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PHARM > TEST 2 random > Flashcards

TEST 2 random Flashcards

1
Q

What are the advantages of administering antiasthma drugs via inhalation?

A
  • delivery directly to site of action.
  • systemic effects minimized.
  • rapid relief of acute attacks.
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2
Q

What are 4 different types of inhalation devices for asthma meds?

A

MDI, respimats, dry-powder inhalers, and nebulizers

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3
Q

What are the advantages of using a Respimat?

A

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

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4
Q

What are the advantages of a nebulizer?

A
  • 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.
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5
Q

What are the disadvantages of a nebulizer?

A
  • 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.
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6
Q

How does a dry powder inhaler (DPI) work?

A

dry micronized powder is delivered directly into the lungs.

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7
Q

Do you need hand breath coordination with a DPI?

A

No, it is breath activated

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8
Q

Which device delivers more drug to the lungs DPI or MDI?

A

DPI

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9
Q

How long should you wait between inhalations when using MDI?

A

1 minute

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10
Q

Disadvantage of MDI?

A

Need hand breath coordination

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11
Q

What does bactericidal mean?

A

kills the bacteria

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12
Q

What are bacteriostatic drugs?

A

weaken the bacteria by affecting protein synthesis

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13
Q

Difference between abx and antimicrobial agent?

A

abx: chemical that is produced by one microbe and has the ability to harm other microbes.
antimicrobial agent: any agent either natural or synthetic.

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14
Q

What does selective toxicity mean?

A

Drugs have the ability to target specific cells while not injuring other cells, organisms, hosts, etc.

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15
Q

What are the 3 mechanisms of selective toxicity?

A
  1. Disrupt bacterial cell wall
  2. Inhibit enzyme unique to bacteria
  3. Disrupt bacterial protein synthesis
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16
Q

Antimicrobial drugs are classified in what 2 categories?

A

susceptible organism and MOA

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17
Q

what kind of bacteria will need narrow and broad spectrum abx?

A

Gram + cocci like staph, strep, and enterococcus

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18
Q

Gram + bacilli like C diff will need what type of abx?

A

Narrow

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19
Q

What gram - cocci bacterial infection will need broad abx?

A

Neisseria gonorrhea

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20
Q

Why are some abx resistant to infection?

A

d/t spontaneous mutations or conjugation

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21
Q

What are the microbial mechanisms for resisting a drug?

A
  • 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.
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22
Q

What are misuses of abx?

A
  • attempted tx of viral infections.
  • tx of fever of unknown origin.
  • improper dosage.
  • tx w/o adequate bacteriologic information.
  • omission of surgical drainage.
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23
Q

How does abx use promote resistance?

A

using broad spectrum and extended use

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24
Q

What is a superinfection?

A

new infection that appears over the course of tx

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25
Q

What is empiric tx?

A

using broad spectrum abx like when tx patients suspected of sepsis

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26
Q

Before selecting an abx what needs to be obtained?

A

cultures

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27
Q

How do we determine drug susceptibility?

A

By looking at the minimum inhibitory concentration (MIC) and min bactericidal concentration (MBC). Helps provider see which will be the most effective.

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28
Q

What is MIC?

A

looking at the lowest level of antimicrobial agent resulting in microbial death

29
Q

What is MBC?

A

looking at the lowest concentration of an antimicrobial that will inhibit the visible growth of a microorganism after overnight incubation

30
Q

What organism factors are considered when selecting an abx?

A

empiric tx, gram staining, PCR, and determining drug susceptibility

31
Q

What host factors are considered when selecting abx?

A

host defenses, site of infection, previous allergic rxn, and genetic factors

32
Q

How does G6PD affect the selection of abx?

A

Some abx can cause hemolysis

33
Q

What are the hemoglobin A1C, pre-meal plasma glucose, and peak post-meal plasma glucose target values in non-pregnant adults?

A

A1C: <7%
Pre-meal: 80-130mg/dL
Post-meal: <180/dL

34
Q

What is the target value for pre and post meal glucose in hospitalized adults?

A

140-180mg/dL

35
Q

What is the target value for pre and post meal glucose for patients who are not susceptible to hypoglycemia? Hint: stringent target

A

110-140mg/dL

36
Q

What is the target value for pre and post meal glucose for perioperative care patients?

A

80-180mg/dL

37
Q

Why are perioperative glucose target values close to normal ranges?

A

Because tissues have to heal post surgery

38
Q

What is the prototype for rapid-acting insulin?

A

Lispro (Humalog)

39
Q

What is the prototype for short acting insulin?

A

Regular (HumuLIN R)

40
Q

What is the prototype for intermediate acting insulin?

A

Neutral Protamine Hagedorn (NPH)

41
Q

What is the prototype for long-acting insulin?

A

Glargine (Lantus)

42
Q

What is the prototype for ultra long-acting insulin?

A

Degludec (Tresiba)

43
Q

Which insulin is the only one that has a cloudy appearance?

A

NPH

44
Q

What is the onset, peak, and duration of Lispro (Humalog)?

A

onset: 15-30min
peak: 0.5-2.5hr
duration: 3-6hr

45
Q

What is the onset, peak, and duration of Regular (HumuLIN R)?

A

onset: 0.5-1hr
peak: 1-5hr
duration: 6-10hr

46
Q

What is the onset, peak, and duration of NPH?

A

onset: 1-2hr
peak: 6-14hr
duration: 16-24hr

47
Q

What is the onset, peak, and duration of Glargine (Lantus)?

A

onset: 1.5-2hr
peak: none
duration: 18-24hr

48
Q

What is the onset, peak, and duration of Degludec (Tresiba)?

A

onset: 0.5-1.5hr
peak: 9hr
duration: >24hr

49
Q

When mixing short acting insulin with long acting insulin which one do we draw up first?

A

Short acting

50
Q

T/F. Do not mix Glargine or ultra-long acting with any other insulin?

A

True

51
Q

When should Humalog be administered? Hint: rapid acting

A

immediately AC or PC

52
Q

When should HumuLIN R be administered?

A

AC

53
Q

When should NPH be administered?

A

injected 2-3 times daily

54
Q

When should Glargine (Lantus) and Degludec (Tresiba) be administered?

A

QD

55
Q

Under what conditions will insulin needs decrease?

A

missed meal, physical activity, 1st trimester pregnancy

56
Q

Under what conditions will insulin needs increase?

A

infection/illness, stress, obesity, adolescent growth spurt, pregnancy after 1st trimester

57
Q

What is the initial dose range for T1DM and T2DM?

A

T1DM: 0.5-0.6 units/kg/day
T2DM: 0.2-0.6 units/kg/day

58
Q

Indications for insulin therapy?

A

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.

59
Q

What is basal dosing?

A

Dosing to keep a constant amount of insulin in the body. Most likely done by long-acting insulin.

60
Q

What is prandial dosing?

A

Scheduled dosing (AC) where we will most likely use short acting.

61
Q

What is correctional dosing?

A

PRN; using a sliding scale

62
Q

What is a normal dosing schedule for T1DM?

A

multiple daily injections prandial and 1 basal insulin. Continuous subcutaneous insulin infusion plus continuous glucose monitoring.

63
Q

What is a normal dosing schedule for T2DM?

A

typically begin with oral agents and then require insulin injections.

64
Q

When will a T2 diabetic need to start with insulin therapy initially?

A

glucose >300mg/dL, A1C> 10%, sx of hyperglycemia, or there is evidence of catabolism

65
Q

How often should sugars be checked if patient is on enteral/tube feedings?

A

Q6h

66
Q

Insulin therapy complications?

A

hypoglycemia (<70mg/dL), hypokalemia, lipohypertrophy, allergic rxns, and drug rxns.

67
Q

What are 3 drugs that interact with insulin?

A

hypoglycemic agents (alcohol), hyperglycemic agents (steroids), and beta blockers

68
Q

What are the s/sx of hypoglycemia?

A

palpitations, tachycardia, sweating, fatigue, excessive hunger

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