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1
Q

What routes are growth hormones usually given?

A

Subcutaneous or intramuscular

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2
Q

What nursing assessments are important for baseline values before starting growth hormone?

A

Blood glucose (high doses can cause hypoglycemia), electrolytes, height and weight, GH levels, whether or not epiphyses have closed (for use in children- acts on newly forming bones)

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3
Q

What is the function of ADH?

A

ADH promotes water reabsorption from the renal tubules to maintain water balance in the body fluids

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4
Q

What is the normal urine output in an adult client?

A

30ml per hour, or 400-600 per day

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5
Q

What is important to monitor in patients with diabetes insipidus?

A

I&O, hydration status, and electrolyte levels (specifically potassium- hypokalemia)

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6
Q

What electrolyte Imbalance can SIADH cause?

A

Hyponatremia caused by fluid overload

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7
Q

What are desmopressin and vasopressin? When are they given?

A

ADH analogues- they act like ADH in the body. They are given when ADH is low (like in diabetes insipidus)

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8
Q

Why are vaptans given?

A

To suppress ADH in conditions like SIADH

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9
Q

What nursing assessments are crucial before giving any drugs that affect the hormone ADH?

A

Electrolyte levels, hydration status, history of hyponatremia, Renal function, nutritional status and habits, drinking habits, and hepatic function

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10
Q

What is the drug of choice for hypothyroidism?

A

Levothyroxine sodium (increased levels of T4 and metabolically deiodinated to T3)

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11
Q

What nursing assessments are important for baseline values before starting levothyroxine?

A

TSH, T4, T3, presence of or history of MI or thyrotoxicosis, adrenal values, weight, vitals, pregnancy status, CBC, CMP, liver function, electrocardiograph

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12
Q

Should prednisone be taken with food?

A

Yes- it causes GI upset without

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13
Q

Which patients should not take levothyroxine?

A

Patients with a history of or current MI or thyrotoxicosis; also contraindicated in adrenal insufficiency, cardiovascular disease (cardiac dysrhythmias, hypertension, angina pectoris), diabetes mellitus, osteoporosis, hypopituitarism, and dysphagia

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14
Q

What are the s/sx of thyroid crisis (thyroid storm)

A

Tachycardia, cardiac dysrhythmias, fever, heart failure, flushed skin, apathy, confusion, behavioral changes, and hypotension and vascular collapse later on

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15
Q

What foods should be avoided when taking thyroid drugs to avoid affecting drug absorption?

A

Soy products (estrogen), cruciferous vegetables, iodized salt, shellfish (iodine), and coffee

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16
Q

Which electrolyte is most affected by parathyroid hormone?

A

Calcium

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17
Q

How do the bisphosphonates help combat hyperparathyroidism?

A

Block osteoclast activity, inhibiting mineralization or resorption of the bone which can lessen osteoporosis caused by hyperparathyroidism

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18
Q

What specific Patient education is important for bisphosphonates?

A

Adequate intake of calcium and vitamin D is important, patients who can’t sit or stand upright for atleast 30 minutes after administration or have esophageal strictures cannot take oral bisphosphonates, s/sx of hypocalcemia and hypophosphatemia

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19
Q

Why should prednisone be used cautiously in diabetes?

A

It can cause hyperglycemia (and hypokalemia)

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20
Q

How does prednisone interact with NSAIDS, diuretics, buprooion, and glucosides?

A

NSAIDS: increased side effects, increased drug action of prednisone
Diuretics: increased side effects
Bupropion: Increased risk of seizures
Glycosides: toxicity (halos around lights, dizziness, etc)

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21
Q

Why should patients taking prednisone avoid crowds?

A

They are more susceptible to infections

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22
Q

What are the therapeutic uses for prednisone or any corticosteroid?

A

Inflammation, neoplasms, multiple sclerosis, collagen disorders, dermatologic disorders, adrenocortical insufficiency, Addison disease, suppression of immune responses and adrenal function

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23
Q

What types of disease processes are primarily treated by the glucocorticoids?

A

Trauma, surgery, inflammation, emotional upsets, anxiety, allergic reactions, debilitating conditions, Autoimmune disorders, ulcerative Colitis, glomerulonephritis, shock, ocular and vascular inflammation, polyarteritis nodosa, hepatitis, asthma, drug reactions, contact dermatitis, anaphylaxis, organ transplants

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24
Q

How do aldosterone and Cortisol work in the body specific to fluids, sodium, potassium, and glucose?

A

Aldosterone holds onto sodium and water and rids potassium, Cortisol increases blood glucose

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25
Which type of insulin is the only insulin that can be administered IV?
Human regular insulin
26
Which herbs increase the hypoglycemic effect when taken with insulin?
Black cohosh, garlic, bilberry, ginseng - "the bee gee's feel a little hypoglycemic when they take insulin with herbs like BGBG- that's why they wrote the song staying alive"
27
Which can cause hypoglycemia- metformin or glipizide?
Glipizide
28
What are the names of the different insulins?
Rapid acting: lispro, aspart, gluisine Short acting: Regular Intermediate acting: NPH Long acting: glargine (lantus), detemir, degludec
29
Which insulin is drawn into the syringe first when mixing insulins?
Regular is drawn up BEFORE nph
30
Which type of insulin can't be mixed with other insulin?
Long-acting
31
What is a negative dromotropic effect?
Decreases conduction of heart cells
32
What is a positive inotropic effect?
Increases myocardial contraction stroke volume
33
What is a negative chronotropic effect?
Decreases heart rate
34
What effects does digoxin have?
Positive inotropic and negative chronotropic
35
Which arrhythmias can be treated with digoxin?
Atrial fibrillation and atrial flutter
36
Which herbs interact with digoxin?
-ginseng can falsely elevate digoxin levels -St. John's wort and psylliuk decreases absorption of digoxin -hawthorn may increase drug effects -licorice and aloe can potentiate drug effects of digoxin (promotes potassium loss, increasing effect of digoxin) -ma-huang/ephedra increases risk of toxicity -goldenseal can decrease drug effects -coleus may potentiate effects
37
What is the normal therapeutic level range for digoxin?
0.8-2.0
38
What are the signs of digoxin toxicity?
D: dysrhythmias I: Eye (blurred vision and color changes) G: GI upset (N&V, diarrhea, abdominal pain)
39
What is the antidote for digoxin toxicity?
Digoxin-immune Fab
40
What is the concern when taking digoxin with a potassium wasting diuretic?
Low potassium increases the drug effects of digoxin, which can increase the risk for toxicity and exacerbate side effects
41
What is the method of action of nitrates to relieve angina?
Reduces venous tone, which decreases the workload of the heart and promotes vasodilation
42
What vital signs would you monitor when giving nitroglycerin?
Blood pressure, heart rate, O2, and respirations
43
What position should the patient be in when taking nitroglycerin?
Sitting or lying position- it can cause hypotension
44
How can a headache be soothed after taking nitroglycerin?
Give acetaminophen
45
What should a patient do if they still have chest pains 5 minutes after taking nitroglycerin?
Call 911- it may be a medical emergency
46
What is special about the storage of nitroglycerin?
They decompose when exposed to light and heat; they need to be kept in their original airtight glass containers
47
When should a patient apply and remove a nitro patch?
Apply once in the morning and remove at night (need atleast an 8-12 hour nitrate-free interval)
48
Why should beta blockers never be abruptly stopped?
Abruptly stopping can cause angina, palpitations, and high blood pressure
49
Why should patients avoid alcohol, caffeine, and tobacco when taking an antidysrhythmic drug?
Alcohol can intensify a hypotensive reaction, caffeine increases catecholamine levels, and tobacco promotes vasoconstriction
50
Which diuretics are potassium-sparing?
Spironolactone, amiloride, triamterene, eplerenone
51
Which diuretics are potassium-wasting?
Loop diuretics (furosemide), thiazides (hydrochlorothiazide)
52
How do diuretics have an antihypertensive effect?
They inhibit reabsorption of sodium and water from the kidney tubules, which lowers blood volume
53
What are the two main reasons diuretics are used?
To decrease hypertension and edema
54
What are the Contraindications of verapamil?
Patients with AV block or HF
55
What is an inotrope?
A medication that changes the force of the hearts contractions
56
What is a dromotrope?
A medication that changes the conduction speed in the AV node (rate of electrical impulses)
57
What is a chronotrope?
A medication that changes the heart rate
58
What drugs are used for heart failure?
ACE inhibitors, ARBs, diuretics, and beta blockers
59
At what heart rate is it unsafe to give digoxin?
If the apical heartrate is <60 bpm
60
Which electrolyte Imbalance increases the risk of digoxin toxicity?
Hypokalemia
61
What time of day is best for taking diuretics?
The morning- this prevents issues with nocturia
62
What are the pharmacodynamics of diuretics?
Loop diuretics have a great sluretic (sodium chloride losing) or natriuretic (sodium-losing) effect and can cause rapid diuresis, decreasing vascular fluid volume and causing a decrease in cardiac output and blood pressure. It's potency causes a vasodilatory effect, increasing Renal flow before diuresis
63
Which diuretics are the weakest?
Potassium-sparing
64
What are the first-line drugs for treating mild hypertension?
Diuretics
65
Why are diuretics commonly given with antihypertensive drugs?
Many antihypertensive can cause fluid retention
66
Which antihypertensives can cause fluid and sodium retention and are commonly taken with a diuretic?
Beta-blockers
67
What are the pharmacodynamics of cardioselective beta adrenergic blockers?
Act mainly on the beta 1 rather than the beta 2 receptors; less likely to cause bronchoconstriction, which makes them the preferred beta adrenergic blockers
68
Which beta adrenergic blockers are cardioselective?
Acebutolol, atenolol, betaxolol, bisoprolol, metoprolol
69
What are the pharmacodynamics of the nonselective beta adrenergic blockers?
Inhibit beta 1 (heart) and beta 2 (bronchial) receptors; HR slows, BP decreases secondary to the decrease in HR, and bronchoconstriction occurs because of unopposed parasympathetic tone
70
What are the nonselective beta adrenergic blockers?
Propranolol, carvedilol
71
What are the main side effects of beta blockers?
Decreased pulse rate, markedly decreased BP, bronchospasm (only in nonselective)
72
What could happen if a patient abruptly stopped taking antihypertensives?
Rebound hypertension, angina, dysrhythmias, and MI can occur
73
Why are non-selectice beta blockers not indicated for patients with respiratory disease?
The unopposed parasympathetic tone causes bronchoconstriction
74
How do ACE inhibitors affect potassium levels?
ACE inhibitors block the release of aldosterone, retaining potassium and excreting water and sodium
75
Which ACE inhibitor should not be taken with food?
Moexipril
76
What is the ACE cough?
A constant, irritated cough. May be relieved by discontinuance of drug - often, an ARB will be substituted without cough as a side effect
77
What is the difference between ACE inhibitors and ARBs?
ACE inhibitors inhibit the angiotensin-converting enzyme in the formation of angiotensin II, ARBs block angiotensin II from the angiotensin I receptors found on many tissues
78
What is general patient teaching for antihypertensives?
-do not stop the medication suddenly (may cause rebound hypertension) -do not take if planning to become pregnant -report any occurrence of bleeding -renal function will need to be monitored -take with food -seek medical help if rhabdomyolysis symptoms appear -rise from sitting to standing slowly for the first week, contact provider if symptoms persist
79
What are the s/sx of rhabdomyolysis?
Dark red or brown urine, little to no urine, muscle aches, muscle swelling, weakness, fatigue, N/V
80
What is the mechanism of action of an HMG-CoA reductase inhibitor in reducing cholesterol?
HMG-CoA reductase inhibitors inhibit the enzyme HMG-CoA reductase in cholesterol biosynthesis, which inhibits cholesterol synthesis in the liver; this decreases the concentration of cholesterol, Decreases LDL, and slightly increases HDL cholesterol. This reduces cholesterol, Decreases CAD, and reduces mortality rates
81
What is rhabdomyolysis? When should patients report symptoms?
The muscles begin to break down and die. Patients should report any unexplained muscle tenderness or weakness, especially if accompanied by fever or malaise
82
What are the common GI disturbances of taking an HMG-CoA reductase inhibitor?
Nausea, diarrhea, constipation, abdominal pain, and dyspepsia
83
Why is taking an HMG-CoA inhibitor a "lifetime commitment"?
Stopping drug therapy will allow cholesterol and LDL levels to return to pretreatment levels
84
Why shouldn't you abruptly stop a statin drug?
It could cause a threefold rebound effect that may cause death from acute myocardial infarction
85
What liver enzymes are monitored when taking a statin?
Alkaline phosphatase (ALP), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), AND AST (a lonely pony and lion; the games great, terrific, and super, tony)
86
What is important to tell a patient when educating about preparation for a blood lipid level test?
Fast for 8-12 hours before getting blood drawn
87
What is important to remember about statins?
S- sore muscles? T- toxicity with grapefruit A- ALT/AST monitoring (liver enzymes) T- therapeutic effect (should lower LDL, increase HDL, lower total cholesterol) I- increase glucose N- not a cure!
88
How does levothyroxine affect vital signs?
Increases metabolism, leading to an increase in HR, BP, Glucose levels, and oxygen demands; it can really stress the heart

Pharm Exam 2 (3 decks)

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