Module 1 and 2

Question 1

What drugs are iron preparations?

Answer 1

ferrous fumarate, ferrous gluconate, ferrous sulfate, iron dextran

Question 2

Major AE/SE of Iron

Answer 2

GI issues (nausea, vomiting, constipation), teeth staining with liquid form, can cause a harmless dark green or black color to stools

Question 3

What can parenteral iron dextran cause?

Answer 3

potential anaphylaxis

Question 4

Pt ed with Iron

Answer 4

give deep into buttock using Z track method, do not consume with food unless extreme stomach upset, taking with Vit C can increase absorp, caution in hx of peptic ulcers, regional entertitis, and ulcerative colitis

Question 5

Drug Interactions with Iron

Answer 5

anatacids and tetracyclines

Question 6

Cyanocobalamin

Answer 6

aka B12; can be given IM, subQ, oral or intranasal; Major SE is hypokalemia; edu on S/S of hypokalemia and intranasal should be given 1 hr before or after hot/spicy foods/liquids

Question 7

What are the different folate preparations?

Answer 7

folic acid, folacin, folate, pteroyl glutamic acid (oral, subQ, IV and IM)

Question 8

Folate Preparations

Answer 8

AE/SE rash, difficulty sleeping, fever; interactions: methotrexate

Question 9

What is the MOA for glucocorticoids?

Answer 9

decreased synthesis and reslase of inflammatory mediators; decreased infiltration and activity of inflammatory cells; decreased edema of the airway mucosa;

Question 10

Beclomethasone

Answer 10

corticosteroid; AE/SE: thrush, dysphonia (hoarse voice), long term high dose can lead to adrenal suppression, bone loss
Edu: admin on regualr schedule, can be enhanced by with SABA 5 mins before; adequate cal and vit d, immunosuppression,

Question 11

Predisone

Answer 11

corticosteroid; AE/SE: long high dose can lead to adrenal supprssion, bone loss, immunosuppression, fluid retention,hypokalemia, peptic ulcer dz,
Edu: monitor and record PEF (those with asthma), effect, normal activity, frequncy, and SABA use
INteractions: penytoin, phenobarbital, reifampin decrease effeciveness (oral contra decreased)

Question 12

Leukotriene Antagonists

Answer 12

anti inflammatory; suppress effects of leukotrienes; decreases inflammatory responses such as edema, mucus secretion, and bronchoconstriction, used as second line therapy if inhaled glucocorticoids cant beused

Question 13

Zafirlukast

Answer 13

leukotriene antagonist/anti inflammatory; decreases edema and bronchoconstriction
AE/SE: HA, GI issues, arthalgia, myalgia, depression, suicidal thinking, hallucinations, churg strauss syndrome, rare live injury
Edu: admin 1 hour before or 2 hours after eating ; concurrent use with theophylline can raise to toxic levels; can raise warfarin levels

Question 14

Mast Cell Stabilizers

Answer 14

prevent the release of histamine and other powerful chemical mediatory from mast cells

Question 15

Cromolyn

Answer 15

inhaled; mast cell stabilizer; suppresses bronchial inflammation but does not cause bronchodialtion ; reduces # & intensity of attacks; used for prophylaxis NOT quick relief;
AE/SE: safest of all antiasthma meds
Edu: via nebulizer; can take weeks for max effects; admin 10-15 mins before exertion

Question 15

Beta 2 Adrenergic Agonists

Answer 15

most effective inhalation drugs for acute bronchospasm and preventing EIB; promote bronchodilation; PRN; 1 min between multiple inhalations

Question 16

Albuterol

Answer 16

inhaled; short acting beta 2 agonist (SABA); PRN to abort ongoing attaack or with EIB before exercise; for severe can be used in nebulizer;
AE/SE: sys effects: tachycardia, angina, and tremor (minimal)
Edu: 1 min or longer between inhalations;
Interactions: MAO inhibitors, tricyclic antidepressants, beta blockers, decrease dogoxin levels, caffeine

Question 17

Salmeterol

Answer 17

inhaled; long acting beta 2 agonist (LABA); used on a FIXED schedule NOT PRN; preferred for pt with stable COPD
AE/SE: may increase risk of severe asthma if used as monotherapy long term
Edu: 1 min between inhales;
Interactions: MAO inhibitors, tricyclic antidepressants, beta blockers, decrease digoxin levels, caffeine;

Question 18

Theophylline

Answer 18

oral or IV; methylxanthines; produces bronchodilation; use on FIXED schedule not PRN preferred for pt with stable COPD; for asthma must be with glucocorticoid
AE/SE: may increase risk of severe asthma if used long term monotherapy;
Edu: slow infusion; incompatible with many other drugs; check serum levels routinely

Question 19

Anticholinergic Drugs

Answer 19

block action of acetylcholine; cause airways to relax and open; reduces bronchoconstriction; approved ONLY for COPD; min sys effects

Question 20

Ipratropium

Answer 20

inhaled, short acting; anticholindergic agent; bronchospasm for COPD
AE/SE: dry mouth, pharynx irritation, increased extraocular pressure, cardiovascular events
Edu: rinse out mouth after inhaled, notify if preg or planning;
Interactions: increases anticholinergic effects with other anticholinergic drugs (antihistamisn, phenothiazines, disopyramide)

Question 21

Tiotropium

Answer 21

inhaled, long acting; anticholinergic agent; therapy of bronchospasm for COPD
AE/SE: dry mouth, constipation, urinary retention, tachycardia, blurred vision, adverse cardio events, notify of angioedema occurs
Edu: rinse out mouth, notify if pregnant or planning; do not use with ipratropium

Question 22

Acetylcysteine

Answer 22

inhaled; mucolytic agent; reacts with mucus to make it less viscous; antidote to acetaminophen OD; used for hypersectrion
AE/SE: can trigger bronchospasm, rash, n/v, smells like rotten eggs
Edu: assess lung sound before and after tx

Question 23

0.9% Sodium Chloride IV bolus

Answer 23

500-1000 ml over 1hr (if not hx of fluid overload); for dehydration and volume loss; monitor for fluid overload

Question 24

Mannitol

Answer 24

inhibits water reabsorption and increases urine flow; prophylaxis to prevent renal failure; SE edema; contrain in HF pulmonary edema; monitor fluids assess for dehydrtaion monitor renal labs; results should be increased urinary out of 30-50 ml/hour

Question 25

Furosemide

Answer 25

promotes fluid loss and decreases preload; increases UOP in AKI; SE hypokalemia , hypotension, dehydration; caution with digoxin (toxcicity); results should be increased UOP 30-50 ml/hr

Question 26

Sodium Polystyrene Sulfonate

Answer 26

aka Kayexalate; gets rid of K; SE hypokalemia, hypocalcemia, hypomagneasema, constipation; place on cardiac monitor, contrain in ileus op, bowel obstruction, hypokalemia may enhance digoxin toxicity, interactions: ACE, ARBS, spironolactone

Question 27

Calcium Acetate and Calcium Carbonate

Answer 27

inhibits GI absorption of phos; preents hyperphosphatemia and renal osteodystrophy from hypocalcemia; SE/AE: low phos, high cal, constipation; contrain: high cal, renal calculi, and low phos; give with water take before or with meals and give other drugs 2 hrs after (esp cardiac); avoid foods that suppress calcium absorp; should increase cal and lower phos

Question 28

Lanthanum Carbonate and Sevelamer

Answer 28

non cal phos binders; reduces phos levels w/o affect cal levels; binds phos in GI; AE/SE: low phos, high cal, constipation/obstruction; take before of w/ meals; teach: report muscle weakness, slow or irregular pulse confusion (low phos)

Question 29

Calcium Channel Blockers

Answer 29

needed if the AKI cause is nephrotoxic meds; increase GFR, prevent mvmt of cal in kidney cells; AE/SE: constipation, edema secondary to vasodilation, dizziness, bradycardia, AV block, decreased contractility; Interactions: digoxin, beta blockers, grapefruit raises levels

Question 30

Folic Acid/Folate

Answer 30

vit B9; abosrbed inGI to increase iron levels; stims RBC, WBC, and platelets; large doses may cause cancers, n/v; does not prevent neuro issues of B12 def; admin after dialysis

Question 31

Calcitriol

Answer 31

active form of vit D; promotes absorp of cal and decreasees pTH concentrations; for management of low cal during renal dialysis; AE/SE: GI discomfort, may give with or w/o food; monitor cal, phos, and vit d levels

Question 32

Epoetin Alfa

Answer 32

erythropoietin stimulating agent; to prevent or correct anemia caused by kidney dx by stim bone marrow to increased RBC production and maturation; AE/SE: overproduction of RBC (which can incrases blood viscosity and cause hypertension), increase risk of MI, notify chest pains; report these s/s immediately bc it can indicate serious cardiac complications: angina, diff breathing, HTN, rapid wt gain, seizures, skin rahs, swelling feet/ankles

Question 33

Cinacalcet

Answer 33

PTH modulator; decreased PTH which decreases cal , can reduce renal osteodytrophy in pt with CKD; AE/SE: low cal, n/v; monitor /report diarrhea or muscle pain (can indicate cal or phos imbalance)