nurs 317 final extra

Question 1

Prototype Summary: Spironolactone
Potassium-Sparing Diuretics

Answer 1

Indications: Primary hyperaldosteronism, adjunctive therapy in the treatment of edema associated with HF, nephrotic syndrome, hepatic cirrhosis; treatment of hypokalemia or prevention of hypokalemia in patients at high risk if hypokalemia occurs; essential hypertension.

Question 2

Prototype Summary: Spironolactone-actions

Answer 2

Actions: Competitively blocks the effects of aldosterone in the renal tubule, causing loss of sodium and water and retention of potassium.

Question 3

Prototype Summary: Spironolactone- contarindications

Answer 3

hyperkalemia, renal disease, or anuria, which could be exacerbated by the effects of these drugs. Routine use during pregnancy is not appropriate; these drugs should be reserved for situations in which the mother has pathological reasons for use, not pregnancy manifestations or complications, and only if the benefit to the mother clearly outweighs the risk to the fetus.

Question 4

oxybutynin (Ditropan XL),

Answer 4

Urinary Tract Antispasmodics

Question 5

oxybutynin (Ditropan XL),

Answer 5

Indications: Relief of symptoms of bladder instability associated with uninhibited neurogenic and reflex neurogenic bladder; treatment of signs and symptoms of overactive bladder.

Question 6

oxybutynin (Ditropan XL),

Answer 6

Actions: Acts directly to relax smooth muscle in the bladder; inhibits the effects of acetylcholine at muscarinic receptors.
Pharmacokinetics:

Question 7

oxybutynin (Ditropan XL)

Answer 7

Monitor the results of laboratory tests, such as urinalysis and urine culture and sensitivity, to evaluate the effectiveness if UTI is the problem, and renal and hepatic function tests to determine the need for possible dose adjustment and to evaluate for possible toxicity.

Assess urinary elimination pattern, including amount and frequency of episodes, and for any complaints of frequency, urgency, pain, or difficulty voiding to monitor for excessive parasympathetic blockade or development of underlying UTI

.Assess for contraindications or cautions: Any history of allergy to these drugs to prevent hypersensitivity reactions; pyloric or duodenal obstruction or other GI lesions or obstructions of the lower urinary tract (e.g., prostate hypertrophy), which could be dangerously exacerbated by these drugs and cause
gastrointestinal adverse reactions and/or urinary retention; glaucoma, which could increase intraocular pressure due to blockage of the parasympathetic nervous system; and current status of pregnancy or lactation, which would require cautious use.

Question 8

dutasteride (Avodart)

Answer 8

Drugs for Treating Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy or enlarged prostate, is a common problem in men, and it increases in incidence with age

Question 9

Drugs for Treating Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH),

Answer 9

Focus on Herbal and Alternative Therapies
Saw palmetto is an herbal therapy that has been used successfully for the relief of symptoms associated with BPH. Patients with BPH should be cautioned not to combine saw palmetto with finasteride because serious toxicity can occur.

Question 10

phenazopyridine

Answer 10

OTHER DRUGS USED THAT AFFECT THE URINARY TRACT AND BLADDER

Urinary Tract Analgesic:(burning, urgency, frequency, pain, discomfort)

Question 11

phenazopyridine & cipro

Answer 11

Clinically Important Drug–Drug Interactions
The risk of toxic effects of this drug increases if it is combined with antibacterial agents used for treating UTIs. If this combination is used, the phenazopyridine should not be used for longer than 2 days.

Question 12

phenazopyridine- adverse

Answer 12

Adverse Effects
Adverse effects associated with this drug include GI upset, headache, rash, and a reddish-orange coloring of the urine, and staining of contact lenses

Question 13

antithyroid drug for pregnancy

Answer 13

PTU is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus.

Bisphosphonates should be used during pregnancy only if the benefit

Question 14

Antithyroid Agents

indications: PTU

Answer 14

Thioamides lower thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone. They also partially inhibit the conversion of T4 to T3 at the cellular level. These drugs are indicated for the treatment of hyperthyroidism. Thioamides include propylthiouracil (PTU) and methimazole (Tapazole).

Question 15

menopause S&S

Answer 15

Menopause is associated with loss of many of the effects of these two hormones on the body, including retention of calcium in the bones,
lowered serum lipid levels,
and maintenance of secondary sex characteristics. As estrogen leaves the blood vessels, many women experience “hot flashes” or vasospasm. Drying vaginal tissue can lead to painful intercourse and more frequent urinary tract infections (UTIs).

Question 16

HRT containg progesterone

Answer 16

Wild yam: 1 to 6 g/d PO; contains progesterone—do not use with HRT; may cause increased blood glucose and other toxic effects; do not combine with disulfiram or metronidazole—severe reaction may occur

Question 17

herb caution for estrogen and progesterone

Answer 17

False unicorn root: 1 to 2 mL PO three times a day; do not use with estrogen or progestins—may alter uterine effects

Question 18

progesterone - Vaginal gel adverse

Answer 18

use is associated with headache, nervousness, constipation, breast enlargement, and perineal pain.

Question 19

progesterone intrauterine systems

Answer 19

are associated with abdominal pain, intensifying endometriosis symptoms, abortion, PID, and expulsion of the intrauterine device.

Question 20

ranitidine (Zantac)- OTC

Answer 20

Histamine-2 Antagonists

Question 21

H2 antagonists

Answer 21

block the release of hydrochloric acid in response to gastrin ,inhibiting gastric acid secretion and reducing total pepsin output.

Question 22

cimetidine (Tagamet HB) dosage

H2 antagonists

Answer 22

300mg qid (with meals)or 800mg at bedtime

Question 23

ranitidine - H2 antagonist adverse

Answer 23

-diarrhea or constipation;
-CNS effects of dizziness, headache, somnolence, confusion, or even hallucinations (thought to be related to possible H2 receptor effects in the CNS);
- cardiac arrhythmias and hypotension (related to H2 cardiac receptor blocking, more commonly seen with IV or IM administration or with prolonged use);
- gynecomastia (more common with long-term use of cimetidine) and impotence.

Question 24

suppression of hydrochloric acid

Answer 24

Proton Pump Inhibitors
- suppress the secretion of hydrochloric acid into the lumen of the stomach

Question 25

high potassium foods

Answer 25

Potassium-Rich Foods Dried fruits (raisins, apricots) Beans, lentils Potatoes Winter squash (acorn, butternut) Spinach, broccoli Beet greens Avocado Bananas Cantaloupe Oranges, orange juice Coconut water Tomatoes Dairy and plant milks (soy, almond) Yogurt Cashews, almonds Chicken Salmon

Question 26

Potassium-Sparing Diuretics - not powerful but retain k+

Answer 26

amiloride (Midamor), eplerenone (Inspra), spironolactone (Aldactone), triamterene (Dyrenium)

Question 27

Carbonic Anhydrase Inhibitors

Answer 27

Are relatively mild diuretics. Available agents include acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide (generic)

Question 28

Carbonic Anhydrase Inhibitors Clinically Important Drug–Drug Interactions

Answer 28

There may be an increased excretion of salicylates and lithium

Question 29

Loop Diuretics

Answer 29

they work in the loop of Henle. Loop diuretics are also referred to as high-ceiling diuretics because they cause a greater degree of diuresis than other diuretics.

Question 30

Loop Diuretics

Answer 30

ethacrynic acid (Edecrin), the first loop diuretic introduced, bumetanide (generic), furosemide (Lasix), torsemide (Demadex)

Question 31

Loop Diuretics furosemide (Lasix)

Answer 31

treatment of acute HF, acute pulmonary edema, edema associated with HF or with renal or liver disease, and hypertension.

Question 32

Loop Diuretics furosemide (Lasix)

Answer 32

Evaluation Evaluate drug effects: urinary output, weight changes, status of edema, blood pressure changes. Monitor for adverse effects: hypotension, hypokalemia, hyperkalemia, hypocalcemia, hypercalcemia, hyperglycemia, increased uric acid levels.

Question 33

Alpha1-selective adrenergic blocking agents

Answer 33

are drugs that have a specific affinity for alpha1-receptors. These drugs include alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (generic)

Question 34

Alpha1-selective adrenergic blocking agents

Answer 34

terazosin: 1-5 mg/day at bedtime BPH: 10mg/day

Question 35

Alpha1-selective adrenergic blocking agents

Answer 35

This causes a decrease in vascular tone and vasodilation, which leads to a fall in blood pressure. Because these drugs do not block the presynaptic alpha2-receptor sites, the reflex tachycardia that accompanies a fall in blood pressure does not occur. They also block smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in male patients with benign prostatic hyperplasia (BPH).

Question 36

(pyelonephritis)

Answer 36

Blockage anywhere in the urinary tract can lead to backflow problems and the spread of bladder infections into the kidney

Question 37

cystitis

Answer 37

Females, with shorter urethras, are particularly vulnerable to repeated urinary tract, bladder, and even kidney infections. Children may also have frequent urinary tract problems. Patients with indwelling catheters or intermittent catheterizations often develop bladder infections or cystitis

Question 38

Correlation between Hemoglobin A1C Level and Mean Plasma Glucose Levels

Answer 38

Hemoglobin A1C (%) Mean Plasma Glucose In mg/dL In mmol/L 6 126 (100–152) 7.0 (5.5–8.5) 7 154 (123–185) 8.6 (6.8–10.3) 8 183 (147–217) 10.2 (8.1–12.1) 9 212 (170–249) 11.8 (9.4–13.9) 10 240 (193–282) 13.4 (10.7–15.7) 11 269 (217–314) 14.9 (12.0–17.5) 12 298 (240–347) 16.5 (13.3–19.3) Adapted from American Diabetes Association. (2018). Glycemic targets: Standards of medical care in diabetes—2018. Diabetes Care 48 (Suppl 1), S55–S64.

Question 39

Chronic Bacterial Prostatitis

Answer 39

Long-term therapy (3 to 4 months) with a low-dose oral antimicrobial agent is often used for treatment.38 Transurethral resection of the prostrate (TURP) has been used to treat males with refractory disease.

Question 40

Diverticulosis

Answer 40

This suggests that factors such as lack of fiber in the diet, a decrease in physical activity, and poor bowel habits, along with the effects of aging, contribute to the development of the disease.

Question 41

Types of Glomerular Disease The clinical manifestations of glomerular disorders generally fall into one of five categories:

Answer 41

Nephritic syndromes Rapidly progressive glomerulonephritis The nephrotic syndrome Asymptomatic disorders of urinary sediment (i.e., -hematuria, prote inuria) Chronic glomerulonephritis5

Question 42

Nephritic syndromes: hallmark- edema

Answer 42

is characterized by massive proteinuria (>3.5 g/day) and lipiduria (e.g., free fat, oval bodies, fatty casts) along with an associated hypoalbuminemia (<3 g/dL), generalized edema, and hyperlipidemia (cholesterol > 300 mg/dL).

Question 43

Acute pyelonephritis upper UTI

Answer 43

represents an infection of the renal parenchyma and renal pelvis. Improperly treated, it can lead to sepsis, renal abscesses, chronic pyelonephritis, and chronic renal failure.

Question 44

nonpituitary ACTH-secreting tumor.

Answer 44

Cushing syndrome can also result from long-term therapy with one of the potent pharmacologic preparations of glucocorticoids; this form is called iatrogenic Cushing syndrome.1

Question 45

liver inflammation

Answer 45

The key enzymes are alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which are present in liver cells. ALT is a more specific indicator

Question 46

portal hypertension- complications

Answer 46

Complications of portal hypertension arise from the increased pressure and dilation of the venous channels behind the obstruction. In addition, collateral channels that connect the portal circulation with the systemic circulation open. The major complications of the increased portal vein pressure and the opening of collateral channels are ascites, splenomegaly, hepatic encephalopathy, and the formation of portosystemic shunts with bleeding from esophageal varices

Question 47

Thyroid storm, or thyrotoxic crisis manifestations:

Answer 47

is manifested by a very high fever, extreme cardiovascular effects (i.e., tachycardia, congestive failure, and angina), and severe CNS effects (i.e., agitation, restlessness, and delirium). The mortality rate is high

Question 48

Buclizine- antihistamine and antiemetic drug

Answer 48

for the treatment of allergy symptoms and prevention of nausea and vomiting

Question 49

Primary Adrenal Cortical Insufficiency

Answer 49

Addison disease- life long drug therapy Fludrocortisone mineralocorticoid corticosteroid Hydrocortisone

Question 50

Glucocorticoid Hormone Excess

Answer 50

Cushing Syndrome-hypercortisolism surgery, irradiation, or pharmacologic treatment is determined largely by the cause of the hypercortisolism CRH stimulation test, high-dose dexamethasone suppression test, radiologic imaging of the pituitary and adrenal glands, and petrosal sinus sampling.

Question 51

Chronic disease

Answer 51

GFR of less than 60 mL/min/1.73 m2 for 3 months or more

Question 52

kidney failure

Answer 52

GFR of less than 15 mL/min/1.73 m2, usually accompanied by most of the signs and symptoms of uremia, or a need to start renal replacement therapy.

Question 53

Ondansetron

Answer 53

antiemetic medication that prevents and treats nausea and vomiting. It's used to treat nausea caused by chemotherapy, radiation, surgery, migraines, or gastroenteritis.

Question 54

Mumps complications

Answer 54

Primary hypogonadism Encephalitis Infections—mumps orchitis (gonadal failure is a much more common manifestation when mumps occurs after puberty

Question 55

The prodromal phase of viral hepatitis

Answer 55

a stage before jaundice appears is characterized by nonspecific symptoms like fatigue, malaise, loss of appetite, nausea, vomiting, and sometimes fever or joint pain.