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98 Cards in this Set
- Front
- Back
Thrombus
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blood clot
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Embolus
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piece of blood clot breaks off and travels to the heart, brain, or lungs
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Anticoagulant vs antiplatelet vs thrombolytic
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Anticoagulant prevents in venous, platelet in artery
Thrombolytic lyse the thrombus |
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Main ADE of anticoagulant, most serious effect and prototype
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bleeding, Heparin. Ordered in units
Serious: Platlets drop. Thrombocytopenia, platelet count drops below 1000 |
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How fast does heparin work
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IV - immediate, subQ starts in 20-30 min.
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Can Heparin be taken by mothers?
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Yes. Only lasts 4 hours and does not cross into milk or placenta.
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When is heparin used?
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Patients on bed rest for a while, post surgery, history, after GYN surgery and had birth control/estrogen before
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What is the PTT
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Partial Thrombolytic time. measure of how long clotting takes.
25 seconds before, up to 50 may be good. Above 50 may be a problem though -- bad side effects likely NORMAL TIME IS 12-13 SECONDS being changed to INR, 2.0-3.0 when on meds, high higher than 3.0, lower dose. |
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What is the antidote to heparin?
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Protamine sulfate. Short acting
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What are fragmin and lovanox?
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Prophylactic heparin like drug with low molecular weight in pre filled syringe with air bubble to push out med. DONT POP THIS AIR BUBBLE
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Warfarin coumadin. How does it work?
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Stops clotting factor in the liver. Stops synthesis of vitamin K.
Takes 3-5 days to be effective, so heparin and coumadin often are given together while waiting for the coumadin to kick in. régulante Vit K in diet! |
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Coumadin and provaxa?
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highest ADEs
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2 Antiplatelet drugs and how they work
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Aspirin (binds to platelet for life of drug). Inhibits function of prostoglandins. Thromboxin A2 inhibitor.
Plavix can also be used like this for people who can't take aspirin Nonsteroidals (only bind while in circulation -- short term) |
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How does aggrastat work?
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Makes platelets slippery so they can't stick together
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When are antithrombotic drugs contraindicated
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recent abdominal surgery or pregnancy
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Thrombolytic prototype AND antidote
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alteplase
used when patient is at risk for fatality/no blood is going through Reestablishes blood flow. Drip the drug in the artery right before the clot to clear it. can't be used in patient with active bleeding. TIME IS TISSUE. "Door of the ER to needle time" should be less than 30 min. Antidote = Amicar |
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What is the cholesterol and tryglyceride level norm?
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less than 200. More in men than women
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Which drugs increase lipids? What else?
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steroids and sympathomimetic adrenergic
smoking, body weight, low fiber |
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How does Mevacor work? Statin
Common and severe effects |
inhibits enzyme that forms cholesterol in the liver
Common: v/d cramps and constipation serious: hepatoxicty (check liver enzymes) and rhabdomyolysis (severe muscular pain and damage |
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When do you take a statin?
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In the evening, when most cholesterol is synthesized
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Colonization
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localized microorganisms without infecting a patient. Happens with MRSA.
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Bacteremia
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Blood infected with bacteria. Septic = infecting multiple organs -- kidneys, lungs etc.
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Latrogenic
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Acquired from surgery
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3 treatment for anaphylaxis from a drug
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preferably just antihistamine
steroid also for inflammation if needed |
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normal WBC range
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5-10k
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How do penicillins, cephalosporins and vancomyacins work? What category are these?
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Beta Lactam -- inhibit cell wall synthesis
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Penicillin prototype and use. Use in women?
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Pen G. Often used as a first line, prophylaxis. Pipercillin has broader spectrum. Can be used in pregnancy but not with birth control
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penicillinase/beta lactamase and adjusted bacteria
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bacteria break up beta lactam ring.
cloxacillin or nafcillin have protective structure unasyn has two components, stopping cleavage |
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What does benemid do?
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Keeps penicillin in system longer
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Cephalosporin prototype
women? how given? |
cefazolin Im or iv. 75% with pen allergy are allergic to cephs too
DO CROSS PLACENTA AND MILK but not bbb Can be given 30 min to 2h before surgery for proph. With milk or food if po |
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What do you always do before giving antibiotics? How is it usually given
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Check C and S report!
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How must vancomycin be delivered?
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Must have infection disease consult and be given very slowly (over up to 2h) to avoid red man syndrome rash. ICUs were using too frequently. tx very bad infections
VRE resistent. |
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3 antibiotics inhibiting protein synthesis
Why not given often? |
aminoglycosides (gentamyacin)
Macrolides tetracyclines second line because sequestered by tissues, greater toxicity chance |
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When is gentamicin used?
cross the bbb? placenta? toxicity? |
bactericidal, but very toxic. Only used for hosp pneumonia and utis from e coli. Good for sepsis because hangs in blood stream. Backup for tb
No bbb, yes placenta and otobarrier, so very ear toxic!!!! Also nephrotoxic. Can be used on dialysis but not for patients with weakened kidney and no dialysis Cholinesterase inhibiters to reverse higher dose once a day is better than small dose throughout the day careful with lasix |
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What happens if pens are used with gents?
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if mixed first, pen kills gent. If given two hours apart, enhances one another
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Normal BUN range
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5-11 or up to 20
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Erythromycin - metabolism, bbb, women and where absorbed
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matabolized in liver and inhibits cyp450
no bob and yes placenta PO absorbed in SI, give away from meal NO GRAPEFRUIT |
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TETRACYCLIN
bbb, women, sequestration, reduced absorption, toxic |
reduced with 2+ or 3+ ions (mg ca fe)
60-80 percent absorbed crosses bbb and bad for women/kids under 9. Causes brown teeth photo and nephrotoxic Don't give with antacid - disactivates |
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How do fluoroquinolones work?
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Inhibit nucleic acid synthesis. Absorbed in soft tissue
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When is fluoro not used?
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Affects joints, so not in kids and elderly or mama. tendon rupture can occur, so no working out!
aluminum, iron and zinc disactivate |
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How do sulfonamides work?
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Inhibit metabolic pathway (EG stop folate function)
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When are sulfonamides used? Who can't use it?
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Not systemically -- for burns and superficially, UTIs bc quick urinary excretion
NOT FOR WOMEN in last term of pregs or hypoglycemics |
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When is pyridium used?
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along with sulfos to help pain with UTIs. Changes urine color though, so don't be scared
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Stevens johnsons syndrom
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weepiness from skin and mucocytosis
most often in white men 10-30 and older eye lip mouth ulceration |
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C difficile. What brings it on? Symptoms?
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Superinfection
dehydration, water loss with blood and puss in poo and pee 10-15 times a day, no appetite vancomycin works, but stool injection is best c difficult must be cleaned with bleach specifically. contact isolation |
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Symptoms of resp disorders
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bronchoconstriction/spasm
inflammation mucosal edema Mucus production |
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What can be used to treat bronchodialators? 3 things, effects and order
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1) Adrenergic drugs (epinephrin, subq or albuterol, B2 selective and fewer heart effects). DO NOT USE IF PERSON HAS A TACKY HEART or make sure education is right
2) Anticholinergic - decrease mucus (DRYING) Atropine, second line, not good for soy allergy folks, not for acute treatment 3) Xanthines/ophyllines. Final line. Bronchodialator, also cns activation with breathing, anxiety, heart rate (pos ionotropic) not for people with ulcers or cardio issues |
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When is albuterol vs epi used?
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Epi - acute crisis, Albuterol - short acting and good for maintenance
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side effects of atropine
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Common: cough, constipation, dryness generally. anticholinergic
Serious -bronchospasm |
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How to know side effects of ophyllines or intention?
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O2 sat, cyanosis
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Early vs late signs of resp distress
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early: increased breathing and HR, confusion and restlessness, accessory muscles
late: cyanosis, lower BP and lower HR |
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3 anti inflammatory drugs, decreasing mucus as well
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1) corticosteroids, chronic use but trying to keep it short for kidneys, increase in acid, decreasing immune and increasing B2 receptor sensitivity
2) Mast cell stabilizers (intal) reducing histamine response, chronic use/prevention 3) Leukotriene inhibitors (Accolate) - not for acute attacks |
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When are corticosteroids contraindicated
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with any infection because weakening of immune system
not for people with ulcers can cause oral candidiasis in extreme, or just dry features |
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Bronchodialators or corticosteroids first?
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bronchodialators first
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Common and serious effects from accolate?
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headache, serious - hepatic failure
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What to check with resp assessment?
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allergies, cardiac MI arrhythmia history, resp status, BP and HR, NV insomnia
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What do antihistamines do?
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Bronchoconstriction
Cough increase capillary permeability increase mucus production Stimulation of sensory peripheral nerve endings Dilation of capillaries |
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Indications for antihistamine
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Allergic rhinitis
Anaphylaxis If shock, need epinephrine Drug allergies – decrease chance in advance Blood transfusion reaction – decrease chance of reaction Contact dermatitis NOT FOR PEOPLE WITH BPH OR GLAUCOMA OR CNS DEPRESSANT |
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NEOSYNEPHRINE what kind?
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topical, adrenergic, rebound effect
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what to do for productive vs non productive cough
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adrenergic (ephedrine), expectorant (guai, liquifies mucus), or mucolytics (overdose on tylenol too) vs antitussive (opiate or dextromethorphan)
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inhalant abuse causes
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stimulation then depressant
injury to all vital organs but especially lungs. Death from arrest and heart issues or occlusion of air |
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How much does the heart pump per min?
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5-6L per min
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SA vs AV node rate vs ventricles
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60-100 vs 40-60 vs 30-40
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Percent of blood plasma
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55
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percent of blog solid
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45
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normal WBC #
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5-10k
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Albumin
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exerts osmotic pressure to hold things intravascularly.
NaCl and glucose do this as well |
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Fibrinogen
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hemostasis/clotting
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gammoglobulin
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defense against infection
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Hematocrit and percentage
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percentage of RBCs
M 42-50 F 40-48 |
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Hemoglobin
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M13-18 F12-16
1:3 ratio hemoglobin:hematocrit |
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What does digoxin do?
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Increases contraction (inotropic) and output but decreases HR (neg chronotropic). Indirect diuretic
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How is digoxin dosed?
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Loaded. First dose is divided by 3 and given every 6-8 hours to get heart rate up ASAP
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Where is digoxin metabolized?
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in the Liver, 30-40percent. Rest unchanged
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What does digoxin need to work?
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Normal electrolytes.
K most important and must be 3.5-5. When too low, more at risk for toxicity. High Ca increases risk, higher than 10 Low Mg increases risk, lower than 1.3 |
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Normal K range
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3.5-5
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Normal Ca range
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8.5-10
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Indirect diuretic effect of digoxin
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increases blood flow generally, so kidney as well
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Tx and contraindications of digoxin
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for: CHF and arrhythmias. Sinus tach
not good for V tack/fib/block |
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ADEs of digoxin
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NVAnorex
CNS vision issues/halos CV bradychardia Serious: Vent fibrilation |
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PMI
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point of max impulse, listen for full 60 seconds in digoxin patients
left 5th intercostal space, at the point of intersection with the left midclavicular line Less than 60, hold the digoxin |
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nursing interventions for digoxin
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K+
Explain med regime Administer w/ meals or water UNLESS ON K+ SPARING DIURETIC!! SEE LATER Pt teaching √ radial pulse daily, hold if pulse < 60/min Do not skip a dose or double a dose Report ADEs |
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What causes arrhythmias
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Change in automaticity
Change in conductivity Or both Hypoxia Ischemia K levels – high or low |
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How do you treat sinus arrhythmias?
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BBlockers or digoxin
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What do you treat atrial arrhythmia
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Digoxin
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How is bradycardia treated?
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Atropine
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Class 1 NA channel blocker for arrhythmia
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Class IB: Prototype: lidocaine (Xylocaine). Sometimes causes bradycardia
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Class 2 Beta Blockers
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- Prototype: propranolol (Inderal)
ANTIARRYTHMIC USE, sometimes other beta blockers being used off label. |
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Class 3 K Blocker
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Prototype: amiodarone (Cardarone)
This has now replaced lidocaine as first line of choice for v tach and v fib. |
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Class 4 Ca blocker
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Slows depolarization, decreasing ventricular rate
Also for hypertension and angina, chest pain Adverse effect most common: Constipation - Prototype: verapamil (Calan) |
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How does the pain from o2 deficit manifest?
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Deficit in o2 supplied or increase in need can cause pain. Radiates up to jaw or down through left arm
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What causes angina
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↑ myocardial O2 demand
Exercise Stress, anxiety Cold weather Smoking ↓ O2 supply to myocardium Atherosclerosis Arteriosclerosis Diabetes due to vascular changes |
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3 classes of antianginal meds
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Nitrates
Beta Blockers (Inderol) Calcium Channel Blockers (slows beat Calan) all decrease o2 demand of heart or increase blood supply |
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Nitrate prototype and physio
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nitroglycerine (Nitrostat)
Dilates veins ↓preload Dilates coronary arteries ↑ myoc O2 flow Dilates arterioles ↓afterload Most common ADE – Hypotension and headaches Contraindication – no viagra/levitra!!! Bio Phospholipid Diesterase lowers BP further. don't use if BP is under 90 |
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What is lasix used for
LOOP |
Rapid, immed diuresis!!!
Works in the loop |
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What is diuril used for?
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NOT for immed diuresis -- daily
Careful with sulfa |
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K Sparing
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Aldactone
NOT used in renal disease/ Do NOT use K supplements |
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What is the osmotic diuretic
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Large molecules pulling fluid intravascularly, and kidneys excrete the fluids. Delivers extra fluid to kidneys – not acting directly on kidneys
Very specialized use. Only used in hospitals and for patients with intracranial pressure. Short term IV use only |