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106 Cards in this Set

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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
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
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