Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHARM EXAMS 3, 4 & 5 > PHARM EXAM 3 > Flashcards

PHARM EXAM 3 Flashcards

1
Q

Addison’s Disease (too little cortisol)

A
  • Decrease in Cortisol
  • Thin
  • Decrease in BS
  • Fatigue
  • Hypo HTN
  • Bronze color
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cushing’s disease (too much cortisol)

A
  • moon face/ buffalo hump
  • Fat redistribution
  • increased in weight
  • decreased immune system
  • increased BS/ HTN
  • alopecia
  • mood change
  • insomia/ anxiety
  • osteoprosos
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hyponatremia

Hypo-< 135 mEq/L

A
  • Tachycardia, thready pulse
  • Fatigue
  • Muscle cramps, especially abdominal, and muscle weakness
  • Nausea, vomiting, dizziness
  • Postural hypotension (possibly from hypovolemia) or hypertension
  • Headache, confusion, or seizures (from swelling of brain cells)
  • Weight changes
  • Personality changes
  • Dry mucous membranes and cool, clammy skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hypernatremia

Hyper- > 145 mEq/L

A
  • Restlessness, agitation (with fluid overload), twitching, coma, seizures
  • Weight loss or changes in weight
  • Intense thirst with dry, rough mucous membranes
  • Flushed ∫©skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

hypokalemia

Hypo-< 3.5 mEq/L

A

Muscle weakness; may ascend to the respiratory muscles as deficiency progresses; paralysis, decreased reflexes

  • Weak and thready pulse, bradycardia,
  • Ventricular dysrhythmia, cardiac dysthymias, cardiac arrest
  • Abdominal distention, decreased bowel sounds
  • Fatigue, vomiting
  • Polyuria
  • Hyperglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hyperkalemia

Hyper- > 5.0 mEq/L

A
  • Vomiting and diarrhea
  • Abnormal cardiac function and cardiac arrest
  • Begins with twitching and leads to weakness and flaccidness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hypoglycemia

A

symptoms: Lethargic/ dizzy/ altered mental status/ HA/ sweaty & shaky

Treatment:
Awake: (need 15 gm of sugar) 4oz of OJ, 15 saltines, 1 tbsp. honey

Unable to swallow but able to follow directions: Glucagon SQ (need glucose storage, takes 30 minutes)
If they are anorexia and has no storage can not give glucagon

Altered LOC, very low sugar: D50 IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hyperglycemia

A

Symptoms: Thirsty/ Dry/ increase urnation/ increased hunger/ leads to mental status change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

No ADH

A
  • increased Urine Output
  • Dehydration
  • increased Na+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Too much ADH

A
  • decreased Urine Output
  • fluid
  • decreased Na+ (headache/ confusion/ seizures)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Liver disease findings

A

Symptoms: Jaundice/ ascites/ Edema/ Abd Pain (RUQ)/ weight gain
At risk: ETOH usage/ Hepatitis / transplant
Labs: AST/ ALT/liver fx test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Renal findings

A

Symptoms: decrease Urine Out put/ Edema/ increased weight/ HTN
At risk: DM/ Old/ HTN
Labs: BUN/ Crat/ GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sensitivity/ culture

A

** obtain sensitivity/ culture before treatment **
Determine type of bacteria.

Obtain sample; view under microscope.

Grow a sample over 24 to 48 hr.

Expose to various antibiotics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

skin/ wound infection

A
  • puss

- skin break down/ stink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ear infection

A
  • dizzy
  • decrease in hearing
  • pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

bladder infection

A
  • dysuria (painful)
  • difficulty
  • frequency
  • change in appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

nails/ bones infection

A

nails: color/ shape change/ gone
bone: pain/ redness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

lungs infection/ Upper RI

A

deep coughing / sputum color/ Rhonchi/ SOB/ wheezing / stradior
Upper RI: Cough/ running Nose/ sore throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Brain infection

A

altered LOC/ HA/ dizzy/ increased IOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Eyes infection

A

discharge/ change in VA/ light sensitivity/ red

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If the pt has fever after 48 hours on the antibiotic the fever should go away otherwise it is not the right antibiotics

A

Anti fever: Tylenol/ IBU/ ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Gram NEG

A
  • Harder to kill with 3 layered cell wall ( thicker cell wall)
  • non oxygen dependent (anaerobic )
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Gram positive

A

thin cell wall - oxygen dependant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Speisis

A

decrease BP/ increased HR/ increased RR/altered LOC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Antibiotic Admin:

A
  • ora: sc food if possible
    IV: med calculations
  • complete full course
  • use only when necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ABX common side effects

A

-GI: N/V (recommend- Probiotics/ yougurt), diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Supra Infections

A
  • C-diff: liquid diarrhea/ smell (oral Vanco) - gloves and gowns before entering and off before leaving
  • Fungal - Mouth : Oral thrush, white pathces, change in taste, stinky breath
  • Vagina: Drainage cottage cheese like (fungal infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antibiotic Resistance

A

Antibiotics kill some bacteria and allow drug resistant bacteria to grow unrestrained.
- develops mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Bacteriostatic

A

Stops from replicating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Bactericidal

A

Kills Bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Allergic reaction

A

-Angio edema
-anaphylaxis
Skin reactions:
-Steve Johns Syndrome: Starts with upper resp.. then pimple rash
-Toxic epidermal Necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Droplet Precautions

A

Remove the mask before you have left the room and then close the door

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Airbone Percautions

A

Remove the mask after you have left the room outside the closed door

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Contact percautions

A

A mask is not needed for this type of percaution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

PCN-> prototype AMOX

A
  • Binds to bacterial cell wall, weakening the wall allowing water to enter, killing the cell.
  • has beta-lactum ring that cuts cells wall and fluid rushes in
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

AMOX + Clavulanate

A

**Resistance to PCN develops when bacteria secrete betalacamase which destroys the beta lactam ring.

-Some drugs inhibit bacterial betalactamase and can be combined with penicillin (clavulanate, sulbactam, tazobactam)

Kills Bactalactamase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

PCN SE

A
  • Diarrhea, nausea and vomiting
  • Supra-infections (pseudo-colitis - blood in stool)
  • Allergy is the most common adverse event
  • Decrease effectiveness of oral contraceptives
  • Cannot be used with aminoglycosides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Cephalosporin: Cefazolin

A

Prototype: Cefazolin*
-Useful against gram negative infections.
Has a beta-lactam ring (cross allergy with PCN 5-10%)
(if they have Anaphylactic to PCN they may react to this med)
-Binds to cell wall and stops cell wall synthesis
-Five generations, each generation widening the spectrum of targets and attempting to decrease resistance to betalacamase.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Cephalosporin: Cefazolin Side Effects

A

allergy, rash, GI complaints. Renal toxicity decreases with subsequent generations (esp with early gen) Labs: BUUN/ CR
S&S decreased OU/ Increased BP/ fluid retention/ edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Normal BUN/ CR

A

CR: 1.2 – 1.5
BUN: 10-25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Tetracycline: Doxycycline

A

Doxycycline*
Give with full glass of water - try to take it sc food if you can - avoid GERD
-Inhibit bacterial protein synthesis, bacteriostatic
-Lipid soluble and can cross the blood brain barrier
Wide spread resistance
-Should take with food but not metal ions like calcium of iron. ( will bind + make med unuseful)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Tetracycline: Doxycycline Side Effects

A

Effect fetal bone growth and teeth development should not be given to pregnant women or children (8 or younger) ** DISCOLORATION of TEETH Grey/ Brown
GERD, irritation of the esophagus
Supra-infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Macrolide: Erythromycin, Azithromycin

A

Give with full glass of water on an empty stomach, not with fruit juice
Inhibit protein synthesis by binding to bacterial ribosome
Bacteriostatic
Extended half lives allow for shorter durations of therapy (eg Z-pack)- long half life & loading dose
** can take amirarone because it will prlong the heart contraction**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Macrolide: Erythromycin, Azithromycin Side effects

A

mild GI upset, diarrhea and abd pain

Adverse effects: hearing loss (can be permanent) , vertigo and dizziness. Cardiac dysrhythmia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Aminoglycoside: Gentamycin

A
  • Narrow Spectrum
    -IV medication (peak and trough levels drawn)
    -Can be used against gram negative bacteria, mycobacteria and protozoans
    Inhibit protein synthesis, bactericidal, powerful
    -Normally reserved for serious gram negative infection and must give IV as poorly absorbed.
    -Sometimes given orally to sterilize the GI tract prior to intestinal surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Aminoglycoside: Gentamycin Side effects

A

Possible serious ototoxicity/neurotoxicity (decrease LOC, change in mental status, confusion, seizures, HA, peripheral neuropathy)/nephrotoxicity

  • tinitus
  • vertigo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

peak and trough levels drawn

A

Peak: Highest concentration of the med in the blood
Trough: Lowest point = drawn 30 min prior to the next dose (before the med start)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Fluoroquinolones: Ciprofloxacin

A

Bactericidal, inhibit DNA synthesis
Good action against gram negative species (UTIs)
Good agents against anthrax and other agents of biologic warfare
Good absorption (can be oral or IV) **No first pass effect*
Can give with food but not with MVI or mineral supplements (separate by 4 hours or 1 hour before)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Fluoroquinolones: Ciprofloxacin Side effects

A

Mild side effects: nausea, vomiting, diarrhea
Dysrhythmia, hepatotoxicity(AST/ALT/Bilirubin), cartilage toxicity and rupture, insomnia, agitation/anxiety/ mood change/
psychotic change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Sulfonamides: Trimethropin-Sulfamethaxazole (Bactrim)

A

Full glass of water
Bacteriostatic Inhibit synthesis of folic acid.
Combined with trimethoprim reduces resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Sulfonamides: Trimethropin-Sulfamethaxazole (Bactrim) Side effects / AD Effects

A

Side effects include nausea and vomiting, urinary crystal formation, photosensitivity.- sensitive to sun ( long sleeves)
Adverse effects: SJS, hepatic necrosis, hyperkalemia(tachy, mucle cramps), severe anemia (Fatigue/SOB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Carbapenems: Ertapenem

A

Widest spectrum
Bactericidal with super strong beta-lactam ring and destruction of the cell wall.
Can only be given IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Carbapenems: Ertapenem Side Effects

A

Adverse effects: confusion and seizures

54
Q

Clindamycin

A

Flagyl-reaction with alcohol, metal taste
Synercid-treatment of VRE
Linezolid-treatment of MRSA, thrombocytopenia. Serotonin reaction causing HTN.
Vancomycin-when taken GI there is no systemic absorprtion, IV can be nephrotoxic. Needs peak, trough.
Daptomycin

55
Q

Vancomycin

A

Oral- no systemic absorption, treatment of Cdiff
IV must be given dilute over 60 minutes to prevent flushing (redman syndrome)
Adverse effects: nephrotoxicity, otoxicity
Peak/ Trough measurements needed.

56
Q

Tuberculosis

A

M. Tuberculosis causes hypersensitivity reaction in the body creating walls around microbes called tubercles. Infection can be re-activated.
Needs prolonged, multi drug treatment.
Active and latent doses
S&S: Cough/ fever/ malaise/ Bloody Spetum(hemaptosis) /night sweats

57
Q

Anti-TB Isoniazid -Can be used for latent or active TB.

A

Adverse Events: peripheral neuropathy, optic neurtitis, hepatotoxicity, blood dyscrasia (change to RBC in bone)

58
Q

Anti-TB Rifampin - for active

A

side effect: orange discoloration of body fluids. Adverse effect: renal failure, hepatotoxicity, hyperuricemia, blood dyscrasias (change to RBC in bone)

59
Q

Systemic Anti-Fungals: Amphotericin IV

A

Systemic: Lungs/ abd/ blood stream

(old treatment) toxic medicine with multiple side effects pancytopenia, cardiac arrest, liver and kidney failure

60
Q

Systemic Anti-Fungals: Micafungin

A

headache, nausea, rash, phlebitis, leukopenia allergic reactions, delirium

61
Q

Azole: Diflucan

A

Broad spetrum
Interfere with biosynthesis of ergosterol which is essential to fungal cell membranes.
Broad spectrum and can be used for systemic, cutaneous and superficial infections.

62
Q

Azole: Diflucan Side effects

A

Severe nausea and vomiting, allergy
Liver failure with ketoconazole (rare with diflucan)
Medication interactions (increased bleeding with warfarin, hypoglycemia with diabetic meds, increased effect of some narcotics)

63
Q

Protozoan Infection

A

Malaria is caused by infection of RBC in Liver. Mosquito illness.
Parasite-> RBC-> RBC Burst-> More parasite

S&S: Fever/ chills/ bones and joint/ anemia
SE: Visual Change/ photo phobia

64
Q

Anti-Malarial Therapy Chloroquine

A

Chloroquine* heme complexing agent, prevent transmission into red blood cells.
Treatment or prevention

Hydroxycholorquine like
Side effects: photophobia, visual changes
Adverse: hemolytic anemia, irreversible retinal damage

65
Q

Anti-Protozoa Metronidazole (Flagyl)

A

Other protozoa infection

  • Cryptosporidiosis- diarrhea/ cramping
  • Giardiasis-drinking contaminated water-iarrhea alternating with greasy stools. Fatigue, cramps
  • Trichomoniasis STD-> Red/ burning/ white and running discharge

Disulfram reaction with alcohol ** Cause severe N/V + abd pain*
Side effect: metallic taste
Adverse effect: seizures, peripheral neuropathy

66
Q

Anti-Helminth Mebendazole

A

-Can be used against multiple types of warms
Used during adult and larvae stage
High concentration in the intestines
Chew and take with fatty meal
As worms die will experience abd pain, distention and diarrhea

67
Q

Virus

A

Intracellular parasite
Contain DNA or RNA information and a protein coat or capsid
Find a target cell and use that cell for replication

Anti-viral:
Used as treatment or prophylaxis
After exposure could receive treatment with vaccine.
Some treatment decreases length or severity of symptom.

68
Q

Helminthic /Worm infection from

A

Worm species: water/ soil continimation

Related to proper sanitation / GI: wt loss- worm absorbs nutrients in body

69
Q

Protozoan Infection from

A

Single celled organisms
Parasites
Water, soil, and animal hosts

70
Q

Herpes: Acyclovir

A

S&S: Blistering/ fluid filled + hurts
-Used to shortened the length
Administer around the clock with food (oral)
IV administration can be painful to vein
Topical use gloves
PO no side effects
IV nephron (hydration)(make sure to drink a lot of fluids), neurotoxicity, thrombophlebitis, vesicant

71
Q

Influenza (Tamaflu)

A

*Oseltamivir
Prophylaxis or treatment
Must be given within 48 hours (24-48 hours trying to tshorten 7 days - 5days)
Adverse effects: neuro-psychosis, SJS

72
Q

HIV: Zidovudine NRTI

A

If mom has HIV will used mets when prego and IV in labor to prevent transfer from mother to baby
Oral or IV
Bone marrow suppression (may need therapy interruption)
Fever/muscle aches
GI side effects
CNS side effects

73
Q

HIV: Delavirdine NNRTI

A

PO, TID, can be dissolved, no antacids
Rash SJS
GI can be severe
Liver disease

74
Q

HIV: Raltegrevir-Integrase Inhibitor

A

PO with or without food
Liver disease
GI
CNS

75
Q

HIV: Ritonavir-Protease Inhibitors

A 
PO with snacks
Hyperglycemia, diabetes
Fat redistribution
Elevated cholesterol and triglycerides
Osteoporosis
Liver disease
GI
76
Q

Pituitary: Anterior and posterior lobes

A

Controls growth and metabolism

Secretes hormones that travel to target tissues

77
Q

hypothalamus

A

Connects to brain by nerves

Connects to pituitary by nerves and blood vessels

Secretes releasing or inhibiting hormones for the pituitary

78
Q

Thyroid

A

Hypothalamus secretes thyroid releasing hormone (TRH).

Anterior pituitary produces thyroid stimulating hormone (TSH).

TSH stimulates the follicular cells of thyroid to produce thyroxine (T4) and triiodothyronine (T3).

Iodine is needed for production of T3 and T4

79
Q

Growth Hormone- Somatropin

A

IM or SQ

  • used in Growth hormone deficiencies, such as Turner’s syndrome in children
  • Growth hormone deficiency in adults to increase lean muscle mass
  • AIDS wasting syndrome
  • Stimulates release of insulin-like growth factor-1 (IGF-1) from liver/other tissues*
80
Q

Growth Hormone- Somatropin Side effects

A

Hyperglycemia

Myalgia (pain in a muscle or group of muscles.)

Hypercalciuria- kidney stones

81
Q

Growth Hormones facts

A

Inadequate secretion during childhood – Short stature

Excessive secretion during adolescence – Gigantism

Excessive secretion during adulthood – Acromegaly

Somatostatin

Inhibits release of growth hormone by the pituitary.

82
Q

ADH: Desmopressin (Synethic ADH)

A

Produced by hypothalamus and stored in posterior pituitary
-Produces effects on kidneys *Works on renal collecting tubules to increase reabsorption of water *
-Short half life, need to give 4-5x per day.
Formulated with peanut oil
-Increases reabsorption of water
-Decreases urine volume

83
Q

ADH: Desmopressin Side effects

A

Admin: Spray latteraly
Side effects: drying/ irritation/ bloody nose
fluid retention- low NA+
Follow up: Labs: renal fx, UA, specific gravity, NA+ (135-145 me 2/L)
Contraindications: Peanut allergy

84
Q

Diabetes insipidus

A

When body hypo-secretion

S&S: alor of pee/ excessive urnation

85
Q

Anti-Diuretic Hormone (ADH)

A

In response to increased osmolarity (highly concentrated blood, dehydration) the pituitary releases ADH
ADH causes the kidney to retain water and decreases water excretion.
Once the concentration of the blood (hydration status) returns to normal the stimulus for release of ADH goes away and the pituitary stops releasing ADH.

86
Q

Hypothyroidism (symptoms)

decreased T3/T4

A
  • waxy/ faatigue/ wt gain/ cold intolerance/ hair + nail change/ decreased in hair/ Brady/ consitipation/ depressed
  • *if severe can lead to myexedima coma**
87
Q

Hyperthyroidism (symptoms) (increased TSH)

A

irritability/ heat intolerance/ anxiety/ tachy/ sweaty/ diarrhea/ Bugs eye(graves disease)/ increased HR

**if severe can lead to thyroid storm –> cardiac arress*

88
Q

Levothyroxine - Synthroid

A

Thyroid replacement
-Synthetic T4 then converts to T3 in the body
-Can take 1-3 weeks for full benefit, usually increased at 4-6 week intervals.
Side effects: Hyperthyroidism (over treatment)
Follow up: Labs: TSH/ T3 + T4

  • life long therapy/ take in AM on empty stomach before breakfast
89
Q

Negative Feedback Loop of Thyroid Hormone Production

A

Hypothalamus produces -> TRH (Thyrotropin-releasing hormone)…this causes the Anterior Pituitary Gland to produce ->TSH (thyroid-stimulating hormone)….this cause the thyroid gland to produce-> T3 & T4

90
Q

Propylthiouracil

A

-When there are too much Thyroid Hormone and this med will Interferes with synthesis of T3 and T4 in the thyroid gland as well as conversion of T4 to T3 in the peripheral tissues.
Can lead to hypothyroidism symptoms
-Given orally several times per day (one tablet q 8 hours) TID
Follow up: Labs; CBC/ TSH
Pregnancy Category D
during pregnacy hyper-thyroid can clear up and then come back

91
Q

Adrenal Gland

A 
Multiple Hormones including cortisol, aldosterone and androgen
*Cortisol- Stress response:
Increase blood sugar
Increase breakdown of lipid and protein
Suppress inflammation
Increase sensitivity to the SNS
Increase breakdown of bones
Dilates bronchial smooth muscle

*Aldosterone- increase fluid retention & decrease K+ which increase BP

92
Q

Cortisol: Hydrocortisone

A

Treatment of adrenal insufficiency
Many treatment targets (Inflammation, allergy, autoimmune disorders)
Excessive, prolonged use leads to Cushing’s like syndrome
Cannot stop suddenly **If stop cortisone suddenly: adrenal insufficiency, hypotension, lethargy, renal failure, nausea and vomiting.
Gradual withdrawal allows the adrenal gland to resume normal function. **

Anxiety, vertigo, insomnia, confusion, depression, HTN, peptic ulcer disease.

93
Q

Low Aldosterone

A

Body excrete excessive water/ sodium and keeps K+

which contributes to dangerous fluid and electrolyte imbalances

94
Q

High Aldosterone

A

too much fluid retention/ sodium and low K+

95
Q

Aldosterone: Fludrocortisone

A

Replacement therapy for acute and chronic adrenocortical insufficiency (Addison’s disease, primary hypoaldosteronism, congenital adrenal hyperplasia) usually along with hydrocortisone

If Addison’s disease effects aldosterone production
Taken with hydrocortisone
PO every day, or three times per week

SE: too much fluid retention/ sodium and low K+
FU: Labs/ kidney check/ BMP + weight gain

96
Q

Oral

Sulfonylurea: Glipizide

A

Stim pancreas to release insulin
*biggest worry= hypoglycemia
Persistent hypoglycemia, GI distress, hepatotoxicity

  • decreased BS + take 30 min pre breakfast
    ETOH= Disulfran- N/V + Flushing
97
Q

Oral

Biguanide: Metformin

A

Increase insulin sensitivity / decrease absorption in intestine
SE: abd cramping dirrhea- but will go away
-Nausea, vomiting, diarrhea, anorexia, headache, dizziness, agitation, fatigue.
**Does not cause hypoglycemia **
** has to be help pre procedures (SX or Scans with IV dyes)-> poss. Lactic acidosis
- eats BID- do not take when you are sick / dehydrated

98
Q

Oral

Melgitinides: Repaglinide

A

Stimulate the pancreas to release insulin.
3x per day 30 min or less pre meals. Skip if not eating, add if eating extra, no more than 4 per day.
SE: hypoglycemia/ Nausea/ diarrhea/ No grape fruit juice with increase toxicity

99
Q

Oral

Thiazolidinediones: Pioglitazone

A
  • Helps cells use insulin better
  • Decreases insulin resistance at the tissues
  • Taken every day with or without food
  • Side effects:hepatotoxicity/ liver hurt/ increase chol
  • Does not need to worry about hypoglycemia
100
Q

Oral

Alpha-glycosidase Inhibitors: Arcabose

A
  • works in intestine/ TAKE before eating up to 3X a day
  • Stops the breakdown of carbohydrates in the intestine and decreases absorption of carbohydrates.
  • Side effects: Stomach Pain/ liver dysfunction/ anemia
  • Treatment of hypoglycemia: Dextrose tabs- can not give sugar because med will get rid of it and can not self correct hypoglycemia
101
Q

Oral

Gliptin: Sitagliptin

A

Increase release of insulin and decreases available glucagon. **SLows gastric emptying*
Taken daily with or without food.
Side effects:HA/ symptoms of upper resp/ pancreatitis
hypoglycemia

102
Q

Diabetes

A

Fasting blood sugar greater than 125 mg/dL on two separate occasions.
Hemoglobin A1C (greater than 6.5%)
Normal BS: 70-100

103
Q

Hyperglycemia

A

Thirsty/ Dry/ increased urniation/ increased hunger and can lead to change in mental status

104
Q

Hypoglycemia

A

lethargic/ dizzy/ altered mental status/ HA/ * SWEATY & SHAKY

105
Q

DIAB TYPE 1

A

insulin Cannot give orally (does not absorb)
Only regular can be given IV
Most given subcutaneously

106
Q

Hypoglycemia treatment

A

Treatment depends on stores of blood sugar and level of consciousness and ability to swallow.

  • Awake: (need 15 gm of sugar) 4oz of OJ, 15 saltines, 1 tbsp. honey
  • Unable to swallow but able to follow direction: Glucagon

SQ (need glucose storage, takes 30 minutes)
Altered LOC, very low sugar: D50 IV

if pt is anorexia they do not have storage and can not give them glucagon

107
Q

Type I Diabetes, Uncontrolled Type II DiabetesInsulin

A

Maintain blood sugar
Usual side effects are hypoglycemia, hypokalemia, and Lipohypertrophy

Steroids, thyroid, and epinephrine antagonize effects
Furosemide and thiazide diuretics can increase glucose
hypoglycemia with beta blockers (hypoglycemia pt can not feel when they have Tachy so it is dangerous)

108
Q

Insulin storage

A

Proper storage: out of heat/light. Opened lasts one month. ROOM TEMP
When to check blood sugar

109
Q

Types of Insulin-MEMORIZE

A

Regular Insulin: Onset 30 minutes, peak in 2 hours, lasts 5 hours GIVE 30 MINUTES PRIOR TO MEAL.
NPH: Onset 1 hours, peak 4 hours, lasts 18 hours GIVE 30 MINUTES BEFORE FIRST MEAL OF DAY, SOMETIMES 30 MINUTES BEFORE SUPPER TOO.

Can mix in same syringe. R first than N

110
Q

Glargine Lantus injection

A

Glargine: gradual onset, begins in 1 hour, no peak, lasts up to 24 hours. CANNOT BE MIXED WITH OTHER INSULINS
Lispro: Onset 5-10 minutes, peak 30 minutes to an hour, duration 3-4 hours. Given 5-10 minutes before a meal.
*Lispro give at the time of meal- give it with tray infront of them**

111
Q

Amylin Mimetics: Pramlinitide injection

A

-give between meals-
Decreased gastric emptying, decrease glucagon, increased feelings of fullness- helps u eat less
Proper storage: store like insulin can be left out / SQ injection
Onset: 60 min prior to meals - start working in 60 min
Side effects: Nausea/ hypoglycemia/ pancreatitis located with RUQ + back
amylin mimetic, if used with insulin can cause severe hypoglycemia

112
Q

Incretin Mimetics: Exenatide injection

A 
**incretin mimetic, if used with insulin can cause severe hypoglycemia**
Similar to glucagon
Decreased gastric emptying 
Increase release of insulin
SQ 60 minutes prior to meals
Peaks in 2 hours
113
Q

H receptor blockers: diphenhydramine

*loratadine - Non drowsy

A

Better at prevention then relief/reverse
Have anticholinergic effects as well: dry membranes
Can cause drowsiness esp older versions. CNS depressants add to this.

Other uses: Vertigo/Motion sickness
Parkinson’s Disease
Insomnia
Urticaria and other skin rashes

114
Q

H receptor blockers: diphenhydramine Side effects

A

Dry mouth, headache, drowsy, bitter taste. (dizzy, urinary retention, thickening of secretions, nausea, vomiting, paradoxical excitation, EPS, agranulocytosis, respiratory depression-First generation)
ANTICHOLINERGIC Side effects

115
Q

Intranasal CorticosteroidsFluticasone-steroid

FLONASE

A

-Glucocoricoid applied directly to the nasal mucosa
-Topical so no serious side effects, not systemic
-Decrease secretion of inflammatory mediators, reduce edema, and cause vasocontriction
*No immediate benefit (1-3 weeks)**
Side effects: Drying, burning, epistaxis

116
Q

Common cold

A

Viral infections of the URT
No cure or effective prevention
Treatment is symptom management

117
Q

Common Cold Symptom ReliefDecongestants

A 
Relieve congestion, oral or intranasal
Can be combined with antihistamines
Sympathomimetic, alpha-adrenergic
Oxymetazoline (Afrin)*, no systemic absorption so no side effects but rebound congestion. 
Should not used longer than 3-5 days.
118
Q

Decongestants: Oxymetazoline, Pseudoephedrine

A
  • DO not give to ppl with heart problems*
  • Taken orally there is no rebound congestion but there is systemic absorption (insomnia, excitability, and HTN)
  • Pseudoephedrine (Sudafed)-phenylephrine
  • Can be made into methamphetamine so must register at pharmacy.
  • Phenylephrine is an alternative decongestant but not as effective
119
Q

Anti-Tussives

A

DO not give to a productive cough
-Can suppress cough if viral, dry and hacking
If cough is r/t removal of excess secretions and foreign material, aspiration or emphysema then cough suppression is not advised.
-Opioids raise the cough threshold at low doses but can lead to CNS/respiratory depression, bronchocontriction in ashtma

120
Q

Anti-Tussives: Dextromethorphan

A

Dextromethorphan*(Rubutisin), non opioid but chemically similar. Work by raising the cough threshold.
There is some abuse potential
Side effects are drowsiness, Headache, GI upset, paradoxical excitation, tremors, euphoria, insomnia
if given with opioids it will make it more potent SYNERGISTIC

121
Q

Expectorants: Guaifenesin

A

Increase mucus flow by reducing the thickness of secretions.
Guaifenesin (Mucinex) helps with dry and productive cough.
Should not be used with children under 6
take with a lot of water

122
Q

Mucolytic: Mucomyst

A

Directly loosens thick viscous bronchial secretions. Break down chemical structure of mucus, makes thinner and easier to cough up.
Bad odor, rotten eggs
Inhalation
Can cause bronchospasm so should not be used with asthmatics.
Reverses acetaminophen (Tylenol) overdose
can not take if pt has asthma

123
Q

Lower Respiratory System

A

Bronchial Smooth Muscle and Autonomic Nervous System

Treatment of Asthma: Open up airways and decrease inflammation

124
Q

Beta Adrenergic Agonists

A

Activate sympathetic nervous system to relax bronchial smooth muscle.
Nonselective (beta 1 and 2) Selective (beta 2)
Acute Bronchoconstriction, bronchospasm but no anti-inflammation component

125
Q

Short acting beta agonists

Albuterol

A

Rescue- fast acting
Last only 2-6 hours
Prn no more than 12 inhalations per day
Headache, dizziness, tremor, nervousness, throat irritation, tolerance
Tachycardia, dysrhythmia, hypokalemia, hyperglycemia, paradoxical bronchoconstriction, increased risk for asthma related death.
do not use with a Beta blocker
-wait 1 min between puffs & hold in puff for 5-10 sec

  • can take 15-30 before exercise
126
Q

Anticholinergics: Ipratropium

A

Alternative to bronchodilators
Slower and less intense
Block the parasympathetic nervous system
Can be used in asthma, copd more commonly
Ipratropium (Atrovent)*, Tiotropium (Spiriva)
Can combine atrovent and albuterol for longer bronchodilation
Spiriva has a longer duration of action and used as prophylaxis for bronchospasm in COPD
*Anticholinergic side effects = Anti sludge - dry mouth,Salivation, Lacrimation, Urination, Defecation, Gastrointestinal Distress and Emesis
**SOY PEANUT ALLERGY **

127
Q

Inhaled Corticosteroids: Betamethasone (Qvar)

A

Hoarseness, dry mouth, cough, sore throat
Candida- fungal infection in mouth - pt must rinse and spit

Systemic absorption (risks

** IF TAKEN WITH Abuterol**
Abuterol goes first THEN THE SEROID**

128
Q

Mast cell stabilizer: Cromolyn

A

Bitter after taste- Take 15-30 min prior exercise

129
Q

Leukotriene Modifiers
(singular -montelukast)
only pill

A

Leukotrienes are mediators involved in allergic and asthmatic reactions.
Leukotrienes in the airway cause edema, inflammation and bronchoconstriction
Montelukast (Singulair)* blocks leukotriene receptors
Reduce inflammation, effect on bronchioles minimal
Headache, cough, nasal congestion, GI upset, increased infection in the elderly.
Contraindicated with alcohol use or hepatic dysfunction

liver dysfunction esp in elderly

130
Q

Sympathetic Alpha receptors located

A
  • Smooth muscles/ arteries
  • Prostate
  • Brain
131
Q

Beta receptors

A
  • Heart
  • lungs
  • kidney
  • Pupil dilate/increase HR/ increase RR/ decrease urine formation/ prostate contract

PHARM EXAMS 3, 4 & 5 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions