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Pharmacology Summer Term > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

BIGUANIDES

A

Only drug is metformin. Most commonly ordered oral agent for DM2. MOA: receptor sensitivity
Does not cause hypoglycemia when used alone.
ADR: mostly GI with decreased appetite and diarrhea (XR helps)
Potentially life threatening lactic acidosis in patient with poor renal function
Do not give if patient is having X-ray studies that require dye. Hold on day of test + 48 Hrs after
GFR < 30 - discontinue drug

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2
Q

SULFONYLUREAS

A

MOA: works on beta cells of pancreas to increase secretion of insulin
Can be used with metformin
ADR: hypoglycemia (beers list)
Possible allergy if allergic to sulfonamide antibiotics
Drugs: “ide’s” glyburide, glipizide, glimepiride

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3
Q

AMYLIN AGONIST

A
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4
Q

DDP-IV

A
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5
Q

GLP-1 AGONIST

A
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6
Q

SGLT2 INHIBITORS

A
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7
Q

What does an incretin mimetic specifically do? Who benefits from them and why?

A

Enhance the action of incretin and those reduce blood glucose levels.
Type 2 diabetics who need to loose weight

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8
Q

Besides checking a patient’s glucose levels or A1C readings? (gold standard), what other labs are important to monitor for a patient receiving oral anti-diabetic medications? Why?

A

Renal function. Some of those meds can cause renal failure

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9
Q

Are there any red flag or contraindicated lab readings for metformin? What would those values represent?

A

Renal function must be checked. GFR< 30 must discontinue drug

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10
Q

What are the important MUST KNOW things about metformin?

A

Potentially life threatening lactic acidosis in patient with poor renal function.
Do not give if patient is having x ray studies that require dye

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11
Q

What are some important teaching considerations for a patient who is taking any kind of insulin?

A

If symptoms of hypoglycemia, need immediate simple sugar
Anything witch raises blood sugar will increase need for insulin

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12
Q

What happens if a patient takes their insulin, then does not eat? What should you do? Are their times you should hold the insulin? if so, under what circumstances?

A

Give patient oral dextrose
Don’t give insulin if patient is not eating

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13
Q

RAPID ACTING

A

ONSET OF ACTION: 15 MIN
PEAK ACTION: 1-2 HOURS
DURATION: 3-4 HOURS

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14
Q

SHORT ACTING/REGULAR

A

ONSET OF ACTION: IV 10-30 MIN
SC 30-60 MIN
PEAK ACTION: IV 15-30 MIN
SC 2-4 HOURS
DURATION: IV 30-60 MIN
SC 5-7 HOURS

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15
Q

INTERMEDIATE/NPH

A

ONSET OF ACTION: 70/30 30 MIN
NPH 2-4 HOURS
PEAK ACTION: 70/30 2-12 HOURS
NPH 4-10 HOURS
DURATION: 70/30 24 HOURS
NPH 10-16 HOURS

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16
Q

LONG ACTING

A

ONSET OF ACTION: 3-4 HOURS
PEAK ACTION: NONE “PEAKLESS”
DURATION: 24 HOURS

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17
Q

HMG-COA REDUCTASE INHIBITORS “STATINS”

A
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18
Q

FIBRIC ACID DERIVATIVES (FIBRATES)

A
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19
Q

NICOTINIC ACID/NIACIN (VITAMIN B3)

A
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20
Q

BILE ACID SEQUESTRANTS

A
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21
Q

DIGOXIN KEY FACTS

A
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22
Q

What is the drug of choice for decompensating congestive heart failure with hypotension? What makes this drug superior to other positive inotropes? (unsung hero of the cardiac world)

A

Dobutamine

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23
Q

What is the most common ADR (side effect) of any anticoagulant medication?

A

Bleeding

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24
Q

What are some patient teaching considerations for anticoagulant therapy?

A

use a safety razor

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25
What are the dietary considerations for anticoagulant therapy? Give examples of Vitamin K rich foods
avoid green leafy vegetables
26
What is a fibrinolytic medication , how does it differ from an anticoagulant?
fibrinolytic breaks down the clot
27
What suffix do these medications end with and list a few common examples from the lecture
28
What are the two dangerous side effects of fibrinolytic/thrombolytic medications?
29
What lab test assess kidney function? (3 main ones)
GFR, Bun and creatinine, creatinine clearance
30
What is considered normal urine output? (a general number and a specific calculation number-write out both)
60 ml/hr 1 ml/kg/hr
31
What are the nursing considerations for any patient on a diuretic (regardless of which kind) there are atleast 5 things that can go here
monitor fluid and electrolyte vital signs daily weight, lung sounds, take diuretic early
32
What is the optimal time of day for a client to take a diuretic? Why?
in the morning, so patient does not have to get up in the middle of the night to use the restroom
33
What aquaretic medication effects antidiuretic hormone (ADH) and why would someone need that medication?
tolvaptan
34
What electrolyte imbalances are seen in a patient with renal failure? (there are 4) How are they managed pharmacologically?
35
What medication is an aquaretic that will not deplete serum sodium levels in a patient
Tolvaptan
36
What patient/condition would benefit from an aquaretic medication
SIADH with severely depleted sodium level/dilutional hyponatremia
37
What are the signs of adrenal insufficiency or Addison’s disease
Decreased blood glucose levels, dehydration, and low BP
38
Under what conditions could we as medical workers cause Addison’s crisis
Abrupt withdrawal of long term steroid use
39
How is Addison’s disease managed with medications
Salt and sugar replacement: aldosterone and corticosteroids
40
What are signs of Cushing’s syndrome? What is the most common cause of Cushing’s syndrome?
Moon face, buffalo hump, poor wound healing, bruising, etc. overuse of glucocorticoid steroids.
41
What is the treatment for diabetes insipidus?
Vasopressin (injection or nasal)
42
How do you know that the treatment for diabetes insipidus is working?
Urine output decreases
43
What are the side effects of vasopressin?
Hypertension, headache, and nasal stuffiness
44
What is the treatment for pheochromocytoma
Alpha blocker first then beta blocker
45
SIADH (excess of ADH) symptoms and treatment:
SX: dilutional hyponatremia, confusion, seizures Treatment: Tolvaptan to reduce serum sodium, patient must be able to drink and report thirst
46
Diabetes Insipidus (deficiency of ADH) symptoms and treatment:
SX: excessive fluid loss from polyuria (dilute urine and concentrated blood), extreme thirst, hypernatremia Treatment: vasopressin (injectable), desmopressin (intranasal) Watch for signs of hypertension and headache with either medication
47
Diabetes insipidus (deficiency of ADH) symptoms and treatment:
SX: excessive fluid loss from polyuria (dilute urine & concentrated blood), extreme thirst, hypernatremia Treatment: vasopressin (injectable), desmopressin (intranasal)
48
Hypothyroidism (deficiency) symptoms and treatment:
SX: lethargy, weight gain, bradycardia, cool dry skin, intolerance to cold, constipation, heart problems Treatment: levothyroxine (synthroid) do not switch between generic and name brand TSH level negative feedback loop for dosing Signs of toxicity: will mimic signs and symptoms of hyperthyroidism
49
Hyperthyroidism (excess) symptoms and treatment:
SX: tremors, nervousness, weight loss, tachycardia, warm skin, intolerance to heat, GI distress Treatment: anti thyroid drugs short term due to toxicity used to stabilize patient for thyroidectomy ADR: hypothyroidism symptoms Beta blockers: symptom management of hypertension and tachycardia
50
Cushing syndrome (excess adrenal gland) symptoms and treatment:
SX: fluid retention due to hypernatremia, hypertension, hyperglycemia, hypokalemia, thing extremities with muscle wasting, Buffalo hump, moon face, gastric hyperacidity Treatment: adjust steroid therapy if that is the cause- Don’t stop abruptly Adrenalectomy if primary tumor
51
Addison’s disease (deficit) symptoms and treatment
SX: hypoglycemia, dehydration, hyponatremia, hyperkalemia, inability to respond to stress Treatment: hormone replacement with cortisol like drugs and mineraloids Steroids- aldosterone for sodium and glucocorticosteroids (drugs that mimic cortisol), prednisolone, dexamethasone, methylprednisolone, etc *if treatment goes to far will have elevated glucose and sodium levels, Cushing’s symptoms
52
Hypoglycemia symptoms and treatment:
SX: dizziness, unceasing hunger, irritability, clammy skin, mood swings, difficulty thinking Treatment: if patient can swallow: glucose tablet = 15 grams of glucose Glucose gel, glucagon (IM, IV, SQ), D50W (IV push) Nursing interventions in place of tablet: 4 oz Orange juice, 4 oz regular soda, 2 tbsp raisins
53
What medications treat T2DM?
Biguanide: (metformin) first line drug and is most commonly ordered oral agent for DM2 works by decreasing glucose production by liver, also increases GI absorption and receptor sensitivity Sulfonylureas: (glyburide,glipizide,glimeparide) works on beta cells of pancreas to increase secretion of insulin, can be used in combo with metformin. can cause hypoglycemia, especially when given with other sulfa drugs. watch for sulfa allergies
54
What other medications treat T2DM?
DDP-IV: sitagliptin (careful with digoxin with this particular drug), linagliptin, alogliptin incretin mimetics: exnatide, liraglutide,dulaglutide, lixisenatide- enhance the action of incretin and thus reduces blood glucose levels SGLT2 inhibitors: dapaglifozin, empaglifozin, canaglifozin - sodium gluclose cotransporter inhibitor, changing renal threshold for glucose and creating "sweet" osmotic diuresis
55
Classes of medications used in the treatment of hypertension
DIURETICS: HCTZ is usually a frontline choice. loop diuretic: furosemide, bumetanide monitor K+ levels BETA BLOCKERS: "lol" family, metoprolol, atenolol, labetalol, propranolol black box warning: do not stop abruptly, need to taper off, use cautiously in diabetic patients as it can mask signs of hypoglycemia ACE INHIBITORS: pril family: captopril,enalapril, ramipril adr: dry cough,angioedema, significant first dose hypotension
56
Classes of medications used in the treatment of hypertension part 2
ANGIOTENSIN RECEPTOR BLOCKERS (ARBS): sartan family (losartan, irbesartan,valsartan) doesnt cause the cough like ACE inhibitors CALCIUM CHANNEL BLOCKERS: amlodipine, nifedipine, nicardipine/verapamil more effective in african americans
57
AMIODARONE
DOC Ventricular Tachycardia with or without pulse, VFIB
58
ADENOSINE
Supraventricular Tachycardia > 150 beats per minute RAPID IV push
59
ATROPINE
Symptomatic bradycardia
60
DIGOXIN
A-fib with congestive heart failure
61
DILTIAZEM
DOC A-fib or A-fib with rapid ventricular response
62
MAGNESIUM SULFATE
Sustained polymorphic Ventricular Tachycardia
63
What would be the recommended treatment for a patient experiencing chest pain/angina?
-oxygen -nitroglycerin (sublingual) -chewable baby aspirin up to 324 mg
64
important patient teaching for nitroglycerin
only take up to 3 tablets, 5 minutes apart, after 2nd pill, call 911 tingling indicates tablet is still good contraindicated with other vasodilaters like erectile dysfunction medications ("afil" family) avoid light and heat exposure (photosensitive) sublingual tablets are ineffective if swallowed acetaminophen for nitro induced headaches, no nsaids or ibuprofen
65
what is the drug of choice used for treatment of hyperlipidemia
HMG COA reductase inhibitors "statins". examples pravastatin, lovastatin, simvastatin, atorvastatin, rosuvastatin
66
key considerations for "statins"
lowers LDL and increases HDLs, some tryglyceride lowering effects promotes plague stability= less risk for rupture of thrombosis reducing atherosclerotic risk, shown to reduce risk of stroke and MI, even with normal cholesterol levels ADR: GI distress, liver dysfunction, muscle aches and weakness, impaired cognitive functioning especially with dementia most effective to take in PM since most cholesterol is produced at night
67
how to monitor effectiveness of hyperlipidemia medications
lipid panel, HDL, LDL levels
68
how do you monitor for adverse reaction of these medications
ALT/AST monitor for headache/dizziness, unusally tired, digestive system problems (constipation, diarrhea, indigestion) muscle pain, sleep problems- call doctor immediately
69
what is the correct route for the administration of heparin or low molecular weight heparin like enoxaparin
subcutaneous or intravenous for heparin SQ for enoxaparin
70
therapeutic monitoring levels for a patient on heparin therapy
PTT 60-80 seconds
71
antidote for heparin overdose
protamine sulfate
72
what is another serious side effect of heparin that requires blood testing
heparin induced thrombocytopenia monitor platelets or CBC
73
What is the correct therapeutic monitoring levels for a client on warfarin
PT/INR INR 2-3 is therapeutic for most patients
74
what is the antidote for a warfarin overdose
Vitamin K
75
what is the dietary teaching required for warfarin
caution about foods rich in vitamin K, do not over do the green leafy vegetables
76
what are alternative anticoagulant therapies in place of warfarin for a client experiencing A fib that would not require therapeutic monitoring
apixaban, rivaroxaban
77
DOC for a client who has a cardiac stent placed for antiplatelet therapy
clopidogrel (plavix) +/- asa therapy
78
if the client is having a heart attack/MI and can not have a cath procedure what medication might be indicated for this client?
TPA fibrinolytic within 6 hour window (alteplase), shorter window for cerebral vascular accident patients - no active bleeding present or major trauma, or surgery in the past couple months - no hemorrhagic CVA (stroke), INR greater than 1.7 if on warfarin
79
Explain the rationale for a client on aspirin therapy taking acetaminophen for headache
aspirin goes through the COX 1 and leads to a therapeutic anti platelet effect. combining two medications like NSAIDS and aspirin through this same process leads to a reverse effect and essentially blocks the desired outcome of decreased clotting. acetaminophen is not an NSAID and therefore does not go through this pathway and does not block the anti-platelet function we are trying to achieve in our cardiac patients.
80
important patient teaching for a client with a UTI
encourage increased fluid intake (water) monitor urinary output asses for elevated temperature, low back pain, elderly patients take nitrofurantoin daily to prevent recurrent UTI's, make sure they drink enough water
81
when should one stop antibiotic therapy for a UTI
WHEN ANTIBIOTICS ARE COMPLETED
82
why is it important as a nurse to monitor a clients urine output? what would be considered "normal"?
60 ml/hr is normal less than 30 ml/hr is bad urine output helps to evaluate renal function so that medications can excrete properly

Pharmacology Summer Term (4 decks)

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