Pharm II Exam 1 Flashcards
1
Q
How should doses be given to children?
A
Smaller doses are given b/c they have immature organse
2
Q
What do immature kidneys mean?
A
Immature excretion
3
Q
How are all meds for infants measured?
A
By their body weight in kg
4
Q
What can alter absorption and metabolism in a pediatric patient?
A
Genetics
5
Q
If an infant has down syndrome, what happens to their absorption?
A
It is slowed down
6
Q
What affects absorption in a pediatric patient?
A
Depends on age, gastric emptying, intestinal motility, route of administration, and skin permeability
7
Q
What would a fever do the absorption?
A
Speed it up
8
Q
If there are GI problems, like babies who are colic can it cause the absorption to change?
A
Make absorption different and it may be difficult for them to absorb anything PO
9
Q
Should meds be given to infants IM?
A
No, there muscles are under developed altering the absorption as well as causing a lot pain
10
Q
What does distribution mean?
A
How does the drug get to its targeted cell
11
Q
What does distribution depend on in an infant?
A
Amount of body water (80%) they have, liver function, protein binding, and development of the blood brain barrier
12
Q
What happens to their plasma protein levels during the distribution of meds?
A
They decrease
13
Q
What happens to the metabolism in pediatric patients?
A
Pediatric patients have immature organs so they cannot break down meds as well as someone who is fully developed.
14
Q
What should be done until liver matures?
A
Calculate drug doses carefully and monitor them closely; liver matures around the end of 2nd year
15
Q
How should meds be given to an infant?
A
PO using a dropper or syringe placed in the inner cheek
16
Q
If IM meds need to be given what size needle needs to be used?
A
Smallest needle possible and given in vastus lateralis (do not give to infant)
17
Q
Are suppositories allowed to be given to infants?
A
YES, they can make administration easier
18
Q
What site should an IV be given to an infant?
A
Scalp veins, foot veins, or hand veins, but more commonly is the scalp
19
Q
Where does the excretion of drugs happen?
A
Kidneys (increased levels of drugs eliminated by the kidneys)
20
Q
Where are drugs eliminated?
A
Urine
21
Q
Having immature kidneys causes?
A
Decreased glomeruluar filtration rate and slowed renal clearance
22
Q
What is important to do before infant gets discharged?
A
Provide parent teaching
23
Q
What is important to remember when administering meds to toddlers and preschoolers?
A
Try and incorporate them as much as possible-they are very hands on at this stage
24
Q
How should explanations be to toddlers and preschoolers?
A
Short and simple
25
Who controls the administration of meds to toddlers and preschoolers?
The parents, so education is important to provide to them
26
If a med is given PO to a toddler or preschooler, what should you do?
Mix med with syrups, applesauce, popsicle, juices
27
Where should the location be for an IM med given to a toddler or preschooler?
Ventrogluteal area
28
Are suppositories recommended for toddlers and preschoolers?
NO, they generally have a strong and quick reaction to them
29
What site should an IV be given to a toddler?
Scalp
30
What site should an IV be given to a preschooler?
Feet, hands, or antecubital
31
What is important to remember before administering meds to school-aged and adolescent patients?
They should participate in the administration; take independently but need supervision
32
What kind of PO meds work well with school-aged patients?
Chewables
33
What should be done if a med is given IM to school-aged and adolescent patients?
Give them praise and encouragement
34
What is the site used for IM injections for school-aged and adolescent patients?
Deltoid
35
Why is education so important to adolescents?
They start to experiment with things
36
What is likely to occur in adult and geriatric patients?
Polypharamacy
37
How should education be given to adult and geriatric patients?
Done simply; using repeat education-reinforcement; getting the patient's family involved is also helpful
38
What happens to absorption, metabolism, and excretion in adult and geriatric patients?
Slows down making it easier for toxic effect; they have a decreased number of receptor sites as well
39
What happens if there are not enough receptor sites?
The drug will stay in the blood stream causing toxic effects
40
To prevent adverse effects, it is important to do what?
Assess drug-drug interactions, drug-herb interactions, drug-diet interactions, assess patients therapeutic drug level, assess creatinine and BUN levels
41
What is the lowest level that Librium, digoxin can go to?
0.25
42
What does BUN stand for?
Blood Urine Nitrogen
43
What is creatinine?
Waste product excreted by the kidneys
44
How are older adults more likely to comply with their daily medication regimen?
If it is going to make their daily lives better
45
What are reasons older adults are more likely to be noncompliant?
Cost, ability to assess the meds, economics
46
What is the key thing to remember when giving older adults meds?
START SLOW AND LOW
47
What happens to the absorption in adult and geriatric patients?
Decreased gastric ability causing an increase in gastric pH; decreased absorption of med causing a decrease in pH, decrease in blood flow and surface area; decreased circulation; decreased muscle mass; changes in peak serum levels
48
What happens to the distribution in adult and geriatric patients?
Slow cardiac output, increase body fat, decrease in body mass and body fluid-risk for toxicity, and decrease in serum albumin
49
What happens to the metabolism in adult and geriatric patients?
Decrease in liver size and mass, decrease in hepatic circulation, decrease in hepatic enzymes of liver, and decreased ability to remove metabolic by products
50
What race metabolizes and excretes quicker?
Asian Americans can much quicker than Caucasians and African Americans
51
What happens to the elimination process in adult and geriatric patients?
Decrease in renal blood flow, number of functioning nephrons, glomerular filtration rate, and tubular secretion; decrease in creatinine and muscle mass;
52
What happens to the glomerular filtration rate in females?
It decreases b/c they have less muscle mass
53
What happens to the glomerular filtration rate in African Americans?
It increases b/c they have more muscle mass
54
Is it safe for women who are pregnant or lactating to take meds?
NO
55
What happens to the blood volume in pregnant women?
Increases
56
Does metabolism increase or decrease in pregnant women?
Increase
57
What do pregnant women retain?
Water
58
The increase in metabolism can cause what?
It can affect drugs causing the drug to be broken down faster, which increases the risk for toxicity
59
Everything in the mom goes directly to whom?
THE BABY
60
What is the drug pregnancy category?
Ranks drugs from A-X describing how dangerous they are
61
A in the pregnancy category means?
The safest
62
X is the pregnancy category means?
The most dangerous
63
What are some drugs used for infertility?
Clomiphene Citrate, Follitropins, Human Chorionic Gonadotropin, Leuprolide, and Menotropin
64
Clomiphene Citrate
Increases FSH; take basal temp. 5-10 days following admin-presence of increased temp means ovulation;
65
What are some side effects of Clomiphene Citrate?
Hot flashes, breast pain/tenderness, uterine bleeding
66
Follitropins
Increased follicle development; admin subq; recieve hCG afterwards
67
What are the side effects of follitropins?
Same as Clomiphene Citrate
68
Human Chorionic Gonadotropin
Replacement for LH
69
What are the side effects of human chorionic gonadotropin?
Edema, depression, breast enlargement, ovarian cysts, and ovarian hypersensitivity
70
Leuprolide
Gonadotropin-releasing hormone; admin subq
71
What are the side effects of leuprolide?
Hot flashes, insomnia, vaginal dryness, decrease breast size, painful intercourse, and bone loss (much like menopausal symptoms)
72
Menotropin
Increase in FH and LH; admin subq in alternative sides of abdomen or IM; followed with hCG
73
What are the side effects of menotropin?
Same as Clomiphene Citrate
74
Why do some baby's have respiratory problems?
They have not yet produced surfactant so baby may be intubated
75
Some premature babies might have respiratory problems. What can be given to treat the baby before she even delivers?
Corticosteroids
76
What are some pregnancy associated symptoms?
Anemia, constipation, GERD, gestational diabetes mellitus, N/V, pregnancy-induced HTN.
77
What can be done if a mom has anemia?
Giving food instead of drugs
78
What is the most common deficiency in pregnant women?
Iron deficiency and folic acid deficiency
79
What can supplements do to a pregnant women?
May lead to excessive levels of hemoglobin, iron overload, HTN in mother and premature birth or low birth weight
80
What can be done if a mom is constipated?
Increase exercise and intake of fluids and eating more high-fiber foods (happens due to a decrease in peristalsis)
81
What should be avoided if a mom is constipated?
Mineral oil, castor oil, all strong laxatives and excessive amounts of any laxative-this can cause uterine contractions and initiate labor
82
What can be done if a mom is experiencing GERD?
Eat small meals, do not eat 2-3 hours before bedtime, avoid caffeine, gas-producing foods, and constipation, sit in upright position
83
What causes GERD in pregnant women?
Hormonal changes relax lower esophageal sphincter, growing fetus increases abdominal pressure; may trigger asthma attacks in patients with asthma
84
What happens if a pregnant women has gestational diabetes mellitus?
Likelihood of structural defects in fetus, congenital deformities
85
How can respiratory depression result from gestational diabetes?
Decrease in the production of surfactant-fetal lung maturity-lack can result in respiratory distress
86
What is the drug of choice for gestational diabetes mellitus?
Insulin
87
What can decrease your risk for developing gestational diabetes mellitus?
Following a good diet and exercising more frequently
88
Why does N/V result from being pregnant?
An increase level of hCG and estrogen, decreased blood sugar, and magnesium deficiency
89
What med can be taken to decrease N/V?
Antiemetic drugs-Zofran is the drug of choice; total parenteral nutrition may be needed if therapy is unsuccessful
90
What is included in pregnancy-induced hypertension?
Preeclampsia and ecamplsia
91
What is preeclampsia?
Manifested by HTN and proteinuria-diastolic BP above 90 mmHg and proteinuria greater than 300 mg in 24 hrs or urine dipstick of 2+
92
What is eclampsia?
Potentially fatal seizures during pregnancy or after birth
93
Patients with pregnancy-induced HTN should....?
Avoid salty foods, sit with feet up, lower stress, bed rest
94
What do Tocolytics do?
Stop preterm labor
95
What are some Tocolytics?
Magnesium Sulfate, Nidefipine, Terbutaline Sulfate, Indomethacin
96
Magnesium Sulfate
Stops nerves that cause uterine contractions (neuromuscular blocking activity)
97
Nifedipine
Decreases uterine contractions and lowers BP (calcium channel blocker)
98
Terbutaliune Sulfate
Inhibits uterine contractions by reducing intracellular calcium levels (beta-adrenergic agent)
99
Indomethacin
Inhibits uterine prostaglandins that initiate uterine contractions of normal labor (NSAIDs) (Aleve)-given if nothing else works
100
What drugs are used for the induction of labor?
Prostaglandins (Dinoprostone) and Oxytocics (Pitocin)
101
What drugs are given to help pain?
Analgesics and anesthetics
102
What are primary skin disorders?
Originate in the skin or mucous membranes (eczema)
103
What are secondary skin disorders?
Result from a systemic condition, such as measles or adverse drug reactions
104
What is dermatitis (eczema)?
Inflammatory response of the skin to either allergens or irritants or trauma; S/S: erythema, pruritus, lesions (acute or chronic)
105
What is atopic dermatitis?
Characterized by dry skin, pruritus, and lesions depending on inflammation, stage of healing and scratching
106
What is contact dermatitis?
Direct contact with irritants or allergens stimulate inflammation
107
What is seborrheic dermatitis?
Disease of the sebaceous glands with excessive sebum (dandruff)
108
What is drug induced dermatitis?
Virtually caused by any drug
109
What are some common inflammatory disorders?
Dermatitis, psoriasis, urticaria, and rosacea
110
What is psoriasis?
Chronic inflammatory disorder; activates T lymphocytes-produces cytokines which stimulate abnormal growth of affected skin cells and blood vessels
111
What are some S/S of psoriasis?
Erythematous, dry and scaling; found anywhere but mostly on bony areas; exacerbating factors: infections, winter, some drugs, stress, obesity, and alcoholism
112
What is urticaria?
Hives; wheal raised edematous area with pale center and red border, very itchy; Histamine is the most common mediator
113
What is Rosacea?
Chronic disease characterized by erythema, telangiectases (fine, red, superficial blood vessels), acne-like lesions of facial skin
114
What are the most common skin disorders in nursing homes?
Pressure ulcers and venous stasis ulcer, also anal recetal disorders
115
What is the most common route to treat skin disorders?
Topical ointment; used when we don't want it to become systemic
116
What is the purpose of using topical ointments?
Helps with the barrier function, soften harden calluses, bunions, helps increase blood flow to that area-helps skin heal faster
117
What is a good antifungal topical ointment>
Nistatin
118
What are some drugs to treat skin disorders?
Antimicrobials, antiseptics, corticosteroid creams, immunosuppressants, emollients or moisturizers, topical enzymes, Ketatolyctics, Retinoids, and sunscreens
119
Action of Retinoids
Suppress sebum production, inhibits comedone formation and inhibition of inflammation; decreases size of sebaceous glands and makes sebum less viscous and less likely to plug follicles
120
Indications of Retinoids
Acne that is unresponsive to other treatments, high-risk neuroblastoma in children and adolescents, psoriasis, aging and wrinkling of skin from sun, and skin cancers
121
Contraindications of Retinoids
Hypersensitivity, pregnant women, hx of mental illness, asthma, liver disease, diabetes, heart disease, osteoporosis, anorexia nervosa
122
Nursing Interventions for Retinoids
Assess for decrease in total cyst count, observe for blurred vision, headache, conjunctivitis, and monitor lab tests
123
Patient education for Retinoids
Take w/ or shortly after meals, report depression, avoid medicated soaps, sun exposure, washing does not improve acnes
124
SE of Retinoids
Dryness and swelling of lips, arthralgia, back pain, hyperlipidemia, psychosis, decreased night vision, bone marrow suppression
125
What are some examples of Retinoids?
Isotretinoin, Acitretin, and Adapalene
