Cardiac
Digitalis: Route? Use? TR? Antidote? Key sign of Tox?
IV
- HF, a-fib, and a-flutter
*when you DIGoxin a hole, you want to dig slow and deep* so contractions slow and become more forceful
- TR: 0.5-2
- Antidote: Digoxin immune FAB IV
YELLOW HALO!!!!!
BB's: SE's? Don't give to what pt's? Hold dose if? Why be cautious with diabetics
- Can mask symptoms of hypoglycemia in pts taking antidiabetic medication
DO NOT give to 2nd or 3rd degree heart block, Asthma, COPD, and patients with low HR and low BP
- SE: Decreased HR and BP, N/V/D, tinnitus, impotence, hypoglycemia
Teach patients to take their own pulse, hold dose if HR <60 beats/min
Statins: most common class for ___ and ___; Contraindication? Check what labs before?
Most often for hyperlipidemia and hypercholestrolemia
- Hepatic disease
- Baseline liver enzymes due to heptotoxcity
Vitamin B3: AKA ___; Only tolerates by _%; SE's? Caution with what patients?
NIACIN
- Tolerated by only 20% of patients
- SE's: niacin flush and skin itching is also common
Can cause hyperglycemia --> use with caution in diabetic patients (monitor liver enzymes)
Amphetamines: Examples? SE's? ___ and ___ will need to be monitored
Amphetamine (Adzenys, Evekeo)/ Dextroamphetamine (Dexadrine) / Lisdexamfetamine (Vyvanse)/ Combo dextroamphetamine plus amphetamine= Adderall
- SE's: Loss of appetite (anorexia), weight loss, growth suppression, dysrhythmias, insomnia
Monitor weight and growth
Digitalis: Check __ before giving; Monitor __ levels; Signs of Dig toxicity? Food?
HR
- Potassium: hypokalemia places at higher risk for dig toxicity
- Anorexia, confusion and delirium, yellow halo around the things they see, heart block and bradycardia
- Maintain potassium (high potassium - avocados, bananas, green leafy vegetables, beans, nuts, dairy)
CCB’s: Endings? Uses? 3 drugs? Most potent?
CCB's are the "pines"
Very Nice Drugs: Verapamil / Nifedipine / Diltiazem
- Most potent is Nifedipine
- Uses: Long term prevention of angina, atrial arrythmias, HTN
Statins: SE's? When to take? Does what to HDL?
- Hepatotoxicity, GI distress, muscle pain, rhabdomyolysis (muscle tissue break down)
When liver produces most cholesterol: take statin before you get into your SATIN sheets at bedtime
- Increases HDL
Bile acid sequestrants: Use? SE's? Causes what deficiency?
SE: GI distress, Cholesterol gallstones, decreased absorption of fat-soluble vitamins, flatulence, constipation and fecal impaction, steatorrhea, N/V, osteoporosis (long term), and a VERY bad taste!
- Binds to intestinal bile acids for fecal elimination which reduces cholesterol
Causes a FOLATE deficiency (anemia)
Amphetamines: MOA? When to take? With or without food? High ___ potential
- MOA: Stimulates and blocks the reuptake of norepinephrine and dopamine, producing increased alertness and euphoria
- Take BEFORE meals on an empty stomach
High potential for abuse! Drugs should be dispensed sparingly: ScheduleII control
Nitroglycerin: Route? Use? Vial? Headache?
- For chest pain
SL nitroglycerin: undergoes first pass metabolism in the liver, which significantly decreases its effectiveness
- Vial: keep away from body heat; remove cotton; keep in original vial; dark, cool, tightly closed
More you use it, the less you have headaches associated with its use
CCB's: SE's? Avoid ___ and ___; Restrict what and why? Hold dose when?
- SE: Headache, nausea, orthostatic hypotension, dizziness, flushing of the skin, reflex tachycardia, peripheral edema, constipation, pulmonary edema
Avoid alcohol and GF juice
- Restrict sodium and fluid intake to minimize edema
Hold dose if HR<60 beats/min or SBP <90 mm/hg
Statins: need an annual what? report ___ pain; avoid ____ and ____
Annual eye exam
- Avoid alcohol and grape fruit
Report muscle pain!!
Bile acid sequestrants: What is the powder? Examples drugs? Can you sip?
Cholestyramine (Questran), Colesevelam (Welchol), Colestipol (Colestid)
- Questran is a powder that is mixed in fluid and given twice a day before meals
Sprinkle powder on the surface of the beverage, let stand for several minutes, then stir thoroughly
-----Avoid sipping or holding it in the mouth because it may damage tooth enamel
Amphetamine-like drugs: 2 examples? Uses? SE's?
Used for ADHD and narcolepsy
- Methylphenidate (Concerta, Ritalin) and Dexmethylphenidate (Focalin)
- SE's: Loss of appetite (anorexia), weight loss, growth suppression, dysrhythmias, insomnia
Nitroglycerin: IV key things? Can it get on hands? How many can you take? Call for help when?
NO! Wear gloves to avoid seeping into the skin of the administrator - will cause an immediate headache and dizziness
- Polyvinyl tubing (plastic will absorb the med), do not use a filter, amber bag to place around it to avoid change due to light (plastic absorbs)
• 5 min between tabs
• No more than 3 tabs
Call for help if first dose doesn't work
Amiodarone: most common what? Uses? SE's? NO ____
Most common potassium channel blocker
- For major dysrrthmias like v-tach and v-fib
SE's: Corneal Deposits and Blue Gray Skin Discoloration
- NO GF Juice
Fibrates: Most common? What drug can't be given with Fibrates? When to give?
NIACIN
- NO warfarin because it increases the risk of bleeding and toxicity and statins due to increased risk of myopathy
- PO twice a day 30 minutes before breakfast and dinner
Bile acid sequestrants: When to take other meds when on these? Why?
This med will block absorption of other meds
- Take all other drugs either 1-2 hours before or 4-6 hours after Questran
Amphetamine-like drugs: Withdrawal symptoms? MOA?
MOA: NDRI-inhibits reuptake of dopamine and norepinephrine resulting in CNS stimulation and augmentation of serotonin action
- Withdrawal symptoms for these drugs (and amphetamines): nausea, vomiting, weakness, and headache
BB’s: Uses? Ending? BBW? B1 versus B2 and examples?
BB are the "lol"
- Angina, arrythmias, and hypertension (HTN)
- Should NOT be stopped abruptly – causes reflex tachycardia, rebound HTN
Beta 1: Heart- Esmolol, Atenolol, Metoprolol (Lopressor)
Beta 2: Lungs- Albuterol, Levalbuterol, Salmeterol, Terbutaline
BOTH: Nadolol (Corgard), Propranolol, Pindolol, Sotalol
Adenosine: Use? SE's? Route? Causes temporary ____
Causes temporary flatline so patient must be on continuous CR monitor
(also digoxin and mag sulfate)
- Used to treat supra-ventricular tachycardia
(mom walks in your room while doing bad a stuff, in your DEN of SIN and it gives her tachycardia) so she needs adenosine to slow her rhythm down
- Given only IV rapid push and flush
SE's: arrhythmias, dyspnea, hypotension, chest pain, face flush
Fibrates: Don't combine with what? SE's?
- DO NOT COMBINE WITH STATINS – risk of myopathy is increased
- SE: GI pain, hepatotoxicity, cholesterol gallstones, myopathy
Desired levels of LDL, HDL, TRI, and CHOL?
LDL: <100
HDL: >60
TRI: <150
C: <200
____ is the most commonly prescribed drug to treat ADHD; ___ and ___ will need to be monitored; When tot take?
Methylphenidate
- Monitor weight and growth
- Take BEFORE meals on an empty stomach