Exam3 Flashcards
(74 cards)
1
Q
causes of hypokalemia
A
- diuretics (eg furosemide, HCTZ)
- insufficient dietary intake
- alkalosis and excessive insulin
- vomiting, diarrhea, and laxative abuse
2
Q
potassium supplement
A
potassium chloride
-PO or IV
3
Q
what should you take with oral potassium supplement and why?
A
food or a full glass of water
-because it is very irritating to the GI tract
4
Q
IV potassium precautions
A
- MUST be infused with a pump (NEVER push by hand)
- very irritating to the veins (must dilute with NS)
- via IVPB/secondary line
5
Q
signs of hyperkalemia
A
- bradycardia (slows heart rate= stop breathing)
- ECG changes (“peaked” T wave)
- weak (numbness, tingling)
- emesis
6
Q
serum potassium level should be:
A
3.5-5.0
7
Q
hyperkalemia can be treated with:
A
- insulin
- sodium bicarb
- sodium polystyrene sulfonate (Kayexelate)
8
Q
overactive bladder in today’s population
A
- 33% of americans (very common)
- most prevalent in older populations
9
Q
major symptoms of overactive bladder
A
- urgency (sudden urge to go)
- frequency (8+ times/day)
- nocturia (2+ times/night)
- urge incontinence (didn’t make it)
10
Q
behavioral therapy treatments for overactive bladder
A
- planning times to void
- planning what times you drink
- limiting caffeine use
- kegel exercises (women)
11
Q
medication for overactive bladder
A
oxybutynin
12
Q
oxybutynin mechanism of action
A
(overactive bladder med)
- an anticholinergic med
- selectively blocks M3 receptors in the bladder, decreasing contractions and the urge to void
13
Q
problems with oxybutynin
A
(overactive bladder med)
- tachycardia
- anticholinergic effects (constipation, blurred vision, photophobia, dry eyes, dry mouth)
14
Q
oxybutynin is contraindicated in clients who have:
A
(overactive bladder med)
-glaucoma
(increased intraocular pressure)
-myasthenia gravis
(immune system destroys Ach receptors, making the muscles very weak)
15
Q
common uses for oral contraceptives
A
- acne (in girls that also want contraception)
- contraception
- dysfunctional uterine bleeding
- menopausal hormone therapy
- premenstrual dysphoric disorder (PMDD)
16
Q
oral contraceptives to know:
A
combination (estrogen/progestin):
ethinyl estradiol/norethindrone
Progestin-only:
norethindrone
17
Q
oral contraceptives mechanism of action
A
- estrogen suppresses the release of follicle stimulating hormone (FSH)
- progestin suppresses the release of luteinizing hormone (LH)
- this prevents ovulation, thins the lining of the uterus, and thickens cervical mucus
18
Q
difference bw progestin and estrogen
A
- progestin does NOT stop ovulation
- when taking a progestin-only oral contraceptive, the risk of thrombosis is smaller
19
Q
thromboembolic events pertaining to OCs
A
- DVT, PE, MI, thrombolic stroke
- risk factors: heave smoking, history of thromboembolism, thrombophilias, older than 35yrs and a smoker
- lower doses today = lower risk
20
Q
breast cancer pertaining to OCs
A
- do NOT increase risk of breast cancer
- however, can increase the RATE of growth
21
Q
drug interactions with OCs
A
- St. John’s wort
- antiseizure meds (phenytoin, carbamazepine, phenobarbital)
- antibiotics (penicillins, cephalosporins, rifampin)
22
Q
transdermal patch (ortho evra)
A
- once a week for three weeks
- no patch on the 4th week
23
Q
vaginal contraceptive ring (nuvaring)
A
- wear for 3 weeks
- no ring the 4th week
- if it falls out: rinse with warm water and reinsert
24
Q
medication options for BPH
A
- alpha1 blockers
- 5-alpha-reductase inhibitors
- saw palmetto
25
alpha1 blockers to know for BPH
- tamsulosin
| - doxazosin
26
alpha1 blockers mechanism
(BPH meds)-tamsulosin, doxazosin
- relax smooth muscle in the neck of the bladder, allowing urine to flow more freely through the urethra
- also block receptors in the vasculature, decreasing blood pressure
27
notable problems with alpha1 blockers (pertaining to BPH)
```
nonselective agents (doxazosin);
-hypotension, dizziness, nasal congestion, sleepiness
```
selective agents:
-abnormal ejaculation
28
5-alpha-reductase inhibitors to know for BPH
ending in -asteride
- finasteride
- dutasteride
29
mechanism of 5-alpha-reductase inhibitors
(BPH meds) -finasteride, dutasteride
- block the enzyme that converts testosterone into DHT (dihydrotestosterone)
- since DHT is what triggers the prostate to grow, this helps halt the growth of the prostate, and even SHRINKS IT.
- DHT also plays a role in male-pattern baldness (these drugs also help regrow hair)
30
notable problems with 5-alpha-reductase inhibitors
(BPH meds) finasteride, dutasteride
- pregnancy category X**
- men must not donate blood
- decreased libido, abnormal ejaculation
- falsely decreased PSA levels (prostate specific antigen= marker for prostate cancer)
- gynecomastia
31
which of the BPH meds can also treat hypertension?
alpha1 blockers--> tamsulosin, doxazosin
32
which of the BPH meds can also treat male-pattern baldness?
5-alpha-reductase inhibitors--> finasteride, dutasteride
33
which of the BPH meds is extremely teratogenic?
5-alpha-reductase inhibitors--> finasteride, dutasteride
34
common causes of erectile dysfunction (ED)
- vascular (hypertension, diabetes, coronary artery disease)
- neurologic (stroke, parkinson's spinal cord injuries)
- hormonal
- drug-induced (SSRIs, betablockers)
- psychogenic (psychological- stress, anxiety, depression)
35
PDE5 inhibitors to know (ED meds)
ending in -nafil
- sildenafil
- tadalafil
- vardenafil
**these drugz do not cause erection; when body starts making PDE5, it halts PDE5 so the erection is maintained
36
notable problems with PDE5 inhibitors (ED meds)
sildenafil, tadalafil, vardenafil
- hypotension
- priapism (~4hr)
- sudden hearing loss
37
PDE5 inhibitors and nitrates
- both increase cGMP levels
- if these drugz are combined, life-threatening hypotension can occur
- wait at least 24 hours
38
"preterm" labor
-defined as birth before 37 weeks
-leading cause of infant mortality and morbidity
(75% of neonatal deaths)- lungs are not fully developed yet
39
induced labor
- more than 22% of deliveries are induced
| - labor should be induced: beyond term (42 weeks)
40
labor and delivery meds to know
- oxytocin
- methylergonovine
- terbutaline
- magnesium sulfate
41
oxytocin
(L&D med)
- increases the strength, frequency, and length of uterine contractions
- use pump and monitor closely
42
when using oxytocin for L&D, stop the infusion if:
- resting uterine pressure > 15-20 mmHg
- contractions lasts > 1 min
- contractions frequency every >2-3min
- pronounced alteration of FHR (fetal HR) or rhythm
43
methylergonovine
(L&D med)
- controls postpartum bleeding
- causes POWERFUL uterine contractions
44
what's the risk of using methylergonovine (L&D med)?
HYPERTENSION
-safer agents such as oxytocin are usually tried first
45
terbutaline
(L&D med)
- suppresses preterm labor
- activates beta2 receptors in the uterus, causing uterine relaxation
46
major side effects of terbutaline (L&D med)
- tachycardia, hypotension
- pulmonary edema
- hyperglycemia
47
magnesium sulfate
(L&D) med
- inhibits release of acetylcholine in synapses of skeletal muscle and uterus
- used for preeclampsia (prevent seizures)
48
magnesium sulfate toxicity
- RR<12/min
- loss of DTR
- hypotension
- urinary output <25-30 mL/hr
49
antidote for magnesium sulfate:
calcium gluconate
50
which of the L&D meds increases the strength, frequency, and length of uterine contractions?
oxytocin
51
which of the L&D meds controls postpartum bleeding?
methylergonovine
52
which of the L&D meds suppresses preterm labor and causes uterine relaxation?
terbutaline
| beta2 agonist
53
which of the L&D meds is used for preeclampsia (and prevent seizures)?
magnesium sulfate
54
always collect specimens ______ starting antibiotic therapy
BEFORE
55
beta-lactam antibiotics to know:
penicillins (-cillin)
-amoxicillin/clavulanate
cephalosporins (ceph- or cef-)
-cephalexin
carbapenems (-penem)
-imipenem
56
mechanism of beta-lactam
penicillins, cephalosporins, carbapenems
- interfere with an enzyme inside bacteria called penicillin binding protein (PBP)
- this enzyme helps bacteria build strong cell walls
- by blocking PBP, bacteria cannot build stron cell walls
- they swell up with water and BURST. Boom!
57
allergic rxns pertaining to beta-lactam antibiotics
beta lactams: penicillins, cephalosporins, carbapenems
- penicillins are the most common cause of drug allergy (0.4-7% of clients)
- (rash to anaphylaxis)
- most likely to occur w/in 30 min
- 1% cross sensitivity to cephalosporins
58
superinfection pertaining to beta-lactam antibiotics
beta-lactams: penicillins, cephalosporins, carbapenems
- Cephalosporins cause C. diff
- advise clients to report watery diarrhea
- treat with metronidazole or vancomycin
59
pneumonic:
| "if you get C. diff, you..."
1. stop (antibiotic)
2. swap (hand foam to soap and water)
3. metronidazole
(stop, drop, and roll)
60
protein synthesis inhibitors (antibiotics) meds to know
tetracyclines
macrolides
- erythromycin
- azithromycin
aminoglycosides
- gentamycin
- neomycin
- amikacin
- tobramycin
- streptomycin
61
problems with TETRACYCLINES
| protein synthesis inhibitor antibiotic meds
- esophageal ulceration (avoid taking at night)
- many food interactions (milk products, calcium, iron supplements, magnesium containing laxatives and antacids)
- teeth discoloration (if <8 yo)
- photosensitivity (sunburn)
62
problems with MACROLIDE
| protein synthesis inhibitor antibiotic meds
(macrolides: erythromycin, azithromycin)
- distorted taste (metallic)
- prolonged QT intervals
63
problems with amiNOglycoside
(aminoglycosides: Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin)
- Nephrotoxicity (watch kidney function)
- Ototoxicity
- NO penicillin (inactivated by PCN if mixed together)
64
fluoroquinolone meds to know
ending in -floxacin
- ciprofloxacin
- levofloxacin
- moxifloxacin
- norfloxacin
- ofloxacin
65
fluoroquinolone mechanism
they disrupt DNA replication in bacterial cells
66
notable problems with fluoroquinolone
- achilles tendon rupture (avoid use in children <18 yo)
- photosensitivity
- multiple food interactions (dairy products, aluminum-magnesium antacids, iron)-- like tetracyclines
67
ciproflaxin treats:
- UTIs
- traveller's diarrhea
- anthrax
68
UTI meds to know
think: SNP--> "Someone Needs to Pee"
- Sulfamethoxazole/trimethoprim
- Nitrofurantoin
- Phenazopyridine
69
mechanism of sulfamethoxazole/trimethoprim
(UTI med)
blocks 2 separate enzymes bacteria need to create their own folic acid
70
mechanism of nitrofurantoin
(UTI med)
enters bacteria and is converted into a toxic substance that destroys bacterial DNA
71
mechanism of phenazopyridine
(UTI med)
an analgesic that works directly on the mucosa of the GU tract
-kidneys filter right out
72
problems with sulfamethoxazole/trimethoprim
(UTI med)
- hypersensitivity
- crystalluria (drink 8+ cups of water per day)
- kernicterus (build up of bilirubin in brain = causes retardation) (don't give to pregnant women or infants <2 mo)
73
problems with nitrofurantoin
(UTI med)
- may turn urine a brownish color
- peripheral neuropathy (rare)
- take with FOOD to increase absorption (40%) and decrease GI discomfort
- contraindicated if renal impairment (increase risk of toxicity)
74
problems with phenazopyridine
(UTI med)
- turns urine an orange-red color (stains)
- GI discomfort (take with food)
