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NUR 334: Pharmacology > Exam 3 Review: Goldstein > Flashcards

Exam 3 Review: Goldstein Flashcards

1
Q

What is the difference between a patient who only needs a SABA PRN and someone that will get a daily asthma medication?
(What would make someone get a daily asthma medication instead of a SABA PRN?)

A

When they use their inhaler too much

o Inhaler is a rescue medication and shouldn’t be used all day/everyday (too much) so they will need to be on daily medication

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2
Q

patient education point - what should someone do after they us their Symbicort inhaler?

A

rinse out their mouth to prevent thrush

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3
Q

two other combination drugs beside Symbicort that also has an inhaled corticosteroid and a LABA?

A

o Advair (fluticasone and salmeterol)
o Breo Ellipta (fluticasone and Vilanterol)

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4
Q

what drug has a black box warning that it is not to be used as monotherapy?

A

Salmeterol

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5
Q

what is monotherapy?

A

use it by itself

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6
Q

what is the black box warning for montelukast?

A

neuropsychiatric events such as depression and suicide

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7
Q

three things to monitor to assess for adverse effects of albuterol?
(SE/AE: Tachycardia, Hypokalemia, Hyperglycemia)

A

o heart rate
o potassium
o glucose

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8
Q

why does albuterol cause tachycardia?

A

because were activating beta 2 but beta 1 also gets affected

o Beta 1 activates your whole fight or flight response – get high heart rate/BP – when body is super stressed it releases sugar because your body needs energy for the flight or flight

  • (reason for AE/SE) Because of the release of sugars it causes hyperglycemia then the body releases insulin to get it under control – and the insulin and glucose into the cell and take potassium with them which causes potassium to go down
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9
Q

two drugs that are used for the treatment of chronic asthma that are not taken by the inhaled route?

A

o Theophyline (structured similar to caffeine)
o Montelukast

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10
Q

drug for the treatment of asthma that needs to be taken QID?

A

Cromolyn

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11
Q

long acting anti-cholinergic drug for asthma?

A

Tiotropium

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12
Q

Two critically important patient education points for anyone diagnosed with asthma?

A

o recognize and avoid your triggers
o know how to use your inhalers

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13
Q

first line drug for the long-term management of asthma?

A

inhaled glucocorticoids or corticosteroids (same thing)

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14
Q

two examples of inhaled corticosteroids

A

o Fluticasone
o Budesonide

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15
Q

in what form is fluticasone available OTC?

A

intranasal

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16
Q

what is intranasal used for?

A

allergies

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17
Q

most commonly used add on medication when an ICS is not achieving symptom control

A

Formoterol (LABA)

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18
Q

IV only drug that is used for acute asthma exacerbation

A

Magnesium

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19
Q

Most important assessment the nurse must make or monitor for someone who is receiving magnesium

A

assess for respirations
o magnesium toxicity

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20
Q

two primary pathophysiology issues of asthma

A

o Bronchoconstriction
o Inflation

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21
Q

what drug class addresses the 3rd and more minor issue of excessive secretions?

A

o Anticholinergics

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22
Q

four adverse effects of taking systemic corticosteroids

A

o females post-menopause increases risk of osteoporosis
o raises your blood sugar
o hypertension
o risk of infection

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23
Q

two examples of systemic corticosteroids

A

o Prednisone
o Methylprednisolone

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24
Q

what is the first line intervention for a patient that comes in with an acute asthma attack?

A

oxygen

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25
Q

what is room air oxygen

A

20.9% - 21%

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26
Q

appropriate flow rate for nonrebreather mask

A

10 - 15

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27
Q

appropriate flow rate for nasal cannula

A

1 - 6

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28
Q

how much FiO2 is for someone on 2L of oxygen via nasal cannula?
(how much percentage of oxygen a person is breathing if they’re on 2L on nasal cannula?

A

29%
8+21

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29
Q

a nurse is caring for a patient who is not breathing and requires oxygen, what is the only appropriate method?

A

bag valve mask (ambu bag)

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30
Q

what is the only device/method a nurse can use to provide both ventilation and oxygenation for our patients?

A

bag valve mask

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31
Q

what is the highest percentage of oxygen we can deliver to our patients? and how?

A

o 100%
o nonrebreather mask

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32
Q

normal pulse ox

A

94 and above

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33
Q

under what guideline can a nurse administer oxygen to a patient without a physicians order

A

standing order

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34
Q

a patient is receiving albuterol for a severe asthma attack, the patient becomes tachycardic and with a heart rate of 155 and complaining of palpations, what would be an appropriate nursing intervention?

A

o we just monitor the heart rate as it increases
o notify the doctor

  • need to get their breathing under control first before we can address increasing heart rate
  • wrong answer would be to “stop medication”
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35
Q

what lung sound would you expect in a patient experiencing an asthma exacerbation

A

wheezing

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36
Q

what would be the most concerning lung sound in a patient with a severe asthma exacerbation

A

nothing (diminished/absent)

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37
Q

what lung sound would indicate an issue with the upper airways

A

stridor

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38
Q

two purposes of ventilation

A

o breathe in oxygen
o breathe out carbon dioxide

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39
Q

a patient presents to your office and states they need their inhaler twice a day for the last 2 weeks, they are already on fluticasone daily,
what would be your priority question

A

how are you taking your medication

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40
Q

five drug classes that work to address bronchoconstriction

A

o LABA
o SABA
o Methylxanthines
o Anticholinergics (short term)
o LAMA (long-term anticholinergic)

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41
Q

four drug classes that work to address inflammation in the airways

A

o systemic corticosteroids
o ICS
o leukotriene receptor antagonists (LTRA)
o mast cell stabilizer

42
Q

two most commonly used alternatives to an ICS

A

o Cromolyn (mast cell stabilizer)
o Theophyline
o Montelukast (LTRA)

(professor wasn’t sure which answer is on the exam so the answer would be cromolyn and one of the other two listed)

43
Q

what is a patient education point for someone taking a methylxanthines

A

avoid caffeine while taking this medication

44
Q

what drug is used for both asthma and allergies

A

Montelukast

45
Q

primary indication for sodium bicarbonate via IV route

A

acidosis

46
Q

what organ is most responsible for maintaining our pH

A

Kidneys

47
Q

the treatment for stable/chronic hyperkalemia

A

o Polystyrene Sulfonate
o Patiromer

48
Q

treat immediately

A

acute/unstable

49
Q

have time to treat

A

chronic/stable

50
Q

if someone has mild hypokalemia, is stable and there is NO symptoms, what would be an appropriate intervention?

A

recommend foods that have high potassium
(banana, potatoes, gatorade, powerade)

51
Q

if someone has mild hypokalemia, is stable and have MILD symptoms, what would be an appropriate intervention?

A

PO Potassium

52
Q

what would I anticipate when infusing potassium into a patient at a rapid rate?

A

o pain at the injection site
o cardiac abnormal rhythms (abnormal heart rhythms)

53
Q

what would be the first nursing intervention for a patient that is receiving potassium infusion (IV) and is complaining of pain at the infusion site?

A

assess the IV site

54
Q

what would be the most common cause of pain during potassium infusion?

A

rate is going to fast

o slow it down (do not need a doctor’s order to taper down)

55
Q

normal serum potassium level

A

3.5 - 5

56
Q

what does serum mean

A

in the blood

57
Q

what nursing intervention would be used to monitor for the most concerning adverse effect of hyperkalemia?

A

ECG machine

58
Q

a patient is receiving an infusion of potassium, what lab can a provider order to monitor their potassium level

A

o CMP (comprehensive metabolic panel)
o BMP (basic metabolic panel)

59
Q

what lab can a provider order to monitor magnesium for a patient receiving an infusion?

A

Magnesium

60
Q

a patient has hypocalcemia and is stable, what order would the nurse anticipate?

A

o PO calcium supplements
o increased calcium in your diet

61
Q

if a patient is hypocalcemic, in addition to calcium supplements, what else MUST the patient take?

A

Vitamin D

62
Q

for what reason might a patient who has unstable hyperkalemia (severe electrolyte imbalance) receive calcium?

A

to protect the heart

63
Q

what are the two most common causes of hypercalcemia?

A

o Parathyroid Issues
o Cancer

64
Q

what two IV drugs are the treatment options for hypocalcemia?

A

o Calcium Gluconate
o Calcium Chloride (most powerful of the two)

65
Q

what fluid will pull volume into the cells?

A

Hypotonic

66
Q

what fluid will push volume from the bloodstreams?

A

hypotonic

67
Q

pull into cell
push from blood

A

hypotonic

68
Q

pull into blood
push from cell

A

hypertonic

69
Q

another name for hypertonic solution

A

3% Sodium Chloride

70
Q

what are 4 names for isotonic fluids?

A

o Normal Saline
o 0.9
o Sodium Chloride
o NaCl

71
Q

name 5 different crystalloid fluids

A

o Normal Saline
o Lactated Ringer (LR)
o 3% Sodium Chloride
o 0.45% Sodium Chloride
o Dextrose 5% in water (D5W)
- - if you just see “Dextrose” then it’s wrong
- - must say “Dextrose 5% in Water”

72
Q

what fluids utilize oncotic pressure

A

o 3% Sodium Chloride
o Colloids
- Albumin (most commonly used oncotic pressure)
- Dextran 40% in D5W
- Plasma Protein Fraction
- Hetastarch 6% in NS

73
Q

what would you monitor for a patient that is receiving sodium bicarbonate?

A

pH (acid level)

74
Q

if a patient receives too much sodium bicarbonate, would their pH go up or down?

A

Up (alkalosis - high pH)

75
Q

what is a normal pH level

A

7.35 - 7.45

76
Q

uses for a magnesium infusion

A

o Pre-term Labor
o Certain Arrhythmias
o Hypomagnesemia
o Asthma
o Laxative

77
Q

is magnesium addressing constriction or addressing inflammation?

A

constriction

78
Q

what electrolyte imbalance is most dangerous?

A

hyperkalemia

79
Q

what is the purpose of using a spacer?

A

o to increase the amount of medication a patient is receiving

80
Q

what OTC medication for allergic rhinitis cannot be used for more than a few days?

A

Oxymetazoline (Afrin)

81
Q

three medications that are use that block histamine and does NOT cause drowsiness

A

o Loratadine (Claritin)
o Fexofenadine (Allegra)
o Cetirizine (Zyrtec)

82
Q

three medications that block histamine and DO cause drowsiness

A

o Diphenhydramine (Benadryl)
o Hydroxyzine
o Doxylamine

83
Q

what could happen if you use Oxymetazoline for more than a few days?

A

can cause rebound nasal congestion

84
Q

what drug class is intranasal fluticasone in?

A

Intranasal Glucocorticoids

85
Q

what drug class is the most used for allergic rhinitis?

A

Histamine One Receptor Antagonist (H1RA)

86
Q

the definition of rhinitis

A

runny nose

87
Q

a drug that is antitussive

A

Dextromethorphan (Delsym, Robitussin)

88
Q

two prescription medications that are also use for patients that have a cough

A

o Benzonatate (Tessalon Perles) numbing agent
o Codeine

89
Q

three patient education would you provide for someone prescribed codeine for a cough?

A

o Don’t take with alcohol (cause CNS depression)
o Intake a lot of fluids (can cause constipation)
o Do not drive

90
Q

what drug class makes our coughs more effective

A

Mucolytics

91
Q

what drug is the most potent drug for the treatment of allergic rhinitis?

A

Fluticasone

92
Q

what S/S would you NOT expect in a patient with allergic rhinitis?

A

Fever

(fever is a sign of infection, not allergy)

93
Q

MOA of antitussives

A

Suppresses/decreases sensitivity of cough receptors

94
Q

Potassium Lab Value

A

3.5 - 5.0 mg/L

95
Q

Sodium Lab Value

A

136 - 145 mEq/L

96
Q

Calcium Lab Value

A

9 - 10 mg/dL

97
Q

Chloride Lab Value

A

98 - 106 mEq/L

98
Q

Phosphorus Lab Value

A

3.0 - 4.5 mg/dL

99
Q

Magnesium Lab Value

A

1.3 - 2.1 mEq/L

100
Q

BUN Lab Value

A

10 - 20 mg/dL

101
Q

Creatinine (CR) Lab Value - Males

A

0.6 - 1.2 mg/dL

102
Q

Creatinine (CR) Lab Value - Females

A

0.5 - 1.1 mg/dL

NUR 334: Pharmacology (13 decks)

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