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Patho/ Pharm > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Stimuli that induce nausea and vomiting

A

Distention of stomach
Torsion or trauma to ovaries, testes, uterus, bladder, or kidneys
Activation of chemoreceptor trigger zone

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2
Q

What neurons are stimulated to induce N/V?

A

Neurons in the medulla oblongata

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3
Q

Most effective drug for N/V

A

Serotonin receptor agonists (ondasteron, zofran)

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4
Q

What can be given with ondasteron to increase its effectiveness

A

Dexamethasone

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5
Q

GERD

A

Reflux of gastric acid and Pepsi from stomach to esophagus

Caused by relaxation of LES

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6
Q

Treatment for GERD

A

Metoclopramide

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7
Q

PUD

A

Erosion of ulcer in upper GI tract

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8
Q

Cause of PUD

A 
H. Pylori
NSAIDS
Pepsi
Stress
Smoking
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9
Q

Treatment of PUD

A

Amoxicillan, tetracycline, metronazole

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10
Q

Ulcerative colitis

A

Large intestine

Large continuous lesions

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11
Q

Clinical manifestations of ulcerative colitis

A

Inflammation of the rectum and colon
Diarrhea 4x a day
Bloody stools

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12
Q

Treatment for ulcerative colitis

A

Sulfasalazine

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13
Q

Gold standard for ulcerative colitis

A

Proctocolectomy with ileo-anal anastomosis

Internal patch

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14
Q

Chron’s disease

A

Small and large intestine
Rarely involves rectum
Patchy

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15
Q

Clinical manifestations of Crohn’s disease

A

Malabsorption of B12, folic acid, vitamin D (may have to use TPN)

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16
Q

Treatment for Crohn’s disease

A

Smaller meal
Eliminate triggers
Treat symptoms
Smoking cessation

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17
Q

Sulfazaline (azulfidine)

A

Anti inflammatory used to treat UC and RA

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18
Q

Sucralfate (carafate)

A

Creates a barrier against acid and pepsin

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19
Q

Metoclopramide (reglan)

A

Prokinetic - blocks dopa and serotonin receptors

Decrease nausea and increased motility

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20
Q

Adverse effects of metoclopramide

A

Sedation

On the BEERS list

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21
Q

When should you take metoclopramide

A

30 minutes before each meal and at bed time

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22
Q

Ondasteron (zofran)

A

Most effective drug to treat nausea

Blocks receptors in brain and gut

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23
Q

ADR for ondasteron

A

Lengthens QT interval - dysrythmias

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24
Q

Dexamethasone

A

Steroid that treats inflammation

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25
Q

Promethazine

A

Antihistamine
Control pain, nausea, vomiting
Can cause necrosis!

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26
Q

Metamucil

A

Bulk forming, give PO with lots of water for obstruction

Swell in water to form gel softening the stool

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27
Q

Docusate

A

Stool softener

Doesn’t allow water to be reabsorbed from stool in large bowel

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28
Q

Docusate should not be used in which patients

A

Pts on q sodium restricted diet

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29
Q

Lactulose

A

Non digestible sugar compound used to treat chronic constipation and hepatic encephalopathy
Removes ammonia

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30
Q

How to treat elevated ammonia

A

Lactulose

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31
Q

PEG

A

Miralax
Bowel cleansing solution that contains PEG plus electrolytes
Cleans bowel in short amount of time

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32
Q

Bisacodyl

A

Stimulates large bowel motility to increase H2 and electrolytes into instestine

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33
Q

What decreases absorption of bisacodyl

A

Antacids and milk

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34
Q

When should you take bisacodyl

A

Bedtime

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35
Q

Magnesium citrate

A

Osmotic laxative

Caution in renal and heart failure

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36
Q

Liver cirrhosis

A

Irreversible inflammatory, fibrotic liver disease
Liver failure commonly associated
Liver is hard or firm when palpated

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37
Q

Lab values for cirrhosis

A

Elevated AST/ALT, bilirubin, alkaline phosphatase

Decreased albumin

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38
Q

ALT normal range

A

7-55

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39
Q

ALAST normal range

A

8-48

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40
Q

Ascites

A

Accumulation of fluid in the peritoneal cavity

Most common factor is liver cirrhosis

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41
Q

What causes ascites

A

Portal HTN –> low oncotic pressure –> leakage of fluid into peritoneal cavity

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42
Q

How can ascites cause sepsis

A

Increased capillary permeability can promote translocation of GI bacteria into peritoneal space = peritonitis –> sepsis

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43
Q

Hepatic encephalopathy

A

Neurological syndrome (impaired cerebral fxn, asterixis, EEG changes

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44
Q

What causes hepatic encephalopathy and what can be used to treat

A

Accumulation of toxins in blood which affect brain: particularly ammonia
Remove ammonia with lactulose

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45
Q

AST/ALT levels for viral liver failure

A

ALT higher than AST

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46
Q

AST/ALT for alcoholic liver failure

A

AST higher than ALT

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47
Q

Ammonia normal level

A

15-45

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48
Q

Pancreatitis

A

Inflammation of pancreas which causes digestive enzymes in pancreas to back up and digest itself

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49
Q

Labs associated with pancreatitis

A

Increased amylase, lipase, glucose
Decreased Ca and Mg
Increased bilirubin, ALT, WBC

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50
Q

Treatment for pancreatitis

A 
Stop autodigestion 
Narcotic for pain (fetanyl)
NPO to rest but
IV fluid
H2 blockers
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51
Q

Acute pancreatitis

A

Epigastric, mid-abdominal pain that is constant, can be severe and incapacitating
Can lead to paralytic ileus

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52
Q

S/S of acute pancreatitis

A

Fever, elevated WBC, abdominal distention (fluid in abdominal cavity)
Major changes in electrolytes especially calcium

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53
Q

Chronic pancreatitis

A

Most common with alcohol use

Cysts form in pancreas

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54
Q

Clinical manifestations of chronic pancreatitis

A

Intermittent abdominal pain and weight loss
Ascites
Increases risk for pancreatic cancer

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55
Q

What may need to be replaced in chronic pancreatitis

A

Pancreatic enzymes (amylase, lipase)

56
Q

Amylase normal range

A

23-85

57
Q

Lipase normal range

A

0-160

58
Q

What causes increased amylase

A

Pancreatic cell injury

59
Q

What causes elevated lipase

A

Pancreatic cell injury

60
Q

What could cause abnormal glucose

A

Pancreatic cell injury, resulting in impaired carbohydrate metabolism, decreased insulin release

61
Q

What causes decreased calcium

A

Fatty acids combined with calcium seen in fat necrosis

62
Q

What causes decreased Mg

A

Fatty acids combined with calcium, seen in fat necrosis

63
Q

What causes elevated bilirubin

A

Hepato-biliary obstructive process

64
Q

What causes elevated ALT

A

Hepato-biliary involvement

65
Q

What causes elevated WBC

A

Inflammatory response

66
Q

What are gall stones made up if

A

Cholesterol

67
Q

When giving IV promethazine, why must you check IV site

A

IV site needs to be patient because promethazine can cause necrosis in your hands
Infiltration will cause major tissue damage

68
Q

What drug is used most frequently in diabetics for gastroparesis

A

Metaclopramide

69
Q

What drug decreases the immune response

A

Sulfasalazine

70
Q

Key manifestation of SLE

A

Butterfly rash

71
Q

Treatment of SLE

A

Immunosuppressive medications and steroids

72
Q

Gout

A

Disruption of uric acid production or excretion

Uric acid level high enough to crystallize in connective tissue throughout body

73
Q

Gouty arthritis

A

When crystals are in synovial fluid

74
Q

Uric acid normal level

A

2.6-6

75
Q

What does increased uric acid cause risk for

A

Kidney stones

76
Q

Limit what foods when you have gout

A

Foods high in purines

77
Q

Rheumatoid arthritis

A

Inflammatory, autoimmune joint disease

Effects connective tissues and joints

78
Q

Manifestations of RA

A

Morning stiffness lasts > 1 hr
Arthritis > 3 joints
Arthritis of hand joints
Rheumatoid nodules

79
Q

Treatment of RA

A 
Methotrexate 
Sulfasalazine 
Enetarcept
Rituximab
Azathioprine 
Cyclosporine
80
Q

Fibromyalgia

A

Chronic widespread diffuse joint pain, fatigue and tender points

81
Q

Manifestations of fibromyalgia

A

Prominent symptom is diffuse, chronic pain that is burning or gnawing in nature
Absence of inflammation

82
Q

Ankylosing spondylitis (AS)

A

Inflammatory joint disease of the spine

Systemic, immune inflammatory disease

83
Q

What causes AS

A

Begins with inflammation of cartilage in vertebrae and SI joint
Inflammatory cells infiltrate and erode fibrocartilage
As repair begins, scar tissue ossified and calcified and the joint eventually fuses

84
Q

Manifestations of AS

A

Low back pain
Lordosis
Kyphosis

85
Q

Treatment of AS

A

Methotrexate, enetarcept, rituximab, azathioprine, cyclosporine

86
Q

Osteomalacia

A

Deficiency of vitamin D

Ca can’t go into bone structure without vitamin D - soft bones

87
Q

What gives bone its tensile strength

A

Collagen

88
Q

Use NSAIDS with caution in what patients

A

Renal patients

89
Q

Methotrexate is used for what patients

A 
Cancer 
Autoimmune diseases (RA)
90
Q

Mechanism of action for methotrexate

A

Interferes with folate metabolism - death to fast producing cells

91
Q

Nursing actions for methotrexate

A

Monitor CBC

Instruct patient to take folate daily

92
Q

What is azathioprine used for

A

Kidney transplants
RA
Chron’s disease
UC

93
Q

Mechanism of action for azathioprine

A

Immunosuppressant

94
Q

Nursing actions for azathioprine

A

Monitor CBC’s (pay attention to low WBC)

95
Q

Allopurinol is used to treat

A

Gout

96
Q

Mechanism of action for allopurinol

A

Decreases the amount of uric acid the body makes

97
Q

ADR for allopurinol

A

Joint swelling

Rash

98
Q

Nursing actions for allopurinol

A

Instruct pt to drink plenty of fluids (3L/day)

99
Q

What does colchicine treat

A

Gout

100
Q

ADR for etanercept

A 
Headache
Upper respiratory infection
Injection site reaction
Infections (esp TB and fungus)
Malignancies
101
Q

Method of action for etanercept

A

Immunosuppressant

Delays progression of joint damage

102
Q

Nursing actions for etanercept

A

Nephrotoxic (monitor Cr and BUN)

Monitor CBC

103
Q

ADR for colchicine

A 
N/V/D
Agranulocytosis 
Leukopenia
Thrombocytopenia 
Aplastic anemia
104
Q

Nursing action for colchicine

A

Monitor CBC

105
Q

Sprain

A

Tear or injury to ligament

106
Q

Strain

A

Tear or injury to tendon “T”

107
Q

What is silver sulfadiazine used for

A

Prevent and treat wound infections in patients with serious burns
Stops the growth of bacteria

108
Q

Nursing action for silver sulfadiazine

A

Continue to give medication even if patient has leukopenia

109
Q

Normal WBC range

A

5000-10000

110
Q

Tretinoin (Retin A) used for

A

Retinoid derivative of vitamin A (cream) used to treat acne and fine wrinkles

111
Q

Nursing actions for tretinoin

A

Increased sensitivity to sun (wear SPF 15 daily)
Causes reddened raw skin
Dry skin

112
Q

Isotrenitoin is used for

A

Severe acne
Decreases sebum
Inflammation

113
Q

Nursing action for isotrenitoin

A

Teratogenic: pregnancy is absolute contraindication for use –> iPLEDGE
Assess for rash
Risk for behavioral changes

114
Q

Mild acne

A

Open comedones are most common

115
Q

Severe acne

A

Characterized by abscesses and inflammatory cysts

116
Q

Most common cancer type

A

Basal cell carcinoma

117
Q

Second most common skin cancer

A

Squamous cell carcinoma

118
Q

What can actinic keratosis turn into

A

Squamous cell carcinoma

119
Q

What cancer is most likely to metastasize

A

Malignant melanoma

120
Q

ABCDE

A

Asymmetry, border, color, diameter, evolving

121
Q

Primary prevention for skin cancer

A

Sunscreen and limit UV radiation

122
Q

Cells responsible for immunity in skin

A

Langerhans cells

123
Q

Cellulitis

A

Infection of the dermis and hypodermis

124
Q

1st degree burn

A

Epidermis only (superficial)
Sunburn without blisters
Heals 3-5 days

125
Q

2nd degree burn

A

Include superficial and deep partial thickness

126
Q

Superficial 2nd degree burn

A

Involve blisters and the tactile and pain sensors remain intact
Healing 3 to 4 weeks
Wound care extremely painful

127
Q

Deep partial thickness 2nd degree burn

A

Involves entire dermis; leaves follicles and sweat glands intact
Healing takes several weeks
Can progress to third degree burn over several days

128
Q

3rd degree burn

A

Destruction of dermis and underlying SQ tissue

Generally no pain because nerves have been destroyed

129
Q

4th degree burn

A

Destruction of dermis, SQ, tendons, muscle, and bones
Black
Will not heal

130
Q

What is used to estimate size of burns

A

Rule of 9’s

TBSA - total body surface area

131
Q

Describe fluid loss in burns

A

Fluid loss is 5 to 10 times greater in damaged skin than in undamaged skin
Edema happens rapidly
Sodium leaking

132
Q

Treatment for burns

A

Fluids (isotonic, LR)
Amount depends on pt weight and % of body surface burned
For first 24 hours >1000 mL/hr given

133
Q

ABCDE for burns

A

Airway, breathing, circulation, disability, exposure/environment

134
Q

What does increased capillary permeability lead to in burns

A

Vasodilation –> lowers BP

135
Q

What does hypovolemia cause in burn patients

A

Hyperviscosity –> increased Hgb –> clumping up of RBC’s –> platelets because of decreased fluid volume –> chunky blood

136
Q

What does tissue ischemia cause in burn patients

A

Acidosis –> decreased cardiac output –> lowers BP more

Patho/ Pharm (1 decks)

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