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NRSG 220 > 1-6 STARRED FLASHCARDS > Flashcards

1-6 STARRED FLASHCARDS

1
Q

What is the action of Abx drugs?

A

Affect target organisms structure, metabolism, or life cycle

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2
Q

What is the goal of Abx medications?

A

To eliminate the pathogen

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3
Q

What is bactericidal and bacteriostatic?

A

-cidal: Kill bacteria
-static: Slow growth of bacteria

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4
Q

What may antibiotics be used for?

A

Prophylactic treatment of people with suppressed or compromised immune systems

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5
Q

Why not just prescribe a really strong Abx?

A

A. delay effective treatment (YES)
B. Give the bacteria more time to grow (YES)
C. Contribute to the development of drug-resistant bacteria (Yes)

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6
Q

What should the patient know when taking Abx? (12 things)

A

finish all abx
do not share
keep away from children
educate about decrease of OCP
when to take with food or when to avoid certain ones
teach clients to wear medic-alert bracelets if allergic
Take probiotics (1-2x/day) to counter antibiotic
monitor for hypersensitivity with first dose
know S&S of allergic rxn
MOST abx taken on empty stomach
Assess renal/hepatic function
assess for persistent diarrhea in children

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7
Q

What is the role of the nurse in Penicillin therapy (4)

A

Assess previous drug runs to penicillin
avoid cephalosporins if pt has severe penicillin allergy (cross sensitivity)
monitor for hyperkalemia and hypernatremia (increases risk in pt with DM or on dialysis)
Monitor cardiac status, including ECG changes

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8
Q

Role of the nurse in cephalosporin therapy?

A

Assess for presence or Hx of bleeding disorders (ceph reduces prothrombin levels)
Assess renal/hepatic function (esp in elderly)
assess for persistant diarrhea in children
avoid alcohol (some cause disulfiram rxn w/alcohol)

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9
Q

Role of the nurse in tetracycline therapy

A

Photosensitivity may result
do not take with milk products, iron supplements, magnesium containing laxatives, or antacids
watch for supra infection such as pseudomembranous colitis

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10
Q

Role of the nurse in Macrolide therapy?

A

Watch liver with EES erythromycin estolate
multiple drug-drug interactions occur with macrolides (CYP)
monitor - exacerbates heart disease
cause a metallic taste in mouth

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11
Q

Aminoglycosides are

A

More toxic than most abx
have potential to cause serious ADEs (ototoxicity, nephrotoxicity, neuromuscular blockage)
last names dont work with this family and macrolides

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12
Q

Ototoxicity is worse if given with?

A

Lasic

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13
Q

Nephrotoxicity is worse If given with

A

Zovirax

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14
Q

Neuromuscular blockage includes

A

Respiratory paralysis

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15
Q

Fluoroquinolones are decreased how much and with what

A

decreased 90% if taken with multivitamins or minerals such as calcium, magnesium, iron, or zinc ions
Decreased 50% is taken with tetracyclines

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16
Q

Important things with fluoroquinolone

A

IV = PO and therefore easy transition to home
NO teenager/athletes: Tendon rupture
Can Cause C diff
QT prolongation/arrhythmias (IRR vs RRR)

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17
Q

Role of the nurse in fluoroquinolone therapy?

A

Norfloxacin may cause photophobia
teach that drug may affect tendons, esp in children
monitor for dysrhythmias
crosses into breast milk

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18
Q

Sulfonamides

A

Widespread use has lead to increases resistance and decreases usage/Rx
used in combo to trat UTIs
anti-inflammatory properties of sulfonamide component can help with RA and ulcerative colitis
teratogenic
do not take breast feeding/pregnant
caution rxn to sulfonamide abx could mean allergy to other sulfonamide medications
allergy to these meds may cause sensitivity to abx - caution with first dose

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19
Q

What is the role of the nurse in sulfonamide therapy

A

assess for anemia/other hematological disorders
assess renal function (may increase risk for crystalluria)
alterante form of BC

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20
Q

Vancomycin MOA

A

Bactericidal, inhibits cell wall synthesis

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21
Q

Vancomycin primary use

A

reserved for severe or resistant gram positive infection, effective for MRSA infections, used to treat C diff

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22
Q

Vancomycin ADEs

A

ototoxicity
nephrotoxicity
red man syndrome
confusion/hallucinations
anaphylaxis

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23
Q

What is acquired resistance

A

as abx are used, they destroy sensitive bacteria

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24
Q

What bacteria stays following acquired resistance

A

only insensitive mutated bacteria remain
1. free from competition from sensitive bacteria (mutated thrives
2. pt now develops infection that is resistant to drug
3. resistant bacteria can be transmitted to others

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25
Q

ARO’s

A

Carbapenem resistant enterobacteriaceae
extended spectrum B lactamase
MRSA
VRE
VRSA

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26
Q

what will MRSA not respond to

A

fluoroquinolone, macrolides, ahminoglycosides or tetracyclines

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27
Q

What is multi drug resistant

A

when an organism is resistant to more than one drug

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28
Q

what do abx not treat

A

viral infections

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29
Q

What is a superinfection

A

host flora killed by abx, MO’s multiply

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30
Q

S&S of superinfections

A

Diarrhea
bladder pain and painful urination
abnormal vaginal discharge
red rash with satellite lesions

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31
Q

What are some considerations for patients taking abx

A

inform as to SE (skin teeth tendons ears kidneys)
assess renal/hepatic function
assess for persistent diarrhea in children
take probiotics to counter
wear medic alert bracelets if allergic
know S&S of allergic rxn

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32
Q

Fungal infections characteristics

A

Not easily transmitted through casual contact
Love dark, moist environments + lots of sugar
serious fungal infection uncommon in healthy individuals
treatment may require weeks to months of therapy due to resistance

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33
Q

Fungal infections in immunocompromised pts

A

systemic fungal infections may be rapidly fatal
may experience frequent fungal infections and require aggressive pharmacotherapy

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34
Q

Nystatin drug interactions/treatment of OD

A

Drug interactions unknown
Treatment of OD: symptomatic

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35
Q

Nystatin considerations

A

Hx and assessment (observe for improvement and report of persistent infections)
Avoid occlusive dressings or ointment on moist dark areas of body
teach pt to avoid sharing shoes, towels, or personal objects

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36
Q

What drugs are similar to nystatin

A

Griseofulvin

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37
Q

What is griseofulvin used for

A

skin infections like lock itch, athletes foot, ringworm, and fungal infections of scalp, fingernails and toenails

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38
Q

Griseofulvin SE

A

phototoxicity
SJS
urticaria
dizziness
decreased OCP
alcohol=disulfiram like rxn

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39
Q

When in doubt

A

check BG (not feeling well, back from exam and didnt eat, sweating or confused)

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40
Q

What to watch for with beta blockers?

A

Hypoglycemia, beta blockers mask the S&S of hypoglycemia

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41
Q

What are the rapid insulin therapies

A
  1. Insulin aspart
    more rapid onset of action and shorter duration of action than regular insulin
  2. Insulin glulisine
    rapid onset and short duration (3 to 5 hrs)
    given by SC injection only
  3. Insulin Lispro
    rapid acting analog of regular insulin
    helps control the rise in BG brought on by a meal
    not given IV; often used with infusion pumps
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42
Q

Rapid acting onset, peak duration

A

Onset: <15 min
Peak: 0.5 to 1 hr
Duration: 3-4hrs

BEST TO BE EATING

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43
Q

Humulin Regular insulin ADEs/Serious ADEs

A

ADEs:
irritation at site
lipodystrophy
weight gain

serious ADEs:
hypoglycemia
rebound hyperglycemia
hypokalemia

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44
Q

Insulin therapy considerations

A

Medicine Hx (herbs and dietary supplements)
alcohol intake and BG
consumed or capable of consuming food before administration
only regular insulin intravenously
assess pts knowledge + educate
do not administer when BG less than 4 mmol
rotate injection sites
check periodic hemoglobin A1C levels
assess for DM complications (eyes heart kidneys feet)

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45
Q

Role of the nurse in insulin therapy

A

be familiar with onset, peak and duration of action of prescribed insulin
be aware of important aspects of each specific insulin
not all types of insulin are compatible (clear before cloudy)
know S&S of hypoglycemia and hyperglycemia

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46
Q

Considerations for all Oral Diabetic Agents

A

Monitor BG
Check for S&S of illness or infection
watch liver function
assess for adherence tp therapy, and the ability for self care
sulfonylureas contraindicated in women who are pregnant or breast-feeding, or persons with renal or liver disease
second generation sulfonylureas have fewer drug-drug interactions

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47
Q

Sulfonylureas

A

increase stimulates insulin release from pancrease
increase sensitivity to insulin receptors
decreased chance of prolonged hypoglycemia
10% experience decreased effectiveness after prolonged use
most SE are minor an GI related

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48
Q

Sulfonylureas contraindications/precautions

A

sensitivity to self drugs to thiazide diuretics
renal or hepatic disease
if used during pregnancy, discontinue at least 1 month before delivery

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49
Q

Sulfonylureas drug interactions

A

alcohol
oral anticoagulants, MAOIs, probenecid, sulfonamides
chloramphenicol, salicylates, clofibrate
rifampin
thiazides, sulfonamide based drugs
ginseng, garlic, black cohosh, juniper berries, fenugreek, coriander, dandelion root

50
Q

Biguanides

A

decreased glucose production by liver
increase insulin sensitivity at tissues
improve glucose transport into cells
do not promote weight gain
usually first line of treatment
6-12 weeks to reach therapeutic effect
need to be held 48 hrs prior and 48 hrs after a pt needs contrast dye to prevent lactic acid build up

51
Q

Biguanades contraindications/precautions

A

impaired renal function
HF, liver failure, Hx of lactic acidosis
concurrent serious infection
any condition that predisposes pt to hypocemia
anemia, D/V, dehydration, fever, gastroparesis, GI obstruction
hyperthyroidism, pituitary insufficiency, trauma
pregnancy/lactation

52
Q

Cholinergic Medications medicinal uses

A

Neurogenic bladder
urinary retention
BPH
Glaucoma
Myasthenia Gravis
Alzheimers

53
Q

Cholinergic medications S&S of toxicity

A

SLUDGE

Salivation
Lacrimation
Urinary incontinence
Diarrhea
Gastrointestinal cramps
Emesis

54
Q

What is physostigmine used for

A

an antidote for anticholinergic poisoning and common pesticide poisoning

55
Q

Anticholinergic medications

A

can be natural like scopolamine and atropine or synthetic like benztropine, dicyclomine, oxybutynin, toleradine, glycopyrrolate

To be used cautiously in the geriatric population (esp in males with BPH and urinary retention)

56
Q

Anticholinergic medications considerations

A

Watch for contraindication in long term usage
sensitivity to light
dry mouth
agitation
blurred vision
high risk of heat stroke in geriatric patients
stress fluids and a high fibre diet
teach pt when to call HCP

57
Q

Adrenergic medications medicinal use

A

Dobutamine (agonist) increase contractility and elevate BP
phenylephrine (agonist) causes vascular constriction in nasal arteries, dries up nasal drip and mucous
Atenolol (antagonist) slows HT and drops BP (not as cardio selective as metoprolol so watch with asthmatics)

Emergency drugs
dopamine - dose dependent
dobutmaine
norepinephrine
epinephrine - protect from light

58
Q

Adrenergic considerations

A

major SE of B agonists is cardiac arrhythmia
these drugs increase myocardial O2 demand and can precipitate engine - avoid in CAD - do not give with MI
avoid caffeine
headache and tremor also common but call HCP is nervousness/jitters or palpitations
alpha 1 adrenergic antagonists are used for BPH (relaxes smooth muscle and urinary retention
assess vital signs prior to administration - previous 12 lead ECG, HR, Heart Hx heart sounds, RR, O2 sat, need for O2, breath sounds, resp effort, skin colour

59
Q

Cholinergic agonists when not to use

A

GI/GU obstruction
bradycardia
epilepsy
hypotension
COPD
parkinsons disease

60
Q

Adrenergic agonists when not to use

A

Narrow angle glaucoma
tachycardia, arythmies or HTN
liver disease
enlarged heart
disorders of arteries and veins
disorders affecting the blood supply to the brain

61
Q

Catecholamines

A

Short duration of action
destroyed rapidly by MAO and COMT
no PO - parenteral or inhalation d/t COMT in the intestinal tract
do not cross BBB

62
Q

Noncatecholamines

A

May be taken PO
not destroyed as rapidly
better able to enter brain and affect CNS

63
Q

Epinephrine considerations

A

assess for underlying problem/pre existing conditions
Hx/Px (VS)
closely monitor resp status
use cardiac monitor/resuscitation equipment
monitor BP closely
inform prescriber of changes in I&O
monitor for hyperglycemia - insulin gtt
examine ocular and nasal mucosa
protect from light (store rip in dark place, brown bag/IV)

64
Q

Phenylephrine contraindications/precautions

A

severe HTN
pre existing bradycardia
advanced CAD
nitroglycerin
narrow angle glaucoma
hyperthyroidism
diabetes

65
Q

Phenylephrine treatment of OD

A

Phentolamine
anti-dysrhythmic drugs

66
Q

Phenylephrine Considerations

A

examine IV sites frequently
advise pt to remove contact lenses
dark eye protection after ophthalmic administration
avoid caffeine (with all adrenergic agonists)
contact HCP is palpitation or jittery/nervousness

67
Q

Muscarinic antagonists uses

A

GI disorders such as IBS
ophthalamic procedures
cardiac rhythm disorders
chemotherapy induced diarrhea
adjuncts to anesthesia
asthma and COPD
antidotes for poisoning or OD
Urge incontinence (overactive bladder)
Parkinsons disease

68
Q

Muscarinic antagonists ADEs

A

Urinary retention
xerostomia
tachycardia
CNS stimulation
Dry eyes
photophobia
urinary retention in BPH

69
Q

Anticholinergic syndrome

A

dry mouth
difficulty swallowing
visual changes
blurred ision
photophobia
agitation and hallucinations

70
Q

Nicotinic Antagonists

A

Motor end plate of muscle causes release of Ach to travel to receptors on skeletal muscle = muscle contraction
continous depolarized state in which calcium does not return to its storage depots

71
Q

Succinylcholine uses

A

surgical anesthesia
pseusocholinesterase
relaxes abdominal muscle, or for relaxation prior to intubation
induces relaxation in less than 1 minute
muscle strength returns quickly after discontinuation of the drug
patients can still feel pain and is aware of surroundings - benzos and opioids

72
Q

Succinylcholine ADEs

A

complete paralysis of diaphragm/intercostalk muscle
tachycardia
hypotension
urinary retention

73
Q

Succinylcholine serious ADEs

A

malignant hyperthermia - muscles rigid, skin hot
resp depression
apnea
dysrhythmias

74
Q

Tubocurarine

A

nondepolarizing neuromuscular blockers
used to relax skeletal muscles during surgical procedures
do not cause sedation, analgesia, or LOC - must use Enzo’s, propofol, and opioids

75
Q

First dose phenomenon

A

When the SNS is blocked, the parasympathetic predominates resulting in hypotension or orthostatic hypotension (decreased blood flow to brain = syncope)
prevention by initial therapy begun with low doses and usually given at bedtime
reflex tachycardia and nasal congestion also occur

76
Q

Selective alpa 1 blockers

A

block peripheral catecholamines
relax smooth muscle of bladder and prostate
increases urine flow

77
Q

alpha 1 blockers action on arterioles

A

block vasconstriction on vascular smooth muscle (afterload) which decreases BP directly

78
Q

Alpha 1 blockers action on veins

A

Block vasoconstriction which decreases venous return (preload) to heart and lowers BP indirectly

79
Q

What can alpha blockers be used with

A

diuretics

80
Q

selective alpha 1 blockers uses

A

benign prostatic hyperplasia
phenochtomocytoma
HTN

81
Q

Benign prostatic hyperplasia

A

two selective agents used
1. Alfuzosin
2. Tamsulosin

82
Q

Pheochromocytoma

A

Small tumour of adrenal medulla causing irregular secretion of Epi and NE
- excessive secretion of catecholamine in this condition causes severe HTN

83
Q

Selective Beta-Adrenergic Antagonists

A

Block only beta 1 receptors
cardioselective
fewer non cardiac SE
little effect on bronchial smooth muscle
can be safely given to clients with asthma and COPS

84
Q

Nonselective beta-ldreergic antagonists

A

block beta 1 and beta 2 receptors
produce more SE than selective beta 1 antagonists
serious SE is bronchoconstriction - caution in pts with COPD or asthma

85
Q

Beta adrenergic antagonists uses

A

most actions relate to CV system
- slow conduction velocity through AV node
- decrease HR (chronotropic)
- decrease force of contractions (inotropic)
during stress/exercise - prevents normal sympathetic stimulation o heart
cautions when administering CCBs concurrently as may potentiate HF

86
Q

ADE’s of beta blockers?

A

prevent hyperglycemic effect of catecholamine
pts with DM can cause hypoglycemia and mask the signs
decreased amount of free fatty acids available during metabolic stress
bronchoconstriction (No pts COPD or asthma)
rebound cardiac excitation if BBs withdrawn abruptly
educate patient to never stop without talking to HCP first

87
Q

Propranolol considerations

A

monitor VS Q15 min - q1hr
Hx &Px - assess for asthma and COPD
review lab tests for kidney, liver, hematologic, and cardiac functions
watch for ADRs in older adults and in pts with impaired renal function
monitor I&O and take daily weights (esp in HF)
educate regarding decreasing salt intake
examine for impaired circulation (SOB, edema etc)
watch for widening QRS - immediate attention

88
Q

Types of nonselective beta blockers

A

Carbedilol - black sheep last name
Labetalol
nadolol
penbutolol
sotalol
timolol

89
Q

metoprolol considerations

A

monitor BP and HR frequently during IV administration
have baseline ECG and repeat if telemetry changes or CP
monitor for symptoms of impending HF
record I&O, weight, bilateral breath sounds
take radial pulse - do not administer if HR <60bpm or is SBP <100 (watch for hypotension symptoms)
do not omit, increase or decrease dose
avoid late evening dose
symptoms of depression
masked hyperthyroidism
report visual problems or cold painful feet/hands
caution in DM pts
discontinue drug slowly due to potential rebound effects
do not breast-feed without consulting provider

90
Q

CCBs myocardial effects

A

reduces force of myocardial contraction (negative inotropic effect)
- reduces inward movement of calcium during plateau phase of action potential

91
Q

CCBs cardiac conduction effects

A

negative chronotropic effect
SA node generates fewer action potential
slows automaticity
decreases HR

92
Q

Nifedipine Drug Interactions

A

With drugs that induce or inhibit CYP3A4
additive effects with other antihypertensives
increased risk of CHF with BB
increased serum levels of digoxin - bradycardia
syncope/drop in BP with alcohol

93
Q

Nifedipine Treatment of OD

A

Rapid-acting vasopressors such as dopamine or dobutamine
calcium infusions

94
Q

Verapamil drug interactions

A

increased digoxin levels = increased bradycardia risk
additive hypotension or bradycardia with other antihypertensive drugs
3x plasma concentration of buspirone
risk of myopathy increased significantly with statins
increases carbamazepine levels = neurotoxicity
grapefruit juice may increase levels

95
Q

Verapamil considerations

A

monitor BP before admin and 30 min to 1 hr after and just prior to next dose
withhold is systolic BP <90 or symptomatic
monitor for edna
keep patient recumbent for at least 1 hr after administration
monitor for heart block or bradycardia with digoxin use
monitor I&O
monitor on telemetry continuously if parenteral

96
Q

Drugs similar to verapamil

A

Diltiazem
treatment of atrial dysrhythmias and HTN, stable and vasospastic angina
same profile as verapamil
migraine prophylaxis off-label

97
Q

The stomach

A

secretes acid, enzymes and hormones that are essential to digestive physiology

98
Q

Natural defenses of the stomach

A

Somatostatin
bicarbonate ion
mucus
prostaglandin E2

99
Q

Prostaglandin antagonists include

A

NSAIDs/ASA (damages GI mucosa directly)
corticosteroids

100
Q

Peptic ulcer risk factors

A

infection with helicobacter pylori
close fam Hx of PUD
drugs (glucocorticosteroids, NSAIDs, platelet inhibitors
Blood group O
smoking
excessive caffeine
psychological stress (thought to be primary cause for many decades)

101
Q

NSAID induced PUD risk factors

A

long term use
advanced age
Hx of ulcers
corticosteroids
anticoagulants
alcohol and smoking

102
Q

H2 receptor antagonists

A

ranitidine
cimetidine
famotidine
nizatidine

103
Q

H2 receptor antagonists pharmacokinetic properties

A

rapid absorption from small intestine
30 min onset of action
half life from 1-4 hours
no known effects on the fetus
excreted primarily from the kidneys

104
Q

ADEs of antacids

A

constipation
at high doses aluminum products bind with phosphate in GI tract = long term use can result in phosphate depletion

High risk:
-malnourished
-alcoholics
-renal disease

105
Q

Contraindications with Antacids

A

prolonged use with low serum phosphate
avoid with suspected bowel obstruction

106
Q

Drug interaction with Antacids

A

dont take with other meds - interfere with absorption

DECREASE
cimetidine, fluoroquinolone, digoxin, isoniazid, cholorowuine, NSAIDS, iron salts, phenytoin, tetracycline, thyroxine

anticholinergic increase effects
aluminum and calcium antacids may inhibit iron absorption

107
Q

Antacids considerations

A

PMH
watch kidney lab values
monitor for bowel changes and worsening symptoms
hold drug and notify prescriber if pt symptoms of appendicitis, undiagnosed GI bleeding, or suspected obstruction

108
Q

Anticholinergic agents and antihistamines N/V

A

Simple nausea like nausea due to motion sickness

109
Q

Serotonin receptor antagonists N/V

A

chemotherapy induced N/V (primary indication for the use of antiemetic medication)

110
Q

Phenothiazine or hydroxyzine N/V

A

antineoplastic therapy

111
Q

Ondansetron therapeutic/pharmacologic

A

There: Antiemetic
Pharm: serotonin (5-HT3) receptor antagonist

112
Q

Ondansetron uses

A

treatment of serious N/V
used at least 30 min prior to chemotherapy and continued for several days after
off-label for cholestatic or opioid-induced pruritic

113
Q

Ondansetron MOA

A

Blocks serotonin receptors in teh chemoreceptor trigger zone

114
Q

Laxative (bulk forming)

A

promotes defecation
prevents and treats constipation

115
Q

Saline Cathartic

A

pulls water into stool
implies accelerated, stronger, and more complete bowel emptying through osmosis

116
Q

Laxatives treatment

A

simple chronic constipation
accelerate removal of ingested toxic substances
accelerate removal of dead parasites
cleanse the bowel prior to diagnostic or surgical procedures

Avoid increased colon pressure
possible bowel perforation
monitor for retrosternal pain

117
Q

Metamucil considerations

A

know PMHx
assess bowel movement and GI functioning
mix powder and granules with at least 8 ounces of a pleasant tasing liquid immediately before use and drink lots of water
immediately report complaints of retrosternal pain after taking the drug
smaller, more frequent doses spaced throughout the day may be indicated to relieve discomfort
monitor warfarin and digoxin levels closely

118
Q

ADEs of diphenoxylate with atropine

A

Dizziness
lethargy/drowsiness
anticholinergic effects of atropine

119
Q

Considerations of diphenoxylate with atropine

A

Know PMHx/Sx
perform complete assessment of bowel movements and GI functioning
report abdominal distention and signs of decreased peristalsis to provider
monitor for S&S of dehydration esp with young children
maintain a safe environment because diphenoxylate with atropine may cause drowsiness or dizziness

120
Q

IBD treatment

A

5-ASA agents, immunosuppressants, biologic therapies and anti-inflammatory drugs

121
Q

Goals of IBD drugs

A

reduce symptoms
keep is remission (immunosuppressive agents)
alyer progression of the disease

NRSG 220 (8 decks)

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