Pharm 3

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Pharm 3
2015-10-12 18:53:24

Pharm 3
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  1. What are "statins?"
    • HMG-CoA reductase inhibitors
    • HMG-CoA reductase is enzyme that serves as primary regulatory site for cholesterol biosynthesis. 
    • By inhibiting this, results in less cholesterol biosynthesis. 
    • As liver makes less cholesterol, it responds by making more LDL receptors on liver cells. 
    • The greater # of LDL receptors increases the removal of LDL from blood
  2. Side effects of statins
    • Muscle and joint pain
    • weakness
    • rhabdomyolysis
    • GI distress
    • headache
  3. Rhabdomyolysis
    • a breakdown of muscle fibers usually due to muscle trauma or ischemia
    • contents of muscle cells spill into systemic circulation, causing potentially fatal renal failure
  4. Appropriate LDL/HDL ratio levels
    • Males - less than 5.0
    • Females - less than 4.5
  5. Desired lipid values
    • Total cholesterol - less than 200
    • LDL - less than 100
    • HDL - More than 60
    • Triglycerides - Less than 149
  6. Cholesterol risk factors
    • >200 overall cholesterol
    • contributes to CVD and hypertension
    • builds plaque on arteries
  7. Types of Lipids
    • HDL - good cholesterol, transports cholesterol for destruction and excretion
    • LDL - Bad cholesterol, carries highest amount wherever it wants
    • VLDL - primary carrier of triglycerides, is reduced to LDL
    • Triglycerides - neutral fats, major storage form of fat in body, important energy source
  8. Problems with low cholesterol diets
    • with high fat, liver makes more cholesterol
    • therefore, must also have low fat diet
  9. What is Gemfibrozil, what should be taught
    • (Lopid) - drug for lipid disorder
    • prescribed for severe hypertriglyceridemia or VLDL levels
    • Is a fibric acid agent
    • Take with meals/food to help ease GI distress
  10. Ch 23
    Diuretic therapy and drugs for renal failure
  11. how are diuretics classified
    according to where it acts in the kidney
  12. Thiazide diuretic pt teaching
    • Take oral K supplement (eat bananas)
    • *daily weights, call if gain >2 lbs or loss > 3lbs/day
    • Teach safety with orthostasis (orthostatic hypo)
    • watch for dehydration & electrolyte imbalance
    • Hypotension
    • increases rate of urine flow (diuretic duh)
  13. diuretic AE's
    • Electrolyte imbalance (K)
    • dehydration
    • dry mouth
    • headaches
    • orthostatic Hypotension
    • ototoxicity (hearing loss)
  14. Medication administration in renal failure
    • treatment attempts to manage cause of dysfunction
    • Reduce dose if GFR is low
    • discontinue nephrotoxic meds
  15. Nephrotoxic meds
    • NSAIDS
    • Ace inhibitors
    • Radiographic Dyes
    • Aminoglycosides (antibiotic-Genomycin, penicillins)
  16. Loop Diuretic
    • Lasix
    • prevents reabsorption of Na and Cl in loop of Henle
    • Increases urine output
    • given in severe renal failure
  17. Chapter 24
    Fluid balance, electrolyte, acid-base disorders
  18. Hyperkalemia
    • a serum potassium level greater than 5 mEq/L
    • may be caused by high consumption of potassium-rich foods or dietary supplements
    • *particularly when pts are taking potassium-sparing diuretics such as spironolactone
  19. symptoms of hyperkalemia
    • most serious is related to cardiac function: dysrhythmias and heart block
    • others include muscle twitching, fatigue, paresthesias, dyspnea, cramping and diarrhea
  20. Hyperkalemia treatment
    • in mild cases, restrict food high in K such as bananas, citrus, peanut butter, broccoli, green leafy veggies
    • if pt is on potassium-sparing diuretic, dose must be lowered or thiazide or loop diuretic must be substituted
    • In severe cases, administering glucose & insulin (causing K to enter cells) dangerous & temporary!
    • Kayexalate will also lower K ~ (goes in brown. Comes out brown) isn't absorbed, but exchanges Na for K as it travels through intestine
  21. How to treat K toxicity to heart
    administer calcium gluconate or calcium chloride
  22. How to treat for acidosis that may be concurrent with hyperkalemia
    infuse sodium bicarb
  23. hyponatremia
    • sodium deficiency
    • serum sodium level less than 135 mEq/L
  24. Hyponatremia plan of action
    • give NaCl IV (0.9% NS or LR)
    • Or use diuretic to remove H2O
  25. K IV administration
    • Give if 2.0 or lower
    • do not exceed 10 mEq/hr, FATAL
  26. hypokalemia
    • occurs when K levels fall below 3.5 mEq/L
    • frequent AE resulting from high doses of loop diuretics
    • can also result from strenuous muscular activity and severe vomiting or diarrhea
  27. hypokalemia s/s
    • muscle weakness
    • lethargy
    • anorexia
    • dysrhythmias
    • cardiac arrest
  28. explain solution tonicitity
    • related to osmolarity.. it's the ability to change water movement across a membrane
    • *water flows from low osmolarity to high osmolarity!
    • Isotonic = 0.9%NS, LR, and D5W
    • D5NS = hypertonic (adding solutes)
  29. Hypertonic uses
    used to relieve cellular edema, specially cerebral edema
  30. hypotonic uses
    • pts w hypernatremia and cellular dehydration
    • *pts who are dehydrated w normal b/p should receive hypotonic solution
    • *pts who are dehydrated w low b/p should be given NS
  31. Isotonic solutions
    • have the same concentration of solutes as plasma
    • therefore, normal plasma is isotonic
  32. Ch 25`
  33. Blood pressure readings
    • Normal = 119/79 or less
    • Pre-HTN = 120-139/80-89
    • Stage 1 HTN = 140-159/90-99
    • Stage 2 HTN = 160 or ↑ / 100 or ↑
  34. Beta blocker contradiction
    • Causes bronchoconstriction, DONT USE ON ASTHMA PT
    • peripheral vascular disease
    • DM - can mask hypoglycemia
    • COPD
  35. beta blocker MOA
    • reduces HR and contractility, therefore reducing cardiac output and lower systemic BP
    • causes bronchial constriction
    • Does this by blocks the sympathetic actions of the heart (blocks adrenergic receptors)
  36. what is HCTZ
    • diuretic
    • Thiazide (an HCTZ) is first line drug for HTN
  37. HCTZ teaching
    • take in the morning
    • check K levels
    • daily weights!
    • rise slowly (causes orthostatic hypotension)
    • dehydration
    • photosensitivity (sun allergy)
  38. loop diuretic lab tests
    check K levels!!
  39. ch 26
    drugs for heart failure
  40. ACE Mech of action
    • reduces activity of RAAS
    • blocks the effects of angiotensin 2
    • decreased BP through 2 mechanisms:
    • lowering peripheral resistance and decreasing blood volume
    • doesn't allow reabsorption of sodium
  41. digoxin therapeutic effects
    inotrope, increases the contractility of heart and lowers HR
  42. digoxin toxicity risks
    • narrow therapeutic range!!
    • HR <60, stop med!
    • can cause:
    • dysrhythmias
    • N/V
    • blurred vision, halo w yellow-green tinge
    • anorexia
    • abdominal pain 
    • fatigue
  43. ace inhibitor side effects
    • 20% of pts experience cough
    • orthostatic hypotension
    • hyperkalemia
    • angioedema
  44. ch 27
    angina pectoris & MI
  45. Angina vs. MI
    • Angina is acute chest pain caused by insufficient oxygen to myocardium
    • MI is heart attack caused by complete coronary artery blockage
  46. calcium channel blockers MOA
    • dilate arterial smooth muscle, reducing BP and decreasing workload
    • some also reduce HR
  47. MONA
    • used on pt that comes in with severe chest pain:
    • Morphine, Oxygen, Nitro, Aspirin
  48. NTG side effects
    • tachycardia
    • orthostatic hypotension
    • dizziness, syncope
    • flushing of face
    • sensitivity to light
  49. NTG teaching
    • long acting nitrates,  transdermal patch or orally: withhold nighttime dose to prevent tolerance
    • short term: use sublingual for acute pain
  50. Retaplase therapeutic indication
    • is a thrombolytic
    • administered to dissolve clots obstructing coronary arteries, thus restoring circulation
    • Most effect when given 20 min-12hr after MI onset
  51. Downside to retaplase
    • primary risk is excessive bleeding due to interference of normal clotting process
    • also expensive 
  52. ch 28
    drugs for shock
  53. colloids vs crystalloids
    colloids: has large molecules that stay in blood cause too big to penetrate cell membranes. they draw water from cells, increasing plasma oncotic pressure. used for pt in hypovolemic shock, hemorrhage

    crystalloids: solutions that contain electrolytes in concentrations resembling plasma. can readily enter cells. used to replace lost fluids and increase urine output
  54. albumin teaching
    • is a blood protein used as colloid
    • draws fluid into blood
    • used for hypovolemic shock
  55. Dopamine administration
    • *is considered both vasopressor and inotropic drug, since it affects strength of myocardial contraction
    • given by IV pump via central line
    • has potential to cause dysrhythmias
  56. serum albumin assessment
    • Liver function tests
    • AST & ALT
  57. shock treatment priority
    • Basic life support
    • ABC
  58. ch 29
  59. beta blocker client teaching
    • will lower heart rate
    • check HR before taking, if <60, withhold med
    • dizziness and syncope common
    • sit up slowly (orthostatic hypotension)
  60. antidysrhythmic side effects
    • can worsen or create new dysrhythmias
    • palpitations, weakness, dysrhythmia, fatigue, dizziness, syncope,
  61. Cardiac output with tachycardia
    • cardiac output decreases when person has tachycardia
    • not enough time for ventricles to fill completely with blood before contraction
  62. Cardioversion rationale
    • is a nonpharmacologic therapy
    • electrical shock to heart momentarily stops all electrical impulses & allows heart to electrically reset
    • safer with fewer side effects
    • *however, if they have a clot in heart, shocking them will cause stroke
  63. dysrhythmias pathophysiology
    • abnormal action potential 
    • controlled by flow of Na, K, and calcium across myocardial cells
  64. ch 30
    drugs for coagulation
  65. heparin side effects
    • bleeding
    • decreased bp
    • increased hr
    • N/V
    • transient thrombocytopenia
    • anaphylaxis
    • anemia
  66. transient thrombocytopenia
    • most common coagulation disorder
    • low platelet count, whether from decreased platelet production of increased platelet destruction
  67. heparin outcomes
    • prevent formation of fibrin clots
    • prevent thrombi from forming or growing larger
  68. INR values
    • International normalized values - allows people to travel and still have blood tests done
    • 2-3 to prevent DVT
    • 2.5-3.5 to prevent arterial thrombosis
    • > 6.0 need vit K
    • high values indicate risk for bleeding and may need reduction of anticoagulant
  69. Lovenox administration
    • Sub Q injections
    • can be given at home
    • is more for prevention of coagulation issues
  70. Warfarin Lab tests
    • Monitor regularly
    • PTINR (PT/INR)
    • *PT is prothrombin time 
    • administer Vit K if INR is > 6.0
  71. Warfarin OD treatment
    Vitamin K via IV can reverse the anticoagulant effects
  72. Warfarin teaching
    • watch for signs of bleeding
    • takes several days to take effect
    • preg cat X
    • no OTC meds or herbs w/o approval
    • NO alcohol or NSAIDs
  73. ch 31
    hemotopoietic disorders
  74. hematopoietic
    • process of blood cell formation
    • occurs primarily in bone marrow
    • begins with stem cell
  75. neumega teaching
    • onset 5-9 days
    • can cause edema
    • very susceptible to adverse bleeding
    • *oldest drug available to enhance platelet production
    • *used in pts who are at risk for thrombocytopenia caused by cancer chemo
  76. alcoholism and folic acid
    • often folate deficient
    • alcohol interferes w folate metabolism in liver
  77. Epogen assessment post admin
    • take BP before and after
    • can cause HTN
    • *drug that stimulates erythropoiesis
    • *also called Procrit
  78. iron administration teaching
    • take with food
    • takes up to 6 months to alleviate anemia
    • *cant take with dairy, with can decrease absorption
  79. Neupogen MOA
    • increases neutrophil production in bone marrow
    • enhances phagocytic functions of neutrophils
  80. Procrit teaching
    • Take BP before and after, can cause HTN
    • will cause dizziness, so rise slowly
    • *also called Epogen