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NURS 200 > Midterm 2 > Flashcards

Midterm 2 Flashcards

(54 cards)

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1
Q

diuretics
– nursing non-pharmacological therapy and care

A

renal diet
- ↓ protein (urea), K, phosphorus, and Mg diet
- Na+ restriction
- fluid restriction
- stop nephrotoxic meds

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2
Q

diuretics
– therapeutic actions and pathophysiology

A

loop
- blocks absorption of Na, K, Cl
- ↑diuresis
- ↓ edema, HTN, HF
thiazide
- blocks Na; ↓H2O
- ↓ edema, HTN
potassium-sparing
- promote retention of K
- aldosterone antagonists

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3
Q

diuretics
– nursing role in pharmacological management

A

tx primary cause of the problem
- w/ CV drugs
diuretics
- assess kidney function
- ↑urinary output
edema, dehydration

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4
Q

diuretics
– renal failure

A
  • nephrotoxic medications to be stopped
    > NSAIDS, ACE inhibitors
  • average dose = fatal
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5
Q

diuretics
- furosemide

A

loop
mech of action:
- prevents reabsorption of Na & Cl
therapeutic effects:
- acute edema
- HTN, HF
adverse effects:
- electrolyte imbalance
- orthostatic hypotension
- syncope from hypovolemia

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6
Q

diuretics
– spironolactone

A

K sparring
mech of action:
- inhibits action of aldosterone
- Na, Cl, H2O excretion are ↑, K retained
therapeutic effect:
- mild HTN
adverse effects:
- hyperkalemia
- muscle weakness, paralysis
- paresthesia
- tachycardia
- headache, dizziness, N
- gynecomastia

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7
Q

diuretics
– mannitol

A

osmotic
mech of action:
- ↑the [of filtrates] in the kidneys and ↓the reabsorption of H2O and Na
therapeutic effects:
- draws out fluid from EVS into blood vessels
- ↓intra cranial pressure
adverse effects:
- overdose = shift of fluid to the vascular compartment > HF or pulmonary edema
- electrolyte imbalance
- hypovolemia, dehydration, tachy
- fatigue, dizziness
- N/V
- convulsions

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8
Q

diuretics
– hydrochlorothiazide

A

thiazide
mech of action:
- acts on kidney tubules
- prevents reabsorption of Na
therapeutic effects:
- HTN
- fluid retention s/o to HF, liver disease, corticosteroid and estrogen therapy
adverse effects:
- electrolyte imbalance
- high blood glucose
- alcohol potentiated the effect
- dizziness
- weakness

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9
Q

diuretics
– nursing assessment, planning, and intervention

A

assessment:
- health hx
- baseline VS
- obtain blood and urine samples
planning:
- pt to exhibit normal fluid & electrolyte balance during therapy
- education regarding action, precautions, and adverse effects
- sx of hypokalemia, hyperkalemia, hypersensitivity
intervention:
- electrolyte levels
- VS > BP
- changes in LOC
- I&O
- K intake, K levels

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10
Q

coagulation
– primary mech. by which coagulation-modifying drugs act

A

anticoagulant
- inhibition of specific clotting factors
anticoagulant/antiplatelet
- inhibition of platelet action
thrombolytic
- dissolving the clot
antifibrinolytic
- inhibition of the destruction of fibrin

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11
Q

coagulation
– explain therapeutic action of each class of drug used in relation to the pathophysiology of coagulation (thromboembolic) disorders

A

anticoagulant
- prevention of clot formation
anticoagulant/antiplatelet
- prevention of clot formation
thrombolytic
- removal of existing clot
antifibrinolytic
- promotion of clot formation

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12
Q

coagulation
– INR, aPPT

A

INR:
an pts whose blood clots normally and who is not on anticoagulation should have an INR of approx. 1.
- The higher your INR is, the longer it takes your blood to clot
- INR target range for someone on warfarin is somewhere between 2.0 and 4.0.

aPPT:
- activated partial thromboplastin time
- also measures the speed of clotting but differs from the PT test in that it aims to establish how blood clots within a blood vessel
- heparin

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13
Q

coagulation
– nursing role in pharmacotherapy

A
  • health hx
  • baseline VS, HR + BP and clotting times
  • adverse effects
  • bleeding
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14
Q

– coagulation
Heparin

A

mech of action:
- activates antithrombin II which inhibits thrombin
- prevents clot formation
- antidote = protamine sulfate
therapeutic effects:
- after MI, after DVT
- prophylaxis
adverse effects:
- bleeding
- osteoporosis
- HIT

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15
Q

coagulation
– Warfarin

A

mech of action:
- inhibits/blocks 2 enzymes that use vit K to produce clotting factors
therapeutic effects:
- DVT, pulmonary embolism
- prevention of CVA/MI
adverse effects:
- micro embolism > purple toe syndrome
- osteoporosis
- abnormal bleeding
drug-food
- avoid green foods which are high in vit K

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16
Q

coagulation
– apixaban

A

mech of action:
- direct Xa inhibitor
therapeutic effects:
- slow/decrese the risk for strokes
adverse effects:
- severe bleeding
- no antidote

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17
Q

coagulation
– clopidogrel

A

mech of action:
- blocks ADP receptor on platelets inhibiting platelet activation and aggregation, thereby extending clotting times
therapeutic effects:
- reduce risk of CVA/MI
- reducing thrombolytic events post CVA/MI
- prevent DVT
- unstable angina/coronary stents
adverse effects:
- headache/dizziness
- diarrhea
- upper resp tract infections
- rash, pruritis

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18
Q

coagulation
– alteplase

A

mech of action:
- converts plasminogen to plasmin which breaks down fibrin in clot
- ↓circulating fibrinogen and plasminogen
therapeutic effects:
- the only clot buster
- thrombotic CVA
- off label use > restore IV catheter patency
adverse effects:
- angioedema
- intercranial bleeding

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19
Q

coagulation
– ticagrelor

A

mech of action:
- ADP receptor antagonists
therapeutic effects:
- antiplatelet drug
- MI, stroke
- prophylaxis
adverse effects:
- hypersensitivity reactions
- bleeding
- dyspnea

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20
Q

coagulation
– aminocaproic acid

A

mech of action:
- inactivates plasminogen precursor for plasmin that digests the fibrin clot
therapeutic effects:
- antifibrinolytic
- acute hemorrhages
adverse effects:
- usually mild
- thrombophlebitis (IV)
- muscle weakness and wasting
- thrombotic event

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21
Q

coagulation
– ADPIE

A

assessment:
- health hx
-
planning

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22
Q

coagulation
– LMWH

Study These Flashcards
A
  • fewer adverse effects than heparin
  • not IV
  • decreased risk for thrombocytopenia
    ex: enoxaparin, daltaparin
23
Q

immune system
– immunostimulants vs immunosupressants

Study These Flashcards
A

immunostimulants:
- ↑ the ability of the immune system to fight infection/disease
- pts w/ cancer, vaccines

immunosuppressants:
- diminish the ability of the immune system to fight infection & disease
- transplant pts to prevent organ rejection
- lupus, RA

24
Q

immune system
– nursing considerations in the implementation of immunosuppressant therapy

Study These Flashcards
A

toxic to bone marrow
- WBC, RBC, platelets
> anemia, leukopenia, thrombocytopenia
risk for infection
assess:
- metastatic cancer, active infections, liver/kidney disease, pregnancy

25
immune system -- classes of drugs used as immunosuppressants
calcineurin inhibitors: - prophylaxis of transplant rejection - disrupt T-cell function antibodies: - transplant rejection, autoimmune disorders, malignancies
26
immune system -- classes of drugs used as immunosuppressants > corticosteroids
drug of choice for short-term anti-inflammatory therapy Reduces bodies response to antigens > infection risk significant long term adverse effects: lymphocyte effect: - reduce circulating lymphocytes monocyte effect: - deplete body of monocytes and macrophages neutrophil effect: - ↑ neutrophils in blood decrease production of prostaglandins and interleukins
27
immune system -- pathophysiology of inflammation and fever
inflammation: - contain injury or destroy invading pathogens - acute and local fever: - many bacteria are killed by high fever
28
immune system -- nurse's role in pharmacological management
- health hx - VS - meds adverse effects - monitor renal and hepatic function - DM caution > tylenol can lead to hypoglycemia
28
immune system -- therapeutic action of drugs used to treat inflammation
NSAIDS: - inhibit the synthesis of prostaglandins by blocking COX 1/2 > you want COX-2 blockers! Systemic Glucocorticoids: - suppresses histamine release - inhibit synthesis of prostaglandins by COX-2 - ex. prednisone
29
immune system -- Ibuprofen
mech of action: - inhibit prostaglandin synthesis of both COX-1 and COX-2 therapeutic effects: - musculoskeletal disorders (RA and osteoarthritis), mil to moderate pain, ↓fever adverse effects: - tummy pain - GI bleed > interfere w/ mucosal lining
30
immune system -- celecoxib
mech of action: - blocks COX-2 but not COX-1 therapeutic effect: - mild to moderate pain - inflammation associated w/ RA and osteoarthritis adverse effects: - less GI bleeding and ulcer formation - ↑ risk of MI and stroke
31
immune system -- aspirin ASA
mech of action - potent antiplatelet effect - blocks COX-1 + COX-2 therapeutic effects: - mild inflammation - fever/pain (but not recommended) adverse effects: - bleeding salicylism: - tinnitus, dizziness, headache, sweating
32
immune system -- acetaminophen
mech of action: - inhibits COX activity in CNS but not in the rest of the body therapeutic effects: - mild to moderate pain - osteoarthritis to hip or knee - headache and myalgia - fever adverse effects: - hepatotoxicity - acute liver failure
32
immune system -- prednisone
mech of action: - synthetic glucocorticoid - suppress histamine therapeutic effects: - autoimmune diseases (RA, lupus) - asthma, COPD - inflammatory bowel disease - shingles adverse effects: - long-term therapy may result in Cushing's syndrome - drug interactions - risk of infection - GI concerns > pain, ulcers, bleeds
33
immune system -- diphenhydramine
*antihistamine mech of action: - antagonizes H1 receptors > prevents vasodilation associated w/ histamine - antagonizes M2 acetylcholine receptors therapeutic effects: - hypersensitivity type I allergic reactions - antiemetic for vertigo/ motion sickness - antitussive, insomnia adverse effects: - sedation - difficulty concentrating - ataxia
34
immune system -- histamine and histamine receptors
H1 receptors - related to allergy response - found on SM cells, vascular endothelium - stimulation of H1 receptors promote vasodilation and ↑permeability of blood vessels, consistent with vascular phase of inflammation H2 receptors - found in stomach on parietal cells - stimulation of H2 receptor triggers release of HCl by parietal cells
35
immune system -- epinephrine
mech of action: - non-specific adrenergic agonist Alpha1 – vasoconstriction Beta1 – ↑HR, force of contraction Beta2 – bronchodilation therapeutic effects: - anaphylaxis - hypotension - dysrhythmias > sever ventricular, brady, asystole - severe asthma adverse effects: - HTN, dysrhythmias - sympathetic effects > dry mouth, N/V, palpitations, headaches
36
bacteria -- methods for classifying bacteria
gram + / gram - shape: - rod-shaped > bacillus - spherical > coccus - spiral O2 use - aerobic - anaerobic
37
bacteria -- mechanisms by which anti-infective drugs act to kill or restrict growth
bacteriocidal = kills bacteria bacteriostatic = prevents growth and reproduction of bacteria damage bacterial cell wall damage cell membrane inhibit protein synthesis inhibit DNA replication inhibit bacterial cell division
38
bacteria -- clinical sig. of bacterial drug resistance
harder to tx - can become resistant to all anti-infectives
39
bacteria -- steps nurse can take to limit development of resistance
- prevent infections when possible - diagnose/ treat infection properly and specifically by identifying bacteria - limit use of antibiotics - prevent transmission of HAIs
40
bacteria -- clinical rationale for selecting specific antibiotics
C&S treat the infection appropriately with the correct drugs - bacteria is sensitive prevents using the wrong type of antibiotic the more specific the tx is, the better it will be
41
bacteria -- b-lactum antibiotics
bactericide - beta-lactum ring structure binds to gram+ cell walls causing lysis ex. penicillin, cephalosporins, carbapenems
42
bacteria -- superinfections
can occur when an anti-infective antibiotic kills host flora secondary infections: - diarrhea - bladder pain - painful urination - abnormal vaginal discharge - c-diff
43
fungal -- systemic vs superficial pharmacotherapy
superficial - not generally severe - less adverse effects systemic - more adverse effects
44
fungal -- most at risk for infection
immunocompromised - HIV, cancer, lupus
45
fungal -- antifungal drug + protozoan infections
therapeutic action: - drugs that disrupt the activities that fungi require to survive protozoan - attacks at the trophozoite life cycle where it is the active/growing stage
46
fungi -- amphotericin B
mech of action: - binds to ergosterol in fungal cell membranes therapeutic effects: - severe systemic mycoses - prophylactic antifungal therapy for immunocompromised adverse effects: - acute fever, chills - NV, anorexia - headache - phlebitis common
47
fungi -- fluconazole
mech of action: - interferes w/ the synthesis of ergosterol therapeutic effects: - infections by candida albicans - cryptococcal meningitis - mycoses resistant to other antifungals adverse effects: - NVD - Steven-Johnson syndrome
48
fungi -- nystatin
mech of action: - binds to ergosterol creating pores allowing intracellular components to leak out therapeutic effects: - candida infections - candidiasis of the intestine adverse effects: topical: - minor skin irritation and burning - contact dermatitis PO: - NVD
49
fungi -- metronidazole
mech of action - binds to DNA, prevents DNA synthesis, causing cell death therapeutic effects: - amebiasis, trichomoniasis - Crohn's disease, colitis - serious respiratory, bone, skin, CNS infections adverse effects: - anorexia, NV, diarrhea, abdominal pain - dizziness, headache - dry mouth, metallic taste - vaginal candidiasis
50
RESP -- ANS and airway diameter
sympathetic system: - bronchodilatation parasympathetic: - bronchoconstriction
50
RESP -- beta2-adrenergic agonists
bronchodilation ultra short-acting: > Ventolin immediate but only last 2-3 hrs short-acting > terbutaline, quick, lasts 5-6 hrs intermediate-acting > slower onset, 8hrs long-acting > Salmeterol - lasts up to 12 hrs
51
RESP --mexylxanthines
long-term management of asthma when b-agonists, anticholinergics don't work - chemically similar to caffeine

NURS 200 (3 decks)

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