Pharm Exam2 Flashcards
Levothyroxine (Synthroid)
Dx, fx, prepared from, contains, routes, fx to metabolic rate and additional fx.
Hypothyroidism ↓ TSH dried animal thyroid glands T3 and T4 PO or IV ↑ metabolic rate ↑ O2 consumption/ATP hydrolysis
Levothyroxine (Synthroid) Side FX (5) with r/o!
Anxiety, tachycardia, heat intolerance
!!! - Fever, diaphoresis which r/in Dehydration
Levothyroxine (Synthroid) education and administration tips (3)
Ø ↑ or ↓ dose suddenly
Administer w/ full glass of H2O
Prepare for ↑BMR by hydrating as necessary
Glucocorticoids
Primary fx, clinical fx and tx.
3 other fx.
R/t Lipogenesis
Increase glucose levels for energy
Blocks inflammation/immune resp. inconj w mineralcorticoids to tx adrenal insufficiency.
↑ fat deposition, ↑ protein breakdown, ↓ protein formation.
Monitor BMI
Glucocorticosteroids: Health Conditions of Concern (5)
Acute infx Diabetes, ↑ glucose disrupts glucose congtrol Acute peptic ulcers Endocrine dz Pregnancy
Diabetes Type 1 vs Type 2
onset, insulin relation, r/by? 1 - 3
Type 1: autoimmune onset in young people, insulin-dependent. Øfx beta cells.
R/by genetics.
Type 2: onset in 40+ yr old people, insulin resistant.
R/by peripheral insulin resistance, ↓pancreas secretion, ↑glucose production by liver
Normal blood sugar range
70 - 110 mg/dL
Prior to administering AM insulin, what should you check?
Blood Glucose Levels (Rapid Finger Glucose)
Insulin used to treat Rapid Finger Glucose sticks?
Short/Rapid acting based on sliding scale
Complications of long term diabetes (9)
Cardiovascular dz Cerebrovascular dz Foot ulcers Atherosclerosis Retinopathy Neuropathy Nephropathy Hypoglycemia Liphypertrophy
How to avoid DM complications
3 Control Factors.
Control of…
blood glucose
lipid levels
htn
How to reduce lipohypertrophy and hypoglycemia (4)
Rotate sites (1 inch between sites) Eat a carb snack! oj, grape juice, milk, glucose tabs.
Instructions for diabetic pts?
Assess limited access of diet
R/f for Type 2 DM?
Obesity indicated by a BMI > 25
Types of insulin (4)
Humalog - rapid acting
Humulin R - short acting
Humulin N - intermediate acting
Lantus - long acting
How does surgery influence blood levels? Proper responses (2)?
↑ blood glucose levels
monitor with RFG
Use rapid acting (Humalog)
Fx of Garlic r/t glucose (2 fx, 1 r/in)
↓ blood pressure and blood glucose
can r/in hypoglycemia
Beta blockers on blood sugar
S/S hypo/hyperglycemia are masked by SNS blockades.
Sulfonyureas.
3 Fx and for what pts.
Major s/fx?
Antidiabetic agents, ↑ pancreatic secretion of insulin, tx for Type 2 DM
Used in pts w/ still fx’ing pancreas
Major s/fx = ↑ r/o Cardiovascular dz
Metformin (Glucophage)
What? For? Fx (3)?
Monitor what with this (2)?
Biguanide for Type2 > 10 yrs old.
↓ liver glucose production by ↓ gluconeogenesis
Also ↑ muscle glucose uptake/use
Monitor renal/liver fx (BUN/Creatinine) especially if receiving IV contrast
Diabetic Ketoacidosis
Cause, fx r/in 7 S/S
Incomplete oxidation of fats r/in ketoacids
Excess blood acids r/in ↑ BUN, dehydration, protein in urine, fruity breath, polyuria, SOB, ↑ electrolytes (Na/K)
Respiratory patterns r/t DKA
Kassmaul respirations
↑ depth, rate
How does Hyperglycemia cause mental confusion?
↑ glucose in blood draws H2O/electrolytes out r/in dehydration which acts on CNS.
Sugar ↑ osmolality of blood and causes CNS to shrink.
Psoriasis
Cause? Topic meds (5), S/S (3)
Chronic inflammatory skin dz
Emollients, Keratolytic agents, coal tar, corticosteroids, cacipotriene
Skin is thick, red plaques, silvery scale.
Isotrentinoin (Accutane)
What is it? Route? Fx? Common Tx for? S/fx?
Teratogen. PO, ↓sebum reduction/anti-inflammatory
Used for Acne
Severe birth defects
How does Acne occur? Onset?
Dz of pilosebaceous unit r/in formation of pustular lesions (inflammatory and noninflammatory).
Begins around puberty r/t ↑androgen production
Actions prior to administering Anti-fungals (4)
Allergies
Monitor BUN/Creatinine
C&S
Baseline CBC and HH
Pressure Ulcers.
What? R/t? Fx on cell? 3 conditions? Stratum corneum tx?
Skin breakdown r/t pressure (cells become hypoxic)
Pressure, moisture, O2 deprivation.
Stratum Corneum rq. adequate hydration via lotion
O2 Deprivation r/t decubitus ulcers?
Lying down puts pressure on cell.
Pressure disrupts capillary flow, r/in O2 deprivation and cell death.
Pressure Ulcer Tx (5)
Re-position q2hrs Pad bony prominences Keep skin clean/dry Assess regularly Adequate hydration of stratum corneum w/ lotion
Skin infx education
↑ diameter if infx is ↑
Mark edges and assess.
Skin infx that responds to systemic antibiotics
Acne
Skin shearing
What? r/t (4)? Preventions (3)?
sliding of tissue over another r/in stretching, blood vessel angulation, injury, and thrombosis.
Move carefully, avoid moving is skin is stuck to surface, pull pt up with draw sheet w/ help
Skin neoplasms (3) and poorest prognosis.
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma <— poorest prognosis
Musculoskeletal strains.
What? S/S (4)? common sites (4)?
Stretching/partial tearing of muscle/tendon units.
pain, stiffness, swelling, local tenderness
lower back, cervical region of spine, knees, ankles
Medications for Musculoskeletal strains (5) with special notes.
NSAIDS, Opiods/Narcotics Øtx inflammation, Celebrex, Fentanyl (Duragesic) is most consistent, through transdermal patch, and has least sedative fx.
Muscuolskeletal strain S/S on elderly?
W/ age, cologne fibers change.
This r/in ↓elasticity and ↑susceptibility to injury.
Stages of Bone Healing (4)
1 - Hematoma formation
2 - Fibrocartilaginous Callus formation
3 - Bony callus formation (ala Ossification)
4 - Remodeling
Administration of Morphine.
For? When (2)? Age limit? Route (6)? s/fx (3)? Anti-s/fx?
Moderate - severe pain. Pre/Post-op, labor NO AGE LIMIT PO, SubQ, IM, PR, epidural, intrathecal Respiratory Depression, sedation, pinpoint pupils
Countered w/ Narcan (Naloxone)
GI Bleeding. Color r/t location.
Layman vs. Medical terminology
Lower = bright red Upper = dark/brownish red tar
Medical Upper = Melena stool
Medical Lower = Hematochezia/Frank Blood
Peptic Ulcer Dz (PTD)
Goal of tx? Most common causes (3)? Medications (3)
Tx of H. Pylori.
Helicobacter pylori, ↑ stress, corticosteroids
Antibiotics (Biaxin/Flagyl), Proton pump inhibitors (Protonix/Nexium), and Histamine 2 receptor agonists (Zantac/Pepcid).
All 3 make TRIPLE THERAPY!
Sucralfate (Carafate)
Fx? Tx for?
Changed by acid in stomach and adheres to ulcer to protect from further injury from acid/pepsin.
Tx for acute duodenum ulcers.
Misoprostol (Cytotec)
Fx? Concern when administering (3)?
Long term NSAID clients to prevent gastric ulcers.
Excessive bleeding or spotting w/ pregnant women may induce labor, ↑% miscarrage, r/in cervical ripening.
H2 blockers.
Fx? Tx for (2)? Drug2Drug interactions? Adfx w/ chronic tx?
↓ hydrochloric acid release in response to gastrin
Gastric/Peptic ulcers,
↑ levels warfarin and r/in bleeding. Monitor INR and PT.
↓ libido, impotence, CNS
Proton pump inhibitors (PPI)
Fx? Tx for (2)?
↓ gastric acid secretion by inhibiting enzymes r/t acid production
Erosive esophagitis and GERD
Gastroesophageal reflux Dz (GERD)
%? S/S (3)? Medications and fx (5)
Most common C/O.
Upset/sour stomach and heartburn.
H2 blockers - ↓ HCL release in response to gastrin
PPI - ↓ HCL secretion into lumen of stomach
Antacids - neutralize acids
GI protectants - coat ulcer
Prostaglandins - ↓ gastrin, ↑ mucus lining secretion
Liver Failure
Cause? How to Dx? Regular fx stopped? S/S (4)? Medications (2)?
Unknown cause but r/in accumulation of neurotoxins in blood (ammonia)
Presence ammonia in blood and cerebral circulation.
Conversion of ammonia to urea.
↓ mental alertness, ↑ confusion, ↑ convulsions, Asterixis (flapping tremor)
Non-absorbable antibiotics (neomycin) and Lactulose
Portal HTN
What (2)? S/S (4)?
↑ resistance of flow in portal venous system and ↑ portal venous pressure
Ascites, esophageal varices, confusion, and forgetfulness
Kupffer cells.
What? Fx (consumes 3 things where)?
Large resident macrophages (aka Stellate macrophages)
Phagocytose old/defecive blood cells, bacteria, and other foriegn material from portal blood as it flows through sinusoid.
IT’S A FILTER!
Cirrhosis
What? Associated w/? S/S? Acute or Chronic? Early signs (3)?
End-Stage chronic liver dz. Most liver tissue is replaced with fibrous tissue.
Associated w/ alcoholism.
S/S portal HTN.
Chronic. Early signs are ascites, weight loss, jaundice.
Antidiarrheal Agents.
Fx? Common mechanisms (3)?
Term to describe GI motility?
De-stimulates GI tract for symptomatic relief from diarrhea.
Bismuth Subsalicylate inhibits local reflexes
Loperamide slows muscle activity
Opium Derivatives fx CNS to slow GI.
GI motility = peristalsis
Laxative Agents.
For what pts? Condition tx’d with lactulose (Chronulac)?
Patients w/ cerebral aneurysms and post MI.
Hepatic encephalopathy
Pancreatitis.
What? Cause for acute? Fx on pancreatic tissues? Most likely contributing factor?
Reversible inflammatory process of pancreatic acini by premature activation of enzymes
Autodigestion r/in acute vers.
R/in potential tissue damage and multi-organ failure.
Likely r/t long term alcohol abuse.
Types of Hepatitis (5)
r/t Liver damage? How to Dx? Least lethal? Spread by fecal-oral? Which can be prevented by immunization?
A - fecal/oral self limiting and least virulent (food)
B - intercourse, needle sharing, blood (healthcare)
C - unclearable chronic carrier condition
D - parenteral IV/drug users, occurs often with B
E - water-borne, self limiting endemic (↑mortality w/ pregnant ♀)
Liver inflammation r/in bile backup which destroys tissue and causes scarring
Dx through ↑ serum aminotransferase levels (AST and ALT), ↑ bilirubin and alkaline phosphates, and Hep antibodies in blood.
Hep A
Hep A
Hep B and A
H. Pylori.
What to avoid when treating for it (4)
Contraindication w/ Triple Therapy (3)?
Aspirin, NSAIDS, grapefruit, antacids.
Alcohol, anti-coagulant therapy, disulfiram
Irritable Bowel Syndrome,
What? Hallmark S/S?
Chronic/recurrent intestinal S/S not explained by structural or biochemical abnormalities.
Ab. pain relieved by defection w/ freq. ▲ in consistency and frequency of stools.
Inflammatory Bowel Dz.
2 types w/ diagnostics?
Chrons: 5 - 6 liquid Øblood stools may have pus/mucus
Ulcerative Colitis: 10 - 20 liquid +blood stools w/ mucus.
↑ ESR and crypts of Leiberkuhn.
Esophageal Cancer
2 types? S/S (3)? How Dx? r/t (2)?
Adenocarcinoma and Squamous cell carcinoma
Dryphagia, anorexia, fatigue
Dx w/ endoscopic surveillance and esophageal dysplasia.
r/t Barret esophagus and long-standing GERD
C. Diff
Full name? What? %flora in humans? Tx?
S/S? How does it occur?
What does it do (4)?
Clostridium Difficle.
Gram+ Spore forming Bacillus.
1-3% normal flora in humans.
Tx with broad-spectrum antibiotics.
Abdominal cramping/Diarrhea.
Disruption of normal intestinal flora b/c antibiotics, diet, etc.
Binds to/damages intestinal mucosa r/in inflammation and necrosis.
Interfere w/ protein synth, ↑ capillary permeability, ↑ peristalsis
