Exam 1 Flashcards
weeks 1-4 (132 cards)
1
Q
Tylenol MOA
A
inhibits synthesis of prostaglandins
dec pain and fever
2
Q
Tylenol Education
A
avoid alcohol
discontinue if rash forms
take exact dose
3
Q
Tylenol adverse affects
A
Steven- Johnson Syndrome
4
Q
Aspirin MOA
A
produce analgesia
dec pain, fever and inflamation
5
Q
Aspirin Education
A
avoid alcohol use
take sitting up and with water
take exact dose
6
Q
aspirin adverse affects
A
GI Bleed
DRESS
Hypersensitivity
7
Q
antihistamine
A
H1 antagonist
8
Q
antihistamine education
A
sedation may occur
avoid alcohol
9
Q
antihistamine adverse affects
A
anticholernegic
10
Q
insulin moa
A
dec blood glucose
stimulate uptake and inhibit liver production
11
Q
insulin education
A
s/s of hypoglycemia (hyper)
inform on how to monitor glucose
display the technique and equipment
12
Q
insulin adverse affects
A
hypoglycemia
hypersensitivity
hypokalemia
13
Q
glucocorticoids moa
A
modulate regulatory proteins
14
Q
glucocorticoids education
A
long term effects
15
Q
glucocorticoid adverse affects
A
osteoporosis
infection
glucose intolerance
growth
16
Q
vasopressin moa
A
identical to ADH
17
Q
Vasopressin adverse affects
A
vasoconstriction
18
Q
desmopressin moa
A
analoug of ADH
19
Q
desmopressin adverse
A
no significant
20
Q
vasopression and desmopressin treat
A
hypothalamic and pituitary function (DI)
21
Q
levothyroxine
A
T4
22
Q
Levothyroxine education
A
QD on empty stomach
Inc absorption
23
Q
levothyroxine adverse affects
A
tachycardia, angina, tremor, nervousness, insomnia
24
Q
methimazole MOA
A
surpress TH production
25
methimazole Education
QD at the same time
26
methimazole adverse affects
agranulocytosis
27
hydrocortisone moa
provides adrenocorticoid
28
hydrocortisone education
follow prescribed schedule
29
hydrocortisone adverse affects
| gluco- and mineralo-
thromboembolism
peptic ulceration
pheochromocytoma
anaphylaxis
30
fludrocortisone MOA
mineralocorticoid
31
fludrocortisone education
follow prescribed schedule
32
fludrocortisone adverse affects
s/s of water and salt retention
| hypokalemia
33
pharmacodynamics
drugs to the body
- dose-response relationship
- efficacy vs potency
34
single occupancy theory (p.dynamics)
respond proportionate to number of occupied receptors
35
modified occupancy
potency vs efficacy
36
affinity
strength of attraction b/w drug and receptor
| - potency
37
intrinsic activity
ability of the drug to activate a receptor
| -efficacy
38
agonist
activates receptors
| - normal reg molecule response
39
antagonist
prevents receptors
- stops reg molecule response
* must have an agonist to produce effect
40
pharmacokinetics
body to the drugs
- absorption
- distribution
- metabolism
- excretion
41
absorption
drugs crossing the membrane into the blood
42
absorption factors (body)
route
gastric emptying time
surface area for absorption
blood flow
43
absorption factors (drug)
```
solubility
surface area
dissolution
structure
pH
ionization
```
44
solubility
channels and pores
transport
penetration
45
active transport
P-glycoprotein (PGP)
| -multi drug transporter-OUT
46
LIVER ATS
into bile
| -elimination
47
KIDNEY ATS
into urine
| -excretin
48
metabolism
biotransformation
49
p450 system
inhibitor- blocks metabolic activity of enzyme
| inducer- increases metabolic activity
50
1st pass effect
rapid inactivation of oral drugs
PO meds from GI tract to portal
high metabolic rate- inactivated on 1st pass no effect
- high metabolism of PO med from Hi to liver and
inactivated drug
51
enterohepatic circulation
repeating cycle glucuronidation
liver to bile
bile to duodenum
duodenum to intestine
52
excretion
removal of drug
| - mainly in kidneys
53
passive tubular reabsorption
lipid soluble
| H2O soluble
54
active tubular secretion
PGP
55
excretion factors
pH
| polypharm
56
glomerular filtration
blood to urine
| protein-bound drugs are not filtered
57
passive reabsorption
lipid-soluble drugs move back into the blood polar and ionized drugs remain in the urine
58
active transport
tubular pumps for organic acids and bases move drug to urine
59
nurse roles in drug admin
- pre-adim assesment
- evaluate response
- promote pt adherence
- implement non-drug measures
- minimize adverse effects and interractions
- make PRN decisions
- 5 R's
60
Drug routes
```
PO
SC
IM
IV
ID
SL
NGT
R
V
```
61
injection angles
IM-90
IV-25
SC-45
ID-10-15
62
5 Rights
```
PT
ROUTE
DRUG
DOSE
TIME
```
63
inflammation
```
INJURY:
-chemokinase
- vasodilation
-neutrophil/macrophage binding
PHAGOCYTOSIS
```
64
five signs of inflammation
```
redness
swelling
heat
pain
loss function
```
65
inflammatory response
a. vasodilation and inc vascular permeability
b. recruitment of leukocytes
c. phagocytosis of ANTIGEN
66
Immune Response
NK cells- non-specific and attack ALL foreign
B cells- specific, produce antibodies with antigens need
CD4
Cytolytic T cells- secrete cytokines to activate other cells
HELPER
Cytotoxic T cells- destroy foreign, require CD4
TOXIC
Macrophage- engulfs and process Ag
Dendritic- capture Ag and migrate to lymphoid
67
leukocytes
```
neutrophil
lymphocyte
monocyte
eosinophils
basophils
```
68
neutrophil
```
60-80% -neutrophil 1st responder
20-30%-lymphocyte- immune response
3-8% - monocyte- phagocytosis
1-6%-eosinophils - allergic rxn
0-2%-basophil- histamine by IgE
```
69
mediators
complement
kinins
clotting factors
cyto-, chemo-kinins
70
humoral immunity
- TH cell binds with self and non-self complex
- displays MHC II on surface
- TH releases interleukin to complete B cell activation
71
complement activation
- recruitment of inflammatory cels
- opsonization of pathogen
- killing of pathogen
72
IgA
1st life of defense
| -secretions
73
IgM
target cell lysis
| -miserable
74
IgD
surface of mature B cells
75
IgE
binds to mast cells- allergic response
| - epi
76
IgG
PHAGOCYTOSIS
| -gone
77
Cellular immunity
1- TH binds dendritic cell
2- TH cell stimulates dendritic cell to express co-stim molecules
3. dendritic cell can activate CD8
78
Hypersensitivity 1
IgE (anaphylaxis)
| -Ag induces crosslink of IgE and Mast cells
79
Hypersensitivity II
IgG (blood transfusion)
| -Ab directed against Ag mediated cell destruction
80
Hypersensitivity III
```
Immune Complex (artus Reaction)
-Ab-Ag complex deposited in tissues
```
81
Hypersensitivity IV
Cell mediated
| -mediate direct cellular damage
82
Insulin types
rapid, short. intermediate acting, long acting
83
rapid acting insulin used in patients with
hyperglycemic events in diabetic pt
84
short acting insulin is used with patients who
need more than 200 units a day
85
intermediate acting insulin MOA
protamine delays effect
| -inc action time
86
long acting insulin
gives constant concentration for more than 24 hours
87
adverse effects of insulin
hypoglycemia
hypersensitivity reactions
hypokalemia
88
interventions
demonstrate technique and use of equipment
| inform on s/s of hypo and hypergylcemic events
89
metaformin
increase insulin sensitivity
| decrease glucose production
90
metaformin education
type II management not cure
| take daily at the same time
91
sulfonylureas
decrease blood sugar-stimulate pancreas to receive insulin
| increases receptor site sensitivity
92
sulfonyreas moa
pancreatic function needed
93
sulfonyreas education
daily at same time
| type 2 treatment not a cure
94
hormone function
```
reproduction
growth and development
fluid homeostasis
metabolism
stress response
```
95
negative feedback loop
stimulus to sensor
sensor to control mechanism
mechanism to effector
effector to stimulus
96
H2O soluble
```
ADH
ACTH
glucagon
Insulin
TSH
```
97
g-protein
2nd messenger
98
protein kinase
become kinase and associate with kinase
99
lipid soluble
T3
T4
Aldosterone
Cortisol
100
lipid soluble process
mRNA transcription
| no signaling cascade
101
lipid soluble receptors are in
nucleus and cytoplasm
102
Hormones are
```
synthesized -> primary location
secretion-> cyclical
feedback-> negative
metabolize
excretion
```
103
posterior pituitary
ADH- regulated by osmolality of plasma and detected in hypothalamus
- act on kidney to reabsorb H20 when blood is too concentrated
104
oxytocin
similar to ADH
| surpress diuresis
105
hypothalmic pituitary
SIADH
| Diabetes insipidus
106
SIADH (hyper)
ectopic production from tumors and medically induced
107
s/s of SIADH
```
hypoatremia
fatigue
cramps
vomitting
anorexia
postural BPchange
```
108
SIADH sequence
ADH - 2 aquaporin- permeable membrane to H2O reabsorbed in urine
results in: inc plasma, inc concentration
109
Diabetes Insipidus (HYPO)
central and nephrogenic DI
Idiopathic
brain trauma/surgery/tumor
chronic renal disease
110
Diabetes Insipidus s/s
polyuria
polydyspia
hyperatremia
hyperosmolality
111
Diabetes Insipidus Treatment
replacement of ADH
112
Thyroid Hormone Synthesis
dietary iondine
thyroglobulin protein
tyrosine AA
thyroid peroxide
113
TH secretion is stumalated by
TSH
114
Hypothyroidism
Thyroid gland dys. function
115
Hypothyroidism s/s
```
lethargy
weakness
dry-pale skin
cold intolerance
weight gain
constipation
bradycardia
```
116
graves disease
follicular cell hyper function
| -leads to: destruction of cell
117
graves s/s
```
sleepiness
inc appetite with weight loss
heat intolerance
tachycardia
hyperreflex
```
118
graves treatment
radioactive iodine
beta blocker
surgical removal
119
DKA
diabetic ketoacidosis
- more T1DM
- <65 years old
- decrease in glucose conc
120
NHHS
nonketoic hyperglycemia hyperosmolar syndrome
- more T2DM
- >65 years old
- elevated ketones
121
Penicilin G-
| Beta Lactams
MOA- bind to bacterial cell wall, resulting in cell death
ED- notify professional if fever, diarrhea develop
ADVERSE- seizures,anaphylaxis, serum sickness, urticaria
122
cephalosporin
MOA- 1st gen target gram positive, 2nd gen target gram negative and 3rd gen penetrate cerebral spinal fluid
ED- may be allergic, if allergic to penicillin
ADVERSE- anaphylaxis, swelling, urticaria, seizures, inc bleeding
123
vancomycin
MOA-binds to bacterial cell wall resulting in cell death
ED- take as directed, contact professional if no improvement
ADVERSE- hypersensitivity, nephrotoxicity, phlebitis
124
erythromyscin
MOA- suppresses protein synthesis at level of 50S bacterial ribosome, bacteriostatic
ED- caution pt to notify if fever and diarrhea occur
ADVERSE- torsades se pointes, ventricular arrhythmia, CDIFF
125
gentamycin
MOA- inhibits protein synthesis at 30s
ED-remain hydrated, report sines of hypersensitivity
ADVERSE- ototoxicity, nephrotoxicity, ataxia, vertigo, hypersensitivity
126
sulfamethazole
MOA- inhibits folic acid metabolism
ED- double stress, notify prof if rash, fever, or diarrhea develop
ADVERSE- erythema multiform, SJ syndrome, toxic epiderrmal, necrolysis
127
NRTI
MOA- prevents formation of 3'-5' phosphodiester
ED- importance of compliance and to discontinue if rash forms
ADVERSE- mitochondrial toxicity, SJ syndrome, CNS effects
128
NNRRTI
MOA- inhibit RT, metabolized through cytochrome P450
ED- emphasize comliance to ensure efficacy
ADVERSE- rash, dizziness, CNS effects, flu like
129
protease inhibitors
MOA- inhibit and block protease activity, viruses unable to infuse and inject
ED- monitor blood glucose if diabetic, discontinue if rash forms
ADVERSE- diarrhea, nausea, anorexia, elevated cholesterol. SJ syndrome
130
Integrase inhibitors
MOA- inhibits activity of integrate, blocks HIV-1 formation
ED- caution pregnant women about rhabdomyolysis
ADVERSE- CNS, Musculoskeletal rhabdomyolysis and myopathy
131
HIV Fusion inhibitors
MOA- prevent fusion of virus with cell membrane, prevents entry of HIV-1
ED- site reaction may occur,
ADVERSE- diarrhea, pneumonia, Site reaction, insomnia, neuropathy
132
CCR5 Antagonist
MOA- blocks receptor site on cell membrane, blocking HIV virus from interacting with the cell
ED- caution about change in effectiveness with drug interaction, possible renal impairment, hypersensitivity
ADVERSE- marviroc, hepatotoxicity, dizziness
