Med management Flashcards
(21 cards)
Can cause gingival hypertrophy
morbilliform rash, lethagy, hirsutism, megoblastic anemia
Phenytoin/Dilantin
Excessive blood levels of phenytoin >20
*no specific antidote (supportive care, HD and transfusion sometimes)
Nystagmus
Tremor
Ataxia
Dizziness
Current standard for heparin overlap in warfarin initiation
5 days
Use of loading dose is recommended in _____ but not ______
Digoxin
not Warfarin
Warfarin mechanism of action
Antagonism of Vit K
Warfarin monitoring
Daily
Then Weekly
Then q 1-4 weels
Low intensity warfarin tx
Efficacy rapidly diminishes below INR of 2.0
High intensity warfarin tx
Safety is compromised at INR above 4
If urgent need for prompt reversal of anti-coag
Administer fresh frozen plasma (contains clotting factors)
If urgent need for prompt reversal of anti-coag, newer products
Prothrombin Complex Concentrate (PCC)
2 kinds, contain all vit-K dep coag factors or just II, IX, X (if second kind, use fresh frozen plasma too)
New anticoag, direct thrombin inhibitor
No monitoring needed
Pradaxa (dabigatran)
New anti-coag, Factor Xa inhibitor
No monitoring needed
Xarelto (rivaroxaban)
Also, Eliquis (apixaban)
Therapeutic range for digoxin
0.5-2.0
half life 36-38 hours, steady state 6-8 hours
Digoxin loading dose
0.25-0.5 STAT w/ 0.25 q 6-8 hours until total dose of 1.0-1.5 mg given
Maintenance digoxin
0.125-0.25 mg/d
Anorexia, nausea, vomiting, diarrhea, PAT w/ block
Dig toxicity sx
Tx of dig tox
D/c drug
Cardiac monitoring
Avoid cardioversion
Ensure adeq K+
Use for life-threatening digoxin tox
Digoxin specific FAB
When to evaluate adequacy of dilantin
blood levels drawn just before next dose
*If toxic sx, get blood levels during sx
Phenytonin metabolism
70% in liver
Key info to know about dosing dilantin/phenytoin
Dose response curve not linear
Can have large increases in serum level with small increases in dose
