FINAL EXAM Review Flashcards
Define obtunded
Mentally dull.
Obtundation is a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states.
What is a gastroscopy?
Gastroscopy (or endoscopy) is an examination of the oesophagus (gullet or food pipe), stomach and duodenum (upper part of the small bowel) using a flexible telescope called a gastroscope.
What is a Cycloplegic eye drop
Cause paralysis of the ciliary muscle, resulting in loss of accommodation for 2 to 48 hours depending on the strength. Doctors use this to allow them to measure a patient’s vision problem
Miotic eyedrops are do what & used for what condition ?
Constrict the pupil. Used to treat glaucoma
Mydriatic eye drops have what effect and are used for?
Dilates the pupil. Used for certain Eye exams and treatment of eye inflammation
What is the antidote for magnesium sulfate?
Calcium gluconate
What is the antidote for heparin/low molecular weight heparin?
Protamine sulfate
What is the antidote for warfarin?
Vitamin K
What is the antidote for acetaminophen?
Acetylcysteine (mucomyst)
What is the antidote for opiates?
Naloxone (narcan)
What is the antidote for benzodiazepines?
Flumazenil
Antidote for digoxin?
Digibind
Antidote for iron?
Deferoxamine
<p>What are schedule 1 medications?</p>
<p>Requires a prescription and provided by pharmacist. Include the following:all prescription drugs, drugs with potential for abuse, controlled drugs, narcotic drugsexample: Morphine</p>
What are schedule 2 medications?
Behind the counter – consultation required from pharmacist example - Ephedrine
What are scheduled 3 medications?
Behind the counter - no consultation or invention required from pharmacist
What are unscheduled drugs?
Can be sold in any store without professional supervision
What is pharmacotherapy?
Application of drugs to prevent disease and ease suffering
What is therapeutic range (duration of action)?
Concentration of the drug that is needed to produce a therapeutic response; Describes when the therapeutic response begins, peaks, and remains therapeutic
What is a loading dose?
A high dosage of the medication administered to a client in order to achieve a quick therapeutic response
what is Pharmacokinetics
How a drug moves through the body (how it is absorbed, distributed, metabolized and excreted)
Repeat four processes: A. D. M. E.
what is Pharmacodynamics
How a drug affects the body (how it works)
Pharmacotherapeutics is
The use of a drug to prevent and treat disease
what is half-life
The time it takes for half of a drug to achieve 50% of the original plasma concentration
Agonist
Drugs that produce the same response as the endogenous substance
antagonist
Drugs that block the endogenous chemical from acting
maintenance drugs are for
chronic conditions
Therapeutic class is
- relates to therapeutic usefulness for treatment
- drugs with similar chemical properties
Pharmacologic class is
“the way a drug works at the molecular, tissue, and body system level”
the effect the drug aims to have on the body
what is drug misuse
Inappropriate use of prescription drugs in a way not intended to be used
what is drug abuse
A pattern of using any drug in such a way that it negatively affects a persons psychological and physiological well-being
what is drug dependence
When someone require a drug to maintain a state of psychological or physical well being.
Adrenergics/Sympathomimetics/Adrenergic agonists produce
fight or flight response
Adrenergic antagonists/antiadrenergics produce
action opposite to adrenergics
rest and digest
Cholinergic/Parasympathomimetics/Muscarinic agonists produce
Rest and digest response
Anticholinergics/muscarinic blockers produce
action opposite of cholinergics
Adrenergic Agonist: What do alpha 1 treat? Action?
treatment of nasal congestion or hypotension, induces mydriasis for eye surgery ex. dopamine (Intropin)
- constricts blood vessels in bronchi
Adrenergic Agonist: What do alpha 2 treat? How is it different from alpha 1?
treatment of hypertension (centrally-acting by inhibiting release of norepinephrine), example: clonidine (Catapres)
Different from Alpha1 as it Acts on the CNS rather than the PNS, and decreases sympathetic activity
Adrenergic Agonist: What do Beta 1 treat?
Cardiac arrest, heart failure, shock. ex. dobutamine (Dobutrex)
- Increases heart rate, force of contraction, velocity of impulse conduction across myocardium
Adrenergic Agonist: What do Beta 2 treat? Non selective?
Asthma and premature labour contractions, example: salbutamol (Ventolin) Bronchodilation
(Nonselective, example: epinephrine stimulates all adrenergic receptors; used for cardiac arrest and asthma.)
what is prazosin (minipress)
Alpha 1 blockers
a medication primarily used to treat high blood pressure, symptoms of an enlarged prostate, and posttraumatic stress disorder (PTSD)
What is the pharmacologic class of metoprolol (lopresssor)
beta-blocker that affects the heart and circulation (blood flow through arteries and veins
- used to treat angina (chest pain) and hypertension (high blood pressure)
what are the direct-acting and indirect-acting actions of Cholinergic Agonist
Direct-acting (muscarinic agonists): Directly bind and activate nicotinic and muscarinic receptors eventually increase smooth muscle tone.
Indirect-acting: inhibitanticholinesterasethe enzyme which destroysacetylcholine
what is the action of Anticholinergics
Occupies acetylcholine receptors, therefore blocking the action of acetylcholine.
Inhibit parasympathetic impulses; induces fight or flight response.
Vitamin A is essential for
Epithelial tissues, skin, eyes, hair, bone growth
Vitamin D is essential for?
Regulates Calcium and Phosphorous
Vitamin E is essential for?
Protects cellular components & RBCs
Vitamin K is essential for?
Required for synthesis of prothrombin & clotting factors
Vitamin B12 is essential for?
RBC formation, CNS maintenance, DNA synthesis
Vitamin B Complex is essential for?
New cell formation, antioxidant, beauty, skin and nails
Vitamin C is essential for?
Helps with iron absorption, normal growth and development
Folic acid is essential for?
DNA synthesis, CNS development of fetus
what are the fat solubles vitamins
Vitamin A, D, E, K
How are water soluble vitamins different from fat soluble? What are the water soluble vitamins?
stored in the body, readily excreted in urine vs. fat soluble which are stored in fatty tissue, liver, and muscle.
- Vitamin B12, B complex, C, Folic acid
Sodium is important for
Nerve conduction, neuromuscular function
Potassium is important for
Conducts nerve impulses to the myocardium, skeletal and smooth muscles
Calcium is important for
Nerve and muscle activity, contraction of the heart muscle, blood clotting, bones and teeth. Should be administered with food
Magnesium is important for
Transmission of neuro muscular activity, myocardium contraction
Iron is important for
Vital for Hgb (hemoglobin) regeneration. Can cause constipation and black/dark green stool.
What do HMG-CoA reductase inhibitors (-statins) do?
Theyre the first line drugs for tx of what disorder?
Inhibit the enzyme HMG-CoA reductase, which results in less cholesterol biosynthesis by liver. Check LFT prior administration.
- Lipid disorders
Bile acid resins or Bile sequestrants
How do they work? How are they eliminated?
Bind bile acids, which contain a high concentration of cholesterol. Because of their large size, resins are not absorbed from the small intestine and the bound bile acids and cholesterol are eliminated in the feces.
Patients need supplements of fat soluble vitamins (A,D,E,K)
What are antilipidemics used to treat?
Cholesterol
What are the actions of bile acid sequestrants?
adjunctive therapy to diet and exercise for the reduction of LDL cholesterol in patients with hypercholesterolemia. Binds bile acids in the GI tract which increases clearance of cholesterol.
how do antianginals work? what are the three types?
They work by either increasing the blood flow to the myocardium or decreasing the O2 demand of the myocardium. Three types: 1) Nitrates 2) Beta blockers 3) Calcium channel blockers
What is the primary therapeutic action of
anti-anginals: Organic Nitrates?
What are the two types?
Can relax both arterial and venous smooth muscles, as well as coronary arteries
- Short Acting: Nitroglycerin SL
- Long-acting: Isosorbide dinitrate
what are Anti-anginals: Beta blockers (-olol) used for? what is the effect?
Used for chronic stable angina.
Negative chronotropic (rate) and negative inotropic effect
(force of contraction)
what are the cardiovascular actions of Calcium channel blockers?
- Relax arteriolar smooth muscle, thus lowering BP and afterload
- Slow conduction velocity, thus decrease HR and cardiac workload
- Dilate the coronary arteries, thus more O2 to the myocardium
calcium-channel blockers are the drug of choice for what?
Drug of choice for variant angina, and may be used monotherapy for pts unable to tolerate beta blockers
What is the drug of choice for chronic stable angina?
beta blockers
drug of choice for acute angina?
nitrates
What are some nursing considerations for antianginals?
- Monitor VS
- Do not crush ER tablets
- Patients on antianginal should avoid taking Sildenafil (Viagra).
- Do not beta-blockers stop abruptly
Differences between thrombolytic drugs, anti-platelets, and anti-coagulants.
- Anticoagulants: Prevent clot formation. Given in DVT to prevent new clot formation. (Ex. Heparin, warfarin)
- Thrombolytic: *dissolve clots. Destroys thrombus, administered in acute MI. Ex. (Reteplase)
- Anti-platelets: Stops platelet aggregation. Contraindicated for patients with bleeding disorders. Ex. Clopidogril
Nursing considerations: what should you monitor for Anticoagulants?
Monitor PTT (partial thromboplastin time) for Heparin and INR (international normalized ratio) for Warfarin
Patients with thromboembolic disorders should avoid
oral contraceptives
Diuretics act by increasing the volume of urine production. They are widely used in the treatment of
Hypertension and Heart failure
Diuretics, in general, reduce total blood volume and circulatory congestion.
What are the potassium-sparing and potassium-wasting diuretics?
- Potassium-sparing, ex: spironolactone (Aldactone)
- Potassium-wasting
1) Thiazide and thiazide-like diuretics, ex: hydrochlorothiazide (HCTZ)
2) Loop, ex: furosemide (Lasix)
how do Calcium Channel Blockers work in lowering BP?
Cause the smooth muscles in the arterioles to relax, lowering PR
What are selective and non-selective Calcium Channel Blockers for Hypertension for?
Selective = blood vessels
(-dipine): nifedipine (Adalat), amlodipine (Norvasc)
non-selective = Blood vessels and heart:
verapamil (Isoptin), diltiazem (Cardizem)
Beta adrenergic antagonists (beta blockers) block
the effects of epinephrine and norepinephrine on the vascular system thus causing vasodilation Ex: metoprolol (Lopresor), timolol (Apo-Timolol)
Drugs that affect the renin-angiotensin-aldosterone pathway decrease blood pressure and increase urine volume. They are widely used in the treatment of HTN, HF, and MI. What are the drugs?
- Angiotensin Converting Enzyme (ACE) inhibitors - (-pril). Ex: Enalapril
- Angiotensin II receptor blockers (ARB) (-sartan). Ex: Losartan
what are Nursing Interventions for antihypertensives?
Monitor VS
Monitor I/O for Diuretics
Instruct to change position slowly to prevent orthostatic hypotension
Administer diuretics in morning
What is the action of Loop Diuretics?
Block the reabsorption of Na+ and Cl- in the loop of Henle. Ex: furosemide
Action of Thiazide and Thiazide-like diuretics
Act on the distal tubule to block Na+ reabsorption and increase K+ and H2O excretion. Ex. Chlorothiazid
Action of Potassium Sparing Diuretics
Block exchange of Na+ and K+ in the distal tubule, causing Na+ to stay in the tubule and leave through the urine, and more K+ to be retained in the body. Ex. spironolactone
Nursing Considerations for Diuretics
Monitor I/O and V/S Monitor weight (baseline weight) Electrolytes (Na+ & K+) Administer in morning Monitor ototoxicity for loop diuretics Monitor lung sounds if patient is getting diuretics for pulmonary edema
Antiarrhythmic: Potassium channel blockers do what?
Delay repolarization of the myocardial cells and lengthen the refractory period. Ex. Amiodarone
Antiarrhythmic: Calcium channel blockers do what?
Work by stopping calcium influx across cardiac and smooth muscle. Ex. Diltiazem
Natural hormones that promote some aspect of blood formation are called? What are examples for hematopoietic disorders?
Nursing considerations?
hematopoietic growth factors. Ex. Epoietin alfa, Erythropoietin Nursing Consideration: Monitor RBC and Hb Can be administered safely for Jehovah’s witness Diet rich in iron may help
what do Expectorants do?
Used to thin bronchial secretions so they can more easily be eliminated by coughing Ex. Guaifenesin
what do Antitussives do?
Used to suppress the cough reflex (usually dry or non-productive cough) Ex. Dextromethorphan
what do decongestants do?
Decongestants produce a vasoconstriction effect Ex. Ephedrine
what do antihistamines do?
Block effects of histamine, given for rhinitis and allergic reactions Ex. Diphenhydramine
What are the 4 Reliever meds for the lower respiratory tact? what are their actions?
- Short-acting β2 agonists (SABA). Sympathomimetics, Relaxes smooth muscle in airways Ex: salbutamol (Ventolin)
- Short-acting anticholinergics (SAAC). Work by antagonizing the actions of acetylcholine. Ex: ipratropium (Atrovent)
- Combination of SABA + SAAC Ex: salbutamol + ipratropium (Combivent)
- Systemic Glucocorticoids Ex. Dexamethasone
What are the 4 Controller meds for the lower respiratory tact? what are their actions?
- Long-acting β2 agonists (LABA). Relax the smooth muscle in the bronchi and increasing bronchodilation Ex: salmeterol (Serevent)
- Long-acting anticholinergics (LAAC). Work by antagonizing the actions of acetylcholine. Ex: tiotropium (Spiriva)
- Inhaled corticosteroids (ICS). Reduce inflammation Ex: budesonide (Pulmicort)
- Combination: Work by combining both a long acting Beta 2 adrenergic agonist with a steroid Ex. Fluticasone and salmeterol (Advair)
Nursing considerations for Medications for Lower Respiratory Tract
- Respiratory assessment
- V/S including RR, O2 sats, BP and HR
- Corticosteroids can increase BP and SABA (Ventolin) can increase HR.
- Administer bronchodilator prior administering inhaled corticosteroids
What chemical depletes in parkinsons?
Dopamine
What 3 types of meds are given for Parkinsons?
Dopamine Agonists/ Dopaminergics, Anticholinergics, and Acetylcholinesterase (AChE) Inhibitors
Dopamine Agonists/ Dopaminergics, Anticholinergics, and ACHe inhibitors are given to help manage Parkinsons disease. What are their actions? examples of meds?
- Dopamine Agonists/ Dopaminergics - Restore dopamine function (regulate movement and emotions)
Ex. Levodopa and Carbidopa - Anticholinergics - Block the effect of ACh (Excitatory neurotransmitor, regulates movement)
Ex. Benztropine - Acetylcholinesterase (AChE) Inhibitors – Increases AcH eventually Increase cognitive function
Ex. tacrine
GABA is the main _______ neurotransmitter. What does it do?
Inhibitory.
works by decreasing brain activity. Although different classes of CNS depressants work in unique ways, ultimately it is their ability to increase GABA activity that produces a drowsy or calming effect.
Serotonin is a ____ neurotransmitter and maintains what?
inhibitory, maintains mood balance
Dopamine is a _____ and ______ neurotransmitter and regulates ?
Inhibitory and excitatory which regulates movement and emotional response. Also helps to regulate reward and pleasure centers in the brain
Norepinephrine is what time of neurotransmitter and what is its action?
Excitatory action related to mood, motor activity, arousal and reward
Acetylcholine is what time of neurotransmitter and what is its action?
Excitatory action which regulates movement and memory
Anticholinergics have what action?
Decrease the activity of acetylcholine.
Not as effective as other agents, therefore mostly used in early onset PD
Mainly used to control tremor and ease dystonia
Example: benztropine (Cogentin)
MS is caused by
CNS demyelination
Centrally acting muscle relaxants are prescribed for MS. What do they cause? Example of drug?
Cause CNS depression
Example: baclofen (Lioresal)- used to relieve painful muscle spasms common in multiple sclerosis, spinal cord lesions or trauma
3 drugs for seizures
Barbiturates, Benzodiazepines, Hydantoins and Phenytoin Like Drugs
Action of Barbiturates. examples
Enhances the inhibitory neurotransmitter GABA, thereby depressing CNS. Ex. Phenobarbital, Gabapentin
Action of Benzodiazepines. examples
Enhances the inhibitory neurotransmitter GABA, thereby depressing CNS. Used for short period of time. Ex. Diazepam, Clonazepam
Action of Hydantoins and Phenytoin Like Drugs:
Suppress Na+ influx by desensitizing Na+ channels. Ex. Phenytoin, carbamazepine
Nursing considerations for Seizure drugs
Nursing diagnosis: Risk for fall
Monitor LOC and RR. Benzodiazepines can cause drowsiness and bradypnea
Phenytoin needs periodic lab works
Antidote for Benzodiazepines is Flumazenil
Phenytoin may change urine color
Antipsychotics all work to decrease
amount of dopamine.
Ex. Resperidone, haloperidol.
Patients with active symptoms and in need of antipsychotics
What are the 3 antidepresants (typical) used and their function
- Selective Serotonin Reuptake Inhibitors (SSRI): slow the reuptake of serotonin (maintain mood) into the presynaptic neuron. It takes up to one month for SSRI to effect and reduce symptoms
- Tricyclic Antidepressants (TCA): Inhibit the reuptake of norepinephrine and serotonin
- Monoamine Oxidase Inhibitors (MAOI): Work by inhibiting monoamine oxidase, the enzyme that breaks down neurotransmitter
Lithium is effective for? what should you monitor?
Effective for mania, bipolar and conduct disorders. Last resort for treatment.
Monitor serum sodium levels closely.
(mechanism of action is unknown)
3 meds for insomnia
Antihistamines Ex: diphenhydramine (Benadryl)
Benzodiazepines- Class of hypnotic medication Ex: lorazepam (Ativan)
Non-benzodiazepines- Class of hypnotic medication Ex: zopiclone (Imovane)
non opioid analgesics vs opioid analgesics - where they act
- Non Opioid Analgesics: act at the peripheral level
- Opioid Analgesics: act in the CNS
what are the 4 classes of drugs for Peptic Ulcers and GERD
- H2- receptor antagonists (Histamine2-blockers)
- Proton pump inhibitors (PPIs)
- OTC antacids
- Antibiotics
H2- receptor antagonists (Histamine2-blockers) - Inhibit histamine at H2-receptor sites in parietal cells, which decreases gastric acid secretions. Long-term use may lead to
Vitamin B12 deficiency.
Ex. Ranitidine (Zantac)
Proton pump inhibitors (PPIs): Blocks the enzyme responsible for HCl secretion. When should it be taken ?
Taken 30 minutes before meals.
Ex. pantoprazole
What are OTC antacids?
Alkaline substances that neutralize gastric acid.
Ex. Calcium Carbonate (Tums)
Medications for Nausea and Vomiting
Anticholinergics and Antihistamines: Work by inhibiting vestibular stimulation in the middle ear. Effective for nausea and vomiting, and motion sickness. Ex. dimenhydrinate (Gravol)
Dopamine Antagonists: Block dopamine II receptor sites in the brain, increase peristalsis. Ex. metoclopramide (Maxeran)
Serotonin (5-HT3) Receptor Antagonists: Suppress nausea and vomiting by blocking serotonin receptors. Preferred drug for serious N/V by antineoplastic therapy, radiation therapy, or surgical procedures. Ex. ondansetron (Zofran)
Culture and Sensitivity test is conducted prior or after administering antibiotics?
Prior
What history needs to be taken before giving antibiotics?
Take history of liver or kidney diseases
Classification of Antibiotics: Cephalosporin is used for
patients allergic to Penicillin
Classification of Antibiotics: Tetracyclines are not to be taken with
milk, iron, magnesium-containing laxatives or antacids.
Classification of Antibiotics: Macrolides may decrease what? and can cause?
May decrease warfarin metabolism and excretion. Can cause hepatotoxicity
Classification of Antibiotics: Fluoroquinolones should not be taken with
with vitamin, mineral supplements or warfarin
Classification of Antibiotics: Sulfonamides may cause
crystals in urine, increase fluid intake
Classification of Antibiotics: Aminoglycoside May cause? Check for what?
nephrotoxicity. Check for BUN and Cr.
Antifungal and Antiviral meds work by
Antifungal Medications: Work by causing the fungal cell wall to become porous and leaky. Ex. Nystatin, fluconazole
Antiviral Medications: Works by inhibiting viral nucleic acid synthesis in the cell. Ex. Tamiflu
