Final Flashcards
(130 cards)
1
Q
What causes iron deficiency anemia?
A
Inadequate intake, malabsorption (duodenal issues), chronic blood loss (e.g., GI bleeding, menstruation), CKD, or hemolysis.
2
Q
What are key signs/symptoms of iron deficiency anemia?
A
Pallor, glossitis, cheilitis, headache, burning tongue sensation, orthostatic hypotension, fatigue.
3
Q
How is iron deficiency anemia treated?
A
Iron replacement (PO/IV), manage underlying cause, take on empty stomach or with vitamin C; stool may turn black; use stool softeners for constipation.
4
Q
What foods are high in iron?
A
Lean meats, legumes, dark leafy greens, fortified cereals.
5
Q
What causes vitamin B12 deficiency and pernicious anemia?
A
Lack of intrinsic factor from gastric atrophy or autoimmune damage; causes malabsorption of B12 in the ileum.
6
Q
What are symptoms of B12 deficiency?
A
Sore/red tongue, anorexia, GI upset, neurologic symptoms: paresthesias, ataxia, cognitive impairment. Can cause irreversible damage if untreated.
7
Q
How is B12 deficiency treated?
A
Lifelong parenteral (IM) or nasal B12: 1000 mcg IM daily x2 weeks, weekly until stable, then monthly for life.
8
Q
What foods are high in B12?
A
Animal products, fortified cereals, soy milk.
9
Q
What causes folate deficiency?
A
Poor diet, alcoholism, pregnancy, malabsorption (celiac, Crohn’s), meds (metformin, phenytoin), dialysis.
10
Q
How is folate deficiency different from B12 deficiency?
A
Folate causes similar anemia symptoms but no neurologic signs unless thiamine is also deficient.
11
Q
What foods are high in folate?
A
Leafy greens, citrus, tomatoes, legumes, fortified cereals.
12
Q
Which red cell indices correlate with each deficiency?
A
Iron: ↓MCV (<80), microcytic/hypochromic
B12/folate: ↑MCV (>100), macrocytic
↓MCH & ↓MCHC also point to iron deficiency.
13
Q
What nutrients are required for RBC production?
A
Iron, folate, B12, protein, vitamins B2, B6, C, E, copper.
14
Q
What does epoetin alfa do?
A
Synthetic EPO; stimulates RBC production. Used for CKD or chemo-induced anemia. Requires functional bone marrow and adequate iron/B12/folate.
15
Q
What are key risks of epoetin alfa?
A
HTN, thrombotic/cardiac events (black box warning). Hold if Hgb ≥10.
16
Q
What does filgrastim do?
A
Stimulates neutrophil production. Used to prevent infection in chemo patients. Stop if ANC >10,000. Side effect: bone pain.
17
Q
What is Candida albicans and where is it found?
A
A fungus that lives on skin and moist mucosal areas (e.g., groin, mouth); can overgrow and cause superficial or systemic infections.
18
Q
What are common systemic fungal infections?
A
Histoplasmosis (bird/bat droppings, lungs), Aspergillosis (nosocomial, immunocompromised), Coccidiomycosis (“Valley Fever”) — causes lung and systemic symptoms.
19
Q
What antifungal is used for systemic infections like candidiasis?
A
Fluconazole — disrupts fungal cell membrane by inhibiting sterol synthesis.
20
Q
What are side effects and considerations for fluconazole?
A
GI upset. Monitor BUN, creatinine, LFTs. Drug interactions: ↑ bleeding with warfarin; ↑ hypoglycemia risk with glipizide/glyburide.
21
Q
What is Amphotericin B used for?
A
Severe progressive systemic fungal infections (e.g., histoplasmosis, aspergillosis).
22
Q
What are key side effects and nursing actions for Amphotericin B?
A
AE: chills, fever, hypotension, nephrotoxicity, ↑ liver enzymes. Nursing: frequent VS, hydrate, infuse slowly (4–6 hrs), may premedicate.
23
Q
How do antiviral drugs work?
A
Inhibit viral replication — they don’t kill the virus but help the immune system suppress it. Need a competent immune system to be effective.
24
Q
What is acyclovir used for and how does it work?
A
HSV-1, HSV-2, chickenpox, shingles. Inhibits viral DNA synthesis.
AE: crystalluria — encourage hydration.
25
What antivirals are used for the flu?
Oseltamivir (oral) and zanamivir (inhaled). Neuraminidase inhibitors → prevent virus release from cells. Must be started within 48 hours of symptom onset.
26
What are the five main types of WBCs?
Neutrophils (60-70%), Eosinophils, Basophils, Lymphocytes (20-25%), Monocytes.
27
What does a 'left shift' mean in WBC count?
↑ band (immature neutrophil) count → indicates acute bacterial infection or inflammation.
28
What is the function of neutrophils?
First responders to bacterial infection; phagocytose pathogens; short lifespan (1–2 days).
29
What is C-reactive protein (CRP)?
Non-specific inflammatory marker; rises 6–10 hrs after injury/inflammation; peaks in 48–72 hrs.
30
Why collect cultures before starting antibiotics?
To identify the specific pathogen and select the most effective antibiotic. Prevents resistance.
31
What do sensitivity results mean?
S = susceptible, I = intermediate, R = resistant. MIC = lowest concentration that inhibits growth.
32
What are the three types of antibiotic therapy?
Empiric: Broad-spectrum before pathogen is known; Definitive: Narrow-spectrum once pathogen is identified; Prophylactic: Preventative.
33
Why is antibiotic stewardship important?
To reduce resistance, improve outcomes, and limit unnecessary drug exposure.
34
What are the 5 D's of antimicrobial stewardship?
Right Drug, Dose, Duration, Drug-route, and timely De-escalation.
35
Why monitor creatinine with gentamicin?
Because gentamicin is nephrotoxic → monitor kidney function to prevent damage.
36
What are the adverse effects of aminoglycosides and vancomycin?
Nephrotoxicity, ototoxicity. Vancomycin IV: watch for Red-man syndrome (flushing, hypotension if infused too fast).
37
What is the target trough level for gentamicin?
< 2 mcg/mL.
38
What is the target trough for vancomycin?
Mild-moderate: 10 mcg/mL; Severe: 15–20 mcg/mL. Check 30 min before 4th dose.
39
What do beta-lactam antibiotics do?
Inhibit bacterial cell wall synthesis (includes penicillins, cephalosporins, carbapenems).
40
Which antibiotics have cross-sensitivity with penicillin?
Cephalosporins, carbapenems → avoid if history of PCN anaphylaxis.
41
What do sulfonamides do and what are side effects?
Inhibit folate synthesis; AE: Stevens-Johnson syndrome, crystalluria, ↑ warfarin effect.
42
Which food interferes with tetracycline absorption?
Dairy, calcium, iron → take before or after meals without these.
43
What is a risk of carbapenems like imipenem?
Seizures (especially in elderly or renal impairment).
44
What is the purpose of combining beta-lactam antibiotics with inhibitors like clavulanic acid?
To prevent bacterial enzymes (beta-lactamases) from breaking down the antibiotic.
45
What do statins do?
Statins (e.g., atorvastatin) lower LDL, cholesterol, and triglycerides, and increase HDL.
46
What is the mechanism of action of statins?
They inhibit HMG-CoA reductase, the enzyme needed for cholesterol synthesis in the liver.
47
What is a serious adverse effect of statins?
Rhabdomyolysis – muscle pain, weakness, dark urine.
## Footnote
Can be reversed if medication is stopped.
48
What are common statin side effects?
Abdominal cramps, constipation, diarrhea, muscle aches (myalgias).
49
When should statins be taken?
Often in the evening (when cholesterol biosynthesis is highest); may be taken with meals.
50
What does niacin (vitamin B3) do?
↑ HDL, ↓ triglyceride synthesis. Not first-line; used with statins.
## Footnote
AE: flushing, pruritus → take NSAID or aspirin 30 min before.
51
What does cholestyramine (bile acid sequestrant) do?
Binds bile acids → ↓ cholesterol and LDL.
## Footnote
AE: constipation, ↓ absorption of fat-soluble vitamins (A, D, E, K).
52
What does gemfibrozil (fibric acid derivative) do?
Activates lipoprotein lipase → ↓ triglycerides.
## Footnote
AE: abdominal pain, diarrhea.
53
What does ezetimibe (Zetia) do?
Inhibits cholesterol absorption in the small intestine. Used alone or with statins. Fewer side effects.
54
What’s the target for LDL and HDL?
LDL: <130 mg/dL (ideal <100)
HDL: >60 mg/dL
55
What lifestyle changes help hyperlipidemia?
↓ saturated/trans fats, ↑ fiber, ↑ omega-3s, stop smoking, exercise.
56
What is the goal of anti-hypertensive therapy?
Prevent complications like stroke, MI, heart failure, and kidney damage by controlling BP.
57
What is the definition of blood pressure?
BP = Cardiac Output × Systemic Vascular Resistance (SVR)
## Footnote
SVR is the force opposing blood flow, primarily influenced by vessel radius.
58
Why is hypertension called the 'silent killer'?
It often causes no symptoms but can lead to life-threatening organ damage (heart, brain, kidneys, eyes).
59
What should be taught to patients post-op or newly prescribed antihypertensives?
Never stop medications suddenly (risk of rebound hypertension)
Get up slowly to prevent orthostatic hypotension.
60
What is orthostatic hypotension?
A sudden drop in BP when standing. Teach patients to rise slowly, dangle legs, and change positions gradually.
61
What does lisinopril (an ACE inhibitor) do?
Blocks conversion of angiotensin I → II
↓ SVR and afterload
↓ aldosterone → ↓ preload
Slows cardiac remodeling
Renoprotective in diabetics.
62
What are common side effects of ACE inhibitors (e.g., lisinopril)?
Dry cough
Orthostatic hypotension
Hyperkalemia
Erectile dysfunction
Dose adjustment needed in renal impairment.
63
What does losartan (an ARB) do?
Blocks angiotensin II receptors → ↓ SVR
↓ aldosterone
No cough, unlike ACE inhibitors
Not used with ACE inhibitors.
64
What are side effects of ARBs (e.g., losartan)?
Hypotension, hyperkalemia, hypoglycemia.
65
What should be avoided when using ACE-Is or ARBs?
Potassium supplements or potassium-sparing diuretics (risk of hyperkalemia).
66
What lifestyle changes help control hypertension?
DASH diet
↓ Sodium (<2300 mg/day)
Weight loss, ↓ alcohol, quit smoking
Stress management
Physical activity.
67
What causes hepatic encephalopathy?
↑ Ammonia due to liver's inability to convert it to urea → crosses blood-brain barrier → neurotoxicity.
68
Signs and symptoms of hepatic encephalopathy?
Confusion, restlessness, asterixis (flapping tremor), disorientation, coma, possible death.
69
How does lactulose treat hepatic encephalopathy?
Traps ammonia in the gut
Increases its excretion in stool
Given PO or rectally
Outcome: improved mental status
70
Lactulose side effects and nursing considerations?
AE: gas, cramps, diarrhea, hyperglycemia
NI: monitor neuro status, ensure 2–3 soft stools/day, mix with juice/water to improve taste
71
What is cirrhosis?
Chronic liver damage → fibrosis, scarring, impaired function of hepatocytes.
72
Common causes of cirrhosis?
Hepatitis C
Alcohol-induced liver disease
73
What are key liver functions lost in cirrhosis?
Albumin & clotting factor synthesis
Ammonia conversion
Bilirubin processing
Drug metabolism
Vitamin (esp. K, B12) and iron storage
74
Why does cirrhosis cause bleeding risk?
↓ vitamin K storage → ↓ prothrombin/clotting factors
Anemia from poor iron/B12/folate absorption
↑ PT/INR
75
Nursing interventions to reduce bleeding risk in cirrhosis?
Use soft toothbrush
Avoid NSAIDs/aspirin
Watch for bruising/petechiae
Prevent straining (use stool softeners)
76
What is the role of vitamin K in cirrhosis?
Replaces depleted stores → supports clotting factor production to prevent/limit bleeding.
77
What are signs of hematologic complications in cirrhosis?
Epistaxis, petechiae, gum bleeding, fatigue, pallor.
78
Why are drug doses adjusted in CKD?
Because many medications are cleared renally; impaired function can lead to accumulation and toxicity. Adjust based on creatinine clearance.
79
What drugs should be avoided in CKD?
NSAIDs (↓ renal perfusion, ↑ nephrotoxicity), certain antibiotics (e.g., aminoglycosides), drugs with magnesium or aluminum (can worsen bone disease).
80
What labs guide medication dosing in CKD?
Creatinine clearance, serum creatinine, GFR.
## Footnote
↓ CrCl and GFR = ↓ renal function → dose reductions needed.
81
What is sodium polystyrene sulfonate (Kayexalate) used for?
To treat mild to moderate hyperkalemia by exchanging Na⁺ for K⁺ in the gut, promoting excretion.
82
What are important precautions for sodium polystyrene sulfonate?
Do not give with bowel dysfunction or history of GI obstruction. Available as oral or enema. May cause diarrhea, monitor K⁺ levels closely.
83
What other common meds are used in CKD?
Epoetin alfa (for anemia), calcium acetate/sevelamer (phosphate binders), vitamin D and calcium supplements, ACE inhibitors/ARBs for HTN and renal protection.
84
What is the best indicator of kidney function?
GFR (Glomerular Filtration Rate).
85
What is proteinuria and why is it important?
Early sign of CKD due to podocyte damage. Persistent 1+ protein on dipstick over 3 months = diagnostic.
86
What are the normal pH values in ABG?
7.35–7.45
87
What are the normal PaCO₂ values in ABG?
35–45 mmHg (Respiratory)
88
What are the normal HCO₃⁻ values in ABG?
22–26 mEq/L (Metabolic)
89
What are the normal PaO₂ values in ABG?
80–100 mmHg
90
What does a COPD ABG typically show?
Respiratory acidosis (pH < 7.35, CO₂ > 45), sometimes with compensated metabolic alkalosis (HCO₃ > 26)
91
What is the ABG clue for respiratory acidosis?
High CO₂, low pH, normal/high HCO₃
92
What is COPD?
A progressive, irreversible airflow obstruction disease. Main causes: smoking, chronic inflammation, loss of lung elasticity.
93
What are the classic clinical manifestations of COPD?
Chronic cough, increased sputum, progressive dyspnea, barrel chest, wheezing, chest tightness, flattened diaphragm on imaging, frequent respiratory infections.
94
Why does a barrel chest occur in COPD?
Air trapping causes lungs to hyperinflate, expanding the chest wall.
95
What worsens gas exchange in COPD?
Destruction of alveoli and capillary beds → impaired oxygen/CO₂ exchange → hypoxemia + hypercapnia
96
What is pursed-lip breathing?
A breathing technique to prolong exhalation, reduce air trapping, and lower dyspnea.
97
What are key nursing teaching points for COPD patients?
Pursed-lip breathing, smoking cessation, avoid sick people & crowds, get vaccines (flu, COVID, pneumonia), monitor for exacerbations, encourage nutrition & small frequent meals.
98
What is SABA and its use?
Short-acting beta-2 agonist: Albuterol; rescue med for bronchospasm.
99
What are the side effects of SABA?
Tremor, nervousness, tachycardia.
100
What is LABA and its use?
Long-acting beta-2 agonist: Salmeterol; prevents bronchospasm; not for acute attacks.
101
What are anticholinergics used for in COPD?
Block ACh → bronchodilation.
102
What are the side effects of anticholinergics?
Dry mouth.
103
What is the purpose of combination inhalers like Advair?
Contain LABA + corticosteroid → bronchodilation + anti-inflammatory effect.
104
What is the key difference between asthma and COPD?
Asthma is reversible with treatment; COPD is not fully reversible.
105
What triggers asthma attacks?
Allergens, exercise, cold air, GERD, smoke, pollution, infections.
106
What is a dangerous sign during an asthma attack?
Silent chest — indicates severely reduced airflow. Medical emergency.
107
What is insomnia?
Inability to fall asleep or stay asleep; may be short-term (stress-related) or long-term (>30 days, often linked to chronic issues like pain or depression).
108
What are non-drug interventions for insomnia?
Avoid caffeine, tobacco, alcohol before bed; no large meals near bedtime; consistent sleep schedule; relaxation techniques (e.g., chamomile, lavender); improve sleep environment (dark, quiet, cool).
109
What is zolpidem (Ambien) used for?
Short-term treatment of insomnia; helps with sleep onset and reducing nighttime awakenings.
110
How does zolpidem work?
Binds to GABA receptors, causing CNS depression similar to benzodiazepines.
111
What are the side effects of zolpidem?
Daytime drowsiness, dizziness, headache; somnambulation (sleepwalking); hallucinations, sleep-driving; risk of rebound insomnia and dependence; take only when 7–8 hours of sleep is available.
112
Why use caution with CNS depressants in older adults?
Slower metabolism → drug accumulation; ↑ risk of falls, confusion, daytime sedation; always start at the lowest effective dose; safety tips: remove hazards, don’t double up on missed doses.
113
What is lorazepam (Ativan) used for?
An anxiolytic benzodiazepine used for anxiety, insomnia (off-label), seizures, and alcohol withdrawal.
114
What are Ativan’s key side effects?
Drowsiness, dizziness, confusion, paradoxical excitation in elderly, respiratory depression (IV route).
115
What is the antidote for benzodiazepine overdose?
Flumazenil.
116
What do antacids do?
Neutralize gastric acid → temporary relief of heartburn and indigestion.
117
What are common antacids and their side effects?
Magnesium (MOM) → diarrhea
Calcium (Tums) → constipation, kidney stones
Aluminum (Amphogel) → constipation, ↓ iron absorption
Combo (Maalox/Mylanta) → balance diarrhea/constipation.
118
What do H2-receptor blockers (e.g., famotidine) do?
Block histamine-2 receptors → ↓ acid secretion
Used for GERD, ulcers
## Footnote
Avoid giving with antacids (↓ absorption).
119
What do proton pump inhibitors (PPIs) like pantoprazole do?
Inhibit proton pumps → ↓ acid production
Indicated for ulcer management and GERD
## Footnote
AE: C. diff-associated diarrhea.
120
What is sucralfate used for?
A mucosal protectant for ulcers; forms a barrier over ulcers.
## Footnote
Give 1 hr before meals and at bedtime.
121
How do anti-emetics work?
Block neurotransmitters (serotonin, dopamine) at the chemoreceptor trigger zone (CTZ) or vomiting center.
122
Examples of anti-emetics and classes?
Ondansetron → serotonin blocker
Promethazine, metoclopramide → dopamine blockers
## Footnote
AE: sedation, dry mouth, constipation, extrapyramidal symptoms (EPS).
123
What is diabetes mellitus?
A chronic disease marked by abnormal insulin production and/or impaired insulin use → leads to hyperglycemia and long-term organ damage.
124
What is the difference between type 1 and type 2 diabetes?
Type 1: Autoimmune, insulin-dependent, early onset
Type 2: Insulin resistance, often related to obesity, inactivity, and genetics.
125
What is prediabetes?
Elevated blood glucose not yet at diabetic levels. High risk for progressing to type 2 diabetes.
126
How can patients prevent or delay type 2 diabetes?
Maintain a healthy weight (through diet & exercise)
Increase physical activity
Manage BP and cholesterol
Limit sugar intake and refined carbs
Monitor glucose regularly.
127
Why are regular blood pressure checks important in diabetes?
HTN is both a cause and complication of diabetes; tight control helps prevent CV and renal damage.
128
What is the first-line medication for prediabetes with obesity?
Metformin — ↓ hepatic glucose production, improves insulin sensitivity.
129
What is the goal of nutrition therapy in diabetes prevention?
Balanced CHO intake (e.g., MyPlate, CHO counting)
High fiber (25–30g/day)
Limit alcohol and trans fats
Encourage plant-based fats and lean proteins.
130
What are 3 lifestyle cornerstones to reduce type 2 risk?
Meal planning (balanced diet, CHO control)
Increased physical activity + weight loss
Routine glucose and A1c monitoring.
