Pharm test 3 Flashcards
(325 cards)
1
Q
What is vision loss because of damage to the optic nerve (because of pressure)
A
Glaucoma
2
Q
What is the slower version of glaucoma that is a slow rise in IOP resulting in vision loss
A
Primary open angle glaucoma (POAG)
3
Q
What is the treatment for POAG
A
Drugs to reduce IOP
4
Q
What is the 2 MOAS for glaucoma drugs?
A
1.) Increase aqueous humor outflow
2.) Reduce aqueous humor production
5
Q
Are glaucoma drugs topical?
A
Yes, the goal is for them to be topical.
6
Q
If pharm therapy is not effective, a patient with POAG would have _________ therapy
A
Surgical
7
Q
What is the kind of glaucoma that is painful and rapid vision loss that can occur in 1-2 days without treatment?
A
Angle closure glaucoma
8
Q
What are some treatment options for Angle Closure Glaucoma?
A
Medications
But normally surgical because it is pretty urgent
9
Q
What are possible first line options for Glaucoma
A
Betablockers
Prostaglandin Analogs
Alpha 2 Adrenergic Agonists
10
Q
What are the two betablockers that are normally used in glaucoma
A
Timolol
Betaxolol
11
Q
What is the betablocker used for glaucoma that is cardioselective
A
Betaxolol
12
Q
What is the betablocker that is non-specific
A
Timolol
13
Q
What is the MOA for betablockers in treating glaucoma?
A
Decreases the production of aqueous humor
14
Q
Are Betablockers in glaucoma well tolerated?
A
Generally yes
15
Q
What are possible systemic effects of beta blockers in glaucoma?
A
HEART— bradycardia
LUNGS– bronchoconstriction
16
Q
What beta blockers can cause bronchospasms in patients with asthma and COPD?
A
Timolol
17
Q
What is the betablocker that should be used for patient’s with lung issues?
A
Betaxolol
18
Q
What is the prostaglandin analog used for glaucoma?
A
Latanoprost
19
Q
What is the MOA of Latanoprost?
A
This increases aqueous humor outflow
20
Q
In theory, what is a better option betablockers or prostaglandin analogs and why?
A
Prostaglandin analogs; because there are lower risk of side effects
21
Q
What are the possible side effects of Latanoprost?
A
Harmless pigmentation of IRIS
Thickening and growth of eyelashes
22
Q
What is the Alpha2-Adrenergic Agonist used for glaucoma?
A
Brimonidine
23
Q
What is the MOA of Brimonidine?
A
Decreasing aqueous humor production AND increasing outflow! THIS ONE DOES BOTH!
24
Q
What is the specific use of Brimonidine in glaucoma?
A
Long term use of POAG
25
What are the possible AE of Brimonidine?
Headache
Dry mouth and nose
Altered taste
Conjunctivitis
Pruritus
26
Does Brimonidine cross the BBB; What can this do?
Yes it does cross the BBB; Can cause hypotension
27
What is the osmotic agent used for glaucoma?
Mannitol
28
What is the specific use of Mannitol in glaucoma?
Closed Angle Glaucoma- reduces IOP super fast
29
What is the MOA of Mannitol
Draws water out of the vitrous humor and into the blood vessels
30
What is a drug that acts by paralyzing ciliary muscles?
Cycloplegics
31
What is a drug that dilates the pupil?
Mydriatics
32
What are the use of cycloplegics and mydriatics?
To measure refraction, intraocular exams, surgeries, and treatment of anterior uveitis
33
What are possible AE for cycloplegics and mydriatics?
Blurred vision
Photophobia
Angle closure glaucoma
Anticholinergic effects- with symptomatic absorption
34
What is the adrenergic agonist that does not cause cycloplegia?
Phenylepherine
35
Why do you use topical eye drop that can also be used for all allergy symptoms?
For allergic Conjunctivitis
36
What is used for Allergic Conjunctivitis that is also a mast cell stabalizer?
Cromolym
37
What can also be used for allergic conjunctivitis to reduce inflammation?
NSAIDS
38
What drugs are used in short term management of Allergic Conjunctivitis?
Glucocorticoids
39
What is another drug that can be used to treat allergic conjunctivitis?
Ocular decongestants
40
What is the painless progressive loss of central vision?
Macular Degeneration
41
What is the treatment for DRY MD?
Multiple vitamins, Antioxidants, Zinc
42
What is the growth of new vessels and fluid leakage?
WET MD
43
What is the treatment for WET MD?
Laser therapy
Photodynamic theraoy
44
What are meds that can be used for WET MD as angiogenesis inhibitors
Ranibizumab
Bevacizumab
45
What is the ophthalmic drug that suppresses the immune system response to promote the resumption of tear production
Topical cyclosporine
46
What is the ocular drug that is a weak adrenergic agonist that constricts the conjunctival blood vessels (These are ocular decongestants)
***End in Zoline***
Naphazoline
Tetrahydrozoline
47
Topical glucocorticoids are used to ___________ inflammation and itching as well as a _______ agent
reduce inflammation and is a drying agent.
48
What are possible AE of glucocorticoids
***Think of Cushings***
Stretch marks
Purpura- like petechia
Telangiectasia- widened blood vessels-
Hypertrichosis- weird hair growth
***Can be absorbed systemically***
49
What is a common AE of topical glucocorticoids?
Thinning of the skin and atrophy of the dermis and epidermal layers
50
What are s/sx of systemic absorption of topical glucocorticoids?
Growth retardation in children and adrenal suppression
51
How are you supposed to apply a topical glucocorticoid?
Thin film and rub it in (Do not use occlusive dressings)
52
What is the skin drug that promotes shedding of the horny layer of the skin
Keratolytics
53
What keratolytic agent is used for warts and corns?
Salicyclic acid
54
What is used to help treat acne, dandruff, psoriasis, and seborrhagic dermaitis?
Sulfur
55
What is a good option to treating acne (firstline)
Benzoyl peroxide
56
What are topical ABX that can be used for acne?
Clindamycin and Erythromycin
57
What are the retinoids that can be used to treat acne
Tretinoin
Adapalene
Tazarotene
58
What are oral acne treatments of acne?
Doxycycline
Minocycline
59
What are two other oral ABX that can be used in acne after Doxycycline and Minocycline
Tetracycline
Erythromycin
60
What is used for severe cystic acne
Isotretinoin (Accutane)
61
What are possible AE of Isotretinoin?
Dry skin
Nosebleed
Lip inflammation
Muscle and joint and bone pain
Depression is rare
TETRAGENIC
62
What must be monitored if someone is on isotretinoin?
Triglycerides and pregnancy
63
What are some other meds that can be used for hormonal acne?
BC and Spironolactone
64
UVA penetrates deeper than UVB and enters the ________ AND the ______
epidermis AND the dermis
65
UVA can cause what 3 issues with the skin
- immunosuppression
- photosensitive drug reactions
- photoaging of the skin
66
UVB penetrates the ______
epidermis (more superficial)- tanning and sunburn
67
UVA and UVB can both cause
skin cancer
68
What is the sunscreen that absorbs UV radiation and dissipates it as heat?
Organic sunscreen
69
PABA sunscreens should be avoided in patients that have what allergies
Sulfa
Benzocaine
Thiazide allergies
70
What are the PABA suncreens
Dioxybenzone
Avobenzone
71
What are the sunscreen that are physical screens that scatter UV radiation
Inorganic sun screens like Zinc oxide and Titanium dioxide
72
SPF protects against _______ not against UVA
UVB
73
SPF is not ______
linear
74
Steps to determining how long SPF protection will last?
How long before they burn (in minutes)
How many of those segments in a hour (So 30 min/60 means 2)
Divide SPF by segment number
That the number of hours that SPF will work
75
UVB is highest from which hours
10-4
76
SPF _-_ provides moderate protection from sunburn but not from CA
2-14
77
SPF _+ protects from everything
15+
78
PABA sunscreens need to be applied 2 hours before __________
Sunexposure
79
What is the chronic inflammatory disorder of the skin, with no cure, and is mostly symptom control?
***Kim Kardashian has this***
Psoriasis
80
What are the topical meds used for Psoriasis?
Glucocorticoids
Vitamin D and A
Anthralin and tars
81
What are systemic meds for psoriasis
Methotrexate- low dose immunosuppresion
Acitretin, glucocorticoids, cyclosporine
82
What are biological agents for Psoriasis
Etanercept
Inflixi***mab***, adalimu***mab***, ustekinu***mab***, (interfers T cells)
83
What are procedures that can help with psoriasis
Photochemotherapy
Coal tar UVB irradiation
84
What is the condition that develops into some skin cancers?
Actinic Keratosis
85
What are treatments for Actinic Keratosis
5FU, NSAIDS, blue lights, and physical intervention
86
Treatments for Atopic dermatitis and Eczema
Glucocorticoids and immunosuppressants
87
What moisturizers that are good for eczema
Oil based like Eucerin and Cetaphil
88
What is treatment for Warts
Saliacyclic acid 3-4% applied daily for 2 weeks and OTC cryotherapy
89
Treatment for hair loss?
***This is silly but the minions in despicable me 2
grow crazy hair when they eat the cupcakes. ***Minion and Minoxidil looks similar***
Minoxidil
90
Treatment for unwanted facial hair?
Their unwanted facial hair drops to the ***FLOOR***
Eflormithine
91
Treatment for impetigo?
1st gen. cephalosporin and dicloxacillin
92
What is the unregulated growth of cells due to DNA alterations
Cancer
93
What takes over and produces cancerous cells?
Activating oncogenes
94
What are the good genes that begin to slow and are overcome by oncogenes?
Inactivating tumor supressor genes
95
What are cancers that have slow cell cycles?
Breast
Lung
Prostate
Colon
Rectum
96
What are rare cancers that have faster cell cycles?
Leukemia
Lymphomas
Testicular Cancers
97
Faster cell cycles respond better to
DRUGS
98
Parts of bulk tumor reduction
Surgery
Irradiation
Chemo
99
What are the 4 drug classes for chemo
Cytotoxic agents
Hormones and hormone antagonists
Biological response modifiers
Targeted drugs
100
Normal cells with a high growth fraction are also destroyed by chemo because chemo is ___________
NONSELECTIVE
101
Intermittent chemo therapy allows normal cells to recover, __________ ones cannot
Malignant
102
Choosing drugs for chemo consits of what three points?
1. Must be effective on its own
2. Different MOAS
3. Minimal overlapping toxicities
103
intraarterial chemo administraion is straight to the
AFFECTED ORGAN
104
Intrathecal chemo administration is into the ______
CNS; avoiding BBB
105
What is the loss of WBCS
Neutropenia-- worried about infection
106
What is the loss of platlets
Thrombocytopenia-- worried about bleeding
107
What is the loss of RBCS
Anemia
108
If ANC is under 500 do what?
HOLD CHEMO
109
What is the greatest risk of infection; days 10-__
Days 10-14; Called NAdir
110
A fever over 100.5 is concerning for what
Neutropenic fever
111
Neutropenic fever is an oncological emergency--- they need what?
ABX!!!
112
What is the Granulocyte colony stimulating factor that grows more WBCS
Filgrastim
113
Platelets under what is concerning?
50,000
114
What is the only NSAIDS that can be given for patients with thrombocytopenia?
Acetaminphen
115
Avoid _______ injections in patients with thrombocytopenia
IM
116
What is the medicine that stimulates platelet growth?
Oprelvekin
117
What is the cell life of a RBC
120 days
118
What is the treatment for anemia?
EPO
119
EPO shortenens the survival of cancer patients and is normally only given for __________
Palliation
120
DO NOT GIVE EPO IN PATIENTS WITH
LEUKEMIA
121
What is the inflammation of the oral mucous membrane?
Stomatitis
122
What is the treatment for mild stomatitis
Mouthwash with lidocaine and benedryl
123
What is the mix for magic mouthwash?
Lidocaine
Malox
benedryl
124
What is the treatment for severe stomatitis
Systemic opiods
125
What is the treatment for mucousisits?
PO dexamethasone
126
What is the treatment for diarrhea in cancer patients
Oral loperamide
127
What are the 3 goals for treatment of N/V
Reduce anticipatory Nausea and vomiting-- BENZO
Prevent dehydration and malnutrition
Promote compliance with chemo
128
What med is used for nausea and vomiting for 0-16 hours post chemo?
ZOFRAN
129
What med is used for late onset N/V? 16 hours to 5 days?
Dexamethasone
130
What other drugs can be used in nausea and vomiting in CA patients
Aprepitant and Serotonin agonist
131
What medicine is used for the prevention of hyperuricemia?
Allopurinol
132
What chemo med is seriously toxic to the heart?
Doxorubicin
133
What chemo med causes injury to the kidneys
Cisplatin
134
What is the chemo med that can cause serious peripheral nerve damage
Vincrisitine
135
What is the largest class of anticancer drug?
Cytotoxic drug
136
Cytotoxic drugs affect normal and cancer cells. This means lots of
SIDE EFFECTS
137
What are the lists of vesicants
***There are 6***
Carmustine
Dacarbazine
Dactinomycin
Doxorubicin
Mitomycin
Vincrisitine.
138
What are the two alkylating agents?
Cyclophosphamide
Carmustine
139
Cyclophosphamide and Carmustine are Cell Cycle phase _____-___________
NON-SPECIFIC
140
What are the possible AE of Cyclophosphamide?
Bone marrow suppression
N/V
Alopecia
***Hemorrhagic Cystitis***
Nephrotoxicity
Sterility
141
Cyclophosphamide can cause hemorrhagic cystitis; what is the treatment for this?
Excessive hydration and Meszna (this protects bladder)
142
Carmustine is an alkylating agent that can cross the BBB. What are some possible AE?
***PULMONARY FIBROSIS***
Bone marrow suppression
N/V
***VESICANT***
143
What is the Platinum Compound that is used for chemo?
CisPLATIN
144
What is the MOA of Cisplatin?
Forms cross links in the DNA
145
What is cisplatin used in?
Testicular CA
Bladder CA
Lung, head, neck, ovarian and endometrial CA
146
CISPLATIN is highly ______
Emetic
147
What are other side effects for Cisplatin
Ototoxic
***Nephrotoxic***
Minor bone marrow suppression
148
Why is Cisplatin good for combination?
Because there is minimal BMS so it can be used in COMBO with chemo drugs that aren't
149
What is the dose limiting SE of Cisplatin
Nephotoxicity
150
What is the treatment for Cisplatin caused nephrotoxocity?
HYDRATE AND LOOP DIURETICS
Hydrate and help the kidneys
151
What are the Antimetabolite chemo drugs?
Methotrexate
Fluoracil
Mercaptopurine
152
Methotrexate is an antimetabolite chemo drug. What cell phase is this specific to?
Cell cycle phase S specific.
153
Methotrexate is used in what cancers?
Lymphoma
Sarcoma
Head and neck cancers
154
What are the possible AE for methotrexate?
Myelosuppression
Hepatotoxic
Alopecia
***Pulmonary fibrosis***
Mucositis
155
What are the two drugs that can cause pulmonary fibrosis
Carmustine and Methotrexate
156
If you give methotrexate at a high dose, you need to give _________. This protects the normal cells from methotrexate toxicities?
Leucovorin (folic acid)
157
Fluoracil is a antimetabolite chemo drug that is Cell phase ___ specific!
This is S phase specific
158
What are the possible AE of Fluorocil?
Neutropenia
Mucositis
Palmar plantar erythrodysesthesia
159
Mecaptopurine is an antimetabolite that is used in the treatment for what cancer?
ALL
160
What are the possible AE of Mecaptopurine
Myelosuppression
Mild hepatotoxicity
N/V
Mucositis
161
What are the two antitumor antibiotics?
Doxorubicin
Dactinomycin
162
What are the two antibiotics that are used to treat cancer?
Doxorubicin
Dactinomycin
163
The chemo ABX need to be given ____ because they are not absorbed well in the GI tract
IV
164
The antitumor ABX are cell phase
NONSPECIFIC
165
What is the ABX that is called the "Red DEvil"
Doxorubicin
166
What are the possible AE of Doxorubicin
Turns urine and tears red
Alopecia
Mucositis
Anorexia
N/V, Vesicant, myelosupression
DELAYED CARDIOTOXICITY
167
What is the important consideration with the administation/doing of doxorubicin
It can lead to HF and they can only get 550mg/mm2 in a lifetime
168
What is the antibiotic that is used in sarcomas and testicular cancer?
Dactinomycin
169
What are the possible AE of Dactinomycin
Myelosuppression
Mucositis
N/V
Diarrhea
Alopecia
VESICANT
170
What are the two mitotic inhibitors that are used in cancer therapy?
Vincristine and Paclitaxel
171
Mitotic inhibitors are cell cycle phase what?
Mitotic inhibitors are cell cycle phase M specific
172
What chemo med has the dose limiting AE of peripheral neuropathy?
Vincristine
173
What are the possible AE of vincristine?
Vesicant
Alopecia
***Peripheral Neuropathy***
174
Why is Vincristine good for combination?
Because there is ***no myelosuppression***
175
Paclitaxel is a mitotic inhibitor that has a severe risk for hypersensitivity. What do you do to help this?
Premedicate with H1 and H2 blockers and dexamethasone 30 minutes to an hour before chemo administration
176
What are the AE of Paclitaxel?
Neutropenia
Peripheral neuropathy
ALopecia
Heart conduction
Muscle and joint pain
177
What is the Topoisomerase Inhibitor?
Etoposide
178
What is Etoposide used in?
Lung and testicular cancer
179
What is the main AE of Etoposide?
Hepatotoxicity (LFTs)
180
What are other SE of Etoposide?
Myelosuppression
Alopecia
Hepatotoxicity
N/V
If IV, make sure you monitor for low BP
181
What is the anti-cancer drug that converts asparagine to aspartic acid?
Asparaginase
182
Asparaginase is only used in what kind of cancer?
ALL
183
How is asparaginase administered?
IV and Im
184
Asparaginase can cause allergies in some patients, so what should the nurse do first?
TEST DOSE
185
Asparaginase can cause a lot of coagulation difficulties, so this can cause issues for what 3 organs?
Liver
Pancreas
Kidneys
186
What are other possible AE for Asparaginase?
CNS depression
N/V
187
Antiestrogen meds for breast cancer patietns that are ER/PR + are what?
Tamoxifen
188
Aromatase inhibitors for breast cancer patients that are ER/PR + are what?
Anastrozole
189
Adjuvant treatment for breast cancer is Her-2/neu women is what?
Trastuzumab
190
What is the gold standard in breast cancer treatment is what?
Tamoxifen
191
How is tamoxifen used?
Established breast Ca and to prevent in high risk pts.
192
What are the benefits of Tamoxifen?
Increased bone mineral density
Improves osteoporosis and dyslipidemia
193
Tamoxifen can be given to ____ and ___ menopausal women
Post and pre menopausal women
194
What are the AE of Tamoxifen?
Hot flashes (give an SSRI)
Fluid retention
Vaginal discharge
N/V
Menstrual irregularities
Endometrial CA
Tetragenic
Blood clots
195
What is the Aromatase inhibitor that is used to treat breast CA?
Anastrozole
196
How is Anastrozole used?
To treat ER + breast cancer in POSTMENOPAUSAL WOMEN
197
What are the AE of Anastrozole?
Increase r/x of fractures and osteoporosis
198
What are some positives of Anastrozole?
Decreased hot flashes, wt. gain, vaginal bleeding, N/V and irritability
199
Women who are taking Anastrozole need what education?
Increase vitamin D and calcium
Increase wt. bearing exercise
Start bisphosphonate if severe
200
What is a special consideration of Anastrozole?
It can cause nephrotoxicity and osteonecrosis of the jaw.
201
What is the monoconal antibody that is used in the treatment of breast CA?
Trastuzumab?
202
Who can take Trastuzumab
Pt. with Her 2/neu overexpression
203
Because Trastuzumab is target, what are the few AE?
Cardiotoxic- DO NOT USE WITH DOXORUBICIN
May have some flu like symptoms upon administration
204
What cytotoxic drugs can be used in breast cancer?
Doxirubicin (4 does of AC for 4 weeks)
Cyclophosphamide
Followed by paclitaxel
205
How is prostate cancer treated?
Androgen deprivation therapy
206
What is the GnRH Agonist that is used in treating prostate cancer?
Leuprolide
207
What are the AE of Leuprolide?
Hot flashes
Bone pain
ED
Loss of libido
Gynecomastia
Decreased muscle mass
208
What education is needed for patients taking Leuprolide?
Need Vitamin D and Calcium
Need weight bearing exercise and bisphosphonates
209
What is another GnRH Antagonist that is used to treat prostate CA?
Degarelix
210
What is the androgen receptor blocker that helps to prevent tumor flare with increased testosterone from leuprolide?
Flutamide
211
What is the dosing considerations for Flutamide?
Give for 2 weeks after stopping and then stop
212
What are the AE for Flutamide?
Hot flashes
Low testosterone
N/V
Diarrhea
Hepatotoxic
213
What med is combined with prednisone because it causes an overproduction of mineral corticoid and prednisone limits?
Abiraterone
214
What are the AE of Abiraterone?
Hypokalmia
Joint swelling
Muscle discomfort
Hepatotoxicity
215
What med is used for prostate cancer that is expensive and focused immunotherapy?
Sipuleucel
216
What are two other meds for prostate cancer?
***End in taxel***
Docutaxel and Cabazitaxel
217
What is the targeted drug that is an EGFR Tyrosine Kinase Inhibitor?
Cetuximab
218
Who is at risk when taking Cetuximab?
Patient's with Alpha Gal from a Tic bite
219
When giving Cetuximab you may need to premedicate with what?
Benedryl
220
What is a special AE with Cetuximab?
Acne like rash- moisturize and avoid alcohol and the sun
221
What is the targeted drug that is a BCR-ABL Tyrosine Kinase Inhibitor and only used in CML?
Imantinib
222
What targeted drug can be used for metastatic melanoma?
(***Raf*** was always outside in OuterBanks so he might have melanoma)
Vemu***raf***enib
223
What is the targeted drug that can be used for ALL?
Rituximab
224
Possible AE of Ritixumab?
Ritixumab is used to ALL ;)
SJS and tumor lysis syndrome (they need allopurinol)
225
What is the targeted drug that is an angiogenesis inhibitor?
Bevacizumab
226
What are the contraindications of Bevacizumab?
Squamous cell lung cancer
227
What is the targeted drug that is used for multiple myeloma and lymphoma?
***Bortezomib***
Bortezomib
228
What are the two immunostimulants?
Ipilimumab and Nivolumab
229
AE of immunooncology therapy will effect
Skin
Endocrine
Liver
GI tract
Nervous system
EYES
RR system
Hematopoietic cells
230
Things to assess for in cancer patients
S/sx that look like an AI disease
Glucocorticoids
231
What are three things that fluid can correct?
Fluid volume and osmolality
Changes in hydrogen ion concentration
Electrolyte imbalances
232
What percentage of fluids are in the intracellular space?
60%
233
What percentage of fluids are in the intravascular and interstitial space?
40% (divided)
234
How many liters are in intravascular fluids?
5 Liters-- 3L of plasma and 2L of RBCs
235
When measuring electrolytes, you are measuring ______ levels in the intravascular space. You cannot measure the intracellular levels
THE EXTRACELLULAR
There is no real way to measure intracelllar levels
236
What fluid mixture is composed of water AND electrolytes?
Crystalloids
237
What are crystalloids beneficial for?
Pass through semipermeable membranes
Good to correct imbalances BUT have a smaller hemodynamic change per unit of volume
238
What are the isotonic crystalloids?
NS 0.9% and LR
239
Isotonic fluids will not cause a fluid shift and all fluid remains ____________
extracellular
240
What is hypertonic crystalloid?
3% NS
241
Hypertonic crystalloids will cause a massive fluid shift from the cell out into the extracellular space, causing a risk of _______________
hypernatremia; because the fluid in the cell balances out the sodium, so all the fluid leaving it will be more concentrated.
242
What are examples of hypotonic crystalloids
1/2 NS, D5W, d51/2 NS
243
Hypotonic crystalloids will cause fluid to move FROM the ___________ INTO the cells
Extracellular
244
When giving NS and LR, Sodium and Chloride do not enters cells but moslty remain __________
extracellularly
245
When giving 1 liter of fluid, about _____ mL of it goes into the intravascular space and the rest in interstitial
250
246
When giving D5W, Dextrose is metabolized into water and _______ _______
Carbon Dioxide
247
When Dextrose crosses membranes, when giving 1 L of fluid, about ___ mL is ____________ and 900 mL goes interstitial
100 mL goes intravascular and 900 mL interstitial
248
What is NS made of?
Water, Na, and Cl
249
What does NS provide?
It is isotonic so it is not moving anywhere
Extracellular fluid replacement
250
What are the 4 uses for NS?
Perioperative replacement
Volume resuscitation
and Mild hyponatremia
Metabolic alkalosis
251
What is LR composed of?
Composed of water, sodium, potassium, chloride, and lactate (similar to blood components)
252
LR provides _________ fluid replacement?
Extracellular
253
What are the uses of LR?
perioperative setting, lower GI fluid losses (diarrhea), burns, and dehydration
254
Lactate is metabolized to bicarbonate to the liver, so there is a risk of
Metabolic alkalosis
255
LR should be used in caution with patients with
Liver disease
256
1/2 NS provides ______ ______ meaning little else is in the fluids
Free water
257
Why would 1/2 NS be used?
This is hypotonic so it carries fluid into the cells
If a patient is hypertonic because of a loss of fluid and needs dilution
Things like hypovolemia and hypernatremia
258
What needs to be monitored in patients receiving 1/2 NS?
SODIUM; WATCH FOR LOW NA
259
Why is D5 1/2 NS used?
Maintenance fluid after it is fixed by NS/LR
260
What do you need to monitor for D5 1/2 NS?
Hyponatremia; Not worried about hyperglycemia
261
What is D5W made of?
Water and dextrose
262
Why is D5W used?
Severe hypernatremia
Small volumes to dilute medication
Used to keep a vein open
263
3% NS provides ________ to the intravascular space?
SODIUM
264
WHy is 3% NS used?
It is hypertonic so it pulls water out
Severe hyponatremia
to decrease ICP in TBI and stroke (pulls the fluid)
265
What must be monitored in patients getting 3% NS
They are getting lots of sodium
SODIUM
NEURO STATUS (they can get seizures with hypernatremia)
266
Colloids are larger particles that cannot cross
capillary membranes
267
What is a colloid that runs slowly and may result in volume overload?
5% albumin
268
What are other colloids mentioned?
Pooled human plasma
Semi-synthetic glucose polymers
Semi-synthetic hydroxytheyl starch
269
What is a colloid that is a volume expander?
25% albumin; this means that fluid left in the vsculature will be 5x greater than what is infused
270
What is the use for 25% albumin
Ascites and Pleural effusions
271
What is the goal in giving 25% albumin
Fluid redistribution
272
What is done for a patient in shock who need intravascular fluid replacement. Increasing volume increase blood pressure
Fluid resuscitation
273
What are the steps for fluid resuscitation
Give 500-1000 mL bolus-- reassess- continue to bolus til the s/sx improve
274
When doing fluid resuscitation, start with
Crystalloids (colloids are $$$$$ and take longer to administer)
275
Fluid maintanence is for who?
someone who may be npo for awhile and needs to stay hydrated
276
what is the most common fluid for maintenance
*** Hypotonics***
D5W 0.45% NaCl + KCl 20-40 mEq/L
277
Daily dose for fluid maintenance
1500 mL for first 20 kg then 20 mL/kg each day
278
What is isotonic contraction
Losing both water and sodium, so ya need to replace both
Sodium and water are lost in = proportions, volume decreases, but osmolality does not change
279
What is the cause for Isotonic Contraction
***Losing both Na and water***
Vomiting
diarrhea
kidney disease diuretics
280
What is the treatment for isotonic contraction
Isotonic fluids
281
What is the Loss of water is > loss of sodium, volume decreases, and osmolality increases
Hypertonic contraction
***Too much salt***
282
What is the cause of hypertonic contraction
Losing fluids so things are over concerntrated
sweating, osmotic diuresis, concentrated food in babies, burns, thirst disorders
283
Treatment for hypertonic contraction
There is too much salt so you need fluids to dilute it
Tx: initially drink water. 50% in the first couple hours and the rest over days
If ineffective: hypotonic fluids ( ½ NS, D5W)
284
What is the loss of sodium > loss of water, volume decreases meaning osmolality decreases?
Hypotonic Solution
285
What is the cause of hypotonic solution
sodium loss from a diuretic
Chronic renal failure
Low aldosterone
286
What is the treatment for hypotonic solution
mild- NS and wathc for fluid overload
severe- infuse 3% NS
287
What is the increase of total body water?
Volume expasion
288
What are causes for volume expansion
OD with fluids
Disease such as CHF
Nephrotic syndrome
Cirrhosis
289
What is the treatment for volume expansion
Diuretics
290
What is it when the patient has a high pH (above 7.45) and low CO2 ((Below 35)
Resp. alkalosis
291
What casues Resp. Alkalosis
Hyperventilation; treat with paper bag or rebreathe co2
292
What is it when there is a low pH (Below 7.35) and a high CO2 (Above 45)
Resp. Acidosis
293
What is the treatment for resp. acidosis
correct the cause, infuse sodium bicarb
294
What is it when there is a high pH (Above 7.45) and high HCO3 (Above 26)
Metabolic alkalosis
295
What is the treatment of metabolic alkalosis
***Need to make things more acidic**
Sodium chlor1de and potassium chloride
296
What is it when there is a low pH (below 7.35) and low hco3 (Below 22)
Metabolic acidosis
297
What is the treatment for metabolic acidosis
*** you need to make things more basic***
Correct the cause, alkalinizing salt if severe
298
Normal Potassium values
3.5-5.0
299
Causes of low K
shift INTO cells
GI loss
urinary loss
decreased magnesium
300
s/sx of hypokalemia (K < 3.5)
paralysis of skeletal muscles and changes in EKG
301
Treatment for mild hypokalmeia (K < 3.3)
PO potassium chloride
302
Treatment for severe hypokalemia (K< 3.2)
IV potassium chloride. never push
303
What are causes for hyperkalemia
Causes: tissue trauma, Addison’s disease, acute acidosis, potassium sparing diuretics, IV potassium overdose
304
What are the S/SX of hyperkalemia
***Think of what happened in class***
Confusion, anxiety, dyspnea, weakness or heaviness of legs, numbness and tingling
305
What is the treatment for hyperkalemia
CALCIUM GLUCONATE- prevents V-fib
Bicarbonate
Insulin- 10 units with glucose
Albuterol- may not always work
Diuretics and Kayexelate and Dialysis
306
What are the normal Mg levels
1.8-3.0
307
What are food sources of Mg
Kelp, wheat bran/germ nuts
308
What are the s/sx of hypomagnesemia
muscle spasms/cramps
mental disorders
arrhythmia, fatigue, muscle weakness, high blood pressure, osteoporosis
309
What is the treatment for hypomagnesemia
Magnesium sulfate
310
Hypermagnesemia is common in pt. with what?
Renal insufficiency
311
Hypermagnesemia can lead to what?
***Think of why you do hourly checks on OB when a momma is getting Mag***
Paralysis of Resp. Muscles and cardiac arrest
312
What is protective against hypermagnesemia
Calcium gluconate
313
PTH and Vitamin D increases what
Absorption
314
Calcatonin increases calcium _______ by the kidneys
Elimiation
315
Food sources for Ca
KElp, dark leafy greens, nuts and dairy
316
Functions for calcium
Nerve transmission, muscle function, bone health, enzymes, sex hormones
317
Osteo_____- break down
CLASTS
318
Osteo______- builds bone
BLASTS
319
Normal Ca levels
8.5-10.5
320
Treatment for hypercalcemia
promote urinary excretion (Furosemide), decrease bone mobilization, decrease intestinal absorption (glucocorticoids), IV saline (dilute)
321
Treatment for hypocalcemia
calcium supplementation (IV calcium gluconate if severe; calcium citrate and vitamin D for mild)
322
Patient education for Biphosphonates (-ronate)
Give with a full glass of water (8 oz)
Give in the morning on an empty stomach
Remain upright for 30 minutes after taking (NOT sitting, moving around, or bending over) can cause esophageal erosion
Avoid chewing alendronate tablets
Avoid food for one hour including coffee and tea, only water
323
Raloxifen is used in what
Osteoporosis, breast CA, decrease cardiovascular risk
324
Teriparatide has a black box warning for
Osteosarcoma; do not give if they have a history of bone CA
325
Cinacelet is used in what?
Hyperparathyroidism
