Nursing 105 Test 3

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What is the action of Dimetane?

given oral to relieve rhinitis

What are the side effects of Benadryl?

drowniness,sedution,blurred vison, tachycardia

What causes rebound nasal congestion?

Phenlyephrine (Afrin, Neosynephrine), pseudophedrine(Sudafed) if used longer than 3-5 days or increased frequency

The patient is instructed to do what activity after acetylcysteine (Mucomyst) is administered?

coughing and postural drainage excerises

What mechanism do opiates (codeine, hydrocodone (Hycodan)) use for their anti-tussive action?

Inhibit cough refles center in the medulla of the brain

What is the drug classification of loraditine (Claritin), astmizole (Hismanal)? (Focus on the non sedating anti-histamine action.)

non sedating anti-histamine action - does not cause drowsiness

What is the drug, cromoln sodium inhaler, used for?

(Intal), giev oraly to inhibit mast cells . Doesn't bronchodilate.

List the sequence of steps for using a multidose respiratory inhaler?

1. Use a spacer device to keep inhaler one and one-half inches away from the mouth. 2. Seal mouth on mouth piece. 3. Breathe deeply once. 4. Activate the inhaler. 5. Continue breathing in for 5 seconds. 6. Hold breathe minimum of 10 seconds (or as long as possible). 7. Breathe out slowly. 8. Wait 2 minutes between doses if second dose is ordered.

What is the purpose of a spacer device on an inhaler?

to keep the inhaler 1 1/2 inches away from the mouth, helps to enhace the delivery of the medications

A pt. needs to gargle with water and spit out the water after using triancinolone(Azmacort), and belcomthasone (Vanceril) inhaler to prevent what from occurring?

To prevent fungal infection in the mouth & throat

If taking both at the same time, which should be used first, a reliever inhaler or a controller inhaler? Which meds are reliever drugs for asthma? Which meds are controller meds for asthma?

If reliever & controller inhalers are ordered, take the bronchodilator inhaler first.

Controller Drugs for Asthma:
Corticosteroids
-Beclomthasone (Vanceril)
-triamcinolone (Azmacort)
Nonsteroidal:
-cromolyn (Intal)
Leukotrine Modifiers
-montelukast (Singulair)
-zafirlukast (Accolate)

Reliever Drugs for Asthma:
Selective Beta 2 Bronchodilators
-albuterol (Proventil)
-metaproterenol (Alupent)
-erbutaline (Brethine)
-salmeterol (Serevent)
Non Selective Beta Adrenergic Bronchodilators
-Theophylline and xanthines
-aminophylline
Glucocorticoids
-prednisone (Deltasone)
-pratropium (Atrovent)

Which meds are selective beta-2 bronchodilators?

albuterol(Proventil) inhaler onset in 5 minutes. Oral onset 15 mins

metaproterenol(Alupent) inhaler onset 1 min, Can be given oral

terbutaline(Brethine) inhaler, oral, injection(IM w/ onset in of 15 mins)

salmeterol(Serevent) inhaler, long acting w/ duration of 12 hrs. Onset action time too long to be used in acute asthma attack.

Which bronchodilator inhaler acts for 12 hrs?

salmeterol(Serevent)

What is the onset time for terbutaline (Brethine) by injection?

15 mins

What is the therapeutic serum theophylline level so that time released capsules can be given?

10-20 mcg/ml serum

Aminophylline alleviates what respiratory symptoms?

Wheezing, SOB, and stimulates respiratory center in the brain.

Aminophylline is administered how most commonly?

IV infusion through IV rate control pump
*Pts. will need second IV site for other fluids and meds since amionphylline is incompatiblein the IV line other IV meds.

What is the action of of Prednisone in the treatment of asthma?

Glucocorticoids - prevent the immune system response to antigens and prevent bronchoconstriction.

Prednisone (Deltasone) - suppress an acute inflammatory process and for immunosuppression and prevents cell-mediated immune reactions (in book , I use Kee 6th edition pg 784).

* if patient requires long term glucocorticoids, given oral 20 mg or less every other day to prevent patients own adrenal gland from stopping production of cortisone

What are the side effects of Predinsone? Why should Prednisone not be stopped suddenly?

-cause elevation in serum glucose
-cause overproduction of gastrin & can cause development of gastric ulcers

Book says on pg 784, side effects of prednisone are nausea,diarrhea, abdonminal distention, inceased appetite,sweating,headache, depression, fush, mood changes.

if stop suddenly it can cause severe changes in b/p and glucose levels

Surfactant is given to prevent what occurrence in the lung?

-to prevent respiratory distress syndrome (hyaline membrane disease in newborns)

-collapse of tine airsacs in lung from deficiency of surfactant

What are the causes of Hypofunction of glands which requires replacement hormones be given?

cancer, congenital absent gland, infection, pituitary insufficiency, surgical removal of gland, radiation

What is the normal body mechanism that regulates hormone secretion?

Negative Feedback System

What is the protocol followed when beginning to give Synthroid? (Focus on small dose initally and gradual increase in dosage.)

Before breakfast daily. Small dose initally and gradual increase in dosage

What is the desired outcome of giving the hormone replacment drug, Synthroid? (Focus on restoration of normal hormone levels.)

to restoration of normal hormone levels

What is the effect on pulse when a patient receives too much Synthroid?

rapid,irregular pulse & angina pain indicate toxicity

What is the action of Propacil?

-blocks synthesis of T3 and T4

What are the toxic effects of Tapazole or Propacil?

Soe throat, fever, rash, leukopenia (monitor CBC)

What are the sleeping precautions for 48 hrs someone who has received radioactive iodide
(I-131)?

sleep alone and avoid embracing or close contact with others

What drug is given for acute tetany?

give calcium chloride or calcium gluconate IV.

What is action of Fosamax?

slow bone loss & increase bone density

What is the correct way to administer Miacalcin?

nasal spray--alternate nostrils with each dose

Why is replacement hormone, cortisone, prescribed: 2/3 dose in the AM and 1/3 dose in the PM?

to refrain from disturbing sleep (circadian cycle)

What is the action of Aldactone?

given oral to block action of aldosterone

Oral contraceptive drugs provide birth control by suppressing what function?

given oral to stop ovulation and provide reversible prevention of pregnancy.

What is the action of Histrlin and why is it given in Hyperfunction of the anterior pituitary?

Given parenterally until puberty to block gonadotropin production & prevent premature sexual development in children

What is the desired growth when a child is given Humatrope?

(HGH) Humatrope given SubQ 3 times/week to promote one inch growth every 6 months in 2-13 years

When a pt has SIADH what drug blocks the action of anitdiuretic hormone (ADH) on the kidneys?

Declomycin

What is the action of Glucotrol?

increase beta cell activity in pancreas to release the already formed insulin into circulation
increase the insulin cell receptor responsiveness

What is the action of Gluocophage?

lowers blood glucose by increasing the receptiveness for insulin on the peripheral insulin receptor sites

What does the term U100 on the insulin vial mean?

that there are 100 units in one milliliter

How is cloudy insulin in suspension properly mixed before administeriong to a pt?

rotate or gently roll the bottle, do not shake (this will cause bubbles to draw up in syringe)

Why are insulin injection sites rotated?

prevents development of fatty tissue fibrosis which hinder absorption

Why is the sequence of drawing regular and intermediate actiong insulins into the same syringe not varied? (Focus on maintaining consistent onset times.)

because it can cause changes with the onset time from injection to injection. onset times must be kept constant.

What does peak onset time mean?

how many mins after receiving the insulin, the most ability to lower blood glucose from the circulation is occuring.

What is the onset time for R Humulin?

30 minutes

What is the duration time for U Humulin?

36 hours

What is the peak action time of NPH insulin when hypoglycemic reaction might occur?

8 hrs

What are the signs and symptoms of hypoglycemia?

headache, dizziness, difficulty problem solving, restlessness, hunger, tachycardia, cold & clammy skin, sweating, decreasing LOC, seizure, coma

What behaviors by the pt cause episodes of hypoglycemia?

Too much insulin, too little food (missed meals), insulin peak activity and too little food, increased exercise with the same food and insulin, decreased food absorption (vomiting, diarrhea)

What behaviors by the pt cause episodes of hyperglycemia?

Excessive food intake

omitting oral hypoglycemic meds

taking corticosteroids or total parenteral nutrition which is 25% glucose

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