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HGTC Pharmacology NUR 161 > Exam 3 Pharm Maps > Flashcards

Exam 3 Pharm Maps Flashcards

1
Q

Assess/monitor __________ and
___________ levels before administering (All diuretics)

A

Blood pressure & Potassium

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2
Q

Monitor ___________ before and after (All diuretics)

A

Urine output

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3
Q

Caution with medications that can
________ blood pressure. (All diuretics)

A

Lower

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4
Q

__________ __________ are important to obtain with all diuretics

A

Daily weights

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5
Q

Assess for ________ prior to ambulation (All diuretics)

A

Dizziness

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6
Q

Take medication _____________ (pt. teaching, All diuretics)

A

In the A.M.

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7
Q

Avoid _____ (pt. teaching, All diuretics)

A

Alcohol

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8
Q

Notify MD if you experience ___, ___, or _____
(pt. teaching, All diuretics)

A

Weakness, Cramps, Heart palpitations

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9
Q

May cause _____ (pt. teaching, All diuretics)

A

Dizziness

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10
Q

Loop diuretic drug name

A

Furosemide (Lasix)
-ide

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11
Q

Reason for taking loop diuretics (3)

A

Hypertension, Pulmonary edema, & Congestive heart failure (CHF)

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12
Q

Action of loop diuretics

A

Acts on ascending LOH to prevent Na & Chloride being reabsorbed back into the BV. (extra water enter tubes)
Where salt goes, water follows

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13
Q

What are diuretics also called

A

Water pills

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14
Q

Loop diuretics contraindications (3)

A

Other nephrotoxic or ototoxic drugs
Digoxin (loss of potassium increases risk of toxicity)
Chronic renal failure

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15
Q

Loop diuretics adverse reactions (6)

A

Ototoxicity, Hypokalemia, Dehydration, Allergy, Nephritis, & Gout (“OH DANG”)

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16
Q

IV push slowly over ____ why? (loop diuretics)

A

1mL/min, Avoid causing tinnitus or hearing loss

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17
Q

Should use caution in the ____. Why? (loop diuretics)

A

Elderly, Because they often have an impaired renal or impaired liver = slow metabolism

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18
Q

Pt. on loop diuretics should eat food rich in __. Why?

A

Potassium, Because they lose a lot of potassium in the urine

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19
Q

Why do loop diuretics cause gout?

A

It causes hyperuricemia (extra uric acid)

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20
Q

What is uric acid?

A

A waste product when cells die and from certain foods
- too much of it causes these urate crystals by joints- joints becomes inflamed (gout)

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21
Q

Thiazide drug name

A

Hydrochlorothiazide (HCTZ)
(-thiazide)

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22
Q

Reason for taking Thiazides (3)

A

Hypertension (1st line DOC)
Pulmonary edema
Congestive HF

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23
Q

Action of Thiazides

A

Promotes Na & water excretion and
holds on to potassium but less than
the Potassium-sparing diuretics.
“The middleman”

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24
Q

Thiazides contraindications (4)

A

Renal failure
Caution with medications
- ACE inhibitors
- Digoxin
- Lithium

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25
Q

Thiazides adverse reactions (3)

A

Dizziness, Impotence, & Electrolyte imbalance

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26
Q

Pt.s on thiazides should avoid ____. Why?

A

Licorice, Excessive amounts can lead to hypokalemia

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27
Q

Monitor _____ with Thiazides

A

Creatine clearance
Hold if <50 mL/min

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28
Q

What is a benefit from using Thiazides?

A

Safest b/c of less effect on potassium levels

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29
Q

Potassium-sparing diuretics drug name

A

Spironolactone (Aldactone)
-one

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30
Q

Reason for taking potassium-sparing diuretics (3)

A

Hypertension, Pulmonary edema, & Congestive HF

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31
Q

Action of potassium-sparing diuretics

A

Promotes Na & water excretion but holds on to potassium in the blood stream.
(more than thiazide diuretics)

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32
Q

Potassium-sparing diuretics contraindications (4)

A

ACE inhibitors (hold on to potassium)
Digoxin (toxicity can cause hyperkalemia)
NSAIDS (increased nephrotoxicity)
Lithium (increases toxicity)

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33
Q

Potassium-sparing diuretics adverse reactions (3)

A

Hyperkalemia
Gynecomastia (overgrowth of breast tissue in men)
Abnormal menstrual cycle

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34
Q

Caution with other ____ (potassium-sparing diuretics)

A

Nephrotoxic drugs

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35
Q

What foods should pt. on potassium-sparing diuretics limit or avoid? Give examples?

A

High potassium
Ex: bananas, meats, fish, legumes, & tomatoes

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36
Q

Compare & contrast potassium-sparing diuretics with ___

A

Loop diuretics & Thiazide

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37
Q

Monitor for ___ & ____(All acid controlling medications)

A

Effectiveness & Abdominal pain

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38
Q

Review medication list for ____ (All acid controlling medications)

A

Drug interactions

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39
Q

Take _____ (All acid controlling medications, pt. teaching)

A

As directed

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40
Q

Avoid ____ (All acid controlling medications, pt. teaching)

A

Acidic foods (Citrus, alcohol, & condiments)

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41
Q

Pt.s on All acid controlling medications should stop

A

Smoking

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42
Q

Proton pump inhibitor (PPI) drug names (3)

A

Pantoprazole (Protonix)
Omeprazole (Prilosec)
Esomeprazole (Nexium)

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43
Q

Reason for taking PPI (3)

A

Gastroesophageal Reflux Disease (GERD)
GI ulcers (NSAIDs, stress-related)
Peptic Ulcer Disease (PUD)

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44
Q

Action of PPI

A

Inhibits protons (hydrogen ions) from entering the stomach – this blocks the production of hydrochloric acid.

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45
Q

PPI contraindications

A

Do not take with Theophylline. Increases risk of theophylline toxicity – hypokalemia, and metabolic acidosis

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46
Q

PPI adverse reactions (4)

A

C-diff, Dementia, Hypomagnesemia, & Multiple drug interactions

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47
Q

Caution while taking the following medications (4) (PPI), Why?

A

Warfarin (increased risk of bleeding)
Benzo (increase serum drug levels)
Antiepileptic drugs (increases serum drug levels)
Digoxin (absorption)

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48
Q

What do I teach my pt. about PPIs?

A

Take on an empty stomach and notify the MD of all medications, long-term use may cause osteoporosis or dementia

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49
Q

What should I monitor for with PPIs?

A

Magnesium level and side effects

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50
Q

H2 antagonist drug names (3)

A

Cimetidine (Tagamet)
Famotidine (Pepcid)
Ranitidine (Zantac)
-tidine

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51
Q

Reason for taking H2 antagonists (4)

A

GERD, PUD, Zollinger-Ellison Syndrome, & GI bleeds

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52
Q

What is Zollinger-Ellison Syndrome?

A

Tumors found in the pancreas & intestines but usually not cancerous

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53
Q

Action of H2 antagonists

A

Blocks H2 receptors which decreases HCL production

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54
Q

H2 antagonist contraindications (2)

A

Know drug allergies & Liver/kidney disease

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55
Q

H2 antagonist adverse reactions (4)

A

Confusion, Impotency, Gynecomastia, & Thrombocytopenia (low platelets)

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56
Q

Pt. on H2 antagonists should ___

A

Stop smoking

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57
Q

Take H2 antagonist _____ hr. before ____

A

1-2, antacids

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58
Q

Antacids drug names (4)

A

Calcium antacids (TUMS)
Sodium antacids (alka-seltzer)
Aluminum salts (Maalox)
Magnesium antacids (MOM)

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59
Q

Reasons for taking Antacids (3)

A

Gastritis, Heartburn, & Acid reflux

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60
Q

Action of antacids

A

Depends on type of antacids

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61
Q

Antacids contraindications

A

Magnesium antacids in renal patients

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62
Q

Antacids adverse reactions (5) (all 4 have their own)

A

Calcium antacids- kidney stones
Magnesium antacids- severe diarrhea
Aluminum salts- constipation
Sodium antacids- cardiac dysrhythmias
Metabolic alkalosis (All of them)

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63
Q

Take antacids ___ to ___ hr. before ____

A

1-2, other medications

64
Q

When administering ____ or (tell pt. to) ____ (antacids)

A

Shake well or chew thoroughly

65
Q

Take antacids with ___

A

8 oz. of water

66
Q

Gastric mucosal protective agents drug name

A

Sucralfate (Carafate)

67
Q

Reason for taking Carafate (2)

A

PUD & Stress ulcer

68
Q

Action of Carafate

A

Binds to ulcer & forms a barrier against pepsin

69
Q

Carafate adverse reactions (3)

A

Constipation, dry mouth, & nausea

70
Q

Carafate must be given ____ before other medications and ____ before meals

A

2 hrs. before other meds & 1-2 hrs. before meals

71
Q

Why is Carafate helpful in pt. with renal failure?

A

It binds with phosphate, lowers phosphate levels, renal pts. hold on to phosphate

72
Q

Compare/contrast Cytotec & Mylicon. (carafate)

A

Cytotec – cytoprotective (protects parietal cells), SE: GI distress, vaginal bleeding. With meals, no pregnancy
Mylicon- used for flatulence, breaks up gas bubbles, no real SE or drug interactions, pregnancy safe

73
Q

Antiemetic Serotonin inhibitor drug name

A

Ondansetron (Zofran)

74
Q

Reason for taking Zofran (2)

A

Nausea & DOC for cancer pt.

75
Q

Action of Zofran

A

Block serotonin receptors in the GI tract and vomiting centers (specifically 5-HT3 receptors)

76
Q

Zofran contraindications

A

Liver problems

77
Q

Zofran adverse reactions (5)

A

Drowsiness, Jaundice, Confusion, QT prolongation, & Serotonin syndrome

78
Q

Pt. on Zofran has symptoms of muscle rigidity, confusion, & agitation. What do you suspect is happening?

A

Serotonin Syndrome

79
Q

Monitor Zofran for ____

A

Over-sedation (No driving or operating heavy machinery)

80
Q

Monitor the pt.’s (Zofran)

A

QT interval

81
Q

Take Zofran_____ min before chemotherapy

A

30 to 60

82
Q

Why should pt. on antiemetic drugs avoid alcohol?

A

These drugs block serotonin (stimulant) & alcohol is a depressant

83
Q

Assess ____ before administering insulin

A

Blood sugar

84
Q

Monitor of s/s of ___ with insulin (what are those?)

A

Hypoglycemia
Confusion, lethargy, tremors, & diaphoretic

85
Q

What is a very important part of insulin admin for a nurse?

A

Verifying the dose in the syringe with another nurse

86
Q

Pt. taking insulin should wear a ___

A

Medical alert bracelet

87
Q

Pt. on insulin should always carry ___ with them

A

Glucagon tablets

88
Q

What should we teach our pts. to due before administering insulin

A

Check a finger stick blood sugar

89
Q

Rapid acting insulin drug names (2)

A

Insulin aspart (HumaLOG) & insulin lispro (NovoLOG)

90
Q

When is the onset of rapid acting insulin, and how long does it last?

A

Onset: within 15 min, give right before a meal
Last:3-5 hrs.

91
Q

Short acting insulin drug name

A

Regular insulin (Humulin R & Novolin R)

92
Q

When is the onset of short acting insulin, and how long does it last?

A

Onset: 30-60 min
Last: 6-10 hrs

93
Q

Intermediate insulin drug name

A

NPH insulin (Humulin N)

94
Q

When is the onset of intermediate insulin, and how long does it last?

A

Onset: 1-2 hrs
Lasts: 10-18 hrs

95
Q

Long acting insulin drug names (2)

A

Insulin detemir (Levemir)
Insulin glargine (Lantus)

96
Q

When is the onset of long acting insulin, and how long does it last?

A

Onset: 1-2 hrs
Last: 24 hr

97
Q

Reason for taking insulin

A

All types of diabetes (mostly type 1)

98
Q

Action insulin

A

Helps remove glucose from the bloodstream into the cells

99
Q

Insulin contraindications (3)

A

Vomiting and/or diarrhea
Surgical pt. (NPO)
Low blood sugar (hypoglycemic)

100
Q

Insulin adverse reaction

A

Hypoglycemia

101
Q

Your pt. is NPO after midnight for surgery, what are your concerns?

A

Hypoglycemia (continue FSBS, monitor for s/s of hypoglycemia, ask MD for IVF with dextrose

102
Q

How do you administer insulin injections? Where? What syringe?

A

Choose/clean injection site pinch skin, inject at a 45-90° angle, and push the plunger slowly. Inject into SubQ tissue; Orange-capped unit syringes.
Cloudy, Clear, Clear, Cloudy

103
Q

What are you going to tell your pt. about their meal planning? (Insulin)

A

Avoid sugars & starches

104
Q

The pt. is slow to respond, has tremors, and is diaphoretic. What do you suspect has happened?

A

Hypoglycemia (administer snack (protein, milk) if conscious. Give glucagon SQ or D50W IV (if lethargic or NPO))

105
Q

Antidiabetic drug name

A

Metformin (Glucophage)

106
Q

Reason for taking Metformin

A

Diabetes

107
Q

Action of Metformin

A

Decreases hepatic glucose production (stops the breakdown of glycogen in the liver)

108
Q

Metformin contraindication

A

Any procedures that use contrast (dye)

109
Q

Metformin adverse reactions (3)

A

Nausea, Vomiting, & Diarrhea

110
Q

Take antidiabetic meds on ___

A

A regular schedule 30 min. before meals

111
Q

Use ___ in moderation with antidiabetic meds

A

Alcohol

112
Q

HOLD antidiabetic meds if pt. is having ____ or _____

A

A surgery or a procedure that uses dye

113
Q

What is the importance of holding antidiabetic medications with contrast?

A

IV contrast slows down GFR - increases metformin in the bloodstream - increases the risk of lactic acidosis. (because metformin blocks a certain enzyme from breaking down glucagon, blocking this enzyme also causes lactic acid buildup in the body.

114
Q

Hormone drug name

A

Glucagon

115
Q

Reason for taking glucagon

A

Hypoglycemia

116
Q

Action of glucagon

A

Hormone that triggers the liver to break down glycogen into glucose

117
Q

Glucagon contraindications

A

Hyperglycemia

118
Q

Glucagon adverse reactions (3)

A

Nausea, Vomiting, Swelling (edema) at injection site

119
Q

When would glucagon be given?

A

Hypoglycemia & cannot eat, unconscious, NPO for procedure, seizure

120
Q

Pts should ____ with glucagon

A

Always keep it on them

121
Q

Hypertonic solution drug name

A

50% dextrose solution (pre-filled syringe)

122
Q

Reason for taking dextrose

A

Hypoglycemia

123
Q

Action of dextrose

A

Replaces sugar in the bloodstream

124
Q

Dextrose contraindications

A

Hyperglycemia

125
Q

Dextrose adverse reactions

A

Rebound hypogylcemia

126
Q

When is 50% dextrose solution used?

A

Emergency use (lethargic, unresponsive, NPO)

127
Q

Give 50% dextrose solution in a ___ IV

A

Large bore

128
Q

Glucocorticoid drug name & suffixes

A

Methylprednisolone (Solumedrol)
-solone or -sone

129
Q

Reasons for taking methylprednisolone (4)

A

Inflammatory disorders such as:
Asthma
COPD exacerbation
PNA
But also IBS or skin disorders

130
Q

Action of methylprednisolone

A

Blocks the inflammatory response
Inhibits certain proteins (leukocytes, etc.) that set off the inflammatory chain

131
Q

Methylprednisolone contraindications (4)

A

 Liver or renal disease (decreases metabolism or excretion)
 Diabetics (increases blood sugar)(steroids stop glucose being used up by muscle, sits in bloodstream)
 GERD (increased risk of stomach ulcers)(increases stomach acid)
 Autoimmune Diseases – (increases exacerbation)

132
Q

Methylprednisolone adverse reactions (6)

A

Edema d/t fluid retention
High blood sugar
Low potassium
Weight gain (major concern for pts.)
Jitteriness or shakiness
Immunosuppression

133
Q

What are some things to avoid while on methylprednisolone

A

Live vaccines, alcohol, ASA, or other NSAIDS

134
Q

What would I tell my pt. about Methylprednisolone?

A

Report leg cramps, edema to MD. Avoid crowds or the sick (immunosuppression)

135
Q

Monitor ___ in diabetic pt. (methylprednisolone)

A

Blood sugar

136
Q

Take methylprednisolone with ____ or ___

A

Food or milk

137
Q

Take the ______. DO NOT ______(methylprednisolone)

A

Take whole dose
DO NOT STOP ABRUPTLY! (cause adrenal insufficiency) (tapered off)

138
Q

Synthetic hormone replacement drug name

A

Levothyroxine (Synthroid)

139
Q

What is an interesting factor about levothyroxine dosage

A

Always dosed in mcg

140
Q

Reason for taking levothyroxine

A

Hypothyroidism (usually caused by Hashimoto’s disease)

141
Q

Action of levothyroxine

A

Replaces the hormone thyroxine (T4 – main hormone of the thyroid gland) that the thyroid is unable to produce.

142
Q

Levothyroxine contraindication

A

Elevated T4 levels

143
Q

Levothyroxine adverse reaction

A

Cardiac arrhythmias
- Chest pain
- Dyspnea
- Palpitations

144
Q

What labs would you monitor for levothyroxine? (3)

A

Routine TSH, T4, & T3 levels

145
Q

How do I direct pt. to take levothyroxine?

A

Take in the morning, an empty stomach or full glass of water, do not interchange brands, avoid foods high in iodine (shellfish, table salts, dairy, green beans) and never stop abruptly.

146
Q

How does the thyroid work?

A

Butterfly shape, produces three hormones (T3, T4, calcitonin) used to regulate metabolism, growth, and development, and maintain temperature, mood, menstruation, etc.

147
Q

Define Hypothyroid and Hyperthyroid

A

The drugs correct deficiency in thyroid hormone (Hypothyroidism) or
Correct excessive thyroid hormone (Hyperthyroidism)

148
Q

A 16-year-old patient has been diagnosed with Hashimoto’s Disease. What medication would you expect the physician to order for this patient?

A

Levothyroxine - Synthroid

149
Q

Levothyroxine Sodium (Synthroid) has been ordered and is a new medication for the patient. What teaching would you provide to this patient? (8)

A
  1. Never discontinue drug abruptly
  2. Importance of f/u visits for thyroid function tests
  3. Drug interactions are common, notify MD of any new medications
  4. May take up to three weeks for effect
  5. Take on empty stomach & with full glass of water before breakfast
  6. Will need lab work and f/u care. (T4, TSH)
  7. side effects: often from toxicity (too much synthroid) see signs of hyperthyroid (tachy, increased BP, intolerance to heat, etc.
  8. When to call MD
150
Q

When caring for a patient with Hypothyroid or Hyperthyroid, what vital signs are important to monitor for effectiveness of medications?

A

BP & HR

151
Q

Mrs. Jones is started on Levothyroxine Sodium. She asks you when she will start to feel better.
What is your best answer?

A

The medication will start to take effect in 2 days, but the full effect will take 3-5 weeks.

152
Q

Why would Inderal be used as another medication to treat Hyperthyroidism?

A

Beta Blockers: Inderal
Beta-blockers ameliorate the symptoms of hyperthyroidism that are caused by increased beta-adrenergic tone. These include PALPITATIONS, TACHYCARDIA, TREMULOUSNESS, ANXIETY, and HEAT INTOLERANCE. Thus, a beta blocker should be started (assuming there are no contraindications to its use) in most patients as soon as the diagnosis of hyperthyroidism is made, even before determining the cause of the hyperthyroidism. They should be continued until resolution of hyperthyroidism.

153
Q

A patient has deficient levels of PTH. What vitamin and supplement would you expect the patient to be taking?

A

Vitamin D & Calcium

154
Q

List 7 specific things about glucocorticoids that you would teach your patient

A
  1. Administer in am 0900 to mimic normal peak diurnal concentration levels. This
    minimizes suppression of the hypothalamic-pituitary axis.
  2. Increase dose if under stress
  3. No live virus vaccines as at increased risk for infection. Examples of live virus vaccines are the chickenpox vaccine and the measles, mumps, and rubella (MMR) vaccine.
  4. Adverse Effects: insomnia, increased water and sodium retention, increased potassium excretion
  5. Suppresses immune and inflammatory responses, Osteoporosis, peptic ulcers, impaired wound healing, hypertension, cataracts
  6. Do not give live vaccines – increase risk infection.
  7. Steroids suppress the immune system = protect from infection
155
Q

Why are steroids tapered?

A

Adrenal gland has stopped producing hormones when they are being given.
Must taper to slowly get adrenal gland to start secreting hormones

156
Q

What effect do Glucocorticoids have on glucose levels?

A

Elevates glucose levels. Monitors diabetic pt. closely

157
Q

A primary nursing diagnosis for pt. taking glucocorticoids is:

A

Risk for infection r/t immunosuppression

HGTC Pharmacology NUR 161 (4 decks)

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