final exam Flashcards

Question

Tamsulosin

Answer 1

block alpha 1- receptor in the prostate, this causes relaxation of bladder and prostate and improves urine flow. indication: Benign Prostatic Hyperplasia SE: orthostatic hypotension and syncope (30-90 minutes after first dose) NI/CE: 30 mins after meal, swallow whole, monitor BP CI: kidney and liver problems, low BP

Answer 2

Therapeutic class: antihypertensives Clonidine available forms: Epidural, tablets and transdermal injection. MOA- unknown Thought to stimulate alpha2 receptors and inhibit central vasomotor centers, decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature and lowering peripheral vascular resistance,BP and HR. Adverse reactions- Bradycardia, chest pain, hypotension, tachycardia, drowsiness, dizziness, confusion, lethargy, constipation, nausea and vomiting.Nursing considerations:drug may be given to rapidly lower BP in some hypertensive emergencies, frequently monitor BPand pulse rate, Observe patient for tolerance to drugs therapeutic effects which may require increased dosage.

Answer 3

Metoprolol and propranolol are both beta-blockers, but they differ in selectivity and uses. Metoprolol is a selective beta-1 blocker, primarily affecting the heart and causing fewer respiratory side effects, making it suitable for patients with asthma or COPD.Its commonly used for hypertension, post-heart attack care, and heart failure. Propranolol, a non selective beta blocker, affects both beta-1 and beta-2 receptors, which can impact the heart, lungs, and other organs, leading to potential bronchoconstriction, making it less suitable for people with respiratory issues. ropranolol is used for a broader range of conditions, including hypertension, migraines, and anxiety. Metoprolol has a more cardio-specific effect, while propranolol may have more pronounced central nervous system effects due to its lipid solubility.

Answer 4

A hormone and medication, also known as adrenaline. Drug Class: Epinephrine is an alpha and beta adrenergic agonist. MOA: This is produced in the adrenal medulla and is stimulated by the sympathetic nervous system. Epinephrine helps open airways and causes vasoconstriction (which reduces swelling). Indication: It can be used to treat anaphylaxis, asthma attacks, cardiac arrest, and low blood pressure.

Answer 5

Beta-1 Agonist MOA: Stimulates beta-1 receptors to increase heart rate, force, contractions, and velocity Indications: cardiogenic shock and severe heart filature to increase contractility and cardiac output Contraindications: Corn allergy if dextrose is used, history of hypertension, acute MI, sulfite sensitivity SE/AE: Increased heart rate and blood pressure, labored breathing, angina, palpitations, and dizziness NC: Monitor EKG blood pressure, and cardiac output

Answer 6

Indirect-acting muscarinic cholinergic agonist Enhances memory in some patients with early Alzheimer’s disease

Answer 7

Drug: Tiotropium Class: anticholinergics long acting MOA: blocks acetylcholine in bronchial smooth muscles, which reduce broncho-constrictive substance release Indication: maintenance treatment of bronchospasm associated with COPD or asthma Side Effect: cough, drying of nasal mucosa, anticholinergic effects (dry mouth), nervousness, headache, dizziness NI/CE: caution with any condition that would be aggravated by the anticholinergic effects of the drug (ex. parkinsons) Drug: Ipratropium Class: anticholinergics short acting MOA: anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine Indication: maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease; treatment of seasonal allergic rhinitis as a nasal spray Side Effect: nervousness, dizziness, headache, GI distress, cough, palpitations Drug: Scopolamine Class: Anticholinergic MOA: blocks ACh receptors in vestibular system Indication: nausea and vomiting associated with motion sickness/surgery Side Effect: anticholinergic effects, decreased GI motility, urinary retention NC/CE: Do not cut patch, Apply to hairless skin behind ear for 3 days or apply the night before surgery and remove 24 hours later, remove before MRI Contraindications (CI): glaucoma Drug: dicyclomine Class: Anticholinergic Indication: Irritable Bowel Syndrome Side Effect: drowsiness, constipation, dry mouth NC/CE: oral

Answer 8

SLUDGE effects: Sweating, salivation, lacrimation, urination, diaphoresis, gastrointestinal cramps/pain, and emesis.

Answer 9

The CNS includes the brain and spinal cord, while the peripheral nervous system consists of everything else. The CNS's responsibilities include receiving, processing, and responding to sensory information

Answer 10

Vascular disorders, such as stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, subdural hemorrhage and hematoma, and extradural hemorrhage.

Answer 11

MOA: Act in the limbic system and the RAS, make GABA more effective, lower doses assist with anxiety, higher doses cause sedation and hypnosis Indication: Anxiety disorders, alcohol withdrawal, hyperexcitability and agitation, status epilepticus, preoperative relief of anxiety and tension to aid in balanced anesthesia sedation and hypnosis Drug: lorazepam AE: respiratory depression, sedation, drowsiness, lethargy, hypotension Contraindications: Allergy to benzodiazepine, Psychosis, Acute narrow angle glaucoma Shock, Coma, Acute alcohol intoxication, Pregnancy Education: caution when driving, risks for falls, avoid alcohol, caution with elderly, risk for dependence and overdose (metabolized in the liver, excreted in the urine)

Answer 12

Methylphenidate (Chapter 8, Week 6 ppt) - MOA: stimulates the brain and blocks reuptake of norepinephrine and dopamine - IN: ADHD, ADD - Side effects: cardiovascular events, HTN, headache, insomnia, abuse and dependence - Considerations: potential for abuse, CV and psychiatric risk, HTN

Answer 13

Serotonin Reuptake Inhibitors #1 Blocks the reuptake of Serotonin Fewer side effects than TCAs and MAOIs Selective Serotonin Reuptake Inhibitors #2 Actions - Inhibits CNS neuronal reuptake of serotonin Indications-Depression, OCDs, panic attacks, bulimia, posttraumatic stress disorders, and other forms of anxiety Selective Serotonin Reuptake Inhibitors #3 Pharmacokinetics -Absorbed from the GI Tract -Metabolized in the liver -Associated with congenital deformities Contraindications -Known allergy, pregnancy, lactation, impaired renal function, MAOI, Grapefruit juice Selective Serotonin Reuptake Inhibitors #4 Adverse Effects -Headache, drowsiness, decreased libido, urinary retention, insomnia, hypotension, suicidal thoughts or serotonin syndrome Drug-Drug Interactions -MAOIs -TCA increase of therapeutic and toxic effect

Answer 14

Increased serotonin in the CNS and is life-threatening Symptoms: mental status changes (agitation, coma, hallucinations) Autonomic instability (tachycardia, changing BP, hypertension) Hyperreflexia Nausea and Vomiting

Answer 15

Monoamine Oxidase Inhibitors; indicated for treatment of patients with depression who are unresponsive to, or unable to take other antidepressant medications. Acts to irreversibly inhibit MAO, allowing norepinephrine, serotonin, and dopamine to accumulate in synaptic cleft. Pharmacokinetics include GI Tract absorption, peak effects in 3-4 hours, metabolized in liver, excreted in urine, and crosses placenta and enters breast milk. Contraindicated in patients with an allergy, cardiovascular disease, headaches, and renal/hepatic impairment. Adverse effects include hypotensive crisis, orthostatic hypotension, liver toxicity, CNS symptoms, mania, anorexia, serotonin syndrome, suicidal thoughts

Answer 16

Mood stabilizer Indication: bipolar disorder MOA: Alters sodium transport in nerve and muscle cells, inhibits the release of norepinephrine and dopamine, but not serotonin, from stimulated neurons AE: related to lithium serum level (therapeutic range is 0.8-1.2 mEq/L) 1.2 - 1.5 – lethargy, slurred speech, muscle weakness, thirst, polyuria 1.5 - 2.0 – above reactions plus ECG changes 2.0 - 2.5 – ataxia, clonic movements, hyperreflexia, seizures >2.5 – multiorgan toxicity, significant risk of death Nursing considerations: Slowly crosses the blood brain barrier, crosses the placenta, enters breast milk, monitor sodium level: low sodium = risk for toxicity Contraindications: Known allergy, renal, cardiac disease, leukemia, metabolic disorders, pregnancy, lactation

Answer 17

first generation (haloperidol): reduces positive symptoms, can cause extrapyramidal symptoms, multiple drug interactions, MOA: block dopamine receptors Second generation (risperidone): reduces positive and negative symptoms, increases metabolic syndrome and weight gain, multiple drug interactions, MOA: blocks specific dopamine 2 receptors and serotonin receptors Extrapyramidal symptoms: Akashia, pseudo-Parkinson's, acute dystonia

Answer 18

DRUGS: phenytoin, levetiracetam, gabapentin Levetiracetam (Keppra) MOA: slows down electrical impulses of brain by interfering with electrolytes and GABA transmission Serious side effects: Serious skin reaction; abnormal blood count Gabapentin MOA: inhibits the release of excitatory neurotransmitters in a similar pathway to GABA Indication: seizures and neuropathic pain SE: Drowsiness, dizziness, mood changes (suicidal); drug reaction with eosinophilia and systemic symptoms (DRESS) Nursing considerations: avoid antacids for 2 hours; don’t stop abruptly

Answer 19

Parkinson’s Disease: a progressive disease of the Central Nervous System impairing body movements. The cause is not known but is a loss of dopaminergic neurons. Onsets later in life with no cure. Symptoms: tremor, bradykinesia, muscle rigidity, instability, dystonia, gat disturbance Carbidopa/levodopa Class: Anti-Parkinson Agent MOA: Levodopa circulates to the Blood Brain Barrier to convert to dopamine. Carbidopa inhibits peripheral plasma breakdown of levodopa and increases it at the BBB. Side Effects: Nausea, mood changes, dyskinesia (uncontrolled or involuntary movements), peripheral neuropathy Admin: Oral, intestinal suspension, intestinal gel Contraindications: older adults may be more sensitive to CNS effects Nursing Considerations: monitor mental state, plan giving around mealtimes, avoid high protein diets

Answer 20

MOA: binds to opioid receptors in CNS to alter perception of painful stimuli o Indications: moderate-severe acute/chronic pain o AE: respiratory depression, hypotension, light-headedness, dizziness, sedation, constipation, nausea, vomiting, sweating · Fentanyl: synthetic · Morphine: natural · Oxycodone (semi-synthetic) · Tylenol with codeine

Answer 21

Reverses adverse effects of narcotics; diagnoses suspected acute narcotic overdose. o Actions: reverses opioid agonist, and analgesic and CNS depression caused by opioid agonist. o Indications: § Reversal of the adverse effects of narcotics. § Treat narcotic dependence. o Pharmacokinetics: § Well absorbed after injection and are widely distributed in the body. § Hepatic metabolism and excreted in the urine. § Enter breast milk. o Contraindications: known allergy. o Adverse effects: agitation, tremors, drowsy, sweating, hypertension, decreased respirations. o Naloxone with opioid dependence: § Acute withdrawal syndrome S/S: body aches, fever, congestion, weakness, shivering or trembling, irritability, increased blood pressure and tachycardia. § Newborns: may experience convulsions, decreased reflexes and crying.

Answer 22

Mechanism of Action Acetaminophen inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever primarily in the CNS Indications for Use Acetaminophen is used to treat mild pain and fever; however, it does not have anti-inflammatory pro Acetaminophen is safe for all ages and can be administered using various routes. Adverse effects include skin reddening, blisters, rash, and hepatotoxicity. Therapeutic Effects- Relief of mild pain and fever Class- analgesic, Antipyretic

Answer 23

nonsteroidal anti inflammatory drugs Include aspirin, ketorolac, celecoxib Common AE: GI bleeds and discomfort, increased blood volume issues and clotting, adverse kidney effect (ie. electrolyte imbalances) Indications: analgesic, antipyretic, anti inflammatory MOA: inhibit prostaglandins, decrease platelets

Answer 24

-Inhaled: Nitrous Oxide MOA: Enters bronchi and alveoli depressing CNS via capillary system -ALWAYS given with OXYGEN -Flammable and potent -Onset within 1-2 minutes -SE: Anxiety, delirium, CV and respiratory depression, hiccups, apnea, middle ear pain -IV: Anesthetics -Fentanyl- opioid receptors in CNS, causing CNS depression altering perception of pain -Propofol- Ideal for most procedures, rapid onset, rapidly absorbed through blood brain barrier, can cause hypotension, respiratory depression, and bradycardia -Methohexital- 10-20 second onset, can cause CNS depression, CV depression, and respiratory depression -Muscle Relaxants: muscle relaxation for surgical procedures -Succinylcholine -30 to 60 second onset -SE: muscle pain, flaccid paralysis, respiratory depression, apnea, malignant hyperthermia

Answer 25

Allergic rhinitis (An allergic reaction caused by exposure to allergens) Common cold (A viral infection of the upper respiratory tract) Sinusitis (Inflammation or infection of the sinus cavities) Pharyngitis (Inflammation of the pharynx) Laryngitis (Inflammation of the larynx)

Answer 26

-indications: treat allergic reactions -MOA: block histamine receptors -nursing considerations: assess allergies, monitor for sedation or anticholinergic effects, ensure patient is hydrated, educate patient not to drink alcohol while taking -contraindications: hypersensitivity, use caution if pregnant, avoid with narrow angle glaucoma, do not use if patient has liver or kidney damage -adverse effects: sedation, dry mouth/throat, dizziness, lightheaded, blurred vision, constipation, headache, nausea, vomiting, cardiac arrythmias

Answer 27

Drug : Pseudoephedrine Decreass Nasal congestion related to the common cold, sinusitis, and allergic rhinitis MOA: Shrinks the nasal mucous membrane by stimulating the alpha andrenergic receptors in the nasal mucous membranes Indication: Promotion of drainage in the sinuses and improving airflow SE: Rebound congestions, Hypertension, Sympathetic effects Topical Nasal Steriod Decongestants Drug: Fluticasone Nasal Spray MOA: Relieves inflammation Indications: seasonal allergic rhinitis SE: Local burning, irritation, stinging, dryness of the mucosa, and headache

Answer 28

triggers, treatment, patient teaching regarding inhaler use Treatment of Asthma: Practice allergen avoidance, Use agents that suppress immune response, and carry fast-acting agents to reverse symptoms.

Answer 29

Chronic Obstructive Pulmonary Disease Forms- Emphysema and chronic bronchitis Patients with COPD- Chronic illness, vulnerability, and dyspnea. Often oxygen dependent. Chronic hypoxemia and hypercapnia Symptoms- Shortness of breath, Wheezing, Chest tightness, Cough, Cyanosis, and Frequent respiratory infections Treatment- Smoking cessation, Pursed lip breathing, Administration of oxygen, Incentive spirometry, Use of preventative and rescue inhalers

Answer 30

Albuterol Class: short acting beta 2 agonist MOA: Reacts as an agonist at beta-receptor sites in the SNS to cause bronchodilation, increased HR, RR, and BP Indications: Treatment and prophylaxis of bronchospasm and prevention of exercise-induced bronchospasm Contraindications: hypersensitivity to drug/milk proteins, death reported with excessive use in patients with asthma, cautiously used for patients with CV disorder/seizures/hyperthyroidism/diabetes SE: fear, anxiety, restlessness, headache, sore throat, dizziness, nausea, palpitation, tachycardia, paradoxical bronchospasm, hypersensitivity NC: May decrease sensitivity of spirometry for diagnosis of asthma, syrup contains no alcohol/sugar and is safe for children as young as 2 years old, monitor for hypersensitivity, corticosteroids may be needed to treat asthma with albuterol, for COVID-19 and COPD symptoms usage include a pressurized metered-dose inhaler Salmeterol Class: long acting beta 2 agonists MOA: mimics effects of SNS to cause bronchial dilation with increased rate and depth of respiration Indications: acute asthma attack, bronchospasm, prevention of exercise-induced bronchospasm Contraindications: hypersensitivity, seizures, hyperthyroidism, hypokalemia, hepatic impairment SE/AE: sympathomimetic stimulation (tachycardia), CNS stimulation (tremors) NC: is not a monotherapy for bronchospasm (BB warning), do not take with other LABA medications

Answer 31

Class: corticosteroid IND: preventative treatment for asthma and COPD MOA: Corticosteroid that reduces inflammation in airways. Taken regularly with an inhaler/ puffer SE: Throat irritation, hoarseness, cough, oropharyngeal candidiasis, flu like symptoms, increases infection risks, NC: Safe in 4 years and older, increase in blood glucose, weight gain, swelling, increase fatigue, bruising, and behavior changes

Answer 32

Drug class: Corticosteroids Indication: severe inflammation, disorders requiring immunosuppression, endocrine deficiency disorders or Acute exacerbations of MS MOA: Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow; and influences protein, fat, and carbohydrate metabolism. Side effects: Fluid retention, edema, hypertension, Na, K+, Ca effects, mood swings, nausea, vomiting, bone reabsorption, delayed wound healing, increased risk for infections Contraindication:systemic fungal infections, cerebral malaria, or active ocular herpes simplex;, Use cautiously in patients with recent MI, GI ulcer, kidney disease, HTN, osteoporosis, diabetes, seizures, hypothyroidism, cirrhosis, active hepatitis, diverticulitis, nonspecific ulcerative colitis, recent intestinal anastomosis, thromboembolic disorders, myasthenia gravis, HF, TB, ocular herpes simplex, and psychiatric disturbances. Patient Education: Do not stop drug abruptly, Report all adverse reactions, tell patients with long term use to consider PT or exercise, and report pregnancy or breastfeeding.

Answer 33

Indications: Asthma, seasonal allergic rhinitis Route: By mouth MOA: Reduces early and late phase bronchoconstriction and nasal mucosa inflammation from antigen challenge SE/AE: headache, dizziness, fatigue, wheezing, pneumonia Contraindications: hypersensitivity, avoid using aspirins Considerations: Assess patient’s underlying condition, monitor for effectiveness. Monitor patients for neuropsychiatric symptoms.

Answer 34

Heart failure/Heart disease Stroke Angina (chest pain) Aneurysm Damage to the kidneys Memory and vision problems

Answer 35

Eating a heart healthy diet with less salt. Getting regular physical activity. Maintaining a healthy weight or losing weight. Limiting alcohol. No smoking. Getting 7-9 hours of sleep daily.

Answer 36

Indication: angina and chest pain MOA: relax vascular smooth muscle, vasodilation Adverse effects: hypotension, palpitations, headache, flushing, nausea, vomiting, dizziness Instructions: sublingual, sit while taking Nurse: check BP, call 911, patient may take up to 3 to relieve chest pain CI: sildenafil (viagra)

Answer 37

Class I: Sodium Channel Blockers Class II: Beta Blockers Class III: Potassium Channel Blockers Class IV: Calcium Channel Blockers

Answer 38

a. Indication: cardiac failure and arrhythmias (specifically A-fib) b. MOA: inhibits Na and K in the myocardium which increases intracellular concentration of calcium c. Adverse effects: nausea, diarrhea, headaches, anxiety, depression, rash, angina, vision changes, facial edema d. Nursing considerations: don’t give if pt has hx of kidney failure or low potassium; don’t give with antibiotics

Answer 39

Increase the excretion of sodium and water from kidney to lower BP Drug: Furosemide MOA: loop diuretic that inhibits absorption of sodium and chloride, causing fluid loss, along with sodium and potassium loss Indication: edema and hypertension Adverse effect: dehydration, hypotension, electrolyte imbalance (hypokalemia) Nursing considerations: give slowly (risk of ototoxicity), monitor BP and potassium, assess for dehydration

Answer 40

Diuretics are drugs that increase the excretion of water and sodium from the kidney leading to lowered blood pressure. Hydrochlorothiazide: MOA: works near distal tubule, promotes excretion of sodium and water Indications: edema and hypertension SE: dehydration, hypotension Nursing considerations: taken daily and does not have immediate effects

Answer 41

Spironolactone [Aldactone] is the potassium sparing diuretic: MOA: binds to aldosterone reception in distal convoluted renal tubule; causes increased amounts of sodium and water excreted while potassium is retained Indications: hypertension, acne Contraindications: hyperkalemia, electrolyte imbalance, tumorigenic Side Effects/Adverse Effects: hyperkalemia, dehydration, hypotension Nursing consideration: monitor potassium, educate to take daily, avoid potassium rich diet

Answer 42

Drug: Captopril MOA: block ACE from converting angiotensin I to angiotensin II causing decreased BP, aldosterone production, small increase in serum potassium levels along with sodium and fluid loss Indication: treatment of hypertension, CHF, diabetic nephropathy, L ventricular dysfunction following MI CI: pregnancy and lithium Education: avoid salt substitutes and food high in potassium SE: dry hacking cough, hypotension, renal insufficiency, tachycardia, MI, rash, pruritus, GI irritation, aphthous ulcers, proteinuria, bone marrow suppression, cough Severe: angioedema - part of body becomes swollen areas include lips, tongue, eyelids, hands, feet

Answer 43

MOA: selectively bind with the angiotensin II receptors in vascular smooth muscle and in the adrenal cortex to block vasoconstriction and the release of aldosterone Indications: hypertension, diabetic neuropathy Contraindications: hypersensitivity SE/AE: hypotension, headache, dizziness, syncope, weakness, diarrhea, abdominal pain, cough, back pain NC: watch for signs of impaired renal function, assess dizziness

Answer 44

Indication: Adjunct to diet in the treatment of elevated cholesterol, § lower LDL and triglycerides § increase HDL MOA: Inhibits HMG-CoA, decreases serum cholesterol levels, LDLs, and triglycerides, increases HDL levels AE: Muscle symptoms (myalgias to rhabdomyolysis) Liver injury GI symptoms: Flatulence, abdominal pain, cramps, nausea, vomiting, and constipation CNS: Headache, dizziness, blurred vision, insomnia, fatigue Contraindication: Active liver disease or history of alcoholic liver disease Drug to Drug interactions: Erythromycin, cyclosporine, gemfibrozil, niacin Digoxin or warfarin Estrogen Grapefruit juice

Answer 45

Indication: Prevent thromboembolism (Deep vein thrombosis and pulmonary embolism), Atrial fibrillation MOA: It inhibits Vitamin K enzyme that causes clotting factors. This leads to a decrease in clotting factors and a reduce blood coagulation Adverse effects: Bleeding complication Contraindications: Bleeding disorders, uncontrolled hypertension, pregnancy. Education: Watch vitamin K (green leafy vegetables), signs of bleeding Drug interaction: NSAIDS, antibiotics Antidote: Vitamin K reverse the effect of warfarin

Answer 46

MOA: inhibits platelet activation and aggregation Indications: MI, stroke, anti-inflammatory, analgesic, antipyretic effects Caution: bleeding disorder, recent surgery, closed head injury AE: bleeding, HA, dizziness, weakness, GI distress Nursing Considerations: avoid NSAIDs, don’t give to children 12 and younger as it could cause Reye’s syndrome, monitor for bleeding

Answer 47

akes 30-60 minutes to work prior to sexual activity MOA: causes muscle relaxation and vasodilation Indications: erectile dysfunction AE: Orthostatic hypotension, urinary frequency, bladder pain

Answer 48

type 1- the body can’t make insulin on its own. type 2: the bodys ineffective use of insulin, leads to high blood sugar levels, body doesn’t produce enough insulin or is resistant to it. Goal of treatment is to regulate blood glucose levels.

Answer 49

Rapid acting, Short acting, Intermediate acting, Long acting.

Answer 50

Hypoglycemia Mild-to-Moderate: ⁃ Shaky or jittery ⁃ Sweaty ⁃ Hungry ⁃ Headache ⁃ Blurred vision ⁃ Sleepy or tired ⁃ Dizzy or lightheaded ⁃ Confused or disoriented ⁃ Pale ⁃ Uncoordinated (appears drunk) ⁃ Irritable or nervous ⁃ Argumentative or combative ⁃ Changed behavior or personality ⁃ Trouble concentrating ⁃ Weak ⁃ Fast or irregular heartbeat Severe: ⁃ Unable to eat or drink ⁃ Seizures or convulsions (jerky movements) ⁃ Unconsciousness Hyperglycemia: ⁃ Fruity odor to breath - Polyuria progressing to oliguria, polydipsia, polyphagia ⁃ Kussmaul’s respirations (rapid and deep) ⁃ Sluggish, Drowsy, stupor ⁃ Hypotension, tachycardia ⁃ Skin warm and dry, dry mucous membranes - Severe cases: Diabetic Ketoacidosis

Answer 51

Glipizide is a sulfonylurea. MOA: beta cell of the pancreases secretes insulin has a sulfonylurea receptor. When stimulated the receptor causes the beta cell to release insulin. 1) stimulate beta cells to increase insulin secretion. 2) increase peripheral insulin sensitivity. 3) reduced hepatic glucose production. This lowers the blood glucose and SE: hypoglycemia.

Answer 52

MOA: Decrease liver glucose production and intestinal absorption of glucose, also increases insulin sensitivity Indications: Prevention of type 2 diabetes in pre diabetic patients, lower glucose in those with type 2 diabetes SE: Diarrhea, nausea,vomiting , constipation CI: Those with liver disease or those at risk for lactic acidosis, eGFR below 30ml/min Client education and nursing consideration: Educate on when to take, side effect signs, monitor blood glucose, monitor liver and kidney function

Answer 53

Therapeutic class: antidiabetic MOA: Stimulates release of insulin and lowers glucagon secretion in presence of elevated glucose levels. Administration: PO Indications: for patients with diabetes trying to control their weight Contraindications: Contraindicated in patients hypersensitive to drug or its components, drug not indicated for patients with type 1 diabetes Adverse effects: CNS: headache, fatigue, dizziness. CV: increased HR, hypotension. EENT: diabetic retinopathy complications. GI: nausea, vomiting, diarrhea, abdominal pain, constipation, dyspepsia, belching, flatulence, GERD Nursing considerations: Monitor patients for hypersensitivity reactions, including anaphylaxis and angioedema. Discontinue drug and treat appropriately if reaction occurs. Use cautiously in patients with a history of hypersensitivity to another glucagon-like peptide-1 agonist

Answer 54

Addison’s – low/absent steroid Cause: Dysfunction of the hypothalamus–pituitary gland–adrenal gland feedback loop Results in insufficient production of steroids by the adrenal glands Most cases are considered an autoimmune disorder Treated with: Add-sone Diet Don’t abruptly stop Don’t believe the medication will cure Indefinitely “life long” Cushing’s – high steroid Treat with: Glucocorticoids

Answer 55

Drugs: Prednisone (PO) and Methylprednisolone (IV) Þ Indication: short-term to reduce inflammation; long-term for immunosuppression Þ Administration Considerations: o NEVER abruptly stop o Use lowest dose possible to control disorder and taper when feasible o May require concurrent treatment for OSTEOPOROSIS or HYPERGLYCEMIA o Regularly monitor for development of symptoms of adrenal suppression o Contraindicated in patients w/ untreated systemic infections Þ Side Effects: o Fluid and electrolyte imbalances o Increase in blood glucose o Development of Cushing’s Syndrome o May mask some signs of infection and new infections may appear

Answer 56

. Thyroid disorders and treatment Hypothyroidism: Increased TSH and decreased T3 and T4 Symptoms/ signs: thin hair, enlarged thyroid gland, puffy face, dry/coarse skin, constipation, poor appetite, slow HR, infertility, carpal tunnel syndrome, cold/swelling in limbs, loss of eyebrow hair, weight gain, poor memory, fatigue Treatment: Levothyroxine MOA: replaces absence of T3 and T4 to improve metabolic and homeostatic functions. Indications: hypothyroidism CI: hyperthyroidism, hypersensitivity SE/AE: nervousness, tremors, insomnia, tachycardia, palpitations, dysrhythmias, Angina NC: monitor heart rate, BP, CV symptoms, symptoms of hyperthyroidism and hypothyroidism and bone mineral density Hyperthyroidism: decreased TSH and increased T3 and T4 Symptoms: Graves disease, goiter, eyelid retraction, exophthalmos, nervousness, weight loss, emotional lability, excessive sweating, heat intolerance, palpitations, frequent bowel movements, proximal muscular weakness and tremor Treatment: Propylthiouracil MOA:Block synthesis of thyroid hormones Indications: hyperthyroidism CI: hypersensitivity, breastfeeding SE/AE: agranulocytes, edema, skin changes, GI distress, drowsiness, headache, hepatic damage, NC: monitor cardiac, observe for hypothyroidism, watch for rash, lupus, agranulocytosis

Answer 57

also known as H2 blockers or H2RAs, are a class of drugs that reduce the amount of stomach acid produced famotidine : drug

Answer 58

Medication – Pantoprazole MOA - Blocks the secretion of hydrochloric acid at the proton pump Indications - GERD, erosive esophagitis, Prophylactic with surgery, In combination with antibiotics for H.Pylori infection, Short-term treatment of active duodenal ulcers AE – Headache, Abdominal pain, diarrhea or constipation, Acute renal dysfunction, Long-term: Osteoporosis & bone fracture, Potential zinc, magnesium, or B12 deficiency, Immediately report signs of bleeding ulcers such as coughing/vomiting of blood NC - Available orally, with an NG tube, or as IV injection in the hospital setting, Can be taken with or without food

Answer 59

(Sucralfate) Coat any injured area in the stomach to prevent further injury. Promotes ulcer healing. Contraindications: Renal failure or dialysis. AE: constipation. Administer on empty stomach, 1-2 hours before meal.

Answer 60

psyllium (Metamucil) (Class : Fiber supplements) Absorb water Safest class of laxatives Commonly used to treat chronic constipation May decrease absorption of some drugs Dissolve with 8 oz water Docusate (Colace) (Class : Stool softener) Absorb water and fats into stool to make it soft Used to prevent constipation SE: Abdominal cramping Milk of Magnesia / polyethylene glycol (MiraLAX) (Class : Osmotic laxative) Increases bowel movement by causing water to be retained with stool Uses: Purging of toxins, For fecal impaction Bisacodyl (Dulcolax) (Class : Stimulant laxative) Often used as bowel prep BM within 1 hour Do not take bisacodyl with milk or antacids Available as oral or rectal suppository

Answer 61

Anticholinergics: Scopolamine Used in combination to treat emesis induced by chemotherapy Dopamine antagonists: Metoclopramide (Reglan) Available PO, IM, or IV MOA: Blocks dopamine receptor to improve nausea SE: CNS depression (drowsiness, fatigue) Severe SE: Tardive dyskinesia or neuro-malignant syndrome Interactions: Alcohol, narcotics, tranquilizers Serotonin antagonists: Ondansetron (Zofran) Oral disintegrating, PO, or IV Indications: Used to manage nausea and vomiting, prevention of surgery and chemo hyperemesis Interactions: None

Answer 62

Uncomplicated Trimethoprim-sulfamethoxazole - Standard therapy in women - Inhibit bacterial synthesis Nitrofurantoin - Treatment for UTI caused by E. coli - Disrupt cell metabolism Second-line agents : -Flueroquinoones (ciprofloxacin and levofloxacin) -Broad-spectrum antibacterial agents -Avoid antacids Treatments of complicated UTIs -Fluoroquinolones (first line) - IV treatments with antibiotics -IV hydration

Answer 63

Candida albicans vaginitis (vaginal yeast infection) Abnormal vaginal discharge caused by yeast Not sexually transmitted Treated by: Oral Fluconazole (diflucan) Bacterial Vaginosis Abnormal vaginal discharge caused by anaerobic bacteria and high vaginal pH Not sexually transmitted Treated by: Metronidazole STIs HPV, cervical cancer Genital warts Herpes (acyclovir) HIV infections = antiretroviral therapy Gonorrhea = treated by Ceftriaxone Chlamydia = treated by Doxycycline Trichomonas = treated by Metronidazole

Answer 64

Estrogen/Progestin Combinations OCP pills: MOA: Suppress LH and FSH inhibiting ovulation; alters cervical mucus and endometrium -ovaries become smaller Indication: Contraception, abnormal uterine bleeding, endometriosis, polycistic ovarian syndrome, acne SE: -Breakthrough bleeding -Nausea -Breast tenderness -Hypertension Instructions: Start day 1 of menstrual cycle, take daily, smoking increases risks for blood clots Contradictions: Smoking, High BP, Heart disease, Breast and cervical cancer, migraine headaches

Answer 65

Every 90 days Pros- no estrogen Cons- delay in return to fertility (6-12 months), amenorrhea, weight gain, HA, acne BBW- use for 5+ years cause reduced bone mass density of lumbar spine and femoral neck

Answer 66

:smooth muscle relaxant to decrease uterine contractions. SE: sweating, confusion, flushing, nausea indication: preterm labor, NI: monitor the patient for adverse effects, ensure the drug is working as expected, and monitor the patient's vital signs

Answer 67

indication: Cervical ripening and to stop postpartum hemorrhage NI/CE: only used in hospital, wait > 4 hours before oxytocin CI: Uterine rupture or uterine, hyperstimulation, Needs to be on fetal monitor to assess contractions and fetal heart rate, used when cervix is not favorable

Answer 68

Used to induce labor if cervix is “favorable”. Causes uterus muscles to contract. IV or IM. Can cause arrhythmia, hypertension, fetal bradycardia, nausea, vomiting, and uterine rupture