Exam 3 Flashcards
3 cells of the gastric gland:
chief, mucous, parietal
parietal cell produces and secretes what?
hydrochloric acid
what can cause peptic ulcer disease?
stress, H. pylori, alcohol, smoking
what are antacids used for?
treatment of peptic ulcer disease
prevention of stress-induced ulcers
relief of manifestations of GERD
how do antacids work?
neutralize acid and promote gastric mucosal defense mechanisms like secretions of mucus, bicarbonate (helps buffer acidic properties of HCl), and prostaglandins (prevent activation of PP by preventing histamine from binding to its corresponding parietal cell receptors)
magnesium antacids are CI in what patients?
renal
aluminum antacids can cause?
constipation
magnesium antacids can cause?
diarrhea
why do we use aluminum and magnesium antacids together?
to counteract their effects (cancel out constipation and diarrhea)
aluminum antacids have the potential to cause what electrolyte issue?
hypophosphatemia - Aluminum hydroxide has a high affinity for phosphate. By binding with phosphate, the drug can reduce phosphate absorption, and can thereby cause hypophosphatemia
how often can these drugs be used everyday?
up to 7, but 4 is normal
muco-protectant sucralfate needs to be given when?
empty stomach
how long to wait before giving other drugs after antacids or sulcrafate?
2 hours
sucralfate can cause?
constipation
what is GERD?
gastroesophageal reflux disease
what are the 3 c’s that start GERD?
caffeine, chocolate, coffee
how do histamine 2 receptor blockers (famotidine) work?
blocks gastric acid secretion by inhibiting H2 receptors and lowers the concentration of hydrogen ions in the stomach
if a patient needs to take an H2 receptor (famotidine) and an antacid, when is the antacid given?
2 hours after
how do PPIs work?
bind directly to the hydrogen-potassium-ATPase pump mechanism and irreversibly inhibit the action of this enzyme, which results in a total blockage of hydrogen ion secretion from the parietal cells.
if the patient has a major blockage of HCL what does that make them more susceptible of getting?
C. diff
if they are on omeprazole longer than the prescribed dose and start to have abdominal pain, bloody stools, loose diarrhea what should they do ?
call the doctor
when should PPIs (omeprazole) be taken?
30-60 min before eating (food may decrease absorption)
if a patient is taking an antidiarrheal longer than 5 days with no improvement, what should they do?
call the doctor
when do we give opiates and anticholinergics together?
opiates decrease transit time of food in the bowel, and anticholinergics slow peristalsis. effects make med unpleasant and discourage abuse of drugs.
the chemoreceptor trigger zone is usually impacted by what 2 neuro receptors?
serotonin and dopamine
how does metoclopramide work?
promote gastric emptying
the oral form of metoclopramide is used for?
GERD and diabetic gastroparesis
which medication has the following side effects:
Tardive dyskinesia: usually from high dose, long-term therapy
EPS: administer an antihistamine (diphenhydramine) to minimize EPSs
Sedation: avoid driving, operating heavy machinery
Diarrhea: monitor for dehydration
Hypotension, SVT
Restlessness, HA, dystonia
Dry mouth
metoclopramide
serotonin blockers like “ondansetron” block what receptors in the chemoreceptor trigger zone (CTZ)?
serotonin
what are B cells?
white blood cells that produce antibodies specific to the antigen that stimulated their production.
what are antibodies?
proteins that bind to the antigen of an invader, tagging the invader for attack or directly neutralizing it. The body produces thousands of different antibodies. Each antibody is specific to a given antigen
What are antigens?
any substance that the immune system can recognize and thus stimulate an immune response
what is the HLA?
Human leukocyte antigens (HLA) are a group of identification molecules located on the surface of all cells in a combination that is almost unique for each person, thereby enabling the body to distinguish self from non-self. This group of identification molecules is also called the major histocompatibility complex.
What are T cells?
white blood cells that are involved in acquired immunity. There are three types: helper, killer (cytotoxic), and regulatory.
Main purpose of the immune system:
distinguish self from non-self and to protect the body from foreign material (antigens), including cancer
Two types of immunity:
- The humoral response (or antibody‐mediated immunity) involves B cells that recognize antigens or pathogens that are circulating in the lymph or blood
- The cell‐mediated response involves mostly T cells and responds to any cell that displays aberrant MHC (Major histocompatibility complex ) -AKA- (HLA markers) including: cells invaded by pathogens, tumor cells, or transplanted cells.
what are primary immunodeficiency diseases - (PIDD)?
a group of disorders caused by inherited or genetic defects in the cells and tissues of the immune system.
what are secondary immune deficiency diseases?
when the immune system is compromised due to an environmental factor. Examples of these outside forces include HIV, chemotherapy, severe burns or malnutrition.
Type 1 – allergic reactions are what type of immune response?
IgE
this drug stimulates all adrenergic receptors
epinephrine
how do antiviral drugs work?
kill or suppress virus by destroying virions or inhibiting the ability of viruses to replicate
what is acyclovir used to treat?
HSV1 (oral), HSV2 (genital), VZV
What is VZV?
Activation of Herpes varicella zoster virus (VZV) (Shingles)
Inflammation of dorsal root ganglia, usually along dermatomes
the patient should have a lot of what when receiving acyclovir?
fluids
what labs need to be monitored with acyclovir?
clearance of drug, kidney (BUN, creatinine)
what are the FACTS of the flu?
fever, aches, chills, tiredness, sudden onset
what should be given within 48 hours of being exposed/start showing signs of the flu?
oseltamivir
when is flu season?
November to april
what is a common complication of the flu?
pneumonia
how does oseltamivir work?
stops budding irons from escaping infected cells and spreading through the body, stops the action of the neuraminidase enzymes and stop their work in the body
what is the difference between CD4 count and viral load?
CD4- WBC that fight infection
viral load- amount of virus a person has
effectiveness of treatment: increase CD4 count and decrease viral load
HIV replication is best suppressed by?
combo or cocktail of drugs to disrupt HIV replication at multiple stages
HAART therapy is a?
combo or cocktail of drugs
what is nicoceptive pain?
pain from physical damage to the body
what are the 2 types of pain?
somatic (pain from skin, muscle, soft tissue)
visceral (pain from internal organs)
what is neuropathic pain?
damage to peripheral nerve or CNS
acute pain?
sudden onset, generally a precipitating event or illness can be identified.
increase pulse, RR, b/p, diaphoresis.
pain control with eventual elimination.
chronic pain?
persistent, may start acute but continues, cause may be unknown.
flat affect, decrease physical activity, withdrawn.
focus on enhancing quality of life, often use adjunctive therapies.
what is adjunctive therapy?
Used in conjunction with opioids & nonopioids, often developed for other purposes, can also be non-med therapies (music, relaxation, massage, acupuncture, heat/cold)
what is inflammation?
immunologic defense against tissue injury, infection, or allergy
what are causes of inflammation?
infection, trauma, surgical intervention, burn, frostbite, autoimmune processes (such as RA)
clinical manifestations of local inflammation?
redness, heat, swelling, pain, loss of function
clinical manifestations of systemic response?
increased WBC, malaise, nausea, anorexia, increased pulse and RR, fever
for soft tissue injuries, what is RICE?
rest, ice, compression, elevation
what is RA?
immune response gone wild.
Prostaglandins
•Following injury, arachidonic acid is converted into prostaglandins, thromboxane, and leukotrienes.
•Considered proinflammatory
•Potent vasodilators
clinical manifestations of RA/JIA?
Symmetric involvement
Fluid accumulation and synovial swelling
Pannus: granular tissue
Eroded cartilage
Ankylosis: extreme stiffness or joint fusion
therapeutic management of RA?
no cure, goal is to relieve pain, slow or stop joint damage, improve ability to function, modified tools to perform ADLs
therapeutic management of JIA?
no specific cure, goals to preserve function & prevent deformities, physical & occupational therapy, sometimes outgrows
what meds do we give for RA?
methotrexate
expected PA of methotrexate
immunosuppression: decrease joint inflammation and joint damage
complications of methotrexate
GI ulceration, increase risk of infection, liver damage, bone marrow suppression
nursing interventions for methotrexate
Watch for S&S of infection, watch for bleeding, watch for jaundice, may take 3-5 months to work so often give NSAID at the beginning
what are ibuprofen (NSAIDS) used for?
inflammation, pain, fever
complications of ibuprofen
GI upset, heartburn, nausea, ulcerations bleeding
nursing interventions for ibuprofen
monitor for signs of bleeding, take with food/milk, recommend a proton pump inhibitor, report symptoms of embolic events
what is opioid use disorder?
chronic disease, changes the brain chemistry (affecting dopamine, the reward center)
symptoms of overdose?
respiratory depression, pinpoint pupils, unconsciousness
what do we do for drug overdose?
naloxone and promote getting professional help
acetaminophen use?
analgesia for mild to moderate pain, fever reduction (no anti-inflammatory or anticoagulant effects)
complications of acetaminophen?
liver damage, hypertension
daily limit for acetaminophen for hx of alcoholism
2000 mg/day
morphine use
analgesia for moderate to severe pain
morphine complications
respiratory depression, constipation, itching, hypotension, urinary retention
morphine med admin
IV- dilute slowly (give over 4-5 min), get baseline VS & monitor, give to cancer patients on a schedule, have naloxone nearby
morphine nursing interventions
monitor vs, hold for RR <12, encourage fiber and stool softener, monitor I&O
naloxone use
reversal of opioid effects (blocks opioid receptors)
increase RR, BP, pulse
naloxone complications
increase RR, BP, pulse
abstinence syndrome (HTN, vomiting, tremors)
pain will be back full force
naloxone med admin
prepare to give every 2-3 minutes until reversed
naloxone nursing interventions
monitor VS, have oxygen and resuscitative equipment ready, person with opioid use disorder keep with them, can buy without prescription in pharmacy
what is SBIRT?
screening, brief intervention, referral to treatment
what does SBIRT provide?
routine and universal screening for everyone
evidenced based care
ongoing transition from primary care to treatment
what is gout?
increased uric acid levels
where does gout affect?
starts in great toes, occur in ursae, tendons, joints
s&s of gout
joint pain, stiffness, limited range of motion, itching, joint inflammation, tophi, erythema
nursing intervention of gout
manage pain, monitor joint inflammation, meds, assist with range of motion, nutrition, promote hydration
therapeutic use of allopurinol
treat the hyperuricemia that causes gout
complications of allopurinol
agranulocytosis, aplastic anemia, potentially fatal skin conditions
allopurinol nursing interventions
Baseline uric acid level level, CBC, liver & kidney function, drink at least 3 liters of fluid per day, monitor for signs of hypersensitivity syndrome, can give with meals to help with GI effects, report bleeding, and/or easy bruising, metallic taste, can cause cataract
which disorder comes from a problem with the thyroid itself?
hypothyroidism
what disorder uses methimazole?
hyperthyroidism
what disorder needs thyroid replacement?
hypothyroidism
what disorder needs an anti-thyroid drug?
hyperthyroidism
what disorder has the following signs: bulging eyes, weight loss, muscle wasting, fine-straight hair
Hyperthyroidism
what disorder has the potential of crisis thyroid storm?
hyperthyroidism
what disorder has the following symptoms: cold, low energy, weight gain, dry skin
hypothyroidism
what med increases metabolic rare, protein synthesis, cardiac output, renal perfusion, oxygen use, body temp, blood volume, and growth?
levothyroxine
what med takes 6-8 weeks to work?
levothyroxine
what med blocks synthesis of thyroid hormones and prevents the oxidation of iodide?
methimazole
what med can take 1-2 weeks to be evident but 3-12 for full effect?
methimazole
which med needs to be taken without food?
levothyroxine
which med would I want to see a decreasing TSH?
levothyroxine
what med should one avoid soy? (thermoreg)
levothyroxine
what med could potentially cause agranulocytosis? (thermoreg)
methimazole
which thermoreg med is a pregnancy cat D?
methimazole
