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Pharm 2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Albuterol is a ____ which is a ____. It is used for

A

Beta 2 Adrenergic Agonist; Bronchodilator (opens up lungs)

Used for managing bronchospasms with asthma

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2
Q

Who shouldn’t use Albuterol?

A

Those with uncontrolled hypertension, cardiac dysrhythmia, high risk of stroke

It raises your BP, which can affect any of these heart issues!

Also those who are beta blockers or ingest lots of caffeine! Again, jitters, high BP, etc.

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3
Q

AE of Albuterol if used too often

A

Jittery! Anxiety, palpitations, tremors, tachycardia (again, it raises BP)

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4
Q

Should a beta 2 adrenergic agonist come before or after glucocorticoid? Why?

A

Beta 2 and then glucocorticoid.

Beta 2 opens the lungs and then glucocortoids come in to settle inflammation

Albuterol and then Beclomethasone Dipropionate (All buts before meth)

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5
Q

Ipratropium (Atrovent) is a ____ and is used for____

A

Inhaled anticholinergic; Bronchoconstriction associated with COPD

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6
Q

Ipratropium may cause ____ and shouldn’t be used on those who have ___

A

Dry mouth/hoarseness

Glaucoma, benign prostatic hyperplasia (enlarged prostate gland!), or bladder neck obstruction

Or those taking other anticholinergics (additive effect)

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7
Q

What is the rescue emergency asthma drug?

A

Beta 2!

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8
Q

How do you instruct someone to take an inhaled anticholinergic?

A

Wait 1-2 minutes between doses
Wait 5 minutes before using another inhalent

NOT RESCUE DRUG

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9
Q

Theophylline is a _____ and is taken _____ to treat ____ (remember therapeutic level!)

A

Methylxanthine (anything starting with Theo); taken in pill form to treat asthma long term (bronchodilator)

Therapeutic level - 5-15 mgc/mL (above 15 = AEs - anxiety, insomnia, tremors, seizures, tachyarrhythmias)

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10
Q

Who should not take Theophylline?

A

Those with uncontrolled cardiac dysrhythmias, seizures, hyperthyroidism, or peptic ulcers

Also those who love caffeine*, char broiled foods, high protein and low carb diets, and smoking

*structurally similar to caffeine! makes sense

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11
Q

Beclomethasone Dipropionate is a _____ which is used for ____

A

Glucocorticoid; Long term management of chronic asthma (suppresses inflammation; used after beta 2)

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12
Q

Beclomethasone Dipropionate patient education

A

Oral candidiasis - use spacer and rinse mouth
Use on a regular schedule
Do not use for acute attack (rescue is beta 2)

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13
Q

Montelukast is a ______ and is used for _____ (know how to take for each)

A

Leukotriene modifier; chronic asthma (pm daily), to prevent exercise induced asthma (2 hrs before), or allergic rhinitis (Most common use)

Not PRN for acute attacks

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14
Q

Montelukast interacts with

A

Phenytoin, Phenobarbital, Rifampin

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15
Q

Diphenhydramine is a _____ (know MOA) while Cetirizine is a ____

A

Diphenhydramine (Benadryl) = Sedating antihistamine; binds to H1 receptors
- sedating, take at bedtime - don’t take with CNS depressants! also fall risk

Cetirizine (Zyrtec) = Nonsedating antihistamine; does not bind to H1
- once a day AM, some people are weird and can still get drowsy, monitor!

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16
Q

Diphenhydramine is used for ____

Cetirizine is used for ____

A

Mild allergic reactions, severe anaphylactic reactions, motion sickness, insomnia

Allergic rhinitis and hives (urticaria)

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17
Q

Anticholinergic effects

A

Can’t see, can’t pee, can’t spit, can’t shit!

This happens with Diphenhydramine and very mildly with Cetirizine

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18
Q

Cetirizine interacts with

A

Theophylline and other antihistamines

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19
Q

Phenylephrine is a ____ given via ____ and treats ___

A

Sympathomimetic; Nasal spray; Decreases nasal congestion r/t allergic rhinitis, sinusitis, common cold

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20
Q

Phenylephrine should not be given to those with

A

Chronic rhinitis*, glaucoma, heart disease, HTN, dysrhythmia

*not meant long term (3-5 days; can cause rebound nasal congestion which leads to abuse)

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21
Q

Codeine is a _____ used for _____; contraindicated for

A

Antitussive (opioid! AE and interactions related to this); NON-productive cough r/t allergies or URI

Chronic (b/c opioid) asthma, emphysema, liver/renal disease, acute alcoholism

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22
Q

Dextromethorphan is a ____ used for ____

AE

A

Antitussive (not opioid despite -meth); NON-productive cough r/t allergies or URI

Can still cause CNS depression in large doses (still avoid opioids)

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23
Q

Guaifenesin is a ____ which makes you ____ (used for)

A

Expectorant (Mucinex); cough up stuff so used for productive coughs r/t colds, URI, bronchitis, pneumonia

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24
Q

Guaifenesin patient education

A

Increase fluid intake to thin mucus (easier to cough up)

Be careful with OTC cold products, may contain Guaifenesin as well

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25
Q

Acetylcysteine is a ____ given via ____, which does what?

A

Mucolytic, given via nebulizer; decreases viscosity of mucus (easier to cough up)

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26
Q

Acetylcysteine is used for ___ but should be avoided by ____ (think of AE)

A

Bronchopulmonary disease and CF, and is antidote to acetaminophen overdose

those at risk of/have GI bleed, or severe respiratory insufficiency (decreases thickness of mucus but increases amount of liquid/bronchial secretions in chest)

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27
Q

Nursing considerations for Acetylcysteine

A

Have suction ready (lots of fluid to be sucked out!)
Monitor/assess respirations frequently!
Tell pt about sulfur smell
Make sure nebulizer doesn’t have any metal or rubber parts (degrades those)

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28
Q

What is the MOA of all insulins?

A

Replaces endogenous insulin (insulin made by the body) and regulates glucose metabolism

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29
Q 
Name, onset, peak and duration of all insulins
Rapid
Short 
Intermediate
Long
A

Rapid: 15 min, 1-2 hrs, 3-5 hrs (Lispro)
Short: 30-60 min, 2-3 hrs, 6-10 hrs (Regular)
Intermediate: 1-2 hrs, 4-8 hrs, 10-16 hrs (Isophane suspension)
Long: 1-2 hrs, duration 5-6 hrs, up to 24 with high doses (Lantus)

30
Q

Pramlintide is used for ____ and peak onset is ____

A

Type 1 and 2; within 20 minutes

31
Q

Exenatide is used for ____ and peak onset is ____

A

Type 2; 2 hrs after dosing

32
Q

What should not be mixed in the same syringe as insulin?

A

Pramlintide

33
Q

When should Exenatide be given?

A

60 minutes before morning and evening meals

34
Q

Oral antidiabetics are indicated for ____, and can cause ____

A

Type 2; hypoglycemia, weight gain, GI discomfort

35
Q

Metformin is a ____; nursing considerations

A

Oral antidiabetic

D/C 24 hrs before CT or MRI b/c contrast dye and drug are too much for kidneys to process
Can cause serious GI AE

36
Q

Pioglitazone (Actos) is a ____; what is the black box warning?

A

Oral antidiabetic

Exacerbates CHF

37
Q

Glipizide (Glucotrol) is a ____ that treats ____

A

Oral antidiabetic

Type 2 (second step after Metformin)

38
Q

What are the advantages of glipizide?

A

Onset is 1 hr (fast), low cost, high A1C efficacy

39
Q

Glipizide interactions

A

Sulfonamide antibiotics - glip reduces effect of this

Alcohol - reduces effect of glip

40
Q

Metformin advantages

A

Rarely causes hypoglycemia, reduces chance of CV events, low cost, high A1C efficacy

41
Q

Pioglitazone should be combined with ___ because

A

Other oral antidiabetic because it can take up to three months to show results

42
Q

Pioglitazone interactions

A

Many!

Insulin, Gemfibrozil, Ketoconazole, Green tea, Ginseng, Garlic

43
Q

Glucagon is a _____ that is given ____ and is for ___

A

Glucose elevating drug

IV, IM, subQ

For nonresponsive hypoglycemic pts

44
Q

Levothyroxine is a ____ which is contraindicated in ____

A

Thyroid replacement drug

Recent MI pts and thyrotoxicosis

45
Q

Levothyroxine AEs

Interactions

A

Usually b/c of excessive doses
Causes s/s of HYPERthyroidism

Interacts with many that effect absorption of levo

46
Q

Levothyroxine nursing considerations

A

Have pt take it on an empty stomach, 30-60min before breakfast
Takes up to 6 weeks to have therapeutic effects
Dosed in mcg!!!
Monitor serum TSH and free thyroid levels to know if thyroid function is increasing (this is the goal)

47
Q

Antithyroids are ___ and ___

Both are contraindicated in ____ and AEs are ____

A

Propylthiouracil (PTU) and Iodine 131 (Iodotope)

Contraindicated in pregnancy

Adverse effects of liver and bone marrow toxicity, agranulocytosis

48
Q

Nursing considerations for antithyroids

A

Both - Monitor CBC at baseline and throughout treatment (b/c they can cause agranulocytosis which is similar to neutropenia)

PTU - takes about 2 weeks for symptoms to improve

Iodine 131 - avoid sleeping in the same bed as someone, kissing, or crowds, as you might contaminate other people (radioactive isotope)

49
Q

Adrenal drugs good and bad

A

Good

  • Anti-inflammatory
  • Immunosuppressant
  • Resp. illness
  • Replacement therapy for Addison’s disease

Bad

  • Glaucoma and cataracts
  • Moon face
  • High BS
  • Increased risk of infection
  • Osteoporosis and fractures (in long term use)
50
Q

Adrenal drugs are ____ and ____

A

HydroCORTIsone and FludroCORTIsone

Corticosteroids

51
Q

Adrenal drugs nursing considerations

A

TAPER OFF
Can cause adrenal suppression
No aspirin (additive GI effects) or antidiabetic drugs (leads to elevated BS)

52
Q

Iron deficiency anemia drugs are ___ and ____ which are given to ____ and (who)

A 
Ferrous Sulfate (PO - tablet or liquid)
Iron Dextran (IV or IM)

Treat or prevent iron deficiency anemia (treats blood loss or inadequate intake; prevents in infants/children, pregnant people)

53
Q

Iron deficiency anemia drugs nursing considerations

A

Do NOT give to pts who have other types of anemia

Interactions are many; know what decreases and increases iron absorption

54
Q

PO forms of iron deficiency anemia drugs

A

Tablet

  • Spread doses out evenly across waking hours
  • Give on empty stomach for best absorption, but can take with food to avoid GI upset (BUT NOT MILK)
  • Do not crush or chew sustained released

Liquid

  • Dilute in compatible liquid
  • Use straw (avoids stained teeth)
  • Rinse mouth with water
  • Provide hard candy or gum
55
Q

IV/IM forms of iron deficiency anemia

A

Give test dose to check for hypersensitivity; real dose after 1 hr
Use 2-3 in needle and Z track method
Bolus no faster than 12.4mg/min
Dilute intermittent infusion to 250-500 mL and run no faster than 50 mg/min
Monitor BP

56
Q

Iron toxicity/overdose

A

300 mcg/dL = serious risk
Symptoms
- N/V, ABD pain, dizziness, hypotension, HA
For serious - Coma, shock, seizures

Treatment is treating symptoms and supportive measures

57
Q

Vit B12 deficiency drugs indications (if you say vit B12 def. I will come for you)

A

Pernicious anemia which is caused by a lack of intrinsic factor or vit B12 def.

58
Q

Vit B12 def. drugs AE

Interactions

A

Diarrhea and HYPOkalemia

Folic acid - can mask s/s of vit B12 def.
Alochol, cimetidine, colchicine, aminosalicylic acid

59
Q

Vit B12 def. drug forms

A

Intranasal and parenteral - best for pts with malabsorption syndrome

Intranasal - give 1 hr before/after hot foods

PO - give with food to enhance absorption

60
Q

Vit B12 def. drugs pt education

A

Expect life long treatment (for those that have irreversible deficiencies)
Eat foods high in B12 (dairy, cereal, egg yolks)
Monitor potassium levels and encourage supplement

61
Q

Folic acid is a _____ used for ____

Is NOT used for

A

Antianemic drug
Folate deficiency
Macrocytic anemia
Pregnancy

Vit B12 def., other types of anemia, neonates

62
Q

Folic acid AE/Nursing considerations

A

Flushing/warm sensation with IV (this is normal)
Bright yellow urine (this is also normal)

Give IV SLOW (30-60 seconds or with fluids)
Encourage foods high in folate (green veggies, liver, some cereals, lentils)
Get baseline labs

63
Q

Epoetin Alpha is a _____ used for _____.

It works by

A

Antianemic drug

Chronic renal failure
Zidovudine (HIV treatment)
Preoperative anemia
Chemotherapy

Stimulating the production of RBCs in the bone marrow

64
Q

Epoetin Alpha is contraindicated for

AEs

A 
Uncontrolled HTN
Some malignancies (It can stimulate cancer growth)
Iron deficient anemia

Hypertension
CV events
Progression of some malignancies

65
Q

Epoetin Alpha nursing considerations

A

Obtain baseline for BP, Hgb, Hct, erythropoietin levels
Make sure BP is controlled
Only give to cancer pt who’s Hgb is less than 10

66
Q

The antirheumatic drugs are ____ and _____

Teaching for both

A

Methotrexate
Etanercept

Avoid crowds
Report signs of infection
Don’t give to pts with infection

67
Q

Methotrexate is used for

A

Cancer and RA (lower dose used for RA than cancer)

68
Q

Methotrexate nursing considerations

A

Depresses immune system - DON’T GIVE to pt with infection
Suppresses bone marrow
6ish weeks for therapeutic effects

69
Q

Etanercept is used for

A

Adult and juvenile RA

70
Q

Etanercept nursing considerations

A

If pt is on this med don’t give live vaccines
SubQ - hypersensitive reactions are common
3-6 weeks for therapeutic effects

Pharm 2 (2 decks)

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