Exam #5 Flashcards
What are the main 3 functions of the kidney
Maintain fluid balance
Maintain acid base balance
Excretion of metabolic wastes
What are the secondary functions of the kidney (3)
Secrete erythropoietin when hypoxia (tells bone marrow to make more RBC)
Secretes renin (secreted by juxtaglomerular cells) when BP is low and when dehydrated
Converts vitamin D into calcitriol when Ca+ is low
What are the 4 classes and actions of dietetics
Loos diuretics
Thiazide diuretics
Potassium sparing diuretics
Osmotic diuretics
Filling pressure/ preload
Diastole
Pressure pushing out/after load
Systole
What medication acts in the ascending limb of the loop of henle
How much reabsorption does it block
Loop diuretics: furosemide (Lasix)
20% block
This medication is used to manage Hypertension (not 1st line and decrease edema in hf, liver and renal disease
Furosemide (loop diuretic)
This medication dislates blood vessels and lowers preload, afterload, and blood pressure
Furosemide (loop diuretic) lasix
3 adverse effects of Furosemide
Hypotension
Sodium, potassium and other electrolyte depletion
Possible hyperglycemia
This medication acts in the DCT to block reabsorption
Thiazide diuretics (Hydrocholorthiazide)
10% Weak diuretic
This medication relaxes arterioles and decreases preload, afterload, and blood pressure
Hydrochlorothiazide
This medication is a first-line treatment for HTN and manages Tamils to moderate HTN, it is also an adjunct treatment for HF and liver disease
Hydrochlorothiazide
This medication has the following adverse effects:
Electrolyte imbalance. Hyopkalemia, possibly hyperglycemia
Hydrochlorothiazide
What secretes aldosterone
Adrenal gland on the kidney
Where does aldosterone act and what does it do
It acts on the DCT and collecting ducts to reabsorb sodium and water (to increase BP) and excrete K+
Which medication is an aldosterone antagonist and blocks the reabsorption of sodium and water while retaining K+
Spiranolactone
Which mediation acts in the DCT and collecting ducts
Spiranolactone
What are the indications for Spiranolactone and adverse effects
Not first line management of HTN
Edema d/t HF, liver and renal disease
Counter acts K+ loss caused by other diuretics (often used with furosemide)
Hyperkalemia
Which medication acts in the PCT and descending limb
Mannitol
This medication inhibits H20 reabsorption mainly, produces rapid diuresis and has the adverse effect of dehydration
Mannitol
Which diuretic us used to treat edema and increase intracranial pressure
Mannitol
What is the recommended time of day to take diuretics
What are the adverse effects (6)
What is the precaution if taking multiple diuretics or anti-HTN
AM
Dizziness, lightheadedness, Orthostatic hypotension, dehydration, constipation, F&E imbalances
Nursing implications for diuretics
D: diet (ie. K+ intake)
I= I/O monitoring, daily weight
U= unbalances F&E
R= ready for dynamic changes (light-headed es, VS, heart breath sound, cardiac rhythm etc)
E= no evening doses
T= take in AM
I= increased risk for Orthostatic hypotension
C= consider age, other meds that increase risk of F&R imbalance and BP changes
What are the 3 steps in hemostasis
Vasoconstriction, formation of platelet plug, clotting cascade
This is the first stage in hemostasis in which an endothelial injury occurs and the body reacts by reducing blood flow and surface pressure
Vasoconstriction (first 20-30 mins)
What exposure trigger the platelet plug and what happens after it is exposed
collagen exposure, activates platelets to secrete stimulators and begin the clotting cascade
What triggers the clotting cascade
What are the 2 pathways for this cascade
What is the overall goal
Clotting factors (plasma proteins)
Intrinsic and extrinsic pathways
Stabilizes clot
This changes the shape and aggregates platelets (activated platelets)
ADP adenosine diphosphate
This induces platelets aggregation to encourage more platelets to be drawn into the plug
Thromboxane A2
This medication prevents the formation of TXA2 and prevents platelet aggregation
Antiplatelet: aspirin (acetylsalicylic acid ASA)
This medication is used to stroke and MI prophylaxis
The adverse effects are GI bleeding and dyspepsia
- may give enteric coated to patients with an increased risk of GI bleeds
Aspirin
This medication is an ADP inhibitor, it alters platelets membrane and prevents signals to aggregate
Clopidogrel (Clavix)
Which 2 meds are given together for CVD
Aspirin and clopidogrel
Clopidogrel other factor
Highly bound to protein (duration of 5 days)
(94-95% bound to protein)
- which is why it is advised to stop blood thinners before a surgery
True of false:
Discontinue ALL anti-platelet mediations 5-7 days before a surgical procedure
TRUE
Food and drug interactions for anti-platelets
Chamomile, feverfew and 3 Gs
Garlic, ginger, gingko
Intrinsic pathway is activated when
Collagen is exposed
Extrinsic pathway is activated when
Tissue factor is released (injury to tissue)
Which medication is an X inhibitor and prevents new clots from forming (no effects on already formed clots)
Rivaroxaban (xarleto) and apixaban (eliquis)
What is the antidote for Ricaroxoban and apixaban
Andexxa
Which medication inhibits the action of clotting factors by inactivating clotting factors 2,7,9 and 10)
Warfarin
Does warfarin dissolve already formed clots
NO, both anticoagulants do not affect already formed clots
What is the onset of action for warfarin,
how many days does it take to reach therapeutic range
What is recommended to be used during the days it takes to reach therapeutic range
Antidote?
If the antidote is given how many days of resistance does warfarin have
36-72 hours
3-5 days
Bridge therapy is needed (usually heparin
Vitamin K
7days
Which factors are vitamin K responsible for hepatic synthesis
Factor 2,7,9,10
What is the difference between Pt and INR
What are the ranges
Therapeutic ranges?
How are they used together
PT: measures the time it takes for a clot to form in the blood
INR: standardized system to interpret PT
PT: 12-15 seconds, TR: 1.5-2
INR: 0.8-1.2 TR: >2-3.5
INR is used to interpret PT
These 7 foods will increase the risk of bleeding on a patient who is taking warfarin
Gingko, garlic, ginger, chamomile, cranberries, black licorice, green tea
The vitamin K rich foods will antagonize the warfarin effect if not eaten consistently
Asparagus, broccoli, cabbage, cauliflower, kale
Consistency is key
Chronic pain persists longer than ______
6 months
What receptors are responsible for opioid binding in the CNS
How do they work
MU and kappa major major recap to rights
Activation alters perception of pain
What 2 medications are used for opioid induced constipation and how do they work
Naloxegol (Movantik) and Methylnatrexone (relistor) bind to the GI Mu receptors to prevent constipation
Which medication can develop a tolerance and comes in short acting and long acting
What is the long acting used for (2)
Morphine, morphine ER
Used for chronic pain and opioid tolerant patients
This medication causes the most nausea out of all the opioids
Morphine
This medication medication has a 6.7 greater potency than morphine
Hydromorphone (diuladid)
Hydromorphoen has increased risk for (3)
And caused ______ nausea than morphine
Orthostatic hypotension
Urinary retention
Respiratory depression
Less
This medication is used to relieve cough and is used in combo with guaifenesin
What special effect does it have
What does that mean
Codeine
Ceiling effect
Increasing dose does not increase the relief, it only increases the risk for adverse effects
This medication is a semi-synthetic opioid
Hydrocodone
This medication is for opioid tolerant patients for the management of breakthrough cancer pain and chronic persistent pain
Fentanyl
How much more potent is fentanyl compared to morphine
100 times
How long does a fentanyl patch take to reach a steady state
How often should the patch be changed
6-12 hours
Every 72 hours
Which medication is used (short acting) for breakthrough pain
Oxycodone
This medication is used for opioid tolerant patietns to reduce or quit heroin/ opiates
Methadone
Does methadone cure dependence
No
Consider holding opiates if RR<___ breaths/ min
Respiratory depression if RR <___10/min
Unresponsive to ____ and _____
12
10
Verbal cues
Painful stimuli
Opioid antagonist for opioid overdose
Nalaxone (Narcan)
IV acetaminophen
Antiinflammatory properties?
Maximum daily dose
Maximum daily dose in _____ patients
Ofirmev
No
4000mg
2-3g
These 2 medications inhibits cox1 and cox2
What are cox 1 and cox 2 responsible for
Aspirin and Ibuprofen
Cox 1- inhibits acid secretion and generates thromboxane A2
Cox2- promotes pain and inflammation
This medication is a selective cox 2 inhibitor that lowers the risk of GI bleeds and ulcer formation
What is is used for
Is it an anticoagulant?
Celecoxib
Used for OR, RA, acute pain and dysmenorrhea
No
NSAID neurological (2), Cardiovascular (1) and Gi adverse effects
Neuro: assess for stroke symptoms (except ASA)
All may cause tinnitus
Cardio: assess for MI (except ASA)
GI: assess for GI bleeds all (except celecoxib)
Other primary classification of adjuvant analgesic therapy
How does it help pain
Dosing schedule?
AE compared to high opioid doses?
Treats which 3 types of pain
Muscle relaxants
Antidepressants
Anti seizure
Corticosteroids
Helps achieve and improve pain relief
Routine (sometimes with smaller opioid doses)
Decreased risk of AE compared to opioid doses
Refractory pain (pain that continues after treatment) neuropathic pain and nerve compression
Muscle relaxants (common ones) (3)
How do they work
Benzodiazepines (2 common)
How do they work
Carisoprodol, cyclobenzaprine, lioresal (baclofen)
Decrease muscle spams dust to injury or musculoskeletal conditions (muscle spasms cause pain and stiffness)
Diazepam and lorazepam
CNA depressant and potentiate GABA (slows down transmission of nerve cells)
What adjuvant therapy is common in back surgery or back pain
Muscle relaxants
What are the 3 types of antidepressants
Tricyclic, selective serotonin re uptake inhibitors and Serotinin- nurepinephrine reuptake inhibitor (SNRI)
What kind of pain are antidepressants used for (2)
Neuropathic and chronic pain
Block norepinephrine and serotonin reuptake in presynaptic nerve terminals
Tricyclic- amitriptyline
How do anti-depressants act to relieve pain
More transmitters available in synaptic cleft, inhibit transmission of pain signals
Block reuptake transporter
(Pain signals are blocked and cannot enter the synaptic cleft and elicit a pain response)
What are the 2 most common anti-seizure medications
Gabapentin and pregabalin
How do gabapentin and pregabalin work
What are they used for overall (4 and which medication is used for which condition)
Gabapentin mechanism is unknown (used for neuropathic pain)
Pregabalin: calcium channel modulation to decrease hyper excitability caused by nerve injury
Management of neuropathic pain including:
Fibromyalgia (pregabalin)
Post hepatic neuralgia (pain after shingles), migraines and restless leg syndrome (Gabapentin)
Adverse effects of anti-seizure medications (5)
Suicidal through, depression, drowsiness, impaired attention, difficulty concentrating
This medication is used to acute and chronic cancer pain
It is used for spinal cord compression, inflammatory joint pain syndromes (ie. Rheumatoid arthritis)
Corticosteroids
How do corticosteroids work
What are 2 common ones
Suppresses inflammation and immune response
Prednisone and dexamethasone
What are potential adverse effects with long term therapy of corticosteroids (8)
Fluid retention (similar to aldosterone effects), hyperglycemia, impaired immune response, peptic ulcers, GIB, osteoporosis, bruising, Hypokalemia
Elderly Physiologic changes like concientice impairment and decreased ability to assess pain with dementia and delirium can lead to
(3)
Worsening health, inadequate assessment and treatment of pain
Decreased cardiac output in the elderly can affect medication _____ and ______
Absorption and distribution
Decreased muscle strength in the lungs results in (2)
Decreased lung expansion and decreased response to hypoxia
Decreased liver perfusion in the hepatic system can lead to (3)
Decreased metabolism of drugs
Prolonged duration of action of drugs and accumulation
Increased risk of adverse effects and drug toxicity
Decreased renal system function leads to (2)
prolonged duration of action and accumulation
Increased risk of AE and drug toxicity
Chinese people may believe pain results from an imbalance between
Yin and yang
Some beliefs may be that _______ pain ____ to improve standing in life after death
Enduring, bravely
People may not want to take pain medication because they believe ____ is a sign of ____ towards ______
Pain, progress, recovery
What are the 2 corticosteroids mentioned in lecture
Prednisone, dexamethasone
What 2 things are corticosteroids recommended for
Spinal cord compression and inflammatory joint pain syndromes like RA
