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105 Cards in this Set
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ferrous gluconate
1. % elemental iron 2. with/without food 3. Form 4. DDI |
1. 12%
2. empty stomach (1 hour ac) 3. tablets only 4. most decrease absorption; vit C increases absorption |
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ferrous gluconate
1. class 2. ADE 3. antacids |
1. oral iron supplement
2. dyspepsia, DVCD, dark stools 3. 1 hour before, 4 hours after antacids. |
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ferrous sulfate
1. class 2. % elemental iron 3. forms |
1. oral iron supplement
2. 20% 3. tablets, drops, elixer, syrup:suspension |
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ferrous fumerate
1. class 2. % elemental iron 3. forms |
1. oral iron supplement
2. 33% 3. tablets, drops, or suspension. |
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name oral iron supplements from most to least elemental iron
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1. ferrous fumerate
2. ferrous sulfate 3. ferrous gluconate |
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FSG-359
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F= fumerate
S= Sulfate G= Gluconate take mg and divide by the corresponding number to get percentage of elemental iron |
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Parenteral iron indications
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severe iron deficiency anemia
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which IV iron supplement has the most elemental, iron?
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ferrlecit
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Which IV iron supplement has the least elemental iron?
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Sucrose
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Name 3 IV iron supplements
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1. Ferrlecit
2. Dextran 3. Sucrose |
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indications for Ferrlecit
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chronic hemodialysis and EPO
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ADE of ferrlecit
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cramps
NV flushing hypotension rash |
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indications for IV Dextran
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oral iron supplementation not possible or ineffecient.
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BBW of Dextran
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give test dose- many anaphylaxis reactions
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ADE of Iron Dextran
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injection site pain & discoloration
hypotension fever chills |
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Iron Sucrose- indications
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chronic hemodialysis and EPO
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Iron Sucrose BBW
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anaphylactic reaction: give test dose first
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ADE of iron sucrose
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leg cramps
hypotension |
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how is dosing decisions made for parenteral iron supplementation?
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weight-based
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in comparison to oral iron supplements, what SE do IV iron supplements have more frequently?
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hypotension
cramps |
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What do you give for a vit B12 deficiency
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cyanocobalamin
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what do you give to treat pernicious anemia
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cyanocobalamin
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If a patient has B12 deficiency and no neurological symptoms: tx =
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OTC B12
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if a patient has B12 deficiency and neurological symptoms (memory & psychosis)
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subQ or IM injection B12
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what is important to do regarding the administration of B12 injections?
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titrate up: 1 per week, then 1 per month, then every month (ultimately)
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ADE of cyanocobalamin
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headache
nausea/vomiting hypok |
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monitor k levels for B12 patients for how long?
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1-2 weeks post initiation of B12 injections, then 1-2 times per year
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what ways can B12 injections be administered?
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1. subQ
2. IM |
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What must you remember to prescribe when writing an Rx for cyanocobalamin?
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needle: gauge and length
IM: long SubQ: short |
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If altering diet to correct mild B12 deficiency, which patients should not add clams, oyster, and tuna to their diet to improve B12 levels?
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someone with Gout
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for iron-deficiency anemia and oral iron supplementation, peds patients require what form?
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drops
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Normal folate-deficiency patients have what dose?
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1 mg every day
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folate-deficiency anemia is common in what syndrome?
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alcoholism
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folic acid deficiency is often drug induced by:
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1. antiseizure medications
2. MTX 3. HTN meds |
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What two drugs can you prescribe for anemia of chronic disease?
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Procrit & Aranesp
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when writing an Rx for Procrit/Aranesp, what else must you provide?
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iron supplementation
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MOA of Procrit/Aranesp?
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stimulate erythroid progenitor division and differentiation
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BBW of Procrit/Aranesp?
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1. increase CV risk in CRF
2. increase risk of death & tumor progression in cancer 3. increase risk of thromboembolic events in surgery patients. |
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CI for Procrit/Aranesp?
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1. uncontrolled HTN
2. Ab-mediated anemia |
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ADEs of Procrit/Aranesp?
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1. HTN
2. Edema 3. Tachycardia 4. Thrombosis 5. NVD |
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Serious ADEs of Procrit/Aranesp?
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1. tumor progression
2. increased mortality 3. CHF 4. Stroke 5. MI 6. Seizure 7. embolism |
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route of administration for Procrit/Aranesp?
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SubQ or IV
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Dosing of procrit/aranesp is dependent on?
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disease
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target Hb level when treating anemia of chronic disease with Procrit/Aranesp?
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10-12
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When can you increase a dose of Procrit/Aranesp 25%?
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if Hb response <1 gm in 4 weeks or Hb <10
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when can you decrease a dose of Procrit/Aranesp by 25%?
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If Hb response >1gm within 2 weeks or hb >12
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Extrinsic clotting cascade activated by:
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tissue thromboplastin
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intrinsic clotting cascade activated by:
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activation of Factor XII by contact
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common clotting cascade:
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converge on factor X-- leading to activation--generation of thrombin and prothrombin
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Thromboembolism occurs in what 3 conditions?
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1. DVT
2. PE 3. VTE |
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What are some risks associated with developing a thromboembolism?
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1. older than 50
2. major surgery 3. history of VTE 4. trauma 5. obesity 6. catheter (dialysis patients) 8. estrogen (OCP or HRT) 9. hypercoagguable states |
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MOA of Unfractioned Heparin
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1. potentiates actions of antithrombin III-- leading to inactivation of thrombin factors & plasmin
2. prevents conversion of fibrinogen to fibrin 3. stimulates release of lipoprotein lipase 4. binds platelets: prevents platelet aggregation. |
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administration of unfractioned heparin
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1. treatment: IV- reliable absorption
2. prophylaxis: SubQ- erratic absorption 3. bolus flush |
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what should you monitor when putting a patient on unfractioned heparin?
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1. aPTT
2. antifactor Xa activity 3. [plasma] |
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CI for unfractioned heparin
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1. severe thrombocytopenia
2. uncontrolled active bleed/ hemorrhage 3. heparin-induced thrombocytopenia (monitor platelets) |
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What is important to know when administering unfractioned heparin?
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the concentration
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Lovenox
1. class |
LMW heparin
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Fragmin
1. class |
LMW Heparin
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LMW Heparin
1. two drugs 2. MOA changes from unfractioned H |
1. Lovenox & Fragmin
2. more predictable anticoagulation dose response, longer half-life, decreased thrombocytopenia & need for monitoring, less erratic subQ abrosption, more antifactor Xa activity. |
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CI of LMW Heparin
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1. history of HIT (heparin-induced-thrombocytopenia)
2. hypersensitivity to pork |
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Dosing of LMW Heparin
1. based on 2. adjusted |
1. actual BW
2. renal |
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Administration of LMW Heparin
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pinch skin- inject at 90* angle
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What should you monitor when giving LMW heparin?
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1. CBC: q5-10 days for 1-2 weeks; then 2-4 weeks
2. PT 3. antifactor Xa 4. platelets 5. occult blood |
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ADEs of LMW heparin
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1. bruising
2. increased liver enzymes & triglycerides 3. hyperK 4. hemorrhage/hematoma 5. fever/confusion |
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if you have arrhythmias or HyperK and you are prescribing LMW heparin, you should:
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bump up the calcium
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T3:
T4: |
T3: Thiodothyronine
T4: Thryoxine |
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T3 is _____ in plasma and _______ bioactive than T3. It comprises ____________- % of free thyroid hormones
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unbound
more 10-25% |
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T4 is _______ to plasma proteins and represents ______% of free thyroid hormones
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bound
75-95% |
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the hypothalamus responds by releasing TRH in situations where ______ levels are decreased
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T4
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Hypothyroidism Disease spectrum
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high TSH, low free T4
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Mild thyroid failure disease spectrum
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high TSH, normal free T4
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euthyroid disease spectrum
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normal TSH, normal free T4
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Thyrotoxicosis (hyperthroidism) disease spectrum
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low TSH, normal/elevated free T3/T4
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Propylthiouriacil (PTU)
1. Use 2. MOA 3. Duration of treatment |
1. Graves disease; prep for surgery until euthyroidic
2. inhibits thyroid hormone synthesis 3. depends on severity of disease (from 6 months-3 years) |
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PTU for surgical prep- once euthyroid levels are reached, what must you do?
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give iodine to decrease vascularity.
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PTU
1. dose 2. BBW 3. Pregnancy Category-max dose |
1. adjust based on TFTs (begin QID)
2. hepatotoxic 3. Cat D: max dose 200 mg/day |
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PTU
1. SE/ADE |
1. dem
2. GI 3. Arthritis 4. granulocytopenia 4. leukopenia |
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Methimazole
1. use 2. MOA 3. potency |
1. hyperthyroidism
2. inhibits thyroid hormone synthesis 3. more potent than PTU |
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compare Methimazole and PTU
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MMI is:
1. more potent 2. longer lasting 3. faster acting |
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Methimazole
1. dose 2. Pregnancy category- max dose & implications |
1. based on TFTs
2. D- max dose: 20 mg/day: excreted in breastmilk |
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Methimazole
SE |
1. derm
2. myalgia/arthralgia 3. jaundice 4. edema 5. nephritis 6. agranulocytosis 7. hepatotoxicity |
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Potassium Iodide
4 brands |
1. SSKI
2. Lugols 3. Thyrosafe 4. Thyroshield |
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Potassium Iodide
1. use 2. MOA 3. FDA pregnancy category |
1. hyperthyroidism
2. inhibits thyroid hormone synthesis and release; increases the volume and decreases the viscosity of respiratory secretions 3. D |
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potassium iodide
CI |
1. hyperkalemia
2. severe dehydration 3. hypothyroidism 4. renal impairment |
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potassium Iodide
SE/ADE |
1. metallic taste
2. GI-upset & bleed 3. arrythmias 4. goiter 5. angioedema |
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if your patient has an adverse drug reaction and complains of "metallic taste" he probably took:
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Potassium Iodide for hyperthyroidism tx
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1. Form of SSKI
2. Lugals: form 3. general administration of both: |
1. iodide drop
2. solution: iodide per drop 3. mix in water or juice |
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Propranolol (inderal)
1. use 2. MOA 3. formulations |
1. symptomatic treatment associated with hyperthyroidism: anxiety, tremor, sweating, increased HR
2. MOA: non-selective beta antagonish: partially blocks conversion of T4 into T3 3. ER |
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Propranolol (Inderal)
1. dose 2. BBW 3. CI |
1. titrate up and then back down, and off.
2. angina exacerbation, MI, or ventricular arrhythmias with abrupt discontinuance 3. cardiogenic shock or sinus bradycardia |
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Propranolol (Inderal)
precautions |
1. bronchial asthma
2. DM 3. uncompensated heart failure 4. abrupt withdrawal 5. pregnancy: 2nd and 3rd trimester |
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SE/ADE of Propranolol
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1. dizziness
2. bradycardia 3. hypotension 4. bronchospasm |
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What do you use to treat hypothyroidism?
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thyroid hormone supplementation (crude or synthetic)
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Crude Thyroid
1. origin 2. T4:T3 ratio 3. Importance: 4. Food |
1. crushed animal thyroid
2. 2-5:1 3. brand names are not bioequivalent 4. take 30 minutes before eating |
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Name 3 synthetic thyroid hormones
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1. levothyroxine
2. liothyronine (cytomel) 3. Liotrix (Thyrolar) |
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Levothyroxine
1. class 2. thyroid hormone 3. dosing |
1. synthetic thyroid hormone
2. PURE T4 3. start low, titrate up; adjust dose q 4-8 weeks based on TFTs |
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Levothyroxine
1. food 2. DDI- 4 categories |
1. take on empty stomach
2. malabsorption syndromes, decreased absorption due to foods/meds, increased clearence due to drugs, or decreased T4-T3 clearance, due to drugs. |
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what drugs increase the clearance of levothyroxine?
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rifampin
carbamazepine phenytoin |
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what drugs decrease the clearance of T4 into T3
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amiodarone
selenium deficiency |
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Liothyronine (Cytomel)
1. Thyroid Hormone 2. ADEs |
1. PURE T3
2. cardiac |
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which synthetic thyroid hormone is pure T3?
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Liothyronine (Cytomel)
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which synthetic thyroid hormone is pure T4?
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Levothyroxine
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Liotrix (Thyrolar)
1. class 2. T4:T3 ratio |
1. synthetic thyroid hormone
2. 4:1 |
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Thyroid Hormones
1. BBW 2. CI |
1. not for weight loss (does increase metabolism)
2. acute MI, thyrotoxicosis, adrenal insufficiency |
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Thyroid hormones
SE/ADE |
1. increased appetite
2. tachycardia 3. weight loss 4. nervousness 5. insomnia 6. heat intolerance 7. tremor 8. arhythmias 9. CHF 10. HTN 11. Angina |
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Thyroid Hormone:
Pregnancy Category |
A
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