Final (Combining Decks) Flashcards

Question

Side Effects: Fibrates (Flushed…flush the urine)

Answer 1

* Flushed Face/Neck * Increased uric acid levels (be careful in those with gout) * Increase risk of rhabdomyolysis (rare) * GI tract issues * Headache

Answer 2

* Monitor lipid levels in 4-6 weeks - Then every 3-4 months - because of increase in uric acid levels, may not want to give to patients with history of gout - not recommended for diabetics because it can cause hyperglycemia Drug interactions: Warfarin and Statins

Answer 3

Normal thyroid gland function

Answer 4

Visible enlargement of the thyroid gland

Answer 5

Antibody mediated autoimmune disease resulting in hyperthyroidism

Answer 6

Autoimmune disease often resulting in hypothyroidism

Answer 7

0.4 to 4.5

Answer 8

Less than 0.4

Answer 9

Above 4.5 ## Footnote Can be primary or autoimmune (Hasimotos, thyroiditis)

Answer 10

* Fatigue * Depression * Dry Skin * Constipation * Bradycardia * Altered menstrual cycles * Weight gain * Changes in hair * Cold intolerance

Answer 11

Severe hypothyroidism online: "a condition, often associated with severe hypothyroidism, characterized by a buildup of mucin in the skin and other tissues, leading to swelling and thickening."

Answer 12

Levothyroxine

Answer 13

Synthroid, Levoxyl

Answer 14

Calcium containing medications, antacids, or iron supplements

Answer 15

Increased in circulating T3 and T4 from overactive thyroid or excessive thyroid hormone production ## Footnote Graves disease is hyper-functioning thyroid

Answer 16

Beta blockers (e.g., Propranolol or Atenolol)

Answer 17

* Anxiety * Restlessness * Diaphoresis * Diarrhea, N/V * Tachycardia / AFib * Weight loss * Heat intolerance * Exophthalmos * Changes in menstrual cycle * Insomnia

Answer 18

* Inhibits release of T3 and T4 * short-term use * can cause iodinism

Answer 19

* Metallic taste * Stomatitis * Sore throat * Hypersensitivity

Answer 20

Thyroid extract from animal thyroid glands that have been dried and powdered -Contains both T3/T4 Side Effects: Change in appetite, chest pain, diarrhea

Answer 21

Methimazole

Answer 22

Inhibits Conversion T4 to T3 Medscape: Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland; blocks synthesis of T4 and T3

Answer 23

Decreasing thyroid hyperactivity and preventing complications

Answer 24

* LFTs * CBC

Answer 25

6-8 weeks after starting and after dose changes

Answer 26

It depends on which ones. PTU can be used in first trimester. Desiccated thyroid can be. Methimazole shouldn’t be used, same with I-131

Answer 27

online: Initially, the body compensates by producing more insulin, but over time, the pancreas struggles to keep up, leading to elevated blood sugar levels and eventually, T2DM From her slides in diff power point: Initially there is increased insulin secretion by the Beta cells to bring down the BS. Insulin not effective/cant bring down blood glucose/ then body needs to increase levels of glucose/beta cells become exhausted

Answer 28

From her type 2 diabetes PP: Basically, RAAS/SNS leads to increased inflammation which leads to more insulin resistance

Answer 29

- Improves how insulin works in the body (Insulin sensitizer) - Decreases absorption of carbohydrates - Decreases glucose production in the liver - Decreases appetite

Answer 30

* GI side effects (common) * Bloating * Diarrhea * Abdominal pain * Nausea * Metallic taste | Increased risk for B12 deficiency

Answer 31

- Hold 48 hours prior to contrast dyes (may lead to lactic acidosis or acute kidney injury) - Contraindicated in patients with renal or hepatic impairment, and heart failure

Answer 32

Renal/hepatic? B12 b/c increased risk of B12 deficiency

Answer 33

Stimulates Beta cells to secrete insulin Decrease glucose production by the liver | *Glipizide and glyburide*

Answer 34

online: the increased insulin levels promote the storage of excess glucose as fat

Answer 35

* Monitor for hypoglycemia * Onset at 90 minutes and peak in 2-3 hours

Answer 36

DO NOT GIVE IF ALLERGIC TO SULFA DRUGS ## Footnote ALso not for pregnant/lactating women/beta blockers

Answer 37

online: They induce insulin secretion from pancreas, with a different mechanism of action from sulfonylureas

Answer 38

Check BS levels?? Onset at 90 minutes and peak in 2-3 hours ## Footnote Should be taken with first bite of food (CUZ IM MEGA HUNGRY)

Answer 39

"Starch Blocker" Inhibit alpha-glucosidase, by delaying the absorption of glucose in the small intestines after a meal - does not increase insulin secretion Online: used to manage post-meal blood sugar spikes by slowing down carbohydrate absorption.

Answer 40

-Improve the effectiveness of insulin by decreasing insulin resistance in adipose and muscles cells -Contraindicated in those patients with heart failure or hepatic impairment -online: fluid retention, increased fat storage, and a shift in fat distribution towards subcutaneous fat can cause weight gain

Answer 41

enhancing insulin release, suppressing glucagon, slowing digestion, and reducing appetite - ultimately improving blood sugar control and potentially leading to weight loss

Answer 42

online: because these medications mimic the effects of the natural hormone glucagon-like peptide-1 (GLP-1), which helps regulate appetite, slows down digestion, and increases feelings of fullness, leading to reduced food intake and weight loss. online: Patients with hx of pancreatitis?

Answer 43

* Inhibits dipeptidyl peptidase 4 (DDP-4) enzyme, which destroys the GI incretin hormones GLP-1 and GIP * Increase insulin secretion * Decrease glucagon secretion to decrease glucose production * Allows incretin hormones to remain in circulation longer

Answer 44

Hypoglycemia

Answer 45

Inhibit reabsorption of glucose in the proximal renal tubules; promote glucose excretion in urine

Answer 46

Increase risk : Yeast infections, UTIs, and Amputation?

Answer 47

* A1C < 7% * FPG 80-130 * PPG <140

Answer 48

To mimic the physiological control of blood glucose levels

Answer 49

* Basal insulin levels – during fasting * Postprandial levels – after eating

Answer 50

* Diabetes Type 1 * Diabetes Type 2 * When not controlled with lifestyle and oral meds * Treat severe DKA or diabetic coma * Treat hyperkalemia in combination with glucose

Answer 51

Only use an insulin syringe and administer subcutaneously

Answer 52

A condition that can be prevented by rotating injection sites ## Footnote Keep injections about 1.5 in away from eachother and if BID use both L and R side

Answer 53

About 1.5 inches away from each other

Answer 54

* Insulin pumps * Insulin pen injectors * Insulin syringes

Answer 55

* Rapid-Acting * Short-Acting (Regular) * Intermediate * Long-Acting

Answer 56

* Aspart * Glulisine * Lispro * Inhaled Insulin | most deadly type of insulin

Answer 57

5-15 minutes ## Footnote Inhaled insulin onsent within ONE minute

Answer 58

30-90 minutes ## Footnote inhaled insulin within 12-15 min

Answer 59

To cover the glucose rise after eating a meal

Answer 60

30 minutes before meals

Answer 61

Throw it out

Answer 62

Isophane or NPH (Neutral Protamine Hagedorn)

Answer 63

Twice a day

Answer 64

2/3 in the morning and 1/3 in the evening ## Footnote Can be pre made in a 70/30 mixture of regular/NPH. -Supplied as a pen which makes for very easy administration. -Can be at room temp for 10 days

Answer 65

Up to 1.5 – 2 hours

Answer 66

Even absorption with no peaks and valleys | Frequently used in Type 2 DM

Answer 67

0.6-0.8 units/kg/day

Answer 68

Adjusted doses dependent on individual blood glucose, usually reserved for inpatient use

Answer 69

Refrigerated until needed

Answer 70

Will need insulin

Answer 71

A medical alert tag

Answer 72

* Must be given with food * Usually given in conjunction with intermediate acting insulin * Always monitor for hyPOglycemia

Answer 73

If Regular insulin (clear) is mixed with NPH human insulin (cloudy), the Regular insulin should be drawn into the syringe first. *May be given IV

Answer 74

Levothyroxine Armour Thyroid (desiccated)

Answer 75

Methimazole Propylthiouracil (PTU) Iodine Solutions

Answer 76

Based on TSH results Life-long medications Safe in pregnancy Should have TSH checked regularly until stablized (6-8 weeks after then annually)

Answer 77

* Inhibits formation of thyroid hormones in the cells * Inhibits conversion of T4 --> T3 * Need baseline CBC/LFTs * Take on empty stomach/30 minutes before eating * Takes several weeks to see effect Used for hyperthyroidism

Answer 78

Methimazole Propylthiouracil (PTU)

Answer 79

Thioamide- * Drug of choice unless pregnant * Side Effects: Less GI effects * **Can cause bone marrow suppression** Pharmacology (Medscape): - Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland - blocks synthesis of thyroxine (T4) and triiodothyronine (T3)

Answer 80

Thioamide * inhibits Conversion of T4-T3 * Can be used during first trimester of pregnancy only * Need to monitor LFT's/CBC Medscape: - Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland - blocks synthesis of T4 and T3

Answer 81

* Iodine (Radioactive) * Use for thyroid cancer, thyrotoxicosis/special cases * Not for pregnancy * Increase fluid intake * Radiation precautions

Answer 82

* Propanolol/Atenolol * To control symptoms * Used in Tachy/arrythmic/HTN adults * Used to control sxs while waiting for meds to take effect

Answer 83

Increased amount and frequency of urination due to renal threshold for glucose reabsorption being exceeded. | Glucose >180 ## Footnote Results in glucose remaining in renal tubule and an osmotic gradient that pulls water from tubule cells into urine.

Answer 84

* Polyuria * Polydipsia * Polyphagia ## Footnote Other symptoms may include blurred vision, fatigue, and weakness.

Answer 85

A hyperglycemic emergency characterized by hyperglycemia, metabolic acidosis, dehydration, and electrolyte loss. ## Footnote Often presents in Type 1 Diabetes but can occur in Type 2. -stored fatty acids can cause DKA

Answer 86

Insulin deficiency leads to the breakdown of fat into free fatty acids and glycerol, converted into ketones by the liver. ## Footnote Ketones are strong acids that can lead to metabolic acidosis.

Answer 87

Increase in fasting blood glucose and/or insulin requirements during early morning hours due to nocturnal elevation of growth hormone. ## Footnote Not triggered by nocturnal hypoglycemic events.

Answer 88

Nocturnal hypoglycemia followed by rebound hyperglycemia due to counter-regulatory hormone release. ## Footnote Occurs from too much or too little insulin at bedtime.

Answer 89

* Infection or illness * Lack of Insulin * Undiagnosed or undertreated diabetes ## Footnote These factors can precipitate DKA in patients.

Answer 90

Fluid replacement to restore intravascular volume and correct electrolyte imbalances. ## Footnote Insulin therapy is also initiated once fluids are administered.

Answer 91

* Extreme dehydration * Poor skin turgor * Dry mucous membranes * Tachycardia * Hypotension * Acetone breath * Kussmaul respirations * Changes in LOC ## Footnote Presenting symptoms also include the 3 P’s and weight loss.

Answer 92

Increased osmotic pressure in the extracellular compartment causes water to shift out of the intracellular space, leading to cellular dehydration and thirst sensation. ## Footnote This condition is known as polydipsia.

Answer 93

Blood glucose level < 70 mg/dL with or without symptoms. ## Footnote Most commonly occurs in patients treated with insulin.

Answer 94

* Hyponatremia * Hyperkalemia ## Footnote These imbalances need to be monitored during treatment.

Answer 95

-Total destruction of the pancreatic beta cells -autoimmune -Types : -1A (90-95%) - Type B (idiopathic, no autoimmune) - Rapid destruction in kids/Slower in adults

Answer 96

A metabolic state where the body uses free fatty acids for energy instead of glucose

Answer 97

* Three “P’s”: * Polydipsia * Polyuria * Polyphagia * Weight loss * Abdominal pain * Neuro symptoms * Blurred vision (accumulation of aqueous humor in the eye) * Other symptoms * Frequent Candida infections * Extremely elevated glucose * Ketones in urine * Metabolic acidosis

Answer 98

Increased appetite with weight loss -Insulin deficiency-cells not receiving glucose- sets into effect compensatory processes to increase blood glucose levels.

Answer 99

Check glucose level in the middle of the night A. Dawn = Normal/High Glucose at 3 AM B. Somogyi = Low Glucose at 3 AM

Answer 100

Accumulation of glucose in aqueous fluid in the cornea alters refraction of light entering the eye

Answer 101

Total destruction of the pancreatic beta cells due to autoimmune response ## Footnote Includes Type 1A (90-95%) and Type 1B (idiopathic, no autoimmune).

Answer 102

Defined as blood glucose < 70 mg/dL with or without symptoms Common causes: * Excessive exercise * alcohol * poor food intake * too much insulin * stress * surgery * medications

Answer 103

Triggers the release of glycogen from the liver

Answer 104

Glucose provides energy for cells, fat is the most dense fuel storage, and proteins are building blocks for tissues ## Footnote Glucose is absorbed into the bloodstream at the intestines and is essential for normal cerebral function.

Answer 105

Type 1 is characterized by autoimmune destruction of pancreatic beta cells; Type 2 involves insulin resistance and deranged insulin secretion/gestational/drug induced ## Footnote Type 1A is autoimmune, while Type 1B is idiopathic.

Answer 106

Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes, often associated with obesity and insulin resistance ## Footnote Metabolic syndrome 5 criteria: abdominal obesity, high blood pressure, high triglyceride levels, low HDL cholesterol, and elevated blood sugar

Answer 107

Amylin, somatostatin, glucagon, and incretins ## Footnote Amylin slows glucose absorption, while glucagon promotes glucose production.

Answer 108

* Family history * Obesity * Ethnicity * Age * Gestational diabetes * Hypertension * Polycystic ovary syndrome (PCOS) * Smoking and alcohol ## Footnote These factors contribute to insulin resistance and deranged insulin secretion.

Answer 109

After a meal ## Footnote Insulin levels decrease during fasting.

Answer 110

* Fatigue * Sweating * Hunger * Dizziness * Rapid heart rate * Anxiety * Irritability * Shakiness * Blurred vision * Confusion * Loss of consciousness * Seizures * Coma ## Footnote Symptoms vary from mild to severe depending on blood sugar levels.

Answer 111

A condition seen **only in Type 2 diabetes** characterized by severe hyperglycemia(>600), hyperosmolality (like DKA), and dehydration due to insulin resistance - Can develop over several days to weeks -Causes: INfection, non-complicance with diet/meds, substance abuse, alcohol ## Footnote **Unlike DKA, there is no ketone formation in HHS.**

Answer 112

* Fasting blood glucose > 126 (2 readings) * 2-hour plasma glucose during OGTT > 200 * Random blood glucose > 200 with hyperglycemic symptoms * Hgb A1C > 6.5% (2 readings) ## Footnote These criteria help in the accurate diagnosis of diabetes.

Answer 113

**High blood sugar levels leading to nerve damage** *Somatic neuropathy:* - Diminished perception: Vibration, pain, temp. - Hypersensitivity: Light touch, occasionally severe "Burning" pain *Autonomic neuropathy:* - Defects in vasomotor and cardiac responses - Urinary retention - Impaired motility of the gastrointestinal tract - Sexual dysfunction

Answer 114

* Sedentary lifestyle * Poor diet (high glycemic carbohydrates) * Smoking ## Footnote These factors contribute to obesity and stress on pancreatic beta cells.

Answer 115

Increased blood glucose: - Beta cells --> Insulin & Amylin Vs Hypoglycemia: - Alpha cells --> Glucagon

Answer 116

Increased waist circumference or belly fat (Apple Shape) High triglycerides Elevated BP High BS Low HDL Ancanthosis Nigricans

Answer 117

* Hyperglycemia causes intracellular fluid shifts ------>polydipsia * Excessive diuresis causes polyuria * Cell starvation from lack of glucose ---------> polyphagia * Fatigue * Weakness * Weight loss * Visual disturbances

Answer 118

* Causes increases in adipose and free fatty acids * Induces inflammation and release of the associated inflammatory mediators * Increases stress on pancreatic B cells as insulin is increased * Results in liver increase glucose in the blood (impaired suppression)

Answer 119

HgbA1c measures the amount of glucose over 120 days. Glucose doesnt normally move into RBCs but when glucose is chronically high it will---> once inside it cannot leave.

Answer 120

Symptoms: extreme glucose level, rapid/thread pulse, hypotension, profound dehydration, polydipsia, polyuria, confusion, disorientation, possible seizure, or coma Treatment: Hydration (given first) IV insulin Electrolyte replacement

Answer 121

To maintain a continuous supply of glucose for energy

Answer 122

- can be used with fibrates - can be used with pregnant women - this med has a strong record of efficacy and safety - take right away when mixed

Answer 123

- are very expensive compared to other classes - can be given in conjunction with statins - decrease LDL, cholesterol, and triglycerides

Answer 124

- do not take with warfarin or statins - will need periodic monitoring - not recommended for diabetics

Answer 125

- rosuvastatin is the most potent; if there was trouble tolerating - you can change from one statin to another - should take them in the evening or at bedtime, but rosuvastatin and atorvastatin can be given in the morning

Answer 126

they play some role in vasodilation

Answer 127

inflammatory cells inside the plaque are reduced and the endothelium is stabilized, which in turn stabilizes the plaque. this is important because it reduces the risk of thromboembolic issues if a part of the plaque breaks off and travels through the bloodstream

Answer 128

Total Cholesterol: desired level is less than 200 LDL: desired level is less than 130 HDL: desired level is 50 or higher Triglycerides: desired level is less than 200 In diabetics and those with increased risk: want LDL < 70

Answer 129

It means to reduce the progression of atherosclerosis and cardiovascular disease by helping increase nitric oxide availability. Endothelial dysfunction occurs from oxidative stress from dyslipidemia, diabetes, smoking, HTN, obesity, and aging. By controlling these factors that shred blood vessels, it reduces endothelial dysfunction. Statins play a role in reducing smooth muscle changes, stabilizing endothelium, reducing friction, and reducing proteins associated with inflammation.

Answer 130

dopamine, serotonin, and GABA

Answer 131

ACH (acetylcholine) and norepinephrine

Answer 132

- chief inhibitory transmitter in the CNS - has a relaxing, antianxiety, and anticonvulsant effect on the brain - has inhibitory effect on muscles (decreases muscle spasms and improved tone)

Answer 133

an excitatory neurotransmitter in the brain stress hormone within the endocrine system

Answer 134

- major mediator of excitatory signal - involved in cognition, memory, and learning

Answer 135

impulses that do not maintain a systematic order (excitatory, inhibitory, and resting phase) become irregular and chaotic and can lead to seizures

Answer 136

a single episode of abnormal electrical discharge from cortical neurons that results in an abrupt and temporary altered state

Answer 137

a group of syndromes characterized by unprovoked, recurrent seizures

Answer 138

continuous seizure activity for more than 5 minutes - OR 2 or more sequential seizures that occur WITHOUT full recovery of consciousness between attacks - is a neurological emergency - requires immediate intervention

Answer 139

- trauma - ETOH withdrawal - illicit drug use - brain tumor - congenital malformations - stroke - metabolic disorders (uremia, electrolyte imbalance) - alzheimer's disease - neurodegenerative disease - idiopathic

Answer 140

- genetic causes (mutated genes) - head trauma - medical disorders (dementia, meningitis, encephalitis) - prenatal injury - developmental disorders (autism, Down syndrome)

Answer 141

- messages from the body are carried by the neurons of the brain through discharges of electrochemical energy; impulses occur in bursts - during periods of unwanted discharged, parts of body may act erratically - for an actual seizure to occur: -- need excitable neurons -- need increase in excitatory glutaminergic activity -- need reduction in activity of normal inhibitory GABA projection - anyone can have a seizure

Answer 142

- absence (petit mal) - tonic-clonic (grand mal) - atonic/akinetic (drop attacks) - status epilepticus

Answer 143

- **starts and remains in one hemisphere** - high-frequency bursts of action potentials and hypersynchronization - may have motor, sensory, and autonomic symptoms and automatisms -- autonomic: due to stimulation of ANS (pallor, sweating, pupillary dilation, epigastric sensation) -- automatisms: often associated with temporal lobe seizures; patient is unaware

Answer 144

- may happen with focal seizures - coordinated involuntary movements happening during state of impaired consciousness either during or after seizure - patient is unaware - often associated with temporal lobe seizures

Answer 145

- focal - retains awareness - focal - altered awareness - partial seizure

Answer 146

- no impairment of consciousness - similar to partial seizures - may have movement of body parts - may experience an aura

Answer 147

- impairment of consciousness - spreads to both hemispheres (this confuses me though because i thought it should start and remain in one hemisphere)

Answer 148

- begins in one part of hemisphere (typically in the temporal or frontal lobe) - may be simple or complex

Answer 149

- **start in one hemisphere and spreads with involvement of both hemispheres** - may have motor and/or nonmotor symptoms - affects both hemispheres of the brain - impairment of consciousness

Answer 150

- begin with rigid violent contractions (tonic) - followed by repetitive clonic activity of all extremities - body stiffens and relaxes generalized

Answer 151

generalized - muscle stiffness, dilation of pupils, altered respirations - usually lasts less than a minute

Answer 152

generalized - short episodes of staring and loss of consciousness for about 10 seconds

Answer 153

generalized - bilateral jerking of muscles - no loss of consciousness

Answer 154

generalized - sudden loss of muscle - "drop to the ground"

Answer 155

- H&P - neurological exam - diagnostic procedures (chemistries, tox screen, CT, MRI, EEG)

Answer 156

Pre-ictal, ictal, and post-ictal

Answer 157

may be started by a trigger and/or preceded by an aura

Answer 158

- actual seizure - increases in metabolic demand (uses a lot of energy)

Answer 159

- has decreased responsiveness - feels fatigue

Answer 160

AKA antiepileptic drugs (AED) - used for long-term management of chronic epilepsy - management of seizures not caused by epilepsy - off label use: anxiety, bipolar disorder, chronic pain, migraines

Answer 161

effective for treatment of focal and generalized seizures

Answer 162

used primarily for focal-onset seizures (including focal which evolve to be convulsive seizures)

Answer 163

- prevent return of the channel to active state, stabilizes them to inactive state - prevents repetitive firing

Answer 164

- calcium going in during cells' resting state facilitates development of an action potential - CCBs **slow depolarization** which is needed for spike-wave bursts - CCBs help to **"lock the channel"**

Answer 165

- may enhance Cl- influx which makes cells more negative and harder for the cell to generate an action potential - some decrease metabolism of GABA so that more GABA is available (GABA is inhibitory)

Answer 166

- bind to glutamate, which is an excitatory neurotransmitter, therefore blocking it from binding and creating excitation - glutamate receptor has 5 potential binding sites

Answer 167

- medications are to control seizures NOT cure - medication prescribed based on the type of seizure - many drugs require blood monitoring - patient education (take as prescribed, never stop taking on own, side effect management)

Answer 168

Sodium channel blocker - works to stabilize the neurons from becoming too excited - stops the spread of seizure activity in the motor cortex - **highly (90%) protein-bound drug: increased risk of drug interactions** Indications: - tonic-clonic seizures - status epilepticus - prophylaxis for surgery

Answer 169

Therapeutic range: 10-20mcg/mL - very narrow therapeutic window - need to monitor levels Given PO, IM, or IV - if administered IV, w/ NSS - infuse over 30-60 minutes - can be very irritating to veins Tube feeds: need to stop feed for 2 hours before AND after

Answer 170

- **gingival hyperplasia** - neurologic: -- drowsiness -- ataxia -- irritability -- visual problems -- peripheral neuropathy -- headache - N/V - Cardiovascular: hypotension, arrhythmias - can cause suicidal thoughts - skin rash including SJS can occur

Answer 171

Classified as a barbiturate - inactivates fast sodium channels leading to enhanced GABA effects and decreased glutamate release Administration consideration: very long half-life - habit forming and dependence

Answer 172

- sedation - diplopia - cognitive skill impairment - respiratory depression - hypotension - hyperactivity and inattention in children

Answer 173

Sodium channel blocker - similar to Phenytoin (also an SCB) in mechanism of action - inhibits spread of seizure activity Used for several different types of seizures: - drug of choice for partial and generalized tonic-clonic seizures - also used for trigeminal neuralgia and bipolar disorder - WILL MAKE ABSENCE AND MYOCLONIC SEIZURES WORSE Needs to be in dry location

Answer 174

partial and generalized tonic-clonic seizures

Answer 175

absence and myoclonic seizures

Answer 176

Labs: - CBC: especially WBC - Drug level: 4-12 mcg/mL Monitor drug levels, sodium, CBC, LFTs, and BUN/Cr especially in those with renal impairment

Answer 177

- Neuro: headache, diplopia, ataxia, drowsiness, sedation - N/V - hyponatremia - decreased blood counts (neutropenia and thrombocytopenia) - rashes can be common - watch for SJS - increases suicidal thoughts * take with food * cannot abruptly discontinue

Answer 178

Sodium channel blocker - same efficacy as carbamazepine but is better tolerated

Answer 179

- used as adjunctive therapy or monotherapy for **partial seizures** in children and adults - *NOT used for absence and myoclonic* - makes them worse Considerations: - increase risk of suicidal ideations - decreases efficacy of oral contraceptives

Answer 180

GABA enhancer; inactivation of fast sodium channels Indications: really any seizure activity - absence, myoclonic, tonic-clonic, partial, neonatal seizures - used to control symptoms of acute mania in bipolar disorder

Answer 181

- can be given with phenytoin - take with food - can cause liver toxicity, need to monitor LFTs - **narrow therapeutic range** -- need to check levels (50-100 mcg/mL) - must be diluted when given IV with at least 50mL NSS or D5W -- give over an hour (no more than 20mg/min) - avoid sudden withdrawal - monitor CBC because can cause thrombocytopenia

Answer 182

- N/V - sedation/dizziness - pancreatitis - increased ammonia levels - thrombocytopenia (monitor CBC) - suicidal thoughts - can cause liver toxicity (watch LFTs)

Answer 183

Thought to act on the calcium channels to decrease glutamate and increase GABA in the brain Indications: - partial seizures - new onset epilepsy - MAY MAKE MYOCLONIC SEIZURES WORSE

Answer 184

- chronic neuropathic pain - anxiety - hot flashes/night sweats - headaches - hiccups - alcohol withdrawal

Answer 185

- fatigue: given at night often - **mental cloudiness** - leukopenia - weight gain - edema - emotional lability - tremors - GI side effects - suicidal thoughts

Answer 186

- reduced dose in renal patients: monitor BUN/Cr - caution in those with addiction history - no drug monitoring needing b/c wide therapeutic range - withdrawal slowly - doses will be very high for pain control

Answer 187

online: Thrombin plays a central role in clot development by converting fibrinogen into fibrin, the main structural component of a blood clot, and activating other factors that contribute to clot stabilization. It also helps activate platelets, which further contribute to clot formation

Answer 188

Online: The main difference between the intrinsic and extrinsic pathways in blood coagulation lies in their initiation: - the intrinsic *pathway* is activated by **factors within the blood itself**, - while the *extrinsic* pathway is **activated by tissue factor released from damaged tissues** outside the blood. Both pathways ultimately converge on the common pathway, where factor X is activated, leading to clot formation aPTT- intrinsic (monitored with heparin) PT- Extrinsic (PT/INR monitored with warfarin)

Answer 189

-Decreases aggregation and formation of the platelet clot (Blocks Cox-1) -Inhibits prostaglandin production

Answer 190

Also an anti-platelet but it INHIBITS platelet aggregation via P2Y12 -It keeps platelets in your blood from attaching to each other and making blood clots -Used for post stent/Post MI/Post stroke patients Starts to work in 24-48 hours but not see full effect for 4-6 days *Used for patients who need the combined therapy of aspirin

Answer 191

Should be stopped at least 2-5 days before surgery Must take everyday unless told otherwise Only provider can stop medication DO NOT GIVE- * Known bleeding disorder * * Active bleeding * * Closed head injuries * * CVA until prove no bleed * * Pregnancy (risk benefit) * * Lactation

Answer 192

A Qualified healthcare provider

Answer 193

Inhibits the production of Vit K

Answer 194

Used in atrial fibrillation, Valvular heart disease, CVA, DVT and PE prevention, post joint replacement (People at risk of blood clot) - Due to the drug being highly protein-bound

Answer 195

PT/INR Want INR at 2 to 3 For mechanical heart valve = 2.5 to 3.5

Answer 196

Takes 4-7 days for take effect

Answer 197

Phytonadione (Vitamin K)

Answer 198

-Takes 4-7 days to take effect -Should be taken in the evening -Requires frequent lab monitoring (PT/INR) -Narrow therapeutic range -Works slowly compared to heparin online: After being stopped, warfarin takes 5–7 days to clear the body.

Answer 199

-Prevent factor Xa from changing prothrombin to thrombin. They bind directly to factor Xa ## Footnote Common factor Xa inhibitors include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). BANS Xa

Answer 200

it directly blocks thrombin, the enzyme responsible for clot formation, whereas the others are direct factor Xa inhibitors. | Twice daily dosing

Answer 201

-Praxbind -Must reduce in renal failure

Answer 202

PTT (prothrombin time) International Normalized Ratio (INR) Activated partial thromboplastin time (aPTT)

Answer 203

-Do not take with Clopidogrel -Must reduce in renal failure online: Factor Xa inhibitors are different from warfarin primarily because they act on a specific enzyme in the clotting cascade, while warfarin affects a broader range of clotting factors.

Answer 204

Andexanet (For eliquis/xarelto) Praxbind (for pradaxa) Pradaxa-is twice daily

Answer 205

Less expensive

Answer 206

Anti-thrombin inhibitor- interferes with conversion of thrombin to prothrombin

Answer 207

online: Heparin works quickly, with IV heparin taking effect within minutes, and subcutaneous heparin within 1-2 hours. The anticoagulant effect of therapeutic doses of heparin is mostly eliminated within 3-4 hours after stopping continuous IV administration, with a half-life of about 60-90 minutes.

Answer 208

Monitored by aPTT usually 1.5-2.5 times baseline control Pt should normalize 2-6 hours after heparin is stopped

Answer 209

Starts by administering an IV bolus dose, followed by continuous dripL Bolus usually 5000units Followed by 1000-1300units/hour Or 80u/kg (can be less) bolus and then 18u/kg/hour Antidote: Protamine sulfate | ALWAYS CHECK DOSE WITH ANOTHER NURSE

Answer 210

-Measures time is takes for plsma to clot when exposed to a reagent -30-45 seconds -Intrinsic pathway -A prolonged APTT can be an indicator of bleeding disorders like hemophilia or von Willebrand disease. -The APTT test is commonly used to monitor the effectiveness of heparin, a blood thinner, and ensure that the patient's blood clotting time is within the therapeutic range.

Answer 211

Unfractionated heparin: * Inhibit thrombus and clot formation by blocking factors Xa * Routes: SQ * Should not be mixed with other medications; multiple interactions * Safe to use during pregnancy, but is considered 2nd line therapy * Adverse Effects: Bleeding, Heparin-Induced Thrombocytopenia, Hypersensitivity Narrow therapeutic range : Requires lab monitoring Want PTT in therapeutic range= 46-70 If aPTT > 70, call the physician LOW MOLECULAR WEIGHT HEPARIN: Commonly used for DVT prophylaxis, MIs Drugs: Enoxaparin (Lovenox) Dalteparin (Fragmin) Route: SQ only Administer 2 inches from the umbilicus; No rubbing/No aspiration Okay to use during pregnancy, considered 1st line Does not require lab monitoring

Answer 212

Online - about 2 days

Answer 213

inject into "love handles" Alternate between sites Do not inject air bubble prior to injection Do Not just injection site after

Answer 214

Stroke! Only given IF within 3-4 hours of onset of symptoms. Only give through a peripheral IV, not a central line (so you can compress the site) - NO injections - No SQ, or IM - No ABGs (blood gas) Monitor vital signs and neurologic status If possible CVA, must do head CT before administering Place patient on bleeding precautions

Answer 215

Second most common type of infection Occurs in Women more than males Accounts for About 50% of all hospital-acquired infections

Answer 216

Accounts for about 50% of all hospital acquired infections Catheter Acquired UTI (CAUTI)

Answer 217

Lower - Bladder and structures below the bladder Upper -Kidneys -Ureters

Answer 218

Pyelonephritis

Answer 219

E. Coli? Urethra

Answer 220

occurs when urine washes out the bacteria in the urethra during urination

Answer 221

Staphylococcus saprophyticus Klebsiella pneumoniae Proteus mirablis Pseudomonas species

Answer 222

Anatomic: - Stones, BPH, Pregnancy Functional: - Infrequent voiding etc.

Answer 223

**Ureterovesical** Reflux: -Cough or squatting can cause urine to move back from the bladder into the **urethra** and then back into the bladder **Vesicoureteral** Reflex: - Occurs at the level of the bladder and **ureter**

Answer 224

Sexually active women Post menopausal women Pregnancy Bladder cancer Renal stones (Calculi) Men with prostate abnormalities (no circumsicion) Anal intercourse Older adults Others at Risk Catherization Instrumentation Diabetes Use of antibiotics

Answer 225

Complicated

Answer 226

Dysuria Frequency Urgency Hematuria Suprapubic pain

Answer 227

May be asymptomatic or present with septic shock Fever, chills, nausea, vomiting Back pain/flank pain

Answer 228

spread of infection from urinary tract to bloodstream

Answer 229

Symptoms can vary: * Incontinence * Foul smelling concentrated urine * Fatigue * Confusion * Dementia * Hallucinations

Answer 230

After 3 months old, more prevalent in girls. -Frequently involved upper urinary tract

Answer 231

* Pain (Pelvic/Perineal) * Urgency * Feeling of bladder fullness/pressure * Women>Men * Exact cause unknown Rule out: Infection Endometriosis Urodynamic Testing

Answer 232

What: Amount of solutes in urine Normal: No true normal but approximately 1.010 Considerations: Extremes of either side can indicate pathology

Answer 233

What: Acid-base Normal: 6.5-7 in the AM 7.5-8 in the PM Considerations: Can be affected by food etc

Answer 234

What: Enzyme given off by WBC Normal: Negative *Present in all patients with UTIS

Answer 235

What: Enzyme released by Enterobacteriaceae Normal: Negative *Can be negative and still have UTI

Answer 236

What: Can be micro and macrocytic Normal: Negative *Can see in trauma, hemolysis, UTI, malignancy

Answer 237

What: Measuring Albumin Normal: Negative Considerations: Renal disease, Pregnancy, Inflammation

Answer 238

What: Renal threshold to eliminate excess glucose Normal: Negative

Answer 239

What: Measures metabolites of fat metabolism Normal: Negative *Insulin insufficiency, starvation, vomiting

Answer 240

Normal: Negative *Liver disease obstruction

Answer 241

Normal: Negative *Liver disease, hemolysis, mono, cirrhosis

Answer 242

What: Coagulated protein by kidney cells Normal: Negative Hyaline (0-5) in healthy people ceullar not normal *Hyaline are clear. Can have cellular RBC or WBC

Answer 243

What: Wastes solutes. Based on pH and urine temp Normal: None but some are ok

Answer 244

Pharmacologic therapy Pt education Acute UTI: 3-7 day course of antibiotic, if uncomplicated Chronic or relapse UTI: Up to 2 week course of antibiotics

Answer 245

Cephalexin Ciprofloxacin Levofloxacin Ampicillin Amoxicillin Bactrim

Answer 246

(Ciprofloxacin or Levofloxacin) are not routinely recommended due to their side effects and increasing bacterial resistance

Answer 247

Drink plenty of fluids daily Void before and after sexual intercourse Avoid douching Take Antibiotics as prescribed Avoid tight/restrictive clothing Shower, don’t bath Personal Hygiene

Answer 248

GFR: average adult 125mL/minute or 180L/day

Answer 249

* Osmolarity of interstitial fluids * Anti diuretic hormone * Action of ADH on the cells in the collecting tubules of the kidney

Answer 250

Prerenal, Intrarenal, Post renal

Answer 251

Decrease in blood flow and perfusion

Answer 252

Secondary to actual injuries to the kidney itself

Answer 253

Related to the obstruction of urine outflow from the kidneys

Answer 254

* Hypotension * Shock * Diarrhea/Vomiting (severe) * Bleeding/hemorrhage * Diuretics * diabetes insipidis * Burns * Heart Failure/MI * Cirrhosis * Sepsis

Answer 255

* Vasculitis * Venous Occlusion * Pre-eclampsia * Acute Tubular Necrosis * Multiple Myeloma * Hypercalcemia * IV contact dyes * Pyelonephritis * Certain meds: NSAIDS, ACE inhibitors, Heavy metals * Transfusion Reaction * Rhabdomyolysis

Answer 256

* Renal Calculi * Enlarged prostate * cancer * diabetes * Functinal obstruction due to drugs * blood clot * Trauma

Answer 257

Most common cause of acute kidney injury Damage to renal tubes causing cells to slough into the tubular lumen and lumen becomes blocked -Decrased urine formation Causes: -Post-ischemia (all causes of severe pre-renal disease) -Nephrotoxic *Permanent injury if not reversed | INTRA renal disorder

Answer 258

Creatinine clearance (100-150 cc/min): Less than 5-10cc/min

Answer 259

Urine sodium (10-20 meQ/L): >20 med/L

Answer 260

Normal: (1.005-1.025) ATN: 1.010 fixed

Answer 261

Normal: (200-1200) ATN: Osmotic = 300mOM

Answer 262

(10-20) 10:1 Fixed

Answer 263

Red/white cells, casts, epithelial cells

Answer 264

Normal: (100-150( Azo: 15-80cc

Answer 265

>10 meq/L | normal: 10-20

Answer 266

Concentrated >450 | Normal: 200-1200

Answer 267

> 15:1 | 10-20

Answer 268

Initial Oliguria Late Diuretic Recovery

Answer 269

0-2 days Initial Insult to point when BUN/Crt rise and/or Urine output drops

Answer 270

1-2 days to 6-8 weeks Drop in GFR, retention of urea, Potassium, sulfate and creatinine. Decrease Urine output and edema

Answer 271

2-8 days Begins with a slow, gradual increase in urine output, then high output

Answer 272

2-4 months Labs return to normal

Answer 273

-Pt will have oliguria and fluid overload -Build up of nitrogenous waste --Uremia, metabolic acidosis, thrombocytopenia -Edema Labs: Urinalysis Serum electrolytes Bun/crt ABG CBC -Imaging -Renal Biopsy

Answer 274

- Return to normal chemical balance, prevent futher complications, restore renal function *Fluid administration diuretics Monitor electrolytes Cardiac monitoring Hemodialysis

Answer 275

Volume overload K+ > 6 meQ/L Metabolic acidosis/serum HC03 >0.15 BUN > 120 mg/dL

Answer 276

**An irreversible, progressive disease** Often Asymptomatic initially until disease is far advanced * Kidney damage or a GFR < 60 mL/min/1.73 m2 for 3 months or longer. * Numerous Causes: * ***Hypertension, *Diabetes**, obesity, glomerulonephritis, SLE, polycystic kidney disease * Loss of functioning nephrons, progressive deterioration of glomerular filtration, ability of tubules to reabsorb, endocrine functions. * As nephrons are destroyed remaining hypertrophy to take on the work.

Answer 277

Stages 1/2: Often asymptomatic + crt normal -Compensation will occur GFR: normal >90 Stage 3: Decreased function <50% nephrons working. -Lab changes -No longer able to compensate GFR- 30-59 Stage 4: -Renal insufficiency is evident -nephrons dead -Diet restriction of proteins -GFR 15-29 Stage 5: Dialysis/transplant GFR: <15

Answer 278

-Buildup of nitrogenous waste: Encephalopathy/Anemia/Thrombocytopenia -Hyperkalemia - hyPOcalcemia (VitD not activated)....leads to hyperparathyroidism/Bone breakdown - Normochromic/normocytic anemia - low albumin - hyPERphostphatemia

Answer 279

Treat underlying cause Monitor labs Smoking cessation Manage hyperglycemia, if diabetic Manage anemia Exercise program Decrease sodium Avoid alcohol Dialysis Kidney transplant

Answer 280

Inflammation of the glomerular capillaries Causes about 25-30% of all ESRD cases Can be acute or chronic Most common cause of acute is post-streptococcal glomerulonephritis *Symptoms:* Pink or cola-colored urine, proteinuria, hematuria, hypertension, fluid retention/edema, decrease urine, nausea and vomiting, muscle cramps, fatigue *Complications*: - Accumulation of wastes or toxins in the bloodstream - Poor regulation of essential minerals and nutrients - Loss of red blood cells - Loss of blood proteins

Answer 281

Begins with an antigen-antibody reaction Antigen-antibody complex damages structures of the glomeruli which causes nephron dysfunction: * Decreased filtration of blood * Decreased urine production * Hypervolemia * Hypertension

Answer 282

-Oliguria often the first symptom Followed by hematuria, proteinuria -Cola colored urine * Edema often of face and hands * HTN * Elevated anti-strep antibodies(ASO) * Increased Creatinine * Decreased serum albumin * Treat the cause and full recovery is expected.

Answer 283

Goal of treatment is to: - Increase urine output - Decrease urinary protein Medications: - Corticosteroids - Antibiotics, if needed - Antihypertensives, if needed - Antipyretics Diet modifications: - Low sodium - Low protein Monitor for complications: - HTN encephalopathy - Heart failure - Pulmonary edema

Answer 284

Damage to the glomerulus -The filter is damaged and things which should stay in are able to leak out through the pores which become bigger due to the damage -Leads to increased permeability of proteins and other substances in the blood -Diabetic nephropathy most common type but can be due to other causes such as: Lupus or amyloidosis ( top 3 causes account for 90% of all cases) --Also vasculitis, allergies, preeclampsia, HTN, and other infections

Answer 285

Albuminuria/Proteinuria EDEMA Labs: -Urinalysis (proteinuria/hematuria) -Elevated BUN/CRT -Low serum albumin -Tests of lupus/hep B/C -24 hours urine *renal US and Renal Biopsy

Answer 286

Monitor diet: Low sodium Protein Adequate fluid intake, but avoid fluid overload Vaccines – pneumococcal and influenza ACE inhibitor or ARB Monitor for complications: Hyperlipidemia Thromboembolism

Answer 287

Produces inflammatory response Related to: -immune complexes and antibody-antigen complexes lodge in capillary. --Immune response develops against the antigens -Inflammatory processes occlude glomerular capillary lumen & damage capillary wall. -Damage allows RBCs to escape into urine. -Alterations due to decrease in GFR, fluid retention and nitrogen waste accumulation. -Also proteinuria, oliguria.

Answer 288

*Post strep G.NephRITIS* Typically seen ages 4-7 Onset: 10-14 days after strep infection Anti-strep titer + Urine- cola colored Heamturia-massive Proteinuria-minimal Hypertension Edema-moderate Hyperkalemia Elevated BUN *NephPHROTIC syndrome* Ages 2-3 years (males) Anti-strep titer NEG Urine- clear Hematuria - microscopic Pretineuria- Massive BP- normal or slightly decreased Hypoalbuminemia Edema-massive K+ normal BUN- normal Hyperlipidemia

Answer 289

Diabetes -Thickening of basement membrane -Dysfunction of glomerular podocytes -Remember they cover the urinary side of the glomerular basement membrane. -Inflammation (T cells and macrophages) into glomerulus Hypertension -Vascular changes -Glomerular changes -Damage to basement membrane (podocytes) - damaged -Allows plasma proteins to escape

Answer 290

* NSAIDs work by inhibiting prostaglandins * Renal prostaglandins protect against decrease renal flow * Prostaglandin inhibition can depress already decreased renal blood flow * Leads to reduction in renal perfusion and decreased GFR

Answer 291

* Dehydration * Arterial volume depletion due to heart failure, nephrotic syndrome or cirrhosis * Chronic kidney disease (CKD), especially stage 3 or worse (estimated GFR <60 mL/min * Volume depletion from aggressive diuresis, vomiting, or diarrhea * Older age * Severe hypercalcemia with associated renal arteriolar vasoconstriction

Answer 292

* In extreme exercise especially in heat the skin and muscle complete for blood flow * Takes away from the pancreas, GI, liver and kidneys * When exercising at max GRF can be reduced by 30-60% * Add dehydration, heat stress * Add chronic NSAID use * Avoid NSAID use outside of recommended doses * Avoid in those with HTN, HF, DM, and Metabolic syndrome * Avoid in states of dehydration * Increase fluids in athletes. * As anti-inflammatory use for shortest time and try to use acetaminophen as well

Answer 293

CAD/CVA/PAD prevention * Maintains AV grafts * Post MI * Post Stent placement * Other vascular disease

Answer 294

Oral anticoagulants, Heparin, Methotrexate, oral DM meds, and Insulin – can increase the risk of toxicity when taken with ASA * Steroids may decrease the ASA effect and cause ulcers * ACE and Beta Blockers * NSAIDS

Answer 295

Argatroban Lepirudin

Answer 296

Patient Education: * Meds must stay in original bottle, don’t place in pill box * Pills should not be crushed * Don’t stop taking for GI issues, unless there is black, tarry stools * Hold before having surgery * Don’t take with Clopidogrel * Watch for drug interactions * Must reduce dose in renal failure * Caution in abrupt stopping * Antidote: Praxbind (idarucizumab) is for Dabigatran only

Answer 297

* Uncontrolled BP (185/110) * History of Hemorrhagic Stroke, aneurysm, or AV malformations * Heparin in the last 48 hours * Current oral anticoagulant * DOAC use * Surgery within 3 months * Platelet count <100,000

Answer 298

Check for signs of bleeding vital signs labs

Answer 299

A: Extrinsic pathway of coagulation and common pathways. The PT/INR assesses the extrinsic pathway of coagulation (which uses clotting factor VII) and common pathways (which uses factor I, II, V, X). The extrinsic pathway is activated when there is outside/external injury that results in blood loss from the vascular system.

Answer 300

The aPTT assess the intrinsic pathway of coagulation and common pathways. The aPTT assesses the intrinsic pathway of coagulation and common pathways. Therefore, clotting factors I, II, V, X (which are part of common pathways) and clotting factors XII, XI, IX, VIII (which are part of intrinsic pathway) are assessed. The intrinsic pathway is activated when there is inside injury within the vascular system. The aPTT is an important result used to assess the effectiveness of Heparin (NOT Warfarin), and it's measured in SECONDS (not milliseconds).

Answer 301

B: 35-45 seconds (This range varies among labs).

Answer 302

An aPTT should be 1.5-2 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.

Answer 303

The answer is A. The therapeutic INR range is 2-3. It may be slightly higher if a patient is at a high risk for clot formation….(ex: up to 4.5)

Answer 304

The answer is A: 10-12 second

Answer 305

The answer is B. A therapeutic INR for a patient taking Warfarin should be 2-3. Therefore, the patient’s medication is not effective at this time for preventing blood clots

Answer 306

The answer is C: Thrombin....Prothrombin turns into thrombin by clotting factor V. When thrombin is on board it is responsible for turning fibrinogen to fibrin. Fibrin is one of the main ingredients for clot formation.

Answer 307

The answers are B, C, and D. All of these could increase the PT level (a normal range is approximately 10-12 seconds).

Answer 308

The answer is C: Normal...an approximate normal range for an aPTT is about 35-45 seconds.

Answer 309

- **furosemide (Lasix)** - bumetanide - torsemide

Answer 310

Inhibit reabsorption of sodium or chloride at the loop of Henle - decrease workload on heart (less water in body) - decrease pulmonary congestion - decrease preload, stroke volume, cardiac output

Answer 311

Decrease blood volume, which decreases venous return and blood pressure

Answer 312

- hyponatremia - **hypokalemia** - hypovolemia - hypomagnesemia - hyperglycemia - ototoxicity

Answer 313

- monitor potassium level! -- monitor other electrolytes too, but potassium very important - monitor I&Os - monitor blood sugar

Answer 314

- change position slowly due to potential orthostatic changes - report weight gain of more than three pounds in a day - enjoy potassium-rich foods especially because hypokalemia is a big risk (raisins are great source) (pulled this from online) MONITOR I & O MONITOR POTASSIUM level | Bumentanide furosemide Torsemide

Answer 315

- spironolactone is a mineralcorticoid receptor antagonist -- AKA aldosterone receptor blocker spironolactone and eplerenone

Answer 316

blocks the exchange of sodium for potassium in the distal tubules - potassium sparing

Answer 317

Indications: hypertension and heart failure - used when one drug is not enough to treat symptoms

Answer 318

- can cause gynecomastia

Answer 319

- monitor potassium (can cause hyperkalemia) - monitor LFTs - monitor BUN/Cr - do not give in renal insufficiency

Answer 320

- take with meals - avoid taking with: -- ACE inhibitors/ARBs -- heparin -- NSAIDs

Answer 321

Class name: digitalis glycosides - digoxin - deslanoside - mitildigoxin

Answer 322

- increases intracellular calcium - allows more calcium to enter myocardial cell during depolarization - **positive ionotropic effect (increase force of contraction)** - increased renal perfusion with a diuretic effect -- decrease in renin release - slowed conduction through AV node (decrease HR)

Answer 323

indications: heart failure and atrial fibrillation not first-line treatment

Answer 324

Has very narrow therapeutic margin: - normal: 0.5-2.0 - desired level: 0.8 Digoxin toxicity: - vision changes, N/V, dizziness - increased risk of hypokalemia - can be life-threatening

Answer 325

Normal level: 0.5-2.0 Desired level: 0.8

Answer 326

*Antidote: digibind* - **always check apical HR and call MD if less than 60** - monitor BUN/Cr and potassium - rapid onset and absorption caution in: - pregnancy and lactation - pediatric and geriatric - renal insufficiency

Answer 327

- take at the same time every day - take 1 hour before or 2 hours after eating - take apical HR before taking: report to provider if less than 60 - learn signs of digoxin toxicity (Nausea, vomiting and vision changes) - cuz when a DIGit goes up your butt you’ll get nausea vomiting and vision changes.. (pulled this from online)

Answer 328

between 50-70%

Answer 329

- HFrEF: heart failure with reduced ejection fraction - HFmrEF: heart failure w/ mid-range ejection fraction - HFpEF: heart failure w/ preserved ejection fraction

Answer 330

- increases HR and contractility; tachycardia - vasoconstriction - activates the RAS system - direct cardiotoxicity - increases myocardial O2 demand - increases wall stress - decreased preload and increased afterload

Answer 331

Not as common as left-sided HF - have deoxygenated blood coming from body, but right side not pumping as well as should be - leads to a "back up" of blood in body **peripheral swelling** Symptoms: - weakness, fatigue - leg/feet edema - vein distension - weight gain - increased urination - hepatomegaly - increased abdominal girth Ascites, edema

Answer 332

Symptoms: - weakness, fatigue - leg/feet edema - vein distension - weight gain - increased urination - hepatomegaly - increased abdominal girth

Answer 333

Left ventricle is unable to pump re-oxygenated blood from lungs to the heart's left atrium - ventricles too stiff - not contracting properly Leads to: - decreased cardiac output - **pulmonary congestion** Common cause of right-sided heart failure Types of left-sided heart failure: - systolic heart failure - diastolic heart failure Crackles in lungs, expect SOB

Answer 334

LV cannot contract forcefully enough to keep blood circulating normally throughout the body - deals with contraction of the heart - low ejection fraction (<40%) Symptoms: - tiredness/fatigue - decreased urine production - increased HR, may be irregular - elevated BP - enlarged heart - pulmonary "congestion" = SOB - coughing (often worse at night) - weight gain - decreased blood flow to extremities

Answer 335

LV has grown stiff or thick; is unable to fill the heart properly, which reduces the amount of blood pumped out to the body - issue with ventricle being too stiff to properly fill heart and being able to contract: ventricular hypertrophy - ejection fraction is typically normal (EF >50%) - often resulting from HTN no medications available to fix diastolic dysfunction

Answer 336

end in -pril - lisinopril - enalapril (can be given IV) - ramipril - captopril

Answer 337

Prevents the conversion of angiotensin 1 to angiotensin 2 - works by vasodilation and by blocking RAAS/aldosterone - helps prevent cardiovascular remodeling Pathophysiology: - decrease aldosterone production - inhibit angiotensin 2 production - decrease vasoconstriction - interfere with RAAS - keep vasodilation effects of bradykinin

Answer 338

First-line treatment for heart failure and hypertension; decrease the workload of overworked cardiac muscle Indications: - HTN - HF - DM - post MI and PCI

Answer 339

- generally well tolerated and absorbed - hyperkalemia - dizziness - **cough** ("ACE cough") -- related to kinins and activation of arachidonic pathway and prostaglandin production -- begins 1-2 weeks of initiation; typically resolves within few days of stopping med - **angioedema** **BLACK BOX WARNING**: - **serious fatal abnormalities: not given in pregnancy and caution in childbearing-age women** - esp in 3rd trimester - contraception very important

Answer 340

- be aware of renal function and potassium - assess orthostasis - awareness of administration to childbearing women - NO NSAID use - should be taken on empty stomach Labs: potassium, BUN, Cr Vitals: BP

Answer 341

- do not give to pregnant women! do not take if pregnant, especially if in 3rd trimester - take on an empty stomach - no NSAID use

Answer 342

- hydrochlorothiazide (HCTZ) - chlorthalidone

Answer 343

- inhibit reabsorption of sodium and chloride from the distal tubules in the kidneys - decrease peripheral resistance - decrease preload - better for sodium sensitive HTN as in african americans and older adults

Answer 344

treat hypertension; first-line medication

Answer 345

- anyone with sulfa allergy should not take - hypokalemia - hyperglycemia (watch w/ diabetics) - can cause exacerbation of gout -- increases uric acid - other electrolyte imbalances (calcium) - orthostasis

Answer 346

- anyone with allergy to **sulfa** should not take - should not be given to patients with history of **gout** - avoid in renal failure **- digoxin toxicity** - may decrease effect of **diabetic** medications **- lithium toxicity** - give early in morning b/c urination Check potassium, glucose, BP, HR

Answer 347

- adherence! - watch diet, exercise - decrease alcohol, stop smoking - avoid NSAIDs which increase BP

Answer 348

end in -sartan - losartan - irbesartan - valsartan

Answer 349

- bind with AG-2 receptors in vascular smooth muscle and adrenal cortex to stop vasoconstriction and aldosterone production - blocks AG-2 from binding at receptor sites in brain, kidneys, heart, periphery, and adrenal tissue

Answer 350

first-line treatment of hypertension; when ACE inhibitor cannot be used

Answer 351

- cough (less than an ACEI) - hyperkalemia (less than ACEI) - headaches - dizziness and syncope - GI complaints - xerostomia (dry mouth) - alopecia

Answer 352

- do not give with an ACE inhibitor - drug interactions with diltiazem, oral anti-fungals - monitor renal function - some drug interactions related to the cytochrome P450 - can be given with or without foods Labs: creatinine; can increase due to possible decreased GFR; LFTs Vitals: I&Os, BP

Answer 353

- avoid during pregnancy - do not take with ACE inhibitor - can take with or without food

Answer 354

- felodipine - amlodipine - nifedipine

Answer 355

- more vascular selection - more of a direct effect on vasodilation and less reduction of calcium - no effect on AV contraction; may increase HR due to vasodilation overall patho of CCBs: - decrease cardiac workload and myocardial O2 consumption - inhibits movement of calcium across membranes of myocardial/arterial muscle cells - alter action potential and block muscle cell contractions - decrease contractility and slows AV conduction - relax and dilate arteries

Answer 356

- hypertension - angina - rate control in AFib - SVT - Raynaud's phenomenon

Answer 357

- peripheral edema (common) - headache - flushing - lightheadedness - dizziness - can have increased HR (double check. It should cause decrease) - GI side effects

Answer 358

- **always check HR prior to giving; call MD if less than 60** - be aware of conduction issues - avoid use in those with heart failure - avoid grapefruit juice - check orthostasis no lab monitoring vitals: HR | Amlodipine Felodipine Nifedipine

Answer 359

- do not drink grapefruit juice - increase fiber in diet - always check HR prior to taking and make sure not less than 60

Answer 360

- verapamil - diltiazem both can be given IV

Answer 361

- **negative ionotropic effects (decrease force of contraction)** - slow AV conduction and rate of SA node overall patho of CCBs: - decrease cardiac workload and myocardial O2 consumption - inhibits movement of calcium across membranes of myocardial/arterial muscle cells - alter action potential and block muscle cell contractions - decrease contractility and slows AV conduction - relax and dilate arteries

Answer 362

- hypertension - angina - arrhythmias (AFib, SVT) - migraines (verapamil)

Answer 363

- bradycardia (can really drop) - decreased cardiac output - GI side effects - should not be used in those with heart block | verapamil, diltiazem

Answer 364

- **always check HR prior to giving; call MD if less than 60** - be aware of conduction issues - avoid use in those with heart failure - avoid grapefruit juice (especially with diltiazem) - check orthostasis no lab monitoring vitals: HR

Answer 365

- increase fiber in diet - always check heart rate before taking and make sure not less than 60 - do not drink grapefruit juice

Answer 366

"-lol ending" - carvedilol - metoprolol - bisoprolol - labetalol - atenolol Selective Beta 1: - metoprolol - atenolol - esmolol - bisoprolol Non selective: - propranolol - carvedilol - nasolol - sotalol

Answer 367

Block the beta-receptors in the sympathetic nervous system, decreasing calcium flow into the myocardial cells, and causing decreased contraction and workload - decreases catecholamine stimulation - decreases myocardial energy demands - reduces remodeling Helps to improve symptoms, reduce hospitalizations, and enhance survival in patients with heart failure with reduced ejection fraction (HFrREF) **blocks SNS responses** - decrease HR - decrease BP - decrease muscle contraction - increase blood flow to the kidneys - decrease renin release

Answer 368

Used in treatment for heart failure; cause decreased contraction and workload - hypertension but not first line - decrease risk of sudden death after MI - all patients after MI and PCI - HR reduction in AFib - palpitations - heart failure - migraines - performance anxiety - hyperthyroidism Special uses: - metoprolol: HR and post MI - propranolol: social anxiety, headaches

Answer 369

- hypotension - **bradycardia** (why you check apical HR) - bronchospasm (don't want to give to COPD or asthma pt) - exacerbation of peripheral vascular disease - fatigue - depression - impotence - sleep issues adverse effects: - worsening of HF especially when first started; why you need to start at low dose

Answer 370

- always start at very low doses b/c can make HF worse - **always check apical heart rate** and call MD if less than 60 - caution use in chronic lung disease b/c may increase risk of asthma attacks (blocks B2 receptor) - may mask hypoglycemic episodes so monitor diabetics - caution in those with brady arrhythmias b/c will drop HR - check for orthostasis - make sure patient is given medication even when NPO - assess for side effects Labs: glucose level especially is patient is diabetic; no other major lab concerns Vitals: HR (check apical)

Answer 371

- ALWAYS check apical heart rate before taking - NEVER stop abruptly: need to taper off -- SNS will surge and go to an extreme if stopped abruptly

Answer 372

Class: angiotensin receptor-neprilysin inhibitor (ARNI) Entresto (sacubitril + valsartan) is the only ARNI

Answer 373

Increase: - naturetic peptides (like BNP) - bradykinin (vasodilation) - other mediators which increase vasodilation

Answer 374

Used for systolic heart failure to improve symptoms and reduce remodeling

Answer 375

- angioedema - hypotension - hyperkalemia - renal failure - cough

Answer 376

monitor potassium, BUN, Cr, BP

Answer 377

- contraindicated in pregnancy - DO NOT TAKE WITH NSAIDs (NSAIDs vasoconstrict so counteracts)

Answer 378

nitroglycerin isosorbide hydralazine and nitrates (combined)

Answer 379

Actions: - arterial and venous dilator (potent vasodilator) - decreases preload and afterload - increases oxygen demand to heart; decrease myocardial oxygen demand Pharmacokinetics: - very rapidly absorbed - tolerance develops easily; need drug-free period - drug-drug interaction with Sildenafil (viagra)

Answer 380

prevention and treatment of attacks of angina pectoris and heart failure

Answer 381

- when taking: tingles or burns under tongue - headache - dizziness

Answer 382

- must stay in original bottle and be protected from light - watch BP before and after giving - always wear gloves when administering (absorbed rapidly) Routes (essentially every route): SL, translingual, transmucosal, OR, OR-SR, IV, topical, transdermal

Answer 383

- oral nitrate - has a drug free period in the delivery system (works for about 18 hours) - can be short acting or sustained-release - side effects similar to NTG (nitroglycerin)

Answer 384

- first drug regimen shown to improve symptoms of heart failure - combined use of hydralazine and nitrate (isosorbide) to: -- decrease preload & afterload by achieving both venous and arterial vasodilation -- decrease systemic & pulmonic vascular resistance -- **positive ionotropic effect on heart** Used in patients who: - have symptoms despite ACEI, BB, diuretic therapy - those who can not tolerate routine therapy

Answer 385

- can 1 every 5 minutes up to 3 taken - pain continues call 911 - DO NOT take with viagra (sildenafil) - must be sitting or lying when taking it - keep medication in original bottle to protect from light

Answer 386

- doxazosin (cardura) - prazosin (minipress)

Answer 387

- inhibit alpha synapse at the alpha adrenergic receptors (blocks SNS) - prevent feedback of norepinephrine

Answer 388

not really used in blood pressure control; considered 3rd or 4th line treatment - "almost work too well"

Answer 389

adverse effects are significant - first dose effect! - orthostatic hypotension - vertigo, syncope, dizziness - tachycardia - sexual dysfunction

Answer 390

- need to monitor patient very closely after giving first dose - avoid use in older adults due to increased sedation and confusion vitals: BP and HR

Answer 391

- let them know about first dose effect and that adverse effects are significant

Answer 392

- hypertension - obesity (especially apple shape; abdominal fat) - abnormal cholesterol levels (hyperlipidemia) - chronic inflammation - insulin resistance

Answer 393

obesity and high-fat diet coupled with sedentary lifestyle cause buildup of adipose tissue, brought on by macrophages and lymphocytes, and produce low-grade chronic inflammatory state - from obesity and inflammation, cells fail to make effective use of insulin - blood sugar increases - beta cells in pancreas secrete insulin - insulin resistance: insulin is not able to reduce blood sugar -- compensatory insulin fails and person remains hyperglycemic insulin resistance causes: - increased catecholamines - **stimulates sodium reabsorption and increases BP** -- BP can decrease with meds that improve insulin sensitivity - endothelial dysfunction - RAAS and SNS dysfunction - smooth muscle proliferation -> hypertrophy and TOD

Answer 394

modify factors to break the cycle - exercise and diet can break the obesity and insulin resistance portion of the circle of death

Answer 395

ACE inhibitors block the converting enzyme - stopping angiotensin 1 from becoming angiotensin 2 - which stops the stimulation of aldosterone secretion -- blocking the increased water and sodium retention -- blocking increased preload - stops constriction of vascular smooth muscle -- stops increased afterload inappropriate RAAS activation from increased angiotensin 2 causes endothelial dysfunction and vascular remodeling (and elevated BP & atherosclerosis) so inhibiting AG2 stops this

Answer 396

Online: Beta-blockers, particularly newer "third-generation" ones like nebivolol and carvedilol, **can improve endothelial dysfunction by enhancing the production of nitric oxide (NO) from endothelial cells**, which helps relax blood vessels and improve blood flow, primarily through their antioxidant properties and by modulating the activity of the enzyme endothelial nitric oxide synthase (eNOS) - essentially promoting better vascular function beyond just lowering heart rate and blood pressure.

Answer 397

Online: Metformin improves endothelial dysfunction **primarily by activating the AMP-activated protein kinase (AMPK) pathway, which leads to increased nitric oxide (NO) production**, reduced oxidative stress, decreased inflammation, and inhibition of endothelial cell apoptosis - thereby enhancing vascular function and protecting against damage to the endothelial lining of blood vessels.

Answer 398

- LDL deposits cholesterol between layers in the artery wall - inflammatory cells (macrophages) engulf deposited cholesterol - inflammatory resp. -- macrophages become giant foam cells -- a fatty streak develops between layers of artery wall - foam cells continue to expand the core of the plaque -- a fibrous outer cap forms from converted smooth muscle cells and other elements - large unstable plaque within thin fibrous cap and can rupture - a blood clot (thrombus) forms at site of plaque rupture - can lead to blockage and blocked artery starts to die

Answer 399

Beta blockers: Carvedilol, metoprolol, bisopropolol DIGOXIN Calcium channel blockers

Answer 400

Vasodilators- decrease workload of overworked cardiac muscle Loop diuretics- Decrease blood volume which decreases venous return and blood pressure Beta blockers (beta-adrenergic antagonists) - decrease contractions and workload b/c decrease calcium flow into myocardial cells

Answer 401

Very rapidly absobed Tolerance developes easily Must have drug free periods **do not take with sildenafil

Answer 402

Goblet cells ## Footnote These cells play a crucial role in trapping particles and pathogens.

Answer 403

The movement of blood through the pulmonary circulation ## Footnote Perfusion is necessary for delivering oxygen to the tissues.

Answer 404

Involuntary response to mechanical or chemical stimulation of the bronchial tree ## Footnote A cough serves to eliminate stimulants from the respiratory tract.

Answer 405

Productive and non-productive ## Footnote A productive cough brings up mucus, while a non-productive cough does not.

Answer 406

Coughing up blood ## Footnote Hemoptysis can be associated with conditions such as tuberculosis, lung cancer, or infection.

Answer 407

Collapse of alveoli, resulting in decreased gas exchange ## Footnote Commonly occurs post-op and can also occur due to compression by a mass.

Answer 408

* Post-operative complications * Compression by a mass

Answer 409

Oxygen level in blood inadequate to meet needs of the tissue

Answer 410

Insufficient amount of oxygen in blood

Answer 411

Inflammation and congestion of the nasal mucosa - Seasonal (hay fever) Inflammatory response to a specific allergen -Symptoms: Nasal congestion, sneezing, stuffiness, watery eyes

Answer 412

Inflammation of the mucus membranes lining the para sinuses Can be acute, subacute, or chronic -Viral (7-10days) - Allergies -Bacterial (up to 4 weeks) -Symptoms: Headache, pain over sinus area, pressure, nasal congestion, purulent discharge

Answer 413

Nasal Congestion Cough Bronchial Secretions

Answer 414

Treatment of nasal congestion and cough -May be OTC/prescriptions -Analgesics (acetaminophen/ibuprofen)

Answer 415

Nasal decongestants Antitussives Antihistamines Expectorants Mucolytics

Answer 416

Used to relieve nasal obstruction and discharge -decreases inflammation of nasal membranes Adverse effects: local stinging and burning Rebound congestion SNS symptoms: increased HR and BP, Urinary retention Pt education: dont use for more than 5 days unless instructed otherwise ## Footnote All drugs are category C pregnancy

Answer 417

Pseudoephedrine (Sudafed) Oxymetazoline (Afrin) Phenylephrine (Vazculep; Neo-synephrine) Fluticasone (Flonase) Triamcinolone (Nasacort)

Answer 418

Used to suppress non-purposeful cough - Depresses the cough receptors in brain, throat, trachea, or lungs Drugs in Class: - Benzonate (Tessalon Perles) - Dextromethorphan (Delsym) -Adverse effects: nausea, drowsiness, rash, and difficulty breathing - Codeine - Hydrocodone bitartrate Adverse effects: Drying of mucus membranes, headache, drowsiness, dizziness ## Footnote All Drugs are Pregnancy Category C(D during labor)

Answer 419

Used to suppress non-purposeful cough -Depresses the cough receptors in brain, throat, trachea, or lungs

Answer 420

Adverse effects: Drying of mucus membranes, headache, drowsiness, dizziness Dextromethorphan – nausea, drowsiness, rash, and difficulty breathing

Answer 421

Contraindications: History of allergy to drugs, those with a head injury, or could be impaired by CNS depression Caution in those with asthma and COPD Caution in children with atopic syndrome Dextromethorphan – Avoid use with alcohol and several psych drugs ## Footnote Dont use for more than 5 days unless specified

Answer 422

First Gen: Diphenhydramine(Benadryl)** Hydroxyzine (Vistaril Second Gen: Certirizine (Zyrtec)** Loratadine (alavert, claritin) Third Gen: Fezofenadine (allegra)

Answer 423

Used for the relief of symptoms associated with allergic responses (i.e. seasonal allergies, angioedema, motion sickness, allergic reactions)

Answer 424

Block the release or action of histamine at the histamine-1 receptor sites Also have anticholinergic and antipruritic effects

Answer 425

May cause dryness of mucus membranes and thickening of secretions drink plenty of fluids ## Footnote first generation also have more drowsiness effects - have gotten better w/ later generations

Answer 426

* May cause drowsiness, dizziness, or impaired mental alertness * Do not smoke * Do not drive or operate heavy equipment after taking * Avoid other medications that also cause sedation * Do not take more than one antihistamine at a time * Many otc cold and “nighttime” or “PM” sinus and allergy medications contain an antihistamine * Also otc sleep aids contain Diphenhydramine (Benadryl) * Avoid prolonged exposure to sunlight **Take with meals to avoid GI upset

Answer 427

Guaifenesin (Mucinex) Onset: 30 minutes Duration: 4-6 hours

Answer 428

Increase productive cough to clear the airway by: * Liquify lower respiratory tract secretions * Decrease the viscosity of secretions

Answer 429

rash, headache, nausea/vomiting, dizziness

Answer 430

* History of allergy to drugs * Persistent cough due to smoking, asthma, emphysema * Productive cough lasting more than 1 week

Answer 431

Acetylcysteine (Acetadote, parvolex) Fast onset via nebulizer Dornase alfa (Pulmozyme

Answer 432

Used to treat cystic fibrosis, asthma, bronchiectasis, COPD, and chronic bronchitis

Answer 433

Breakdown and liquefy of respiratory tract secretions

Answer 434

* GI upset * stomatitis * rhinorrhea * Bronchoconstriction * bronchospasm * urticaria * rash

Answer 435

History of allergy to drugs Presence of acute bronchospasm - Can be given in nebulizer form- pt should know how to use one

Answer 436

* Echinacea different preparations no better that a placebo * Vitamin C decrease incidence and severity of colds and influenza Regular used appears to play a role in the defense mechanisms of the respiratory system * Zinc Sulfate decrease incidence and severity of cold symptoms in adults Can lead to loss of smell with nasal zinc *

Answer 437

First chemical mediator releases in immune and inflammatory responses

Answer 438

There are 3 major components: Bronchoconstriction – in response to a trigger Airway inflammation – due to t-helper cells and ige-mediated pathways Bronchial hyperresponsiveness –due to activated mast cells which lead to the release of inflammatory mediators (Histamine, prostaglandins, and leukotrienes) ## Footnote Overtime, Airway thickening and hyperplasia of the smooth muscle may lead to remodeling of lung tissue

Answer 439

Dyspnea, wheezing, cough, prolonged expiration Chest tightness Accessory muscle use

Answer 440

*Short-acting beta-agonists (SABAs) -**take before exercising.** - include albuterol (ProAir HFA, Proventil-HFA, Ventolin HFA) and levalbuterol (Xopenex HFA). are inhaled medicines that help open airways. Should not be used every day As it can make them less effective. *Ipratropium, a SAMA, (Atrovent HFA) is an inhaled medicine that relaxes the airways

Answer 441

symptoms: wheezing, chest tightness, difficulty breathing at night Treatment: * Montelukast (Singulair) * Albuterol * Long-Acting-beta agonists * Leukotrienes ## Footnote Worse at night and may disrupt sleep

Answer 442

**Acute, Severe asthma that is refractory to treatment. Can be life threatening** Patient may have no wheezing or cough

Answer 443

* Beta 2 adrenergic agonists (short/Long) * Muscarinic antagonists * Leukotriene Receptor Antagonists * Methylxanthines

Answer 444

**Known as "rescue drug" Always used first to treat an acute attack** Meds: Albuterol (proair, ventolin, proventil) Administration * Shake the inhaler before use * 2-4 puffs every 20 minutes, up to 3 doses * No relief, call the physician

Answer 445

Aka: Proair, Ventolin, Proventil Administration: - Exercise-induced – 2 puffs 15 to 30 minutes before exercising - Bronchospasm/Constriction -- Inhaler solution – 3 to 4 times a day -- Inhaled powder – 3-4 times a day Contraindications: CAD, HTN, Diabetes, Seizure disorder Side Effects: - Muscle tremors - Cardiac: Angina, tachy, palpitations - CNS: agitations, anxiety, insomnia, seizures

Answer 446

Causes: - Smooth muscle relaxation in the lungs, muscles, and liver - vasodilation of the bronchial passage - release of insulin

Answer 447

Side effects: Tachycardia, tremors/shakiness, palpitations, anxiety, sweating, and arrhythmias, and insomnia

Answer 448

Avoid use with Beta-blockers and Nsaids

Answer 449

Maintenance Drug- allows airway to stay open -Seen as inhaler-metered dose or dry powder -**used in combination with steroid** Meds: Salmeterol (serevent)

Answer 450

**salmeterol (Serevent) and formoterol (Foradil) should not be used without a steroid in asthma for all ages Need to weigh the risk vs benefits** NEVER USE AS A RESCUE INHALER - SHOULD NOT BE USED IN CHILDREN LESS THAN AGE 4 and NEVER WITHOUT A STEROID ## Footnote USE WITH A STEROID!!

Answer 451

Blocks muscarinic cholinergic receptors by antagonizing the neurotransmitter acetylcholine in smooth muscle ## Footnote USED AFTER SABA

Answer 452

Local: dry mouth, hoarseness Systemic: * dizziness * headache * fatigue * palpitations * urinary retention

Answer 453

-Ipratropium Bromide (Atrovent):*Short acting* -Tiotropium Bromide (Spiriva):*Long acting*

Answer 454

Short-acting (SAMA) Can cause anticholinergic side effects NOT FOR ACUTE BRONCHOSPASM Can not use if allergic to peanuts or SOY products

Answer 455

Long-Acting (LAMA) Inhibits the muscarinic M3 receptors in the lungs Can cause a cough/dry mouth Not for acute bronchospasm

Answer 456

Bronchodilator **Current asthma guidelines do not support it's use** May be used at second-line treatment Several drug interations **DO not use if breastfeeding or pregnant**

Answer 457

Side effects: N/v, irritability, tremors, insomnia, tachyarrhythmias Requires drug monitoring due to **very narrow therapeutic range** Avoid caffeine Avoid smoking

Answer 458

~sone~ Beclomethasone (Qvar) Fluticasone (Flovent)

Answer 459

Mainstay of asthma treatment and advanced COPD * Suppress airway inflammation * Decrease mucus secretions * Suppress the release of histamines by mast cells * Increase sensitivity of beta-2 adrenergic receptors **only about 10-30% make it into the lungs**

Answer 460

May be used alone or in combination with other bronchodilators - Caution with hepait patients

Answer 461

Side effects: * headache * dry mouth * cough * hoarseness * candida infection (rinse mouth) * adrenal insufficiency * hyperglycemia Also QVAR - rinse mouth after use (thrush) - caution in hepatic patients - not for emergencies

Answer 462

Teach patient to rinse mouth after use Inhaled steroids are not for emergency use

Answer 463

Taken at night | Montelukast

Answer 464

Asthma (rarely used) Exercise-Induced Bronchoconstriction Allergic rhinitis

Answer 465

Headache, GI symptoms, liver dysfunction Generally, well tolerated BLACK BOX WARNING: Neuropsychiatric: agitation, aggression, depression, sleep disturbances, suicidal thoughts & behavior

Answer 466

Age limitations (Exercise-induced) - 1 tablet at least 2 hours before exercise for patients 6 years and older. Seasonal allergic rhinitis: Daily, age 2 and older Asthma – age 12 months and older ## Footnote Reduced effect if taken with phenytoin

Answer 467

black box warning: psychiatric side effects such as aggression, depression, agitation, sleep disturbances, suicidal thoughts, and suicide.

Answer 468

Adjunctive therapy for moderate to severe asthma | omalizumab

Answer 469

Used in children 6+ years

Answer 470

pain at injection site, headache, nausea, fatigue

Answer 471

<0.1% anaphylaxis

Answer 472

Prevent bronchoconstriction by preventing the release of chemical mediators from mast cells - Effective long-term therapy - - Not for treatment of asthma attacksd

Answer 473

Side effects: * hypotension * sore throat * taste changes * bronchospasm * chest pain * restlessness * nausea * dizziness

Answer 474

* Shake canister before each use * Breath out steadily * Place mouthpiece between lips * Tilt head back slightly * Depress the inhaler while taking a slow, deep breath in * Hold breathe for about 10 seconds then exhale slowly * Repeat after 5 minutes, if needed * Clean mouthpiece ## Footnote Rinse mouth after

Answer 475

- swallowing - eructation (burping) - thrush - abdominal pain - emesis

Answer 476

has proton-pump so PPIs has H2 receptors so H2-receptor agonists

Answer 477

There are high concentrations in the gastric mucosa and secretions - inhibit acid secretion - stimulate mucus and bicarbonate secretion

Answer 478

secrete mucus

Answer 479

- secrete HCl: sterilizes and breaks down food (mainly protein and carbs) - secrete intrinsic factor: needed to absorb B12 in small intestines - acid synthesis controlled by proton pump: pump triggers acetylcholine, histamine, gastrin

Answer 480

Three types: - parietal (localized, knife-like, sharp) - visceral: distention, inflammation (colicky, crampy) - referred Biochemical mediators of inflammatory response (histamine, bradykinin, serotonin) stimulate organic nerve endings producing abdominal pain - abd. organs are sensitive to stretching and distention

Answer 481

A backward movement of gastric contents into the esophagus - lower esophageal sphincter relaxes spontaneously 1-2hr after eating, allowing regurgitate into esophagus Causes Esophageal mucosal damage: - erosive esophagitis - Barrett esophagus (repeated injury causes metaplasia, change to columnar epithelium, precancerous) Many people self medicate Diagnosis: endoscopy and manometry

Answer 482

Certain conditions, substances, foods, and medications can weaken or hinder closure of the lower esophageal sphincter - alcohol - acidic foods - fatty foods - chocolate - coffee - nicotine - obesity - pregnancy - hiatal hernia - medications: anticholinergics, beta agonists, CCBs, nitrates, progesterone

Answer 483

- **dysphagia** - **heartburn** - **regurgitation** - bitter taste - upper abd. pain w/in hour of eating - increases w/ lying or increased intra-abdominal pressures - can have symptoms w/ no acid - cough, increasing asthma symptoms - may seem like angina also increases risk of aspiration, especially with chronic GERD

Answer 484

**Lifestyle and diet changes**: - decrease dietary fats - eat small meals - stop smoking - avoid lying down for 3hr following a meal - avoid alcohol - weight loss - elevate HOB **Pharmacology** - antacids - H2 blockers - PPIs - prokinetic agents

Answer 485

An autoimmune disorder triggered by gluten Clinical manifestations: - abd. pain - bloating - diarrhea - weight loss - steatorrhea (fat in stool; oily, gray) - weakness - flatus - fatigue Labs: H/H, CMP, genetic testing, IgA, antibody testing Treatment: - remove gluten from diet - vitamin replacement - corticosteroids

Answer 486

Gram-negative rods that colonize in the mucus-secreting epithelial cells of the stomach - increased incidence in those of Hispanic and African American ethnicity Spread person-person through saliva, feces, vomiting Commonly causes: - peptic ulcers - gastritis - gastric cancer Most are asymptomatic

Answer 487

- small curved gram-negative rods **secretes urease (enzyme) that converts urea to ammonia, which neutralizes acidity of the stomach for bacteria to survive** - burrows into mucosal layer leading to erosion and inflammation - produces enzymes and toxins: -- impacts protection of mucosa to acidic environment -- intense inflammatory response -- creates immune response w/ T and B cells

Answer 488

- many asymptomatic - dull burning pain in abdomen - increase pain w/ empty stomach - N/V - dyspepsia - bloating - weight loss

Answer 489

- urea breath test - serologic tests - stool antigen test - endoscopic biopsy

Answer 490

- antibiotics - Bismuth (has antibacterial effect) - PPI (raises the pH) - H2 blockers

Answer 491

- inflammatory erosion in stomach (gastric ulcer) or duodenal lining (duodenal ulcer) - occur in upper portion of the GI tract Patho: - hypersecretion of HCl - ineffective mucus production - poor cellular repair Has periods of exacerbation and remissions - commonly seen in middle aged individuals Causes: - **h. pylori infection** - **use of ASA or NSAIDs** - stress - alcohol

Answer 492

- occur in the stomach -- tends to develop in antral region of stomach adj. to acid-secreting mucosa in body -- ages 55-65 male and female - epigastric pain 1-2 hours after eating - can cause hematemesis or melena - heartburn, chest discomfort, and early satiety are common - can cause gastric carcinoma Patho: - primary defect is increased mucosal permeability to hydrogen ions - frequent H. pylori - gastric secretion normal or less than normal

Answer 493

**most common type of PUD** - occurs in the duodenum - epigastric pain 2-3 hours after eating: -- increased gastrin levels stay high after eating and continue to stimulate secretion of acid -- impaired duodenal bicarb secretion -- failure of feedback where acid in antrum inhibits gastrin release -- rapid gastric emptying overwhelms buffering - can cause melena or hematochezia - heartburn, chest discomfort are less common but may be seen - pain may waken patient during the night Causes: H. pylori, smoking, NSAIDs, stress, genetic predisposition

Answer 494

- chronic intermittent pain in epigastric area - pain increases about 30 mins-2 hours after eating - night time pain between 11p-2a - spasm and acid - RELIEVED w/ food, antacids Treat h. pylori, help acids, relieve pain can cause melena or hematemesis can lead to hemorrhage, perforation, gastric outlet obstruction

Answer 495

- pain tends to INCREASE with eating - belching - early satiety - anorexia - N/V - weight loss - tends to be chronic can cause melena or hematemesis can lead to hemorrhage, perforation, gastric outlet obstruction

Answer 496

- promote healing - relieve pain - decrease acid levels - prevent recurrence Treat with: - lifestyle changes (avoid caffeine, alcohol, tobacco, spicy high fat foods, ASA, NSAIDs) - antibiotics - PPIs - H2 inhibitors

Answer 497

rushing of fluids and gurgling sounds as gas moves

Answer 498

Infrequent, incomplete, or difficult passage of stool - most common GI complain - treatment directed toward relieving cause

Answer 499

- fewer than 3 spontaneous BMs/week - passage of hard/lumpy stool with >25% of defecations - straining >25% of defecations - incomplete evacuation or obstruction >25% of time - manual maneuvers to remove stool >25% of time

Answer 500

Primary: idiopathic Secondary: r/t medical conditions, medications, structural abnormalities, lifestyle: - primary disorder of GI motility - disease processes (DM, MS, spinal cord injury, obstruction, etc) - certain medication s(like opioids) - post surgery - diet; poor fluid intake

Answer 501

- high carb/low fiber diet want high fiber diet and fluids

Answer 502

attracts water and turns to gel during digestion; slows digestion - found in oat bran, barley, nuts, seeds, beans, lentils, peas, some fruits and veggies; also psyllium

Answer 503

Adds bulk to the stool and helps food pass faster through the intestines - found in wheat bran, lentils, whole grains, bran cereal, shredded wheat

Answer 504

- severe abdominal pain, nausea, cramps - appendicitis, enteritis, diverticulitis - ulcerative colitis - acute surgical abdomen - fecal impaction - habitual use (abuse)

Answer 505

- chemical/stimulants - bulk forming/stimulants - osmotic stimulants - surfactant laxatives - lubricants - emollients - saline cathartics - GI opioid receptor antagonists

Answer 506

Stimulant improve defecation by increasing motility through **irritating the mucosa and increasing water in the stool** - **releases prostaglandins and cAMP** - increases smooth muscle contractions and electrolyte which stimulates peristalsis Also increase water in intestines Should only be used periodically Can be given oral (work in 6-12hr) or rectal (work in 15-20mins)

Answer 507

- **bisacodyl (dulcolax)** - cascara - castor oil - **senna (sennokot)** Note: sennokot S is the stool softener

Answer 508

- diarrhea - abdominal cramping - nausea - fluid and electrolyte imbalance

Answer 509

Increase GI motility by **increasing size of fecal matter** - used for short-term constipation - need to be taken with plenty of water - best given at night b/c slow-acting Drug of choice for elderly, during post-partum, and with poor diets - safe in pregnancy

Answer 510

- methycellulose (citrucel) - polycarbophil (FiberCon) - **psyllium (metamucil)**

Answer 511

- diarrhea - abdominal cramping - nausea - fluid and electrolyte imbalances

Answer 512

Work by having solutes that increase osmotic "pull of fluid" INTO the GI tract - will increase the pressure in GI tract and stimulate more intestinal motility

Answer 513

- those with renal impairment - abuse concerns

Answer 514

- magnesium sulfate (epsom salts) - magnesium citrate - magnesium hydroxide (milk of mag) - lactulose - polyethylene glycol (miralax) - polyethylene glycol electrolyte solution (GoLytely)

Answer 515

- diarrhea - abdominal cramping - nausea - fluid and electrolyte imbalances

Answer 516

Used to make defecation easier WITHOUT stimulating the movement of the GI tract

Answer 517

- mineral oil - glycerin - docusate (colace)

Answer 518

Aka: stool softener - makes defecation easier WITHOUT stimulating movement of GI tract - given when straining to have a BM is harmful Do not rely on medication to provide relief or prevent constipation

Answer 519

- used for opioid-induced and/or refractory constipation - is a selective antagonists to opioid binding at the mu-receptor - do not cross BBB and acts specifically at **peripheral opioid receptor sties** like GI tract, but does **not affect the analgesic effects of opioids in CNS**

Answer 520

Opioid antagonist approved for treatment of opioid-induced constipation in adults with chronic noncancer pain

Answer 521

- abdominal or rectal discomfort - painful defecation - N/V - anorexia - impaction - ileus - hemorrhoids - ruptured bowel - anal fissure

Answer 522

- dietary fiber: need 20-35 grams/day; higher amounts may cause bloating and gas pains - need to find balance -- go slow -- fiber 1 cereal or bars are good -- metamucil, citrucel -- fruit (apples, peaches, pears, raisins, grapes, cherries) - increase fluids especially with fiber - exercise - bathroom hygiene (footstool), leave enough time, schedule time periods - stool diary with Bristol chart

Answer 523

loose or watery stools (>3/day)

Answer 524

Causes: - infection - drug-induced - emotional stress - colitis - DM - liver disease, etc Other factors: - water content - presence of unabsorbed food - bacteria content - intestinal secretions/mucus - children vs. adult

Answer 525

Systemic: - dehydration - electrolyte imbalances - metabolic acidosis or alkalosis - weight loss - signs of infection Local: - cramps - abdominal pain - steatorrhea - hematochezia

Answer 526

- injury to gut, dietary factors, or problem with digestion - associated with large stool volumes Example: lactose intolerance

Answer 527

- intestines secrete more fluids and electrolytes that can be absorbed - associated w/ large stool volumes Ex: infection and inflammation

Answer 528

- alterations in mucosal integrity, epithelial loss, enzyme destruction - associated w/ more than 6 stools a day Ex: inflammatory diseases, cancer, cancer treatments

Answer 529

- remove cause - fluid and electrolyte replacement - opioids (paregoric, deodorized tincture of opium (DTO)) - **diphenoxylate Hcl/atropine (Lomotil)** - **loperamide (imodium)** - yogurt - kaolin/pectin (kaopectate) - bismuth subsalicylate (pepto bismol) - bulk forming agents - probiotics

Answer 530

- decreases peristalsis - promotes reabsorption of water from GI tract - increases transit time oral medication can be given up to 4x/day

Answer 531

- nausea - dry mouth - urinary retention - dizziness - sedation - restlessness

Answer 532

- do not use in children under 4 y/o - hepatic impairment

Answer 533

- barbiturates - alcohol - tranquilizers

Answer 534

- slows intestinal motility and by affecting water and electrolyte movement through bowel - decreases peristalsis oral medication

Answer 535

- constipation - dizziness - nausea - abdominal cramping - urinary retention

Answer 536

- children under 2 y/o - patients w/ bloody stools and high fever - pt w/ acute UC - basically intestinal infections: -- bacterial enterocolitis caused by invasive organisms -- pseudomembranous colitis

Answer 537

- dehydration - orthostasis - electrolyte imbalances (hyperkalemia, seizures) - malnutrition - CV or renal compromise - impaired immune function - perianal skin breakdown - reduced absorption of oral meds - pain - anxiety - exhaustion - decreased quality of life

Answer 538

Characterized by a variable combination of chronic and recurrent intestinal symptoms - increased motility and abnormal intestinal contractions associated w/ stressful situations - women > men - no special diet Avoid fatty and/or gas producing foods, alcohol, caffeine

Answer 539

- **abdominal pain** - altered bowel function - flatulence - bloating - nausea - anorexia - constipation or diarrhea

Answer 540

- alostron - eluxadoline - lubiprostone - lyoscyamine anti-spasmotics, anticholinergics

Answer 541

A recurrent, granulomatous type of inflammatory response affecting the GI tract - **cobblestone appearance** - most common site is terminal ileum or cecum - periods of exacerbations and remissions **slow but progressive; involving ALL layers of GI**

Answer 542

- diarrhea - abdominal pain - weight loss - fluid and electrolyte imbalances - malaise - low-grade fever

Answer 543

- fistula formation - abdominal abscess - intestinal obstruction

Answer 544

Non-specific inflammatory condition of the colon - often begins gradually and can become worse over time - cause is unknown Commonly occurs: - between ages 15030 - older than 60 - have family member w/ IBD - is Ashkenazi Jewish descent Treatment depends on severity Increases risk of colon cancer - can have megacolon or perforation **only impacts mucosal and submucosal layers**

Answer 545

- diarrhea w/ blood or pus - abdominal discomfort - urgent need to have BM - fatigue - nausea - loss of appetite -> malnutrition - weight loss - fever - anemia

Answer 546

A condition of having diverticula (outpouching) in the colon - commonly in the descending or sigmoid colon (LLQ pain) - affects about 40% of US pop. by age 60 can be asymptomatic until inflamed

Answer 547

Is an inflammation of the diverticulum Causes: - pain - N/V - fever - elevated WBCs

Answer 548

- perforation w/ peritonitis - abscesses - hemorrhage - fistula - bowel obstruction

Answer 549

Block histamine 2 receptors on parietal cells leading to **decreased gastric acid secretions** - also decrease HCl production by about 70%

Answer 550

GERD and PUD

Answer 551

End in **"tidine"** - ranitidine (zantac) - famotidine (pepcid) - cimetidine (tagamet) can get OTC Cross the placenta and breast milk

Answer 552

- diarrhea/constipation - drowsiness - headache - hypotension

Answer 553

- smoking can decrease effectiveness; no smoking - should be taken 30 mins before meals - avoid overeating - **no NSAIDs**

Answer 554

Suppresses gastric acid production - more effective than H2 blockers

Answer 555

- PUD - H. pylori - GERD - dyspepsia (indigestion)

Answer 556

- nausea - diarrhea - abdominal pain - fatigue - headache are well tolerated

Answer 557

- fractures - dementia - infection - gastric cancer - cardiovascular events - kidney disease Also pernicious anemia bc can affect B12 absorption

Answer 558

B12, calcium, magnesium, iron - can cause pernicious anemia - increase risk of osteoporosis esp if on long-term

Answer 559

Clopidogrel (which is a platelet inhibitor)

Answer 560

End in **"prazole"** - omeprazole (prilosec) - lansoprazole (prevacid) - rabeprazole (aciphex) - pantoprazole (protonix) - esomeprazole (nexium)

Answer 561

Neutralize stomach acid by direct contact - may stimulate prostaglandins Should take 1-2hr after a meal because digestion occurs then and increases level of acid Have multiple drug interactions

Answer 562

- gastritis - GERD - PUD

Answer 563

- sodium bicarbonate (baking soda) - calcium carbonate (tums) - aluminum hydroxide (can cause constipation) - magnesium hydroxide (can cause diarrhea)

Answer 564

- depends on type - constipation/diarrhea - sodium loading

Answer 565

- **take all medications at least 1 hour before or after taking the antacid b/c multiple interactions** - chew tablets and drink at least 8oz of fluid after - shake liquid before pouring dose

Answer 566

A polymer of sucrose with aluminum hydroxide - forms a protective coating on the mucosal lining, particularly in ulcerated areas - adheres to epithelial cells, ulcer craters, or eroded areas - can prevent mucositis Can cause constipation b/c of aluminum hydroxide

Answer 567

Sucralfate (carafate) Misoprostol (cytotec)

Answer 568

given QID on an empty stomach, one hour before meals and at bedtime - can dissolve in 20oz of water and drink Caution in patients with renal impairment

Answer 569

- antacids - warfarin - phenytoin - fluoroquinolones

Answer 570

A prostaglandin analog - binds to prostaglandin receptors in parietal cells - decreases gastric acid secretion - increased GI blood flow - stimulates mucus production administer 2-4 times/day

Answer 571

- PUD - not effective for GERD

Answer 572

- diarrhea - abdominal pain - headache

Answer 573

- pregnancy and lactation (used for abortion and inducing labor) - IBD

Answer 574

- the conscious recognition of the imminent need to vomit - may or may not result in vomiting - mediated by the ANS

Answer 575

- rhythmic and spasmodic movement involving diaphragm and abdominal muscles - controlled by the respiratory center in the brainstem

Answer 576

- **dopamine-2** (CTZ) - **serotonin** (CTZ, GI tract) - neurokinin-1 (CTZ) - corticosteroid - acetylcholine - histamine - opioid - muscarinic - cannabinoid

Answer 577

- decreased quality of life - non-compliance - dehydration - electrolyte imbalances - decreased self-care - decreased function - nutritional deficits - taste changes - decreased performance status - esophageal tears - weight loss - anorexia

Answer 578

- occurs within mins-hrs after chemo - depends on type, dose, route, schedule risk factors: - gender (women>men) - age - stage of disease - alcohol use - comorbidities

Answer 579

think they will get sick so they do

Answer 580

- occurs at least 24hr following chemo - acute n/v increase risk other risk factors: - high-dose chemo - certain agents - poorly controlled n/v

Answer 581

- occurs despite standard treatment - requires further intervention

Answer 582

- unrelieved n/v despite standard and breakthrough treatment

Answer 583

- anticholinergics (scopolamine, dicyclomine (bentyl)) - antihistamines - neurolytics (chlorpromazine, haldol) - prokinetics (metoclopramide, cisaprine) - serotonin (ondanestron) - adjunct medications: corticosteroids, benzodiazepines, cannabinoids Can be administered PO, SL, rectal, IV, IM, SQ, transdermal

Answer 584

Block acetylcholine at the muscarinic receptors - also used to treat motion sickness - must be removed before an MRI b/c contains aluminum **scopolamine (transderm scop)**

Answer 585

- dry mouth - urinary retention - blurred vision - exacerbation of narrow-angle glaucoma - skin irritation

Answer 586

Need to be given before N/V experienced Serotonin receptors are present both peripherally and centrally - given for chemo, radiation, therapy, or post-op N/V - metabolized in the liver and excreted in the urine

Answer 587

Drugs end in **"setron"** - **ondansetron (zofran)** - granisetron (kytril) - dolasetron (anzemet) - palonosetron (aloxi)

Answer 588

- **headache** (usually r/t spread of infusion IV) - diarrhea - fever - hypotension - QT prolongation

Answer 589

Blocks serotonin in the CTZ - routes: PO, SL, IV, IM - dose: 4mg or 8mg Pregnancy category B

Answer 590

- patients taking anticonvulsants b/c can decrease seizure threshold Use lowest dose in hepatic and renal impairment

Answer 591

- headache - constipation - diarrhea - fatigue Serotonin syndrome from too much in body; can be mild or life-threatening

Answer 592

- piperaze phenotiazine/antipsychotics (prochlorperazine) - metoclopramide (reglan) - butyrophenon derivate/antipsychotics (droperidol and haloperidol)

Answer 593

- motion sickness - chemo-induced N/V - post-op N/V Considered second-line therapy Have antihistamine and anticholinergic properties

Answer 594

- block dopamine receptors in CTZ and acetylcholine - are not to be give in Parkinson's b/c can make it worse

Answer 595

- promethazine (phenergan) - trimethobenazamide (tigan)

Answer 596

Also classified as a non-phenothiazine - routes: oral, IV, IM Pregnancy Category B

Answer 597

- GERD - diabetic gastroparesis - N/V

Answer 598

May cause tardive dyskinesia

Answer 599

- bowel obstruction - GI bleeding - pheochromocytoma - epileptics

Answer 600

- restlessness - drowsiness - extrapyramidal symptoms (EPS) - neuroleptic malignant syndrome (NMS): hypernatremia, change in LOC, rigidity - suicidal ideations

Answer 601

Butyrophenone derivative Routes: PO, IV, IM Pregnancy Category C - cleft palate

Answer 602

- schizophrenia - control of tics and vocal utterances of Tourette's disorder - N/V

Answer 603

elderly patients with dementia-related psychosis

Answer 604

- patients with severe toxic CNS depression or comatose states from any cause - hypersensitivity to drug - Parkinson's disease - dementia

Answer 605

- sedation - EPS - tardive dyskinesia - dystonia - dizziness - QT prolongation

Answer 606

Are centrally acting Routes: oral, suppositories, IM, IV

Answer 607

Used for N/V related to: - anesthesia - severe vomiting - intractable hiccoughs

Answer 608

- patients in comas or severe CNS suppression - severe hypo/hypertension - liver dysfunction - severe renal impairment

Answer 609

- **prochlorperazone (compazine)** - chlorpromazine (thorazine) - perphenazine (trilafon) - thiethylperazine maleate (torecan (IM) or norazine (PO or PR))

Answer 610

- decreased CNS stimulation - hypotension - cardiac arrhythmias - autonomic effects - urine may become pink to red-brown in color - endocrine effects - photosensitivity

Answer 611

Piperaze Phenothiazine Routes: PO, IV, IM, PR Metabolized by the liver, excreted in urine Indications: - N/V - schizophrenia - non-psychotic anxiety - morning sickness

Answer 612

- drowsiness - hypotension - EPS - **tardive dyskinesia** - NMS - dystonia - photophobia - blurred vision

Answer 613

is a vesicant

Answer 614

- patients taking antipsychotic drugs - children - older adults -> psychosis

Answer 615

AKA: antihistamines - also have anticholinergic properties - block muscarinic receptors Indications: - motion sickness - morning sickness - allergies

Answer 616

- **diphenhydramine (benadryl)** - meclizine - promethazine - doxylamine succinate

Answer 617

- drowsiness - blurred vision - dry mouth - hypo/hypertension - urinary retention

Answer 618

Precise mechanism of action is not known - suppresses prostaglandin release from hypothalamus - may inhibit the process of N/V - anti-inflammatory Cochrane report: low-degree of evidence for N/V Administer slowly: if you go too fast, weird sensations in the lower region are felt

Answer 619

used as an adjunct to treat CINV

Answer 620

- dexamethasone (decadron): is compatible with zofran - prednisone (deltasone)

Answer 621

- insomnia - anxiety - acne - hyperactivity

Answer 622

Have been used for a variety of ailments Types: - CB-1 receptors: GI tract - CB-2 receptors: inflammatory & epithelial cells Equal in efficacy to ondansetron

Answer 623

- **drobabinol (marinol)** - nabilone (cesamet)

Answer 624

- sedation - vertigo - euphoria - dry mouth - tachycardia - paranoid reactions

Answer 625

- oral route - dosage: 2.5mg, 5mg, 10mg - pregnancy category C - **highly protein bound - increases interactions**

Answer 626

- anorexia - CINV that has failed standard treatment - appetite stimulant

Answer 627

- elderly patients due to increased risk of neuro-psychoactive effects - patients with a history of alcohol and/or substance abuse - patient with underlying psychiatric disorders (mania, depression, schizophrenia)

Answer 628

- mood changes - euphoria - depression - insomnia - psychosis (in extreme cases)

Answer 629

Thienobenzodiazepine - also an antipsychotic Routes: PO, IM Pregnancy Category C

Answer 630

- depressive episodes r/t bipolar I - treatment resistant depression - acute agitation r/t schizophrenia and bipolar I mania - N/V

Answer 631

elderly patients with dementia-related psychosis

Answer 632

- elderly patients with dementia-related psychosis - fluoxetine in combination - in combination with lithium or valproate

Answer 633

CBC, glucose, lipid profile

Answer 634

- hypotension - weight gain - suicidal ideations - NMS - sedation

Answer 635

Affects GABA neurotransmitter - CNS depressant; interferes with afferent nerves

Answer 636

- alprazolam (xanax) -- dose/route: 0.5-2mg PO - lorazepam (ativan) -- dose/routes: 0.5-2mg PO, SL, IV

Answer 637

- typically used as an adjunct agent for acute or delayed N/V - anticipatory N/V

Answer 638

- drowsiness - sedation - confusion - agitation - dependence and withdrawal symptoms - hallucinations

Answer 639

Inducer of the CYP450 system - also inhibits substance P Routes: PO and IV Given in combination with other anti-emetics

Answer 640

to prevent and treat acute and delayed nausea associated with **highly emetogenic chemotherapy**

Answer 641

**Ends in "pitant"** - **arepitant (emend)** - fosaprepitant dimeglumine (emend) - rolapitant (varubi)

Answer 642

- diarrhea - constipation - gastritis - anorexia - headache - fatigue

Answer 643

Route: IV Dosage: 150mg Can cross the BBB - metabolized in liver and excreted in the urine and feces

Answer 644

- pimozide - warfarin - oral contraceptives - corticosteroids

Answer 645

- liver enzyme elevation - dehydration - hiccups - Steven-Johnson syndrome

Answer 646

Other drugs to control N/V: - scopolamine (anticholinergic) Herbal and vitamin supplements: - ginger - pyridoxine (vitamin B6) Medications used to augment anti-emetics: - diphenhydramine (benadryl) - lorazepam - megestrol acetate (megace)

Answer 647

- should be used with caution - increased risk for adverse effects

Answer 648

- frequently used for surgery and chemo - pregnancy and lactation: -- has not been studied -- many drugs can enter breast milk

Answer 649

- more likely to experience an adverse effect from drug(s) - issue of hepatic and/or renal impairment

Answer 650

- weight - hydration status - serum electrolytes - creatinine - LFTs - intake and output

Answer 651

Manifested primarily as acute dystonic reactions Dystonic reactions may include: - sudden onset of muscular spasms esp in head, neck, or opisthotonos - laryngospasm, dysphagia, oculogyric crisis - involuntary spasms of the tongue and mouth: difficultly speaking and swallowing - akathisia, restlessness, akinesia, other Parkinsonian-like symptoms (tremor)

Answer 652

- depends on severity of symptoms - reduce or discontinue drug - anticholinergic drugs can be used to treat acute dystonic reactions

Answer 653

- may be given in cases of overdosing or poisoning - used to induce vomiting - no longer recommended for home use

Answer 654

- standard of practice prior to 2003 - standard of practice now -- dispose of any ipecac in home -- if needed: call poison control center

Answer 655

- assess/identify factors contributing to symptoms of N/V - administer antiemetic as prescribed - if patient receiving anticholinergic, monitor for side effects Focused assessment: - skin - cardiac - intake and output - lab studies - s/s of dehydration Evaluation: - did symptoms improve - good urine output - able to tolerate food

Answer 656

- drink plenty of fluids - small frequent meals - avoid strong smells

Answer 657

Different vomiting pathways are blocked - combining antiemetic drugs from various categories allows the blocking of the vomiting center and CTZ through different pathways, enhancing antiemetic effect

Answer 658

Dry mouth - anticholinergic drugs block the PNS -> causes the body to "rest and digest" - blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth)

Answer 659

Ondansetron (Zofran) - is a serotonin blocker

Answer 660

Hormones that counteract the effects of insulin: glucagon, epinephrine, cortisol, and growth hormones ## Footnote They help increase blood glucose levels when they drop.

Answer 661

Needed for metabolism

Answer 662

* Stimulates metabolic activity and oxygen consumption of cells * Produces heat and thermogenesis * Stimulates carbohydrate, fat and protein metabolism * Increases rate of glucose absorption * Increases erythropoiesis * Influences mood * Works with growth hormone, insulin, and sex steroids to promote growth * Required for normal respiratory response to hypoxia and hypercapnia * Critical for fetal neural and skeletal development

Answer 663

Inhibition of TSH

Answer 664

It is used for energy, stored as glycogen in the liver, or converted into fat ## Footnote Excess glucose can also be excreted in urine.

Answer 665

The breakdown of stored glycogen to make glucose -This process occurs in the liver and muscle tissue when glucose levels are low. (Prolonged starvation) -In response to Epinrephrine, glucagon, insulin

Answer 666

Insulin stimulates the uptake, use, and storage of glucose by promoting glycogen synthesis and inhibiting gluconeogenesis ## Footnote It is released by beta cells in the pancreas.

Answer 667

when your body does not immediately need glucose from the food you eat for energy, it stores glucose primarily in muscle and the liver as glycogen for later use

Answer 668

a hormone produced by alpha cells in the pancreas - it is released in response to a drop in blood sugar, prolonged fasting, exercise, and protein-rich meals

Answer 669

* Excretion of waste prodcts and urine * Regulation of BP * RBC production- erythropoietin * Breakdown of drugs * Metabolism of hormones * Regulation of Electrolytes and acid-base balance * Synthesis of Vit D * Fluid Balance * Balance of pH of blood stream

Answer 670

Stroke Volume X HR Normally, 4-8L /min

Answer 671

- gastric goblet cells (mucus secretion) - parietal cells: HCl and intrinsic factor - chief cells -- pepsinogen: converts to pepsin; protein breakdown - G cells: gastrin

Answer 672

There are high concentrations in the gastric mucosa and secretions - inhibit acid secretion - stimulate mucus and bicarbonate secretion

Answer 673

secrete pepsinogen which converts to pepsin, the enzyme for protein digestion

Answer 674

Prostaglandin E2 (PGE2) - protective - stimulates gastric mucus production and pancreatic bicarb secretion

Final (Combining Decks) Flashcards

(726 cards)