Pharm KC1

• Medication error prevention

  -medication reconciliation

  
  

  -be aware of sound alike and look alike meds
• trough level


  lowest level (serum concentration) which med is present in the body
• trough specimen


  collected right before next dose
• herbal therapies


  have pharmacologic effects; used to treat various conditions

  
  

  serious potential side effects; may interfere w/ prescribed meds
• med allergy


  may be unknown

  
  

  anaphylaxis: airway swelling, wheezing, tachy, hypotension = sign of developing shock
• trailing zero


  after a whole # may lead to overdosage
• serum elevation


  dose of med should be reduced (provider) or held
• liver


  primary site of med metabolism
• kidney


  excretion site for most meds
• Check


  patients eGFR or creatinine clearance
• enteric-coated meds


  can't be crushed
• serum digoxin level


  0.5 to 2.0 ng/mL

  
  

  *check levels for at risk of toxicity (AKI, CKD, low K+)
• heparin IV infusion


  treatment goal: keep aPTT b/w 60-80 secs
• Normal aPTT


  27-38 sec (NYU)
• IV heparin


  may cause HIT (heparin-induced thrombocytopenia)
• antiplatelet meds


  nearly all can cause thrombocytopenia
• aspirin


  bite and chew at once in acute MI

  
  

  *suppository also
• warfarin therapy


  for A fib

  
  

  maintain INR b/w 2-3
• How would you know the thrombolytic worked?

  1) know reason why you gave

  2) focus on what to assess
• critical levels of INR

  require fresh frozen plasma (FFP) transfusion;

  
  

  especially if pt needs surgery or actively bleeding
• half life of clopidogrel

  3 to 5 days, can last up to 7
• epistaxis


  could be a sign of blood thinner toxicity
• NSAID's


  can potentially increase risk of bleeding in pt taking anticoagulants
• while on warfarin


  periodic INR testing to evaluate response to treatment is required
• patient teaching


  vital for patients taking warfarin or any blood thinner
• statins


  can potentially cause rhabdomyolysis and myalgia
• Lithium


  should not be given w/ loop diuretics such as furosemide b/c they reduce lithium's renal clearance and add a high risk of lithium toxicity
• hypertension


  exacerbates heart failure due to increase afterload (vascular resistance)
• IV furosemide


  remains the gold standard in the treatment of acute pulmonary edema
• antidysrhythmics


  pro-arrhythmics; may cause hypotension and bradycardia
• Nurse should check


  serum potassium level before giving furosemide; as it can result in potassium loss due to diuresis
• procainamide


  and other antidysrhythmics are used to suppress ventricular tachycardia
• dry cough


  side effect of ACE inhibitors
• BB and surgery


  should not be skipped
• orthostatic hypotension


  antihypertensives can cause
• non cardioselective BB


  can cause brochospasm
• collaborate w/ provider


  when sudden changes in vitals related to antiHTN's and antiDR's
• diuretics can cause


  nephrotoxicity