TEST 2 random Flashcards
What are the advantages of administering antiasthma drugs via inhalation?
- delivery directly to site of action.
- systemic effects minimized.
- rapid relief of acute attacks.
What are 4 different types of inhalation devices for asthma meds?
MDI, respimats, dry-powder inhalers, and nebulizers
What are the advantages of using a Respimat?
deliver fine mist, does not use propellants, extremely small particle size to ensure greater delivery of the drug into the lungs, and decreased drug deposited in the mouth/oropharynx
What are the advantages of a nebulizer?
- does not require coordinated inhalation from patient
- variety of attachments like masks for less cooperative patients.
- can administer oxygen and nebulized medication simultaneously
- some medications will only be formulary as a nebulizer solution.
What are the disadvantages of a nebulizer?
- potential increase risk of aerosolization of pathogens because equipment needs to be cleaned frequently.
- longer dose delivery time.
- some units require power source.
- some units require compressed oxygen or air.
How does a dry powder inhaler (DPI) work?
dry micronized powder is delivered directly into the lungs.
Do you need hand breath coordination with a DPI?
No, it is breath activated
Which device delivers more drug to the lungs DPI or MDI?
DPI
How long should you wait between inhalations when using MDI?
1 minute
Disadvantage of MDI?
Need hand breath coordination
What does bactericidal mean?
kills the bacteria
What are bacteriostatic drugs?
weaken the bacteria by affecting protein synthesis
Difference between abx and antimicrobial agent?
abx: chemical that is produced by one microbe and has the ability to harm other microbes.
antimicrobial agent: any agent either natural or synthetic.
What does selective toxicity mean?
Drugs have the ability to target specific cells while not injuring other cells, organisms, hosts, etc.
What are the 3 mechanisms of selective toxicity?
- Disrupt bacterial cell wall
- Inhibit enzyme unique to bacteria
- Disrupt bacterial protein synthesis
Antimicrobial drugs are classified in what 2 categories?
susceptible organism and MOA
what kind of bacteria will need narrow and broad spectrum abx?
Gram + cocci like staph, strep, and enterococcus
Gram + bacilli like C diff will need what type of abx?
Narrow
What gram - cocci bacterial infection will need broad abx?
Neisseria gonorrhea
Why are some abx resistant to infection?
d/t spontaneous mutations or conjugation
What are the microbial mechanisms for resisting a drug?
- decrease the concentration of a drug at its site of action.
- inactive a drug.
- alter the structure of drug target molecules.
- produce a drug antagonist.
What are misuses of abx?
- attempted tx of viral infections.
- tx of fever of unknown origin.
- improper dosage.
- tx w/o adequate bacteriologic information.
- omission of surgical drainage.
How does abx use promote resistance?
using broad spectrum and extended use
What is a superinfection?
new infection that appears over the course of tx
What is empiric tx?
using broad spectrum abx like when tx patients suspected of sepsis
Before selecting an abx what needs to be obtained?
cultures
How do we determine drug susceptibility?
By looking at the minimum inhibitory concentration (MIC) and min bactericidal concentration (MBC). Helps provider see which will be the most effective.
What is MIC?
looking at the lowest level of antimicrobial agent resulting in microbial death
What is MBC?
looking at the lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation
What organism factors are considered when selecting an abx?
empiric tx, gram staining, PCR, and determining drug susceptibility
What host factors are considered when selecting abx?
host defenses, site of infection, previous allergic rxn, and genetic factors
How does G6PD affect the selection of abx?
Some abx can cause hemolysis
What are the hemoglobin A1C, pre-meal plasma glucose, and peak post-meal plasma glucose target values in non-pregnant adults?
A1C: <7%
Pre-meal: 80-130mg/dL
Post-meal: <180/dL
What is the target value for pre and post meal glucose in hospitalized adults?
140-180mg/dL
What is the target value for pre and post meal glucose for patients who are not susceptible to hypoglycemia? Hint: stringent target
110-140mg/dL
What is the target value for pre and post meal glucose for perioperative care patients?
80-180mg/dL
Why are perioperative glucose target values close to normal ranges?
Because tissues have to heal post surgery
What is the prototype for rapid-acting insulin?
Lispro (Humalog)
What is the prototype for short acting insulin?
Regular (HumuLIN R)
What is the prototype for intermediate acting insulin?
Neutral Protamine Hagedorn (NPH)
What is the prototype for long-acting insulin?
Glargine (Lantus)
What is the prototype for ultra long-acting insulin?
Degludec (Tresiba)
Which insulin is the only one that has a cloudy appearance?
NPH
What is the onset, peak, and duration of Lispro (Humalog)?
onset: 15-30min
peak: 0.5-2.5hr
duration: 3-6hr
What is the onset, peak, and duration of Regular (HumuLIN R)?
onset: 0.5-1hr
peak: 1-5hr
duration: 6-10hr
What is the onset, peak, and duration of NPH?
onset: 1-2hr
peak: 6-14hr
duration: 16-24hr
What is the onset, peak, and duration of Glargine (Lantus)?
onset: 1.5-2hr
peak: none
duration: 18-24hr
What is the onset, peak, and duration of Degludec (Tresiba)?
onset: 0.5-1.5hr
peak: 9hr
duration: >24hr
When mixing short acting insulin with long acting insulin which one do we draw up first?
Short acting
T/F. Do not mix Glargine or ultra-long acting with any other insulin?
True
When should Humalog be administered? Hint: rapid acting
immediately AC or PC
When should HumuLIN R be administered?
AC
When should NPH be administered?
injected 2-3 times daily
When should Glargine (Lantus) and Degludec (Tresiba) be administered?
QD
Under what conditions will insulin needs decrease?
missed meal, physical activity, 1st trimester pregnancy
Under what conditions will insulin needs increase?
infection/illness, stress, obesity, adolescent growth spurt, pregnancy after 1st trimester
What is the initial dose range for T1DM and T2DM?
T1DM: 0.5-0.6 units/kg/day
T2DM: 0.2-0.6 units/kg/day
Indications for insulin therapy?
DM, IV insulin for DKA, gestational diabetes, hyperkalemia, cardioprotective effects for cardiac surgery patient, aids in the diagnosis of growth hormone deficiency, and required by all T1DM and many with T2.
What is basal dosing?
Dosing to keep a constant amount of insulin in the body. Most likely done by long-acting insulin.
What is prandial dosing?
Scheduled dosing (AC) where we will most likely use short acting.
What is correctional dosing?
PRN; using a sliding scale
What is a normal dosing schedule for T1DM?
multiple daily injections prandial and 1 basal insulin. Continuous subcutaneous insulin infusion plus continuous glucose monitoring.
What is a normal dosing schedule for T2DM?
typically begin with oral agents and then require insulin injections.
When will a T2 diabetic need to start with insulin therapy initially?
glucose >300mg/dL, A1C> 10%, sx of hyperglycemia, or there is evidence of catabolism
How often should sugars be checked if patient is on enteral/tube feedings?
Q6h
Insulin therapy complications?
hypoglycemia (<70mg/dL), hypokalemia, lipohypertrophy, allergic rxns, and drug rxns.
What are 3 drugs that interact with insulin?
hypoglycemic agents (alcohol), hyperglycemic agents (steroids), and beta blockers
What are the s/sx of hypoglycemia?
palpitations, tachycardia, sweating, fatigue, excessive hunger
