Exam 1 Flashcards
(70 cards)
1
Q
What 3 electrolytes, if imbalanced, result in neurotransmission and muscular contraction problems?
A
- sodium
- potassium
- calcium
2
Q
What are 2 important interruptions that may occur when neurotransmission and muscular contraction occur?
A
- cardiac rhythm abnormalities
- skeletal muscle function compromise
3
Q
What are the 2 primary causes of edema?
A
- elevated hydrostatic pressure
- heart failure can result in increased ECF volume
- decreased osmotic forces in blood
- liver failure and protein malnutrition can result in hypoalbuminemia
4
Q
What are 2 other ways that edema can result?
A
- alterations in capillary permeability
- histamine
- inflammation
- sodium retention
- illness
- consumption of salty foods
5
Q
What are some signs and symptoms of hyponatremia?
A
- headache
- lethargy
- confusion
- N&V
- diarrhea
- muscle cramps/spasms
6
Q
How is hyponatremia treated?
A
slow replacement of sodium with adequate fluids
7
Q
What are some signs and symptoms of hypokalemia?
A
- anorexia
- cardiac arrhythmias
- leg cramps
- prominent U wave, flattened T wave, prolonged PR
- digitalis toxicity
8
Q
What are 2 medications that can cause hypokalemia?
A
- adrenergic agents – stimulating agents like epinephrine
- use of IV dextrose – stimulates insulin release
9
Q
How is hypokalemia treated?
A
replacement of potassium at acceptable rate
rapid infusion (not PO or IV infusion) may result in cardiac arrest – used as a lethal injection
10
Q
What is 1 way that hyperkalemia may result?
A
decreased renal perfusion can result in potassium retention
11
Q
What are symptoms of hyperkalemia?
A
– early symptoms:
- numbness
- muscle cramps
- diarrhea
– can lead to cardiac arrest
12
Q
What are some signs and symptoms of hypocalcemia?
A
- neuromuscular excitability
- paresthesia
- hypotension
- cardiac arrhythmias
13
Q
What can chronic hypocalcemia result in?
A
bone pain and bone fragility
14
Q
What are 2 causes of hypercalcemia?
A
- elevated parathyroid hormone
- cancer – malignant cells result in bone destruction
15
Q
What are some signs and symptoms of hypercalcemia?
A
- decreased neuromuscular excitability
- weakness
- renal calculi
- cardiac arrhythmias
16
Q
What are 3 causes of hypophosphatemia?
A
- decreased intestinal absorption
- increased excretion by kidneys
- intracellular shift
17
Q
What are some signs and symptoms of hypophosphatemia?
A
- tremors
- muscle weakness
- hyporeflexia
18
Q
What is the most common cause of hyperphosphatemia?
A
kidney failure
19
Q
What does hyperphosphatemia often accompany?
A
hypocalcemia
Ca2+ and P3+ have a balanced inverse relationship
20
Q
What are antibiotics? What is the goal of antibiotics?
A
– chemicals that inhibit specific bacteria
– goal is to decrease the population of the invading bacteria to a point where the human immune system can effectively deal with the invader
21
Q
What are the 3 ways that antibiotics are made?
A
- living microorganisms
- synthetic manufacture
- genetic engineering
22
Q
What are bacteriostatic drugs?
A
substances that prevent the growth of bacteria
23
Q
What are bactericidal drugs?
A
substances that kill bacteria directly
24
Q
Differentiate between gram-positive and gram-negative bacteria.
A
– gram-positive: bacteria with cell walls that retain a stain, resisting decolorization with alcohol
– gram-negative: bacteria with cell walls that lose stains, decolorized by alcohol
25
Differentiate between aerobic and anaerobic bacteria.
-- **aerobic:** require oxygen for survival
-- **anaerobic:** do not require oxygen for survival
26
The longer an antibiotic has been in use, what is more likely to develop?
greater chance that the bacteria will develop resistance (emergence of a resistant strain)
27
Describe aminoglycosides:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** infections caused by gram-negative aerobic bacilli
-- bactericidal
-- **contraindications:**
* renal or hepatic disease
* ototoxic --\> hearing loss
* herpes or mycobacterial infection
* myasthenia gravis
* parkinsonism
* lactation
-- **adverse effects:**
* ototoxicity
* nephrotoxicity
-- **drug-drug interactions:**
* penicillins
* cephalosporins
* diuretics
* neuromuscular blockers
* succinylcholine
* citrate anticoagulated blood
28
Describe carbapenems:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** broad-spectrum (gram+ and gram-) antibiotic
-- bactericidal
-- **contraindications:**
* seizure disorders
* meningitis
* pregnancy and lactation
-- **adverse effects:**
* Pseudomembranous colitis
* C. diff diarrhea
* N/V --\> dehydration and electrolyte imbalances
* superinfections -- because it kills both gram+ and gram-, including gut flora
-- **drug-drug interactions:**
* valproic acid
* meropenem
29
Describe cephalosporins:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** treatment of infections -- similar to penicillin in structure and activity
-- bacteriostatic and bactericidal
-- **contraindications:**
* allergies to cephalosporins or penicillin
* renal or hepatic impairment
-- **adverse effects:**
* GI tract:
* N/V
* diarrhea
-- **drug-drug interactions:**
* aminoglycosides
* oral anticoagulants
* ETOH (ethanol)
30
Describe fluoroquinolones:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** broad spectrum antibiotic, but mostly used against gram-
-- bactericidal
-- **contraindications:**
* pregnancy or lactation
* renal dysfunction
-- **adverse effects:**
* h/a
* dizziness
* insomnia
* depression
-- **drug-drug interactions:**
* iron salts
* sucralfate
* mineral supplements
* antacids
* quinidine
* theophylline
* NSAIDs
31
Describe penicillins and penicillinase-resistant antibiotics:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** broad spectrum antibiotic -- interferes with ability of bacteria to build cell walls
-- bactericidal
-- **contraindications:**
* allergies to penicillins or cephalosporins
* renal disease
* caution with pregnant or lactating women
-- **adverse effects:**
* GI tract
-- **drug-drug interactions:**
* tetracyclines
* parenteral aminoglycosides
32
Describe sulfonamides:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** broad spectrum antibiotic -- inhibits folic acid synthesis
-- bacteriostatic
-- **contraindications:**
* thiazide diuretics
* pregnancy
-- **adverse effects:**
* GI tract
* renal effects -- filtration of the drug
-- **drug-drug interactions:**
* tolazamide
* glyburide
* cyclosporine
33
Describe tetracyclines:
-- indication
-- bacteriostatic or bactericidal
-- contraindications
-- adverse effects
-- drug-drug interactions
-- **indication:** treatment of various bacterial infections and acne when penicillin is contraindicated
-- bacteriostatic
-- **contraindications:**
* allergies to tetracyclines or tartrazine
* pregnancy or lactation
* renal or hepatic dysfunction
* penicillin G
* oral contraceptive therapy
* methoxyflurane
* digoxin
-- **adverse effects:**
* GI tract
* damage to teeth and bones
* photosensitivity
-- **drug-drug interactions:**
* penicillin G
* oral contraceptives
* digoxin
* administer on empty stomach
34
What are the 5 ways that anemia could develop?
1. deficiencies
* iron
* vitamin B12
* folic acid
* poor nutrition
2. blood loss
* chronic
* acute
* GI bleeds
3. hemoglobinopathies
4. medications
5. hemolysis
35
What are the major signs and symptoms of anemia?
* GI tract blood loss
* menorrhagia -- heavy menstrual periods
* pale complexion
* tachycardia
* jaundice
* splenomegaly -- breakdown and collection of RBCs
* nutritional anemia:
* glossitis
* cheilitis -- inflammation of lips
* koilonychia -- spoon nails
* pica
-- anemia can be asymptomatic
36
Describe iron:
-- indication
-- pharmacokinetics
-- adverse effects
-- food-drug interactions
-- **indication:** treatment of iron deficiency anemias; adjunctive therapy with Epoetin Alfa -- raises serum iron
-- **pharmacokinetics:**
* absorbed in small intestines
* binds to transferrin
* transported in the blood
* small amounts lost in sweat, urine, sloughing of skin, mucosal cells, and intestinal cells
-- **adverse effects:**
* oral -- GI irritation and CNS toxicity
* parenteral iron -- anaphylaxis, local irritation, staining of tissues, phlebitis
-- **food-drug interactions:**
* eggs
* milk
* coffee
* tea
* acidic liquids
37
What 2 things could result from a vitamin B12 deficiency?
1. anemia
2. neurological issues
38
What are some ways that vitamin B12 deficiency could develop?
* lack of intrinsic factor -- needed for B12 absorption
* pernicious anemia -- intestines cannot absorb B12
* dietary deficiency
* gastric atrophy
* chronic *Helicobacter pylori* infection
* chronic alcoholism
* gastric bypass surgery
* Crohn's disease
39
What are the 2 ways that vitamin B12 anemia is treated?
1. address underlying etiology
2. IM B12 injections
40
What are erythropoietins?
secreted by the kidneys; stimulate the bone marrow to make more RBCs
41
What are 3 drugs that mimic the action of erythropoietin?
1. Epoetin Alfa (Epogen, Procrit)
* treats anemia associated with renal failure and AIDS
* decreases need for blood transfusions in pts undergoing surgery
2. Darbopoetin Alfa (Aranesp)
* treats anemia associated with chronic renal failure -- pts on dialysis
3. Methoxy Polyethylene Glycol-Epoetin Beta (Mircera)
* treats anemia associated with chronic renal failure -- pts on dialysis
42
Describe antiplatelets:
-- actions
-- indications
-- pharmacokinetics
-- **actions:**
* inhibit platelet adhesion and aggregation by blocking receptor sites on the platelet membrane
* anagrelide -- blocks production of platelets in bone marrow
-- **indication:**
* reduce risk of transient ischemic attacks (TIAs), stroke, and MI
* anti-inflammatory
* analgesic
* anti-pyretic
-- **pharmacokinetics:**
* well absorbed
* binds to plasma proteins
* metabolized in liver
* excreted in urine
43
Name one type of antiplatelet drug.
aspirin
44
Describe anticoagulants:
-- action
-- contraindications
-- indications
-- adverse effects
-- **action:** interferes with normal cascade of clotting process
-- **contraindications:**
* allergy
* pregnancy
* renal or hepatic disorders
-- **indications:**
* prevents and treats thrombus and PE formation
* treats atrial fibrillation
-- **adverse effects:**
* bleeding
* GI upset
* hepatic dysfunction
* alopecia
* dermatitis
* bone marrow suppression
* prolonged and painful erection
45
Name one type of anticoagulant.
heparin
46
Describe thrombolytics:
-- action
-- indications
-- pharmacokinetics
-- adverse effects
-- **action:** breaks down thrombi that have been formed by stimulating plasmin system
-- **indications:**
* acute MI
* PE
* ischemic stroke
-- **pharmacokinetics:**
* must be injected
* are cleared from the body after liver metabolism
* pregnancy and lactation
-- **adverse effects:**
* bleeding
* cardiac arrhythmias
* hypotension
* hypersensitivity -- rash, flushing, bronchospasm, anaphylaxis
47
Name one type of thrombolytic.
urokinase
48
What are the 5 functions of the kidneys?
1. acid-base balance
2. waste elimination
3. secretory function
4. vitamin D synthesis and calcium balance
5. glucose homeostasis
49
How do the kidneys function in acid-base balance?
excrete and absorb H+ ions and bicarbonates as needed
50
How do the kidneys aid in waste elimination?
eliminate urea, uric acid, creatinine, and drugs from the blood
51
What are the kidneys' secretory functions?
* secretion of erythropoietin (EPO)
* increase RBCs in response to hypoxia
* secretion of renin
* released in response to low BP or perfusion
* activation of renin-angiotensin-aldosterone (RAAS)
52
How do the kidneys function in vitamin D synthesis and calcium balance?
* kidneys activate vitamin D
* vitamin D aids in calcium absorption
53
How do the kidneys function in glucose homeostasis?
* renal threshold to reabsorb glucose (180 mg/dL)
* if exceeded, glucose excreted in urine
* degradation of insulin
* gluconeogenesis
54
What are the 3 categories of renal dysfunction? Describe each.
1. **prerenal:** decreased blood flow and perfusion to the kidney
2. **intrarenal:** actual injuries to the kidney
3. **postrenal:** obstruction of urine outflow from the kidney
55
Describe thiazide diuretic:
-- action
-- indication
-- adverse effects
-- **action:** blocks chloride pump, increasing excretion of Na+, Cl-, H2O
-- **indication:** treatment of edema associated with HF, cirrhosis, corticosteroid or estrogen therapy, and renal dysfunction; treatment of HTN
-- **adverse effects:**
* GI upset
* CNS complications
* hypovolemia
56
Name one type of thiazide diuretic.
hydrochlorothiazide
57
Describe loop diuretics:
-- action
-- indication
-- adverse effects
-- **action:** blocks chloride pump in ascending loop of Henle
-- **indication:** treatment of edema associated with HF, acute pulmonary edema, and hypertension
-- **adverse effects:**
* hypokalemia
* volume depletion
* hypotension
* hyperglycemia
* GI upset
58
Name one type of loop diuretic.
furosemide
59
Describe potassium-sparing diuretics:
-- action
-- indications
-- adverse effects
-- **action:** blocks effects of aldosterone in renal tubule, causing loss of sodium and water, and retension of potassium
-- **indication:**
* treatment of hyperaldosteronism
* treatment of edema associated with HF, nephrotic syndrome, hepatic cirrhosis
* treatment or prevention of hypokalemia
-- **adverse effects:**
* hyperkalemia
* diarrhea
60
Describe osmotic diuretics:
-- action
-- indications
-- adverse effects
-- **action:** elevates osmolarity of glomerular filtrate, causing loss of water, sodium, and chloride
-- **indications:**
* prevention and treatment of oliguric phase of renal failure
* reduction of intracranial pressure -- treats cerebral edema
* diagnostic measurement of GFR
-- **adverse effects:**
* hypotension
* GI upset
* fluid and electrolyte imbalances
61
What is obstructive uropathy?
inability of urine to drain from the urinary tract; most common pathophysiological problem in the urinary tract
62
What are renal calculi?
kidney stones
63
Who commonly gets kidney stones? What is a common cause?
-- men 60+ years old
-- BPH common cause
64
What may occur if kidney stones obstruct the urinary tract for too long?
* prolonged obstruction leads to increased hydrostatic pressure in nephrons, decreasing GFR
* urine backs up into kidneys (hydronephrosis)
* results in nephron death -- nephron function does not recover
65
How common are UTIs in the US? What population experiences UTIs most frequently? What types of patients are at greater risk for developing UTIs?
-- 2nd most common infection in the US
-- females experience UTIs more frequently
-- patients with indwelling catheters or intermittent catheterization are at greater risk
66
What are some signs and symptoms of UTIs?
* urinary frequency
* urgency
* burning with urination -- associated with cystitis (inflammation of the bladder)
* chills, fever, flank pain, tenderness -- associated with acute pyelonephritis (kidney infection)
67
What organisms are the most common cause of lower UTIs?
* *E. coli*
* *Proteus* -- more commonly associated with catheterization or use of urinary instruments
* *Pseudomonas*
* *Klebsiella*
68
Where are bacteria normally located in a healthy urinary tract?
urethral opening only
69
What factor increases the risk of urinary tract infection?
stagnant urine
70
Name one type of potassium-sparing diuretic.
spironolactone
