) IV
    • minimal adverse effects
    • long term consequences unknown
    • heal in 4-8 wks
    • for prevention of ulcers
  16. CYTOTEC(misoprostol)
    • synthetic prostaglandin
    • given w/ NSAID to protect gastric mucosa
  17. CARAFATE(sulcralfate)
    • acts locally to protect gastric mucosa
    • specific to GI problems
    • difficult to administer -> needs to be given 2 hrs before/after other meds
  18. Laxatives
    - mild effect to eliminate soft stools
    METAMUCIL(psyllium)
    • bulk-forming
    • long term
  19. Laxatives
    - mild effect to eliminate soft, formed stoold
    COLACE(docusate sodium)
    • surfactant
    • prevents straining
  20. Laxatives
    - mild effect to eliminate soft, formed stools
    MINERAL OIL
    • lubricant
    • softens hard, dry feces
  21. Cathartics
    - strong effect to elimiate loose stools
    MAGNESIUM CITRATE
    saline bowel prep
  22. Cathartics
    - strong effect to eliminate loose stools
    DULCOLAX(bisacodyl)
    • stimulant
    • glycerine suppository
    • *temporary -> takes 3 days
  23. Antidiarrheal
    IMMODIUM(loporamide)
    • opiate
    • synthetic meperdine
  24. Antidiarrheal
    LOMOTIL(diphenoxylate)
    opiate
  25. Antidiarrheal
    METAMUCIL
    bulk-forming
  26. Antidiarrheal
    PEPTO-BISMOL(bismuth salts)
  27. Antiemetics
    ZOFRAN(ondansetron)
    5 hydroxytryptamine 3 receptor antagonist
  28. Antiemetics
    REGLAN(metaclorpramide)
    prokinetic agent
  29. Antiemetics
    • PHENOTHIZINE
    • GINGER
  30. Obesity
    MERIDIA(sibutramine)
    appetite suppressant
  31. Obesity
    XENICAL(orlistat)
    fat blocker
  32. Immunization
    - contraindicated during febrile illness, immunosuppressant treatment, leukemia/lymphoma, pregnancy
    RHOGAM
    • can cause pain at site, fever, malaise, serum sickness, muscle ache, anaphylaxis
    • observe for 30 mins
    • check CDC 1/yr
    • refrigerate
    • maintain records
    • avoid pregnancy w/ rubella, varicell for 3 mths
    • Tylenol for discomfort
  33. Hematopoetic (formulations of erythropoeitin)
    - prevent/treat anemia
    EPOGEN(epoetin alfa) SC or IV
    • check blood counts
    • can cause N/V/D
    • usually well tolerated
    • new vial every 21 days
    • BP, HTN
  34. Colony Stimulating
    - stimulate blood cell production by bone marrow in xplant or chemo-induced neutropenia
    NEUPOGEN(G-CSF)(filgrastim)
    • prevents infection
    • stimulates arteriole growth
    • can cause bone pain, redness @ injections site
    • give 24 hrs after chemo
    • avoid infections
  35. Interleukins
    - activates cellular immunity
    - inhibits tumor growth
    PROLEUKIN(aldesleukin) IV
    • treats renal cancer, melanoma, Kaposi's sarcoma, HW -> actives killer cells
    • can cause MI, capillary leak syndrome
    • optimal dose not been established
    • stop drug w/ life threatening side effects
    • report bleeding
  36. Interferons
    - anitneoplastic
    - inhibits viral replication -> reprograms virus
    ROFERON A
    INTRON A
    (interferon alfa 2a/2b)
    • prevents rapid growth of malignancies
    • treats hairy cell leukemia, Kaposi's sarcoma, chronic hep
    • can cause flu-like symptoms, depression, suicide
    • refrigerate
    • don't shake
    • photosensitive
  37. Immunosuppressants
    - interfere w/ production/function of immunity cells
    CORTICOSTEROIDS
  38. Immunosuppressants
    - interferes w/ production/function of immunity cells
    SANDIMMUNE(cyclosporine)
    • antirejection agent -> organ xplants
    • inhibits T lymphocytes
    • can cause tremors, headache, oral candida, seizures
    • monitor renal status
    • use provided syringe/glass container
    • stir room temp. apple juice/repeat -> no water
  39. Cytotoxic/Antiproliferative
    - inhibits purine synthesis (DNA/RNA)
    IMURAN(azathioprine)
    • used w/ renal xplants, rheumatoid arthritis
    • given w/ meals to decr N/V
    • asses pain
    • avoid crowds
  40. Monoclonal Antibody
    - treats rheumatoid arthritis & Chrone's
    - neutralizes activity of tumor necrosis factor alpha
    REMICADE(infliximab)
    • can cause headache, dizziness, fatigue, anxiety, fever, rash
    • give immediately after reconstitution
    • do not breastfeed
    • check for absence of blood in stool
  41. Antineoplastic
    • interfers w/ cell replication, nutrient supply, nucleic genetics
    • cell specific
    • specific % of kills
    • drug resistant
    • harmful to rapid healthy cells
    • treats Hodgkin's, leukemia, Wilm's, Ewing's
    • less effective in lung, colon, prostate cancers
    • solid tumors used before/after surgery &/or radiation
    • methothrexate in small doses for rh arth & psoriasis
  42. Alkylating
    - nitrogen/mustard derivitive
    - interferes w/ cell division & structure of DNA during all phases of malignant cycle
    - broad spectrum of activity
    - causes bone marrow depression
    CYTOXAN(cyclophosphamide)
    • take on empty stomach
    • drink 2-3 L/day
    • may cause cystitis
  43. Alkylating
    - nitrogen/mustard derivitive
    - interferes w/ cell division & structure of DNA during all phases of malignant cycle- broad spectrum of activity
    - causes bone marrow depression
    PLATINOL(cisplatin)
    • treats hematological & solid cancers
    • causes N/V, nephrotoxicity, ototicity
    • check renal function
    • 3-4 wk intervals
  44. Antimetabolites (cell specific)
    - enter cancer cells -> deprive them of DNA materials
    - treats rapidly growing tumors
    RHEUMATREX(methotrexate)
    • avoid alcohol, aspirin, sunlight
    • excreted by kidneys
  45. Antimetabolites
    - enter cancer cells -> deprive them of DNA materials
    - treats rapidly growing tumors
    5-FU(flourouracil)
    • drink plenty of water
    • toxic effects = bone marrow depression, mucositis, alopecia, GI ulcers
  46. Anti Tumor Antibiotics
    - bind to DNA-> blocks DNA/RNA transcription
    ADRIAMYCIN(doxorubicin)
    • treats leukemia, breast/lung/ovarian cancers
    • causes bone marrow depression, GI upset, alopecia, cardiotoxicity, tissue necrosis w/ IV infiltrate
    • urine may turn red
    • check for edema, dypsnea, fatigue
    • excreted in bile -> toxicity incr w/ impaired hepatic function
  47. Plant Alkaloids (cell specific)
    - vinca genus plant
    - stops mitosis
    ONCOVIN(vincristin)
    • treats Hodgkin's, acute lymphoblastic leukemia
    • can cause severe tissue damage w/ IV infiltrate, peripheral nerve toxicity
    • toxic w/ renal impairment
    • prepare pt. for side effects
    • starts antiemetics before & take on schedule
    • mucositis (stomatisits)

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