Now, bad combos. Here's a great summary slide for you.
I want you to really make sure that you focus in on this.
Remember, they won't say your patient has low potassium and is also taking digoxin.
What are you concerned about?
They'll give you some clues that the patient has low potassium.
Maybe they're on a loop diuretic.
They might give you some other options
but they're gonna see if you pick up these bad combos.
Low potassium for any reason plus digoxin equals an increased risk for dig toxicity.
So if the patient's on corticosteroids, remember, especially if it's a mineralocorticoid,
that can cause the body to hang on to sodium, dump off potassium.
So watch patients taking corticosteroids who are also taking digoxin.
Also, we already talked about if someone's on furosemide,
that's a loop diuretic, that can cause low potassium.
So those 2 bulletpoints there are to remind you you're not gonna see an obvious answer
in the stem of a question that will say this patient has low sodium.
They might use one of these 2 examples to help you recognize this patient has high sodium
so they've lost their potassium in corticosteroids.
For furosemide, we know that will drop the potassium.
That's what they're really good at. So watch out for those types of questions.
Now, ACE inhibitors plus the potassium-sparing diuretic,
that's gonna equal way too much hyperkalemia or potassium.
MAOIs, foods with tyramine, that can equal hypertensive crisis.
Ginger, garlic, or gingko plus an anticoagulant or antiplatelets are not a good combo.
Gingko, garlic, or ginger, they're the 3 Gs.
You can put them in any order that you want but those are 3 of the natural supplements
over the counter that increase your propensity to bleed.
So I don't want a patient that's taking an herbal supplement, unbeknownst to me,
also taking an anticoagulant and antiplatelet.
So it's very important for you to ask patients what other supplements or vitamins
or medications they may be taking.
These are not an example of hey, you can't have ginger chicken
the next time you go out for Asian food. This means supplements.
So if people are taking any one of these 3 supplements,
you want them to stop taking those if they're also on an anticoagulant or antiplatelet.
Now, levadopa/carbidopa, that's a combo that we use to treat Parkinson's,
should not be taken at the same time the patient eats a high protein meal.
So I know I've told you that you can't remember which medications you take with food,
which medications you don't, but this is a dietary exception.
Things like this are worth your time.
So levadopa/carbidopa needs those protein transporters.
If the patient is taking high protein meals along with this medication,
it will compete for those receptors, those transporters, and the medication is going to be less effective.
Trust me. Anyone with Parkinson's disease does not need less effective medication.
Antacids and oral medications.
You want a 1-2 hour window before and after the antacids and the oral meds.
Meaning, if I have taken an antacid at 10 AM, then I can't take a medication 'til noon
and I shouldn't take another antacid until 2 PM.
Antacids change the pH of your stomach which will mess with the absorption of medications
and it affects different medications in different manners.
Most will be less effective oral medications.
Some may have increased levels but keep in mind, antacids and oral medications are not a good idea.
You want that window of time 1-2 hours before and after.
Now, bisphosphonates or doxycycline and lying down equals esophagitis.
This might seem like a little odd so I wanna remind you.
Bisphosphonates are the medications that we give to women to treat osteoporosis.
Doxycyline is in the antibiotics family
so these two medications cause erosive esophagitis if you lay down.
So just write yourself a note.
Erosive over that esophagitis to remind you it's not just a mild sore throat. It's horrific.
So this is a very important patient education point.
To spare your patients from this pain, you want to be sure that you educate anyone
on a bisphosphonate prescription or a doxycycline prescription not to lay down
when they take the medication.
So you also don't want them to take it at night or near bedtime.
Coumadin and vitamin K rich foods.
Vitamin K is the antidote for coumadin so that'll make it less, less, less, much less effective.
So patients need to be very educated on which foods contain vitamin K and so do you.
So be sure to review that before your exam so you remember which foods are rich in vitamin K.
Dark green leafy healthy things are just some of the foods that are rich in vitamin K.
Anyone being considered for thrombolytics, you can't have trauma, surgery,
or important clots like in their head or following a procedure.
That could lead to massive hemorrhage. So we're talking about bad combinations.
Anyone who's considering thrombolytics and who's had trauma, surgery,
or have important clots that need to stay there are at an increased risk for severe hemorrhage
and shouldn't get thrombolytics. Tetracyclines and kids.
That's a specific antibiotic. Tetracyclines. Think about teeth because this will rot the teeth.
We don't give tetracyclines to pediatric patients anymore
because they end up with teeth that looks horribly stained.
Now again with kids, fluoroquinolones. That's a group of antibiotics.
You don't wanna give them to kids because that can lead to a tendon rupture.
So it's a unique one. Those are 2 unique ones for children.
Okay, that is 2 full slides of bad combos.
Now, I know we went through that very, very quickly
but it's important that you recognize each one of these.
These are low-hanging fruit that every nurse is expected to know
that these are bad combinations that put your patient at risk.
So spend a little time and extra effort in going over each one of these
so these don't catch you on an exam.
Now, looking at this one, oh my goodness. Wasn't this overwhelming?
Because you're talking about grapefruit juice.
There really isn't a way to memorize all these because let me show you.
Right. These are bad combos with grapefruit juice. Can you memorize all those?
Wow, if you can, we need to get you a hobby.
What's probably best for you to look at this and see what am I willing to commit to memory
or what makes sense to me. Well, obviously the -statins, -statins, -statins.
That's kind of an easy one to pull that together.
Now, you've got some medications that treat seizures like carbamazepine
so you spend some time in that one.
I just wish we could tell people if you're taking any medication,
you're not allowed to have grapefruit juice but should you get a really mean question
about grapefruit juice in certain medications, just do your best.
I gave you not even a complete list of the medications that are impacted by grapefruit juice.
MAOIs, right, they don't play well with lots of things.
Certain foods, indirect-acting sympathomimetic agents, antidepressants, TCAs, SSRIs,
antihyper drugs, and meperidine.
So good rule of thumb for MAOIs, yeah, don't eat tyramine-containing foods
or essentially take any other medications.
Well, I'm just kidding but it sure feels that way with MAOIs.
So we don't use these very much anymore if we absolutely can avoid it.
So what do you next? Well, you need to develop a study plan.
Go back through your notes today and if you could even spend some time today,
reviewing your notes on the same day is the best way to reinforce information.
Use spaced repetition. You've got some notes from today, quiz yourself.
Use those as tools to reinforce the information.
Take some practice quizzes to help you learn a drug name and key facts about drugs.
And don't forget, you can do this.
Thank you for watching our video today.