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Fall > Pharm Exam 1 Mod 1-4 > Flashcards

Pharm Exam 1 Mod 1-4 Flashcards

1
Q

A patient taking Flonase is instructed to avoid eating black licorice while taking the drug. Why?

A

It potentiates the drugs action

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2
Q

Adverse effects of antihistamines include

A

Drowsiness or dizziness
Tachycardia or palpitations
Urine retention
Dry mouth

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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.

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4
Q

Diphenhydramine is contraindicated for …

A

Hypersensitivity to the drug
Benign prostatic hyperplasia
Narrow-angle glaucoma
Gastrointestinal obstruction

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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.

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6
Q

Pseudoephedrine (decongestant) has what mechanism of action

A

Activates alpha1-adrenergic receptors, causing vasoconstriction and decreasing mucosal swelling.

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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.

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8
Q

Children diagnosed with allergic rhinitis are at a greater risk for what ?

A

Middle ear infections

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9
Q

Flonase does what?

A

Decreases inflammation through vasoconstriction and anti inflammatory processes

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10
Q

What is the purpose for mucous

A

It neutralizes airborne pathogens.

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11
Q

Tut healer and Flexhaler are types of what device?

A

Dry powder inhaler (DPI)

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12
Q

What is status asthmaticus?

A

A severe prolonged form of asthma unresponsive to drug treatment that may lead to respiratory failure

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13
Q

Common asthma triggers

A

Air pollutants.
Allergens
Chemicals and food
Respiratory infections
Stress

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14
Q

Two categories of asthma drugs.

A

Quick relief and long term.

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15
Q

Quick relief asthma medication classes

A

Short acting beta2 adrenergic agonists (SABA)— bronchodilation
Anticholinergics—bronchodilation
Corticosteroids: systemic — anti inflammatory

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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.

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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

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18
Q

Asthma Drugs that end in “-ium” aka aclidinium, ipratropium, tiotropium, umeclidinium are of what class?

A

Anticholinergics

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19
Q

Asthma drugs that end in “-lline” aka aminophylline, and theophylline, are of what class?

A

Methylxanthines

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20
Q

Beta adrenergic agonists work how?

A

Activate the sympathetic nervous system, which relaxes bronchial smooth muscle resulting in bronchodilation

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21
Q

If someone has chronic asthma they need to be treated for bronchospasm relief as well as what?

A

Inflammation

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22
Q

Beta-agonist medications that activate only beta 2 receptors are called what

A

Selective drugs

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23
Q

Where are beta 1 receptors located

A

The heart

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24
Q

Where are beta 2 receptors located

A

Smooth muscle of lungs, uterus, other organs

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25
Q

Non selective Beta agonists activate what receptor (s)

A

Both beta 1 and beta2

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26
Q

Epinephrine and isoproterenol are examples of what type of drugs

A

Nonselective beta adrenergic agonists

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27
Q

Long acting beta adrenergic medications have what black box warning?

A

Their use is associated with an increase risk of asthma related deaths.

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28
Q

Long acting beta agonists have a slow onset and will not abort acute bronchospasms. T/f?

A

True.

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29
Q

Anticholinergics have what mechanism of action?

A

Block the parasympathetic nervous system. Increases bronchodilation

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30
Q

Asthma drugs that end in “-asone “ or “-onide “ are of what class

A

Inhaled corticosteroids

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31
Q

Cromolyn is what type of drug

A

Mast cell stabilizer.

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32
Q

What is the preferred therapy for preventing asthma attacks

A

Inhaled corticosteroids

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33
Q

What type of asthma drugs could reduce growth velocity in some children

A

Inhaled corticosteroids

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34
Q

Anticholinergics drugs contraindications

A

Narrow angle glaucoma. Benign prostatic hyperplasia. Renal disorders. Urinate bladder neck obstruction. And older adults.

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35
Q

Beta adrenergic agonist contraindications

A

History of MI or dysrhytmia.
Breastfeeding not recommended
Under 6 limited

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36
Q

Methylxanthines are contraindicated for

A

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

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37
Q

Adverse effect of inhaled corticosteroids

A

Orioharyngeal candidiasis

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38
Q

A patient taking ipratropium receives a new prescription for tiotropium. What patient eduction needs to be provided by the nurse?

A

Tiotroprium is only taken once per day where the old prescription, ipratropium is taken 4 or more times per day.

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39
Q

Emphysema is characterized how

A

By loss of bronchiolar elasticity and destruction of alveolar wall structures

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40
Q

Arformoterol is what kind of beta agonist.

A

Long acting.

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41
Q

Anticholinergic medication can cause constipation. Educate clients to increase fiber. T/f

A

True

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42
Q

Cromolyn might be prescribed to a patient with COPD why

A

The patient has an allergy to corticosteroids or they are ineffective

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43
Q

What is the drug that’s mechanism of action interferes with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol.

A

Statins

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44
Q

What is the drug that’s mechanism of action decreases both VLDL and LDL levels

A

Niacin.

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45
Q

What is the drugs that’s mechanism of action blocks the absorption of cholesterol from the small intestine

A

Ezetimibe

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46
Q

What is the drug that’s mechanism of action binds bile acids, thus increasing the excretion of cholesterol in the stool

A

Bile acid sequestrants

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47
Q

Rare but serious adverse effects of statins

A

Severe myopathy and rhabdomyolisis

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48
Q

What is rhabdomyolisis

A

Contents of muscle cells spill into the systemic circulation, causing potentially fatal acutely renal failure

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49
Q

What should be avoided during statin therapy because of their potential to interfere with statin metabolism and increased risk of sever myopathy

A

Macrolide antibiotics, such as erythromycin, Azole antifungals, fibrin acid drugs, certain immunosuppressants

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50
Q

Statins with short half lives, such as lovastatin and simvastatin should be administered when

A

At night because cholesterol biosynthesis in the liver is higher at night.

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51
Q

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

A

Heart healthy

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52
Q

Patients taking statins could benefit from enhancing their diet with foods rich in CoQ10- like pork- why?

A

Statins reduce coQ10 synthesis

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53
Q

Lipid lowering drugs can deplete or diminish the absorption of what?

A

Fat soluble vitamins and folic acid

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54
Q

Gemfibrozil (Lopid) can increase the risk of bleeding. T/f

A

True
What drug would need to be lowered.
Warfarin.

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55
Q

Gemfibrozil is contraindicated in patients with what

A

Chronic kidney disease

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56
Q

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?

A

Ezetimibe (Zetia)

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57
Q

A serum triglyceride level of less than 150 mg/deal is considered.

A

Normal or desired

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58
Q

A serum triglyceride level of 188mg/dL would be considered?

A

Borderline high risk

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59
Q

A serum triglyceride level between 200mg/dL and 499 mg/dL would be considered what?

A

High risk

60
Q

Gemfibrozil (fibric acid derivative) is indicated for the treatment of what conditions

A

Hyper triglycerides and hypercholesterolemia
(It lowers VLDL with an increase in HDL)

NOT effective for lowering LDL

61
Q

Niacin for lowering cholesterol should not be used in patients with diabetes. Why

A

It can increase fasting glucose levels

62
Q

Atorvastatin (Lipitor ) is what kind of drug

A

HMB-CoA reductase inhibitor.

63
Q

A patient has a triglyceride level of 450 mg/dL. Which drug should the nurse anticipate being prescribed for this patient

A

Fibric acid

64
Q

Cholestyramine (Questran) can bind to other drugs. When should it be taken with a patient who also takes digoxin

A

2hours before or 4 hours after

65
Q

If statins are having minimal impact and aren’t tolerated well by the patient, what drug would be the next choice

A

Gemfibrozil (lopid)

fibric acids

66
Q

A patient continues to experience elevated cholesterol levels despite taking prescribed medication. Which drug should the nurse identify that is causing this patients result.

A

Ezetimibe (zetia)

67
Q

A patient is prescribed Gemfibrozil (Lopid). For which reason should the nurse expect the medication to be discontinued for this patient

A

Elevated low density lipoproteins (LDL)

68
Q

What is the primary carrier of triglycerides that is reduced to become a LDL

A

VLDL

69
Q

Common side effects of statins include

A

Headache, fatigue, muscle or joint pain, heartburn.
Often patients can tolerate these over time.

70
Q

Cholestyramine is contraindicated for what

A

Biliary obstruction

71
Q

What warms, cleans and humidifies air before entering the lungs

A

URT
Upper respiratory tract

72
Q

What’s the first line of defense your body uses for preventing pathogens to enter through URT

A

Nasal mucosa

73
Q

What medication is prevention for allergic rhinitis

A

Intranasal corticosteroids

74
Q

What are H1 receptor blockers (antagonist) mechanism of action

A

Antihistamines that block the histamine (H1) receptors.

75
Q

What class of drug relieves nasal congestion by causing vasoconstriction in the nasal passage?

A

Nasal decongestants - sympathomimetic
Oxymetazoline (Afrin)
What’s the warning for this drug???
Can cause rebound congestion only use 3-5 days

76
Q

What drugs are effective in treating inflammation of nasal passage and used to prevent allergic rhinitis?

A

Intranasal corticosteroids.
Fluticasone (Flonase)
-pregnancy cat. C(risk cannot be ruled out)
Beconase (beclomethasone nasal)
- hoarseness, dry mouth, cough, sore throat, oropharyngeal candidiasis.

77
Q

What drugs are used to dampen cough reflex (best for non productive cough)

A

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
Q

Respiration drive is determined by what

A

The brain

79
Q

What opens the respiratory lumen?

A

Bronchodilation

80
Q

Constriction and dilation is regulated by what

A

Two branches of the ANS.
Sympathetic- cause bronchodilation
Parasympathetic- cause bronchoconstiction.

81
Q

What is a chronic pulmonary disease with inflammation and bronchospasm components?

A

Asthma

82
Q

What are asthma med goals

A

To terminate acute bronchospasms in progress and to reduce the frequency of attacks

83
Q

What category medication is Albuterol (ProAir HFA) in and what are side effects of it

A

It’s a bronchodilator. Specifically SABA
Can cause tachycardia, hypokalemia, hyperglycemia, nervousness

84
Q

What category of drugs is Ipratropium (Atrovent)

A

A bronchodilator. Specifically Anticholinergics (cholinergic blocker)

Rinse mouth after to avoid bad taste.
If paradoxical bronchospasm occurs, withhold medication and notify HCP immediately

85
Q

What medication class is Beclomethasone (Qvar) in and it’s side effects

A

Inhaled corticosteroid. Can cause oral candidiasis. May reduce growth in some pediatric pt.

86
Q

What category drug is cromolyn (gastrocrom)

A

Mast cell stabilizer. Inhibits release of histamine and other inflammatory mediators.
Preventative, long term medication

87
Q

What category drug is montelukast (singulair)

A

It’s a leukotrine modifier. Mediators of immune response.
This is the only drug in the class safe for pediatric use.

88
Q

Copd is most commonly caused by what conditions

A

Chronic bronchitis- strongly associated w/smoking
Emphysema- strongly associated with smoking.

89
Q

What meds are used for Copd

A

Antibiotics (tx infections)
Expectorant, mucolytics (control cough)
Bronchodilators (relieve bronchospasms)

90
Q

Triglycerides should be less than what number to be in normal range

A

Less than 150

91
Q

What is the drug Atorvastatin (Lipitor)

A

Statin.
Side effects- myalgia, arthralagia, rhabdomyolisis (leads to renal failure!) elevated hepatic enzymes.

92
Q

What do B-complex Vitam B do for lipid disorders and name the drug given

A

Decreases the VLDL into LDL, reduced triglycerides.
Niacin is what’s given
Side effects- flushing, nausea, diarrhea, hepatotoxicity, gout

93
Q

What do Fibric Acid Drugs do for lipid disorders

A

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
Q

What do the kidney excrete that helps regulate bp

A

Renin enzyme

95
Q

What do kidneys excrete that stimulates red blood cell production

A

Erythropoietin hormone

96
Q

Kidney are responsible for the production of what, which helps maintain bone homeostasis

A

Calciferol the active for of vitamin D

97
Q

If a drug is bound to plasma proteins will it pass through the glomerulus and enter the filtrate or continue circulating in the blood.

A

Continue circulating. It’s too big

98
Q

Plasma proteins such as albumin found in pt urine indicates what

A

Kidney pathology.

99
Q

What are primary goals for a pt with kidney failure

A

Maintain blood flow through the kidneys and adequate urine output

100
Q

Tests to diagnose kidney failure

A

Urinalysis
Metabolic panels
-Cr, BUN, eGFR
(Creatine, blood urea nitrogen, glomerular filtration rate).

101
Q

What are primary measures of structural kidney damage

A

Proteinuria and albuminuria

102
Q

What diagnostic imaging can be used to provide a more detailed diagnosis of kidney disease

A

CT scan, sonography, MRI

103
Q

Most frequent cause of Acute kidney injury causes

A

Renal hypoperfusion (lack of sufficient blood flow through kidneys)
Usually caused by heart failure, hemorrhage, dehydration, toxins, dysthymias.

104
Q

What happens in end stage renal disease

A

Kidneys no longer able to function in their own; dialysis or transplant tx options.

105
Q

What is the medication management of kidney failure

A

Diuretics to increase urine output.
Cardiovascular drugs to tx underlying HTN or heart failure.

106
Q

Dietary management of kidney disease can include..

A

Protein restriction
Reducing sodium, potassium, phosphorus, and magnesium intake.

107
Q

Diuretic drugs and therapy for kidney failure

A

Diuretics: Loop/ thiazide/ potassium sparing.
Used for: HTN, AKI & CKD, heart failure, pulmonary edema.

Nurse teaching: monitor weight, HR, BP

108
Q

Bumetanide (bumex) is what kind of drug

A

Loop diuretic. Most potent of them.
It blocks the reabsorption of Na+ an Cl- in the nephron loop.
Side effect: hypokalemia, hypotension
Ototoxic

109
Q

Ethacrynic acid (edecrin) is what kind of drug

A

Loop diuretic.
Side effect: ototoxicity.

110
Q

Chlorothiazide (Diuril) and hydrochlorothiazide (microzide) are what kind of drugs

A

Thiazide diuretics.
Block Na+ reabsorption and increase k+ and water excretion.
Side effect: hypokalemia (palpitations), hypotension, dehydration

111
Q

Spironolactone (Aldactone) is what kind of drug?

A

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
Q

Furosemide and torsemide are what kind of drugs

A

Loop diuretic
Furosemide (Lasix)- is the most popular and lasts 6 hrs.

113
Q

Loop diuretics are mainly used for ….

A

Edema …..
Cardiac failure

114
Q

Loop diuretic side effects.

A

Ototoxic. Decreased potassium and magnesium. Metabolic alkalosis (blood pH turning basic). Dehydration. (Fluid loss)

115
Q

Potassium sparing diuretics can treat what and have what side effects

A

Tx: HTN, heart failure, edema.
Side effects: elevated potassium levels; high levels can lead to gynecomastia

116
Q

Thiazide and thiazide like diuretics work on what part of kidneys. Used for what?

A

Distal convoluted tubule. To prevent sodium from being reabsorbed.
Used for HTN, Edema.

117
Q

Thiazide diuretics side effects

A

Gout.
Decreased sodium (hyponatremia)
Decreased potassium (hypokalemia)
Increased Uric acid (hyperuremia)
Increased blood glucose (hyperglycemia)

118
Q

Necessary nursing precautions when giving diuretics? (Remember the acronym)

A

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
Q

K wasting diuretics end in what suffix

A

-ide. Furosemide & hydrochlorothiazide

120
Q

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

A

Potassium sparing

121
Q

If a patient is on loop diuretic and their potassium levels came back abnormal what’s the first nursing action

A

Place on cardiac monitor.

122
Q

Never push potassium IV. It’s only administered via a bag 1hr or more. Typically 4hr

A

It will kill patient

123
Q

Before administering diuretics, you take the pt BP and it comes back low, what action do you take.

A

Hold the med. contact HCP

124
Q

OTC medications like NSAIDs, antacids, acetaminophen, and cough and flu, should be avoided with diuretics why?

A

All contain high levels of sodium.

125
Q

The nurse suspects a pt has overdosed on acetazolamide (Diamox). What drug should the nurse expect to be prescribed for this

A

Sodium bicarbonate. To treat the metabolic acidosis that an OD of Diamox would produce.

126
Q

Overdose of the drug hydrochlorothiazide (microzide) is treated how?

A

Infusions of normal saline
Od manifests as electrolyte depletion

127
Q

Overdose of the drug furosemide (lasix) is treated how?

A

Supportive replacement fluids and electrolytes. Possibly administering a vasopressor (norepinephrine)
Od results in hypotension and severe fluid and electrolyte loss.

128
Q

What amount of weight gain or loss in a 24-hr period should be reported when taking diuretics?

A

2lbs (1kg)

129
Q

Excess fluid volume leads to what

A

HTN, heart failure, peripheral/pulmonary edema

130
Q

Fluid depletion leads to what

A

Shock
Dehydration

131
Q

Hypertonic IV fluid does what

A

Removes water from cells and can result in dehydration. from interstitial fluid into plasma.

132
Q

Hypotonic IV fluids do what

A

Can result in hypotension due to movement of water out of vascular system. From plasma into interstitial fluid.

133
Q

Isotonic Crystalloid fluids

A

Normal saline. (0.9% NaCl)
Lactated ringers.

They increase plasma volume without any major fluid shifts.
Indications: vomiting, diarrhea, surgical procedures, hypotension

134
Q

Hypertonic crystalloid fluids

A

Hypertonic saline (3%)
Expands volume by drawing water from cells.
Indications: hyponatremia, cerebral edema, cellular edema

135
Q

Hypotonic crystalloid fluids

A

Hypotonic saline. (.45%)
Fluid from plasma to cells.
(Gets em fat)
Indication: hypernatremia, cellular dehydration

136
Q

If a patient is dehydrated and has a low BP. What do you give

A

Normal saline.

137
Q

If a patient is dehydrated with a normal BP. What do you give.

A

0.45% NaCl

138
Q

Colloids are larger molecules that remain in blood. They have the same effect as what ? And are indicated for what

A

Hyper tonic solutions.
Indications: hypovolemic shock, hemorrhage, burns.

139
Q

5% albumin IV fluid does what

A

Increases BP and urinary output
Used in critical care frequently

It is a plasma volume expander

140
Q

Dextran 40 does what and used for what

A

Effective at increasing plasma volume within minutes.
Can cause fluid overload: tachycardia, edema, Dyspnea, cough.
It’s a plasma volume expanded

141
Q

A patient has a serum calcium level of 12.5. What tx should you expect?

A

Calcitonin or hypotonic fluids would be prescribed

142
Q

A patient has severe hyponatremia. How would you expect this to be treated

A

3% sodium chloride

143
Q

Potassium
Normal level range
Hyper/ hypo level symptoms

A

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
Q

Calcium

A

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
Q

Chloride

A

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).

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