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Pharm > Exam 5 blueprint > Flashcards

Exam 5 blueprint Flashcards

1
Q

What drugs are 1st gen antihistamines?

A

Diphenhydramine, Hydroxyzine, meclizine, Promethazine

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2
Q

Indications for 1st gen antihistamines

A

Allergic Rhinitis, motion sickness, induce sleep, and runny nose

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3
Q

Side effects of 1st gen antihistamines

A

Sedation and anti-cholinergic effects. . Drys everything

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4
Q

Adverse effects of 1st gen antihistamines

A

Cross blood brain barrier, sedation and cholinergic effects

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5
Q

Contraindications of 1st gen histamines

A

narrow-angle glaucoma, BPH and take precaution with urinary retention

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6
Q

What drugs are in 2nd gen antihistamines?

A

cetrizine, fexofendamine, loratadine, azelastine

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7
Q

Indications for the use of 2nd gen antihistamines?

A

First line therapy for allergic rhinitis. Same as first gen but do not cause sedation or cross the bbb

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8
Q

Nursing interventions/ Client education for 2nd gen antihistamines

A

Increase fluids, avoid all juice, especially grapefruit, apple, and orange. Juice decreases the effect of the histamine.

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9
Q

What drugs are decongestants?

A

Pseudoephedrine, Phenylephrine,

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10
Q

When do we use decongestants?

A

Temporarily relieve nasal congestion

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11
Q

Mechanism of action of Decongestants

A

Stimulate alpha-adrenergic receptors, Vasoconstriction, shrink nasal mucosa and reduce nasal secretions.

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12
Q

Side effects of decongestants

A

tachycardia, nervousness, tremors, anxiety, restlessness, weakness, dry mucus memebranes

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13
Q

Contraindications of decongestants

A

Contraindicated: glaucoma, pre-existing hypertension, cardiac disease, hyperthyroidism.

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14
Q

Precautions of decongestants

A

Diabetics: consult HCP before taking
Patients with hypertension do not take.

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15
Q

What are the topical decongestants?

A

Naphazoline, Oxymetazoline, Tetrahydrozoline, Xylometazoline.

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16
Q

Patient teaching for Topical decongestants

A

avoid over use of them. Can cause tolerance Do not take for more than 3 days in a row

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17
Q

Indications for topical decongestants

A

Nasal sprays used for decongestants.

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18
Q

Side/ Adverse effects of topical Decongestants

A

Rebound congestion.

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19
Q

Rebound congestion fixing

A

tapering with one nostrils at a time

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20
Q

What drugs are expectorants?

A

Guaifenesin

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21
Q

Indications for Expetorants (guaifenesin)?

A

relieves symptoms of respiratory conditions with a dry non-productive cough by reducing adhesiveness and surface tension of mucus

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22
Q

Patient teaching of Expectorants (mucinex)

A

read labels of medicine. Take with full glass of water, Asthma: be careful, can cause bronchospasm.
Coughing, deep breathing, have to increase fluid intake, if they do not, medicine will not work right. 8 8oz glasses a day. Will not suppress their cough.

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23
Q

What drugs are antitussives?

A

Dextromethorphan, Codeine, Benzonatate

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24
Q

Indications of antitussive medicine

A

Used to suppress cough reflex. Treats only a dry non-productive cough.

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25
Q

Side effects of Antitussive: codeine

A

drowsiness, dizziness, irritability, constipation and restlessness

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26
Q

What can codeine cause, especially to older adults?

A

respiratory depression and dependence

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27
Q

Who can not take Antitussives and why?

A

patients with asthma and emphysema because the sputum could be retained and causing pneumonia

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28
Q

Patient teaching for antitussives codeine?

A

do not take more than perscribed doses, changes positions slowly, avoid activites that require alertness. Use hard candy, increase fibers fluid and exercise. Avoid alcohol.

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29
Q

Patients should report what when taking an antitussive?

A

cough that lasts longer than a week and a rash with fever.

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30
Q

If patient has respiratory depression we can administer?

A

nalaxone

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31
Q

What is Dextromethorphan antitussive used for?

A

cough suppression.

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32
Q

side effects of antitussive dextromethorphan

A

dizziness nausea sedation

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33
Q

What drugs are Inhaled corticosteroids?

A

Beclomethasone, Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone, Ciclesonide

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34
Q

Indications of inhaled corticosteroid

A

Reduce inflammation in the bronchial tree. Used for prophylactic management of asthma and tx of COPD

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35
Q

Inhaled corticosteroids are what?

A

maintenance drugs, do not help with acute attack.

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36
Q

Adverse effects of Inhaled corticosteroids

A

sore throat, hoarseness,coughing, dry mouth, oral yeast infection (thrush).

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37
Q

Patient teaching of inhaled corticosteroids

A

teach back method, use albuterol for acute attack. Use bronchodilator first. Then use corticosteroid

Rinse mouth out after using. Do not swallow.
use spacer

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38
Q

Adverse effect of corticosteroid in children (systemic)

A

decrease adrenal function, decreased growth and bone mass. Can delay growth

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39
Q

Do we use a corticosteroid everyday even if we do not have symtoms?

A

yes because if the patients do not use it everyday it will not be effective.

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40
Q

COPD inhaled..

A

maintenance

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41
Q

COPD: oral

A

exacerbation

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42
Q

What are the systemic corticosteroids?

A

Methylprednisolone and Prednisone

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43
Q

Indications for systemic corticosteroids

A

COPD exacerbation, Inflammation where they need higher doses of their medicine. Stress or switching from oral to inhaled.

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44
Q

What can corticosteroids cause?

A

Hyperglycemia, diabetics need to monitor their blood sugar,

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45
Q

Corticosteroids can cause sodium retention so we need to monitor for ?

A

weight gain

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46
Q

Contraindications of Corticosteroids?

A

active fungal infections, live virus vaccines

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47
Q

Nursing considerations of corticosteroids?

A

height and weight in children, bone density screening, delayed wound healing, buffalo hump, infections, dehydration.

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48
Q

Important patient teaching about corticosteroids

A

taper off to prevent asthma exacerbation rinse mouth, avoid large crowds and wash hands. can take 4 weeks t

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49
Q

What drugs are Leukotriene Modifiers?

A

Zafirlukast, montelukast

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50
Q

Indications of Leuotriene Modifiers

A

Oral prophylaxis and chronic treatment of asthma, not for acute attacks.

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51
Q

Adverse Effects of Leukotriene Modifiers

A

depression, SI, bleeding, seizures, can affect liver.

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52
Q

What drugs are anticholingergics?

A

Ipratropium (short acting)
Tiotropium (long acting)

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53
Q

Indications of anticholinergics?

A

used to treat asthma, bronchitis, pulmonary emphysema

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54
Q

Contraindications? precautions of Anticholinergics?

A

Contra: peanut allergy
Caution: narrow-angle glaucoma/ BPH

Take medicine everyday

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55
Q

What medications are Methylxanthines?

A

Theophylline and aminophylline

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56
Q

Indications for Methylzanthines

A

asthma and reversal bronchospasm

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57
Q

Side and Adverse effects of Methylxanthines

A

serum 20-25: Gi, NVD and CNS headache insominia and irritability
serum over 30: hypotension hyperglycemia, arrhtmias, seizures, brain damage and death.

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58
Q

Drug interactions of Methylxanthines

A

Smoking can decrease serum drug levels, Coffee, tea, sode, chocolate. soda.

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59
Q

What drugs are Bronchodilators/ Beta 2 Agonist?

A

Short acting RESCUE: Albuterol, Levalbuterol, Pirbuterol

Long acting: Arformoterol Formoterol Indacaterol, Olodaterol Salmeterol

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60
Q

Indications of Bronchodilators/ Beta agonist

A

COPD, acute bronchospasm and preventive exercise-induced asthma. Preferred over Beta 1 because of cardiac effects

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61
Q

Patient teaching for BETA agonist

A

using the short term acting medicine more than 2-3 times a week means their asthma is not well controlled.
Use beta agonist inhaler first.

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62
Q

Long acting beta agonist can be used

A

in combination of corticosteroid to prevent asthma. NEED to use Beta agonist inhaler first. BOTH used with spacer: spacer increases the amount of drug delivered to the lung.

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63
Q

Spacer teaching

A

MDI inhaler. BOTH used with spacer: spacer increases the amount of drug delivered to the lung.

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64
Q

Side effects and adverse effects of Beta agonist

A

Inhaled: throat irritation, sinus tachycardia, hypertension, anxiety, nervousness, tremor, dizziness, palpitations, angina, hyperglycemia, bronchospasm, urticaria, angioedema.

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65
Q

What is the drug used in Thyroid Hormone Replacement?

A

Levothyroxine

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66
Q

Drug interactions of Levothyroxine

A

Wafarin: increases effect of Levothyroxine
Digoxin: decreases effect of Levothyroxine.
Some vitamins and supplements

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67
Q

Drug interactions of levothyroxine continued

A

If patient on warfarin, monitor PT and INR and monitor for bleeding

If patient on digoxin monitor for CHF, Edema, fluid retention, crackles, sob

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68
Q

Patients on Levothyroxine should take their medicine _____ before vitamins/ supplements and other medicines

A

4 hours

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69
Q

Patients should take Levothyroxine 30-60 minutes ____ breakfast on ____

A

before, an empty stomach

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70
Q

Adverse Effects of Levothyroxine

A

Overmedication and Chronic over tx.

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71
Q

Levothyroxine is drug of choice for tx of

A

hypothyroidism

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72
Q

Overmedication and chronic overtx with levothyroxine can cause

A

a-fib, bone loss, and hyperthyroidism.

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73
Q

Biggest Patient Teaching with Levothyroxine

A

monitor hr before administering medicine

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74
Q

Before admitting levothyroxine the nurse checks the pts hr. if their hr is over 100 we should?

A

hold the medicine

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75
Q

what is a u thyroid?

A

when the thyroid is normal and within normal limits

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76
Q

What are the antithyroid drugs?

A

Prophylthioracil and Methimazole

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77
Q

Assessments and interventions of Antithyroid medicines?

A

Asses for thyroid crisis (storm),
Monitor the thyroid hormones, CBC , daily weights

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78
Q

Thyroid crisis (storm) s/s?

A

Tachcardia, fever, flushed skin, restlessness, confusion, behavior changes

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79
Q

What is agranulacytosis and what do we administer when this happens?

A

a life-threatening situation where the patient has extremely low white blood cells. (Neutrophills). admin Filgrasium.

80
Q

What are the antidiuretic hormone drugs?

A

Vasopressin and Desmopressin

81
Q

Indication for antidiuretic hormone?

A

used to treat diabetes insipidus

82
Q

Nursing interventions for antidiuretic hormone?

A

Monitor for overhydration, reduce fluid intake, small effective dose, monitor daily weights, ecg and iv site, s/s of MI

83
Q

Adverse effects of antidiuretic hormone?

A

reabsoprtion of too much water, MI, hyponatremia,

84
Q

ADH drug has bbw for what?

A

severe hyponatremia.

85
Q

Eval of ADH drugs?

A

Decreased urine output, decreased thirst, and sodium and potassium within normal limits

86
Q

What drug is used for Hyperparathyroidism?

A

calcitonin-salmon

87
Q

Side and Adverse effect of Calcitonin-salmon?

A

Gi disturbances, skin rash, flushing, nasal irritation
A: hypocalcemia

88
Q

How to recognize Biphosphonates?

A
  • dronate
89
Q

Indiciations of Biphosphonates

A

Inhibit osteoclast activity and decrease bone turnover and reabsorption.

Postmenopausal osteoporosis, male osteoporosis, osteoporosis caused by glucocorticoids, and Paget disease

90
Q

Patient Teaching for Biphosphonates

A

Check calcium level before starting and treat it. Take on empty stomach, sit up for 30 mins after, preform weight bearing exercises, eat diet high in calcium and vitamin d . Report vision changes

91
Q

What drugs are corticosteroids for Adrenoinsufficiency?

A

Dexamethasone, prednisone, fluticasone, betamethasone, methylpredinsolone, prednisolone, tramcinolone

92
Q

Indications for corticosteroids for adrenoinsufficiency?

A

Addison’s disease (replacement of adrenal corticoid)
malfunctioning adrenal glands

93
Q

Adverse effects of corticosteroids for adrenoinsufficiency?

A

Suppression of adrenal gland function, Cushing’s Syndrome, Bone loss/ Osteoporosis, Peptic Ulcer Disease.

94
Q

Patient teaching for corticosteroids for adrenoinsufficnecy

A

Avoid abrupt discontinuation, take in the morning/ when you wake up, weight bearing exercises, high calcium/ vitamin D diet, medical alert, NSAIDs, Report black tarry stools, Gi bleed, report Cushing Syndrome

95
Q

Adrenal Insufficiency symptoms

A

Anorexia, hypoglycemia, lethargy, restlessness, weakness.

96
Q

Types of Insullin

A

Rapid, Short, Intermediate, long

97
Q

Rapid-acting insulin medicaions

A

Lispro, Aspart, Glulisine

98
Q

Rapid Acting Insulin onset, duration, and peak.

A

Onset: 15-30 minutes before meals
Duration 3-6 hours
Peak: 30 mins-2.5 hours

99
Q

Which insulin are patients at highest risk of getting hypoglycemia

A

Rapid-acting

100
Q

Short-acting insulin medicine

A

Regular

101
Q

Short-acting insulin onset, duration, peak

A

Onset: 30-60 minutes
Duration: 6-10 hours
Peak: 1-5 hours

102
Q

Intermediate-acting insulin medication

A

NPH

103
Q

Intermediate-acting onset, duration, peak

A

Onset: 1-2 hours
Duration: 16-24 hours
Peak: 6-14 hours

104
Q

What are the long-acting insulin medicines?

A

Detemir and glargine

105
Q

Can long-acting medicines be mixed with other insulins?

A

no

106
Q

Long-acting insulin onset, duration, peak

A

Onset: 70 mins
Duration: 18-25 hours
Peak: no peak

107
Q

Combination insulin

A

Short and intermediate or rapid and intermediate
70/30 75/25

108
Q

Actions of insulin

A

promotes the use of glucose by body cells and storing glucose as glycogen in the muscle cells. This then reduces blood glucose

109
Q

Complications of insulin

A

Hypoglycemia, lipohypertrophy, hypokalemia, hyperglycemia

110
Q

Can you give long-acting insulins via IV?

A

no

111
Q

Hypoglycemia symptoms

A

Sweating, nervousness, hunger, tremors, weakness, mental confusion, headache

112
Q

Hyperglycemia symptoms

A

Increased blood glucose, excessive thirst, hunger, urine output, 3 p’s.

113
Q

How is insulin used in type 1 diabetes, type 2 and gestational diabetes?

A

glycemic control

114
Q

Those with type 2 diabetes should implement what?

A

lifestyle changes

115
Q

Those with type 2 dm may require insulin when?

A

the oral antidiabetic pill does not work. Illness, trauma, severe renal failure, liver, neuropathy, tx of dka, and being treated for hyperkalemia and at times of stress.

116
Q

Indications for Insulin

A

low blood sugar

117
Q

What insulins can be given via iv

A

rapid and short

118
Q

____ and Trauma are two reasons a patient with T2DM may require insulin

A

illness

119
Q

If the patient is awake and has hypoglycemia we can give the _______

A

oral glucose

120
Q

If patient is not awake and unconscious, or npo and have hypoglycemia we can give _____?

A

iv glucose or subcut glucogon

121
Q

what is lipohypertrophy?

A

what can occur if we do not rotate injection sites

122
Q

Patients should keep snacks with how many carbs in case of hypoglycemia?

A

15 g carb snack/ oj 4oz, 8oz milk

123
Q

We should teach our patients to do what when doing insulin injections?

A

rotate injection sites within 1 anatomical region, and teach back-method.

124
Q

We should teach our patients too?

A

recognize s/s of hypoglycemia, wear medical alert bracelet, how to check bs. healthy diets.

125
Q

Unopened vials of insulin should be?

A

refrigerated?

126
Q

How long is opened insulin allowed to be out of the fridge?

A

1 month

127
Q

How do we mix insulins?

A

roll in hands, inject air into the NPH (cloudy), inject air into regular (clear), draw clear, draw cloudy

128
Q

AC/HS

A

before meals and at bedtime

129
Q

The sliding scale is only used for

A

rapid and short-acting insulin

130
Q

Is every sliding scale the same?

A

no

131
Q

When do we use the sliding scale?

A

before meals and at bedtime. (AC/HS).

132
Q

Sulfonylurea drugs?

A

Glipzide, glyburide, glimepiride

133
Q

What drug class is Sulfonylureas?

A

oral hypoglycemia

134
Q

Who do we use Sulfonylureas for?

A

used for T2DM

135
Q

How do Sulfonylureas work in Type 2 diabetics?

A

promotes insulin release from the pancreas.

136
Q

Adverse effects of Sulfonylureas?

A

hypoglycemia

137
Q

What are the contraindications for sulfonylureas?

A

treatment of DKA, sulfa allergy, alcohol

138
Q

Patient teaching for Sulfonylureas?

A

monitor for s/s hypoglycemia, monitor poc glucose, 15g carb snacks, bs log, take breakfast, avoid alcohol

139
Q

Examples of 15g carb snacks?

A

4oz oj, 80z milk, 20z grape juice, glucose tablets.

140
Q

why should those on sulfonylureas avoid alcohol?

A

cause disulfiram like reaction

141
Q

Indications for metformin

A

control blood glucose levels in type 2

142
Q

How does Metformin work?

A

reduces the production of glucose, decreases absorption of glucose, and increases insulin sensitivity.

143
Q

What drug class is metformin?

A

Biguanide

144
Q

Patient teaching for metformin?

A

monitor weight loss, take with meaks, vitamin b12, folic acid supplements. s/s of lactic acidosis

145
Q

Metformin has a black box warning for?

A

lactic acidosis

146
Q

what symptoms of lactic acidosis should we teach our patients on Metformin to report?

A

hyperventilation, myalgia, sluggishness, n/v

147
Q

How long before receiving contrast dye should our patients stop taking metformin?

A

24-48 hours

148
Q

How long after contrast dye can patients resume taking metformin?

A

48 hours.

149
Q

Should patients over 80 years old take metformin?

A

no

150
Q

What is the indication for glucagon?

A

emergency management of insulin-induced hypoglycemia (unconscious)

151
Q

What are the Estrogen drugs?

A

estradiol, estriol

152
Q

Can we give estrogen only to a patient with a uterus?

A

no

153
Q

What are the adverse effects of estrogen?

A

endometrial hyperplasia, risk for thrombotic events, hyperpigmentation, ovarian/endometrial cancer

154
Q

What kind of cancers can be caused by the use of estrogen?

A

endometrial and ovarian cancer

155
Q

A patient with a history of these things is contraindicated with taking estrogen?

A

Pregnancy (x), thrombophlebitic events, and estrogen-dependent cancers

156
Q

Patients on estrogen should quit smoking to reduce

A

risk of thrombotic events

157
Q

Estrogen is contraindicated in

A

heart disease/ family history, vaginal bleeding, certain cancers, and thrombotic diseases. risk of fibroid tumors , tobacco use

158
Q

What are the progestein drugs?

A

progesterone, Hydroxyprogesterone, medroxyprogesterone, megastrol, norgestrel

159
Q

What effects does progesterone have on the body?

A

weight gain, edema and depression. Thromboembolism or P. E. breast cancer, jaundice, migtaines, birth defects, spontaneous abortion

160
Q

Progestin is contraindicated with patients who

A

have cirrhosis, liver disease, pregnancy, breast cancer .

161
Q

Progesterone is a catagory

A

x

162
Q

What drugs are the combination of hormonal contraceptives?

A

-transdermal patch: ethinyl estradiol and norelgestromin.

163
Q

Adverse effects of combination contraceptives?

A

Breast fullness, n/v depression and edema, increased risk of clotting, Thrombotic events, Vaginal bleeding, hyper: tension, kalemia, glycemia

164
Q

Contraindications of combined contraceptives

A

pregnancy, thrombophlebitic events, smoking, over 35.

165
Q

what are estrogen-dependent cancers?

A

estrogen, breast, endometrial.

166
Q

What can happen if women take estrogen alone and have a uterus?

A

endometrial hyperplasia?

167
Q

Finasteride indication

A

tx of bph, stimulate hair growth slows progesterone tissue/

168
Q

Patient teaching for Finasteride?

A

pregnant women should not touch it, therapeutic effects can take 6 months, Do not donate blood until a month after stopping medicine, anti-hypertensive teaching.cat x

169
Q

patients on finasteride should report?

A

symptoms of gynecomastia, impotence and decreased libido.

170
Q

Older adults on finasteride are more likely to see?

A

hypotension

171
Q

Tamsulosin indication

A

BPH reduces smooth muscle of bladder and prostate

172
Q

MOA for Tamsulosin

A

highly protein bound, Alpha 1 adrenergic antagonist. Relaxes the smooth muscle of the bladder.

173
Q

Adverse effects of tamsulosin?

A

hypotension, dizziness, nasal congestion sleepiness, fatigue, problems with ejaculation, floppy iris syndrome.

174
Q

if our patient has had cataract surgery. tamsulosin can cause them to have?

A

floppy iris syndrome

175
Q

what is the indication for PDE5-inhibitors?

A

erectile dysfunction

176
Q

Contraindications for PDE5-inhibitors

A

nitrates, grapefruit juice,

177
Q

PDE5 should not be taken with drugs that

A

lower bp (alcohol, antihypertensives, alpha adrenergic receptors

178
Q

What drug is used for thyroid hormone replacement?

A

levothyroxine

179
Q

Vitamins and supplements should be taken how long after levothyroxine

A

4 hours

180
Q

What drugs interact with levothyroxine

A

warfarin, digoxin, some vitamins and supplements

181
Q

AE of levothyroxine

A

overtx overmed, leads to hyperhyroidism, afib increased risk of bone loss

182
Q

Patient teaching levothyroxine

A

30-60 minutes before breakfast on an empty stomach and only with water. medical alert bracelet. dont stop abruptly, weight gain

183
Q

Propylthiouracil has bbw for?

A

severe hepatotoxicity

184
Q

Biggest d/e of our antithyroid drug is

A

hypothyroidism?

185
Q

For our patients on anti-thyroid drugs we need to monitor?

A

vs, daily weight, t3, t4, TSH , cbc, s/s infections s/s of hypothyroidism?

186
Q

Why do we need to monitor s/s of infection with antithyroid drugs?

A

agranulocytosis-extremely low white blood cell levels

187
Q

what can occur if we abruptly stop taking antithyroid drugs?

A

thyroid crisis

188
Q

if our patient has increased tsh they will have

A

hypothyroidism

189
Q

If patient has decreased tsh levels they will have

A

hyperparathyoidism.

190
Q

Nursing interventions for antidiuretic hormones?

A

monitor for overhydration

191
Q

What are the adverse effects of desmopressin and vasopressin

A

reabsorption of too much water, mi, hyponatremia

192
Q

intranasal desmopressin starts with a

A

bedtime dose

193
Q

Why do we monitor usg in antidiuretic hormones

A

show how concentrated urine is

194
Q

Eval of anti-diuretic hormone

A

decreased, urine, dehydration, thirst, increased usg

195
Q

when do we take adrenal corticosteroids?

A

in the morning when you wake up

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