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70 Cards in this Set

  • Front
  • Back
What is the definition of pharmaceutical care?
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.
List the 4 outcomes of pharmaceutical care
1. Cure of a disease
2. Eliminate or reduce symptoms
3. Arresting or slowing disease
4. Preventing a disease of symptomatology
What are the 4 patient drug related needs?
1. Is the medication appropritate?
2. Is it effective?
3. Is it safe?
4. Is the patient compliant with their medications?
What is essential for Patient Assessment?
1. Understad your patients
2. Assess the drug realted needs (saftey, efficacy, appropriateness, compliance)
3. Identify drug therapy problems
What are the drug related problems?
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
What are the factors associated with drug realted problems (DRP)?
-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
How would you state a DRP?
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
What are the standards of Patient Care?
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)
Intracellular components?
Extracellular components?
Normal sodium range?
135 - 147 mEq/L
Normal chloride range?
97 - 106 mEq/L
Normal BUN?
7 - 20 mg/dL
Normal potassium?
3.5 - 4.8 mEq/L
Normal carbon dioxide?
22 - 32 mEq/L
Normal glucose?
70 - 110 mg/dL
causes, presentation, significance and management?
-water retention with normal sodium stores
-water retention with sodium depletion

-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

-can lead to neurolgic problems, seizures, respiratory arrest, death

-mild to moderate = loop diuretic to reduce Na in urine, water restriction
-severe = hypertonic saline infusion along with a loop diuretic
causes, presentation, significance and management?
-Loss of water (vomiting or diarrhea)
-Infusion of a hypernatremic solution

-Cognitive dysfucntion = lethargy, confusion, abnormal speech
-Dehydration = orthostatic hypotension, tachycardia, dry armpits
-Other = seizures

-CNS problems

-infusion with hypotonic dextrose or saline along with a diuretic to remove excess sodium
causes, presentation, significance, management?
-transcellular shifts, increased reanal loss, loop diuretics, extrarenal losses, trauma

-fatigue, muscle weakness, arrythmias


-potassium supplementation
causes, presentation, significance,management?
-acidosis, insulin deficency, renal failure, intracellular shift of K in to WBC

-muscle weakness, paralysis, abdominal distention, diarrhea
-possibe EKG changes

-bradycardia with possible v.fib and or cardica arrest if untreated

-aldosterone, chelators
Lactate Dehydrogenase
Liver damage = see release of isozyme 4 and 5

Heart damage = see release of isozyme 1 and 2
Creatinine Kinase
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
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
Aspartate Aminotransferase
Used to evaluate myocardial injury and to assess the prognosis of liver disease
Alanine Aminotransferase
liver specific
Alkaline Phosphatase
elevation may indicate billiary obstruction, cholestatic janudice or bone turnover, bone growth, pregnancy
% of RBC in realtion to total volume
hemoglobin is related to the # of RBC
Reticulocyte count
show if new RBC are being made
erythrocyte count
increase in this will show inflammation
acitvated prothromboplastin time
used to monitor unfractionated heparin
prothrombin time
used to monitor warfarin
international normalized ratio
used to monitor warfarin
Food triggers
1. vitamin K
2. heavy metals/ minerals
3. grapefruit juice
4. colas
5. tyramine
Medication triggers
1. warfarin
2. levothyroxine
3. digoxin
4. B blockers
5. CC blockers
6. bisphosphonates
7. theophylline
8. lithium
10. P450 drugs
Lipitor (atorvastatin)
avoid grapefruit juice
Synthroid; Levothroid; Levoxyl (levothyroxine)
do not take with food; avoid with minerals
zithromax (azithromycin)
take with food; increase tolerability with food
Norvasc (amlodipine)
take with food, avoid grapefruit juice
zoloft (sertraline)
avoid grapefruit juice
glucophage (metformin)
can take with food
motrin (ibuprofen)
can take with food
ambien (zolpidem tartrate)
do not take with food; food reduces rate and extent of abs
deltasone,orasone (prednisone)
can take with food
celebrex (celecoxib)
can take with food
fosamax (alendronate)
do not take with food; only take w/ water. At least 30 mins before food (ideal is 2 hours)
premarin (conjugated estrogens)
grapefruit juice increases abs
allegra (fexofenadine)
grapfruit juice decreases abs
plavix (clopidogrel)
can take with food
K-Dur, K-Tab (potassium chloride)
can take with food
Coumanin (warfarin)
keep vitamin K constant
augmentin (amoxicillin/clavulanate)
can take with food
levaquin (levofloxacin)
can take with food; separate minerals 2hrs pre or 6 hrs post
Calan; Covera (verapamil)
can take with food; food dec. diff btw peaks and troughs; grapefruit juice inc. bioavailability
Cipro (ciprofloxacin)
can give with food; separate minerals 2hrs pre or 6 hrs post
Ery-Tab (erythromycin)
only take enteric coated with food
Crestor (rosuvastatin)
separate minerals 2hrs pre or 6 hrs post
Luride (fluoride)
separate minerals 2hrs pre or 6 hrs post
Pharmacokinetic inteaction
disposition (ADME) of object drug in the body is effected by precipitant drug
Pharmacodynamic interaction
pharmacologic activity of object drug is effected by precipitant drug
Drug related factors for the devlopment of DI
1. narrow thereputic index
2. high potency
3. high protien binding
4. extensivly metabolized by P450
Patient realted factors for the devlopment of DI
1. age (very young and very old)
2. number of concomitant meds
3. comorbidities
4. genetics
How to define and detemine a DI
1. detemine PK and PD parameters
2. evaluate potential interactions in humans
3. look at post marketing data
Function of CYP450 enzyme system
metabolize drugs, foregin substances and synthesize endogenous steroids
Common P450s for metabolizing drugs in humans
1A2, 2C9, 2C19, 2D6, 2E1, 3A4
Inhibition of P450
precipitant drug competes with object drug for metabolism (competitive or non competitive)
Induction of P450
precipitnat drug stimulates the production of an enzyme that metabolizes the object drug
azole antifungals
macrolide antibiotics
Top offensive agents/classes
fluoroquinolone/tetrcycline antibiotics