Pharm revision EXMAM

Question 1

Heparin vs Warfarin

Answer 1

Warfarin

Inhibits the synthesis of Vit K dependent clotting factors
Nursing responsibilities - Contra - hx of haemorrhagic conditions. Regular INR tests and drug adjustments depending on INR (time for blood to clot). Risk of bleeding, check for GI bleeding. caution w dental tx

Heparin

Heparin – inactivates 2 factors resulting in inhibition of thrombin and preventing fibrin clot formation.

LMWH Low Molecular Weight Heparin - inhibits factor Xa only – resulting in inhibition of thrombin and preventing fibrin clot formation
Nursing respons - lipohypertrophy, not for pregnancy, requires regular aPPT monitoring, monitor for signs of GI bleeding. caution w dental tx

Question 2

Discuss the WHO analgesic ladder and side effects to step 2 and 3 and its purpose

Answer 2

Purpose: framework used to guide the pharmacological treatment of pain in chronic pain and palliative care patients.

Step 1 [mild 1-3] non opiod (NSAID or paracetamol) + non pharm adjuvents
Step 2 [moderate 4-6] non opioids (paracetamol + NSAID + weak opioid like codeine or tramadol) + non pharm adju
Step 3 (severe 7-10) Strong opioids (morphine, fentanyl, oxy) non pharm adju.

Side effects to 2 and 3 - constipation, nausea and vomiting, sedation, resp depression.

Question 3

Three primary types of opioid receptors and the main one

Answer 3

Mu*
Kappa*

Delta*

Main one is MU

Question 4

function of prostaglandin

Answer 4

• prosta are a group of lipids made up @ site of tissue damage. metabolised by cox enzyme and action in pain is to dec threshold of nociceptors. physiological function - inflammation through vasodilation, platelet aggregation, maintain renal blood flow.

Question 5

NSAIDs should be avoided in late pregnancy due to:

Answer 5

the prolongation of gestation and labour

Question 6

Naloxone, the opioid antagonist, has the greatest activity on which receptors?

Answer 6

Mu

Question 7

Physiological responses to acute pain include:

Answer 7

Increased blood pressure, increased pulse rate, dilated pupils and perspiration are physiological responses to acute pain.

Question 8

Define superinfection

Answer 8

Infection occurding during AB therapy, AB’s destroy normal flora and overgrowth of micro-org become resistant to AB’s.

Question 9

Describe the mechanisms of action for the broad category of penicillins.

Answer 9

Inhibit bacterial cell wall synthesis by disrupting rigid cross link structure causing lysis and cell death. Also called ‘beta-lactam’, therefore it is bactericidal.

Question 10

Describe benefits of Penicillin

Answer 10

Effective against wide variety of bacteria, both gram+/- bacteria. Tx of choice for gram +ve infection. E.g. amoxicillin, flucloxacillin.

Question 11

What can bacteria do that is capable of destroying penicillin and how can this be overcomed?

Answer 11

Bacteria can produce enzymes called beta-lactamases capable of destroying penicillin. To overcome this form of resistance, beta-lactamase ihibitors were developed e.g. clavulanic acid. Amoxycillin + clavulanic acid = amoxycillin clavulanate.

Question 12

Discuss the adverse effects for penicillins.

Answer 12

• Nausea, vomiting, diarrhea, abdo pain, candidasis, alleric reactions
  Some to be taken on an empty stomach but majority on full

Effectiveness of oral penicillins decreased when taken with caffeine, crtrus fruit, cola, fruit juices or tomato juice.

Question 13

Discuss the nursing role in supporting the patient/client taking antibiotic therapy.

Answer 13

Ax other medication nicl herbal or OTC. Check specimen results and follow up as required. Infection control. Pt education - what is AB for, how and when to take, empty stomach or w food. Explain possible side effects, consider superinfection, Montir for change in symptoms, improvement and deterioration.

Question 14

Identify strategies to prevent the incidence of antibiotic resistance.

Answer 14

immunization, safe food preperation, handwashing, using AB’s as directed

Question 15

The trough level is

Answer 15

The trough level is the lowest concentration in the patient’s bloodstream, therefore, the specimen should be collected just prior to administration of the drug

Question 16

Common sign and symptom of penicillin and what should you do during first admin

Answer 16

Common signs and symptoms of penicillin allergy include hives, rash and itching.

Monitor after first admin for 30 mins for any allergic reactions

Question 17

Indications for use of Insulin . Which diabetes need insulin? When may you require short term insulin therapy?

Answer 17

All persons with type 1 diabetes require regular insulin
Persons with type 2 diabetes may eventually require regular insulin due to disease progression

Acute conditions that result in hyperglycaemia that require short term insulin therapy
Surgery, stress, infection, pregnancy

Question 18

Insulin ADR’s and during a HYPO event what would you do

Answer 18

Hypoglycaemia
Education must focus on avoiding a “hypo” and treating a “hypo”

Give quick acting carbohydrate (e.g. 6 jelly beans)
Recheck BGL in 10 minutes if still low repeat above
When BGL above 4mmol/L have a complex carbohydrate snack
If BGL not responding seek medical help
Avoid driving or operating machinery if having a “hypo”
Let GP or diabetes nurse know if having regular “”hypo’s”
If person is unconscious, ABCD and give glucagon injection

Weight gain
Education on healthy eating plan
Care with low carbohydrate diets
Teenage support groups

Lipohypertrophy
From not rotating sites of injection – not specifically a drug ADR

Question 19

What is the only biguanide used in NZ and MOA?

Answer 19

Metformin. Increase glucose uptake and utilisation in skeletal muscle. Reduces glucose production in liver. Increases insulin sensitivity. Reduces low and very low density lipoproteins

Question 20

Metformin contraindications and cautions

Answer 20

Conditions prediposing to increased lactate production causing lactic acidosis with is fatal - pt’s with renal or hepatic impairment, cardiac disease, dehydration, severe burns and infections, recent major surgery or trauma.

Not recommended for us in pregnancy or lactation

Cautions: acute gastric illness - stop metformin while unwell
Stop prior to surgery to reduce ris of lactic acidosis

Question 21

Sulfonylurea drugs Gliclazideglipizide glibenclamide MOA

Answer 21

Increase insulin release from pancreas
Increases cellular sensitivity to insulin by increasing # of insulin receptors

Reduces heaptic glycogenolysis

Question 22

Contraindications and warnings for Sulfonylurea drugs

Answer 22

Caution in older persons due to decreased renal and hepatic function and higher risk of hypoglycaemia
Avoid in persons with:

Hypersensitivity,
Severe renal or hepatic impairment,
Ketoacidosis or diabetic coma,
Undergoing surgery
Pregnancy & lactation

Question 23

Sick days for insulin plan

Answer 23

Take BGL’s more often - if out of range check 2hrly
Increase insulin if indicated
Drink more unsweetened fluids
Organise a sick day kit that you can use - short/long acting insulin, sick day plan, 2 bottles of water, icecream, test strips

Question 24

Clozapine is what type of antipsychotic - and describe agranulocytosis, S+S and how they test for this

Answer 24

low white blood cell or neutrophil count
Weekly blood tests for first 18 weeks of treatment, then 4 weekly thereafter

Symptoms of concern - fever, rigor, sore throat, any signs of infection and cognitive changes.

Question 25

3 ways AB’s work

Answer 25

Interefere with bacterial cell wall structure (penicillin). Interfere with DNA replication. Interfere with protein synthesis (Macrolides, tetracyclines).

Question 26

Superinfection meaning

Answer 26

Infection occurring during AB therapy AB’s destroy normal flora → overgrowth of micro-org resistant to AB’s

Question 27

Peak vs trough level

Answer 27

Peak is highest concentration of drug in patients bloodstream, Trough is opposite