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Pharm test 3 Flashcards

1
Q

What is vision loss because of damage to the optic nerve (because of pressure)

A

Glaucoma

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2
Q

What is the slower version of glaucoma that is a slow rise in IOP resulting in vision loss

A

Primary open angle glaucoma (POAG)

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3
Q

What is the treatment for POAG

A

Drugs to reduce IOP

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4
Q

What is the 2 MOAS for glaucoma drugs?

A

1.) Increase aqueous humor outflow
2.) Reduce aqueous humor production

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5
Q

Are glaucoma drugs topical?

A

Yes, the goal is for them to be topical.

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6
Q

If pharm therapy is not effective, a patient with POAG would have _________ therapy

A

Surgical

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7
Q

What is the kind of glaucoma that is painful and rapid vision loss that can occur in 1-2 days without treatment?

A

Angle closure glaucoma

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8
Q

What are some treatment options for Angle Closure Glaucoma?

A

Medications
But normally surgical because it is pretty urgent

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9
Q

What are possible first line options for Glaucoma

A

Betablockers
Prostaglandin Analogs
Alpha 2 Adrenergic Agonists

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10
Q

What are the two betablockers that are normally used in glaucoma

A

Timolol
Betaxolol

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11
Q

What is the betablocker used for glaucoma that is cardioselective

A

Betaxolol

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12
Q

What is the betablocker that is non-specific

A

Timolol

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13
Q

What is the MOA for betablockers in treating glaucoma?

A

Decreases the production of aqueous humor

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14
Q

Are Betablockers in glaucoma well tolerated?

A

Generally yes

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15
Q

What are possible systemic effects of beta blockers in glaucoma?

A

HEART— bradycardia
LUNGS– bronchoconstriction

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16
Q

What beta blockers can cause bronchospasms in patients with asthma and COPD?

A

Timolol

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17
Q

What is the betablocker that should be used for patient’s with lung issues?

A

Betaxolol

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18
Q

What is the prostaglandin analog used for glaucoma?

A

Latanoprost

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19
Q

What is the MOA of Latanoprost?

A

This increases aqueous humor outflow

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20
Q

In theory, what is a better option betablockers or prostaglandin analogs and why?

A

Prostaglandin analogs; because there are lower risk of side effects

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21
Q

What are the possible side effects of Latanoprost?

A

Harmless pigmentation of IRIS
Thickening and growth of eyelashes

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22
Q

What is the Alpha2-Adrenergic Agonist used for glaucoma?

A

Brimonidine

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23
Q

What is the MOA of Brimonidine?

A

Decreasing aqueous humor production AND increasing outflow! THIS ONE DOES BOTH!

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24
Q

What is the specific use of Brimonidine in glaucoma?

A

Long term use of POAG

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25
Q

What are the possible AE of Brimonidine?

A

Headache
Dry mouth and nose
Altered taste
Conjunctivitis
Pruritus

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26
Q

Does Brimonidine cross the BBB; What can this do?

A

Yes it does cross the BBB; Can cause hypotension

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27
Q

What is the osmotic agent used for glaucoma?

A

Mannitol

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28
Q

What is the specific use of Mannitol in glaucoma?

A

Closed Angle Glaucoma- reduces IOP super fast

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29
Q

What is the MOA of Mannitol

A

Draws water out of the vitrous humor and into the blood vessels

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30
Q

What is a drug that acts by paralyzing ciliary muscles?

A

Cycloplegics

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31
Q

What is a drug that dilates the pupil?

A

Mydriatics

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32
Q

What are the use of cycloplegics and mydriatics?

A

To measure refraction, intraocular exams, surgeries, and treatment of anterior uveitis

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33
Q

What are possible AE for cycloplegics and mydriatics?

A

Blurred vision
Photophobia
Angle closure glaucoma
Anticholinergic effects- with symptomatic absorption

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34
Q

What is the adrenergic agonist that does not cause cycloplegia?

A

Phenylepherine

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35
Q

Why do you use topical eye drop that can also be used for all allergy symptoms?

A

For allergic Conjunctivitis

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36
Q

What is used for Allergic Conjunctivitis that is also a mast cell stabalizer?

A

Cromolym

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37
Q

What can also be used for allergic conjunctivitis to reduce inflammation?

A

NSAIDS

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38
Q

What drugs are used in short term management of Allergic Conjunctivitis?

A

Glucocorticoids

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39
Q

What is another drug that can be used to treat allergic conjunctivitis?

A

Ocular decongestants

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40
Q

What is the painless progressive loss of central vision?

A

Macular Degeneration

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41
Q

What is the treatment for DRY MD?

A

Multiple vitamins, Antioxidants, Zinc

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42
Q

What is the growth of new vessels and fluid leakage?

A

WET MD

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43
Q

What is the treatment for WET MD?

A

Laser therapy
Photodynamic theraoy

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44
Q

What are meds that can be used for WET MD as angiogenesis inhibitors

A

Ranibizumab
Bevacizumab

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45
Q

What is the ophthalmic drug that suppresses the immune system response to promote the resumption of tear production

A

Topical cyclosporine

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46
Q

What is the ocular drug that is a weak adrenergic agonist that constricts the conjunctival blood vessels (These are ocular decongestants)
End in Zoline

A

Naphazoline
Tetrahydrozoline

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47
Q

Topical glucocorticoids are used to ___________ inflammation and itching as well as a _______ agent

A

reduce inflammation and is a drying agent.

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48
Q

What are possible AE of glucocorticoids
Think of Cushings

A

Stretch marks
Purpura- like petechia
Telangiectasia- widened blood vessels-
Hypertrichosis- weird hair growth
Can be absorbed systemically

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49
Q

What is a common AE of topical glucocorticoids?

A

Thinning of the skin and atrophy of the dermis and epidermal layers

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50
Q

What are s/sx of systemic absorption of topical glucocorticoids?

A

Growth retardation in children and adrenal suppression

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51
Q

How are you supposed to apply a topical glucocorticoid?

A

Thin film and rub it in (Do not use occlusive dressings)

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52
Q

What is the skin drug that promotes shedding of the horny layer of the skin

A

Keratolytics

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53
Q

What keratolytic agent is used for warts and corns?

A

Salicyclic acid

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54
Q

What is used to help treat acne, dandruff, psoriasis, and seborrhagic dermaitis?

A

Sulfur

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55
Q

What is a good option to treating acne (firstline)

A

Benzoyl peroxide

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56
Q

What are topical ABX that can be used for acne?

A

Clindamycin and Erythromycin

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57
Q

What are the retinoids that can be used to treat acne

A

Tretinoin
Adapalene
Tazarotene

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58
Q

What are oral acne treatments of acne?

A

Doxycycline
Minocycline

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59
Q

What are two other oral ABX that can be used in acne after Doxycycline and Minocycline

A

Tetracycline
Erythromycin

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60
Q

What is used for severe cystic acne

A

Isotretinoin (Accutane)

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61
Q

What are possible AE of Isotretinoin?

A

Dry skin
Nosebleed
Lip inflammation
Muscle and joint and bone pain
Depression is rare
TETRAGENIC

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62
Q

What must be monitored if someone is on isotretinoin?

A

Triglycerides and pregnancy

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63
Q

What are some other meds that can be used for hormonal acne?

A

BC and Spironolactone

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64
Q

UVA penetrates deeper than UVB and enters the ________ AND the ______

A

epidermis AND the dermis

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65
Q

UVA can cause what 3 issues with the skin

A
  • immunosuppression
  • photosensitive drug reactions
  • photoaging of the skin
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66
Q

UVB penetrates the ______

A

epidermis (more superficial)- tanning and sunburn

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67
Q

UVA and UVB can both cause

A

skin cancer

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68
Q

What is the sunscreen that absorbs UV radiation and dissipates it as heat?

A

Organic sunscreen

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69
Q

PABA sunscreens should be avoided in patients that have what allergies

A

Sulfa
Benzocaine
Thiazide allergies

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70
Q

What are the PABA suncreens

A

Dioxybenzone
Avobenzone

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71
Q

What are the sunscreen that are physical screens that scatter UV radiation

A

Inorganic sun screens like Zinc oxide and Titanium dioxide

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72
Q

SPF protects against _______ not against UVA

A

UVB

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73
Q

SPF is not ______

A

linear

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74
Q

Steps to determining how long SPF protection will last?

A

How long before they burn (in minutes)
How many of those segments in a hour (So 30 min/60 means 2)
Divide SPF by segment number
That the number of hours that SPF will work

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75
Q

UVB is highest from which hours

A

10-4

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76
Q

SPF - provides moderate protection from sunburn but not from CA

A

2-14

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77
Q

SPF _+ protects from everything

A

15+

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78
Q

PABA sunscreens need to be applied 2 hours before __________

A

Sunexposure

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79
Q

What is the chronic inflammatory disorder of the skin, with no cure, and is mostly symptom control?

Kim Kardashian has this

A

Psoriasis

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80
Q

What are the topical meds used for Psoriasis?

A

Glucocorticoids
Vitamin D and A
Anthralin and tars

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81
Q

What are systemic meds for psoriasis

A

Methotrexate- low dose immunosuppresion
Acitretin, glucocorticoids, cyclosporine

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82
Q

What are biological agents for Psoriasis

A

Etanercept
Infliximab, adalimumab, ustekinumab, (interfers T cells)

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83
Q

What are procedures that can help with psoriasis

A

Photochemotherapy
Coal tar UVB irradiation

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84
Q

What is the condition that develops into some skin cancers?

A

Actinic Keratosis

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85
Q

What are treatments for Actinic Keratosis

A

5FU, NSAIDS, blue lights, and physical intervention

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86
Q

Treatments for Atopic dermatitis and Eczema

A

Glucocorticoids and immunosuppressants

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87
Q

What moisturizers that are good for eczema

A

Oil based like Eucerin and Cetaphil

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88
Q

What is treatment for Warts

A

Saliacyclic acid 3-4% applied daily for 2 weeks and OTC cryotherapy

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89
Q

Treatment for hair loss?
This is silly but the minions in despicable me 2
grow crazy hair when they eat the cupcakes. **Minion and Minoxidil looks similar*

A

Minoxidil

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90
Q

Treatment for unwanted facial hair?

Their unwanted facial hair drops to the FLOOR

A

Eflormithine

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91
Q

Treatment for impetigo?

A

1st gen. cephalosporin and dicloxacillin

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92
Q

What is the unregulated growth of cells due to DNA alterations

A

Cancer

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93
Q

What takes over and produces cancerous cells?

A

Activating oncogenes

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94
Q

What are the good genes that begin to slow and are overcome by oncogenes?

A

Inactivating tumor supressor genes

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95
Q

What are cancers that have slow cell cycles?

A

Breast
Lung
Prostate
Colon
Rectum

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96
Q

What are rare cancers that have faster cell cycles?

A

Leukemia
Lymphomas
Testicular Cancers

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97
Q

Faster cell cycles respond better to

A

DRUGS

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98
Q

Parts of bulk tumor reduction

A

Surgery
Irradiation
Chemo

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99
Q

What are the 4 drug classes for chemo

A

Cytotoxic agents
Hormones and hormone antagonists
Biological response modifiers
Targeted drugs

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100
Q

Normal cells with a high growth fraction are also destroyed by chemo because chemo is ___________

A

NONSELECTIVE

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101
Q

Intermittent chemo therapy allows normal cells to recover, __________ ones cannot

A

Malignant

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102
Q

Choosing drugs for chemo consits of what three points?

A
  1. Must be effective on its own
  2. Different MOAS
  3. Minimal overlapping toxicities
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103
Q

intraarterial chemo administraion is straight to the

A

AFFECTED ORGAN

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104
Q

Intrathecal chemo administration is into the ______

A

CNS; avoiding BBB

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105
Q

What is the loss of WBCS

A

Neutropenia– worried about infection

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106
Q

What is the loss of platlets

A

Thrombocytopenia– worried about bleeding

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107
Q

What is the loss of RBCS

A

Anemia

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108
Q

If ANC is under 500 do what?

A

HOLD CHEMO

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109
Q

What is the greatest risk of infection; days 10-__

A

Days 10-14; Called NAdir

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110
Q

A fever over 100.5 is concerning for what

A

Neutropenic fever

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111
Q

Neutropenic fever is an oncological emergency— they need what?

A

ABX!!!

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112
Q

What is the Granulocyte colony stimulating factor that grows more WBCS

A

Filgrastim

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113
Q

Platelets under what is concerning?

A

50,000

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114
Q

What is the only NSAIDS that can be given for patients with thrombocytopenia?

A

Acetaminphen

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115
Q

Avoid _______ injections in patients with thrombocytopenia

A

IM

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116
Q

What is the medicine that stimulates platelet growth?

A

Oprelvekin

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117
Q

What is the cell life of a RBC

A

120 days

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118
Q

What is the treatment for anemia?

A

EPO

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119
Q

EPO shortenens the survival of cancer patients and is normally only given for __________

A

Palliation

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120
Q

DO NOT GIVE EPO IN PATIENTS WITH

A

LEUKEMIA

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121
Q

What is the inflammation of the oral mucous membrane?

A

Stomatitis

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122
Q

What is the treatment for mild stomatitis

A

Mouthwash with lidocaine and benedryl

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123
Q

What is the mix for magic mouthwash?

A

Lidocaine
Malox
benedryl

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124
Q

What is the treatment for severe stomatitis

A

Systemic opiods

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125
Q

What is the treatment for mucousisits?

A

PO dexamethasone

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126
Q

What is the treatment for diarrhea in cancer patients

A

Oral loperamide

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127
Q

What are the 3 goals for treatment of N/V

A

Reduce anticipatory Nausea and vomiting– BENZO
Prevent dehydration and malnutrition
Promote compliance with chemo

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128
Q

What med is used for nausea and vomiting for 0-16 hours post chemo?

A

ZOFRAN

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129
Q

What med is used for late onset N/V? 16 hours to 5 days?

A

Dexamethasone

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130
Q

What other drugs can be used in nausea and vomiting in CA patients

A

Aprepitant and Serotonin agonist

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131
Q

What medicine is used for the prevention of hyperuricemia?

A

Allopurinol

132
Q

What chemo med is seriously toxic to the heart?

A

Doxorubicin

133
Q

What chemo med causes injury to the kidneys

134
Q

What is the chemo med that can cause serious peripheral nerve damage

A

Vincrisitine

135
Q

What is the largest class of anticancer drug?

A

Cytotoxic drug

136
Q

Cytotoxic drugs affect normal and cancer cells. This means lots of

A

SIDE EFFECTS

137
Q

What are the lists of vesicants
There are 6

A

Carmustine
Dacarbazine
Dactinomycin
Doxorubicin
Mitomycin
Vincrisitine.

138
Q

What are the two alkylating agents?

A

Cyclophosphamide
Carmustine

139
Q

Cyclophosphamide and Carmustine are Cell Cycle phase _____-___________

A

NON-SPECIFIC

140
Q

What are the possible AE of Cyclophosphamide?

A

Bone marrow suppression
N/V
Alopecia
Hemorrhagic Cystitis
Nephrotoxicity
Sterility

141
Q

Cyclophosphamide can cause hemorrhagic cystitis; what is the treatment for this?

A

Excessive hydration and Meszna (this protects bladder)

142
Q

Carmustine is an alkylating agent that can cross the BBB. What are some possible AE?

A

PULMONARY FIBROSIS
Bone marrow suppression
N/V
VESICANT

143
Q

What is the Platinum Compound that is used for chemo?

144
Q

What is the MOA of Cisplatin?

A

Forms cross links in the DNA

145
Q

What is cisplatin used in?

A

Testicular CA
Bladder CA
Lung, head, neck, ovarian and endometrial CA

146
Q

CISPLATIN is highly ______

147
Q

What are other side effects for Cisplatin

A

Ototoxic
Nephrotoxic
Minor bone marrow suppression

148
Q

Why is Cisplatin good for combination?

A

Because there is minimal BMS so it can be used in COMBO with chemo drugs that aren’t

149
Q

What is the dose limiting SE of Cisplatin

A

Nephotoxicity

150
Q

What is the treatment for Cisplatin caused nephrotoxocity?

A

HYDRATE AND LOOP DIURETICS
Hydrate and help the kidneys

151
Q

What are the Antimetabolite chemo drugs?

A

Methotrexate
Fluoracil
Mercaptopurine

152
Q

Methotrexate is an antimetabolite chemo drug. What cell phase is this specific to?

A

Cell cycle phase S specific.

153
Q

Methotrexate is used in what cancers?

A

Lymphoma
Sarcoma
Head and neck cancers

154
Q

What are the possible AE for methotrexate?

A

Myelosuppression
Hepatotoxic
Alopecia
Pulmonary fibrosis
Mucositis

155
Q

What are the two drugs that can cause pulmonary fibrosis

A

Carmustine and Methotrexate

156
Q

If you give methotrexate at a high dose, you need to give _________. This protects the normal cells from methotrexate toxicities?

A

Leucovorin (folic acid)

157
Q

Fluoracil is a antimetabolite chemo drug that is Cell phase ___ specific!

A

This is S phase specific

158
Q

What are the possible AE of Fluorocil?

A

Neutropenia
Mucositis
Palmar plantar erythrodysesthesia

159
Q

Mecaptopurine is an antimetabolite that is used in the treatment for what cancer?

160
Q

What are the possible AE of Mecaptopurine

A

Myelosuppression
Mild hepatotoxicity
N/V
Mucositis

161
Q

What are the two antitumor antibiotics?

A

Doxorubicin
Dactinomycin

162
Q

What are the two antibiotics that are used to treat cancer?

A

Doxorubicin
Dactinomycin

163
Q

The chemo ABX need to be given ____ because they are not absorbed well in the GI tract

164
Q

The antitumor ABX are cell phase

A

NONSPECIFIC

165
Q

What is the ABX that is called the “Red DEvil”

A

Doxorubicin

166
Q

What are the possible AE of Doxorubicin

A

Turns urine and tears red
Alopecia
Mucositis
Anorexia
N/V, Vesicant, myelosupression
DELAYED CARDIOTOXICITY

167
Q

What is the important consideration with the administation/doing of doxorubicin

A

It can lead to HF and they can only get 550mg/mm2 in a lifetime

168
Q

What is the antibiotic that is used in sarcomas and testicular cancer?

A

Dactinomycin

169
Q

What are the possible AE of Dactinomycin

A

Myelosuppression
Mucositis
N/V
Diarrhea
Alopecia
VESICANT

170
Q

What are the two mitotic inhibitors that are used in cancer therapy?

A

Vincristine and Paclitaxel

171
Q

Mitotic inhibitors are cell cycle phase what?

A

Mitotic inhibitors are cell cycle phase M specific

172
Q

What chemo med has the dose limiting AE of peripheral neuropathy?

A

Vincristine

173
Q

What are the possible AE of vincristine?

A

Vesicant
Alopecia
Peripheral Neuropathy

174
Q

Why is Vincristine good for combination?

A

Because there is no myelosuppression

175
Q

Paclitaxel is a mitotic inhibitor that has a severe risk for hypersensitivity. What do you do to help this?

A

Premedicate with H1 and H2 blockers and dexamethasone 30 minutes to an hour before chemo administration

176
Q

What are the AE of Paclitaxel?

A

Neutropenia
Peripheral neuropathy
ALopecia
Heart conduction
Muscle and joint pain

177
Q

What is the Topoisomerase Inhibitor?

178
Q

What is Etoposide used in?

A

Lung and testicular cancer

179
Q

What is the main AE of Etoposide?

A

Hepatotoxicity (LFTs)

180
Q

What are other SE of Etoposide?

A

Myelosuppression
Alopecia
Hepatotoxicity
N/V
If IV, make sure you monitor for low BP

181
Q

What is the anti-cancer drug that converts asparagine to aspartic acid?

A

Asparaginase

182
Q

Asparaginase is only used in what kind of cancer?

183
Q

How is asparaginase administered?

184
Q

Asparaginase can cause allergies in some patients, so what should the nurse do first?

185
Q

Asparaginase can cause a lot of coagulation difficulties, so this can cause issues for what 3 organs?

A

Liver
Pancreas
Kidneys

186
Q

What are other possible AE for Asparaginase?

A

CNS depression
N/V

187
Q

Antiestrogen meds for breast cancer patietns that are ER/PR + are what?

188
Q

Aromatase inhibitors for breast cancer patients that are ER/PR + are what?

A

Anastrozole

189
Q

Adjuvant treatment for breast cancer is Her-2/neu women is what?

A

Trastuzumab

190
Q

What is the gold standard in breast cancer treatment is what?

191
Q

How is tamoxifen used?

A

Established breast Ca and to prevent in high risk pts.

192
Q

What are the benefits of Tamoxifen?

A

Increased bone mineral density
Improves osteoporosis and dyslipidemia

193
Q

Tamoxifen can be given to ____ and ___ menopausal women

A

Post and pre menopausal women

194
Q

What are the AE of Tamoxifen?

A

Hot flashes (give an SSRI)
Fluid retention
Vaginal discharge
N/V
Menstrual irregularities
Endometrial CA
Tetragenic
Blood clots

195
Q

What is the Aromatase inhibitor that is used to treat breast CA?

A

Anastrozole

196
Q

How is Anastrozole used?

A

To treat ER + breast cancer in POSTMENOPAUSAL WOMEN

197
Q

What are the AE of Anastrozole?

A

Increase r/x of fractures and osteoporosis

198
Q

What are some positives of Anastrozole?

A

Decreased hot flashes, wt. gain, vaginal bleeding, N/V and irritability

199
Q

Women who are taking Anastrozole need what education?

A

Increase vitamin D and calcium
Increase wt. bearing exercise
Start bisphosphonate if severe

200
Q

What is a special consideration of Anastrozole?

A

It can cause nephrotoxicity and osteonecrosis of the jaw.

201
Q

What is the monoconal antibody that is used in the treatment of breast CA?

A

Trastuzumab?

202
Q

Who can take Trastuzumab

A

Pt. with Her 2/neu overexpression

203
Q

Because Trastuzumab is target, what are the few AE?

A

Cardiotoxic- DO NOT USE WITH DOXORUBICIN
May have some flu like symptoms upon administration

204
Q

What cytotoxic drugs can be used in breast cancer?

A

Doxirubicin (4 does of AC for 4 weeks)
Cyclophosphamide
Followed by paclitaxel

205
Q

How is prostate cancer treated?

A

Androgen deprivation therapy

206
Q

What is the GnRH Agonist that is used in treating prostate cancer?

A

Leuprolide

207
Q

What are the AE of Leuprolide?

A

Hot flashes
Bone pain
ED
Loss of libido
Gynecomastia
Decreased muscle mass

208
Q

What education is needed for patients taking Leuprolide?

A

Need Vitamin D and Calcium
Need weight bearing exercise and bisphosphonates

209
Q

What is another GnRH Antagonist that is used to treat prostate CA?

210
Q

What is the androgen receptor blocker that helps to prevent tumor flare with increased testosterone from leuprolide?

211
Q

What is the dosing considerations for Flutamide?

A

Give for 2 weeks after stopping and then stop

212
Q

What are the AE for Flutamide?

A

Hot flashes
Low testosterone
N/V
Diarrhea
Hepatotoxic

213
Q

What med is combined with prednisone because it causes an overproduction of mineral corticoid and prednisone limits?

A

Abiraterone

214
Q

What are the AE of Abiraterone?

A

Hypokalmia
Joint swelling
Muscle discomfort
Hepatotoxicity

215
Q

What med is used for prostate cancer that is expensive and focused immunotherapy?

A

Sipuleucel

216
Q

What are two other meds for prostate cancer?
End in taxel

A

Docutaxel and Cabazitaxel

217
Q

What is the targeted drug that is an EGFR Tyrosine Kinase Inhibitor?

218
Q

Who is at risk when taking Cetuximab?

A

Patient’s with Alpha Gal from a Tic bite

219
Q

When giving Cetuximab you may need to premedicate with what?

220
Q

What is a special AE with Cetuximab?

A

Acne like rash- moisturize and avoid alcohol and the sun

221
Q

What is the targeted drug that is a BCR-ABL Tyrosine Kinase Inhibitor and only used in CML?

222
Q

What targeted drug can be used for metastatic melanoma?
(Raf was always outside in OuterBanks so he might have melanoma)

A

Vemurafenib

223
Q

What is the targeted drug that can be used for ALL?

224
Q

Possible AE of Ritixumab?

Ritixumab is used to ALL ;)

A

SJS and tumor lysis syndrome (they need allopurinol)

225
Q

What is the targeted drug that is an angiogenesis inhibitor?

A

Bevacizumab

226
Q

What are the contraindications of Bevacizumab?

A

Squamous cell lung cancer

227
Q

What is the targeted drug that is used for multiple myeloma and lymphoma?

Bortezomib

A

Bortezomib

228
Q

What are the two immunostimulants?

A

Ipilimumab and Nivolumab

229
Q

AE of immunooncology therapy will effect

A

Skin
Endocrine
Liver
GI tract
Nervous system
EYES
RR system
Hematopoietic cells

230
Q

Things to assess for in cancer patients

A

S/sx that look like an AI disease
Glucocorticoids

231
Q

What are three things that fluid can correct?

A

Fluid volume and osmolality
Changes in hydrogen ion concentration
Electrolyte imbalances

232
Q

What percentage of fluids are in the intracellular space?

233
Q

What percentage of fluids are in the intravascular and interstitial space?

A

40% (divided)

234
Q

How many liters are in intravascular fluids?

A

5 Liters– 3L of plasma and 2L of RBCs

235
Q

When measuring electrolytes, you are measuring ______ levels in the intravascular space. You cannot measure the intracellular levels

A

THE EXTRACELLULAR
There is no real way to measure intracelllar levels

236
Q

What fluid mixture is composed of water AND electrolytes?

A

Crystalloids

237
Q

What are crystalloids beneficial for?

A

Pass through semipermeable membranes
Good to correct imbalances BUT have a smaller hemodynamic change per unit of volume

238
Q

What are the isotonic crystalloids?

A

NS 0.9% and LR

239
Q

Isotonic fluids will not cause a fluid shift and all fluid remains ____________

A

extracellular

240
Q

What is hypertonic crystalloid?

241
Q

Hypertonic crystalloids will cause a massive fluid shift from the cell out into the extracellular space, causing a risk of _______________

A

hypernatremia; because the fluid in the cell balances out the sodium, so all the fluid leaving it will be more concentrated.

242
Q

What are examples of hypotonic crystalloids

A

1/2 NS, D5W, d51/2 NS

243
Q

Hypotonic crystalloids will cause fluid to move FROM the ___________ INTO the cells

A

Extracellular

244
Q

When giving NS and LR, Sodium and Chloride do not enters cells but moslty remain __________

A

extracellularly

245
Q

When giving 1 liter of fluid, about _____ mL of it goes into the intravascular space and the rest in interstitial

246
Q

When giving D5W, Dextrose is metabolized into water and _______ _______

A

Carbon Dioxide

247
Q

When Dextrose crosses membranes, when giving 1 L of fluid, about ___ mL is ____________ and 900 mL goes interstitial

A

100 mL goes intravascular and 900 mL interstitial

248
Q

What is NS made of?

A

Water, Na, and Cl

249
Q

What does NS provide?

It is isotonic so it is not moving anywhere

A

Extracellular fluid replacement

250
Q

What are the 4 uses for NS?

A

Perioperative replacement
Volume resuscitation
and Mild hyponatremia
Metabolic alkalosis

251
Q

What is LR composed of?

A

Composed of water, sodium, potassium, chloride, and lactate (similar to blood components)

252
Q

LR provides _________ fluid replacement?

A

Extracellular

253
Q

What are the uses of LR?

A

perioperative setting, lower GI fluid losses (diarrhea), burns, and dehydration

254
Q

Lactate is metabolized to bicarbonate to the liver, so there is a risk of

A

Metabolic alkalosis

255
Q

LR should be used in caution with patients with

A

Liver disease

256
Q

1/2 NS provides ______ ______ meaning little else is in the fluids

A

Free water

257
Q

Why would 1/2 NS be used?

This is hypotonic so it carries fluid into the cells

A

If a patient is hypertonic because of a loss of fluid and needs dilution
Things like hypovolemia and hypernatremia

258
Q

What needs to be monitored in patients receiving 1/2 NS?

A

SODIUM; WATCH FOR LOW NA

259
Q

Why is D5 1/2 NS used?

A

Maintenance fluid after it is fixed by NS/LR

260
Q

What do you need to monitor for D5 1/2 NS?

A

Hyponatremia; Not worried about hyperglycemia

261
Q

What is D5W made of?

A

Water and dextrose

262
Q

Why is D5W used?

A

Severe hypernatremia
Small volumes to dilute medication
Used to keep a vein open

263
Q

3% NS provides ________ to the intravascular space?

264
Q

WHy is 3% NS used?

It is hypertonic so it pulls water out

A

Severe hyponatremia
to decrease ICP in TBI and stroke (pulls the fluid)

265
Q

What must be monitored in patients getting 3% NS

They are getting lots of sodium

A

SODIUM
NEURO STATUS (they can get seizures with hypernatremia)

266
Q

Colloids are larger particles that cannot cross

A

capillary membranes

267
Q

What is a colloid that runs slowly and may result in volume overload?

A

5% albumin

268
Q

What are other colloids mentioned?

A

Pooled human plasma
Semi-synthetic glucose polymers
Semi-synthetic hydroxytheyl starch

269
Q

What is a colloid that is a volume expander?

A

25% albumin; this means that fluid left in the vsculature will be 5x greater than what is infused

270
Q

What is the use for 25% albumin

A

Ascites and Pleural effusions

271
Q

What is the goal in giving 25% albumin

A

Fluid redistribution

272
Q

What is done for a patient in shock who need intravascular fluid replacement. Increasing volume  increase blood pressure

A

Fluid resuscitation

273
Q

What are the steps for fluid resuscitation

A

Give 500-1000 mL bolus– reassess- continue to bolus til the s/sx improve

274
Q

When doing fluid resuscitation, start with

A

Crystalloids (colloids are $$$$$ and take longer to administer)

275
Q

Fluid maintanence is for who?

A

someone who may be npo for awhile and needs to stay hydrated

276
Q

what is the most common fluid for maintenance

* Hypotonics*

A

D5W 0.45% NaCl + KCl 20-40 mEq/L

277
Q

Daily dose for fluid maintenance

A

1500 mL for first 20 kg then 20 mL/kg each day

278
Q

What is isotonic contraction
Losing both water and sodium, so ya need to replace both

A

Sodium and water are lost in = proportions, volume decreases, but osmolality does not change

279
Q

What is the cause for Isotonic Contraction

Losing both Na and water

A

Vomiting
diarrhea
kidney disease diuretics

280
Q

What is the treatment for isotonic contraction

A

Isotonic fluids

281
Q

What is the Loss of water is > loss of sodium, volume decreases, and osmolality increases

A

Hypertonic contraction
Too much salt

282
Q

What is the cause of hypertonic contraction

Losing fluids so things are over concerntrated

A

sweating, osmotic diuresis, concentrated food in babies, burns, thirst disorders

283
Q

Treatment for hypertonic contraction

There is too much salt so you need fluids to dilute it

A

Tx: initially drink water. 50% in the first couple hours and the rest over days
If ineffective: hypotonic fluids ( ½ NS, D5W)

284
Q

What is the loss of sodium > loss of water, volume decreases meaning osmolality decreases?

A

Hypotonic Solution

285
Q

What is the cause of hypotonic solution

A

sodium loss from a diuretic
Chronic renal failure
Low aldosterone

286
Q

What is the treatment for hypotonic solution

A

mild- NS and wathc for fluid overload
severe- infuse 3% NS

287
Q

What is the increase of total body water?

A

Volume expasion

288
Q

What are causes for volume expansion

A

OD with fluids
Disease such as CHF
Nephrotic syndrome
Cirrhosis

289
Q

What is the treatment for volume expansion

290
Q

What is it when the patient has a high pH (above 7.45) and low CO2 ((Below 35)

A

Resp. alkalosis

291
Q

What casues Resp. Alkalosis

A

Hyperventilation; treat with paper bag or rebreathe co2

292
Q

What is it when there is a low pH (Below 7.35) and a high CO2 (Above 45)

A

Resp. Acidosis

293
Q

What is the treatment for resp. acidosis

A

correct the cause, infuse sodium bicarb

294
Q

What is it when there is a high pH (Above 7.45) and high HCO3 (Above 26)

A

Metabolic alkalosis

295
Q

What is the treatment of metabolic alkalosis
*Need to make things more acidic

A

Sodium chlor1de and potassium chloride

296
Q

What is it when there is a low pH (below 7.35) and low hco3 (Below 22)

A

Metabolic acidosis

297
Q

What is the treatment for metabolic acidosis
* you need to make things more basic*

A

Correct the cause, alkalinizing salt if severe

298
Q

Normal Potassium values

299
Q

Causes of low K

A

shift INTO cells
GI loss
urinary loss
decreased magnesium

300
Q

s/sx of hypokalemia (K < 3.5)

A

paralysis of skeletal muscles and changes in EKG

301
Q

Treatment for mild hypokalmeia (K < 3.3)

A

PO potassium chloride

302
Q

Treatment for severe hypokalemia (K< 3.2)

A

IV potassium chloride. never push

303
Q

What are causes for hyperkalemia

A

Causes: tissue trauma, Addison’s disease, acute acidosis, potassium sparing diuretics, IV potassium overdose

304
Q

What are the S/SX of hyperkalemia
Think of what happened in class

A

Confusion, anxiety, dyspnea, weakness or heaviness of legs, numbness and tingling

305
Q

What is the treatment for hyperkalemia

A

CALCIUM GLUCONATE- prevents V-fib
Bicarbonate
Insulin- 10 units with glucose
Albuterol- may not always work
Diuretics and Kayexelate and Dialysis

306
Q

What are the normal Mg levels

307
Q

What are food sources of Mg

A

Kelp, wheat bran/germ nuts

308
Q

What are the s/sx of hypomagnesemia

A

muscle spasms/cramps
mental disorders
arrhythmia, fatigue, muscle weakness, high blood pressure, osteoporosis

309
Q

What is the treatment for hypomagnesemia

A

Magnesium sulfate

310
Q

Hypermagnesemia is common in pt. with what?

A

Renal insufficiency

311
Q

Hypermagnesemia can lead to what?
Think of why you do hourly checks on OB when a momma is getting Mag

A

Paralysis of Resp. Muscles and cardiac arrest

312
Q

What is protective against hypermagnesemia

A

Calcium gluconate

313
Q

PTH and Vitamin D increases what

A

Absorption

314
Q

Calcatonin increases calcium _______ by the kidneys

A

Elimiation

315
Q

Food sources for Ca

A

KElp, dark leafy greens, nuts and dairy

316
Q

Functions for calcium

A

Nerve transmission, muscle function, bone health, enzymes, sex hormones

317
Q

Osteo_____- break down

318
Q

Osteo______- builds bone

319
Q

Normal Ca levels

320
Q

Treatment for hypercalcemia

A

promote urinary excretion (Furosemide), decrease bone mobilization, decrease intestinal absorption (glucocorticoids), IV saline (dilute)

321
Q

Treatment for hypocalcemia

A

calcium supplementation (IV calcium gluconate if severe; calcium citrate and vitamin D for mild)

322
Q

Patient education for Biphosphonates (-ronate)

A

Give with a full glass of water (8 oz)
Give in the morning on an empty stomach
Remain upright for 30 minutes after taking (NOT sitting, moving around, or bending over)  can cause esophageal erosion
Avoid chewing alendronate tablets
Avoid food for one hour including coffee and tea, only water

323
Q

Raloxifen is used in what

A

Osteoporosis, breast CA, decrease cardiovascular risk

324
Q

Teriparatide has a black box warning for

A

Osteosarcoma; do not give if they have a history of bone CA

325
Q

Cinacelet is used in what?

A

Hyperparathyroidism

Nurs 306 / Pharm 2 (4 decks)

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