Exam 3 Flashcards

1
Q

Promethazine

A

Phenothiazine
Indications: prevnts chemo induced emesis
Condraditions: gluacome, older adults, kidney and liver disease, children
Adverse effects: blurred vision, urinary retnetion, dry mouth, photosensitivity, drowsiness, confusion, Q and T chnages on EKG, EPS, nueroleptic maligant syndrome
Monitor: tissue injury
BB warning: do not give to kids with reyes disease, premature kids or kids under 2. Do not take with respiratory depressants, older adults have an increased risk of death

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2
Q

Hydroxyzine

A

Antihistamine
- blocks H2 recpetos and action of acetylcholine in the brain
Indications: moring sickness/vertigo, anxiety, N/V
Contradictions: renal impairment, hepatic impairment, early pregnancy, PIMS( potentially inappropriate med) prolonged QT intervals
Adverse effects: drowsiness, dizziness, confusion, dry mouth, thick resp secretions, blurred vision, urinary retention, tachycardia
* Give IM, do not take with sedatives,

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3
Q

5 Hydroxytrtptamine3

A

Used for chemo and post of N/V, early preg,
Antagonizes serotonin receptors to stop emetogenic drugs or toxins
Contradictions: hepatic impairment
Adverse effects: disrrhea, headache, dizziness, constipation, fatigue, elevation of liver enzymes, prolonged QT intervals
* dissolving tab wont work if pt has phenoketouria, st wart increases levels, grape fruit juice decreases levels

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4
Q

Aprepitant

A

substance P/ Neurokinin 1 antagonist
Blocks activity of P at NK1 in the brain that causes nasuea
Indications: Chemo N/V
* check albumin levels, cant bind with no protein
Contraditions: dont use with ranolazine, pimozide, or cisapride
Adverse effects: fatigue, weakness, dizziness, abnormal heart rhythm, headache, hiccups
* no st john wart of grapefruit juice, use non oral birth control, 1 hr before chemo and for 2 days after

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5
Q

Marijauana

A

Synthetic cannabinoids
_ not FDA approved, common for abuse, synthetic approved by FDA
Euphoria, paranoia, can cause withdrawal symptoms: insomnia, irritability, nausea, sweating, loose stools, anorexia

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6
Q

Non pharm for N/V

A

acupuncture, ginger
if pregnant: small frequent meals, dry crackers, high in protein, clear liquid diet

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7
Q

How insulin works

A

Stimulates carbohydrate metabolism in skeletal muscle, cardiac muscle, and adipose tissue for energy
- facilitates glucose storage in the liver
- moves glucose into fat cells to be broken down
- stimulates protein synthesis
- beta blocker and alcohol effect this process

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8
Q

Type one diabetes

A
  • only 10% of cases
    auntoimmune disorder that destorys pancreatic beta cells
    usually begins after age 4 and peaks at 10-12 for males and 12-14 for females
  • symptoms start when 20% beta cells are left
  • insulin administered when no beta cells are left
    Higher risk for DKA
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9
Q

Diabetes types two

A
  • 90% of cases
    insulin resistence usually impaired at a cellular level
  • formally developed around 40 but now in younger people
  • more gradula onset
  • usually starts with oral antidiabetics (metformin)
  • Risks: genetics, obesity, sedentary lifetstyle, metabolic syndrome
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10
Q

S/S of diabetes

A

More likely in type 1
Polydipsia: increased thirst
Glucosuria: glucose in urine
Polyphagia: increased hunger
Less obvious s/s: fatigue, weight loss, vaginitis, erectile dysfunction, numbness, slow or poor wound healing, intermittent blurred vision

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11
Q

Diagnostics for diabetes:

A

HbA1c: N: 5.7, PD: 5.7-6.4, D: 6.5+
Fasting plasma glucose: N: under 100, PD: 100-125, D: 126+
75g oral glucose tolerance test: N; 140, PD: 140-199, D: 200+
Random: should always be under 200 or diabetes is assumed

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12
Q

Complications: DKA

A

ketones in blood stream and cause acidemia
- body tires to compensate
- no insulin and illness
Early s/s: blurred vision, anorexia, N/V, thirst, polyuria
- check BG, urinalysis, and blood work
Tx: continuous IV insulin, IV fluids, K=, sodium bicarb, identify and treat infection

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13
Q

Complications: HHS

A

no ketosis
- excessive amount of glucose and electrolytes in the blood stream
- occurs when client unaware of DM
s/s: glucosuria, dehydration, altered mental status, seizures, come
- Can lead to HHNC (coma)
- same treatment as. DKA

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14
Q

Exogenous insulins

A
  • lowers blood glucose by increasing uptake by body cells and decreasing production by liver
  • Use: only drug effective for type 1, uncontrolled DM tyoe 2, gestational diabetes, and hyperkalemia
    Pharm: give sub Q ( only reg can be given IV)
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15
Q

Hypoglycemia

A

Bg: 60-70 and under, cold and clammy, tachycardia, palpitations, diaphoresis, shakineess, chnage in mental status, headache, weakness
Awake and alert: 15 grams of carbs
Unresponsive: push 25-50% dextrose IV
- retest and repeat if needed

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16
Q

Mixing insulins

A

put air in each dose before combining
- clear rapid or short acting should be pulled up first
- NEVER MIX LONG ACTING

17
Q

How is each class different

A

Liver: Biguanide, reduces hepatic glucose production
Pancreas: sulfonylureas, meglitinides, stimulate insulin secretion
Cells/tissues: Thiazolidinediones, biguanide, insulin sensitizers
Gut: GLP1 recptor agonist, DPP 4 inhibitor: mimic incretions
Kidneys: SGLT-2 transporters, reduce renal glucose reabsorption

18
Q

Glyburide

A

Sulfonylureas
Action: insulin secretion by the pancreatic beta cells
Condraidtioms: hepersnitivity to sulfa drugs, renal and hepatic impairment
Cautions: pregnancy, lactaion, pituitary, thyroid disorders
- high risk of hypoglycemia
BB warning: lactic acidosis

19
Q

Metformin

A

Biguanides, 1st line for type II diabetes
Action: decreases heatptic glucose production
Contraditions: hepatic or renal disease, over 80, crdiac or resp, insuffiencency, hx of lactic acidosis
AE: lactic acidosis( can cause kidney failure with this medication) , dizziness, N/V, abd crmaping, malabsorption of amino acids
- Does NOT cause hypoglycemia
Edu: may be head with IV contrast, no alc, w meals in evening

20
Q

Acarbose

A

Alpha- glucosidase ingibitor
Action: inhibits enzymes that digest carbs
- usually prescibed with a drug that enhances insulin (sulfa)
Contraditions: DKA, cirrhosis, inflammatory /malabsorp intestinal disease, severe abdominal kidney function
AE: bloating, diarrhea
- does NOT cause hypoglycemia
- glucgon must be taken if hypoglycemia occurs w other medication in combination w this one
- CANNOT GIVE CARBS

21
Q

Rosiglitazone maleate ( Avandia)

A

Thiazolidinediones
Action: decreases insulin resistance (needs betas to work)
- not common, high risk of heart failure and atherosclerotic CV events

22
Q

Repaglinide (Prandin)

A

Meglitinides
Action: stimulates pancreatic secretion of insulin
- better reduction of AlC when given with insulin or metformin
AE: hypoglycemia

23
Q

GLP-1 nd GIP therapies

A

stimulates release of insulin and improves sensitivity
decreases slow gastric emptying
may increase formation of new beta cells
decreased glucagon production

24
Q

Dipeptidyl- peptidase 4 ( DPP4)

A
  • Gliptins
    Action: prevents activation of incretins by inhibiting DPP4 enzymes
    Contraditions: insulin, urine ketones, kidney failure, heart failure
  • dont mix with other drugs causing hypoglycemia
    AE: URI symptoms, joint pain
25
Q

Iflozin

A

sodium-glucose cotransporter 2 inhibitor ( SGLT2)
Action: decreases renal absoprtion, of glucose, promotes excretion of excess glucose in urine
Contraditions: hypersneivity, severe rena; disease, sevre hepatic impairment, pregnancy, lactation
Caution: moderate renal disease, pancreatic disease, heart failure, hypovolemia, PVD, hypotension, dizziness, syncope.
Benefits: systolic bp, weight loss, reduced cardio vassular death, reduced renal disease
AE: genital yeasy or funagl infection, hyperkalmeia, UTI, dehydratin
Serious AE: necrtoizing factitsi of the perinuem, AKI, bone disease, increased risk of lower leg amputation
- ensure pt is well hydrated when taking
- monitor hydration, bp and K
- avoid salt substitutes,

26
Q

Exenatide

A

Glucagon like peptide -1 GLP-1
Action: incretin like action, potentiates secretions of insulin in presence of glucose, supresses gluconeogenesis, slows gastric emptying, and promotes satiety
BB warning: caused thyroid cancer in animals
Contradictions: liver disease on HMG-CCoA, reductase inhibitors, pregnancy/lactation, kidney failure
AE: Gi distress, nausea, hypoglycemia, weightloss, pancreatitis

27
Q

Nursing interventions for diabetes

A

test for urine ketones
check BG
S/S of UTI, PVD, visio chnages, ketoacidosis, hypoglycemia
- edcuate regular health care visits

28
Q

psyllium: bulk-forming laxatives

A

It absorbs extra water inside the body to stimulate a bowel movement.
AE:- Flatulence
- Abdominal cramps
- Esophageal or bowel obstruction
Contradictions: Intestinal obstruction
Fecal impaction

29
Q

Docusate calcium (constipation)

A

It increases the amount of water eliminated through a bowel movement.
AE:
- Stomach pain
- Diarrhea
- Cramping
Contraditions: rectal bleeding and allergic reaction

30
Q

Biscodyl (constipation)

A

Cathartics

This drug works by irritating the mucosa in the GI system, which pulls water into the bowel lumen.
AE:
- Abdominal pain
- Cramping
- Nausea
- Diarrhea
- Weakness
Contradictions:
- Allergy
- Fecal impaction
- Intestinal obstruction
- Undiagnosed abdominal pain

31
Q

Lactulose (constipation)

A

miscellaneous agents for constipation.

This drug works by pulling water into the lumen intestinal lumen and producing acid in the colon.
AE:
- Bloating, gas
- Stomach pain
- Diarrhea
- Nausea, vomiting
Contradictions:
- Diabetes
- Colonoscopy

32
Q

Diphhenoxylate with atropine (diarrhea)

A

Opiate related antidiarrheal agents

This drug happens by slowing the process of peristalsis. The drug acts on the smooth muscle inside the GI system.
AE:
- Tachycardia
- Dizziness
- Headache
- Flushing
- N/V
- Urinary retention
- Dry skin
Contradictions:
- diarrhea
- antibiotic associated colitis

33
Q

Loperamide (diarrhea)

A

opiate related antidiarrheal agents

This drug works by acting on mu- receptors to decrease the time the bowel movement takes to exit the body
AE:
- Dry mouth
- Flatulence
- Abdominal pain
- Dizziness
- Drowsiness
- Constipation
Contradictions: kids 2 and under

34
Q

Bismuth Subsalicylate ( diarrhea)

A

Salicylates

This drug coats ulcers to prevent damage from stomach ulcers.
AE:
- Darkening of stool and tongue
- Ringing in the ears