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63 Cards in this Set
- Front
- Back
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Simvastatin |
Zocor may cause rhabdomyalisis (educate) shouldn't be over 80 mg |
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Signs of rhabdo |
muscle damage muscle weakness dark urine fatigue Contact PCP Rhabdomyolysis is breakdown of muscle fibers. Muscle breakdown causes the release of myoglobin into the bloodstream. Myoglobin can cause kidney damage. |
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Dose limitations for Simvastatin of 10 mg for pts on? |
Old Ca Channel Blockers Verapamil (Calan, Verelan, Isoptin) Diltiazem (Cardizem, Taztia, Cartia, Dilacor, Tiazac) |
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Dose limitations for Simvastatin 20 mg for patients on
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Amiodarone Amlodipine (Norvasc, Caduet, Lotrel, Twynsta) Ranolazine (Ranexa) |
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If you see a pt on a statin with meds such as old ca channel blockers, amiodarone, amlodipine, Ranolazine, management plan? |
M5 Consider another statin b/c of interaction b/t (list 2 drugs) or M4 Dosage change r/t to guidelines |
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Specifically ask males if they use this med? |
ARE YOU ON ANY MEDS FOR ERECTILE DYSFUNCTION?
(PDE-5 inhibitors)
b/c they may purchase them on their own ADVISE ANY PT ON PDE5 INHIB. NOT TO TAKE ANY NITRATES, DOCUMENT
NITROGLYCERIN ISOSORBIDE ISORDIL DINITRATE ISORDIL MONONITRATE |
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PDE-5 inhibitors?
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Sildenafil (Viagra, Revatio-pulm htn) Tadalafil (Cialis, Adcirca-pulm htn ) Vardenafil (Levitra) Avanafil (Stendra) The phosphodiesterase type 5 (PDE5) inhibitors cause vasodilation in the penis |
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PDE-5 Inhibitors should not be taken with which meds? |
Nitrates hypotensive effects appear to be potentiated by PDE 5 |
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Avoid which meds if taking PDE-5 inhibitors |
NITROGLYCERIN ISOSORBIDE ISORDIL DINITRATE ISORDIL MONONITRATE |
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If pt is taking PDE5 Inhibitor and a nitrates what is the management plan? |
M5 member taking nitrate and erectile dysfunction med, consider alt med, risk of hypotension and falls |
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Adcirca's other name |
Tadalafil (Cialis)
Adcirca is used to treat pulmonary hypertension |
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If you see Wafarin & a macrolide, management plan? |
(Erythromycin, clarithromycin), sulfa macrolide decrease hepatic metabolism of warfarin, which increases INR, bleeding risk M7 Consider careful laboratory monitoring (list both meds for INR) |
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If you see Wafarin & a quinolone, management plan?
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(Cipro, Levfloxin) Hypoprothrombinemic effects of warfarin are increased M7 Consider careful laboratory monitoring (both for INR) |
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If you see Wafarin & a phenytoin, management plan?
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M7 Consider careful laboratory monitoring (both for INR and Phenytoin level |
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If you see Wafarin educate on?
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-Advise them not to take any OTC blood thinners ASA, NSAIDS increased risk of irritation to GI mucosa and hemorrhage -Vit K (lower warfarin effect), multi vit w/ K foods rich in vit K, -Some a/b and other meds can influence INR, always ask when change in regimen |
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If you see Wafarin & phenytoin, management plan?
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M7- Monitor INR and phenytoin levels more closely especially when there is a therapy change involving these medications
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Meds that can increase warfarin levels Management plan if not going to a clinic to monitor INR? |
Nsaids Omeprazole Tramadol Sulfa ASA Macrolides Quinolone Synthroid NOT SAM QS M7- Monitor INR more closely when there is a therapy change involving these medications |
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If you see a member with multivitamin and warfarin, management plan? |
M7- Monitor INR more closely when there is a therapy change involving these medications Member on Warfarin & newly started on MVI w/ Vit K. PCP to consider more frequent monitoring of INR talk to pt about the possible interaction as multivitamins have vitamin K which decreases the effects of Warfarin and put the member at risk for clots |
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With Potassium, be careful of which meds that can increase Potassium and lead to arrhythmia? Management Plan? |
Spironolactone ACE Inhibitors Triamterene (Dyrenium- kind of "water pill" (potassium-sparing diuretic). SAT M7- Monitor K level closely, especially when there is a change in the regimen |
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With Potassium, be careful of which meds that can decrease K?
Management Plan? |
Loop diuretics (Furosemide, bumetanide, Torsemide) Thiazide diuretics (hydrochlorothiaide, Metolazone, Chlorthalidone) These meds flush out K M7- Monitor K level closely, especially when there is a change in the regimen |
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Low Potassium can increase the toxicity of what meds? What does it do? Other meds that can contribute? Management Plan? |
Digoxin Increases risk of Torsade de pointes with med such as Geodan Quinolones esp Avelox (Moxifloxacin) Amiodarone M7- Monitor K level closely, especially when there is a change in the regimen |
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Extended release forms of Potassium can cause GI damage when administered with? Management Plan? |
anticholinergics M7- Monitor K level closely, especially when there is a change in the regimen substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. An |
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Anticholinergic drugs are used to treat a variety of conditions such as?
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Gastrointestinal disorders (e.g., gastritis, diarrhea, pylorospasm, diverticulitis, ulcerative colitis, nausea, and vomiting)
Genitourinary disorders (e.g., cystitis, urethritis, and prostatitis) Respiratory disorders (e.g., asthma, chronic bronchitis, and chronic obstructive pulmonary disease [COPD]) Sinus bradycardia due to a hypersensitive vagus nerve.Insomnia, although usually only on a short-term basis.Dizziness (including vertigo [a.k.a. 'the spins'] and motion sickness-related symptoms) have antisialagogue effects (decreasing saliva production), and most produce some level of sedation, both being advantageous in surgical procedures. |
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Digoxin range? |
Rec not to exceed 0.125 ng/ml day for elderly 0.5- 0.9 ng/ml rec for CHF pts <2.0 ng/ml for average person low -no effect high - dig toxicity |
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Which meds increase the serum concentration level of Digoxin? Management plan? |
PPIs Atorvastatin (Lipitor) NSAIDS PAN M5 preferably (alt med) increases digoxin level M7 (monitor more frequently) or M4 (change dose) |
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Digoxin toxicity increases as potassium? |
potassium decreases inverse relationship |
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PPIs |
Omeprazole (Prilosec, Prilosec OTC),
lansoprazole (Prevacid, Prevacid 24-Hour), dexlansoprazole (Dexilent, Kapidex) rabeprazole (Aciphex), pantoprazole (Protonix) esomeprazole (Nexium), Zegarid, a rapid release form of omeprazole. increase the serum concentration of digoxin M7 (monitor more frequently) or M4 (change dose) or M5 (alt med) |
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Which meds enhance the av blocking effects of digoxin and possibly increase the serum concentration of digoxin? Management Plan? |
Diltiazem Verapamil M5 Consider alt med- Has the potential to enhance the AV blocking effects of Digoxin or |
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Digoxin may enhance the AV blocking effect of ? Management Plan? |
Dronedarone (Multaq) and Dronedarone (Multaq) may increase the serum concentration of Digoxin M5 Consider alt med- Consider alternative med, AV blocking effect increase (Digoxin and list med) AND M7 Check with the PCP for more frequent monitoring |
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Amiodarone may _______________ the serum concentration of Digoxin Management Plan? |
increase M5 Consider alt med- Consider alternative med, AV blocking effect increase (Digoxin and list med and M7 Check with the PCP for more frequent monitoring |
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Omeprazole can block/ stop the effects of? What else can be used? Management plan? |
Plavix (Clopidogrel) needs Cytochrome P2C19 Omeprazole strongly uses CYP2C19 enzyme Pantoprazole (Protonix PPI) better choice M5 Pantoprazole is a better choice, has less impact on Plavix |
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Omeprazole causes stomach pH to increase, which prevents absorption of which med? Management plan? |
Ferrous Sulfate po b/c stomach is less acidic Ferrous gluconate is not affected by omeprazole M5 Select an alter. med Ferrous gluconate better choice Also educate the member to take iron with Vitamin C or an acidic drink |
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Omeprazole can _____the serum level of Warfarin? More of a problem when? Management Plan? |
Increases level of Warfarin Make sure member is monitored If not monitored or member takes omeprazole prn select M7 Careful monitoring of INR, Omeprazole increases INR M3 Educate member that Omeprazole is not to provide rapid relief is to be taken consistently Recommend Ranitidine (H2 blocker)- can be taken prn and will not interact with Wafarin M5 |
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Tramadol inhibits which seizure med? Management plan? |
Carbamazepine (Tegretol) Tramadol and Carbamazepine inhibit each other M5 Consider an alternative medication |
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Tramadol should not be be used with which meds, as Tramadol can enhance the serotonergic effect of causing serotonin syndrome Management plan? |
SSR Inhibitors
SNR Inhibitors TCA M5 Consider alternative meds |
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TCA ex? |
Amitriptyline (Tryptomer, Elavil, Endep)
Doxepin (Adapin, Sinequan) Nortriptyline (Pamelor, Aventyl, Norpress) Imipramine (Tofranil, Janimine, Praminil) |
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SSR Inhibitors ex? Selective serotonin reuptake inhibitors (SSRIs) |
Citalopram (Celexa)
Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil, Pexeva) Sertraline (Zoloft) |
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SNR Inhibitors
Serotonin and norepinephrine reuptake inhibitors (SNRIs) |
Duloxetine (Cymbalta)
Venlafaxine (Effexor XR) Desvenlafaxine (Pristiq) |
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Tramadol _____serum concentration of Warfarin |
increases M7 more frequent monitoring of INR when Tramadol is added or discontinued |
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Tramadol increases the risk of malignant neuroleptic syndrome when its used along with? Management plan? |
Antipsychotics and neuroleptics M5 Choose alternative med |
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antipsychotics |
Haldol Risperidal |
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NSAIDS should not be used w/ ARB and ACE inhibitors |
decrease antihypertensive effects of ACEi increase the risk of nephrotoxicity that have renal impairment; monitor renal function if concomitant use |
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NMS |
Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder most often caused by an adverse reaction toneuroleptic or antipsychotic drugs. NMS typically consists of muscle rigidity, fever, autonomic instability, and cognitive changes such as delirium, and is associated with elevated plasma creatine phosphokinase.
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Drugs that can precipitate NMS |
butyrophenones (haloperidol) orphenothiazines (promethazine and chlorpromazine) are reported to be at greatest risk.
various atypical antipsychotics such as clozapine, olanzapine, risperidone, quetiapine, and ziprasidone have dopaminergic drugs (such as levodopa) for Parkinson's disease, most often when the drug dosage is abruptly reduced ntiemetic metoclopramide lithium M5 |
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NSAID with Beta Blocker not advised b/c |
NSAID inhibition of renal prostaglandin synthesis allows unopposed pressor systems to produce htn M5 alt med, avoid or adjust beta blocker dose SULINDAC may be a better choice with a beta blocker |
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NSAIDs can cause Digoxin levels to ______ Management plan |
increase and cause dig toxicity Should avoid NSAIDS in pts with HF M5 Alt med advised pt has HF & M7 monitored more frequently |
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NSaids can cause increased risk of GI ulceration and nephrotoxicity with what med? Management plan? |
Biphosphonates M6 ADVERSE REACTION increase GI and renal tox risk M7 monitor renal function please monitor CBC for signs of anemia and Creatinine for renal tox |
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If you see pt is on an NSAID |
Make sure you advise pt not to take meds in the same class |
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Avoid which meds with ETOH |
Flagyl Benzo Barbituate |
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Synthroid is best absorbed when taken |
on an empty stomach |
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Which meds should be taken four hours apart when taking Synthroid? |
1 Calcium 2 Aluminum Hydroxide (Maalox) 3 Fe 4 Vitamins and minerals |
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When you enter Synthroid on the med list what should you type
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In the frequency area of the med screen, type TAKE ON EMPTY STOMACH 30 MIN BEFORE EATING OR 4 H AFTER OTHER MEDICATIONS |
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What meds decrease the effects of Synthroid? Management plan |
SPECT C SSRI Phenytoin Estrogen Carbamazepine TCA Cipro M7 Consider close monitoring of TSH with these combinations |
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What meds can increase or decrease the effect of Synthroid |
Amiodarone (iodine) Lovastatin M7 Consider close monitoring of INR when adding or changing Synthroid dose |
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Synthroid's effects on Warfarin |
Synthroid can increase the effect of Warfarin M7 increased monitoring Can be a problem if dose of Synthroid is adjusted |
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Education with synthroid |
Synthroid best absorbed on an empty stomach at least 30 min before eating and must have 4 hrs of separation from other meds M2 |
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Omeprazole other name?
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Prilosec, Prilosec OTC
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lansoprazole other name?
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Prevacid, Prevacid 24-Hour
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Pantoprazole other name?
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Protonix
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Esomeprazole other name?
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Nexium
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Ranexa |
Antianginal med
Ranolazine is used alone or with other medications to treat ongoing angina (chest pain or pressure that is felt when the heart does not get enough oxygen). |
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digoxin toxicity signs
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Confusion
Irregular pulse Loss of appetite Nausea, vomiting diarrhea Fast heartbeat Vision changes (unusual), including blind spots, blurred vision, changes in how colors look, or seeing spots) |
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Foods rich in Vit K |
*Kale *Collards *Spinach *Turnip Mustard green Beet green Brocolli Brussels sprout Onion |
