311 Final Flashcards by Naomi Wheeler

What are the 4 basic steps in Hemostasis

Vessel injury
Vessel spasm
Platelets adhere to form plug
Insoluble Fibrin strands form and coagulate

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Damaged cells initiating a series of complex reactions is called what

Coagulation cascade

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What is the intrinsic pathway of a coagulation cascade

The activated response to injury

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What is the extrinsic pathway in the coagulation cascade

Blood leaking out of vessels

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What clotting factors are made by the liver

Prothrombi—-> thrombin
Fibrinogen

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What vitamin is required for the liver to make clotting factors

Vitamin K

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Patients with hepatic impairment usually have coagulation issues. T/f

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How are coagulation disorders diagnosed

Prothrombin time (PT)
Activated partial thromboplastin time (aPTT)
Platelets.

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What do anticoagulants and antiplatelets modify

They prevent clot formation

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What do thrombolytics do

Removal of an existing clot by
Dissolving the clot

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What are hemostatic and clotting factor concentrates used for ?

Promotion of clot formation.
Hemostatics = inhibition of fibrin destruction
Clotting factor concentrates= administration of missing clotting factors

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Drugs that are used to prolong bleeding time and prevent thrombi are called what

Anticoagulants

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Thumb therapy is usually initiated with what route

IV; then transitioned to PO

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What are 4 primary anticoagulant drug classes?

Heparin
vitamin k antagonists
Direct thrombin inhibitors
Factor Xa inhibitors

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What drugs are associated with DVT

Estrogens, hormaonal contraceptive, raloxifene (evista).

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What lab value would you expect to monitor in someone who is receiving Heparin

aPTT

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What is heparin overdose tx

Protamine sulfate

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Can heparin be self administered?

Yes

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Warfarin indications

MI, DVT, mechanical valves, strike prevention

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What food should you avoid if taking warfarin?

Foods high in K: spinach, kale, turnip, broccoli

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Where does hematopoiesis occur

Red bone marrow

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What vitamins/ minerals are required for hematopoiesis?

Vitamin B, vitamin C, copper, iron.

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What drugs are used for blood cell formation disorders?

Epoetin
Ferrous sulfate
Vitamin B

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What is the black box warning for Epoetin (Epogen)

Increased risk of thromboembolis causing: TIA, MI, Stroke

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What condition makes RBCs have a decreased capacity to deliver oxygen to tissues?

Anemia

What are three categories of anemia

Blood loss due to hemorrhage Increased erythrocyte destruction Decreased erythrocyte production

What is the classification of anemia generally based on

The description of the erythrocytes size and color

What are example of anemia classified as microcytic-hypochromic morphology with the description of small, abnormally shaped erythrocytes with decreased hemoglobin concentration

Iron deficiency anemia and thalassemia

What anemia is classified as macro-normochromic in morphology and described as large abnormally shaped erythrocytes with normal hemoglobin concentration?

Pernicious anemia and folic acid deficiency anemia

Signs and symptoms of anemia

Pallor Fatigue Lethargy Dizziness/fainting Chronic disease can result in HF

What is cyanocobalim (nascobal) used for and the side effects

To treat anemia. It is IM or SQ Side effects: hypokalemia, arthralgia, dizziness. Pregnancy cat A

What disease manifests as lesions located in the stomach or small intestine

Peptic ulcer disease

Risk factors for peptic ulcer disease

Blood type O Family hx Smoking tobacco Caffeine use Drugs: aspirin, nsaids, corticosteroids, platelet inhibitors Stress Helicobacter pylori.

What pharmacotherapy is used for Peptic Ulcer disease

Proton pump inhibitor H2- receptor antagonist Antacids Antibiotics Miscellaneous drugs

What drugs block enzyme responsible for secreting hydrochloric acid in the stomach

Proton pump inhibitors

What drugs suppress the volume and acidity of parietal cell secretion

H2-receptor antagonists

Should antacids be taken at the same time as H2 receptor antagonist?

No because absorption of the H2- receptor antagonist will be diminished

Zantac (ranitidine) is what kind of drug. has what side effects, what should be monitored, and when should it be taken

H2- receptor antagonist Headache Monitor liver and renal fx Take after meals.

Side effects of proton pump inhibitors

Headache Abdominal pain Diarrhea Nausea and vomiting Long term therapy increases risk of osteoporosis (can interfere with ca absorption)

When Do you want to take proton pump inhibitors

20-30 min before meals

Will a patient feel immediate relief from proton pump inhibitors

No. It can take several days of therapy before patients gain relief from ulcers pain

Which peptic ulcer drug decreases acid secretion the most

Proton pump inhibitors

A patient with peptic ulcer disease associated with H. Pylori infection has what increased risk

Gastric cancer.

What is the main administration guideline for antacids

Administer at least 2 hours before or after other drugs to decrease affecting other drugs absorption

What is Lomotil used for

Anti diarrhea. It is an opioid one and most effective.

Side effects of Imodium

Constipation, nausea, dizziness

Alternating constipatation and diarrhea often occurs with what condition

IBS

Examples of inflammatory bowel disease (IBD)

Crohns : ulcers in distal portion of small intestine. Ulcerative Colitis: mucosal erosions in large intestine Hyperactive immune response resulting in chronic intestinal inflammation.

Is crohns a condition that affects the large or small intestine

Small

Ondansetron (zofran) is what kind of drug, used for what, with what adverse effects

Serotonin receptor antagonist used for nausea Adverse effects: it prolongs QT intervals leading to Dysrrhythmias, Use cautiously with other QT prolonging drugs (haldol, Amiodarone)

What condition occurs when digestive enzymes are not released into the duodenum and cause inflammation in surrounding tissues

Pancreatitis

Causes for pancreatitis

Gallstones for women EtOH for men

Pancrelipase(creon) is used for what and what are administered guidelines

For patients that have insufficient pancreatic enzymes. Give 1-2 hours before meals Do not crush

Vitamin D levels can be affected by what kind of drugs

Certain anticonvulsants

What vitamin is given to promote clotting

Vitamin K

When administering TPN what do you monitor and how long do you take the TPN out of fridge prior to using

Monitor glucose levels and 30 minutes prior to

What hormone acts on the collecting ducts of kidneys to increase water reabsorption

ADH

When water increases in the body what happens to the serum osmolality

It is reduced

What hormones have receptors on nearly every cell in the body

Thyroid and insulin

What is synthetic adh known as

Vasopressin (Vasostrict)

A deficiency in adh results in what condition

Diabetes insipidus

What condition is characterized by the production of large volumes of very dilute urine, accompanied by increased thirst and polyuria.

Diabetes insipidus

What is desmopressin (DDAVP)

Synthetic form of adh for diabetes insipidus and nocturia

What labs do you want to monitor when administering desmopressin

Sodium labs.

What hormone increases BMR

Thyroid

What systems does the thyroid gland affect

Cardio, respiratory, GI and neuromuscular

What is the negative feedback system

Thyroid hormone low- hypothalamus secretes TRH- TRH stimulates anterior pituitary to secrete TSH- TSH stimulates thyroid to produce and secrete T3 &T4- blood levels of thyroid hormone increase and negative feedback suppresses secretion of TSH and TRH

What does the adrenal cortex secrete

Glucocorticoids: cortisol Mineralocorticoids: aldosterone Gonadocorticoids: male androgens and small amount of estrogen

What is used as replacement therapy for patients with adrenocortical insufficiency

Corticosteroids (glucocorticoids)

What is important to monitor with corticosteroids

Blood glucose as it increases with this drug.

What is administration guidelines for corticosteroids

Educate on the importance of taking this med at same time every day Administer with food

What is the difference between Cushings disease and Cushing’s syndrome

Disease- prolonged high level of corticosteroids present in body (from pituitary gland tumor producing excess amounts of ACTH) Syndrome- high level of corticosteroids present in body. (From long term therapy with high doses of systemic corticosteroids)

Symptoms of cushings

-Adrenal atrophy -Moon face -Osteoporosis -Htn -Acne -Obesity in upper body -Increased risk of infections and delayed round healing.

Tests for diagnosing diabetes mellitis

Hemoglobin A1C at 6.5% or higher Fasting plasma glucose of at least 8 hrs at 126 mg/dL or higher Oral glucose test results of 200 mg/dL or higher.

DKA primarily occurs in what type of patients

Type 1 diabetes

Which diabetes occurs due to an autoimmune destruction of pancreatic beta cells resulting in a lack of insulin secretion

Type 1 diabetes

What kind of syringes should you use for insulin admin

Only calibrated syringes

What kind of insulin is humalog

Rapid Sq 5-10 min prior to meals Monitor electrolytes (maybe cause decreased serum k+, ca+, and mg

What kind of insulin is Lantus

Long acting Sq Once daily same time every day

Symptoms of hypoglycemia

Nausea, paleness, sweating, diaphoresis, tremors, irritability, headache, lightheaded, anxiety, decreased LOC

Signs of hyperglycemia

Flushed, dry skin, polyuria, polyphagia, polydipsia, drowsiness, glycosuria, ketonuria, acetone breath and infection

What is Metformin used for, mechanism of action.

For diabetes mellitis type 2; it decreases the production of glucose and reduces insulin resistance

Can glargine be mixed with other insulins

311 Final Flashcards

(83 cards)