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NUR 660 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

safe to give live vacc if CD4 is

A

> 200 for HIV pts

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2
Q

tetanus and diptheria

A

booster every 10 years

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3
Q

TDAP

A

safe in pregnancy, protect baby from whooping cough

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4
Q

MMR

A

obtain titers, give in 2 doses if no immunity

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5
Q

varicella

A

2 doses given 4-8 wks apart

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6
Q

hep A and B

A

combo given in 3 doses at birth

1-2 mos and 406 mos

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7
Q

MMR and varicella

A

live vaccines

not safe during pregnancy

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8
Q

HPV

A

dead virus

give males and females starting age 13

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9
Q

colon cancer screening

A

age 45 if no fam hx then every 10 years

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10
Q

mammogram

A

yearly age 45-54

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11
Q

pap smear

A

for cervical ca every 3 years starting age 25

-every 5 years for HPV

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12
Q

when to test for TB

A

risk factors- travel, immigration, congregate living

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13
Q

positive TB

A

5-15mm sometimes, >15mm always positive

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14
Q

latent TB

A

skin test or quantiferon, will have neg cxray

-impaired immunity pts have higher risk of developing active TB from latent

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15
Q

HLD screening

A

cholesterol every 5 years starting age 20

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16
Q

Ezetimibe

A

lowers LDL

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17
Q

Niacin

A

lowers TG, s/e headache and flushing, used for TG >250

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18
Q

secondary causes of HLD

A

CKD, obesity, tobacco, alc

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19
Q

BMI

A

25-29 overweight, >30 obese

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20
Q

DM screening

A

annual aged 45 and older

-higher risk if belly >40 inches

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21
Q

eye exam

A

2-4 years

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22
Q

most preventable cause of disease in US

A

tobacco

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23
Q

diagnosis of asthma

A

FEV1 <80% of predicted or FEV1/FVC <65%

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24
Q

Asthma tx

A
  • ICS, LABA, LAMA
  • leukotriene modifiers
  • biologics only for severe disease
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25
Q

monitor asthma pt

A

1-2 mos after starting then every 3-12 mos

-within 1 wk exacerbation

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26
Q

pregnant asthmatics

A

monitor every 4-6 weeks

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27
Q

reversible airway obstruction

A

12% increase in FEV1 post- SABA tx

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28
Q

S/s pna

A

crackels, bronchial breath sounds, tactile fremitis, egophony, tachycardic

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29
Q

low risk pna

A

can be treated outpt

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30
Q

tx PNA

A

amoxicillin, doxy, macrolide

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31
Q

tx PNA with comorbidities

A

augmentin, cephalosporin/macrolide, doxy, or fluroquinolone

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32
Q

sarcoidosis

A

systemic disease affecting lungs in most cases

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33
Q

sarcoidosis s/s

A

fever, neuropathy, myopathy, blood dyscrasias, hypercalcemia

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34
Q

sarcoidsis cxray

A

bilateral hilar and right paratracheal lymph adenopathy

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35
Q

tx sarcoidosis

A

steroids or immunosuppressants

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36
Q

risk factor COPD

A

tobacco smoke, MJ, pollution, coal miners

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37
Q

s/s COPD

A

SOB, chronic cough, sputum, hx risk factors

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38
Q

diagnosis COPD

A

FEV1/FVC <0.7 after bronchodilator

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39
Q

COPD pts should be screened for

A

Alpha 1 antitrypsin

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40
Q

COPD tx

A
  • SABA, LABA
  • antimuscarinics- SAMA, LAMA
  • ICS
  • phosphodiesterase inhibitors
  • methylxantines
  • oral steroids
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41
Q

CAD risk factors

A

HTN, HLD, smoking, obesity, DM, stress

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42
Q

systolic CHF

A

< 40% EF

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43
Q

diastolic CHF

A

> 40% EF

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44
Q

CHF risk factors

A

metabolic syndrome, doxorubicin, fam hx cardiomyopathy

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45
Q

stage A CHF

A

high risk but no structural dx or s/s

 ACEi or ARB, statin when indicated

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46
Q

stage b chf

A

structural dx without signs of HF

 ACEi, ARB, BB

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47
Q

stage c CHF

A

structural dx with current or prior HF
 Treat comorbidities, diuresis, revascularization
 Diuretics, hydralazine, isosorbide dinitrate, digoxin
 Some need ICD, CRT, valve surg

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48
Q

stage D CHF

A

refractory, symptoms at risk, always in hospital

 LVAD, transplant, chronic inotropes, palliative, hospice, turn off ICD

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49
Q

CHF classes

A

o Class I: no limitations
o Class II: slight limitation of physical activity, no sx at rest
o Class III: Marked limitation of physical activity
o Class IV: Inability to carry on any physical activity without discomfort

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50
Q

chronic HF tx

A

 Diuretics, ACE, ARB, aldosterone antagonist, BB
 in selected pts
• Vasodilators- nitrates, BiDi
• Positive inotrope-Digoxin-monitor K+ levels
• Ivabradine (Corlanor)- not for ADHF or with bradycardia
• Sacubitril/valsartan (Entresto

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51
Q

left sided HF

A

backup into atria and pulm veins, pulm congestion and edema

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52
Q

right sided HF

A

backs into R atria and venous circulation- JVD, hepatomegaly, vascular congestion and peripheral edema
 Main cause is RV infarct or PE, chronic pulm HTN

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53
Q

A-fib cHADs- stroke risk score

A 
	CHF history
	HTN hx
	Age >75
	DM hx
	Stroke or TIA symptoms previously
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54
Q

diabetes dx

A

A1C of 6.5 or higher
o FBG >126
o Oral tolerance test >200

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55
Q

prediabetes dx

A

o Impaired fasting glucose 100-125

o A1C 5.7-6.4%

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56
Q

dysmetabolic syndrome

A

impaired fasting glucose, elevated triglycerides, low HDL, central obesity, inc BMI, HTN

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57
Q

LADA

A

latent autoimmune diabetes in adults, eventually requires insulin, usually non-obese

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58
Q

o Insulin resistance (inc BMI)

A

 Biguanides, thizaolidinediones

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59
Q

o Insulin secretory defect

A

 Sulfonylureas, meglitinides, insulin

60
Q

o Excessive hepatic gluconeogenesis

A

 Biguanides, GLP1, DPP4 inhibitors

61
Q

o Excessive consumption of carbs

A

 Alpha-glucosidase inhibitors, biguanides, DPP4

62
Q

gestational DM

A

insulin resistance and carb intolerance
o Screening at 24 and 24 weeks
o BG >140 abnormal, BG >200 diabetic
o Treat initially with diet/exercise, then metform, glipizide, NPH, Humalog

63
Q

a1c goal

A

7 or less

64
Q

rapid acting insulin

A

novolog, apirdra, Humalog

65
Q

short acting

A 
regular insulin (Humulin R or Novolin R)
	Onset less than 15 min, peaks at 1 hr
66
Q

short and intermediate mix

A

novolin, Humulin

 Usually twice daily dosing

67
Q

long acting

A

lantus, levemir, Tresiba

 Once or twice daily, peakless, steady release over 24 hrs

68
Q

biguanides

A

metformin, first line DM2 tx
o Increase glucose uptake by muscle and fat
o Don’t use in renal insufficiency, CHF, sepsis, acidosis, hypoxia, AMI
o Interacts with OCPs, phenytoin, Ca channel blockers

69
Q

sulfonylureas

A

glyburide, glipizide, glimepiride
o Caution in renal insufficiency and HF
o Elderly at risk of hypoglycemia from glyburide

70
Q

Meglitinides

A

starlix (okay in renal insufficiency), expensive

71
Q

Thiazolidinediones

A

pioglitazone and rosiglitazone, increase glucose uptake by fat/muscle
o Black box warning for CHF due to risk of peripheral edema and macular edema

72
Q

• Alpha-Glucosidase inhibitors

A
  • acarbose and miglitol, reduce glucose absorption from small bowel
    o GI symptoms—GAS!
73
Q

incretins

A

GIP, GLP1 (byetta, symlin, Victoza, Trulicity)

o Stimulate pancreatic B cells to produce more insulin

74
Q

DPP4 inhibitors

A

januvia, onglyza, tradjenta
o Enhance ability to secrete insulin by raising incretin levels
o Need to monitor renal fxn and dig levels

75
Q

SGLT2 inhibitors

A

Invokana, Jardiance- reduce glucose reabsorption in kidneys

o Don’t use in CKD, may increase dig levels

76
Q

Meds causing hyperglycemia

A

o Corticosteroids, nicotinic acid, phenytoin, alpha interferon, thiazides, pentamidine, diazoxide, protease inhibitors

77
Q

primary hyperparathyroidism

A

causes hypercalcemia, can cause parathyroid cancer

o refer to endocrinologist, treatment is removal of gland or medical therapy

78
Q

hypothyroid

A 
o	primary- most common type of hypo, high TSH, low T4
o	subclinical- high TSH, normal T4
o	secondary (central)- normal or low TSH, low T4
79
Q

causes hypothyroid

A

autoimmune, iodine deficiency

80
Q

treatment hypothyroid

A

thyroid hormone, goal is TSH 0.4-3.5 and free T4 0.9-2

81
Q

s/s hyperthyroid

A

weak, tremor, heat intolerance, weight loss, active bowels, afib, menstrual dysfunction

82
Q

causes hyperthyroid

A

pituitary adenoma, hyperemesis gravidarum, trophoblastic disease, thyroiditis

83
Q

graves dx (hyperthyroid)

A

younger population, autoimmune
 at risk- high iodine intake, stress, fam history
 treatment- beta blocker
• tapazole (methimazole)
• PTU- more liver issues than tapazole, used in pregnancy

84
Q

thyroid storm

A

life threatening, high fever, tachy, N/V, agitation, coma

85
Q

cushings dx

A

-too much cortisol
central obesity, weakness, thin skin, facial obesity, bruising, buffalo hump
•

86
Q

addisons dx

A
  • too little cortisol

- chronic fatigue, weakness, hypotension, hypoglycemia, hyperkalemia

87
Q

PUD

A

-more common in duodenum
o Can be caused by NSAIDs, other A/C, H pylori
o Higher incidence in COPD, liver dx and renal failure
o Common cause of GI bleed

88
Q

PUD tx

A

ranitidine, cimetidine, famotidine

89
Q

PPI

A

inc risk of gastric ca, inc risk H pylori, s/e headache/constipation

90
Q

GERD

A

o Can develop barretts esophagus- metaplastic columnar replaces squamous epithelium, higher risk of cancer

91
Q

GERD tx

A

o Treatment- H2 blockers, antacids , avoid laying flat after meals
 May need to escalate to PPI

92
Q

GI bleeds can be caused by

A

SSRI, ASA, NSAIDs, other anticoag

93
Q

primary HTN

A

essential HTN

-unknown cause

94
Q

secondary HTN

A

known cause such as thyroid disease, renin and aldosterone abnormalities, OSA, obesity, cushings, steroid use, hyperthyroid, hyperparathyroid, sympathomimetics

95
Q

normal bp

A

<120/80

96
Q

elevated BP

A

120-129 over <80

97
Q

stage 1 HTN

A

130-139 / 80-89

98
Q

stage 2 HTN

A

at least 140 over at least 90

99
Q

hypertensive crisis

A

> 180 over >120

100
Q

first line tx for HTN

A

thiazide, ACEi, ARB, ca channel blocker

101
Q

thiazide (chlorthalidone

A

monitor K, Na, Ca, uric acid, caution in gout pts

 Caution in diabetics cuz it can increase BG

102
Q

ACEi- “prils”

A

don’t combine with ARB, increased risk of hyperkalmia in renal pts, may cause angioedema, avoid in pregnancy

103
Q

ARB “-sartans”,

A

may use 6 weeks after stopping ACEi with angioedema

104
Q

Ca channel blocker-

A

don’t use with HFrEF, caution in renal impairment

 “-dipine”, diltiazem, verapamil, don’t use with BB d/t risk of bradycardia

105
Q

second line HTN tx

A

loop diuretics, K sparing diuretics, BB, renin inhibitors, alpha 1 blocker, direct vasodilators

106
Q

Loop diuretics

A

best for HF and renal failure

107
Q

o K sparing diuretics

A

avoid if GFR <45, amiloride, triamterene

108
Q

aldosterone antagonist- spironolactone

A

 Good for resistant HTN, primary hyperaldosteronism, K sparing
 s/e impotence and gynecomastia

109
Q

o BB- atenolol, metoprolol, bisoprolol

A

 Only first line for ischemic heart disease or HF

 Avoid stopping suddenly

110
Q

o Non-cardioselective BB

 Propranolol, nadalol

A

avoid with asthma, wean

111
Q

o Direct renin inhibitor- aliskiren

A

long acting, don’t combine with ace or arb, more risk for hyperkalemia, good for pregnancy!

112
Q

o Alpha 1 blocker

A

older adults at risk for ortho hypo
 Doxazosin, prazosin, terazosin
 Good for pts with BPH

113
Q

Centrally acting- clonindine, methydopa

A

CNS effects, last line drug

114
Q

HTN with comorbidities

A

<130/80

115
Q

stage 2 HTN tx

A

rec two first line drugs

116
Q

black HTN pts

A

ca channel blocker or thiazide

117
Q

DM and HTN

A

ACE and ARB

118
Q

target organ damage

A

o Dilated eye exam- hypertensive retinopathy
o Displacement of PMI
o Urine for proteinuria, GFR

119
Q

DASH

A

low fat and low salt, rich K, Mag, Ca

120
Q

risk factors for kidney stones

A

sedentary, high temps, diet with salt/animal fat/animal protein/leafy greens. Vasectomy, HTN
o occur because of obstruction, urinary stasis, infection, dehydration, increased ca and vit d, excessive excretion of uric acid, vit a deficiency

121
Q

s/s kidney stones

A

renal colic, nausea, urinary frequency, hematuria, hx recent UTI
o diagnosis by UA with blood and visualization of stone by imaging

122
Q

UTI- E coli or candida s/s

A

dysuria, frequency, hematuria, nocturia, lower back or suprapubic pain
o UA may show alkaline, elevated nitrates, leukocyte esterase, sediment of RBC/WBC/mucus

123
Q

UTI tx

A

 Ampicillin and sulfonamides
 Nitrofurantoin- gram neg and gram pos cocci
 Trimethoprim-sulfamethoxazole 3 day regimen
 Fluroquinolones
• Don’t give during pregnancy

124
Q

pregnant UTI

A

amoxicillin, nitrofurantoin or cephalexin

125
Q

PTSD tx

A

cognitive behavioral therapy, sertraline and paroxetine, other SSRI
 Prazosin to control nightmares

126
Q

agent orange

A

Vietnam, southeast asia, korea, thailand

127
Q

ionizing radiation registry

A

• Hiroshima or Nagasaki

128
Q

gulf war registry

A

unexplained illness

129
Q

other vet issues

A

open air burn pits, hep c, camp lejune water contamination

130
Q

strep pharyngitis s/s

A

fever, tonsillar erythema, exudate, tender anterior cervical lymph nodes, sandpaper rash, acute onset

131
Q

tx strep

A

PCN or azithromycin if allergy

132
Q

acute sinusitis s/s

A

maxillary pain, poor response to decongestants, colored boogies, low grade temp
-caused by strep, H influenza, Moraxella

133
Q

acute sinusitis tx

A

Bactrim, amoxicillin/augmentin, ceftin, macrolides (2-3 week treatment)

134
Q

AOM tx

A

o pain management by Tylenol or ibuprofen
o amoxicillin or augmentin
o can do azithromycin if pcn allergy

135
Q

mono s/s

A

fever, pharyngeal exudates, posterior cervical lymphadenopathy, petechial rash on palate

136
Q

mono tx

A

supportive, monitor hepatosplenomegaly, may monitor LFTs, avoid strenuous activity and contact sports

137
Q

geriatric syndromes

A

o Dysphagia, Incontinence, Sleep disorders, Delirium, Visual disturbances , Dizziness, Syncope , Gait disturbances, Falls, Osteoporosis, Pressure ulcers

138
Q

aphasia

A

disorder of producing or understanding speech

139
Q

apraxia

A

inability to execute a voluntary motor despite normal muscle function. Not related to lack of understanding or physical paralysis.

140
Q

Agnosia

A

inability to recognize & identify objects or persons despite knowledge of characterisitcs.

141
Q

alz stages

A

o Stage 1- short term memory loss, emotional changes, communication trouble
o Stage 2- worsening stage 1 issues, hallucinations, compulsive, repetitive behavior
o Stage 3- nonverbal, bedbound
o Typical course 7-10 years, can last up to 20 years

142
Q

alz treatment

A

o Cholinesterase inhibitors- donepezil, rivastigimine, galantamine
o NMDA antagonists- memantine, gingko biloba, caffeine, nicotine
o Behavioral- antipsychotics, antidepressants, mood stabilizers

143
Q

general anxiety disorder

A

excessive worry over 6 months about multiple concerns
 Hyperarousal, insomnia
 May have other comorbid mental disorders
 Tx- short term benzos, SNRIS, SSRIs, buspirone, TCAs, cognitive behavioral therapy

144
Q

depression

A

o Risk factors- adolescent and elderly, female, fam hx, chronic pain or stress
o Tx- SSRI, SNRI, DCAs

145
Q

PTSD

A

lasts longer than 1 month after event, significantly affects personal life
o Tx- CBT, prolonged exposure therapy, SSRI, short term benzos

NUR 660 (1 decks)

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