Pharm Final

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cswett
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151031
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Pharm Final
Updated:
2012-04-29 22:05:45
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Pharm Final
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Pharm Final
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  1. Thrombolytics
    • 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
  2. Amiodarone SE/ ADR
    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
  3. Anticoagulants
    • -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
  4. INR
    • 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
  5. Warfarin - why takes so long to work
    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
  6. Difference between Heparin and Lovanox
    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
  7. Hypnotic vs. Sedative
    Hypnotic - goal is sleep

    Sedative - goal is calm
  8. Bendodiazepines
    • 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
  9. Alterations in Dopamine
    • 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
  10. Parkinsons - Early stages
    • 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)
  11. Late Parkinsons Treatment
    • 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
  12. Antipsychotics
    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
  13. Antidepressants - TCA - Trycyclic Antidepressants
    • - 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
  14. Antidepressants - SSRI's
    • 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
  15. BUN
    Creatinine
    BUN 6-20 mg/ dL

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

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