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Exam 5 review (pharm.)
Terms in this set (143)
What is peptic ulcer?
- Erosion of the mucosa layer, usually associated with acute inflammation
- Lesion located in the stomach or small intestine
What is the primary cause of a peptic ulcer?
What are the risk factors for PUD?
- Family history
- Blood group O
- Tobacco use
- Medications: corticosteroids, NSAIDs, platelet inhibitors
- Psychological stress
- H. pylori
What are the symptoms of PUD?
- Burning or gnawing in upper abdominal area
- Worse pain when stomach is empty
- If deep, bleeding... seen in bright red vomit or black tarry stools
Management of PUD/Lifestyle changes includes:
- Eliminating tobacco and alcohol
- Reducing stress
- Avoiding certain foods (ex: acidic or spicy foods)
- Avoidance of NSAIDs if possible
- Treatment of H. pylori
- Exercise/Losing weight, especially in obese patients
- Elevating the head of patients in bed
- Eating smaller meals throughout the day
- Avoid caffeinated beverages
What are the goals for treatment of PUD?
- Provide immediate relief from symptoms
- Promote healing of the ulcer
- Prevent recurrence
What medication provides immediate relief from symptoms? (PUD)
What medications promote healing of the ulcer? (PUD)
H2s or PPIs
What medications prevent recurrence? (PUD)
2 antibiotics + H2
2 antibiotics + PPI
How is PPIs different to H2s?
Both are medications to promote healing of the ulcer (PUD).
- PPIs: more direct = work better = $$$
- H2s: indirect = doesn't work as well = $
PPI's prototype drug?
What is PPIs action?
Binds to enzyme that releases acid, thus reducing acid secretion
Why are PPIs used for only SHORT-TERM control?
Because it affects the absorption of Ca+, which can lead to osteoporosis
How long is therapy for PPIs?
4 wks, depending on severity of ulcer
PPIs administration considerations?
- Taken on an EMPTY stomach.
- Do NOT break or chew tablets or capsules.
- Can be given IV, but needs to be give SLOWLY (over 5 min.) because it can cause IV SITE IRRITATION.
When given IV, why are PPI's administered slowly?
Because it can cause IV site irritation
What are PPI's and H2s SEs/AEs?
HA, N/V, any kind of hypersensitivity to the drug
What patient teaching can a nurse give a patient who is taking PPIs or H2s?
To be compliant because it takes a couple of days to see the effect of the ulcer healing.
Prisolec (generic name?)
Protonix (generic name?)
Nexium (generic name?)
What medication ends in -prazole?
What medication ends in -tidine?
Zantac (generic name?)
Pepcid (generic name?)
What is H2s action?
Suppress parietal cell acid secretion (decrease acids produced)
Why is H2s only used for SHORT-TERM control?
Because B12 deficiency may occur with long term use
Example drug of antacids
calcium carbonate (Tums)
Tums (generic name?)
What are antacids used for?
To neutralize acids, making the stomach more basic
- Provides immediate symptomatic relief
What is the treatment for H. pylori?
What are the drugs that affect GI motility?
- GI stimulants
Which laxative can chemically irritate the lining of the GI tract? It's used for aggressive constipation.
Which laxative causes the fecal matter to increase in bulk?
Which laxative helps the intestinal contents move more smoothly? It lubricates and makes the stools a little bit more slipper so that it doesn't get blocked up. Some of these are not true laxatives.
What are antiemetics agents used for?
To control severe N/V.
What patient teaching can we give for a patient who is taking an antiemetic?
Stay hydrated! We don't want them to be dehydrated. So, little sips of something that has electrolytes would be an intervention.
Zofran (generic name?)
Phenergan (generic name?)
What antiemetic agent is also considered as a 1st generation histamine (H1) receptor antagonist?
Term for: drug that blocks ACE, the enzyme responsible for converting angiotensin I to angiotensin II in the lungs; this blocking prevents the vasoconstriction and aldosterone release related to angiotensin II.
Angiotensin-converting enzyme (ACE) inhibitor
Term for: specific receptors found in blood vessels and in the adrenal gland that react with angiotensin II to cause vasoconstriction and release of aldosterone.
Angiotensin II receptors
Term for: pressure receptor; located in the arch of the aorta and in the carotid artery; responds to changes in pressure and influences the medulla to stimulate the sympathetic system to increase or decrease blood pressure.
Term for: area of the medulla at which stimulation will activate the SNS to increase blood pressure, heart rate, and so forth.
Term for: sustained blood pressure above normal limits with no discernible underlying cause.
Term for: sustained blood pressure that's lower than that required to adequately perfuse all of the body's tissues.
Term for: force that resists the flow of blood through the vessels, mostly determined by the arterioles, which contract to increase resistance; important to determining overall blood pressure.
Term for: compensatory process that leads to increase blood pressure and blood volume to ensure perfusion of the kidneys; important in the continual regulation of blood pressure.
Term for: severe hypotension that can lead to accumulation of waste products and cell death.
Term for: the amount of blood pumped out of the ventricle with each beat; important in determining blood pressure.
Term for: resistance against which the heart has to beat.
Term for: volume of blood being pumped by the heart.
Term for: enlargement of the heart, commonly seen with chronic hypertension, valvular disease, and heart failure.
Term for: discomfort with respirations, often with a feeling of anxiety and inability to breathe, seen with left-sided heart failure.
Term for: a condition in which the heart muscle fails to adequately pump blood around the CV system, leading to backup or congestion of blood in the system.
Term for: blood-tinged sputum, seen in left sided heart failure when blood backs up into the lungs and fluid leaks out into the lung tissue.
Term for: getting up to void at night, reflecting increased renal perfusion with fluid shifts in the supine position when a person has gravity-dependent edema related to heart failure; other medical conditions, including UTI, increase the need to get up and void.
Term for: difficulty breathing when lying down, often referred to by the number of pillows required to allow a person to breathe comfortably.
Term for: effect resulting in an increased force of contraction.
Term for: amount of blood that is brought back to the heart to be pumped throughout the body.
Term for: severe left sided heart failure with backup of blood into the lungs, leading to loss of fluid into the lung tissue.
Term for: rapid and shallow respirations, seen with left sided heart failure.
What is known as growth hormone deficiency that causes short stature (in children, prior to puberty)?
What is known as excess secretion of growth hormone caused by a tumor on the pituitary? This condition causes bones to be deformed - enlargement of small bones in hands, feet, face, skull nose, lower jaw, and forehead.
What is given to prevent Dwarfism?
What is somatotropin's action?
To stimulate growth and metabolism in almost every cell in the body; growth hormones.
How is somatotropin administered?
What is a nursing consideration for somatotropin?
Overstimulation of growth
What conserves water, helps hold onto the water in the body, increases water reabsorption, and stops diuresis?
What does ADH insufficiency cause?
What is diabetes insipidus? (characterized as)
Production of large volumes of dilute urine
What is the treatment of diabetes insipidus?
Desmopressin and vasopressin (an artificial replacement form of ADH that can also constrict blood vessels and increase blood pressure)
What patient teaching would be give for a patient who is taking vasopressin?
Monitor for toxicity signs
Symptoms of hypothyroidism includes:
- General weakness
- Muscle cramps
- Dry skin
- Goiter (may or may not be present)
- Slurred speech
- Weight gain
- Decreased sense of smell or taste
- Intolerance to cold
Symptoms of hyperthyroidism includes:
- Increased body metabolism
- Weight loss
- Elevated body temperature
What are patient teaching given to a patient who is getting treatment for hypothyroidism?
The treatment is continued LIFELONG. "Start low and go slow."
What is the treatment for hypothyroidism?
Replacement therapy with T3 or T4 (levothyroxine)
- since there's a deficiency (HYPOthyroidism), we need to replace the thyroid hormones
Synthroid (generic name?)
What are the nursing considerations for levothyroxine (Synthroid)?
We want the patient to take this medication first thing, in the morning because fatty foods can delay the absorption of this medication.
What are patient teachings can we give to a patient who is taking levothyroxine (Synthroid)?
- Take every day.
- Take in the morning on an empty stomach (about 30 min. before you eat)
What disease is a primary adrenocoritcal insufficiency caused by autoimmune destruction of adrenal glands? (corticosteroid deficiency)
What is the treatment for Addison's disease?
[For ADDison's disease, you need to ADD more corticosteroids]
What is the hormone secreted by the adrenal cortex that is a class of corticosteroids?
Stress hormones that prepares the body for stress includes:
glucocorticoid (cortisol, corticosterone, cortisone)
List 2 corticosteroids that treats Addison's disease.
cortisone and prednisone
What disease has high levels of corticosteroids present over long periods, endogenously?
What is the common cause of Cushing's disease?
Long-term therapy with systemic corticosteroids
Symptoms of Cushing's disease includes:
- Adrenal atrophy
- Increased risk of infection
- Delayed wound healing
- Redistribution of fat around face, shoulders, and neck
What is the goal of treatment for Cushing's disease?
To identify and treat the cause
What is the preferred drug for Cushing's disease?
What is the action of ketoconazole (Nizoral)?
Blocks synthesis of corticosteroids (suppresses the release of corticosteroids)
What are nursing considerations for ketoconazole (Nizoral)?
- May develop tolerance.
- NOT to be used in pregnancy (because it interferes with the development of the placenta).
What patient teachings can we give to a patient who is taking ketoconazole (Nizoral)?
- Do not use for a long-term; ONLY SHORT-TERM.
- Do not use when pregnant.
What are some nursing considerations for insulin therapy?
- It provides replacement for inadequate insulin production or secretion.
- Adminstering the right amount at the right time is crucial... there MUST be glucose in the blood!
What must the blood have in order to get insulin therapy?
What are the types of insulins?
- Rapid-acting insulin
- Regular or Short-acting insulin
- Intermediate-acting insulin
- Long-acting insulin
What is helpful for people who have trouble drawing up insulin out of 2 bottles reading the correction directions and dosages? It's useful for people who have poor eyesight or dexterity and is convenient for people whose diabetes has been stabilized on this combination.
What patient teaching can be given for a patient who is taking rapid-acting insulin?
Taken with the first bite of food.
What is the onset for rapid-acting insulin?
What is the onset for regular/short-acting insulin?
What is the onset for intermediate-acting insulin?
2 to 4 hours
What is the onset for long-acting insulin?
What is the peak for rapid-acting insulin?
What is the peak for regular/short-acting insulin?
2 to 3 hours
What is the peak for intermediate-acting insulin?
4 to 12 hours
What is the peak for long-acting insulin?
What is the duration for rapid-acting insulin?
2 to 4 hours
What is the duration for regular/short-acting insulin?
3 to 6 hours
What is the duration for intermediate-acting insulin?
12 to 18 hours
What is the duration for long-acting insulin?
Precose (generic name?)
Glucophage (generic name?)
Avadia (generic name?)
Glucotrol (generic name?)
DiaBeta (generic name?)
Example drug of alpha-glucoside inhibitor
Example drug of biguanides
Example drug of thiozolidinediones
2 examples drug of sulfonylureas
glipizide (Glucotrol) and glyburide (DiaBeta)
What is the action of glucagon?
This pancreatic hormone maintains adequate serum levels of glucose between meals and is secreted when blood glucose levels fall.
Why do patients use glucagon?
To increase blood glucose levels (hyperglycemia effect)
What gives the opposite effect of glucagon?
What is the primary SE of glucagon?
Hyperglycemia SEs includes:
- Itchy skin
What is another term that is considered a hyperglycemia condition?
What type of diabetes mellitus is when there is no insulin due to an autoimmune cause?
What type of diabetes mellitus is when there is insulin resistance/deficiency due to obesity and sedentary lifestyle?
What is the first kind of treatment for Type 2 DM?
If lifestyle changes of diet and exercise have failed to regulate the glucose levels for Type 2 DM, what other treatment can the patient receive for their diabetes?
Antidiabetic drugs or insulin injections (exogenously)
What is the main drug/food interaction for ALL antidiabetic drugs?
What patient teaching can we give for patients that are taking antidiabetic drugs?
Do not take with alcohol.
What are sxs of hypoglycemia?
- Altered mental status
- Shakiness, trembling, difficulty with fine motor movements
- Slurred speech
What are sxs of lactic acidosis? Lactic acidosis is the build up of lactic acid. Think about when you run so much and your muscles starts building up lactic acid.
- Overwhelming fatigue
What is the advantage of alpha-glucosidase inhibitors?
This type of antidiabetic drug does not cause hypoglycemia. It prevents hyperglycemia.
What is the advantage of acarbose (Precose)?
This alpha-glucosidase inhibitor does not cause hypoglycemia. It prevents hyperglycemia.
What is the main AE of acarbose (Precose) or alpha-glucosidase inhibitors?
Liver damage (ascites, jaundice)
What is the SEs of acarbose (Precose)?
(Since this drug helps suppress carbohydrates digestion = too much carbs that's staying in stomach)
- Abdominal pain
What is thiozolidinediones action?
Resensitizes your tissues to insulin
[thio... really hard to say = sensitivity; when you can't pronounce your friend's name right, they can be sensitive about it...]
AEs of metformin (Glucophage) includes:
HYPOglycemia and lactate acidosis
List the antidiabetic (non-sulfonylureas) drug classifications.
- Alpha-glucosidase inhibitors
What are 2 examples of antidiabetic (sulfonylureas) drugs?
glipizide (Glucotrol) and glyburide (Diabeta)
What is the patient teaching given for sulfonylureas (antidiabetic drugs)?
Only taken 1 to 3 times a day WITH your meal.
What are SEs/AEs of sulfonylureas?
- Increased appetite
- Aplastic anemia
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