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Nursing > N365 Exam 4 > Flashcards

N365 Exam 4 Flashcards

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1
Q

Antihistamine (H2 blocking agent)
Dec. production of acid & gastrin-enzyme
ADR: Uncommon; HEADACHE, TIREDENESS; dizziness, confusion, myalgias, PNEUMONIA
Good for infrequent, mild symptoms

A

Famotidine (Pepcid)

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2
Q

Proton-pump inhibitor; gastric acid suppressant; “Prodrug” that inhibits H-K-ATPase which produces gastric acid
ADR: headache & N/V/D (short-term use); CKD, dementia, Mag deficiency, PNEUMONIA, weakened bones (long-term use)
MOST EFFECTIVE DRUG FOR DEC. GASTRIC ACID PRODUCTION; good for long-term
Comes in enteric-coated tablet (delayed release)

A

Omeprazole (Prilosec)

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3
Q

Local action on ulcers (forms “Band-Aid); inhibits pepsin, bile salts, and gastric acid
ADR: most common- CONSTIPATION
MUST BE TAKEN ON EMPTY STOMACH!
Do NOT give w/in 30 min of antacid (needs pH >4 for activation)
May bind w/ Tagamet, Dilantin, Tetracycline (separate by 2 hours)
May interfere w/ fat soluble vitamin absorption (K,A,D,E)

A

Sucralfate (Carafate)

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4
Q

Antacid, non-systemic –> Neutralizes gastric acid
ADR: w/ Aluminum –> constipation; w/ Mag –> diarrhea (drug BALANCES the two)
Can reduce absorption of tetracycline, digoxin, INH, & chlorpromazine
MUST BE TAKEN AFTER MEALS

A

Magnesium & Aluminum Hydroxide Gels (Maalox)

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5
Q

Antiflatulent
Causes gas bubbles to coalesce and free the gas, which is then eliminated by belching/passing gas; prevents formation of mucus surrounded gas pockets
ADR: NONE
Often found in combination w/ antacids

A

Simethicone (Mylicon)

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6
Q

Antiemetic, anticholinergic, antihistamine
Decreases GI motility and GI spasm; PREVENTS MOTION SICKNESS
ADR: anticholinergic effects (Sedation, Dry mouth, Blurred vision, Urinary retention
Do NOT use in glaucoma (inc. intraocular pressure)
May MASK Sx OTOTOXICITY

A

Diphenhydrinate (Dramamine)

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7
Q

Antiemetic; acts directly on CTZ and vomiting center
ADR: SEDATION, HYPOTENSION, DYSTONIAS, anticholinergic effects (Blurred vision, Constipation, Urinary Retention; Dry Mouth)
NEVER GIVE IV form!!!!!
Not effective for motion sickness
Synergistic for analgesia

A

Promethazine (Phenergan)

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8
Q

Antiemetic- works in CTZ and antagonizes emesis, Stimulates acetylcholine effect
ADR: CNS (Drowsiness, Dizziness, Anxiety); EXTRAPYRAMIDAL Sx & Gynecomastia
Can be additive to CNS depressants
Administer 30 min BEFORE MEALS
Useful w/ Emetic Anticancer Agents
CONTRAINDICATED: obstruction, hemorrhage, GI tract perforations
May be used for diabetic gastroparesis

A

Metoclopramide (Reglan)

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9
Q

Antiemetic; selective serotonin receptor antagonist
ADR: Constipation, Rashes, Transient Blurred Vision (“buzzy feeling”)
Effective for CINV (give 30 min BEFORE chemo)
Does NOT prevent delayed CINV

A

Ondansetron (Zofran)

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10
Q

Cathartic, saline; Forms MgCl2 in stomach which has laxative effect
ADR: Occasional Diarrhea; May absorb mag ions (only a concern in renal failure!)
Mild drug, often given to children
ADMINISTER W/ LOTS OF WATER
Caution in renal failure!!
Also polyethylene glycol (Miralax)

A

Magnesium hydroxide mixture (Milk of Magnesia)

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11
Q

Cathartic, stimulant; stimulates peristalsis
ADR: Intestinal cramps, diarrhea, Mild rectal burning w/ suppository form
Do not give oral tab with antacid or milk (enteric coated)
Do NOT cut, crush, chew

A

Bisacodyl (Dulcolax)

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12
Q

Bulk-forming laxative; absorbs water, mech. stimulates bowel (IS FIBER SUPP.)
ADR: RARE
Powder must be stirred in 8oz. glass of water and consumed immediately
CAN DECREASE CHOLESTEROL

A

Psyllium (Metamucil)

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13
Q

Emollient agent; acts as detergent (mixes water and fat with stool)
ADR: Negligible. Some diarrhea
Caution: may cause absorption of mineral oil if given together
Not sure if it really does anything!!

A

Sodium docusate (Colace)

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14
Q

Antidiarrheal; similar to an opioid, suppresses bowel motility
ADR: CONSTIPATION, nausea, abd. cramps
BLACK BOX: TORSADES DE POINTES & CARDIAC ARREST w/ high doses!!
Initially Schedule V (d/t opioid-like abuse)

A

Loperamide (Imodium)

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15
Q

Hormone, anterior pituitary; stimulation of adrenal cortex
ADR: delayed wound healing, GI ulcers/perforation, amenorrhea, Cushing’s syndrome, diabetes, withdrawal
Used for diagnostic testing of adrenal insufficiency

A

Corticotropin (ACTH)

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16
Q

Hormone, posterior pituitary; renal conservation of water, contraction of smooth muscle, inc. GI motility
ADR: Excessive vasoconstriction (incl. coronary arteries), arrhythmias, dec. CO; Water Retention & INTOXICATION; Intestinal and Uterine cramps; allergic rxns
Used to treat DIABETES INSIPIDUS

A

Vasopressin (Pitressin, ADH)

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17
Q

Hormone, posterior pituitary; stimulates uterine smooth muscle contraction; some vasopressor activity
ADR: water intoxication w/ large doses; allergic rxns; with injudicious use UTERINE RUPTURE, HYPERTENSIVE CRISIS, CEREBRAL HEMORRHAGE, PELVIC HEMATOMA; bradycardia, arrhythmias

A

Oxytocin (Pitocin, Syntocinon)

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18
Q

Vitamin; stimulates intestinal calcium absorption; dec. calcium excretion, inc. resorption of bone
ADR: HYPERCALCEMIA (anorexia, N/V, weakness, constipation, AMNESIA, disorientation, HALLUCINATIONS, vertigo, headache, THIRST, polyuria, ATAXIA

A

Cholecalciferol/Ergocalciferol (Vitamin D3/D2)

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19
Q

Hypocalcemic hormone; directly inhibits osteoclasts (dec. bone resorption); dec. tubular resorption of Ca
ADR: HYPOCALCEMIA w/ TETANY, allergic rxns, N/V, Tenderness & Swelling of hands
Do NOT give more than 2 cc per site
Used for osteoporosis, hypercalcemia, multiple myeloma

A

Calcitonin-salmon (Miacalcin, Calcimar)

20
Q

Bone resorption inhibitor; inhibits osteoclast activity
ADR: MILD; may have GI distress; can lead to esophagitis and ulcers
MUST BE TAKEN 30 MIN BEFORE FIRST INTAKE OF THE DAY
Take with a FULL glass of water
Avoid lying down for at least 30 min. after!
CONCERN: bone necrosis & Afib w/ IV form

A

Alendronate sodium (Fosamax)

21
Q

Thyroid hormone; regulates growth/development; inc. metabolism
ADR: HYPERthyroidism (nervousness, insomnia, TACHYCARDIA, palpitations, WEIGHT LOSS, diarrhea, menstrual irregularities)
ENHANCES ORAL ANTICOAGULANTS!!
Caution in heart Dx, diabetes, & pts on Tricyclic antidepressants
Separate by calcium carbonate by >4 hrs & TAKE ON EMPTY STOMACH

A

Levothyroxine sodium (Synthroid, Levothroid)

22
Q

Thyroid hormone; destroys thyroid tissue w/o destroying whole gland
ADR: delayed HYPOthyroidism; depressed hematopoietic system, THYROIDITIS
Used for Dx of thyroid disorders
Not for use in pregnancy/lactation, or in children

A

Iodine-131

23
Q

Inc. cellular uptake of AA, glucose, and other monosaccharides
ADR: HYPOGLYCEMIA, some allergic rxns; INSULIN RESISTANCE IN TYPE 2
**Only regular insulin can be given IV

A

Insulin

24
Q

Oral hypoglycemic; dec. hepatic glucose production & intestinal glucose absorption
ADR: GI (METALLIC TASTE, N/V, abd. pain, weight loss, cognitive decline?
LACTIC ACIDOSIS in renally impaired!!!
BLACK BOX: should be D/C’d 48 hours before iodine contrast study and restarted 48 hours after!!
Does NOT usually cause hypoglycemia!

A

Metformin (Glucophage)

25
Q

Insulin sensitizer; dec. insulin resistance
ADR: URI, headache, sinusitis, MYALGIA, dec. TG levels, raises LDL a bit, raises HDL
*ONLY INDICATED FOR TYPE 2 DIABETES

A

Pioglitazone (Actos)

26
Q

Corticosteroid; anti-inflammatory, vasoconstriction for BP maintenance, carb. metabolism, fat metabolism, IMMUNOSUPPRESSIVE, stress effects (release catecholamines); can affect mood
ADR: delayed wound healing, GI ulceration & perforation; amenorrhea; disorders of Ca metabolism; CUSHING’S SYNDROME; CATARACTS; can precipitate DIABETES
Withdrawal is a concern!! –> WEAN!!
Some effect on Na retention & K excretion

A

Hydrocortisone/Cortisone (Prednisone, Decadron, Medrol, Solu-Medrol)

27
Q

Hormone, androgen; promotes male characteristics; powerful Anabolic agent
ADR: Na & water retention; LIVER TOXICITY; nausea; HYPERcalcemia; lipid disorders; In females (deepening of voice, hirsutism, acne, masculinization)
Contraindicated in prostate cancer, cardiorenal dysfunction, PREGNANCY
SCHEDULE III (abuse for muscle building)

A

Testosterone

28
Q

Hormone, progestin; Hormone of pregnancy; inhibits ovulation (dec. LH/FSH); makes endometrium softer; thickens cervical mucus; dec. sensitivity of uterus to oxytocin; develops secretory apparatus in mammary glands; inc. body temp during ovulation; inc. insulin levels
ADR: GI Sx, headache; IRREGULAR VAGINAL BLEEDING; photosensitivity; EDEMA, WEIGHT GAIN; breast tenderness; HIRSUTISM; migraine; DEPRESSION
Major use is contraception (w/ estrogen)
Used for amenorrhea, threatened abortion, endometriosis
Non-contraceptive use: counteract ADRs of estrogen

A

Progesterone (Provera-Medroxyprogesterone)

29
Q

Hormone; stimulates female characteristics; dec. FSH, facilitate ovulation (inc. LH); development of endometrium; inc. serum TG & HDL, dec. LDL & cholesterol; inc. blood glucose; INC VIT K CLOTTING FACTORS & PLT AGGR.
ADR: “pregnancy sx” (N/V, anorexia, breast tenderness); inc. female characteristics; FLUID RETENTION; BREAKTHROUGH BLEEDING; depression, HTN, Headache
EMBOLIC Dx, cancer, & gallbladder dx
Used for CONTROL OF MENOPAUSE SX & DYSFUNCTIONAL UTERINE BLEEDING
CONTRAINDICATED IN: estrogen-dependent cancers (breast, ovarian, etc.) & Thromboembolic Disorders

A

Sodium estrone sulfate (Premarin)

30
Q

Anticonvulsant; increases GABA (inhibitory)
ADR: most common (N/V/D), mild/transient drowsiness, TREMORS, weight gain
AVOID OTHER CNS DEPRESSANTS (alcohol)
Various forms are NOT interchangeable
For Tonic-Clonic Seizures, Migraines, BPD
ASPIRIN LOWERS SERUM LEVELS
BLACK BOX: not for use in kids <2 d/t fatal hepatotoxicity
Do NOT stop abruptly

A

Valproic Acid (Depakote, Depakene)

31
Q

Anticonvulsant; inhibits flow thru Na & Ca channels
ADR: Well-tolerated; SKIN TOXICITY (RASH)
Better tolerated in elderly
For EPILEPSY in PREGNANT women (preg. category C)
For partial, generalized tonic-clonic seizures, absence seizures; also BPD
Fewer Cog. ADRs than carbamazepine
ORAL CONTRACEPTIVE REDUCE LEVELS

A

Lamotrigine (Lamictal)

32
Q

Anticonvulsant; dec. neuronal discharge
ADR: Visual disturbance, dizziness, confusion; Mild leukopenia, thrombocytopenia; N/V/D, HYPOnatremia,
Minimal effect on cognitive function!
DEC. EFFECT OF ORAL CONTRACEPTIVES AND WARFARIN!! (induces microsomal sys)
Therapeutic range: 4-12 mcg/mL
Metabolism inhibited by GRAPEFRUIT JUICE

A

Carbamazepine (Tegretol)

33
Q

Anticholinesterase; blocks destruction of acetylcholine; inc. muscle strength
ADR: CHOLINERGIC CRISIS (N/V/D, SALIVATION, Sweating, periph vasodilation, bronchial constriction; RESP. ARREST), bradycardia, muscle cramps
USED FOR Dx & Tx MYASTHENIA GRAVIS!!
ANTIDOTE = ATROPINE!!!!!

A

Neostigmine (Prostigmin)

34
Q

Anticholinergic; parasympatholytic; vasodilation (atropine flush), dec. GI motility, DRIES secretions
ADR: Fairly Safe. Dry mouth, THIRST, difficulty swallowing & talking, constipation, blurred vision, CUTANEOUS FLUSH
May be used periop to prevent slowing of heart
CONTRAINDICATED: GLAUCOMA & BPH

A

Atropine

35
Q

Anti-Parkinson; precursor for dopamine, crosses BBB
ADR: anorexia, N/V, DYSKINESIAS (think tics!); ORTHO HYPOTENSION; dysrhythmias, MENTAL CHANGES
May darken sweat or urine!
Avoid vitamin B6 & CAUTION WITH MAOIs
Absorption inhibited with PROTEIN foods

A

Levodopa (L-dopa)

36
Q

Acetylcholinesterase inhibitor; blocks enzyme that breaks down Ach; leads to inc. of Ach in brain, SMALL improvements in ALZHEIMER’S
ADR: N/V/D, headache, insomnia, dream disturbances, fatigue
Best taken on empty stomach!

A

Donepezil (Aricept)

37
Q

Alkylating chemo agent; inactivates DNA
ADR: N/V, BMD (nadir btwn 9-14 days); ALOPECIA; Reproductive changes (amenorrhea, azoospermia); Teratogen; HEMORRHAGIC CYSTITIS; HYPERURICEMIA
Also used for Rheumatoid Arthritis
Mesnex & INC. hydration protect bladder

A

Cyclophosphamide (Cytoxan)

38
Q

Antimetabolite chemo agent, folate antagonist; inhibits DNA synthesis
ADR: Leukopenia, thrombocytopenia; STOMATITIS; PULMONARY INFILTRATES/ FIBROSIS; hepatotoxicity; N/V, alopecia, TUBULAR NECROSIS (kidneys)
Also used in Rheumatoid Arthritis
Keep pt WELL HYDRATED!!
RESCUE DRUG = LEUCOVORIN (folinic acid)

A

Methotrexate (Rheumatrex, MTX)

39
Q

Antimetabolite chemo agent; Purine analog; inhibits DNA synthesis
ADR: N/V, anorexia, leukopenia, BMD; JAUNDICE; HYPERURICEMIA
Powerful immunosuppressant (used in UC & Crohn’s)

A

Mercaptopurine (6-MP, Purinethol)

40
Q

Antimetabolite chemo agent; pyrimidine analog; inhibits DNA/RNA synthesis
ADR: BMD (nadir 9-14 days); STOMATITIS, GI ULCERS, N/V/D, alopecia; Alteration in taste (aversion to protein-rich foods); HAND-AND-FOOT SYNDROME
Limited to solid tumors (palliative Tx)
Direct hepatic artery infusion for liver carcinoma (dec. systemic SE)

A

Fluorouracil (5-FU, Adrucil)

41
Q

Antibiotic antitumor agent; distorts DNA structure; Cell-cycle nonspecific
ADR: SIGNIFICANT bmd (by day 7); alopecia, N/V, STOMATITIS, acute/delayed CARDIOTOXICITY
URINE & TEARS TURN RED
Red colored foods cause N/V, anorexia
Can cause SEVERE local damage if it extravasates (IS A VESICANT)

A

Doxorubicin HCl (Adriamycin)

42
Q

Chemo agent; blocks metaphase
ADR: MILD BMD; NEUROTOXIC (peripheral neuropathy, LOSS OF DTRs, VOCAL CORD PARALYSIS, ptosis, diplopia, paralytic ileus); GI disturbance, alopecia
Good for remissions esp. in CHILDREN
IS A VESICANT

A

Vincristine (Oncovin)

43
Q

Chemo agent; inhibits DNA precursors; Cell-cycle Nonspecific
ADR: N/V, MILD/TRANSIENT BMD, OTOTOXIC (esp. high freq. hearing loss); NEPHROTOXIC; peripheral neuropathy (tingling/numbness fingers, toes, face)
Given with MANNITOL FLUSH before & after to prevent tubular necrosis
Do NOT give with aluminum needles (forms precipitate)

A

Cis-platinum (Cisplatin)

44
Q

Chemo agent; arrests mitosis
ADR: BMD (nadir at 11 days); SEVERE HYPERSENSITIVITY RXNS (hypotension, dyspnea, urticaria); PERIPHERAL NEUROPATHY; bradycardia, heart block, MI; ARTHRALGIA; GI (mucositis, N/V/D); alopecia; change in liver function
SHOULD NOT BE GIVEN W/ NEUTROPHIL COUNTS <1500
Premedicate with CORTICOSTEROIDS, BENADRYL, H2 ANTAGONISTS

A

Paclitaxel (Taxol)

45
Q

Antiestrogen, SERM; competitive antagonist at estrogen receptors
ADR: N/V, HOT FLASHES; other (menstrual irregularities, INC. TUMOR/BONE PAIN), may develop ENDOMETRIAL CANCER
Target cells must be ER positive
Agonist effect in some tissues (uterus, bone), antagonist effect in others (breasts)

A

Tamoxifen (Nolvadex)

Nursing (8 decks)

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