Adv Pharm Test 3 2nd Semester

• Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli.
• *Huge effect on cardiac muscle

• Diuretics (Lasix)
• Digitalis (Digoxin competes with K+ in Na/K+ ATP pump)
• Water intoxication
• Corticosteroids
• Diarrhea/Laxative abuse
• Vomiting

• Encourage potassium rich foods
• K+ replacement (IV or PO)
• Monitor lab values
• D/C potassium-wasting diuretics
• Treat underlying cause

An increase in K+ causes increased excitability of cells

• Increase in K+ intake
• Renal failure *most common
• K+ sparing diuretics

• Eliminate K+ administration
• Increase K+ excretion (Lasix, Kayexalate)
• Infuse glucose and insulin
• Cardiac moniroting

• Excessive diaphoresis
• Wound drainage
• NPO
• CHF
• Low salt diet
• Renal disease
• Diuretics

• FVD: IV therapy to restore both fluid and Na
• FVE: Administer osmotic diuretic (Mannitol) to excrete water rather than sodium
• Increase oral sodium intake and restrict oral fluid intake

• Renal failure
• Corticosteroids
• Increase in oral Na intake
• Na containing IV fluids
• Decreased urine output with increased urine concentration
• Diarrhea
• Dehydration
• Fever

• FVD: 0.45% NS. If caused by both Na and fluid loss, will administer NaCl. If inadequate renal excretion of sodium, will administer diuretics
• Mild: Ensure water intake

• Decreased oral intake
• Lactose intolerance
• Decreased vitamin D intake
• End stage renal disease
• Diarrhea
• Acute pancreatitis
• Hyperphosphatemia
• Immobility
• Removal or destruction of parathyroid gland

Hypocalcemia

Hypocalcemia

• Calcium supplements
• Vitamin D (helps Ca+ absorption)
• High calcium diet
• Seizure precautions

• Excessive Ca+ intake
• Excessive vitamin D intake
• Renal failure
• Hyperparathyroidism
• Malignancy
• Hyperthyroidism

• Eliminate calcium administration
• Drug therapy
• Isotonic NaCl
• Diuretics
• Calcium reabsorption inhibitors (Phosphorus)
• Cardiac monitoring

• 1. HTN
• 2. CHF
• 3. Coronary artery disease
• 4. MI
• 5. Cardiac arrhythmia

• Diuretics
• Sympatholytic drugs
• Vasodilator drugs
• Calcium channel blockers
• Angiotensin (ACE) inhibitors

• Contractile function is reduced
• CO unable to maintain BP
• Blood accumulates in heart (dilatation), lungs (pulmonary congestion), abdomen (ascites), and lower extremities (peripheral edema)
• Patient is weak and has difficulty breathing

• Increase sodium excretion and relax arterial blood vessels (vasodilation)
• Elimination of excess fluid allows the heart to function more efficiently

• Loop diuretics
• *Lasix

Excessive loss of fluid, sodium and potassium

By decreasing heart rate and increasing cardiac output

Block the influx of calcium into the heart and arterial blood vessels to vasodilate and lower blood pressure, cardiac work, and oxygen demand

Hypertension, angina pectoris, cardiac arrhythmias

• Verapamil and diltiazem act on both the heart and blood vessels to lower BP
• Nifedipine and other calcium channel blockers lower BP by vasodilatoin

• Excessive vasodilation
• Hypotension
• Cutaneous flushing
• Headache

• Block angiotensin receptors on blood vessels and adrenal cortex
• These drugs produce vasodilation and decrease the activity of aldosterone

• Stimulate the formation of nitric oxide, a potent vasodilator of blood vessels
• Vasodilation of veins and arteries decreases cardiac work and cardiac oxygen consumption to relieve the pain of MI

• Vasomotor flushing, dizziness, and headache are common
• Sudden drop in BP, fainting, tachycardia
• *Patients should be seated when taking these drugs sublingually

• Acute attacks of angina
• Prevent anginal attacks

Nitroglycerin

• Sympathetic beta receptor stimulation of the heart increases heart rate, force of contraction, and oxygen consumption
• Blockade of beta receptors decreases cardiac work and cardiac oxygen demand

Digoxin

• Increase the contractile force of myocardial contractions
• Decrease heart rate and atrioventricular conduction

Increase drug toxicity and can cause cardiac arrhythmias

Decrease the action of Dig

Increase the actions and toxicity

• Dizziness, nausea, vomiting
• Visual disturbances "halo effect" around lights signal overdose
• Bradycardia, ectopic beats, and a variety of other cardiac arrhythmias can occur and can be life threatening

Licocaine

Block the Na+ channel

Propranolol

Primarily blocks cardiac beta receptors to slow heart rate, AV conduction, and prolong the refractory period

Amiodarone

Interferes by blocking the potassium channel

Verapamil and diltiazem