Test 4 - key points only Flashcards
What is an inotropic effect?
INCREASES RATE & FORCE OF CONTRACTION
Does digoxin have a negative or positive chronotropic effect?
Negative
What are the key reason digoxin is used?
o HEART FAILURE
o DECREASES HEART RATE
If someone is experiencing digoxin toxicity, what will it cause?
HYPOKALEMIA.
SOME DUIRETICS CAN CAUSE LOW K+
WHAT ARE THE ADVERSE EFFECTS OF DIGOXIN?
o SEEING GREEN YELLOW PURPLE HALOS
o BRADYCARDIA
o HYPOKALEMIA
WHAT IS USED FOR DIG TOXICITY?
• DIGIBIND FOR DIG TOXICITY
DIGOXIN IS HELD FOR WHAT REASON?
o HOLD IF HR <60
IF HF WAS GETTING WORSE HOW WOULD YOU KNOW?
o EDEMA
o WEIGHT GAIN
o RESPIRATORY RATE INCREASED
o INCREASED ACTIVITY INTOLERANCE
WHAT IS MILRINONE USED FOR?
IT IS USED FOR SHORT-TERM MANAGEMENT OF HEART FAILURE
WHAT IS THE MOST COMMON ROUTE OF MILRINONE?
IT IS USUALLY GIVEN AS A WEEKLY 6-HOUR IV INFUSION
WHAT MUST BE MONITORED WHEN GIVING MILRINONE?
INTAKE, OUTPUT, HEART RATE, BP, WEIGHT (DAILY), RESPIRATIONS
WHAT ARE ANTIDYSRHYTHMIC DRUGS USED FOR?
THEY ARE USED FOR CARDIAC RHYTHMS
HOW DO MOST DRUGS USED FOR RHYTHM WORK?
MOST DRUGS THAT WORK FOR RHYTHM WILL SLOW HEART RATE AND POSSIBLY DROP BP QUICKLY
WHICH DRUG IS USED FOR VENTRICULAR DYSRHYTHMIAS?
LIDOCANE
WHEN TAKING ANTIDYSRHYTHMIAS, WHAT ARE PEOPLE AT HIGH RISK FOR
o RISK OF FALLS
o ORTHOSTATIC HYPERTENSION
-BECAUSE THEY SLOW THE HEART RATE AND POSSIBLY DROP B/P QUICKLY
WHAT ANTIDYSRHYTHMIA IS THE DRUG OF CHOICE FOR IV DRUG TREATMENT?
LIDOCANE
WHAT IS AN EXPECTED EFFECT OF ADENOSINE?
ADENOSINE MAY CAUSE ASYSTOLE FOR A FEW SECONDS (LITERALLY STOPS THE HEART, AND A NORMAL SINUS NODE KICKS IN MAKING IT FUNCTION NORMAL AGAIN)
WHAT IS AN ANTIANGINAL THAT CAN BE PROVIDED SUBLINGUAL, TOPICAL, AND IV?
• NITROGLYCERIN
NITROGLYCERIN MUST BE PROTECTED FROM?
LIGHT AND KEEP IN ITS ORIGINAL PACKAGING
WHEN ADMINISTERING NITROGLYCERIN TOPICALLY, YOU MUST: (3 POINTS)
WEAR GLOVES OR YOULL GET A HEADACHE
ALTERNATE LOCATION
DO NOT PUT OVER HEART
WHAT IS A CONTRAINDICATION WHEN TAKING NITROGLYCERIN?
ANEMIA IS A CONTRAINDICATION TO NITRO
WHAT ARE THE RECOMMENDATIONS FOR TAKING NITROGLYCERIN WHEN A CLIENT IS HAVING CHEST PAIN?
(NEW RECOMMANDATIONS)
IF THE PERSON IS STILL HAVING CHEST PAIN AFTER 1 DOSE OF SUBLINGUAL NITRO AFTER 5 MIN., 911 SHOULD BE CALLED IMMEDIATELY
OR
(OLD RECOMMANDATIONS)
Take an SL tablet, and wait 5 minutes
If no relief in 5 minutes, take a second SL tablet
If no relief in 5 minutes, take a third SL tablet
After three tablets, or 15 minutes, if no relief of chest pain, call 911 immediately
WHAT EFFECT DOES GRAPEFRUIT JUICE HAVE ON calcium channel blockers?
Grapefruit juice can reduce the metabolism of calcium channel blockers
WHAT DRUG IS CONTRAINDICATED WHEN TAKING NITROGLYCERIN?
VIAGRA
BECAUSE NITRO IN IV IS POISON AND HAS A DYNAMITE EFFECT WE SHOULD NOT:
SMOKE AND IT MUST BE PROTECTED FROM LIGHT
WHY MUST A CLIENT USING NITROGLYCERIN TAKE IT OFF AT NIGHT FROM THE DRUG?
To reduce tolerance, the patient may be instructed to remove topical forms at bedtime and apply new doses in the morning, allowing for a nitrate-free period
BETA BLOCKERS- METROPOLOL
HOW DOES IT WORK
IT SLOWS THE HEART RATE WAY DOWN
BETA BLOCKERS- METROPOLOL
WHAT SHOULD YOU ALWAYS TAKE BEFORE GIVING IT?
• MAKE SURE TO TAKE A PULSE
o HOLD IF HR <60
BETA BLOCKERS- METROPOLOL
WHAT IS A NEGATIVE SIDE EFFECT
CONSTIPATION
BRADYCARDIA
BETA BLOCKERS- IS ALSO USED FOR:
o ALSO USED FOR STAGE FRIGHT & MIGRAINE HEADACHES
WHAT EFFECT DO BETA BLOCKERS HAVE ON PEOPLE?
• FLAT AFFECT – CALMING
b-blockers and angiotensin-converting enzyme (ACE) inhibitors have been found to be more effective in what race?
more effective in white patients than in Black patients
Calcium channel blockers (CCBs) and diuretics have been shown to be more effective in what race?
more effective in Black patients than in white patients
WHAT IS THE RANGE FOR PRE-HYPERTENSION
(130–139/85–89 mm Hg)
WHAT IS THE RANGE FOR Stage 1 hypertension
Stage 1 hypertension 140/90–159/99
WHAT IS THE RANGE FOR Stage 2 hypertension
Stage 2 hypertension 160+/100+
WHY DO PEOPLE OFTEN STOP TAKING ACE INHIBITORS BECAUSE OF A?
NAGGING COUGH
WHAT ARE THE FIRST LINE DRUG FOR DIABETICS WITH HYPERTENSION
ACE INHIBITORS BECAUSE OF THE RENAL PROTECTIVE EFFECTS
WHAT IS THE TARGET BLOOD PRESSURE RANGE FOR DIABETICS?
BELOW 130
ANTIHYPERTENSIVE DRUGS CAN HAVE WHAT NEGATIVE EFFECT ON MEN?
IMPOTENCE
WHAT IS THE MOST COMMONLY USED DIURETIC FOR HYPERTENSION
THIAZIDE DIURECTICS- SPIRANOLACTONE, AND ALDACTONE
WILL AN ANTICOAGULANT PREVENT CLOTS OR DISSOLVE THEM
• PREVENTS CLOTS! DOES NOT DISSOLVE CLOTS!!!
WHAT ARE TWO COMMON ANTICOAGULANTS?
- HEPARIN/LOVENOX
* COUMADIN
WHEN ADMINISTERING HEPARIN/LOVENOX (SC) WHAT ARE SOME KEY STEPS?
o DON’T RUB IN
o DON’T ASPIRATE
o STAY AWAY FROM UMBILICUS
o ROTATE SITES
WHAT IS THE ANTIDOTE FOR HEPARIN
PROTAMINE SULFATE
WHAT IS THE ANTIDOTE FOR COUMADIN
VIT K
HEPARIN Is monitored by
activated partial thromboplastin times (aPTTs)
COUMADIN Is monitored by
International Normalized Ratio (I&R)
WHAT IS THE SAFEST OTC PAIN MED TO TAKE WHEN ON A ANTICOAGULANT (COUMADIN AND HEPARIN)
Tylenol is the safest
ARE HEPARIN AND COUMADIN SAFE TO OVERLAP?
Heparin and Coumadin (warfarin) work in different places on the cascade. They are safe to overlap because they work in different places
WHAT IS THE BIGGEST RISK WITH ANTICOAGULANTS (HEPARIN & COUMADIN)?
• RISK OF BOTH DRUGS IS BLEEDING
WHAT KIND OF FOOD MUST A PERSON WATCH WHEN TAKING COUMADIN?
o PEOPLE WHO TAKE COUMADIN NEED TO WATCH HOW MUCH VEGGIES WITH VITAMIN K THEY CONSUME
WHAT DRUG CAN BE USED FOR PEOPLE WHO HAVE A RISK FOR CLOTS (LOW DOSE)
ASPIRIN (DOES NOT DISSOLVE CLOTS)
ASPIRIN SHOULD NEVER BE GIVEN TO?
o NEVER GIVE TO CHILDREN
WHAT ARE SOME SYMPTOMS OF ASPIRIN TOXICITY?
VISION CHANGES
TINITUS
WHAT IS THE DRUG KNOWN AS THE CLOT BUSTER?
• STREPTOKINASE - ONLY GIVEN AS A ONE TIME THING
ANTILIPEMIC DRUGS
THE HMG-CoA INHIBITORS ARE ALSO CALLED THE?
STATINS (atorvastatin, Lipitor)
ANTILIPEMIC DRUGS ARE USED TO?
LOWER CHOLESTEROL
HOW LONG DO ANTILIPEMIC DRUGS TAKE TO WORK?
6-8 WEEKS
Which drug stops the absorption from the small intestine (works in the gut) safer medication
EZEOTROL – ABSORBED IN THE GUT
ANTILIPEMIC DRUGS Nicotinic acid is available OTC as what type of drug?
Nicotinic acid is vitamin B3
ANTILIPEMIC DRUGS Nicotinic acid causes flushing (due to histamine release), what OTC drug prevents flushing in small doses?
ASPIRIN
When taking any statins, what must any patient report
o RHABDOMYOLYSIS (muscle pain, myopathy) – EVENTUALLY LEADS TO KIDNEY FAILURE.
When taking any statins what must be avoided?
CANT TAKE WITH GRAPEFRUIT JUICE because it Interacts with the following and may (although rarely) lead to the development of rhabdomyolysis:
ANTILIPEMIC DRUGS ESPECIALLY THE HMG–CoA Reductase Inhibitors (statins): Adverse Effects
Elevations in liver enzymes or liver disease
LIVER DYSFUNCTION AND BILIARY OBSTRUCTION
ANTILIPEMIC DRUGS WORK IN THE GUT & CAUSE CONSTIPATION. EXCEPT FOR?
FIBRIC ACID DERIVATIVES (GEMFIBROZIL, LOPID)
FIBRIC ACID DERIVATIVES (GEMFIBROZIL, LOPID) HAVE AN ADVERSE EFFECT OF
THE SHITTY SHITS
NON-DRUG MEANS OF CONTROLLING BLOOD CHOLESTEROL LEVELS SHOULD BE TRIED FRIST, HOW IS THIS DONE?
LIFE STYLE MODIFIATION EG. DIET, EXERCISE
HOW DO SEDATIVES EFFECT THE CNS?
IN LOW DOSES:
At low doses, they calm the CNS without inducing sleep
THEY REDUCE NERVOUSNESS, EXCITABILITY, & IRRITABIITY
HOW DO SEDATIVES EFFECT THE CNS?
IN HIGH DOSES:
At high doses, they calm the CNS to the point of causing sleep AND BECOME A HYPNOTIC
WHEN TAKING SEDATIVES OR HYPNOTICS THERE ARE TWO MAJOR SAFETY ISSUES:
o NO DRIVING
o DROWSINESS RISK FOR FALLS AND STUFF
HOW DO Hypnotics EFFECT THE CNS?
THEY INDUCE SLEEP
A sedative can become a hypnotic if it is given in large enough doses
WHAT DRUG IS LONG ACTING:
Sedative–hypnotic and control of convulsive conditions
pentobarbital
Barbiturates: Adverse Effects
Reduced REM sleep, resulting in
Because you have less rem you are quick to get angry, irritable, Agitated
and the inability to deal with normal stress
Barbiturates & benzodiazepines cannot be used in combination with:
ALCOHOL
Barbiturates (Phenobarb) cannot be used much today because:
benzodiazepines are safer and have a higher efficacy
What adverse effects do benzodiazepines have?
they have a hangover effect -> make you really tired & high risk for falls
When benzodiazepines are stopped this can cause:
rebound insomnia may occur for a few nights after 3-4 weeks the regimen has been discontinued
Interactions with benzodiazepines are:
other CNS depressants because this may lead to further CNS depression (including decreased B/P and respiratory rate, sedation, confusion, and diminished reflexes)
Is there an antidote to benzodiazepines?
no narcan does not work
If an overdose occurs when taking benzodiazepines this is severe, what interventions may be needed?
o OVERDOSE – SEVERE CNS DEPRESSION WILL NEED BREATHING SUPPORT
Why is Phenobarb used in 3RD WORLD COUNTRIES
BECAUSE IT IS CHEAP
PHENYTOIN/DILANTIN SHOULD NOT BE USED WHEN:
o SHOULD NOT BE USED PREGNANT BECAUSE IT IS A TERATOGEN
LONG TERM USE OF PHENYTOIN/DILANTIN CAN CAUSE:
DILANTIN FACIES, GINGIVITAL HYPERPLASIA, HIRSUTISM AND ACNE
WHEN TAKING PHENYTOIN/DILANTIN A DOSE SHOULD NEVER BE SKIPPED BECAUSE OF:
A NARROW THERAPEUTIC INDEX
WHAT IS DIAZEPAM/VALIUM USED FOR:
STATUS EPILEPTICUS
WHAT IS GABAPENTIN USED FOR?
o USED FOR SEIZURES
WHAT CAN DEVELOP WHEN GABAPENTIN IS STOPPED?
o CAN DEVELOP WITHDRAWAL SEIZURES
WHAT IS AN OFF LABELED USE FOR GABAPENTIN?
NEUROPATHIC OR NERVE PAIN AFTER SURGERY
WHEN TAKING TOPIMAX THE DRUG CAN NEVER BE CRUSHED BECAUSE:
THEY ARE AN EXTENDED RELEASE FORM
LYNN SAID TO LOOK UP TOPAMAX: HERE’S THE BLUE BOX INFO
Topiramate (Topamax) is a structurally unique drug chemically related to fructose, classified as a sulfamate substituted monosaccharide. Topiramate is indicated for management of patients (adults and children over 6 years of age) with newly diagnosed epilepsy and as adjunctive therapy for partial seizures in adults and children 2 years of age and older. It is also indicated for the prophylaxis of migraine headache in adults. Its exact mechanism of action is unknown. However, it is believed to work by blocking sodium channels in neurons, blocking glutamate activity, and enhancing GABA activity
Cholinergic Drugs:
Stimulate pupils
Constriction (miosis)
Reduced intraocular pressure
AND ARE CONTRAINDICATED WITH GLUCOMA
Cholinergic Drugs: Problematic in people with:
asthma, obstructions, Bradycardia
Defects in cardiac impulse conduction
Cholinergic Drugs:
Used to arrest or slow the progression of Alzheimer’s disease if done at an early enough stage
donepezil (Aricept)
Cholinergic Drugs:
bethanechol (Duvoid):
Increases tone and motility of bladder and gastrointestinal (GI) tract
Relaxes sphincters in bladder and GI tract, allowing them to empty
Is helpful for postsurgical atony of the bladder and GI tract
Is administered orally
Cholinergic Drugs:
Adverse effects are a result of overstimulation of the PSNS
Effects of the drug are the side effects of the drug
Cholinergic Drugs: Interactions
Anticholinergics, antihistamines, sympathomimetics
Cholinergic Drugs:
Encourage patients with myasthenia gravis to take medication ____ ________before eating to help improve chewing and swallowing
30 minutes
What is the antidote for cholinergics?
Atropine is the antidote for cholinergics*** ; it should be available in the patient’s room for immediate use if needed
- The two types of cholinergic receptors are _______________________ and __________________________.
The two types of cholinergic receptors are muscarinic and nicotinic.
The blood–brain barrier does not allow exogenously supplied dopamine to enter, but it does allow _______ __ ______.
levodopa to enter
There is an imbalance of neurotransmitters and the drug therapy is aimed at balancing these two neurotransmitter:
Is caused by an imbalance of two neurotransmitters:
Dopamine
Acetylcholine (ACh)
drug therapy is aimed at increasing levels of dopamine as long as there are functioning nerve terminals remaining, Anticholinergic can block ___________
Anticholinergic can block acetylcoline
Selective MAOI Therapy: selegiline
Adverse Effects
Can’t eat aged cheese, red wine, baked yeast, a ton of food reactions. LEADS TO HYPERTENSIVE CRISIS.
which drug causes release of dopamine from the storage sites at the end of nerve cells that are still intact
Blocks the reuptake of dopamine into the nerve endings, allowing more to accumulate both centrally and peripherally
Does not stimulate dopamine receptors directly
amantadine (Symmetrel)
Blue Box info
Amantadine (Symmetrel) is believed to work in the CNS by eliciting the release of dopamine from nerve endings, resulting in higher concentrations of dopamine in the CNS. It is most effective in the earlier stages of PD when there are still significant numbers of nerves to act on and dopamine to be released. As the disease progresses, however, the population of functioning nerves diminishes, and so does amantadine’s effect. Amantadine is usually effective for only 6 to 12 months. After amantadine fails to relieve the hypokinesia and rigidity, a dopamine agon- ist such as bromocriptine is usually tried next. Amantadine is contraindicated in patients who have shown a hypersensitivity reaction to it, women who are lactating, and children younger than 1 year of age (amantadine is also an antiviral drug).
why is the combination of levodopa or levodopa–carbidopa and selegiline
AUGMENTS LEVADOPA THERAPY.
Carbidopa helps levodopa get to the blood brain barrier.
selegiline: Adverse Effects
Doses higher than ___ mg/day may cause more severe adverse effects, such as hypertensive crisis
10 mg/day
LEVADOPA is given with___________ which does not cross the blood–brain barrier, prevents levodopa breakdown in the periphery
Carbidopa,
Enhanced CNS depressant effects with __________, CNS depressants, amantadine (Symmetrel), phenothiazines, tricyclic antidepressants, and antihistamines
alcohol
When starting dopaminergic drugs, assist patient with __________ because dizziness may occur
walking
Teach patient to avoid foods high in vitamin B6 because it can?
reverse the effects of the levadopa
levodopa preparations may darken the patient’s __________ & _________– NORMAL EFFECT*
urine and sweat
A “drug holidays” must be used with patients using levodopa long term because:
NOT WANTING TO BURN OUT RECEPTORS
WHAT ARE THE EXPECTED THERAPEUTIC RESPONSES TO LEVODOPA?
Levodopa is converted to dopamine and helps supplement the deficient amounts of dopamine in the brain. In PD, there is an imbalance between dopamine and Ach. Levodopa helps restore this balance. Improvement in activities of daily living and other symptoms of the disease is the result.
What is the concept of half life?
is the time it takes for one half of a given amount of a drug in the body to be removed and is a measure of the rate at which the drug is eliminated from the body. For instance, if the maximum level that a particular dosage could achieve in the body is 100 mg/L and in 8 hours the measured drug level is 50 mg/L, then the estimated half- life for that drug is 8 hours.
Why is grapefruit often contraindicated?
Because it has clinically significant grapefruit juice–drug interactions
What is the concept of first-pass effect?
If the drug is metabolized in the liver or excreted in the bile, some of the active drug will be inactivated or diverted before it can reach the general circulation and its intended sites of action. This is known as the first-pass effect, and it reduces the bio- availability of the drug to less than 100%.
___________ is the movement of a drug from its site of administration into the bloodstream for distribution to the tissues.
Absorption (GI or skin problems)
Why is parental route medications faster?
Medications given by the parenteral route also have the advantage of bypassing the first-pass effect of the liver..
___________ refers to the transport of a drug in the body by the bloodstream to its site of action
Distribution (CV system)
______________is also referred to as biotransformation because it involves the biochemical alteration of a drug can alter the biotransformation of a drug, including genetics, diseases, and the concurrent use of other medication
Metabolism (liver)
_________ is the process through which drugs are eliminated; the primary organ responsible for this is the kidney. Two other organs that play an important role in the excretion of drugs are the liver and the bowel.
Excretion (kidneys)
The ratio of a drug’s toxic level to the level that provides therapeutic benefits is referred to as the drug’s __________ ___________
therapeutic index.
What is the preferred site for injections in children?
Generally, the vastus lateralis muscle is well developed and not located near major nerves or blood vessels. It is the preferred site of injection of drugs such as immunizations for infants
What are diuretics used for?
CHF, kidney failure, HTN
Where does furosemide (Lasix) work?
Works in the loop of Henle
Loop Diuretics: Drug Effects
Decreased fluid volume, which causes
Reduced blood pressure (BP) Reduced pulmonary vascular resistance Reduced systemic vascular resistance Reduced central venous pressure Reduced left ventricular end-diastolic pressure *Potassium and sodium depletion
What are indications of Loop Diuretics
Edema associated with heart failure or hepatic or renal disease
Control of hypertension
Hypercalcemia (increase renal excretion of calcium)
Certain cases of heart failure resulting from diastolic dysfunction
Loop Diuretics:Contraindications
Known drug allergy
Allergy to sulfonamide antibiotics
Hepatic coma
Severe electrolyte loss-
Loop Diuretics:what is a major concern with diuretics
Hypokalemia
With which diuretic is potassium-sparing?
spironolactone (Aldactone)
Patients taking ____________ along with a_____________preparation should be taught to monitor for digitalis toxicity
diuretics , digitalis
Liver function tests to determine hepatotoxicity:
Bilirubin
what tests are done to determine nephrotoxicity?
BUN & creatinine
Growth hormone has what effect on the body?
Regulates anabolic processes related to growth and adaptation to stressors; promotes skeletal and muscle growth
The drug that mimics growth hormone (GH) is?
Somatropin Hormone
____________ ______________has the function of increasing water absorption
Antidiuretic Hormone
Antidiuretic Hormone
It concentrates the __________ and causes potent vasoconstriction
urine
In which of the following conditions is somatropin contraindicated? In clients with: A. Dwarfism B. Acromegaly C. Hypopituitarism D. Addison’s disease
B. Acromegaly
Acromegaly is caused by excessive growth hormone, and thus this drug would be contraindicated,
The nurse admitting a client with acromegaly anticipates administering which of the following medications? A. octreotide B. somatropin C. corticotropin D. desmopressin
A. octreotide
Octreotide suppresses growth hormone, the culprit of acromegaly.
Where is the target for adrenocorticotropic hormone?
adrenal gland
Which drug is used for bedwetting?
desmopressin (DDAVP)
Patients on antithyroid medications should be advised that:
they should never be stopped abruptly without physician’s permission or even switch brands
signs and symptoms of _________ _________ , or what is often called _________ ________These include tachycardia, heart irregularities, fever, heart failure, flushed skin, con- fusion, apathetic attitude, behavioural changes, possible hypotension, and vascular collapse.
thyroid crisis, “thyroid storm.”
Hyperthyroid symptoms are:
sweating, tachycardia, anxiety, and weight loss
Hypothyroid symptoms are:
lethargy, fatigue, weight gain, (eg. cretinism and myxedema)
what is a hyperthyroid treatment?
surgery or radiation
what is a hypothyroid treatment?
thyroid replacement which is usually synthroid
What are the signs of hyperglycemia?
Polyuria
Polydipsia
Polyphagia
what is the drug of choice for type 2 diabetes?
metformin - because it is the safest and less likely to cause hypoglycemia
Why is a sliding scale used in the hospital?
Sliding scale is typically used for hospitalized diabetic patients due to the unpredictability and the effect illness can have on blood sugars
What is the month test used for diabetics?
Hemoglobin A1C is the test used to tell the 3 month scale
When drawing up two types of insulin in one syringe, always withdraw the _________ or ____ _________insulin first
regular or rapid-acting
NPH (Humulin-N, Novolin ge NPH)
Has a cloudy appearance
Is slower in onset and has a more prolonged duration than endogenous insulin
Which insulin is used for continuous intravenous infusions? A. insulin glargine B. insulin aspart C. insulin Regular D. insulin Ultralente
C. insulin Regular
A long-acting insulin?
insulin glargine
A rapid-acting insulin?
lispro insulin
Clients with diabetes mellitus should avoid alcohol consumption because ________________.
Clients with diabetes mellitus should avoid alcohol consumption because alcohol is broken down in the body to simple carbohydrates, which leads to increases in blood glucose. In addition, alcohol can increase insulin’s hypoglycemic effects.
Which rapid-acting insulin starts working in less than 15 minutes after administration?
A. insulin aspart
B. insulin glargine
C. insulin Regular
D. insulin Ultralente
insulin aspart
Insulin aspart is a rapid-acting insulin. Insulin glargine and Ultralente insulin are long-acting. Regular insulin is short-acting.
Which of the following should the nurse do when administering 30 units regular insulin and 70 units NPH insulin?
A. Rotate sites at least once weekly and label the sites used on a diagram
B. Inform the client that mixing insulins will help increase insulin production
C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin
D. Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption
C. Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin
The nurse would include which of the following statements when teaching a client about insulin glargine?
A. “You can mix this insulin with Lente insulin to enhance its effects.”
B. “You should inject this insulin just before meals because it is fast-acting.”
C. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”
D. “The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day.”
C. “You cannot mix this insulin with regular insulin and thus will have to take two injections.”
Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins.
24. Which of the following methods of administration would achieve the most beneficial effect when the nurse plans to administer glipizide?
A. With food
B. At bedtime
C. 15 minutes post-prandial
D. 30 minutes before a meal
D. 30 minutes before a meal
What should be cautioned in DM patients because it can cause hyperglycemia?
corticosteriods
What are some uses of steroids?
they are used to prevent rejection in organ transplant, asthma, and arthritis
Any condition where inflammation or over active immune system plays a role
Too much adrenal causes?
cushings
Too little adrenal causes?
addisons
Abrupt withdrawal from adrenal drugs is not recommended because this may precipitate an
adrenal crisis
Some side effect to adrenal corticosteroids drugs may be?
weight gain and moon facies
when taking corticosteroids drugs you have to be careful with _______, ______, &__________ because of risk for bleeding
alcohol, NSAIDS, and ASA
Oral contraceptives are contraindicated with?
antibiotics, antivirals, and anti-tb
why is it important to finish taking antibiotics until the prescription is finished?
to prevent the infection from coming back
Explain the rationale for not taking dairy products, iron, or calcium with tetracycline. What would be recommended if these products are not taken out of the diet?
Milk, calcium, iron, and cheeses chelate or bind up the tetracycline, resulting in decreased levels of tetracycline. Tetracycline should be taken 2 hours before or after eating the foods listed above to help alleviate this problem.
Ms. S. is taking an aminoglycoside for the treatment of a recurrent UTI. What conditions should be assessed for or laboratory studies performed before the initiation of therapy?
Aminoglycosides are nephrotoxic and ototoxic. It is important to assess renal functioning prior to therapy because these antibiotics may worsen renal dysfunction. A hearing assessment is also important before initiation of therapy because vestibular function may be impaired as well. BUN, creatinine clearance, serum creatinine, and audiometric testing should all be assessed, when indicated.
Is the treatment of choice for MRSA and other Gram-positive infections but causes red man syndrome
vancomycin
what drug turns tears and urine orange?
Rifampin
Compliance issues are a big concern for TB drugs because
- Non-adherence increases the incidence of drug-resistant organisms
- Stress importance of strict adherence to regimen
Why is multiple drug therapy often used for TB?
this reduces chances of developing resistance
Antivirals need to be started within ___hrs before viral replication
48hrs
Combination therapy is used for antiretroviral HIV
Antiretroviral therapy (ART) includes at least three medications
Because these medications work in different ways to reduce the viral load
WHEN TAKING AMPHOTERICIN B (FUNGIZONE) AKA “AMPHOTERRIBLE” PRE-TX IS USUALLY DONE WITH AN ANTIPYRETIC, ANTIHISTAMINE, ANTIEMETIC AND STEROID TO
REDUCE SEVERITY OF THE INFUSION RELATED REACTION
DOES NOT KILL ORGANISM, USED ON SKIN
ANTISEPTICS
KILLS ORGANISM, NOT USED ON SKIN
DISINFECTANTS
Amphotericin B (Fungizone) ADVERSE EFFECTS ARE?
o Renal toxicity
o Neurotoxicity: seizures and paraesthesias
TRUE OR FALSE
SUPPRESSING A COUGH CAN BE DANGEROUS
TRUE
WHY IS IT NECESSARY TO TAKE LOTS OF WATER WITH ANTITUSSIVES?
TO THIN SECRETIONS
fexofenadine (Allegra)
loratadine (Claritin)
cetirizine (Reactine)
o Nonsedating (peripherally acting)
diphenhydramine (Benadryl)
chlorpheniramine (Chlor-Tripilon)
o Sedative – May cause drowsiness
ANTIHISTAMINES SHOULD BE TAKEN BEFORE___________ ___________
SYMPTOMS START
WHICH WOULD YOU TAKE FIRST THE BRONCHODILATOR OR THE STEROID
- BRONCHODILATOR SHOUD BE USED FIRST TO OPEN THE AIRWAYS, THEN CORTICOSTEROIDS
ANTI-INFLAMMATORY PUFFERS ARE TAKEN?
DAILY
BRONCHODILATORS ARE TAKEN?
AS NEEDED
ADVERSE EFFECT TO NASAL DECONGESTANTS?
REBOUND CONGESTION
ORAL DECONGESTANTS DO NOT CAUSE REBOUND CONGESTION BUT THEY CAN CAUSE ____________
EXCITABILITY
DO NOT DRINK OR EAT ANYTHING WITH CAFFINE IF TAKING THIS MEDICATION
XANTHINE DERIVATIVES
WHICH DRUG WOULD YOU TEST BY PUTTING IT IN WATER?
VENTOLIN - IT WILL FLOAT WHEN EMPTY
