Fluid Volume Excess
according to pharm (not the therapeutics notes), what is the normal urine output in 24 hours?
around 2 L
name 2 lab(s) that are monitored for heparin?
for warfarin?
Heparin: aPTT, platelet count, HCT
warfarin: PT, INR, platelet count
what is the drug of choice for acute angina
extra points: why is it?
nitroglycerin
why? Because it is a potent vasodilator that relaxes smooth muscle and increases blood flow to heart
what is the most common cause of seizures in epileptic patients?
abruptly stopping anti-epileptic medications in diagnosed seizure disorders and noncompliance
True or False
dyslipidemia agents are more effective when used as monotherapy
FALSE
most, if not all, dyslipidemia drugs are to be used in addition to proper diet, exercise, and health habits
what drug is effective against HTN regardless of ethnicity or age?
hydrochlorothiazide which is a thiazide diuretic
what is the anticoagulant of choice in pregnancy?
heparin or warfarin?
heparin
heparin is category C
warfarin is category X
True or False?
antihypertensive drugs can be discontinued (stopped) pretty much immediately because the body can regain BP control quickly
FALSE
antihypertensive drugs should never be stopped abruptly due to the possibility of rebound hypertension (which can lead to hypertensive crisis), taper drugs off slowly
what is the oldest and most widely used antiepileptic?
phenytoin (Dilantin), which used to control tonic-clonic, psychomotor, and non-epileptic seizures
phenytoin must have drug levels monitored
when should abortive medications for headaches be taken?
as soon as you feel symptoms or recognize a migraine coming on, abortive meds are NOT preventative
what is the drug of choice when rapid fluid loss effects are needed?
furosemide (loop diuretic)
what drug is known as a "clot buster" and should be given within 4.5 hours of symptom onset?
ateplase aka t-PA
known as a clot buster because it helps convert plasminogen to plasmin which breaks down clots causing ischemia in the body
what should you teach a patient prescribed nitroglycerin to do at the first sign of acute angina?
sit down and take nitroglycerin at the first sign of attack
next steps:
take another pill if no relief in 5-10 minutes, take up to 3 total doses, call HCP if angina is not relieved by 3 tabs in about 15 minutes
which one of these meds would be given for status epilepticus?
1. phenobarbital
2. dantrolene sodium
3. carbamazepine
4. diazepam
extra points: name another drug that has an unlabeled use for status epilepticus
Levetiracetam (Keppra) has an off-label use for status epilepticus although it is not as effective as lorazepam and diazepam
which drug/class is complimentary to statins and produces synergistic (LDL lowering) effects?
ezetimibe (Zeita) or Cholesterol Absorption Inhibitors; great when used with statins and good for high fat diets
Match prototype drugs to answers
furosemide, hydrochlorothiazide, spironolactone, mannitol
1. used for cerebral edema and oliguria in acute renal failure
2. effective for HTN regardless of ethnicity or age
3. used when RAPID fluid loss effects are needed
4. is used in combination with other agents/diuretics
1. mannitol (Osmotic Diuretic)
2. hydrochlorothiazide (Thiazide Diuretic)
3. furosemide (Loop Diuretic)
4. spironolactone (Potassium-Sparing Diuretics)
what is HIT?
heparin-induced thrombocytopenia: immune-mediated adverse drug reaction which is life-threatening, must discontinue all heparin if diagnosed with HIT
losartan, captopril, nifedipine
1. blocks conversion of angiotensin I to angiotensin II
2. blocks Ca channels and prevents movement of extracellular calcium into myocyte
3. prevents binding of angiotensin II w/ body tissue receptors
1. captopril (ACE inhibitor)
2. nifedipine (Calcium Channel Blocker)
3. losartan (Angiotensin II Receptor Blocker aka ARB)
2 part question!
1. what is gabapentin's mechanism of action?
2. gabapentin is sometimes used for seizures, but what is it more commonly used for?
1. it's unknown!
2. postherpetic neuralgia (burning pain in skin/nerves) and neuropathic pain/neuropathy
what is the most effective drug to raise HDLs?
niacin
in addition to preventing the elimination of potassium which can cause hyperkalemia, what other major adverse effects does potassium-sparing diuretics have??
extra points if you can name the classification and/or manifestations of this adverse effect
anti-androgen effects
manifestations: gynecomastia (enhanced male breasts), impotence (erectile dysfunction), decreased libido, menstrual irregularities, hirsutism (excess hair), breast tenderness
how long does it take for warfarin to have measurable levels?
how long does it take warfarin to have EFFECTIVE levels?
what can be done to keep anticoagulant effects while warfarin is starting to work?
1. 48 hours or 2 days
2. 3-5 days
3. put or keep patient on heparin, which has a faster onset of action
Answer each question
1. atenolol is the prototype for what?
2. what does it do?
3. name 1 adverse effect
4. name 1 thing as a nurse you need to watch/teach with this drug
1. beta-blockers
2. blocks adrenergic receptors in the heart to decrease workload and O2 consumption
3. bradycardia/dysrhythmias/impotence/bronchospasm/fatigue/nightmares/gastric pain
4. watch HR (hold less than 50)/monitor BUN and LFTs/avoid alcohol/monitor BG for hypoglycemia/monitor I&O or daily weights
why do you need to monitor CBC for carbamazepine and phenytoin?
these two drugs can cause agranulocytosis and aplastic anemia
agranulocytosis: bone marrow does not make enough granulocytes (type of WBC)
aplastic anemia: bone marrow does not make enough new blood cells
what is the major fatal adverse effect of atorvastatin?
hint: it has to do with the MS system
extra credit: what signs do you look for?
myopathy or rhabdomyolysis
Rhabdo occurs when damaged muscle tissue releases its proteins and electrolytes into the blood. These substances can damage the heart and kidneys and cause permanent disability or even death
muscle tenderness, weakness, elevated creatine kinase