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Pharm Exam 2 > Flashcards > Flashcards

Flashcards

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
Q

Which type of insulin is the only insulin that can be administered IV?

A

Human regular insulin

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26
Q

Which herbs increase the hypoglycemic effect when taken with insulin?

A

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”

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27
Q

Which can cause hypoglycemia- metformin or glipizide?

A

Glipizide

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28
Q

What are the names of the different insulins?

A

Rapid acting: lispro, aspart, gluisine
Short acting: Regular
Intermediate acting: NPH
Long acting: glargine (lantus), detemir, degludec

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29
Q

Which insulin is drawn into the syringe first when mixing insulins?

A

Regular is drawn up BEFORE nph

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30
Q

Which type of insulin can’t be mixed with other insulin?

A

Long-acting

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31
Q

What is a negative dromotropic effect?

A

Decreases conduction of heart cells

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32
Q

What is a positive inotropic effect?

A

Increases myocardial contraction stroke volume

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33
Q

What is a negative chronotropic effect?

A

Decreases heart rate

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34
Q

What effects does digoxin have?

A

Positive inotropic and negative chronotropic

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35
Q

Which arrhythmias can be treated with digoxin?

A

Atrial fibrillation and atrial flutter

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36
Q

Which herbs interact with digoxin?

A

-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
Q

What is the normal therapeutic level range for digoxin?

A

0.8-2.0

38
Q

What are the signs of digoxin toxicity?

A

D: dysrhythmias
I: Eye (blurred vision and color changes)
G: GI upset (N&V, diarrhea, abdominal pain)

39
Q

What is the antidote for digoxin toxicity?

A

Digoxin-immune Fab

40
Q

What is the concern when taking digoxin with a potassium wasting diuretic?

A

Low potassium increases the drug effects of digoxin, which can increase the risk for toxicity and exacerbate side effects

41
Q

What is the method of action of nitrates to relieve angina?

A

Reduces venous tone, which decreases the workload of the heart and promotes vasodilation

42
Q

What vital signs would you monitor when giving nitroglycerin?

A

Blood pressure, heart rate, O2, and respirations

43
Q

What position should the patient be in when taking nitroglycerin?

A

Sitting or lying position- it can cause hypotension

44
Q

How can a headache be soothed after taking nitroglycerin?

A

Give acetaminophen

45
Q

What should a patient do if they still have chest pains 5 minutes after taking nitroglycerin?

A

Call 911- it may be a medical emergency

46
Q

What is special about the storage of nitroglycerin?

A

They decompose when exposed to light and heat; they need to be kept in their original airtight glass containers

47
Q

When should a patient apply and remove a nitro patch?

A

Apply once in the morning and remove at night (need atleast an 8-12 hour nitrate-free interval)

48
Q

Why should beta blockers never be abruptly stopped?

A

Abruptly stopping can cause angina, palpitations, and high blood pressure

49
Q

Why should patients avoid alcohol, caffeine, and tobacco when taking an antidysrhythmic drug?

A

Alcohol can intensify a hypotensive reaction, caffeine increases catecholamine levels, and tobacco promotes vasoconstriction

50
Q

Which diuretics are potassium-sparing?

A

Spironolactone, amiloride, triamterene, eplerenone

51
Q

Which diuretics are potassium-wasting?

A

Loop diuretics (furosemide), thiazides (hydrochlorothiazide)

52
Q

How do diuretics have an antihypertensive effect?

A

They inhibit reabsorption of sodium and water from the kidney tubules, which lowers blood volume

53
Q

What are the two main reasons diuretics are used?

A

To decrease hypertension and edema

54
Q

What are the Contraindications of verapamil?

A

Patients with AV block or HF

55
Q

What is an inotrope?

A

A medication that changes the force of the hearts contractions

56
Q

What is a dromotrope?

A

A medication that changes the conduction speed in the AV node (rate of electrical impulses)

57
Q

What is a chronotrope?

A

A medication that changes the heart rate

58
Q

What drugs are used for heart failure?

A

ACE inhibitors, ARBs, diuretics, and beta blockers

59
Q

At what heart rate is it unsafe to give digoxin?

A

If the apical heartrate is <60 bpm

60
Q

Which electrolyte Imbalance increases the risk of digoxin toxicity?

A

Hypokalemia

61
Q

What time of day is best for taking diuretics?

A

The morning- this prevents issues with nocturia

62
Q

What are the pharmacodynamics of diuretics?

A

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
Q

Which diuretics are the weakest?

A

Potassium-sparing

64
Q

What are the first-line drugs for treating mild hypertension?

A

Diuretics

65
Q

Why are diuretics commonly given with antihypertensive drugs?

A

Many antihypertensive can cause fluid retention

66
Q

Which antihypertensives can cause fluid and sodium retention and are commonly taken with a diuretic?

A

Beta-blockers

67
Q

What are the pharmacodynamics of cardioselective beta adrenergic blockers?

A

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
Q

Which beta adrenergic blockers are cardioselective?

A

Acebutolol, atenolol, betaxolol, bisoprolol, metoprolol

69
Q

What are the pharmacodynamics of the nonselective beta adrenergic blockers?

A

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
Q

What are the nonselective beta adrenergic blockers?

A

Propranolol, carvedilol

71
Q

What are the main side effects of beta blockers?

A

Decreased pulse rate, markedly decreased BP, bronchospasm (only in nonselective)

72
Q

What could happen if a patient abruptly stopped taking antihypertensives?

A

Rebound hypertension, angina, dysrhythmias, and MI can occur

73
Q

Why are non-selectice beta blockers not indicated for patients with respiratory disease?

A

The unopposed parasympathetic tone causes bronchoconstriction

74
Q

How do ACE inhibitors affect potassium levels?

A

ACE inhibitors block the release of aldosterone, retaining potassium and excreting water and sodium

75
Q

Which ACE inhibitor should not be taken with food?

A

Moexipril

76
Q

What is the ACE cough?

A

A constant, irritated cough. May be relieved by discontinuance of drug - often, an ARB will be substituted without cough as a side effect

77
Q

What is the difference between ACE inhibitors and ARBs?

A

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
Q

What is general patient teaching for antihypertensives?

A

-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
Q

What are the s/sx of rhabdomyolysis?

A

Dark red or brown urine, little to no urine, muscle aches, muscle swelling, weakness, fatigue, N/V

80
Q

What is the mechanism of action of an HMG-CoA reductase inhibitor in reducing cholesterol?

A

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
Q

What is rhabdomyolysis? When should patients report symptoms?

A

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
Q

What are the common GI disturbances of taking an HMG-CoA reductase inhibitor?

A

Nausea, diarrhea, constipation, abdominal pain, and dyspepsia

83
Q

Why is taking an HMG-CoA inhibitor a “lifetime commitment”?

A

Stopping drug therapy will allow cholesterol and LDL levels to return to pretreatment levels

84
Q

Why shouldn’t you abruptly stop a statin drug?

A

It could cause a threefold rebound effect that may cause death from acute myocardial infarction

85
Q

What liver enzymes are monitored when taking a statin?

A

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
Q

What is important to tell a patient when educating about preparation for a blood lipid level test?

A

Fast for 8-12 hours before getting blood drawn

87
Q

What is important to remember about statins?

A

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
Q

How does levothyroxine affect vital signs?

A

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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