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Pharm2 > Exam3 > Flashcards

Exam3 Flashcards

1
Q

causes of hypokalemia

A
  • diuretics (eg furosemide, HCTZ)
  • insufficient dietary intake
  • alkalosis and excessive insulin
  • vomiting, diarrhea, and laxative abuse
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2
Q

potassium supplement

A

potassium chloride

-PO or IV

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3
Q

what should you take with oral potassium supplement and why?

A

food or a full glass of water

-because it is very irritating to the GI tract

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4
Q

IV potassium precautions

A
  • MUST be infused with a pump (NEVER push by hand)
  • very irritating to the veins (must dilute with NS)
  • via IVPB/secondary line
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5
Q

signs of hyperkalemia

A
  • bradycardia (slows heart rate= stop breathing)
  • ECG changes (“peaked” T wave)
  • weak (numbness, tingling)
  • emesis
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6
Q

serum potassium level should be:

A

3.5-5.0

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7
Q

hyperkalemia can be treated with:

A
  • insulin
  • sodium bicarb
  • sodium polystyrene sulfonate (Kayexelate)
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8
Q

overactive bladder in today’s population

A
  • 33% of americans (very common)

- most prevalent in older populations

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9
Q

major symptoms of overactive bladder

A
  • urgency (sudden urge to go)
  • frequency (8+ times/day)
  • nocturia (2+ times/night)
  • urge incontinence (didn’t make it)
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10
Q

behavioral therapy treatments for overactive bladder

A
  • planning times to void
  • planning what times you drink
  • limiting caffeine use
  • kegel exercises (women)
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11
Q

medication for overactive bladder

A

oxybutynin

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12
Q

oxybutynin mechanism of action

A

(overactive bladder med)

  • an anticholinergic med
  • selectively blocks M3 receptors in the bladder, decreasing contractions and the urge to void
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13
Q

problems with oxybutynin

A

(overactive bladder med)

  • tachycardia
  • anticholinergic effects (constipation, blurred vision, photophobia, dry eyes, dry mouth)
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14
Q

oxybutynin is contraindicated in clients who have:

A

(overactive bladder med)

-glaucoma
(increased intraocular pressure)

-myasthenia gravis
(immune system destroys Ach receptors, making the muscles very weak)

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15
Q

common uses for oral contraceptives

A
  • acne (in girls that also want contraception)
  • contraception
  • dysfunctional uterine bleeding
  • menopausal hormone therapy
  • premenstrual dysphoric disorder (PMDD)
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16
Q

oral contraceptives to know:

A

combination (estrogen/progestin):
ethinyl estradiol/norethindrone

Progestin-only:
norethindrone

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17
Q

oral contraceptives mechanism of action

A
  • estrogen suppresses the release of follicle stimulating hormone (FSH)
  • progestin suppresses the release of luteinizing hormone (LH)
  • this prevents ovulation, thins the lining of the uterus, and thickens cervical mucus
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18
Q

difference bw progestin and estrogen

A
  • progestin does NOT stop ovulation

- when taking a progestin-only oral contraceptive, the risk of thrombosis is smaller

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19
Q

thromboembolic events pertaining to OCs

A
  • DVT, PE, MI, thrombolic stroke
  • risk factors: heave smoking, history of thromboembolism, thrombophilias, older than 35yrs and a smoker
  • lower doses today = lower risk
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20
Q

breast cancer pertaining to OCs

A
  • do NOT increase risk of breast cancer

- however, can increase the RATE of growth

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21
Q

drug interactions with OCs

A
  • St. John’s wort
  • antiseizure meds (phenytoin, carbamazepine, phenobarbital)
  • antibiotics (penicillins, cephalosporins, rifampin)
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22
Q

transdermal patch (ortho evra)

A
  • once a week for three weeks

- no patch on the 4th week

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23
Q

vaginal contraceptive ring (nuvaring)

A
  • wear for 3 weeks
  • no ring the 4th week
  • if it falls out: rinse with warm water and reinsert
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24
Q

medication options for BPH

A
  • alpha1 blockers
  • 5-alpha-reductase inhibitors
  • saw palmetto
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25
Q

alpha1 blockers to know for BPH

A
  • tamsulosin

- doxazosin

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26
Q

alpha1 blockers mechanism

A

(BPH meds)-tamsulosin, doxazosin

  • relax smooth muscle in the neck of the bladder, allowing urine to flow more freely through the urethra
  • also block receptors in the vasculature, decreasing blood pressure
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27
Q

notable problems with alpha1 blockers (pertaining to BPH)

A 
nonselective agents (doxazosin);
-hypotension, dizziness, nasal congestion, sleepiness

selective agents:
-abnormal ejaculation

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28
Q

5-alpha-reductase inhibitors to know for BPH

A

ending in -asteride

  • finasteride
  • dutasteride
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29
Q

mechanism of 5-alpha-reductase inhibitors

A

(BPH meds) -finasteride, dutasteride

  • block the enzyme that converts testosterone into DHT (dihydrotestosterone)
  • since DHT is what triggers the prostate to grow, this helps halt the growth of the prostate, and even SHRINKS IT.
  • DHT also plays a role in male-pattern baldness (these drugs also help regrow hair)
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30
Q

notable problems with 5-alpha-reductase inhibitors

A

(BPH meds) finasteride, dutasteride

  • pregnancy category X**
  • men must not donate blood
  • decreased libido, abnormal ejaculation
  • falsely decreased PSA levels (prostate specific antigen= marker for prostate cancer)
  • gynecomastia
31
Q

which of the BPH meds can also treat hypertension?

A

alpha1 blockers–> tamsulosin, doxazosin

32
Q

which of the BPH meds can also treat male-pattern baldness?

A

5-alpha-reductase inhibitors–> finasteride, dutasteride

33
Q

which of the BPH meds is extremely teratogenic?

A

5-alpha-reductase inhibitors–> finasteride, dutasteride

34
Q

common causes of erectile dysfunction (ED)

A
  • vascular (hypertension, diabetes, coronary artery disease)
  • neurologic (stroke, parkinson’s spinal cord injuries)
  • hormonal
  • drug-induced (SSRIs, betablockers)
  • psychogenic (psychological- stress, anxiety, depression)
35
Q

PDE5 inhibitors to know (ED meds)

A

ending in -nafil

  • sildenafil
  • tadalafil
  • vardenafil

**these drugz do not cause erection; when body starts making PDE5, it halts PDE5 so the erection is maintained

36
Q

notable problems with PDE5 inhibitors (ED meds)

A

sildenafil, tadalafil, vardenafil

  • hypotension
  • priapism (~4hr)
  • sudden hearing loss
37
Q

PDE5 inhibitors and nitrates

A
  • both increase cGMP levels
  • if these drugz are combined, life-threatening hypotension can occur
  • wait at least 24 hours
38
Q

“preterm” labor

A

-defined as birth before 37 weeks
-leading cause of infant mortality and morbidity
(75% of neonatal deaths)- lungs are not fully developed yet

39
Q

induced labor

A
  • more than 22% of deliveries are induced

- labor should be induced: beyond term (42 weeks)

40
Q

labor and delivery meds to know

A
  • oxytocin
  • methylergonovine
  • terbutaline
  • magnesium sulfate
41
Q

oxytocin

A

(L&D med)

  • increases the strength, frequency, and length of uterine contractions
  • use pump and monitor closely
42
Q

when using oxytocin for L&D, stop the infusion if:

A
  • resting uterine pressure > 15-20 mmHg
  • contractions lasts > 1 min
  • contractions frequency every >2-3min
  • pronounced alteration of FHR (fetal HR) or rhythm
43
Q

methylergonovine

A

(L&D med)

  • controls postpartum bleeding
  • causes POWERFUL uterine contractions
44
Q

what’s the risk of using methylergonovine (L&D med)?

A

HYPERTENSION

-safer agents such as oxytocin are usually tried first

45
Q

terbutaline

A

(L&D med)

  • suppresses preterm labor
  • activates beta2 receptors in the uterus, causing uterine relaxation
46
Q

major side effects of terbutaline (L&D med)

A
  • tachycardia, hypotension
  • pulmonary edema
  • hyperglycemia
47
Q

magnesium sulfate

A

(L&D) med

  • inhibits release of acetylcholine in synapses of skeletal muscle and uterus
  • used for preeclampsia (prevent seizures)
48
Q

magnesium sulfate toxicity

A
  • RR<12/min
  • loss of DTR
  • hypotension
  • urinary output <25-30 mL/hr
49
Q

antidote for magnesium sulfate:

A

calcium gluconate

50
Q

which of the L&D meds increases the strength, frequency, and length of uterine contractions?

A

oxytocin

51
Q

which of the L&D meds controls postpartum bleeding?

A

methylergonovine

52
Q

which of the L&D meds suppresses preterm labor and causes uterine relaxation?

A

terbutaline

beta2 agonist

53
Q

which of the L&D meds is used for preeclampsia (and prevent seizures)?

A

magnesium sulfate

54
Q

always collect specimens ______ starting antibiotic therapy

A

BEFORE

55
Q

beta-lactam antibiotics to know:

A

penicillins (-cillin)
-amoxicillin/clavulanate

cephalosporins (ceph- or cef-)
-cephalexin

carbapenems (-penem)
-imipenem

56
Q

mechanism of beta-lactam

A

penicillins, cephalosporins, carbapenems

  • interfere with an enzyme inside bacteria called penicillin binding protein (PBP)
  • this enzyme helps bacteria build strong cell walls
  • by blocking PBP, bacteria cannot build stron cell walls
  • they swell up with water and BURST. Boom!
57
Q

allergic rxns pertaining to beta-lactam antibiotics

A

beta lactams: penicillins, cephalosporins, carbapenems

  • penicillins are the most common cause of drug allergy (0.4-7% of clients)
  • (rash to anaphylaxis)
  • most likely to occur w/in 30 min
  • 1% cross sensitivity to cephalosporins
58
Q

superinfection pertaining to beta-lactam antibiotics

A

beta-lactams: penicillins, cephalosporins, carbapenems

  • Cephalosporins cause C. diff
  • advise clients to report watery diarrhea
  • treat with metronidazole or vancomycin
59
Q

pneumonic:

“if you get C. diff, you…”

A
  1. stop (antibiotic)
  2. swap (hand foam to soap and water)
  3. metronidazole

(stop, drop, and roll)

60
Q

protein synthesis inhibitors (antibiotics) meds to know

A

tetracyclines

macrolides

  • erythromycin
  • azithromycin

aminoglycosides

  • gentamycin
  • neomycin
  • amikacin
  • tobramycin
  • streptomycin
61
Q

problems with TETRACYCLINES

protein synthesis inhibitor antibiotic meds

A
  • esophageal ulceration (avoid taking at night)
  • many food interactions (milk products, calcium, iron supplements, magnesium containing laxatives and antacids)
  • teeth discoloration (if <8 yo)
  • photosensitivity (sunburn)
62
Q

problems with MACROLIDE

protein synthesis inhibitor antibiotic meds

A

(macrolides: erythromycin, azithromycin)

  • distorted taste (metallic)
  • prolonged QT intervals
63
Q

problems with amiNOglycoside

A

(aminoglycosides: Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin)

  • Nephrotoxicity (watch kidney function)
  • Ototoxicity
  • NO penicillin (inactivated by PCN if mixed together)
64
Q

fluoroquinolone meds to know

A

ending in -floxacin

  • ciprofloxacin
  • levofloxacin
  • moxifloxacin
  • norfloxacin
  • ofloxacin
65
Q

fluoroquinolone mechanism

A

they disrupt DNA replication in bacterial cells

66
Q

notable problems with fluoroquinolone

A
  • achilles tendon rupture (avoid use in children <18 yo)
  • photosensitivity
  • multiple food interactions (dairy products, aluminum-magnesium antacids, iron)– like tetracyclines
67
Q

ciproflaxin treats:

A
  • UTIs
  • traveller’s diarrhea
  • anthrax
68
Q

UTI meds to know

A

think: SNP–> “Someone Needs to Pee”

  • Sulfamethoxazole/trimethoprim
  • Nitrofurantoin
  • Phenazopyridine
69
Q

mechanism of sulfamethoxazole/trimethoprim

A

(UTI med)

blocks 2 separate enzymes bacteria need to create their own folic acid

70
Q

mechanism of nitrofurantoin

A

(UTI med)

enters bacteria and is converted into a toxic substance that destroys bacterial DNA

71
Q

mechanism of phenazopyridine

A

(UTI med)

an analgesic that works directly on the mucosa of the GU tract
-kidneys filter right out

72
Q

problems with sulfamethoxazole/trimethoprim

A

(UTI med)

  • hypersensitivity
  • crystalluria (drink 8+ cups of water per day)
  • kernicterus (build up of bilirubin in brain = causes retardation) (don’t give to pregnant women or infants <2 mo)
73
Q

problems with nitrofurantoin

A

(UTI med)

  • may turn urine a brownish color
  • peripheral neuropathy (rare)
  • take with FOOD to increase absorption (40%) and decrease GI discomfort
  • contraindicated if renal impairment (increase risk of toxicity)
74
Q

problems with phenazopyridine

A

(UTI med)

  • turns urine an orange-red color (stains)
  • GI discomfort (take with food)

Pharm2 (7 decks)

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