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NURS 316A > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What 3 electrolytes, if imbalanced, result in neurotransmission and muscular contraction problems?

A
  1. sodium
  2. potassium
  3. calcium
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2
Q

What are 2 important interruptions that may occur when neurotransmission and muscular contraction occur?

A
  1. cardiac rhythm abnormalities
  2. skeletal muscle function compromise
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3
Q

What are the 2 primary causes of edema?

A
  1. elevated hydrostatic pressure
    • heart failure can result in increased ECF volume
  2. decreased osmotic forces in blood
    • liver failure and protein malnutrition can result in hypoalbuminemia
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4
Q

What are 2 other ways that edema can result?

A
  1. alterations in capillary permeability
    • histamine
    • inflammation
  2. sodium retention
    • illness
    • consumption of salty foods
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5
Q

What are some signs and symptoms of hyponatremia?

A
  • headache
  • lethargy
  • confusion
  • N&V
  • diarrhea
  • muscle cramps/spasms
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6
Q

How is hyponatremia treated?

A

slow replacement of sodium with adequate fluids

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7
Q

What are some signs and symptoms of hypokalemia?

A
  • anorexia
  • cardiac arrhythmias
  • leg cramps
  • prominent U wave, flattened T wave, prolonged PR
  • digitalis toxicity
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8
Q

What are 2 medications that can cause hypokalemia?

A
  1. adrenergic agents – stimulating agents like epinephrine
  2. use of IV dextrose – stimulates insulin release
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9
Q

How is hypokalemia treated?

A

replacement of potassium at acceptable rate

rapid infusion (not PO or IV infusion) may result in cardiac arrest – used as a lethal injection

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10
Q

What is 1 way that hyperkalemia may result?

A

decreased renal perfusion can result in potassium retention

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11
Q

What are symptoms of hyperkalemia?

A

– early symptoms:

  • numbness
  • muscle cramps
  • diarrhea

– can lead to cardiac arrest

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12
Q

What are some signs and symptoms of hypocalcemia?

A
  • neuromuscular excitability
  • paresthesia
  • hypotension
  • cardiac arrhythmias
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13
Q

What can chronic hypocalcemia result in?

A

bone pain and bone fragility

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14
Q

What are 2 causes of hypercalcemia?

A
  1. elevated parathyroid hormone
  2. cancer – malignant cells result in bone destruction
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15
Q

What are some signs and symptoms of hypercalcemia?

A
  • decreased neuromuscular excitability
  • weakness
  • renal calculi
  • cardiac arrhythmias
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16
Q

What are 3 causes of hypophosphatemia?

A
  1. decreased intestinal absorption
  2. increased excretion by kidneys
  3. intracellular shift
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17
Q

What are some signs and symptoms of hypophosphatemia?

A
  • tremors
  • muscle weakness
  • hyporeflexia
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18
Q

What is the most common cause of hyperphosphatemia?

A

kidney failure

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19
Q

What does hyperphosphatemia often accompany?

A

hypocalcemia

Ca2+ and P3+ have a balanced inverse relationship

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20
Q

What are antibiotics? What is the goal of antibiotics?

A

– chemicals that inhibit specific bacteria

– goal is to decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader

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21
Q

What are the 3 ways that antibiotics are made?

A
  1. living microorganisms
  2. synthetic manufacture
  3. genetic engineering
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22
Q

What are bacteriostatic drugs?

A

substances that prevent the growth of bacteria

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23
Q

What are bactericidal drugs?

A

substances that kill bacteria directly

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24
Q

Differentiate between gram-positive and gram-negative bacteria.

A

– gram-positive: bacteria with cell walls that retain a stain, resisting decolorization with alcohol

– gram-negative: bacteria with cell walls that lose stains, decolorized by alcohol

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25
Q

Differentiate between aerobic and anaerobic bacteria.

A

– aerobic: require oxygen for survival

– anaerobic: do not require oxygen for survival

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26
Q

The longer an antibiotic has been in use, what is more likely to develop?

A

greater chance that the bacteria will develop resistance (emergence of a resistant strain)

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27
Q

Describe aminoglycosides:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: infections caused by gram-negative aerobic bacilli

– bactericidal

– contraindications:

  • renal or hepatic disease
  • ototoxic –> hearing loss
  • herpes or mycobacterial infection
  • myasthenia gravis
  • parkinsonism
  • lactation

– adverse effects:

  • ototoxicity
  • nephrotoxicity

– drug-drug interactions:

  • penicillins
  • cephalosporins
  • diuretics
  • neuromuscular blockers
  • succinylcholine
  • citrate anticoagulated blood
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28
Q

Describe carbapenems:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: broad-spectrum (gram+ and gram-) antibiotic

– bactericidal

– contraindications:

  • seizure disorders
  • meningitis
  • pregnancy and lactation

– adverse effects:

  • Pseudomembranous colitis
  • C. diff diarrhea
  • N/V –> dehydration and electrolyte imbalances
  • superinfections – because it kills both gram+ and gram-, including gut flora

– drug-drug interactions:

  • valproic acid
  • meropenem
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29
Q

Describe cephalosporins:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: treatment of infections – similar to penicillin in structure and activity

– bacteriostatic and bactericidal

– contraindications:

  • allergies to cephalosporins or penicillin
  • renal or hepatic impairment

– adverse effects:

  • GI tract:
    • N/V
    • diarrhea

– drug-drug interactions:

  • aminoglycosides
  • oral anticoagulants
  • ETOH (ethanol)
30
Q

Describe fluoroquinolones:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: broad spectrum antibiotic, but mostly used against gram-

– bactericidal

– contraindications:

  • pregnancy or lactation
  • renal dysfunction

– adverse effects:

  • h/a
  • dizziness
  • insomnia
  • depression

– drug-drug interactions:

  • iron salts
  • sucralfate
  • mineral supplements
  • antacids
  • quinidine
  • theophylline
  • NSAIDs
31
Q

Describe penicillins and penicillinase-resistant antibiotics:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: broad spectrum antibiotic – interferes with ability of bacteria to build cell walls

– bactericidal

– contraindications:

  • allergies to penicillins or cephalosporins
  • renal disease
  • caution with pregnant or lactating women

– adverse effects:

  • GI tract

– drug-drug interactions:

  • tetracyclines
  • parenteral aminoglycosides
32
Q

Describe sulfonamides:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: broad spectrum antibiotic – inhibits folic acid synthesis

– bacteriostatic

– contraindications:

  • thiazide diuretics
  • pregnancy

– adverse effects:

  • GI tract
  • renal effects – filtration of the drug

– drug-drug interactions:

  • tolazamide
  • glyburide
  • cyclosporine
33
Q

Describe tetracyclines:

– indication

– bacteriostatic or bactericidal

– contraindications

– adverse effects

– drug-drug interactions

A

– indication: treatment of various bacterial infections and acne when penicillin is contraindicated

– bacteriostatic

– contraindications:

  • allergies to tetracyclines or tartrazine
  • pregnancy or lactation
  • renal or hepatic dysfunction
  • penicillin G
  • oral contraceptive therapy
  • methoxyflurane
  • digoxin

– adverse effects:

  • GI tract
  • damage to teeth and bones
  • photosensitivity

– drug-drug interactions:

  • penicillin G
  • oral contraceptives
  • digoxin
  • administer on empty stomach
34
Q

What are the 5 ways that anemia could develop?

A
  1. deficiencies
    • iron
    • vitamin B12
    • folic acid
    • poor nutrition
  2. blood loss
    • chronic
    • acute
    • GI bleeds
  3. hemoglobinopathies
  4. medications
  5. hemolysis
35
Q

What are the major signs and symptoms of anemia?

A
  • GI tract blood loss
  • menorrhagia – heavy menstrual periods
  • pale complexion
  • tachycardia
  • jaundice
  • splenomegaly – breakdown and collection of RBCs
  • nutritional anemia:
    • glossitis
    • cheilitis – inflammation of lips
    • koilonychia – spoon nails
    • pica

– anemia can be asymptomatic

36
Q

Describe iron:

– indication

– pharmacokinetics

– adverse effects

– food-drug interactions

A

– indication: treatment of iron deficiency anemias; adjunctive therapy with Epoetin Alfa – raises serum iron

– pharmacokinetics:

  • absorbed in small intestines
  • binds to transferrin
  • transported in the blood
  • small amounts lost in sweat, urine, sloughing of skin, mucosal cells, and intestinal cells

– adverse effects:

  • oral – GI irritation and CNS toxicity
  • parenteral iron – anaphylaxis, local irritation, staining of tissues, phlebitis

– food-drug interactions:

  • eggs
  • milk
  • coffee
  • tea
  • acidic liquids
37
Q

What 2 things could result from a vitamin B12 deficiency?

A
  1. anemia
  2. neurological issues
38
Q

What are some ways that vitamin B12 deficiency could develop?

A
  • lack of intrinsic factor – needed for B12 absorption
  • pernicious anemia – intestines cannot absorb B12
  • dietary deficiency
  • gastric atrophy
  • chronic Helicobacter pylori infection
  • chronic alcoholism
  • gastric bypass surgery
  • Crohn’s disease
39
Q

What are the 2 ways that vitamin B12 anemia is treated?

A
  1. address underlying etiology
  2. IM B12 injections
40
Q

What are erythropoietins?

A

secreted by the kidneys; stimulate the bone marrow to make more RBCs

41
Q

What are 3 drugs that mimic the action of erythropoietin?

A
  1. Epoetin Alfa (Epogen, Procrit)
    • treats anemia associated with renal failure and AIDS
    • decreases need for blood transfusions in pts undergoing surgery
  2. Darbopoetin Alfa (Aranesp)
    • treats anemia associated with chronic renal failure – pts on dialysis
  3. Methoxy Polyethylene Glycol-Epoetin Beta (Mircera)
    • treats anemia associated with chronic renal failure – pts on dialysis
42
Q

Describe antiplatelets:

– actions

– indications

– pharmacokinetics

A

– actions:

  • inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane
  • anagrelide – blocks production of platelets in bone marrow

– indication:

  • reduce risk of transient ischemic attacks (TIAs), stroke, and MI
  • anti-inflammatory
  • analgesic
  • anti-pyretic

– pharmacokinetics:

  • well absorbed
  • binds to plasma proteins
  • metabolized in liver
  • excreted in urine
43
Q

Name one type of antiplatelet drug.

A

aspirin

44
Q

Describe anticoagulants:

– action

– contraindications

– indications

– adverse effects

A

– action: interferes with normal cascade of clotting process

– contraindications:

  • allergy
  • pregnancy
  • renal or hepatic disorders

– indications:

  • prevents and treats thrombus and PE formation
  • treats atrial fibrillation

– adverse effects:

  • bleeding
  • GI upset
  • hepatic dysfunction
  • alopecia
  • dermatitis
  • bone marrow suppression
  • prolonged and painful erection
45
Q

Name one type of anticoagulant.

A

heparin

46
Q

Describe thrombolytics:

– action

– indications

– pharmacokinetics

– adverse effects

A

– action: breaks down thrombi that have been formed by stimulating plasmin system

– indications:

  • acute MI
  • PE
  • ischemic stroke

– pharmacokinetics:

  • must be injected
  • are cleared from the body after liver metabolism
  • pregnancy and lactation

– adverse effects:

  • bleeding
  • cardiac arrhythmias
  • hypotension
  • hypersensitivity – rash, flushing, bronchospasm, anaphylaxis
47
Q

Name one type of thrombolytic.

A

urokinase

48
Q

What are the 5 functions of the kidneys?

A
  1. acid-base balance
  2. waste elimination
  3. secretory function
  4. vitamin D synthesis and calcium balance
  5. glucose homeostasis
49
Q

How do the kidneys function in acid-base balance?

A

excrete and absorb H+ ions and bicarbonates as needed

50
Q

How do the kidneys aid in waste elimination?

A

eliminate urea, uric acid, creatinine, and drugs from the blood

51
Q

What are the kidneys’ secretory functions?

A
  • secretion of erythropoietin (EPO)
    • increase RBCs in response to hypoxia
  • secretion of renin
    • released in response to low BP or perfusion
  • activation of renin-angiotensin-aldosterone (RAAS)
52
Q

How do the kidneys function in vitamin D synthesis and calcium balance?

A
  • kidneys activate vitamin D
  • vitamin D aids in calcium absorption
53
Q

How do the kidneys function in glucose homeostasis?

A
  • renal threshold to reabsorb glucose (180 mg/dL)
    • if exceeded, glucose excreted in urine
  • degradation of insulin
  • gluconeogenesis
54
Q

What are the 3 categories of renal dysfunction? Describe each.

A
  1. prerenal: decreased blood flow and perfusion to the kidney
  2. intrarenal: actual injuries to the kidney
  3. postrenal: obstruction of urine outflow from the kidney
55
Q

Describe thiazide diuretic:

– action

– indication

– adverse effects

A

– action: blocks chloride pump, increasing excretion of Na+, Cl-, H2O

– indication: treatment of edema associated with HF, cirrhosis, corticosteroid or estrogen therapy, and renal dysfunction; treatment of HTN

– adverse effects:

  • GI upset
  • CNS complications
  • hypovolemia
56
Q

Name one type of thiazide diuretic.

A

hydrochlorothiazide

57
Q

Describe loop diuretics:

– action

– indication

– adverse effects

A

– action: blocks chloride pump in ascending loop of Henle

– indication: treatment of edema associated with HF, acute pulmonary edema, and hypertension

– adverse effects:

  • hypokalemia
  • volume depletion
  • hypotension
  • hyperglycemia
  • GI upset
58
Q

Name one type of loop diuretic.

A

furosemide

59
Q

Describe potassium-sparing diuretics:

– action

– indications

– adverse effects

A

– action: blocks effects of aldosterone in renal tubule, causing loss of sodium and water, and retension of potassium

– indication:

  • treatment of hyperaldosteronism
  • treatment of edema associated with HF, nephrotic syndrome, hepatic cirrhosis
  • treatment or prevention of hypokalemia

– adverse effects:

  • hyperkalemia
  • diarrhea
60
Q

Describe osmotic diuretics:

– action

– indications

– adverse effects

A

– action: elevates osmolarity of glomerular filtrate, causing loss of water, sodium, and chloride

– indications:

  • prevention and treatment of oliguric phase of renal failure
  • reduction of intracranial pressure – treats cerebral edema
  • diagnostic measurement of GFR

– adverse effects:

  • hypotension
  • GI upset
  • fluid and electrolyte imbalances
61
Q

What is obstructive uropathy?

A

inability of urine to drain from the urinary tract; most common pathophysiological problem in the urinary tract

62
Q

What are renal calculi?

A

kidney stones

63
Q

Who commonly gets kidney stones? What is a common cause?

A

– men 60+ years old

– BPH common cause

64
Q

What may occur if kidney stones obstruct the urinary tract for too long?

A
  • prolonged obstruction leads to increased hydrostatic pressure in nephrons, decreasing GFR
  • urine backs up into kidneys (hydronephrosis)
  • results in nephron death – nephron function does not recover
65
Q

How common are UTIs in the US? What population experiences UTIs most frequently? What types of patients are at greater risk for developing UTIs?

A

– 2nd most common infection in the US

– females experience UTIs more frequently

– patients with indwelling catheters or intermittent catheterization are at greater risk

66
Q

What are some signs and symptoms of UTIs?

A
  • urinary frequency
  • urgency
  • burning with urination – associated with cystitis (inflammation of the bladder)
  • chills, fever, flank pain, tenderness – associated with acute pyelonephritis (kidney infection)
67
Q

What organisms are the most common cause of lower UTIs?

A
  • E. coli
  • Proteus – more commonly associated with catheterization or use of urinary instruments
  • Pseudomonas
  • Klebsiella
68
Q

Where are bacteria normally located in a healthy urinary tract?

A

urethral opening only

69
Q

What factor increases the risk of urinary tract infection?

A

stagnant urine

70
Q

Name one type of potassium-sparing diuretic.

A

spironolactone

NURS 316A (3 decks)

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