Exam 5 blueprint Flashcards
(195 cards)
1
Q
What drugs are 1st gen antihistamines?
A
Diphenhydramine, Hydroxyzine, meclizine, Promethazine
2
Q
Indications for 1st gen antihistamines
A
Allergic Rhinitis, motion sickness, induce sleep, and runny nose
3
Q
Side effects of 1st gen antihistamines
A
Sedation and anti-cholinergic effects. . Drys everything
4
Q
Adverse effects of 1st gen antihistamines
A
Cross blood brain barrier, sedation and cholinergic effects
5
Q
Contraindications of 1st gen histamines
A
narrow-angle glaucoma, BPH and take precaution with urinary retention
6
Q
What drugs are in 2nd gen antihistamines?
A
cetrizine, fexofendamine, loratadine, azelastine
7
Q
Indications for the use of 2nd gen antihistamines?
A
First line therapy for allergic rhinitis. Same as first gen but do not cause sedation or cross the bbb
8
Q
Nursing interventions/ Client education for 2nd gen antihistamines
A
Increase fluids, avoid all juice, especially grapefruit, apple, and orange. Juice decreases the effect of the histamine.
9
Q
What drugs are decongestants?
A
Pseudoephedrine, Phenylephrine,
10
Q
When do we use decongestants?
A
Temporarily relieve nasal congestion
11
Q
Mechanism of action of Decongestants
A
Stimulate alpha-adrenergic receptors, Vasoconstriction, shrink nasal mucosa and reduce nasal secretions.
12
Q
Side effects of decongestants
A
tachycardia, nervousness, tremors, anxiety, restlessness, weakness, dry mucus memebranes
13
Q
Contraindications of decongestants
A
Contraindicated: glaucoma, pre-existing hypertension, cardiac disease, hyperthyroidism.
14
Q
Precautions of decongestants
A
Diabetics: consult HCP before taking
Patients with hypertension do not take.
15
Q
What are the topical decongestants?
A
Naphazoline, Oxymetazoline, Tetrahydrozoline, Xylometazoline.
16
Q
Patient teaching for Topical decongestants
A
avoid over use of them. Can cause tolerance Do not take for more than 3 days in a row
17
Q
Indications for topical decongestants
A
Nasal sprays used for decongestants.
18
Q
Side/ Adverse effects of topical Decongestants
A
Rebound congestion.
19
Q
Rebound congestion fixing
A
tapering with one nostrils at a time
20
Q
What drugs are expectorants?
A
Guaifenesin
21
Q
Indications for Expetorants (guaifenesin)?
A
relieves symptoms of respiratory conditions with a dry non-productive cough by reducing adhesiveness and surface tension of mucus
22
Q
Patient teaching of Expectorants (mucinex)
A
read labels of medicine. Take with full glass of water, Asthma: be careful, can cause bronchospasm.
Coughing, deep breathing, have to increase fluid intake, if they do not, medicine will not work right. 8 8oz glasses a day. Will not suppress their cough.
23
Q
What drugs are antitussives?
A
Dextromethorphan, Codeine, Benzonatate
24
Q
Indications of antitussive medicine
A
Used to suppress cough reflex. Treats only a dry non-productive cough.
25
Side effects of Antitussive: codeine
drowsiness, dizziness, irritability, constipation and restlessness
26
What can codeine cause, especially to older adults?
respiratory depression and dependence
27
Who can not take Antitussives and why?
patients with asthma and emphysema because the sputum could be retained and causing pneumonia
28
Patient teaching for antitussives codeine?
do not take more than perscribed doses, changes positions slowly, avoid activites that require alertness. Use hard candy, increase fibers fluid and exercise. Avoid alcohol.
29
Patients should report what when taking an antitussive?
cough that lasts longer than a week and a rash with fever.
30
If patient has respiratory depression we can administer?
nalaxone
31
What is Dextromethorphan antitussive used for?
cough suppression.
32
side effects of antitussive dextromethorphan
dizziness nausea sedation
33
What drugs are Inhaled corticosteroids?
Beclomethasone, Budesonide, Flunisolide, Fluticasone, Mometasone, Triamcinolone, Ciclesonide
34
Indications of inhaled corticosteroid
Reduce inflammation in the bronchial tree. Used for prophylactic management of asthma and tx of COPD
35
Inhaled corticosteroids are what?
maintenance drugs, do not help with acute attack.
36
Adverse effects of Inhaled corticosteroids
sore throat, hoarseness,coughing, dry mouth, oral yeast infection (thrush).
37
Patient teaching of inhaled corticosteroids
teach back method, use albuterol for acute attack. Use bronchodilator first. Then use corticosteroid
Rinse mouth out after using. Do not swallow.
use spacer
38
Adverse effect of corticosteroid in children (systemic)
decrease adrenal function, decreased growth and bone mass. Can delay growth
39
Do we use a corticosteroid everyday even if we do not have symtoms?
yes because if the patients do not use it everyday it will not be effective.
40
COPD inhaled..
maintenance
41
COPD: oral
exacerbation
42
What are the systemic corticosteroids?
Methylprednisolone and Prednisone
43
Indications for systemic corticosteroids
COPD exacerbation, Inflammation where they need higher doses of their medicine. Stress or switching from oral to inhaled.
44
What can corticosteroids cause?
Hyperglycemia, diabetics need to monitor their blood sugar,
45
Corticosteroids can cause sodium retention so we need to monitor for ?
weight gain
46
Contraindications of Corticosteroids?
active fungal infections, live virus vaccines
47
Nursing considerations of corticosteroids?
height and weight in children, bone density screening, delayed wound healing, buffalo hump, infections, dehydration.
48
Important patient teaching about corticosteroids
taper off to prevent asthma exacerbation rinse mouth, avoid large crowds and wash hands. can take 4 weeks t
49
What drugs are Leukotriene Modifiers?
Zafirlukast, montelukast
50
Indications of Leuotriene Modifiers
Oral prophylaxis and chronic treatment of asthma, not for acute attacks.
51
Adverse Effects of Leukotriene Modifiers
depression, SI, bleeding, seizures, can affect liver.
52
What drugs are anticholingergics?
Ipratropium (short acting)
Tiotropium (long acting)
53
Indications of anticholinergics?
used to treat asthma, bronchitis, pulmonary emphysema
54
Contraindications? precautions of Anticholinergics?
Contra: peanut allergy
Caution: narrow-angle glaucoma/ BPH
Take medicine everyday
55
What medications are Methylxanthines?
Theophylline and aminophylline
56
Indications for Methylzanthines
asthma and reversal bronchospasm
57
Side and Adverse effects of Methylxanthines
serum 20-25: Gi, NVD and CNS headache insominia and irritability
serum over 30: hypotension hyperglycemia, arrhtmias, seizures, brain damage and death.
58
Drug interactions of Methylxanthines
Smoking can decrease serum drug levels, Coffee, tea, sode, chocolate. soda.
59
What drugs are Bronchodilators/ Beta 2 Agonist?
Short acting RESCUE: Albuterol, Levalbuterol, Pirbuterol
Long acting: Arformoterol Formoterol Indacaterol, Olodaterol Salmeterol
60
Indications of Bronchodilators/ Beta agonist
COPD, acute bronchospasm and preventive exercise-induced asthma. Preferred over Beta 1 because of cardiac effects
61
Patient teaching for BETA agonist
using the short term acting medicine more than 2-3 times a week means their asthma is not well controlled.
Use beta agonist inhaler first.
62
Long acting beta agonist can be used
in combination of corticosteroid to prevent asthma. NEED to use Beta agonist inhaler first. BOTH used with spacer: spacer increases the amount of drug delivered to the lung.
63
Spacer teaching
MDI inhaler. BOTH used with spacer: spacer increases the amount of drug delivered to the lung.
64
Side effects and adverse effects of Beta agonist
Inhaled: throat irritation, sinus tachycardia, hypertension, anxiety, nervousness, tremor, dizziness, palpitations, angina, hyperglycemia, bronchospasm, urticaria, angioedema.
65
What is the drug used in Thyroid Hormone Replacement?
Levothyroxine
66
Drug interactions of Levothyroxine
Wafarin: increases effect of Levothyroxine
Digoxin: decreases effect of Levothyroxine.
Some vitamins and supplements
67
Drug interactions of levothyroxine continued
If patient on warfarin, monitor PT and INR and monitor for bleeding
If patient on digoxin monitor for CHF, Edema, fluid retention, crackles, sob
68
Patients on Levothyroxine should take their medicine _____ before vitamins/ supplements and other medicines
4 hours
69
Patients should take Levothyroxine 30-60 minutes ____ breakfast on ____
before, an empty stomach
70
Adverse Effects of Levothyroxine
Overmedication and Chronic over tx.
71
Levothyroxine is drug of choice for tx of
hypothyroidism
72
Overmedication and chronic overtx with levothyroxine can cause
a-fib, bone loss, and hyperthyroidism.
73
Biggest Patient Teaching with Levothyroxine
monitor hr before administering medicine
74
Before admitting levothyroxine the nurse checks the pts hr. if their hr is over 100 we should?
hold the medicine
75
what is a u thyroid?
when the thyroid is normal and within normal limits
76
What are the antithyroid drugs?
Prophylthioracil and Methimazole
77
Assessments and interventions of Antithyroid medicines?
Asses for thyroid crisis (storm),
Monitor the thyroid hormones, CBC , daily weights
78
Thyroid crisis (storm) s/s?
Tachcardia, fever, flushed skin, restlessness, confusion, behavior changes
79
What is agranulacytosis and what do we administer when this happens?
a life-threatening situation where the patient has extremely low white blood cells. (Neutrophills). admin Filgrasium.
80
What are the antidiuretic hormone drugs?
Vasopressin and Desmopressin
81
Indication for antidiuretic hormone?
used to treat diabetes insipidus
82
Nursing interventions for antidiuretic hormone?
Monitor for overhydration, reduce fluid intake, small effective dose, monitor daily weights, ecg and iv site, s/s of MI
83
Adverse effects of antidiuretic hormone?
reabsoprtion of too much water, MI, hyponatremia,
84
ADH drug has bbw for what?
severe hyponatremia.
85
Eval of ADH drugs?
Decreased urine output, decreased thirst, and sodium and potassium within normal limits
86
What drug is used for Hyperparathyroidism?
calcitonin-salmon
87
Side and Adverse effect of Calcitonin-salmon?
Gi disturbances, skin rash, flushing, nasal irritation
A: hypocalcemia
88
How to recognize Biphosphonates?
- dronate
89
Indiciations of Biphosphonates
Inhibit osteoclast activity and decrease bone turnover and reabsorption.
Postmenopausal osteoporosis, male osteoporosis, osteoporosis caused by glucocorticoids, and Paget disease
90
Patient Teaching for Biphosphonates
Check calcium level before starting and treat it. Take on empty stomach, sit up for 30 mins after, preform weight bearing exercises, eat diet high in calcium and vitamin d . Report vision changes
91
What drugs are corticosteroids for Adrenoinsufficiency?
Dexamethasone, prednisone, fluticasone, betamethasone, methylpredinsolone, prednisolone, tramcinolone
92
Indications for corticosteroids for adrenoinsufficiency?
Addison's disease (replacement of adrenal corticoid)
malfunctioning adrenal glands
93
Adverse effects of corticosteroids for adrenoinsufficiency?
Suppression of adrenal gland function, Cushing's Syndrome, Bone loss/ Osteoporosis, Peptic Ulcer Disease.
94
Patient teaching for corticosteroids for adrenoinsufficnecy
Avoid abrupt discontinuation, take in the morning/ when you wake up, weight bearing exercises, high calcium/ vitamin D diet, medical alert, NSAIDs, Report black tarry stools, Gi bleed, report Cushing Syndrome
95
Adrenal Insufficiency symptoms
Anorexia, hypoglycemia, lethargy, restlessness, weakness.
96
Types of Insullin
Rapid, Short, Intermediate, long
97
Rapid-acting insulin medicaions
Lispro, Aspart, Glulisine
98
Rapid Acting Insulin onset, duration, and peak.
Onset: 15-30 minutes before meals
Duration 3-6 hours
Peak: 30 mins-2.5 hours
99
Which insulin are patients at highest risk of getting hypoglycemia
Rapid-acting
100
Short-acting insulin medicine
Regular
101
Short-acting insulin onset, duration, peak
Onset: 30-60 minutes
Duration: 6-10 hours
Peak: 1-5 hours
102
Intermediate-acting insulin medication
NPH
103
Intermediate-acting onset, duration, peak
Onset: 1-2 hours
Duration: 16-24 hours
Peak: 6-14 hours
104
What are the long-acting insulin medicines?
Detemir and glargine
105
Can long-acting medicines be mixed with other insulins?
no
106
Long-acting insulin onset, duration, peak
Onset: 70 mins
Duration: 18-25 hours
Peak: no peak
107
Combination insulin
Short and intermediate or rapid and intermediate
70/30 75/25
108
Actions of insulin
promotes the use of glucose by body cells and storing glucose as glycogen in the muscle cells. This then reduces blood glucose
109
Complications of insulin
Hypoglycemia, lipohypertrophy, hypokalemia, hyperglycemia
110
Can you give long-acting insulins via IV?
no
111
Hypoglycemia symptoms
Sweating, nervousness, hunger, tremors, weakness, mental confusion, headache
112
Hyperglycemia symptoms
Increased blood glucose, excessive thirst, hunger, urine output, 3 p's.
113
How is insulin used in type 1 diabetes, type 2 and gestational diabetes?
glycemic control
114
Those with type 2 diabetes should implement what?
lifestyle changes
115
Those with type 2 dm may require insulin when?
the oral antidiabetic pill does not work. Illness, trauma, severe renal failure, liver, neuropathy, tx of dka, and being treated for hyperkalemia and at times of stress.
116
Indications for Insulin
low blood sugar
117
What insulins can be given via iv
rapid and short
118
____ and Trauma are two reasons a patient with T2DM may require insulin
illness
119
If the patient is awake and has hypoglycemia we can give the _______
oral glucose
120
If patient is not awake and unconscious, or npo and have hypoglycemia we can give _____?
iv glucose or subcut glucogon
121
what is lipohypertrophy?
what can occur if we do not rotate injection sites
122
Patients should keep snacks with how many carbs in case of hypoglycemia?
15 g carb snack/ oj 4oz, 8oz milk
123
We should teach our patients to do what when doing insulin injections?
rotate injection sites within 1 anatomical region, and teach back-method.
124
We should teach our patients too?
recognize s/s of hypoglycemia, wear medical alert bracelet, how to check bs. healthy diets.
125
Unopened vials of insulin should be?
refrigerated?
126
How long is opened insulin allowed to be out of the fridge?
1 month
127
How do we mix insulins?
roll in hands, inject air into the NPH (cloudy), inject air into regular (clear), draw clear, draw cloudy
128
AC/HS
before meals and at bedtime
129
The sliding scale is only used for
rapid and short-acting insulin
130
Is every sliding scale the same?
no
131
When do we use the sliding scale?
before meals and at bedtime. (AC/HS).
132
Sulfonylurea drugs?
Glipzide, glyburide, glimepiride
133
What drug class is Sulfonylureas?
oral hypoglycemia
134
Who do we use Sulfonylureas for?
used for T2DM
135
How do Sulfonylureas work in Type 2 diabetics?
promotes insulin release from the pancreas.
136
Adverse effects of Sulfonylureas?
hypoglycemia
137
What are the contraindications for sulfonylureas?
treatment of DKA, sulfa allergy, alcohol
138
Patient teaching for Sulfonylureas?
monitor for s/s hypoglycemia, monitor poc glucose, 15g carb snacks, bs log, take breakfast, avoid alcohol
139
Examples of 15g carb snacks?
4oz oj, 80z milk, 20z grape juice, glucose tablets.
140
why should those on sulfonylureas avoid alcohol?
cause disulfiram like reaction
141
Indications for metformin
control blood glucose levels in type 2
142
How does Metformin work?
reduces the production of glucose, decreases absorption of glucose, and increases insulin sensitivity.
143
What drug class is metformin?
Biguanide
144
Patient teaching for metformin?
monitor weight loss, take with meaks, vitamin b12, folic acid supplements. s/s of lactic acidosis
145
Metformin has a black box warning for?
lactic acidosis
146
what symptoms of lactic acidosis should we teach our patients on Metformin to report?
hyperventilation, myalgia, sluggishness, n/v
147
How long before receiving contrast dye should our patients stop taking metformin?
24-48 hours
148
How long after contrast dye can patients resume taking metformin?
48 hours.
149
Should patients over 80 years old take metformin?
no
150
What is the indication for glucagon?
emergency management of insulin-induced hypoglycemia (unconscious)
151
What are the Estrogen drugs?
estradiol, estriol
152
Can we give estrogen only to a patient with a uterus?
no
153
What are the adverse effects of estrogen?
endometrial hyperplasia, risk for thrombotic events, hyperpigmentation, ovarian/endometrial cancer
154
What kind of cancers can be caused by the use of estrogen?
endometrial and ovarian cancer
155
A patient with a history of these things is contraindicated with taking estrogen?
Pregnancy (x), thrombophlebitic events, and estrogen-dependent cancers
156
Patients on estrogen should quit smoking to reduce
risk of thrombotic events
157
Estrogen is contraindicated in
heart disease/ family history, vaginal bleeding, certain cancers, and thrombotic diseases. risk of fibroid tumors , tobacco use
158
What are the progestein drugs?
progesterone, Hydroxyprogesterone, medroxyprogesterone, megastrol, norgestrel
159
What effects does progesterone have on the body?
weight gain, edema and depression. Thromboembolism or P. E. breast cancer, jaundice, migtaines, birth defects, spontaneous abortion
160
Progestin is contraindicated with patients who
have cirrhosis, liver disease, pregnancy, breast cancer .
161
Progesterone is a catagory
x
162
What drugs are the combination of hormonal contraceptives?
-transdermal patch: ethinyl estradiol and norelgestromin.
163
Adverse effects of combination contraceptives?
Breast fullness, n/v depression and edema, increased risk of clotting, Thrombotic events, Vaginal bleeding, hyper: tension, kalemia, glycemia
164
Contraindications of combined contraceptives
pregnancy, thrombophlebitic events, smoking, over 35.
165
what are estrogen-dependent cancers?
estrogen, breast, endometrial.
166
What can happen if women take estrogen alone and have a uterus?
endometrial hyperplasia?
167
Finasteride indication
tx of bph, stimulate hair growth slows progesterone tissue/
168
Patient teaching for Finasteride?
pregnant women should not touch it, therapeutic effects can take 6 months, Do not donate blood until a month after stopping medicine, anti-hypertensive teaching.cat x
169
patients on finasteride should report?
symptoms of gynecomastia, impotence and decreased libido.
170
Older adults on finasteride are more likely to see?
hypotension
171
Tamsulosin indication
BPH reduces smooth muscle of bladder and prostate
172
MOA for Tamsulosin
highly protein bound, Alpha 1 adrenergic antagonist. Relaxes the smooth muscle of the bladder.
173
Adverse effects of tamsulosin?
hypotension, dizziness, nasal congestion sleepiness, fatigue, problems with ejaculation, floppy iris syndrome.
174
if our patient has had cataract surgery. tamsulosin can cause them to have?
floppy iris syndrome
175
what is the indication for PDE5-inhibitors?
erectile dysfunction
176
Contraindications for PDE5-inhibitors
nitrates, grapefruit juice,
177
PDE5 should not be taken with drugs that
lower bp (alcohol, antihypertensives, alpha adrenergic receptors
178
What drug is used for thyroid hormone replacement?
levothyroxine
179
Vitamins and supplements should be taken how long after levothyroxine
4 hours
180
What drugs interact with levothyroxine
warfarin, digoxin, some vitamins and supplements
181
AE of levothyroxine
overtx overmed, leads to hyperhyroidism, afib increased risk of bone loss
182
Patient teaching levothyroxine
30-60 minutes before breakfast on an empty stomach and only with water. medical alert bracelet. dont stop abruptly, weight gain
183
Propylthiouracil has bbw for?
severe hepatotoxicity
184
Biggest d/e of our antithyroid drug is
hypothyroidism?
185
For our patients on anti-thyroid drugs we need to monitor?
vs, daily weight, t3, t4, TSH , cbc, s/s infections s/s of hypothyroidism?
186
Why do we need to monitor s/s of infection with antithyroid drugs?
agranulocytosis-extremely low white blood cell levels
187
what can occur if we abruptly stop taking antithyroid drugs?
thyroid crisis
188
if our patient has increased tsh they will have
hypothyroidism
189
If patient has decreased tsh levels they will have
hyperparathyoidism.
190
Nursing interventions for antidiuretic hormones?
monitor for overhydration
191
What are the adverse effects of desmopressin and vasopressin
reabsorption of too much water, mi, hyponatremia
192
intranasal desmopressin starts with a
bedtime dose
193
Why do we monitor usg in antidiuretic hormones
show how concentrated urine is
194
Eval of anti-diuretic hormone
decreased, urine, dehydration, thirst, increased usg
195
when do we take adrenal corticosteroids?
in the morning when you wake up
