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Pharm Final Flashcards

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1
Q

Which contraceptives are contraindicated if a woman smoked? Why?

A

CHC’s, transvaginal ring, and the patch: cigarette smoking increases the risk of serious cardiovascular events while using combination oral contraceptives

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2
Q

Who should not use combined oral contraceptives?

A

-pregnant women (or suspected)
-people at risk for or with a history of venous thrombosis
-vascular disease (including coronaryartery disease and cerebrovascular accident or past or current history of DVT or pulmonary embolism)
-Liver disease (cirrhosis, viral hepatitis, benign or malignant liver tumors)
-undiagnosed vaginal bleeding or known or suspected endometrial cancer
-breast cancer
-tobacco use of more than 15 cigarettes per day in a patient older than 35 years of age

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3
Q

When is Emergency Contraception most effective within? When is the cutoff for taking it?

A

Most effective within 24 hours, needs to be taken within 72 hours

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4
Q

Pharmacologic treatment of PMS

A

-antidepressants treat mental side effects
-Hormonal therapy can be used in treating the physical and mental issues associated with PMS (CHC pills, transdermal, and transvaginal ring) *progestin only products can worsen depression
-Regular NSAID or non-opioid analgesics for pain

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5
Q

Can progestin-only hormonal therapy be used for PMS?

A

No: it can worsen depression

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6
Q

Drugs that lessen effectiveness of Oral Combined Hormonal Contraceptives: My Adolescent Boyfriend Simply Can’t Take Fatherhood

A

Migraine drugs
Antibiotics
Barbiturates
Sedatives
C- anti-convulsants
T-anti-tubercular
F-anti-fungal

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7
Q

What are the indications for androgen therapy?

A

Treatment of delayed male puberty, androgen deficiency in males (male hypogonadism- congenital or acquired), replacement therapy for testicular failure in adult males, palliative treatment if carcinoma of the breast, and deficiency or absence of endogenous testosterone

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8
Q

What are the effects of taking anabolic steroids?

A

-increase protein synthesis within cells causing buildup of cellular tissue (anabolism) - especially in muscles
-androgenic and virilizing properties; development and maintenance of masculine characteristics such as the growth of the vocal cords and body hair
-a sudden dramatic increase in weight and body size, increased acne,and changed in mood and behavior
-may become more aggressive and physical
-LDL and decreased HDL; acne, high blood pressure, liver damage, and dangerous changes in the left ventricle of the heart

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9
Q

How do phosphodiesterase inhibitors work in erectile dysfunction?

A

They facilitate erections by enhancing blood flow to the penis

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10
Q

What drug classes and foods/herbs interactnwith the PDE-5 inhibitors?

A

Drugs: Nitroglycerin and other nitrate drugs
Foods/herbs: Grapefruit

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11
Q

How are antisndrogend used for BPH and prostate cancer?

A

Antiandrogens block the synthesis or action of androgens (stops the androgens from fueling tumor growth by binding to androgen receptors)

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12
Q

What is vertical transmission?

A

The passage of infecting organisms from mother to neonate

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13
Q

Which tetracycline is contraindicated for chlamydia treatment in the 2nd and 3rd trimesters in pregnancy?

A

Doxycycline

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14
Q

How do pharmacokinetics and dynamics change in pregnancy?

A

1) effect of circulating steroid hormones on the livers metabolism of drugs
2) reduced GI motility and increased gastric pH
3) increased glomerular filtration rate and increased renal perfusion, resulting in more rapid renal excretion of drugs
4) expanded maternal circulating blood volume, resulting in dilution of drugs
5) alteration in the clearance of drugs in later pregnancy, resulting in decrease in serum and tissue concentrations of drugs
-disorders such as diabetes mellitus and gestational hypertension may result in decreased renal perfusion and subsequent drug accumulation
-fetus is more likely to have evident drug effects because of their immature liver

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15
Q

Which herbs are strongly contraindicated in pregnancy?

A

-feverfew, rosemary, and sage are emmenagogues that stimulate blood flow in the uterus
-Kava decreases platelets
-Dong-quai, garlic, and ginkgo biloba increase bleeding when used with anticoagulants
-Ginseng may decrease the action of anticoagulants
-St. John’s wort has mutagenic effects on the cells of the developing embryo and fetus
-penny royal, rue, tansy, and blue cohosh taken orally or topically can be abortifacient

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16
Q

Why is taking iron and folic acid important during pregnancy?

A

Iron prevents iron deficiency anemia, folic acid prevents birth defects (neural tube defects especially)

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17
Q

Which mild analgesics are recommended or not recommended during pregnancy?

A

Acetaminophen should be used in the third trimester rather than aspiring and ibuprofen (overall preferred)

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18
Q

Can you use NSAIDS during pregnancy?

A

NO NSAIDS PAST THE 2nd TRIMESTER

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19
Q

How much coffee can you have daily while pregnant?

A

1 cup per day, preferably spaced throughout the day

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20
Q

What does caffeine do to an infant?

A

Caffeine can decrease intervillous placental flow due and also infants cannot metabolize it

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21
Q

Define tocolytic

A

Decreases uterine muscle contractions

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22
Q

What drug class is terbutaline?

A

Beta2-adrenergic agonist

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23
Q

What is the black box warning for terbutaline?

A

Should not be given for prolonged tocolysis (more than 48-72 hours)
-pregnant women experience arrhythmias, increased HR, hyperglycemia, hypokalemia, myocardial ischemia, pulmonary edema.
-infant HR may be increased and hypoglycemia in neonates has been observed

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24
Q

What are common side effects of terbutaline?

A

Tremors, dizziness, nervousness, tachycardia, hypotension, chest pain, palpitations, nausea, vomiting, hyperglycemia, and hypokalemia

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25
Patient education for terbutaline
-teach pt s/sx of PTL: mentrual-type cramps, sensations of pelvic pressure, low backache, increased vaginal discharge, and abdominal discomfort -instruct pt on what to do when feeling PTL contractions: void, recline on left side to increase uterine blood flow, and drink extra fluids. Notify provider if contractions do not cease or begin to intensify -report heart palpitations and dizziness to provider
26
What drug is best for long-term tocolytic therapy? Short term?
Long term: nifedipine Short term: terbutaline
27
What is the antidote for magnesium toxicity?
Calcium gluconate 1g IV push over 3 minutes
28
What are the side effects of magnesium toxicity?
Respiratory depression and arrest, circulatory collapse, cardiac arrest
29
What is the role of corticosteroids in preterm labor?
Accelerate lung maturation and lung surfactant development in the fetus in utero, decreasing incidence and severity of respiratory distress syndrome (RDS) and increasing survival of preterm infants (for neonates between 24 and 34 weeks)
30
What are the most common opioids given in labor for moderate to severe pain?
Butorphanol tartrate and nalbuphine
31
What is the antidote for opioid analgesics?
Naloxone
32
How do giving opioids in labor affect the fetus and the newly delivered infant?
Decreased FHR variability, neonatal CNS depression, hypotonia at birth, mild behavioral depression, depression of neonatal respirations, and depression of neonatal Neurobehavior
33
Why would a mixed narcotic agonist-antagonist be used in labor?
As adjunct to anesthesia (sedation and pain management)
34
What is the blackbox warning for promethazine?
Severe tissues damage with injections, which can cause necrosis and gangrene (Z track method needed, dilute IV doses over 20 minutes)
35
Why is promethazine used in labor?
As a sedative
36
How does the epidural affect maternal BP and fetal oxygen?
Hypotension in mother, CNS depression in infant (varying degrees of fetal and neonatal toxicity as well)
37
When is oxytocin administered in labor?
Via an IV pump during induction to prevent tachysystole (more than 5 contractions per 10 minutes in 2 consequence intervals)
38
What is the antidote for oxytocin?
Tocolytics (terbutaline)
39
How are dinoprostone or misprostol used differently in labor induction than oxytocin?
Dinoprostone is inserted vaginally via a sterile catheter or inserted as a vaginal insert; it is used to ripen an unfavorable cervix
40
What conditions are Contraindications for methylergonovine?
Pregnancy
41
What is methylergonovine used for?
Post-partum hemorrhage (not used in labor induction)
42
When can women resume intercourse after giving birth?
After lochia has ceased or advised by HCP
43
Interventions for lactation suppression
Tight bra worn continuously for 10-14 days, no stimulation of breast or nipples, pramoxine hydrochloride
44
Engorgememt nursing interventions
Cold cabbage leaves (replace when they wilt), express a small amount of milk before having infant latch
45
What route is Rhogam given?
IV or IM
46
Why is rubella immunity important in pregnancy?
Contraction during the first trimester can cause abortion or neurologic and developmental sequence associated with congenital rubella syndrome (transmission of virus to fetus via placenta); cataracts, glaucoma, deafness, heart defects, and mental retardation are seen with this syndrome
47
Why is the MMR virus given during the post partum period?
Live attenuated viruses can cross the placenta and result in viral infection of the fetus
48
How do surfectants assist in newborn breathing?
Surfectants decrease the surface tension of the alveoli to allow the lungs to fill with air and prevent the alveoli from deflating
49
Why is drug absorption less in infants?
Lack of maturation of GI tract is most pronounced in infancy; gastric pH is alkaline at birth, gastric emptying is affected by feeding (breastfeeding causes faster gastric emptying time), reduced intestinal surface, immature enzyme function -IM/SUBQ: Level of peripheral perfusion and effectiveness of circulation affects drug absorption
50
What are the preferred sites for IM injection for a pediatric patient?
Ventrogluteal, vastus lateralis
51
Active vs passive immunity
Active: occurs when the body's immune response is stimulated by an antigen or when a pathogen enters the body- immune response develops long-lasting immunity Passive: can be natural (body makes it's own antibodied) or acquired (antibody are given)- either way, the immunity is immediate and short lived - recipient does not induce their own immune response
52
When is DTap used? TDAP?
Dtap for active immunity in children 6 weeks to 6 years, Tdap as an active booster for those 20 and up
53
What are the Contraindications for varicella vaccination?
The presence of moderate to severe acute illness or active untreated TB, contraindicated in pregnancy (fetal harm unknown)
54
What is the minimum urine output per hour for an adult?
0.5-1 mL/kg/hr
55
What is the difference between crystalloid and colloid solutions?
Crystalloid solutions contain fluid and electrolytes and can freely cross capillary walls (short term maintenance of fluids), colloid solutions contain protein and other large molecular substances that increase osmolarity without dissolving in the solution and is unable to cross capillary walls (plasma expanders)
56
What do colloids do to "expand plasma"?
Pull fluids from the interstitial space into the plasma
57
How much does one unit of whole blood increase hemoglobin and hematocrit?
Hgb: 0.5-1 g/dL Hct- 3 points?
58
How many mL in one unit of whole blood? PRBCs?
Whole: 500 mL/unit PRBC: 350 mL/unit
59
Why is blood given through y tubing?
Y tubed allow for saline to be attached at one end for flushing- never dilute or mix medications with blood
60
How many hours do you have to infuse a unite of blood?
4 hours
61
What drugs are usually given with or before a blood transfusion?
Antihistamines (prevents or lessens reactions)
62
What is the rate for giving potassium?
10 mEq/hr
63
Should IV potassium be diluted?
Always: also, never administer via IV push
64
Calcium carbonate vs calcium citrate
Calcium carbonate: should be taken with meals because it requires stomach acid to dissolve; more Calcium per pill Calcium citrate: well absorbed and doesn't constipate, but contains less calcium per pill (less dependent on stomach acid for absorption)
65
How do laxatives and antacids affect magnesium?
They can cause hypermagnesemia
66
What nursing assessments are important for baseline values before starting growth hormone?
-height and weight -BG and electrolytes (hypoglycemia may occur) -GH levels -whether or not epiphysis have fused (acts on newly forming bones in children)
67
What is the primary function of prolactin?
Stimulation of breast tissue for milk production
68
What is important to monitor in patients with diabetes insipidus?
I&O, hydration status, and electrolyte levels
69
What do desmopressin and vasopressin do?
They are ADH analogues: they act like ADH in the body (give when ADH is low, like in DI)
70
What do vaptans do?
The vaptans (conivaptan and tolvaptan) are given to suppress ADH in such conditions such as SIADH (too much ADH)
71
What nursing assessments are crucial before giving any drugs that affect the hormone ADH?
Electrolyte levels, hydration status, history of hyponatremia, Renal function, nutritional status and habits, drinking habits, hepatic function
72
What is the drug of choice for hypothyroidism?
Levothyroxine sodium (increases T4 and metabolically is deiodinated to T3)
73
What nursing assessments are important for baseline values before starting levothyroxine?
TSH, T4, T3, presence or history of MI and/or thyrotoxicosis, adrenal values, weight, vitals, pregnancy test, CBC, CMP, liver function, electrocardiograph
74
Should prednisone be taken with food?
Yes- it causes GI upset
75
What are the s/sx of thyroid storm?
Tachycardia, cardiac dysrhythmias, fever, heart failure, flushed skin, apathy, confusion, behavioral changes, and hypotensionnand vascular collapse later on
76
Is levothyroxine given with food?
No- it is taken 30-60 minutes before any food or meds
77
What foods affect drug absorption of thyroid drugs?
Soy products (estrogen), cruciferous vegetables, iodized salt, shellfish (iodine), coffee
78
Which electrolyte is most effected by parathyroid hormone?
Calcium
79
How do the bisphosphonates help combat hyperparathyroidism?
Block osteoclast activity, inhibiting mineralization or resorption of the bone which can lessen osteoporosis caused by hyperparathyroidism
80
What patient education is important for bisphophonates?
Vitamin D and calcium intake is important, patients who can't sit upright for atleast 30 minutes after administration or have esophageal strictures cannot take oral bisphophonates, s/sx of hypocalcemia and hypophosphatemia
81
What types of disease processes are primarily treated by the glucocorticoids?
Trauma, surgery, inflammation, emotiona upsets, anxiety, allergic, debilitating conditions, Autoimmune disorders, ulcerative colitis, glomerulonephritis, shock, ocular and vascular inflammation, polyarteritis nodosa, hepatitis, asthma, drug reactions, contact dermatitis, anaphylaxis, organ transplants
82
Why should prednisone be used cautiously in diabetes?
It can cause hyperglycemia (and hypokalemia)
83
Prednisone drug interactions
NSAIDS: increased side effects, increased drug action of prednisone Diuretics: increased side effects Bupropion: increased risk of seizures Glycosides: toxicity (halos around lights, etc)
84
Does prednisone make you more vulnerable to infections?
Yes- avoid crowds
85
What are the therapeutic uses for prednisone or any corticosteroid?
Inflammation, neoplasms, multiple sclerosis, collagen disorders, dermatologic disorders, adrenocortical insufficiency, Addison disease, suppression of immune responses and adrenal function
86
How do aldosterone and Cortisol work in the body specific to fluids, electrolytes, and glucose?
Aldosterone holds onto sodium and water and rids potassium, Cortisol increases blood glucose
87
Which insulin is the only one that can be administered IV?
Human regular insulin
88
Which herbs increase the hypoglycemic effect when taken with insulin?
The Bee Gees feel a little hypoglycemic when they take insulin with herbs like BGBG (black cohosh, garlic, bilberry, ginseng)- that's why they wrote the song stayin alive
89
Which can cause hypoglycemia: metformin or glipizide?
Glipizide?
90
Positive Dromotropic effect
Increases conduction of heart cells
91
Positive inotropic effect
Increases myocardial contraction stroke volume
92
Positive chronotripic effect
Increase heart rate
93
Which arrhythmias can be treated with digoxin?
Afib and flutter
94
What is the normal therapeutic range for digoxin?
0.8-2.0
95
Signs of digoxin toxicity
Dysrhythmias I eyes (blurred vision) Gi upset
96
What is the antidote for digoxin toxicity?
Digoxin-immune Fab
97
What is the concern when taking digoxin with a potassium wasting diuretic?
Low potassium increases the drug effects of digoxin
98
What is the method of action of nitrates to relieve angina?
Reduces venous tone, decreasing the workload of the heart and promoting vasodilation
99
What position should a patient be in when being given nitroglycerin?
Sitting or lying position (hypotension can occur)
100
What can relieve a headache after receiving nitroglycerin?
Acetaminophen
101
What should a patient do if they still have chest pain 5 minutes after taking SL nitroglycerin?
Call 911 (may be a medical emergency)
102
How long should a nitro patch be off for at night?
8-12 hours min
103
What happens when BB are abruptly stopped?
Angina, palpitations, and or high blood pressure
104
Why is furosemide given as a slow IV push?
Hearing loss can occur if rapidly injected
105
Which drug increases ototoxicity of furosemide?
Aminoglycosides (mycins)
106
What are the most common reasons to give an osmotic diuretic?
To decrease intracranial and intraocular pressure
107
Do antihypertensives cause fluid retention?
Yes: give a diuretic with them
108
What do cardioselective beta blockers do?
Act mainly on beta 1 rather than beta 2; less likely to cause bronchoconstriction (preferred BB)
109
Why should antihypertensives never be abruptly stopped?
Rebound hypertension, angina, dysrhythmias, and MI can occur
110
How do ACE inhibitors affect potassium levels?
Block the release of aldosterone
111
How long does it take HMG-CoA reductase inhibitors to elicit a therapeutic effect?
Results may be seen as early as 2 weeks
112
Do not stop a statin drug abruptly. Why?
It could cause a threefold rebound effect that may cause death from acute MI
113
What liver enzymes are tested when taking a statin?
ALP, ALT, GGT, AST
114
Statin info
Sore muscles Toxicity with grapefruit ALT/AST monitoring Therapeutic effect Increase glucose Not a cure!
115
What does levothyroxine do to vital signs?
Speeds everything up!
116
What drugs are used for rhinitis?
Antihistamines
117
What drugs are used for nasal congestion?
Nasal decongestants (sympathomimetic amines)
118
What drug is used for a cough?
Antitussives (dextromethorphan)
119
How do antihistamines work to decrease a runny nose and congestion?
Compete with histamine receptors (H1 and H2) to prevent a histamine response (prevents constriction of extravascular smooth muscles and prevents increase in gastric secretions)
120
What are common anticholinergic side effects?
Dry mouth, urine retention, blurred vision, and wheezing
121
What is the difference between H1 and H2 blockers?
H1 blocker; prevents constriction of extravascular smooth muscles H2 blocker; prevents an increase in gastric secretion (prevents gastric ulcers)
122
What is the major side effect of diphenhydramine?
Drowsiness
123
Why shouldn't parents give their children diphenhydramine to induce sleep?
Children are more susceptible to the side effects of antihistamines (unusual excitement or irritability)
124
How does pseudophedrine work to decrease congestion?
Stimulates alpha-adrenergic receptors, producing vascular constriction of the capillaries within the nasal mucosa
125
What side effects will you expect when first taking pseudophedrine?
Nervousness, restlessness, increased BP and BG, dizziness, HA, photophobia, insomnia, palpitations, dysrhythmias, hypertension, tachycardia, and nausea
126
What is the difference between an antitussive and an expectorant?
Antitussives act on the cough control center in the medulla to suppress the cough reflex, expectorant loosen bronchial secretions so they can be eliminated by coughing
127
What can frequent use of decongestants cause?
Tolerance and rebound nasal congestion, rebound vasodilation instead of vasoconstriction
128
What class of drugs are given for bronchospasm associated with COPD and asthma?
Bronchodilators, methylxanthines, leukotriene antagonists, glucocoorticoids, cromolyn, and anticholinergics
129
Which drug is used for children with asthma?
Cromolyn and oral glucocorticoids (in severe cases, children may be ordered an oral beta-2 adrenergic agonist)
130
What is tiotropium used for?
Maintenance treatment of bronchospasms associated with COPD
131
Patient education for tiotropium
-administered via handihaler -handihalers Need washed with warm water and dried -any capsules that are open and not used need thrown away
132
What is the method of action of aminophylline-theophylline?
Relaxes smooth muscles of the bronchi, bronchioles, and pulmonary blood vessels by inhibiting the enzyme phosphodiesterase, resulting in an increase in cAMP, which promotes bronchodilation
133
Why is theophylline not prescribed as frequently?
Potential damger of serious adverse effects: dysrhythmias, seizures, and cardiac arrest (efficacy isn't better than beta agonists or glucocorticoids)
134
What does theophylline toxicity look like?
Hyperglycemia, decreased clotting time, and (rarely) increased WBC (leukocytosis)
135
What precautions should be taken when administering theophylline IV?
Rapid administration can cause dizziness, flushing, hypotension, Severe bradycardia, and palpitations -must be given slowly via an infusion pump
136
What are the Contraindications for theophylline?
Seizure disorders, cardiac, renal, or liver disease
137
Which common drugs should be avoided when taking montelukasts?
Aspirin and NSAIDS (block drug action)
138
What are montelukasts used for?
Prevention of acute attacks and treatment and treatment of chronic asthma
139
When should leukotriene receptor antagonists be taken?
In the evening for maximum effectiveness
140
Why are glucocorticoids not used for acute asthma attacks?
They can take 1-4 weeks for their full effect
141
Normal theophylline range
5-15 (greater than 20 is toxicity)
142
Bronchodilator lifestyle changes
-increase protein, lower carbs (increases theophylline elimination) -stop smoking -take drugs after meals to avoid GI upset -monitor HR and report abnormalities to provider -remain hydrated

Pharm Exam 2 (3 decks)

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