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z S1: Self Care > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

For nicotine absorption, it is _____ dependent

A

pH

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2
Q

The more basic a compound is then the _____ it is absorbed

A

better

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3
Q

Acidic media (limited absorption)

A

cigs

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4
Q

Alkaline media (significant absorption)

A

pipes
cigars
tobacco
oral nicotine products

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5
Q

Nicotine is well absorbed in the where

A

small intestine (low bioavailability)

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6
Q

Nicotine is rapidly absorbed across respiratory epithelium through what mechanisms

A

lung pH = 7.4
large alveolar surface area
extensive capillary system

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7
Q

Approximately __ mg of nicotine is absorbed from each cig

A

1 mg

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8
Q

How does excretion of nicotine occur

A

through kidneys
through breast milk

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9
Q

Nicotine has predominantly ____________ effects

A

stimulatory

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10
Q

CNS nicotine pharmacodynamics

A

pleasure
arousal
improved task performance
anxiety relief

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11
Q

Cardiovascular system nicotine pharmacodynamics

A

Increase heart rate
Increase cardiac output
Increase blood pressure
Coronary vasoconstriction
Cutaneous vasoconstriction

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12
Q

Most nicotine symptoms manifest within the first ___ to ___ days peak within the first week and subside within __ to ____ weeks

A

1-2 days
2-4 weeks

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13
Q

Tobacco users maintain a minimum serum nicotine concentration in order to:

A

prevent withdraw symptoms
maintain pleasure
modulate mood

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14
Q

Users self-titrate nicotine intake by

A

smoking/vaping more frequently and intensely

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15
Q

Tobacco use is mainly associated by what environmental factor

A

conditioned stimuli

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16
Q

Treatment for tobacco dependence should address the ___________ and __________ aspects of dependence

A

physiological and behavioral

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17
Q

Pharmacotherapy is not recommended for what patients

A

pregnant smokers
smokeless tobacco users
individuals smoking fewer than 10 cigs a day
adolescents

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18
Q

Nicotine replacement therapy (NRT) rational for use

A

-reduces physical withdraw from nicotine
-eliminates the immediate, reinforcing effects of nicotine that is rapidly absorbed via tobacco smoke
-allows patient to focus on behavioral and psychological aspects of tobacco cessation

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19
Q

NRT products approximately _________ quit rates

A

doubles

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20
Q

NRT precautions

A

patients with underlying cardio disease
-recent MI
-serious arrhythmia
-serious or worsening angina

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21
Q

What is the mg strengths that nicotine gum and lozenges come in

A

2 and 4 mg

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22
Q

When do you use 2 mg gum/lozenge

A

if first cig is smoked more than 30 min after waking

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23
Q

When do you use 4 mg gum/lozenge

A

if the first cig is smoked within 30 min of waking

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24
Q

What is the recommended baseline of gum/lozenges that someone should use a day

A

9 pieces (1 piece q 1-2 hr through wk 1-6)

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25
Q

When using gum or lozenges do not eat or drink for _____ minutes before or while using it

A

15

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26
Q

Chewing lozenge or using incorrect gum chewing technique can cause excessive and rapid release of nicotine resulting in what

A

lightheadedness/dizziness
nausea and vomiting
hiccups
irritation of throat and mouth

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27
Q

Transdermal nicotine patch

A

24 hour patch
avoids hepatic first-pass metabolism
nicotine levels are lower and fluctuate less than with smoking

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28
Q

Light smoker transdermal patch dosing

A

<10 cig a day
14 mg * 6 weeks

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29
Q

Heavy smoker transdermal patch dosing

A

> 10 cigs a day
21 mg * 6 weeks

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30
Q

When using a transdermal patch it is best not to use the same area for about how long

A

1 week

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31
Q

It is important to remove nicotine patch before MRI appointments because why

A

all patches have metal in them

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32
Q

Transdermal nicotine patch common adverse effects

A

irritation at the patch site
mild itching
burning
tingling
sleep disturbances

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33
Q

What is one of the main disadvantage of transdermal nicotine patches

A

when used as monotherapy they can not be titrated

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34
Q

If skin stays red more than ___ days or if it swells or a rash appears, contact a health provider

A

4

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35
Q

What are the 5 A’s of smoking cessation

A

Ask (about use)
Advise (to quit)
Assess (readiness to quit w/in 30 days)
Assist (quit attempt)
Arrange (follow-up care)

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36
Q

The common cold defn

A

a self-limiting viral infection of the upper respiratory tract
(late autumn through spring)

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37
Q

Self-inoculation of flu

A

the most common and effective method (contact with surface then touch eye)

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38
Q

Methods of flu prevention

A

wash hands frequently (soap, alcohol)
Avoid touching nose and eyes
Avoid close contact with infected
Clean environmental surfaces in hared public spaces

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39
Q

Pathophysiology of common cold

A

virus attaches to mucous membrane
cell defense activated
chemical mediators of inflammation released
cholinergic stimulation
inflammation of the mucous membrane
vasodilation of nasal

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40
Q

Duration of cold

A

few days
typical about a week
25% of colds last >2 weeks

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41
Q

Scratchy throat sore throat symptom

A

most noticeable on day 1
usually present for only the first couple days
may or may not need treatment
(may use oral analgesics)

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42
Q

Sneezing symptom

A

Minimal; It is not the same as allergic sneezing not a concern

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43
Q

Runny Nose symptom

A

usually brief at start of illness
variable in clinical significance
clear and runny secretions at first
secretions then become thicker and harder to drain
may or may not need treatment
(first gen antihistamine)

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44
Q

Nasal Congestion “stuffy head” symptoms

A

nearly 100% of pts have nasal involvement
present for several days
often the most bothersome symptom people seek help for
decongestants

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45
Q

Cough symptoms

A

Infrequent
usually appears by day 4-5
often not bothersome until nasal symptoms subside

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46
Q

Systemic Complaints

A

usually absent of minimal severity if present
may or may not need treatment
oral antigesics

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47
Q

What to use for systemic complaints or scratchy/sore throat

A

acetaminophen
NSAIDs

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48
Q

Key point of runny nose

A

histamine is not the the cause of a runny nose

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49
Q

First generation antihistamines ______ relieve a runny nose from the common cold

A

MIGHT (anticholinergic activity)

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50
Q

Effectiveness of first gen antihistamines in runny nose

A

reduce sneezing
adults: some effectiveness
children: ineffective for the common cold
(No way to predict if patient will respond)

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51
Q

Adverse effects of first gen antihistamine in runny nose

A

drowsiness/sedation
drying effect (thickened nasal discharge, increase duration of nasal congestion)

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52
Q

Precautions of first gen antihistamine in runny nose

A

narrow angle glaucoma
urinary retention (worsen BPH)

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53
Q

Available ingredients in first gen antihistamine in runny nose

A

Doxylamine succinate (nyquil)
Chlorpheniramine maleate (most common)
Brompheniramine (Dimetapp)
Diphenhydramine (“nighttime” use)
-6 year age limit

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54
Q

Nasal Decongestants MOA

A

sympathomimetic activity
alpha-receptor stimulation constricts blood vessels in the nasal mucosa

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55
Q

FDA approved uses nasal decognestants

A

temporarily relief of sinus congestion and pressure
nasal congestion due to the common cold, hay fever or other upper respiratory allergies

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56
Q

Dosage Forms for nasal decongestants

A

Oral
Topical - nasal sprays and vapor inhalers

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57
Q

Pseudoephedrine (sudafed)

A

has cardiac effects due to beta-receptor stimulation (not for CV disease)
crosses BBB acts as CNS stimulant (cause insomnia)

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58
Q

Pseudoephedrine immediate release dosages

A

30mg tab, 15mg/5ml liquid
4-6 hours up to 4 doses/24 hours
>12 60mg (max 240mg)
6-11 30mg (max 120mg)
4-5 15mg (max 60mg)

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59
Q

Pseudoephedrine sustained release dosage

A

120mg SR tab q12hrs or 240mg ER tab doses q24hrs
age: >12 years

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60
Q

Issues with Pseudoephedrine (sudafed)

A

legal (minimize drug diversion for methamphetamine production)
CNS stimulation
wearing off of SR or ER products

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61
Q

Phenylephrine HCL (Sudafed-PE)

A

low oral bioavailability due to extensive 1st pass effect and erratic absorption
short half-life
(not for CV patients)
decrease CNS stimulation than Phenylephrine HCL

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62
Q

Dosage form Phenylephrine HCL immediate release

A

10mg tabs, 2.5mg/5ml
q4hrs up to 6 doses per day
>12 yrs 10mg (max 60mg)
6-11 yrs 5 mg (max 30mg)
4-5 2.5 mg (max 15mg)

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63
Q

Issues with phenylephrine

A

controversy over efficacy
CNS stimulation (less common)

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64
Q

Contraindication with Phenylephrine HCL

A

patients using antidepressant drugs MAO-I
(could give hypertensive crisis)
Nardil (phenelzine)**
Parnate (tranylcypromine)
Marplan (isocarboxazid)

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65
Q

Pregnancy indications in nasal decongestants

A

do not use except under physician advice
no self care
vasomotor rhinitis cause by increase estrogen and pregnancy causes this

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66
Q

Lactation and Breastfeeding in nasal decongestants

A

Phenylephrine not compatible
Pseudoephedrine is okay?? (known to decrease milk production) -> talk to physician

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67
Q

Topical Nasal Decongestants MOS

A

sympathomimetic vasoconstrictor; act locally on the nasal mucosa; acts very rapidly

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68
Q

Liquid nasal sprays

A

age limitation depends on drug
usually >6 or >12 yo
Parents should be discouraged from using these products in children

69
Q

Oxymetazoline

A

administered q10-12 hours (max 2 doses in 24 hrs)
>12 yo
Afrin

70
Q

Phenylephrine

A

q4hrs
pts >6 or >12 yo
Neosynephrine

71
Q

Warnings for nasal decongestants

A

heart disease
high BP
difficulty urinating due to enlarge prostate
rebound congestion (rhinitis medicamentosa, when drug wears off)
do not use longer than 3 days

72
Q

When might the nasal sprays be appropriate to consider recommending

A

when someone can not take sudafed
take at bedtime (no insomnia)

73
Q

Vapor Inhaler (medicated) age

A

> 6 yo
(can use in cardiac disease)

74
Q

Ingredients in vapor inhalers

A

levmetamfetamine
-max use 7 days
propylheadrine
-max 3 days

75
Q

Purpose of coughing

A

defensive mechanism; clears airways of inhaled or foreign material, excess mucus, abnormal secretion such as fluid, blood, pus

76
Q

Non-productive cough/dry cough/hacking cough

A

-stimulated by a mechanical irritant, other type of irritant or inflammation
-excessive coughing can cause damage to respiratory structures
(can suppress cough with drugs)

77
Q

Productive cough/wet cough

A

-associated with an underlying inflammatory process
-secretions may be clear, purulent, discolored, blood-tinged or foul-smelling
-self-care may not be appropriate based on other symptoms

78
Q

Appropriate use of expectorants/protussive ingredients

A

to make an ineffective produce cough become productive
(increase effectiveness of cough by making mucus thinner)

79
Q

guaifenesin (mucinex) dosing and adverse effects

A

should be taken with water to make more effective
> 12 yrs higher dose
>4 yo peds dosing

80
Q

guaifenesin (mucinex) adverse effects

A

nausea
GI upset

81
Q

cough suppressant/antitussive ingredient appropriate use

A

for some nonproductive coughs (dry cough)

82
Q

dextromethorphan (delsym)

A

non-narcotic; no addictive properties at normal antitussive doses
no sedative, analgesic, or respiratory depressive properties at normal doses

83
Q

dextromethorphan (delsym) MOA

A

acts centrally in the medulla
depresses the cough center which increases the cough threshold

84
Q

dextromethorphan (delsym) dosing

A

> 12 max, 10-20 mg q4hr, 120mg/24 hrs
4 peds
(OHIO legal issue 18yo to purchase w/ prescription)

85
Q

dextromethorphan (delsym) contraindications

A

in people taking or w/in 14 days of using MAOI antidepressant
DM
serotonin syndrome

86
Q

What patient types are at high risks for flu

A

65 yo and older
people with chronic medical conditions
pregnant women
younger children

87
Q

For 1st gen antihistamines label warning now include do NOT use “…”

A

to make child sleepy

88
Q

Modification of OTC cough and cold products to state do not use in children under ___ yo

A

4

89
Q

Patient assessment indications

A

allergy
common cold
flu

90
Q

Patient assessment symptoms

A

how bothersome
options for treatment
side effects

91
Q

Patient assessment patient factors

A

age
allergies
medical conditions
medications
pregnancy
breastfeeding

92
Q

RDA (recommended dietary allowance)

A

nutrient intake that meets the needs of ~98% of healthy Americans
developed by the National Academy of Sciences
subdivided by sex and age

93
Q

RDI (reference daily intake)

A

established by FDA
based on RDA values

94
Q

% Daily Value (DV) calculation

A

(# nutrient per serving/RDI) *100

95
Q

AI (adequate intake)

A

when insufficient evidence exists to set an RDA

96
Q

UL (tolerable upper intake level)

A

highest level of daily nutrient intake that is likely to pose no adverse health risk for almost all individuals in the general population

97
Q

What are the fat-soluble vitamins

A

A: retionol bio active, beta carotene (from animals)
D: D2 and D3 in foods, supplements
E: (alpha-tocopherol)
K: synthesized by intestinal bacteria

98
Q

What are the water-soluble vitamins

A

C: ascorbic acid (antioxidant, immune function, blood vessels, collagen)

99
Q

What are the actual names of vitamin B1, B2, B3, B5, B6, B7, B9 and B12

A

B1: thiamine
B2: riboflavin
B3: niacin
B5: pantothenic acid
B6: pyridoxine
B7: biotin
B9: folate
B12: cobalamin

100
Q

Populations of concern for vitamin B9 (folic acid)

A

women of childbearing age
pregnant women (w/o can lead to neural tube birth defects)
alcoholism/malabsorption disorders

101
Q

The labeling of folic acid supplements has changed to account for what

A

the bioavailability of synthetic folic acid is greater than the folate in foods

102
Q

RDA of adult females and pregnant females for folic acid

A

adult: 400 mcg DFE
pregnant: 600 mcg

103
Q

UL of folic acid

A

1000 mcg

104
Q

Vitamin B12 (cobalamin) RDA

A

2.4 mcg/day

105
Q

populations of concern for cobalamin

A

vegans
adults >50 yo (from decrease in stomach acid secretion)
people who use PPIs
patients on longterm metformin

106
Q

Irons

A

mineral required for adequate hemoglobin and functioning of RBCs

107
Q

UL of iron

A

45 mg (can be hard to tolerate)

108
Q

what does tannins in coffee and tea do to iron

A

decrease absorption

109
Q

what does vitamin C do to iron

A

increase absorption

110
Q

Magnesium

A

electrolyte cofactor involved in a wide variety of functions and processes in the body

111
Q

RDA and UL of magnesium

A

males 400mg
females 300mg
UL: 400 mg

112
Q

Common uses for magnesium

A

constipation
muscles
insomnia

113
Q

Who should not take magnesium

A

people with severe kidney disease

114
Q

Who might benefit from taking a multivitamin

A

-eat poorly due to disease, socioeconomic, EtOH abuse, older age
-eliminate a variety of food sources from their diet
-malabsorption problems
(fills gap in diet)

115
Q

Safety issues for multivitamins

A

children
elderly (tough to swallow pills)

116
Q

What is heartburn

A

a symptom of burning sensation in the chest that can spread to neck and back (usually w/in 1 hr of eating)

117
Q

What is episodic heartburn

A

infrequent/occasional
may be associated with diet/lifestyle

118
Q

What is frequent heartburn classified as

A

> 2 days per week

119
Q

What is dyspepsia

A

Symptoms of epigastric discomfort; pain, burning, fullness, early satiation, bloating, belching, nausea

120
Q

What is GERD (gastroesophageal reflux disease)

A

Disease with esophageal symptoms or tissue injury from gastric acid flowing back into the esophagus or beyond

121
Q

Typical Symptoms of GERD

A

frequent heartburn
regurgitation
water brash

122
Q

Atypical Symptoms of GERD

A

noncardiac chest pain
asthma
laryngitis, hoarseness, chronic cough, pnemonitis
dental erosion
globus sensation

123
Q

What is PUD (peptic ulcer disease)

A

disease with sores/ulcers in stomach lining or duodenum

124
Q

Pathophysiology of heartburn: Anti-Reflux Barriers

A

lower esophageal sphincter
diaphragmatic crura
phernoesophageal ligaments
acute angle of His

125
Q

Pathophysiology of heartburn: esophageal acid clearance

A

peristalsis
saliva secretions
gravity

126
Q

Pathophysiology of heartburn: tissue resistance

A

blood supply replenishes tissues w/ nutrients and removes hydrogen and CO2

127
Q

Risk factors of heartburn

A

diet
lifestyle
diseases (motility disorders, PUD, scleroderma)
medications
genetics
pregnancy

128
Q

Exclusions for self-care of heartburn

A

> 3 months
symptoms while taking H2RA or PPI
severe heartburn
nocturnal
difficulty swallowing foods
vomiting blood
chronic coughing
chest pain

129
Q

Goals of treatment for heartburn

A

provide symptom relief
reduce recurrence of symptoms
prevent and manage unwanted side effects of meds

130
Q

Non-pharm therapy of heartburn

A

avoid certain foods, large meals, lying down after eating
weight loss
elevate head of bed (6-8 inches)
smoking cessation
limit alcohol and caffeine

131
Q

Pharm therapy of heartburn

A

antacids

132
Q

Antacids approved OTC use (>2 yo)

A

mild, infrequent, acid indigestion
(combo w/ ASA or APSP may be used for over eating, drinking, or hangover)

133
Q

Characteristics of antacids

A

Rapid relief (<5 min)
Brief Duration (only as long as present in stomach)

134
Q

MOA of antiacids

A

neutralizes gastric acid
increase LES pressure
act as a buffer

135
Q

Potency of antiacids

A

based on mEQ of ANC (acid neutralizing capacity)
-amount of acid buffered per dose over specified time
-must have at least >5 mEQ per dose

calcium carb > sodium bicarb > magnesium salts > aluminum salts

136
Q

Drug interactions of antiacids: antacid binding

A

attaches to different drug affected absorption
separate doses by 2-4 hrs
(tetracyclines, fluoroquinolones, azithromycin)

137
Q

Drug interactions of antiacids: pH changes

A

disintegration, dissolution, ionization of drug changes affecting absorption
separate doses by 2 hrs
(ketoconazole, itraconazole, iron)

138
Q

Alginic acid

A

inactive ingredient in gaviscon
best taken after eating
more effective if standing

139
Q

Alginic acid MOA

A

combines w/ sodium bicarb in saliva to form sodium alginate
viscous layer floats on surface of stomach contents acting a protectant/barrier to esophagus

140
Q

H2RAs approved use >12 yo

A

treats mild-moderate episodic heartburn
prevents heartburn and acid indigestion when anticipated due to triggers

141
Q

H2RAs MOA

A

reversibility inhibit histamine on H2 receptor of the parietal cell decreasing acid production
good for fasting or nocturnal symptoms

142
Q

Potency of H2RAs

A

can sub for one another (low -> low dose or high -> high)

143
Q

Drug interactions with H2RAs: pH changes

A

disintegration, dissolution, ionization of drug changes affecting absorption
avoid longer durations
(ketoconazole, itraconazole, iron)

144
Q

Drug interactions with H2RAs: cimetidine

A

inhibit various CYP enzymes
avoid interactions with warfarin, theophylline, phenytonin

145
Q

PPIs approved use >18 yo

A

Treats frequent heartburn (no more than 4 months)
Take 30-60 min before breakfast

146
Q

PPIs characteristics

A

slower onset
longer duration

147
Q

PPIs MOA

A

irreversibly inhibit hydrogen potassium ATPase (proton pump) of parietal cell blocking secretion with longer effects than H2RAs

148
Q

PPIs potency

A

clinically equally effective and interchangeable
some individuals respond better to different drugs

149
Q

PPIs drug interactions: pH changes

A

disintegration, dissolution, ionization of drug changes affecting absorption
avoid longer durations
(ketoconazole, itraconazole, iron)

150
Q

PPIs drug interactions: Inhibits CYP2C19

A

increases drug concentration or reduce conversion to active forms

151
Q

Bismuth Subsalicylate

A

treat heartburn, upset stomach indigestion, nausea every 30-60 min as needed
avoid in children (Reyes syndrome)
advise that stool and tongue turn black

152
Q

Bismuth Subsalicylate MOA

A

uncertain, but believed to be topical effect

153
Q

What heartburn drugs are not used in pregnancy

A

H2RAs
PPIs
(antacids are recommended)

154
Q

What are the antiacid drugs

A

calcium carbonate
magnesium hydroxide (milk of magnesium)
aluminum hydroxide
sodium bicarbonate

155
Q

What are the H2RA drugs

A

Famotidine (pepcid)
Cimetidine (tagamet)

156
Q

What are the PPI drugs

A

Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Esomeprazole (Nexium)
Omeprazole (Zegrid)

157
Q

What are the overweight, obesity, and extreme obesity classifications for BMI

A

overweight: 25-29.9
obese: 30-39.9
extreme: >40

158
Q

Waist circumference assesses what

A

distribution of adipose tissue

159
Q

What is the worst kind of obesity

A

Central (fat around the waist)
component of metabolic syndrome

160
Q

What is a higher risk waist circumference

A

male: >40 inches
female: >35 inches

161
Q

What is a low calorie diet for females and males

A

females: 1200-1500
males: 1500-1800

162
Q

According to the obesity guidelines physical activity to lose weight is what

A

not an effective way to lose weight

163
Q

What are the changes in behavior for lifestyle modifications in obesity

A

social support
self-monitoring calories
stimulate control, problem solving, and cognitive strategies

164
Q

What are the 4 strategies for weight loss

A

> 1 yr maintenance prograns
weighting at least once a wk
continue reduced calorie diet
high levels of physical activity (~300 min/wk)

165
Q

What is the recommended weight loss goals

A

decrease weight by 5-10% w/in 6 months

166
Q

Non-prescription pharmacotherapy orlistat MOA

A

intestinal lipase inhibitor
(you will increase your weight loss more than 50% then if you would just go on a weight loss diet)

167
Q

What is the required lifestyle modification of taking orlistat

A

low-fat diet (less than 15g of fat)
(can cause flatulence with discharge)
take a multivitamin at bedtime

168
Q

What is the selected dietary supplements promoted for weight loss

A

chromium
picolinate
helps with carb metabolism

169
Q

What are the three supplements that claim to increase energy expenditure

A

caffeine
green tea extracts (hepatotoxicity problems)
bitter orange (causes CNS stimulation and cardio effects)

z S1: Self Care (2 decks)

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