Final (Combining Decks) Flashcards

Question

Nursing Considerations (Labs/vital sings): Statin | caution combining with what med?

Answer 1

- Common to experience muscle pain, fatigue, & mild digestive issues - Assess for muscle pain & monitor for side effects - LFTs and liver enzymes (manage by reducing the dose or stopping until levels return to normal) - Lipid panel - check 4-6 weeks after starting - start with lower dose and increase as needed - caution with combining statins with fibrates - pregnancy category X

Answer 2

* Abdominal pain and Diarrhea (most common) * Upper airway infections * Arthralgias (joint pain)

Answer 3

Can be given in combination with statins Do not take in pregnancy or breastfeeding

Answer 4

Contraindications * Allergy * Pregnancy or lactation * Severe liver disease Can take with meals Can be given in combinations with statins or to those who can't tolerate statins

Answer 5

- Can inhibit absorption of Vit: A, D, E, K - Can be used together with fibrates - Will decrease LDL but may also increase triglycerides/HDL - Can be used with pregnant women/pt with acute liver disease (monitor liver enzymes) - when mixing: give the medication right away because it will turn solid if it sits

Answer 6

* Itching * Swelling * Pain or bruising at injection site

Answer 7

* Constipation * Abdominal Pain * Diarrhea * Heartburn * Gallstones

Answer 8

Administered by SQ injection weekly or monthly - Can be given with statins - reserved for those w/ very high LDL or can't tolerate statins - are monoclonal antibodies

Answer 9

* Flushed Face/Neck * Increased uric acid levels (be careful in those with gout) * Increase risk of rhabdomyolysis (rare) * GI tract issues * Headache

Answer 10

* Monitor lipid levels in 4-6 weeks - Then every 3-4 months - because of increase in uric acid levels, may not want to give to patients with history of gout - not recommended for diabetics because it can cause hyperglycemia Drug interactions: Warfarin and Statins

Answer 11

Thyroid gland ## Footnote The thyroid is responsible for producing key hormones that regulate metabolism.

Answer 12

* Thyroxine (T4) * Triiodothyronine (T3) * Calcitonin

Answer 13

Needed for metabolism

Answer 14

Normal thyroid gland function

Answer 15

Visible enlargement of the thyroid gland

Answer 16

Antibody mediated autoimmune disease resulting in hyperthyroidism

Answer 17

Autoimmune disease often resulting in hypothyroidism

Answer 18

* Stimulates metabolic activity and oxygen consumption of cells * Produces heat and thermogenesis * Stimulates carbohydrate, fat and protein metabolism * Increases rate of glucose absorption * Increases erythropoiesis * Influences mood * Works with growth hormone, insulin, and sex steroids to promote growth * Required for normal respiratory response to hypoxia and hypercapnia * Critical for fetal neural and skeletal development

Answer 19

Thyroid Stimulating Hormone (TSH) from the anterior pituitary

Answer 20

Via a negative feedback mechanism

Answer 21

Inhibition of TSH

Answer 22

0.4 to 4.5

Answer 23

Less than 0.4

Answer 24

Above 4.5 ## Footnote Can be primary or autoimmune (Hasimotos, thyroiditis)

Answer 25

* Fatigue * Depression * Dry Skin * Constipation * Bradycardia * Altered menstrual cycles * Weight gain * Changes in hair * Cold intolerance

Answer 26

Severe hypothyroidism

Answer 27

Levothyroxine

Answer 28

Synthroid, Levoxyl

Answer 29

Calcium containing medications, antacids, or iron supplements

Answer 30

Increased in circulating T3 and T4 from overactive thyroid or excessive thyroid hormone production ## Footnote Graves disease is hyper-functioning thyroid

Answer 31

Beta blockers (e.g., Propranolol or Atenolol)

Answer 32

* Anxiety * Restlessness * Diaphoresis * Diarrhea, N/V * Tachycardia / AFib * Weight loss * Heat intolerance * Exophthalmos * Changes in menstrual cycle * Insomnia

Answer 33

* Inhibits release of T3 and T4 * short-term use * can cause iodinism

Answer 34

* Metallic taste * Stomatitis * Sore throat * Hypersensitivity

Answer 35

Thyroid extract from animal thyroid glands that have been dried and powdered -Contains both T3/T4 Side Effects: Change in appetite, chest pain, diarrhea

Answer 36

Methimazole

Answer 37

Inhibits Conversion T4 to T3 Medscape: Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland; blocks synthesis of T4 and T3

Answer 38

Decreasing thyroid hyperactivity and preventing complications

Answer 39

* LFTs * CBC

Answer 40

6-8 weeks after starting and after dose changes

Answer 41

It depends on which ones. PTU can be used in first trimester. Desiccated thyroid can be. Methimazole shouldn’t be used, same with I-131

Answer 42

online: Initially, the body compensates by producing more insulin, but over time, the pancreas struggles to keep up, leading to elevated blood sugar levels and eventually, T2DM From her slides in diff power point: Initially there is increased insulin secretion by the Beta cells to bring down the BS. Insulin not effective/cant bring down blood glucose/ then body needs to increase levels of glucose/beta cells become exhausted

Answer 43

From her type 2 diabetes PP: Basically, RAAS/SNS leads to increased inflammation which leads to more insulin resistance

Answer 44

- Improves how insulin works in the body (Insulin sensitizer) - Decreases absorption of carbohydrates - Decreases glucose production in the liver - Decreases appetite

Answer 45

* GI side effects (common) * Bloating * Diarrhea * Abdominal pain * Nausea * Metallic taste | Increased risk for B12 deficiency

Answer 46

- Hold 48 hours prior to contrast dyes (may lead to lactic acidosis or acute kidney injury) - Contraindicated in patients with renal or hepatic impairment, and heart failure

Answer 47

Renal/hepatic?

Answer 48

Stimulates Beta cells to secrete insulin Decrease glucose production by the liver | *Glipizide and glyburide*

Answer 49

online: the increased insulin levels promote the storage of excess glucose as fat

Answer 50

* Monitor for hypoglycemia * Onset at 90 minutes and peak in 2-3 hours

Answer 51

DO NOT GIVE IF ALLERGIC TO SULFA DRUGS ## Footnote ALso not for pregnant/lactating women/beta blockers

Answer 52

online: They induce insulin secretion from pancreas, with a different mechanism of action from sulfonylureas

Answer 53

Check BS levels?? Onset at 90 minutes and peak in 2-3 hours ## Footnote Should be taken with first bite of food (CUZ IM MEGA HUNGRY)

Answer 54

"Starch Blocker" Inhibit alpha-glucosidase, by delaying the absorption of glucose in the small intestines after a meal; does not increase insulin secretion Online: used to manage post-meal blood sugar spikes by slowing down carbohydrate absorption.

Answer 55

-Improve the effectiveness of insulin by decreasing insulin resistance in adipose and muscles cells -Contraindicated in those patients with heart failure or hepatic impairment -online: fluid retention, increased fat storage, and a shift in fat distribution towards subcutaneous fat can cause weight gain

Answer 56

enhancing insulin release, suppressing glucagon, slowing digestion, and reducing appetite, ultimately improving blood sugar control and potentially leading to weight loss

Answer 57

online: because these medications mimic the effects of the natural hormone glucagon-like peptide-1 (GLP-1), which helps regulate appetite, slows down digestion, and increases feelings of fullness, leading to reduced food intake and weight loss. online: Patients with hx of pancreatitis?

Answer 58

* Inhibits dipeptidyl peptidase 4 (DDP-4) enzyme, which destroys the GI incretin hormones GLP-1 and GIP * Increase insulin secretion * Decrease glucagon secretion to decrease glucose production * Allows incretin hormones to remain in circulation longer

Answer 59

Hypoglycemia

Answer 60

Inhibit reabsorption of glucose in the proximal renal tubules; promote glucose excretion in urine

Answer 61

Increase risk : Yeast infections, UTIs, and Amputation?

Answer 62

* A1C < 7% * FPG 80-130 * PPG <140

Answer 63

Hormones that controls the storage and metabolism of carbohydrates, proteins, and fats ## Footnote This activity occurs primarily in the liver, in muscle, and in adipose tissues.

Answer 64

Synthesis of glycogen

Answer 65

Promotes protein synthesis and helps store fat by preventing its breakdown for energy

Answer 66

Beta cells of the Islet of Langerhans in response to increased blood sugar

Answer 67

To mimic the physiological control of blood glucose levels

Answer 68

* Basal insulin levels – during fasting * Postprandial levels – after eating

Answer 69

* Diabetes Type 1 * Diabetes Type 2 * When not controlled with lifestyle and oral meds * Treat severe DKA or diabetic coma * Treat hyperkalemia in combination with glucose

Answer 70

Only use an insulin syringe and administer subcutaneously

Answer 71

A condition that can be prevented by rotating injection sites ## Footnote Keep injections about 1.5 in away from eachother and if BID use both L and R side

Answer 72

About 1.5 inches away from each other

Answer 73

* Insulin pumps * Insulin pen injectors * Insulin syringes

Answer 74

* Rapid-Acting * Short-Acting (Regular) * Intermediate * Long-Acting

Answer 75

* Aspart * Glulisine * Lispro * Inhaled Insulin | most deadly type of insulin

Answer 76

5-15 minutes ## Footnote Inhaled insulin onsent within ONE minute

Answer 77

30-90 minutes ## Footnote inhaled insulin within 12-15 min

Answer 78

To cover the glucose rise after eating a meal

Answer 79

30 minutes before meals

Answer 80

Throw it out

Answer 81

Isophane or NPH (Neutral Protamine Hagedorn)

Answer 82

Twice a day

Answer 83

2/3 in the morning and 1/3 in the evening ## Footnote Can be pre made in a 70/30 mixture of regular/NPH. -Supplied as a pen which makes for very easy administration. -Can be at room temp for 10 days

Answer 84

Up to 1.5 – 2 hours

Answer 85

Even absorption with no peaks and valleys | Frequently used in Type 2 DM

Answer 86

0.6-0.8 units/kg/day

Answer 87

Adjusted doses dependent on individual blood glucose, usually reserved for inpatient use

Answer 88

Refrigerated until needed

Answer 89

Will need insulin

Answer 90

A medical alert tag

Answer 91

* Must be given with food * Usually given in conjunction with intermediate acting insulin * Always monitor for hyPOglycemia

Answer 92

If Regular insulin (clear) is mixed with NPH human insulin (cloudy), the Regular insulin should be drawn into the syringe first. *May be given IV

Answer 93

Levothyroxine Armour Thyroid (desiccated)

Answer 94

Methimazole Propylthiouracil (PTU) Iodine Solutions

Answer 95

Based on TSH results Life-long medications Safe in pregnancy Should have TSH checked regularly until stablized (6-8 weeks after then annually)

Answer 96

* Inhibits formation of thyroid hormones in the cells * Inhibits conversion of T4 --> T3 * Need baseline CBC/LFTs * Take on empty stomach/30 minutes before eating * Takes several weeks to see effect

Answer 97

Methimazole Propylthiouracil (PTU)

Answer 98

Thioamide- * Drug of choice unless pregnant * Side Effects: Less GI effects * Can cause bone marrow suppression Pharmacology (Medscape): - Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland - blocks synthesis of thyroxine (T4) and triiodothyronine (T3)

Answer 99

Thioamide * inhibits Conversion of T4-T3 * Can be used during first trimester of pregnancy only * Need to monitor LFT's/CBC Medscape: - Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland - blocks synthesis of T4 and T3

Answer 100

* Iodine (Radioactive) * Use for thyroid cancer, thyrotoxicosis/special cases * Not for pregnancy * Increase fluid intake * Radiation precautions

Answer 101

* Propanolol/Atenolol * To control symptoms * Used in Tachy/arrythmic/HTN adults * Used to control sxs while waiting for meds to take effect

Answer 102

Increased amount and frequency of urination due to renal threshold for glucose reabsorption being exceeded. | Glucose >180 ## Footnote Results in glucose remaining in renal tubule and an osmotic gradient that pulls water from tubule cells into urine.

Answer 103

* Polyuria * Polydipsia * Polyphagia ## Footnote Other symptoms may include blurred vision, fatigue, and weakness.

Answer 104

A hyperglycemic emergency characterized by hyperglycemia, metabolic acidosis, dehydration, and electrolyte loss. ## Footnote Often presents in Type 1 Diabetes but can occur in Type 2. -stored fatty acids can cause DKA

Answer 105

Insulin deficiency leads to the breakdown of fat into free fatty acids and glycerol, converted into ketones by the liver. ## Footnote Ketones are strong acids that can lead to metabolic acidosis.

Answer 106

Increase in fasting blood glucose and/or insulin requirements during early morning hours due to nocturnal elevation of growth hormone. ## Footnote Not triggered by nocturnal hypoglycemic events.

Answer 107

Nocturnal hypoglycemia followed by rebound hyperglycemia due to counter-regulatory hormone release. ## Footnote Occurs from too much or too little insulin at bedtime.

Answer 108

* Infection or illness * Lack of Insulin * Undiagnosed or undertreated diabetes ## Footnote These factors can precipitate DKA in patients.

Answer 109

Fluid replacement to restore intravascular volume and correct electrolyte imbalances. ## Footnote Insulin therapy is also initiated once fluids are administered.

Answer 110

* Extreme dehydration * Poor skin turgor * Dry mucous membranes * Tachycardia * Hypotension * Acetone breath * Kussmaul respirations * Changes in LOC ## Footnote Presenting symptoms also include the 3 P’s and weight loss.

Answer 111

Increased osmotic pressure in the extracellular compartment causes water to shift out of the intracellular space, leading to cellular dehydration and thirst sensation. ## Footnote This condition is known as polydipsia.

Answer 112

Blood glucose level < 70 mg/dL with or without symptoms. ## Footnote Most commonly occurs in patients treated with insulin.

Answer 113

* Hyponatremia * Hyperkalemia ## Footnote These imbalances need to be monitored during treatment.

Answer 114

-Total destruction of the pancreatic beta cells -autoimmune -Types : -1A (90-95%) - Type B (idiopathic, no autoimmune) - Rapid destruction in kids/Slower in adults

Answer 115

A metabolic state where the body uses free fatty acids for energy instead of glucose

Answer 116

* Three “P’s”: * Polydipsia * Polyuria * Polyphagia * Weight loss * Abdominal pain * Neuro symptoms * Blurred vision (accumulation of aqueous humor in the eye) * Other symptoms * Frequent Candida infections * Extremely elevated glucose * Ketones in urine * Metabolic acidosis

Answer 117

Increased appetite with weight loss -Insulin deficiency-cells not receiving glucose- sets into effect compensatory processes to increase blood glucose levels.

Answer 118

Check glucose level in the middle of the night A. Dawn = Normal/High Glucose at 3 AM B. Somogyi = Low Glucose at 3 AM

Answer 119

Accumulation of glucose in aqueous fluid in the cornea alters refraction of light entering the eye

Answer 120

Total destruction of the pancreatic beta cells due to autoimmune response ## Footnote Includes Type 1A (90-95%) and Type 1B (idiopathic, no autoimmune).

Answer 121

Defined as blood glucose < 70 mg/dL with or without symptoms Common causes: Excessive exercise, alcohol, poor food intake, too much insulin, stress, surgery, and medications

Answer 122

Triggers the release of glycogen from the liver

Answer 123

The body creates glucose from non-carbohydrate sources instead of using the Krebs cycle

Answer 124

Glucose provides energy for cells, fat is the most dense fuel storage, and proteins are building blocks for tissues ## Footnote Glucose is absorbed into the bloodstream at the intestines and is essential for normal cerebral function.

Answer 125

Hormones that counteract the effects of insulin: glucagon, epinephrine, cortisol, and growth hormones ## Footnote They help increase blood glucose levels when they drop.

Answer 126

Type 1 is characterized by autoimmune destruction of pancreatic beta cells; Type 2 involves insulin resistance and deranged insulin secretion/gestational/drug induced ## Footnote Type 1A is autoimmune, while Type 1B is idiopathic.

Answer 127

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes, often associated with obesity and insulin resistance

Answer 128

It breaks down to form CO2 and water ## Footnote This process is part of cellular respiration.

Answer 129

It is used for energy, stored as glycogen in the liver, or converted into fat ## Footnote Excess glucose can also be excreted in urine.

Answer 130

The breakdown of stored glycogen to make glucose -This process occurs in the liver and muscle tissue when glucose levels are low. (Prolonged starvation) -In response to Epinrephrine, glucagon, insulin

Answer 131

The synthesis of glucose by the liver from non-carbohydrate sources ## Footnote It primarily occurs from amino acids and fats. Can lead to development of ketones

Answer 132

Insulin stimulates the uptake, use, and storage of glucose by promoting glycogen synthesis and inhibiting gluconeogenesis ## Footnote It is released by beta cells in the pancreas.

Answer 133

Amylin, somatostatin, glucagon, and incretins ## Footnote Amylin slows glucose absorption, while glucagon promotes glucose production.

Answer 134

* Family history * Obesity * Ethnicity * Age * Gestational diabetes * Hypertension * Polycystic ovary syndrome (PCOS) * Smoking and alcohol ## Footnote These factors contribute to insulin resistance and deranged insulin secretion.

Answer 135

After a meal ## Footnote Insulin levels decrease during fasting.

Answer 136

* Fatigue * Sweating * Hunger * Dizziness * Rapid heart rate * Anxiety * Irritability * Shakiness * Blurred vision * Confusion * Loss of consciousness * Seizures * Coma ## Footnote Symptoms vary from mild to severe depending on blood sugar levels.

Answer 137

A condition seen only in Type 2 diabetes characterized by severe hyperglycemia(>600), hyperosmolality (like DKA), and dehydration due to insulin resistance - Can develop over several days to weeks -Causes: INfection, non-complicance with diet/meds, substance abuse, alcohol ## Footnote Unlike DKA, there is no ketone formation in HHS.

Answer 138

* Fasting blood glucose > 126 (2 readings) * 2-hour plasma glucose during OGTT > 200 * Random blood glucose > 200 with hyperglycemic symptoms * Hgb A1C > 6.5% (2 readings) ## Footnote These criteria help in the accurate diagnosis of diabetes.

Answer 139

High blood sugar levels leading to nerve damage Somatic neuropathy: Diminished perception: Vibration, pain, temp. Hypersensitivity: Light touch, occasionally severe "Burning" pain Autonomic neuropathy: Defects in vasomotor and cardiac responses Urinary retention Impaired motility of the gastrointestinal tract Sexual dysfunction

Answer 140

* Sedentary lifestyle * Poor diet (high glycemic carbohydrates) * Smoking ## Footnote These factors contribute to obesity and stress on pancreatic beta cells.

Answer 141

Increased blood glucose Beta cells Insulin & Amylin Vs Hypoglycemia Alpha cells Glucagon

Answer 142

Increased waist circumference or belly fat High triglycerides Elevated BP High BS Low LDL Apple Shape Ancanthosis Nigricans

Answer 143

* Hyperglycemia causes intracellular fluid shifts ------>polydipsia * Excessive diuresis causes polyuria * Cell starvation from lack of glucose ---------> polyphagia * Fatigue * Weakness * Weight loss * Visual disturbances

Answer 144

* Causes increases in adipose and free fatty acids * Induces inflammation and release of the associated inflammatory mediators * Increases stress on pancreatic B cells as insulin is increased * Results in liver increase glucose in the blood (impaired suppression)

Answer 145

HgbA1c measures the amount of glucose over 120 days. Glucose doesnt normally move into RBCs but when glucose is chronically high it will---> once inside it cannot leave.

Answer 146

Symptoms: extreme glucose level, rapid/thread pulse, hypotension, profound dehydration, polydipsia, polyuria, confusion, disorientation, possible seizure, or coma Treatment: Hydration (given first) IV insulin Electrolyte replacement

Answer 147

To maintain a continuous supply of glucose for energy

Answer 148

- can be used with fibrates - can be used with pregnant women - this med has a strong record of efficacy and safety - take right away when mixed

Answer 149

- are very expensive compared to other classes - can be given in conjunction with statins - decrease LDL, cholesterol, and triglycerides

Answer 150

- do not take with warfarin or statins - will need periodic monitoring - not recommended for diabetics

Answer 151

- rosuvastatin is the most potent; if there was trouble tolerating - you can change from one statin to another - should take them in the evening or at bedtime, but rosuvastatin and atorvastatin can be given in the morning

Answer 152

they play some role in vasodilation

Answer 153

inflammatory cells inside the plaque are reduced and the endothelium is stabilized, which in turn stabilizes the plaque. this is important because it reduces the risk of thromboembolic issues if a part of the plaque breaks off and travels through the bloodstream

Answer 154

Total Cholesterol: desired level is less than 200 LDL: desired level is less than 130 HDL: desired level is 50 or higher Triglycerides: desired level is less than 200 In diabetics and those with increased risk: want LDL < 70

Answer 155

It means to reduce the progression of atherosclerosis and cardiovascular disease by helping increase nitric oxide availability. Endothelial dysfunction occurs from oxidative stress from dyslipidemia, diabetes, smoking, HTN, obesity, and aging. By controlling these factors that shred blood vessels, it reduces endothelial dysfunction. Statins play a role in reducing smooth muscle changes, stabilizing endothelium, reducing friction, and reducing proteins associated with inflammation.

Answer 156

dopamine, serotonin, and GABA

Answer 157

ACH (acetylcholine) and norepinephrine

Answer 158

- found in the CNS, PNS, and ANS - can be either excitatory or inhibitory (depends on neurons secreting it) -- PNS: excitatory at neuromuscular junctions -- ANS: inhibitory and slows heart rate

Answer 159

- derived from tryptophan - found primarily in the GI tract, platelets, and brainstem - contributor to feeling of well being - inhibitory

Answer 160

- located mainly in the substantia nigra of midbrain/basal ganglia region - numerous functions: -- behavior and cognition -- voluntary motor movement -- motivation punishment and reward -- attention -- working memory -- learning - involved in many neuropsychiatric and voluntary motor movement disorders: -- social phobia, ADHD, drug and alcohol dependence -- Parkinson's disease -- Tourette's syndrome

Answer 161

- chief inhibitory transmitter in the CNS - has a relaxing, antianxiety, and anticonvulsant effect on the brain - has inhibitory effect on muscles (decreases muscle spasms and improved tone)

Answer 162

an excitatory neurotransmitter in the brain stress hormone within the endocrine system

Answer 163

- major mediator of excitatory signal - involved in cognition, memory, and learning

Answer 164

action potential (neuron conducts impulses) - abrupt changes in the membrane potential permit nerve signals to be transmitted from the cell body down the axon - stimulates sodium, potassium, and calcium ions to move across the axonal membrane

Answer 165

- depolarization of the neuron: positively charged ion - repolarization of neuron: return of neuron to a negative value - resting period

Answer 166

impulses that do not maintain a systematic order (excitatory, inhibitory, and resting phase) become irregular and chaotic and can lead to seizures

Answer 167

a single episode of abnormal electrical discharge from cortical neurons that results in an abrupt and temporary altered state

Answer 168

a group of syndromes characterized by unprovoked, recurrent seizures

Answer 169

continuous seizure activity for more than 5 minutes - OR 2 or more sequential seizures that occur WITHOUT full recovery of consciousness between attacks - is a neurological emergency - requires immediate intervention

Answer 170

- trauma - ETOH withdrawal - illicit drug use - brain tumor - congenital malformations - stroke - metabolic disorders (uremia, electrolyte imbalance) - alzheimer's disease - neurodegenerative disease - idiopathic

Answer 171

- genetic causes (mutated genes) - head trauma - medical disorders (dementia, meningitis, encephalitis) - prenatal injury - developmental disorders (autism, Down syndrome)

Answer 172

- messages from the body are carried by the neurons of the brain through discharges of electrochemical energy; impulses occur in bursts - during periods of unwanted discharged, parts of body may act erratically - for an actual seizure to occur: -- need excitable neurons -- need increase in excitatory glutaminergic activity -- need reduction in activity of normal inhibitory GABA projection - anyone can have a seizure

Answer 173

- absence (petit mal) - tonic-clonic (grand mal) - atonic/akinetic (drop attacks) - status epilepticus

Answer 174

- **starts and remains in one hemisphere** - high-frequency bursts of action potentials and hypersynchronization - may have motor, sensory, and autonomic symptoms and automatisms -- autonomic: due to stimulation of ANS (pallor, sweating, pupillary dilation, epigastric sensation) -- automatisms: often associated with temporal lobe seizures; patient is unaware

Answer 175

- may happen with focal seizures - coordinated involuntary movements happening during state of impaired consciousness either during or after seizure - patient is unaware - often associated with temporal lobe seizures

Answer 176

- focal - retains awareness - focal - altered awareness - partial seizure

Answer 177

- no impairment of consciousness - similar to partial seizures - may have movement of body parts - may experience an aura

Answer 178

- impairment of consciousness - spreads to both hemispheres (this confuses me though because i thought it should start and remain in one hemisphere)

Answer 179

- begins in one part of hemisphere (typically in the temporal or frontal lobe) - may be simple or complex

Answer 180

- **start in one hemisphere and spreads with involvement of both hemispheres** - may have motor and/or nonmotor symptoms - affects both hemispheres of the brain - impairment of consciousness

Answer 181

- begin with rigid violent contractions (tonic) - followed by repetitive clonic activity of all extremities - body stiffens and relaxes generalized

Answer 182

generalized - muscle stiffness, dilation of pupils, altered respirations - usually lasts less than a minute

Answer 183

generalized - short episodes of staring and loss of consciousness for about 10 seconds

Answer 184

generalized - bilateral jerking of muscles - no loss of consciousness

Answer 185

generalized - sudden loss of muscle - "drop to the ground"

Answer 186

- H&P - neurological exam - diagnostic procedures (chemistries, tox screen, CT, MRI, EEG)

Answer 187

Pre-ictal, ictal, and post-ictal

Answer 188

may be started by a trigger and/or preceded by an aura

Answer 189

- actual seizure - increases in metabolic demand (uses a lot of energy)

Answer 190

- has decreased responsiveness - feels fatigue

Answer 191

AKA antiepileptic drugs (AED) - used for long-term management of chronic epilepsy - management of seizures not caused by epilepsy - off label use: anxiety, bipolar disorder, chronic pain, migraines

Answer 192

effective for treatment of focal and generalized seizures

Answer 193

used primarily for focal-onset seizures (including focal which evolve to be convulsive seizures)

Answer 194

- prevent return of the channel to active state, stabilizes them to inactive state - prevents repetitive firing

Answer 195

- calcium going in during cells' resting state facilitates development of an action potential - CCBs slow depolarization which is needed for spike-wave bursts - CCBs help to "lock the channel"

Answer 196

- may enhance Cl- influx which makes cells more negative and harder for the cell to generate an action potential - some decrease metabolism of GABA so that more GABA is available (GABA is inhibitory)

Answer 197

- bind to glutamate, which is an excitatory neurotransmitter, therefore blocking it from binding and creating excitation - glutamate receptor has 5 potential binding sites

Answer 198

- medications are to control seizures NOT cure - medication prescribed based on the type of seizure - many drugs require blood monitoring - patient education (take as prescribed, never stop taking on own, side effect management)

Answer 199

Sodium channel blocker - works to stabilize the neurons from becoming too excited - stops the spread of seizure activity in the motor cortex - **highly (90%) protein-bound drug: increased risk of drug interactions** Indications: - tonic-clonic seizures - status epilepticus - prophylaxis for surgery

Answer 200

Therapeutic range: 10-20mcg/mL - very narrow therapeutic window - need to monitor levels Given PO, IM, or IV - if administered IV, w/ NSS - infuse over 30-60 minutes - can be very irritating to veins Tube feeds: need to stop feed for 2 hours before AND after

Answer 201

- **gingival hyperplasia** - neurologic: -- drowsiness -- ataxia -- irritability -- visual problems -- peripheral neuropathy -- headache - N/V - Cardiovascular: hypotension, arrhythmias - can cause suicidal thoughts - skin rash including SJS can occur

Answer 202

Classified as a barbiturate - inactivates fast sodium channels leading to enhanced GABA effects and decreased glutamate release Administration consideration: very long half-life - habit forming and dependence

Answer 203

- sedation - diplopia - cognitive skill impairment - respiratory depression - hypotension - hyperactivity and inattention in children

Answer 204

Sodium channel blocker - similar to Phenytoin (also an SCB) in mechanism of action - inhibits spread of seizure activity Used for several different types of seizures: - drug of choice for partial and generalized tonic-clonic seizures - also used for trigeminal neuralgia and bipolar disorder - WILL MAKE ABSENCE AND MYOCLONIC SEIZURES WORSE Needs to be in dry location

Answer 205

partial and generalized tonic-clonic seizures

Answer 206

absence and myoclonic seizures

Answer 207

Labs: - CBC: especially WBC - Drug level: 4-12 mcg/mL Monitor drug levels, sodium, CBC, LFTs, and BUN/Cr especially in those with renal impairment

Answer 208

- Neuro: headache, diplopia, ataxia, drowsiness, sedation - N/V - hyponatremia - decreased blood counts (neutropenia and thrombocytopenia) - rashes can be common - watch for SJS - increases suicidal thoughts * take with food * cannot abruptly discontinue

Answer 209

Sodium channel blocker - same efficacy as carbamazepine but is better tolerated

Answer 210

- used as adjunctive therapy or monotherapy for partial seizures in children and adults - NOT used for absence and myoclonic - makes them worse Considerations: - increase risk of suicidal ideations - decreases efficacy of oral contraceptives

Answer 211

GABA enhancer; inactivation of fast sodium channels Indications: really any seizure activity - absence, myoclonic, tonic-clonic, partial, neonatal seizures - used to control symptoms of acute mania in bipolar disorder

Answer 212

- can be given with phenytoin - take with food - can cause liver toxicity, need to monitor LFTs - **narrow therapeutic range** -- need to check levels (50-100 mcg/mL) - must be diluted when given IV with at least 50mL NSS or D5W -- give over an hour (no more than 20mg/min) - avoid sudden withdrawal - monitor CBC because can cause thrombocytopenia

Answer 213

- N/V - sedation/dizziness - pancreatitis - increased ammonia levels - thrombocytopenia (monitor CBC) - suicidal thoughts - can cause liver toxicity (watch LFTs)

Answer 214

Thought to act on the calcium channels to decrease glutamate and increase GABA in the brain Indications: - partial seizures - new onset epilepsy - MAY MAKE MYOCLONIC SEIZURES WORSE

Answer 215

- chronic neuropathic pain - anxiety - hot flashes/night sweats - headaches - hiccups - alcohol withdrawal

Answer 216

- fatigue: given at night often - **mental cloudiness** - leukopenia - weight gain - edema - emotional lability - tremors - GI side effects - suicidal thoughts

Answer 217

- reduced dose in renal patients: monitor BUN/Cr - caution in those with addiction history - no drug monitoring needing b/c wide therapeutic range - withdrawal slowly - doses will be very high for pain control

Answer 218

the step by step process of breaking down of glucose into pyruvic acid, NADH, and ATP (energy)

Answer 219

when your body does not immediately need glucose from the food you eat for energy, it stores glucose primarily in muscle and the liver as glycogen for later use

Answer 220

process of glucose formation from non-carbohydrate substances

Answer 221

the breakdown of stored glycogen to glucose

Answer 222

the synthesis of glucose from non-carbohydrate sources - the opposite process of glycolysis

Answer 223

a hormone produced by alpha cells in the pancreas - it is released in response to a drop in blood sugar, prolonged fasting, exercise, and protein-rich meals

Answer 224

Online: The main difference between the intrinsic and extrinsic pathways in blood coagulation lies in their initiation: - the intrinsic pathway is activated by factors within the blood itself, - while the extrinsic pathway is activated by tissue factor released from damaged tissues outside the blood. Both pathways ultimately converge on the common pathway, where factor X is activated, leading to clot formation aPTT- intrinsic PT- Extrinsic

Answer 225

-Decreases aggregation and formation of the platelet clot (Blocks Cox-1) -Inhibits prostaglandin production

Answer 226

Also an anti-platelet but it INHIBITS platelet aggregation via P2Y12 -It keeps platelets in your blood from attaching to each other and making blood clots -Used for post stent/Post MI/Post stroke patients Starts to work in 24-48 hours but not see full effect for 4-6 days *Used for patients who need the combined therapy of asparin

Answer 227

Should be stopped at least 2-5 days before surgery Must take everyday unless told otherwise Only provider can stop medication DO NOT GIVE- * Known bleeding disorder * * Active bleeding * * Closed head injuries * * CVA until prove no bleed * * Pregnancy (risk benefit) * * Lactation

Answer 228

A Qualified healthcare provider

Answer 229

Inhibits the production of Vit K

Answer 230

Used in atrial fibrillation, Valvular heart disease, CVA, DVT and PE prevention, post joint replacement (People at risk of blood clot) - Due to the drug being highly protein-bound

Answer 231

PT/INR Want INR at 2 to 3 For mechanical heart valve = 2.5 to 3.5

Answer 232

Takes 4-7 days for take effect

Answer 233

Phytonadione (Vitamin K)

Answer 234

-Takes 4-7 days to take effect -Should be taken in the evening -Requires frequent lab monitoring (PT/INR) -Narrow therapeutic range -Works slowely compared to heparin

Answer 235

-Prevent factor Xs from changing prothrombin to thrombin. They bind directly to factor Xa ## Footnote Common factor Xa inhibitors include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa).

Answer 236

it directly blocks thrombin, the enzyme responsible for clot formation, whereas the others are direct factor Xa inhibitors. | Twice daily dosing

Answer 237

-Praxbind -Must reduce in renal failure

Answer 238

PTT (prothrombin time) International Normalized Ratio (INR) Activated partial thromboplastin time (aPTT)

Answer 239

-Do not take with Clopidogrel -Must reduce in renal failure

Answer 240

Andexanet (For eliquis/xarelto) Praxbind (for pradaxa) Pradaxa-is twice daily

Answer 241

Less expensive

Answer 242

Anti-thrombin inhibitor- interferes with conversion of thrombin to prothrombin

Answer 243

online: Heparin works quickly, with IV heparin taking effect within minutes, and subcutaneous heparin within 1-2 hours. The anticoagulant effect of therapeutic doses of heparin is mostly eliminated within 3-4 hours after stopping continuous IV administration, with a half-life of about 60-90 minutes.

Answer 244

Monitored by aPTT usually 1.5-2.5 times baseline control Pt should normalize 2-6 hours after heparin is stopped

Answer 245

Starts by administering an IV bolus dose, followed by continuous dripL Bolus usually 5000units Followed by 1000-1300units/hour Or 80u/kg (can be less) bolus and then 18u/kg/hour Antidote: Protamine sulfate | ALWAYS CHECK DOSE WITH ANOTHER NURSE

Answer 246

-Measures time is takes for plsma to clot when exposed to a reagent -30-45 seconds -Intrinsic pathway -A prolonged APTT can be an indicator of bleeding disorders like hemophilia or von Willebrand disease. -The APTT test is commonly used to monitor the effectiveness of heparin, a blood thinner, and ensure that the patient's blood clotting time is within the therapeutic range.

Answer 247

* Inhibit thrombus and clot formation by blocking factors Xa * Routes: SQ * Should not be mixed with other medications; multiple interactions * Safe to use during pregnancy, but is considered 2nd line therapy * Adverse Effects: Bleeding, Heparin-Induced Thrombocytopenia, Hypersensitivity Narrow therapeutic range : Requires lab monitoring Want PTT in therapeutic range= 46-70 If aPTT > 70, call the physician LOW MOLECULAR WEIGHT HEPARIN: Commonly used for DVT prophylaxis, MIs Drugs: Enoxaparin (Lovenox) Dalteparin (Fragmin) Route: SQ only Administer 2 inches from the umbilicus; No rubbing/No aspiration Okay to use during pregnancy, considered 1st line Does not require lab monitoring

Answer 248

Online - about 2 days

Answer 249

inject into "love handles" Alternate between sites Do not inject air bubble prior to injection Do Not just injection site after

Answer 250

Stroke! Only given IF within 3-4 hours of onset of symptoms. Only give through a peripheral IV, not a central line (so you can compress the site) NO injections No SQ, or IM No ABGs (blood gas) Monitor vital signs and neurologic status If possible CVA, must do head CT before administering Place patient on bleeding precautions

Answer 251

Second most common type of infection Occurs in Women more than males Accounts for About 50% of all hospital-acquired infections

Answer 252

Accounts for about 50% of all hospital acquired infections Catheter Acquired UTI (CAUTI)

Answer 253

Lower - Bladder and structures below the bladder Upper -Kidneys -Ureters

Answer 254

Pyelonephritis

Answer 255

E. Coli? Urethra

Answer 256

occurs when urine washes out the bacteria in the urethra during urination

Answer 257

Staphylococcus saprophyticus Klebsiella pneumoniae Proteus mirablis Pseudomonas species

Answer 258

Anatomic: - Stones, BPH, Pregnancy Functional: - Infrequent voiding etc.

Answer 259

Ureterovesical Reflux: -Cough or squatting can cause urine to move back from the bladder into the urethra and then back into the bladder Vesicoureteral Reflex: - Occurs at the level of the bladder and ureter

Answer 260

Sexually active women Post menopausal women Pregnancy Bladder cancer Renal stones (Calculi) Men with prostate abnormalities (no circumsicion) Anal intercourse Older adults Others at Risk Catherization Instrumentation Diabetes Use of antibiotics

Answer 261

Complicated

Answer 262

Dysuria Frequency Urgency Hematuria Suprapubic pain

Answer 263

May be asymptomatic or present with septic shock Fever, chills, nausea, vomiting Back pain/flank pain

Answer 264

spread of infection from urinary tract to bloodstream

Answer 265

Symptoms can vary: Incontinence Foul smelling concentrated urine Fatigue Confusion Dementia Hallucinations

Answer 266

After 3 months old, more prevalent in girls. -Frequently involved upper urinary tract

Answer 267

* Pain (Pelvic/Perineal) * Urgency * Feeling of bladder fullness/pressure * Women>Men * Exact cause unknown Rule out: Infection Endometriosis Urodynamic Testing

Answer 268

What: Amount of solutes in urine Normal: No true normal but approximately 1.010 Considerations: Extremes of either side can indicate pathology

Answer 269

What: Acid-base Normal: 6.5-7 in the AM 7.5-8 in the PM Considerations: Can be affected by food etc

Answer 270

What: Enzyme given off by WBC Normal: Negative *Present in all patients with UTIS

Answer 271

What: Enzyme released by Enterobacteriaceae Normal: Negative *Can be neagtive and still have UTI

Answer 272

What: Can be micro and macrocytic Normal: Negative *Can see in trauma, hemolysis, UTI, malignancy

Answer 273

What: Measuring Albumin Normal: Netagive Considerations: Renal disease, Pregnancy, Inflammation

Answer 274

What: Renal threshold to eliminate excess glucose Normal: Negative

Answer 275

What: Measures metabolites of fat metabolism Normal: Negative *Insulin insufficiency, starvation, vomiting

Answer 276

Normal: Negative *Liver disease obstruction

Answer 277

Normal: Negative *Liver disease, hemolysis, mono, cirrhosis

Answer 278

What: Coagulated protein by kidney cells Normal: Negative Hyaline (0-5) in healthy people ceullar not normal *Hyaline are clear. Can have cellular RBC or WBC

Answer 279

What: Wastes solutes. Based on pH and urine temp Normal: None but some are ok

Answer 280

Pharmacologic thearpy Pt education Acute UTI: 3-7 day course of antibiotic, if uncomplicated Chronic or relapse UTI: Up to 2 week course of antibiotics

Answer 281

Cephalexin Ciprofloxacin Levofloxacin Ampicillin Amoxicillin Bactrim

Answer 282

(Ciprofloxacin or Levofloxacin) are not routinely recommended due to their side effects and increasing bacterial resistance

Answer 283

Drink plenty of fluids daily Void before and after sexual intercourse Avoid douching Take Antibiotics as prescribed Avoid tight/restrictive clothing Shower, don’t bath Personal Hygiene

Answer 284

* Excretion of waste prodcts and urine * Regulation of BP * RBC production- erythropoietin * Breakdown of drugs * Metabolism of hormones * Regulation of Electrolytes and acid-base balance * Synthesis of Vit D * Fluid Balance * Balance of pH of blood stream

Answer 285

Adults tend to lose approximately 10% of their nephrons for each decade beginning at 40 ## Footnote by age 70- nephrons will be down 30mL/min=95mL/min

Answer 286

GFR: average adult 125mL/minute or 180L/day

Answer 287

* Oslomarity of interstitial fluis * Anti diuretic hormone * Action of ADH on the cells in the collecting tubules of the kidney

Answer 288

Removal of: - Water - waste products - excess electrolytes - unwanted substances

Answer 289

Prerenal, Intrarenal, Post renal

Answer 290

Decrease in blood flow and perfusion

Answer 291

Secondary to actual injuries to the kidney itself

Answer 292

Related to the obstruction of urine outflow from the kidneys

Answer 293

* Hypotension * Shock * Diarrhea/Vomiting (severe) * Bleeding/hemorrhage * Diuretics * diabetes insipidis * Burns * Heart Failure/MI * Cirrhosis * Sepsis

Answer 294

* Vasculitis * Venous Occlusion * Pre-eclampsia * Acute Tubular Necrosis * Multiple Myeloma * Hypercalcemia * IV contact dyes * Pyelonephritis * Certain meds: NSAIDS, ACE inhibitors, Heavy metals * Transfusion Reaction * Rhabdomyolysis

Answer 295

* Renal Calculi * Enlarged prostate * cancer * diabetes * Functinal obstruction due to drugs * blood clot * Trauma

Answer 296

Most common cause of acute kidney injury Damage to renal tubes causing cells to slough into the tubular lumen and lumen becomes blocked -Decrased urine formation Causes: -Post-ischemia (all causes of severe pre-renal disease) -Nephrotoxic *Permanent injury if not reversed | INTRA renal disorder

Answer 297

Creatinine clearance (100-150 cc/min): Less than 5-10cc/min

Answer 298

Urine sodium (10-20 meQ/L): >20 med/L

Answer 299

Normal: (1.005-1.025) ATN: 1.010 fixed

Answer 300

Normal: (200-1200) ATN: Osmotic = 300mOM

Answer 301

(10-20) 10:1 Fixed

Answer 302

Red/white cells, casts, epithelial cells

Answer 303

Normal: (100-150( Azo: 15-80cc

Answer 304

>10 meq/L | normal: 10-20

Answer 305

Concentrated >450 | Normal: 200-1200

Answer 306

> 15:1 | 10-20

Answer 307

Initial Oliguria Late Diuretic Recovery

Answer 308

0-2 days Initial Insult to point when BUN/Crt rise and/or Urine output drops

Answer 309

1-2 days to 6-8 weeks Drop in GFR, retention of urea, Potassium, sulfate and creatinine. Decrease Urine output and edema

Answer 310

2-8 days Begins with a slow, gradual increase in urine output, then high output

Answer 311

2-4 months Labs return to normal

Answer 312

-Pt will have oliguria and fluid overload -Build up of nitrogenous waste --Uremia, metabolic acidosis, thrombocytopenia -Edema Labs: Urinalysis Serum electrolytes Bun/crt ABG CBC -Imaging -Renal Biopsy

Answer 313

- Return to normal chemical balance, prevent futher complications, restore renal function *Fluid administration diuretics Monitor electrolytes Cardiac monitoring Hemodialysis

Answer 314

Volume overload K+ > 6 meQ/L Metabolic acidosis/serum HC03 >0.15 BUN > 120 mg/dL

Answer 315

An irreversible, progressive disease Often Asymptomatic initially until disease is far advanced * Kidney damage or a GFR < 60 mL/min/1.73 m2 for 3 months or longer. * Numerous Causes: * *Hypertension, *Diabetes, obesity, glomerulonephritis, SLE, polycystic kidney disease * Loss of functioning nephrons, progressive deterioration of glomerular filtration, ability of tubules to reabsorb, endocrine functions. * As nephrons are destroyed remaining hypertrophy to take on the work.

Answer 316

Stages 1/2: Often asymptomatic + crt normal -Compensation will occur GFR: normal >90 Stage 3: Decreased function <50% nephrons working. -Lab changes -No longer able to compensate GFR- 30-59 Stage 4: -Renal insufficiency is evident -nephrons dead -Diet restriction of proteins -GFR 15-29 Stage 5: Dialysis/transplant GFR: <15

Answer 317

-Buildup of nitrogenous waste: Encephalopathy/Anemia/Thrombocytopenia -Hyperkalemia - hyPOcalcemia (VitD not activated)....leads to hyperparathyroidism/Bone breakdown - Normochromic/normocytic anemia - low albumin - hyPERphostphatemia

Answer 318

Treat underlying cause Monitor labs Smoking cessation Manage hyperglycemia, if diabetic Manage anemia Exercise program Decrease sodium Avoid alcohol Dialysis Kidney transplant

Answer 319

Inflammation of the glomerular capillaries Causes about 25-30% of all ESRD cases Can be acute or chronic Most common cause of acute is post-streptococcal glomerulonephritis *Symptoms:* Pink or cola-colored urine, proteinuria, hematuria, hypertension, fluid retention/edema, decrease urine, nausea and vomiting, muscle cramps, fatigue *Complications*: Accumulation of wastes or toxins in the bloodstream., Poor regulation of essential minerals and nutrients, Loss of red blood cells, Loss of blood proteins.

Answer 320

Begins with an antigen-antibody reaction Antigen-antibody complex damages structures of the glomeruli which causes nephron dysfunction: * Decreased filtration of blood * Decreased urine production * Hypervolemia * Hypertension

Answer 321

-Oliguria often the first symptom Followed by hematuria, proteinuria -Cola colored urine * Edema often of face and hands * HTN * Elevated anti-strep antibodies(ASO) * Increased Creatinine * Decreased serum albumin * Treat the cause and full recovery is expected.

Answer 322

Goal of treatment is to: Increase urine output Decrease urinary protein Medications: Corticosteroids Antibiotics, if needed Antihypertensives, if needed Antipyretics Diet modifications: Low sodium Low protein Monitor for complications: HTN encephalopathy Heart failure Pulmonary edema

Answer 323

Damage to the glomerulus -The filter is damaged and things which should stay in are able to leak out through the pores which become bigger due to the damage -Leads to increased permeability of proteins and other substances in the blood -Diabetic nephropathy most common type but can be due to other causes such as: Lupus or amyloidosis ( top 3 causes account for 90% of all cases) --Also vasculitis, allergies, preeclampsia, HTN, and other infections

Answer 324

Albuminuria/Proteinuria EDEMA Labs: -Urinalysis (proteinuria/hematuria) -Elevated BUN/CRT -Low serum albumin -Tests of lupus/hep B/C -24 hours urine *renal US and Renal Biopsy

Answer 325

Monitor diet: Low sodium Protein Adequate fluid intake, but avoid fluid overload Vaccines – pneumococcal and influenza ACE inhibitor or ARB Monitor for complications: Hyperlipidemia Thromboembolism

Answer 326

Produces inflammatory response Related to: -immune complexes and antibody-antigen complexes lodge in capillary. --Immune response develops against the antigens -Inflammatory processes occlude glomerular capillary lumen & damage capillary wall. -Damage allows RBCs to escape into urine. -Alterations due to decrease in GFR, fluid retention and nitrogen waste accumulation. -Also proteinuria, oliguria.

Answer 327

*Post strep G.NephRITIS* Typically seen ages 4-7 Onset: 10-14 days after strep infection Anti-strep titer + Urine- cola colored Heamturia-massive Proteinuria-minimal Hypertension Edema-moderate Hyperkalemia Elevated BUN *NephPHROTIC syndrome* Ages 2-3 years (males) Anti-strep titer NEG Urine- clear Hematuria - microscopic Pretineuria- Massive BP- normal or slightly decreased Hypoalbuminemia Edema-massive K+ normal BUN- normal Hyperlipidemia

Answer 328

Diabetes -Thickening of basement membrane -Dysfunction of glomerular podocytes -Remember they cover the urinary side of the glomerular basement membrane. -Inflammation (T cells and macrophages) into glomerulus Hypertension -Vascular changes -Glomerular changes -Damage to basement membrane (podocytes) - damaged -Allows plasma proteins to escape

Answer 329

* NSAIDs work by inhibiting prostaglandins * Renal prostaglandins protect against decrease renal flow * Prostaglandin inhibition can depress already decreased renal blood flow * Leads to reduction in renal perfusion and decreased GFR

Answer 330

* Dehydration * Arterial volume depletion due to heart failure, nephrotic syndrome or cirrhosis * Chronic kidney disease (CKD), especially stage 3 or worse (estimated GFR <60 mL/min * Volume depletion from aggressive diuresis, vomiting, or diarrhea * Older age * Severe hypercalcemia with associated renal arteriolar vasoconstriction

Answer 331

* In extreme exercise especially in heat the skin and muscle complete for blood flow * Takes away from the pancreas, GI, liver and kidneys * When exercising at max GRF can be reduced by 30-60% * Add dehydration, heat stress * Add chronic NSAID use * Avoid NSAID use outside of recommended doses * Avoid in those with HTN, HF, DM, and Metabolic syndrome * Avoid in states of dehydration * Increase fluids in athletes. * As anti-inflammatory use for shortest time and try to use acetaminophen as well

Answer 332

CAD/CVA/PAD prevention * Maintains AV grafts * Post MI * Post Stent placement * Other vascular disease

Answer 333

Oral anticoagulants, Heparin, Methotrexate, oral DM meds, and Insulin – can increase the risk of toxicity when taken with ASA * Steroids may decrease the ASA effect and cause ulcers * ACE and Beta Blockers * NSAIDS

Answer 334

Argatroban Lepirudin

Answer 335

Patient Education: * Meds must stay in original bottle, don’t place in pill box * Pills should not be crushed * Don’t stop taking for GI issues, unless there is black, tarry stools * Hold before having surgery * Don’t take with Clopidogrel * Watch for drug interactions * Must reduce dose in renal failure * Caution in abrupt stopping * Antidote: Praxbind (idarucizumab) is for Dabigatran only

Answer 336

Uncontrolled BP (185/110) * History of Hemorrhagic Stroke, aneurysm, or AV malformations * Heparin in the last 48 hours * Current oral anticoagulant * DOAC use * Surgery within 3 months * Platelet count <100,000

Answer 337

Check for signs of bleeding vital signs labs

Answer 338

A: Extrinsic pathway of coagulation and common pathways. The PT/INR assesses the extrinsic pathway of coagulation (which uses clotting factor VII) and common pathways (which uses factor I, II, V, X). The extrinsic pathway is activated when there is outside/external injury that results in blood loss from the vascular system.

Answer 339

The aPTT assess the intrinsic pathway of coagulation and common pathways. The aPTT assesses the intrinsic pathway of coagulation and common pathways. Therefore, clotting factors I, II, V, X (which are part of common pathways) and clotting factors XII, XI, IX, VIII (which are part of intrinsic pathway) are assessed. The intrinsic pathway is activated when there is inside injury within the vascular system. The aPTT is an important result used to assess the effectiveness of Heparin (NOT Warfarin), and it's measured in SECONDS (not milliseconds).

Answer 340

B: 35-45 seconds (This range varies among labs).

Answer 341

An aPTT should be 1.5-2 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.

Answer 342

The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation….(ex: up to 4.5)

Answer 343

The answer is A: 10-12 second

Answer 344

The answer is B. A therapeutic INR for a patient taking Warfarin should be 2-3. Therefore, the patient’s medication is not effective at this time for preventing blood clots

Answer 345

The answer is C: Thrombin....Prothrombin turns into thrombin by clotting factor V. When thrombin is on board it is responsible for turning fibrinogen to fibrin. Fibrin is one of the main ingredients for clot formation.

Answer 346

The answers are B, C, and D. All of these could increase the PT level (a normal range is approximately 10-12 seconds).

Answer 347

The answer is C: Normal...an approximate normal range for an aPTT is about 35-45 seconds.

Answer 348

- **furosemide (Lasix)** - bumetanide - torsemide

Answer 349

Inhibit reabsorption of sodium or chloride at the loop of Henle - decrease workload on heart (less water in body) - decrease pulmonary congestion - decrease preload, stroke volume, cardiac output

Answer 350

Decrease blood volume, which decreases venous return and blood pressure

Answer 351

- hyponatremia - **hypokalemia** - hypovolemia - hypomagnesemia - hyperglycemia - ototoxicity

Answer 352

- monitor potassium level! -- monitor other electrolytes too, but potassium very important - monitor I&Os - monitor blood sugar

Answer 353

- change position slowly due to potential orthostatic changes - report weight gain of more than three pounds in a day - enjoy potassium-rich foods especially because hypokalemia is a big risk (raisins are great source) (pulled this from online) MONITOR I & O MONITOR POTASSIUM level | Bumentanide furosemide Torsemide

Answer 354

- spironolactone is a mineralcorticoid receptor antagonist -- AKA aldosterone receptor blocker

Answer 355

blocks the exchange of sodium for potassium in the distal tubules - potassium sparing

Answer 356

Indications: hypertension and heart failure - used when one drug is not enough to treat symptoms

Answer 357

- can cause gynecomastia

Answer 358

- monitor potassium (can cause hyperkalemia) - monitor LFTs - monitor BUN/Cr - do not give in renal insufficiency

Answer 359

- take with meals - avoid taking with: -- ACE inhibitors/ARBs -- heparin -- NSAIDs

Answer 360

Class name: digitalis glycosides - digoxin - deslanoside - mitildigoxin

Answer 361

- increases intracellular calcium - allows more calcium to enter myocardial cell during depolarization - **positive ionotropic effect (increase force of contraction)** - increased renal perfusion with a diuretic effect -- decrease in renin release - slowed conduction through AV node (decrease HR)

Answer 362

indications: heart failure and atrial fibrillation not first-line treatment

Answer 363

Has very narrow therapeutic margin: - normal: 0.5-2.0 - desired level: 0.8 Digoxin toxicity: - vision changes, N/V, dizziness - increased risk of hypokalemia - can be life-threatening

Answer 364

Antidote: digibind - **always check apical HR and call MD if less than 60** - monitor BUN/Cr and potassium - rapid onset and absorption - caution in: -- pregnancy and lactation -- pediatric and geriatric -- renal insufficiency

Answer 365

- take at the same time every day - take 1 hour before or 2 hours after eating - take apical HR before taking: report to provider if less than 60 - learn signs of digoxin toxicity (Nausea, vomiting and vision changes) - cuz when a DIGit goes up your butt you’ll get nausea vomiting and vision changes.. (pulled this from online)

Answer 366

end in -pril - lisinopril - enalapril (can be given IV) - ramipril - captopril

Answer 367

Prevents the conversion of angiotensin 1 to angiotensin 2 - works by vasodilation and by blocking RAAS/aldosterone - helps prevent cardiovascular remodeling Pathophysiology: - decrease aldosterone production - inhibit angiotensin 2 production - decrease vasoconstriction - interfere with RAAS - keep vasodilation effects of bradykinin

Answer 368

First-line treatment for heart failure and hypertension; decrease the workload of overworked cardiac muscle Indications: - HTN - HF - DM - post MI and PCI

Answer 369

- generally well tolerated and absorbed - hyperkalemia - dizziness - **cough** ("ACE cough") -- related to kinins and activation of arachidonic pathway and prostaglandin production -- begins 1-2 weeks of initiation; typically resolves within few days of stopping med - **angioedema** **BLACK BOX WARNING**: - **serious fatal abnormalities: not given in pregnancy and caution in childbearing-age women** - esp in 3rd trimester - contraception very important

Answer 370

- be aware of renal function and potassium - assess orthostasis - awareness of administration to childbearing women - NO NSAID use - should be taken on empty stomach Labs: potassium, BUN, Cr Vitals: BP

Answer 371

- do not give to pregnant women! do not take if pregnant, especially if in 3rd trimester - take on an empty stomach - no NSAID use

Answer 372

- hydrochlorothiazide (HCTZ) - chlorthalidone

Answer 373

- inhibit reabsorption of sodium and chloride from the distal tubules in the kidneys - decrease peripheral resistance - decrease preload - better for sodium sensitive HTN as in african americans and older adults

Answer 374

treat hypertension; first-line medication

Answer 375

- anyone with sulfa allergy should not take - hypokalemia - hyperglycemia (watch w/ diabetics) - can cause exacerbation of gout -- increases uric acid - other electrolyte imbalances (calcium) - orthostasis

Answer 376

- anyone with allergy to sulfa should not take - should not be given to patients with history of gout - avoid in renal failure - digoxin toxicity - may decrease effect of diabetic medications - lithium toxicity - give early in morning b/c urination Check potassium, glucose, BP, HR

Answer 377

- adherence! - watch diet, exercise - decrease alcohol, stop smoking - avoid NSAIDs which increase BP

Answer 378

end in -sartan - losartan - irbesartan - valsartan

Answer 379

- bind with AG-2 receptors in vascular smooth muscle and adrenal cortex to stop vasoconstriction and aldosterone production - blocks AG-2 from binding at receptor sites in brain, kidneys, heart, periphery, and adrenal tissue

Answer 380

first-line treatment of hypertension; when ACE inhibitor cannot be used

Answer 381

- cough (less than an ACEI) - hyperkalemia (less than ACEI) - headaches - dizziness and syncope - GI complaints - xerostomia (dry mouth) - alopecia

Answer 382

- do not give with an ACE inhibitor - drug interactions with diltiazem, oral anti-fungals - monitor renal function - some drug interactions related to the cytochrome P450 - can be given with or without foods Labs: creatinine; can increase due to possible decreased GFR; LFTs Vitals: I&Os, BP

Answer 383

- avoid during pregnancy - do not take with ACE inhibitor - can take with or without food

Answer 384

- amlodipine - felodipine - nifedipine

Answer 385

- more vascular selection - more of a direct effect on vasodilation and less reduction of calcium - no effect on AV contraction; may increase HR due to vasodilation overall patho of CCBs: - decrease cardiac workload and myocardial O2 consumption - inhibits movement of calcium across membranes of myocardial/arterial muscle cells - alter action potential and block muscle cell contractions - decrease contractility and slows AV conduction - relax and dilate arteries

Answer 386

- hypertension - angina - rate control in AFib - SVT - Raynaud's phenomenon

Answer 387

- peripheral edema (common) - headache - flushing - lightheadedness - dizziness - can have increased HR (double check. It should cause decrease) - GI side effects

Answer 388

- **always check HR prior to giving; call MD if less than 60** - be aware of conduction issues - avoid use in those with heart failure - avoid grapefruit juice - check orthostasis no lab monitoring vitals: HR | Amlodipine Felodipine Nifedipine

Answer 389

- do not drink grapefruit juice - increase fiber in diet - always check HR prior to taking and make sure not less than 60

Answer 390

- verapamil - diltiazem both can be given IV

Answer 391

- **negative ionotropic effects (decrease force of contraction)** - slow AV conduction and rate of SA node overall patho of CCBs: - decrease cardiac workload and myocardial O2 consumption - inhibits movement of calcium across membranes of myocardial/arterial muscle cells - alter action potential and block muscle cell contractions - decrease contractility and slows AV conduction - relax and dilate arteries

Answer 392

- hypertension - angina - arrhythmias (AFib, SVT) - migraines (verapamil)

Answer 393

- bradycardia (can really drop) - decreased cardiac output - GI side effects - should not be used in those with heart block

Answer 394

- **always check HR prior to giving; call MD if less than 60** - be aware of conduction issues - avoid use in those with heart failure - avoid grapefruit juice (especially with diltiazem) - check orthostasis no lab monitoring vitals: HR

Answer 395

- increase fiber in diet - always check heart rate before taking and make sure not less than 60 - do not drink grapefruit juice

Answer 396

"-lol ending" - carvedilol - metoprolol - bisoprolol - labetalol - atenolol Selective Beta 1: - metoprolol - atenolol - esmolol - bisoprolol Non selective: - propranolol - carvedilol - nasolol - sotalol

Answer 397

Block the beta-receptors in the sympathetic nervous system, decreasing calcium flow into the myocardial cells, and causing decreased contraction and workload - decreases catecholamine stimulation - decreases myocardial energy demands - reduces remodeling **blocks SNS responses** - decrease HR - decrease BP - decrease muscle contraction - increase blood flow to the kidneys - decrease renin release

Answer 398

Used in treatment for heart failure; cause decreased contraction and workload - hypertension but not first line - decrease risk of sudden death after MI - all patients after MI and PCI - HR reduction in AFib - palpitations - heart failure - migraines - performance anxiety - hyperthyroidism Special uses: - metoprolol: HR and post MI - propranolol: social anxiety, headaches

Answer 399

- hypotension - **bradycardia** (why you check apical HR) - bronchospasm (don't want to give to COPD or asthma pt) - exacerbation of peripheral vascular disease - fatigue - depression - impotence - sleep issues adverse effects: - worsening of HF especially when first started; why you need to start at low dose

Answer 400

- always start at very low doses b/c can make HF worse - **always check apical heart rate** and call MD if less than 60 - caution use in chronic lung disease b/c may increase risk of asthma attacks (blocks B2 receptor) - may mask hypoglycemic episodes so monitor diabetics - caution in those with brady arrhythmias b/c will drop HR - check for orthostasis - make sure patient is given medication even when NPO - assess for side effects Labs: glucose level especially is patient is diabetic; no other major lab concerns Vitals: HR (check apical)

Answer 401

- ALWAYS check apical heart rate before taking - NEVER stop abruptly: need to taper off -- SNS will surge and go to an extreme if stopped abruptly

Answer 402

Class: angiotensin receptor-neprilysin inhibitor (ARNI) Entresto (sacubitril + valsartan) is the only ARNI

Answer 403

Increase: - naturetic peptides (like BNP) - bradykinin (vasodilation) - other mediators which increase vasodilation

Answer 404

Used for systolic heart failure to improve symptoms and reduce remodeling

Answer 405

- angioedema - hypotension - hyperkalemia - renal failure - cough

Answer 406

idk? monitor potassium, BUN, Cr, BP

Answer 407

- contraindicated in pregnancy - DO NOT TAKE WITH NSAIDs (NSAIDs vasoconstrict so counteracts)

Answer 408

nitroglycerin isosorbide hydralazine and nitrates (combined)

Answer 409

Actions: - arterial and venous dilator (potent vasodilator) - decreases preload and afterload - increases oxygen demand to heart; decrease myocardial oxygen demand Pharmacokinetics: - very rapidly absorbed - tolerance develops easily; need drug-free period - drug-drug interaction with Sildenafil (viagra)

Answer 410

prevention and treatment of attacks of angina pectoris and heart failure

Answer 411

- when taking: tingles or burns under tongue - headache - dizziness

Answer 412

- must stay in original bottle and be protected from light - watch BP before and after giving - always wear gloves when administering (absorbed rapidly) Routes (essentially every route): SL, translingual, transmucosal, OR, OR-SR, IV, topical, transdermal

Answer 413

- can 1 every 5 minutes up to 3 taken - pain continues call 911 - DO NOT take with viagra (sildenafil) - must be sitting or lying when taking it - keep medication in original bottle to protect from light

Answer 414

- doxazosin (cardura) - prazosin (minipress)

Answer 415

- inhibit alpha synapse at the alpha adrenergic receptors (blocks SNS) - prevent feedback of norepinephrine

Answer 416

not really used in blood pressure control; considered 3rd or 4th line treatment - "almost work too well"

Answer 417

adverse effects are significant - first dose effect! - orthostatic hypotension - vertigo, syncope, dizziness - tachycardia - sexual dysfunction

Answer 418

- need to monitor patient very closely after giving first dose - avoid use in older adults due to increased sedation and confusion vitals: BP and HR

Answer 419

- let them know about first dose effect and that adverse effects are significant

Answer 420

- hypertension - obesity (especially apple shape; abdominal fat) - abnormal cholesterol levels (hyperlipidemia) - chronic inflammation - insulin resistance

Answer 421

obesity and high-fat diet coupled with sedentary lifestyle cause buildup of adipose tissue, brought on by macrophages and lymphocytes, and produce low-grade chronic inflammatory state - from obesity and inflammation, cells fail to make effective use of insulin - blood sugar increases - beta cells in pancreas secrete insulin - insulin resistance: insulin is not able to reduce blood sugar -- compensatory insulin fails and person remains hyperglycemic insulin resistance causes: - increased catecholamines - **stimulates sodium reabsorption and increases BP** -- BP can decrease with meds that improve insulin sensitivity - endothelial dysfunction - RAAS and SNS dysfunction - smooth muscle proliferation -> hypertrophy and TOD

Answer 422

modify factors to break the cycle - exercise and diet can break the obesity and insulin resistance portion of the circle of death

Answer 423

ACE inhibitors block the converting enzyme - stopping angiotensin 1 from becoming angiotensin 2 - which stops the stimulation of aldosterone secretion -- blocking the increased water and sodium retention -- blocking increased preload - stops constriction of vascular smooth muscle -- stops increased afterload inappropriate RAAS activation from increased angiotensin 2 causes endothelial dysfunction and vascular remodeling (and elevated BP & atherosclerosis) so inhibiting AG2 stops this

Answer 424

Online: Beta-blockers, particularly newer "third-generation" ones like nebivolol and carvedilol, **can improve endothelial dysfunction by enhancing the production of nitric oxide (NO) from endothelial cells**, which helps relax blood vessels and improve blood flow, primarily through their antioxidant properties and by modulating the activity of the enzyme endothelial nitric oxide synthase (eNOS) - essentially promoting better vascular function beyond just lowering heart rate and blood pressure.

Answer 425

Online: Metformin improves endothelial dysfunction **primarily by activating the AMP-activated protein kinase (AMPK) pathway, which leads to increased nitric oxide (NO) production**, reduced oxidative stress, decreased inflammation, and inhibition of endothelial cell apoptosis - thereby enhancing vascular function and protecting against damage to the endothelial lining of blood vessels.

Answer 426

- LDL deposits cholesterol between layers in the artery wall - inflammatory cells (macrophages) engulf deposited cholesterol - inflammatory resp. -- macrophages become giant foam cells -- a fatty streak develops between layers of artery wall - foam cells continue to expand the core of the plaque -- a fibrous outer cap forms from converted smooth muscle cells and other elements - large unstable plaque within thin fibrous cap and can rupture - a blood clot (thrombus) forms at site of plaque rupture - can lead to blockage and blocked artery starts to die

Answer 427

Stroke Volume X HR Normally, 4-8L /min

Answer 428

Cannot directly meausre so we measure cardiac output via: preload, afterload, and contractility

Answer 429

At the end of diastole, or when L ventricle is filled/ mitral valve closed. More stretching = more blood which is good. But excessive stretching can lead to heart failure | Preload = stretching

Answer 430

55-70% anything below 40% is abnormal

Answer 431

Beta blockers: Carvedilol, metoprolol, bisopropolol DIGOXIN Calcium channel blockers

Answer 432

Vasodilators- decrease workload Loop diuretics- Decreae blood volume Beta blocks- decrease contractions and workload

Answer 433

Very rapidly absobed Tolerance developes easily Must have drug free periods **do not take with sildenafil

Answer 434

Three lobes

Answer 435

Two main bronchi

Answer 436

Bronchioles

Answer 437

* Conducting airway * Respiratory airway

Answer 438

* Nose * Mouth * Pharynx * Larynx * Trachea * Bronchi

Answer 439

Gas exchange

Answer 440

* Bronchiole * Arteriole * Pulmonary capillaries * Veins

Answer 441

Warms, moistens, and filters ## Footnote This process enhances the quality of air before it reaches the lungs.

Answer 442

Goblet cells ## Footnote These cells play a crucial role in trapping particles and pathogens.

Answer 443

Nose, sinuses, nasal cavity, pharynx, larynx, bronchi ## Footnote These structures work together to condition the air.

Answer 444

* Alveolar macrophages * Neutrophils * Mast cells * Cough reflex ## Footnote These mechanisms help protect the lungs from infection and damage.

Answer 445

Phagocytosis of pathogens and debris ## Footnote They are essential for maintaining lung health.

Answer 446

Respond to infection and inflammation ## Footnote They are a type of white blood cell involved in the immune response.

Answer 447

Histamines and other mediators ## Footnote They are involved in allergic reactions and inflammation.

Answer 448

True ## Footnote It helps expel irritants and pathogens from the airways.

Answer 449

Lobules and alveoli ## Footnote The respiratory tract is essential for gas exchange.

Answer 450

Alveoli ## Footnote Alveoli are also referred to as respiratory sacs.

Answer 451

Type II cells ## Footnote Surfactant helps reduce surface tension in the alveoli.

Answer 452

Mediastinum ## Footnote The mediastinum contains the heart, esophagus, thymus gland, and other blood vessels and nerves.

Answer 453

Right ventricle ## Footnote This blood is delivered via the pulmonary artery.

Answer 454

gas exchange

Answer 455

False ## Footnote Surfactant is produced by type II cells.

Answer 456

* Heart * Esophagus * Thymus gland * Blood vessels * Nerves

Answer 457

A specialized cellular mechanism within the bronchioles ## Footnote It plays a crucial role in clearing mucus and pathogens from the respiratory tract.

Answer 458

* Ciliated pseudostratified columnar epithelial cells * Goblet cells ## Footnote These cells work together to produce and move mucus.

Answer 459

Moves mucus from the bronchioles to the throat ## Footnote The cilia beat in a wave-like motion to facilitate this movement.

Answer 460

Produce mucus ## Footnote Mucus traps dust, pathogens, and other particles.

Answer 461

Cilia move mucus upward to the throat ## Footnote This process helps keep the airways clear and allows for mucus to be swallowed.

Answer 462

* Smoking * Respiratory Infections ## Footnote These factors can impair the function of the mucociliary apparatus.

Answer 463

False ## Footnote It also includes goblet cells which are essential for mucus production.

Answer 464

[downward] ## Footnote This downward movement is essential for clearing mucus effectively.

Answer 465

In the alveoli ## Footnote Alveoli are tiny air sacs in the lungs where the exchange of oxygen and carbon dioxide takes place.

Answer 466

Oxygen enters the alveolus and moves across the alveolar membrane into the blood ## Footnote This process is crucial for supplying oxygen to the body's tissues.

Answer 467

The heme portion of hemoglobin ## Footnote Hemoglobin is a protein in red blood cells responsible for transporting oxygen.

Answer 468

Oxyhemoglobin ## Footnote Oxyhemoglobin is the compound formed when oxygen binds to hemoglobin, facilitating oxygen transport in the bloodstream.

Answer 469

The process of inspiration and expiration of air ## Footnote Ventilation is essential for gas exchange in the lungs.

Answer 470

The respiratory center in the brain ## Footnote It receives input from chemoreceptors and lung receptors (stretch and irritant receptors).

Answer 471

Vagus nerve ## Footnote The vagus nerve plays a crucial role in regulating breathing.

Answer 472

The movement of blood through the pulmonary circulation ## Footnote Perfusion is necessary for delivering oxygen to the tissues.

Answer 473

The ratio of the amount of oxygen reaching the alveoli to the amount of blood reaching the alveoli ## Footnote This ratio is critical for effective gas exchange.

Answer 474

Both ventilation and perfusion should be equal ## Footnote An equal ratio facilitates optimal gas exchange.

Answer 475

Leads to a decrease in gas exchange ## Footnote Imbalances can result from various conditions affecting either ventilation or perfusion.

Answer 476

An area where there is no perfusion ## Footnote Dead space can occur in certain lung conditions, reducing overall efficiency of gas exchange.

Answer 477

Dyspnea (Shortness of breath) ## Footnote Dyspnea indicates difficulty in breathing and is a key clinical manifestation in respiratory issues.

Answer 478

Involuntary response to mechanical or chemical stimulation of the bronchial tree ## Footnote A cough serves to eliminate stimulants from the respiratory tract.

Answer 479

Productive and non-productive ## Footnote A productive cough brings up mucus, while a non-productive cough does not.

Answer 480

Coughing up blood ## Footnote Hemoptysis can be associated with conditions such as tuberculosis, lung cancer, or infection.

Answer 481

False ## Footnote Hemoptysis can also be associated with tuberculosis and various infections.

Answer 482

Collapse of alveoli, resulting in decreased gas exchange ## Footnote Commonly occurs post-op and can also occur due to compression by a mass.

Answer 483

* Post-operative complications * Compression by a mass

Answer 484

Oxygen level in blood inadequate to meet needs of the tissue

Answer 485

Less than 60 mm Hg

Answer 486

Insufficient amount of oxygen in blood

Answer 487

A hormone secreted by the kidneys in response to low oxygen levels ## Footnote Erythropoietin plays a crucial role in regulating red blood cell production.

Answer 488

Low oxygen levels ## Footnote This response is critical for maintaining adequate oxygen levels in the body.

Answer 489

Stimulates the bone marrow to increase the production of Red blood cells ## Footnote This process is essential for improving oxygen transport in the blood.

Answer 490

Any disorder that causes hypoxia, such as: * COPD * High altitudes * Cardiac disease ## Footnote These conditions lead to reduced oxygen availability, triggering Erythropoietin secretion.

Answer 491

Several viruses invade the upper respiratory tract leading to an inflammatory response.

Answer 492

About 5-7 days.

Answer 493

Mucus membranes become engorged.

Answer 494

There is an increase in mucus production.

Answer 495

Hand hygiene.