Pharm-Final Exam Review Revision 2024

Statins, when do you take them? - answersAt NIGHT** How do Statins work? - answersBlocks the enzyme responsible for the biosynthesis of cholesterol Two potentially life-threatening adverse effects of Statins - answersRhabdomyolysis and Liver damage **Check CPK (Creatine phosphokinase test) and LFT (Liver function test)** What will patient complain of with Rhabdomyolysis? - answersMuscle and joint pain All cholesterol medications have what kind of adverse effects? - answers**GI: diarrhea, nausea, vomiting, constipation Bile acid sequestrants (Questran), what form do they come in? - answersPowdered form -**Give with 4 oz of water** What do you tell patients taking Bile acid sequestrants (Questran) about taking other medications? - answersTake 2 hrs before or 4 hrs after. How does Niacin make us feel? - answersFlushing feeling** -To reduce take Aspirin (Decreases LDL 20%) Diuretics, when are they taken? - answersIn the MORNING How do diuretics work to reduce BP - answersIncrease urine output, which decreases circulating fluid volume What do loop diuretics do to our potassium? - answersDecrease What do look diuretics do to our BP? - answersDecrease Calcium channel blockers, should patient increase calcium in diet? - answersNO Calcium channel cause vasodilatation, what does that do to us? - answersGive headache Most common adverse effect of ACE inhibitors - answersDry hacking cough Most life threatening adverse effect of ACE inhibitors - answersAngioedema Digoxin - answersCheck apical pulse for 60 sec. ** Hold less 60 ** High blood pressure - answersFirst: Start with lifestyle modifications -If that doesn't work, give diuretics, ACE inhibitors, and/ or beta blockers What should you do when giving BP meds, before and after? - answersCheck BP BP low after starting new BP med, what do you do? - answersDont worry, have patient call if they have to get up to use the restroom so they don't FALL. Do you get a cough with ARB? (Angiotensin receptor blocker) - answersNO Could you get Angioedema with ARB? (Angiotensin receptor blocker) - answersYou can What do ACE inhibitors do to our Potassium? - answersIncreases What do Beta Blockers do to our HR? - answersSlow it down What do Beta Blockers do to our BP? - answersDecrease Can someone with Asthma, COPD, or tracheal stricture take beta blockers? - answersThey cannot take BETA2 blockers (lungs) What might happen to Potassium when taking DIgoxin? - answersDecrease What is the most important vital sign to check when giving Digoxin - answersAPICAL PULSE Labs to check when taking Digoxin? - answersDigoxin and Potassium Nitroglycerine - answersTake Sublingual -Take 3 x 5 min apart, then call 911 ** How do you prevent tolerance with Nitrates? - answersTake off at night Long-acting Nitrates are contraindicated to who? - answersPeople with GLAUCOMA ** Patient walks into emergency room with chest pain - answersM-Morphine O-Oxygen N-Nitroglycerin A-Asprin (Improves supply and demand) Hospital doesn't have a cath lab, what will you do for a patient having an MI? - answersGive thrombolytics Throbolytics adverse effect - answersBLEEDING Who cannot get throbolytic therapy? - answersRisk of bleeding: Trauma patients, hemophilia, Von Willabrand Disease, surgery before 4-6 weeks, hemorrhagic stroke. What blood test do you do for Heparin? - answersPTT What blood test do you do for Coumadin? - answersPT/INR Is it possible to use Coumadin or Heparin to break up a clot? - answersNO** -They PREVENT clots from forming or getting bigger. (Thrombolytics break up clot) What are the 5 Vassopressors? - answersEpinephrin Dopamine Lovaphed (Norepinephrin) Vassopresin Neosynepherine (Phenyleprine) What two Vassopressors increase HR? - answersEpinephrine and Dopamine Coumadin overdose? - answersVitamin K Acetaminophen overdose? - answersMuccomyst Opioid overdose? - answersNarcan Hyperthermia overdose? - answersDantroline When should Plavix be stopped? - answersStop 5 days before surgery * Vitamin K rich foods - answersGreens: Spinach, kale, cilantro, and cranberries Epogen, what blood tests should be checked? - answersHNH (Hgb and Hct) Epogen is contraindicated in - answersPatients with uncontrolled hypertension Septic Shock - answers**GIVE FLUIDS Any shock with volume depletion? - answersGive fluids -HR will increase (do NOT take Dopamine, or Epinephrin) Anticholinergic adverse effects - answersUrinary retentions (cant pee), blurred vision (cant see), Constipation (cant poop), cant spit (dry mouth), tachycardia Anxiety disorders - answersTake Benzodiazapine Benzodiazapine overdose - answersRomazacon Opioid adverse reaction - answersRespiratory depression ** Tricyclic antidepressants, who cannot take? - answersAny cardiovascular issues MAOI's cannot eat - answersFoods rich with Tyramine -**Aged cheese, smoked meats, red wine, caviar** SSRI improvement - answers4-6 weeks, about a month -After a month, monitor for SUICIDAL tendencies** Ambien for sleep, key issue? - answersSleep walking and safety. All seizure disorders - answersMonitor serum levels -DO NOT abruptly stop - will cause rebound seizures Teaching with Valproic Acid - answersNO soda or Carbonated beverages (champagne, sparkling waters) What should you watch for while taking Zorontin? - answers**Gingival Hyperplasia** Lithium teaching - answersKeep hydrated, regular diet (no sodium restrictions), no exercise on hot days, check labs, do not abruptly stop Patients with Myasthenia Gravis, Parkinson's and Alzheimer's - answersTake medication on time, everyday Ear drops for a child - answersBack and DOWN Ear drops for an adult - answersBack and UP Eye drops - answersPressure on the inner canthus - stops systemic effect* Adverse reactions of Vaccines - answersPain at injection site, soreness, fever, body aches. -With live vaccines, might see the disease Vaccines are contraindicated in - answersPatients who are SICK Patient taking immunosupresants are at risk for - answersINFECTION Reduce the spread of virus - answersHand Washing Prevent the resistance of bacteria while taking antibiotics - answersFinish it all, don't use it to treat anything that wont respond to therapy (viral infections), hand washing, correct drug for correct disease How do you know your own the right antibiotic? - answersCulture and sensitivity -Takes about 72 hrs** -Start patient on BROAD SPECTRUM antibiotics, until culture comes back, then can start on NARROW SPECTRUM. Almost all antibiotics have an adverse effect of diarrhea, what can you do ? - answersGive yogurt and probiotics (lactobacillus) Superinfection - answersBlack furry tongue, vaginal discharge, painful urination, diarrhea -Do something for symptoms Teaching with Tetracyclines - answersBirth control isn't going to work (give alternative form), avoid milk or dairy, wear sunscreen or protective clothing (hat), finish the dose What should you watch for with ahminoglycosides? - answersHearing loss ** (Nephrotoxicity and Ototoxicity) -Sings of hearing loss: Patient asks to repeat, TV loud, patient talking loud. Fluoroquinolones: Ciprofloxacin, and Levofloxacin - answersAchilles tendon rupture ** -Patient cannot walk How long do we treat Tuberculosis? - answers6-12 months Key in treatment of viral infections? - answersTIMING** -Flu time frame: 48 hrs, or it wont work Patients taking chemotherapy medications (Antineoplastic) will have - answersImmunosupression -Protect from infection and bleeding by: Isolation, washing hands, PPE, no fresh fruits and veggies, no fresh flowers, no sick visitors. -If patient wants to ambulate in hallway, they need a mask. Patient feeling nauseous, what do you do? - answersAntiemetics taken before nausea. Patient doesn't feel like eating much, and wakes up one day wanting fast food, what do you do? - answersGive it to them Patient anorexic: Give supplements to boost nutrition Teaching with Antineoplastics - answers-No razors and dental floss -Use soft tooth brush Anticoagulants - answersIncrease risk of bleeding Peak and Trough - answersPeak: 30-60 min after Trough: 30-60 min before Potentially life threatening adverse effect of neuroleptic drugs: antipsychotics - answersNeuroleptic malignant syndrome **Characterized by muscle rigidity and hyperthermia ** Adverse effect of neuroleptic drugs: antipsychotics that is permanent if not identified early - answersTardive dyskinesia **Characterized by repetitive muscle movements** Mouth with soars - answersNo spicy foods, hot foods or drinks, no citrus