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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
Warfarin preferred method of anticoagulation in
mechanical prosthetic cardiac valves | and PE prevention
26
In afib and a flutter what is preferred method of anticoagulation?
Inhibitors
27
Starting dose of warfarin:
5mg per day | 7.5 mg/d if weight is over 80 kg
28
Consider lowering warfarin dose in:
``` Patients: Older than 75 Multiple comorbid conditions Elevated liver enzymes Changing thyroid status (OMEC) ```
29
Warfarin monitoring:
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
30
What factors do the direct thrombin inhibitors affect?
Xa and thrombin
31
MOA of direct thrombin inhibitors:
Inhibits thrombin directly. Prevents cleaving of fibrinogen to fibrin by thrombin. Directly binds to thrombin and stops the process.
32
What is the only oral direct thrombin inhibitor?
Etexilate (pradaxa)
33
MOA of direct factor xa inhibitors:
Directly bind to factor Xa and inhibit Xa activity. Prevents the cleaving of prothrombin to thrombin.
34
Direct xa inhibitors include:
Dabigatran (pradaxa) Rivaroxaban (xarelto) Apixaban (eliquis)
35
Which direct Xa inhibitor has an antidote?
Dabigatran (pradaxa) and is a prodrug that is activated in the liver.
36
Labs for direct oral anticoagulants:
Prior to initiation: PT/PTT Platelets Creatinine- dose adjustment with decreased CrCl
37
CrCl for dabigatran (pradaxa) and dosage:
CrCl of 15-30 adjust dose to 75mg BID | CrCl less than 15 avoid use
38
Rivaroxaban (xarelto) and CrCl:
CrCl less than 30 do not use.
39
What is anticoagulant of choice in patients with severe kidney disease?
Warfarin
40
Thyroid hormones:
T3- free/active hormone | T4- T4 minus iodine equals T3
41
Disease of destruction of thyroid gland:
Hypothyroid
42
Hypothyroid lab results:
Elevated TSH Low free T4 Normal or low free T3
43
Life threatening hypothyroidism that leads to coma, hypothermia, CV collapse, hypoventilation, and eventually death.
Myxedema
44
Exogenous thyroid hormones:
Levothyroxine T4 Triiodothyronine T3 Liotrix 4:1 mixture of T4 and T3
45
The drug of choice for thyroid replacement and suppression therapy because of its longer half-life.
Levothyroxine
46
Thyroid hormones patient education:
Take on an empty stomach | May take 6-8 weeks to see changes
47
What is thyroid agent of choice in CV disease:
T4
48
ADRs with thyroid replacement:
Symptoms of hyperthyroidism | Long term replacement- decreases bone density in hip/spine
49
Treatment for hypothyroidism is indicated:
In patients with TSH levels greater than 10 or in patients with TSH levels between 5-10 with visible goiter.
50
Levothyroxine dosing for patients with no known CV disease:
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
Levothyroxine dosing in patients older than 50 with CV disease or long standing hypothyroidism:
Initial dose between 12.5-25mcg/day
52
Second-line supplemental therapy in hypothyroidism:
Liothyronine (cytomel)
53
Contraindications with liothyronine (cytomel):
History of cardiac events. Increase risk of cardiac events by 3-4 times
54
What TSH is targeted with treatment of hypothyroidism?
0.3-3 TSH should be measured in 6-8 weeks Once TSH is stable annual evaluation
55
Overproduction of thyroid hormone:
Hyperthyroidism
56
Lab results of hyperthyroidism:
Low TSH | High free T4 and T3
57
Over ingestion of thyroid hormone:
Thyrotoxicosis
58
Drugs for hyperthyroidism:
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
ADRs of antithyroid agents:
Agranulocytosis, drowsiness, headache, alopecia, skin rashes, renal/hepatic failure
60
Lab work with antithyroid agents:
Thyroid studies CBC Liver panel-PTU Recheck in 1-2 months after starting drug
61
What drugs used in thyroid storm?
Lugol’s solution and SSKI
62
Hyperthyroid treatment in pregnancy:
PTU in first trimester | Methimazole- preferred 2nd and 3rd trimester
63
Where is vitamin D made?
Made in the skin from exposure to sunlight
64
Functions of vitamins D:
Promotes calcium absorption in the gut. Maintains serum calcium and phosphate concentrations. Required for bone growth and remodeling.
65
What test is used to test for vitamin D deficiency?
Serum 25(OH)D
66
What test is used in patients with renal disease to determine vitamin D deficiency?
1,25 (OH) D
67
Risk factors for vitamin D deficiency:
``` 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
Recommended dietary allowance of vitamin D:
0-1: 400 IU 1-70: 600 IU >70: 800 IU
69
Treatment recommendations for vitamin D:
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
Goal lab level for vitamin D:
30-32 ng /dL | Follow up testing 3 months after intimation of treatment
71
Vitamin D toxicity:
>150 ng/dL
72
Dosing for treatment of vitamin d deficiency:
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
Goal INR in prophylaxis of venous thrombosis, treatment of venous thrombosis, treatment of PE:
INR 2-3
74
INR goal in patients with mechanical prosthetic heart valves and hypercoagulable conditions.
INR of 2.5-3.5

Nurp 423 Exam 2 (4 decks)

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