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Pharm 2 > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

Ra[id acting insulin

A 
Insulin lispro   (Humalog))
Insulin aspart (Novalog)
Insulin glue sine 
Onset: 5-15 minutes
Peak: 30-90 minutes, 1-3 hours
Duration: 2-5 hours, 3-5 hours 
Clear
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2
Q

Short acting insulin

A 
Insulin regular 
100 units/1mL
Onset: 30 minutes
Peak: 2.5-5 hours
Duration: 6-8 hours 
Clear
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3
Q

Intermediate acting insulin

A 
Insulin isophane NPH
Humulin
Onset: 1-2 hours 
Peak: 6-12 hours
Duration: 18-24 hours 
Cloudy
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4
Q

Long acting insulin

A 
Lantus
Levemir 
Onset: 1 hour, 3-4 hours
Peak: None, 6-8 hours
Duration: 24 hours
Clear
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5
Q

Informed consent

A

Physician

RN

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6
Q

Indication for transfusion

A 
Restore intravascular volume 
Restore the oxygen carrying capacity of blood (RBC)
Replace the clotting factor 
Platelets to reverse coagulation 
Replaces WBC in neutropenia clients
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7
Q

Autologous

A

Donated in advance of need
Perioperatively: uses machine that washed and filters the blood, remvoes anticoagulants and clotting factors
Postoperatively: removed from tubes at the site of bleeding and filtered before re-infusion

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8
Q

Salvaged blood

A

Must be infused 6 hours of begining

More than 50% of clients total blood volume is re-infused, replacement of clotting factors is necessary

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9
Q

Advantages of autologous transfusions

A

Reduces risk of incompatibility reactions

Conservation of blood supply

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10
Q

Autologous transfusions

A

1-5 units
Must cease more than 72 hours before surgery
Tested for disease and virus
Unit of PRBC can be stored for 5-6 weeks

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11
Q

Direct donation

A

Blood specifically for a. Certain person

Not safer than other allergenic donations

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12
Q

Risks with transduction

A

Improper labeling
Completion of requisition in the collection
Distribution of blood
Unforeseen incompatibilities

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13
Q

Safety measures

A

Barcode system
Lab screening procedures
2 RNs check blood

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14
Q

Religion that does not allow blood transfusion or organ donation

A

Jehovah Witness

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15
Q

Transfusion guidelines

A

Know clients normal VS range
Elevation of temp and HR can be sig of transfusion reaction
Hypotension can occur with severe reaction
Assess clients most recent electrolyte values
If blood is transfused rapidly there may be transient hyperkalemia
Nurse must ensure that sample of clients blood has been sent to lab within past 72 hours
16-20 gauge
Filter required
Transfusion history

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16
Q

Pre administration

A 
Correctly verify product and client
Check name, ID number, DOB
Verify what is ordered 
Check clients blood type 
Check unit number 
Check expiration date and time
Check for leaks, bubbles, clots, or purplish color
Y tubing
Spike 0.9% NS
Dextrose will cause coagulation of donor blood
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17
Q

Administration

A

Stay with pt for first 15 minutes of transfusion
Initial glow rate should be 2mL/min or 20 gtt/min
Blood should not hang for more than 4 hours (bacterial growth)

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18
Q

Teaching considerations of blood transfusion

A 
Amount of.  Time it will take
Monitor Vs
Instruct pt. To inform nurse if pain, swelling or redness occurs at IV site 
Explain purpose 
S/SX of transfusion reaction
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19
Q

Acute transfusion reactions

A 
Acute hemolytic reaction
Febrile
Allergic
Circulatory 
Sepsis
Lung injury
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20
Q

Acute hemolytic reaction

A

Most dangerous
Common cause is ABO incompatible blood
90% caused by improper product to patient identification
May lead to renal failure, DIC ,and death
Occurs First 15-50 mL of blood

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21
Q

Assessment of acute hemolytic reactions

A 
Fever
Chills
Low back pain
Chest tightness
Dyspnea
Anxiety 
Hemoglobin in urine
Hypotension
Bronchospasm
Vascular collapse
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22
Q

Treatment for acute hemolytic reaction

A

Maintain blood volume
Renal perfusion
Prevent and manage DIC

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23
Q

Febrile reaction

A

Most common
Leukocyte incompatibility
Most at risk if received 5 or more units
More than 10% with chronic requirements

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24
Q

Symptoms of febrile transfusion reaction

A

Chills first
Than a fever more than 1 degree Celsius begins 2 hours after transfusion has begun
Antiprytics treatment

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25
Q

Allergic reactions

A

Histamines

May use epinephrine and corticosteroids

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26
Q

Signs and symptoms of allergic reaction

A

Urticaria
Generalized itching
Flushing

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27
Q

Signs. And. Symptoms of bacterial contamination

A

Fever
Chills
Hypotension after transfusion is complete
Treat immediately to prevent septic shock
Antibiotics, IV fluids, corticosteriods, vaspressors

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28
Q

Transfusion related acute lung injury

A

Occurs 2-4 hours after transfusion
May develop as late as 48 hours
Due to an antibody mediated reaction between recipients leukocytes and antileukocyte antibodies from donor

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29
Q

TRALI

A 
Acute SOB
Hypotension
Fever
Eventual pulmonary edema 
Chest x-ray will show bilateral pulmonary infiltrates 
Occur with plasma administration
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30
Q

Massive blood transfusion reaction

A

Citrate toxicity
Hypocalcemia
Hyperkalemia

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31
Q

Delayed transfusion reactions.

A

Iron overload
Occurs as early as 3 days as late as several months
5-10 days

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32
Q

Signs and symptoms of delayed transfusion reaction

A

Anemia
Increased bilirubin
Jaundice

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33
Q

Infections include

A 
hep B& C
HIV
Human herpes 6
EBV
Human T cell leukemia 
Cytomegalovirus 
Malaria
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34
Q

Pediatric considerations with blood transfusions

A

20% or 50mL of volume run very slowly
Nurse stay at patients bedside
27 gauge
Positive pressure through an infusion pump
Blood replacement is recommended when childs blood loss totals 5-7% total blood volume

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35
Q

Typical S/SX of transfusion reactions

A 
Chills
Fever
Flushing
Cough
Wheezing
SOB
Low back pain
Tachycardia
Hypotension
Hemoglobinuria 
Acute jaundice 
Dark urine
Bleeding
Vascular collapse 
Shock
Cardiac arrest
Death
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36
Q

Nursing interventions for transfusion reaction

A 
Stop transfusion 
Remove tubing and replace tubing
Notify HCP and blood bank
Obtain blood samples from opposite arm
Return remainder of blood to blood bank 
Monitor VS q 15 minutes
37
Q

Ad mister prescribed meds for transfusions reaction

A 
Epinephrine 
Antihistamine
Antibiotics 
Antipyretic 
Diuretics 
Corticosteriods
38
Q

Total parenteral nutrition

A

Complete nutritional needs of a client

Pt unable to use GI tract

39
Q

2 ways to deliver TPN

A

Peripheral

Central

40
Q

Peripheral TPN

A 
Lower dextrose contrentrated solutions; less than 10%
Short term(less than 2 weeks
Do not have a large nutritional need
Pt who can tolerate large fluid loads 
Fat,CHO,protein
41
Q

Indications for peripheral TPN

A 
Procedures that restrict oral intake
Anorexia caused by radiation or chemo
GI illnesses
After any type of surgery
Oral nutrition wont be started for more than 5 days
42
Q

Contraindications of peripheral TPN

A 
Allergy 
Genetic disease (unable to digest certain nutrients)
43
Q

Side effects of peripheral TPN

A

Phlebitis
Fluid overload
Renal or heart patients

44
Q

Central TPN

A

Required central venous access device
High concentration of glucose 10%-35%
Longer treatment for 7-10 days

45
Q

Indications of central TPN

A

Malabsorption: Crohns, ulcerative colitis, bowel obstruction, radiation enteritis, severe diarrhea and vomitting, AIDS
Acute pancreatitis
Chemo
Radiation
Bone marrow transplant
Hypermetabolic pts: sepsis, trauma, burns cover more than 40% of body

46
Q

Central TPN nutrition

A 
Amino acid solutions
Intralipids
Vitamins
Minerals
Trace elements 
Glucose solution
47
Q

Team involved in central TPN

A

Dietitians
Pharmacists
Physicians

48
Q

Contraindications of central TPN

A

Functional GI tract

Most complex and serious consequences

49
Q

Side effects of central TPN

A 
Surrounding central line: insertion, use, maintenance 
Infection
Hyperglycemia
Fluid imbalances
Electrolyte imbalances
50
Q

Refeeding syndrome

A

Occurs when malnourished pts. First receive TPN
TPN forces electrolytes to shift from plasma to intracellular compartments
Symptoms develop first 24-48 hours
Slow rate: 1000 calories per 24 hours increase rate very slowly
Monitor serum electrolytes first 2 days

51
Q

Refeeding syndrome causes

A 
Hypophosphatemia 
Hypomagnesemia
Hypocalcemia
CHF
Pulmonary edema
MI
52
Q

Amino acids

A

Protein synthesis or anabolism
Reduces catabolism
Essential and nonessential
Break down to urea in liver

53
Q

Poor tolerance to amino acid

A

Elevated BUN and creatinine

If BUN and creatinine stay elevated may need to decrease protein

54
Q

Carbohydrates

A 
Supplied through dextrose 
Used as a source of calories 
Peripheral TPN below 10%
central TPN 25-35%
Supplemental insulin may be given
55
Q

Patients at risk for not tolerating higher percent of carbs.

A 
DM
Sepsis
Pancreatitis 
On steroid therapy
Renal insufficiency
56
Q

Fats

A

Essential fatty acids

Source of energy or calorie

57
Q

Essential fatty acid deficiency

A 
Hair loss
Scaly dermatitis 
Growth retardation 
Decreased platelets 
Fatty liver
58
Q

Lipid. Emulsions

A

Intralipid: soybean oil
Liposyn: safflower
Should not exceed no more than 60% of calories
Helps prevent hypo/hyperglycemia and hyper osmolarity

59
Q

High risk with lipids

A

Cardiac conditions
AIDS
Can cause triglycerides and cholesterol

60
Q

Lab studies to do before TPN

A 
Total protein
Albumin
BUN
RBC
WBC
Vitamin B12
Cholesterol 
Hemoglobin
Electrolytes
Lipid profile 
Dedicated line for TPN only
61
Q

Administration of TPN

A

0.2 micron filter to trap bacteria
NO filter on lipids
Never give TPn without verification of catheters proper placement
Check physician orders against bag
Monitor blood sugars frequently every 2 hours at first then qid
Hyper and hypoglycemia
Watch s/sx of fluid overload

62
Q

Prevent infections of TPN by

A

Hand washing
Sterile technique
Change TPN tubing every 24 hours
Monitor temp

63
Q

Monitor response to TPN

A

Lab studies
More energy
Increased strength
Increased weight

64
Q

Time to discontinue TPN when

A

Pt. Taking 50-60% of calories by mouth or enterally

Wean from TPN by reducing total calories from TPN

65
Q

Indications for Treatment for HIV///AIDS

A

Symptomatic patients
Asymptomatic clients before CD4 count decreases 350
CD4 counts greater than 350

66
Q

Highly active Antiviral therapy goals

A 
Decrease VL
Increase number of CD4 Tcells
Prevents resistance
Client in good clinical condition
Prevention of secondary infection and cancer
COMPLIANCE is huge!
67
Q

5 classifications of Antiretroviral agents

A 
Reverse transcriptase inhibitors 
Protease inhibitors 
Entry inhibitors 
CCR5 antagonists 
Integrate inhibitors
68
Q

Prototype and action for NRTI’s

A

Zidovudine

Block by blocking the reverse transcriptase enzyme needed in viral replication

69
Q

NRTI’s

A

Taken with food except didanosine

GI side effects tend to decrease within first 2 weeks

70
Q

Side effects of NRTI’s

A 
Lactic acidosis
Hepatic stenosis 
Peripheral neuropathy
Myopathy 
Pancreatitis 
Lipoatrophy
71
Q

Prototype and action of NNRTI’s

A

Efavirenz
Prevents viral replication by competing with binding of reverse transcriptase enzyme at the active site
Advantage: reserve protease inhibitor

72
Q

Side effects of NNRTI’s

A 
CNS toxicities: 
Dizziness
Sedation 
Nightmares
Euphoria 
Loss of concentration 
CAUTIONSLY: clients with depression and other mental health disorders
73
Q

PI’s

A

Act at the end of the HIV life cycle to inhibit the production of infectious HIV viruses
First line choice: lopinavir

74
Q

PI’s side effects

A 
Nausea
vomiting
Diarrhea
Metabolic abnormalities: 
Dyslipidemia 
Fat misdistribution
Insulin resistance
75
Q

Entry Inhibitors prototype and action

A

Enfuvirtide
Mechanism that inhibits gp41 fusion to prevent HIV cell entry so targets prevention of the fusion of HIV and the CD4
Combination with 3-5 other antiretroviral agents
Subcutaneously BID

76
Q

Side effects to entry inhibitors

A 
98% reactions at site 
Rash
Diarrhea
Fever
Hypotension
77
Q

CCR5 antagonists

A

Maraviroc
Selectively and reversible binds to the chemokine receptor
Combination with other antireviral agents

78
Q

Side effects of CCR5

A 
Cough
Pyrex is
Upper respiratory tract infections
Rash
Abdominal pain
Dizziness
79
Q

Integrate inhibitors

A

Raltegravir

Inhibits insertion of HIV DNA into human DNA

80
Q

Side effects of integrate inhibitors

A

Nausea
Diarrhea
Headache
Pyrexia

81
Q

Antiviral therapy and nursing care

A

Ongoing assessment

Assess for side effects

82
Q

Bacterial most common

A

TB
Mycobacterium Avium complex
Pneumonia
Septicemia

83
Q

Protozoal most common

A

PCP
Toxoplasmosis
Leishmaniasis
Cryptosporidosis

84
Q

Fungal most common

A

Candidiasis

Crytococcosis

85
Q

Viral most common

A

CMV
Herpes simplex
Herpes zoster

86
Q

HIV most common

A

Lymphoma
Squamous cell carcinoma
Kaposi sarcoma

87
Q

Protocols based on 2 parameters insulin infusion

A

Immediate blood glucose result

Rate of change in blood glucose level (last hourly measurment)

88
Q

Side effects of insulin

A 
Tachycardia
Palpitations
Headache
Lethargic
Tremors
Weakness
Fatigue
Delirium 
Sweating
Hypoglycemia
Hypokalemia
Blurred vision
Dry mouth
Hunger
Urticaria

Pharm 2 (4 decks)

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