Exam 7: Units 12, 13, & 14 Flashcards
1
Q
class warfarin
A
anticoagulant
2
Q
MOA warfarin
A
decreases synthesis of clotting factors
3
Q
which 4 clotting factors does warfarin decrease?
A
2 (II)
7 (VII)
9 (IX)
10 (X)
4
Q
warfarin is for _____ of blood clots (DVT, PE)
A
PREVENTION - anticoagulants only prevent, they do not break down
5
Q
a patient should not be given warfarin if they have
A
active bleeding anywhere (including peptic ulcers)
6
Q
warfarin is ____ pregnancy safe
A
NOT pregnancy safe
7
Q
black box warning for warfarin
A
bleeding/fatal hemorrhage
8
Q
this syndrome is a side effect of warfarin
A
purple toe syndrome
9
Q
this may happen with long-term use of warfarin
A
osteoporosis
10
Q
antidote for warfarin
A
vitamin K
11
Q
monitor ____ while giving warfarin
A
INR
12
Q
therapeutic range for INR
A
2-3
13
Q
this should be added as a consideration while using warfarin
A
contraception - warfarin is not pregnancy safe
14
Q
class heparin
A
anticoagulant
15
Q
MOA heparin
A
enhances anti-thrombin III
blocks conversion of prothrombin to thrombin and fibrinogen to fibrin
16
Q
do not use heparin if the patient is
A
currently bleeding or has a bleeding disorder (including peptic ulcers)
17
Q
this may happen with long-term use of heparin
A
osteoporosis
18
Q
antidote for heparin
A
protamine sulfate
19
Q
heparin is only given via these two routes
A
IV and SQ
20
Q
monitor ____ while giving heparin
A
aPTT
21
Q
therapeutic range for aPTT
A
1.5-2.5 times normal
22
Q
the nurse may need to draw this lab for a patient using heparin
A
CBC - need to know of any bleeding
23
Q
class dabigatran
A
anticoagulant
24
Q
MAO dabigatran
A
directly inhibits thrombin
25
dabigatran would be considered for a patient if they have a thromboembolism from
atrial fibrillation
26
dabigatran is contraindicated for a patient who has any
mechanical heart valves
27
dabigatran may cause GI-related side effects such as (x2)
dyspepsia or gastritis
28
life threatening adverse effect of any anticoagulant
hemorrhage
29
class clopidogrel
antiplatelet
30
MOA clopidogrel
inhibits platelet aggregation
31
warfarin is given via this route
oral
32
heparin is _____ pregnancy safe
IS pregnancy safe! Does not cross the placenta or into breastmilk
33
warfarin is _____ pregnancy safe
is NOT pregnancy safe - warfarin is teratogenic
34
heparin has a _____ onset than warfarin
Heparin has a FASTER onset than warfarin
"Heparin is Hella fast"
35
life-threatening adverse effect with clopidogrel
hemorrhage
risk of epidural/spinal hemorrhage
36
2 black box warnings for clopidogrel
hemorrhage
risk of thrombosis if d/c without another anticoagulant
37
monitor these labs while giving clopidogrel
baseline liver function tests (LFT)
38
clopidogrel must be held for this long BEFORE surgery
1-2 weeksq
39
clopidogrel must be held for this long AFTER surgery
5 days
40
a patient with hyperlipidemia should keep total fat intake to
<30% of total calorie intake
41
a patient with hyperlipidemia should keep cholesterol intake to
less than 200 mg
42
class atorvastatin
antilipemic
43
MOA atorvastatin
inhibits enzyme needed for cholesterol production
44
atorvastatin is contraindicated in
pregnancy and lactation
45
huge side effect TO KNOW with atorvastatin
rhabdomyolysis: breakdown of muscle tissue that releases harmful substances into the bloodstream
46
atorvastatin may cause ____ dysfunction
liver dysfunction
47
atorvastatin may increase ____ levels
digoxin
48
this class of medication may increase atorvastatin levels
antibiotics
49
____ prevents metabolism of atorvastatin
grapefruit juice
50
monitor for _____ toxicity while using atorvastatin
digoxin toxicity
51
monitor these three labs while using atorvastatin
LFT
Lipid panels
HgbA1C
52
this is common with atorvastatin
GI upset
53
a patient should use this while taking atorvastatin
contraception - this medication is NOT pregnancy safe
54
class cyclobenzaprine
muscle relaxant
55
MOA cyclobenzaprine
relieves muscle spasm by acting on the brain stem
56
cyclobenzaprine is contraindicated in this dysrhythmia
QT prolongation
57
cyclobenzaprine would be contraindicated for a patient who had a recent
MI
58
do not give cyclobenzaprine to a patient who has either of these to organ dysfunctions
liver or kidney
59
in general, muscle relaxers cause this expected side effect
drowsiness/sedation
60
cyclobenzaprine may cause this in the tongue
edema of tongue
61
since cyclobenzaprine causes "low and slow" side effects, this may result in the mouth
dry mouth
62
cyclobenzaprine may cause this if taken with an MAOI
Hypertensive crisis - d/c MAOI at least 14 days before beginning other meds
63
cyclobenzaprine may have a synergistic effect with
alcohol - increased sedation/CNS depression
64
use extreme caution with cyclobenzaprine in this age group
elderly
65
due to its 'low and slow' side effects, cyclobenzaprine causes risk for
an increased fall risk
66
cyclobenzaprine should not be used
long-term
67
class dantrolene sodium
muscle relaxant
68
MOA dantrolene sodium
acts directly on the skeletal muscle to inhibit calcium from releasing into the sarcoplasmic reticulum
Calcium Contracts
low calcium = low contraction
69
dantrolene sodium, when given PO, is indicated for muscle _____
spasticity
70
dantrolene sodium, when given IV, is indicated for
malignant hyperthermia
71
contraindication for dantrolene sodium
NO CONTRAINDICATION due to its emergency use
72
be cautious giving dantrolene sodium to a patient with
severe liver disease
73
black box warning for dantrolene sodium
hepatotoxicity
74
dantrolene sodium may cause this in the muscles
muscle weakness
75
this class of medication may increase toxicity with dantrolene sodium
calcium channel blockers
76
monitor this while giving dantrolene sodium
liver function (due to its BBW on hepatotoxicity)
77
class baclofen
muscle relaxant
78
MOA baclofen
increases GABA activity in the brain which increases muscle relaxation
79
baclofen causes these kinds of side effects
low and slow
80
Black Box Warning for baclofen
rhabdomyolysis and multiple organ failure have occurred when this drug was stopped abruptly
81
main nursing consideration for baclofen
DO NOT D/C ABRUPTLY!
Must taper!
82
class calcium carbonate
electrolyte replacement
dietary supplement
83
these two items are required for calcium absorption
magnesium ans vitamin D
84
do not give calcium carbonate to a patient with this cardiac dysrhythmia
ventricular fibrillation
85
do not give calcium carbonate to a patient with this toxicity
digoxin toxicity
86
do not give calcium carbonate to a patient with an overdose of this vitamin
vitamin D overdose (too much calcium absorption may occur)
87
calcium carbonate may cause this in the kidneys
kidney stones
88
calcium carbonate may cause
constipation (C's)
89
calcium carbonate may cause this if given with digoxin
increased intotropic effects (increased cardiac FOC) and increased risk cardiac dysrhythmias
90
calcium carbonate antagonizes the effects of
calcium channel blockers
91
calcium carbonate is an antacid, so it will
decrease the absorption of other medications
92
avoid giving calcium carbonate with
other medications
93
low ____ may contribute to osteoporosis
low estrogen (post-menopausal)
94
two main drugs used to treat osteoporosis
calcium drugs and vitamin D supplements
95
class raloxifene
estrogen receptor agonist/antagonist
Selective Estrogen Receptor Modulator (SERM)
96
MOA raloxifene
binds to estrogen receptors to decrease bone resorption
97
raloxifene can be used for prophylaxis against
breast cancer (by preventing breast tissue growth)
98
raloxifene is not _____ safe
pregnancy/lactation
99
do not give raloxifene to a patient with a history of
thromboembolic event
100
black box warning for raloxifene
increased risk thromboembolic event
101
raloxifene may cause a decrease in
cholesterol
102
raloxifene may cause these two side effects (also s/s of menopause)
hot flashes
leg cramps
103
do not give raloxifene with
warfarin
104
check this lab when treating with raloxifene
LFTs
105
call provider immediately if the patient is taking raloxifene and is reporting
calf pain/tenderness
106
do not take raloxifene with other drugs containing
estrogen
107
class alendronate
bisphosphonate
108
MOA alendronate
prevents bone resorption by blocking the activity of osteoclasts
109
along with treating osteoporosis, alendronate may also treat this disease
Paget's Disease
=chronic bone disorder where the bones become abnormally large, weak, and deformed
110
condition where bones become soft and weak due to inadequate mineralization
osteomalacia
111
alendronate should not be given to a patient with an
esophageal abnormality
112
alendronate may have a ____ taste
metallic taste
113
alendronate may cause this in the GI tract
esophagitis
114
wait at least ____ before taking any other medications if also taking alendronate
30 minutes
115
make sure the patient does this after taking a dose of alendronate
sit upright/ambulate for at least 30 minutes to avoid esophagitis
116
monitor this electrolyte level when treating with alendronate
serum and urinary calcium
117
monitor these two labs while treating with alendronate
LFT and renal function tests
118
most common anti-inflammatory disorder caused by a breakdown of articulate cartilage
osteoarthritis
119
class adalimumab
biologic response modifier
immunomodulator
monoclonal antibody
antirheumatic
120
MOA adalimumab
blocks normal inflammatory and immune responses
121
adalimumab is mainly indicated for
rheumatoid arthritis and other autoimmune diseases
122
be cautious giving adalimumab with an active
active infection
123
be cautious giving adalimumab with a
live vaccine
124
black box warning for adalimumab
infection - med causes immunosuppression
125
adalimumab may cause ____ symptoms
flu-like symptoms
126
adalimumab may cause ____-like syndrome
Lupus-like syndrome
127
adalimumab may cause this due to its route of entry (injection)
injection site pain
128
adallimumab may interact with this, so do not give these during therapy
live vaccine
129
monitor this organ function while treating with adalimumab
liver function
130
joint pain and a photosensitive rash should be reported if taking adalimumab and are s/s of
Lupus-like syndrome
131
goal of glaucoma pharmacology
lower intraocular pressure (IOP)
132
type of glaucoma that is the most common
open-angle glaucoma
133
closed angle glaucoma is caused by
lens thickening
134
this kind of glaucoma is a medical emergency
closed-angle glaucoma
135
which type of glaucoma has a slower onset?
open angle glaucoma
Open angle glaucoma occurs Over time
136
treatment for closed-angle glaucoma includes
surgical options
137
treatment for open-angle glaucoma include
medications
138
#1 choice of drug for open angle glaucoma
prostaglandins
= latanoprost
139
two reasons why latanoprost (prostaglandin) is the first choice of drug for open angle glaucoma
fewer side effects
longer duration
140
class latanoprost
prostaglandin agonist
141
MOA latanoprost
reduces IOP by increasing outflow of aqueous humor
142
latanoprost can change
the color of the eye (iris pigmentation)
143
a positive side effect of latanoprost is that it can cause
eyelash growth
144
class timolol
topical beta blocker
145
MAO timolol
decreases production of aqueous humor
146
if systemic absorption occurs with timolol, side effects are similar to
other beta blockers - bradypnea, hypotension
147
main side effect with optical solution medications
eye stinging
148
class apraclonidine
alpha agonist (mainly alpha 2)
149
MOA apraclonidine
decreases aqueous humor production
150
apraclonidine can cause sensation of
a foreign body in the eye
151
apraclonidine can cause an increase in
blood flow to the eye
152
class pilocarpine
cholinergic agonist
153
pupil constriction AKA
miosis
154
MOA pilocarpine
produces miosis (pupil constriction) for better outflow of aqueous humor
155
nearsightedness, AKA
myopia
156
pilocarpine may cause a decreased vision in
low light
157
one toxic effect of pilocarpine is
vertigo (feelings of dizziness)
158
why is pilocarpine not first-line med?
greater toxicity and QID dosing
159
class dorzolamide
carbonic anhydrase inhibitor
160
MOA dorzolamide
decreases production of aqueous humor by interfering with synthesis of carbonic anhydrase
161
dorzolamide is generally used when
other medications have failed
162
the oral formulation of dorzolamide can cause systemic effects like
n/v
lethargy
paresthesias (abnormal skin sensations)
163
dorzolamide contains ____ which may cause allergic reactions
sulfur
164
these kinds of drugs relax the ciliary muscle and cause pupil dilation
mydriatic drugs
165
these kinds of drugs dilate and paralyze the ciliary muscle
cycloplegic drugs
166
apply optic medications to the _____ by pulling the lower eyelid down
lower canthus
167
infection/inflammation of the outer ear canal where moisture from water creates an environment for bacteria/fungi to grow
otic externa
"swimmer's ear"
168
infection/inflammation of the middle ear that is common in children, usually following a cold or upper respiratory infection
otis media
169
inflammation of the inner ear, specifically the labyrinth, often caused by a viral (sometimes bacterial) infection
otis interna
labrynthitis
170
cerumen accumulation can be treated with
cerumenolytics
= loosen and remove impacted cerumen
171
NEVER use the _____ to warm otic solutions
microwave
172
when administering otic solutions to a child under 3, pull the pinna
down and back
173
when administering otic solutions to a patient over 3 years old, pull the pinna
up and back
