Exam Two Flashcards
1
Q
4 Upper respiratory infections
A
- Common cold
- Acute rhinitis
- Sinusitis
- Acute pharyngitis
2
Q
How many colds a year do adults have?
A
2-4
3
Q
How many colds a year do children have?
A
4-12
4
Q
T/F: 50% of colds are experienced in the winter.
A
True
5
Q
What causes the common cold?
A
Rhinovirus
6
Q
What is acute rhinitis?
A
acute inflammation of the mucous membranes of the nose
7
Q
T/F: acute rhinitis usually accompanies a common cold.
A
True
8
Q
What is allergic rhinitis?
A
Hay fever, caused by pollen or foreign substance. Not the same thing as acute rhinitis.
9
Q
When is the common cold most contagious?
A
1-4 days before the onset of symptoms (incubation period)
10
Q
T/F: transmission of the common cold is caused mainly by viral droplets released when sneezing.
A
False; occurs more frequently from touching contaminated surfaces and then touching the nose or mouth.
11
Q
What are symptoms of the common cold?
A
nasal congestion, nasal drainage (rhinorrhea), cough, and increased mucosal secretions
12
Q
What are the four groups of drugs used to treat cold symptoms?
A
- Antihistamines (H1 blocker)
- Decongestants (sympathomimetic amine)
- Antitussives (suppresses coughing)
- Expectorants
13
Q
What happens when histamine is released from mast cells?
A
Vascular smooth muscle contraction, which leads to runny nose and congestion
14
Q
What effect does H1 blockers have?
A
PREVENTS constriction of the smooth muscles lining the nasal cavity.
15
Q
What effect does H2 blockers have?
A
PREVENTS increase of gastric acid secretion, thereby preventing peptic ulcers. (not used for respiratory disorders)
16
Q
What side effects are associated with first generation antihistamines?
A
drowsiness, anticholinergic effects (dry mouth, blurred vision, urine retention, decreased secretions which is good for runny noses)
17
Q
What should clients be advised not to do while taking1st gen antihistaimines?
A
Drive motor vehicles/use heavy equipment due to sedative effects
18
Q
T/F: the most popular first generation antihistamine is diphenhydramine (Benadryl).
A
True
19
Q
What receptor does diphenhydramine (Benadryl) effect?
A
It blocks the H1
20
Q
T/F: Benadryl is okay to be used as a sleep aid in the elderly.
A
False
21
Q
Which group of drugs does diphenhydramine (Benadryl) have an increased effect with?
A
CNS Depressants (ETOH, narcotics, sedatives, barbiturates)
22
Q
T/F: Benadryl is sometimes used to pre-medicate prior to blood tranfusions to avoid common minor blood reactions
A
True
23
Q
What is another common name for second-generation antihistamines?
A
nonsedating antihistamines
24
Q
T/F: second-generation antihistamines have fewer anticholinergic effects than first generations do.
A
True
25
Name one second-generation antihistamine
cetirizine (Zyrtec)
fexofenadine (Allegra)
oratadine (Claritin)
26
T/F: antihistamines can be used in emergency situations, such as anaphylaxis.
False
27
What causes nasal congestion?
Dilation of nasal blood vessels
28
What is the action of decongestants?
stimulate the alpha-adrenergic receptors to produce vasoconstriction or capillaries, thereby shrinking nasal mucous membranes and decreasing nasal fluid secretions (runny nose)
29
What classification are decongestants?
Alpha-adrenergic agonists/ sympathomimetics
30
What is rebound nasal congestion?
rebound vasodilation instead of vasoconstriction caused by frequent use of decongestants. Caused by irritation of the nasal mucosa
31
What is an example of a systemic decongestant?
ephedrine, phenylephrine, and pseudoephedrine
32
What are the side effects of decongestants?
Same as any adrenergic drug: stimulation of CNS, increased BP, HR, and blood glucose
33
What are decongestants contraindicated in?
hypertension, cardiac disease, and hyperthyroidism, and DM
34
What are glucocorticoids used for?
treatment of allergic rhinitis
35
How do glucocorticoids work?
Decrease local immune response/antiinflammatory action
36
Example of a glucocorticoid?
Beconase, Vanceril, Flonase, Nasacort
37
What do antitussives act on?
cough center in the medulla to suppress cough reflex
38
With what kind of cough can an antitussive be used?
nonproductive and irritating
39
Examples of nonarcotic antitussives?
Dextromethorphan, romilar, robitussin DM
40
Examples of narcotic antitussive?
Codeine
41
What is the purpose of expectorants?
loosen bronchial secretions so they can be eliminated by coughing
42
T/F: it is questionable if expectorants are clinically effective
True
43
What is the best expectorant?
Hydration
44
What is the most common expectorant preparation?
guaifensein
45
What are two pathophysiologic changes than occur with restrictive lung disease?
Decrease in total lung capacity/elasticity of lung tissues and decreased ability to take a full inhalation
46
Examples of restrictive lung diseases?
pulmonary fibrosis, pneumonitis, lung tumors, scoliosis, myasthenia gravis
47
What are the pathophysiologic changes that occur with COPD?
airway obstruction with increased airway resistance of airflow to lung tissues
48
Name the 4 causes/types of COPD
1. chronic bronchitis
2. Bronchiesctasis (dilation of bronchi)
3. emphysema
4. chronic asthma
49
Why is treatment for COPD focused on symptom control?
Permanent irreversible damage to lung tissue may occur
50
What is the etiology of asthma?
hypereractive immune system, stimulated by a trigger
51
The hallmark symptoms of asthma, wheezing and difficulty breathing, are due to what?
bronchospasm
52
What are the 3 signs of COPD?
Dyspnea, bronchoconstriction, and mucus secretion
53
When allergens attach themselves to mast cells, what is the result?
antigen-antibody reaction, which stimulates the release of chemical mediators: histamines, leukotrienes
54
What do the chemical mediators (histamines, leukotrienes) stimuate?
Bronchoconstriction
55
What is the goal of an acute asthmatic attack?
Stop bronchospasm and prevent continued hyperimmune response
56
What is the first line of defense for an acute asthmatic attack?
Sympathomimetics
57
Which drug is given SC to promote bronchodilation and elevate blood pressure in the event of an acute asthmatic attack?
Epinephrine (adrenaline)- used for emergencies
58
T/F: epinephrine is dangerous to use except in life threatening situations
True
59
What is a medication that is for acute asthmatic attacks, but is rarely used because of its side effects?
Isoproterenol (Isuprel)
60
What type of drug is isoproterenol (Isuprel)?
non-selective adrenergic agonist (stimulates beta 1 and 2)
61
Which drug can have tolerance with excess use and have paradoxical spasm with overuse?
Metaproterenol (alupent)
62
Which drug is preferred for emergency tx or rescue inhaler for home?
albuterol (Proventil)
63
What type of drug is albuterol?
Beta 2 agonsit
64
T/F: high doses of beta 2 agonists can cause some degree of beta 1 stimulation.
True
65
What two side effects may be seen with albuterol?
increase in heart rate and blood glucose
66
What type of drug is ipratropium bromide (Atrovent) and what is its purpose?
anticholinergic, dilates bronchioles
67
T/F: Atrovent has more side effects compared to traditional anticholinergics.
False; it has less side effects
68
If a patient is using a B agonist in addition to Atrovent, which should be used FIRST?
B agonist, then Atrovent
69
If a patient is using a corticosteroid in addtion to Atrovent, which should be given FIRST?
Atrovent
70
What two drugs make up Combivent?
ipratropium (Atrovent) and albuterol
71
What is the action of methylxanthine (xanthine)?
stimulates CNS and respiration, dilates coronary and pulmonary vessels, leading to bronchodilation
72
What are the three methylxanthine derivatives?
aminophylline, theophylline, and caffeine
73
What are side effects of theophylline?
GI disturbances, nervousness,
74
T/F: tobacco increases the metabolism of theophylline, giving it a short half life and producing less effect/
True
75
What is the drug action for Leukotriene receptor antagonists?
reduce inflammatory process and decrease bronchoconstriction
76
Why are leukotriene receptor antagonists not used for acute asthma attacks?
The effects last for 24 hours
77
Which leukotriene receptor antagonist is used for kids 6 years and older
montelukast (Singulair)
78
Which leukotriene receptor antagonists are used for adults and children over 12?
zileuton (Zyflo) and zafirlukast (Accolate)
79
What is the drug name for the aerosol inhaler of the glucocorticoid?
beclomethasone (Vanceril, Beclovent)
80
T/F: inhaled steroids have less systemic effects.
True
81
T/F: patients should NOT wash their spacers and mouths after using a inhaler.
False; they should wash things things to prevent left behind drug deposits, which may lead to candida albicans
82
T/F: glucocorticoids must be tapered when stopping
True
83
What do mast cell stabilizers do?
stabilize the mast cell membrane to suppress the release of histamine, resulting in an anti-inflammatory response
84
Do mast cell stabilizers have a bronchodilator effect?
No, and they should not be used for an acute asthmatic attack
85
Examples of mast cell stabilizers.
comolyn (Intal) and nedocromil (Tilade)
86
What is the action of Mucolytics?
liquidfy and loosen thick mucus secretions
87
acetylcysteine (Mucomyst) is what type of drug?
Mucolytic
88
What two things can acetylcysteine (Mucomyst) be used for if given orally?
1. Antidote for acetaminophen overdose
| 2. Protect kidney in radiology dye studies
89
T/F: acetylcysteine (Mucomyst) smells and tastes awful.
True
90
What is preferred to give in Step 1 of the treatment program for asthma?
SABA PRN
91
What is preferred to give in step 6 of the treatment program for asthma?
High-dose ICE+LABA+oral corticosteroid
92
What are diuretics used to treat?
hypertension and edema in heart failure and liver or kidney failure
93
What is natriuresis and what drugs have the greatest effect in causing it?
sodium loss in the urine; drugs that act on the tubules closest to the glomeruli
94
How do diuretics produce antihypertensive effects?
by blocking Na and H2O reabsorption, which leads to loss through urine.
95
Which tube do thiazide diuretics act on?
the distal tube
96
T/F: thiazide should be used cautiously in patients with decreased renal function.
True
97
What hypo lab abnormality might thiazide cause?
hypokalemia (K) **enhances digoxin, can cause digitalis toxicity
98
What hyper lab abnormalities might thiazide cause?
Hypercalcemia (calsium), hyperglycemia, and hyper uricemia (serum uric acid)
99
If a patient has more urine output, should you expect an increase or decrease in electrolyte levels?
Decrease
100
Because it may cause hypokalemia, thiazide should not be used with...
steroids
101
Where do loop diuretics work and what do they do?
Act on ascending loop and inhibit Na reabsorption= water loss
102
T/F: loop diuretics are dose dependent. the higher the dose, the greater the effect of the drug
True, this is called the high ceiling
103
T/F: loop diuretics are less potent than thiazides.
False; loop diuretics are more potent, causing 2-3x more water loss
104
Name the most common loop diuretic
furosemide (Lasix)
105
What lab changes may occur with loop diuretics?
Hypokalemia, hypoatremia (sodium), and hypocalcemia
106
What is the onset of loop diuretics orally? IV?
Oral: 30 minutes; IV: 3-5 minutes
107
If a patient is on loop diuretics, a nurse should do what two things?
1. watch electrolytes
| 2. make safe path to restroom
108
In high or rapid doses, loop diuretics are associated with...
otoxicity; damage to the 8th cranial nerve
109
What is the action of osmotic diuretics?
increase osmolality of plasma and fluid in renal tubules, which leads to an increase in excretion of Na, Cl, K, and water b/c it is pulled into the blood and ultimately the urine
110
T/F: osmotic diuretics are used for emergencies and are short term with a short drug action.
True
111
What two types of pressure are decreased by osmotic diuretics?
intracranial and intraocular
112
Which diuretic is used to prevent renal failure?
Osmotic diuretics
113
Example of a osmotic diuretic?
Mannitol
114
How is mannitol administered?
IV
115
What is a problem that is common with mannitol and should be watched out for?
Mannitol with crystalize if exposed to a low temp. Vial must be warmed to dissolve crystals before administration. Do not give mannitol if crystals are present
116
T/F: osmotic diuretics pulls water from interstitial space to vascular space, then moves to the kidney where we get rid of it
True
117
Why might pulmonary edema result from an osmotic diuretic use?
rapid fluid shift can overload a weak heart
118
How does fluid loss effect HR and BP
Will lead to tachycardia and hypotension
119
What do potassium sparing drugs interfere with?
Na-K pump controlled by aldosterone
120
T/F: potassium-sparing diuretics are aldosterone agonists.
False; they are aldosterone antagonists, they interfere with the pump controlled by aldosterone
121
Which diuretic is the least potent?
potassium-sparing
122
Example of a potassium-sparing diuretic
spironolactone (Aldactone)
123
Which diuretic are potassium-sparings typically paired with?
Thiazide to lessen K+ loss
124
What is a side effect of potassium-sparing diuretics?
hyperkalemia; do not take a potassium supplement if on this drug
125
What types of drugs should not be taken with potassium-sparing diuretics?
Any drug that holds on to K (like ACE inhibitors)
126
What is the most effective way to monitor fluid volume?
daily weights
127
Besides weight, what can be used to monitor fluid volume?
I & O, BP, fatigue, weakness, breath sounds and edema (last two not best)
128
T/F: fall risk is increased if a patient is on diuretics.
True
129
Name 4 medically approved uses for CNS stimulants
ADHD, Narcolepsy, obesity (sort of), reveral of respiratory distress
130
Do CNS stimulants increase or decrease the level of NTs?
Increase
131
Which two NTs do Amphetamines stimulate the release of?
norepinephrine and dopamine
132
What two problems are treated with amphetamines?
ADHD and narcolepsy
133
What is a common amphetamine?
amphetamine (Adderall)
134
Four side effects of amphetamines?
1. sleeplessness
2. restlessness
3. tremors
4. irritability
135
What cardiovascular problems may occur while taking amphetamines?
tachycardia, palpitations, dysrhythmias, and hypertension (can be dangerous for people w/ high HR or BP)
136
T/F: long term use of amphetamines does not typically lead to dependence and tolerance
False
137
T/F: amphetamine use is associated with substance abuse problems later in life
True
138
What should you do if toxicity is suspected to cause excretion of amphetamines?
decrease the urine pH
139
Name a common amphetamine-like drug
methylphenidate (Ritalin)
140
T/F: Ritalin should not be given 6 hours before bed
True
141
What is a common amphetamine-like drug given for narcolepsy?
modafinial (Provigil)
142
What four things should be assess for with patients taking Ritalin?
BP, pulse, weight, and judgment (May produce false sense of well-being)
143
T/F: patients taking Ritalin should take a drug holiday
True
144
What are two purposes of a drug holiday?
1. chance to reevaluate without drug to see if still needed
| 2. prevent tolerance- can start drug back up again at a lower dose
145
T/F: patients on ritalin should avoid alcohol, but not caffeine
False; they should avoid both
146
Name of a anorexiant
dextroamphetamine (Dexedrine)
147
T/F: dexedrine is associated with problems of tolerance, dependence, and abuse
True
148
T/F: dexedrine is recommended as an appetite supressant
False; it is not recommended
149
Due to its association with causing hemorrhagic strokes in women, which drug was taken out of OTC cold and weight loss drugs?
phenylpropanolamine
150
What is the primary purpose of analeptics?
stimulate respiration
151
Two examples of analeptics
Caffeine and theophylline (bronchodilator)
152
What are analeptics most commonly used for?
newborn respiratory distress
153
Example of a respiratory CNS stimulant
Doxopram (dopram)
154
Doxopram should be used cautiously with...
neonatal apnea- mechanical ventilation is better
155
What is the pathophysiology of headaches/migranes
inflammation and dilation of blood vessels in the head
156
Preventative treatment for headaches includes...
Beta-adrenergic blockers (propanolol), anticonvulsants (valproic acid), and tricyclic antidepressants (amitriptyline)
157
What are triptans used to treat?
headaches
158
Example of a triptan
zolmitriptan (Zomig)
159
What type of drug is a triptan?
selective serotonin receptor agonist
160
Triptans must be used cautiously if the patient has a history of...
Mi or hypertension
161
What is the drug of choice for treating insomnia?
Sedative-hypnotics
162
During which stage of sleep does most recallable dreams occur?
REM
163
What is the most mild form of CNS depression?
Sedation
164
What types of effects do low doses of sedative-hypnotics produce?
Sedative effects: diminishes responses but does not alter consciousness
165
What types of effects do high doses of sedative-hypnotics produce?
Hypnotic (sleep) effects
166
T/F: hypnotic drug therapy should be short-term to prevent drug tolerance and dependence
True
167
Which controlled substance class do barbiturates belong to?
Class II (accepted medical use, but highly addictive)
168
Which herbal supplements will produce an additive type effect with barbiturates?
Kava kava and Valerian
169
T/F: barbiturates should not be used for less than one month
False; they should not be used for MORE than two weeks (is okay for sleep, but not seizures)
170
What is thiopental sodiam (pentothal) used for?
General anesthetic, truth serum, and euthanasia of animals
171
Which barbiturate is ultrashort-acting?
thopental sodium (Pentothal)
172
This type of drug works by increase the action of inhibitory NT GABA to the GABA receptors
benzodiazepines
173
What is the result of the action of benzodiazepines?
neuron excitability is reduced- can also be used as an anticonvulsant and for ETOH withdrawal (uses same receptors)
174
What controlled substance class are benzodiazepines?
Class IV
175
What is flumazenil and what is it used for?
A benzodiazepine ANTAGONIST; used for benzodiazepine overdose
176
T/F: although it uses the same receptors as alcohol, withdrawal symptom will not occur if benzodiazepines are suddenly stopped.
False; withdrawal syndrome will occur
177
What are three goals of using benzodiazepines as hypnotics?
1. decrease anxiety
2. pre-op sedation
3. treat insomnia
178
Example of a benzodiazepine used as a hypnotic?
Alprazolam (Xanax)
179
Nonbenzodiazepines are used to treat what?
insomnia
180
Example of an nonbenzodiazepine?
zolpidem (Ambien) *should not be used for more than 10 days*
181
Before giving sedatives/hypnotics to older adults, what should the nurse first assess?
Cause of insomnia, eliminate it. (may be pain, nocturia, or other drug use)
182
T/F: sedative-hypnotics must be used cautiously in older adults
True
183
What are important nursing interventions for an older adult taking a sedative-hypnotic?
Start at 50% less dose, start low, go slow
Use drugs with shorter half lives
increased risk for confusion and falls
Should not take benzodiazepines more than 4 nights a week.
184
T/F: even if a person has isolated seizures, they still are identified as having epilepsy.
False; the are not identified as having epilepsy if they have isolated seizures
185
50% of seizures are caused by what?
unknown causes
186
What is common in all causes of seizures?
Na, K, and Ca cannot move across cell membranes as they should, resulting in hyper excitability, with abnormal electrical charges
187
If an isolated seizure is caused by fever, alcohol intox, or electrolyte imbalance, how is it treated?
Treat the underlying problem, and the seizure will resolve.
188
What are the peak periods of seizures?
puberty and pregnancy
189
Which part of the brain is involved with generalized seizures? Are they convulsive or non convulsive?
Involves BOTH hemispheres of the brain; may be BOTH convulsive or non.
190
What part of the brain is involved in partial seizures? Will there be a loss of consciousness?
Involves ONE hemisphere of the brain; may or may not be loss of consciousness
191
Tonic generalized seizures
sustained muscle contraction
192
Clonic generalized seizures
dysrhythmic muscle contraction
193
Atonic generalized seizures
w/o muscle tone: dead drop, loss of posture
194
What is the definition of a status epileptic?
Seizure lasting longer than 30 mins: repeated seizures w/o return to baseline neuro status
195
What will happen if a seizure is not stopped?
person may become hypoxic and sustain anoxic brain injury
196
What is the first choice of drug to use to treat status epileptics?
Benzodiazepines (valium and ativan)
197
What is lorazepam (Ativan) IV preferred over valium?
shorter duration
198
What is a side effect of benzodiazepines?
Respiratory depression
199
What is the second choice of drug used to treat status epileptics?
Barbiturates- sustain "brain rest"
200
T/F: with febrile (fever) seizures, anticonvulsants are not used in children
True
201
T/F: epilepsy develops in approximately 2.5% of children who have had one or more febrile seizure
True
202
Should phenytoin (Dilantin) be used in pregnant women for the treatment of seizures?
NO- may cause teratogenic effects on fetus, contraception is required if on this drug
203
Why are seizures more likely in pregnancy?
Changes in metabolism and hormone changes can alter seizure threshold.
204
What is the action of Anticonvulsants (AEDs)?
Suppress abnormal electrical impulses from spreading, thereby preventing seizures
205
T/F: anticonvulsants eliminate the cause of seizures
False; they do not
206
Which of the following do anticonvulsants increase and decrease: Na, Ca, action of GABA
Decrease Na and Ca
| Increase action of GABA (which creates an inhibitory effect)
207
What does drug choice for anticonvulsants depend on?
seizure pattern, EEG, and patient tolerance/response
208
How do you know when to stop increasing the dose of an anticonvulsant?
when there are either: no seizures or side effects become intolerable
209
T/F: sudden stop of anticonvulsants can cause rebound seizures
True
210
What type of drug is phenytoin (Dilantin)?
Anticonvulsant
211
Because Dilantin has a low therapeutic index, it must be monitored closely. What range should the serum level fall into?
10-20 mcg/ml
212
What pharmacokinetics/pharmacodynamics are important to know for Dilantin?
Absorbed slow/differently in person to person, long half life (22 hours), highly protein bound (long duration and more drug interactions)
213
What is important for the nurse to know when IV use of phenytoin (Dilantin) is being administered?
1. Dilated with normal saline ONLY
2. must be filtered in line to avoid precipitation
3. should be slow and IVPB
4. Monitor EKG if loading dose or cardiac problems
214
What are side effects of phenytoin (Dilantin)?
Gingival hyperplasia (overgrowth of gum tissue), thrombocytopenia, hyperglycemia
215
T/F: Dilantin may increase or decrease with use of digoxin and coumadin
True
216
T/F: the preferred way of administering phenytoin (Dilantin) is with a meal.
False; preferred on empty stomach
217
For which anticonvulsant is bone marrow depression a major side effect?
carbamazepine (Tegretol)
218
Can carbamazepine (Tegretol) be used to treat ETOH withdrawal and some psychiatric disorders?
Yes, but it is not approved by the FDA
219
Can valproate be used to treat most types of seizures?
Yes
220
What is a big concern for the drug valproate?
Hepatoxicity- monitor liver enzymes
221
Why is phenobarbital not used as the first choice for an anticonvulsant?
causes sedation and poor pt. tolerance
222
What should NOT be taken with Phenobarbital?
Alcohol, will cause an additive effect
223
Why are barbiturates like phenobarbital used as anticonvulsants?
puts the brain to sleep to decrease metabolic activity to allow ppl to recover and prevent them from becoming brain dead.
224
Which drug is used to treat petit mal (absent) seizures?
Succinimides (like Zarontin)
225
What must patients taking anticonvulsants wear?
an ID bracelet
226
T/F: it is okay for a patient on an anticonvulsant to switch to the generic brand
False; should get OKed by a MD
227
What are the cardinal symptoms of parkinson's disease?
rigidity, tremor, and bradykinetics (abnormal movements)
228
What is the pathophysiology of parkinson's diease?
Decreased dopamine, so Ach takes over and over stimulates motor neurons
229
What is the goal of treatment for parkinson's?
Increase dopamine, which has an inhibitory effect on the muscles
230
Example of an antichoinergic used to treat parkinsons
Benztropine mesylate (Cogentin)
231
T/F: anitcholinergics are sympatholytics that inhibit the release of Ach
True
232
How do dopaminergics treat parkinson's?
convert to dopamine and increase the amount of dopamine available
233
What is a precursor of dopamine?
Levodopa
234
What is levodopa converted to?
dopamine
235
Why must high doses of levodopa be given to be effective?
To get more past the blood brain barrier and into the CNS, this causes significant side effects
236
What are the side effects of high doses of levodopa?
GI upset, dyskinesia, orthostatic hypotension, cardiac dysrhythmias, psychosis
237
What is the on-off phenomenon?
symptoms come and go depending on the level of dopamine (low drug level= symptoms on, high drug level= symptoms off)
238
What are the advantages of combining carbidopa with levodopa?
more dopamine reaches basal ganglia, and smaller doses of levodopa can be used
239
What does carbidopa do
inhibits enzyme breakdown of levodopa in the periphery
240
What is it called when levodopa is combined with carbidopa?
Sinemet
241
T/F: Sinemet is available is several different doses, so the nurse must be careful because the pt. will get different doses at different times of the day
True
242
What do MAO-B inhibitors do?
prevent breakdown of dopa
243
Example of a MAO-B inhibitor
Selegiline (eldepryl)
244
Example of a dopamine agonist
Amantadine hcl (Symmetrel)
245
What is dyskinesia?
impaired voluntary movement, sometimes a side effect with parkinson's drugs
246
T/F: patients can take carbidopa-levodopa with food to decrease nausea and it will not effect absorption
False; they can take with food, but will decrease absorption
247
Is alzheimer's curable?
No :(
248
Alzheimer's is associated with a deficiency of which NT?
Ach
249
What is the progression of symptoms seen in alzheimer's?
confusion> memory loss> dementia> personality changes
250
What are ACE inhibitors?
Drugs used to inhibit cholinesterase, which decreases the amount of Ach (therefore, ACE inhibitors increase amount of Ach)
251
Example of a ACE inhibitor
donepril (Aricept)
252
T/F: drugs may decrease rate of progression of Alzheimer's, but do not prevent disease progression
True
253
How many people see improvement with Alzheimer's?
1/3
254
What type of teaching is important for Alzheimer's?
family safety: falls, wandering (2nd stage) and inability to monitor own meds
255
Which disease is the autoimmune deficiency of ACH receptors, leading to decrease neuromuscular transmission?
Myasthenia Gravis
256
What is thought to cause the symptoms of psychosis?
imbalance (probably a lack) of dopamine
257
T/F: antipsychotic agents can be used to treat both anxiety and depression
False; they can treat neither, only psychotic disorders
258
Which receptors are affected by antipsychotic agents?
Blocks D2 Dopamine receptors (may cause psuedoparkinson's)
259
Phenothiazines falls into which drug category?
Antipsychotic agents
260
What are phenothiazines more commonly used for?
antiemetic (control of nausea and hiccups)
261
Why are phenothiazines not often used?
They cause significant sedation and ortostatic hypotension
262
What is the neuroleptic malignant syndrome?
rare but fatal condition where person loses autonomic control; cannot control BP or temp.
263
Examples of phenothiazines
chorpromazine (Thorazine)
Fluphenazine (Prolixin)
Thioridazine (Mellaril)
264
What can atypical antipsychotics be used for?
positive and negative symptoms of schizophrenia and dementia
265
Example of a serotonin/dopamine antagonist
risperidone (Risperdal)
266
Which antipsychotic has an adverse reaction of agranulocytosis?
clozapine (Clozaril)
267
What are adverse effects of antipyschotic agents called?
EPS: extrapyramidal reactions (pseudoparkinsonism)
268
T/F: even if an antipsychotic is stopped, parkinson-like side effects may not go away
True
269
How long might the full therapeutic effects for phenothiazines take?
3-6 weeks for psychosis, immediate for antiemetic
270
Which drug might make the urine pinkish or red-brown?
Phenothiazines
271
Do antipsychotics have side effects that are like sympathetic or parasympathetic drugs?
Sympathetic/anticholinergic
272
How long after starting meds can EPS be seen?
5-30 days
273
Why should patients taking antipsychotics avoid sunlight?
marked photosensitivity occurs
274
Antipsychotics increase/decrease the seizure threshold
Decrease- will make it easier for pts prone to seizures to have them
275
Will alcohol have an additive or antagonist effect with antipsychotics
Additive
276
T/F: two antipsychotics may be taken together
False; should NOT be given together
277
What should the nurse do if a patient is coming off an antipsychotic?
taper them, slowly come off, start at 1/4-1/2 usual adult dose
278
How do antipsychotic doses change for older adults?
require 25-50% less, and are at an increased risk for side effects
279
What is the difference between primary and secondary anxiety?
Secondary is related to a drug and is NOT treated with anxiolytics; primary is not related to a drug and IS treated with anxiolytics
280
In what time frame can drug tolerance to anti anxiety drugs occur?
less than 2-3 months
281
Which drugs can be used for anxiety, but are also anticonvulsants (AED)
Benzodiazepines: Valium, Xanax
282
How should the dose be adjusted for benzodiazpines if the patient has liver or renal disease
Less should be given
283
This is very important to not take with benzodiazepines
ETOH
284
In the event of a benzodiazepine overdose, the nurse should...
maintain airway and give and emetic followed by charcoal or flumazenil, unless the person is just simply sedated
285
What is the pathophysiology behind depression?
an insufficient amount of NTs (norepinepherine, serotonin, and dopamine)
286
Which herbal supplements may be used for depression?
St. John's wort and ginkgo
287
T/F: herbal supplements for depression should be D/C 1-2 week before surgery to decrease the bleeding risk
True
288
Explain the action of TCAs
BLOCKS UPTAKE of NTs so more chemicals stay in neuro synapse and there can be more transmission of impulses
289
How long do TCAs take to be therapeutic?
2-4 weeks
290
TCAs may cause fatal overdoses in which body system?
Cardiac
291
What is the prototype TCA?
nortriptyline (Aventyl)
292
TCAs have cholinergic/anticholinergic side effects
anticholinergic
293
Name 3 important side effects of TCAs
drowsiness, orthostatic hypotension, and dysrhythmias
294
How do SSRIs work?
BLOCK the REUPTAKE of serotonin, enhancing transmission
295
Which drugs should SSRIs not be used with?
MAO-I
296
Why are SSRIs used more often than TCAs?
they have less sedation and anticholinergic side effects and an overdose in not likely to be fatal (but they cost more :()
297
T/F: SSRIs can be used for the prevention of migraine headaches
True
298
What is the prototype SSRI?
fluoxetine (Prozac): effective in 50-60% of clients who do not respond to TCAs
299
What is the most common SSRI prescribed?
sertraline (Zoloft)
300
How long do SSRIs take to be therapeutic?
1-4 weeks
301
What is a big reason for noncompliance with SSRIs?
sexual dysfunction
302
How do MAO-Is increase levels of NE, dopamine, and serotonin?
inhibit the enzyme monoamine oxidase
303
What must be avoided when on MAO-Is?
Foods that contain Tyramine (cheese, cream, yogurt, coffee, chocolate, bananas, raisins, soy sauce, beer, red wine)
304
What could result from consuming foods containing tyramine or sympathomimetics while on MAO-Is?
Hypertensive crisis
305
Which group of drugs are contraindicated for MAO-Is?
TCAs
306
Lithium is also commonly called what type of drug?
Antimania
307
What is the toxic range for lithium?
1.5-2 mEq/L, this is very narrow
308
How often should serum levels be monitored when on lithium?
Biweekly, then monthly when drug is started
309
Lithium toxicity is more likely when which electrolyte is low?
Na; this sometimes occurs with increase perspiration or dehydration, diuretic therapy
310
T/F: patients taking lithium should also be put on a Na restricted diet
False; in fact, they may need to take salt tablets
311
T/F: lithium can be taken with NSAIDS
False
312
What is regular cardiac output?
3.5-5 L/min
313
Blood in ventricle at end of diastole; volume of blood in heart
preload
314
Resistance to flow out of ventricle
Afterload
315
Increasing which 4 things will increase cardiac workload
preload, afterload, rate, and contractility
316
Inotrope
drug that effects CONTRACTILITY
317
Chronotrope
drug that effects HEART RATE
318
Dromotrope
drug that effects CONDUCTION (+ will increase contractility, - will decrease contractility)
319
What are the 3 goals of cardiovascular drugs?
1. Improve pump function
2. decrease cardiac oxygen requirements
3. improve blood flow to body tissues
320
Which 3 drugs are most commonly used for shock/hypotension
1. Epinephrine (adrenaline)
2. dopamine
3. dobutamine
321
Which CV drug is most powerful to increase HR, contractility, vasoconstriction, and oxygen needed by the heart
Epinephrine (adrenalin)
322
What are low doses of dopamine used for?
improving renal blood flow by dilating the renal artery
323
What are high doses of dopamine used for?
action similar to epinephrine, increase HR and BP
324
Which group of drugs is used to improve pump function?
Cardiac glycosides
325
Digitalis/digoxin (Lanoxin) is used for what?
improve pump function, it is a cardiac glycoside
326
Digoxin is positive/negative: inotrope, chronotrope, dromotrope
positive inotrope, but negative chromo-and-dromotropes (increases contractility, but slows the rate to allow the ventricles to fill up)
327
What are side effects related to digoxin?
Rhythm and rate issues, "yellow" vision, headache, nausea and vomiting.
328
At what number is digoxin toxic?
>2.0 mg/dL
329
T/F: digoxin is highly protein bound and has many interactions with other drugs
True
330
What are some indications that digoxin is working?
improved mental status, urine output of 30ml/hr, improved activity tolerance, controlled heart rate
331
If digoxin is not effective, what is used to treat CHF?
phosphodiesterase inhibitors
332
What type of drug is Primacor?
a phosphodiesterase inhibitor
333
T/F: K levels should be around 4, because decreed K increases the effects of digoxin
True
334
Which 3 electrolytes should be watched while on digoxin?
K, Ca, and Magnesium
335
Why are many drugs that are used to treat angina also used to treat hypertension?
They both cause vasodilation, decreasing pressure
336
What is angina caused by?
lack of blood flow to heart tissues (Ischemia- decreased flow, no damage)
337
Chronic stable angina
due to stress or exertion
338
Unstable angina
chest pain for no apparent reason
339
Vasospastic angina
occurs at rest
340
Why are nitrates unique?
they affect both veins and arteries
341
nitroglycerine (NTG) is what class of drug?
Nitrate
342
Venous dilation decreases what?
Preload (decreased return to the heart)
343
Arterial vasodilation decreases what?
afterload (heart doesn't have to push as hard)
344
What is the overall goal of nitrates?
decrease O2 demand and increase O2 supply
345
Atenolol, propanolol and metoprolol are what types of drugs?
Antianginal- beta blockers (decrease symp. effect)
346
Verapamil and diltizem, Ca channel blockers, prevent what?
movement of Ca across membrane= less muscle contraction
347
T/F: Calcium channel blockers will cause hypocalcemia
False; will not change serum Ca level
348
what are the side effects of Nitrates?
hypotension and headache (HA)
349
How would the nurse decide if it is okay to give NTG
check blood pressure
350
How will beta blockers affect HR and O2 demand?
Decrease both
351
What are the side effects of beta-blockers?
decreased BP & HR, sexual dysfunction, fatigue, bronchospasm, glucose problems, rebound angina or high BP if not tapered off
352
Are Ca channel blockers positive or negative ionotropes? Dromotropes?
negative ino, negative dromo
353
Cardizem, Calan, and Norvasc are all what types of drug
Antianginal-beta blockers
354
What are the side effects of Ca channel blockers?
bradycardia, peripheral edema, hypotension, constipation, headache, liver and renal changes
355
Hypertension is described at what number?
140/90, but interventions are required before that
356
T/F: hypertension requires individualize treatment plans and may require many types of drugs
True
357
What do adrenergic agents do to alpha 1 receptors and why
Block alpha 1 to dilate periphery
358
Besides hypertension, what are adrenergic agents also used to treat?
benign prostate hypertrophy
359
What do adrenergic agents do to alpha 2 receptors and why?
stimulate alpha 2 to dilate CNS
360
If a patient has high lipid levels, which choice of drug may be best for hypertension?
adrenergic agents
361
What 2 herbal supplements interact with adrenergic agents to stimulate the CNS?
Ma huang, ephedra
362
How do antihypertensive vasodilators acts?
directly on arteriolar smooth muscle to cause relaxation and vasodilation to decrease BP
363
Example of a vasodilator
hyralazine (Apresoline)
364
If bloodflow/pressure is low, what will happen?
aldosterone will be secreted and cause sodim and water retention, which will increase BP
365
What do ACE inhibitors do?
prevent conversion of angiotensin I to angiotension II so vascoconstriction and fluid retention are decreased
366
T/F: ACE inhibitors are especially good for tx of HF
True
367
What are the side effects of ACE inhibitors?
HYPERkalemia, dry "ACE" cough, hypotension, angioedema (severe swelling of tongue, lips: go to ER)
368
Why are ARIIB's different from ACE inhibitors?
they work at the receptor
369
PTT and APTT monitoring is used for what drug?
Heparin
370
PT monitoring is used for what drug?
Warafarin
371
What is the prefered lab test to measure the effects of heparin and warafarin?
INR
372
What is the normal value for INR?
1.0
373
What do PTT and APTT measure?
deficiencies in certain clotting factors
374
What does PT measure?
the time it takes blood to clot in the presence of certain clotting factors
375
What do the results of a clot depend on?
Where is is formed
376
A clot formed in an artery will cause what?
inhibited blood flow, ischemia and necrosis (platelet aggregation, atherosclerosis)
377
A clot formed in a vein will cause what?
decreased venous return, edema (due to stasis, vessel injury, coagulation factors, oral contraceptive, smoking, obesity)
378
What type of drug is heparin?
Anticoagulant
379
What does heparin do?
Prevent thrombin- so fibrin is not formed and there is no clot
380
What are low dose SubQ heparin used for?
prophylaxis of DVT
381
What are high dose IV heparin used for?
prevent growth of clot, DOES NOT DISSOLVE CLOT
382
T/F: heparin is available in several different concentrations
True
383
What is the half life of heparin?
Short, 4-6 hours
384
T/F: heparin is for short term use, if needed for longer, the patient should be put on coumadin
True
385
Lovenox and Fragmin are...
Low molecular weight heparins
386
LMWHs are used more for...
home use due to longer action, bridge between heparin and coumadin
387
What are doses for LMWHs based on?
weight and reason for giving
388
What are contraindications of heparin?
active/recent bleeding, strokes, ulcers, scheduled surgery
389
Doses for heparin should be based on
WEIGHT, WEIGHT
390
T/F: heparin can be IV, SC, or oral
False; no oral
391
If normal PTT/APTT is 20 seconds, the therapeutic value for heparin would be...
30-60 seconds (1.5-2.5 times normal)
392
T/F: if heparin is being taken for prophylaxis, PTT should barely be altered
True
393
What are the side effects of heparin?
bleeding at site, thrombocytopenia, heparing induced thrombocytopenia (never give pt heparin again)
394
This drug is an oral anticoagulant
Warfarin (Coumadin)
395
How does warfarin act?
inhibits VITAMIN K clotting factors
396
Does warfarin have a short or long half life?
Long, several days
397
T/F: warfarin is highly protein bound and takes several days to reach therapeutic effects
True
398
How many days before invasive procedures must warfarin be stopped?
2-3 days (use LMWH or heparin in meantime)
399
What is the therapeutic range for INR?
2-3 (normal is 1)
400
Is coumadin highly protein bound?
yes
401
T/F: ginger, ginko, garlic, and ginseng increase the action of warfarin
True
402
Vitamin K is an agonist/antagonist of warfarin
ANTAgonist
403
What should be used in an emergency to reverse the effects of heparin
protamine sulfate
404
What should be used to immediately reverse the effects of coumadin?
Fresh frozen plasma, which contains clotting factors
405
What should be used to slowly reverse the effects of coumadin?
Vitamin K
406
Which foods have high vitamin K content?
dark leafy vegetables
407
If a patient is allergic to heparin, what is used instead?
Direct thrombin inhibitors, like Acova or Refludan
408
Antiplatelet drugs are used for prophylaxis for what ?
CVA, MI
409
T/F: aspirin inhibits platelet aggregation
True, will take 81-325mg/day
410
T/F: if a patient is taking aspirin once a day, it is for pain
False; it is for prophylaxis of artery thrombosis
411
What do antilipemics do?
Lower blood lipid levels
412
A high risk cholesterol level is...
>240
413
A moderate risk cholesterol level is...
200-240
414
What do statins do?
interfere with how lipids are metabolized/formed in the liver.
Increase HDL and decrease LDl
415
What is included in important teaching about statins?
monitor liver function, report muscle weakness, pain, rhabdomyolysis is a serious reaction (breakdown of protein in skeletal muscles, causes renal failure), avoid pregnancy
416
What is the prototype statin?
atrovastatin calcium (lipitor)
417
How does resin, cholestryamine (Questran), work?
collects cholesterol in the gut, binds with bile
418
T/F: do not give Questran with other meds, it might prevent absorption
True
419
Which drug makes RBCs more flexible?
pentoxifylline (Trental)
420
Why should a patient not smoke while taking Trental?
it is the biggest risk factor for peripheral arterial disease
421
T/F: viagra is reported to be associated with transient ischemic attack
True
