Cps Ii Exam 1- Warfarin

Front 1

monitoring frequency for warfarin (starting-2, when stable, if doses are changed)

Back 1

1. START 2-3 days after initiation to give warfarin time to work-->then twice weekly at initiation of therapy, until 2 consecutive therapeutic INRs (rate that INRs increase should be 0.1-0.2/day in first week)
2. Weekly x one month
3. Monthly once stable
4. When weekly doses are changed, boluses are given, or doses held, the INR will be drawn in 1-2 weeks. Monthly INRs will then resume

Front 2

steady state of warfarin reached when?

Back 2

10-14 days

Front 3

altering dose for INR goal 2-3:
if INR < 2
if INR 3-3.5
if INR 3.6-4
if INR > 4

Back 3

INR < 2: increase weekly dose by 5-20%

INR 3-3.5: decrease weekly dose by 5-15%

INR 3.6-4: hold 0-1 doses and/or decrease weekly dose by 10-15%

INR > 4: hold 0-2 doses and/or decrease weekly dose by 10-20%

Front 4

altering dose for INR goal 2.5-3.5:
if INR < 2
if INR 2-2.4
if INR 3.6-4.6
if INR > 4.7-5.2
INR > 5.2

Back 4

INR <2 reload x1 or increase weekly dose by 10-20%

INR 2-2.4 -->increase weekly dose by 5-15%

INR 3.6-4.6 --> decrease weekly dose by 5-15%

INR 4.7-5.2-->hold 0-1 doses and/or decrease weekly dose by 10-20%

INR > 5.2 hold 0-2 doses and/or decrease weekly dose by 10-20%

Front 5

medications on the Beers list that are highly anticholinergic (4)

Back 5

First generation antihistamines: particularly diphenhydramine, doxylamine, hydroxyzine, promethazine,

(Brompheniramine, carbinoxamine, Chlorpheniramine, clemastine, cyproheptadine, dexbrompheniramine, dexchlorpheniramine, Triprolidine)

Front 6

Beers list what is it (and age)

Back 6

a list of meds for geriatrics (65+) where the potential risks outweigh the benefits

Front 7

CV drugs to avoid (beers list)- 1 (3 subcategories) category, 1 other category, 4 specific drugs

Back 7

Antiarrhythmic drugs class ia, ic, III (Amiodarone, Dofetilide, Dronedatone, flecainide, ibutilide, procainamide, propafenone, quinidine, sotalol).
Digoxin >0.125 mg/d unless for afib
no alpha blockers for htn (higher dose)
spironolactone > 25 mg/d (increased K+)
dronederone
disopyradine

Front 8

diabetes drugs to avoid (beers list) - 2
why? what do we use instead?

Back 8

Insulin (sliding scale- meaning the version where you base how much insulin to give on your drawn blood lvls, not all insulin) , long acting sulfonylureas (Chlorpropamide, glyburide).

increased risk of hypoglycemia.

just use metformin if SCr is ok, and glipizide 5 mg QD

Front 9

extrinsic risk factors for elderly falls (3)

Back 9

environmental hazards (poor lighting, slippery floors, uneven surfaces, etc.)
• footwear and clothing
• inappropriate walking aids or assistive devices

Front 10

exposure to risks...risk factors for falls in elderly (3)

Back 10

exposure to risky environmental
conditions (slippery or uneven floors, cluttered areas, degraded pavements), acute fatigue
unsafe practice in exercise sessions

Front 11

7 meds that can increase risk of falls

Back 11

benzodiazepines
psychotropics (...any psych med i guess...SSRIs, hypnotics, etc)
class 1a anti-arrhythmic medications (Disopyramide, Quinidine, Procainamide- DOUBLE QUARTER POUNDER)
digoxin
diuretics
sedatives.
4+ meds

Front 12

diabetes drugs NOT to use in beers criteria for pt with a certain preexisting disease

Back 12

thiazolidinediones in CHF

Front 13

5 patient demographics type characteristics that intrinsically increase risk of falls in elderly

Back 13

hx of falls
age-->increasing falls with age
gender: older old-->women > men
living alone
WHITE PEOPLE FALL MORE THAN MINORITIES

Front 14

3 activity/nutrition related characteristics that increase risk of falls in elderly

Back 14

sedentary (atrophy)
nutritional deficiency (low BMI, vitamin D deficiency)
impaired mobility/gait

Front 15

6 disease/condition related characteristics that increase risk of falls in elderly

Back 15

meds, esp BDZ
medical conditions
psychological status (fear of falling)
impaired cognition
foot problems
visual impairments

Front 16

6 medical conditions that case increased risk of falls in elderly
1 that is associated

Back 16

circulatory disease
chronic obstructive pulmonary disease
depression
arthritis
Thyroid dysfunction leading to excess circulating thyroid hormone
diabetes (if loss of peripheral sensation)
incontinence also frequently present

Front 17

3 types of urinary incontinence

Back 17

urge, overflow and stress

Front 18

urge incontinence- may occur when?

pathophys

Back 18

Bladder overactivity may occur during bladder filling and urine storage due to involuntary bladder (detrusor) contractions.

Symptoms of bladder overactivity occur because the detrusor muscle is overactive and contracts inappropriately during the filling phase which, in the neurologically normal individual, results in a sense of urinary urgency.

Front 19

overflow incontinence- result of what? (2)

common?

Back 19

result of urethral overactivity and/or bladder underactivity

uncommon type

Front 20

overflow incontinence pathophys

Back 20

Overflow incontinence results when the bladder is filled to capacity at all times but is unable to empty, causing urine to leak from a distended bladder past a normal or even overactive outlet and sphincter

Front 21

Stress incontinence- due to what (sum it up in 2 words)

pathophys

Back 21

urethral underactivity

the compromised urethral sphincter is no longer able to resist the flow of urine from the bladder during periods of physical activity. basically, increases in intraabdominal pressure during physical activity are transmitted to the bladder compressing it and forcing urine through the weakened sphincter

Front 22

stress incontinence usually noticed when? (5)

Back 22

exertional activities such as exercise, running, lifting, coughing, and sneezing

Front 23

5 disease related reversible factors for incontinence (ignore other one...)

Back 23

Psychological
Pregnancy, vaginal delivery, episiotomy (cutting shit in the vagina)
Endocrine disorders (Diabetes, Hypercalcemia, Diabetes insipidus)
Restricted mobility- get rid of aggravating or precipitating cause
Stool impaction

Front 24

6 drugs that are potential reversible factors in incontinence

Back 24

Diuretics
Caffeine
Anticholinergic drugs- retention
Narcotics/sedative hypnotics/alcohol (confusion, sedation, subsequent peeing of pants)
Alpha-adrenergic agents (both agonists like decongestants which can produce retention, and antagonists- may worsen stress incontinence)
Calcium channel blockers

Front 25

DIA of...potential reversible factors

mnemonic?

Back 25

Delirium
Infection (Urinary tract)
atrophic urethritis or vaginits

DIAPPPERS

Front 26

urge incontinence: post void residual

causes (3)

Back 26

normal
Usually neurologic cause like interruption of CNS inhibitory pathways
Age-related changes
Bladder irritation by infection, stones, neoplasms

Front 27

2 main causes for overflow incontinence

Back 27

Diminution or loss of detrusor contraction
OR

obstruction of bladder outlet

Front 28

4 types of drugs that cause overflow incontinence

Back 28

Anticholinergics
Narcotics
Anti-depressants
Smooth muscle relaxants

Front 29

3 causes of bladder obstruction in overflow incontinence

Back 29

Prostatic hyperplasia or carcinoma
Urethral stricture
Genital prolapse in women

Front 30

4 things that cause diminution or loss of detrusor contraction (which leads to overflow)

Back 30

(due to drugs, fecal impaction, diabetes, or lower spine injury)

Front 31

2 main causes of sphincter/stress incontinence

Back 31

Damage to urethra due to surgery or trauma
Decreased pelvic floor compliance as a result of normal aging, multiparity or surgery

reversible usually

Front 32

4 behavioral things a patient can do for incontinence

Back 32

Kegel exercise
vaginal weight training
Bladder training
Biofeedback

Front 33

2 behavioral things a caregiver can do for incontinence

Back 33

Habit training
Prompted voiding

Front 34

treatments for overactive bladder (3 drug categories)
explain rationale for each

Back 34

Anticholinergics
-Inhibit detrusor contraction
-May increase bladder capacity
Bladder relaxants
-Inhibit involuntary bladder contractions
-Highly anticholinergic
Estrogen-Mechanisms unknown

Front 35

2 anticholinergics (not bladder specific) that can be used for urge

Back 35

imiprimine, amitriptyline

Front 36

4 treatment categories for overflow

Back 36

Correct any outflow obstruction (the -zosins: doxazosin, tamsulosin)
Cholinergic agonists (bethanecol)
alpha-adrenergic blockers
Surgery

Front 37

stress incontinence therapies (4) give MoA for drugs (2 are non drug)

Back 37

Nonpharmacologic (kegals)
Alpha-adrenergic agonists (sudafed)- increases smooth muscle tone increasing urethral resistance
Estrogen- Stimulate squamous epithelium
Surgery

Front 38

generally, when are catheters used (and for what type of incontinence)

4 indications for it

Back 38

short-term use in overflow incontinent patients when wounds need to be protected

Persistent overflow causing infection or renal
dysfunction
 Not correctable surgically
 Contaminated wounds
 Terminally ill

Front 39

when might you use TCAs (anticholinergic activity too) for incontinence?

Back 39

for urge incontinence (or mixed- combo of urge and stress) if other co-existing indications like depression or neuropathic pain

Front 40

bladder relaxants for urge (2)

Back 40

oxybutinin- cheapest

tolterodine (detrol)- LA is qd so easier

Front 41

4 alpha antagonists used for overflow incontinence and MoA

Back 41

alpha adrenergic antagonists:

prazosin, terazosin, doxazosin, tamsulosin (flomax)

MoA: When alpha 1 receptors in the bladder neck and the prostate are blocked, this causes a relaxation in smooth muscle and therefore less resistance to urinary flow. usually alpha 1 receptors cause contraction of smooth muscle (i.e. of the sphincter)

Front 42

cholinergic used for overflow incontinence (if atonic bladder)

dose...

Back 42

Bethanechol 25-50 mg TID

Front 43

when is estrogen used for incontinence
MoA
route

Back 43

if vagina atrophy is going on (atrophic urethritis/vaginitis)- stimulates squamous epithelium

topical- oral may worsen

Front 44

First line (check this...) therapy for stress incontinence
optional first line therapy

Back 44

duloxetine???

imipramine...