Pharmacy practice III

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alvo2234
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186330
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Pharmacy practice III
Updated:
2012-12-01 18:11:11
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Pharmacy practice III final minerals
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Pharmacy practice III final (minerals)
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  1. recommended daily Calcium intake for males
    • 51-70: 1000mg
    • > 70: 1200mg
  2. Recommended daily Calcium intake for Females > 51 yrs
    1200mg
  3. Calcium dosing 
    500 mg in 2-3 divided doses
  4. Calcium function
    • factor for a number of enzymes
    • acetylcholine synthesis
    • increase cell permeability aiding in vit B12 absorption
    • regulates muscle contraction/relaxation
    • catalyzes several steps in clotting cascade
    • contributes to function integrity of cells
  5. Calcium deficiency can cause
    • convulsions
    • tetany
    • behavioral/personality disorders
    • growth retardation
    • bone deformities
  6. Causes of malabsorption of Calcium
    • Hypoparathyroidism
    • vitamin D deficiency
    • renal failure
    • long-term anticonvulsant therapy
    • decreased dietary intake
  7. Calcium approved uses
    • treat Ca++ deficiency
    • acid indigestion
    • hyperphosphatemia
    • -associated with end-stage renal disease
  8. Calcium controversial uses
    • prevent PMS
    • prevent colon cancer
    • weight loss
  9. Calcium salts
    • carbonate 40%
    • Citrate 21%
    • Lactate 18%
    • Gluconate 9%
    • Phosphate 23-39%
  10. Calcium carbonate, phosphate
    • insoluble 
    • take with meals
  11. Calcium citrate, lactate, gluconate
    • soluble 
    • preferable in patients with:
    • -achlorhydria
    • -H2A
    • -PPI
  12. Calcium safety concerns
    • hypercalcemia
    • > 3g/day may be harmful
    • kidney stones
    • anorexia
    • N,V
    • constipation
    • polyuria
    • deposition of calcium in soft tissue
  13. Calcium interactions
    • Iron, Zinc, Mg++ decrease absorption (separate by 2 hr)
    • Corticosteroids (inhibit absorption)
    • Aluminum-containing antacids, phosphates, cholestyramine
    • -decrease calcium absorption
    • -separate by 2 hrs
    • H2 blockers, PPI (decrease absorption; consider citrate)
    • Levothryoxine (decrease Levo absorp; separate 4 hrs)
    • Tetracyclines, Fluoroquinolones
    • -decrease antibiotic absorption 
    • -separate by 2 hrs before or 6 hrs after antibiotic
    • Phenytoin, Carbamazepine, Phenobarbital
    • -increase Vitamin D metabolism (decrease Ca absorption)
    • -calcium and vitamin D supplementation
  14. Iron daily intake 
    males and females > 51 yrs: 8 mg
  15. Iron dosing 
    • ferrous sulfate 325 mg 2-4 tables daily 
    • severe or chronic cases
    • -325 mg 3-4 x/day x 3-6 months
  16. function of iron
    oxygen and electron transport
  17. functional iron
    hemoglobin, myoglobin, heme-containing enzymes, transferrin
  18. stored iron
    • hemoglobin (60-70% of body iron)
    • ferritin/hemosiderin
    • -intestinal mucosa
    • -liver
    • -spleen
    • -bone marrow
  19. Iron deficiency can cause
    • pallor
    • fatigue
    • coldness/numbness of extremities
    • anemia
    • -spit or spoon shaped nails
    • -sore tongue
    • -angular stomatitis
    • -dyspnea on exertion
    • -hypochromic microcytosis
  20. cause of iron deficiency
    • blood loss
    • inadequate diet
    • malabsorption
    • pregnancy
    • lactation
    • treatment with epoeitin alfa without iron supplementation
  21. Cause of iron deficiency elderly
    • poor nutrition
    • compromised absorption (achlorhydria)
    • GI blood loss 
    • -malignancy
    • -gastric ulceration
    • -use of nsaids
  22. Iron use
    • iron deficiency anemia 
    • -supplementation not recommended in elderly unless there is a confirmed diagnosis of iron deficiency anemia
  23. Iron salts
    • sulfate 20%
    • fumurate 33%
    • gluconate 12%
  24. Improving absorption of Iron
    acidic media (ascorbic acid)
  25. Iron AE
    • GI irritation (take with food; may decrease iron by 50%)
    • constipation
    • dark tarry stools
  26. Iron interactions
    • antacids (decrease solubility and absorption separate by 2)
    • tetracyclines fluoroquinolones 
    • -decrease antibiotic and iron absorption
    • -take antibiotic 2 hrs before or 6 hrs after
    • levothyroxine
    • -decrease levo absorption (separate by 4 hrs)
  27. Zinc recommended intake
    • males > 51: 11 mg
    • females > 51: 8 mg
  28. function of zinc
    • trace element
    • cofactor in DNA, RNA, protein synthesis
    • cofactor gene expression
  29. deficiency in zinc (rare) leads to
    • growth retardation
    • low insulin lvs
    • anorexia 
    • mental lethargy
    • irritability
    • low sperm count
    • generalized hair loss
    • rough, dry skin
    • impaired wound healing 
    • decreased thyroid function
    • poor sence
  30. causes of zinc deficiency
    • malabsorption syndromes
    • alcoholism
    • chronic renal disease
    • chronic debilitating disease
  31. Zinc oral uses
    • deficiency
    • common cold
    • flu
    • acute LRTI
    • recurrent ear infections
  32. zinc topical uses
    • acne 
    • herpes simplex
    • wound healing
    • dental plaque formation and gingivitis
    • common cold 
    • eye irritation
  33. zinc IV uses
    parenteral nutrition to promote healing in burn victims
  34. zinc effective uses
    • zinc deficiency
    • diarrhea
    • wilsons disease
  35. zinc variable efficacy
    • burns 
    • common cold 
    • gingivitis
    • herpes simplex sore
    • hypogeusia
    • osteoporosis
    • muscle cramps
    • vitamin A deficiency
  36. Zinc likely ineffective
    • alopecia
    • eczema
    • cataracts
    • inflammatory bowel disease
    • influenza
    • malaria
    • prostate cancer
    • psoriasis
    • rheumatoid arthritis
    • tinnitis
  37. insufficient reliable evidence
    • alzheimers disease
    • asthma
    • esophageal cancer
    • impotence
    • neurological trauma
    • wrinkled skin
  38. Zinc AE
    • N,V
    • metallic taste in mouth
    • copper deficiency
    • acute renal tubular necrosis
    • interstitial nephritis
    • lethargy fatigue
    • dehydration
    • worsening of BPH
    • skin discoloration
    • blood dyscrasias
    • impaired sense of smell/anosmia
  39. Zinc drug interactions
    • zinc decreases the absorption of:
    • copper
    • iron
    • magnesium
    • amiloride
    • penicillamine
    • quinolones
    • Zinc increase absorption of:
    • manganese
  40. zinc drug disease interaction
    • alcoholism 
    • hemodialysis
    • malabsorption syndromes
    • -sprue
    • -crohns disease
    • -short gut syndrome
    • rheumatiod arthritis
  41. Magnesium recommended daily intake
    • males > 51 years: 420
    • female > 51 years: 320
  42. Magnesium
    • normal bone formation
    • > 300 enzymes
    • maintenance of nerve and muscle electrical 
    • impulse transmission
    • calcium and potassium homeostasis
  43. magnesium deficiency can cause
    • neuromuscular irritability
    • increased CNS stimulation
    • delirium
    • convulsion
  44. causes of magnesium deficiency 
    • GI/renal loss
    • acute chronic diarrhea
  45. Mg++ approved uses
    hypomagnesemia
  46. Magnesium non FDA approved uses
    • prophylaxis of (PMS, migraine, atherosclerosis)
    • treament of (asthma and hypertension)
  47. magnesium salts
    • oxide
    • chloride
    • gluconate
    • hydroxide
    • citrate
    • lactate
    • l-aspartate HCL
  48. Mg++ AE
    • diarrhea
    • hypermagnesemia
    • -muscle weakness
    • -lethargy
    • -sedation
    • -stupor
    • -coma
    • -hypotension
    • -dysrhythmias
  49. Mg++ drug interactions
    • tetracycline, fluoroquinolone 
    • -decreased antibiotic absorption
    • -separate by 2hrs before or 6hrs after
  50. Potassium (RDA)
    • 40-60 mEq
    • 20 mEq to prevent hypokalemia
    • 40-100 mEq daily in 2-3 divided doses for 
  51. Potassium function
    • acid/base balance
    • nerve impulse transmission
    • muscle contraction
    • gastric secretion
    • regulation of blood pressure
    • glucose homeostasis
  52. causes of potassium deficiency
    • decreased intake
    • cellular shift
    • GI loss
    • increased urinary loss
  53. Potassium FDA approved indication
    hypokalemia
  54. Potassium AE
    • weakness
    • loss of appetite
    • twitching
    • abnormal heart rhythm
  55. potassium levels between 2.5 and 3 mEq/L
    may be asymptomatic
  56. potassium levels below 2.5 mEq/L
    • severe muscle weakness
    • rhabdomyolysis
    • tachycardia
    • AV block 
    • sinus bradycardia
    • V tach/V fib
  57. potassium levels > 5 mEq/L
    • paresthesia
    • generalized  weakness
    • vertigo
    • mental confusion
    • hypotension
    • cardiac arrhythmias
    • heart block
    • death
  58. potassium drug interactions increase K+
    •  -ACEI
    • -ARB
    • -Potassium sparing diuretic
    • -corticoids
  59. K+ drug interactions that decrease K+
    • aminoglycosides
    • amphotericin B
    • Beta 2 agonist
    • cisplatin
    • theophylline
    • penicillin salts
    • stimulant lax
    • tetracyclines
    • B12 supplementation
  60. potassium drug disease interactions
    • aspirin/tartrazine sensitivity
    • GI motility conditions
  61. potassium caveats
    symptoms of hypokalemia and hyperkalemia may be similar

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