Pharm 2 Exam #3 (Chpt. 42, 13, 12, 14) Flashcards

Question

Antidiarrheals: Opiates, Opiate-related agents

Answer 1

Diphenoxylate with atropine (Lomotil) — contraindicated with IBD b/c can cause severe complications of toxic mega colon Difenoxin (Motofen) Loperamide (Imodium) Opiates decrease GI motility. Opiates may cause respiratory depression. Especially children and older adults May cause physical dependence Atropine contraindicated in glaucoma.

Answer 2

Imodium is structurally related to Lomotil but causes less CNS depression and can be purchased as an OTC drug. *NOTE: Prolonged use of these meds may cause physical dependence.*

Answer 3

**Ioperamide (Imodium) ** — Is used cautiously as it slows peristalsis and may also slow the exit of infectious organism from the GI tract (causing infectious diarrhea). — Allow patient to poop it out as opposed to slowing and maintaining bacteria in the gut if using this drug ________________________________ *NOTE:* Traveler’s diarrhea can be reduced by drinking bottled water, washing fruit, and eating cooked vegetables. Meats should be cooked until well done.

Answer 4

Prescriptive antiemetics Antihistamines Anticholinergics Dopamine antagonists Benzodiazepines Serotonin antagonists Glucocorticoids Cannabinoids (for patients with cancer) Miscellaneous ____________________________________________ **NOTE: these drugs act as antagonists to *dopamine, histamine, serotonin, and acetylcholine,* which are all associated with N/V** — Cannabinoids: dronabinol (Marinol) — Miscellaneous: Diphenidol (Vontrol), Trimeth (*reduce availability in Dopamine that can trigger EPS*), Metoclopramide (Reglan),

Answer 5

Hydroxyzine (Vistaril) Promethazine (Phenergan) Scopolamine (Transderm-Scop) Side effects: drowsiness, dry mouth, blurred vision caused by pupillary dilation, tachycardia (with anticholinergic use), and constipation These drugs should not be used by patients with glaucoma.

Answer 6

** — Antihistamines + Opiates = additive effects r/t respiratory depression** — Antihistamines and anticholinergic agents reduce opioid-induced vestibular sensitivity. — Antihistamines have CNS depressant effects and adding an *opiate* will have sedating effect **adding to** respiratory depression

Answer 7

Phenothiazine antiemetics Chlorpromazine (Thorazine) — used as an antipsychotic Prochlorperazine edisylate (Compazine) Promethazine (Phenergan) droperidol (Inapsine) Butyrophenone — (Haldol found in this category for antipsychotic patients) Contraindicated in patients with QT prolongation Side effects: moderate sedation, hypotension, EPS, CNS effects, and mild anticholinergic symptoms ____________________________________________ Benzodiazepines Lorazepam effectively provides emesis control, sedation, anxiety reduction, and amnesia when *used in combination with a glucocorticoid and serotonin 5-HT3 receptor antagonist (can cause ischemic colitis).*

Answer 8

Category: Phenothiazines MOA: blocks H1-receptor sites and inhibits CTZ Onset: 15-60 minutes (oral); 20 minutes (IM); 3-5 minutes (IV) Duration: 4-6 hours (oral, IM, IV) *— Treats/prevents motion sickness, N/V and sedation induction — A CNS depressant and an additive if taken with EtOH, narcotics/opiates, sedative-hypnotics, and general anesthetics — Anticholinergic effects *increase* when combined with antihistamines (e.g. atropine) _Side effects:_ have antihistamine + anticholinergic properties, watch for EPS and CNS effects (restlessness, weakness, systolic rxns, agitation) _Contraindications:_ Narrow angle glaucoma, intestinal obstruction, blood dyspraxia’s, liver dysfunction, COPD

Answer 9

Ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet), palonosetron (Aloxi) — *work on 5H-T receptors* — Best used for patients CINV, PONV, radiation therapy NV, viral gastritis NV & NVP (pregnancy)

Answer 10

_Benefits:_ reduces N/V r/t chemotherapy, post-op, radiation, viral gastritis, & pregnancy _Common side effects:_ headache, diarrhea, dizziness, and fatigue *These drugs DO NOT block dopamine so will not cause EPS effects* **These drugs can also prolong the QT measurement —> TORSADES de Pointes** — Antidote: Magnesium IV

Answer 11

Dexamethasone (Decadron) Methylprednisolone (Solu-Medrol) Administered IV Effective in suppressing emesis associated with cancer chemotherapy *NOTE: Because these are administered IV and for only a short while, side effects normally associated with glucocorticoids are minimized*

Answer 12

*IBD* = inflammatory bowel disease — electrolytes, biologic? Med, malabsorption *e.g. ulcerative colitis, celiac, crohn’s* ___________________ IBS = irritable bowel syndrome — no inflammation — usually diet/stress-related — C(constipation predominant; don’t poop for 2 weeks) | D(diarrhea predominant)

Answer 13

Class: Antidiarrheals CSS V Dose: initially, 2 tabs (2.5mg diphenoxylate, 0.025mg atropine each tablet); MAX = 8 tablets MOA: inhibits gastric motility by exerting effect on smooth muscle cells of GI tract Therapeutic effects: Tx diarrhea by slowing intestinal motility Contraindications: severe diarrhea d/t pseudomembranous colitis; Increased CNS depression when drinking EtOH, antihistamines, opioids, sedative-hypnotics; MAOIs = may enhance HTNive crisis Labs to check: increased serum liver enzymes, amylase S/Eff: drowsiness, dizziness, confusion, euphoria, H/A, restlessness, abd pain, N/V, flushing, urine retention A/Eff: angioedema, pancreatitis, tachycardia, lieu’s, toxic mega colon

Answer 14

*Peptic Ulcer Disease (PUD)* — Group of upper GI disorders characterized by varying degrees of erosion of the gut wall — Develops when aggressive factors outweigh defensive factors

Answer 15

*Aggressive factors:* H pylori, NSAIDs, acid, pepsin, hyperstimulative —purpose: disorders stimulates the gut causing issues *Defensive factors:* mucus, bicarb, submucosal blood blow, prostaglandins — purpose: to keep/maintain gut health ____________________________________ NOTE: NSAIDs inhibits prostaglandins =setting person up to development of erosions in the gut wall

Answer 16

*most common cause of PUDs* — Gram negative bacillus that can colonize the stomach and duodenum — 60-75% of patients with peptic ulcer disease (PUD) have it — Tx: control acid production, but will not cure, but trying to create conditions conducive to stomach; e.g. Take an anti acid (will neutralize acid in stomach and allow healing to occur) but will not FIX the hyper acidity problem that originally caused the problem — use antibiotics in conjunction to get RID of H.pylori and CURE problem

Answer 17

Esophageal ulcer Results from reflux of acidic gastric secretions into esophagus due to an incompetent cardiac sphincter Gastric ulcer Results from a breakdown of gastric mucosal barrier Duodenal ulcer Results from hypersecretion of acid Stress ulcer Results from trauma, burns, major surgery

Answer 18

— Cardiac sphincter = top of stomach = lower esophageal sphincter (LES) — Pyloric sphincter = @ end of stomach — duodenum = beginning of small intestine — stomach = starts digestion and makes hydrochloric acid — lower stomach used to low pH — small intestine = not used to low pH ( if lots of acid in tummy and moves to duodenal —> duodenal ulcers Once you impair the mucosal barrier Pepsin = used to start digestion of protein (stomach muscle is made of protein) Heartburn = fluid refluxing through cardiac sphincter/LES and damaging the esophageal mucosa (not made for acidic pH) Stomach can develop erosion = more difficult to heal in presence of more acid and pepsin

Answer 19

**GERD Gastroesophageal Reflux Disease aka reflux esophagitis** — inflammation of the esophageal mucosa caused by reflux of gastric content into the esophagus _Cause:_ incompetent lower esophageal sphincter — cannot maintain it’s competency (can’t stay shut very well), will allow reflux, creating sensation of heartburn of reflux esophagitis _Triggers:_ EtOH, smoking, stress, spicy foods

Answer 20

*When reflux moves all the way to oropharynx and throat causing **laryngapharyngeal reflux (LPR)** — dangerous b/c opportunity to aspirate gastric content to the lungs —> aspiration pneumonia —> DEATH Triggers: EtOH, spicy foods, smoking

Answer 21

— Avoid tobacco — Avoid alcohol — Avoid hot, spicy, greasy foods — Take any NSAIDS (2nd leading cause of PUD and aggregate the GI tract); including aspirin and oroal glucocorticoids, w/ food or in decreased dosage — Sit upright — Do not eat before bedtime — Wear loose fitting clothing (e.g. tight belts, pants can increase risk of reflux)

Answer 22

1) Tranquilizers 2) Anticholinergic drugs 3) Antacids 4) H2 blockers 5) Proton pump inhibitors 6) Pepsin inhibitor 7) Prostaglandin E1 analog

Answer 23

MOA: reduce acetylcholine (ACh) production = reduce vagal stimulation, decrease anxiety *Calms vagus nerve | When vagus nerve is activated and releases ACh, it can increase histamine receptors —> increased HCl acid ==> less ACh, less histamine, HCl acid produced* _Drugs_ Chlordiazepoxide (Librium) Clidinium bromide (Quarzan)

Answer 24

MOA: Inhibit ACh and inhibit histamines that will promote HCl acid production *decrease ACh (breaking pathology chain leading to ulcer development/erosion)* _Drugs_ —

Answer 25

MOA: compounds that neutralize HCl acid + reduce pepsin activity, which is not healthy for erosion| *acid back diffusion:* have an erosion in the mucosa of gastric stomach and with that erosion comes ability for acid to diffuse back into the ulcer and make it worse so need to get env’t conducive to healing to get mucosa back in tact* *Not going to be effective when you made the HCl, but now can _neutralize_ the acid you have produced; not systemically absorbed, but can change the pH WITHIN the tract; do not give w/ other meds b/c binds with contents in GI tract and if take w/ medicines = will impair absorption/efficacy; take 1-2 hours AFTER meal (acid production at its highest)* _Drugs_ *Sodium bicarbonate (Alka-Seltzer)* — **NOT FOR:** HTN, Cardiovascular diseases, fluid overload, heart failure *Calcium carbonate (Tums)* = taking as supplement and not for Hburn Magnesium (Mg) hydroxide/aluminum hydroxide (Maalox) = cause diarrhea; **NOT FOR** renal patients (their Mg runs high) — Aluminum (Al) hydroxide (Amphojel) = cause constipation; **NOT FOR** hx of chronic constipation

Answer 26

*antacid* MOA: neutralizes gastric activity Onset: 15-30 minutes | Peak = 0.5hr | Duration = 1-3hrs Therapeutic effects: hyperacidity, gastric/duodenal ulcer, reflux esophagitis; reduce hyperphosphoatemia Side effects: — N/V — Anorexia — Abdominal cramping/constipation — Weakness — Impaired cognition RN Intervention: **NOT for patients with diarrhea, hepatic/renal disease, HYPOphosphatemia, HYPERcalcemia, HYPOmagnesemia, dehydration, GI bleeding/obstruction, older adults, osteoporosis, children, pregnancy**

Answer 27

MOA: *(found in stomach mainly) = reduce production of HCl acid; reducing stress (from ACh) that can lead to HCl production* _Drugs:_ — Cimetidine (Tagamet) — 1stG — Ranitidine (Zantac) — 2ndG — Famotidine (Pepcid) — 2ndG — can cause anemia — Nizatidine (Axid) — 2ndG

Answer 28

Oldest _MOA:_ — reduce gastric acid production by blocking H2 receptors of parietal cells in stomach — promote healing of ulcer by eliminating cause Therapeutic effect: The patient’s abdominal pain is expected to decrease after 1 to 2 weeks of drug therapy, but healing may take 1 to 2 months. _Side effects:_ — H/A — Dizziness — Diarrhea — Constipation — Reversible impotence — Gynecomastia: histamine tube blockers resemble hormones in chemical structure hence possible side effect for men **removed from the market b/c of some inactive ingredients found harmful**

Answer 29

MOA: reduce gastric acid by inhibiting hydrogen/potassium ATPase *Newest, expensive, most effective = suppress gastric acid secretions; even if you have simulation of ACh + histamine production, a PPI can prevent hyper secretions of HCl that leads to ulcer development* _Side Effects:_ H/A, insomnia, dizziness, dry mouth, flatulence, abdominal pain, malabsorption of minerals and vitamins, increase risk of ventilator-assisted pneumonia (VAP) b/c of LER (have a higher pH, some bacteria may grow and reflux into throat and aspirate a little bit), increase risk of C.diff (abnormal bacteria growing), chronic use can lead to **osteoporosis/fractures** — Swallow whole; do not crush/chew capsules/tablets b/c unstable in stomach acid _Drugs:_ Omeprazole (Prilosec) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Pantoprazole (Protonix) *Esomeprazole (Nexium)* Dexlansoprazole (Dexilant)

Answer 30

MOA: reduce gastric acid by inhibiting hydrogen/potassium ATPase Therapeutic effects: healing erosive GERD. dyspepsia, Helicobacter pylori infection, pyrosis, and Zollinger-Ellison syndrome, and for NSAID-induced ulcer prophylaxis _Side Effects:_ H/A, insomnia, dizziness, dry mouth, flatulence, abdominal pain, malabsorption of minerals/vitamins (B12, Ca, Mg, Fe, lead) increase risk of ventilator-assisted pneumonia (VAP) b/c of LER (have a higher pH, some bacteria may grow and reflux into throat and aspirate a little bit), increase risk of C.diff (abnormal bacteria growing), chronic use can lead to osteoporosis/fractures

Answer 31

— *Cimetidine* interacts with oral anticoagulants, theophylline, caffeine, phenytoin (Dilantin), diazepam (Valium), propranolol (Inderal), phenobarbital, and calcium channel blockers. — *Cimetidine* can cause an increase in blood urea nitrogen (BUN), serum creatinine, and serum alkaline phosphatase. Neither cimetidine nor ranitidine should be taken with antacids. — If want to take Zantac + Tums = separate within *at least an hour* — Teach patient to eat foods rich in vitamin B12 to avoid deficiency as a result of *cimetidine* and *ranitidine* therapy. **DO NOT TAKE TOGETHER WITH Tagmet, Zantac, Cimetidine, Rinitadine** **Best given 2-3hrs AFTER eating and BEFORE bedtime b/c acid production is the highest and you will receive biggest neutralization of acid at that time**

Answer 32

*Pepsin inhibitors* MOA: mucosal protective drugs; combines w/ protein to form a thick paste covering ulcer, protects from acid and pepsin Side effect: constipation RN Interventions: — Do not take with antacids — Take as a slurry: immediately coat ulcer bed, does not have to break down tablet — Given *30 minutes before meals & @ bedtime* *coats ulcer bed (nothing in pathology chain) and doesn’t let pepsin aggregate it further, creating an env’t conducive to healing; ulcer is like a raw sore and pepsin can further deepen the sore*

Answer 33

*defensive factors in the gut* MOA: — inhibits gastric acid secretion and increases cytoprotective mucus in GI tract; counteracts effects of NSAIDs on prostaglandins (from diminishing/ help maintain) — *Defensive factors = help protect stomach from HCl acid (no pathological impact in altering hypersecretions, but can help stomach deal with increase in HCl acid)* Patients who complain of gastric distress from NSAIDs such as aspirin or indomethacin prescribed for long-term therapy can benefit from misoprostol. Who would you expect this would be?? RN Interventions: — Cytotec is contraindicated in pregnancy as it can cause **uterine contractions**

Answer 34

_Anticholinergics:_ not taken with acute/narrow angle glaucoma d/t drying up Sx’s ____________________ _Antacids:_ best taken 1-3hrs *after meals;* may experience acid rebound; watch out for HYPERcalcemia, Burnetts syndrome (milk-alki syndrome) r/t XS use of Tums; NBicarb = HYPERNa + H2O retention, metabolic alkalosis, caused by XS bicarbonate, and acid rebound ______________ _Histamine 2 blockers:_ abdominal pain will decrease after 1-2 weeks of drug therapy, but healing may take 1-2 months

Answer 35

Key To Remember (KTR): if the serum range is larger, it will be OUTSIDE the cell (ECF), if smaller serum range, it will be INSIDE cell (ICF)

Answer 36

FAT-soluble = not stored in body = **Vitamins ADEK** = megadoses may cause toxic effects — A = teratogenic effect, hypervitaminosis, nightblindness, leukopenia, aplastic anemia | *3000mcg/day* — D = HYPERcalcemia, anorexia, N/V | if deficient = rickets —> osteomalacia (soften bone) — E = fatigue, weakness, GI upset, H/A, breast tenderness, fat malabsorption syndromes, breakdown of RBCs — K = hyperbilirubinemia (kernicterus in newborns), MUST have EKG ready! | if deficient —> spontaneous hemorrhaging WATER-soluble = stored in body and XS vitamins are excreted through urine (not really toxic) = **C, B1-12** ___________________ Mnemonic: *”A DEK of cards are FAT”* Mnemonic: *“I C you B in the bathroom a lot”*

Answer 37

— *Nasogastric tube* – can be used to give nutrition or empty stomach contents (gastric decompression) — *Nasoduodenal or nasojejunal tube* – goes through pyloric sphincter; weighted Dobhoff tube; smaller bore and more flexible than NG; decreases aspiration risk; clogs easily! — *Gastrostomy and PEG (percutaneous endoscopic gastrostomy)* – both gastric feeding tubes; flexible, larger bore than Dobhoff; difference is surgeon puts in gastrostomy tube; GI specialist can take patient to endoscopy and insert PEG tube; so PEGs are cheaper and require less anesthesia then gastrostomy tubes — *Jejunostomy tube* – bypasses stomach and still can be used for feedings or intestinal decompression.

Answer 38

— Blenderized = formulas made with natural foods in liquid form to pass through tubes. i.e. thinned baby food — Polymeric (milk-based or lactose-free) = can be milk based or lactose free; provide complete nutritional requirements if given in sufficient amounts; multiple formulas….Nephro (for renal), Pulmocare (for COPD), Glucerna (for diabetics), NutriHep (for liver failure), etc. — Elemental or monomeric = supplemental formulas that provide specific nutrients for specific GI dysfunction or malabsorption syndromes (i.e. pancreatic enzymes, low fat/high protein mixes, etc)

Answer 39

— Blenderized = thinned baby food (be able to pass through tubes) — Polymeric = can be milk-based or lactose-free; complete nutritional requirements; multiple formula options — Elemental/monomeric = specific nutrients for specific GI dysfunction/malabsorption syndromes like pancreatic enzymes, low fat/high protein mixes

Answer 40

— Bolus = 250-400mL of solution rapidly administered q4-6/day — Nocturnal = only @ night — Infusion - Intermittent drip = q3-6h over 30-60 minutes by gravity drip or infusion pump - Continuous drip = @ slower rate over 24hr period - Cyclic infusions Major side effect of enteral feedings = diarrhea NOTE: dehydration can occur if an insufficient amount of H2O is given with/or b/w feedings | Watch for aspiration pneumonia = biggest complication of enteral nutrition **DO NOT FEED PATIENT WHILE LYING DOWN OR UNCONSCIOUS**

Answer 41

*BMI is 1st step of nutrition assessment* **A**septic technique **L**abel enteral equipment **E**levate HOB at least 30 degrees **R**riht patient, formula, tube **T**race all lines and tubing back to patient

Answer 42

— Less risk of infection — Maintains GI integrity — Less costly — Body uses it more efficiently

Answer 43

_Common mistakes:_ — Drug incompatible with administration through a tube — Failure to prepare drug properly — Use of faulty techniques _______________ _Results in:_ — Occluded feeding tube — Reduced drug effect — Drug toxicity — Harm, death

Answer 44

Nursing Implications: BMI is first step of nutrition assessment. Diarrhea can be managed by decreasing the rate of the infusion or diluting the concentration. Be sure patient is receiving “free” water. Keep HOB elevated. Turn off feeding pump when turning, changing sheets. Provide meticulous oral care. Monitor patient’s weight and vital signs. Check gastric residual before feeding and q4-6 hours if continuous feedings…over 100 ml notify MD. Flush tube, after meds and feedings to prevent clogging. GI and respiratory assessments are key. Change feeding bag daily. Ask pharmacy to change meds to liquid formulations if possible, but always add water to reduce osmolality – this helps prevent GI upset and tube clogging. Watch labs – renal panel (hydration status), albumin (nutritional status), white blood count (infection)

Answer 45

TPN + Total Parenteral Nutrition _Indications:_ Bowel obstruction Inflammatory bowel disease Severe pancreatitis Need bowel rest Severe trauma Severly malnourished _Nutrients:_ Hyperosmolar glucose Amino acids Vitamins Water & Electrolytes Minerals Trace elements Lipids

Answer 46

— Air embolism — Pneumothorax, hemothorax — Hyper/Hypoglycemia — Infection — Hypervolemia (fluid overload); hyperosmolar concentrated formula — weak hearts beware! Increasing preload + if cannot tolerate it —> HEART FAILURE

Answer 47

*Valsalva maneuver* = bearing down to temporarily increase pressure in venous system so less likely to get air in system when pulling catheter out If unable to = hold breath If unable to do that = pull tube out when they *inhale* COVER WITH OCCLUSIVE DRESSING + APPLY WITH TEGADERM+ LEAVE WITH 24HRS TO ENSURE PUNCTURE IS HEALED

Answer 48

PICC = Peripheral = inserted all the way to the R atrium from the brachial area (down the arm) Subclavian = catheter inserted below clavicular into subclavian vein Internal Jugular (IJ) vein = central line where line goes down to a R atrium External Jugular (EJ) vein = Place the gauze and pause + 5 minutes + patient needs to bear down — b/c DO NOT want air into ducted into the vascular system

Answer 49

Normal osmolality: 180-200mOsm/kg Hyperosmolality: Hypo-osmolality: Iso-osmolality:

Answer 50

— Vomiting — Diarrhea — NG hook to suction

Answer 51

*Isotonic:* D5W (isotonic then hypotonic inside body) | 0.9%NS | Lactated Ringers *Hypotonic:* 0.45%NaCl *Hypertonic:* D51/2NS | D5NS | D10H2O Dextrose5 in water (D5W) Isotonic (unless continuous or rapid) Lactated Ringer’s Isotonic solution Normal saline solution (0.9% NSS) Isotonic solution D5 LR Hypertonic solution D5W and 0.45% NSS Hypotonic solution D10W Hypertonic solution

Answer 52

— Laxatives: soft stool — Cathartics: soft to watery stool w/ cramping — Purgatives: for watery stool w/ cramping _Types:_ — Osmotic (saline) = pull water to gut = tx of constipation; for Go-Lytely = for procedure to clean out the gut — Stimulant (irritants) = irritates gut to relieve the constipation to stimulate defecation — Bulk forming = safer, not irritating to gut, not habit-forming (can be used daily) to keep stool soft; can use them for diarrhea b/c act as an absorbent, when constipated, will draw water to gut to relieve Emollient (stool softeners) = *do not promote peristalsis,* decreases surface tension of stool to help make stool softer Diarrhea = acts as an absorbent Go-Lytely = bowel prep, osmolality, *finish entire bottle w/in ~3hours*

Answer 53

— Prolific diarrhea…If cannot get off the toilet ALL day — Never? If elevated serum ammonia levels in patient’s with Liver Diseases (e.g. fibrosis, cirrhosis) b/c high levels are toxic to the brain and can cause encephalopathy S/Sx we see: confusion, agitation, disorientation

Answer 54

Can leads to dependency where you are unable to poop without using these

Answer 55

*Therapeutic use* — megaloblastic (macrocyclic) anemia, folate deficiency (EtOH), prevent neural tube defects in in developing fetus *Administration* — orally (preferred), subQ, IM, IV; Check Vitamin B12 levels to confirm absence of B12 deficiency, baseline serum folate, Hgb, RBC, and reticulocyte count and monitor periodically thereafter; HCTZ should start to improve w/in 2 weeks *Adverse Rxns* —

Answer 56

Docusate (Colase) = stool-softener Bisacodyl (Dulcolax) = stimulant (contact) laxative

Answer 57

*Miscellaneous Antiemetics* _Action:_ suppress impulses to CTZ + increases GI transit time; have prokinetic effect (increases peristalsis) on the gut — Used in the tx of post-op emesis, cancer chemotherapy, and radiation therapy

Answer 58

EPS; tardive dyskinesia = chewing, licking

Answer 59

**Erythromycin** (low dosages, not antibiotic dosing levels) Renzapride (2008, a Phase III trial in USA has been completed) **Cisapride** (still available under compassionate-release programs) – a serotonin active agent; Cisapride was voluntarily pulled from the market by Janssen Pharmaceutica in July 2000 (in the United States) due to the risk of rare but serious cardiac events, which in some cases led to deaths. A significant proportion of these reported cases had other known risk factors. In less than one percent of the cases, the events occurred in the absence of risk factors.

Answer 60

*Think sensory impulses* — Odors — Smells, — Taste — Gastric mucosal irritation

Answer 61

*When reflux moves all the way to oropharynx and throat causing **laryngapharyngeal reflux (LPR)** — dangerous b/c opportunity aspirate gastric content to the lungs —> aspiration pneumonia —> DEATH

Answer 62

*When reflux moves all the way to oropharynx and throat causing **laryngapharyngeal reflux (LPR)** — dangerous b/c opportunity aspirate gastric content to the lungs —> aspiration pneumonia —> DEATH

Answer 63

Apply ice packs to site of IV administration. Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr. **CORRECT Maintain infusion rate at no greater than 20 mEq/hr. Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr.** INCORRECT Administer potassium as a bolus over 10 minutes. Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr. Teach the patient signs and symptoms of hypokalemia. Too rapid an infusion of potassium may cause cardiac arrest. Therefore, IV potassium infusion rates should not exceed 20 mEq/hr.

Answer 64

**Flushes skin and increased thirst** Mental confusion + Seizures, V/D, and Lethargy and HoTN are ALL HYPONatremia S/Sxs

Answer 65

Stop the blood transfusion

Answer 66

**FFP** Fresh-frozen plasma is indicated to increase clotting factors in patients with a known deficiency. Albumin and plasma protein factors do not contain clotting factors. Although whole blood does contain the same ingredients as fresh-frozen plasma, the amount of volume that must be administered to give the patient the necessary clotting factors may be contraindicated in a patient with renal insufficiency.

Answer 67

**5% albumin** If the total protein level falls below 5.3 g/dL, fluid shifts out of blood vessels into the tissues. When this happens, colloid replacement therapy is required to reverse this process by increasing the colloid oncotic pressure. The three most commonly used are 5% albumin, dextran 40, and hetastarch. They all have a very rapid onset of action as well as a long duration of action.

Answer 68

Renal failure Potassium replacement therapy is indicated in the treatment or prevention of potassium depletion in patients with severe renal disease, acute dehydration, untreated Addison’s disease, severe hemolytic disease, conditions involving extensive tissue breakdown (e.g., multiple trauma, severe burns), and hyperkalemia from any cause.