Pharm Final

• dissolve blood clots - "clot busters" -used in stroke
• - does not tell the difference between good clot and bad clot - can cause you to bleed to death
• 2 kinds of stroke-can bleed to death if used in hemoragic stroke
• -very good for ischemic stroke

Amiodarone - Antidysrhythmic

• (ABC safety) pulmonary fibrosis *** PRIORITY must be able to breath - - like old cracked rubber band
• FEB1 - force expiratory breathing
• need to do baseline & follow-up spirometry (nurse can do)

• Thyroid disfunction
• Retinal Depostis
• Smurf Sydrone - check for cyanosis

• -prevent clot formation and/ or existing clot growth
• - as clot grows becomes fiable
• - greater chance of breaking off

• -Inpatient: (IV or SQ route)
• - heparin
• - low molecular weight heparin (Lovenox)

• -Outpatient:
• -(PO) - Warfarin/ Coumadin

• used for warfarin
• - normal 2-3 -international normalization ratio
• Coumadin changes from batch to batch -
• <2-3 risk of forming clots
• >2-3 risk of bleeding to death

Time: -shortest lived clotting factor has half-life ~ 1 1/2 - 2 hours = start to see anitcoagualtion in 8-10 hours

-Longest lived clotting factors: halflife ~ 1 1/2 to 2 days = to achieve maximum effect takes 8 to 10 days

Heparin - SQ - varying absorbtion/ activity due to ununiform size of molecules

• Lovonox - low molecular weight heparin - heparin that has been cut to unirform size & shape
• - predictable dose- response PTT test is less accurate with lovonox
• -antidote is protamine sulfate - less effective on lovonox than heparin

Hypnotic - goal is sleep

Sedative - goal is calm

• Sleeping pills
• LOTTA - short onset ~1 hour,
• short duration ~ 8 hours

• L lorazepan - Adavan
• O oxazepam - Serax
• T temazepam - Restoril
• T triazolam - Halcion
• A alprazolam - Xanax

If not LOTTA - short onset & LONG duration

• LOT - end in zepam - no real change in half life with age
• TA - end in zolam - half life gets longer with age - avoid in geriactric patient

Medazolam - Versed - versitile sedative - misnamed because goal is sleep - used in conscious sedation

• PD: Wide therapeutic index
• ETHO will alter affects of benzodiazapines - can cause effects up to 200 times normal dose -
• Buzz effect - function of how quick onset of action is - quicker onset - more buzz

• Patient Education
• -Dedicate 8 hours to sleep
• -Avoid ETOH

• Dopamine - -deficiency of dopamine in niagra striatum - Paralysis Agitans =Parkinsons Disease
• - Tx: Dopamine Agonists

• -Excess - mesocortical (reasoning)/ limbic (emotion) - Dementia Praecox-Schizophrenia - (break of the mind) - break with reality (not separate personalities) - Halucinations(Multiple personality disorder is a subset of anxiety disorder)
• Tx - Dopamine antagonists

• If you overtreat Parkinsons with dopamine -mimic schizophrenia (halucinations)
• If you overtreat schizophrenia -minic Parkinsons

• Goal is to take advantage of dopamine you have left
• Selegiline/ Eldepryl
• - PD: mono amine oxidaise inhibitor (MAOI)
• Neurotransmitter (Dopamine) ejected into synapse between neuron
• >1% binds to receptor
• 20% broken down by enzymes
• 80% Reuptake

Inhibits enzymes that would break down dopamine takes advantage of dopamine you have left

• Patient education:
• -To avoid hypertensive crisis and/or seizures
• -avoid cold & cough remedies - SNS agonists
• -Avoid other psychiatric drugs
• - report all phychiatric meds to dr
• -Avoid food high is tyramine (food restrictions)
• Tyramine - fermented (yeast) products - aged cheese or meats - no soy sauce, pepperoni, dark beers, red wines, dark chocolate, fava beans, organ meats (froix grois)

• Late: Get dopamine from outside source
• Dopamine can't survive stomach acid
• - cant cross BBB

• Levodopa
• - can cross BBB
• - fairly stable in stomach acid
• - enzyme converts L-dopa to dopamine
• - exists on both sides of BBB
• -part of every dose gets waisted
• - 99% gets converted outside CNS

• Carbidopa - inhibits enzyme outside of CNS (does not cross BBB)
• levodopa/ Larodopa
• L-dopa + Cabidopa/ Sinemet (synergy - decrease dose to 1/3 levodopa)
• Patent changes from levodopa to Sinemet - levodopa will decrease

• Nursing Notes
• On/ off - make sure the drug lasts the entire dosing interval-with dose increases/ changing interval remark upon mental statusassess -A & O x 3

• Food limitation - avoid excess B6 and high protein meals
• B6 - overcomes carbiudopahigh protein - interferes with levodopa

Secation : GOAL IS CALM

• Sedation occurs immediately (Haldol)
• More ordered though processes takes 3 weeks to 3 month

Typical antipsychotics-true dopamine antagonisits-haloperidol/ Haldol

• Atypical -not dopamine antagonists at standard doses - however excess dosage can cause movement problems
• olanzepine/ Zyprexa

• SE/ADR - sedation, risk for movement disorders (document if occurs), anticholenergic side effects (dry mouth, dry eyes ?all are alpha blockers - risk for orthostatic hypotension
• -CNS antihistamine
• - blocks sence of fullness - overeat - weight gain-assess for type 2 DM on regular basis

• BLACK BOX WARNING
• Sodium channel blocker - arrhythmias - overtreatment causes V-fib-
• ALKALOSIS is tx for psychotic induced V-fib
• sodium bicarb - (malox) 1mEq/ kg

• - old tricyclics - Amitryptiline/ Elavil (also used for Migraine, peripheral neuropathy)
• -takes 3 weeks to 3 months to work

• SE/ADR - sedation-anticholenergic effects - dry mouth, dry eyes, urinary retention, constipation
• -Alpha blocking effects - orthosattic hypotension-CNS antihistamine - weight gain-
• Sodium channel blocking - same as above

• SSRI's
• seratonin specific reuptake inhibitors
• Sertraline/ Zoloft

• SE/ADR
• - Photosensitivity
• --weight loss....followed by weight gain
• -sedation but more activating (gives more energy to commit suicide)

BLACK BOX - increase suicidal thoughts in teens

• Seratonin syndrome - severe overdose or mixed with MAOI -
• - causes labile BP - BP vasolates between high and low
• - - causes seizures
• - - hyperpyresis - dangerously high fever - cooling blankets and baths

Also used as anxiety meds - most take 3 weeks to 3 months

Antianxiety - Xanex (Benzodiazepines)- works immediately

BUN 6-20 mg/ dL

• Creatinine
• 0.5 - 1.1 women
• 0.6- 1.3 men