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Pharm II > Exam 3 (4/26) > Flashcards

Exam 3 (4/26) Flashcards

1
Q

Know indications for sitagliptin (Januvia)

A

Monotherapy for those in who metformin is contraindicated or not tolerated.
Not for type 1 diabetics
promotes the release of insulin and decreases the release of glucagon
Used in combination with metformin and other agents.

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2
Q

Review AE’s of glipizide (Glucotrol)

A

Hypoglycemia
Weight gain
GI discomfort

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3
Q

Review proper handling, storage, and administration of insulin

A

All insulins: Protect from heat and light. Do not freeze.
Vials:
Unopened:
If stored in the refrigerator, good until the expiration date on the label.
If stored at room temperature (up to 86o F), good for 1 month.
After opening: Mark the expiration date on all opened vials.
Good for about a month (regardless if stored at room temp. or in the refrigerator.)
Before administering insulin ALWAYS check your patient’s blood glucose levels
Roll vials between hands prior to withdrawing dose. Do NOT shake to mix suspensions.
Only use insulin syringes, calibrated in units to measure and give insulin
Check doses with another RN before administering
Ensure correct timing of doses with meals and know if the patient is NPO
When combining 2 compatible insulins in 1 syringe, withdraw the Regular or rapid-acting insulin first
Pens:
Most require removal of needle after every injection. Store without needle attached.
Only give regular insulin through IV
Insulin in pumps:
Insulin in reservoir should be discarded after at least every 6 days.
Infusion set (tubing) and infusion insertion site should be changed every 3 days

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4
Q

Identify the importance of rotating sites when administering insulin

A

Prevents lipodystrophy: lumps (fat) that interfere with insulin absorption
Better absorption and metabolism when sites are rotated.

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5
Q

Know the advantages of basal-bolus insulin therapy

A

It most closely mimics function of a healthy pancreas

Also allows for flexibility as to when meals are taken

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6
Q

Review the black box warning for pioglitazone (Actos)

A

Black box warning: Exacerbates CHF
S/S:
Excessive, rapid weight gain, dyspnea, and or edema.

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7
Q

Review interactions between insulin and beta blockers

A

Pt’s who are diabetic and are taking insulin and beta blockers need to be careful with monitoring blood glucose carefully.
May not be aware of hypoglycemic effects as quickly.

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8
Q

Identify serious AE’s of metformin (Glucophage)

A 
Lactic acidosis: Extremely rare but serious complication
vitamin B12 deficiency if used for long term 
GI: N/D, Anorexia
Discontinue metformin (Glucophage) 24 hours before using IV contrast dye for a CT or MRI. Iv contrast dye is hard on the kidneys and so is metformin so the two should not be administered together.
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9
Q

Know the onset of action for each of the prototype insulins

A 
Lispro (Humalog): Rapid-acting
Onset: 15 min
Regular (Humulin R): Short-acting
Onset: 30-60 mins
Isophane Suspension (NPH; Humulin N): Intermediate-acting
Onset: 1-2 hours
 Insulin glargine (Lantus): Long-acting
Onset: 1-2 hours
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10
Q

Review glycemic goal recommendations from the ADA

A

Fasting blood glucose 70-130

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11
Q

Know advantages to taking exenatide (Byetta)

A

Does not need to be taken as frequently

Causes weight loss and appetite suppression

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12
Q

Know nursing interventions for a client who is NPO and taking oral antidiabetic drugs

A

Primary concern is how long they will be NPO
Check blood glucose level
Consult with prescriber and figure out if you should administer or not

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13
Q

Review the rationale for holding metformin (Glucophage) for a client receiving IV contrast for CT/MRI

A

Both are very hard on the kidneys, kidney damage

Discontinue 24 hours before using IV contrast dye.

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14
Q

Know indications for glucagon (GlucaGen)

A

Insulin-induced hypoglycemia
Non-responsive with hypoglycemia
Converts liver glycogen to glucose

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15
Q

Review administration timing for glipizide (Glucotrol)

A

30 minutes prior to meals

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16
Q

Understand how to appropriately administer a beta 2 adrenergic agonist and a glucocorticosteroid inhaler when both are prescribed to the client

A

Use short-acting preparations for acute exacerbations
Use long-acting preparations for long-term control
Inhale beta 2 adrenergic agonists BEFORE inhaling glucocorticoids
Follow dosage limits and schedules
Monitor and Report:
Tachycardia
Heart palpitations
Chest pain

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17
Q

Understand when to give albuterol prescribed for exercise induced asthma

A

Use inhaler 15-30 minutes before exercise

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18
Q

Know the indications and contraindications for albuterol

A 
Indications: asthma (short & long-term management)- bronchodilator
Contraindications: 
uncontrolled hypertension
cardiac dysrhythmias
high risk for stroke
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19
Q

Know adverse effects of inhaled anticholinergics: ipratropium (Atrovent)

A

Dry mouth
Hoarseness
Increased intraocular pressure
Urinary retention

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20
Q

Understand appropriate dosing, frequency, when to give ipratropium

A

Administer using a nebulizer or inhaler
Maintain the prescribed time between puffs – wait 1-2 minutes before inhaling second dose (if prescribed)
Delay use of other inhalants for 5 minutes
Rise the mouth after use to avoid unpleasant taste and mucosal dryness
May cause mouth dryness – provide water and hard candy
Monitor urinary retention – especially in older adults
Do NOT use as emergency rescue drug!
Maintenance drug- scheduled twice daily

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21
Q

Know food interactions with theophylline

A

Caffeine
Charcoal broiled food
Diet high in protein and low in carbs
St. John’s wort, Smoking (nicotine), Cimetidine, floroquinolones

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22
Q

Know theophylline therapeutic blood level range

A

5-15 mcg/ml

Can give activated charcoal if too high (to decrease absorption)

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23
Q

Review patient teaching of the use of beclomethasone dipropionate (QVAR) inhaler

A

Watch for oral candidiasis (thrush in mouth)- rinse mouth after use or use a spacery
Spaces decreases drug contact with oral mucosa
Initiate antifungal therapy when indicated
Used for long-term management of chronic asthma (regular schedule)
Take after beta 2 adrenergic agonist
DO NOT use for acute attack
Used on a regular schedule rather than PRN

24
Q

Why is it important to taper off prednisone?

A

Prevention of adrenal crisis/suppression

Monitor plasma drug levels to determine adrenal function

25
Know adverse effects of prednisone
``` Suppression of adrenal function Muscle wasting & bones demineralization (osteoporosis) Hyperglycemia PUD Infection Fluid & electrolyte imbalances ```
26
Know the adverse effects of beclomethasone (Beconase AQ) nasal spray
Dry mucous membranes Epistaxis (nose bleed) Sore throat headache
27
What would indicate a therapeutic response to cromolyn – what is its indication for use?
Suppress inflammation Allergy-related asthma Prophylaxis exercise-induced bronchospasm Prophylaxis for seasonal allergies Management of allergic rhinitis (intranasally)
28
Know appropriate dosing, frequency, when to give montelukast
Take once daily in the evening To prevent exercise induced bronchospasm: take 2 hours before exercising and do not repeat dose for 24 hours Mix oral granules with something like applesauce, carrots, rice, or ice cream and place directly on the tongue
29
What is the MOA of montelukast?
Inhibits release of leukotrienes, which causes bronchoconstriction
30
Which bronchodilator inhaler is used for acute asthma attacks?
Albuterol (Proventil, Ventolin)
31
Know adverse/side effects and contraindications for diphenhydramine (Benadryl)
``` AE: Pt’s are a FALL RISK! Drowsiness Dizziness Anticholinergic effects: Dry mouth, urinary retention, changes in vision, constipation, increased HR, headache Gi Discomfort Contraindications: Children younger than 2 Breastfeeding Glaucoma BPH ```
32
Know adverse effects of phenylephrine and what chronic use of nasal sprays can cause
AE’s: CNS stimulation (agitation, insomnia, anxiety) Vasoconstriction (tachycardia and palpitations) Rebound Nasal congestion Potential for abuse We don’t want them to use it longer than 3-5 days, with chronic use there is a risk for abuse and rebound congestion.
33
Know indication and adverse effects of codeine
``` Indication: Suppress chronic, nonproductive, harmful cough. AE’s: CNS depression Dizziness Nausea/vomiting Constipation Respiratory depression ```
34
Know drug interactions with dextromethorphan (Delsym)
MAOI’s | May cause increased analgesic effects of opioids
35
What teaching is important to someone taking guaifenesin (Mucinex)
Thins mucus to cough it up easier Drink fluids, give drug with 8 oz of water Notify prescriber if cough worsens or high fever develops Use only when needed Do not give with combination products for colds that also include guaifenesin Do not chew or crush sustained-release formulations
36
Know the indication for guaifenesin
Treatment of productive cough with colds and other upper respiratory infections; bronchitis
37
What teaching is needed for someone taking acetylcysteine (Acetadote)
Expect sulfur-like (rotten egg) odor Need suction equipment near by Clear airway and assess ability to cough before administration If given via nebulizer make sure it does not include metal or rubber parts. Instill directly into the tracheostomy tube. For acetaminophen (Tylenol) toxicity, dilute oral acetylcysteine with juice or soft drinks Patient instructions: Report any difficulty breathing or worsening cough Expectorate secretions instead of swallowing them Take antiemetic as needed
38
Know adverse reaction to acetylcysteine (Acetadote)
Bronchospasm aspiration of excessive secretions GI distress
39
Know MOA of cetirizine (Zyrtec)
Bind to H1 receptors and block release of histamine | Used for allergic rhinitis, chronic idiopathic urticaria (hives)
40
Identify interactions for doxorubicin (Adriamycin)
Increased toxicities when used with other chemo drugs or with radiation therapy Increases serum digoxin levels
41
Review administration interventions for paclitaxel (Taxel)
Give antihistamines and antipyretics prior to lessen the symptoms to prevent the hypersensitive reactions Causes hypersensitivity reactions often
42
Know AE’s of methotrexate (Trexall)
Hair loss Nausea/Vomiting Diarrhea Myelosuppression (fewer platelets, WBC, and RBC due to decreased bone marrow activity)
43
Identify which s/s indicate a client receiving chemotherapy has developed an infection
Don’t rely on WBC count | Describing s/s of sore throat, tired, muscle ache, low grade fever.
44
Know why tumor markers are important and how they are used to identify and monitor cancer
Help us screen for certain cancers Prostate cancer Help us determine if treatment plan is working or not PSA levels started really high, but goes down once treatment is started
45
Review dose-limiting AE’s of antineoplastic drugs
GI (N/V, Anorexia) Bone marrow suppression: Infection can come from decreased production of bone marrow cells. Greater risk for infection, look at WBC.
46
Know nursing interventions for cleaning a chemotherapy spill
Wear gloves | Get a spill kit
47
Review which labs to monitor for a client receiving chemotherapy
WBC Platelets Liver/kidney function
48
Review common AE’s of hematopoietic drugs
Fever Muscle aches Bone pain flushing
49
Know s/s of allergic reaction to oprelvekin (Neumega)
Itching Rash Anaphylactic symptoms (difficulty breathing)
50
Review indications for oprelvekin (Neumega)
``` Prevent severe thrombocytopenia in patients receiving chemo Low platelet count = risk of bleeding ```
51
Know the administration timing for filgrastim (Neupogen)
Administer BEFORE patient develops an infection Do NOT administer 24 hours before or after myelosuppressive chemotherapy drugs- may cause changes in WBC counts Must know current WBC count before administering Use D5W to dilute when administering
52
Identify patient teaching for etanercept (Enbrel)
Do not take if you have an active infection At risk for infection bc it can depress immune response Wash hands, avoid big crowds, stay away from sick Teach s/s of infection: fever, sore throat, body ache Administer subQ into thigh, abdomen or upper arm (rotate) Available in autoinjector, prefilled syringe or multiple dose vial Store in refrigerator (w/ exception of autoinjector) Protect from light Onset of action: 1-2 weeks Screen for latex allergy prior to administering
53
Know indications for adalimumab (Humira)
Severe cases of RA that have failed to respond to other treatment
54
Review AE’s of oprelvekin (Neumega)
Fever Muscle aches Bone pain flushing
55
Know contraindications for filgrastim (Neupogen)
Allergy Presence of more than 10% immature tumor cells in bone marrow Do not administer to patients with an active infection

Pharm II (4 decks)

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