Pharm

• PT/INR


  Goes with LMWH and coumadin. Therapeutic level INR is 2.0-3.5 and PT is 11-12.5 seconds
• PTT


  Goes with heparin, therapeutic level is 25-35 seconds
• Anticoagulants


  • Prevent the formation of clots by inhibiting certain clotting factors
• Common prophylactic anticoagulants


  • Enoxaparin (lovenox, LMWH)
  • Dalteparin (Fragmin, LMWH)
  • Coumadin (Warfarin)
• Antidote for warfarin


  Vitamin K
• Antidote for heparin


  Protamine sulfate (1mg per 100 units)
• Dietary and CAM/herbal restrictions with anticoagulants

  • Garlic, ginkgo, ginseng
  • Foods high in vitamin K if taking coumadin (tomatoes, spinach, kale)
• Client teaching with anticoagulants (heparin, LMWH, warfarin)

  • Report excessive bleeding
  • Signs and symptoms of shock
  • Will bruise and bleed more easily
  • Use soft toothbrush
  • No contact sports
  • Implement fall risk prevention
  • Electric razor
  • Avoid foods high in vitamin K
  • Regular lab testing
  • No IM injections
  • Wear a medical alert bracelet
  • Consult Dr. Before taking other meds or OTC products
  • Inject into Sub Q tissue, 2" away from belly button and change injection sites
• Coumadin


  Inhibits synthesis of Vitamin K in the GI tract which inhibits production of several clotting factors
• Coumadin uses


  • A Fib
  • Chronic PE's and DVT's
  • Mechanical heart valves
• Heparin


  Used intravenously to prevent further clot formation in patients with MI, DVT, or PE. Keeps the existing clot from getting worse while the body breaks down the existing clot naturally
• LMWH


  Low molecular weight heparin, more predictable, used for DVT prophylaxis and as a bridge to Coumadin therapy
• Client teaching for high cholesterol

  • Take medications at night since cholesterol is synthesized while we sleep
  • Report any adverse reactions
  • Avoid alcohol (statins)
  • Eat a low sodium diet
  • Stay hydrated
  • Limit high fat foods
• Lifestyle modifications for high cholesterol

  • Diet
  • Exercise
  • Limit sodium (1500 mg per day)
  • Limit high fat foods
• Reportable conditions for high cholesterol

  • Statins: Abnormal muscle cramps or aches, Jaundice, large abdomen
• Cholestyramine


  Bile acid Sequestrants, prevents resorption of bile acids from the small intestine which is necessary for the absorption of cholesterol
• Administration of cholestyramine


  Powder must be mixed, never taken dry, can't take other meds for 4 hours after Questran (effects other meds absorption)
• Adverse effects of cholestyramine

  • Constipation
  • Heartburn
  • Nausea
  • Belching
  • Bloating
• Statins


  Keeps the liver from synthesizing cholesterol (can cause liver damage: Jaundice, large abdomen, elevated liver enzymes), blocks the enzyme HMG-CoA which is necessary for the synthesis of cholesterol by the liver (Can affect the muscles, cramps or aches that are out of the ordinary)
• Adverse reactions of statins

  • Myopathy possibly leading to rhabdomyolysis
  • Elevations in liver enzymes or liver disease
  • Mild GI disturbances
  • Rash
  • Headache
• Fenofibrate


  Used together with a proper diet, to treat high LDL cholesterol, high total cholesterol, and high triglyceride levels with subsequent decreased risk of pancreatitis, inhibits triglyceride synthesis
• Fenofibrate brand names


  • Triglide
  • Fibricor
  • Lipofen
  • Trilipix
  • Fenoglide
  • Antara
• Adverse reactions of fenofibrate

  • Hypersensitivity
  • DVT
  • Hepatotoxicity
• Dietary and CAM/herbal restrictions for high cholesterol

  • Grapefruit
  • Milk thistle
  • Hawthorn
  • Low sodium diet (1500 mg per day)
  • Low fat diet
• Lab monitoring with medications to treat high cholesterol

  • HDL
  • LDL
  • Total cholesterol
  • ALT (liver)
  • AST (liver)
  • Serum bilirubin (liver)
  • Total protein and albumin (liver)
• Client teaching and lifestyle modifications with HTN meds and diuretics

  • Exercise (mild to moderate exercise) 3-5 times per week
  • Diet changes: Fruits, vegetables, low sodium and cholesterol diet
  • Stop smoking, limit alcohol
  • Promote safety (orthostatic hypotension)
• ACEs


  Normally used to treat HTN, by opening up blood vessels decreasing resistance, can be used with heart failure to decrease resistance for the heart to pump against, can protect the kidneys by decreasing resistance for blood to flow to the kidneys (used with people who have type 2 diabetes)
• Actions of ACEs


  Decrease peripheral vascular resistance without increasing cardiac output, increasing cardiac rate, or increasing cardiac contractility
• Side effects of ACEs

  • Dizziness
  • Orthostatic hypotension (teach safety)
  • GI distress
  • Cough (stop medication if this occurs, will be given ARBs (end in tan))
  • Headache
  • Hyperkalemia
• ACE inhibitors


  • Captopril
  • Enalapril
  • Benazepril
• Loop diuretics


  Potassium wasting diuretics, help treat CHF, HTN, and fluid retention, used second after thiazide diuretics, lower BP and push excess fluid out
• Side effects of loop diuretics

  • Orthostatic Hypotension (Maintain Safety)
  • Hypokalemia (eat fruits and vegetables high in K+)
• Nursing assessment for loop diuretics

  • Monitor kidney function (GFR, BUN, creatinine)
  • Monitor electrolytes (especially K+)
  • Monitor Vital signs
  • Take meds in the morning to prevent nocturia-induced insomnia
• Loop diuretics


  • Furosemide
  • Bumetanide
  • Torsemide
• Aldactone


  K+ sparing diuretic, used to treat heart failure, HTN, and hypokalemia, lower BP and push excess fluid out
• Nursing assessment for Aldactone

  • Monitor kidney function (GFR, BUN, creatinine)
  • Monitor electrolytes (especially K+)
  • Monitor Vital signs
  • Take meds in the morning to prevent nocturia-induced insomnia
• Side effects of Aldactone

  • Orthostatic Hypotension (maintain safety)
  • Hyperkalemia (avoid foods high in K+)
  • Hyponatremia (keeps body from absorbing sodium)
• Digoxin


  Manages heart rate, heart failure, and dysrhythmias, controls cardiac output and ventricular response in A Fib, has a narrow therapeutic index and high risk to patient, requires close monitoring for toxicity
• Side effects of digoxin

  • Fatigue
  • Dysrhythmia
  • Visual disturbances
  • Anorexia
  • Hypokalemia
• Nursing assessment for digoxin

  • Full minute apical pulse must be >60
  • Monitor potassium levels
  • Signs and symptoms of toxicity: Bradycardia, Green halos in vision, Hypokalemia