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Merry Christmas!
A very Merry Christmas to all our friends and family 🙂
Enjoy the most wonderful time of the year and be safe!
Study Tip: Dilated Cardiomyopathy
Dilated Cardiomyopathy – a disease that causes the enlargement of all the chambers of the heart, usually starting in the left ventricle which is heart’s main pumping chamber. The ventricle stretches, dilates, and unable to pump blood as it should. There is decreased cardiac out and decrease contractility as a result. Causes of primary cardiomyopathy is unknown, secondary cardiomyopathy may be caused by ischemia, infection, or metabolic disorders.
Cardiomyopathy is a common cause of heart failure and dysrhythmia, dilated cardiomyopathy can also contribute to irregular heartbeats (arrhythmias), blood clots or sudden death. Treatment include digoxin, antidysrhythmics, beta blockers, and calcium channel blockers. Heart transplantation may be considered if the damage to the heart is considered to be permanent and unrecoverable.
Content area: Med-Surg | Cardiac
Remedial/Refresher Course
NCLEX Pharm: Heparin
Class: Anticoagulant
Indication:
- Prevention of clotting in arterial and heart surgery
- Disseminated Intravascular Coagulation (DIC)
- Atrial fibrillation with embolization
- DVT and Pulmonary embolism
Side effects:
- Hematology: Thrombocytopenia, bleeding, bruising, injection-site reactions,
- Skin: hair loss,
- GI: liver enzyme changes
Nursing Tips:
- Heparin is a High Alert Medication
- Adjust dose based on lab results.
- Dosage is considered adequate when the activated partial thromboplastin time (APTT) is 1.5 to 2 times normal
- Give by deep subcutaneous injections; do not give IM.
- Have protamine sulfate on hand as antidote.
- Protect clients from injury, report bleeding gums, black or tarry stools, and severe headache.
- Avoid intramuscular route of administration because of the frequent occurrence of hematoma at the injection site.
- Always follow facility’s heparin protocol, whenever working with this medication.
Ref: Roach’s Introductory Clinical Pharmacology
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NCLEX Study Tips
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Rophem 🙂
NCLEX Pharm: Lunesta
Generic Name: Eszopiclone
Brand Name: Lunesta
Class: Sedative, Hypnotic, Nonbenzodiazepine
Indication: Sleeping pill, Lunesta is used to treat insomnia.
Side effects: Confusion, clumsiness or unsteadiness (older adults), daytime anxiety and/or restlessness, difficulty with coordination (older adults), mood or mental changes.
Adverse effects: Headache, chest pain, migraine.
Nursing Tips:
- Lunesta may be habit-forming.
- Contraindicated in liver disease; breathing disorder.
- Contraindicated in History of depression, mental illness, or suicidal thoughts.
- Contraindicated in history of drug or alcohol addiction.
- Teach clients to avoid alcohol, it can lead to very serious interactions.
Ref: Roach’s Introductory Clinical Pharmacology
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Rophem 🙂
Pharm: MAOIs and Tyramine Foods
Monoamine Oxidase Inhibitors (MAOI) are
- Best known to be powerful anti-depressants.
- They are effective therapeutic agents for panic disorder and social phobia.
- MAOIs are tried when other antidepressants don’t work, due to side effects.
- MAOIs can cause dangerous interactions with foods and beverages that contain Tyramine. See table below.
Tyramine
- Tyramine is an amino acid that regulates blood pressure
- It occurs naturally in the body, and it’s found in certain foods.
Important: Clients taking MAOIs will need to avoid foods containing high levels of tyramine.
Common side effects of MAOIs include:
- Dry mouth, Headache, Drowsiness
- Nausea, diarrhea or constipation
- Dizziness or light-headedness
- Skin reaction at the patch site
Nursing Implications:
- Monitor for occipital headache, nausea, vomiting, sweating, fever, chest pain.
- Notify the MD quickly, if client complain of any of the signs above.
- Monitor for other drug interactions e.g. sedatives, hypnotics, & analgesics.
- Check if client is taking Herbal products – St John’s wort has a potential for adverse reaction when taken with antidepressants.
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Rophem 🙂
NCLEX Pharm: Dilantin
Generic name: Phenytoin Sodium. Brand name: Dilantin
Class: Antiepileptic, Anticonvulsant, Antiarrhythmic
Indication: Seizures, Cardiac Arrhythmias
Side effects:
- Hematology: aplastic anemia, hematopoietic complications,
- Neuro: ataxia, dizziness, drowsiness, insomnia
- Skin: purpuric dermatitis, Steven-Johnson syndrome.
- GI: gingival hyperplasia, liver damage
Nursing Tips:
- Therapeutic serum level 10-20 mcg/ml
- Do not stop abruptly, to prevent status epilepticus.
- Stop if rash, depressed blood count, enlarged lymph nodes, hypersensitivity reaction, signs of liver damage develop.
- Not for use in pregnancy, it will cause fetal hydantoin syndrome; mental & physical birth defects.
- Phenytoin is occasionally used in the treatment of cardiac arrhythmias, those associated with digitalis intoxication
- Continually monitor cardiac rhythm; check BP frequently.
- Dilantin capsules should be taken by mouth, swallowed whole. Do not open or crush medication.
- Patient should take medication with a full glass (8 ounces) of water unless the doctor directs otherwise.
- Dilantin should be used regularly and all doses taken on time to keep the serum level constant.
- Products that contain calcium (e.g., antacids, calcium supplements) and nutritional tube-feeding products may decrease the absorption of phenytoin. Separate liquid nutritional products at least 1 hour before and 1 hour after phenytoin dose.
To your Success!
Rophem 🙂
Holiday Sales
‘Tis the season of giving 🙂 To bring out the special Christmas spirit and to usher in the new year, we have decided to host a new year sale.
FIRST – Continuing Education Courses are at 15% off for Nurses and Advanced Nurses in the following states: 
- Florida
- Georgia
- South Carolina
- District of Columbia
- Arkansas
- Licensed Midwives.
- Alabama Nurses*
By using the code SAVE15, you can save when you get the course
package for your respective state, and you will be renewal ready.
Course credits post to CE Broker website within 24 hours.
(*Alabama Board of Nursing accepts CE courses that are approved by other BON within the US, see link for reference – http://www.alabamaadministrativecode.state.al.us/docs/nurs/610-X-10.pdf)
SECOND – Two for the price of One! Rophem NCLEX Review for graduate nurses. 
Get your license this New Year 2019 with Rophem and what better way to stay accountable than with a friend. Get one NCLEX review and invite a friend for FREE, or simply split the bill for double the reward! Now you and a friend can do it together – #passNCLEX! Register Now on rophem.com! Seats are limited!
January 7, 8, 9, 10 (Mon to Thur).
January 14, 15, 16, 17 (Mon to Thur) – 9 am each day.
Rophem 🙂
Dose of Nursing 