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305 FINAL (study guide questions) Flashcards

1
Q

Different Routes of Drug Admin

A

-Oral (30-45min onset)
-Sublingual (3-5min onset)
-Subcutaneous (15-30min onset)
-IM (10-20min onset)
-IV (1-3min onset)
-Inhalation (1-5min onset)
-Topical (1-30min onset)

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2
Q

What happens during the first pass effect?

A
  1. Oral drug taken
  2. Drug absorbed across the intestinal mucosa
  3. Drug enters portal circulation and travels to liver
  4. On first pass through the liver, drug is metabolized to less active forms
  5. Drug metabolites (less active) leave the liver for distribution to tissues
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3
Q

How can CYP450 affect drug metabolism and what food should be avoided?

A

-Inactivates drugs and accelerates their excretion
-Sometimes creates metabolite that produces a greater therapeutic effect
EX: codeine metabolized to morphine

AVOID grapefruit juice

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4
Q

Assessment for ADPIE

A

-Health history
-Baseline data
-Med use, otc use, illicit drug use, lifestyle, habits, reproductive history
-Most important step (creates baseline)

Reassessment
-Desired response?
-Adverse effects?
-Pt capability of assuming responsibility for self-care

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5
Q

Nursing Diagnosis for ADPIE

A

-Focus on pt needs
-Promote therapeutic drug effect
-Minimize adverse effects
-Maximize pt self care

Risk diagnosis:
1. Diagnostic statement
2. Related factor or inferred cause

Actual Diagnosis
1. Diagnostic statement
2. Related factor or inferred cause
3. Evidence to support statement

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6
Q

Planning for ADPIE

A

-Goals for pt

Outcomes for pt
-Evaluate degree of goal completion
-Focus on what pt will do
-Discussed with pt or caregiver
-Should be written

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7
Q

Implementation for ADPIE

A

-Administer
-Continue
-Monitor
-Carry out
-Provide education

Monitor Med
-Admin of med, therapeutic/adverse effects, pt statements, objective data

Patient education
-Primary role for nurses
-Implement teach back

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8
Q

Evaluation for ADPIE

A

-Compare current status with goals
-Evaluation begins new cycle when
1. New assessment data gathered/analyzed
2. Nursing diagnosis reviewed/rewritten
3. Goals or outcomes are refined
4. New interventions are carried out

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9
Q

Nurse’s responsibilities for reporting med error

A

-Legal and ethical responsibility to report all errors
-Report errors and near misses
-Report observed errors and near misses
-FDa coordinates reporting of med errors
1. MedWatch
2. NCC MERP
3. DMEPA

Document
-Med given
-Monitor VS
-Assess for adverse effects
-Notify provider
-Document everyone notified
-Inform patient

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10
Q

What can be done to prevent med errors?

A

-Look up med
-Assess pt to get baseline
-5 rights, 3 checks
-Educate pt about med before giving
-Reassess client after med
-Watch for look alike, black box warning, narrow therapeutic window
-Clarify confusing orders
-2 client identifiers

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11
Q

Adverse effects of alendronate (Fosamax)

A

-Diarrhea
-Nausea
-Vomiting
-GI irritation
-Metallic or altered taste
-Pathologic fractures with long term use

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12
Q

What is alendronate (Fosamax) used to treat

A

To prevent postmenopausal osteoporosis

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13
Q

How to screen for lice

A

-Look for eggs and debris on hair shaft
-Called nits

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14
Q

What is used to treat lice?

A

lindane (kwell)

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15
Q

Superficial burn characteristics

A

-Red
-Painful
-Dry
-No blisters

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16
Q

Partial thickness burn characteristics

A

-Red
-Blistered
-Swollen
-Painful

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17
Q

Full thickness burn characteristics

A

-White or charred
-No pain since nerve endings are destroyed

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18
Q

Admin of ear drops to child/adult

A

-Lie on side
-Pull up and back for adults
-Pull down and back for child

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19
Q

Key teaching points when administering topical scabicide

A

-Monitor daily for 1-2 weeks

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20
Q

Know risk factors for atopic dermatitis

A

-Tend to have family history of eczema
-Chronic-genetic disposition
-Family history of asthma

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21
Q

Adverse effects of hypocalcemia (CRAMPSS)

A

-Convulsions
-Reflexes hyperactive
-Arrhythmias
-Muscle spasms
-Positive Trousseau’s and Chvostek’s signs
-Sensation of tingling/numbness
-Stridor (bronchospasms and laryngospasms)

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22
Q

Hypercalcemia Adverse Effects

A

-Painful bones (and fractures)
-Kidney stones (calcium bases)
-Tired moans (muscle weakness)
-GI groans (nausea and vomiting)
-On the throne (polyuria and constipation)
-Psych overtones (altered mentation, psychosis, forgetfulness, stupor)

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23
Q

Adverse Effects of raloxifene

A

-Hot flashes
-Migraine
-Flu like symptoms
-Endometrial disorder
-Breast pain
-Vaginal bleeding
-Potential fetal harm

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24
Q

Use of raloxifene

A

Prevent and treat osteoporosis

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25
Common side effects of timolol eyedrops
-local burning and stinging upon instillation
26
Use for timolol eyedrops
Used to treat glaucoma
27
First line drug for osteoarthritis
-Tylenol (acetaminophen)
28
Therapeutic uses of trentinoin
-Treat and control mild to moderate acne vulagris
29
Adverse effects of trentinoin
-Dry skin, erythema, itching, photosensitivity -Don't give to people with fish allergy
30
Characteristics of Rosacea
-Non pustule papules -Flushed face around nose and cheeks -Soft tissues of nose may swell (rhinophyma)
31
Rosacea Treatments
Benzoyl Peroxide
32
Known precautions and contraindications for lindane (Kwell)
-Use only after other treatments have failed -Need RX -Known to cause seizures
33
What is lindane (Kwell) used to treat
-Lice and scabies
34
What is the function of the dermis?
-Foundation for hair and nails -Contains nerve endings, oil glands, sweat glands, blood vessels
35
Know the use of calcium salts and nursing administration
-Prevent and treat mild hypocalcemia for osteoporosis -Paget disease -Chronic hypoparathyroidism -Rickets -Pregnancy and lactation -Rapid childhood growth
36
Adverse effects of calcium salts
-Hypercalcemia -Dysrhythmias -Cardiac Arrest
37
allopurinol adverse effects and nursing admin
-Steven-johnson syndrome -Hypersensitivity syndrome, drowsiness, headache, vertigo -Give after or with meals. May be crushed and mixed with food or fluids
38
What is allopurinol used to treat
Gout
39
allopurinol Adverse Effects
-Stevens-Johnson sydrome
40
Nursing considerations and how to assess for effectiveness of biophosphonate therapy
Bone density scan
41
What is biophosphonate used to treat?
osteoporosis
42
Modifiable risk factors for osteoporosis
-No alcohol or tobacco -Increase physical activity -Increase vitamin D or calcium
43
Signs and symptoms of gout
-Extreme pain, red, inflamed tissue -Sudden onset, often at night -Can be triggered by alcohol, dehydration, stress, joint injury, or fever
44
What is used to treat gout
allopurinol
45
Adverse effects of topical glucocorticoids
-No serious adverse effects -Usually stinging, burning, redness of skin
46
Adverse effects of PO and sub q psoriasis drugs
-Malignancies -Serious infections -Skin peeling -Depression -Myocardial infarction (MI) -Gingival enlargement
47
Symptoms of psoriasis
-Red patches of skin covered with flaky-silver-colored scales (plaques)
48
What is the treatment of rickets?
-Calcium salts -Returns serum calcium levels to normal
49
What happens when there is high levels of calcium in the bloodstream?
-Hypotension -Bradycardia -Dysrhythmias and cardiac arrest
50
Adverse Effect of topical medications for psoriasis
Common Side Effects -Stinging, irritation, itching Adverse Effects -Paresthesia, arthralgia, malignancies, infections, elevated liver function tests
51
Epidermis Layers
Stratum Corneum -outermost, strongest layer -large amount of keratin -forms barrier to repel bacteria and foreign matter Stratum basale: -deepest layer -supplies new cells to epidermis Middle layers -stratum spinosum -stratum granulosum -stratum lucidum
52
Names and areas of different fungal infections
-Tinea pedis (athletes foot) -Tinea cruris (jock itch) -Tinea capitis (ringworm on scalp) -Tinea unguium (nails)
53
What should you do when taking antibiotics?
Finish the entire series
54
Open angle glaucoma
-Resistance to drainage of aqueous humor through trabecular meshwork -Usually bilateral
55
Closed angle glaucoma
-Drainage channel is blocked usually by the iris -Usually unilateral
56
Know admin technique for eyedrops
-Tilt head back -Pull lower lid down creating a pocket -Put a drop in the pocket without touching eye with the bottle -Close eye and press finger against the inside corner of eye
57
What meds are given for both open angle and closed angle glaucoma
Prostaglandins -Dilate trabecular meshwork -Increase aqueous humor outflow Beta-adrenergic blockers -Decrease production of aqueous humor -Adverse Effects: Bronchoconstriction, dysrhythmias, hypotension Alpha2-adrenergic agonists -Decrease production of aqueous humor Carbonic anhydrase inhibitors -Decrease production of aqueous humor
58
Symptoms of otitis media
-Associated with upper respiratory infections and allergies -Auditory tube irritation
59
Adverse effects of Raloxifene
Hot flashes, migraine, headache, breast pain, vaginal bleeding, flu-like symptoms
60
What is Raloxifene used to treat?
-Prevent osteoporosis in postmenopausal women -Decrease bone resorption
61
Adverse effects and education for Humira
-Injection site pain, upper respiratory infection, headache, rash -Increased risk for serious infections and malignancies (TB and Hep B, leukemias, lymphomas)
62
What is Humira used to treat?
-Reduce signs and symptoms of moderate to severe rheumatoid arthritis -Psoriasis
63
Permethrin uses and contraindications
-used to treat scabies and pediculides -chrysanthemums are a contraindication
64
Psoriasis vulgaris characteristics
-Lesions that form into plaques -Usually silver or grey and bleed when removed
65
Psoriatic arthritis
-Resembles rheumatoid arthritis -Fingers and toes are most common sites
66
Risk factors for Glaucoma
-Long term use of some meds (glucocorticoids, antihypertensives, antihistamines, antidepressants) -Hypertension -Mirgraines -Severe near or farsightedness -Normal aging
67
What pressure range indicates need for treatment of glaucoma?
21-30 mmHg OR Signs of optic nerve damage or visual-field changes are present

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