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Pharmacology 1 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q
  1. what are the functions of diuretics (2)?
  2. What are diuretics indicated for (6)?
  3. Overall, what are the most common adverse effects with diuretic use?
A
  1. increase urine produced by kidneys and increase sodium output.
  2. edema (associated w/ CHF), pulmonary edema, liver disease, renal disease, hypertension, conditions causing hyperkalemia
  3. GI, fluid and electrolyte imbalance, hypotension, and electrolyte disturbance.
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2
Q
  1. Name the 5 categories of diuretics:
  2. What are Thiazide diuretics indicated for, and where do they work?
  3. What are Loop diuretics indicated for, and where do they work?
  4. What are potassium-sparing diuretics indicated for, and where do they work?
  5. What are Carbonic Anhydrase Inhibitor diuretics indicated for, and where do they work?
  6. What are Osmotic diuretics indicated for, and where do they work?
A
  1. Thiazides, Loop, potassium-sparing, carbonic anhydrase inhibitors, osmotic diuretics
  2. edema associated w/ CHF, cirrhosis, HTN. Distal convoluted tubule
  3. CHF. Loop of Henle.
  4. CHF and HTN. Distal tubule and collecting duct.
  5. Increased Ocular pressure. Proximal tubule.
  6. Increased Intra-cranial pressure. Glomerulus, tubule.
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3
Q
  1. Name the potassium-wasting diuretic that provides maximal urine output:
  2. Name the potassium-sparing diuretic:
  3. Both of these drugs can cause alterations of which electrolytes?
A
  1. furosemide
  2. spironolactone
  3. Na+, Ca+, Mg+
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4
Q
  1. As nurses, what should we assess for with diuretics?
  2. What should we be watching out for (as far as cautions)?
  3. What condition can be worsened with diuretics?
  4. Diuretics may inhibit the breakdown of …………… causing hyper………… .
  5. Thiazides may cause sun sensitivity increasing …….. skin conditions.
A
  1. Patient history, physical exam, and allergies. Skin, edema, cardiopulmonary status, weight, and fluid in and out. Liver, renal labs
  2. can cause dizziness and falls, safety measures with elderly.
  3. Gout b/c urates get resorbed
  4. glucose, hyperglycemia
  5. Lupus
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5
Q
  1. Name the prototype Thiazide:
  2. Action:
  3. Indications:
  4. Contraindications:
A
  1. Hydrochlorothiazide (HydroDiuril)
  2. Blocks chloride pump causing chloride and sodium to be excreted in urine
  3. edema from CHF, liver and renal diseases, hypertension
  4. Lithium use, pregnancy/lactation, fluid and electrolyte imbalance.
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6
Q
  1. Symptoms of hypokalemia:

2. Which diuretic is famous for causing this?

A
  1. leg cramps, constantly tired, alkalosis, shallow breath, irritable, confused, weakness, arrhythmias, thready pulse, intestinal immotility.
  2. Furosemide (Lasix)
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7
Q
  1. What is the prototype Loop Diuretic? Is it strong?
  2. Action:
  3. Indications:
  4. contraindications:
  5. What two things can happen if administered too quickly?
  6. Drug to drug:
A
  1. Furosemide (Lasix). Yes, much stronger than other diuretics. Bumetandine is a stronger loop diuretic.
  2. Blocks chloride pump in ascending loop of henle reducing resorption of Na+ and chloride
  3. acute CHF, acute pulmonary edema, edema r/t CHF, edema r/t renal or liver disease, hypertension
  4. electrolyte depletion, pregnancy/lactation, anuria, renal failure, and hepatic coma.
  5. tinnitus and hypotension. Can case ototoxicity
  6. NSAIDs, aminoglycosides, anticoagulation, cisplatine
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8
Q
  1. Prototype Potassium-sparing (plus one more):
  2. Action
  3. Indications:
  4. Contraindications:
  5. Adverse Effects:
  6. Drug to drug:
A
  1. Spironolactone, triamterene
  2. Block the actions of aldosterone in the distal tubule. Causes a loss of sodium while retaining potassium
  3. Hyperaldosteronism, Adjunct to Thiazide or loop diuretics. Patients who are at risk for hypokalemia
  4. hyperkalemia, renal disease or anuria, patients taking amiloride or triamterene
  5. Hyperkalemia
  6. salicylates
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9
Q
  1. Name 2 Carbonic Anhydrase Inhibitors:
  2. What are these drugs used for?
  3. Action:
  4. Indication:
A
  1. acetazolamide (Diamox), and methazolamide (generic).
  2. Used as adjuncts to other diuretics when a more intense diuresis is needed.
  3. blocks the effects of carbonic anhydrase causing more sodium and bicarbonate to be excreted in urine
  4. adjunct diuresis and Glaucoma
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10
Q
  1. Prototype Osmotic diuretic:
  2. Action:
  3. Indications:
A
  1. Mannitol (Omitrol)
  2. pulls water into renal tubule without sodium loss
  3. Intracranial pressure, acute renal failure due to shock, overodose, or trauma
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11
Q
  1. What 3 things determine blood pressure?
  2. Briefly cover RAAS
  3. What 4 things does hypertension cause?
  4. Give the ranges of BP:
A
  1. Heart rate, stroke volume (amount pumped from ea ventricle on ea heartbeat), and total peripheral resistance (reisitance of arteries to the blood).
  2. Renin released from kidney upon decreased perfusion triggers liver to produce angiotensin 1. Lungs convert angiotensin 1 to 2. Angiotensin 2 vasoconstricts and triggers aldosterone from adrenal cortex. Aldosterone causes resorption of sodium and water in kidneys to increase BP
  3. stroke, renal failure, loss of vision, and CAD/cardiac death
  4. 120/80 normal. 120-129/80 elevated. 130-139/80-89 stage 1.
    140+/90+ stage 2.
    >180/>120 hypertensive crisis. Go to ER
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12
Q
      1. Name the 5 types of drugs used to treat hypertension:
A
  1. Diuretics: decreases sodium and blood volume
  2. ACE Inhibitors: blocks conversion of angio 1 to angio 2 thus blocking vasoconstriction
  3. Beta-blocker: decreased heart rate and strength of contraction and vasodilation
  4. Calcium Channel Blocker: relaxes muscle contraction
  5. Vasodilators: directly acts on vascular smooth muscle to decrease resistance.
  6. ARBs: block angiotensin II from binding to its receptors in vascular smooth muscle and adrenal glands.
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13
Q
  1. Prototype ACE inhibitor: and their suffixes:
  2. What dangerous side effect can ACE inhibitors cause?
  3. Contraindications:
  4. What race of people is not as responsive to ACE inhibitors?
  5. Adverse effects (most important in ALL CAPS):
A
  1. Captopril, Lisinopril. “pril” drugs
  2. Angioedema. Hyperkalemia. Tachycardia
  3. pregnancy/lactation, renal impairment
  4. blacks
  5. DRY COUGH, dizziness from vasodilation, GI upset, renal insufficiency.
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14
Q
  1. Angiotensin II receptor blocker prototype (ARBs):
  2. Indication:
  3. adverse effects:
A
  1. Losartan “artans”
  2. alone or as a combo therapy for hypertension especially in type 2 diabetes.
  3. dizziness, headache, GI upset, couggh, hypotension.
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15
Q
  1. What are the 3 types of calcium channel blockers?
  2. What is the prototype of calcium channel blockers?
  3. Indications:
  4. Contraindications:
  5. Adverse effects:
A
  1. Hydropyridines, non-hydropyridines, phenylalkylamines.
  2. Diltiazem
  3. Angina (all types) and hypertension. Decreases workload of heart
  4. heart block, sick sinus syndrome, renal/hepatic, pregnancy, lactation
  5. dizziness, headache, peripheral edema, bradycardia, atrioventricular block
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16
Q
  1. What are vasodilators reserved for?
  2. Action:
  3. Prototype and its indications:
  4. Name 2 other vasodilators and their indications:
A
  1. hypertensive emergencies, malignant hypertension.
  2. causes vasodilation and drop in BP by acting directly on vascular smooth muscle.
  3. Nitroprusside. Hypertensive crisis and control during surgery
  4. Hydralazine: maintain increased renal blood flow.
    Minoxidil: only for severe and unresponsive hypertension.
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17
Q
  1. Name 2 drugs and their indications that are used for hypotension
  2. What is the name of the category of drugs used to treat hypotension or shock:
A
  1. midodrine: orthostatic hypotension in adults.
    droxidopa: neurogenic hypotension
  2. Sympathetic Adrenergic Agonists or Vasopressors
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18
Q
  1. What is the general principal of treatment of CHF?
  2. What are 4 major causes of Congestive Heart Failure?
  3. Signs and symptoms of L heart failure:
  4. Signs and symptoms of R heart failure:
A
  1. Allowing the heart muscle to contract more efficiently to bring system back to balance.
  2. CAD, Cardiomyopathy, Hypertension, Valvular Heart Disease
  3. Hypoxia, anxiety, rales, tachypnea, dyspnea, orthopnea, hemoptysis, cardiomegaly, S3, GI pain/upset, decreased peripheral pulses.
  4. elevated jugular venous pressure, splenomegaly, hepatomegaly, decreased renal perfusion when upright, but opposite when lying down (nocturia), pitting edema, weakness/fatigue.
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19
Q
  1. Prototype cardiac glycoside and its indications
  2. Action:
  3. Contraindications:
  4. ……. ……. must be at least 60bpm to give Digoxin.
  5. Why must potassium be evaluated?
  6. What are the signs of Digoxin toxicity?
  7. Drug to drug
A
  1. Digoxin, treats heart failure and atrial fibrilation
  2. increases intracellular calcium in myocardial cells increasing force of contraction.
  3. conditions that slow heart rate, subaortic stenosis, MI, renal insufficiency, and electrolyte abnormalities
  4. apical pulse
  5. low potassium and cause toxicity, but high potassium can cause less potency.
  6. yellow halos, nausea, and anorexia
  7. Cardiac Glycosides doesn’t play nice with others. Many drug interactions ie: quinidine, erythromycin, potassium losing diuretics, etc.

7.

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20
Q
    • 3 Name the 3 big causes of cardiac arrhythmias:

4. Name the types of cardiac arrhythmias:

A
  1. Altered action potentials from electrolyte imbalances, drugs, acidosis, or waste product buildup
  2. decreased O2 delivery to cells
  3. structural damage to heart that alters conduction pathways
  4. tachycardia, bradycardia, premature atrial or ventricular contractions (PACs) or (PVCs), atrial flutter, atrial or ventricular fibrillation, alterations in conduction (heart blocks or bundle branch blocks).
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21
Q
      1. Describe the 4 classifications of antiarrhythmics:
A
  1. Class 1: block sodium channels
  2. Class 2: block beta-receptors
  3. Class 3: block potassium channels
  4. Class 4: block calcium channels
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22
Q
  1. Prototype Class 1 Antiarrhythmic:
  2. Indications:
  3. adverse reactions:
A
  1. Lidocaine
  2. management of ventricular arrhythmias during cardiac surgery or MI
  3. dizziness, fatigue, cardiac arrest, nausea, vomiting, hypotension
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23
Q
  1. Prototype Class 3 antiarrhythmic:
  2. Action:
  3. Indications:
  4. Cautions:
  5. Adverse effects:
A
  1. Amiodarone
  2. prolongs action potentials by blocking potassium channels
  3. life threatening ventricular arrhythmias and long term atrial fibrillation stabilization
  4. shock, hypotension, respiratory depression, prolonged QT, renal or hepatic disease
  5. dizzness, malaise, heart failure, cardiac arrest, GI, hepatotoxicity, pulmonary toxicity, corneal microdeposits, worsening of arrhythmias
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24
Q
  1. Name 2 other drugs to treat arrhythmias:

2. Nursing considerations for antiarrythmics:

A
  1. digoxin and Adenosine
  2. Assess for allergies, heart block, and QT interval prolongations

Labs (electrolytes and renal functions). ECG

Monitor cardiac rhythm.

Teach client to not stop drug too quickly

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25
Q
  1. How does Prinzmetal angina differ from the others?
  2. What is the action of antianginal drugs in general?
  3. What are 4 types/groups of drugs that have antiangina effects?
A
  1. caused by spasm of the blood vessels, not just vessel narrowing
  2. improves blood delivery to heart by dilating blood vessels and decreasing heart’s work
  3. Nitrates, Beta-blockers, calcium chanel blockers, and Piperazine Acetamide
26
Q
  1. Prototype Nitrate:
  2. Action:
  3. Indication:
  4. Contraindications:
  5. Caution:
  6. Adverse Effects:
  7. Drug to drug:
A
  1. Nitroglycerine
  2. direct action on smooth muscle to relax
  3. prevent/treat angina
  4. pregnancy/lactation, cerebral hemorrhage, head trauma, and severe anemia.
  5. Hepatic/renal disease, hypotension, hypovolemia, conditions that limit cardiac output
  6. hypotension, tachycardia, headaches, and dizziness
  7. ergots, heparin
27
Q
  1. In general, what do beta blockers do?
  2. Prototype Beta-blocker and suffix for group:
  3. Indications:
  4. Contraindications:
  5. Caution:
  6. Adverse effects:
  7. Drug to drug:
A
  1. block sympathetic stimulation of beta adrenergic receptors in the heart and kidneys, thus decreasing cardiac workload
  2. metoprolol suffix “olol”
  3. stable angina, hypertension, heart failure
  4. DONT GIVE to <60bpm. Asthma, COPD (may cause bronchoconstriction), heart block, cardiogenic shock, pregnancy/lactation
  5. Diabetes - may mask hypoglycemia, Peripheral vasc. disease, and thyrotoxicosis
  6. bradycardia, HF, bronchospasm, GI upset, anything related to sympathetic blockage
  7. clonidine
28
Q
  1. What should the nurse be closely watching with beta-blockers?
  2. What is a teaching point about stopping beta-blockers?
  3. Name 2 lesser known modifiable risk factors to CAD:
A
  1. Cardiovascular status, hyper/hypoglycemia, liver/renal function, fall risk from orthostatic hypotension
  2. Dont quit abruptly
  3. Gout and untreated bacterial infections
29
Q
      1. What are the normal, borderline, high, and very high levels levels for total cholesterol, LDL’s, High Densitys, and Triglycerides?
A
  1. Total Cholesterol: <200 = normal, 200 - 239 = borderline, and >239 = high
  2. LDL: 100 - 129 = normal, 130 - 159 = borderline, 160 - 189 = high, > 189 = very high
  3. High Density: <40 = low, >60 = high
  4. Triglycerides: <150 = normal, 150-199 = borderline, 200 - 499 = high, >500 = very high
30
Q
  1. What is the prototype bile acid sequestrants and indication:
  2. Mechanism of Action:
  3. Adverse Effects:
  4. Drug to drug:
A
  1. Cholestyramine. Indicated for the reduction of serum cholesterol for primary hypercholesterolemia, priritus associated w/ partial biliary obstruction
  2. binds w/bile acids in GI allowing excretion in feces, resulting in lowered cholesterol.
  3. GI pain, constipation (fecal impaction), and nausea, rashes, vitamin A, D, and K deficiencies (increased bleeding times), and headache
  4. malabsorption of fat-soluble vitamins, warfarin, thiazide diuretics, digoxin, thyroid hormones, and corticosteroids.
31
Q
  1. Prototype HMG-CoA inhibitors and indication:
  2. Mechanism of Action:
  3. Contraindications:
  4. Adverse reactions:
  5. Drug to drug:
  6. What must be checked before giving this drug?
A
  1. Atorvastatin (Lipitor): adjunct to diet in primary hypercholesteromia. Reduces LDLs, triglycerides, raises HDLs. Indicated for teens and adults that have risk factors to CAD.
  2. Blocks the enzyme, HMG-COA reductase thus blocking cholesterol synthesis and lowering cholesterol, LDL, and triglycerides while increasing HDL’s
  3. Active liver disease, persistent AST and ALT elevation, pregnancy/lactation
  4. rash, GI upset, RHABDOMYOLYSIS
  5. erythromycin, cyclosporin, gemfibrozil, niacina, digoxin, warfarin, estrogen, grapefruit juice. Doesn’t play nice
  6. ALT and AST levels
32
Q
  1. What is the prototype drug of cholesterol absorption inhibitors?
  2. Mechanism of action:
  3. Drug to drug:
  4. Adverse effects:
A
  1. Ezetimibe: adjuct to diet/exercise. adjunct to atorvastatin in treatment of familial hypercholesterolemia and sitosterolemia
  2. Works in the brush border of the small intestine to inhibit the absorption of cholesterol
  3. Cholestyramine, fenofibrate, gemfibrozil, antacids, Cyclosporine, Fibrates, Warfarin
  4. ANGIOEDEMA, headache, dizzy, GI pain, upper resp infections, muscle pain
33
Q
      1. Name 3 other medications used to treat high cholesterol and explain briefly how they work:
  2. what are the nursing considerations for treating patients with lipid lowering medications?
A
  1. Niacin (B3): inhibits release of free fatty acids from adipose tissue and increases rate of triglyceride removal from plasma
  2. Fenofibrates: inhibits triglyceride synth in the liver , may help break down triglycerides
  3. Gemfibrozil: Inhibits peripheral breakdown of lipids, Reduced production of triglycerides and LDL, Increases HDL.
  4. Always check liver status, pregnancy and lactation. Check for GI upset, and muscle pain. Check for efficacy. Educate on diet and exercise
34
Q
      1. Name the 5 steps in cogulation

6. What stimulates platelets to start adhering?

A
  1. local vasoconstriction seals off injury.
  2. platelet aggregation forms a platelet plug.
  3. Hageman factor is activated
  4. Intrinsic pathway converts prothrombin to thrombin to seal the system.
  5. Extrinsic pathway clots blood that has leaked out of the vascular system.
  6. endothelium from the damaged vessel
35
Q
  1. A condition that predisposes a person to clot and emboli formation is known as:
  2. A disorder in which excess bleeding occurs:
  3. What do anticoagulant drugs do?
  4. What do thrombolytic drugs do?
A
  1. thromboembolic disorder
  2. hemorrhagic disorder
  3. interfere w/ clotting cascade and thrombin formation
  4. alter formation of platelet plug and block receptor sites on platelet thus inhibiting aggregation and adhesion (aspirin, plavix).
  5. break down thromi by stimulating plasmin system
36
Q
  1. Prototype antiplatelet and its indication:
  2. Contraindications:
  3. Cautions:
  4. Adverse effects:
  5. Drug to drug:
A
  1. Aspirin. Reduce risks of MI and stroke, anti-inflammatory, anti-pyretic.
  2. allergy, pregnancy, lactation
  3. bleeding disorder, recent surgery, closed-head injury
  4. bleeding, headache, dizzyness, weakness, GI distress
  5. anything that affects clotting
37
Q
  1. Name the 2 prototype anticoagulants:
  2. Action of warfarin (Coumadin):
  3. Action of heparin:
  4. Contraindications to both:
  5. Adverse reactions:
  6. What is the lab test for heparin? Warfarin?
A
  1. warfarin (Coumadin), and heparin.
  2. maintains anti-coagulation when patient is susceptible to dangerous clotting.
  3. inhibits conversion of prothrombin to thrombin
  4. pregnancy, renal, or hepatic disorders. Anything that can be compromised by bleeding.
  5. Hair loss, anemia, osteoporosis, BLEEDING, THROMBOCYTOPENIA
  6. Heparin: aPtt
    Warfarin: INR or PT
38
Q
  1. Heparin cannot be given .. ……… .
  2. Since it is fast-acting, it is often used in ……….. situations.
  3. Why does it require close monitoring?
  4. What is Heparin antidote? Warfarin antidote?
  5. Do not administer heparin to anyone with … (give a few examples):
  6. What do we continually assess for?
A
  1. by mouth
  2. urgent
  3. because it is variable in each patient
  4. Heparin: Protamine. Warfarin: Vitamin K
  5. any situation that could cause more bleeding: stroke, recent delivery, trauma, uncontrolled HTN.
  6. bleeding. Look for blood in stool, urine, IV site, GI bleeds
39
Q
  1. Name 2 factor Xa inhibitors and a little trick for remembering these:
  2. What are the indications of these drugs?
  3. Name a low-molecular weight heparin:
  4. What is enoxaparin indicated for?
A
  1. rivaroxaban and apixaban (Eliquis). Both have Xa in their names and inhibit factor Xa.
  2. prophylaxis against DVT especially for post op knee and hip
  3. enoxaparin (Lovenox)
  4. prevention of clots and emboli after certain surgeries and bed rest.
40
Q
  1. Protoype thrombolytic agent and indication:
  2. Mechanism of Action:
  3. Contraindications:
  4. Adverse effects:
  5. drug to drug:
A
  1. Urokinase. Lysis of pulmonary embloi
  2. activates plasminogen to plasmin which breaks down fibrin. Dissolves clots.
  3. Any condition that is worsened by dissolution of clots
  4. bleeding, cardiac arrhythmias, hypotension
  5. anticoagulants, anti-platelets.
41
Q
  1. What is iron deficiency anemia?
  2. What is megaloblastic anemia?
  3. What is pernicious anemia?
  4. who is at risk for iron deficiency anemia?
A
  1. a negative iron balance occurs
  2. insufficient B12 or Folic acid to create healthy RBCs
  3. A type of megaloblastic anemia in which the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed
  4. menstruating women, pregnant/nursing women, rapidly growing adolescents w bad diet, People w/ GI bleeds
42
Q
  1. Prototype drug for RBC production:

2. With which patients should we be extra cautious in giving erythropoietins?

A
  1. Erythropoietin

2. severe hypertensive, pregnant, abnormal renal functions, cancer patients,

43
Q
  1. Prototype for iron def. anemia:
  2. Contraindications:
  3. Adverse effects:
  4. Drug to drug:
A
  1. Iron (ferrous sulfate)
  2. hemochromatosis, hemolytic anemia, people w/ normal iron balance, peptic ulcer, colitis, regional enteritis
  3. GI irritation, CNS toxicity, Parentarel iron associated w/ anaphylaxis, tissue staining, phlebitis
  4. antacids, tetracycline, cimetidine, fluoroquinolones, chloramphenicol
44
Q
  1. Iron needs an acidic environment to absorb. So what should be avoided or given?
  2. How to administer liquid iron, especially in children? Why?
  3. Stools will be ……….. or ……….. . And it causes ………
  4. What do chelating agents do?
  5. What causes flate deficiency?
A
  1. Give orange juice, avoid antacids
  2. thru a straw because it stains teeth
  3. black, green, constipation
  4. bind to metal ions to remove heavy metals from blood
  5. absorption problems in small intestines, drugs that cause these problems, malnutrition and alcoholism.
45
Q
  1. What do we give for folic acid deficiency?
  2. How is folic acid administered?
  3. How do we administer B12 for pernicious anemia? B12 is also known as:
  4. Adverse effects for folic acid:
  5. Adverse reactions to B12:
  6. Drug to drug for both:
A
  1. folic acid
  2. orally, IM, subcutaneously, IV. Intranasal spray (may cause nasal irritation)
  3. IM injection. Remember, can’t be absorbed in intestines. Cobalamin
  4. pain at injection site or nasal irritation if inhaled through nose.
  5. Itching, anaphylaxis, heart failure, pulmonary edema, hypokalemia, pain at injection site
  6. very few because these are essential.
46
Q
      1. Name the 4 types of drugs used to treat upper respiratory infections and briefly describe what they do:
A
  1. Antitussives - block the cough reflex
  2. Decongestants, 3 types:
    Topical: decrease blood flow to upper respiratory and decrease production of mucous.
    Oral Decongestants
    Topical Steroid Decongestants
  3. Antihistamines: Block release of histamine.
  4. Expectorants - Mucolytics make cough more productive to clear airway.
47
Q
  1. Where do codeine, hydrocodone, and dextromethorphan work and what type of upper respiratory drugs are these?
  2. Where do topical nasal decongestants and nasal steroids work?
  3. Where do mucolytics work?
  4. Where do antihistamines work?
A
  1. Medullary cough center. Antitussives.
  2. Directly in the sinuses.
  3. directly on mucous
  4. on mast cells
48
Q
  1. Most antitussives are ………… derivatives. Name a few examples:
  2. What are their actions?
  3. Indication:
  4. Contraindications:
  5. Caution:
  6. Adverse effects:
  7. Drug to drug:
  8. What to watch for with patients taking these drugs?
A
  1. Morphine. Codeine, hydrocodon, dextromethorphan (prototype)
  2. Act on medullary cough center to depress cough reflex.
  3. Controls non-productive cough
  4. Patients who need to cough to maintain their airway. Head injury or CNS impairment.
  5. Those with narcotic addiction
  6. drying of mucous membranes, CNS effects, GI upset.
  7. MAOI’s
  8. respirations, temp, orientation, and affect
49
Q
  1. What is the action of topical nasal decongestants?
  2. Give 2 examples of these drugs:
  3. Indication:
  4. Contraindications:
  5. Cautions:
  6. Adverse effects:
  7. Drug to drug:
A
  1. Sympathomimetic. Decreases inflammation and the overproduction of secretions by causing local vasoconstriction to upper respiratory tract
  2. Oxymetazolin (Afrin) and phenylephrine.
  3. Relieves nasal congestion from common cold and allergic rhinitis.
  4. Lesion or erosion of mucous membranes.
  5. Any condition that may be exacerbated by sympathetic activity
  6. Rebound congestion (don’t use more than 5-7 days), local stinging, sympathomimetic effects.
  7. cyclopropane or halothane
50
Q
  1. Prototype oral decongestant:
  2. Action:
  3. Contraindications:
  4. Cautions
  5. Adverse effects:
A
  1. Pseudoephedrine.
  2. stimulates alpha/beta adrenergic receptors to vasoconstrict respiratory tract mucosa, thus reducing nasal congestion
  3. hypertension, CAD, anything aggravated by sympathetic stimulation, < 4 years old
  4. pregnancy, lactation, hyperthyroidism, diabetes, enlarged prostate, cardiac ischemia, glaucoma
  5. SEIZURES, CARDIAC COLLAPSE, anxiety, nervousness, palpitations, dry mouth
51
Q
  1. Prototype nasal steroid decongestant:
  2. Indication:
  3. Adverse effects:
A
  1. Flunisolide
  2. Used for allergic rhinitis when other treatments don’t work. Relieves inflammation (esp after polyp removal). Not systemically absorbed.
  3. local burning, irritation, dryness of mucosa, headache, increased risk of infection
52
Q
  1. Name 2 antihistamines (both 1st and 2nd gen):
  2. Indications:
  3. Actions:
  4. Cautions:
  5. Adverse effects:
A
  1. Loratadine (Claritin), diphenhydramine
  2. allergies, allergic conjuctivitis, urticaria, angioedema
  3. blocks histamines, anticholinergic and antipruritic effects
  4. pregnancy and lactation, history of arrhythmias (can change QT)
  5. drowsiness, anticholinergic effects
53
Q
  1. Prototype expectorant/mucolytic:
  2. Indications:
  3. Actions:
A
  1. Guaifenesin also, acetylcysteine
  2. relief of dry, non-productive cough with mucus in resp tract. Atelectasis, diagnostic bronchoscopy, postoperative patients, tracheostomies
  3. facilitates the removal of viscous mucus by making it less thick
54
Q
      1. What are the 6 categories of medications to treat lower respiratory conditions like COPD, Pneumonia, etc?
A
  1. Sympathomimetics
  2. Xanthines
  3. Anticholinergics
  4. Inhaled steroids
  5. Leukotriene Receptor Agonists
  6. Mast Cell Stabilizers
55
Q
  1. Prototype sympathomimetic and a few others just for good measure.
  2. Indication:
  3. Action:
  4. Adverse effects:
  5. Drug to drug
  6. In the nursing assessment of sympathomimetics, xanthines, and anticholinergics, what must we watch for?
A
  1. Epinephrine. Albuterol, Arformoterol
  2. anaphylaxis, asthma attacks, respiratory distress from COPD
  3. mimics the sympathetic nervous system to induce dilation, increased rate and depth of respiration (also increases HR and BP)
  4. BRONCHOSPASM, nervousness, tremors, angina, arrhythmias, hypertension, GI upset
  5. General anesthetics
  6. BP, HR, (all meds can increase these), nervousness, palpitations and arrhythmias.
56
Q
  1. T or F, are xanthines are used a lot today.
  2. Prototype and indication:
  3. Action:
  4. Contraindications:
  5. Adverse effects:
  6. Drug to drug:
A
  1. F
  2. Aminophylline. Relief or prevention of asthma and bronchospasm from COPD
  3. Direct effect at smooth muscle or resp. tract. Narrow therapeutic range requires lab values
  4. GI problems, CAD, renal/hepatic disease, alcoholism and hyperthyroidism
  5. GI upset, irritability, seizure, brain damage.
  6. many interactions. Nicotine increases metabolism
57
Q
  1. Anticholinergic prototype and indication:
  2. Action:
  3. What do we assess for?
  4. Adverse effects:
  5. Special instructions:
A
  1. Ipratropium - for bronchospasm of COPD and for those who can’t tolerate sympathomimetics
  2. blocks vagally mediated reflexes by antagonizing acetylcholine.
  3. bronchospasm, bladder obstruction, prostatic hypertrophy, urinary output, HR and BP
  4. nervousness, dizziness, headache, GI, cough, palpitations, urinary retention, and dry mouth
  5. wait 5 min after puff for full bronchodilation before next puff
58
Q
  1. Inhaled steroids Prototype: (name a few and suffixes):
  2. Indications:
  3. Actions:
  4. Can these be used to treat acute attacks? Why or why not?
  5. Contraindications:
  6. Adverse effects:
  7. IMPORTANT NURSING INTERVENTION:
A
  1. Budesonide. beclomethasone, fluticasone. Suffixes “ides” and “sones”
  2. Very effective treatment for bronchospasm due to inflammation. Prevents and treats asthma.
  3. Decreases inflammatory response in airways.
  4. No because they take a few days to work.
  5. Pregnancy and lactation
  6. sore throat, hoarseness, cough, dry mouth, susceptibility to fungal infections, rebound congestion
  7. Must rinse mouth with inhaled steroids to prevent thrush
59
Q
  1. Prototype Leukotriene Recptor Modulator:
  2. Indication
  3. Action:
  4. Caution:
  5. Adverse effects:
  6. Drug to drug:
  7. Remember about this drug:
A
  1. montelukast (Singulair) or Zafirlukast (“lukast”)
  2. Prophylaxis and chronic treatment of bronchial asthma in adults and kids older than 12. Zafirlukast is for ages >5.
  3. specifically blocks receptors for leukotrienes.
  4. HEPATIC/renal impairment, and preg/lactation
  5. GI upset, elevated LIVER ENZYMES, general pain
  6. doesn’t play nice. Propranolol, theophylline, terfenadine, warfarin
    Calcium channel blockers, cyclosporine, or aspirin.
  7. Can cause liver damage
60
Q
  1. Mast Cell Stabilizer prototype and indication:
  2. Actions:
  3. What is SRSA?
  4. Is Cromolyn still considered in the standars of treatment for its indicated purpose? Why or why not?
A
  1. Cromolyn. Indications-Treatment of chronic bronchial asthma, Exercise induced asthma , and Allergic rhinitis
  2. Inhibits release of histamine and slow-reacting substance of anaphylaxis (SRSA)> reduces inflammation by inhibiting inflammatory response.
  3. SRSA is a mixture of various leukotrienes (LTC4, LTD4 and LTE4), that cause bronchoconstriction
  4. No, because of the availability of more specific and safe alternatives

Pharmacology 1 (4 decks)

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