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Nurp 423 Exam 2 > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What affects iron absorption?

A

Vitamin C increases absorption

Milk/dairy decreases absorption

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2
Q

Iron deficiency results in what 2 things?

A
  1. Iron deficiency anemia

2. Low metabolism level

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3
Q

How is iron stored?

A

Ferritin

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4
Q

When do you not give iron?

A

Hemochromatosis and hemolytic anemia

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5
Q

Adverse reactions to iron supplementation:

A

GI symptoms- constipation, GI upset

Acute toxicity

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6
Q

How long do you treat iron deficiency anemia?

A

Treatment for 3-4 months after H/H return to normal

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7
Q

Iron dosage for adults:

A

150-300 mg elemental iron daily

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8
Q

Iron dosage for treatment of premature infants:

A

2-4 mg/kg/day

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9
Q

Iron dosage for treatment of infants and young kids:

A

4-6 mg/kg/day

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10
Q

How to take iron for patient education?

A

On an empty stomach if possible. Take with vitamin C to enhance absorption and avoid taking with dairy.

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11
Q

Causes of folic acid deficiency:

A
  1. Poor intake
  2. Impaired absorption- secondary to GI surgery, Dilantin, pregnancy
  3. Increased demand
  4. Impaired utilization
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12
Q

Can you have too much folic acid?

A

No it’s water soluble and easily excreted.

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13
Q

Where is folic acid absorbed?

A

Small intestine

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14
Q

Dosage for prevention of folic acid deficiency:

A

0.4mg/day prior to conception and during pregnancy

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15
Q

Treatment dosage of folic acid with anemia due to folic acid deficiency:

A

Initial: 1mg/day in adults and children
Maintenance: 0.1 mg/day or 0.8 mg/day in pregnant or lactating women

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16
Q

Causes of vitamin B12 deficiency:

A
  1. Poor intake ( found in animal products)

2. Impaired absorption ( lack of intrinsic factor, diseases of the ilium, stasis, bariatric surgery)

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17
Q

Prevention of vitamin b12 deficiency dosages:

A

Pregnancy 2.2 mcg/day
Lactation 2.6 mcg/day
Infants 0.3-0.5 mcg/day
Children 1-10: 0.7- 1.4 mcg/ day

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18
Q

Treatment of vitamin b12 deficiency:

A

1000 mcg oral cobalamin daily for 6-12 weeks

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19
Q

Pernicious anemia treatment:

A

Initial dose 1000 mcg/day IM or SC x7 days the. 100-1000 mcg IM per week x 1 month

Maintenance:
1000 mcg IM monthly or:
500 mcg intranasal cyanocobalamin weekly or:
1000 mcg PO daily- last resort

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20
Q

Difference between anticoagulants and antiplatelet agents:

A

Anticoagulants affect the clotting cascade. Antiplatelet agents affect platelet functions.

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21
Q

Factors that are vitamin k dependent:

A

2, 7, 9, 10

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22
Q

Warfarin affects which factor:

A

7

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23
Q

Warfarin pregnancy category:

A

X

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24
Q

Antidote to warfarin:

A

Vitamin K

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25
Q

Warfarin preferred method of anticoagulation in

A

mechanical prosthetic cardiac valves

and PE prevention

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26
Q

In afib and a flutter what is preferred method of anticoagulation?

A

Inhibitors

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27
Q

Starting dose of warfarin:

A

5mg per day

7.5 mg/d if weight is over 80 kg

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28
Q

Consider lowering warfarin dose in:

A 
Patients:
Older than 75
Multiple comorbid conditions
Elevated liver enzymes 
Changing thyroid status 
(OMEC)
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29
Q

Warfarin monitoring:

A

INr daily until in therapeutic range for 2 consecutive days then:
2-3 times weekly for 1-2 weeks then:
Less frequently but at least every 6 weeks

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30
Q

What factors do the direct thrombin inhibitors affect?

A

Xa and thrombin

31
Q

MOA of direct thrombin inhibitors:

A

Inhibits thrombin directly. Prevents cleaving of fibrinogen to fibrin by thrombin. Directly binds to thrombin and stops the process.

32
Q

What is the only oral direct thrombin inhibitor?

A

Etexilate (pradaxa)

33
Q

MOA of direct factor xa inhibitors:

A

Directly bind to factor Xa and inhibit Xa activity. Prevents the cleaving of prothrombin to thrombin.

34
Q

Direct xa inhibitors include:

A

Dabigatran (pradaxa)
Rivaroxaban (xarelto)
Apixaban (eliquis)

35
Q

Which direct Xa inhibitor has an antidote?

A

Dabigatran (pradaxa) and is a prodrug that is activated in the liver.

36
Q

Labs for direct oral anticoagulants:

A

Prior to initiation:
PT/PTT
Platelets
Creatinine- dose adjustment with decreased CrCl

37
Q

CrCl for dabigatran (pradaxa) and dosage:

A

CrCl of 15-30 adjust dose to 75mg BID

CrCl less than 15 avoid use

38
Q

Rivaroxaban (xarelto) and CrCl:

A

CrCl less than 30 do not use.

39
Q

What is anticoagulant of choice in patients with severe kidney disease?

A

Warfarin

40
Q

Thyroid hormones:

A

T3- free/active hormone

T4- T4 minus iodine equals T3

41
Q

Disease of destruction of thyroid gland:

A

Hypothyroid

42
Q

Hypothyroid lab results:

A

Elevated TSH
Low free T4
Normal or low free T3

43
Q

Life threatening hypothyroidism that leads to coma, hypothermia, CV collapse, hypoventilation, and eventually death.

A

Myxedema

44
Q

Exogenous thyroid hormones:

A

Levothyroxine T4
Triiodothyronine T3
Liotrix 4:1 mixture of T4 and T3

45
Q

The drug of choice for thyroid replacement and suppression therapy because of its longer half-life.

A

Levothyroxine

46
Q

Thyroid hormones patient education:

A

Take on an empty stomach

May take 6-8 weeks to see changes

47
Q

What is thyroid agent of choice in CV disease:

A

T4

48
Q

ADRs with thyroid replacement:

A

Symptoms of hyperthyroidism

Long term replacement- decreases bone density in hip/spine

49
Q

Treatment for hypothyroidism is indicated:

A

In patients with TSH levels greater than 10 or in patients with TSH levels between 5-10 with visible goiter.

50
Q

Levothyroxine dosing for patients with no known CV disease:

A

Initial dose: 50 mcg/day for 2-4 weeks and may increase in increments of 25 mcg/day until average full replacement of 100-125 mcg/day

51
Q

Levothyroxine dosing in patients older than 50 with CV disease or long standing hypothyroidism:

A

Initial dose between 12.5-25mcg/day

52
Q

Second-line supplemental therapy in hypothyroidism:

A

Liothyronine (cytomel)

53
Q

Contraindications with liothyronine (cytomel):

A

History of cardiac events. Increase risk of cardiac events by 3-4 times

54
Q

What TSH is targeted with treatment of hypothyroidism?

A

0.3-3
TSH should be measured in 6-8 weeks
Once TSH is stable annual evaluation

55
Q

Overproduction of thyroid hormone:

A

Hyperthyroidism

56
Q

Lab results of hyperthyroidism:

A

Low TSH

High free T4 and T3

57
Q

Over ingestion of thyroid hormone:

A

Thyrotoxicosis

58
Q

Drugs for hyperthyroidism:

A

Propylthiouracil (PTU)- inhibits the synthesis of thyroid hormones by blocking peripheral conversion of T4 to T3

Methimazole ( tapazole)- blocks the synthesis of T3 and T4 in the thyroid gland. Blocks oxidation of iodine.

59
Q

ADRs of antithyroid agents:

A

Agranulocytosis, drowsiness, headache, alopecia, skin rashes, renal/hepatic failure

60
Q

Lab work with antithyroid agents:

A

Thyroid studies
CBC
Liver panel-PTU
Recheck in 1-2 months after starting drug

61
Q

What drugs used in thyroid storm?

A

Lugol’s solution and SSKI

62
Q

Hyperthyroid treatment in pregnancy:

A

PTU in first trimester

Methimazole- preferred 2nd and 3rd trimester

63
Q

Where is vitamin D made?

A

Made in the skin from exposure to sunlight

64
Q

Functions of vitamins D:

A

Promotes calcium absorption in the gut.
Maintains serum calcium and phosphate concentrations.
Required for bone growth and remodeling.

65
Q

What test is used to test for vitamin D deficiency?

A

Serum 25(OH)D

66
Q

What test is used in patients with renal disease to determine vitamin D deficiency?

A

1,25 (OH) D

67
Q

Risk factors for vitamin D deficiency:

A 
Vitamin D deficiency diets
Breastfed infants
Older adults
Limited exposure to sun
People with darker skin 
Comorbid conditions such as IBD, obesity, and CKD
68
Q

Recommended dietary allowance of vitamin D:

A

0-1: 400 IU
1-70: 600 IU
>70: 800 IU

69
Q

Treatment recommendations for vitamin D:

A

Special groups: obese adults/children, pregnant women, lactating women, and breastfed babies need higher dosing.
Pregnancy: minimum 1400 IU
Lactation: 1400 IU
Mothers of breastfed babies: 4000-6000 IU

70
Q

Goal lab level for vitamin D:

A

30-32 ng /dL

Follow up testing 3 months after intimation of treatment

71
Q

Vitamin D toxicity:

A

> 150 ng/dL

72
Q

Dosing for treatment of vitamin d deficiency:

A

Infants: 2000 IU daily x 6 weeks or 50000 IU weekly x 6 weeks

Children 1-18: 2000 IU daily x 6 weeks or 50000 IU weekly x 6 weeks

Adults: 6000 IU daily of D2 or D3 or 50000 IU weekly x 8 weeks to achieve blood level of 30
Maintenance: 1500-2000 IU daily

73
Q

Goal INR in prophylaxis of venous thrombosis, treatment of venous thrombosis, treatment of PE:

A

INR 2-3

74
Q

INR goal in patients with mechanical prosthetic heart valves and hypercoagulable conditions.

A

INR of 2.5-3.5

Nurp 423 Exam 2 (4 decks)

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