Pharm II Exam 2
Terms
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- S&S Alcohol intoxications
-
Euphoria
slurred speech
ataxia
sedation
flushed face
mood swings
nystagmus - S&S Opiate Intoxication
-
euphoria
slurred speech
ataxia
sedation
motor retardation
dysphoria
miosis - S&S Cocaine Intoxication
-
euphoria
grandiosity
motor agitation
hypervigilance
elation
sweating/chills
mydriasis - S&S Alcohol W/D
-
tremor
anxiety
nausea
vomitting
hallucinations
seizures
hyperthermia - S&S Opiate W/D
-
fever
diarrhea
lacrimation
rhinorrhea
mydriasis
insomnia
piloerection
muscle ache - S&S Cocaine W/D
-
fatigue
sleep disturbances
nightmares
depression
increased appetite - OTC Category I
- recognized as safe and effective, not misbranded
- OTC Category II
- not recognized as safe and effective
- OTC Category III
- insufficient data
- Most herbal meds are classified as OTC Class?
- II
- DSHEA- Dietary Supplement
- A product not intended to supplement the diet that bears or contains one or more of the following dietary ingrediants: a vitamin, mineral, amino acid, herb or other botanical
- Chamomile uses
-
mild sedative
antispasmotic - Chamomile allergic rxn
-
people also allergic to rag weed
itchy eyes
hives
tongue swelling and airway tightness - Chamomile also contains the chemical...
-
coumarin which is a blood thinner
could increase the effects of warfarin
must monitor closely - Echinacea is a
- purple cone flower touted as an immune system booster
- Echinacea used for more than 8 weeks
-
increased risk of liver damage
Theoretically may counter the effects of immunosuppressants used in transplant pts, corticosteroids etc..
Not recommended in immunesupressed - Feverfew uses
-
migraines
muscle aches - Feverfew beliefs
- block the synthsus of leukotrienes, prostaglandins and thromboxane
- Feverfew CI
- Pregnancy
- Feverfew blocks
-
platelet activity...
use with caution if you are taking Coumadin or Heparin or ASA - Garlic beliefs
-
dec BP
dec cholesterol (~10-15%)
blocks ATP citrate lysase, an imp step in the process of converting carbs to fat - Garlic blocks
-
platelet activity...
may inc INR and cause inc risk of bleeding - Ginger uses
-
nausea
stomach upset - Ginger was proven to be effective in...
-
post surgery nausea
morning sickness
motion sickness - Ginger can
-
prolong bleeding
avoid in pts on coumadin - Gingko biloba beliefs
- memory enhancer
- Gingko biloba activity
-
Flavoglycosides act as free radical scavangers and inc cerebral blood flow
antiplatelet activity - Ginseng belief
-
mood elevator
fatigue/stress reliever
energy enhancer - Ginseng structure is similar to
- steroids
- Ginseng proven in study of 36 newly dx DM pts
-
200mg-->
increased vigor
increased feeling of well-being
lower blood sugar - Ginseng Adverse Effects
- high doses cause HTN
- Ginseng drug interactions
- enhance effects of hypoglycemia agents and antihypertensives
- Glucosamine and Chondroitin beliefs
-
symptomatic relief of OA
may stimulate cell growth and inhibit inflammation - Glucosamine and Chondroitin is derrived from
- crabs, lobster and shrimp
- Chondroitin is part of the...
- proteoglycan structure
- Chondroitins effects of cartilage
- elasticity and resilence
- Glucosamine cautions
-
brittle diabetics
shellfish allergy - St Johns Wart name
- Hypericum perforatum
- St John Wart is licensed in Germany for tx of
- anxiety, depression and sleep disorders
- St Johns wart is similar to
- amitriptyline (Elavil)
- St Johns wart was disproved to be effective for...
- moderate to sever depression
- Dig and St Johns Wart
- Dig concentrations have been shown to decrease by 25% with administration of St Johns Wart
- MAOIs, TCAs, triptans, ergot alkaloids and SSRIs with St Johns Wart
-
leads to serotonin syndrome
confusion
agitation
hyperthermia
muscle spasms
seizures - St Johns Wart with tetracycline and certain NSAIDs
- increased risk of sun burns
- Valerian and Kava Kava beliefs
-
sleep aids
increases the risk for CNS depression when used with EtOH and barbs - Ephedra is a
-
CNS stimulant
Cardiac stimulant
Uterine stimulant
PV constricter - Ephedra uses
-
weight loss
stimulant
enhanced althletic performance - Ephedra AEs
-
nervousness
anxiety
h/a
insomnia
dizziness
palpitations
tachyarrhythmias
HTN
cardiac arrest
AMI
sudden death
TIAs
strokes
seizures - Black Cohosh tx of
- menopausal sx
- Black Cohosh is...
- Phytoestrogrens and contains small amounts of salicylate acid
- Black Cohosh is CI in...
- woman with a h/o estrogen-dependant tumors or endometrial cancers
- Black Cohosh effects
- antiplatelet effects similar to ASA
- White Willow Bark effects
-
Antiinflammatory
1851= ASA- same CI - Hawthorn uses
-
angina
HTN
heart failure
Acts as a vasodilator and a cardiotonic - Hawthorn cautions
-
concomittant cardiovascular agents
elderly- inc risk for Hypotn - D/C these meds preoperatively
-
ephedra
garlic
gingko biloba
ginseng
kava
St Johns Wart - Digoxin and Warfarin are of the leading causes of...
- drug incuded admission into the hospital
- Dig poisoning S&S
-
stomach upset
nausea
vomitting
diarrhea
blurred vision
greenish yellow halos
dec HR
arrhythmias
cardiac arrest - Siberian Ginseng and Motherwart are similar to
- Dig`
- Licorice uses
-
PUD
affects K balance
causes hypokalemia--> increases in the toxic effects of Dig= DO NOT USE TOGETHER - Warfarin OD
-
easy bruising
bleeding gums
nose bleeds
blood in urine and or stool - Herbal interactions with Warfarin- inc bleeding
-
feverfew
gingko
ginseng
garlic - Herbal interactions with Warfarin- dec Warfarin's effect
-
gingeng
St Johns Wart
Green tea - Do not use Zinc Lozenges with
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Immunosuppressants
i.e. steroids, cyclosporine, azathiprine, MTX - Tannin and Iron Supplements
-
can lead to anemia
Black Cohosh
feverfew
St Johns Wart - Fluorine and metal cations
-
chelated complex formed
decreases bioavailability when given concurrently with Iron, Zinc, Aluminum, Calcium - Tetracycline
-
mineral insoluble chelated complexes
Ca (dairy), iron, aluminum, zinc
decrease bioavailability - Grapefruit Juice
-
Blocks the metabolism of certain drugs
IV meds are not affected
Culprit
Bioflavenoids
quercetin and naringin - MAOI + tyramine containing foods
-
NOT ALLOWED: cheeses, aged and fermented products
Nardil- phenelzine
Marplan- isocarboxazid
Parnate- tranycypromine - Decrease RBC production
-
Iron
Folate
B-12
Renal failure
Bone Marrow
Suppression
ACD - Increase in RBC production
-
hemolysis
abNL production - S&S of all Anemias
-
fatigue
pallor
icterus
hepatosplenomegaly
tachycardia
wide pulse pressure
pale mucous mb
cardiac decompensation
shortness of breath
dizziness - S&S of B12 deficiency
-
dysphagia
anorexia
beefy red tongue
psychosis
paresthesia of hands and toes
+ Romberg
+ Babinski
impared vibratory and position sense
ataxia
decreased DTR - S&S of Folate deficiency
-
Same as B12 but no CNS effects
ecchymosis
purpura
loss of skin elasticity
early graying of hair - S&S Iron deficiency
-
spooning of nails
angular stomatitis
glossitis
achlorhydria
craving for substances
low in iron - S&S Hemolytic anemia
-
painful crisis
abdominal pain
hemoglobinuria
jaundice
leg ulcers - Iron deficiency parameter increased
- TIBC
- Iron deficiency parameter decreased
-
MCV
Hb/Hct
MCHC
Ferritin
Iron
% transferrin saturation
reticulocyte - B12 deficiency LAbs
-
+ Shilling test
inc MCV
inc indirect bilirubin
dec B12
dec Hg/Hct
dec WBC
dec Platelet count - Folate deficiency Labs
-
inc MCV
inc indirect bilirubin
dec serum folate
dec Hg/Hct
dec reticulocyte count - renal failure labs
-
dec hg/hct
dec retic count
dec EPO - Hemolytic Anemias labs
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inc retic count
inc unconjugated bilirubin
dec hg/hct - ACD labs
-
inc ferritin
dec hg/hct
dec serum iron
dec TIBC - What is the most common cause of macrocytic anemia?
- Alcoholism
- Iron Def Anemia Tx
-
Tx cause...
blood cause
inc requirement
dec absorption - Prevent Iron def in
- Infants and Pregnancy
- Ferrous Sulfate
-
Feosol- Elixir
Fer-in-sol- Drops
Fer-in-sol- Syrup - Ferrous Gluconate
- Fergon- Elixir
- Increase required doses of Iron in Folate Deficiency
-
Pregnancy
Infancy
Infection
Malignancy
Hemolytic Anemia
NL Dose= 200mcg/day - Decrease intake in Folate deficiency
-
decreased absorption with drugs
decreased intake with malnutrition
altered metabolism - Tx of Folate Deficiency
-
Folic Acid 1mg daily 2-3weeks
Continue if risk factors continue - Tx of Folate Deficiency in Childbearing women
- 400mcg/day- NTD
- B12 sources
-
oysters
clams
liver
dineys
muscle meats
milk products
egg yolks - B12 def types
-
pernicious
vegan - Triad of B12 def
-
weakness
sore tongue
numbness/neuropathies
i.e.
peripheral neuropathies
tinnitis
neuritis
vertigo
h/a - B12 tx
-
B12 30-100mcg/mL for 2-3 weeks
then 100mcg q2-4weeks for life - Monitoring with B12
-
retic count in 5 days
h/h should normalizein 1-2 months
neurologic sx may improve but some may stay for life - Anemia of Chronic Disease...
-
Functional iron deficiency
Decrease life span of EBC or RBC Destruction
Inadequate marrow response to EPO - What causes ACD
-
Chemotherapy
Radiation
Disease - ACD affects qual of life when
- Hb falls below 10g/dL
- ACD S&S
-
pallor
fatigue
SOB
DOE - Interventions for ACD
-
blood transfusions
exogenous EPO - Therapy for ACD
-
Inprove QOL
decrease transfusions
60% of pts respond
SE: pain at inj site, thrombosis, HTN - Dose for ACD
-
Procrit 40,000units SC q week or Aranesp 200mcg SC q2weeks
Should get 0.5-1.0g/dL increase Hb in 4 weeks
Increase dose if no response
D/C use if no response with inc doses in 4 weeks
transfuse if Hb <8g/dL - EPO Therapy tests
-
H/H
Iron studies
Folate
B12 def
Treat with iron supplementation during tx if iron def or not responding - Over responders to EPO therapy
-
Stop once Hb >12g/dL
Hold until Hb drops below 11g/dL
restart EPO at reduced dose or delayed interval
If Hb rise too quickly >2g in 4 weeks--> reduce
Hb >13g/dL can increase the risk of thrombosis
Some evidence that maintaining Hb>12g/dL can decrease survival