Pharm Exam1 Flashcards
S/S of Stress (↑3 ↓2)
↑ HR, BP, Pupil dilation, ↓ secretions, GI mobility
How does stress cause cell damage (4)
free radicals, hypoxia, ATP depletion, !intracellular calcium homeostasis
Stress phase 1: Alarm (2, 4 released)
SNS and HPA on, fight v flight initiated
Cortisol, adrenaline, noadrenaline released
Stress phase 2: Resistance (4)
Selective defenses.
Homeostasis restores balance for period of recovery. Hormones normalize.
If condition persists body adapts to continued effort.
Stress phase 3: Exhaustion (4, 4 AKA)
Stress levels stay high, very hazardous for health
Resources depleted, results in systemic damage
AKA: Overload/burnout/adrenal fatigue/
maladaption/dysfx
Increase of cell numbers?
Hyperplasia
Adaptations to Stress (10)
Physiologic/Anatomic reserve Time Genetic Endowment Age Gender Health Status Nutrition Sleep-wake cycles Hardiness Coping
Increased capacity to adapt to stress
Coping
Types of Stress (3)
Acute (time limited), Chronic (intermittent), PTSD (sustained)
Which type of stress if fight v. flight?
Acute
Which system manifested first w/ stress response?
Autonomic Nervous System
Wheezing/SOB w/ acute bronchial asthma is caused by? (2)
Inflammatory response and swelling
States of PTSD (1 description, 3 phases)
PTSD is chronic activation of stress related to an event (SNS is activated, cortisol levels ↓)
Intrusion
Avoidance (numbing)
Hyperarousal (irritability, startle reflex)
Definition of “Intrusion State”
“Flashbacks” and nightmares of event in detail
Sections of CNS? (2)
Brain and spinal cord
Where do SNS impulses come from? (3)
Hypothalamus, adrenal medulla, spinal cord
S/S of Fight v. Flight (6)
↑ RR, diaphoresis, dilated pupils, ↓ secretions, GI motility, constriction of sphincters
How does heat cause cell injury?
Coagulation of blood vessels and tissue proteins
How does cold cause cell injury?
Viscosity induces vasoconstriction through SNS reflex.
↓ blood results in hypoxia -> tissue injury
also… frost bite.
Types of Adrenergic Receptor sites (4)
A1 - bladder/vasoconstriction, iris dilation
A2 - ↑ insulin release from pancreas
B1 - cardiac and contractility
B2 - bronchi,vasodilation, relaxation of uterus
Which site when stimulated results in myocardial activity and an increased HR?
Beta 1
What does PNS do?
Opposite of SNS. Begins energy storage and conservation
“Rest of Digest”
Adrenergic blockers fx? (↑1 ↓3)
Treatment similar to?
↓ BP, pulse, renin levels ↑ renal perfusion
Treatment for HTN
When receiving adrenergic blockades. Priority assessment?
Monitor HR
Areas of Pharmacology (5)
Pharmaco…
Dynamics - org to chemi
Kinetics - drug action, HL, peak, duration, metabolism
Therapeutics - therapeutic fx of drugs + admin
Economics - value of therapy vs another
Genomics - drug fx vs. individual genetics
Area of pharmacology involved in exploring unique differences in drug responses due to genetic makeup?
Pharmacogenomics
Phases of Pharmacokinetics (4)
Absorption, Distribution, Metabolism/Biotransformation, Excretion
Labs to administer if giving nephrotoxic antibiotics
Creatinine and BUN
FDA Category where fetal abnormalities > beneficial fx of drugs
Category X substances.
Concerns when administering to older pts? (3)
↑ susceptible to AdFx
Monitor hydration, nutrition, hepatic renal fx
Ensure compliance (alarms/reminders)
More effective method of antibiotic therapy?
Broad vs Selective
Selective targets infections
(IV is quickest)
Broad used when C&S not available or pt is too sick to wait for results
Preventing drug resistance (4)
Only use if C&S identifies
↓ dis/misuse
Complete full round
!save for self-medication in future
How do penicillins fight bactera?
Interfere w/ cell wall building
What antibiotic is used to prophylactically treat family members living w/ a pt with tb?
Isoniazid
When does antibiotic therapy stop?
When full round is complete
How do organisms develop resistance?
alter cell walls/enzymes to become resistant to unfavorable conditions/situations
How to prevent accumulation of anti-infective in kidneys?
Hydration throughout drug therapy
Lab values to monitor when administering aminoglycosides?
BUN and creatinine monitor renal system
When is Flagyl (metronidazole) used prophylactically
For pts undergoing vaginal, abdominal, or colorectal surgery (pre/post op)
Flagyl
Type of antiinfective?
Antiprotozoal
Ketoconazole (Nizoral) and Lotrimin
Type of antiinfectives?
Antifungals?
How are Nizoral/Lotrimin applied?
Topically. Nizoral also can be taken orally
Nizoral/Lotrimin Contraindications? (6)
Hepatic dysfx Renal dysfx Endocrine/Fertility probs Pregnant/Lactating Known allergy/hypersensitivity reaction Open lesions
Where can Candidiasis infx occur? (2)
mouth and vagina (vaginitis)
What is oral Candidiasis called?
Thrush
Sidefx to warn pt when giving antifungals (5)
Systemic - bruising/bleeding, yellowing eyes/skin (hepatic toxicity)
Topical - serious irritation, burining, pain
STOP IF ANY OCCUR
What should nurse monitor if administering antifungals? (!, 4)
They’re very toxic!
Monitor renal, hepatic fx, CBC (%blood, platlet b/c excessive bruising)
Pressure generated through semipermeable membrane?
Osmotic
Diffusion?
Movement of un/charged particles from [High] to [Low]
What is tonicity if ECF > ICF
Hypertonic. Stronger forces draw H2O.
Causes of interstitial edema (4)
↑ capillary filtration pressure, permeability ↓ capillary colloidal osmotic pressure, lymphatic flow
Most effective method to measure body fluid volume (do this every day)
Urine output
What condition can occur w/ rapid infusion of hypertonic solution
Edema
How do electrolyes fx a cell
Electrolyes form ions.
Ions help determine osmotic pressure of body fluids
Normal values of electrolyes (5)
Na 135-145 K 3.5-5 Mg 1.2-2 Ca 9-10.5 P 3-4,5
Hyponatremia fx on cell?
Cell swells
What electrolytes is inversely related to calcium?
Phosphorus
Isotonic fluid body deficit results in? (what travels w/ h2o?)
Hyponatremia
Causes of hyponatremia (4)
Manifestations (4)
↓ renal fx, sweating, GI losses, SIADH
Edema, cramps, weakness, fatigue
What to administer to counter hypermagnesemia
IV Ca
What to monitor when administering NSS? (5)
Hypervolemia, edema, crackles, HR, BP
PSNS neurotransmitter and fx (3)
Acetylcholine.
Fx pre/postganglionic neurons to ↑ digestion, nutrient absorption, and protein building to conserve energy
What are Cholinergic Agents? (Parasympathomimetics) and !?
Imitate AChs to make PSNS fx
!? cannot be limited to specific site, often cause fx on whole body and cause undesirable adfx
What is Duvoid (bethanchol)
Cholinergic agonist, used for non-obstructive post/operative/partum UTR, also reflux esophagitis
What are cholinergic agonists used to treat? (4+1)
↑ bladder tone, excretions, GI secretions, mouth secretions for dry mouth (Sjogren)
relieve intraocular pressure
Fx of anti-cholinergics?
Depresses PSNS and lets SNS dominate
Fight v Flight S/S
Most common anti-cholinergic and fx on vitals?
Atropine.
↑ HR.
Found in natural produces (belladona) and in herbal therapy which can cause toxciity
Anti-cholinergic Adfx? (7)
dry mouth, constipation, UTR, ↑ HR. ↓ sweating, blurred vision, dilated pupils
Conditions worsened w/ anti-cholinergics? (8)
Narrow angle laucoma, GI/GU obstruction, prostatic hypertrophy, HTN, tachycardia, renal/liver dysfx
ARF vs CRF
Acute Renal Failure - seriously ill. rapid decline in fx due to poor balance/excretion
Chronic - permanent loss of nephrons.
Fx lost in CRF
fx kidney nephrons and GFS. Remainders have to work harder
Common indicator of ACF?
Azotemia, accumulation of nitrogenous wastes
What does kidney activate to maintain Ca levels in body?
Vit K b/c it promotes Ca absorption
!P, it cannot excrete P
Signs of recovery from ARF? (↑,↓, possibility?)
↑ urine output, ↓ creatinine
Possible BUN, Creatinine, K, and P levels remain elevated but eventually will normalize
Pre/Intrinsic/Post Renal? (3,3,2)
Pre - ↓ blood flow b/c hemorrhage, CHF, dehydration
Intrin - injury to kidney, ischemia, obstruction, etc.
Post - urine outflow obstruction (prostatic hyperplasia)
Renal failure caused by acute dehydration?
Urinary obstruction?
dehy - pre
obs - post
Prototype Diuretics. (5)
Thiazide (Hydrochlorotiazide), blocks Cl pump results in ↓Na, K, Cl
Loop (Furosemia), fx loop of Henle, results in ↓h2o, Na, K
Carbonic Anhydrase inhibitors (Acetazolamid), inhibits carbonic anhydrase, resulting in basic urine (treats glaucoma)
Potassium sparing (Spironolactone), sparts K in exchange of ↓Na and H2o
Osmotic (Mannitol), ↑ osmalrity of GFR, ↓h2o, Na, Cl
Lab to monitor when giving Furosemide? (4)
HypoK, HypopH, HypoCa, hyperGlycemia
Diuretic for glaucoma?
Acetazolamid (Diamox)
Class of diuretics most commonly used for out/inpt conditions?
Loops
What does Chlorothiazide do? (treats what caused by 4)
treat edema caused by HF, liver dz, and renal dz.
Also HTN
What imbalance if pt has leg cramps, fatigue when taking thiazide?
Hypokalemia
Which tubules are fx’d by thiazide? (and 2 electros)
Distal, Cl and Na
MOST important instruction when giving pt diuretic therapy
Maintain fluid intake to avoid rebound
Diamox is a…?
Carbonic Anhydrase Inhibitor
Drug interactions to watch w/ Diamox? (2)
Lithium and Salicylate levels
Nephritis v. Nephrosis
Nephritic - inflammatory response w/ ↓ GFR, results in retention and accumulation
Nephrotic - ↑ GFR, proteins in urine yo
What causes edema in pt with nephritic syndrome and glomerulonephritis?
nephritis causes Na and H2o retention, glomerulo - ↓ plasma pressure (↓ GFR) and protein loss
Bladder/UT dz (3)
Lower UTObs/Stasis - kidney ok but retained (can cause kidney dmg)
Spastic - failure to store b/c spasms/neural dmg
Flaccid - failture to empty b/c muscle/neuropathy
Types of incontinence (3)
Stress - involuntary loss b/c coughing
Overactive - urgency b/c hyperdetrusor muscle
Overflow - loss b/c increase pressure w/out muscle activity
Which incontinence includes dysfx detrusor?
Overflow
Most common Bacteria w/ uncomplicated UTIs?
Ecoli