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Pharmacology III Review

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Karch CHp. 49-55

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Pharmacology III Review

  1. 1. Pharmacology Review III Chp. 39 - 59
  2. 2. Renal failure <ul><li>Acute </li></ul><ul><ul><li>Decreased oxygen to kidneys, R-A-A fails </li></ul></ul><ul><ul><li>Oliguria <400 ml/day </li></ul></ul><ul><ul><li>Wastes accumulate, electrolyte imbalance </li></ul></ul><ul><ul><li>Anemia (no erythropoetin produced) </li></ul></ul><ul><ul><li>Creatinine, BUN increase </li></ul></ul><ul><ul><li>Measure GFR (glomerular filtration rate) </li></ul></ul><ul><li>Chronic </li></ul><ul><ul><li>Diabetes most common cause </li></ul></ul><ul><ul><li>Polycystic kidney disease </li></ul></ul><ul><ul><li>Aspirin, NSAIDs, cocaine toxicity </li></ul></ul>
  3. 3. Case Study Drugs treating Anemias <ul><li>Carl comes into your clinic three times a week for epoetin alfa… </li></ul><ul><li>He mentions some chest pain. </li></ul><ul><li>What type of assessments will you perform on him? </li></ul>My Hct is improved, But…..
  4. 4. Epoetin alfa, Procrit <ul><li>Epoetin alfa will increase the number of RBC (it’s suppose to!) </li></ul><ul><li>Hypertension, Edema and chest pain </li></ul><ul><li>Weakness, dizziness, and seizures are also possible </li></ul>Increased RBCs = Increased Vascular Presure
  5. 5. Diuretics <ul><li>Commonly used for hypertension </li></ul><ul><li>Treat edema related to: </li></ul><ul><ul><li>CHF </li></ul></ul><ul><ul><li>Acute Pulmonary Edema </li></ul></ul><ul><ul><li>Liver disease </li></ul></ul><ul><ul><li>Renal disease </li></ul></ul><ul><li>Contraindications </li></ul><ul><ul><li>Lupus </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Liver disease </li></ul></ul><ul><ul><li>Gout </li></ul></ul>
  6. 6. Case Study Diuretics <ul><li>Granny Starbucks is taking Lasix to treat CHF. </li></ul><ul><li>She loves coffee, but it makes her pee. </li></ul><ul><li>Now, granny won’t drink more than a few sips of anything, because she doesn’t want to become incontinent. </li></ul><ul><li>What’s your advice? </li></ul>
  7. 7. Granny and Lasix <ul><li>Explain to granny: </li></ul><ul><ul><li>Take Lasix in the morning, so she won’t have nocturia </li></ul></ul><ul><ul><li>Continue to drink fluids to prevent “fluid rebound”, more edema (because of R-A-A) </li></ul></ul>Worse things can happen, Granny! Pulmonary Edema Is life threatening When fluid backs up into the lungs.
  8. 8. Granny and Lasix <ul><li>The rapid loss of fluid can cause </li></ul><ul><li>Hypotension and dizziness </li></ul><ul><li>So Granny is also at risk for falls…… </li></ul>
  9. 9. Diuretics <ul><li>Diuretics increase sodium excretion, as well as water excretion from kidneys… </li></ul><ul><li>Loss of fluid volume can cause: </li></ul><ul><ul><li>electrolyte imbalance </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Hypoglycemia </li></ul></ul><ul><ul><li>metabolic alkalosis </li></ul></ul>Monitor Potassium levels
  10. 10. Case Study Diuretics <ul><li>A bipolar patient on 100 mg PO/day of hydrochlorothiazide complains of weakness, muscle cramps, and pain in his big toe… </li></ul>What type of tests need to be done?
  11. 11. Hydrochlorothiazide <ul><li>Check Potassium level for hypokalemia </li></ul><ul><li>Check Uric acid levels for gout </li></ul><ul><li>Check lithium levels for toxicity if patient taking lithium for bipolar disorder </li></ul>Digoxin levels and Antidiabetic drugs levels May also be affected
  12. 12. Case Study Fuosemide <ul><li>Granny Starbucks calls back to talk to the nurse…. </li></ul><ul><li>Now, she has bloody gums when she brushes her teeth. </li></ul><ul><li>Did you ask granny if she was also on coumadin? </li></ul>
  13. 13. Furosemide and Anti-coagulants <ul><li>Increased risk of bleeding </li></ul><ul><li>Take a moment and warn granny to avoid aspirin and ginko biloba with coumadin as well. These also increase anticoagulation. </li></ul>
  14. 14. Case Study Potassium -sparing diuretics <ul><li>Granny Strabucks’ doctor changes her order to 100 mg/day Aldactone. </li></ul><ul><li>Granny’s daughter calls to say that granny is suddenly very confused since her lunch of spinach salad. </li></ul><ul><li>Is it a sudden case of Alzheimers’ or since she quit taking ginkgo biloba? </li></ul>
  15. 15. Hyperkalemia <ul><li>Alzheimers’ is a gradual loss of cognitive ability </li></ul><ul><li>Most common side effect of potassium sparing diuretics is hyperkalemia </li></ul><ul><li>Lethargy, confusion, muscle cramps, ataxia (inability to control muscles) </li></ul><ul><li>Granny needs to go to ER because of a risk for cardiac arrhythmias as well </li></ul>
  16. 16. Case Study Osmotic Diuretics <ul><li>A young man comes into ER having had a motorcycle crash. He receives mannitol 2 g/kg IV to relieve intracranial pressure. </li></ul><ul><li>He is admitted and the CNA tells you the patient is urinating so much the catheter bag has been emptied twice this shift. What will you say? </li></ul>
  17. 17. Osmotic Diuretics <ul><li>Inform the CNA that diuresis is expected. </li></ul><ul><li>Monitor the patient’s electrolytes closely </li></ul>Sodium (Na+) 135-145 mEq/L Potassium (K+) 3.5-5.0 mEq13/L Calcium (Ca++) 4.5-5.5 mg/dl Bicarbonate (HCO3-) 22-26 mEq/L Chloride (CL-) 95-105 mEq/L) Magnesium (Mg++) 1.5-2.5 mEq/L Phosphate (Po4-- ) 2.8-4.5 mg/dl
  18. 18. Loop of Henle <ul><li>Thiazides work at the distal tubule </li></ul><ul><li>Carbonic anhydrase inhibitors work at the proximal end of tubule - increase acid </li></ul><ul><li>Loop diuretics block the chloride pump where 30% of sodium is usually reabsorbed </li></ul><ul><li>Osmotic diuretics do not lose sodium </li></ul>
  19. 19. Case Study Loop Diuretics <ul><li>How much fluid can be lost per day? </li></ul><ul><li>20 lbs. </li></ul><ul><li>It may take several hours to relieve acute plumonary edema. </li></ul>
  20. 20. Case Study Urinary Tract Analgesic <ul><li>The poor patient from the motorcycle crash is out of ICU, but is complaining of extreme pain from that catheter. </li></ul><ul><li>The doctor prescribed: </li></ul><ul><li>Pyridium 200 mg PO tid </li></ul><ul><li>The same CNA tells you the patient has blood in his urine. </li></ul><ul><li>What do you say? </li></ul>
  21. 21. Pyridium <ul><li>Tell the CNA reddish, orange urine is a side effect of pyridium </li></ul><ul><li>Monitor for GI upset, headache and rash </li></ul><ul><li>Use pyridium for only 2 days </li></ul>Have you thanked your Nursing Assistant Today?
  22. 22. Case Study Bladder Protectant <ul><li>What do coumadin </li></ul><ul><li>And </li></ul><ul><li>Pentosan polysufate sodium (Elmiron) </li></ul><ul><li>For interstitial cystitis </li></ul><ul><li>have in common? </li></ul>
  23. 23. Pentosan polysufate sodium <ul><li>Both have anti-coagulant action </li></ul><ul><li>And </li></ul><ul><li>involve increased risk of bleeding </li></ul><ul><li>Especially with NSAIDs </li></ul>
  24. 24. Upper Respiratory System <ul><li>Nose </li></ul><ul><li>Mouth pharynx </li></ul><ul><li>Larynx </li></ul><ul><li>Trachea </li></ul><ul><li>Bronchial tree </li></ul>Move that mucous Goblet cells - trap dust,pollen,bacteria
  25. 25. Respiration <ul><li>The medulla increases the rate and depth of respiration based on input from chemoreceptors sensitive to what? </li></ul>
  26. 26. Respiration <ul><li>Carbon dioxide levels </li></ul><ul><li>And acid levels regulate our breathing, not oxygen levels </li></ul><ul><li>Inflammation from </li></ul><ul><li>pneumonia causing </li></ul><ul><li>viruses or bacteria </li></ul><ul><li>decrease the gas exchange </li></ul>
  27. 27. Cough Medicines
  28. 28. Antitussives <ul><li>True or False: </li></ul><ul><li>Antitussives can be used as long as the patient has a productive cough </li></ul>
  29. 29. Antitussives <ul><li>Cough suppression can cause </li></ul><ul><li>accumulation of secretions </li></ul><ul><li>Traditional antitussives like hydrocodone are potentially addictive (narcotics) </li></ul>False-Patient should seek medical evaluation after 1 week.
  30. 30. Case Study Mucolytics <ul><li>Rachel is going to perform postural drainage on a patient with thick mucous secretions and atelectasis in the left lung. </li></ul><ul><li>She knows it will help to administer a bronchodilator or nebulizer treatment </li></ul><ul><li>30-60 mins. Before the procedure… </li></ul><ul><li> She chooses a mucolytic---- </li></ul>
  31. 31. Pulmozyme <ul><li>Rachel uses dornase alfa (Pulmozyme) </li></ul><ul><li>Because it will break up the mucous </li></ul><ul><li>Pulmozyme is also used for: </li></ul><ul><li>-cystic fibrosis </li></ul><ul><li>-tracheotomies </li></ul>Elmo With a trach
  32. 32. Nasal Spray <ul><li>Causes vasoconstriction to shrink swollen membranes, opens clogged nasal passages </li></ul>Blow nose first Cover one nostril Tilt head back Do not squeeze forcefully, Might send drug into sinuses
  33. 33. Nasal Sprays <ul><li>Rebound Congestion </li></ul><ul><li>(rhinitis medicamentosa) </li></ul><ul><li>All May cause localized burning, stinging </li></ul>Afrin, Allerest, Pretz-D Beclovent, Pulmicort, Decadron, Azmcort, AeroBid Topical Nasal Decongestants Topical Nasal Steroid Decongestants
  34. 34. <ul><li>Asthma </li></ul><ul><li>Emphysema </li></ul><ul><li>COPD </li></ul><ul><li>Respiratory Distress </li></ul><ul><li>Syndrome </li></ul>Pumonary Obstructive Diseases Obstruction Of Alveoli
  35. 35. Case Study Oral Decongestants <ul><li>Now that you’re a nurse, your friends all want free medical advice…like your neighbor who’s little girl has a stuffy nose and an earache. </li></ul><ul><li>What can you recommend </li></ul><ul><li>for relief of the pain and </li></ul><ul><li>congestion of otitis media? </li></ul>
  36. 36. Oral Decongestants <ul><li>Pseudoephedrine (Sudafed, Decofed) </li></ul><ul><li>Adult </li></ul><ul><li>60 mg PO q4-6 hr </li></ul><ul><li>Pediatric: </li></ul><ul><ul><ul><li>2-5 yrs 15 mg PO q4h-6h </li></ul></ul></ul><ul><ul><ul><li>6-12 yrs 30 mg PO q4h-6h </li></ul></ul></ul>Monitor blood pressure, pulse and auscultations for cardiac stimulation
  37. 37. Case Study Decongestants <ul><li>Available OTC, safe for everyone right? </li></ul><ul><li>Which of the following patients should NOT use Sudafed? </li></ul><ul><ul><li>55 yr old women with hypothyroid </li></ul></ul><ul><ul><li>35 yr old with diabetes type I </li></ul></ul><ul><ul><li>75 yr old with BPH </li></ul></ul><ul><ul><li>66 yr old who jogs daily but has hypertension </li></ul></ul>
  38. 38. Pseudoephedrine <ul><li>None of these patients should take it! </li></ul><ul><li>Also any patient with glaucoma,or coronary disease </li></ul>Used for nasal congestion from common cold, allergic rhinitis And cookin’ up meth
  39. 39. And you thought OTC medicines were safe…….. Antihistamines like Allegra, Benadryl and Claritin can cause heart arrhythmias, GI upset, drowsiness and cross the placenta in pregnancy
  40. 40. Case Study Theophylline <ul><li>Steffan, a smoker, who has had asthma for years takes: </li></ul><ul><li> Theo-Dur 400 mg/day PO. </li></ul><ul><li>He was recently laid off and has been home chain smoking because of the stress. </li></ul><ul><li>He comes to ER, can’t breathe and </li></ul><ul><li>his heart is actin’ crazy. </li></ul><ul><li>His wife states, “he has been so irritable, you all can just deal with him, I’m going home!” </li></ul><ul><li>What will you explain to her? </li></ul>
  41. 41. Nicotine and Theophylline <ul><li>Steffan has increased the level of nicotine in his system </li></ul><ul><li>Nicotine breaks down theophylline </li></ul><ul><li>He no longer has the therapeutic level of theophylline to manage his asthma </li></ul><ul><li>Irritability is an expected side effect </li></ul>He may have a dangerous heart arrhythmia
  42. 42. Bronchodilators <ul><li>Adults </li></ul><ul><li>(Prophylactic) </li></ul><ul><ul><li>Albuterol </li></ul></ul><ul><ul><li>Tormalate </li></ul></ul><ul><ul><li>Foradil </li></ul></ul><ul><ul><li>Isoetharine </li></ul></ul><ul><ul><li>Xopenex </li></ul></ul><ul><li>Children < 12 yr </li></ul><ul><ul><li>Albuterol </li></ul></ul><ul><ul><li>Alupent </li></ul></ul><ul><ul><li>Isuprel </li></ul></ul><ul><ul><li>Serevent </li></ul></ul><ul><li>Acute only </li></ul><ul><ul><li>Ephedrine </li></ul></ul>
  43. 43. How to get the most out of your asthma meds…. <ul><li>Use the least possible amount </li></ul><ul><li>Use 30-60 mins. before exercise </li></ul><ul><li>Provide small, frequent meals </li></ul><ul><li>Know warning signs </li></ul><ul><li>Monitor pulse, BP, </li></ul><ul><li>and GI upset </li></ul>Yeah! I used My Inhaler 30 mins. ago
  44. 44. Lung Surfactants <ul><li>Survanta (beractant) </li></ul><ul><li>Insafur (calfactant </li></ul><ul><li>Curosurf (poractant) </li></ul>For babies weighing less than 1350g At risk for RDS Effects of hypotension, pneumothorax, Patent ductus arteriosus, Increased bilirubin And sepsis
  45. 45. Mast Cell Stabilizers <ul><li>Intal (cromolyn) </li></ul><ul><li>Tilade (nedocromil) </li></ul>Blocks histamine from mast cells esp. For exercise-induced asthma - ok for kids > 2 years Blocks eosinophils, neutrophils, macrophages AND mast cells Use with corticosteroids, only for those over 12 years old
  46. 46. Cromolyn <ul><li>Cannot be used during an acute asthma attack </li></ul><ul><li>Asthmatic children taking this drug should not be in a smoke-filled environment </li></ul>Come on in! Can’t, I’m on Cromolyn!

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