Pharm Exam 2 Flashcards
How should a patient use a MDI (metered-dose inhaler)?
- Inhale slowly
- Hold breath for 10 SECONDS
What can DPIs (Dry Powder Inhalers) cause?
Hoarseness
When using a dry powder inhaler (DPI), you should instruct a patient to breathe in (slowly/rapidly)?
Rapidly. They are breath activated!
How can a patient decrease the incidence of candidiasis with inhaled glucocorticoids?
- Rinse mouth after use
- Brush teeth
- use a spacer
What time of day should you administer Montelukast (Singulair)?
Bedtime!
Because there are more leukotrienes in body at nighttime (leukotrienes are what cause lung inflammation, which is why you usually cough more at night) and we want to suppress them.
What is typically used for acute asthma episodes?
Glucocorticoids
Should a patient use their beta agonist inhaler after using their glucocorticoid inhaler?
No. Patient should use beta agonist FIRST, wait 5 minutes, and then use the glucocorticoid inhaler.
What does albuterol do?
Improves the ability of cilia and bronchodilates lungs
Albuterol is a type of drug called a short-acting bronchodilator. It provides relief from an asthma attack by relaxing the smooth muscles in your airways. It’s usually taken with a metered dose inhaler (ProAir HFA, Proventil HFA, others).
What device allows for the longest delivery of asthma medication?
Nebulizer
Ipratropium bromide is considered a ______ _______?
anticholinergic agent.
Ipratropium is a bronchodilator that is used to to prevent bronchospasm in people with COPD (chronic obstructive pulmonary disease), including bronchitis and emphysema.
Which has the most interactions with other meds?
Cimetidine
Sucralfate (carafate) is best taken:
- on an empty stomach
- before bed
- one hour before meals
A patient should wait how long between taking their antacid and other medications
60 minutes, one hour
Misoprostol (cytotec) requires caution during pregnancy because:
It contracts the uterus! Misoprostol can induce labor or could induce a miscarriage (abortion)
Which of the following can induce CNS toxicity in a patient with renal failure?
Magnesium Hydroxide (Milk of Magnesia).
It can cause confusion and other symptoms
Black stool is a common benign side effect of:
Pepto bismol
Can get black tongue and black stool
Which bacteria causes peptic ulcer disease?
H. Pylori (Helicobacter pylori)
What indicated upper GI bleeding?
- Bright red blood in emesis
- coffee ground emesis
- tarry black stools
T or F: Prostaglandins protect the stomach by increasing mucus and bicarbonate and decreasing stomach acid
True!
Metformin works by ______ the sensitivity of insulin receptors and ______ hepatic glucose production.
Increases
Decreasing
When is Lantus best administered? Why?
Best at bedtime. Lantus can be BID, but if q.d., administer at bedtime so patients glucose levels will be covered through nightime.
Lantus is long acting, so it has nothing to do with meals.
What should the nurse administer if the patient is extremely hypoglycemic?
Either glucagon or IV glucose
Why not lantis? Because it is long acting
Name the med class that can become less effective in T2DM over time
Sulfonylureas
____ insulin can be drawn up with short acting or rapid acting insulin
NPH insulin! NPH can be drawn up with short/rapid acting insulin, but CANNOT be drawn up with long acting insulin.
NPH insulin= intermediate acting insulin
Name three types of rapid acting insulin. Generic and brand name.
- Lispro (humalog)
- Aspart (novolog)
- Glulisine (apidra)
Contrast dye is contraindicated for patients taking ______
What can mixing this cause?
Metformin
already decreased kidney function, contrast dye worsens and can cause lactic acidosis
Which med (name) masks the symptoms of hypoglycemia? What type of medication is it (what does it do)
Metoprolol (lopressor)
Metoprolol is a beta blocker, which slows the heart rate down. This would mask the high heart rate that results from hypoglycemia.
What is the black box on thiazolidinediones for? Who should you not give it to?
Risk of severe heart failure. It can cause fluid retention which puts major stress on the heart (as we know).
Do NOT administer to patients with CHF!!!!!!
What is a common ending for fluoroquinolones?
-floxacin
-acin
What ending is commonly associated with aminoglycosides?
-mycin
What ending is associated with the penicillin family?
-cillin :)
What reaction should nurses be aware of when administering penicllin?
Allergic reaction/Anaphylaxis. 1% of all people are allergic to penicillin.
What does selective toxicity for antibiotics mean?
- The ABX has a small therapeutic window (you need to closely monitor amounts)
- Needs to kill bacteria without harming the patient
An ideal antimicrobial agent exhibits selective toxicity, which means that the drug is harmful to a pathogen without being harmful to the host. Often, selective toxicity is relative rather than absolute; this implies that a drug in a concentration tolerated by the host may damage an infecting microorganism.
At what glucose level is a patient considered hypoglycemic?
below 70mg/dL
At what glucose level is a patient considered hyperglycemic?
greater than 125 mg/dL
Which of the following types of insulin can be given intravenously?
- short-acting
- intermediate acting
- long acting
- short acting!!!!
What does bacteriostatic mean?
Prevents growth of bacteria
How should you administer tetracycline?
- Give 1 hour before or 2 hours after food.
- Full glass of water
- Avoid before bedtime (acid reflux)
- Space consumption of milk, and minerals (calcium, iron, Mg, aluminum, and zinc) with tetracyclines by 2 HOURS.
What drug should patients with penicillin allergies avoid and why?
Cephalosporins. (cephalosporins have a beta lactam ring, just like penicllins)
If a patient has a superinfection of C. diff, the nurse expects that they:
Are on antibiotics
What is Steven Johnson Syndrome (SJS) also known as?
Red man syndrome (think of the drawing on the board during class)
Which antibiotic is most commonly associated with Red Man Syndrome/ SJS?
Vancomycin.
Also have trouble urinating and hearing with vancomycin. Think ototoxicity and nephrotoxicity!
What should a nurse tell a patient who asks if they can stop taking their antibiotics once they feel better?
No, you should take the entire prescription otherwise you will develop antibiotic resistance and your illness will likely return.
What is a side effect that a nurse should be very concerned about?
Frequent diarrhea. It can cause dehydration which is a leading cause of death in other countries and is risky.
Aztreonam (azactam) is best known to combat/kill which type of bacteria?
Gram negative aerobic bacteria.
Which antibiotic can strongly impact dentition? Who should not receive it?
Tetracyclines.
Do not give to children or pregnant women because it impacts the development of teeth
Remember: think cycling on a bicycle, dont want to fall off and break your teeth.
If your patient is on doxycycline and going camping or to the beach, what should you tell them?
Wear sunscreen! Doxy causes you to be extremely photosensitive.
What severe adverse effect are aminoglycosides associated with?
Ototoxicity (irreversible). Think tinnitus, hearing loss, vertigo.
Also, nephrotoxicity.
It takes the drug a long time to wash out from ears and kidneys, high levels here.
Avoid aminoglycosides with other ototoxic drugs, like vancomycin!
What is the best way to administer tetracycline?
- With a full glass of water
- 2 hours between tetracycline and milk products or products high in iron
If a newborn is exposed to sulfonamides, what are they are risk for?
Kernicterus.
Sulfonamides can cause high levels of bilirubin which damages the brain.
What do fluoroquinolones put patients at risk for?
Tendon rupture, especially achilles rupture.
If a patient has G6PD deficiency, the nurse should question an order for what?
Sulfa drugs. Sulfonamide.
Taking sulfa drugs with a G6PD deficiency can cause hemolytic anemia (Blood cells break/burst)
True or False: Azithromycin is known to inhibit liver enzymes.
False! Azithromycin is the only one in its class that does NOT inhibit enzymes.
What antibiotics do we prefer for anaerobic bacteria?
Clindamycin (cleocin)
Flagyl (metronidazole)
KNOW BOTH OF THESE!!! There will be a question that probably has 4 choices and we need to be able to identify both of these drugs.
True or False: a patient on fluoroquinolones with a potential tendon rupture should continue to bear weight
False! They should rest.
What is the most common ending for PPIs (proton pump inhibitors)
-prazole
What is the most common medication ending for bronchodilators?
-terol
