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ABSN Cohort 19 > Pharm2 -FINAL- EXAM OF MY LIFE > Flashcards

Pharm2 -FINAL- EXAM OF MY LIFE Flashcards

1
Q 
Phenytoin (6 - TCIA sfx I)
Trade Name
Class
Indications
Action
S/Fx
Implementation
A 
Dilantin
Anti-arrythmic/convulsive
Seizures r/t Digoxin toxicity
↓ seizures by infl. ion transport
↓ CNS, ↓BP, bleeding gums
Seizure precautions, HypoTN
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2
Q

Naloxone (6 TCIAsfxI)

A 
Narcan
Opiod Agonist
Opiod OD
Competitively blocks opiod receptors
Ventricular arrhythmias, N/V
Pain management r/t opioid antagonism
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3
Q

Morphine (6 TCIAsfxI) + COUNTER

A 
none
Opiod
Pain
Opiate receptor agonist and ↓ CNS
Respiratory depression, constipation, ↓LoC, HypoTN
Monitor LoC, RR, GI, BP

COUNTER with Naloxone

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4
Q

Flumazenil (6 TCIAsfxI)

A 
Romazicon
Benzo antagonist
Benzo antagonist
Reverses fx of benzodiazepines
Seizures, N/V
Seizure precautions, amnesia
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5
Q

Haloperidol (6 TCIAsfxI)

A

Haldol
Anti-psychotic
Schizo, manic, psychoses, agitation
Block dopa. receptors in brain… also anticholi and anti-hista.
EPS (Extra Pyrimidal S/S such as dystonia, akathsia, tardiv dyskinesia), blurred vision, constipation, dry mouth
Monitor EPS, oral care, Ø EtoH

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6
Q

Phenylephrine (6 TCIAsfxI)

A 
Neo-Synepherine
Adrenergic-Agonist, vasopressor
HypoHTN r/t shock or anesthesia
Constricts blood vessels, stimulating alpha adrenergic receptors r/in vaso-constriction
Altered CNS, arrhythmias, dyspnea
Monitor BP and EKG for arrhythmias
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7
Q

Nitroprusside (6 TCIAsfxI)

A 
Nipride
Vasodilator
HTN crisis, cardiogenic shock
Peripheral vasodilation
Diziness, H/A, Abd. pain, N/V
Monitor for HypoTN, cyanide and thiocyanate toxicity
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8
Q

Midazolam (6 TCIAsfxI) + COUNTER

A 
Versed
Benzodiazepine
Sedation and amnesia for procedures, seizures
General CNS Depression
↓ LoC, Respiratory Depression
N/V
Educate on amnesia fx

COUNTER with Flumazenil

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9
Q

Methylprednisol (6 TCIAsfxI)

A

Solumedrol
Steroid
Allergic/Inflammatory Dz
Supresses inflammatory and normal immune response
Altered mental status, HTN, acne, muscle wasting, osteoporosis, Cushings dz s/s
Monitor glucose, GI bleeds, immunosuppression

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10
Q

Propofol (6 TCIAsfxI)

A

Diprivan
Anesthetic
Procedures, intubation, sedation and anesthesia
Hypnotic + some amnesia
Bradicardia, HypoHTN, burning @ site
Propofol infusion syndrome (↑K, ↑TriGlys, ↑ liver size)
Assess CNS fx and level via Richmond Agitation Sedation Scale (RASS)

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11
Q

Mannitol (6 TCIAsfxI)

A

Osmitrol
Osmotic Diuretic
Acute renal failure, edema, ICP, IOP
↓ re-absorption @ kidneys
Confusion, chest pain, dehydration, electro imbas
Monitor extravasation, urine output 30 - 50 mL/hr

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12
Q

Vasopressin (6 TCIAsfxI)

A 
Hormone (ADH)
Deficient ADH, vasodilatory shock, GI hemorrhage
↑ re-absorption @ kidneys
GI distress, angina, dizziness
Water intoxication
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13
Q

Gabapentin (6 TCIAsfxI)

A

Neurontin
Analgesic adjunct/Anti-convulsant
Neuralgia, bipolar, anxiety, neuropathy
↓ pain, migraines r/t nerve generated pain
↓ LoC, depression, ataxia
Withdrawal crisis, wean off, monitor for SI (Self-Injury)

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14
Q

Manifestations of Severe Acute Respiratory Syndrome (SARS) (8) + Diagnose with…?

A 
Similar to respiratory infx
Fever > 100.4F, or > 38C
HA
General Body Ache
Cold symptoms
Within 2 - 7 days dry cough/difficulty breathing
Hypoxia, low O2sat, breathlessness
X-rays show pattern similar to PNA
Manifestations + Rapid SARS test that detects SARS-CoV RNA in blood after 2 days S/S begin
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15
Q

Treatment of Sepsis (2)

A

Fluid resuscitation for hypovolemic + distributive shock
(begin immediately to pts with serum lactate levels > 2)
Early initiation of Broad Spectrum Antibiotics/Antifungals

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16
Q

Antibiotic/Fungal Types and Respective Therapy (4)

A

Chemotherapy/GI flora organisms (Gram negative) tx with aminoglycosides and cephalosporins cefazolin (Ancef) and ceftizoxime (Cefozox)
Indwelling Catheter-Staph tx with vancyomycin
Oral infx (strept/candida) tx with nystatin
Aspiration PNA - tx with clindamycin

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17
Q

Stages of Acute Respiratory Distress Syndrome (ARDS) (3 and length)

A

Exudative Phase ( 1 - 3 days )
Fibroproliferative ( 3 - 7 days )
Repair and Recovery ( up to 6 months )

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18
Q

ARDS is characterized by (4) Criteria for Diagnosis

A

–Characterized by bilateral pulmonary infiltrates in X-ray
–Acute Onset
–PAWP/PCWP 18 mm Hg less with NO CHF
PAWP - pulmonary artery wedge pressure
PCWP - pulmonary capillary wedge pressure
–PaO2/FiO2 ratio less than 200 mm Hg

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19
Q

ARDS Pathophysiological Results (3)

A

Inflammatory Injury
Pulmonary/Alveolar Epithelium disrupted, r/in fluid in pulmonary interstitial space, r/in pulmonary edema
Inflammatory response in pulmonary vasculature r/t injury

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20
Q

ARDS S/S (7)

A 
Initial injury r/in inflammation/infx (PNA -> sepsis)
Cough w/ sputum
HypoHTN
Dyspnea
Hypoxemia (shock!)
Similar to CHF, use CXR to differentiate
Respiratory Alkalosis
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21
Q

ARDS Exudative Phase (length + 3)

A

1 - 3 days
Diffuse microvascular injury and alveolar damage
Invasion of imflammatory cells into interstitium
Development of Hyaline membranes in alveolar spaces (Ø surfactant r/in difficulty breathing)

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22
Q

ARDS Fibroproliferative phase (length + 2)

A

3 - 7 days
Lung repair period
Recovery dependent on severity and influence of other factors

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23
Q

ARDS Repair and Recovery Phase (length + 3)

A

up to 6 months
Return to normal compliance/gas exchange
Permanent dmg to lung architecture
Reduced quality of life throughout recovery

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24
Q

ARDS treatment (5) + THE CAUSE OF IT ALL?!

A

Tx underlying cause (sepsis, PNA, burns, trauma, etc)
Vent with PEEP (Positive End Expiratory Pressure) to keep alveoli inflated
Fluid management (diuretics or restriction)
Anti-inflammatories to ↓ response in vasculature
Nitric Oxide ↑ blood flow to vasculature

NEUTROPHILS!

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25
Q

Cause of Pulmonary Edema r/t ARDS

A

injury + inflammatory response r/in leaky vessels which leaks into pulmonary interstitial space r/in pulmonary edema

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26
Q

5 Predisposing Factors of ARDS

A

Sepsis, pneumonia

Trauma, burns, chemical inhalation

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27
Q

Types of Sedation (4)

A

Light
Moderate (Conscious, Procedural)
Deep
General Anesthesia

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28
Q

Light Sedation (2)

A

Normal response to verbal commands

Cognition impaired but ventilation/CV fx unaffected

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29
Q

Moderate (Conscious, Procedural) Sedation (3)

A

Depressed LoC, pt responds to verbal commands

Ventilation/CV tx not needed

30
Q

Deep Sedation (2)

A

Depressed LoC, not easy to awake (req. repeated/painful stimuli)
Impaired spontaneous ventilation, requires airway management… but CV fx usually adequate

31
Q

General Anesthesia (2)

A

Unarousable even to painful stimuli

Impaired spontaneous ventilation and req. management (possible mechanical ventilation), CV function may be impaired

32
Q 
Lab Values r/t Obstructive Sleep Disorders (4)
Breathing
HH
SpO2?
ABGs (3)
A 
Ø breathing for > 10 seconds
Hematocrit ↑ r/t ↓ O2 (kidneys release erythropoetin in low O2 environments which ↑ RBC count to ↑ O2 capacity)
Variations in SpO2
ABGs...
Hypoxemia (PaO2 less than 80 mmHg)
Hypercarbia (PaCO2 more than 45 mmHg)
Respiratory Acidosis
33
Q

Burn Initial Shift (time + 3)

A

first 24 hours
3rd spacing occurs r/in ↑ HH
↓ Na due to third spacing
↑ K due to cell destruction

34
Q

Burn Fluid Remobilization (time + 4)

A

48 - 72 hours
↓ Na, ↑ K
↑ WBC’s r/t inflammation, then ↓ r/t left shift
ABGs show hypoxemia, metabolic acidosis (r/t hypovolemia and kidney perfusion)

35
Q

Burn Fluid Resuscitation Notes (6)

A

Critical during first 24 hrs to avoid burn shock
Establish 2 large bore IVs
Initiated in adults when >20% TBSA (Total Body Surface Area)
Elderly when >5-15&
Children >10-15% (more, 5.8 mL/kg/% TBSA)

36
Q

Parkland Formula (5)

A 
4 mL Ringer's Lactate x TBSA % x kg = total fluid to be infused in 24 hrs
1/2 is infused in first 8 hrs
second 1/2 infused over next 16 hrs
Ø Dextrose b/c osmotic diuretic effect
RINGER'S LACTATE!!! NOT DEXTROSE!!!
37
Q

Types of Burns (5)

A 
Exposure to heat, thermal burn
Extreme cold
Caustic Chemicals, Chemical Burns
Radiation
Electric Current, Electric Burns
38
Q

Exposure to Heat, Thermal Burn (Cause, Reaction, Result)

A

Exposure to flame/hot object
Microvascular inflammatory response
Burn edema, burn shock

39
Q

Extreme Cold Burn (Cause, Reaction, Result)

A

Severe cold temperatures (frostbite) dependet on insulation, nutritional status, exertion, heat generation, alcohol, drug use.
Tissue damage takes weeks to determine extent
Vasoconstriction of peripheral vasculature to preserve core temperature r/in tissue freezing and death.

40
Q

Caustic Chemicals, Chemical Burns (Cause, Reaction, Result)

A

Exposure to acid, alkali, or organic substances
Acid - Eschar
Alkali - ↑ Tissue Damage
Organic Substance - systemically absorbed r/in renal/hepatic toxicity
Inhaled - lung parenchymal injury
Chemicals - systemic pulmonary, CV, renal, and hepatic issues
Various Results, such as hydrofluoric acid which reacts with Ca and Mg r/in arrhythmias

41
Q

Radiation Burns (Cause, Reaction, Result)

A

Radiant Energy being transferred to body
Bad for skin, blood vessels, intestinal lining, and bone marrow
Production of cellular toxins

42
Q

Electric Current, Electrical Burns (Cause, Reaction, Result)

A

Conversion of electrical activity to heat dependent on pathway/resistance
Nerves/blood cells act as electrical conductors
Internal damage, difficult to determine. Exit site most often foot.

43
Q

Burn Depths (5)

A 
Superficial
Superficial Partial
Deep Partial
Full-Thickness
Subdermal
44
Q

Superficial Burn (5)

A

epidermis only
can be caused by sun/brief exposure to liquids
erythema, pain, minimal edema
Ø blisters, dry skin
heals in 3 -5 days via sloughing, no scars

45
Q

Superficial Partial Burn (6)

A

epidermis + papillary layer of dermis (superficial layer)
hot liquids, brief contact with objects/flash flame
erythema, brisk cap refill, blisters, moist
moderate edema, VERY painful
heals in 10 - 14 days via re-epitheliaization
Ø scarring, but potential for hypo/hyperpigmentation

46
Q

Deep Partial Burn (8)

A

epidermis + reticular layer (deep)
caused by flame, hot liquids/objects, radiation, tar
erythematous or pale, sluggish cap refill
moist or dry, Ø blisters
significant edema and altered sensation
heals in 2 - 3 weeks
potential scarring for hypo/hyperpigmentation
MAY require skin grafting for optimal fx and appearance

47
Q

Full Thickness Burn (8)

A

epidermis, dermis, and SQ layer
nerve damage MAY, may or may not have pain
flame, electricity, or chemicals
dry, leathery, white
Øcap refill
requires skin grafting
heals via contraction and granulation of tissue
definite scarring and hypo/hyperpigmentation

48
Q

Subdermal Burn (4)

A

epidermis, dermis, SQ, muscle, tendon/bone
electricity or prolonged contact
charred, dry
REQUIRES skin grafting, flap, or amputation

49
Q

Progression of Shock (4 Stages + Description)

A

Pathway/Progression - ↓ CO2, tissue perfusion, and O2 deliver to cells r/in anaerobic metabolism and lactic acidosis

Compensatory - neuroendocrine responses activated to restore CO and O2

Progressive - Compensatory mechanism can’t restore homeostasis (1. Major d/fx of many organisms, 2. Continues low blood flow with poor perfusion which builds metabolic wastes MODS

Refractory - cell destruction so severe that death is inevitable and pt is resistant to conventional therapy

50
Q 
Commonality between shocks
Hypovolemic (1)
♥ Related (2)
Distributive (3)
Transport Shock (1)
A

Commonality - ↓ oxygenation

Hypovolemic - not enough blood due to bleeding, trauma, or dehydration

♥ related - 1. Cardiogenic (♥ can’t pump enough to properly circulate (HF, MI, Valvular Dz)) 2. Obstructive Shock - External cause impeding pumping (tamponade, PE, pneumothorax)

Distributive - 1. Septic - inflammatory response/infx dilates vessels and r/in leaking 2. Neurogenic - Ø sympathetic signalling through spinal cord r/in loss of vessel integrity/tone (High spinal cord injury) 3. Anaphylactic - immune response r/t histamine release r/in vasodilation

Transport - impaired perfusion of O2 to tissues (anemia, CO poisoning)

51
Q

Burn shock types (3), Tx (3), and End point

A

Cardiogenic - ↓ CO
Hypovolemic - ↓ intravascular volume
Elevated Systemic Vascular Resistance

Tx w/ fluid resuscitation and other shock tx (vasopressors, inotropes)

Adequate urine output (signifies adequate perfusion to kidneys)

52
Q

Fluid shift during Burns (2 routes)

A

instravascular to interstitial spaces and evaporation can result in a Hypervolemic state.

53
Q

Burn shock is proportinal to…?

A

Extent and depth of injury

54
Q

40% TBSA?

A

Great risk of death

55
Q

Chemical and Vasoactive Mediators Cause and 2 Fx

A

Cause arterial construction.
Followed by vasodilation and ↑ capillary permeability r/in loss of capillary seal and massive fluid/electrolyte shift from intravascular space into interstitium

56
Q

Positioning of a pt with a brain injury (5)

A

Head of bed 30 degrees (↓ ICP ↑ venous drainage from cerebral veins)
Avoid head flexion, extension, rotation ( ↓ dmg from cerebral veins)
Avoid hip flexion ( b/c it ↑ ICP via CSF shift)
Ø Trendelenburg
Consider cervical spine injury ruled out, use neck collar to keep spine straight and head midline

57
Q

2 Types of Posturing and indications of…

A

Decorticate (Flexor) - Arms like C’s, cervical spinal tract or cerebral hemisphere
Decerebrate (Extensor) - Arms like E’s, midbrain or Pons

58
Q

What is Cerebral Perfusion Pressure (CPP)
Formula to determine
Normal Range (+3 notes)

A

Pressure gradient necessary to supply blood to brain
CPP = MAP - ICP
80 - 100 mmHg
ischemia occurs at 40 - 70 mmHg
MUST be > 70 mmHg for adequate oxygenation, with
high ICP, goal for CPP is 80 mmHg
if ICP rises to MAP level, brain perfusion stops and
death occurs

59
Q

Lower Motor Neuron SCI’s (Spinal Cord Injuries) (2)

A

Below L1, involving lumbar, sacral, and coccygeal nerves = “cauda equina”
These are NOT considered SCI’s
Injuries adjaent to end of spinal cord (T11 - L1) often are a combination of upper and lower motor neuron injuries

60
Q

Complete SCI’s meaning and 2 Types

A

Complete - loss of ALL voluntary/sensory fx below area of injury

Paraplegia - in thoracolumbar (T2-L1) region, loss of motor fx in lower extremities

Quadraplegia - in cervical/thoracic regions (C1-T1), impaired fx of arms, trunk, legs, and pelvic organs may occur

61
Q

Incomplete SCI’s meaning and 3 Types

A

Incomplete - preservation of some sensory/motor fx below level of injury due to partial transection of spinal cord

Anterior Cord
Fx lot - motor, pain, temp, touch
Fx present - proprioception, vibration

Brown - Segard
Fx lost - voluntary motor movement on side of injury, pain, temp, sensation ON OPPOSITE SIDE
Fx present - side of body with best motor control has little to no sensation

Central Cord
Fx Lost - motor, sensory in upper extremities
Fx present - motor, sensory in lower extremities, some blader and bowel fx.

62
Q

Secondary SCI’s meaning and 3 Types

A

24 hr period following injury that contributes to neural fx loss
Ischemia
Elevated Intracellular Calcium
Inflammatory Process

63
Q

2ndary SCI Ischemia 4 Fx

A

↓ blood flow to spinal cord
↓ blow flow in thrombi
edema r/in ↓ perfusion
vasoconstrictive substances ↓ circulation

64
Q

2ndary SCI Elevated Intracellular Calcium 4 Fx

A

Calcium accumulates at site of injury, breaks down protein & phospholipids
Ions ↑ inflammatory response
cell membrane is damaged, neuronal death occurs

65
Q

2ndary SCI Inflammatory Process 3 Fx

A

leukocytes infiltrate injured area

Edema forms and ↓ blood supply, this also prevents assessment of extent of injury until it is resolved

66
Q

3 Ways to Prevent 2ndary SCI’s

A

Administration of methylprednisolone
Surgical interventions: decompression/stabilization
Manual immobilization

67
Q

3 Types of Shock r/t SCI’s

A

Spinal Cord
Neurogenic
Hemorrhagic

68
Q

Spinal Cord Shock (5)

A

r/in loss of ALL neurologic fx (including reflexes and rectal tone).
Takes hours, days, or weeks to return
Reflexes return from feet upward
Bulba Caverosa Reflex - central reflex, first to return and is a sign that shock is resolving
After resolved, SCI extent determined by which reflexes are intact

69
Q

Neurogenic Shock (3)

A

HypoHTN, bradycardia, and peripheral vasodilation

70
Q

8 ways to Tx a SCI patient

A

Immobilization used skeletal traction (Crtuchfield tongs, Halo traction)
Medications
Monitor Respiratory and Cardiac Status
Bowel/Bladder Management
Assess for skin breakdown
Maintain normothermic environment
Assess for S/S of autonomic dysreflexia “hyperreflexia” which are spinal lesions above T6
Surgical Inteventions: anterior cervical laminectomy with fusion or posterior laminectomy

71
Q

Tx a SCI patient (5 Medications)

A

Atropine for bradycardia r/t neurogenic shock
Vasopressors (Dopamine) to ↑ Spinal Cord perfusion
Methylprednisone
Blood Transfusion - fluid resuscitation for hemorrhagic shock
Darvon - H2 Agonists (Zantac, Pepcid)

72
Q

S/S of autonomic dysreflexia “hyperreflexia” (8)

A 
Over distended bowel/bladder
Stimulation of Skin
Pain
HTN
Bradycardia
Sudden onset throbbing headache
Nasal Congestion
Nausea

ABSN Cohort 19 (28 decks)

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