Pharm Exam 1 Mod 1-4 Flashcards
A patient taking Flonase is instructed to avoid eating black licorice while taking the drug. Why?
It potentiates the drugs action
Adverse effects of antihistamines include
Drowsiness or dizziness
Tachycardia or palpitations
Urine retention
Dry mouth
Activation of the sympathetic nervous system does what to the upper respiratory tract
It causes arterioles of the nose to constrict and mucosal layer to thin. This widens the airway allowing more air to get in.
Diphenhydramine is contraindicated for …
Hypersensitivity to the drug
Benign prostatic hyperplasia
Narrow-angle glaucoma
Gastrointestinal obstruction
Fexofenadine (Allegra) has what mechanism of action
It is an H1- receptor antagonist. It competes with histamine by binding to the histamine (H1) receptor sites.
Pseudoephedrine (decongestant) has what mechanism of action
Activates alpha1-adrenergic receptors, causing vasoconstriction and decreasing mucosal swelling.
A patient is prescribed Intranasal corticosteroids for allergic rhinitis. What should the nurse instruct the patient to expect from this medication
It will decrease the secretion of inflammatory mediators, reduce tissue edema, and cause a mild vasoconstriction.
Children diagnosed with allergic rhinitis are at a greater risk for what ?
Middle ear infections
Flonase does what?
Decreases inflammation through vasoconstriction and anti inflammatory processes
What is the purpose for mucous
It neutralizes airborne pathogens.
Tut healer and Flexhaler are types of what device?
Dry powder inhaler (DPI)
What is status asthmaticus?
A severe prolonged form of asthma unresponsive to drug treatment that may lead to respiratory failure
Common asthma triggers
Air pollutants.
Allergens
Chemicals and food
Respiratory infections
Stress
Two categories of asthma drugs.
Quick relief and long term.
Quick relief asthma medication classes
Short acting beta2 adrenergic agonists (SABA)— bronchodilation
Anticholinergics—bronchodilation
Corticosteroids: systemic — anti inflammatory
Long term asthma medication classes
Corticosteroids: inhaled—anti inflammatory
Mast cell stabilizer—anti inflammatory
Leukotriene modifiers—anti inflammatory
Long acting beta2 adrenergic agonists—bronchodilation
Methylxanthines—bronchodilation
Immunomodulators— monoclonal antibody.
Most asthma Drugs that end in “-ol” aka
Albuterol, salmeterol, olodaterol, metaproterenol, levalbuterol, indacaterol, formoterol, arformoterol, (and the odd one out terbutaline) are of what class?
Beta adrenergic agonists
Asthma Drugs that end in “-ium” aka aclidinium, ipratropium, tiotropium, umeclidinium are of what class?
Anticholinergics
Asthma drugs that end in “-lline” aka aminophylline, and theophylline, are of what class?
Methylxanthines
Beta adrenergic agonists work how?
Activate the sympathetic nervous system, which relaxes bronchial smooth muscle resulting in bronchodilation
If someone has chronic asthma they need to be treated for bronchospasm relief as well as what?
Inflammation
Beta-agonist medications that activate only beta 2 receptors are called what
Selective drugs
Where are beta 1 receptors located
The heart
Where are beta 2 receptors located
Smooth muscle of lungs, uterus, other organs
Non selective Beta agonists activate what receptor (s)
Both beta 1 and beta2
Epinephrine and isoproterenol are examples of what type of drugs
Nonselective beta adrenergic agonists
Long acting beta adrenergic medications have what black box warning?
Their use is associated with an increase risk of asthma related deaths.
Long acting beta agonists have a slow onset and will not abort acute bronchospasms. T/f?
True.
Anticholinergics have what mechanism of action?
Block the parasympathetic nervous system. Increases bronchodilation
Asthma drugs that end in “-asone “ or “-onide “ are of what class
Inhaled corticosteroids
Cromolyn is what type of drug
Mast cell stabilizer.
What is the preferred therapy for preventing asthma attacks
Inhaled corticosteroids
What type of asthma drugs could reduce growth velocity in some children
Inhaled corticosteroids
Anticholinergics drugs contraindications
Narrow angle glaucoma. Benign prostatic hyperplasia. Renal disorders. Urinate bladder neck obstruction. And older adults.
Beta adrenergic agonist contraindications
History of MI or dysrhytmia.
Breastfeeding not recommended
Under 6 limited
Methylxanthines are contraindicated for
Coronary artery disease, angina pectoris
Severe renal or liver disorders, peptic ulcer
Benign hyperplasia, diabetes melitus.
Not recommended while breastfeeding
Caution in older adults and hound children
Adverse effect of inhaled corticosteroids
Orioharyngeal candidiasis
A patient taking ipratropium receives a new prescription for tiotropium. What patient eduction needs to be provided by the nurse?
Tiotroprium is only taken once per day where the old prescription, ipratropium is taken 4 or more times per day.
Emphysema is characterized how
By loss of bronchiolar elasticity and destruction of alveolar wall structures
Arformoterol is what kind of beta agonist.
Long acting.
Anticholinergic medication can cause constipation. Educate clients to increase fiber. T/f
True
Cromolyn might be prescribed to a patient with COPD why
The patient has an allergy to corticosteroids or they are ineffective
What is the drug that’s mechanism of action interferes with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol.
Statins
What is the drug that’s mechanism of action decreases both VLDL and LDL levels
Niacin.
What is the drugs that’s mechanism of action blocks the absorption of cholesterol from the small intestine
Ezetimibe
What is the drug that’s mechanism of action binds bile acids, thus increasing the excretion of cholesterol in the stool
Bile acid sequestrants
Rare but serious adverse effects of statins
Severe myopathy and rhabdomyolisis
What is rhabdomyolisis
Contents of muscle cells spill into the systemic circulation, causing potentially fatal acutely renal failure
What should be avoided during statin therapy because of their potential to interfere with statin metabolism and increased risk of sever myopathy
Macrolide antibiotics, such as erythromycin, Azole antifungals, fibrin acid drugs, certain immunosuppressants
Statins with short half lives, such as lovastatin and simvastatin should be administered when
At night because cholesterol biosynthesis in the liver is higher at night.
Total cholesterol of under 200 with the LDL under 100 and the HDL at 60 or higher is
A) dangerous
B) at risk
C) heart healthy
Heart healthy
Patients taking statins could benefit from enhancing their diet with foods rich in CoQ10- like pork- why?
Statins reduce coQ10 synthesis
Lipid lowering drugs can deplete or diminish the absorption of what?
Fat soluble vitamins and folic acid
Gemfibrozil (Lopid) can increase the risk of bleeding. T/f
True
What drug would need to be lowered.
Warfarin.
Gemfibrozil is contraindicated in patients with what
Chronic kidney disease
What drug is the only drug in a class called cholesterol absorption inhibitors and can block absorption of cholesterol which can cause the body to respond by creating more cholesterol?
Ezetimibe (Zetia)
A serum triglyceride level of less than 150 mg/deal is considered.
Normal or desired
A serum triglyceride level of 188mg/dL would be considered?
Borderline high risk
A serum triglyceride level between 200mg/dL and 499 mg/dL would be considered what?
High risk
Gemfibrozil (fibric acid derivative) is indicated for the treatment of what conditions
Hyper triglycerides and hypercholesterolemia
(It lowers VLDL with an increase in HDL)
NOT effective for lowering LDL
Niacin for lowering cholesterol should not be used in patients with diabetes. Why
It can increase fasting glucose levels
Atorvastatin (Lipitor ) is what kind of drug
HMB-CoA reductase inhibitor.
A patient has a triglyceride level of 450 mg/dL. Which drug should the nurse anticipate being prescribed for this patient
Fibric acid
Cholestyramine (Questran) can bind to other drugs. When should it be taken with a patient who also takes digoxin
2hours before or 4 hours after
If statins are having minimal impact and aren’t tolerated well by the patient, what drug would be the next choice
Gemfibrozil (lopid)
fibric acids
A patient continues to experience elevated cholesterol levels despite taking prescribed medication. Which drug should the nurse identify that is causing this patients result.
Ezetimibe (zetia)
A patient is prescribed Gemfibrozil (Lopid). For which reason should the nurse expect the medication to be discontinued for this patient
Elevated low density lipoproteins (LDL)
What is the primary carrier of triglycerides that is reduced to become a LDL
VLDL
Common side effects of statins include
Headache, fatigue, muscle or joint pain, heartburn.
Often patients can tolerate these over time.
Cholestyramine is contraindicated for what
Biliary obstruction
What warms, cleans and humidifies air before entering the lungs
URT
Upper respiratory tract
What’s the first line of defense your body uses for preventing pathogens to enter through URT
Nasal mucosa
What medication is prevention for allergic rhinitis
Intranasal corticosteroids
What are H1 receptor blockers (antagonist) mechanism of action
Antihistamines that block the histamine (H1) receptors.
What class of drug relieves nasal congestion by causing vasoconstriction in the nasal passage?
Nasal decongestants - sympathomimetic
Oxymetazoline (Afrin)
What’s the warning for this drug???
Can cause rebound congestion only use 3-5 days
What drugs are effective in treating inflammation of nasal passage and used to prevent allergic rhinitis?
Intranasal corticosteroids.
Fluticasone (Flonase)
-pregnancy cat. C(risk cannot be ruled out)
Beconase (beclomethasone nasal)
- hoarseness, dry mouth, cough, sore throat, oropharyngeal candidiasis.
What drugs are used to dampen cough reflex (best for non productive cough)
Antitussives.
non opiod
Benzonatate (tessalon)
-anesthetizes the receptor sites of the lungs.
Dextromethotphan (delsym)
- can cause cns toxicity.
opiod
Most effective
Raise cough threshold in cns.
Codeine
- caution in pt. With asthma, can cause brochoconstriction.
Respiration drive is determined by what
The brain
What opens the respiratory lumen?
Bronchodilation
Constriction and dilation is regulated by what
Two branches of the ANS.
Sympathetic- cause bronchodilation
Parasympathetic- cause bronchoconstiction.
What is a chronic pulmonary disease with inflammation and bronchospasm components?
Asthma
What are asthma med goals
To terminate acute bronchospasms in progress and to reduce the frequency of attacks
What category medication is Albuterol (ProAir HFA) in and what are side effects of it
It’s a bronchodilator. Specifically SABA
Can cause tachycardia, hypokalemia, hyperglycemia, nervousness
What category of drugs is Ipratropium (Atrovent)
A bronchodilator. Specifically Anticholinergics (cholinergic blocker)
Rinse mouth after to avoid bad taste.
If paradoxical bronchospasm occurs, withhold medication and notify HCP immediately
What medication class is Beclomethasone (Qvar) in and it’s side effects
Inhaled corticosteroid. Can cause oral candidiasis. May reduce growth in some pediatric pt.
What category drug is cromolyn (gastrocrom)
Mast cell stabilizer. Inhibits release of histamine and other inflammatory mediators.
Preventative, long term medication
What category drug is montelukast (singulair)
It’s a leukotrine modifier. Mediators of immune response.
This is the only drug in the class safe for pediatric use.
Copd is most commonly caused by what conditions
Chronic bronchitis- strongly associated w/smoking
Emphysema- strongly associated with smoking.
What meds are used for Copd
Antibiotics (tx infections)
Expectorant, mucolytics (control cough)
Bronchodilators (relieve bronchospasms)
Triglycerides should be less than what number to be in normal range
Less than 150
What is the drug Atorvastatin (Lipitor)
Statin.
Side effects- myalgia, arthralagia, rhabdomyolisis (leads to renal failure!) elevated hepatic enzymes.
What do B-complex Vitam B do for lipid disorders and name the drug given
Decreases the VLDL into LDL, reduced triglycerides.
Niacin is what’s given
Side effects- flushing, nausea, diarrhea, hepatotoxicity, gout
What do Fibric Acid Drugs do for lipid disorders
Activate the enzyme lipoprotein lipase, lower LDL, triglycerides and most effective lipid drug to increase HDL
Fenofibrate (Lofibra)
-administered with meals to decrease GI upset
What do the kidney excrete that helps regulate bp
Renin enzyme
What do kidneys excrete that stimulates red blood cell production
Erythropoietin hormone
Kidney are responsible for the production of what, which helps maintain bone homeostasis
Calciferol the active for of vitamin D
If a drug is bound to plasma proteins will it pass through the glomerulus and enter the filtrate or continue circulating in the blood.
Continue circulating. It’s too big
Plasma proteins such as albumin found in pt urine indicates what
Kidney pathology.
What are primary goals for a pt with kidney failure
Maintain blood flow through the kidneys and adequate urine output
Tests to diagnose kidney failure
Urinalysis
Metabolic panels
-Cr, BUN, eGFR
(Creatine, blood urea nitrogen, glomerular filtration rate).
What are primary measures of structural kidney damage
Proteinuria and albuminuria
What diagnostic imaging can be used to provide a more detailed diagnosis of kidney disease
CT scan, sonography, MRI
Most frequent cause of Acute kidney injury causes
Renal hypoperfusion (lack of sufficient blood flow through kidneys)
Usually caused by heart failure, hemorrhage, dehydration, toxins, dysthymias.
What happens in end stage renal disease
Kidneys no longer able to function in their own; dialysis or transplant tx options.
What is the medication management of kidney failure
Diuretics to increase urine output.
Cardiovascular drugs to tx underlying HTN or heart failure.
Dietary management of kidney disease can include..
Protein restriction
Reducing sodium, potassium, phosphorus, and magnesium intake.
Diuretic drugs and therapy for kidney failure
Diuretics: Loop/ thiazide/ potassium sparing.
Used for: HTN, AKI & CKD, heart failure, pulmonary edema.
Nurse teaching: monitor weight, HR, BP
Bumetanide (bumex) is what kind of drug
Loop diuretic. Most potent of them.
It blocks the reabsorption of Na+ an Cl- in the nephron loop.
Side effect: hypokalemia, hypotension
Ototoxic
Ethacrynic acid (edecrin) is what kind of drug
Loop diuretic.
Side effect: ototoxicity.
Chlorothiazide (Diuril) and hydrochlorothiazide (microzide) are what kind of drugs
Thiazide diuretics.
Block Na+ reabsorption and increase k+ and water excretion.
Side effect: hypokalemia (palpitations), hypotension, dehydration
Spironolactone (Aldactone) is what kind of drug?
Potassium sparing diuretic. Na+ & water excretion is increased & body retains more K.
Side effect: hyperkalemia, no K supplements and limit K in diet.
Reduces mortality in pt with CHF.
Furosemide and torsemide are what kind of drugs
Loop diuretic
Furosemide (Lasix)- is the most popular and lasts 6 hrs.
Loop diuretics are mainly used for ….
Edema …..
Cardiac failure
Loop diuretic side effects.
Ototoxic. Decreased potassium and magnesium. Metabolic alkalosis (blood pH turning basic). Dehydration. (Fluid loss)
Potassium sparing diuretics can treat what and have what side effects
Tx: HTN, heart failure, edema.
Side effects: elevated potassium levels; high levels can lead to gynecomastia
Thiazide and thiazide like diuretics work on what part of kidneys. Used for what?
Distal convoluted tubule. To prevent sodium from being reabsorbed.
Used for HTN, Edema.
Thiazide diuretics side effects
Gout.
Decreased sodium (hyponatremia)
Decreased potassium (hypokalemia)
Increased Uric acid (hyperuremia)
Increased blood glucose (hyperglycemia)
Necessary nursing precautions when giving diuretics? (Remember the acronym)
Diet (needs to increase dietary K)
Input & output; & daily weights
Unbalanced fluid & electrolytes
Ready for decreased BP & increased HR
Evening dose is a no-no
Take AM
Increased orthostatic hypotension
Cigarettes (
K wasting diuretics end in what suffix
-ide. Furosemide & hydrochlorothiazide
If a patient has edema and potassium levels of less than 3.5 what kind of diuretic would you expect them to be put on
Potassium sparing
If a patient is on loop diuretic and their potassium levels came back abnormal what’s the first nursing action
Place on cardiac monitor.
Never push potassium IV. It’s only administered via a bag 1hr or more. Typically 4hr
It will kill patient
Before administering diuretics, you take the pt BP and it comes back low, what action do you take.
Hold the med. contact HCP
OTC medications like NSAIDs, antacids, acetaminophen, and cough and flu, should be avoided with diuretics why?
All contain high levels of sodium.
The nurse suspects a pt has overdosed on acetazolamide (Diamox). What drug should the nurse expect to be prescribed for this
Sodium bicarbonate. To treat the metabolic acidosis that an OD of Diamox would produce.
Overdose of the drug hydrochlorothiazide (microzide) is treated how?
Infusions of normal saline
Od manifests as electrolyte depletion
Overdose of the drug furosemide (lasix) is treated how?
Supportive replacement fluids and electrolytes. Possibly administering a vasopressor (norepinephrine)
Od results in hypotension and severe fluid and electrolyte loss.
What amount of weight gain or loss in a 24-hr period should be reported when taking diuretics?
2lbs (1kg)
Excess fluid volume leads to what
HTN, heart failure, peripheral/pulmonary edema
Fluid depletion leads to what
Shock
Dehydration
Hypertonic IV fluid does what
Removes water from cells and can result in dehydration. from interstitial fluid into plasma.
Hypotonic IV fluids do what
Can result in hypotension due to movement of water out of vascular system. From plasma into interstitial fluid.
Isotonic Crystalloid fluids
Normal saline. (0.9% NaCl)
Lactated ringers.
They increase plasma volume without any major fluid shifts.
Indications: vomiting, diarrhea, surgical procedures, hypotension
Hypertonic crystalloid fluids
Hypertonic saline (3%)
Expands volume by drawing water from cells.
Indications: hyponatremia, cerebral edema, cellular edema
Hypotonic crystalloid fluids
Hypotonic saline. (.45%)
Fluid from plasma to cells.
(Gets em fat)
Indication: hypernatremia, cellular dehydration
If a patient is dehydrated and has a low BP. What do you give
Normal saline.
If a patient is dehydrated with a normal BP. What do you give.
0.45% NaCl
Colloids are larger molecules that remain in blood. They have the same effect as what ? And are indicated for what
Hyper tonic solutions.
Indications: hypovolemic shock, hemorrhage, burns.
5% albumin IV fluid does what
Increases BP and urinary output
Used in critical care frequently
It is a plasma volume expander
Dextran 40 does what and used for what
Effective at increasing plasma volume within minutes.
Can cause fluid overload: tachycardia, edema, Dyspnea, cough.
It’s a plasma volume expanded
A patient has a serum calcium level of 12.5. What tx should you expect?
Calcitonin or hypotonic fluids would be prescribed
A patient has severe hyponatremia. How would you expect this to be treated
3% sodium chloride
Potassium
Normal level range
Hyper/ hypo level symptoms
3.5-5
More abundant inside cell.
Fx: muscle conduction (including heart), metabolize carbs, moves glucose inside cell w/ insulin., maintain pH balance
Hypokalemia: muscle weakness, nausea vomiting, constipated, ekg-st depressed, t wave flat, q wave big, decreased dtr, decreased LOC, confused, drowsy (most commonly from: diarrhea excess, diuretics, beta adrenergic agonists, diet)
Hyperkalemia: EKG tall twaves, prolonged QT, muscle cramping/weakness, diarrhea, nausea, hyperactive bowel sounds, numbness/tingling, confused, anxious, restless or irritable. (Most commonly from renal failure or chemotherapy, crush injuries, diabetic ketoacidosis, medications ex: spiralactone, )
Calcium
8.5-10 ish
Fx: cardiac muscle depolarization, bone and teeth, nerve impulse transmission, regulate BP.
Hypercalcemia: nausea, decreased appetite, decreased dtr, muscle weakness, lethargy, blurred vision, vomiting, confusion, constipation, cardiac arrhythmia, bradycardia, short qt interval. (Causes: diet or supplement , cancer, end stage renal disease, osteoporosis, bone fractures, low phosphorus level, thiazide diuretic, hyper parathyroid)
Hypocalcemia: muscle spasms, parasthesia hands and lips, chovstek sign or trussou sign, cardiac arrhythmia, vfib, tosades de pontes. Diarrhea, osteoporosis. (Caused: renal failure, parathyroidextomy, hypo parathyroidism, excessive diarrhea, low magnesium, vit d deficiency)
Chloride
95-110
Fx: maintains osmotic pressure and fluid balance, maintain acid base balance.
Hyper: lethargic, headache, peripheral vasodilation, hypotension, decrease cardiac output,tachycardia, Tachypnea, metabolic acidosis abg. (Cause: dehydration, diabetic ketoacidosis, od of salicylates, hypernatremic, chloride meds, keyaxolate)
Hypo: confused, restless, muscle cramps, convulsion, hyperactive dtr, hypo ventilation, (caused: excessive gi loss, dehydration, hyponatremia, dka, acidosis, diuretics, fluid overload).
