Pharm Test 4 study guide

 

 

OD Reversal Drugs

 

 

  • NARCAN

 

      • Opiate antidote
      • given even if there is an OD of unknown cause

 

  • Flumazenil

 

    • Antidote for benzos

 

  • Amyl Nitrate

 

    • For Chest pain
    • cyanide antidote

 

  • Ipecac

 

    • To Puke
    • mallory weiss tear from violent puking
    • vomiting like the exorcist

 

  • Atropine

 

    • to stop cholinergic effects
    • It is an anticholinergic

 

  • Charcoal

 

      • Binds med in the gut so it cannot be absorbed then is passed in the stool.
      • Powder form mixed in water and sucked through a straw to prevent reddining of the teeth.

 

  • Vitamin K

 

      • Antidote for Warfarin

 

  • Protamine Sulfate

 

    • Antidote for heparin

 

Cancer

 

Antimetabolite

 

  • 5FU (fluorouracil)
  • Pyrimidine analog (disrupts nucleic acid fxn)

 

      • IV or topical admin (topical for skin cancer and we may not need to know this)
      • Cell cycle S-phase specific, prevents thymidine production
      • bone marrow depression
      • High alert medication

 

  • MTX methotrexate
  • Folic acid analog (prevents folic acid conversion)

 

    • Sphase specific
    • PREG category X
    • High alert med
    • dose limiting bone marrow supression
    • Kills rapidly dividing cells, and causes immunosuppression
    • SE: Pulmonary fibrosis, Hepatotoxicity, nephrotoxic, Steven-Johnson’s syndrome, and aplastic anemia
    • for the pulmonary toxicity, early signs are a dry nonproductive cough
    • for SJS, assess for rash as an early sign
    • for nephrotoxicity low back and flank pain is an early sign as well as changes in urination patterns or pain.

 

Alkylating agents

alkylates DNA and binds 2 guanines together to prevent the helix from becoming unbound, therefore inhibiting replication. The dose is limited by bone marrow suppression, but can be given in a bolus.

 

  • Mustargen (mechlorethamine)

 

      • inhibits DNA and RNA protein synthesis
      • for hodgkin’s disease and malignant lymphomas.
      • Cell cycle phase nonspecific
      • Contraindicated in pregnancy
      • SE: thrombocytopenia, Leukocytopenia, Seizures
      • monitor for bleeding and bone marrow suppression
      • notify provider for sore throat, neph-toxic s/s, bruising, bleeding, red stools
      • DO not drink alcohol, or take NSAIDs, or ASPIRIN, this will increase bleeding risk

 

  • Mustard Gas

 

      • similar to the nitrogen mustards, but for warfare.

 

  • Cytoxan (cyclophosphamide)

 

    • High alert med
    • most common alkylating agent
    • cell cycle phase nonspecific
    • SE: Pulmonary fibrosis, myocardial fibrosis, hemorrhagic cystitis(increase fluid intake to 3000ml/day), leukopenia(monitor for , thrombocytopenia(monitor for bleeding), anemia.  
    • increases effects of warfarin, phenobarb and rifampin increase toxicity of this drug. Prolongs the effects of cocaine.
    • monitor for edema, crackles, cardio/resp distress, HF s/s.
    • crosses BBB

 

Antibody Anti-tumor

 

  • Doxorubicin (Adriamycin)

 

    • antitumor antibiotic
    • binds directly to DNA and stops replication
    • High alert med
    • dose limiting heart failure, and bone
    • cell cycle S phase specific
    • SE: CARDIO TOXIC, dark urine stools, palms and nails, alopecia, leukopenia,
    • monitor uric acid levels, bleeding and CBC, I’s and O’s

 

Platinum

 

  • Cisplatin

 

    • produces crosslinks in DNA and is cell cycle nonspecific
    • dose limiting kidney failure
    • metastatic, head and neck, testicular, ovarian, bladder ,lung, and colon cancer
    • tubular necrosis in the kidney, ototoxic, bone marrow suppression,  severe nausea and vomiting in the first hour after administration.
    • MOA similar to alkylating agents
    • Kidney Failure is a dose limiting factor.

 

Mitotic Inhibitors

 

  • Vincristine

 

    • prevents cell division (m-phase specific)
    • SE: peripheral neuropathy (Neurotoxic), barely and bone suppression!!
      • vinblastine causes bone marrow suppression and not peripheral neuropathy, so when used together there is not stacking of those side effects.

 

AntiHormones

 

  • Tamoxifen
  • antiestrogen

 

    • for treatment and PREVENTION of estrogen related cancers ie. breast
    • SE: causes CANCER, birth defects, vaginal discharge w/ bleeding.
    • DD: carbamazepine = rapid metabolism. and erythromycin = slowed metabolism.   

 

 

  • prednisone
  • use in high doses
  • glucocorticoids
  • toxic to lymphocytes and lymph tissues

 

 

 

  • progestin (megace)
    • For breast cancer and endometrial cancer
    • used in AIDS pt for anorexia, weight gain and stim of appetite

 

Anticoagulants

 

 

  • Aspirin

 

      • suppress platelet aggregation for the platelet’s life span through cyclooxygenase inhibition.
      • doubles bleeding time for up to seven days
      • can be used for prophylaxis of MI in men and questionable in women.
      • risk of GI hemorrhage
  • Heparin

 

      • Interrupt coag pathway in factor X and thrombin
      • prevents thrombosis, post op thrombus, and more clots forming
      • SE: HEMORRHAGE, HIT, Sensitivity reaction bc it is animal product, All kinds of bleeding (gums, bruises, petechiae, hematoma, red or black stool)
      • HIT heparin induced thrombocytopenia – antibodies develop against Heparin, and the person can NEVER GET THE DRUG AGAIN, there will also be long term bleeding issues associated with this
      • RAPID acting, and only given IV never PO or IM
      • Made from animals
      • normal aPTT is 40 seconds
      • therapeutic aPTT with heparin is 60-80 seconds
      • PROTAMINE SULFATE is the antidote
    • Lovenox
      • LMW Heparin – low molecular weight heparin
      • only stops factor X not thrombin
      • for prevention and treatment of DVT, prevents complications with unstable angina
      • do not need to check aPTT
      • never givin IM

 

  • Argatroban

 

      • direct thrombin inhibitor
      • Use this drug if the patient is experiencing HIT
        • also bivalirudin does this (monitor with ACT test)
      • monitor with aPTT
      • no reversal agent
      • expensive

 

  • Streptokinase

 

      • Thrombolytic: Dissolves clot after formation
      • stick all IV’s before giving drug
      • converts plasminogen to plasmin
      • for acute MI, pulmonary emboli, to break up a clot in a central line
      • can cause bleeding, Allergic RXN,

 

  • tPA alteplase

 

      • thrombolytic: Dissolves clot after formation
      • stick all IV’s before giving drug
      • major bleeding issues. but not as much of an allergy risk
      • very similar to streptokinase

 

  • Dabigatran (Pradaxa)

 

      • direct thrombin inhibitor
      • ORAL anti coag for stroke PT’s w/ non valvular Afib
      • very expensive,
      • bleeding problems as well

 

  • clopidogrel (Plavix)

 

      • ADP receptor antagonist
      • given with ASA sometimes, but do not take ASA
      • for PAD and CVA
      • these are contraindicated with HERBALS
      • proton pump inhibitors makes plavix not effective

 

  • Warfarin (coumadin)

 

    • indirectly decreases many clotting factors
    • works in the LIVER not the blood
    • normal tests while on warfarin are INR(2-3sec) and PT (12sec)
    • effects IIV, IX, X and prothrombin
    • for long term treatment of thrombosis, or pulmonary embolism, also prophylaxis of clot formation(TIA, Prosthetic valve, Afib)
    • Lasts much longer than heparin
    • SE: bleeding like the rest
    • keep Vit K levels consistent throughout treatment
    • Vit K is the antidote
    • d/d interactions increase clotting: quinidine, antibiotics, NSAIDs, cimetidine, thyroid hormones, ASA, Tylenol even

 

Musculoskeletal

 

 

  • Diazepam (Valium)

 

      • Centrally acting MM relaxants
      • flumazenil is the antidote for this
      • used to treat spasticity
      • CNS depression, sedation
      • benzo

 

  • Selegiline (Eldepryl)

 

    • for parkinson’s and for pt’s taking levodopa

 

 

  • Baclofen

 

      • for spasticity
      • analog for GABA
      • SE: sedation and HA, dizziness, diplopia and weakness
      • do not stop the administration of this drug suddenly
      • taper over 2 weeks or: hallucinations, fever rigidity, paranoia, seizures
      • DO NOT mix with ALCOHOL
      • given 2-3 times/day
      • herbal interactions: kava-kava, valerian root, or chamomile these can cause CNS depression
      • no antidote
    • Carbamazepine (tegretol)
      • SZ med
      • nerve pain and bipolar disorder

 

  • cyclobenzaprine (Flexeril)

 

      • Centrally acting MM relaxants
      • do not use in:hyperthyroidism, heart conduction difficulties, heart failure, recent MI.
      • urine color change
      • do not use with other SSRI’s

 

  • Metaxalone (Skelaxin)

 

      • Centrally acting MM relaxants
      • ACH effects, caution in sedation w/ elderly

 

  • methocarbamol (Robaxin)

 

      • Central acting MM relaxant
      • unknown MOA
      • for acute injuries
      • give ¾ x/day, urine color change, dizzy, drowsy, metallic taste.
      • intensifies with ETOH
      • chemically similar to tricyclic antidepressants

 

  • Tizanidine (Zanaflex)

 

      • Centrally acting MM relaxants
      • ACH effects, caution in sedation w/ elderly

 

  • NM Blocker in general
  • Bisphosphonates (alendronate)

 

      • decrease bone resorption
      • SE: esophageal irritation, Heartburn, osteonecrosis of the jaw, atypical femur fracture
      • SEVERE esophagitis, stand for 30 MINUTES after swallowing with water only
      • do not take with other drugs

 

  • Teriparatide

 

      • STIMULATES bone formation
      • SQ injection
      • can be taken for up to 2 years

 

  • NSAIDs (COX 1 and 2)

 

      • used in RA until the DMARDS kick in, (this is changing from NSAIDS to glucocorticoids though)
      • 1st line treatment for gout

 

  • DMARDs (MTX, Arava, Plaquenil)
  • Disease-modifying anti-rheumatic drugs

 

      • given first for RA
      • take glucocorticoids until DMARD’s take effect
      • suppress autoimmune inflammatory process
        • TNF is a part of the inflammatory process…

 

  • Synvisc

 

      • injectable directly into the joint
      • cartilage and synovial fluid synthesis

 

  • Indomethacin

 

    • NSAID for gout
    • inhibits prostaglandins
    • only give for 3-6  days

 

  • colchicine

 

    • older gout drug
    • stops inflammation cycle, by decreasing mobility of granulocytes
    • treats acute gout attack

 

  • Allopurinol

 

    • febuxostat (Uloric)
    • Xanthine oxidase inhibitor, stops production of uric acid
    • for chronic gout
    • Drink 3 liters of water per day

 

Diabetes Mellitus

 

Proinsulin is the prohormone to insulin, and is bound to a C-peptide. The peptide will be found in T2DM, but not T1DM.

type 1 can have Ketoacidosis (DKA), and type 2 can have Hyperosmolar hyperglycemic non ketotic state (HHNK)

 

incretins stimulate insulin release, suppresses glucagon, slows GI emptying, as well as suppress appetite.

 

prediabetes

Impaired fasting glucose (IFG) 100-125

impaired glucose tolerance (IGT) 140 – 199 two hours after the oral glucose tolerance test

6.5% > HgA1c > 5.7%

 

Diabetes Diagnosis

HgA1c > 6.5%

FBG > 126

glucose tolerance > 200

 

Insulin

(also promotes K uptake by the cells, so can also be given for hyperK)

 

  • Lantus

 

      • no peak, duration of 24 hours

 

  • Detemir

 

      • no peak, duration of 24 hours

 

  • NPH

 

      • O: 60-120 P: 6-14 D: 16-24
      • cloudy solution

 

  • 70/30

 

      • 70% NPH, 30% Regular
      • roll gently to mix

 

  • Regular

 

      • O: 30-60 min P: 1-5hr D: 6-10hr

 

  • Lispro

 

    • O: 5-10 min P: 30min-2.5hr D: 3-6.5hr

 

Orals

 

  • Biguanide (Metformin)

 

      • stops liver glucose production in liver, increases glucose uptake in the periphery skeletal muscles.
      • Will NOT cause insulin production. this means that this drug does NOT put a person at risk for hypoglycemia.
      • Can be used with regular insulin and sulfonylureas
      • SE: Renal issues from LACTIC ACIDOSIS. If a person has renal insufficiency they are put at a much higher mortality rate.
      • MONITOR renal fxn.

 

  • Sulfonylureas (glipizide, Amaryl)

 

      • First line, promotes insulin secretion,
      • SE: HYPOGLYCEMIA
      • similar structure to a sulfonamide antibiotic
      • these are 2nd gen. and have longer durations than the 1st gen and fewer d/d interactions.
      • D/D: all cause HypoGLY: ETOH, sulfonamides, Cimetidine, NSAIDs, beta blockers

 

  • Glitazones (pioglitazone)

 

      • decrease insulin resistance, and decreases liver glucose production
      • SE: HYPOGLYCEMIA
      • Not a first line med
      • D/D interactions: CIMETIDINE, ketoconazole, rifampin, Atorvastatin

 

  • Glinides

 

      • stimulates pancreatic secretion of insulin
      • SE: HYPOGLYCEMIA
      • Can be used with metformin
      • DD: Gemfibrozil

 

  • A-Glucosidase inhibitors (acarbose, miglitol)

 

      • Delays carb absorption
      • 2% of drug is absorbed orally
      • SE: abb cramps, borborygmus bowel sounds, flatulence

 

  • DPP-4 inhibitors (Sitagliptin)

 

    • Stops DPP-4 from breaking down incretin
    • the hormone Incretin increases insulin release, decreases hepatic glu production and release.
    • Few SE and DD

 

Injectable noninsulin

 

 

  • INcretin mimetics (exenatide – Byetta)

 

      • increase release of insulin, decrease glucagon secretion, makes you feel full, and slows GI emptying
      • SQ INJECTION at breakfast and supper
      • from Gila monster spit
      • Nausea and vomiting
      • Hypoglycemia possible WITH sulfonylureas
      • a new formulation is once a week SQ injection!
      • SE: weight loss

 

  • Amylin mimetics (pramlintide – Symlin)

 

    • Slows GI emptying, decrease glucagon release, pt will feel more full, decrease postprandial glucose levels
    • SE: HYPOGLYCEMIA

 

Antianemics (heme)

 

 

  • Iron sulfate

 

      • use a straw
      • toxic in kids
      • Makes RA worse
      • for iron deficiency anemia

 

  • B12

 

      • treats b12 or pernicious anemia
      • b12 is needed to synthesize folic acid for cell growth and development
      • Cyanocobalamin

 

  • Folic Acid (folate)

 

      • for folic acid anemia
      • essential for cell replication
      • anemia can be from alcoholism, liver damage.

 

  • Deferoxamine

 

      • high affinity for ferric iron
      • do not take with oj

 

  • Erythropoietin

 

    • stimulates RBC production
    • mimics a natural hormone produced in the kidney
    • needs the supplies to make RBC’s: iron, folate, and B12
    • indications: chronic renal failure, anemia from chemo, or a chronic anemic patient having surgery.
    • can cause HTN
    • if HGB increases above 11 MI, CVA, and HF chances are increased dt increased clotting

Pharmacology Session 12

Session 12

 

Diabetes

 

DM 1 – autoimmune disorder of carb, fat, and protein metabolism

DM 2 – late onset disorder of carb, fat, and protein metabolism

  • resistance to insulin, and can have decreased insulin
  • liver is breaking down glycogen into glucose because the sugar cannot get into the cells and signals are sent saying that the cells need more sugar.

 

glucagon increases blood sugar by breaking down glycogen

amylin decreases blood sugar, helps with seisity telling the brain that you are full

 

  • Proinsulin is produced by the pancreas, and medications are just in the insulin form
  • if a person does not have any c peptides that are attached to the proinsulin, then their pancreas is not creating any insulin.

 

  • Ghrelin – produced in the stomach, low levels in of this increases insulin resistance,
  • Incretins – inhibit glycogen and increase insulin
  • IFG – impaired fasting glucose
  • IGT – impaired glucose tolerance

 

criteria for DM diagnosis

  • HgA1C > or equal to 6.5%
  • FBG > 126 mg/dl (7mmol/l)

 

DM 1 has a risk of ketoacidosis

DM 2 has a risk of Hyperosmolar hyperglycemic nonketotic state

 

Any body stressor will increase blood sugar

 

long term complications

  • macrovascular DX: HTN, stroke, Heart DX
  • microvascular DX: neph, neur, retin, Gastroparesis

 

Know the patho of each class and the adverse effects.

oral

  • Metformin (glucophage)
  • Sulfon
  • Glitazones
  • Alpha Glucosidase inhibitors
  • Gliptins

Injectable

  • Incretin mimetics
  • Amylin mimetics
  • Insulins shortest to longest
    • lispro (humalog) 5-10 min onset
    • aspart (nocolog) 15-20 min onset
    • glulisine (apidra) 15 min onset
    • Regular (humulin) 30 min onset peak in 2-4 hr and duration of 6-8 hr
    • NPH neutral protamine 60, 6-8hr, 15 hr
    • Detemir, Glargine

 

Insulin admin

  • rotate injection sites to prevent lipodystrophy
    • upper arm, thigh, abdomen
  • mixing
    • draw up clear first (clear before cloudy)
      • clear is often fast acting and cloudy is often long acting)
    • don’t mix often
    • NPH can mix with anything
  • can store for 1 month at room temp and 3 months at a cooler temp

 

  • regular insulin
  • onset 60
  • peak 2-4 hr
  • duration 6-8 hr

 

  • Lispro
    • 5-10
  • NPH insulin
    • 60-120 min
    • 6-14 hr
    • 16-24 hr
    • cloudy
  • Glargine (lantus)
    • CANNOT BE MIXED
    • 24hr duration of action
    • given SQ
      • clear liquid
    • very stable
  • Combo insulin
    • roll the vial gently to mix the short acting insulin and the NPH.

 

ORAL drugs

 

 

  • Biguanide
  • Metformin, often 1st drug prescribed

 

        • inhibits glu production in liver
        • decreases insulin resistance

 

  • does not cause hypoGLU
  • can cause lactic acidosis (don’t take with alcohol or contrast dye)

 

          • stops metabolism of lactic acid resulting in metabolic acidosis
          • can be fatal in half of people
          • happens more often in pts with renal insufficiency

 

  • Sulfonamides
  • sulfonylureas (-ide)

 

        • one of the first meds
        • increase insulin release

 

  • can cause hypoGLU
  • don’t take with alcohol, NSAID, Sulfonamides, Cimetidine, Beta blockers
  • all cause hypoGLU
  • thiazolidinediones (glitazones)
  • Avandia (rosiglitazone)
  • Actos (pioglitazone)
  • can cause hypoGLU

 

  • Glinides
    • increase insulin production
    • can cause hypoGLU
  • A-glucosidase inhibitors
    • Acarbose (precose) Miglitol (Glyset)
      • works in the small intestine to delay glu absorption
      • only 2% of the drug is absorbed orally
      • S/E are all GI issues ie. flatulence, upset stomach
  • Incretin Enhancers DPP-4 inhibitors
    • sitagliptin (januvia)
      • stops breakdown of incretins, stimulates release of insulin from pancreas, decreases liver glu production
      • well tolerated
      • no DD interactions

 

Other injectables non insulin

 

  • GLP-1 agonist is an incretin mimetic
    • correction of insulin amount
    • stops liver from unneeded glu production
    • decreases absorption of glu at intestinal level

 

  • exenatide (byetta)
    • increased fullness
    • decrease glucagon
    • decrease glu production
    • increase insulin
    • decrease gi emptying
    • from gila monster spit

 

DKA happens in type 1

HHNS happens in type 2 higher glu levels than DKA.

  • no ketones in urine

 

somogyi effect – hypoGLU at night

Dawn effect – hyper GLU at night

 

Nursing Care of Child Bearing Families Session 5:

 

Session 5

 

starting the labor process

  • we don’t really know what starts labor
    • uterine distention
    • aging of the placenta
    • hormones
    • fetal adrenals
    • psychological

 

  • signs of labor
    • lightening – fetus dropping into the pelvis
      • days to weeks before labor
    • bloody show
    • weight loss, from loose stools
    • burst of energy and nesting

 

  • stages of labor
    1. Stage 1: onset of regular contractions
  • latent: 0-3 cm
    • duration of 6-8hr
    • contractions 5 – 30 mins and irregular
  • active: 3-8cm
    • 3-6hr
    • contractions: 3-5 mins and regular and moderate to strong
  • transition: 7-10cm
    • duration: 20-40 min
    • contractions: 2-3 min regular and strong

 

  1. Stage 2: full dilation to the delivery of baby
    1. Pushing with contractions
  2. Stage 3: time between baby born, and the placenta coming out. (20-30) min
    1. retained placenta is over 30 minutes
    2. signs of placental detachment
      1. change of uterus shape
      2. gush of blood
      3. urge to push again, more contractions
    3. prevention of hemorrhage
      1. pitocin – 10-40 units IV
      2. methergine – 0.2 mg IM
        1. do not give if HTN in pt
      3. hemabate – 250 mcg IM
        1. prostaglandin
        2. contraindicated in asthma (bronchoconstriction)
      4. cytotec (misoprostol)- 600- 800 mcg PO
        1. synthetic prostaglandin
        2. do not give vaginally if she is actively bleeding
  3. Stage 4: 0-4hrs after delivery, bonding and breastfeeding

 

episiotomy can be done when…

  • shoulder dystocia
  • fetal distress

 

nullipara women go through 12-18 hr of labor on average 

multipara women have shorter labor time on average

 

  • things we can do to help as a student
    • hygiene
      • chux, washcloth, mouthwash

 

false pregnancy

  • no cervical change

true pregnancy

  • water broke (things to confirm this)
    • ferning seen under a microscope
    • also higher ph than urine

SROM – spontaneous rupture of membranes

AROM – artificial rupture (HOOK)

PROM – Pre labor

pPROM – preterm pre labor

Malodorous fluid- infection in the fluid

 

GBS

    • group beta strep
    • 10 – 30% of women colonized

 

  • universal screening at 35-37 weeks
  • the screen stays negative for about five weeks after negative test.
  • Pen 6million units
  • WHAT, WHY, HOW do we check, and how do we treat.

 

  • then every four hours after

Pharmacology session 11:

Cancer, Musculoskeletal, and poison:

Cancer

  • unregulated cell proliferation
  • activation of oncogenes, and inactivation of tumor suppressor genes
  • these are genetic changes

Chemotherapy

  • disseminated cells
  • interrupts mitosis during cell division
    Hair, GI tract, skin all divide fast too so most of the symptoms come from this.
  • solid tumors
    • use radiation and surgery
  • killing all of the malignant cells is almost impossible
  • dose limiting effect is when a specific amount of dose causes adverse effects that will outweigh the benefit of the drug.
  • toxicities of chemo
    • cisplatin – tubular necrosis in the kidney
    • Vincristine – Neurotoxicity – in the periphery
    • Daunorubicin – cardiac toxic HF
    • The classes are by what they kill
    • Must be certified to administer cancer drugs
    • INFILTRATION is very important!!! chunks of tissue will fall off!!!
  • Megace (progestin)
    • increases appetite
    • used in aids and anorexia
    • s/e alopecia

Hormone/ Hormone antagonists

  • anti-estrogen
    • Tamoxifen, raloxifene
  • Estrogen
    • DES
      • causes vaginal cancer decades later in the mother, daughter, granddaughter, (testicular cancer in the sons)

Musculoskeletal Drugs

muscle spasms

  • Caused by hypoCa, injury, back pain,

treatment

    • non medication first ie. ice and PT
    • Anti-inflammatories
    • CNS acting MM relaxers
      • Methocarbamol – (robaxin)
        • decreases activity and tone of muscle
        • tid-Qid
        • color of urine changes
  • MM relaxers should be short term use only
  • Drugs for spasticity
    • Baclofen (Lioresal)
    • similar to GABA
    • Causes diplopia and weakness
    • do not come off drug fast, must be tapered
      • if taken off too fast causes fever, tetanus, hallucinations
    • NO Antidote
  • NM blockers
    • block ACH from the nicotinic receptors
      • causes MM relaxation
    • Non-depol NM blocker
      • tubocurarine (curare)
        • old, used in arrows!
        • flaccid paralysis
        • not CNS action
        • works in tissues only
  • NM blocker II
    • Flaccid paralysis
    • – curinum
  • Depol neuro MM blocker
    • Succinylcholine
      • very short acting paralysis
        • for intubation
      • S/E: Malignant hyperthermia, sever MM contractions and cannot get out of the contraction, arrhythmias, Potassium release from MM
      • Can’t move but can hear and feel
      • can’t breath
      • Face recovers first, but there may be a lot of the drug still in the system

Calcium

  • normal value 8.5-10.5 mg/dl
  • absorption increased by vit D and PTH
  • hypoCa: increase twitching chvostek’s sign, rickets, convolution

osteoporosis

  • increased fragility of bone and low bone bone mass
  • can run in the family
  • prevention through Ca supplementation, weight bearing exercise, and not smoking
  • Drugs that stop resorption of bone
    • – dronates
  • drug that help build bone
    • teraperitda
  • Calcium supplements should be separated throughout the day

Paget’s disease

  • bone overgrowth, but very fragile

bisphosphonates

  • Alendronate (fosamax) -Dronate
    • inhibitor of osteoclast from breaking down bone
    • the amount of time between doses can range from weeks to a year
    • S/E: GI esophageal irritation(take an hour before other drugs and stay upright for 30 min after taking it), osteonecrosis of the jaw(loose teeth), atypical femur fracture(mid thigh)
    • only take with water
    • renal Fxn needs to be high
    • foods high in metals can slow absorption
  • Denosumab
    • reduces bioresorption
    • for pt that has osteoporosis but cannot be on bisphosphonate
  • Teriparatide (Forteo)
    • Stimulates bone formation (unique!!)

Selective estrogen receptor modulator or SERM

  • raloxifene (evista)
    • less bone loss
    • do not give if any coagulopathies are present

Pramipexol (Mirapex)

  • not miralax
  • for RLS
    • and used in parkinson’s
  • narcoleptic effects, and drowsiness

Rheumatoid arthritis   

  • autoimmune, symmetrical stiffness
  • systemic S/S: thinning and nodules under skin,
  • wake up with pain in joints, and with more movement it improves
  • DMARD – disease modifying antiRA drugs
    • stops inflammation and autoimmune function to delay function
  • treat s/s then try to get function back and treat pain.
  • Plaquenil
    • non-biologic DMARD
  • Etanercept (enbrel)
  • biologic are most expensive

gout

  • cannot process uric acid
  • chronic inflammatory disorder
    • uric acid crystals form in the night when the blood flow is low
      • this causes toe pain
  • treat with NSAID for pain and inflammation
    • watch for GI upset and do not take with ETOH
  • Uloric allopurinol
    • preventative for chronic gout

Posins

prevention is best

identify the problem

irrigate the poison on the skin

  • the solution to pollution is dilution

removal

  • lavage through large bore tube
  • activated charcoal
    • powder, mixed in water and
  • ipecac to throw up
    • mallory weiss tear from violent puking
    • vomiting like the exorcist
  • sodium bicarb to raise ph of blood
    • also increase renal excretion
  • mental health drugs do not commonly dialize

antidotes

  • metal:
    • chelation
  • anticholinergic
    • physostigmine
  • non depol NM blocker
    • neostigmine
  • ACHase inhibitors
    • atropine
  • opiates
    • narcan
  • Benzos
  • acetaminophen
    • mucomyst, protects the kidney
  • Radiation
    • iodine to protects the thyroid from problems in the future.
  • Nerve Gas
    • Atropine, and 2-PAM chloride (hold the auto injector to the leg for 5-10 seconds)
      • you can die from too much of this antidote.

herbs

  • echinacea
    • for cold, not for prevention. doesn’t work well, does not work in kids
  • zink
    • same as echinacea
  • glucosamine
    • turns into chondroitin in the body
    • shoulders are weird, some people have reduced pain in the shoulder with this
    • sulfa allergy
  • CQ10
    • when taking lipid drugs
    • to replenish the body’s own CQ10
    • might as well take it
  • omega 3
    • lowers triglycerides.
  • niacin
    • increases chances for hemorrhagic stroke.
  • vit E
    • antioxidant
    • toxic in over 1500 IU/ day
    • makes cancer grow faster
  • st.john’s wort
    • SSRI drug
    • for mild depression

Pharmacology Session 10:

Hemophilia – decreased number of RBC’s

Causes

  • blood loss
  • Iron deficiency
  • RBC lysis
  • ?
  • Most common is iron deficiency
  • microcytic, hypochromic
  • pale RBC
  • the oral iron supplement is taken through as straw
    • so it doesnt stain teeth
  • can cause chelation
  • S/E constipation, use with caution in kids (toxicity)
  • Use z-track for IM
  • antidote is deferoxamine for OD
  • B12 deficiency Anemia (pernicious anemia and people did die from it in the olden days)
    • need b12 to catalyze folic acid
      • dark red meats
    • need intrinsic factor (IF) to absorb b12
    • neurologic and GI issues:
      • hallucinations, memory issues,
    • used to be given IM only, now can be given po routes as well
    • megaloblastic – big RBC
  • Folic acid anemia (similar to b12)
    • get folic acid from dark leafy greens
  • RBC production
    • EPO – Epoetin A
      • mimics erythropoietin
    • chronic renal failure, anemia of chronic disease or from chemo.
      • these people can use EPO
    • cyclists take this (illegally) to improve performance.
  • WBC production
    • Filgrastim (neupogen)
      • very expensive
      • stim growth of WBC
  • Thrombopoietic GF (thrombocyte production)
    • Oprelvekin (interleukin) thrombopoietin

Hemostasis is important to stop the loss of blood through a cut, and allow the tissues to start the repair process.

Virchow’s triad – stasis, vessel injury, and hypercoagulability

Thrombosis (clot) – from a local tissue ingury in the artery, and in the vein it often comes from blood that is too slow so a clot can form, and eventually break of the vessel wall.

Anticoags effect Clotting cascade in these ways:

  • Platelet aggregation

do not give an anticoag in active hemorrhage, hemophilia, and pregnancy*.

  • Heparin through sq or IV
    • blocks the clotting cascade at Xa and XIa
    • used for the prevention of more clots, and post op thrombous
      • ***only giving in pregnancy (SQ) if the mom has a preexisting bleeding disorder
      • These do not dissolve the clot, but only prevent the clot
    • S/E: Hemorrhage, HIT, petechiae, BLEEDING GUMS,
    • if OD use Protamine sulfate
    • Test:
      • aPTT normal is 40 sec, Normal range on heparin or coumadin is sixty to eighty seconds
    • Lovenox is low molecular weight heparin.
    • Measured in Units/ml
      • can be as high as 10,000 units per mil
    • HIT – heparin induced thrombocytopenia
      • if this process occurs the patient can NEVER get heparin again
      • use Argatroban if HIT occurs
  • LMWH – low molecular weight heparin
    • Enoxaparin (lovenox) -heparin
      • patient can do self injections sq
      • no need for
  • Dabigatran (pradaxa)
    • Direct thrombin inhibitor
    • Very expensive
    • for reduction of stroke risk in an patient without  nonvalvular atrial fibrillation
  • Xarelto – Xa inhibitor
  • Warfarin (coumadin)
    • works in the liver to inhibit production of the clotting factors
    • Highly absorbed and bound to proteins
    • for long term prevention of thrombosis, Afib, pulmonary embolism
    • Vit K is antidote not K + not potassium.
    • TERATOGENIC
      • pregnant moms that need this drug should switch to heparin
    • lots of DD interactions
      • quinidine, antibi, NSAIDS, cimetidine, and T hormones
    • INR test on coumadin between 2-3 for heart valve 3-4.5
    • takes days for effect
      • heparin only takes about one and a half hours
  • Thrombolytics
    • bleeding is a big problem
      • so put in all of your lines first then give the drug.
    • only give in early clot development so to not create an embolis
  • antiplatelet
    • ASA – suppresses platelet aggregation by blocking the enzyme that makes the platelets “sticky”
      • prevention of MI
    • Clopidogrel (plavix)
      • can be used with ASA
      • Herbs that increase bleeding time
        • ginger, ginseng, garlic
  • peripheral neuropathy is unique to vincristine

Nursing care of child Bearing Families Session 4:

Accelerations are always good

  • at least 15 bpm increase and at least 15 second duration

Decelerations

  • early
    • gradual onset
      • time it takes to go from baseline to nadir (bottom) is at least 30 seconds
    • Gradual return to baseline
    • can be OK
    • on time with contractions, and head compression (not and issue)
  • Late
    • Gradual onset
    • after a contraction (timing is late) resolves after contraction has ended.
    • associated with lack of blood flow to the baby from the placenta.
      • placental insufficiency
  • Variable
    • Abrupt onset
      • less than 30 seconds from baseline to the nadir
    • From cord compression
  • Prolonged deceleration
    • longer than 2 minutes and less than 10
    • decrease of at least 15 bpm

Category 1

  • Baseline rate: 110-160 bpm.
  • Baseline FHR variability: moderate
  • Late or variable decelerations: absent
  • Early decelerations: present or absent
  • Accelerations: present or absent

Category 2

  • Not 1 or 3

Category 3

  • Absent baseline FHR variability and any of the following: –
    • Recurrent late decelerations
    • Recurrent variable decelerations
    • Bradycardia
  • OR just
  • Sinusoidal pattern

Labor and delivery

Secondary powers

  • physiologic pushing
    • grunting
    • more O2 throughout mom and baby
    • may take more time
    • cannot feel this Ferguson’s reflex when on an epidural
  • Closed glottis pushing
    • Take a deep breath and push
    • less O2 throught

effacement is the thinning of the cervix

dilation is the opening of the cervix