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2020 Pharmacology I > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

1
Q

absorption

A

tramission of med from site of entry to bloodstream

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2
Q

rate of absorption

A
  • how soon med takes effect
  • affected by formulation, route of admin
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3
Q

What determines how strong the effect of a med will be?

A

amount of med absorbed

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4
Q

first-pass effect

A

med goes through liver first and is partly metabolized, reducing the amount available to cause therapeutic effect

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5
Q

pros and cons of PO route

A
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6
Q

pros and cons of IV route

A
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7
Q

distribution

A

transportation of med from blood stream to site of action

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8
Q

traffic

A
  • perfusion
  • what’s in the way
  • how fast it’s moving
  • ability to travel between cells
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9
Q

plasma protein binding

A
  • some meds need to bind to protein for transportation
  • albumin most common
  • meds can compete for binding sites
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10
Q

unbound drug

A
  • free drug = drug effects
  • can lead to toxicity
  • check serum protein if giving multiple protein-binding meds
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11
Q

metabolism

A
  • biotransformation
  • turns drug into less active or inactive form
  • happens primarily in liver, but also in kidneys, lungs, bowel, blood
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12
Q

factors affecting metabolism

A
  • requires higher dose
    • ↑ enzymes: rapid metabolism
    • first-pass effect (PO): inactivates portion of dose
  • possible toxicity
    • similar meds: use same pathway
  • requires lower dose
    • nutritional status: ↓ enzymes produced
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13
Q

toxicity

A
  • unbound drug accumulation
  • can be caused by
    • poor metabolism
    • poor excretion
    • competing drugs
  • check organ fxn, plasma drug levels before admin
  • know s/sx of toxicity for meds you give
  • stop med, notify provider
  • give antidote if applicable
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14
Q

hepatotoxicity

A
  • liver highly susceptible
  • alterations in liver enzyme may not show sx
  • polypharmacy ↑ risk
  • teaching: Tylenol, ETOH ↑ risk
  • assess fxn before giving meds
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15
Q

s/sx of hepatotoxicity

A
  • jaundice: yellowing of skin, sclera
  • fatigue
  • loss of appetite
  • N&V
  • wt loss
  • dark or tea-colored urine
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16
Q

excretion

A
  • primarily through kidneys, but other pathways exist (sweat)
  • kidney fxn will affect excretion
  • check BUN, Cr
  • kidney dz = smaller dose
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17
Q

MEC

A

minimum effective concentration

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18
Q

minimum effective concentration (MEC)

A

lowest amount of drug needed in blood to produce therapeutic effect

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19
Q

therapeutic range

A

drug blood level at which therapeutic effect is achieved, but toxicity is not

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20
Q

therapeutic index

A
  • width of therapeutic range
  • high = better safety margin
  • low = high risk (narrow therapeutic range)
    • close monitoring of plasma drug levels required
    • trough levels drawn immediately before next dose
    • peak levels drawn at time indicated by pharmacy
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21
Q

half life

A
  • time it takes for med in body to drop by 50%
  • short (4-8 hr): more frequent dosing
  • long: less frequent dosing, takes longer time to reach plateau
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22
Q

assessment before medication therapy

A
  • health hx
    • age
    • chief complaint
    • all Dx health problems
    • adverse effects/side effects
    • herbal/natural products used
    • caffeine, tobacco, ETOH, street drug use
    • pt’s understanding of med purpose
    • pt’s beliefs, concerns, feelings about med
    • FOOD AND MED ALLERGIES
  • physical exam - focused or comprehensive
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23
Q

components of Rx

A
  • pt name
  • date and time of Rx
  • name of med
  • dosage of med
  • route of admin
  • time and frequency
  • signature of provider
  • ALL REQUIRED
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24
Q

six rights of safe med administration

A
  • right medication
  • right dose
  • right route
  • right time
  • right documentation
  • 7TH RIGHT: right of pt refusal
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25
Q

common med errors

A
  • wrong med of IV fluid
  • incorrect dose or IV rate
  • wrong pt
  • wrong route
  • wrong time
  • admin of known allergic med
  • omission of dose
  • inccorect D/C of med or IV fluid
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26
Q

how to prevent med errors

A
  • know about the medication
  • get info about pt’s Dx and conditions (allergies, organ failure, deficiencies, etc.)
  • know pt allergies
  • get assessment data (VS, labs, etc.)
  • omit or delay as indicated by pt condition, and NOTIFY PROVIDER
  • practice six rights every time
  • interpret Rx accurately; look out for
    • error-prone abbreviations
    • confused medication names
    • high-alert meds
    • confusing decimals
  • verify with provider if unclear or seems inappropriate
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27
Q

when to report med errors

A

EVERY TIME, as soon as pt is taken care of

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28
Q

culture of safety

A
  • ALWAYS report med errors
  • focus on system changes to prevent errors
  • point out near misses
  • notify provider of error; pt should be told
  • follow facility policy on reporting
  • don’t mention reporting form in pt chart
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29
Q

side effect

A
  • a secondary effect of a drug
  • mild, do not require stopping medication
  • example: drowsiness with morphine
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30
Q

adverse effect

A
  • undesired, inadvertent, unexpected, SEVERE response to med
  • stop med immediately, treat rxn
  • report to FDA medWatch
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31
Q

anticholinergic effects

A
  • muscarinic receptor blockade
  • most effects in
    • eyes
    • smooth muscle
    • exocrine glands
    • heart
  • teaching: how to minimize dicomfort (↑ fluids, etc.)
  • ABCDs
    • agitation
    • blurred vision
    • constipation/confusion
    • dry mouth
    • stasis of urine/sweating
  • AKA
    • can’t pee
    • can’t see
    • can’t spit
    • can’t shit
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32
Q

immunosuppression

A
  • decreased or absent immune response
  • agranulocytosis: caused by some meds that damage bone marrow
  • immunosuppressant meds (i.e. steroids) mask sx (fever, inflammation, etc.)
  • monitor for delayed wound healing, s/sx of infection
  • teaching: avoid contagions (hand sanitizer, sick people, mask, etc.)
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33
Q

agranulocytosis

A
  • ↓ in infection-fighting granulocytes in the blood
  • may occur
    • in some leukemias
    • after treatments toxic to bone marrow (e.g., chemotherapeutic agents; clozapine)
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34
Q

non-opioid analgesics

A
  • pain meds w/o opioid
  • pain assessment: faces, 0-10, FLACC
  • for mild-moderate pain
  • desired outcome: ↓ pain, ↓ fever, ↓ inflammation
  • also used as
    • antipyretic (no ASA in children)
    • anti-inflammatory (not acetaminophen)
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35
Q

acetaminophen

A
  • non-opioid analgesic, antipyretic
  • modulates pain signal transmission by slowing production of prostaglandins in CNS
  • route: OTC PO, Rx IV forms
  • interactions
    • ETOH: > 1-2 drinks/day
    • caution with warfarin (bleeding risk)
  • read labels, avoid OD with combo meds
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36
Q

acetaminophen toxicity

A
  • one of the most common ODs
  • antidote
    • acetylcysteine
    • IV or PO
    • within 8-10 hr of ingestion
    • higher initial dose
  • toxic dose (if available): > 7.5 g in adults, 150 mg/kg in children
    • max safe dose = 4 g/day for adults, 90 mg/kg in children
  • interventions
    • labs
      • electrolytes
      • LFT, BUN, Cr
      • acetaminophen level, toxicology
      • CBC, PT
      • BG
      • urine tox screen
      • Hcg (if appropriate for pt)
    • activated charcoal (best within 4 hr of ingestion)
    • ICU
  • s/sx
    1. nausea
    2. vomiting
    3. malaise
    4. diarrhea
    5. diaphoresis
    6. abd pain
    7. ↑ blood/urine level of acetaminophen
    8. ↑ liver enzyme in first day
    9. jaundice, altered coagulation in first 36 hr
    10. liver failure
    11. coma
    12. death
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37
Q

NSAIDs

A
  • MOA: inhibits enzyme that produces prostaglandins (COX-1 and COX-2) → ↓ inflammation, pain, fever
  • complications
    • ↑ risk of GI ulcer, bleeding, renal impairment
    • ↑ risk of MI and stroke (except ASA)
  • interactions
    • risk of bleed with anticoagulants, glucocorticoids, other NSAIDs
  • admin
    • stop as directed before procedures
    • notify provider about bad SE: bleeding, N&V, abd pain
    • routes: PO, IV, IM
  • contraindication: hypersensitivity to ASA (applies to all NSAIDs)
  • precautions
    • bleeding disorders
    • GI bleed
    • severe hepatic, renal, or CV dz
    • pregnancy: safe use not established, avoid during second half
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38
Q

complications of ASA

A
  • Reye syndrome (rare, but serious)
  • salicylism (mild toxicity)
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39
Q

Reye syndrome

A
  • rare, but serious
  • happens when used as antipyretic in children with viral illness
  • s/sx
    • diarrhea
    • tachypnea
    • vomiting
    • severe fatigue
    • fever
    • hypoglycemia → confusion, sz, LOC
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40
Q

slicylism

A
  • mild ASA toxicity
  • s/sx
    • tinnitus
    • sweating
    • HA
    • dizziness
    • resp alkalosis
  • stop taking and notify provider
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41
Q

ASA toxicity

A
  • progresses from slicylism
  • s/sx
    • high fever
    • sweating
    • acidosis
    • dehydration
    • electrolyte imbalances
    • coma
    • resp depression
  • medical emergency
  • interventions
    • gastric lavage/activated charcoal
    • hemodialysis
    • cooling with tepid water
    • IV fluid correction
    • acidosis: Tx with bicarb
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42
Q

opioid agonist common side effects

A
  • resp depression
    • monitor VS
    • do not give if RR < 12
    • worse with concurrent ETOH, CNS depressants
  • sedation
    • fall risk
    • monitor VS
    • avoid certain activities
    • worse with concurrent ETOH, CNS depressants
  • constipation
    • prevention (↑ fluid and fiber, docusate sodium)
    • acute Tx: laxative
    • long-term use: opioid antagonist
  • N&V: antiemetic (promethazine = synergist, or ondansetron
  • orthostatic hypotension
    • fall risk
    • move slowly
    • worse with antihypertensives
  • urinary retention
    • monitor I&O
    • encourage voiding Q4H
    • assess for distention
    • worse with BPH and concurrent anticholinergics
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43
Q

opioid long-term use

A
  • physical dependence
    • can lead to abuse or illicit use
    • withdrawal: must taper
  • tolerance
    • diminished therapeutic response
    • will not get relief or SE from normal dose
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44
Q

acute opioid OD

A
  • s/sx
    • resp depression
    • coma
    • pinpoint pupils
  • Tx
    • stop med
    • CPR
    • antidote: naloxone
    • mechanical ventilation
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45
Q

PCA

A

panti-controlled analgesia

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46
Q

PCA pump

A
  • allows self-admin
  • pt must be awake
  • don’t let family push button
  • on-demand only or basal rate with PRN dose
  • when switching to PO: ensure adequate pain control
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47
Q

NSAIDs to know

A
  • 1st gen (COX-1 and COX-2)
    • ibuprofen (Advil, Motrin)
    • aspirin (Bayer, etc.)
    • naproxen (Aleve)
    • indomethacin
    • diclofenac
    • ketorolac (Toradol)
    • meloxicam (Mobic)
  • 2nd gen (COX-2)
    • celecoxib (Celebrex)
48
Q

diuretics

A
  • baseline and ongoing assess
    • wt
    • VS
    • I&O
    • electrolytes
    • BG
    • LFT
    • cholesterol
  • teach about s/sx of electrolyte and fluid imbalance
  • usually given early in day, esp when scheduled
  • consider foley in immobile pts
  • add to fall risk
49
Q

loop diuretics

A
  • MOA: block reabsorption of Na and Cl to prevent water reabsorption
  • used when large amts need to be excreted (pulmonary edema, conditions not responsive to other diuretics)
  • ototoxic - monitor for tinnitus
  • can cause hypokalemia
    • vomiting, fatigue, cramps, weakness
    • monitor labs
    • teaching: high-K+ foods: bananas, potatoes, dried fruit, nuts, spinach, citrus
50
Q

diuretics to know

A
  • loop
    • furosemide (Lasix)
  • thiazide
    • hydrochlorothiazide (Microzide)
  • K-sparing
    • spironolactone (Aldactone)
  • osmotic
    • mannitol (Osmitrol)
51
Q

loop and thiazide diuretics interactions

A
  • digoxin toxicity: monitor cardiac status and K levels
  • antihypertensives: ↑ hypotension, monitor VS
  • lithium: ↑ effects → toxicity, esp if hyponatremic
  • NSAIDS: block diuretic effects
52
Q

thiazide diuretics

A
  • MOA: same as loop, but milder effects
  • same interactions as loop
  • first line med for essential HTN
  • risk for hypokalemia
  • hyperglycemia - monitor BG
  • hyperuricemia, hypomagnesemia, ↑ lipids
    • monitor labs
    • hypomagnesemia s/sx: weakness, muscle twitching, tremors
53
Q

s/sx of hypokalemia

A
  • vomiting
  • fatigue
  • leg cramps
  • weakness
54
Q

s/sx of hypomagnesemia

A
  • weakness
  • muscle twitching
  • tremors
55
Q

hyperuricemia

A

excess uric acid in blood

56
Q

K-sparing diuretics

A
  • MOA: block action of aldosterone → K+ retention, Na and water excretion
  • combined with other diuretics to spare K+ in HTN Tx
  • monitor for hyperkalemia
    • > 5
    • weakness
    • fatigue
    • dyspnea
    • dysrhythmias
    • N&V
  • endocrine SE
    • impotence
    • gynecomastia
    • hirsuitism
57
Q

s/sx of hyperkalemia

A
  • weakness
  • fatigue
  • dyspnea
  • dysrhythmias
  • N&V
  • K+ > 5
58
Q

K-sparing diuretics interactions

A
  • ACE inhibitors → ↑ K+ retention
  • K+ supplements: hyperkalemia
59
Q

K-sparing diuretics contraindication

A
  • kidney failure
  • anuria
60
Q

osmotic diuretics

A
  • MOA: ↑ serum osmolality: pulls water into vascular system for excretion
  • uses: ↓ ICP, IOP; protect kidneys during AKI
  • complications
    • HF, pulmonary edema: crackles, dyspnea, wt gain NVD
    • rebound ICP: change in LOC, HA, N&V
    • metabolic acidosis: restlessness and drowsiness
  • contraindications
    • active intracranial bleed
    • anuria
    • severe pulmonary edema
    • dehydration
    • renal failure
  • interactions
    • lithium: monitor lithium levels, may need ↑ dose
    • ↑ risk for hypokalemia with cardiac glycosides
61
Q

potassium

A
  • reference: 3.5-5.0 mEq/L
  • monitor lab, ECG
  • s/sx of hypo
    • anorexia
    • N&V
    • lethargy
    • muscle weakness
    • leg cramps
    • LOC/orientation: confusion, anxiety, apathy, irritability, coma
    • CV changes
  • s/sx of hyper
    • muscle weakness: legs → trunk
    • fatigue
    • nausea
    • bradycardia
    • possible dysrhythmia
    • parathesias
  • dietary
    • hyper: avoid high-K+ foods
    • hypo: eat more potatoes, bananas, nuts, dried fruit, spinach
62
Q

s/sx of hypoglycemia

A
  • ↓ BG
  • shaking
  • tachycardia
  • diaphoresis
  • dizziness
  • anxiety
  • hunger
  • vision changes
  • weakness
  • fatigue
  • HA
  • irritability
  • → insulin shock
63
Q

s/sx of hyperglycemia

A
  • extreme thirst
  • urinary frequency
  • dry skin
  • hunger
  • blurred vision
  • drowsiness
  • slow wound healing
64
Q

insulin

A
  • MOA: promote cellular uptake of glucose; glucose → glycogen; move K+ into cells
  • use: control BG, Tx for acute hyperkalemia
65
Q

types of insulin

A
  • rapid
    • lispro (Humalog)
    • aspart (NovoLog)
    • glulisine (Apidra)
  • short: regular (Humulin R, Novolin R)
  • intermediate
    • NPH (Humulin N)
    • detemir (Levemir): dose-dependent (more med = longer duration), so 0.4 U/kg = 20-24 hr, long-acting; do not mix, do not give IV
  • long: glargine (Lantus)
66
Q

insulin dosing

A
  • titrated to pt needs
  • pt should track BG
  • A1c: average BG over 3 mo
  • intermediate/long: adjusted over time
  • rapid and short: based on BG level or CHO count
  • pts may need larger dose when
    • sick
    • stressed
    • growing
    • pregnant
    • taking meds
    • eating more
  • pts may need smaller dose when exercising or early pregnancy
67
Q

mixing insulin

A
  • inject air: cloudy, then clear
  • draw up: clear, then cloudy
68
Q

abrupt onset hypoglycemia

A
  • SNS effects
  • tachycardia
  • palpitations
  • diaphoresis
  • shakiness
69
Q

gradual onset hypoglycemia

A
  • PNS manifestations
  • HA
  • tremors
  • weakness
70
Q

Tx of hypoglycemia

A
  • conscious pts: snack of 15g carbs
    • 4 oz OJ
    • 2 oz grape juice
    • 8 oz milk
    • glucose tabs per package instructions
  • unconscious pts: IV glucose or SQ/IM glucagon
  • encourage medical alert bracelet
71
Q

self-injection teaching

A
  • rotate injection sites with 1 in between to prevent lipohypertrophy
  • stay a few inches from umbilicus
  • pinch skin up if not enough SQ fat for needle
72
Q

glucagon

A
  • use: ↑ BG in hypoglycemic emergency
  • routes: SQ, IM, IV
  • give food when pt conscious
  • look for BG > 50 after admin
73
Q

s/sx of hypothyroidism

A
  • intolerance to cold
  • receding hairline, hair loss, brittle hair and nails, dry skin
  • extreme fatigue, lethargy, apathy
  • dull, blank expression
  • facial and eyelid edema, thick tongue
  • anorexia, constipation
  • muscle aches, weakness
  • menstrual disturbances
  • late s/sx
    • ↓ body temp
    • bradycardia
    • wt gain
    • ↓ LOC
    • thick skin
    • cardiac complications
74
Q

levothyroxine

A
  • synthetic thyroid hormone replacement
  • most common, though others exist
  • overmedication = hyperthyroidism
  • ↑ metabolic rate and fxn
  • start low and go slow
  • watch for and report s/sx of hyperthyroidism
  • admin: take on empty stomach with no other meds
  • monitor: TSH, T4
  • lifelong therapy needed
  • eval: better mood and energy, ↑ appetite, stable temp, ↓ wt
75
Q

s/sx of hyperthyroidism

A
  • intolerance to heat
  • fine, straight hair; finger clubbing; localized edema
  • tremors, muscle wasting
  • diarrhea, wt loss
  • bulging eyes, enlarged thyroid
  • facial flushing, ↑ systolic BP
  • breast enlargement, menstrual changes
76
Q

anti-thyroid meds

A
  • propylthiouracil (PTU)
  • methimazole
  • radioactive iodine
  • Lugol’s solution (strong iodine)
77
Q

PTU and methimazole

A
  • blocks synth of thyroid hormone, inhibits iodine use by gland
  • overmedication = hypothyroidism
  • complications: agranulocytosis, hypatotoxicity
  • teaching
    • report
      • s/sx of hypothyroid
      • sore throat
      • fever
    • monitor CBC, LFT
    • onset: 1-2 wks
    • do not d/c abruptly
78
Q

radioactive iodine

A
  • destroys thyroid tissue permanently
  • high dose: treat hyperthyroid
  • low dose: thyroid scan
  • complications
    • radiation sickness (monitor for s/sx)
      • hematemesis
      • epistaxis
      • severe N&V
    • bone marrow depression (monitor CBC)
  • teaching/admin
    • limit contact with others to 30 min/day
    • 2-3 L of fluid/day
    • follow protocol for human waste disposal
79
Q

Lugol’s solution

A
  • non-radiactive iodine
  • MOA: inhibits thyroid hormone production and blocks release of hormone to bloodstream
  • uses: ↓ size of thyroid before surgery, emergency Tx of thyrotoxicosis
  • complication: iodism
    • s/sx
      • metallic taste
      • stomatitis
      • sore teeth, gums
      • HA
      • rash
      • severe GI distress
      • swelling of glottis
    • notify provider, stop Tx
    • give thiosulfate, gastric lavage
  • teaching/admin
    • ↓ Na intake
    • eval: wt gain, normal sleep, WNL HR
80
Q

antidiuretic hormone

A
  • vasopressin
  • desmopressin (DDAVP)
81
Q

diabetes insipidus

A
  • body can’t manage water balance
  • polyria, polydipsia
  • UOP up to 15 L/day
  • Tx: ADH (vasopressin, desmopressin)
82
Q

ADH

A
  • promotes reabsorption of water in kidney
  • vasoconstriction
  • uses
    • Tx of diabetes insipidus
    • sometimes in code blue to ↑ central blood flow
    • control some types of bleeding
  • desired outcomes
    • ↓ UOP, about 1.5-2 L/day
    • ↑ BP (code blue)
    • controlled bleeding
      • desmo: hemophilia
      • vaso: GI bleed
83
Q

ADH SE and interactions

A
  • water intoxication
    • reabsorb too much water
    • monitor for s/sx
      • sleepiness
      • pounding HA
    • ↓ H2O intake
  • myocardial ischemia
    • contraindicated in CVD
    • monitor ECG, BP
  • monitor I&O, UA specific gravity, electrolytes
84
Q

adrenal hormone replacement

A
  • hydrocortisone, prednisone
  • SE
    • hyperglycemia
      • monitor BG, insulin needs
    • osteoporosis (long-term use)
      • Ca and vit D supplements
    • adrenal insufficiency (abrupt d/c)
      • TAPER
    • PUD, GI discomfort
      • monitor for blood in stool, abd pain
      • prophylactic H2 blocker
    • infection: monitor for s/sx
  • eval: relief of sx of adrenal insufficiency
    • weakness
    • hypoglycemia
    • hyperkalemia
    • fatigue
85
Q

s/sx of adrenal insufficiency

A
  • weakness
  • hypoglycemia
  • hyperkalemia
  • fatigue
86
Q

med types for Tx of PUD

A
  • abx
  • H2 blockers
  • PPIs
  • antacids
  • prostaglandin E analog
  • mucosal protectant
87
Q

abx for PUD

A
  • amoxicillin (Amoxil)
  • bismuth (Pepto-Bismol)
  • clarithromycin (Biaxin)
  • metronidazole (Flagyl)
  • tetracycline
  • tinidazole
88
Q

general rules for abx

A
  • take all of medicine, even if you start feeling better
  • the more frequent the dosing, the higher risk of noncompliance
  • for nausea: take with small amount of food unless contraindicated
  • report allergic rxn: rash, hives, itching, anaphylaxis
  • treat anaphylaxis as emergency
    • wheezing
    • swelling of lips, tongue, throat
    • difficulty breathing
89
Q

H2 blockers

A
  • not antacids
  • MOA: block histamine, one of the first stimuli for acid production
  • onset: within 1 hr
  • duration: 9-12 hr
90
Q

PPIs

A
  • MOA: block proton pump that exchanges H+ for K+, suppressing acid secretion
  • onset: up to 4 days
  • duration: 1-3 days
  • greater acid suppression than H2 blockers: suppresses all acid secretion, not just one stimulus
91
Q

antacids

A
  • MOA: directly neutralize acid in stomach
  • onset: 5 min
  • duration: 30-60 min
  • Al and Ca compounds: constipation
  • Mg compounds: diarrhea
  • MANY interactions; should be taken 1 hr before or 2 hr after any other meds
92
Q

prostaglandin E analog

A
  • misoprostol
  • acts like prostaglandins, which protect stomach mucosa
  • pregnancy risk category X
93
Q

PUD emergent sx

A
  • acute severe abd pain
  • blood in stool or vomit
  • coffee-ground emesis (hematemesis)
94
Q

things to avoid with PUD

A
  • spicy foods
  • caffeine
  • nicotine
  • NSAIDs
  • anticoagulants
95
Q

bulk-forming laxatives

A
  • psyllium
  • can cause obstruction of esophagus, intestines
96
Q

surfactant laxatives

A
  • stool softener
  • docusate sodium
  • often given as preventative with opioids
97
Q

stimulant laxatives

A
  • bisacodyl
  • alters fluid/electrolyte transport
  • fluid accumulation in bowel stimulates peristalsis
98
Q

osmotic laxatives

A
  • magnesium hydroxide
  • lactulose
  • bowel prep
99
Q

laxative considerations

A
  • Hx: duration of use
  • bulk laxatives: take with water to prevent obstruction
  • all can lead to diarrhea
  • goal: return to regular, soft, easy BMs
100
Q

laxative contraindications

A
  • fecal impaction
  • bowel obstruction
  • acute surgical abd (risk of perforation)
  • nausea, cramping, abd pain
  • ulcerative colitis, diverticulitis (except bulk-forming)
101
Q

some roles of vitamins and minerals

A
  • RBC production
  • bone building
  • nerve cell fxn
  • hormone production
102
Q

complications of vitamin and mineral deficiency

A
  • anemias
  • heart dz
  • cancers
  • osteoporosis
103
Q

iron supplement SE

A
  • constipation
  • nausea
  • diarrhea
  • vomiting
  • backache
104
Q

iron supplement teaching

A
  • take on empty stomach 1 hr before meal unless GI distress occurs
  • extra vitamin C helps absorption of PO Fe
  • harmless green or black stools
  • therapy duration: 1-2 mo
  • eat foods high in Fe
    • liver
    • egg yolk
    • muscle meat
    • yeast
    • grains
    • green, leafy veggies
105
Q

evaluation: iron supplement

A
  • 4-7 days: ↑ reticulocyte
  • 1 mo+: ↑ Hgb of 2 g/dL
  • improvement in skin and mucuous membrane pallor, energy level, fatigue
106
Q

potassium chloride

A
  • essential for conduction of nerve impulses, electrical excitability of muscle, regulation of acid/base balance
  • use
    • hypokalemia
    • supplement for K+-depleting meds
    • excessive vomiting, diarrhea, laxatives, intestinal drainage, GI fistula
107
Q

potassium chloride complications

A
  • GI distress and ulceration
    • N&V
    • diarrhea
    • abd pain
    • esophagitis
    • take with food or 8 oz water
  • hyperkalemia
    • eval with serum level
    • for IV admin: monitor for s/sx of hyperkalemia
108
Q

supplements in medication Hx

A
  • always ask what they’re taking and why
  • be respectful
  • put on list, tell provider and pharmacist
  • recognize serious SE/AE
  • teach pt
109
Q

asthma

A
  • chronic airway dz
  • inflammatory disorder: inflammation or hyper-responsiveness
  • intermittent and reversible
  • airway obstrution - small airway dz
  • leads to
    • bronchoconstriction
    • bronchospasm
    • can be sudden
110
Q

COPD

A
  • chronic
  • constant, often with worsening periods
  • progressive
  • largely irreversible
  • airflow restrictions and inflammation
  • most cases preventable (smoking)
111
Q

lower resp disorder Tx

A
  • bronchodilators (beta2-adrenergic agonists)
  • methylxanthines
  • inhaled anticholinergics
  • anti-inflammatory meds
    • glucocorticoids
    • mast cell stabilizers
    • leukotriene modifiers
112
Q

beta2-adrenergic agonists

A
  • prototype: albuterol (Ventolin, Pro-Air)
  • action: activate receptors in bronchial smooth muscle to relax and dilate
  • bronchospasm relieve, histamine blocked, diliary motility increased
  • routes: inhalation (short-acting), oral
  • uses: prevention of exercise-induced asthma, bronchospasm, long-term control of asthma
113
Q

beta2-adrenergic agonist complications

A
  • tachycardia, agina
    • monitor for chest, jaw, arm pain or palps; notify of HR increase > 20-30 bpm
    • avoid caffeine
    • may need lower dose
  • tremors: usually resolve with continued use
114
Q

anticholinergics (inhaled)

A
  • prototype: ipratropium (Atrovent)
  • other: tiotropium
  • MOA: blocks muscarinic receptors for bronchodilation
  • use: relieves bronchospasm
    • COPD
    • allergen- or exercise-induced
    • off-label: asthma
115
Q

methylxanthines

A
  • prototype: thophylline
  • relaxes bronchial smooth muscle
  • route: PO or IV (emergency only)
  • acts like caffeine (avoid drinking caffeine when using)
116
Q
A

2020 Pharmacology I (21 decks)

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