Exam 3 Section (50% of Questions) Flashcards
1
Q
Seizure meds do NOT
A
cure
2
Q
Epilepsy is seizure activity that is
A
chronic and recurrent
3
Q
Examples of single-instance seizure
A
febrile seizure; kids, hypoglycemia, alcohol and drug abuse, overdose, withdrawal
4
Q
With single-instance seizure, we must treat the
A
underlying cause
5
Q
Tonic-clonic seizures are
A
the most common type of generalized seizure
6
Q
generalized seizures involve both hemispheres and involve
A
loss of consciouness, bilateral and symmetrical
7
Q
What does the tonic in tonic-clonic seizure imply?
A
sustained contraction of skeletal muscles—patient can’t even take a deep breath—fear of hypoxia; what causes patient to fall to floor
8
Q
What does the clonic in tonic-clonic seizure imply?
A
rapid rhythmic jerking motion
9
Q
Absence seizure—petit mal
A
last only a minute or so—blank stare
10
Q
Atonic seizure
A
sudden loss of muscle tone
11
Q
Febrile seizure
A
convulsions brought on by a fever in infants or small children
12
Q
Partial seizures involve
A
one hemisphere and don’t involve loss of consciousness
13
Q
Complex partial seizure characteristics
A
smacking lips or pacing back and forth
14
Q
Antiseizure medications/AEDs prototype
A
Phenytoin (Dilantin)
15
Q
Phenytoin (Dilantin) is the ___ drug of choice
A
first — is the oldest and most widely used
16
Q
Phenytoin (Dilantin) is used to treat
A
Tonic-Clonic seizures
17
Q
Phenytoin (Dilantin) mechanism of action is
A
Na Channel Blocker
the influx of sodium causes an action potential that causes the neurons to fire
Will raise the seizure threshold—raises the level of stimulation required to initiate a seizure
18
Q
Phenytoin (Dilantin) Contraindications (4)
A
- Bradycardia
- Heart block
- Allergy to med
- CNS depression
19
Q
When is used Phenytoin (Dilantin) used prophylactically?
A
before surgery to reduce chances of post op seizures
20
Q
Patients can be kept on Phenytoin (Dilantin) for what amount of time?
A
6 months to a year
21
Q
One of main issues with anti-seizure meds is
A
non-compliance
22
Q
Gingival hyperplasia is when
A
gums hypergrow can almost cover the teeth especially with kids—must see dentist every 6 months
23
Q
Phenytoin (Dilantin) can be mixed only with ____, and not with ____
A
Phenytoin (Dilantin) can be mixed only with normal saline not with dextrose
24
Q
3 Black box warnings for Phenytoin (Dilantin)
A
- Category D for pregnancy
- Must be given slowly!—if IV push, pull up a chair, have a seat, and do it slowly
- Higher risk of suicide
25
When patients are seizing, you can use both dilantin and benzo, but not in the
same syringe
26
Serious ADE for Phenytoin (Dilantin) - 2
1. Stevens-Johnson Syndrome
| 2. Hepatotoxicity
27
patients with DM might need ___ if given Dilantin
increased diabetes medication
28
Benzodiazepines prototype
Prototype: Diazepam (Valium)
29
How do benzos work? What are some examples?
Enhances GABA
alprazolam (Xanax)
chlordiazepoxide (Librium)
clonazepam (Klonopin)
diazepam (Valium)
30
Clonazepam (Klonopin) treats ___ seizures
absence
31
Lorazepam (Ativan) is used as a ___ treatment for seizures
long-acting
32
Epilepsy patients are not prescribed benzos for daily use, only to
stop seizures like status epilepticus
33
status epilepticus
dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them
34
Long acting barbiturate prototype
Phenobarbital
35
Main cause of status epilepticus
is cold-turkey stopping meds
36
Nursing care for patients with seizures:
- Ask if have ever had a seizure
- How long
- When was last seizure
- Does anything precipitate it
- Risk for injury
- Noncompliance with meds
37
Nursing interventions for patients with seizures:
- Observe and document
- Do not restrain the patient
- Clear other things away
- Loosen clothing around neck
- Only use padded tongue blade if patient says I’m seizing
38
ONLY use padded tongue blade
BEFORE the patient starts seizing
39
most tonic-clonic seizures are over in
less than 2-3 min
if they’re not, call the rapid response team (if it gets near 3 minutes)
40
Main point of patient teaching for patients on anti seizure medications is
DON’T STOP THE MEDICATIONS unless you have specific instructions from HCP for how/with
41
Mr. Grover is a 62-year-old police captain. He is hospitalized for thrombophlebitis of the right leg and a r/o (rule out) pulmonary emboli. He is on Heparin 10,000 units IV drip every 6 hours.
Mr. Grover develops epigastric-burning pain between his meals and his HCP orders:
Tagament 300 mg IV every 6 hours
Amphogel 30 mL PO between meals and HS (bedtime)
What specific assessment will you want to make after he takes the Amphogel?
Assess pain levels
42
Mr. Grover is a 62-year-old police captain. He is hospitalized for thrombophlebitis of the right leg and a r/o (rule out) pulmonary emboli. He is on Heparin 10,000 units IV drip every 6 hours.
Mr. Grover develops epigastric-burning pain between his meals and his HCP orders:
Tagament 300 mg IV every 6 hours
Amphogel 30 mL PO between meals and HS (bedtime)
With regard to the Amphogel, what adverse effect will you assess him for?
Constipation
43
At 1PM, after lunch, Mr. Grover vomits a small amount of bright red blood. You have notified Mr. Grover’s HCP regarding this new development and she has scheduled Mr. Grover for an upper endoscopy in the morning.
In the meanwhile, what are you going to do about his 2 pm Amphogel dose and why?
Hold because it’s an oral med and he just threw up
44
At 1PM, after lunch, Mr. Grover vomits a small amount of bright red blood. You have notified Mr. Grover’s HCP regarding this new development and she has scheduled Mr. Grover for an upper endoscopy in the morning.
What should be done about his 6PM Tagament dose and why?
Give it because it’s IV
45
At 1PM, after lunch, Mr. Grover vomits a small amount of bright red blood. You have notified Mr. Grover’s HCP regarding this new development and she has scheduled Mr. Grover for an upper endoscopy in the morning.
What should be done about his 6pm Heparin dose?
Hold it
46
Peptic and ulcer disease occurs in any areas that are
exposed to HCL acid and pepsin
47
In GERD: heartburn, reflux brings HCL and pepsin up to the
lower part of the esophagus
48
What are the two medications that are most commonly associated with ulcers?
1. Aspirin
| 2. non-steroidals
49
Main causes of ulcers (5 categories)
1. stress
2. major trauma
3. major systemic infections
4. stroke, MI, head trauma
5. smoking
50
2 types of medications for the GI tract
1. cell destruction
| 2. cell protection
51
3 methods of Cell Destruction medications
1. Gastric acid (HCL): Acetylcholine and Histamine II
2. Pepsin
3. H. Pylori
52
5 methods of Cell protection medications
1. Mucus
2. Dilution of HCL acid
3. Tight esophageal sphincter
4. Cytroprotective prostaglandins
5. Alkalization
53
H Pylori is the bacteria found in about ___ % of gastric ulcers and ___ % of duodenum ulcers
75; 90
54
For acetylcholine, think
- "wet" - released by PSNS
- acetylcholine can be produced within GI tract by mere thought of food
- receptors for this are in the pyramidal cells
- also have receptors for histamine II, causing more gastric acid to be released
55
5 Types of Anti-ulcer Meds:
1. Antacids
2. Ulcer adherent
3. Histamine II Receptor Blockers
4. Proton Pump Inhibitors
5. H. Pylori Agents
56
Antacids are alkaline solutions that
neutralize acid
57
Antacids prototype:
Aluminum + Magnesium: Maalox, Mylanta (Gelusel, Di-Gel)
58
Aluminum Hydroxide:
Amphogel
59
Amphogel is very often used by the patients that have chronic renal failure because
they have difficulty removing and getting rid of phosphates that are in food
60
Magnesium Hydroxide:
MOM -- Treats constipation, upset stomach, or heartburn. This medicine is a laxative and an antacid.
61
Sodium Bicarbonate: Alka-Seltzer and Bromo-Seltzer is high in sodium, so it's NOT for patients who have
HTN or heart disease
they either need another type of antacid or a low-sodium option
62
All antacid mediations are made for ___ use
short term (weeks) -- NOT years
63
Antacids bring HCL up above pH of
3.5
64
When patients have ulcers they often describe the pain as
burning
65
Patients don’t want to take antacid along with other medications because
antacids will decrease the absorption of other medications
ideally they should take them 2 hours apart (meds first, then 2 hours later, antacids)
66
DO NOT GIVE digoxin and calcium channel blocker at the same time as
antacids
67
Directions for taking antacids
1. Drink down antacid
2. then drink a full 8 oz glass of water which will help the antacid to get down to where it needs to be and not interfere with pH at all
3. Most patients do better taking antacids 1 hour after meals (this will help the effect last for about 3-4 hours)
68
Antacids can cause ___ because of aluminum or ___ because of magnesium
constipation; diarrhea
69
Ulcer Adherent prototype
sucralfate (carafate)
70
sucralfate (carafate) is the least popular because it has a
very cumbersome schedule (1 hour before eating and at bedtime for at least 4-8 weeks)
71
if given with meals or antacids, sucralfate (carafate) will
lose its effectiveness
72
Histamine 2 blockers will antagonize or block the histamine, which will
prevent the secretion of gastric acid, which decreases the acidity and amount of gastric acid
73
Histamine 2 Receptor Blocking Agents Prototype:
Cimetidine (Tagamet)
74
Histamine 2 receptor blocking agents (prototype: Cimetidine (Tagamet)) are used to
prevent and treat stress ulcers
75
histamine 2 receptor blocking agents (prototype: Cimetidine (Tagamet)) are not used very often because they
interfere so much with so many medications
76
You would not want to give histamine 2 receptor blocking agents (prototype: Cimetidine (Tagamet)) to a patient with
kidney or liver disease
77
Proton Pump Inhibitors (PPIs) prototype
Omeprazole (Prilosec)
78
Prilosec is the __ drug of choice, and there are about ___ $ in sales
first
100 million prescriptions written a year for these- $13.9 billion in sales
79
Omeprazole (Prilosec) is recommended for what length of time?
recommended for 8-12 week use ONLY
80
long term risks associated with Omeprazole (Prilosec)
- increased risk for bone loss
| - increased risk for developing C. Diff
81
Omeprazole (Prilosec) works by
preventing or stopping the “pumping” or release of gastric acid
82
When can you take Prilosec?
Right before meals - it's very well absorbed
83
H. Pylori Agents are a combination of:
Antibiotic + PPI
antibiotic can be 2 of the 4:
1. Amoxicillin
2. Clarithromycin (Biaxin)
3. Metronidazole (Flagyl)
4. Tetracycline
and then a Proton Pump Inhibitor or a H2 blocker
84
Prevpak consists of
1 Lansoprazel (Prevacid),
2 Amoxicillin,
1 (Clarithromycin (Biaxin)
more expensive but better compliance since everything is in one package
85
Laxative results in
Mild effects w/ the formation of soft stool
86
Cathartic results in
Strong effect w/ elimination of liquid or semi-liquid stool
87
Colace is often given to patients who
we don’t want to be bearing down to go to the bathroom, such as patients with increased ICP, recent MI
88
Saline cathartic is often given
before a colonoscopy
89
Irritant or stimulant cathartics are the most abused because of the incorrect belief that
you must have a bowel movement every day
90
As soon as someone gets on an opiate, they should start
increasing fluid and fiber in their diet
91
patients on anticholingerics tend to be
constipated
92
3 main contraindications for laxatives and cathartics
1. Abd pain of unknown origin
2. Bowel perforation
3. GI obstruction
93
most of the time, diarrhea is self-limiting, which means
it stops in 12-48 hours
94
Causes of diarrhea (7)
- Excessive use of laxatives
- Intestinal infection
- Highly spiced foods
- Lack of digestive enzymes
- Inflammatory bowel disease
- Drug therapy
- Intestinal cancer
95
Anti-diarrheal specific therapy includes
antibiotics and digestive enzymes
96
Anti-diarrheal Opiate derivatives (2)
- Diphenoxylate HCL w atropine sulfate (Lomotil)
| - Ioperamide (Imodium)
97
Anti-diarrheal miscellaneous
- Bismuth Subsalicylate (Pepto-Bismol, Kaopectate)
98
BRAT diet for anti-diarrheal
bananas, rice, applesauce, tea/toast
99
We don't want to stop diarrhea if it's from
toxic substance (food poisoning or some such) - need fluids and just to get it out
100
Always assess for bowel sounds before you give
anti-emetics
101
Dramamine and the anticholingeric Scopolamine are commonly used for
motion sickness
102
Zofran is a very common anti-emetic in the hospital, and is great for patients who have n/v because of
surgery or chemo
103
Anti-emetics work best when given
ahead of time
104
if the patient is coming in for chemo and you know it’ll cause n/v, most places will dose the patient will dose the patient with Zofran ___ hr before chemo
30 min-1 hour
105
Benzodiazepines in and of themselves are not anti-emetics but they may be used
in a multi-drug regime if a patient needs
they decrease anxiety which helps the patient sleep, provides a little sedation
106
Phenothiazines, particularly compazine, are known for being quite
painful
put a fresh needle on it, let patient know it’s going to sting, and then make sure you’re ready to duck b/c it’s so painful
107
What are examples of Bulk forming laxatives?
Metamucil
| Fibercon
108
How do Bulk forming laxatives work?
Adds bulk to increase peristalsis
109
What is the time frame that bulk forming laxatives activate within?
24 hr
110
What is an example of Surfactant or Stool softeners?
Colace
111
What are examples of Saline Cathartics?
MOM, Fleets, GoLYTELY
112
How do Saline Cathartics work?
they increase osmotic pressure
113
What are Saline cathartics most used for?
For rapid bowel cleaning
114
What are examples of Irritant or stimulant cathartics?
Cascara, Senekot, Dulcolax
115
How do Irritant or stimulant cathartics work?
Irritates the GI mucosa, which leads to increased peristalsis
116
What is an example of a Lubricant laxative, and how long should it take to work
Mineral oil
Should work within 8 hr
117
Diabetes Mellitus is a chronic systemic disease of
metabolic and vascular abnormalities
metabolic: changes in the way that CHOs, fats and protein are metabolized leads to increased blood sugar
Vascular: Atherosclerosis, changes in microcirculation
118
Elevated levels of glucose are called
hyperglycemia
119
Chance of diabetes Increases __ % for every 2 lbs a patient is overweight
4
120
Type 1 diabetes
Defect in insulin secretion
- thinking it’s an autoimmune disorder
- starts at an early age
- more sudden onset
- more difficult to control
- more complications
- always require the administration of insulin
121
Type 2 diabetes
Not producing enough to meet needs, or has developed insulin resistance to own insulin
can have combination of both; often on oral meds, but may also be on insulin as well
122
Signs and symptoms of DM
Poluria—pee often
Always thirsty
Always hungry
123
Normal levels of fasting blood sugar and Hemoglobin A1C
FBS: 70-100 mg/dL
Hemoglobin A1C: 4% - 5.6%
124
Pre-diabetic levels of fasting blood sugar and Hemoglobin A1C
FBS: 100-125 mg d/L
Hemoglobin A1C: 5.7% - 6.4%
125
Diabetic levels of fasting blood sugar and Hemoglobin A1C
FBS: > 125 mg d/L
Hemoglobin A1C: > 6.5%
126
Goal for insulin use (3)
1. maintain BS 70-100
2. prevent complications
3. prevent hypoglycemia
127
True or false: Exogenous and endogenous insulin have same effects on body
True
128
Insulin is the ___ effective treatment for Type 1 diabetes
only
129
Symptoms of hypoglycemia
- Shakiness, Nervousness or anxiety
- Sweating, chills and clamminess
- Confusion, including delirium
- Rapid/fast heartbeat
etc.
130
Which types of insulin are clear? (3)
1. Humalog
2. Regular Insulin
3. Glargine
131
Which types of insulin are cloudy? (2)
1. Intermediate acting
| 2. long acting ultralente
132
What is rapid acting insulin, what is it used for, how long is its onset and how long does it last?
Humalog (Lispro)
used for rapid reduction of BS
onset is between 10-15 min
lasts for 3h
133
Insulin regimes (3)
1x/day: elderly
2x/day: conventional
3-4x/day: intensive
134
70/30 Insulin is
70% NPH (intermediate acting), 30% Regular
135
Rapid and short acting Insulin covers meals...
immediately AFTER the injection
136
Intermediate acting Insulin is expected to cover
subsequent meals
137
Long acting Insulin provides
a relatively constant level of Insulin and act as a basal Insulin
138
Only ___ insulin is given IV
regular (all others are given sub q)
139
Always want to ___ when administering insulin
rotate sites
140
For Type 1 DM, how often should you check blood sugar?
2-4x/day
141
For Type 2 DM, how often should you check blood sugar?
2-3x/week
| one 2hr postprandial -- this means after a meal
142
“Fractionals” or Sliding scale:
```
BS Insulin dose
150-199 2 units
200- 249 4 units
250-299 6 units
300-349 8 units
350-399 10 units
> 400 Call MD
```
143
Insulin pumps can remain in place for __ days, and are often
3; regular insulin or lispro
144
Oral hypoglycemics, Sulfonylureas prototype
glipizide (Glucotrol)
145
Oral hypoglycemics, Megitinide prototype
Repaglinide (Prandin)
146
Oral hypoglycemics are for patients with ___, and they work by ___
impaired glucose production
increasing insulin production
147
Sulfonylureas are not to be used during pregnancy because they can cause
fetal hypoglycemia and even fetal death
148
Antihyperglycemics work to
decrease insulin resistance
149
Thiazolidinediones prototype
Pioglitazone (Actos)
150
Thiazolidinediones are contraindicated for patients with
active liver disease
151
Thiazolidinediones work by
stimulating insulin receptors on fat, muscle, and liver cells
152
Biguanide prototype
metformin (Glucophage)
153
Alpha-Glucosidase Inhibitors prototype
Acarbose (Precose)
[Miglitol (Glyset)]
154
Biguanide is usually taken with breakfast and dinner, and helps to
decrease hepatic glucose production
155
Black box warning for biguanide (metformin) is
lactic acidosis
156
Black box warning for Thiazolidinediones (Pioglitazone) is
CHF
157
Alpha-Gulcodidase (Acarbose) is easier to dose because it's taken
multiple times a day with a meal
158
Alpha-Gulcodidase (Acarbose) works by
Inhibiting alpha glucodate enzymes in GI tract to delay digestion of complex carbohydrates into glucose
159
To lower risk factors for CVD for DM patients, it's often recommended that they take what 3 combination of drugs?
1. Statin
2. ASA/day
3. ACE Inhibitor
160
the adrenal cortex produces what 3 things?
1. adrenal sex hormones
2. Mineral corticoid (Aldosterone)
3. Glucocorticoids – “Steroids”
161
Aldosterone holds on to ___ and eliminates ___
Na and H20; eliminates K+
162
if patient has low aldosterone (Addison's disease), their body
gets rid of Na and H20 and keeps K+
163
if patient has high aldosterone (Addison's disease), their body
keeps Na and H2O, get rid of K+
164
Glucocorticoids prototype:
prednisone
165
Steroids have an effect on carbohydrate metabolism—more glucose, also increases insulin resistance—the combination can cause
hyperglycemia
166
Actions of Steroids (8):
1. hyperglycemia
2. anti-inflammatory
3. immunosuppressive
4. euphoria, mood change, aggression
5. ulcers
6. muscle wasting
7. FVE: edema, Hi BP: hypokalemia
8. breath easier
167
5 ways to decrease the ADEs of steroids
1. Try using topically, or in an inhaler with minimal systemic absorption
2. Shortest course possible
3. Taper off
4. Alternate day therapy—every other day take a double dose
5. Give in am because of circadian rhythm—9-10 is our highest point of steroid production—want to give therapy along with diurnal pattern
168
Prednisone, Cortisone are used as
Immunosuppressants
169
Prednisone is used to treat GI concerns such as
crohns, ulcerative collitis
170
Cortisone is used to treat endocrine disorders such as
Addison's disease
171
Medrol is used to treat
allergic disorders (serious)
172
Decadron helps with neurological issues because it decreases
ICP
173
For patients with high BP or CHF, aldoserone causes them to
hold onto sodium and water
174
Glucocorticoids are contraindicated in
- Systemic fungal infection
| - T.B.
175
For Glucocorticoids, avoid use or use cautiously in
```
Pregnancy
patients at risk for infection/ with infection
DM
Peptic ulcer disease
Renal insufficiency
Psychosis
High BP, CHF
```
176
When giving Glucocorticoids, you should always assess
Sodium, potassium, calcium
| Baseline blood sugar
177
Give Glucocorticoids before ___ AND with ___
9am, with food/milk
178
Patients taking Glucocorticoids should have a diet that is
hi in K, protein, Ca, low in Na, high in fluid
179
Patients taking Glucocorticoids should report
sore throats, fever, visual disturbances, tarry stool
180
Patients taking Glucocorticoids should avoid
immunizations, contagious people
181
Mrs. Medrol is admitted to the hospital for a knee replacement. She has been on long-term corticosteroid therapy for her asthma.
List three symptoms indicative of excessive doses of corticosteroids for which Mrs. Medrol must be assessed.
1. High blood sugar, which can trigger or worsen diabetes
2. Increased risk of infections
3. Thinning bones (osteoporosis) and fractures
182
Mrs. Medrol is admitted to the hospital for a knee replacement. She has been on long-term corticosteroid therapy for her asthma. What is the most likely complication of the surgery in Mrs. Medrol’s case?
Infection, because the immune response has been decreased
183
histamine 2 receptor blocking agents are always given
PO
184
It can take about ___ weeks of taking histamine 2 receptor blocking agents before healing of ulcer
6-8 weeks
185
histamine 2 receptor blocking agents are metabolized by the ____ and excreted by the ____
liver; kidney
186
histamine 2 receptor blocking agents ___ cross the placenta and get into breast milk but ___ cross the BBB
DO cross the placenta and get into breast milk
DO NOT cross BBB
187
Rapid acting (clear) insulin agent is
Humalog (Lispro)
188
Short acting (clear) insulin agent is
Regular "R"
189
Intermediate acting (cloudy) insulin agents are
1. NPH ("Humulin N")
| 2. Lente ("Humulin L")
190
Long acting (cloudy) insulin agent is
Ultralente "UL"
191
Long acting (clear) insulin agent is
glargine (Lantus)
192
Humalog (Lispro) onset time, peak time, duration
Onset: 10-15 min
Peak: 1 h
Duration: 3H
193
Regular "R" insulin onset time, peak time, duration
Onset: 30min-1h
Peak: 2-3h
Duration: 4-6h
194
NPH ("Humulin N") and Lente ("Humulin L") onset time, peak time, duration
Onset: 3-4b
Peak: 4-12h
Duration: 16-20h
195
Ultralente "UL" onset time, peak time, duration
Onset: 6-8h
Peak: 12-16h
Duration: 20-30h
196
glargine (Lantus) onset time, peak time, duration
Onset: 1h
Peak: No peak
Duration: 24 hours
197
For glargine, ___ mix with other insulins
DO NOT
198
What is ultralente used for?
To control fasting plasma glucose
199
Short-acting Regular insulin should be given ___ min AC
20-30
200
Type 1 diabetes always require the administration of
insulin
201
We want to give steroids in the morning because
of circadian rhythm—9-10 is our highest point of steroid production—want to give therapy along with diurnal pattern
202
If blood sugar is 150-199, give insulin dose of
2 units
203
If blood sugar is 200- 249, give insulin dose of
4 units
204
If blood sugar is 250-299, give insulin dose of
6 units
205
If blood sugar is 300-349, give insulin dose of
8 units
206
If blood sugar is 350-399, give insulin dose of
10 units
207
If blood sugar is > 400, what should you do?
call MD
