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Pharm > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What do vitamins mainly help with?

A

Metabolism
Healing
Growth

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2
Q

Two types of vitamins

A

Water-soluble (C and B vitamins)

Fat-soluble (A, D, E, and K)

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3
Q

Water-soluble vitmains

A

Dissolve in blood

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4
Q

Fat-soluble vitamins

A

Must have carrier molecule

Stored in muscles liver and fat cells

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5
Q

Which type of vitamin is easier to become toxic with? Why?

A

Fat soluble

Because you are able to store it

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6
Q

Which type of vitamin is easier for the body to become deficient in?

A

Water soluble

It is easier for the kidneys to excrete

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7
Q

Who might need vitamins?

A 
Pregnancy - folic acid (prenatal)
Immunocompromised - cancer
Malnourished 
Osteoporosis - Vitamin C and Ca
Anemia - Iron and B vitamins
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8
Q

What vitamin help absorb iron?

A

Vitamin C (Ascorbic acid)

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9
Q

Which vitamin is given for Wernicke-Korsakoff Syndrome?

A

Vitamin B1 (Thiamine)

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10
Q

A deficiency of vitamin B9 will cause __

A

Birth defect - spina bifida

B9 (folic acid)

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11
Q

Who is most at risk for a vitamin B12 deficiency?

A

Older population and patients with GI disease and food allergies

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12
Q

What does B6 interact with?

A

Parkinson’s drugs

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13
Q

A patient cannot take a hyperlipidemic drug “-statins”. What would the nurse recommend to give the Pt. instead?

A

Vitamin B3

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14
Q

3 C’s related to Vitamin C

A

Collagen
Cold (immunity)
Collect iron

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15
Q

Wernicke-Korsakoff Syndrome

A

Loss of ability to talk

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16
Q

Who is most at risk for Wernicke-Korsakoff Syndrome?

A

Alcoholic

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17
Q

How much vitamin B9 (folic acid) would a pregnant women need to take in a day?

A

400-800 mcg

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18
Q

A patient comes in with weakness, tingling in hands and feet and complaints of mood swings. What may the nurses suspect the patient id deficient in?

A

Vitamin B 12 (Cyanocobalamin)

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19
Q

Vitamin E will increase what kind of lab?

A

PT time - causes bleeding

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20
Q

What vitamin will increase the risk for clotting?

A

Vitamin K

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21
Q

A patient comes into the ER hemorrhaging. The patient is taking Warfarin for their recent Dx of PE. What would the nurse anticipate to give the patient?

A

Vitamin K

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22
Q

Sign of vitamin A deficiency?

A

Night Blindness

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23
Q

What lab will the nurse check before admin of vitamin K?

A

PT and INR

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24
Q

What breaks down Vitamin K?

A

Bile

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25
Q

What patient will be at risk for vitamin K deficiency?

A

Gallbladder problems

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26
Q

What are mineral especially good for?

A

Bone health and blood formation

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27
Q

A patient who is deficient in vitamin E is at risk for ___

A

Clotting

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28
Q

What foods are rich in retinol?

A

Carrots, sweet potatoes, pumpkins, mangos, and spinach

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29
Q

What would you want to monitor on any patient receiving electrolytes?

A

Monitor the heart function

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30
Q

What patient would you caution when giving calcium supplement?

A

Cancer patient

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31
Q

Why does a pregnant women need an iron supplement?

A

Because the blood volume expands

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32
Q

Foods rich in iron

A

Red meats, Spinach, Oysters, fish

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33
Q

What patients are typically given a TPN?

A 
Pt. with GI/absorption disorders
Pt. who cannot eat
Long term bowel rest after surgery
Congenital disorders
Ventilator/Sedated - Critically ill
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34
Q

What kind of IV is TPN given through?

A

Central line

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35
Q

How often do you have to change the central line when giving TPN?

A

Every 24 hours

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36
Q

PUD

A

Group of upper GI disorders of varying degrees of the gut wall
Complicated by: hemorrhage and perforation

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37
Q

PUD causes:

A

Imbalance of the protection of the mucosal lining and aggravating factors

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38
Q

Protective factors

A

Mucus
Bicarbonate
Blood flow
Prostaglandins

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39
Q

GI ulcers cannot form without ___ ___

A

Gastric acid

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40
Q

A patient with H. pylori is more common to have ___ ulcers

A

Duodenal ulcers

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41
Q

Most common cause of gastric ulcers:

A

H. pylori

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42
Q

Second most common cause of gastric ulcers:

A

NSAIDS

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43
Q

What drugs may increase gastric pH?

A

Antacids, Histamine2-Antagonist, and PPIs

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44
Q

When the gastric pH is increased what is also increased?

A

Pepsin activity

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45
Q

Pepsin

A

An enzyme that contributes to ulcer formation by breaking down proteins in the gut wall

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46
Q

Risk factors for ulcer development

A

> 60 years old - natural body changes
Hx of ulcer disease
High dose NSAIDS
PPIs are preferred**

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47
Q

Goals of drug therapy

A

Get rid of H. pylori
Reduce gastric acidity
Enhance mucosal defenses

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48
Q

A patient comes in with severe GI upset. The MD decides that it is GI ulcers caused by H. pylori. What does the nurse anticipate the doctor to order?

A

Antibiotics (Two minimum should be used in conjunction) and either a PPI or Histamine 2 Receptor Antagonist

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49
Q

What test would the MD order for a person with suspected H. pylori?

A

Staining (Stool or serologic test)
Breath test
These are noninvasive tests.

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50
Q

H. pylori is highly sensitive to what antibiotic?

A

Amoxicillin

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51
Q

Antibiotics work best under high pH conditions. So what would the nurse want to administer in conjunction with an antibiotic to raise the gastric pH?

A

an anti-secretory agent PPI or H2 Receptor antagonist

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52
Q

What is the goal of an antibiotic regimen?

A

Minimize the resistance - use a minimum of 2 antibiotics together and up to 3

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53
Q

What are the first choice drugs for treating gastric and duodenal ulcers?

A

H2 receptor antagonist

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54
Q

IV bolus of Cimetidine can cause:

A

Hypotension and Dysrhythmias

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55
Q

What class of drugs is most effective for suppressing secretion of gastric acid?

A

PPIs

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56
Q

What population is at risk for PPIs adverse effects?

A

Older adults (Fractures, osteoporosis, pneumonia, acid rebound, C. Diff.)

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57
Q

What are the preferred drug to treat NSAID induced ulcers?

A

H2 receptor Antagonist and PPIs

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58
Q

When giving pantoprazole via IV the nurse should pay special attention to:

A

IV site reactions (Thrombophlebitis and abscess)

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59
Q

When giving pantoprazole PO what side effects are common?

A

Headache
Diarrhea
Pneumonia

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60
Q

What is the education involved for a Pt. who has gastric ulcers but refuses medications?

A

Traditional “anti ulcer” diet does not accelerate healing
Changing the Pt.s eating pattern to 5-6 small meals a day reduce pH flucuations
Avoid smoking, NSAIDS, aspirins, alcohol, and stress

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61
Q

A patient has undiagnosed abdominal pain. The MD suspects ulcers and orders Mg Hydroxide. What is the nurse’s next action?

A

Question the order - Mg Hydroxide should not be given to a Pt. with undiagnosed abdominal pain

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62
Q

A patient is on the unit for renal dialysis. They start developing indigestion and ask for Milk of Magnesia. What is the nurse’s next action?

A

Consult the MD - use antacid with caution with patients with renal impairments

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63
Q

A patient is currently taking Cimetidine and requests an antacid for indigestion. What is the nurse’s next action?

A

Educate that H2 receptors and Antacids have to be taken 2 hours apart because of their reactions to each other.

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64
Q

How long does sucralfate last?

A

6 hrs.

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65
Q

What are ACE and ARBs given for?

A

Hypertension

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66
Q

What are Beta blockers or Ca Channel blockers used for?

A

High BP OR HR

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67
Q

Vasodilators can be used for:

A

High BP or Chest pain

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68
Q

ACE inhibitors effect what system? And because of that, what lab would the nurse want to monitor?

A

RASS

Monitor K+ levels can cause hyperkalemia

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69
Q

A nurse is administering an ACE inhibitor. What may the nurse want to monitor when taking vitals?

A

BP and HR

Too low BP can cause the HR to go up and compensate

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70
Q

A patient is taking a ACE inhibitor. The nurse is doing her bedside assessment and notices large bruises on the forearm. What is the nurses next action?

A

Call the HCP and report the bruises. May want to switch to different drug.

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71
Q

What teaching may you want to provide to a patient on an ACE inhibitor?

A

Monitor BP at same time everyday and before admin
Take med at same time everyday
This is only an aid - want lifestyle changes
Avoid food high is K+
Use caution with OTC meds

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72
Q

A patient is taking an ACE inhibitor but also needs a cough med. The nurse knows that cough meds and perfusions meds are usually not compatible. What can the nurse recommend to the patient?

A

Coricidin is the only cough med that is compatible with antihypertensive drugs

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73
Q

A patient has hypertension and hyperkalemia. What antihypertensive would you except the HP to order?

A

Losartan

74
Q

A patient is taking Metroprolol at home and says that they forgot to take it the last few days. What is the nurse’s next action?

A

Assess for rebound hypertension

75
Q

A patient comes in with Prinzmetals angina. What med is most commonly used for that?

A

Ca Channel Blocker

76
Q

What major side effect should the nurse be concerned about with Ca Channel Blockers?

A

AV Heart block

77
Q

Caution Ca Channel Blockers in a patient with ___ ___

A

Heart failure

78
Q

A patient is currently having an irritating cough with sputum. The patient also take an ACE inhibitor. What is the nurse’s next action

A

Assess for CHF - wet cough sign of CHF

Dry cough normal with ACE inhibitors

79
Q

When giving nitroglycerin sublingual, the patient complains of burning under the tongue. What is the nurse’s next action?

A

Educate the burning is a normal side effect for SL nitro

80
Q

If nitro is giving SL for chest pain. How many doses can the nurse give? If pain is not treated within that range what does the nurse do next?

A

3 doses

The nurse needs to call the MD

81
Q

When giving nitro, the nurse should ask about __. Why?

A

Erectile dysfunction meds

B/c they cause vasodilation also

82
Q

If giving Hydralazine and the patient reports sudden flushing. The nurse should:

A

Educate that it is a normal side effect

83
Q

A patient is going home with a new prescription of Digoxin. What should the nurse educate the patient on before they leave?

A

Eat foods rich in K+: bananas, potatoes, avocados, leafy greens
Check pulse at home before admin
Make doc appt. to check levels

84
Q

What is considered toxic levels of digoxin?

A

> 2.0 nanograms

85
Q

Antidote for digoxin

A

Digibind

86
Q

What main adverse effect would indicate toxicity

A

Yellow-green halos

87
Q

Why would you give digoxin to a patient?

A

CHF

88
Q

How long should the nurse check the pulse and where would you check it before giving Digoxin?

A

for 1 min. apical pulse

89
Q

If a patient cannot tolerate a “-statin” what can the nurse suggest for the patient to lower LDLs

A

Vitamin B3

90
Q

What adverse effects will the nurse educate the patient about when giving an antilipidemic?

A

Liver impairment
Rhabdomylosis
Cateracts

91
Q

When a patient on an antilipidemic reports muscle pain. What is the nurse’s next action?

A

Call HCP and get them changed to a different drug.

92
Q

Anticoagulants

A

disrupt the coagulation cascade thereby suppressing the formation of fibrin

93
Q

Antiplatelet

A

Inhibit platelet aggregation

94
Q

Thrombolytics

A

Promote lysis of fibrin causing dissolution of thrombi

95
Q

What is the preferred anticoagulant for a woman who is pregnant?

A

Heparin

96
Q

What is the antidote for Heparin and Enoxaparin?

A

Protamine Sulfate

97
Q

What lab would you want to monitor for heparin?

A

PTT

98
Q

What major side effect would the nurse want to monitor when giving Heparin and Enoxaparin?

A

Thrombocytopenia

99
Q

A pregnant patient is admitted to the unit for a DVT. The MD orders Warfarin as an anticoagulant. What is the nurse’s next action?

A

Question the order - Warfarin causes fetal harm, suggest Heparin

100
Q

A patient on the unit is currently having a stroke. What anticoagulant is most appropriate for this situation?

A

Heparin - rapid acting

101
Q

What meds do anticoagulants usually react to?

A

Each other and Antiplatelets

102
Q

What is the antidote for Warfarin?

A

Vitamin K

103
Q

What lab would you want to monitor for Warfarin?

A

PT and INR

104
Q

A patient is taking warfarin, Tylenol for fever, and Aspirin for chest pain. What is the nurse most concerned with?

A

All three of these taken together increases the risk for bleeding enormously

105
Q

A patient taking warfarin also taking an oral contraceptive. What does the nurse need to educate this patient on the effects of these drug interactions

A

Oral contraceptive decrease the effects of warfarin

106
Q

Food that are rich in vitamin K

A

Mayo, Soybean oil, Canola oil, green leafy greens

107
Q

A patient is being discharges after being admitted for PE. What does the nurse suspect the patient to be discharged with? Heparin/Warfarin?

A

Warfarin - more maintenance therapy

108
Q

What two drugs have no friends?

A

Promethazine and Clopidogrel (plavix)

109
Q

Which anticoagulant is irreversible?

A

Dabigatran

110
Q

True/False: Enteric coated aspirin will decrease the risk for GI bleed.

A

False, they do not. The risk for GI bleed is the same

111
Q

Aspirin should/should not be taken with food?

A

Should

Adverse effect: GI bleed - food decrease risk

112
Q

First gen antihistamines cause a major side effect ___

A

Sedation

113
Q

Second gen antihistamines were developed because they do not cause ___

A

Sedation

114
Q

How long should you use decongestants for?

A

3-5 days

115
Q

What could happen if you use a decongestant for more than 5 days?

A

Rebound nasal congestion

116
Q

A patient come in to the clinic who has been taking a decongestant but complains that sneezes haven’t stopped. What is the nurse’s next action?

A

Educate that decongestant only relieve stuffiness, not other symptoms of colds (sneeze, cough, sputum)

117
Q

What class of drug is most effective for treating allergic rhinitis?

A

Glucocorticoids

118
Q

What major side effects is the nurse most concerned about?

A 
Adrenal insufficiency (Addison's Disease)
Hyperglycemia
119
Q

True/False: Glucocorticoids are taken PRN

A

False, they are on routine basis, must be taken everyday to feel effects

120
Q

What population is at risk for taking Glucocorticoids?

A

Children - cause delay in growth

121
Q

What would the nurse want to monitor for a patient on Glucocorticoids?

A

Urine output

Blood sugar

122
Q

What would the nurse want to monitor if a patient is taking Codeine?

A

Respiratory depression

123
Q

What adverse effect does Dextromethorphan (non-opioid antitusssive) cause?

A

Euphoria

124
Q

Antitussives should be cautioned is what population?

A

Children under 4 years old

125
Q

True/False: Banzonatate can crushed is the patient cannot swallow

A

False: Never crush, chew, ope, puncture tablets.

126
Q

What should the nurse further assess when the patient is prescribed an antitussive?

A

The patient’s OTC meds. Educate that cough meds may have the same drugs in it as another. Should not take two together. May get more drug than realize

127
Q

Guaifenesin is used for patient who can/cannot swallow?

A

Can swallow

128
Q

What population would you want to avoid giving Guaifenesin to?

A

Older adults
Pt. on fluid restrictions
Aspiration precautions

129
Q

What population would you want to avoid giving Acetylcysteine to?

A

Patients who are allergic to sulfa

130
Q

What major education point would you provide to a patient taking Guaifenesin?

A

Drink lots of fluid!

131
Q

A patient is experiencing a Tylenol overdose. What would you give the patient?

A

Acetylcysteine

132
Q

A patient has a history of asthma. Currently not having an acute attack but needs a maintenance drug to suppress symptoms. Which of the follow would you suspect the MD to order: Prednisone, Beclomethasone, or Dexamethasone?

A

Beclomethasone is used on a fixed schedule as a MDI for non emergent maintenance for asthma

133
Q

Why do you have to taper glucocorticoids?

A

To prevent adrenal insufficiency

134
Q

What is the patient at risk for when taking a glucocorticoid PO?

A

GI ulcers

Watch for bleeding (black tarry stools, coffee grounds in emesis)

135
Q

What is the patient at risk for when taking a glucocorticoid MDI?

A

Candidiasis infection

Educate to rinse mouth after use to prevent

136
Q

What drug treats Candidiasis infection?

A

Mycostatin

137
Q

Who is at risk when taking glucocorticoid?

A

Diabetics

138
Q

What route is most effective for long term asthma Tx?

A

MDI

139
Q

What are adverse effects for Montelukast?

A

Mood swings and suicidal ideations

140
Q

What populations will you use caution in administering Montelukast

A

Children, Hx of depression, suicide and psych probs, Use of SSRI, and cardiac probs

141
Q

Major side effects of Epinephrine

A

Palpitation, Nervousness, Dysrhythmias, and hyperglycemia

142
Q

What Beta 2 Adrenergic Agonist is use for maintenance?

A

Salmeterol

143
Q

What Beta 2 Adrenergic Agonist is use for emergencies?

A

Albuterol

144
Q

Which Beta 2 Adrenergic Agonist effects K+?

A

Albuterol

145
Q

What Beta 2 Adrenergic Agonist should be used with a glucocorticoid?

A

Salmeterol (Beclomethasone)

146
Q

Which one would you take first: Bronchodilator or glucocorticoid?

A

Bronchodilator first so the glucocorticoid (Anti-inflammatory) can do its job

147
Q

What patient population should you avoid giving Ipratropium to?

A

Pt. with glaucoma

148
Q

What is the therapeutic range for Theophylline?

A

10-20 mcg/mL

149
Q

What must you assess before giving Theophylline?

A

Peaks and troughs

150
Q

A patient presents to clinic. They take Theophylline and just drank a whole pot of coffee. What should the must assess for?

A

Toxicity - N/V/D, dysrhythmias, seizures, death

151
Q

You just administered one puff of beclomethasone. How long should you wait before administering another dose?

A

1 min.

152
Q

How long should you wait between administering a bronchodilator and a glucocorticoid?

A

5 min.

153
Q

Electrolyte imbalance that increases the levels of Digoxin

A

Hypokalemia

154
Q

Ending of beta-blocker drugs

A

“-olol”

155
Q

Digoxin is withheld if apical pulse is below ___

A

60 beats/min

156
Q

Beta blockers cannot be discontinued due to this potential untoward effect

A

Rebound hypertension

157
Q

Most common side effect of Nitro

A

Headache

158
Q

An electrolyte imbalance associated with clients taking ACE inhibitors and K+ supplements

A

Hyperkalemia

159
Q

A common side effect of this class of drugs is nonproductive cough

A

ACE Inhibitors

160
Q

This drug can be given up to 3 doses for chest pain

A

Nitro

161
Q

Blood sugar should be monitored closely in patient with diabetes taking this class of drugs

A

Beta blockers

162
Q

A type of beta blocker that is contraindicated in patient that have asthma or COPD

A

Nonselective

163
Q

A potential life threatening side effect of statins characterized by skeletal muscle pain and weakness

A

Rhabdomyosis

164
Q

A Digoxin level above 2.0 nanograms/mL is considered ___

A

Toxic

165
Q

A potential fatal side effect of ACE inhibitors

A

Angioedema

166
Q

A class of lipid lowering drugs that can be toxic to the liver

A

“-statins”

167
Q

This antidysrhythmic requires a baseline pulmonary evaluation, chest x-ray, liver function test, and thyroid function test

A

Amiodarone

168
Q

This class of drugs end in “-sartan”

A

ARBs

169
Q

Syptoms of drug toxicity of this drug includes: N, halos, and different colored lights

A

Digoxin

170
Q

The most effect drug for ling term control of asthma

A

Glucocorticoids

171
Q

Systemic Glucocorticoids must be tappered in order to avoid this

A

Adrenal insufficiency

172
Q

The name of the drug that is a leukotriene receptor agonist and can cause mood swings

A

Montelukast

173
Q

This drug stimulates the flow of secretions in the respiratory tract

A

Guaifenesin

174
Q

A type of response that requires prior exposure that stimulates the production of IgE antibodies

A

Allergic

175
Q

The nurse should assess these before and after nebulizer treatment

A

Breath sounds

176
Q

An expected, common side effect of a beta2 adrenergic agonist

A

Tachycardia

177
Q

An example of a short acting beta 2 adrenergic agonist that is a rescue inhalation med

A

Albuterol

178
Q

First line therapy for anaphylaxis

A

Epinephrine

179
Q

First gen antihistamine that may have a paradoxical effect (CNS stimulation) in children

A

Diphenhydramine

180
Q

The most effective cough suppressant agent or ingredient prescribed

A

Codeine

181
Q

A severe allergic reaction characterized by bronchoconstriction, hypotension, and edema of glottis-histamine plays a minor role

A

Anaphylaxis

Pharm (4 decks)

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