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70 Cards in this Set
- Front
- Back
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What is the definition of pharmaceutical care?
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Pharmaceutical care is the patient centered practice in which the practitioner assumes responsibility for a patient's drug-related needs and is held accountable for this commmitment.
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List the 4 outcomes of pharmaceutical care
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1. Cure of a disease
2. Eliminate or reduce symptoms 3. Arresting or slowing disease 4. Preventing a disease of symptomatology |
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What are the 4 patient drug related needs?
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1. Is the medication appropritate?
2. Is it effective? 3. Is it safe? 4. Is the patient compliant with their medications? |
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What is essential for Patient Assessment?
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1. Understad your patients
2. Assess the drug realted needs (saftey, efficacy, appropriateness, compliance) 3. Identify drug therapy problems |
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What are the drug related problems?
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1.Unnecessary drug therapy (drug without indication)
2.Needs additional therapy (indication without drug) 3.Ineffective drug therapy (wrong drug) 4.Dosage too low (underdose) 5.Dosage too high (overdose) 6. Adverse drug reactions/drug interactions 7. Non-compliance/adherance 8. Inappropriate laboratory follow up |
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What are the factors associated with drug realted problems (DRP)?
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-greater than 3 concurrent disease states
-medication regimen changes greater than 4 times per year -more than 5 medications in regimen -greater than 12 medication doses per day -history of non-compliance -presence of drugs that require thereputic monitoring -diabetes |
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How would you state a DRP?
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1. State the patient's name
2. Is it actual or potential undesirable sign or symptom? 3. State the sign, symptom or disease that is undesirable 4. "Secondary to" 5. Potential drug related cause |
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What are the standards of Patient Care?
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1. Collection of patient specific data
2. Assessment of drug-related needs 3. Identify drug-related problems 4. Devlop the goals of therapy 5. State inteventions 6. Schedule follow-up evaluations (follow up with the patient) |
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Intracellular components?
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potassium
phosphate magnesium |
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Extracellular components?
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sodium
chloride bicarbonate |
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Normal sodium range?
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135 - 147 mEq/L
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Normal chloride range?
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97 - 106 mEq/L
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Normal BUN?
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7 - 20 mg/dL
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Normal potassium?
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3.5 - 4.8 mEq/L
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Normal carbon dioxide?
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22 - 32 mEq/L
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Normal glucose?
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70 - 110 mg/dL
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Hyponatremia
causes, presentation, significance and management? |
Causes
-water retention with normal sodium stores -water retention with sodium depletion Presentation -neurologic = altered metal status, cognitive impairment, +/- of seizures -hypovolume related = dry mucuos membranes, tachycardia, orthostatic hypotenstion -hypervolume related = rales, S3 gallop, peripheral edema -muscle weakness and cramping Significance -can lead to neurolgic problems, seizures, respiratory arrest, death Management -mild to moderate = loop diuretic to reduce Na in urine, water restriction -severe = hypertonic saline infusion along with a loop diuretic |
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Hypernatremia
causes, presentation, significance and management? |
Causes
-Loss of water (vomiting or diarrhea) -Infusion of a hypernatremic solution Presentation -Cognitive dysfucntion = lethargy, confusion, abnormal speech -Dehydration = orthostatic hypotension, tachycardia, dry armpits -Other = seizures Signifacance -CNS problems Managment -infusion with hypotonic dextrose or saline along with a diuretic to remove excess sodium |
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Hypolkalemia
causes, presentation, significance, management? |
Causes
-transcellular shifts, increased reanal loss, loop diuretics, extrarenal losses, trauma Presentaion -fatigue, muscle weakness, arrythmias Significance -death Treatment -potassium supplementation |
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Hyperkalemia
causes, presentation, significance,management? |
Causes
-acidosis, insulin deficency, renal failure, intracellular shift of K in to WBC Presentation -muscle weakness, paralysis, abdominal distention, diarrhea -possibe EKG changes Signifcance -bradycardia with possible v.fib and or cardica arrest if untreated Managment -aldosterone, chelators |
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Lactate Dehydrogenase
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Liver damage = see release of isozyme 4 and 5
Heart damage = see release of isozyme 1 and 2 |
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Creatinine Kinase
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Heart damage = see increase of CK-MB at 4-8 hours after a heart attack; it will peak at 12-24 hours and levels decline after 3 days
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Troponin
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Heart damage = I form is specific to the myocardium; increases will be see with in 2-4 hours and the remain elevated for 10-14 days
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Aspartate Aminotransferase
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Used to evaluate myocardial injury and to assess the prognosis of liver disease
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Alanine Aminotransferase
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liver specific
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Alkaline Phosphatase
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elevation may indicate billiary obstruction, cholestatic janudice or bone turnover, bone growth, pregnancy
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Hematocrit
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% of RBC in realtion to total volume
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Hemoglobin
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hemoglobin is related to the # of RBC
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Reticulocyte count
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show if new RBC are being made
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erythrocyte count
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increase in this will show inflammation
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aPTT
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acitvated prothromboplastin time
used to monitor unfractionated heparin |
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PT
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prothrombin time
used to monitor warfarin |
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INR
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international normalized ratio
used to monitor warfarin |
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Food triggers
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1. vitamin K
2. heavy metals/ minerals 3. grapefruit juice 4. colas 5. tyramine |
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Medication triggers
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1. warfarin
2. levothyroxine 3. digoxin 4. B blockers 5. CC blockers 6. bisphosphonates 7. theophylline 8. lithium 9. MAOI 10. P450 drugs |
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Lipitor (atorvastatin)
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avoid grapefruit juice
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Synthroid; Levothroid; Levoxyl (levothyroxine)
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do not take with food; avoid with minerals
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zithromax (azithromycin)
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take with food; increase tolerability with food
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Norvasc (amlodipine)
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take with food, avoid grapefruit juice
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zoloft (sertraline)
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avoid grapefruit juice
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glucophage (metformin)
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can take with food
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motrin (ibuprofen)
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can take with food
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ambien (zolpidem tartrate)
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do not take with food; food reduces rate and extent of abs
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deltasone,orasone (prednisone)
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can take with food
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celebrex (celecoxib)
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can take with food
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fosamax (alendronate)
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do not take with food; only take w/ water. At least 30 mins before food (ideal is 2 hours)
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premarin (conjugated estrogens)
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grapefruit juice increases abs
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allegra (fexofenadine)
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grapfruit juice decreases abs
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plavix (clopidogrel)
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can take with food
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K-Dur, K-Tab (potassium chloride)
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can take with food
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Coumanin (warfarin)
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keep vitamin K constant
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augmentin (amoxicillin/clavulanate)
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can take with food
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levaquin (levofloxacin)
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can take with food; separate minerals 2hrs pre or 6 hrs post
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Calan; Covera (verapamil)
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can take with food; food dec. diff btw peaks and troughs; grapefruit juice inc. bioavailability
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Cipro (ciprofloxacin)
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can give with food; separate minerals 2hrs pre or 6 hrs post
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Ery-Tab (erythromycin)
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only take enteric coated with food
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Crestor (rosuvastatin)
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separate minerals 2hrs pre or 6 hrs post
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Luride (fluoride)
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separate minerals 2hrs pre or 6 hrs post
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Pharmacokinetic inteaction
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disposition (ADME) of object drug in the body is effected by precipitant drug
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Pharmacodynamic interaction
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pharmacologic activity of object drug is effected by precipitant drug
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Drug related factors for the devlopment of DI
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1. narrow thereputic index
2. high potency 3. high protien binding 4. extensivly metabolized by P450 |
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Patient realted factors for the devlopment of DI
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1. age (very young and very old)
2. number of concomitant meds 3. comorbidities 4. genetics |
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How to define and detemine a DI
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1. detemine PK and PD parameters
2. evaluate potential interactions in humans 3. look at post marketing data |
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Function of CYP450 enzyme system
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metabolize drugs, foregin substances and synthesize endogenous steroids
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Common P450s for metabolizing drugs in humans
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1A2, 2C9, 2C19, 2D6, 2E1, 3A4
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Inhibition of P450
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precipitant drug competes with object drug for metabolism (competitive or non competitive)
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Induction of P450
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precipitnat drug stimulates the production of an enzyme that metabolizes the object drug
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Inducers
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phenobarbitol
phenytoin carbamazepine rifampin smoking |
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Inhibitors
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azole antifungals
macrolide antibiotics amiodarone cimetidine ritonavir |
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Top offensive agents/classes
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warfarin
fluoroquinolone/tetrcycline antibiotics theophylline cyclosporine digoxin |
