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Exam 2 Flashcards

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1
Q

Albuterol is a ____ which is a ____. It is used for

A

Beta 2 Adrenergic Agonist; Bronchodilator (opens up lungs)

Used for managing bronchospasms with asthma

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2
Q

Who shouldn’t use Albuterol?

A

Those with uncontrolled hypertension, cardiac dysrhythmia, high risk of stroke

It raises your BP, which can affect any of these heart issues!

Also those who are beta blockers or ingest lots of caffeine! Again, jitters, high BP, etc.

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3
Q

AE of Albuterol if used too often

A

Jittery! Anxiety, palpitations, tremors, tachycardia (again, it raises BP)

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4
Q

Should a beta 2 adrenergic agonist come before or after glucocorticoid? Why?

A

Beta 2 and then glucocorticoid.

Beta 2 opens the lungs and then glucocortoids come in to settle inflammation

Albuterol and then Beclomethasone Dipropionate (All buts before meth)

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5
Q

Ipratropium (Atrovent) is a ____ and is used for____

A

Inhaled anticholinergic; Bronchoconstriction associated with COPD

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6
Q

Ipratropium may cause ____ and shouldn’t be used on those who have ___

A

Dry mouth/hoarseness

Glaucoma, benign prostatic hyperplasia (enlarged prostate gland!), or bladder neck obstruction

Or those taking other anticholinergics (additive effect)

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7
Q

What is the rescue emergency asthma drug?

A

Beta 2!

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8
Q

How do you instruct someone to take an inhaled anticholinergic?

A

Wait 1-2 minutes between doses
Wait 5 minutes before using another inhalent

NOT RESCUE DRUG

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9
Q

Theophylline is a _____ and is taken _____ to treat ____ (remember therapeutic level!)

A

Methylxanthine (anything starting with Theo); taken in pill form to treat asthma long term (bronchodilator)

Therapeutic level - 5-15 mgc/mL (above 15 = AEs - anxiety, insomnia, tremors, seizures, tachyarrhythmias)

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10
Q

Who should not take Theophylline?

A

Those with uncontrolled cardiac dysrhythmias, seizures, hyperthyroidism, or peptic ulcers

Also those who love caffeine*, char broiled foods, high protein and low carb diets, and smoking

*structurally similar to caffeine! makes sense

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11
Q

Beclomethasone Dipropionate is a _____ which is used for ____

A

Glucocorticoid; Long term management of chronic asthma (suppresses inflammation; used after beta 2)

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12
Q

Beclomethasone Dipropionate patient education

A

Oral candidiasis - use spacer and rinse mouth
Use on a regular schedule
Do not use for acute attack (rescue is beta 2)

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13
Q

Montelukast is a ______ and is used for _____ (know how to take for each)

A

Leukotriene modifier; chronic asthma (pm daily), to prevent exercise induced asthma (2 hrs before), or allergic rhinitis (Most common use)

Not PRN for acute attacks

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14
Q

Montelukast interacts with

A

Phenytoin, Phenobarbital, Rifampin

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15
Q

Diphenhydramine is a _____ (know MOA) while Cetirizine is a ____

A

Diphenhydramine (Benadryl) = Sedating antihistamine; binds to H1 receptors
- sedating, take at bedtime - don’t take with CNS depressants! also fall risk

Cetirizine (Zyrtec) = Nonsedating antihistamine; does not bind to H1
- once a day AM, some people are weird and can still get drowsy, monitor!

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16
Q

Diphenhydramine is used for ____

Cetirizine is used for ____

A

Mild allergic reactions, severe anaphylactic reactions, motion sickness, insomnia

Allergic rhinitis and hives (urticaria)

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17
Q

Anticholinergic effects

A

Can’t see, can’t pee, can’t spit, can’t shit!

This happens with Diphenhydramine and very mildly with Cetirizine

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18
Q

Cetirizine interacts with

A

Theophylline and other antihistamines

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19
Q

Phenylephrine is a ____ given via ____ and treats ___

A

Sympathomimetic; Nasal spray; Decreases nasal congestion r/t allergic rhinitis, sinusitis, common cold

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20
Q

Phenylephrine should not be given to those with

A

Chronic rhinitis*, glaucoma, heart disease, HTN, dysrhythmia

*not meant long term (3-5 days; can cause rebound nasal congestion which leads to abuse)

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21
Q

Codeine is a _____ used for _____; contraindicated for

A

Antitussive (opioid! AE and interactions related to this); NON-productive cough r/t allergies or URI

Chronic (b/c opioid) asthma, emphysema, liver/renal disease, acute alcoholism

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22
Q

Dextromethorphan is a ____ used for ____

AE

A

Antitussive (not opioid despite -meth); NON-productive cough r/t allergies or URI

Can still cause CNS depression in large doses (still avoid opioids)

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23
Q

Guaifenesin is a ____ which makes you ____ (used for)

A

Expectorant (Mucinex); cough up stuff so used for productive coughs r/t colds, URI, bronchitis, pneumonia

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24
Q

Guaifenesin patient education

A

Increase fluid intake to thin mucus (easier to cough up)

Be careful with OTC cold products, may contain Guaifenesin as well

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25
Acetylcysteine is a ____ given via ____, which does what?
Mucolytic, given via nebulizer; decreases viscosity of mucus (easier to cough up)
26
Acetylcysteine is used for ___ but should be avoided by ____ (think of AE)
Bronchopulmonary disease and CF, and is antidote to acetaminophen overdose those at risk of/have GI bleed, or severe respiratory insufficiency (decreases thickness of mucus but increases amount of liquid/bronchial secretions in chest)
27
Nursing considerations for Acetylcysteine
Have suction ready (lots of fluid to be sucked out!) Monitor/assess respirations frequently! Tell pt about sulfur smell Make sure nebulizer doesn't have any metal or rubber parts (degrades those)
28
What is the MOA of all insulins?
Replaces endogenous insulin (insulin made by the body) and regulates glucose metabolism
29
``` Name, onset, peak and duration of all insulins Rapid Short Intermediate Long ```
Rapid: 15 min, 1-2 hrs, 3-5 hrs (Lispro) Short: 30-60 min, 2-3 hrs, 6-10 hrs (Regular) Intermediate: 1-2 hrs, 4-8 hrs, 10-16 hrs (Isophane suspension) Long: 1-2 hrs, duration 5-6 hrs, up to 24 with high doses (Lantus)
30
Pramlintide is used for ____ and peak onset is ____
Type 1 and 2; within 20 minutes
31
Exenatide is used for ____ and peak onset is ____
Type 2; 2 hrs after dosing
32
What should not be mixed in the same syringe as insulin?
Pramlintide
33
When should Exenatide be given?
60 minutes before morning and evening meals
34
Oral antidiabetics are indicated for ____, and can cause ____
Type 2; hypoglycemia, weight gain, GI discomfort
35
Metformin is a ____; nursing considerations
Oral antidiabetic D/C 24 hrs before CT or MRI b/c contrast dye and drug are too much for kidneys to process Can cause serious GI AE
36
Pioglitazone (Actos) is a ____; what is the black box warning?
Oral antidiabetic Exacerbates CHF
37
Glipizide (Glucotrol) is a ____ that treats ____
Oral antidiabetic Type 2 (second step after Metformin)
38
What are the advantages of glipizide?
Onset is 1 hr (fast), low cost, high A1C efficacy
39
Glipizide interactions
Sulfonamide antibiotics - glip reduces effect of this | Alcohol - reduces effect of glip
40
Metformin advantages
Rarely causes hypoglycemia, reduces chance of CV events, low cost, high A1C efficacy
41
Pioglitazone should be combined with ___ because
Other oral antidiabetic because it can take up to three months to show results
42
Pioglitazone interactions
Many! | Insulin, Gemfibrozil, Ketoconazole, Green tea, Ginseng, Garlic
43
Glucagon is a _____ that is given ____ and is for ___
Glucose elevating drug IV, IM, subQ For nonresponsive hypoglycemic pts
44
Levothyroxine is a ____ which is contraindicated in ____
Thyroid replacement drug Recent MI pts and thyrotoxicosis
45
Levothyroxine AEs Interactions
Usually b/c of excessive doses Causes s/s of HYPERthyroidism Interacts with many that effect absorption of levo
46
Levothyroxine nursing considerations
Have pt take it on an empty stomach, 30-60min before breakfast Takes up to 6 weeks to have therapeutic effects Dosed in mcg!!! Monitor serum TSH and free thyroid levels to know if thyroid function is increasing (this is the goal)
47
Antithyroids are ___ and ___ Both are contraindicated in ____ and AEs are ____
Propylthiouracil (PTU) and Iodine 131 (Iodotope) Contraindicated in pregnancy Adverse effects of liver and bone marrow toxicity, agranulocytosis
48
Nursing considerations for antithyroids
Both - Monitor CBC at baseline and throughout treatment (b/c they can cause agranulocytosis which is similar to neutropenia) PTU - takes about 2 weeks for symptoms to improve Iodine 131 - avoid sleeping in the same bed as someone, kissing, or crowds, as you might contaminate other people (radioactive isotope)
49
Adrenal drugs good and bad
Good - Anti-inflammatory - Immunosuppressant - Resp. illness - Replacement therapy for Addison's disease Bad - Glaucoma and cataracts - Moon face - High BS - Increased risk of infection - Osteoporosis and fractures (in long term use)
50
Adrenal drugs are ____ and ____
HydroCORTIsone and FludroCORTIsone Corticosteroids
51
Adrenal drugs nursing considerations
TAPER OFF Can cause adrenal suppression No aspirin (additive GI effects) or antidiabetic drugs (leads to elevated BS)
52
Iron deficiency anemia drugs are ___ and ____ which are given to ____ and (who)
``` Ferrous Sulfate (PO - tablet or liquid) Iron Dextran (IV or IM) ``` Treat or prevent iron deficiency anemia (treats blood loss or inadequate intake; prevents in infants/children, pregnant people)
53
Iron deficiency anemia drugs nursing considerations
Do NOT give to pts who have other types of anemia | Interactions are many; know what decreases and increases iron absorption
54
PO forms of iron deficiency anemia drugs
Tablet - Spread doses out evenly across waking hours - Give on empty stomach for best absorption, but can take with food to avoid GI upset (BUT NOT MILK) - Do not crush or chew sustained released Liquid - Dilute in compatible liquid - Use straw (avoids stained teeth) - Rinse mouth with water - Provide hard candy or gum
55
IV/IM forms of iron deficiency anemia
Give test dose to check for hypersensitivity; real dose after 1 hr Use 2-3 in needle and Z track method Bolus no faster than 12.4mg/min Dilute intermittent infusion to 250-500 mL and run no faster than 50 mg/min Monitor BP
56
Iron toxicity/overdose
300 mcg/dL = serious risk Symptoms - N/V, ABD pain, dizziness, hypotension, HA For serious - Coma, shock, seizures Treatment is treating symptoms and supportive measures
57
Vit B12 deficiency drugs indications (if you say vit B12 def. I will come for you)
Pernicious anemia which is caused by a lack of intrinsic factor or vit B12 def.
58
Vit B12 def. drugs AE Interactions
Diarrhea and HYPOkalemia Folic acid - can mask s/s of vit B12 def. Alochol, cimetidine, colchicine, aminosalicylic acid
59
Vit B12 def. drug forms
Intranasal and parenteral - best for pts with malabsorption syndrome Intranasal - give 1 hr before/after hot foods PO - give with food to enhance absorption
60
Vit B12 def. drugs pt education
Expect life long treatment (for those that have irreversible deficiencies) Eat foods high in B12 (dairy, cereal, egg yolks) Monitor potassium levels and encourage supplement
61
Folic acid is a _____ used for ____ Is NOT used for
Antianemic drug Folate deficiency Macrocytic anemia Pregnancy Vit B12 def., other types of anemia, neonates
62
Folic acid AE/Nursing considerations
Flushing/warm sensation with IV (this is normal) Bright yellow urine (this is also normal) Give IV SLOW (30-60 seconds or with fluids) Encourage foods high in folate (green veggies, liver, some cereals, lentils) Get baseline labs
63
Epoetin Alpha is a _____ used for _____. It works by
Antianemic drug Chronic renal failure Zidovudine (HIV treatment) Preoperative anemia Chemotherapy Stimulating the production of RBCs in the bone marrow
64
Epoetin Alpha is contraindicated for AEs
``` Uncontrolled HTN Some malignancies (It can stimulate cancer growth) Iron deficient anemia ``` Hypertension CV events Progression of some malignancies
65
Epoetin Alpha nursing considerations
Obtain baseline for BP, Hgb, Hct, erythropoietin levels Make sure BP is controlled Only give to cancer pt who's Hgb is less than 10
66
The antirheumatic drugs are ____ and _____ Teaching for both
Methotrexate Etanercept Avoid crowds Report signs of infection Don't give to pts with infection
67
Methotrexate is used for
Cancer and RA (lower dose used for RA than cancer)
68
Methotrexate nursing considerations
Depresses immune system - DON'T GIVE to pt with infection Suppresses bone marrow 6ish weeks for therapeutic effects
69
Etanercept is used for
Adult and juvenile RA
70
Etanercept nursing considerations
If pt is on this med don't give live vaccines SubQ - hypersensitive reactions are common 3-6 weeks for therapeutic effects

Pharm 2 (2 decks)

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