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Pharm: Exam 2, Pt 2
Terms in this set (138)
Nitrostat: generic name
nitrostat: drug class
dilates coronary arteries to increase blood flow to the heart
how does nitrostat work
keep in glass/metal container that they come in with cotton to absorb moisture
-keep in cool place
-dispose of medication 6 months after opening (loses potency)
Nitrostat directions pertaining to sublingual tablets
hypotension (may be orthostatic) or headache
most common side effects of nitrostat
most common route for nitrostat
0.3-0.6 mg/repeat q5min x 2 PRN chest pain
common dosage for sublingual nitrostat for CP acute attacks
1-2 sprays/repeat q5min x 2 PRN chest pain; 1-2 sprays 5-10 minutes prior
common dosage translingual (spray) nitrostat for CP acute attacks
coumadin: generic name
coumadin: drug class
long term prevention/management of
-atrial fibrillation (helps to prevent clot formation)
what does coumadin treat
vitamin K, given subq
with an INR 5 or greater, 24 hours
Coumadin: vitamin K is given _, works within _
not fast-acting antidote for coumadin
fresh frozen plasma (FFP)
If faster coumadin reversal is needed, MD may order _
tell clients to limit intake of _ when taking coumadin
-PT: 10-14 (normal), 15.5-35 (on coumadin)
-INR: 0.8-1.1 (normal), 2-3 (on coumadin), 2.5-3.5 (high risk)
-platelets: 150,000-450,000 (may be on low end of normal, but should remain WNL)
list lab considerations for clients taking coumadin
Heparin: drug class
short term prevention/management of:
-thromboembolic disorders (VTE, PE, AFib)
heparin is used for what type of treatment?
subq and IV
routes of administration for heparin
weight based protocol established and monitored by pharmacists
heparin is typically given based on what type of protocol
protamine sulfate (IV): effect in 30 sec-1 min
antidote for heparin overdose
-aPTT: 30-40 secs (normal), 45-100 (on heparin)
-platelets: 150,000 - 450,000
lab considerations for client taking heparin
heparin-induced thrombocytopenia (HIT)
heparin overdose may lead to what immune response
causes the body to develop antibodies that attach to the platelets and form clots; after the clot is formed, the antibodies release the platelets from the bloodstream, leading to a low platelet count
What is heparin-induced thrombocytopenia (HIT)?
heparin: HIT can cause platelet count to drop as low as _
5-12 days after treatment begins
HIT can occur when?
stop heparin and begin a low molecular-weight heparin -LMWH- (lovenox)
If a patient receiving heparin develops HIT, what is the priority action of the nurse?
client takes heparin for a very long time
What increases the client's risk for developing HIT?
generic name for Lovenox
lovenox drug class
it is a low molecular weight Heparin used for the treatment of and prophylaxis for VTEs/PEs
what is lovenox used for
patients who have undergone knee/hip surgery for up to 7-14 days post-op
Who is lovenox commonly used for?
what condition is lovenox NOT common for
Lovenox: route of administration
weight based per kilogram
Lovenox is based on ...
therapy along with coumadin until therapeutic INR is reached
Lovenox may be used as a "bridge for ...
INR is >2 for at least 2 consecutive days
Lovenox may be used as a bridge therapy along with coumadin until...
once a day
Common dosage for lovenox is given how many times a day
twice a day
In rare instances, lovenox may given how many times a day
platelets (may be on lower end of normal, but should remain normal)
Lab consideration required for a client taking lovenox
encourage patients not to use _ while on anticoags
increases risk of bleeding
Why can't clients use gingko biloba while on anticoags
low molecular weight
Since lovenox is a weaker form of heparin, what is it considered as?
L-low molecular weight
V- D"V"T prophylaxis, immobility, stints, cardiac surgeries-indicators
E- L'E"ave bubbles in syringe
N-never by IM only sub-give within 2 hours of prep abdominal surgery and 12 hours of knee surgery
O- n"O" rubbing after administered, no aspiration, no mixing with other drugs
X- X out for par allergies, heparin allergies PUD: leukemia
Lovenox: list the acronym
hematuria, nosebleeds, gingival bleeding, bruising
when a patient is taking lovenox, what should you observe for?
What size needle is needed when giving lovenox
What med should you avoid when giving lovenox
-liver disease present
-platelets less than 150,000
-using thrombolytic meds
implement lovenox when?
Plavix: generic name
platelet aggregation inhibitor
plavix: drug class
MI or strokes in patients with atherosclerotic disease (fatty deposits in the arteries that can severely decrease blood flow)
Plavix reduces the risk of ...
less "sticky", thereby inhibiting their ability to clump together and form clots
Plavix causes platelets to be...
inactivates thrombin in the clotting process
How does heparin work?
decreases the activity of vitamin K, thereby decreasing clotting activity
How does Coumadin work?
once a day
How many times a day do clients commonly take plavix
T or F: Plavix requires constant monitoring of blood work
Since plavix causes the platelets to be less sticky and not diminish them in number, what lab consideration is not directly effected
7 days prior to planned procedure
when should plavix (or any bleeding meds, really) be discontinued when there is a planned procedure coming up?
skin disorders, URIs, flu-like symptoms
when a patient is taking plavix, what should you watch out for?
hypertension, hepatic and renal problems, and history of bleeding
Caution use of plavix with ...
Before beginning and every 2 days for a week, then weekly
When a client is taking Plavix, when should there be Platelet counts?
Lipitor: generic name
lipid lowering agent
lipitor: drug class
lipid lowering agent: common suffix
complications of coronary artery disease in patients who are asymptomatic and have high LDL/low HDL
Lipitor is used to prevent ...
Works more to decrease _ than to increase _
dietary modifications and exercise
Lipitor is more effective in conjunction with ...
drug-induced hepatitis and increased liver enzymes
Lipitor may cause what effects on the liver...
known liver disease
Lipitor should NOT be used with clients who have ...
-Liver function tests (AST, ALT)
Lab considerations when a client is taking Lipitor
Which drug may cause rhabdomyolysis
breakdown of muscle tissue that causes protein (myoglobin) to be released into the bloodstream leading to kidney damage (tea-colored urine)
what is rhabdomyolysis
glucophage: generic name
glucophage drug class
oral hypoglycemic to control NIDDM
glucophage is typically the first choice for ...
1st choice for oral hypoglycemic to control NIDDM
Type II diabetes
Glucophage is used in managing
modified diet, insulin, or other oral hypoglycemics (sulfonylureas-glyburide)
glucophage may be given in conjunction with ..
PO and extended release (XR)
glucophage: route of administration
500-1000 mg BID
typical dose of glucophage
discontinue metformin when which function becomes impaired
impaired renal function may limit excretion of metformin, leading to lactic acidosis (build up of lactate in the blood) and possible kidney/multi-organ failure)
Why should you monitor for impaired renal function when a client is taking glucophage
before (up to 48 hours) or at the same time of studies, and 48 hours after study
A client is scheduled for a CT scan requiring IV administration of contrast media. The patient is scheduled for metformin-when should he or she take it?
hold the metformin and give 48 hours AFTER studies
A client is scheduled for a CT scan requiring IV administration of contrast media within the next hour; however, the client is scheduled to take metformin. What should the nurse do?
highly toxic to kidneys
Why is it important for a client to hold metformin 48 hours before and after studies with IV contrast?
limited fluid intake
consideration should be given to withholding Metformin in instances resulting ...
Glucophage does not typically cause what kind of gain...
less than 5%
HgbA1C level that indicates negative results in DM
HgbA1C level that indicates pre DM
6.5% or higher
HgbA1C level that indicates Diabetes Mellitus
micronase: generic name
micronase: drug class
Type II diabetes
Micronase is used to treat ...
Micronase may be used in conjunction with what drug ...
produce and use insulin
Micronase can help the body to do what in order to treat DM Type II
how much of the micronase is excreted by the liver
Which is more like to result in hypoglycemia: metformin or micronase?
does, does NOT
micronase _ cause weight gain, glucophage _ cause weight gain
with AM meals (if twice a day, AM and bedtime)
When is micronase typically administered?
pts respond to this more quickly
Why does Micronase cause hypoglycemia more than Metformin?
which oral hypoglycemic may cause photosensitivity?
metformin and micronase
Name the two oral hypoglycemics we are studying
Oral hypoglycemic that causes photosensitivity
the pancreas should produce ... for micronase to be effective
A client is taking micronase. Tell the client to avoid ...
these are common herbal therapies used to treat diabetes but may increase the effects of anti diabetic medications, leading to severe hypoglycemia
A client who is prescribed Micronase claims that she also takes ginkgo biloba, aloe vera, cinnamon, and ginger. What should the nurse tell the client?
Lantus and Levemir
Name long-acting insulins
Lantus: generic name
onset: 1-2 hrs
Duration: 24 hrs
peak: none (insulin is delivered at a constant steady level over time)
Lantus: list the onset, duration, and peak
10-100 mg Subq, once daily
Lantus: common dosage
Lantus (is/is not) administered with regards to meals
Lantus is typically given at when ...
-do not mix with other insulins
-vial is good for 28 days once opened
-S/S of hypoglycemia
-use only insulin syringes
education for taking lantus
Levemir: generic name
onset: 5-15 minutes
duration: 24 hrs
Levemir: list onset, duration, and peak
0.1-0.2 units/kg subq, once a day (typically in the evening) or divided into 2 doses (in AM and bedtime)
Levemir: common dosage
basal insulins (long acting)
If a pt is NPO, which insulins are only allowed for you to take?
Levemir (is/is not) given in regards to meals
Humalog: generic name
onset: 5-15 minutes
peak: 1-2 hrs
duration: 3-4 hrs
Humalog: list onset, peak,and duration
Humalog: insulin type
long acting insulins or oral hypoglycemics
What should rapid acting insulins be used in conjunction with?
15 minutes before a meal
Humalog should be administered when ...
avoid severe hyperglycemia
Why should humalog be administered 15 minutes before meals?
What intermediate acting insulin can humalog be mixed with?
Which insulin can be used by an insulin pump
sliding scale or carbohydrate count
Humalog is typically given according to ...
(NPH/ regular mixture)
Humulin 70/30: generic name
70% NPH, 30% regular
Humulin: list the correct percent of NPH and regular insulin
onset: 30 minutes
peak: 2-12 hrs
duration: 18-24 hrs
Humulin: onset, peak, duration
Which insulin should NOT be mixed because it is already mixed?
works rapidly (regular) but lasts longer (intermediate)
How is Humulin both a regular and intermediate insulin?
-with meals (during the day) or PM snack (at night) based on a sliding scale
-in the AM with breakfast and in the evening with supper
Humulin can be given when?
If Humulin is given at bedtime, what will the client also need?
Regular insulin can be mixed with what type of insulins?
Which rapid acting is fastest?
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