PHARM FINAL STUDY GUIDE copy.docx

**[PHARM FINAL STUDY GUIDE]** **[MEASUREMENT]** **[EQUIVALENT]** ------------------------------- ------------------------------ **3 tsp.** **1 Tbsp.** **1 Tbsp.** **1 Fluid Ounce** **8 oz.** **1 cup** **2 c.**...

**[PHARM FINAL STUDY GUIDE]** **[MEASUREMENT]** **[EQUIVALENT]** ------------------------------- ------------------------------ **3 tsp.** **1 Tbsp.** **1 Tbsp.** **1 Fluid Ounce** **8 oz.** **1 cup** **2 c.** **1 pint** **2 pints** **1 quart** **4 qt.** **1 gallon** **1 juice glass** **4 oz.** **1 teacup** **6 oz.** **1 glass** **8 oz.** **1 tsp** **5 mL** **1 Tbsp** **3 tsp./15 mL** **I gram** **1000 mg** **1 microgram** **0.000001 g** **1 kilogram** **2.2 lbs.** **1 mg** **1000 mcg or 0.001 g** **1lb** **16 oz.** **[Dosage Calculation:]** **[GENERIC: ]** **Dose Required Quantity** [ **.** ]**X [.] = X** **Dose On Hand X** Example: Metoprolol (Lopressor), 25 mg PO, is ordered. Metoprolol is available as 50 mg tablets. How many tablets would the nurse administer? **25mg 1 tablet** [ **.**] **X [.] = 0.5 tablets** **50 mg X** **[INFUSION TIME: ]** **Total Volume** [ **.**] **mL/hr.** Example: Infuse 1L of NS at 125 mL/hr. How many hours total will the infusion run for? **1000mL** [ **.**] **= 8 hours** **125 mL/hr** **[mL/hr]** **Total Volume (mL)** [ **.**] **Total Time (hr)** Example: Infuse 250mL over the next 120 minutes by infusion pump. **250 mL** [ ] **= 125 mL/hr** **2 hours** **[Drops Per Minute]** **Total Volume mL/hr** [ **.** ]**X drop factor. = [ ] OR [.] X drop factor =** **Total time (min) time (60 min)** Example: Calculate the IV flow rate for 1200mL of NS to be infused for 6 hours. The infusion set is calibrated for a drop factor of 15gtts/mL. **1200mL** [ **.**] **x 15gtt = 50 drops per minute** **360 min** **[DRUG DOSAGE AND FLOW RATE ]** **D (desired amnt{mcg, mg, u}) X** [ **.** ] **X [.]X Q(How much) = X(mL/min, mL/hr)** **Time (min/hr) H (what available in bag)** Example: Give pt 500mg of dopamine in 250mL of D5W to infuse at 20mg/hr. Calculate the flow rate in mL/hr. **20 mg X 250mL 10mL** [ **.** ]**X [.] X [.] = [.]** **Hr 500mg X hr** **[Prefix/Suffix ]** ---------------------------------- ------------------------------------------ ----------------------------------- **-afil** **Phosphodiesterase Inhibitor** **Sildenafil** **-bital** **Barbiturate** **Phenobarbital** **Cef-** **Cephalosporin ABX** **Cefactor** **Cort-** **Corticosteroid** **Hydrocortisone** **-dipine** **Calcium Channel Blocker** **Amlodipine** **-eprazole** **Proton Pump Inhibitor -PPI** **Omeprazole** **-floxacin** **Quinolone** **Ciprofloxacin** **-mysin** **ABX** **Azithromycin** **-olone** **Corticosteroid** **Prednisolone** **-oprazole** **Proton Pump Inhibitor PPI** **Pantoprazole** **-phylline** **Bronchodilator** **Theophylline** **Pred** **Corticosteroid** **Prednisone** **-profen** **NSAID** **Ibuprofen** **-setron** **Ondansetron** **Serotonin receptor antagonist** **-tadine** **Antihistamine** **Loratadine** **-vir** **Antiviral** **Acyclovir** **-zolam** **Benzodiazepam** **Midazolam** **-azone** **Corticosteroid** **Betamethasone** **-caine** **Local anesthetic** **Lidocaine** **-cillin** **Penicillin Antibiotic** **Amoxicillin** **-cycline** **Tetracycline ABX** **Doxycycline** **-dronate** **Bone resorption inhibitor** **Alendronate** **\--fenac** **NSAID** **Diclofenac** **-gliptin** **Antidiabetic** **Sitagliptin** **-olol** **Beta blocker** **Metoprolol** **-onide** **Corticosteroid** **Budesonide** **-pramine** **Tricyclic Antidepressant** **Clomipramine** **-pril** **ACE Inhibitor** **Ramipril** **-sartan** **HMG-CoA Reductase Inhibitor (statin)** **Atorvastatin** **-terol** **Beta agonist bronchodilator** **Albuterol** **-zepam** **Benzodiazepam** **Lorazepam** **-zosin** **Alpha Blocker** **prazosin** **[MILITARY TIME:]** 0100, 0200, 0300, 0400, 0500, 0600, 0700, 0800, 0900, 1000, 1100, 1200, 1300, 1400, 1500, 1600, 1700, 1800, 1900, 2000, 2100, 2200, 2300, 2400 **[MEDICATION ADMINISTRATION: ]** - **[TOPICAL: ]** - Administered through the skin for local/systemic effects. - Forms: ointment, lotions, gel, cream, plaster, liniment, powder, and intradermal patch - Follow all precautions when handling/applying/discarding patches - **[NASAL:]** - Given through the nose - Tx: seasonal allergies, asthma, congestion from cold, sinus conditions - Form: spray, inhaler, instillation - Pt tilt head back for absorption - Can be addictive - **[ORAL:]** - Anything by mouth (PO) - Tablets, capsules, elixirs, syrup, SR, XR, enteric coated - Most common med that CANNOT BE GIVEN BY MOUTH= INSULIN - **[VAGINAL:]** - Foams, gels, jellies, lotions - IUD- birth control - Antifungals-yeast infection - Contraceptives: gel, lotions, jellies, foam - **[OTIC:]** - Directly into ear canal - Cerumen tx: Debrox (carbamide peroxide) - Be room temp. - Adult: pull pinna up and back - Children: pull pinna down and back - **[OPHTHALMIC:]** - Infections, glaucoma tx/prevention, and facilitate exam/tx - Drops lubricate the eye/tx other conditions through absorption - Ointments are applied to lower eye lids - Drops 1^st^, Ointment 2^nd^ - Inner to outer application, pull down eyelid and apply ointment -- do not touch the applicator to the eye - Wear gloves, and do not touch applicator to eye to avoid contamination - Have pt look up, apply drops, close eye to prevent med. From entering nasolacrimal duct - Apply light pressure with finger to inner eye to keep drug from leaking into lacrimal duct - **[INHALANTS:]** - Nebulizer/Metered Dose Inhaler- MDI - Oxygen mask, cannula, CPAP - Clean mouthpiece after every use - Rinse mouth out AFTER beclomethasone inhalers: steroid meds - **[BUCCAL]** - CHEEK - Troches (lozenges) - Swish and spit out, others to sit and dissolve - Do not eat or drink anything within 15-20 minutes afterwards - **[SUBLINGUAL]** - Under tongue - Quick absorption - **[NG TUBE]** - Only liquids or tablets have to be crushed or mixed with water - 1^st^ check placement - Flush with NS before and after med. admin. to keep tube patent - **[RECTAL:]** - Enemas, suppositories, suspensions, ointments - **[INTRADERMAL (ID):]** - TB, allergy testing - Inner forearm, upper back - 10°-15° degrees, short/small gauge needle - **[SUBCUTANEOUS (SUBQ):]** - Into fat under skin - Insulin and Heparin - Sites: Back of upper arm, thigh, 2 inches from umbilicus in abdomen, scapula - Rotate sites regularly - 45° degree angle - Do not aspirate - Bunch up tissue before injection - Up to 1mL - 25--29-gauge needle - 5/8 inch - **[INTRAMUSCULAR (IM):]** - Onset is 10-15 minutes: Drug Allergy will be evident by this point - 90° degree angle - Given for antibiotics, pain meds, vaccines - Needle 1-2 inches, Gauge 20-23 g - Z-track method used for irritating meds - Sites: Deltoid, Ventrogluteal (safe for ALL pt 2yo and up), vastus lateralis-can be used in all age groups - Site should be clear of tattoos, scar tissue, lesion, rashes, or other injuries - Hold skin taut - **[INTRAVANEOUS (IV): ]** - Most rapid - Iv fluids, med to tx illness, to prevent illness, part of dx procedure, provide hydration and nutrition - 3 Main Types: Saline, Lactated Ringer's, and Dextrose - Check label against order 3x - PCA- pt controlled analgesic pumps - Given 3 Ways: Piggyback, infusion, or IV push - Bags are raised higher than pt heart - TPN nutrition, blood transfusion - 14g-24g - Angiocath-butterfly needle or Cath - Complications: Infiltration, Thrombus (blood clot), phlebitis (vein inflammation), air emboli (bubble in bloodstream) **[7 Rights of Safe Medication Administration: ]** 1. **Right person** 2. **Right drug** 3. **Right dose** 4. **Right time** 5. **Right route** 6. **Right technique** 7. **Right documentation** A constant among all medication administration is that the medication and equipment must be kept sterile before administration. When should you NOT give an oral med? - If pt is NPO, epigastric pain, acute pancreatitis, bloody vomit, gag reflex diminished, pt unconscious Skin Disorders - Classified as: inflammatory, infectious, cancerous - Topical/Systemic - Caused by bacteria, parasites, viruses, and fungi - Treatment: - Antibiotics=bacteria - Vitamin A, acid, or antibiotic - OTC: cream, gel, lotion contain BENZOYLE PEROXIDE -- bacteriostatic - Retinoids: Vitamin A reduces oil production - Reduce both function of sebaceous glands and keratinization - S/E: birth defects, emotional problems, HEPATOTOXICITY - RESERVED FOR SEVERE ACNE - SALICYLIC ACID, SULFUR, OR RESORCINOL used topically to remove infected skin by shedding - Systemic Antibiotics: TETRACYCLINES in extreme cases - IMPETIGO; topical antibiotics, topical corticosteroids, and if severe systemic antibiotics - Antifungals=fungi - Tinea - Topical Antifungals: CLOTRIMAZOLE (LOTRIMIN) OR TERBINAFINE (LAMISIL) - Candidiasis - Yeast infection of genitals or oral (thrush) - Topical Antifungal: NYSTATIN - ANTIFUNGALS: USE CAUTION WITH DEPRESSED BONE MARROW, TAKE FULL COURSE - Antiviral-virus - Depend on host for survival - HPV, Herpes simplex virus 1 and 2 - HPV genital warts are destroyed by cryosurgery or salicylic acid - HSV1 and HSV 2 tx with antiviral - ANTIVIRAL: NEED TO TAKE FULL COURSE - Pediculicides=parasite - Scabies, Lice - Scabicides - Inflammatory Skin Conditions: - Burns: - 1^st^ degree: SOLARCAINE - 2^nd^ degree: SILVER SULFADENE - 3^RD^ degree: COLLAGENASE (SANTYL), DUODERM, BECAPLERMIN(REGRANEX), ANALESICS, ANTIINFLAMMATORY, ANTIBIOTICS - Atopic Dermatitis: - "eczema" - Topical Corticosteroids: HYDROCORTISONE ACETATE 1% (CORTEF) - CORTICOSTERIODS: CONTRAINDICATED IN SERIOUS INFECTIONS, SUPPRESSES INFLAMMATION AND IMMUNE RESPONSE, RESOLUTION OF SKIN INFLAMMATION - Topical Immunomodulators: TACROMLIMUS (PROTOPIC), PIMECROLIMUS (ELIDEL) - Oral antihistamines: DIPHENHYDRAMINE (BENADRYL) - ANTIHISTAMINE: LOWER ALLERGIC SYMPTOMS, LOWER N/V, LOWER ANXIETY, RELIEF OF PRUITIS, MONITOR FOR INCREASED SEDATION, CAN CAUSE DRY MOUTH, DRY EYES, BLURRED VISION - Psoriasis: - Flaky, white appearance - Topical corticosteroids, low dose antihistamines, salicylic acid, or phototherapy - Antipsoriatic Agents: ANTHRALIN (PSORIATEC), CALCIPOTRIENE (DOVONEX, CALCITRENE) METHOTREXATE- oral/injectable - Skin Cancer - Basal Cell Carcinoma: - Most common form - Tx: surgical, topical preparations: FLUOROURACIL, Topical Immunomodulator: IMIQUIMOD, cryotherapy - Squamous Cell Carcinoma: - Arise from malignant keratinocytes - Can metastasize - Tx: surgical removal, radiation - Malignant melanoma: - Unpredictable form spreads through blood and lymphatic system - Tx: sugery, radiation, chemo MUSCULOSKELETAL SYSTEM - GLUCOCORTICOSTERIODS: - Mimic cortisol - Lower inflammation - DO NOT CURE gout/arthritis - Given to control pain/inflammation (arthritis) - Lower body's ability to fight infection (short term) - DEXAMETHASONE (DECADRON) - METHYLPREDISONE (MEDROL) - HYDROCORTISONE - PREDISONE - PREDNISOLONE - S/E: adrenal insufficiency, osteoporosis, infection, risk of HYPERglycemia, psychological disturbances, interferes with sleep, peptic ulcer to healing process being delayed, Cushing's Syndrome, glucose intolerance, fluid and electrolyte imbalance, cataracts, and gastric acid, do not discontinue, increase WBC, and makes them not functional so become immunocompromised. - Long term use can cause low density and growth - Cushing's Syndrome: - High level cortisol - S/E: weight gain, thin arms and legs, round face, increase fat around base of neck, Fatty hump b/t shoulders, easy bruising, wide purple stretch marks, mainly on abdomen, breasts, hip, and under arms weak muscles - **[DMARDS: Disease Modifying Antirheumatic Drugs]** - Lower joint destruction and lower progression of Rheumatoid Arthritis - Used in pt with arthritis (rheumatoid) - Lower immune systemically - Not cure, joint motility - METHOTREXATE (RHEUMATREX) - CYCLOSPORINE (NEORAL) - SULFASALAZINE (AZULFIDINE) - GOLD AUROTHIOGLUCOSE (SOLGANAL) - NSAIDS - PT EDU - REPORT S/E INFECTION, BLEEDING, SOB, DYSURIA - AVOID ALCOHOL WITH METHOTREXATE - PT NEED TO AVOID SUNLIGHT EXPOSURE - METHOTREXATE MUST BE STORE AT ROOM TEMP. - **[CALCIUM/BONE MEDS]** - Ca+ is needed for nerves, bones, and muscles to function properly - LOW Ca+= bones break, HIGH Ca+= not enough available in blood to assist in muscle contraction - MEDS: - NSAIDs - COLCHICINE (COLCRYS) - ALLOPURINOL (ZULOPRIM) - FEBUXOSTAT (ULORIC) - CELECOXIB (CELEBREX) - METHOTREXATE (PHEUMATREX) - CYCLOSPORINE (NEORAL) - SULFALAZINE (AZULDIFINE) - GOLD SALT - DEXAMTHASONE (DECADRON) - METHYLPREDISONE(MEDROL) - CAPSAICIN, BENGAY, ICY HOT - AMITRIPTYLINE (ELAVIL) - NORTRIPTYLINE (PAMELOR) - ANTICONVULSANTS - CARBAMAZEPINE (TEGRETOL) - MORPHINE (ROXANOL) - **[FIBROMYALGIA]** - Chronic pain in muscles/soft tissues around jts - Tx: low factors (lack of exercise, poor coping), PT, antidepressants, anti-inflammatories, TRIGGER pt injections, narcotics - PREGABALIN (LYRICA) - S/E: suicidal thoughts - **[MUSCLE SPAMS]** - Develop disorders or use of psyche drugs, muscles move uncoordinated (spastic) ways - Tx: MUSCLE RELAXANTS: CYCLOBENZAPRINE(FLEXERIL) - ANTISPASMODICS: METRAXALONE (SKELAXIN) - SOMETIMES BENZO: DIAZEPAM (VALIUM) - DULOXETINE (CYMBALTA); TCA - BOTOX- PARALYZES MUSCLE - CHOLINESTERASE INHIBITORS: NEOSTIGMINE (PROGSTIGMIN) - DANTROLENE (DANTRIUM) - BACLOFEN (LIORESAL) - **[GOUT]** - SUDDEN SEVERE ATTACK OF PAIN, REDNESS, JT TENDERNESS, MAINLY BIG TOE/FT, DUE TO BUILD UP OF URIC ACID - TX: NSAIDs- 1^st^ - COLCHINE (COLCRYS) - ALLUPURINOL (ZYLOPRIM) - FEBUXOSTAT (ULORIC) **[OPIOIDS]** - Strong pain killers - Lower CNS - "narcotics" = opium - Higher addictive properties - Synthetic/semisynthetic sources - Produces euphoria/happiness - Closely monitored, used for general anesthetic-surgery - S/E- lower respiratory function, lower BP, Risk of OD - Ex: NALOXONE (NARCAN)-**[ANTIDOTE]** - MORPHINE, MEPERDINE (DEMEROL), FENTANYL=**[BIG GUNS]** **[ANTISEIZURE MEDS]** - **[BARBITUATES:]** PHENYTOIN (DILANTIN), PHENOBARBITAL (LUMINAL), ETHOSUXIMIDE (ZARONTIN) **["SUCCINIMIDES"]** **[GABA]** - VIGABUTRIN (SABRIL) - BENZO: DIAZEPAM (VALIUM) **[ANTICONVULSANT]** - LAMOTRIGNE (LAMICTAL) - TIAGABINE (GABITRIL) - TOPIRAMATE (TOPAMAX) - CARBAMAZEPINE (TEGRETOL) **[ANXIOLYTIC]** - Lowers fears, dangers, tension - Tx: GAD, phobias, PTSD, OCD, Anxiety/Restlessness - **[Benzo:]** LORAZEPAM (ATIVAN), DIAZEPAM (VALIUM), ALPRAZOLAM (XANAX) - **[Barbituates:]** PHENOBARBITAL **[SSRI]** - CELEXA (CITALOPRAM), FLUOXETINE (PROZAC), SERTRALINE (ZOLOFT) **[SNRI]** - VENLAFAXINE (EFFEXOR XR) **[TCA]** - AMITRYPTYLINE (ELAVIL) **[INSOMNIA]** - **[BARBITUATES: ]** - LOWER CNS (LOWER HR/LOWER RR) - HELPS PT RELAX - **[NONNARCOTIC BARBITUATES:]** - ZOLPIDEM(AMBIEN) - ESZOPIDONE(LUNESTA) **[THYROID MEDS]** - THYROID (AMROUR THYROID, BIOTHYROID) - LIOTHYRONINE (CYTOMEL) - LEVOTHYROXINE (SYNTHYROID, LEVOXYL) - RADIOACTIVE SODIUM IODIDE I-131 (IDOTOPE) - PROPYLTHIOURACIL - METHIMAZOLE (NORTHYX, TAPAZOLE) - T3, T4 **[DIABETIC MEDS]** - INSTA-GLUCOSE (GEL) - BD GLUCOSE (CHEWABLE TAB) - GLUCAGON (GLUCA GEN) **[1^st^ Gen: SULFONYLUREA ANTIHYPERGLYCEMIC]** - ACETOHEXAMIDE (DYMELOR) - CHLORPROPAMIDE (DIABINESE) - TOLAZAMIDE (TOLINASE) - TOLBUTAMIDE (OVINASE) **[2^nd^ Gen : SUFLONYLUREA ANTIHYPERGLYCEMIC]** - GLIMEPIRIDE (AMARYL) - GLIPIZIDE (GLUCOTROL) - GLYBURIDE (DIABETA, MICRONASE, GLYNASE) **[SODIUM-GLUCOSE COTRANSPORTER 2 (SGLT-2) INHIBITORS]** - EMPAGLIFLOZIN (JARDIANCE) - CANAGLIFLOZIN (INVOKANA) - DAPAGLIFLOZIN (FORXIGA) (FARXIGA) **[DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITORS]** - LINAGLIPTIN (TRANJENTA) - SITAGLIPTIN (JANUVIA) - ANAGLIPTIN (SUINY) **[GLUCAGON-LIKE GLUCOSIDASE PEPTIDASE 1 (GLP-1) INHIBITOR]** - LIRAGLUTIDE (VICTOZA) - DULAGLUTIDE (TRULICITY) **[BIGUANIDES]** - METFORMIN **[THIAZDIDINEDIONES]** - GLITAZONE - ROSIGLITAZONE (AVANDIA) - PROGLITAZONE (ACTOS) **[MEGLITINIDES]** - NATEGLINIDE (STARLISE) - VEPAGLINIDE (PRANDIN, NOVO NROM) **[INSULIN]** - **[MIXING: ]** - **[1^ST^ CLEAR + 2^ND^ CLOUDY\*\*]** - **[RAPID ACTING]** - GIVEN AT START OF MEALS - Most **[DEADLY]** - Onset: 15 min - Peak: 30-90 min - Duration: 3-5 hr - ASPART (NOVOLOG)-MOVE YOUR ASS - LISPRO (HUMALOG)- LETS GO - GLULISINE- FAST LIKE A LIMOSINE - **[SHORT ACTING]** - SLIDING SCALE, 30-60 min BEFORE MEALS - READY TO GO IV-T**[HE ONLY IV INSULIN]** - REGULAR -- HUMULIN R, NOVOLIN R, VELOSULIN R - Onset: 30-60 min - Peak: 2-4 hr - Duration: 5-8 hr. - **[IMMEDIATE ACTING]** - GIVE 2X/DAY - COVERS HALF THE DAY TO OVERNIGHT - CLOUDY/MIXED (**[clear before cloudy]**)(regular before NPH) - Onset: 60-120 min - Peak: 4-12 hr - Duration: 14 hours - NPH: HUMULIN N, NOVOLIN N, RELION - **[LONG ACTING]** - COVERS A FULL DAY - CAN BE COMBINED BUT NEVER MIXED - LAST **[1.5 DAYS]**, TAKEN AM/PM - Onset: 60-120 min - Peak: NO PEAK - Duration: 24 hr. - CANNOT BE MIXED - DETRIMIR (Levemir)- Lasts all year - LANTUS (Basaglar)- Lantern - Glargine ( Tonjeo)- Large - **[ULTRA LONG ACTING]** - LAST 36HR OR LONGER - **[PREMIXED INSULIN]** - INSULIN PENS - **[INHALED INSULIN]** - AFREZZA - INSTANT **[RULES OF INSULIN]** - Watch for signs of hypoglycemia - Shaky, clammy, pale, sweaty - **[Cool and clammy, give me candy]** - **[Awake:]** pt eat candy, juice, low fat milk - **[Unconscious:]** Stab with IV D50 - **[Regular Insulin]**- **[ONLY]** insulin given IV - **[NPH-]** if mixed, clear to cloudy (NPH is cloudy) - **[Long acting-]** Do not mix: **[NO PEAK]** - Rotate injection sites, do not aspirate/massage - Always increase insulin with: (glucose high with any type of stress) - Stress - Sepsis - Sickness - Steriods **[Insulin Pump]** - Gives steady dose of insulin for Type 1 DM - Check BG 4x/day - Push bolus at meals **[Remember: ]** **[Type 1: YOU HAVE NONE]** - NO INSULIN CAN BE PRODUCED - NEEDS INSULIN **[Type 2 : YOU ARE THE PROBLEM]** - Encourage healthy diet, exercise - Potential oral med use - Insulin -- last resort - **[S/E: ]** - HA, increased sweating, tingling, irritable, blurred vision, tremor, weak, low BG, hypokalemia, abd pain, N/V, metallic taste (metformin), aplastic anemia rash (sulfonylureas), swelling, weight gain (thiazolidinediones) **[ANTIANGINALS]** - NITROGLYCERINE (NITROLINGUAL, NITROQUICK, NITROSTAT, NITROBID,NITRO-DUR) - NITROGLYCERINE TOPICAL (NITROBID OR NITRO APPLI KIT) - NSAIDs **[ANTICOAGULANTS/ANTIPLATELETS]** - **[WARFARIN-]** COUMADIN - ANTIDOTE: **[VITAMIN K]** - **[HEPARIN]** - ANTIDOTE: **[PROTAMINE SULFATE]** - ENOXAPRIN (LOVENOX) - **[ASPIRIN]** - **[TICLOPIDINE (TICLID)]** - **[CLOPIDROGEL (PLAVIX)]** - ABCIXIMAB (REO PRO) - EPTIFIBATIDE (INTEGRITIN) - TIROFIBAN (AGGRASTAT) - ADENOSINE DIPHOSPHATE (ADP) RECEPTOR BLOCKER - GLYCOPROTEIN IIB/IIA INHIBITORS - **[ANTICOAGULANTS:]** - INTERFERES WITH BLOOD CLOTTING PROCESSES, USED TO PREVENT THROMBUS AND EMBOLUS - **[PREVENT-DVT, PE, ATRIAL FIBRILLATION]** - **[DO NOT]** DISSOLVE CLOTS - MONITOR FOR **[SIGNS OF BLEEDING: BLEEDING, BRUISES, NOSEBLEED, BLACK STOOL, HEMATURIA)]** - **[PREVENT STROKE, MI, AND POSSIBLE DEATH]** - HEPARIN OD=PROTAMINE SULFATE - WARFARIN OD- VITAMIN K - MONITOR **[PTT -- HEPARIN, INR- WARFARIN]** - **[ANTIPLATELETS:]** - INTERFERES WITH THE 1^ST^ STEP IN THE CLOTTING PROCESS, PLATE AGGREGATION - **[BALANCE Ach AND DOPAMINE]** (THERE IS LACK OF DOPAMINE AND EXCESS OF Ach IN PARKINSON'S) - MAY CAUSE **[DROWSINESS/DIZZINESS]** - RESOLUTION OF **[PARKINSON'S AND EXTRAPYRAMIDAL S/S]** **[DIURETICS]** **[THIAZIDE DIURETICS (K+ WASTING):]** - Dry up body by excreting K+, increases urination - INCREASE EXCRETION OF Na+, CL-, K+, H2O IN DISTAL TUBE AND ASCENDING LOOP OF HENLE - **[ONLY]** give if K level is in range (3.5-5.0) - Used for HF, worsening crackles, new edema in legs, rapid weight gain - Ex: HYDROCHLOROTHIAZIDE (HYDRO DIURIL, AQUAZIDE H, ESIDRIX, MICROZIDE) CHLOROTHIAZIDE (DIURIL, DUIRIL SODIUM) - WATCH FOR LOW K= LOW HEART BEATS(FLAT T WAVE, ST DEPRESSION, U WAVE) - ENCOURAGE K RICH FOODS- BANANAS, GREEN LEAFT VEGGIES, MELON **[LOOP DIURETICS (K+ WASTING) NO LICORICE=LOW K+]** - Dry up body excreting K+, increases urination - STOPS REABSORPTION OF Na+, CL-, K+ and H20 IN LOOP OF HENLE, AND PROXIMAL AND DISTAL RENAL TUBULES - **[ONLY]** given if K+ level is in range -- (3.5-5.0) - Watch for low K+=low heart beats (Flat T wave, ST depression, U wave) - HF, worsening crackles, new edema in legs, rapid weight gain - Ex: FUROSEMIDE (LASIX)- given **[too fast]**=tinnitus, hypotension - Given **[too slow]**=kidney damage, high BUN, high Cr+, low K+ - BUMETANIDE (BUMEX) - TORSEMIDE (DEMADEX) - ERTACRYNIC ACID (EDECRIN, SODIUM EDECRIN) **[POTASSIUM SPARRING DIURETICS]** - AMILORIDE (MIDAMOR) - TRIAMTERENE (DYRENIUM) - SPIRONOLACTONE (ALDACTONE) - CONTAINS ALDOSTERONE AT RECEPTOR SITES IN DISTAL TUBULE: EXCRETE Na+, CL-, H2O, not K - Blocks Aldosterone directly=release Na+ and H20 - "**[spares" K+ in body]** - Watch **[for increasing K=]**increased heart beat (peak T wave, ST elevation) - Avoid K+ rich foods/no salt substitutes - Make sure to put on cardiac monitor **[OSMOTIC DIURETIC]** - **[MANNITOL]** - Low thickness of blood=increased cerebral blood flow= low blood volume and ICP - Tx **[increased ICP, lower eye pressure]** - S/E: HA, nausea, acute renal failure (large doses) - Watch neurologic and renal status **[KEY FOR POTASSIUM WASTING AND SPARING:]** - **[ALWAYS CHECK BP-]**HOLD IF SYSTOLIC LOWER THAN 100 - **[ALWAYS CHECK BUN, CR, K LEVELS-]** HEART MONITOR - GIVE IN **[MORNING]** NOT NIGHT - **[DAILY WEIGHTS]** - NO SODIUM MEDS (COUGH/FLU, ANTACIDS, NSAIDs) - TEACH ORTHOSTATIC HYPOTENSION, RISK SUNBURN **[DIURETICS:]** - **[TX:]** HTN, EDEMA, HF - **[LOW K]** -- RISK OF **[DIGOXIN TOXICITY]** - MONITOR INTAKE, OUTPUT, LUNG SOUNDS, SKIN TUGOR - ORTHO HYPO - LOW BP, LOW URINE OUTPUT, LOW EDEMA, LOW ICP - LOWER FLUID VOLUME IN BODY **[ANTIHYPERTENSIVES]** - **[ACE INHIBITORS (-PRIL)]** - BENAZEPRIL (LOTENSIN) - CAPTOPRIL (CAPOTEN) - ENALAPRIL (VASOTEC) - FOSINOPRIL (MONOPRIL) - ANGIOTENSIN-RECEPTOR BLOCKERS (ARBs) (-SARTAN) - CANDESARTAN (ANTACAND) - EPROSARTAN (TEVETEN) - IRBESARTAN (AVAPRO) - LOSARTAN (COZAAR) - OLMESARTAN (BENICAR) - TELMISARTAN ( MICARDIS) - VALSARTAN (DIOVAN) - Stop normal function of RAAS- low BP by getting rid of Na+ and H20 and increasing K+ - Teratongenic-not for pregnancy - K+ levels- EKG (Peak T wave/ST elevation) - K+ diet- AVOID K+ rich foods - Watch BP/ortho hypo - Abrupt discontuiation could cause rebound HTN - Encourage weight loss, low sodium diet, stop smoking and alcohol use - Decrease BP **[Beta Blockers (-olol)]** - ACEBUTOLOL (SECRETAL) - ATENOLOL (TENORMIN) - BISPROLOL ( ZEBETA) - NADOLOL (CORGARD) - NEBIVOLOL (BYSTOLIC) - PROPANOLOL (INDERAL LA ) - METOPROLOL - Stop beta receptors from doing their job-lower HR/BP - Beta 2 receptors work on the lungs so we may see bronchospasm - DO NOT GIVE TO ASTHMA, COPD PT - Can be given to HF pt - May mask sx of hypoglycemia - ALWAYS check HR/BP before GIVING- HOLD if BP lower than 90/hr lower than 60 - WATCH. Ortho hypo, wheezing, low HR, low BP - Tx: HTN, angina, tachyarrhythmias, migraines, MI, glaucoma, and HF - Beta 1-heart - Beta 2- lungs - Taper, or risk rebound HTN and tachycardia - Lower BP, freq/severity of angina, arrhythmias control, prevent MI and migraines - SELECTIVE: - ATENOLOL - METOPROLOL - NONSELECTIVE: - PROPANOLOL - SOTALOL **[CALCIUM CHANNEL BLOCKERS (CCB). (-dipine) low BP (-zem/-amil) low BOTH HR/BP]** - Tx: HTN, angina, coronary artery spasm - Blocks Ca+ entry into cells of vascular smooth muscle - Blocks Na+ into beta receptors - Lower force of myocardial contraction/conductivity, low HR, low, peripheral vascular resistance - Produce relaxation of coronary and vascular smooth muscle, dilates coronary arteries, increase myocardial O2 delivery, low O2 demand - S/E: edema, dysrhythmias - Do not crush or open - Monitor ortho hypo - Lower BP, freq/severity of angina, increase activity tolerance - Stop movement of Ca+ which relaxes smooth muscle-lowers resistance-lowers BP - DO NOT give to HF pt (will worsen) - ALWAYS check HR/BP BEFORE giving- HOLD if BP LOWER THAN 90/HR LOWER THAN 60 - WATCH for ortho hypo - HA=NORMAL FINDING - ALODIPINE (NORVASE) - DILTIAZEM(CARDIZEM, DILACOR, TIAZAC, DILTIA XL) - NEFIDIPINE (PROCARDIA XL) - VERAPAMIL HYDROCHLORIDE (ISOPTIN, CALAN, VERCLAN, ADALAT-CRVERA-HS **[VASOLDILATORS]** - Can be used in HF - PERIPHERAL AND CORONARY VASODILATORS - Tx and prevent angina, high BP, low preload/afterload, low myocardial O2 demand - Rotate transdermal patches/remove after 12-14 hrs=patch free 10-12 hr daily - CHECK K LEVEL - Relaxes smooth muscle=**[low BP, high O2 to major organs]** - **[Normal S/E]**: - HA, flushing, hypotension - **[DO NOT]** take with Viagra (sildenafil) - **[Hold]** if BP systolic **[lower than 100 or drops below 30]** - **[Monitor BP \*ortho hypo\*]** - NITROGLYCERIN - NITROPRUSSIDE - ISOSORBIDE - ISOSORBIDE DINITRATE (DILATRATE-SR, ISOBID, ISONATA, ISORDIL, ISOTRATE, SORBITRATE) - ISOSORBIDE MONONITRATE - HYDRALAZINE (APRESOLINE) **[CARDIAC GLYCOSIDES]** - **[FOR HF]** can be given as antiarrhythmic - **[DOES NOT]** affect **[BP ONLY HR]** - "digs is for a forceful contraction" - **[THERAPEUTIC RANGE: 0.5-2.0]** - **[DOES NOT]** waste K+- don't change K+ diet - **[POSITIVE INOTROPES (]**improve contractility and cardiac output) - **[NEGATIVE DROMOTROPIC]** (slow AV conduction rate) - **[NEGATIVE chronotropes]** (low HR and improve cardac output) - Act as a**[ntiarrhythmi]**c via tropic effect, - **[MONITOR K+ LEVEL, DIG LEVEL]** - **[Low K+=High risk of Toxicity]** - S/E: - **[Toxicity-]** - vision change, dizzy,N/V, irregular pulse, confusion - DIGOXIN (CARDOXIN, DIGETEK, LANOXICAPS, LANOXIN) **[Dysrhythmias]** - **[Na+ Channel Blockers:]** - PROPAFENONE (RHYTHMOL) - FLECAINIDE (TAMBOCOR) - QUINIDINE (QUINIDEX) - **[BETA BLOCKERS]** - ATENOLOL (TENORMIN) - PROPANOLOL (IRDERAL) - **[K+ CHANNEL BLOCKERS (INTERNAL FIBRILATORS)]** - AMIODARONE (CORDARONE) - SOTALOL (BETAPACE) - BRETYLIUM - **[Ca+ CHANNEL BLOCKERS]** - DILITAZIM (CARDIZEM) - VERAPAMIL (ISOPTIN, CALAN) **[KEY TAKEAWAYS]** - **[LOW BP]**-ALL EXCEPT DIGOXIN - **[LOW HR]**-BETA BLOCKERS, CCB'S (ZEM/AMIL) - **[DO NOT GIVE]** WITH HF-CCB'S - **[YES FOR HF-]**DIGOXIN, BB'S, VASODILATORS, DIURETIC - **[NOT FOR PREGNANCY]**- ACE/ARBs - **[WATCH VITALS!]** DO NOT SKIP ABRUPTLY! **[LIPID DISORDERS: ]** - HDL=GOOD - LDL=BAD - VLDL=BAD - TRIGLYCERIDES **[HMG-Co-A- Reductase Inhibitors. (-STATINS)]** - Low blood levels of lipids - Encourage liver to make less cholesterol - Use low cholesterol and low risk of MI/stroke - **[Increase LDL]** receptors - Stops enzyme HMG-Co-A Reductase to low cholesterol production - S/E: **[liver toxicity ( HEPATOTOXICITY)]** - Myopathy (muscle pain) - **Rhabdomyolysis** - Monitor **[LFTs/CK levels (NML-22-198u/L)]** metabolized in liver, excreted by kidneys - **[AVOID ALCOHOL]** - **[TAKE IN EVENING]** - **[NO GRAPEFRUIT JUICE!]** - ATORVASTATIN (LIPITOR) - LOVASTATIN (MERACOR) - PRAVASTATIN (PRAVACHOL) - ROSUVASTATIN (CRESTOR) - SIMVASTATIN (ZOCOR) **[BILE ACID SEQUESTRANTS. (COLE-) AKA RESINS]** - **[LOW LDL]** - LOWER CHOLESTEROL - LOWER CHOLESTEROL BY BINDING BILE ACIDS IN THE GUT**[= PEE OUT=]**PULLS MORE CHOLESTEROL FROM BLOODSTREAM TO MAKE BILE - **[TEACH TO]** INCREASE FIBER/FLUIDS - **[INTERVERES WITH ABSORPTION]** OF FAT SOLUBLE VITAMINS **[(A,D,E,K)]** - TAKE WITH FOOD - BINDS BILE ACIDS, IMPEDING ABSORPTION (ELIMIATION IN FECES) - BILE ACID SEQUESTRANT (FOOD ADDITIVE IMPROVING QUALITY) - **[S/E:]** - CONSTIPATION - FLATULENCE - GI DISTURBANCE - BAD TASTE - COLESEVELAM (WELCHOL) - COLESTEPAL (COLESTID) - CHOLESTYRAMINE (QUESTRAN) **[FIBRIC ACID DERIVERATIVES. (HAS "fib" IN NAME)]** - **[Lower trigyleride]** synthesis in liver - **[Increase HDL]** - Lower triglycerides - Lipoprotein lipolysis - Give **[30 min before breakfast and dinner]** - WATCH **[LFTs and CK levels (NML: 22-198u/L)]** - S/E: **[HEPATOTOXICITY]** - MYOPATHY - **[GALLSTONES]** - GI UPSET - N/V - FENOFIBRATE (TRICOR) - GEMFIBROZIL (LOPID) - CLOFIBRATE HYPERLIPIDEMIC MEDS - ALL AFFECT THE LIVER AND LIPID PROFILE - MEDS MOST LIKELY WILL NOT BE RX TO LOWER CHOLESTEROL DURING PREGNANCY - LFTs: - AST: 10-40 u/L - ALT: 7-56 u/L - ALP: 40-120 u/L - Billi: \