Adv Pharm Test 3 2nd Semester

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Adv Pharm Test 3 2nd Semester
2013-10-25 18:39:39
Adv Pharm Test 2nd Semester

Adv Pharm Test 3 2nd Semester
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  1. Hypokalemia: Pathophysiology
    • Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli.
    • *Huge effect on cardiac muscle
  2. What causes hypokalemia?
    • Diuretics (Lasix)
    • Digitalis (Digoxin competes with K+ in Na/K+ ATP pump)
    • Water intoxication
    • Corticosteroids
    • Diarrhea/Laxative abuse
    • Vomiting
  3. What do you do if your patient has hypokalemia?
    • Encourage potassium rich foods
    • K+ replacement (IV or PO)
    • Monitor lab values
    • D/C potassium-wasting diuretics
    • Treat underlying cause
  4. Hyperkalemia: Pathophysiology
    An increase in K+ causes increased excitability of cells
  5. What causes hyperkalemia?
    • Increase in K+ intake
    • Renal failure *most common
    • K+ sparing diuretics
  6. What do you do if your patient has hyperkalemia?
    • Eliminate K+ administration
    • Increase K+ excretion (Lasix, Kayexalate)
    • Infuse glucose and insulin
    • Cardiac moniroting
  7. What causes hyponatremia?
    • Excessive diaphoresis
    • Wound drainage
    • NPO
    • CHF
    • Low salt diet
    • Renal disease
    • Diuretics
  8. What do you do if your patient has hyponatremia?
    • FVD: IV therapy to restore both fluid and Na
    • FVE: Administer osmotic diuretic (Mannitol) to excrete water rather than sodium
    • Increase oral sodium intake and restrict oral fluid intake
  9. What causes hypernatremia?
    • Renal failure
    • Corticosteroids
    • Increase in oral Na intake
    • Na containing IV fluids
    • Decreased urine output with increased urine concentration
    • Diarrhea
    • Dehydration
    • Fever
  10. What do you do if your patient has hypernatremia?
    • FVD: 0.45% NS. If caused by both Na and fluid loss, will administer NaCl. If inadequate renal excretion of sodium, will administer diuretics
    • Mild: Ensure water intake
  11. What causes hypocalcemia?
    • Decreased oral intake
    • Lactose intolerance
    • Decreased vitamin D intake
    • End stage renal disease
    • Diarrhea
    • Acute pancreatitis
    • Hyperphosphatemia
    • Immobility
    • Removal or destruction of parathyroid gland
  12. What does a positive Trousseau's sign indicate?
  13. What does a positive Chvostek's sign indicate?
  14. What do you do if your patient has hypocalcemia?
    • Calcium supplements
    • Vitamin D (helps Ca+ absorption)
    • High calcium diet
    • Seizure precautions
  15. What causes hypercalcemia?
    • Excessive Ca+ intake
    • Excessive vitamin D intake
    • Renal failure
    • Hyperparathyroidism
    • Malignancy
    • Hyperthyroidism
  16. What do you do if your patient has hypercalcemia?
    • Eliminate calcium administration
    • Drug therapy
    • Isotonic NaCl
    • Diuretics
    • Calcium reabsorption inhibitors (Phosphorus)
    • Cardiac monitoring
  17. Diseases of the cardiovascular system:
    • 1. HTN
    • 2. CHF
    • 3. Coronary artery disease
    • 4. MI
    • 5. Cardiac arrhythmia
  18. What drug classes are used to treat cardiovascular disease?
    • Diuretics
    • Sympatholytic drugs
    • Vasodilator drugs
    • Calcium channel blockers
    • Angiotensin (ACE) inhibitors
  19. What is CHF?
    • Contractile function is reduced
    • CO unable to maintain BP
    • Blood accumulates in heart (dilatation), lungs (pulmonary congestion), abdomen (ascites), and lower extremities (peripheral edema)
    • Patient is weak and has difficulty breathing
  20. What is the action of diuretics?
    • Increase sodium excretion and relax arterial blood vessels (vasodilation)
    • Elimination of excess fluid allows the heart to function more efficiently
  21. What kind of diuretics are used in patients with reduced renal function?
    • Loop diuretics
    • *Lasix
  22. What are common adverse effects of diuretic therapy?
    Excessive loss of fluid, sodium and potassium
  23. How do beta blockers lower BP?
    By decreasing heart rate and increasing cardiac output
  24. What is the action of calcium channel blockers?
    Block the influx of calcium into the heart and arterial blood vessels to vasodilate and lower blood pressure, cardiac work, and oxygen demand
  25. What are calcium channel blockers used to treat?
    Hypertension, angina pectoris, cardiac arrhythmias
  26. Calcium channel blocker drugs:
    • Verapamil and diltiazem act on both the heart and blood vessels to lower BP
    • Nifedipine and other calcium channel blockers lower BP by vasodilatoin
  27. What are the adverse effects of calcium channel blockers?
    • Excessive vasodilation
    • Hypotension
    • Cutaneous flushing
    • Headache
  28. What is the action of angiotensin (ACE) inhibitors?
    • Block angiotensin receptors on blood vessels and adrenal cortex
    • These drugs produce vasodilation and decrease the activity of aldosterone
  29. What is the action of nitrates?
    • Stimulate the formation of nitric oxide, a potent vasodilator of blood vessels
    • Vasodilation of veins and arteries decreases cardiac work and cardiac oxygen consumption to relieve the pain of MI
  30. What are adverse effects of nitrates?
    • Vasomotor flushing, dizziness, and headache are common
    • Sudden drop in BP, fainting, tachycardia
    • *Patients should be seated when taking these drugs sublingually
  31. What are nitrates used to treat?
    • Acute attacks of angina
    • Prevent anginal attacks
  32. Nitrates drugs:
  33. What is the action of beta blockers?
    • Sympathetic beta receptor stimulation of the heart increases heart rate, force of contraction, and oxygen consumption
    • Blockade of beta receptors decreases cardiac work and cardiac oxygen demand
  34. Cardiac glycoside drugs:
  35. What is the main pharmacological effect of Digoxin?
    • Increase the contractile force of myocardial contractions
    • Decrease heart rate and atrioventricular conduction
  36. Effects of hypokalemia on Digoxin:
    Increase drug toxicity and can cause cardiac arrhythmias
  37. Effects of hyperkalemia on Digoxin:
    Decrease the action of Dig
  38. Effects of hypercalcemia on Digoxin:
    Increase the actions and toxicity
  39. What are the adverse effects of Digoxin?
    • Dizziness, nausea, vomiting
    • Visual disturbances "halo effect" around lights signal overdose
    • Bradycardia, ectopic beats, and a variety of other cardiac arrhythmias can occur and can be life threatening
  40. Class 1 local anesthetic-type antiarrhythmic drug:
  41. What is the action of Lidocaine?
    Block the Na+ channel
  42. Class 2 antiarrhythmic drug:
  43. What is the action of Propranolol?
    Primarily blocks cardiac beta receptors to slow heart rate, AV conduction, and prolong the refractory period
  44. Class 3 antiarrhythmic drug:
  45. What is the action of Amiodarone?
    Interferes by blocking the potassium channel
  46. Class 4 antiarrhythmic drug:
    Verapamil and diltiazem