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Pharm Facts to Know

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Administration alerts for ACE inhibitors

1st dose phenomenon - Treat hypotension with NS Monitor for hypokalemia in diabetes or Renal impairment Do not take if Pregnant Give foods/other meds >2 hours prior or 4 hours after Monitor GI effects, obtain GI history Give over a period of 5 minutes Don't mix with other meds Watch for bleeding with patients on anticoagulants Check for abdominal pain When using with Warfarin, monitor PT/INR Give with food Avoid parenteral injury - leads to bleeding risk Watch for reperfusion dysrhythmias Give within 20min - 12hr of onset of MI Give within 20min - 3hr of onset for CVA Quick and efficient Direct to site of action Onset almost immediate Decreased Side effects BLEEDING - monitor CBC, lumbar and abdominal pain, Guiac tests, Potassium rich food intake Soy or Peanut allergy <12 yo Elderly Other anticholinergics bradycardia Heart block Hypotension Prinzmetals Angina Decompensated CHF Severe Asthma COPD Digoxin, Oral contraceptives, Insulin, Antihypertensives ETOH Hypersensitivity Pregnant or breastfeeding Status asthmaticus / acute exacerbations

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Definition of Asthma

a chronic pulmonary disease with inflammatory and bronchospasm components. Difficult to measure precise dose 10%-15% of drug is placed Instructions are complicated for some Side effects if improperly used Causes hypokalema and dysrhythmias Grapefruit reduces metabolism of CCBs, causing drug buildup Transports cholesterol away from tissues and back to liver, where it is broken down and united with bile to be excreted Transports cholesterol form liver to tissues and organs to build plasma membranes or make steroids. Excess lines the blood vessels. Primary carrier of triglycerides in blood, is then reduced to LDL Patient rinses mouth out after administration Not for acute attack Assess Vitals (RR, HR, O2, Cardiac Rhythm, Lung sounds, Resp effort, skin color) Not for breastfeeding women Use caution with elderly & children Check IV tubing patency Monitor for Necrosis Discontinue slowly Monitor LFTs, Creatinine, GI upset Not for pregnant patients No grapefruit No CCBs Can cause Rhabdymyolysis If BP severely elevated, stop medication and call MD If therapeutic effect obtained (good BP), discontinue slowly, or it can cause rebound hypotension Monitor BP, VS, Flow rate & site of inj. for extravasation

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Disadvantages of Inhalation Route

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Administration alerts for Bile-Acid Resins

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Administration alerts for cardiac glycosides Administration alerts for Fibrinic Acid Agents

Drug-Drug interaction between Diuretics & Digoxin Food-Drug interactions for CCBs Function & role of HDL

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Administration alerts for thrombolytics

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Function & role of LDL

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Function & role of VLDL Key assessment of proper use of Glucocorticoids Key assessment/Monitoring for Methylxanthines

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Advantages of Inhalation Route

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Assessment/monitoring for anticoagulants

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CIs for Anticholinergics

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Key assessments/monitoring for Inotropes Key assessments/monitoring for Statins

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CIs for BBs used for HF

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Key assessments/monitoring for vasoconstrictors

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CIs for Glucocorticoids

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Know the link between LDL levels & Cardiovascular Disease Long-Term (CHRONIC) Asthma Therapy Long-Term asthma goals

LDL transports cholesterol from liver to tissues & organs, and excess is stored in lining of blood vessels, causing atherosclerosis Beta Agonists (salmeterol) Leukotriene Modifiers (zafirlukast, Accolate) Glucocorticoids (beclomethasone) Control symptoms, prevent daily exacerbation, recognize & manage triggering factors that exacerbate asthma, control nocturnal symptoms, prevent exercise-induced bronchospasms, reduce morbidity & mortality. Men 5 Women 4.5 LDL <100 HDL >40 Do not stop abruptly Take one tab under tongue every 5 minutes up to 3 tabs until pain is gone. Do not take alcohol with this drug If using a patch, make sure nobody touches it Anticholinergics (ipratropium, Atrovent) Recognize decline in peak expiratory flow (PEF) and/or change in diurnal pattern of PEF, aggressive treatment of asthma flare, return patient to previous level of functioning

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Optimal LDL/HDL ratio for men & women Optimal levels of LDL & HDL Patient ED for minimizing adverse effects of BBs Patient ED for selfadministration of Nitroglycerin Short- Term (ACUTE) Asthma Therapy Short-Term asthma goals

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