Final Review Flashcards
Complications of diuretics
Electrolyte imbalance (potassium - hypokalemia)
Dehydration
Hypertension
Fluid loss
Define muscular atrophy - what is it, what does it look like
Breakdown of muscle tissue
Not using muscles enough
Paralysis, coma, bed rest could cause it
Compare to opposite side of the body - smaller
Intended use and side effects of steroids
Intended use - reduce inflammation
Side effects - infection, bulking up/weight gain, buffalo hump, moon face
Complications of peptic ulcer disease
Fistulas Common from H.pylori, overuse of aspirin Hematemesis (vomiting blood) Weight loss if severe Pain
What does Warfarin do and what does too much Warfarin look like
Blood thinner
Prevents clots from forming
Slower than Heparin
Monitor PT
Use electric razor, no contact sports, watch for excessive bruising
Avoid grapefruit juice (it contains Vitamin K which could decrease the effects)
Sympathomimetic bronchodilators
Mimics sympathetic nervous system - beta 2
Bronchodilate before giving steroids
Asthma, exacerbation of COPD
Side effects: increased HR, increased BP, restlessness
If your patient has been newly diagnosed with COPD, what medications would you see them taking
Bronchodilators if they’re having exacerbation
Steroids to decrease inflammation
Mucolytics to reduce mucous
Encourage coughing and deep breathing
Some things that cause constipation
Opioids Some foods Dehydration Lack of exercise/movement Menopause To decrease constipation - increase fluids, exercise, laxatives/stool softeners
What might cause a patient to be in a fluid volume overload/deficit
Fluid overload - renal disease, ineffective cardiac output, drinking too much fluid, SIADH
Fluid deficit - diabetes insipidus, diuretics, dehydration
Patient education for patient going home on a diuretic
Increased urination Monitor urine output Daily weight check - notify doctor if greater than 3 lbs a day Take in fluids but don’t over hydrate Take diuretics in the morning Hypernatremia, hyperkalemia Main electrolyte to monitor is potassium Monitor for signs of hypotension - dizziness, lethargy, fatigue, bounding pulse
What are some side effects of narcotics
CNS depression
Respiratory depression
Altered levels of consciousness
Consideration to keep in mind when prescribing meds to an elderly patient
Decreased kidney and liver function Decreased drug excretion Toxic high levels in body Adverse effects of meds Start low, go slow with prescription
What is the normal range for sodium in the body
135-145
Hyponatremia - excess fluid
Hypernatremia - dehydration
First signs and symptoms are neuro: HA, confusion, and altered consciousness
What medications would you give to someone who has the common cold (URI)
Antitussive - suppress cough
Decongestant - pseudoephedrine
- too much can cause rebound congestion
- increased HR and BP
Potential physiologic changes with GERD
Barrett’s esophagus - acid damaging lining of tissue of esophagus
Aspiration
Patient education to consider if sending someone home on a corticosteroid inhaler
Rinse mouth after - can cause thrush an decrease normal flora of the mouth
Use a spacer
Not an emergency inhaler
Localized - don’t have to worry about Cushing’s
What would you teach your patient who is taking a drug that is treating high cholesterol (statin)
GI upset
If your patient has gone to surgery who is oversedated, what do you do
Check for respiratory depression
Give Narcan
Antacids
Stabilize pH in the stomach Used for GERD Some drug to drug interactions Can be taken as a calcium supplement Problems - electrolyte imbalance, heart failure (depending on type of antacid), could be masking a deeper problem
If you give someone medication for pain, how do you assess them afterwards
Pain level, where it is located, if it’s radiating, when it started, quality of pain
Last time they received the medication
Opioids - respiratory depression, CNS depression
Levothyroxine (Synthroid)
Thyroid medication for hypothyroidism
Take first thing in the morning
Slow to work
Signs of a functioning thyroid
Effects of glargine lantus insulin
Long acting (24 hours) Onset 1 hour “1 day is 24 hours” Take first thing in the morning No peak Type 2 diabetes
Categories of drugs
Schedule I — most potential for abuse and dependence, no medicinal qualities (Heroin, LSD, Marijuana, Ecstasy, Peyote)
Schedule II — high potential for abuse and dependence, some medicinal qualities (Vicodin, Cocaine, Meth, OxyContin, Adderall)
Schedule III — moderate potential for abuse/dependence, acceptable medicinal qualities, doctor’s prescription required (Tylenol w/ Codeine, Ketamine, Steroids, Testosterone)
Schedule IV — low potential for abuse/dependence, acceptable medicinal qualities, prescription required but fewer refill regulations (Xanax, Darvan, Valium, Ativan, Ambien, Tramadol)
Schedule V — lowest potential for abuse/dependence, acceptable medicinal qualities, prescription required, fewest refill regulations (Robitussin AC, Lomotil, Motofen, Lyrica)
If you have a patient with a disease such as TB, what are some assessments/treatments
Bacterial infection of the lungs
Drug to treat is INH (antibiotic), Rifampin (can cause liver failure, urine to turn orange)
Airborne precautions
Stays dormant in lungs, immunosuppression will reactivate it (steroids)
What to do if you have a medication to give but have never seen it before
Look up indications/contraindications
Drug to drug interactions
Patient history
Side effects of antihistamines
Nausea and vomiting
Drowsiness
First generation vs second generation
- First generation causes drowsiness, second generation doesn’t
Side effects of sympathomimetic stimulants
Increase HR, BP
Decrease urinary output and bowel movements
What does pro arrhythmic mean
Causes a new arrhythmia
Consider dyrythmias - amiodarone
Lispro humalog insulin
“Lispro, let’s go”
Fast acting
Give with food
Onset 5-15 min, peak 30-60 min, duration 2-4 hours
What is a cross allergy of penicillin
Cephalosporins
Causes of acute pyelonephritis
Untreated UTI
Signs and symptoms - flank pain, proteinuria, elevated WBC, cloudy urine
Some factors that affect drug metabolism
Old age
Liver function
Weight
Gender
If the patient is on diuretics and starts complaining of blurred vision and nausea, what are you going to do
Check vitals and electrolytes - potassium
What are some adverse effects of long-term corticosteroid therapy
Cushing’s - moon face, buffalo hump
Fluid and electrolyte imbalance
Increased appetite
Decreased immune function
Chest pain
Nitroglycerin - decreases BP
MONA - morphine, oxygen, nitroglycerin, aspirin
Patient teaching with steroids
Don’t stop too quickly - so body can adjust and begin to make their own steroids
Decreased immune system
Take in the morning - can make you alert and excited
How would you treat pernicious anemia
Vitamin B12
Difference between BUN and serum creatinine
Blood Urea Nitrogen - do not depend on BUN alone because it can be increased if patient is dehydrated
Serum Creatinine - better picture of glomerular function
What is benign prostatic hyperplasia and how to treat it
Enlarged prostate that causes difficulty urinating
Treat with Flomax
Pregnant women should not handle the drug
May take 3-4 months before seeing effect
Don’t have kids for a while because it can have toxic effects
Crohn’s Disease
Inflammatory bowel disease Can occur in any part of the GI tract Autoimmune Medications: steroids Painful
Risk factors for strokes
Modifiable - high BP, smoking, sedentary lifestyle, oral birth control
Non modifiable - family history, age
Anticoagulants
Blood thinners
Given to prevent blood clots
Warfarin (Coumadin)
- PO, slow
- Antidote — vitamin K
- Monitor PT and INR
Heparin, Lovenox
- antidote — protamine sulfate
- heparin — monitor PTT
- works faster
- lovenox can be administered at home, does not require labs
Contraindications - active bleed
GI Bleed vs Iron Stool
GI Bleed - black tarry stool (melena)
Iron Stool - clay and dark stool
Why would you give a patient atropine that’s going into surgery
Anticholinergic
Slows motility
Decreases saliva (patient could aspirate during surgery)
Alpha and beta receptors
Sympathetic
Beta 1 - heart
Beta 2 - lungs
Alpha 1 - nerve membranes (blood vessels, iris, bladder)
Alpha 2 - stimulation decreases SNS output
Digoxin toxicity
Too little potassium
Potassium and digoxin fight for the same receptor
Not enough potassium allows digoxin to take over
NSAIDS
Used for pain and inflammation Inhibit prostaglandin synthesis Cox 1 - “Blood will run” - NSAIDs that block Cox 1 increases risk of bleeding Cox 2 - “Nothing gets through” - NSAIDs that block Cox 2 can increase the risk of stroke and clots
Example of a drug allergy and drug adverse effects
Allergy - anaphylaxis
Adverse effects - GI upset
Antibiotic used to treat MRSA
Vancomycin
Adverse effects: tinnitus, Red Man Syndrome
Organ for excretion of drugs
Kidneys
Adverse effects of opioids
CNS depression
Constipation
Respiratory depression
When would you give codeine
To suppress cough
Do not give to someone who is sedated, comatose, or cannot clear their own airway
Define what a subdural hematoma
Bleed under the dural layer
Can be caused by fall, car crash
Decreased levels of consciousness
Medications to not give for active brain bleeding
Aspirin
Anything that inhibits Cox 1
Seizure medications
Decrease brain activity
Do not give to someone who already has an altered level of consciousness
Dilantin (Phenytoin)
Anti-seizure medication
Dizziness, nausea, vomiting
Fall risk
Cause behind Parkinson’s
Not enough dopamine
Baclofen
Anti spasmodic
Monitor CNS and respiratory depression
Dysphagia
Difficulty swallowing
Aspiration - make sure airway is cleared
Adverse effects of statin medications
Liver damage - jaundice
Main adverse effect of ace inhibitors
Dry cough
End in “-pril”
Modifiable factor of coronary artery disease
Diet
Smoking
Exercise
Acute right lower quadrant pain with rebound tenderness
Appendicitis
Hematochezia
Bleeding in stool
Do you give more fluids with SIADH
No
Fluid restriction
Monitor weight daily
Diabetes that is insulin dependent
Type 1
Hypothyroidism
Constipation
Bradycardia
Feeling cold
Lower metabolism
Adverse effects of ciprofloxacin
“Cipro, hell no”
Suicide
Aortic tendon rupture
When would client stop taking antibiotic
Once entire course is finished
Severe allergy
If stopped early, at risk for antibiotic resistant infection/superbug (c.diff)
Treatment for hyperthyroidism
Radiation
Thyroid removal - have to take synthroid
What does bactrim do
Sulfonamide drug
Can be used for UTI
What is stress incontinence
Pressure that causes leakage
Some factors that can contribute to development of CKD
Untreated UTI
Chronic hypertension
Some things that can cause development of UTI
Dehydration
Old age (confusion)
Bacteria (wiping back to front)
What does zofran do
Treats nausea
Conditions that can cause nausea and vomiting
Everything
Risk factors for peptic ulcer disease
H.pylori
Excessive aspirin use
