Real Final Flashcards

Question

role of nurse in sulfonamide therapy*

Answer 1

- assess for anemia or other hematological disorders (HgB and platelets) - assess renal function, sulfonamides may increase risk for crystalluria -> encourage increased fluids - ensure if on oral contraceptive pills that pt uses alternate form of birth control - teach how to decrease effects of photosensitivity - contraindicated in pt with history of hypersensitivity to sulfonamides -> can induce skin abnormality called Stevens-johnson syndrome

Answer 2

used for tx of infections known or suspected to be caused by a multi-drug resistant (MDR) bacteria used primarily in hospitalized pt low incidence of adverse effects don't interchange IV and IM

Answer 3

- vancomycin (PO/IV) - breaks down amino acid wall - used to treat C-Diff

Answer 4

- clindamycin (IV only) - can cause C. Diff

Answer 5

mechanism of action = bactericidal, inhibits cell wall synthesis primary use = reserved for severe or resistant gram-positive infections, effective for MRSA infections, used to treat C. Diff adverse effects = ototoxicity, nephrotoxicity (NOT hepatotoxic), red man syndrome, confusion/hallucinations, anaphylaxis

Answer 6

when antibiotics are used, they destroy sensitive bacteria insensitive (mutated) bacteria remain -> free from competition from bacteria that were sensitive to the drug, the mutated bacteria thrives -> the pt now develops an infection that is resistant to conventional therapy -> this resistant bacteria can be transmitted to others

Answer 7

aka. antibiotic resistance organisms (ABO) -> carbapenem-resistant enterobacterioaceae (CBO/CBE) -> PCNs and cephalosporins are useless -> Methicillin-resistant staphylococcus-aureus (MRSA) -> will not respond to fluroquinolones, macrocodes, ahminoglycosides, or tetracyclines*** To-many-fucking-antibiotics -> Vancomycin-resistant entoerocci (VRE) -> vancomycin-resistant staphylococcus-aureus (VRSA or VISA)

Answer 8

when an organism is resistant to more than one drug = multi drug resistant - teach pt to take full course of abx, even when they feel better - do not save antibiotics or share with others - antibiotics don't treat viral infections - over prescribing has lead to ARO - C&S prior to treatment is preferable

Answer 9

may reduce resistance as you will know you are using the right abx and not potentially exposing the body to an abx that is not treating the correct bacteria -> leads to increased resistance C&S testing may take days or weeks for results and tests several abx for effectiveness

Answer 10

a secondary infections that occur when too many host flora are killed by an abx microorganisms multiply -> more food for bad bacteria S+S - diarrhea (pseudomembranous colitis or c. diff) - bladder pain and painful urination (e.coli/UTI) - abnormal vaginal discharge (yeast - Candida) - red rash with satellite lesions (yeast - candida) ex. thrush, c.diff

Answer 11

N/V/diarrhea

Answer 12

Calcium, iron for tetracyclines magnesium, aluminium

Answer 13

- inform pt about side effects -> skin, teeth, tendons, ears, kidneys - tell pts to take probiotics to counter antibiotic - teach pt to wear medic-alert bracelets if allergic - make sure pt knows S+S of allergic reaction

Answer 14

- not easily transmitted through casual contact -> they love dark, moist environments and lots of sugar -serious fungal infections are uncommon in people with healthy immune defences - immunocompromised pt. (DM, HIV, cancer) -> systemic fungal infections may be rapidly fatal and may experience frequent fungal infections and require aggressive pharmacotherapy - tx may require weeks to months of therapy due to resistance.

Answer 15

disease caused by a fungus infection two classifications -> superficial and subcutaneous (topical meds), and systemic (oral meds)

Answer 16

systemic anti fungal med for severe infections administered over 2-6 hours -> start a second IV because fluids have to run constantly while administering amphotericin SE = acute fever, chills, vomiting, anorexia, headache, phlebitis, potassium deficiency, electrolyte imbalance Serious adverse effects = cardiac arrest, ototoxicity, nephrotoxicity, hepatotoxicity, anaphylaxis, dysrhythmias, blood abnormalities. if given to quickly can lead to shock dont give if BUN over 40mg/dL or if serum creatinine over 3mg/dL -> kidney function

Answer 17

antifungals broad spectrums can be administered PO and have good safety profile systemic azoles have a similar spectrum to ampotericin B but less toxic and given PO SE = N/V/diarrhea be aware in pt with hepatic and renal impairment -> CYP monitor serum levels

Answer 18

anti fungal -> superficial type used for candida infections (thrush) of the vagina, skin, mouth, throat, and GI adverse effects -> minor skin irritation and burning (topical), contact dermatitis (topical), diarrhea/N/V (PO) contraindications -> hypersensitivity to the drug, pregnancy and lactation

Answer 19

drug interactions = unknown treatment of overdose = symptomatic considerations: - Hx and assessment -> observe for improvement and report persistent infections - avoid occlusive dressing or ointment on moist, dark areas of the body - teach pt to avoid sharing shoes, towels, or personal objects -> especially with candida

Answer 20

griseofulvin -> give PO only (ineffective topically) used to tx skin infections such as jock itch, athletes foot, and ringworm, and fungal infections of scalp, finger/toenails reserved for cases with hair, nail, or large body surface involvement side effects = photosensitivity, SJS, urticaria (rash), dizziness, decreased effecting of oral contraceptive pills, alcohol = disulifiram-like (Antabuse) reaction

Answer 21

- if the pt is not feeling well - if pt is back from an exam and didn't get breakfast - if pt is sweating or confused - if in doubt - watch for hypoglycemia with beta blockers -> they mask the S+S of hypoglycemia

Answer 22

rebound effect with hyperglycemia in the morning overdose of insulin leads to hypoglycemia due to long acting insulins or no snack before bed blood sugar drops while sleeping and the body releases hormones to counteract the drop results in hyperglycemia when waking up

Answer 23

hyperglycemia present in the morning hormones are released that trigger the liver to put out glucose in predawn hours -> not enough insulin in the body to counter regulate blood sugar rise growth hormone/ cortisol are possible factors

Answer 24

ex. lisper (Humalog), aspart (novorapid), glulisine (apidra) onset = < 15 min -> give 0-15 min before meal peak = 30 min to an hour -> best time to be eating duration = 3-4 hours.

Answer 25

ex. regular (humulin R or novolin R) Onset = 30 min to a hour -> give 30 min before a meal** peak = 2-3 hours duration = 8 hour regular insulin is the only one that can be given IV -> to treat DKA or HHNK ** used in gestational diabetes*

Answer 26

- irritation at injection site - lipodystrophy - weight gain serious adverse effect - hypoglycemia - rebound hyperglycemia - hypokalemia

Answer 27

- medicine hx -> herbs and dietary supplements, noting any meds that could alter the affects of insulin ex. - garlic, black cohosh, bitter melon, bilberry, ginseng, rosemary, cocoa, sulfonlureas, MAOIs, steroids, alcohol, salicylates, furosemide, ACE inhibitors, thiazide diuretics - assess alcohol intake and blood glucose levels - ensure pt has consumed or has food to eat to prevent a hypoglycaemic reaction -> caution when sending pt off to procedures - administer only regular insulin IV - assess pt knowledge of insulin therapy, diet, exercise, and how they impact serum glucose levels

Answer 28

- DO NOT administer when blood glucose levels are less than 4 mmol of if pt has signs of hypoglycemia - rotate injection sites weekly to prevent lipodystophy - check periodic hemoglobin A1C levels - assess pt for S+S of long-term diabetes complications -> eyes, heart, kidneys, feet

Answer 29

- be familiar with onset, peak, and duration of prescribed insulin* - be aware of important aspects of each specific insulin * - not all types of insulin are compatible -> some can't be mixed into a single syringe - when mixing insulins clear must always be drawn up first* - know signs and symptoms of hypoglycemia and hyperglycemia*

Answer 30

- monitor BG for hypo/hyperglycemia - check for S+S of illness or infection - watch liver function - assess for adherence to therapy and ability for self-care - sulfonylureas contraindicated in women who are pregnant or breast feeding, and in people with renal or liver disease - second generation sulfonylureas have fewer drug-drug interactions

Answer 31

an oral anti diabetic med - increase insulin release from pancreas - increased sensitivity to insulin receptors - decreased chance of prolonged hypoglycemia - 10% experience decreased effectiveness after prolonger use - most SE are minor and GI related ex. glipzide glyburide glimepiride

Answer 32

- sensitivity to sulpha drugs or thiazide diuretics -renal or hepatic disease - if used during pregnancy, discontinue at least 1 month before delivery

Answer 33

- alcohol - oral anticoagulants, MAOIs, probenecid, sulfonamides - chloramphenicol, salicylates, clofibrate - rifampin - thiazides/sulfonamide bades drugs - ginseng, garlic, black cohosh, juniper berries, fenugreek, coriander, dandelion root

Answer 34

- decrease glucose production by the liver - increase insulin sensitivity at tissues - improve glucose transport into cells - do not promote weight gain - usually first line treatment - 6-12 weeks to reach therapeutic effect - needs to be held 48 hours prior and 48 hours after a pt needs contrast dye to prevent lactic acid build up only drug is metformin

Answer 35

- impaired renal function* - heart failure, liver failure, history of lactic acidosis - concurrent serious infection - any condition that predisposes pt to hypoxeima - anemia, diarrhea, vomiting, dehydration, fever, gastroparesis, GI obstruction - hyperthyroidism*, pituitary insufficiency, trauma - pregnancy and lactation

Answer 36

periphery -> decreases blood flow to fingers, toes, penis, nose pupils pee

Answer 37

decrease BP, HR, NE release, causes vasoconstriction (less than alpha 1 receptors), decreases insulin secretion, and causes platelet aggregation

Answer 38

an umbrella term for beta and alpha receptors

Answer 39

lungs and uterus

Answer 40

catecholamines - adrenalin (epinephrine) - noradrenalin (norepinephrine) - dopamine

Answer 41

acetylcholine

Answer 42

"wet as an ocean" possible SE - slowed HR - decreased contractility - drop in BP - pupil constriction - increased digestion - bronchial constriction

Answer 43

- neurogenic bladder - urinary retention -BPH - glaucome - myasthenia graves - alzheimer's

Answer 44

"SLUDGE" salivation lacrimation (flow of tears) urinary incontinence diarrhea GI cramps emesis

Answer 45

used as an antidote for anticholinergic poisoning (atropine)

Answer 46

"dry as the desert" possible SE= dry mouth, decreased nasal mucous, urinary retention, increased HR, bronchial dilation, pupil dilation ex. atropine scopolamine benxotropine dicylomine anticholinergics are to be used cautiously with the geriatric population -> especially in males with BPH and urinary retention

Answer 47

anticholinergic reversal drug for cholinergic overdose

Answer 48

kick the bear nonselective adrenergic agonist = epinephrine alpha agonist = phenylephrine beta agonist = iosproterenol may act directly by binding to adrenergic receptors or indirectly by increasing the amount of norepinephrine at synapses classified as catecholamines or noncatecholamines

Answer 49

adrenergic agonists - short duration of action - destroyed rapidly by MAO and COMT (comt is an enzyme in the intestinal tract that degrades catecholamines like dopamine, epinephrine, and norepinephrine) - NO PO -> must be parenteral or inhalation due to COMT in the GI tract - does not cross BBB are bear drugs

Answer 50

adrenergic agonists - can be taken PO - not destroyed as rapidly as catecholamines - better able to enter brain and affect CNS

Answer 51

activate both alpha and beta receptors and are used to treat bronchospasm, cardiac arrest, and hypotension

Answer 52

generally prescribed fr nasal connection and hypotension may be used to dilate the pupil during eye exams

Answer 53

prescribed for treatment of hypertension and act through non-autonomic mechanisms

Answer 54

HEART critical care drugs -> epinephrine, NE, dopamine used for heart attack, heart failure, shock

Answer 55

lungs and uterus - used to treat asthma - reduce preterm labor contractions of uterus

Answer 56

works on adipose tissue, skeletal muscle, bladder, and gallbladder - regulation of lipolysis and thermogenesis - some anti-stress effects and use in overactive bladder

Answer 57

nonselective adrenergic agonist, catecholamine fight or flight response adverse effects - nervousness - tremors - tachycardia -dizziness - headache - stinging at site serious adverse effects - HTN - dysrhythmias - pulmonary edema -cardiac arrest

Answer 58

- assess for underlying problem or preexisting conditions - history and prognosis -> vital signs - closely monitor resp status - use cardiac monitor/resuscitation equipment - monitor BP closely - inform prescriber of changes in intake and output - monitor for hyperglycemia (stress response increase blood sugar) -> insulin gtt - examine ocular and nasal mucosa - protect from light -> extreme heat and cold will denature it - store api-pens in a dark place of pt is on epinephrine they must be on telemetry

Answer 59

ex. levophed -> nearly dead, life saving med does not activate beta3 receptors

Answer 60

an alpha 1 agonist is an antihypotensive and nasal decongestant contraindications - severe HTN - preexisting bradycardia - advanced CAD - nitroglycerin - narrow-angle glaucoma - hyperthyroidism - diabetes

Answer 61

alpha 1 agonist tx of overdose - phentolamine - anti-dysrhythmic drugs considerations - examine IV sites frequently - advise pt to remove contact lenses - dark eye protection after ophthalmic administration - avoid caffeine -> with all adrenergic agonists - contact HCP is palpitations or jittery/nervousness.

Answer 62

ex. Belladonna -> natural source of alkaloids with anticholinergic activity uses - GI disorders such as IBS - ophthalmic procedures - cardiac rhythm disorders - chemo induced diarrhea - adjuncts to anesthesia -> decrease secretions - asthma and COPD -> bronchodilation effects - antidotes for poisoning or overdose - urge incontinence (overactive bladder) -> watch with BPH - Parkinson disease helps with spasms -> after prostate or bladder surgery -> after chemo diarrhea, induces spasms

Answer 63

Beta 1 don't have to worry about asthmatics -> won't constrict airway

Answer 64

there is a relatively high incidence of adverse effects ex. atropine - urinary retention - xerostomia (dry mouth) - tachycardia - CNS stimulation - dry eyes - photophobia - urinary retention in BPH

Answer 65

aka overdose - dry mouth, difficulty swallowing - visual changes, blurred vision, photophobia - agitation and hallucinations antidote is physostigmine -> generally only administered to pt showing severe symptoms

Answer 66

works at motor end plate of muscle -> causes release of Ach to travel to receptors on skeletal muscle = muscle contraction continuous depolarized state in which calcium does not return to its storage depots = sustained muscle contraction and then flaccid muscle and paralyzes pt necessary for certain surgical procedures depolarizing = succinylcholine (watch for contraction to signal success, restlessness indicates no success)(used during short medical-surgical procedures) non depolarizing = tubocararine (lasts longer, used during longer surgical procedures)

Answer 67

paralysis preceded by contraction is fast acting and pt will recover quickly muscles will be sore -> like clenching a muscle for a long time

Answer 68

- surgical anesthesia - pseudocholinesterase - relaxes abdominal muscles or for relaxation prior to intubation - induces relaxation in less than 1 minute - muscle strength returns quickly discontinuation of the drug - pt can still feel pain and is aware of their surroundings -> use benzes and opioids

Answer 69

- complete paralysis of diaphragm/intercostal muscles -> watch for respiratory paralysis - tachycardia - hypotension - urinary retention serious adverse effects - malignant hyperthermia -> muscles rigid, skin hot - respiratory depression - apnea - dysrhythmias black box warning - children with congenital musculoskeletal diseases at greater risk for cardiac arrest - no way to predict which pt at risk

Answer 70

nicotinic antagonist non depolarizing neuromuscular blockers (NDNBs) tubocurarine is the prototype -> 9 others in the class used to relax skeletal muscles during surgical procedures -> causes flaccid paralysis does not cause sedation, analgesia, or loss of consciousness -> must use benzos, propofol, and opioids

Answer 71

alpha receptors are located on smooth muscle of the heart, GI and GU systems, and the brain blocking of alpha receptors dilates blood vessels -> decreased BP decrease peripheral resistance and decreases preload

Answer 72

when SNS is blocked the PNS predominates -> causes hypotension, orthostatic hypotension due to decreased blood flow to the brain and may cause syncope prevention by initial therapy given at low doses and usually given at bedtime reflex tachycardia and nasal congestion also occur

Answer 73

ex. phentolamine and phenoxybenzamine activate alpha 1 and alpha 2 receptors high incidence of side effects like hypotension (and compensatory tachycardia), N/V/diarrhea, increased urination, and erectile disfunction

Answer 74

greater treatment of HTN, but never first line option selective alpha1 blockers work on arterioles and veins ex. - doxazosin - prazosin -terazosin

Answer 75

- block peripheral catecholamines - work on arterioles -> block vasoconstriction on vascular smooth muscle (after load) which lowers BP directly - works on veins -> block vasoconstriction which decreased venous return (preload) to hear and lowers BP indirectly - alpha blockers can be used concurrently with other drugs like diuretics to decrease BP relax smooth muscle of bladder (detrusor) and prostate -> increases urine flow alpha blocker = severe HTN

Answer 76

- benign prostatic hyperplasia -> two selective agent used in BPH - alfuzosin and tamsulosin alpha1 blockers don't cure the condition -> surgery needed - pheochromocytoma (small tumour of adrenal medulla -> causing irregular secretion of epi and NE) -> excessive secretion of catecholamine causes severe HTN - HTN -> alpha1 blockers are used to treat severe HTN - Raynauds disease

Answer 77

selective: - block only beta1 receptors - cardio selective - fewer non cardiac side effects - little effect on bronchial smooth muscle - can safely be given to clients with asthma and COPD nonselective: - block beta1 and beta2 receptors - produce more side effects than selective beta 1 antagonists - serious side effect is bronchoconstriction -> caution in pt with COPD and asthma

Answer 78

- most therapeutic actions relate to the CV system - slow conduction velocity through AV node -> decreased HR (chronotropic) and decreased force of contractions (inotropic) - during stress/exercise prevents normal sympathetic stimulation to heart - caution when administering CCBs concurrently as may potentiate heart failure

Answer 79

- prevents hyperglycaemic effect of catecholamines -> dangerous in pt with DM - cause hypoglycemia and can masks S+S of it - beta blockers decrease amount of free fatty acids available during metabolic stress - bronchoconstriction -> cannot be used in pt with COPD, asthma - rebound cardiac excitation may occur if beta blockers are withdrawn abruptly -> educate pt to never stop without talking to HCP first

Answer 80

non-selective beta blocker used for - HTN - angina pectoris - dysrhythmias - migrane prophylaxis - MI prophylaxis side effects - N/V/D - CNS - bradycardia contraindications - bradycardia - hypotension - 2nd and 3rd degree heart block - HF - COPD/asthma - diabetes - reduced renal output - cardiogenic shock

Answer 81

- monitor VS q15min - q1hr - hx and prognosis -> assess for asthma and COPD - review lab tests for kidney, liver, hematologic, and cardiac function - watch for ADRs in older adults and in pt with impaired renal fuction - monitors I/O and take daily weights -> especially in HF - educate regarding decreasing salt intake and not to stop drug suddenly - examine pt for impaired circulation -> IRR, SOB, BLE edema - caution when giving CCBs concurrently may potentiate HF - watch for widening QRS segment -> immediate nursing attention

Answer 82

- olol - carvedilol -> black sheep last name - labetalol -> black sheep last name - nadolol - pendutolo - pindolol -sotalol -> watch for widening QRS complex - timolol

Answer 83

selective beta1 blocker treats HTN side effects - N/V - dizziness - fatigue - insomnia - bradycardia - dyspnea

Answer 84

- monitor BP and HR frequently during IV administration - have baseline ECG and repeat if telemetry changes or chest pain - monitor for symptoms of impending HF - record I&O, daily weights, bilateral breath sounds - take radial pulse -> don't administer if HR <60bpm or is SBP <100 (watch for hypotension) - do not omit, increase or decrease dose -> you can hold but let HCP know if you are - avoid late evening doses - watch for symptoms of depression - watch for masked hyperthyroidism - report visual problems, cold painful tender feet or hands - caution with DM pt - discontinue drug slowly due to potential rebound effect - dont breast feed without consulting provider.

Answer 85

Beta blockers that exhibit mixed beta-antagonist and beta-agonist activity, characterizes a group of beta blockers that are able to stimulate beta-adrenergic receptors (agonist effect) and to oppose the stimulating effects of catecholamines (antagonist effect) in a competitive way

Answer 86

prevents contraction of peripheral arterioles -> vasodilation and fall in BP after load reduced -> lower myocardial oxygen demand and less workload for heart dilation of coronary arteries -> more blood flow to heart CCBs stop influx of CA into vascular smooth muscle.

Answer 87

myocardium effects - reduces force of myocardial contractions (negative inotropic effect) - reduces inwards movement of calcium during plateau phase of action potential cardiac conduction effects - negative chronotropic effect - SA node generates fever action potentials - slows automaticity - decreases HR

Answer 88

are selective for vascular smooth muscle and are used to treat HTN and angina pectoris - dipine

Answer 89

dihydropyridine CCB selectively blocks Ca channels in vascular smooth muscle decreases amount of Ca available for muscle contraction

Answer 90

drug interactions - may interact with drugs that induce or inhibit CYP3A4 (liver) - additive effects with other antihypertensive drugs - increased risk of congestive heart failure with beta blockers - increased serum levels of dioxin -> bradycardia - syncope/drop in BP with alcohol overdose tx - rapid-acting vasopressor such as dopamine or dobutamine - calcium infusions

Answer 91

act on both vascular smooth muscle and the myocardium treat HTN and coronary artery disease

Answer 92

nondihydropyridine CCB antidysrhythmic, antihypertensive, chronic angina

Answer 93

increases digoxin levels = increased risk of bradycardia additive hypotension or bradycardia with other hypertensive drugs 3x plasma concentration of bus-irons risk of myopathy increases significantly with statins verapamil increases carbamazepine (tegretol) levels = neurotoxicity (ataxia) -> increase tegretol levels when D/C verapamil grapefruit juice may increase levels -> don't take it wit any CCB

Answer 94

- monitor BP before administration of drug and 30 min to 1 jour after and just prior to next dose - withhold drug if systolic BP <90 or symptomatic - monitor for edema - keep pt recumbent for at least 1hr after administration - monitor for heart block or bradycardia with digoxin use - monitor I/O - monitor on telemetry continuously if giving it IV

Answer 95

diltaiazem - tx of partial dysrhythmias and HTN, stable and vasospastic angina - same profile as verapamil - migraine prophylaxis off-label

Answer 96

the stomach secretes acid, enzymes, and hormone that are essential to digestive physiology natural defences include - Somatostatin (inhibits gastric secretion) - Prostaglandin E2 - bicarb ion - mucus prostaglandin antagonists include - NSAIDs/ASA (damages GI mucosa directly) - corticosteroids

Answer 97

peptic ulcer disease

Answer 98

peptic ulcer risk factors - infection with helicobacter pylori - close family history of PUD - drugs -> glucocorticoids, NSAIDs, and platelet inhibitors - blood group O - smoking tobacco - excessive caffeine - psychological stress -> for a long time though to be primary cause of PUD

Answer 99

- long-term use - advanced age - history of ulcers - corticosteroids -> predispose people to peptic ulcers, increased risk of perforation - anticoagulants - alcohol and smoking

Answer 100

end in -prazole block gastric acid secretion of H+, K+, and ATPase and are the drugs of choice in the therapy of PUD and GERD activated by food intake -> take 20-30 mins before first major meal of the day don't effect pH levels, just amount of acid in the stomach

Answer 101

H2- receptor antagonists - Ranitidine - cimetidine -> causes the most issues in this family, interacts with a lot of different meds - famotidine - nizatidine ends in -tidine suppresses gastric acid secretion impacts pH levels.

Answer 102

- rapid absorption from small intestine - 30min onset - half life 1-4 hours - no known effects on the fetus - excreted primarily from kidneys

Answer 103

alkaline substance that neutralize stomach acid to treat symptoms of heartburn

Answer 104

- CONSTIPATION - at high doses, aluminum products bind with phosphate in GI tract -> long term use can result in phosphate depletion - high risk = malnourished people, alcoholics, renal disease exam question: - constipation due to meds can lead to obstruction - be very careful with pt who are constipated - if obstructed stop med - firm, distended, tender, with N/V = obstruction - only thing getting past an obstruction is watery poop we want SNT no D

Answer 105

- prolonged use with low serum phosphate - avoid with suspected bowel obstruction

Answer 106

- don't take with other meds -> interferes with absorption - decreased absorption of cimetidine, fluoroquinolones, digoxin, isoniazid, chloroquine, NSAIDs, iron salts, phenytoin, tetracyclines, and thyroxine - anticholinergic drugs increase effects of antacids - aluminum and calcium antacids may inhibit absorption of dietary iron

Answer 107

- past medical history - watch kidney lab values - monitor for bowel changes and worsening symptoms - hold drug and notify MRP if pt has symptoms of appendicitis, undiagnosed GI bleeding, or a suspected obstruction

Answer 108

- anticholinergic agents (scopolamine) and antihistamines (dimenhyrdrinate/diphenhydramine) are used for simple nausea, like nausea due to motion sickness - serotonin receptor antagonists (zofran) are for chemotherapy-induced nausea and vomiting which is the primary indication for the use of antiemetic meds exam question: serotonin triggers nausea by being released into the gut faster than it can be digested -> antiemetic target serotonin receptors to reduce nausea scopolamine is used for sea sickness, little white patch behind ears can give metoclopramide, gravel, and ondansetron at the same time

Answer 109

antiemetic serotonin receptor antagonist treats serious N/V, used at least 30min prior to chemotherapy and continued for several days after off label use for cholestatic of opioid-induced pruritus blocks serotonin receptors int he chemoreceptor trigger zone

Answer 110

laxative -> bulk forming = Metamucil and surfactant type = docusate sodium - promote defecation - prevents and treats constipation saline cathartic -> pulls water into stools (sennosides) - implies accelerated, stronger, and more complete bowel emptying through osmosis

Answer 111

- treats simple, chronic constipation - accelerate removal of ingested toxic substance - accelerate removal of dead parasites - cleanse the bowel prior to diagnostic or surgical procedures - avoid increased colon pressure - possible bowel perforation - monitor for retrosternal pain exam question: retrosternal pain with bulk-forming laxatives

Answer 112

bulk forming laxative - know past medical history - assess bowel movements and GI functioning - mid powder and granules with at LEAST 8 OUNCES of a pleasant tasting liquid immediately before and drink lots of water** - immediately report complaints of retrosternal pain after taking drug to prescriber*** - smaller more frequent doses spaces through the day may be indicated to relieve discomfort - monitor warfarin and digoxin levels closely

Answer 113

antidiarrheal it is a opioid acts on smooth muscle cells of the intestine to slow peristalsis adverse effects*** - dizziness - lethargy, drowsiness -> may also cause dizziness - anticholinergic effects of atropine -> anti pig, drys up poop, causes heart palpitations

Answer 114

- know past medical history and symptoms - perform complete assessment of bowel movements and GI functioning -> monitor frequency and consistency of stools - report abd distention and signs of decreased peristalsis to provider - monitor S+S of dehydration especially in young kids - maintain safe environment because it may cause drowsiness or dizziness

Answer 115

IBD is treated with 5-ASA agents, immunosuppressants, biologic therapies, and anti-inflammatory drugs goals - reduce symptoms - keep in remission -> immunosuppressive agents - alter progression of the disease

Answer 116

agent for IBD be aware of sulpha allergies -> sulfonamide is the basis of several drug groups - sulfonylureas - sulfonamide abx - loop and thiazide diuretics.

Answer 117

* Patients with sulfonamide or salicylate hypersensitivity * Patients with urinary obstruction * May worsen blood dyscrasias * Hepatic impairment * Dehydration * Diabetes or hypoglycemia

Answer 118

- triglycerides -> neutral fats, most common, major storage form of fat in body - phospholipids -> essential to building plasma membranes - sterols -> aka. cholesterol, best known, promotes atherosclerosis

Answer 119

are important predictors of CV disease HDL (high density lipoprotein) - contains most apoprotein LDL (low density lipoprotein) - contains most cholesterol HDL is better than LDL VLDL (very low density lipoprotein) - primary carrier of triglycerides in blood

Answer 120

high levels of lipids in blood long term consequences of being unaware of hyperlipidemia is cardiovascular disease

Answer 121

elevated blood cholesterol cholesterol is made in the liver

Answer 122

abnormal levels if lipoproteins

Answer 123

increase in triglyceride levels patients are often asymptomatic until progression to chest pain or HTN

Answer 124

- maintain a healthy weight - exercise -> 30min 3-5 days a week - monitor blood lipid levels regularly - dietary modification - minimize alcohol -> especially beer

Answer 125

- most effective at reducing blood lipid levels - are the recommended first line therapy - can reduce LDL levels by 20 to 40% - can raise HDL levels - can lower triglyceride and VLDL levels work by interfering with the HMG-CoA reductase, an enzyme involved with the biosynthesis of cholesterol

Answer 126

administering statins to pts with no history of CVD

Answer 127

slowing progression and reducing mortality in pts with history of CVD

Answer 128

are very hard on the liver - test liver function before starting med, 6 weeks after and then every 3 to 6 months all are given orally and tolerated well by most no grapefruit juice (>1L) stop if myopathies (muscle disease) occur ARE ALL PREGNANCY CATEGORY X

Answer 129

rhabdomyolysis - the breakdown of muscle fibres - rare but serious adverse effect of statins when muscles begin to breakdown, the larger muscle cells enter the blood stream and can wreck the kidneys when they filter the blood -> in bad cases patients may need to go on dialysis or get a kidney transplant

Answer 130

antihyperlipidemic HMG-CoA reductase inhibitor -> liver makes less cholesterol and responds by making more LDL receptors to remove cholesterol from blood

Answer 131

- headache - GI cramping - diarrhea - constipation - rhabdomyolysis contraindications - pregnancy - lactation - caution in hepatic impairment

Answer 132

- may increase digoxin levels (slow HR) - may increase levels of oral contraceptive pills - increase erythromycin levels

Answer 133

- obtain baseline lipid values - monitor LDL cholesterol levels - assess lipid lab tests within 2-4 weeks of initiation of therapy or change in dose - assess for signs of rhabdomyolysis or myopathies (will look like generalized muscles pain/aches all over) - observe for digoxin toxicity - watch for hepatotoxicity -> teach pts about S+S of liver failure: jaundice, RUQ pain, changes in stools, and distention, bleeding/bruising - no grapefruit juice - NO ALCOHOL (think liver)

Answer 134

are often combined with statins to reduce LDL cholesterol levels tend to cause more frequent adverse effects in the GI tract can produce 20% drop in LDL levels

Answer 135

antihyperlipidemic bile acid sequestrant binds to bile acids and forms insoluble complex containing cholesterol that is excreted in feces -> also lowers LDL levels by increasing LDL receptors on hepatocytes

Answer 136

- constipation -> increase fibre intake to prevent - bloating - belching - nausea - obstruction of GI tract - hyperchloremic acidosis - malabsorption syndrome

Answer 137

reduces effect of digoxin, penicillins, iron, thyroid med, and thiazide diuretics increases effects of warfarin because less vitamins K is absorbed

Answer 138

- completely dissolve powder before administration - increase fluid intake - assess for early signs of hypoprothrombinemia (risk of bleeding) - monitor lab tests for therapeutic effectiveness - consult prescriber to see if supplemental vitamins A,D and folic acid are required in long-term care

Answer 139

can reduce triglycerides and LDL cholesterol levels, but adverse effects limit its usefulness is a B- complex vitamin (B3) produces more adverse effects than statins causes additive effects with other drugs decreases the production of VLDL

Answer 140

lower triglyceride levels but have little effect on LDL cholesterol -> used to treat severe hypertriglyceridemia include: - fenofibrate - fenofibric acid - gemfibrozil

Answer 141

antihyperlipidemic fibric acid agent second line therapy after statins inhibits breakdown of stored fat

Answer 142

- abdominal cramping - diarrhea - nausea - dyspepsia (indigestion) - headache - dizziness - peripheral neuropathy - diminished libido - cholelithiasis (gall stones) - anemia - eosinophilia (increase in eosinophils) - bleeding contraindications - gallbladder disease - serious liver impairment - renal impairment

Answer 143

- increased risk of myositis and rhabdomyolysis with use of statins - increased risk of bleeding with anticoagulants - enhanced hypoglycaemic effects with anti diabetic agents

Answer 144

- monitor lab tests - consult provider if inadequate response after 3 months - educate pt that drug will cause bloating and gas - watch for bleeding

Answer 145

antihyperlipidemic only drug in its class blocks absorption of cholesterol in intestinal lumen -> body responds by making more cholesterol statin must be administered concurrently

Answer 146

goal of the RAAS system is to increase blood pressure and blood volume BP drops -> SNS kicks in -> stimulates kidneys juxtaglomerular cells to release renin -> renin activates angiotensiongen within the liver to form angiotensin I-> ACE (angiotensin converting enzyme) that is found in the lungs and kidneys converts angiotensin I to angiotensin II -> angiotensin II causes vasoconstriction, increased sodium reabsorption, stimulates the leases of ADH and aldosterone

Answer 147

they are the first line agents in treatment of HTN and HF they block the conversion of angiotensin I to angiotensin II -> because this occurs in the lung, there is potential for pt to develop a cough decreases in BP and pulse rate decreases release of aldosterone which reduces blood volume they also inhibit the break down of bradykinin (it is similar to histamine) -> accumulation of bradykinin causes several of the adverse effects of ACE inhibitors are heart and kidney protective -> good to give to pts with HF and DM

Answer 148

- slow progression of heart failure - lower mortality of recent acute MI - prophylaxis for adverse cardiac events - prevent or delay progression of renal disease and retinopathy of diabetics (can also increase the body's sensitivity to insulin, sometime used off-label to prevent new-onset type 2 diabetes)

Answer 149

there is a low incidence of serious adverse effects contraindicated with: - hypotension - renal failure - hyperkalemia -> caution when using ACEI with K+ sparing diuretics -> watch K+ levels (do lab work regularly) angioedema is the most serious -> rapid swelling of throat, face, larynx, tongue can lead to airway obstruction all carry black box warning regarding risk for major congenital defects.

Answer 150

antihypertensive ACE inhibitor therapeutic effects - heart failure - HTN - acute MI MOA - bings to and inhibits action of ACE - decrease in serum angiotensin II reduces aldosterone, which results in less sodium and water retention

Answer 151

- cough - headache - dizziness - orthostatic hypotension serious: - angioedema - agranulocytosis - hepatotoxicity

Answer 152

- pregnancy category D - angioedema - hyperkalemia - serious renal impairment

Answer 153

- check renal labs and K+ levels for hyperkalemia - monitor BP before administration and 30 mins to 1 hour after

Answer 154

decreased antihypertensive activity and worsened renal disease with use of NSAIDs synergistic hypotensive action with diuretics and other hypotensive hyperkalemia with potassium supplements and potassium sparing diuretics pregnancy category C (first semester) Pregnancy category D (second and third trimesters)

Answer 155

normal saline or vasopressor hemodialysis

Answer 156

are used to treat HTN and heart failure block angiotensin II from activating their target receptors in smooth muscle -> causing vasodilation, reduce pulse rate, and decrease BP they also prevent aldosterone secretion and promote the excretion of Na+ and water by the kidneys

Answer 157

same as ACEI - treat HTN and HF - some are approved to treat MI and prophylaxis of CVA do not cause cough and angioedema is less common

Answer 158

antihypertensive ARB therapeutic effects and uses: - HTN - CVA prophylaxis - Prevention of diabetic nephropathy - off label use for heart failure MOA: - selectively blocks angiotensin AT1 receptors, resulting in decreased BP - blockade prevents cardiac remodelling and deterioration of renal function in pts with diabetes

Answer 159

normal saline or vasopressor the drug is not removed by hemodialysis

Answer 160

decreased antihypertensive activity with NSAIDs additive hypotensive actions with diuretics and other hypotensive hyperkalemia with potassium supplements and potassium-sparing diuretics additive hypotensive effect with alcohol

Answer 161

monitor for hypotension monitor electrolytes, CBC, liver and renal function during therapy

Answer 162

works on the kidneys and promotes the reabsorption of water and excretion of potassium will increase BP

Answer 163

used to treat edema and HTN spironolactone -> K+ sparing diuretic and eplerenone

Answer 164

treats HF and CV disease a combination of and ARB and a neprilysin inhibitor neprilysin inhibitor increases vasodilatory peptides, which helps the body get rid of more sodium and open blood vessels wider pregnant or breastfeeding people should not take ARNIs ex. sacubitril/valsartan

Answer 165

HR less than 60 BPM major indication for pacemakers common bradydysrhythmias - sinus bradycardia - sinoartrial node dysfunction - atrioventricular conduction block

Answer 166

HR over 100 BPM common ones - atrial tachycardia - atrial flutter - afib - ventricular tachycardia - ventricular fibrillation

Answer 167

sodium channel blockers act by blocking ion channels in myocardial cells

Answer 168

quinidine disopyramide procainamide

Answer 169

lidocaine mexiletine phenytoin

Answer 170

flecainide propafenone

Answer 171

beta blockers

Answer 172

Potassium channel blockers ex. amiodoarone

Answer 173

calcium channel blockers

Answer 174

location of failure: left sided failure = pulmonary edema right sided failure = peripheral edema type of failure: systolic failure = decreased contractility, decreased ejection fraction diastolic failure = decreased ventricular filling, normal ejection fraction

Answer 175

be concerned about clots because the blood will pool and clot in the atria when giving a med that fixes the quiver in the atria, the blood with clots will go out into the body -> could cause DVT, stroke, MI

Answer 176

- ensure the pt monitor for dependent bilateral lower extremity (BLE) edema -> both legs have to have edema for it to be HF - watch for worsening SOB or new onset SOB - evaluate the number of pillows needed to sleep at night or if the are sleeping in a recliner - weigh themselves every day -> same time, scale, clothes: call HCP if 2lb weight gain in 1 day (textbook) , or 5lbs in 2-3 days (reality)

Answer 177

- reduce preload - reduce systemic vascular resistance (after load reduction) - inhibition of RAAS and vasoconstrictor mechanisms of sympathetic nervous system

Answer 178

ACE inhibitors are becoming more common as first line treatment for HF instead of cardiac glycosides (digoxin) policies are changing

Answer 179

- used in treating HF before ACE inhibitors -> less common now, policies are changing - increased contractility -> improves symptoms, but does not improve mortality - stabilize cardiac conduction abnormalities -> water for other antiarrhythmics **** (test question) - digitalization -> dose gradually increases until tissues become saturated with medications and symptoms of HF diminish

Answer 180

can dramatically reduce hospitalizations and increase the survival of pts with heart failure

Answer 181

drug for hear failure cardiac glycoside, positive inotropic (strength of contraction) agent indications = heart failure

Answer 182

- general malaise - dizziness - headache - N/V - anorexia - visual disturbances -> blurred or yellow vision or green halos serious AE - ventricular dysrhythmias - AV block - atrial dysrhythmias - sinus bradycardia

Answer 183

can cause hyperkalemia with -> ACEI, spironolactone, potassium supplements

Answer 184

mechanism - relax venous muscle -> reduces preload = less work for the heart - relax arterial muscle -> increases blood flow to myocardium adverse effects = hypotension, headache, tolerance nitric oxide is a cell-signalling molecule and potent vasodilator short acting = to stop angina attack long acting = prevent angina attacks ex. nitroglycerin

Answer 185

works at vascular smooth muscle, forms nitric oxide, which trigger a cascade resulting in release of calcium ions relaxes both arterial and venous smooth muscle = less cardiac return (less preload) dilates coronary arteries = increases O2 to the myocardium

Answer 186

NO VIAGRA with nitrates -> life threatening hypotension and CV collapse additive hypotension with - antihypertensives - ethanol - CCBs - antidepressants - phenothiazines sympathomimetics antagonize action

Answer 187

beta-adrenergic blockers - reduce myocardial demand -> decreases HR (negative chronotropic effect), decreases contractility (negative inotropic effect), decreases BP, counter effects of sympathetic stimulation - reduces conduction -> prevents dysrhythmias - therapy usually continued for rest of pts life

Answer 188

ACE inhibitors - given within 24 hours of onset MI - prevents cardiac remodelling - suppress dysrhythmias - therapy usually continued for rest of pts life - watch K+ levels and for angioedema - check lab work for K+ and renal function

Answer 189

160 to 325 mg initially and then 81 mg daily lower dose causes less GI bleeding

Answer 190

- dissolve active clots - only for use in early MI -> best within 30 mins, no benefit after 24 hours - severe risk of bleeding ex. alteplase (Activase)

Answer 191

choice of anti epileptic drug therapy is dependent on seizure type and characteristics, as well as - medical history - results of EEG and other tests - comorbidity conditions never stop taking medication even if feeling "better" without guidance of HCP, may cause WITHDRAWAL seizures

Answer 192

- control seizures by acting in limbic, thalamic, and hypothalamic regions of the CNS - there are limited applications -> used for seizures when other drugs are proven ineffective - when administering by IV, resuscitation equipment should be readily available -> monitor pt closely for CV collapse and resp depression

Answer 193

- educate pt on S+S of resp depression and CV collapse - assess for decrease in seizure activity - maintain pt safety pre and post seizures -> watch for triggers - assess for history of smoking -> may require larger doses - assess for urinary retention - do not mix with other drugs parenterally

Answer 194

are effective in the management of most types of seizures but have many adverse effects

Answer 195

anti epileptic drug - shake suspension well prior to administration - watch for extravasation with IV route - beck blood levels regularly (like with lithium and digoxin) - monitor CBC (for blood dyscrasia) - watch for near changes and side effects - monitor blood glucose in diabetics - assess folic acid deficiency

Answer 196

anti epileptic drug - hypersensitivity - increased ocular pressure (visual disturbances) - lupus - cardiac/hepatic disease - HTN - older adults - pregnancy category D

Answer 197

- do not administer within 14 days of MAOI - watch lab results - assess for CNS ADRS - assess for GI distress - assess VS and I/O

Answer 198

anti epileptic drug gaba agonist additive sedation with CNS depressants and alcohol more rapid metabolism with enzyme inducing anti epileptic drugs increased serum levels of TCAS (tricyclic antidepressants) increased serum levels of aspirin, isoniazid, and cimetidine -> watch for bleeding decreased absorption with cholestyramine

Answer 199

- monitor seizure activity and check serum levels - obtain baseline platelet counts and check PT/PTT/INR regularly during therapy - monitor for signs of hyperammonemia and bleedings - watch liver lab work

Answer 200

heart - hypertrophy - MI - HF -> watch for rapid wt gain (5lbs/ 2-3 days), SOB, BLE edema eyes - blindness -> frequent eye checks brain - stroke -> assess for speech changes, dropping face, one sided weakness kidneys - kidney failure -> watch for protein in the urine (micro and macro albuminuria)

Answer 201

thiazide diuretic is first line treatment option for HTN multi-drug therapy is often required diuretics decrease blood volume and pressure

Answer 202

- dehydration - hyponatremia - hypokalemia (less with potassium-sparing diuretics) - nocturia (if taken too late in the day) - orthostatic hypotension

Answer 203

thiazide and thiazide-like diuretics - most common diuretic for HTN - ex. hydrochlorothiazide potassium-sparing diuretics - triamterene, spironolactone loop (high-ceiling) diuretics - usually not used for HTN - furosemide, bumetanide = K+

Answer 204

causes vasodilation by reducing angiotensin II - decreases aldosterone effects -> increases effectiveness of diuretics - protects the kidneys - ex. enalapril, lisinopril, captopril

Answer 205

- persistent cough - postural hypotension - hyperkalemia - angioedema

Answer 206

inhibit effects of angiotensin II has similar effect to ACEI has fewer adverse effects - hypotension - angioedema -> rarer than with ACEI - more expensive - no cough ex. losartan

Answer 207

aka beta blockers nonspecific beta blockers also causes bronchoconstriction -> use with caution for pt with asthma or heart failure beta -blocker therapy - at low doses adverse effects are uncommon - at higher doses, adverse effect include: - fatigue, activity intolerance - erectile dysfunction - masks symptoms of hypoglycemia - clinical depression

Answer 208

relax arterial smooth muscle directly = decreased resistance and decreased after load -> some drugs also affect veins such as isosorbide denigrate (long acting nitrate) = also decreased preload ex. hydralazine, diazoxide, nitroprusside

Answer 209

- reflex tachycardia (HR increases in response to low BP ), and hypotension - fluid retention -> can be minimized with beta blockers and diuretics

Answer 210

antihypertensive direct vasodilator therapeutic use - moderate to severe HTN - hypertensive emergencies - acute heart failure MOA - causes peripheral vasodilation - decreased vascular resistance, heart rate, cardiac output - decreased after load - is selective for arterioles *

Answer 211

- past medical history - monitor lab tests for antinuclear antibody titer before and during therapy - monitor I & O - watch for adverse effects -> HA, tachycardia, palpitation, N/V/D, orthostatic hypotension - assess for rapid drop in BP and subsequent tachycardia (reflex tachycardia)

Answer 212

use in hypertensive emergencies a direct vasodilator

Answer 213

aka. fibrinolytics -> alteplase (tPa), tenecteplase (TNK-tPa) dissolve bonds that hold existing thrombi together clot busters -> are only used for life-threatening illnesses

Answer 214

amniocaproic acid and tranexamic acid inhibit the activation of plasminogen to plasmin (destroys clots) , prevent the break up of fibrin and maintain clot stability used to prevent excessive bleeding used to stabilize post surgical bleeds

Answer 215

parenteral - heparin - LMWH - fondaparinuxn (chemically related to LMWH) - direct thrombin inhibitors oral - warfarin - dabigatran do not actually breakdown existing clots -> prevent enlargement and formation of new ones

Answer 216

- baseline blood tests - monitor aPTT(tests how long it take for blood to clot) every 6 hours when adjusting dose (follow PPOs) - monitor for signs of bleeding - apply firm pressure for 5 mins venous and 10 mins for arterial needle sticks - reduce risk of trauma - keep heparin antidote readily available (protamine sulphate)

Answer 217

- no razors, wax or use electric razor instead - soft bristled toothbrush - no high impact activities - if bleeding for longer than 30 min, go to hospital - if GIB bleed (coffee ground emesis or melena) go to hospital

Answer 218

stop use 24hrs pre and post surgery

Answer 219

- assess for risk of thromboemboli - monitor PT/INR - monitor urine, stool, liver function, and blood - monitor risk groups for non adherence - teach pt to avoid or eat sparingly food rich in vitamin K, such as broccoli, leafy greens

Answer 220

- provide education for anticoagulants - monitor for signs of bleeding - apply firm pressure for 5 min venous and 10 mins for arterial needle sticks - reduce risk of trauma

Answer 221

anticoagulant indirect thrombin inhibitor therapeutic effects - acute thromboembolic disorders - DVT/PE - unstable angina/evolving MI - prophylaxis MOA - activates antithrombin III, which inhibits thrombin and to lesser extent factor Xa -> prevent the formation of clots

Answer 222

- baseline blood tests - monitor aPTT every 6hrs when adjusting dose - monitor for signs of bleeding - apply firm pressure 5 min for venous and 10 mins for arterial needle sticks - reduce risk of trauma - keep heparin antidote readily available (protamine sulfate)

Answer 223

"aka P2Y12 inhibitors irreversibly inhibit platelet ADP receptors (for platelets life -> 8 days) -> inhibit aggregation (decreases body's ability to clot) -> makes the blood less "sticky

Answer 224

bleeding neutropenia/agranulocytosis thrombotic thrombocytopenia purpura(blood clots form in small blood vessels throughout the body, leading to low platelet counts, red blood cell destruction, and potential organ dysfunction)

Answer 225

anti platelet agent ADP receptor blocker therapeutic effects - reduce risk of CVA/MI - reducing thrombolytic events post CVA/MI - prevent DVT - prevent thrombi formation in unstable angina/coronary stents MOA - inhibits ADP receptors on platelets and prolongs bleeding time by irreversibly inhibiting platelet aggregation -CYP450 interaction (liver)

Answer 226

risk of bleeding with thrombolytics may outweigh benefits -> watch for S+S of hemorrhagic stroke (LOC) streptokinase (SK)/ urokinase (UK) - older, slower, more side effects, cheap, and allergenic - treat PE, MI, DVT tenecteplase (TNK-tPa), alteplase (tPa) - are newer drugs with fewer side effects

Answer 227

aka hemostatics administered via IV stabilizes clots, prevents digestion of fibrin clot by plasmin

Answer 228

- aplastic anemia - hepatic cirrhosis - postoperative cardiac surgery - certain carcinomas - hemophilia A (blod clotting disorder) - excessive post surgical bleeds

Answer 229

agent for anemia iron supplement

Answer 230

- N/V - brown stains on teeth from liquid - darkened stools - constipation

Answer 231

hemochromatosis PUD regional enteritis ulcerative colitis

Answer 232

- assess vital signs for cellular hypoxia - give on a empty stomach if possible - if difficulty swallowing tablets or capsules, recommended a liquid formulation or a less corrosive form, such ferrous gluconate - prevent staining of teeth -> rinse with H2O - monitor bowel movements - continue iron therapy for 2-3 months after normal Hgb - mix feosol elixir with water

Answer 233

- don't take tablets or capsules within 1 hour of bedtime - do not crush tablets of empty contents of capsule - take ferrous sulfate with a full glass of water - rinse mouth with clear water immediately after ingestion - consume citrus fruit or tomato juice with preparations (except the elixir form) - avoid taking drug with milk, eggs, antacids, or caffeine - dark green or black stools are a harmless side effect - report constipation or diarrhea

Answer 234

agent for anemia vitamin supplement used for vitamin B12 deficiency anemia

Answer 235

- rashes, itching, or other signs of allergy serious AE - sodium retention with possible worsening of HF - anaphylaxis - hypokalemia and potential dysrhythmias

Answer 236

decreased absorption with - ethanol/alcohol - amino salicylic acid (ASA) - omeprazole - neomycin - chloramphenicol

Answer 237

alternates between extreme feelings of sadness and extreme mania significantly impacts social and occupational functioning nonpharmacologic interventions -> support groups, ECT -> triggers include lack of sleep, excessive stress, poor nutrition pharmacologic interventions -> highly individualized based on severity and predominant symptoms non adherence is a serious problem

Answer 238

antimanic alkali-metal ion salt used to treat bipolar disorder lithium increases the synthesis of serotonin

Answer 239

initial AE - polyuria, nocturia - N/V - muscle weakness long term AE - kidney impairment - goiter - circulatory collapse contraindications - serious CV or renal impairment - severe dehydration - sodium depletion precautions - urinary retention - older adults/ children - CV disease - diabetes

Answer 240

diuretics = increased risk of lithium toxicity NSAIDs and thiazide diuretics can increase lithium levels antithyroid drugs and drugs containing iodine cause increased hypothyroid effect haloperidol causes increased neurotoxicity SSRIs, MAOIs, dextromethorphan may result in serotonin syndrome some herbal and food interactions

Answer 241

monitor serum levels Q1-3 days initially and 2-3 months after assess for symptoms of bipolar disorder before and during treatment obtain baseline thyroid, kidney, cardiac function, electrolyte levels monitor for symptoms of lithium toxicity assess daily for weight changes, edema, changes to skin turgor lithium is a salt so think water levels in the body -> dehydrated increased lithium and over hydrated decreased lithium levels -> watch pts what increase exercise or are N/V/D monitor sodium intake -> continue to take table salt to maintain osmotic hydration but don't over do it

Answer 242

1. Nausea/Vomiting 2. Persistent diarrhea 3. Coarse trembling of hands or legs. 4. Frequent muscle twitching such as pronounced jerking of arms or legs. 5. Blurred vision. 6. Marked dizziness. 7. Difficulty walking. 8. Slurred speech. 9. Irregular heart beat. 10. Swelling of the feet or lower legs.

Answer 243

the precise etiology of schizophrenia remain unknown genetic component -> 5 to 10x greater risk if first degree relative has disorder neurotransmitter imbalance -> overactive dopaminergic pathways in basal nuclei -> associated with dopamine type 2 (D2) receptors - antipsychotic drugs block these receptors too much dopamine second generation (atypical) antipsychotics have become drugs of choice for the treatment of schizophrenia

Answer 244

initial treatment - first doses of antipsychotic drug may be higher than normal -> produces sedation if pt is agitated, aggressive, or posing danger to others most drugs are provided orally benzodiazepines (lorazepam) -> provided IM to relax pt and may allow initial dose of antipsychotic to be reduced acute symptoms usually resolve in 3 to 7 days

Answer 245

extrapyramidal side effects neuroleptic malignant syndrome adverse effects on reproductive system -> major cause of nonadherance; sexual, menstrual, or breast dysfunction

Answer 246

refers to locations in the CND associated with postural and automatic movements include: - acute dystonia -> severe spasms of the muscles of the tongue, face, neck, or back, arching forward of trunk while legs thrust back - akathisia -> pacing, squirming, inability to sit still - Parkinsonism -> tremor, rigidity, shuffling gait, drooling, symptoms can't be distinguished from true parkinsons - tardive dyskinesia -> involuntary, unusual movements of tongue and face and lip-smoking movements

Answer 247

- potentially fatal adverse reaction - symptoms include high fever, diaphoresis, muscle rigidity, tachycardia, BP fluctuations - without quick, aggressive treatment, condition can deteriorate to stupor or coma - treatment includes antipyretics, electrolytes, muscle relaxants

Answer 248

antipsychotic (first-generation) nonphenothiazine, dopamine antagonist

Answer 249

- anticholinergic symptoms -> blurred vision, dry eyes, glaucoma - weight gain - headache - anemia - phytotoxicity - MOST LIKELY TO PRODUCE EPS serious AE - tachycardia - cardiac arrest - laryngospasm - respiratory depression - seizures - neuroleptic malignant syndrome - agranulocytosis/leukopenia/leukocytosis

Answer 250

antipsychotic (second generation, atypical) benzisoxazole and dopamine antagonist

Answer 251

if medication causes drowsiness -> take at bedtime watch pt for orthostatic hypotension -> rise slowly assess for EPS/TD/ Akathesias/ NMS educate pt for S+S of above and what to watch for and when to contact HCP encourage sips of water or hard candies for sry mouth and anticholinergic like symptoms avoid alcohol and caffeine increase fluid and fibre watch liver lab results and educate pt on S+S of liver involvement (jaundice and stool) tell pt to report significant wt gain (5lb per week) ensure pt knows that definite improvement may not be seen for 6-8 weeks

Answer 252

second generation atypical antipsychotics 1. quetiapine (Seroquel) 2. olanzapine (zyprexa) 3. clozapine (colzaril, flazaclo) -pine

Answer 253

be sure to know the S+S of and which drugs cause : - tardive dyskinesia -> Haloperidol, Fluphenazine, Risperidone - EPS -> Haloperidol, Fluphenazine, Risperidone (high dose) - neuroleptic malignant syndrome -> Haloperidol, Fluphenazine, Olanzapine - serotonin syndrome -> SSRIs, MAOIs, Tramadol, MDMA, Serotonergic combos

Answer 254

aripiprazole -> only drug in this class - monitor for EPS symptoms or anticholinergic effects - ensure adequate nutrition, fluid - monitor for signs of neuroleptic malignant syndrome - watch liver labs provide pt education - monitor for weight gain or changes in sexual characteristics (lactation in men) - no alcohol use of illegal drug use - no caffeine use - no smoking

Answer 255

typical antipsychotics have more adverse effects compared to atypical

Answer 256

- apprehension - worry, fear - palpitations - shortness of breath - heart burn - dry mouth - excess sweating high levels of anxiety or a "panic attack" can often be misconstrued as a heart attack rule out MI first -> diagnostic tests and ECG -> then obtain a history of recent events that might trigger anxiety or that might indicate drug abuse.

Answer 257

accurate diagnosis necessary nurse needs to take complete history to rule out - medications that may worsen/cause anxiety symptoms - medical conditions that may be associated with anxiety - consider non pharmacological interventions that will reduce environmental, physical and emotional stressors prior to medications

Answer 258

GI bleed Hemorrhagic stroke Trauma Surgery Blood disorders

Answer 259

are the drugs of choice for generalized anxiety disorder and short-term therapy of insomnia - change dose gradually- do not stop abruptly - watch for suicidal ideation - may cause mania or psychosis - watch in use with dysfunctional kidneys, liver, CV or pulmonary system - use cautiously when using with the elderly

Answer 260

anti anxiety/ anti seizure agent benzodiazepine, GABA receptor agonist - aspirate prior to injection (IM) - assess for paradoxical CNS excitement (unexpected increase in activity and arousal as a result of taking a medication or drug intended to have a sedative or calming effect) - advise pt to stop smoking - watch CBC, liver and renal function - does the pt actually need anti anxiety meds? - assess for S+S of overdose or abuse - teach nonpharmacologic methods of sleep and relaxation - assess for suicidal ideation dont give to pregnant women

Answer 261

sedative-hypnotics have a high dependence -> limit treatment to 14 days overdose or withdrawal are severe

Answer 262

barbiturate sedative-hypnotic anti epileptic drug

Answer 263

- over sedation - hangover effect, lethargy - hallucinations - blood dycrasias - hypocalcemia - hepatic disease - N/V/D/C - paradoxical excitation in children/ older adults

Answer 264

- coma - Steven johnson syndrome - angioedema - periorbital edema - thrombophlebitis

Answer 265

- monitor for respiratory depression - assess pt given IV barbiturates q15 mins - monitor for signs of blood dycrasias - aspirate prior to injection - monitor therapeutic concentrations of drug -> like dig, dilantin, and lithium - teach nonpharmacologic methods of relaxation/sleep - assess baseline hepatic and renal function and monitor during therapy - if pt develops fever, angioedema, and body rash -> hold med and call MD

Answer 266

a mood disorder - persistent disturbance in emotion that impairs ability to effectively deal with ADLs - two primary types of mood disorders are depression and bipolar disorder causes of depression - environmental - situational - hereditary - no longer though to be related to parenting or unresolved childhood conflicts often coexist with other conditions - anxiety - substance abuse - hypertension or arthritis

Answer 267

majority of persons who commit suicide have been diagnosed with major depression three or more weeks of antidepressant therapy may be required before pts mood begins to improve -> 6 - 8 weeks to reach maximal benefit -> risk of attempted suicide highest the month before pharmacotherapy nurses role - careful monitoring of talk of suicide - weekly or daily pt contact - careful monitoring of medications

Answer 268

side effects - anticholinergic effects/sympathomimetic effects - orthostatic hypotension - sedation -> worsened by concurrent use of other CNS depressants - relatively high incidence of sexual dysfunction (cause of cessation) - withdrawal symptoms if not tapered -> don't stop suddenly - may take 3 weeks to see effects and 6 weeks to see optimum benefits

Answer 269

tricyclic antidepressant norepinephrine reuptake inhibitor blocks Ach receptors

Answer 270

- heart attack, heart block, dysrhythmias - asthma, GI disorders, alcoholism, schizophrenia, bipolar disorder - avoid use with alcohol - seizure disorders precautions -> due to sympathomimetic effect - suicidal tendencies - urinary retention - prostatic hyperplasia - cardiac/hepatic disease - increased intraocular pressure - hyperthyroidism - Parkinson disease

Answer 271

- monitor for suicidal ideation - be sure patient swallows each dose - encourage compliance - monitor for urinary retention or constipation - treat for dry mouth

Answer 272

drugs of choice for treating depression due to low incidence of serious adverse effects

Answer 273

when a pt takes multiple medications (or overdose) that causes serotonin to accumulate in neurons in CNS -> confusion, restlessness, tremors, lack of muscle control conservative treatment to discontinue all serotonergic drugs.

Answer 274

SSRI antidepressant, anti anxiety agent

Answer 275

- N/V/D/C - anorexia - cramping - fluctuations in weight - sexual dysfunction - seizures - poor concentration - nightmares - hot flashed - palpitations - serotonin syndrome exam question?* pediatric patients may experience personality disorders or hyperkinesia (extreme or excessive movement of the body, especially the muscles)

Answer 276

- bipolar disorder - cardiac dysfunction - diabetes - seizure disorders - carefully observe pediatric patients for hyperkinesia and personality changes/disorders*** - late pregnancy

Answer 277

- rare use - high incidence of adverse effects - avoid foods containing tyramine (MAO in food) -> food that have been aged or fermented (think charcuterie board) - avoid L-tyrosine -> tyramine a component of tyrosine - avoid caffeine - off label use for OCD, panic disorder, social anxiety disorder, migraine prophylaxis - potentiates (increases) effect on insulin and diabetic drugs

Answer 278

-dizziness/orthostatic hypotension - drowsiness/HA - sexual dysfunction - anorexia / diarrhea serious AE - hypertensive crisis -> with foods with tyramine (charcuterie board) - dyshythmias - SIADH like symptoms (low sodium, increased BP) high incidence of adverse effects and high level of non-compliance

Answer 279

precautions - epilepsy - severe, frequent headaches - HTN - dysrhythmias - suicidal tendencies considerations - assess for suicidal ideation - encourage compliance - avoid foods containing tyramine -> charcuterie board - avoid L-tyrosine -> tyramine is a component of tyrosine - avoid caffeine

Answer 280

Monitor APTT. Monitor injection sites. Monitor level of consciousness (LOC). Monitor PT/INR. correct answer is monitor level of consciousness -> risk of bleeding could lead to hemorrhagic stroke

Answer 281

1. No Calcium (or dairy) 2. No Thyroid meds 3. Constipates 4. Causes black feces 5. N&V/Take with food

Answer 282

1. Watch Liver: a. Jaundice (watch enzymes) b. No ETOH c. Stool changes d. RUQ Pain e. Distension 2. Rhabdomyolysis 3. Grapefruit Juice (don't take it)

Answer 283

No Calcium (or dairy) 2. No Iron 3. No Caffeine 4. Take on an empty stomach

Answer 284

1. Heart Block 2. Hypotension 3. Bradycardia 4. BB: Asthmatics, Diabetics (masks S&S hypoglycemia), don’t stop suddenly 5. CCB: HF, RF & no grapefruit juice

Answer 285

Blood dyscrasias (CBC) 2. Bile (Liver/No ETOH) 3. Brain (CNS depressant & interactions) 4. BP (Hypotension) 5. Bonkers (makes elderly go delirious sometimes)

Answer 286

Seizures 2. Suicidal ideation 3. Sexual dysfunction 4. Ø Stopping suddenly (SS) 5. See (Narrow Angle Glaucoma) 6. Cirrhosis (Liver/No ETOH) 7. CNS depressant & interactions

Answer 287

RF 2. Hypotension 3. Hyperkalemia – watch K+ with K+ sparing diuretics 4. Angioedema 5. Cough

Answer 288

1. Liver 2. Rust coloured urine 3. Metallic taste in the mouth

Answer 289

Osteoporosis 2. Poor wound healing/Risk for infections 3. Mood volatility 4. Moon Face/Buffalo Hump (Truncal obesity) 5. GI Bleed (MUST take with food) a. Never stop suddenly b. Hyperglycemia in Diabetics

Answer 290

LOC 2. Decreased respirations 3. N/V 4. Constipation 5. Urinary Retention

Answer 291

Keep out of reach of children 2. Do not share 3. No leftovers (take ALL as prescribed) 4. N/V/D 5. Watch skin, ears, kidneys – drink lots of water

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