Pharm Exam

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  1. Digoxin (Lanoxin)
    *High Alert Med*

    • Ther. Class:
    • antiarrhythmic, inotropics

    • Pharm. Class:
    • digitalis glycosides

    • Indications:
    • Heart failure, atrial fibrillation and atrial flutter (slows ventricular rate), paroxysmal atrial tachycardia

    • Action:
    • increases the force of myocardial contraction, prolongs refractory period of the AV node, decreases the conduction through the SA and AV nodes

    • Therapeutic Effects:
    • Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect)

    • Contraindications/Precautions:
    • Hypersensitivity, uncontrolled ventricular arrhythmias, AV block (in absence of pacemaker), known alcohol intolerance

    • Use Cautiously in:
    • Hypokalemia (greatly increase the risk of digoxin toxicity), hypercalcemia (increased risk of toxicity especially with mild hypokalemia), diuectice use (may caue electrolyte imbalance), hypothyroidism, MI,

    • Side Effects:
    • fatigue, headache, blurred vision (yellow or green vision), arrhythmias, bradycardia, ECG changes, AV block, SA block, thrombocytopenia, anorexia, N&V, diarrhea, electrolyte imbalances with acute digoxin toxicity

    • Drug-Food:
    • Concurrent ingestion of high fiber meals may cause decreased absorption. Administer digoxin 1 hour before or 2 hours after such a meal.

    • Assessment:
    • Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if pulse rate is <60 bpm in an adult, <70 bpm in a child or <90 bpm in an infant. Also notify health care professional promptly if any significant changes in rate, rhythm, or quality of pulse.

    • Toxicity and over dose:
    • Therapeutic serum digoxin levels range from 0.5-2 ng/mL. Serum levels may be drawn 6-8 hr after a dose is administered.
  2. Calculate IV Flow Rate
    • mL to be infused X tubing drop factor (gtts/mL)
    • _________________________________ = gtts/min
    • time to be infused over (in min)
  3. Carbamazepine (Tegretol)
    • Ther. Class:
    • anticonvulsants, mood stabilizer

    • Indications:
    • treatment of tonic-clonic, mixed, and complex-partial seizures, management of pain in trigeminal neuralgia or diabetic neuropathy.

    • Action:
    • Decreases synaptic transmission in the CNS by affecting sodium channels in neurons.

    • Therapeutic Effects:
    • Prevention of seizures, relief of pain trigeminal neuralia, and decreased mania

    • Contraindications/Precautions:
    • hypersensitivity, bone marrow suppression, concomitant use or use withthin 14 days of MAO inhibitors. May increase risk of suicidal thoughts or behaviors.

    • Side Effects:
    • Suicidal thoughts, ataxia, drowsiness, fatigue, psychosis, sedation, vertigo, blurred vission, corneal opacities, nystagmus, pneumonitis, CHF, hypertension, syncope, hypotention, hepatits, pancreatitis, weight gain, urinary retention, Stevens-Johnson syndrom, Toxic Epidermal Necrolysis, uticaria, photosensitivity, rashes, SIADH, agranulocytosis, aplastic anemia, thrombocytopenia, eosinophilia, leuopenia, increased liver enzymes, lymphadenopathy, hepatic failure (rare)

    • Drug-Drug Interactions:
    • May increase metabolism and therefore decrease levels/effectiveness of numerous drugs. Concurrent use (within 2 weeks) of MAOIs may result in hyperpyrexia, hypertension, seizures and death

    • Drug-Food Interactions:
    • Grapefruit juice increased serum levels and oral bioavailability by 40% and therefore may increase effects

    • Assessment:
    • Monitor closely for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.

    Monitor for changes in skin condition in early therapy. Stevens-Johnson syndrome and toxic epidermal necrolysis are significantly more common in patients with a particular human leuocyte antigen (HLA) alle, HLA-B*152 (occurs almost exclusively in patients with Asian ancestry). Screen patients of Asian ancestory before starting treatment.
  4. Iorazepam (Ativan)
    • Ther. class:
    • analgesic adjuncts, antianxiety agents, sedative/hypnotic

    • Pharm. Class:
    • benzodiazepines

    • Indications:
    • Anxiety disorder (oral), preoperative sedation (injection), decreased preoperative anxiety and provides amnesia. Unlabled use as antiemetic prior to chemotherapy

    • Action:
    • Depressess the CNS, probably by potentiating GABA, an inhibitory neurotransmitter

    • Therapeutic Effects:
    • sedation, decreased anxiety, decreased seizues
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Pharm Exam
topics for pharmacology exam
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