Exam #5 Flashcards by JANETH Martinez

What are the main 3 functions of the kidney

Maintain fluid balance
Maintain acid base balance
Excretion of metabolic wastes

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What are the secondary functions of the kidney (3)

Secrete erythropoietin when hypoxia (tells bone marrow to make more RBC)
Secretes renin (secreted by juxtaglomerular cells) when BP is low and when dehydrated
Converts vitamin D into calcitriol when Ca+ is low

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What are the 4 classes and actions of dietetics

Loos diuretics
Thiazide diuretics
Potassium sparing diuretics
Osmotic diuretics

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Filling pressure/ preload

Diastole

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Pressure pushing out/after load

Systole

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What medication acts in the ascending limb of the loop of henle
How much reabsorption does it block

Loop diuretics: furosemide (Lasix)
20% block

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This medication is used to manage Hypertension (not 1st line and decrease edema in hf, liver and renal disease

Furosemide (loop diuretic)

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This medication dislates blood vessels and lowers preload, afterload, and blood pressure

Furosemide (loop diuretic) lasix

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3 adverse effects of Furosemide

Hypotension
Sodium, potassium and other electrolyte depletion
Possible hyperglycemia

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This medication acts in the DCT to block reabsorption

Thiazide diuretics (Hydrocholorthiazide)
10% Weak diuretic

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This medication relaxes arterioles and decreases preload, afterload, and blood pressure

Hydrochlorothiazide

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This medication is a first-line treatment for HTN and manages Tamils to moderate HTN, it is also an adjunct treatment for HF and liver disease

Hydrochlorothiazide

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This medication has the following adverse effects:
Electrolyte imbalance. Hyopkalemia, possibly hyperglycemia

Hydrochlorothiazide

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What secretes aldosterone

Adrenal gland on the kidney

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Where does aldosterone act and what does it do

It acts on the DCT and collecting ducts to reabsorb sodium and water (to increase BP) and excrete K+

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Which medication is an aldosterone antagonist and blocks the reabsorption of sodium and water while retaining K+

Spiranolactone

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Which mediation acts in the DCT and collecting ducts

Spiranolactone

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What are the indications for Spiranolactone and adverse effects

Not first line management of HTN
Edema d/t HF, liver and renal disease
Counter acts K+ loss caused by other diuretics (often used with furosemide)
Hyperkalemia

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Which medication acts in the PCT and descending limb

Mannitol

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This medication inhibits H20 reabsorption mainly, produces rapid diuresis and has the adverse effect of dehydration

Mannitol

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Which diuretic us used to treat edema and increase intracranial pressure

Mannitol

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What is the recommended time of day to take diuretics
What are the adverse effects (6)
What is the precaution if taking multiple diuretics or anti-HTN

AM
Dizziness, lightheadedness, Orthostatic hypotension, dehydration, constipation, F&E imbalances

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Nursing implications for diuretics

D: diet (ie. K+ intake)
I= I/O monitoring, daily weight
U= unbalances F&E
R= ready for dynamic changes (light-headed es, VS, heart breath sound, cardiac rhythm etc)
E= no evening doses
T= take in AM
I= increased risk for Orthostatic hypotension
C= consider age, other meds that increase risk of F&R imbalance and BP changes

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What are the 3 steps in hemostasis

Vasoconstriction, formation of platelet plug, clotting cascade

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This is the first stage in hemostasis in which an endothelial injury occurs and the body reacts by reducing blood flow and surface pressure

Vasoconstriction (first 20-30 mins)

What exposure trigger the platelet plug and what happens after it is exposed

collagen exposure, activates platelets to secrete stimulators and begin the clotting cascade

What triggers the clotting cascade What are the 2 pathways for this cascade What is the overall goal

Clotting factors (plasma proteins) Intrinsic and extrinsic pathways Stabilizes clot

This changes the shape and aggregates platelets (activated platelets)

ADP adenosine diphosphate

This induces platelets aggregation to encourage more platelets to be drawn into the plug

Thromboxane A2

This medication prevents the formation of TXA2 and prevents platelet aggregation

Antiplatelet: aspirin (acetylsalicylic acid ASA)

This medication is used to stroke and MI prophylaxis The adverse effects are GI bleeding and dyspepsia - may give enteric coated to patients with an increased risk of GI bleeds

Aspirin

This medication is an ADP inhibitor, it alters platelets membrane and prevents signals to aggregate

Clopidogrel (Clavix)

Which 2 meds are given together for CVD

Aspirin and clopidogrel

Clopidogrel other factor

Highly bound to protein (duration of 5 days) (94-95% bound to protein) - which is why it is advised to stop blood thinners before a surgery

True of false: Discontinue ALL anti-platelet mediations 5-7 days before a surgical procedure

TRUE

Food and drug interactions for anti-platelets

Chamomile, feverfew and 3 Gs Garlic, ginger, gingko

Intrinsic pathway is activated when

Collagen is exposed

Extrinsic pathway is activated when

Tissue factor is released (injury to tissue)

Which medication is an X inhibitor and prevents new clots from forming (no effects on already formed clots)

Rivaroxaban (xarleto) and apixaban (eliquis)

What is the antidote for Ricaroxoban and apixaban

Andexxa

Which medication inhibits the action of clotting factors by inactivating clotting factors 2,7,9 and 10)

Warfarin

Does warfarin dissolve already formed clots

NO, both anticoagulants do not affect already formed clots

What is the onset of action for warfarin, how many days does it take to reach therapeutic range What is recommended to be used during the days it takes to reach therapeutic range Antidote? If the antidote is given how many days of resistance does warfarin have

36-72 hours 3-5 days Bridge therapy is needed (usually heparin Vitamin K 7days

Which factors are vitamin K responsible for hepatic synthesis

Factor 2,7,9,10

What is the difference between Pt and INR What are the ranges Therapeutic ranges? How are they used together

PT: measures the time it takes for a clot to form in the blood INR: standardized system to interpret PT PT: 12-15 seconds, TR: 1.5-2 INR: 0.8-1.2 TR: >2-3.5 INR is used to interpret PT

These 7 foods will increase the risk of bleeding on a patient who is taking warfarin

Gingko, garlic, ginger, chamomile, cranberries, black licorice, green tea

The vitamin K rich foods will antagonize the warfarin effect if not eaten consistently

Asparagus, broccoli, cabbage, cauliflower, kale Consistency is key

Chronic pain persists longer than ______

6 months

What receptors are responsible for opioid binding in the CNS How do they work

MU and kappa major major recap to rights Activation alters perception of pain

What 2 medications are used for opioid induced constipation and how do they work

Naloxegol (Movantik) and Methylnatrexone (relistor) bind to the GI Mu receptors to prevent constipation

Which medication can develop a tolerance and comes in short acting and long acting What is the long acting used for (2)

Morphine, morphine ER Used for chronic pain and opioid tolerant patients

This medication causes the most nausea out of all the opioids

Morphine

This medication medication has a 6.7 greater potency than morphine

Hydromorphone (diuladid)

Hydromorphoen has increased risk for (3) And caused ______ nausea than morphine

Orthostatic hypotension Urinary retention Respiratory depression Less

This medication is used to relieve cough and is used in combo with guaifenesin What special effect does it have What does that mean

Codeine Ceiling effect Increasing dose does not increase the relief, it only increases the risk for adverse effects

This medication is a semi-synthetic opioid

Hydrocodone

This medication is for opioid tolerant patients for the management of breakthrough cancer pain and chronic persistent pain

Fentanyl

How much more potent is fentanyl compared to morphine

100 times

How long does a fentanyl patch take to reach a steady state How often should the patch be changed

6-12 hours Every 72 hours

Which medication is used (short acting) for breakthrough pain

Oxycodone

This medication is used for opioid tolerant patietns to reduce or quit heroin/ opiates

Methadone

Does methadone cure dependence

Consider holding opiates if RR<___ breaths/ min Respiratory depression if RR <___10/min Unresponsive to ____ and _____

12 10 Verbal cues Painful stimuli

Opioid antagonist for opioid overdose

Nalaxone (Narcan)

IV acetaminophen Antiinflammatory properties? Maximum daily dose Maximum daily dose in _____ patients

Ofirmev No 4000mg 2-3g

These 2 medications inhibits cox1 and cox2 What are cox 1 and cox 2 responsible for

Aspirin and Ibuprofen Cox 1- inhibits acid secretion and generates thromboxane A2 Cox2- promotes pain and inflammation

This medication is a selective cox 2 inhibitor that lowers the risk of GI bleeds and ulcer formation What is is used for Is it an anticoagulant?

Celecoxib Used for OR, RA, acute pain and dysmenorrhea No

NSAID neurological (2), Cardiovascular (1) and Gi adverse effects

Neuro: assess for stroke symptoms (except ASA) All may cause tinnitus Cardio: assess for MI (except ASA) GI: assess for GI bleeds all (except celecoxib)

Other primary classification of adjuvant analgesic therapy How does it help pain Dosing schedule? AE compared to high opioid doses? Treats which 3 types of pain

Muscle relaxants Antidepressants Anti seizure Corticosteroids Helps achieve and improve pain relief Routine (sometimes with smaller opioid doses) Decreased risk of AE compared to opioid doses Refractory pain (pain that continues after treatment) neuropathic pain and nerve compression

Muscle relaxants (common ones) (3) How do they work Benzodiazepines (2 common) How do they work

Carisoprodol, cyclobenzaprine, lioresal (baclofen) Decrease muscle spams dust to injury or musculoskeletal conditions (muscle spasms cause pain and stiffness) Diazepam and lorazepam CNA depressant and potentiate GABA (slows down transmission of nerve cells)

What adjuvant therapy is common in back surgery or back pain

Muscle relaxants

What are the 3 types of antidepressants

Tricyclic, selective serotonin re uptake inhibitors and Serotinin- nurepinephrine reuptake inhibitor (SNRI)

What kind of pain are antidepressants used for (2)

Neuropathic and chronic pain

Block norepinephrine and serotonin reuptake in presynaptic nerve terminals

Tricyclic- amitriptyline

How do anti-depressants act to relieve pain

More transmitters available in synaptic cleft, inhibit transmission of pain signals Block reuptake transporter (Pain signals are blocked and cannot enter the synaptic cleft and elicit a pain response)

What are the 2 most common anti-seizure medications

Gabapentin and pregabalin

How do gabapentin and pregabalin work What are they used for overall (4 and which medication is used for which condition)

Gabapentin mechanism is unknown (used for neuropathic pain) Pregabalin: calcium channel modulation to decrease hyper excitability caused by nerve injury Management of neuropathic pain including: Fibromyalgia (pregabalin) Post hepatic neuralgia (pain after shingles), migraines and restless leg syndrome (Gabapentin)

Adverse effects of anti-seizure medications (5)

Suicidal through, depression, drowsiness, impaired attention, difficulty concentrating

This medication is used to acute and chronic cancer pain It is used for spinal cord compression, inflammatory joint pain syndromes (ie. Rheumatoid arthritis)

Corticosteroids

How do corticosteroids work What are 2 common ones

Suppresses inflammation and immune response Prednisone and dexamethasone

What are potential adverse effects with long term therapy of corticosteroids (8)

Fluid retention (similar to aldosterone effects), hyperglycemia, impaired immune response, peptic ulcers, GIB, osteoporosis, bruising, Hypokalemia

Elderly Physiologic changes like concientice impairment and decreased ability to assess pain with dementia and delirium can lead to (3)

Worsening health, inadequate assessment and treatment of pain

Decreased cardiac output in the elderly can affect medication _____ and ______

Absorption and distribution

Decreased muscle strength in the lungs results in (2)

Decreased lung expansion and decreased response to hypoxia

Decreased liver perfusion in the hepatic system can lead to (3)

Decreased metabolism of drugs Prolonged duration of action of drugs and accumulation Increased risk of adverse effects and drug toxicity

Decreased renal system function leads to (2)

prolonged duration of action and accumulation Increased risk of AE and drug toxicity

Chinese people may believe pain results from an imbalance between

Yin and yang

Some beliefs may be that _______ pain ____ to improve standing in life after death

Enduring, bravely

People may not want to take pain medication because they believe ____ is a sign of ____ towards ______

Pain, progress, recovery

What are the 2 corticosteroids mentioned in lecture

Prednisone, dexamethasone

What 2 things are corticosteroids recommended for

Spinal cord compression and inflammatory joint pain syndromes like RA

Exam #5 Flashcards

(91 cards)