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NS373—Pharmacology > Exam 4 Notes > Flashcards

Exam 4 Notes Flashcards

1
Q

4 drug indications for endocrine disorders

A
  1. Replacement (HRT)
  2. Shrinking hormone-receptive tumors
  3. Processsing an exaggerated response
  4. Block endogenous hormone action
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2
Q

nursing care for pituitary drugs

A
  • Monitor for desired effect based on indication
    • I&O and urine specific gravity
    • Physical growth
    • VS
    • Blood sugar
    • Electrolytes
  • Assess for thirst
  • Monitor correct use of meds
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3
Q

addison’s disease

A

adrenal insufficiency

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4
Q

3 steroid precautions

A
  • Infection
  • DM - causes hyperglycemia
  • Peptic ulcer disease
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5
Q

pt teaching for steroids

A
  • Inform of side effects: delayed wound healing; masked infection; bone changes; Cushing’s (moon face, wt gain); ↑ appetite; CNS effects (euphoria, nervousness, insomnia, personality changes); acne; facial hair; menstrual changes; impaired ability to respond to stress; hyperglycemia
  • Avoid areas where you could get an infection
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6
Q

action of glucocorticoids (4)

A
  • ↑ glucose levels, protein breakdown
  • Formation/storage of fat
  • Anti-inflammatory
  • Immunosuppressive
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7
Q

4 s/s of Cushing’s

A
  • Hyperglycemia
  • Fat to shoulders & face
  • Muscle weakness
  • Bruising - monitor K
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8
Q

indications for glucocorticoids (9)

A
  • Allergies
  • Asthma
  • Cancer
  • Edema
  • Inflammatory diseases
  • Rheumatic diseases
  • Shock
  • Skin disorders
  • Transplant rejection prophylaxis
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9
Q

lethargy; apathy; memory impairment; emotional changes; slow speech; deep coarse voice; edema; thick dry skin; cold intolerance; slow pulse; constipation; wt gain; abnormal menses

A

hypothyroidism

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10
Q

tachycardia; palpitations; dysrhythmias; diaphoresis; heat intolerance; nervousness; exophthalamos (bulging eyes); wt loss; confusion; behavioral changes; goiter

A

hyperthyroidism

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11
Q

nursing care for thyroid meds

A
  • Monitor VS - especially EKG
  • Monitor wt
  • Monitor drug-drug interactions
  • Assess TH & glucose levels
  • Regulate environmental temp
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12
Q

pt teaching for thyroid meds

A
  • Do not stop abruptly OR switch brands
  • Take on empty stomach, same time of day
  • Report sx
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13
Q

insulin produced by…

A

pancreatic beta cells in Islets of Langerhans

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14
Q

function of insulin

A
  • Released in response to ↑ blood glucose
  • ↓ blood glucose by promoting reuptake of glucose, aminio acids, fatty substances
  • Stored glucose converted to glycogen, stored in liver & muscle
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15
Q

glucagon produced by…

A

pancreatic alpha cells in Islets of Langerhans

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16
Q

function of glucagon

A
  • Released in response to ↓ blood glucose
  • ↑ glucose
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17
Q

normal fasting glucose

A

60-100 mg/dL

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18
Q

high risk for DM fasting glucose level

A

100-125 mg/dL

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19
Q

diabetes glucose levels

A

>125 mg/dL

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20
Q

normal hemoglobin A1C

A

<5.3%

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21
Q

high risk A1C

A

5.7-6.4%

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22
Q

diabetes A1C

A

>6.5%

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23
Q

IDDM

A

type 1

insulin dependent

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24
Q

NIDDM

A

type 2

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25
Q

function of incretin enhancers

A

mimic glucagon like peptides

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26
Q

sx of hypoglycemia

A
  • <50 mg/dL glucose
  • Hunger
  • Irritability
  • Cool, clammy skin
  • Diaphoresis
  • n/v
  • Tachycardia
  • h/a
  • LOC changes
  • Lack of coordination
  • Seizures
  • Death
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27
Q

insulin analogs

A

modifications of onset & duration of action

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28
Q

fastest absorbing site for insulin

A

abdomen

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29
Q

insulin that can be given IV

A

regular

30
Q

70% NPH + 30% regular

A

Humulin 70/30

31
Q

50% NPH + 50% regular

A

Insulin isophane NPH 50/50

32
Q

75% lispro protamine + 25% lispro

A

Humalog 75/25

33
Q

treats temporary anticipated glucose elevations (ex. pts on steroids, hospitalized pts)

A

sliding scale insulin

34
Q

nursing care for DM drugs

A
  • Diet, excercise
    • Less sugar & simple carbs
    • More fiber-rich carbs
  • Follow up lab tests
  • Teach s/s of hypoglycemia & action to take
  • Teach self blood glucose monitoring
  • Medic alert card, tag, bracelet
  • No alcohol
  • Report nvd, fever, inability to eat
35
Q

autonomic NS influence - ↓ HR & conduction

A

vagus nerve

36
Q

more dangerous type of arrhythmias

A

ventricular

37
Q

AKA atrial arrhythmias

A

supraventricular

38
Q

function of RAAS

A

increase BP

39
Q

steps of RAAS system (7)

A
  1. Activated with ↓ blood flow to kidneys
  2. Kidneys release renin
  3. Angiotensinogen converted to angiotensin I
  4. Angiotensin I travels to lungs - angiotensin-converting enzyme (ACE) converts it to angiotensin II
  5. Angiotensin II causes widespread vasocontriction
  6. Aldosterone released from adrenal cortex - causes Na+ and water retention
  7. ADH released from posterior pituitary - causes water retention
40
Q

amt of blood pumped from each ventricle with each contraction

A

stroke volume

41
Q

resistance of muscular arteries to blood being pumped

A

peripheral resistance

42
Q

send info to brain about blood pressure

A

baroreceptors

43
Q

elevated BP

A

120-129 and >80

44
Q

HTN stage 1

A

130-139 and 80-89

45
Q

HTN stage 2

A

140-179 and 90-119

46
Q

hypertensive crisis (HTN stage 3)

A

180+ and 120+

47
Q

nonpharm methods to decrease BP

A

exercise, ↓ alcohol and Na+, weight reduction

48
Q

classes of drugs used for HTN (8)

A
  • Alpha 1 blockers
  • Alpha 2 blockers
  • ACE inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta blockers
  • Calcium channel blockers
  • Direct vasodilators
  • Diuretics
49
Q

first line anti-HTN

A
  • ACE inhibitors
  • ARBs
  • Thiazide diuretics
50
Q

second line anti-HTN

A
  • Beta blockers
  • Centrally acting alpha & beta blockers
  • Direct acting vasodilators
  • Direct renin inhibitors
  • Peripherally acting adrenergic neuron blockers
51
Q

first line drugs for mild HTN

A

diuretics

52
Q

nursing care for diuretics

A
  • Monitor I & O; lab values (electrolytes, glucose); sx electrolyte imbalance (especially Na+ and K+); dehydration; compliance; pulse and BP
  • Teach pt to read labels & watch Na+ and K+ intake
  • Pt may be on fluid restriction - make sure they get all they are allowed to have
  • Give drugs in AM
53
Q

nursing care for anti-HTN

A
  • Monitor VS; F & E
  • Teach adverse effects
  • Low Na+ diet
  • Teach nonpharm methods to reduce BP—Na+ restriction, fluid restriction, caffeine restriction, weight control
  • Sit or stand slowly
  • Adherence to regimen
  • Lab tests may be necessary
54
Q

who is more at risk for HTN?

A

African Americans

men

55
Q

how do African Americans differ in responsiveness to anti-HTN drugs?

A

Most responsive to single drug therapy

MORE responsive to diuretics, Ca channel blockers, alpha blockers

LESS responsive to ACE inhibitors, ARBs, renin inhibitors, beta blockers

56
Q

HF results from… (4)

A
  • CAD (↓ blood flow to heart, hyperlipidemia)
  • Cardiomegaly & cardiomyopathy
  • HTN
  • Valvular disease
57
Q

CO =

A

stroke volume x HR

58
Q

preload

A

volume of blood in ventricles at end of diastole

59
Q

afterload

A

resistance the LV must overcome to eject blood into aorta/through circulation

60
Q

sx of RSHF

A
  • Fatigue
  • ↑ peripheral venous pressure
  • Ascites
  • Hepatomegaly & splenomegaly
  • Distended jugular
  • Anorexia
  • Wt gain
  • Dependent edema
61
Q

sx of LSHF

A
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Pulmonary congestion (crackles; cough; wheezes; bloody sputum; tachypnea)
  • Tachycardia
  • Confusion
  • Restlessness
  • Fatigue
  • Cyanosis
62
Q

drug classes used to treat HF

A
  • ACE inhibitors & ARBs
  • Beta blockers
  • Diuretics
  • Cardiac glycosides
  • Vasodilators
  • Phosphodiesterase inhibitors
  • Combination drugs - inhibit RAAS, ↓ afterload
63
Q

goals of drugs for HF

A

↑ cardiac output; ↓ vasoconstriction; loss of excess fluid

64
Q

nursing care for HF drugs

A
  • Monitor VS; serum digoxin; electrolyte levels; daily weight
  • Teach low Na+ diet & fluid restriction
  • No smoking, alcohol - limit caffeine
  • Teach sx to report:
    • Dyspnea
    • Frothy sputum
    • Excessive fatigue
    • Edema
65
Q

stable vs unstable angina

A

stable - predictable based on exertion/activity

unstable - unpredictable

66
Q

goal of antianginal drugs

A

reduce O2 demand of myocardium

67
Q

how to antianginals achieve their goal? (5)

A
  • Slow HR
  • Dilate veins - ↓ preload
  • Dilate coronary arteries
  • ↓ force of contraction
  • Lower BP - ↓ afterload
68
Q

desirable lipid labs (total, LDL, HDL, triglycerides)

A
  • <200 total
  • <130 LDL
  • >50 HDL
  • <200 triglycerides
69
Q

borderline high lipid labs (total, LDL, HDL, triglycerides)

A
  • 200-239 total
  • 130-159 LDL
  • 40-49 HDL
  • 200-399 triglycerides
70
Q

high lipid labs (total, LDL, HDL, triglycerides)

A
  • 240+ total
  • 160 + LDL
  • <40 HDL
  • 400+ triglycerides
71
Q

non-diet intervention that raises HDL

A

exercise

NS373—Pharmacology (18 decks)

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