Exam 3 Pharm Maps Flashcards
1
Q
Assess/monitor __________ and
___________ levels before administering (All diuretics)
A
Blood pressure & Potassium
2
Q
Monitor ___________ before and after (All diuretics)
A
Urine output
3
Q
Caution with medications that can
________ blood pressure. (All diuretics)
A
Lower
4
Q
__________ __________ are important to obtain with all diuretics
A
Daily weights
5
Q
Assess for ________ prior to ambulation (All diuretics)
A
Dizziness
6
Q
Take medication _____________ (pt. teaching, All diuretics)
A
In the A.M.
7
Q
Avoid _____ (pt. teaching, All diuretics)
A
Alcohol
8
Q
Notify MD if you experience ___, ___, or _____
(pt. teaching, All diuretics)
A
Weakness, Cramps, Heart palpitations
9
Q
May cause _____ (pt. teaching, All diuretics)
A
Dizziness
10
Q
Loop diuretic drug name
A
Furosemide (Lasix)
-ide
11
Q
Reason for taking loop diuretics (3)
A
Hypertension, Pulmonary edema, & Congestive heart failure (CHF)
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
13
Q
What are diuretics also called
A
Water pills
14
Q
Loop diuretics contraindications (3)
A
Other nephrotoxic or ototoxic drugs
Digoxin (loss of potassium increases risk of toxicity)
Chronic renal failure
15
Q
Loop diuretics adverse reactions (6)
A
Ototoxicity, Hypokalemia, Dehydration, Allergy, Nephritis, & Gout (“OH DANG”)
16
Q
IV push slowly over ____ why? (loop diuretics)
A
1mL/min, Avoid causing tinnitus or hearing loss
17
Q
Should use caution in the ____. Why? (loop diuretics)
A
Elderly, Because they often have an impaired renal or impaired liver = slow metabolism
18
Q
Pt. on loop diuretics should eat food rich in __. Why?
A
Potassium, Because they lose a lot of potassium in the urine
19
Q
Why do loop diuretics cause gout?
A
It causes hyperuricemia (extra uric acid)
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)
21
Q
Thiazide drug name
A
Hydrochlorothiazide (HCTZ)
(-thiazide)
22
Q
Reason for taking Thiazides (3)
A
Hypertension (1st line DOC)
Pulmonary edema
Congestive HF
23
Q
Action of Thiazides
A
Promotes Na & water excretion and
holds on to potassium but less than
the Potassium-sparing diuretics.
“The middleman”
24
Q
Thiazides contraindications (4)
A
Renal failure
Caution with medications
- ACE inhibitors
- Digoxin
- Lithium
25
Thiazides adverse reactions (3)
Dizziness, Impotence, & Electrolyte imbalance
26
Pt.s on thiazides should avoid ____. Why?
Licorice, Excessive amounts can lead to hypokalemia
27
Monitor _____ with Thiazides
Creatine clearance
Hold if <50 mL/min
28
What is a benefit from using Thiazides?
Safest b/c of less effect on potassium levels
29
Potassium-sparing diuretics drug name
Spironolactone (Aldactone)
-one
30
Reason for taking potassium-sparing diuretics (3)
Hypertension, Pulmonary edema, & Congestive HF
31
Action of potassium-sparing diuretics
Promotes Na & water excretion but holds on to potassium in the blood stream.
(more than thiazide diuretics)
32
Potassium-sparing diuretics contraindications (4)
ACE inhibitors (hold on to potassium)
Digoxin (toxicity can cause hyperkalemia)
NSAIDS (increased nephrotoxicity)
Lithium (increases toxicity)
33
Potassium-sparing diuretics adverse reactions (3)
Hyperkalemia
Gynecomastia (overgrowth of breast tissue in men)
Abnormal menstrual cycle
34
Caution with other ____ (potassium-sparing diuretics)
Nephrotoxic drugs
35
What foods should pt. on potassium-sparing diuretics limit or avoid? Give examples?
High potassium
Ex: bananas, meats, fish, legumes, & tomatoes
36
Compare & contrast potassium-sparing diuretics with ___
Loop diuretics & Thiazide
37
Monitor for ___ & ____(All acid controlling medications)
Effectiveness & Abdominal pain
38
Review medication list for ____ (All acid controlling medications)
Drug interactions
39
Take _____ (All acid controlling medications, pt. teaching)
As directed
40
Avoid ____ (All acid controlling medications, pt. teaching)
Acidic foods (Citrus, alcohol, & condiments)
41
Pt.s on All acid controlling medications should stop
Smoking
42
Proton pump inhibitor (PPI) drug names (3)
Pantoprazole (Protonix)
Omeprazole (Prilosec)
Esomeprazole (Nexium)
43
Reason for taking PPI (3)
Gastroesophageal Reflux Disease (GERD)
GI ulcers (NSAIDs, stress-related)
Peptic Ulcer Disease (PUD)
44
Action of PPI
Inhibits protons (hydrogen ions) from entering the stomach – this blocks the production of hydrochloric acid.
45
PPI contraindications
Do not take with Theophylline. Increases risk of theophylline toxicity – hypokalemia, and metabolic acidosis
46
PPI adverse reactions (4)
C-diff, Dementia, Hypomagnesemia, & Multiple drug interactions
47
Caution while taking the following medications (4) (PPI), Why?
Warfarin (increased risk of bleeding)
Benzo (increase serum drug levels)
Antiepileptic drugs (increases serum drug levels)
Digoxin (absorption)
48
What do I teach my pt. about PPIs?
Take on an empty stomach and notify the MD of all medications, long-term use may cause osteoporosis or dementia
49
What should I monitor for with PPIs?
Magnesium level and side effects
50
H2 antagonist drug names (3)
Cimetidine (Tagamet)
Famotidine (Pepcid)
Ranitidine (Zantac)
-tidine
51
Reason for taking H2 antagonists (4)
GERD, PUD, Zollinger-Ellison Syndrome, & GI bleeds
52
What is Zollinger-Ellison Syndrome?
Tumors found in the pancreas & intestines but usually not cancerous
53
Action of H2 antagonists
Blocks H2 receptors which decreases HCL production
54
H2 antagonist contraindications (2)
Know drug allergies & Liver/kidney disease
55
H2 antagonist adverse reactions (4)
Confusion, Impotency, Gynecomastia, & Thrombocytopenia (low platelets)
56
Pt. on H2 antagonists should ___
Stop smoking
57
Take H2 antagonist _____ hr. before ____
1-2, antacids
58
Antacids drug names (4)
Calcium antacids (TUMS)
Sodium antacids (alka-seltzer)
Aluminum salts (Maalox)
Magnesium antacids (MOM)
59
Reasons for taking Antacids (3)
Gastritis, Heartburn, & Acid reflux
60
Action of antacids
Depends on type of antacids
61
Antacids contraindications
Magnesium antacids in renal patients
62
Antacids adverse reactions (5) (all 4 have their own)
Calcium antacids- kidney stones
Magnesium antacids- severe diarrhea
Aluminum salts- constipation
Sodium antacids- cardiac dysrhythmias
Metabolic alkalosis (All of them)
63
Take antacids ___ to ___ hr. before ____
1-2, other medications
64
When administering ____ or (tell pt. to) ____ (antacids)
Shake well or chew thoroughly
65
Take antacids with ___
8 oz. of water
66
Gastric mucosal protective agents drug name
Sucralfate (Carafate)
67
Reason for taking Carafate (2)
PUD & Stress ulcer
68
Action of Carafate
Binds to ulcer & forms a barrier against pepsin
69
Carafate adverse reactions (3)
Constipation, dry mouth, & nausea
70
Carafate must be given ____ before other medications and ____ before meals
2 hrs. before other meds & 1-2 hrs. before meals
71
Why is Carafate helpful in pt. with renal failure?
It binds with phosphate, lowers phosphate levels, renal pts. hold on to phosphate
72
Compare/contrast Cytotec & Mylicon. (carafate)
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
Antiemetic Serotonin inhibitor drug name
Ondansetron (Zofran)
74
Reason for taking Zofran (2)
Nausea & DOC for cancer pt.
75
Action of Zofran
Block serotonin receptors in the GI tract and vomiting centers (specifically 5-HT3 receptors)
76
Zofran contraindications
Liver problems
77
Zofran adverse reactions (5)
Drowsiness, Jaundice, Confusion, QT prolongation, & Serotonin syndrome
78
Pt. on Zofran has symptoms of muscle rigidity, confusion, & agitation. What do you suspect is happening?
Serotonin Syndrome
79
Monitor Zofran for ____
Over-sedation (No driving or operating heavy machinery)
80
Monitor the pt.'s (Zofran)
QT interval
81
Take Zofran_____ min before chemotherapy
30 to 60
82
Why should pt. on antiemetic drugs avoid alcohol?
These drugs block serotonin (stimulant) & alcohol is a depressant
83
Assess ____ before administering insulin
Blood sugar
84
Monitor of s/s of ___ with insulin (what are those?)
Hypoglycemia
Confusion, lethargy, tremors, & diaphoretic
85
What is a very important part of insulin admin for a nurse?
Verifying the dose in the syringe with another nurse
86
Pt. taking insulin should wear a ___
Medical alert bracelet
87
Pt. on insulin should always carry ___ with them
Glucagon tablets
88
What should we teach our pts. to due before administering insulin
Check a finger stick blood sugar
89
Rapid acting insulin drug names (2)
Insulin aspart (HumaLOG) & insulin lispro (NovoLOG)
90
When is the onset of rapid acting insulin, and how long does it last?
Onset: within 15 min, give right before a meal
Last:3-5 hrs.
91
Short acting insulin drug name
Regular insulin (Humulin R & Novolin R)
92
When is the onset of short acting insulin, and how long does it last?
Onset: 30-60 min
Last: 6-10 hrs
93
Intermediate insulin drug name
NPH insulin (Humulin N)
94
When is the onset of intermediate insulin, and how long does it last?
Onset: 1-2 hrs
Lasts: 10-18 hrs
95
Long acting insulin drug names (2)
Insulin detemir (Levemir)
Insulin glargine (Lantus)
96
When is the onset of long acting insulin, and how long does it last?
Onset: 1-2 hrs
Last: 24 hr
97
Reason for taking insulin
All types of diabetes (mostly type 1)
98
Action insulin
Helps remove glucose from the bloodstream into the cells
99
Insulin contraindications (3)
Vomiting and/or diarrhea
Surgical pt. (NPO)
Low blood sugar (hypoglycemic)
100
Insulin adverse reaction
Hypoglycemia
101
Your pt. is NPO after midnight for surgery, what are your concerns?
Hypoglycemia (continue FSBS, monitor for s/s of hypoglycemia, ask MD for IVF with dextrose
102
How do you administer insulin injections? Where? What syringe?
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
What are you going to tell your pt. about their meal planning? (Insulin)
Avoid sugars & starches
104
The pt. is slow to respond, has tremors, and is diaphoretic. What do you suspect has happened?
Hypoglycemia (administer snack (protein, milk) if conscious. Give glucagon SQ or D50W IV (if lethargic or NPO))
105
Antidiabetic drug name
Metformin (Glucophage)
106
Reason for taking Metformin
Diabetes
107
Action of Metformin
Decreases hepatic glucose production (stops the breakdown of glycogen in the liver)
108
Metformin contraindication
Any procedures that use contrast (dye)
109
Metformin adverse reactions (3)
Nausea, Vomiting, & Diarrhea
110
Take antidiabetic meds on ___
A regular schedule 30 min. before meals
111
Use ___ in moderation with antidiabetic meds
Alcohol
112
HOLD antidiabetic meds if pt. is having ____ or _____
A surgery or a procedure that uses dye
113
What is the importance of holding antidiabetic medications with contrast?
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
Hormone drug name
Glucagon
115
Reason for taking glucagon
Hypoglycemia
116
Action of glucagon
Hormone that triggers the liver to break down glycogen into glucose
117
Glucagon contraindications
Hyperglycemia
118
Glucagon adverse reactions (3)
Nausea, Vomiting, Swelling (edema) at injection site
119
When would glucagon be given?
Hypoglycemia & cannot eat, unconscious, NPO for procedure, seizure
120
Pts should ____ with glucagon
Always keep it on them
121
Hypertonic solution drug name
50% dextrose solution (pre-filled syringe)
122
Reason for taking dextrose
Hypoglycemia
123
Action of dextrose
Replaces sugar in the bloodstream
124
Dextrose contraindications
Hyperglycemia
125
Dextrose adverse reactions
Rebound hypogylcemia
126
When is 50% dextrose solution used?
Emergency use (lethargic, unresponsive, NPO)
127
Give 50% dextrose solution in a ___ IV
Large bore
128
Glucocorticoid drug name & suffixes
Methylprednisolone (Solumedrol)
-solone or -sone
129
Reasons for taking methylprednisolone (4)
Inflammatory disorders such as:
Asthma
COPD exacerbation
PNA
But also IBS or skin disorders
130
Action of methylprednisolone
Blocks the inflammatory response
Inhibits certain proteins (leukocytes, etc.) that set off the inflammatory chain
131
Methylprednisolone contraindications (4)
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
Methylprednisolone adverse reactions (6)
Edema d/t fluid retention
High blood sugar
Low potassium
Weight gain (major concern for pts.)
Jitteriness or shakiness
Immunosuppression
133
What are some things to avoid while on methylprednisolone
Live vaccines, alcohol, ASA, or other NSAIDS
134
What would I tell my pt. about Methylprednisolone?
Report leg cramps, edema to MD. Avoid crowds or the sick (immunosuppression)
135
Monitor ___ in diabetic pt. (methylprednisolone)
Blood sugar
136
Take methylprednisolone with ____ or ___
Food or milk
137
Take the ______. DO NOT ______(methylprednisolone)
Take whole dose
DO NOT STOP ABRUPTLY! (cause adrenal insufficiency) (tapered off)
138
Synthetic hormone replacement drug name
Levothyroxine (Synthroid)
139
What is an interesting factor about levothyroxine dosage
Always dosed in mcg
140
Reason for taking levothyroxine
Hypothyroidism (usually caused by Hashimoto's disease)
141
Action of levothyroxine
Replaces the hormone thyroxine (T4 – main hormone of the thyroid gland) that the thyroid is unable to produce.
142
Levothyroxine contraindication
Elevated T4 levels
143
Levothyroxine adverse reaction
Cardiac arrhythmias
- Chest pain
- Dyspnea
- Palpitations
144
What labs would you monitor for levothyroxine? (3)
Routine TSH, T4, & T3 levels
145
How do I direct pt. to take levothyroxine?
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
How does the thyroid work?
Butterfly shape, produces three hormones (T3, T4, calcitonin) used to regulate metabolism, growth, and development, and maintain temperature, mood, menstruation, etc.
147
Define Hypothyroid and Hyperthyroid
The drugs correct deficiency in thyroid hormone (Hypothyroidism) or
Correct excessive thyroid hormone (Hyperthyroidism)
148
A 16-year-old patient has been diagnosed with Hashimoto’s Disease. What medication would you expect the physician to order for this patient?
Levothyroxine - Synthroid
149
Levothyroxine Sodium (Synthroid) has been ordered and is a new medication for the patient. What teaching would you provide to this patient? (8)
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
When caring for a patient with Hypothyroid or Hyperthyroid, what vital signs are important to monitor for effectiveness of medications?
BP & HR
151
Mrs. Jones is started on Levothyroxine Sodium. She asks you when she will start to feel better.
What is your best answer?
The medication will start to take effect in 2 days, but the full effect will take 3-5 weeks.
152
Why would Inderal be used as another medication to treat Hyperthyroidism?
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
A patient has deficient levels of PTH. What vitamin and supplement would you expect the patient to be taking?
Vitamin D & Calcium
154
List 7 specific things about glucocorticoids that you would teach your patient
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
Why are steroids tapered?
Adrenal gland has stopped producing hormones when they are being given.
Must taper to slowly get adrenal gland to start secreting hormones
156
What effect do Glucocorticoids have on glucose levels?
Elevates glucose levels. Monitors diabetic pt. closely
157
A primary nursing diagnosis for pt. taking glucocorticoids is:
Risk for infection r/t immunosuppression
