Pharm Exam 1 Mod 1-4 Flashcards
(145 cards)
1
Q
A patient taking Flonase is instructed to avoid eating black licorice while taking the drug. Why?
A
It potentiates the drugs action
2
Q
Adverse effects of antihistamines include
A
Drowsiness or dizziness
Tachycardia or palpitations
Urine retention
Dry mouth
3
Q
Activation of the sympathetic nervous system does what to the upper respiratory tract
A
It causes arterioles of the nose to constrict and mucosal layer to thin. This widens the airway allowing more air to get in.
4
Q
Diphenhydramine is contraindicated for …
A
Hypersensitivity to the drug
Benign prostatic hyperplasia
Narrow-angle glaucoma
Gastrointestinal obstruction
5
Q
Fexofenadine (Allegra) has what mechanism of action
A
It is an H1- receptor antagonist. It competes with histamine by binding to the histamine (H1) receptor sites.
6
Q
Pseudoephedrine (decongestant) has what mechanism of action
A
Activates alpha1-adrenergic receptors, causing vasoconstriction and decreasing mucosal swelling.
7
Q
A patient is prescribed Intranasal corticosteroids for allergic rhinitis. What should the nurse instruct the patient to expect from this medication
A
It will decrease the secretion of inflammatory mediators, reduce tissue edema, and cause a mild vasoconstriction.
8
Q
Children diagnosed with allergic rhinitis are at a greater risk for what ?
A
Middle ear infections
9
Q
Flonase does what?
A
Decreases inflammation through vasoconstriction and anti inflammatory processes
10
Q
What is the purpose for mucous
A
It neutralizes airborne pathogens.
11
Q
Tut healer and Flexhaler are types of what device?
A
Dry powder inhaler (DPI)
12
Q
What is status asthmaticus?
A
A severe prolonged form of asthma unresponsive to drug treatment that may lead to respiratory failure
13
Q
Common asthma triggers
A
Air pollutants.
Allergens
Chemicals and food
Respiratory infections
Stress
14
Q
Two categories of asthma drugs.
A
Quick relief and long term.
15
Q
Quick relief asthma medication classes
A
Short acting beta2 adrenergic agonists (SABA)— bronchodilation
Anticholinergics—bronchodilation
Corticosteroids: systemic — anti inflammatory
16
Q
Long term asthma medication classes
A
Corticosteroids: inhaled—anti inflammatory
Mast cell stabilizer—anti inflammatory
Leukotriene modifiers—anti inflammatory
Long acting beta2 adrenergic agonists—bronchodilation
Methylxanthines—bronchodilation
Immunomodulators— monoclonal antibody.
17
Q
Most asthma Drugs that end in “-ol” aka
Albuterol, salmeterol, olodaterol, metaproterenol, levalbuterol, indacaterol, formoterol, arformoterol, (and the odd one out terbutaline) are of what class?
A
Beta adrenergic agonists
18
Q
Asthma Drugs that end in “-ium” aka aclidinium, ipratropium, tiotropium, umeclidinium are of what class?
A
Anticholinergics
19
Q
Asthma drugs that end in “-lline” aka aminophylline, and theophylline, are of what class?
A
Methylxanthines
20
Q
Beta adrenergic agonists work how?
A
Activate the sympathetic nervous system, which relaxes bronchial smooth muscle resulting in bronchodilation
21
Q
If someone has chronic asthma they need to be treated for bronchospasm relief as well as what?
A
Inflammation
22
Q
Beta-agonist medications that activate only beta 2 receptors are called what
A
Selective drugs
23
Q
Where are beta 1 receptors located
A
The heart
24
Q
Where are beta 2 receptors located
A
Smooth muscle of lungs, uterus, other organs
25
Non selective Beta agonists activate what receptor (s)
Both beta 1 and beta2
26
Epinephrine and isoproterenol are examples of what type of drugs
Nonselective beta adrenergic agonists
27
Long acting beta adrenergic medications have what black box warning?
Their use is associated with an increase risk of asthma related deaths.
28
Long acting beta agonists have a slow onset and will not abort acute bronchospasms. T/f?
True.
29
Anticholinergics have what mechanism of action?
Block the parasympathetic nervous system. Increases bronchodilation
30
Asthma drugs that end in “-asone “ or “-onide “ are of what class
Inhaled corticosteroids
31
Cromolyn is what type of drug
Mast cell stabilizer.
32
What is the preferred therapy for preventing asthma attacks
Inhaled corticosteroids
33
What type of asthma drugs could reduce growth velocity in some children
Inhaled corticosteroids
34
Anticholinergics drugs contraindications
Narrow angle glaucoma. Benign prostatic hyperplasia. Renal disorders. Urinate bladder neck obstruction. And older adults.
35
Beta adrenergic agonist contraindications
History of MI or dysrhytmia.
Breastfeeding not recommended
Under 6 limited
36
Methylxanthines are contraindicated for
Coronary artery disease, angina pectoris
Severe renal or liver disorders, peptic ulcer
Benign hyperplasia, diabetes melitus.
Not recommended while breastfeeding
Caution in older adults and hound children
37
Adverse effect of inhaled corticosteroids
Orioharyngeal candidiasis
38
A patient taking ipratropium receives a new prescription for tiotropium. What patient eduction needs to be provided by the nurse?
Tiotroprium is only taken once per day where the old prescription, ipratropium is taken 4 or more times per day.
39
Emphysema is characterized how
By loss of bronchiolar elasticity and destruction of alveolar wall structures
40
Arformoterol is what kind of beta agonist.
Long acting.
41
Anticholinergic medication can cause constipation. Educate clients to increase fiber. T/f
True
42
Cromolyn might be prescribed to a patient with COPD why
The patient has an allergy to corticosteroids or they are ineffective
43
What is the drug that’s mechanism of action interferes with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol.
Statins
44
What is the drug that’s mechanism of action decreases both VLDL and LDL levels
Niacin.
45
What is the drugs that’s mechanism of action blocks the absorption of cholesterol from the small intestine
Ezetimibe
46
What is the drug that’s mechanism of action binds bile acids, thus increasing the excretion of cholesterol in the stool
Bile acid sequestrants
47
Rare but serious adverse effects of statins
Severe myopathy and rhabdomyolisis
48
What is rhabdomyolisis
Contents of muscle cells spill into the systemic circulation, causing potentially fatal acutely renal failure
49
What should be avoided during statin therapy because of their potential to interfere with statin metabolism and increased risk of sever myopathy
Macrolide antibiotics, such as erythromycin, Azole antifungals, fibrin acid drugs, certain immunosuppressants
50
Statins with short half lives, such as lovastatin and simvastatin should be administered when
At night because cholesterol biosynthesis in the liver is higher at night.
51
Total cholesterol of under 200 with the LDL under 100 and the HDL at 60 or higher is
A) dangerous
B) at risk
C) heart healthy
Heart healthy
52
Patients taking statins could benefit from enhancing their diet with foods rich in CoQ10- like pork- why?
Statins reduce coQ10 synthesis
53
Lipid lowering drugs can deplete or diminish the absorption of what?
Fat soluble vitamins and folic acid
54
Gemfibrozil (Lopid) can increase the risk of bleeding. T/f
True
What drug would need to be lowered.
Warfarin.
55
Gemfibrozil is contraindicated in patients with what
Chronic kidney disease
56
What drug is the only drug in a class called cholesterol absorption inhibitors and can block absorption of cholesterol which can cause the body to respond by creating more cholesterol?
Ezetimibe (Zetia)
57
A serum triglyceride level of less than 150 mg/deal is considered.
Normal or desired
58
A serum triglyceride level of 188mg/dL would be considered?
Borderline high risk
59
A serum triglyceride level between 200mg/dL and 499 mg/dL would be considered what?
High risk
60
Gemfibrozil (fibric acid derivative) is indicated for the treatment of what conditions
Hyper triglycerides and hypercholesterolemia
(It lowers VLDL with an increase in HDL)
NOT effective for lowering LDL
61
Niacin for lowering cholesterol should not be used in patients with diabetes. Why
It can increase fasting glucose levels
62
Atorvastatin (Lipitor ) is what kind of drug
HMB-CoA reductase inhibitor.
63
A patient has a triglyceride level of 450 mg/dL. Which drug should the nurse anticipate being prescribed for this patient
Fibric acid
64
Cholestyramine (Questran) can bind to other drugs. When should it be taken with a patient who also takes digoxin
2hours before or 4 hours after
65
If statins are having minimal impact and aren’t tolerated well by the patient, what drug would be the next choice
Gemfibrozil (lopid)
fibric acids
66
A patient continues to experience elevated cholesterol levels despite taking prescribed medication. Which drug should the nurse identify that is causing this patients result.
Ezetimibe (zetia)
67
A patient is prescribed Gemfibrozil (Lopid). For which reason should the nurse expect the medication to be discontinued for this patient
Elevated low density lipoproteins (LDL)
68
What is the primary carrier of triglycerides that is reduced to become a LDL
VLDL
69
Common side effects of statins include
Headache, fatigue, muscle or joint pain, heartburn.
Often patients can tolerate these over time.
70
Cholestyramine is contraindicated for what
Biliary obstruction
71
What warms, cleans and humidifies air before entering the lungs
URT
Upper respiratory tract
72
What’s the first line of defense your body uses for preventing pathogens to enter through URT
Nasal mucosa
73
What medication is prevention for allergic rhinitis
Intranasal corticosteroids
74
What are H1 receptor blockers (antagonist) mechanism of action
Antihistamines that block the histamine (H1) receptors.
75
What class of drug relieves nasal congestion by causing vasoconstriction in the nasal passage?
Nasal decongestants - sympathomimetic
Oxymetazoline (Afrin)
What’s the warning for this drug???
Can cause rebound congestion only use 3-5 days
76
What drugs are effective in treating inflammation of nasal passage and used to prevent allergic rhinitis?
Intranasal corticosteroids.
Fluticasone (Flonase)
-pregnancy cat. C(risk cannot be ruled out)
Beconase (beclomethasone nasal)
- hoarseness, dry mouth, cough, sore throat, oropharyngeal candidiasis.
77
What drugs are used to dampen cough reflex (best for non productive cough)
Antitussives.
*non opiod*
Benzonatate (tessalon)
-anesthetizes the receptor sites of the lungs.
Dextromethotphan (delsym)
- can cause cns toxicity.
*opiod*
Most effective
Raise cough threshold in cns.
Codeine
- caution in pt. With asthma, can cause brochoconstriction.
78
Respiration drive is determined by what
The brain
79
What opens the respiratory lumen?
Bronchodilation
80
Constriction and dilation is regulated by what
Two branches of the ANS.
Sympathetic- cause bronchodilation
Parasympathetic- cause bronchoconstiction.
81
What is a chronic pulmonary disease with inflammation and bronchospasm components?
Asthma
82
What are asthma med goals
To terminate acute bronchospasms in progress and to reduce the frequency of attacks
83
What category medication is Albuterol (ProAir HFA) in and what are side effects of it
It’s a bronchodilator. Specifically SABA
Can cause tachycardia, hypokalemia, hyperglycemia, nervousness
84
What category of drugs is Ipratropium (Atrovent)
A bronchodilator. Specifically Anticholinergics (cholinergic blocker)
Rinse mouth after to avoid bad taste.
If paradoxical bronchospasm occurs, withhold medication and notify HCP immediately
85
What medication class is Beclomethasone (Qvar) in and it’s side effects
Inhaled corticosteroid. Can cause oral candidiasis. May reduce growth in some pediatric pt.
86
What category drug is cromolyn (gastrocrom)
Mast cell stabilizer. Inhibits release of histamine and other inflammatory mediators.
Preventative, long term medication
87
What category drug is montelukast (singulair)
It’s a leukotrine modifier. Mediators of immune response.
This is the only drug in the class safe for pediatric use.
88
Copd is most commonly caused by what conditions
Chronic bronchitis- strongly associated w/smoking
Emphysema- strongly associated with smoking.
89
What meds are used for Copd
Antibiotics (tx infections)
Expectorant, mucolytics (control cough)
Bronchodilators (relieve bronchospasms)
90
Triglycerides should be less than what number to be in normal range
Less than 150
91
What is the drug Atorvastatin (Lipitor)
Statin.
Side effects- myalgia, arthralagia, rhabdomyolisis (leads to renal failure!) elevated hepatic enzymes.
92
What do B-complex Vitam B do for lipid disorders and name the drug given
Decreases the VLDL into LDL, reduced triglycerides.
Niacin is what’s given
Side effects- flushing, nausea, diarrhea, hepatotoxicity, gout
93
What do Fibric Acid Drugs do for lipid disorders
Activate the enzyme lipoprotein lipase, lower LDL, triglycerides and most effective lipid drug to increase HDL
Fenofibrate (Lofibra)
-administered with meals to decrease GI upset
94
What do the kidney excrete that helps regulate bp
Renin enzyme
95
What do kidneys excrete that stimulates red blood cell production
Erythropoietin hormone
96
Kidney are responsible for the production of what, which helps maintain bone homeostasis
Calciferol the active for of vitamin D
97
If a drug is bound to plasma proteins will it pass through the glomerulus and enter the filtrate or continue circulating in the blood.
Continue circulating. It’s too big
98
Plasma proteins such as albumin found in pt urine indicates what
Kidney pathology.
99
What are primary goals for a pt with kidney failure
Maintain blood flow through the kidneys and adequate urine output
100
Tests to diagnose kidney failure
Urinalysis
Metabolic panels
-Cr, BUN, eGFR
(Creatine, blood urea nitrogen, glomerular filtration rate).
101
What are primary measures of structural kidney damage
Proteinuria and albuminuria
102
What diagnostic imaging can be used to provide a more detailed diagnosis of kidney disease
CT scan, sonography, MRI
103
Most frequent cause of Acute kidney injury causes
Renal hypoperfusion (lack of sufficient blood flow through kidneys)
Usually caused by heart failure, hemorrhage, dehydration, toxins, dysthymias.
104
What happens in end stage renal disease
Kidneys no longer able to function in their own; dialysis or transplant tx options.
105
What is the medication management of kidney failure
Diuretics to increase urine output.
Cardiovascular drugs to tx underlying HTN or heart failure.
106
Dietary management of kidney disease can include..
Protein restriction
Reducing sodium, potassium, phosphorus, and magnesium intake.
107
Diuretic drugs and therapy for kidney failure
Diuretics: Loop/ thiazide/ potassium sparing.
Used for: HTN, AKI & CKD, heart failure, pulmonary edema.
Nurse teaching: monitor weight, HR, BP
108
Bumetanide (bumex) is what kind of drug
Loop diuretic. Most potent of them.
It blocks the reabsorption of Na+ an Cl- in the nephron loop.
Side effect: hypokalemia, hypotension
Ototoxic
109
Ethacrynic acid (edecrin) is what kind of drug
Loop diuretic.
Side effect: ototoxicity.
110
Chlorothiazide (Diuril) and hydrochlorothiazide (microzide) are what kind of drugs
Thiazide diuretics.
Block Na+ reabsorption and increase k+ and water excretion.
Side effect: hypokalemia (palpitations), hypotension, dehydration
111
Spironolactone (Aldactone) is what kind of drug?
Potassium sparing diuretic. Na+ & water excretion is increased & body retains more K.
Side effect: hyperkalemia, no K supplements and limit K in diet.
Reduces mortality in pt with CHF.
112
Furosemide and torsemide are what kind of drugs
Loop diuretic
Furosemide (Lasix)- is the most popular and lasts 6 hrs.
113
Loop diuretics are mainly used for ….
Edema …..
Cardiac failure
114
Loop diuretic side effects.
Ototoxic. Decreased potassium and magnesium. Metabolic alkalosis (blood pH turning basic). Dehydration. (Fluid loss)
115
Potassium sparing diuretics can treat what and have what side effects
Tx: HTN, heart failure, edema.
Side effects: elevated potassium levels; high levels can lead to gynecomastia
116
Thiazide and thiazide like diuretics work on what part of kidneys. Used for what?
Distal convoluted tubule. To prevent sodium from being reabsorbed.
Used for HTN, Edema.
117
Thiazide diuretics side effects
Gout.
Decreased sodium (hyponatremia)
Decreased potassium (hypokalemia)
Increased Uric acid (hyperuremia)
Increased blood glucose (hyperglycemia)
118
Necessary nursing precautions when giving diuretics? (Remember the acronym)
Diet (needs to increase dietary K)
Input & output; & daily weights
Unbalanced fluid & electrolytes
Ready for decreased BP & increased HR
Evening dose is a no-no
Take AM
Increased orthostatic hypotension
Cigarettes (
119
K wasting diuretics end in what suffix
-ide. Furosemide & hydrochlorothiazide
120
If a patient has edema and potassium levels of less than 3.5 what kind of diuretic would you expect them to be put on
Potassium sparing
121
If a patient is on loop diuretic and their potassium levels came back abnormal what’s the first nursing action
Place on cardiac monitor.
122
Never push potassium IV. It’s only administered via a bag 1hr or more. Typically 4hr
It will kill patient
123
Before administering diuretics, you take the pt BP and it comes back low, what action do you take.
Hold the med. contact HCP
124
OTC medications like NSAIDs, antacids, acetaminophen, and cough and flu, should be avoided with diuretics why?
All contain high levels of sodium.
125
The nurse suspects a pt has overdosed on acetazolamide (Diamox). What drug should the nurse expect to be prescribed for this
Sodium bicarbonate. To treat the metabolic acidosis that an OD of Diamox would produce.
126
Overdose of the drug hydrochlorothiazide (microzide) is treated how?
Infusions of normal saline
Od manifests as electrolyte depletion
127
Overdose of the drug furosemide (lasix) is treated how?
Supportive replacement fluids and electrolytes. Possibly administering a vasopressor (norepinephrine)
Od results in hypotension and severe fluid and electrolyte loss.
128
What amount of weight gain or loss in a 24-hr period should be reported when taking diuretics?
2lbs (1kg)
129
Excess fluid volume leads to what
HTN, heart failure, peripheral/pulmonary edema
130
Fluid depletion leads to what
Shock
Dehydration
131
Hypertonic IV fluid does what
Removes water from cells and can result in dehydration. from interstitial fluid into plasma.
132
Hypotonic IV fluids do what
Can result in hypotension due to movement of water out of vascular system. From plasma into interstitial fluid.
133
Isotonic Crystalloid fluids
Normal saline. (0.9% NaCl)
Lactated ringers.
They increase plasma volume without any major fluid shifts.
Indications: vomiting, diarrhea, surgical procedures, hypotension
134
Hypertonic crystalloid fluids
Hypertonic saline (3%)
Expands volume by drawing water from cells.
Indications: hyponatremia, cerebral edema, cellular edema
135
Hypotonic crystalloid fluids
Hypotonic saline. (.45%)
Fluid from plasma to cells.
(Gets em fat)
Indication: hypernatremia, cellular dehydration
136
If a patient is dehydrated and has a low BP. What do you give
Normal saline.
137
If a patient is dehydrated with a normal BP. What do you give.
0.45% NaCl
138
Colloids are larger molecules that remain in blood. They have the same effect as what ? And are indicated for what
Hyper tonic solutions.
Indications: hypovolemic shock, hemorrhage, burns.
139
5% albumin IV fluid does what
Increases BP and urinary output
Used in critical care frequently
It is a plasma volume expander
140
Dextran 40 does what and used for what
Effective at increasing plasma volume within minutes.
Can cause fluid overload: tachycardia, edema, Dyspnea, cough.
It’s a plasma volume expanded
141
A patient has a serum calcium level of 12.5. What tx should you expect?
Calcitonin or hypotonic fluids would be prescribed
142
A patient has severe hyponatremia. How would you expect this to be treated
3% sodium chloride
143
Potassium
Normal level range
Hyper/ hypo level symptoms
3.5-5
More abundant inside cell.
Fx: muscle conduction (including heart), metabolize carbs, moves glucose inside cell w/ insulin., maintain pH balance
Hypokalemia: muscle weakness, nausea vomiting, constipated, ekg-st depressed, t wave flat, q wave big, decreased dtr, decreased LOC, confused, drowsy (most commonly from: diarrhea excess, diuretics, beta adrenergic agonists, diet)
Hyperkalemia: EKG tall twaves, prolonged QT, muscle cramping/weakness, diarrhea, nausea, hyperactive bowel sounds, numbness/tingling, confused, anxious, restless or irritable. (Most commonly from renal failure or chemotherapy, crush injuries, diabetic ketoacidosis, medications ex: spiralactone, )
144
Calcium
8.5-10 ish
Fx: cardiac muscle depolarization, bone and teeth, nerve impulse transmission, regulate BP.
Hypercalcemia: nausea, decreased appetite, decreased dtr, muscle weakness, lethargy, blurred vision, vomiting, confusion, constipation, cardiac arrhythmia, bradycardia, short qt interval. (Causes: diet or supplement , cancer, end stage renal disease, osteoporosis, bone fractures, low phosphorus level, thiazide diuretic, hyper parathyroid)
Hypocalcemia: muscle spasms, parasthesia hands and lips, chovstek sign or trussou sign, cardiac arrhythmia, vfib, tosades de pontes. Diarrhea, osteoporosis. (Caused: renal failure, parathyroidextomy, hypo parathyroidism, excessive diarrhea, low magnesium, vit d deficiency)
145
Chloride
95-110
Fx: maintains osmotic pressure and fluid balance, maintain acid base balance.
Hyper: lethargic, headache, peripheral vasodilation, hypotension, decrease cardiac output,tachycardia, Tachypnea, metabolic acidosis abg. (Cause: dehydration, diabetic ketoacidosis, od of salicylates, hypernatremic, chloride meds, keyaxolate)
Hypo: confused, restless, muscle cramps, convulsion, hyperactive dtr, hypo ventilation, (caused: excessive gi loss, dehydration, hyponatremia, dka, acidosis, diuretics, fluid overload).
