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Pharm Exam 3 > Review > Flashcards

Review Flashcards

1
Q

Signs and symptoms of hypertension

A

Flushed face

Headache*

Vision changes

Strong bounding pulses

Dizziness

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2
Q

How do we tell when the hypertension medications are working?

A

Lower HTN around 120/80

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3
Q

What are some common adverse effects of most blood pressure medications?

A

Hypotension

Orthostatic hypotension

If systolic is less than 100.. we hold medication

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4
Q

Signs of hypotension?

A

Dizzy

Pale

Nauseous

Syncope

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5
Q

Patient education for hypertension medications

A

Get up slowly

Don’t stop taking abruptly because it can cause rebound hypertension which can cause hypertension crisis

Taken everyday

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6
Q

Adverse effects of ace inhibitors

A

Angioedema- EMERGENCY

Hypotension

Cough- report so we can switch

Hyperkalemia- avoid salt substitutes

Very nephrotoxic

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7
Q

Interactions for ACE inhibitors

A

Other anti HTN

NSAIDS- also nephrotoxic

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8
Q

What do ARBs end with

A

Sartan

Losartan and valsartan

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9
Q

Benefits of arb over ace

A

No cough

Lower risk of Angioedema- but hold if history with ace

Lower risk of hyperkalemia

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10
Q

Adverse effects of beta blockers

A

Bradycardia- hold if HR is < 60

Hypotension- hold if < 100

Rebound tachycardia (don’t stop suddenly)

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11
Q

Signs and symptoms of bradycardia?

A

Fatigue

Dizziness

Treat with atropine

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12
Q

What are the calcium channel blockers?

A

Verapamil, diltiazem, amlodipine

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13
Q

What do Verapamil, diltiazem, amlodipine treat

A

Hypertension, angina, and dysrhythmias

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14
Q

Which calcium channel blocker is used for hypertension

A

Amlodipine

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15
Q

Which calcium channel blocker is used for dysrhythmias

A

Verapamil, diltiazem

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16
Q

Adverse effects of the calcium channel blockers

A

Cardio suppression (bradycardia/hf)

Orthostatic hypotension

Constipation, especially verapamil, so moving around/exercise, drink fluids, dietary fiber

Rebound tachycardia/hypertension

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17
Q

Interactions of Verapamil, diltiazem, amlodipine

A

Anything that lowers heart rate

Digoxin, beta blockers and grape fruit juice

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18
Q

What is angina?

A

Chest pain that is caused by the heart due to lack of oxygen and blood flow

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19
Q

Difference between angina and heart attack?

A

In angina some blood can still get by, but with heart attack there is a total blockage of the artery so no blood gets by

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20
Q

What is the main medication used to treat angina?

A

Nitroglycerine and isosorbide

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21
Q

How do nitrates work?

A

Vasodilation of the coronary arteries

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22
Q

Adverse effects of nitroglycerine and isosorbide

A

Headache (normal) due to vasodilation

Hypotension

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23
Q

What would we give for acute angina

A

Sublingual because it’s rapid treatment

And if they are having a heart attack right now.. we give IV

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24
Q

Cautions for nitroglycerine and isosorbide

A

ED medications like slidenafil. They cannot have nitro within 24 hours of the last time they took this medication because it causes life threatening hypotension that’s irreversible

Anti HTN meds

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25
Q

Education for nitroglycerine and isosorbide

A

Store in a dark, cool, and dry place. The medication will degrade if there is light, heat or moisture.

Angina attack: stop, sit, take 1 tablet and rest for 5 mins. If not improved, call 911.

Can take 3 total doses 5 mins apart

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26
Q

What is heart failure

A

The heart is not pumping enough blood. It can’t fill.. and it can’t pump.. It can be caused by chronic hypertension, heart attack, coronary artery disease, etc.

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27
Q

What’s the main drug to treat heart failure

A

Digoxin

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28
Q

What is digoxin

A

It’s a positive inotropic (increase force of contraction of heart)

Negative chronotropic (slows the heart rate by slowing the signals that start in the SA node)

Negative dromotropic (slows speed.. by slowing the travel of the impulse through the conduction system)

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29
Q

Before giving digoxin what should we asses for

A

Heart rate.. hold if less than 60

Check apical heart rate for 1 full min.

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30
Q

Adverse effects for digoxin

A

Bradycardia

toxicity
It has a narrow therapeutic window 0.5-2.0 ng/ml… greater than 2=toxicity

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31
Q

What are signs of early toxicity of digoxin

A

GI effects: anorexia, NV, & abdominal pain

32
Q

What are late or severe signs of toxicity from digoxin

A

Yellow or green halos in vision

Brady dysrhythmia

Hypokalemia can increase risk of toxicity

33
Q

Education for digoxin

A

Take apical HR for 1 full min

Report & hold if HR less than 60

Report changes in HR and rhythm

Take same time each day

Report signs of toxicity

If a dose is missed, don’t double it

34
Q

If toxic from digoxin what do we give

A

Digoxin immuno fab

35
Q

Adverse effects of statins

A

Hepatotoxic (monitor ast and alt labs, look out for anorexia, NV, abdominal distention, jaundice) avoid other hepatotoxic medication like acetaminophen and alcohol

Myopathy (muscle pain)

Rhabdomyolysis

36
Q

Signs of Rhabdomyolysis

A

Myopathy

Dark urine

Flank pain

37
Q

Contraindications for statins

A

Pregnancy

Sever liver disease

38
Q

Interactions for statins

A

Grapefruit juice

39
Q

Education for statins

A

Report muscle pain, jaundice, dark coloured urine, or kidney pain

40
Q

When do we swab for cultures

A

Before any antibiotic is given

41
Q

Normal white blood cell range

A

11.2 - 4.1

42
Q

Why do we monitor WBC during antibiotic therapy?

A

It lets us know if the antibiotic is working

43
Q

What should a patient do if taken contraceptives and is prescribed antibiotics

A

Stop taking them and use non hormonal form of contraception like a barrier

44
Q

Signs and symptoms of c diff

A

Bad diarrhea

Mucus, pus and blood in the diarrhea

Abdominal pain

45
Q

What are the 3 Supra infections

A

Thrush (fungus in mouth)

C.diff

Yeast infection

46
Q

What are signs and symptoms of an allergic reaction to penicillin

A

Rashes/hives

urticaria (itching)

Anaphylaxis- swelling in the airway,face, bright red skin colour, low BP

47
Q

If someone is having an allergic reaction what do we do?

A

Stop giving medication

Give epi IM

48
Q

Averse effects for penicillins?

A

Renal impairments so monitor BUN, creatine, GFR

49
Q

If someone has anaphylaxis with penicillin, will you give a cephalosporin?

A

No because of cross sensitivity to penicillin

Now you could still give if they had a minor infection

50
Q

When do we use vancomycin

A

Reserved for serious infections

Treatment of systemic infections by IV

Treatment of c diff by PO

51
Q

Adverse effects of vancomycin

A

Red man syndrome- extreme flushing.. so slow the infusion by at least 60 mins.. because if you give vancomycin to fast.. it causes red man syndrome

Nephrotoxic- so draw a trough just prior to the next dose

52
Q

Main drugs to treat TB

A

Ribampin

Isoniazid

53
Q

What is the difference between active TB and latent TB

A

Latent: they are not showing any symptoms and they are not infectious.

Active: the infection is actively destroying the lungs, coughing up blood

54
Q

Main adverse effects of rifampin and isoniazid

A

Hepatotoxic so patients should avoid other hepatotoxic drugs

55
Q

What is the big main adverse affects for all anticoagulant

A

Hemorrhage

56
Q

What are signs of bleeding

A

Bleeding gums, or small wounds

Excessive bruising, petechiae, or hematomas

Frank blood (bright red) in emesis or stool

Coffee ground emesis or black tarry stool “melena”

Nose bleeds

Fatigue and pallor

Tachycardia

Occult bleeds (slow GI bleed)

57
Q

What labs tell you if your patient is bleeding?

A

H&H

When it’s low that means they are bleeding.

58
Q

What are the 2 types of heparins

A

Heparin

Enoxaparin which is like a weaker heparin

59
Q

What does IV heparin treat?

A

Acute treatment of ischemic stroke, PE, MI, or DVT

60
Q

What is enoxaparin used for

A

Prevent DVT and PE

It’s a bridge to oral therapy. So while we wait for the PO therapy to reach its therapeutic effects, we can give enoxaparin

61
Q

Adverse effects of heparin and enoxaparin

A

Hemorrhage and the antidote is protamine sulfate.. it binds and inactivates heparins

Heparin induced thrombocytopenia (HIT)… so hold medication if platelets are less than 100,000. Don’t give to a patient with low platelets or who is actively hemorrhaging

62
Q

Adverse effects of warfarin

A

Hemorrhage- highest risk when starting or adjusting dose.. and the antidote is vitamin k

Liver damage- so monitor AST/ALT/Bilirubin
Jaundice

63
Q

Patient education for warfarin

A

Taken daily PO at the same time

Will have to get frequent lab monitoring

Know what foods are high in vitamin K like green leafy vegetables so that they can keep there vitamin K levels consistent

64
Q

What is warfarin contraindicated in?

A

Pregnancy! It will cause fetal demise

65
Q

What is alteplase used for?

A

To dissolve every blood clot in your body

So if someone is having a stroke or a heart attack, and we don’t have a cath lab.. they have a massive PE and they are dying on the table.. well give them alteplase

66
Q

Adverse effects for alteplase

A

Hemorrhage

Spontaneous bleeding

Hemorrhagic stroke

67
Q

What are the anti platelets

A

Clopidogrel and aspirin

68
Q

Adverse effects for clopidogrel and ASA

A

GI bleed- coffee ground emesis, black tarry stool

Hemorrhage

Thrombocytopenia- unusual bruising, bleeding that won’t stop

69
Q

Adverse effects just got aspirin

A

Nephrotoxicity

Salicylism - tinnitus

Reye’s syndrome- don’t give to children especially if they just had a viral infection

70
Q

What is the dose for aspirin to prevent cardiac events

A

81 mg

71
Q

What are the types of anemia

A

Pernicious

B12 deficiency

Iron deficiency

Megaloblastic

CKD

72
Q

What is the difference between pernicious and B12 anemia

A

With both of these, you’re not getting enough B12, but with pernicious you’re not able to absorb the B12 in your diet because you lack intrinsic factor

B12 deficiency just means you’re not eating enough B12

73
Q

What route do you give b12 to someone with pernicious anemia

A

Injection IM

74
Q

What route of administration of b12 for people with b12 deficiency anemia

A

PO

75
Q

What causes iron deficiency anemia

A

Not eating enough iron or heavy menstruation

76
Q

What causes megaloblastic anemia

A

Not enough folic acid

77
Q

What is CKD anemia?

A

The kidneys can no longer secrete it’s hormone erythropoietin to notify bone marrow to create more red blood cells

Pharm Exam 3 (6 decks)

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