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Pharmacology Exam 4
Terms in this set (90)
indications for Octreotides
acromegaly, carcinoid tumors, esophageal varices
adverse effects of Octreotides
-may affect glucose regulation (can produce hypoglycemia in pts with type 1 DM)
-interaction with ciprofloxacin: prolonged QT interval
indications for Somatropin
-growth hormone deficiencies (hypopituitary dwarfism)
-pts w/ HIV who have wasting syndrome or cachexia
adverse effects of Somatropin
-hypo or hyperglycemia
-injection site reaction
nursing considerations regarding somatropin
do not shake, and only given SubQ or IM
indications for vasopressin
-hypotensive emergencies (shock)
-pulseless cardiac arrest
-stops bleeding of esophageal varices
-polyuria (helps retain fluid)
adverse effects of vasopressin
IV extravasation (tissue death)
patient teaching regarding vasopressin
-do not inhale (given via nasal spray/pump)
-rotate injection sites
-do not discontinue abruptly
patient teaching for a patient taking a growth hormone
-keep a journal reflecting Childs growth
-if child limps call the doctor
signs and symptoms of hypothyroidism
cold intolerance, unintentional weight gain, depression, dry brittle hair and nails, thickened skin, hair loss, constipation, lethargy
what is the main drug for hypothyroidism?
what are the adverse effects of levothyroxine?
-everything in the body speeds up
-stimulates the heart, can cause tachycardia, dysrhythmias, HTN, angina, heat intolerance
what are the signs and symptoms of hyperthyroidism?
diarrhea, flushing, increased appetitive, muscle weakness, fatigue, palpitations, irritability, nervousness, sleep disorders, heat intolerance, altered mensural flow
what are the main drugs for treating hyperthyroidism?
-methimazole (not an anti-fungal)
what is thyroid crisis or thyroid storm?
-a severe and potentially life threatening exacerbation of the symptoms to hyperthyroidism that is usually induced by stress or infection
-can occur in patients taking a thyroid suppressing drug
patient teaching regarding what foods to avoid taking a medication for the thyroid?
avoid iodized salt and shellfish
difference between type 1 and type 2 diabetes
Type 1-Must have insulin because body is not producing it (GENETIC)
Type 2- Body not producing enough insulin
what are the three P's of diabetes?
polyuria (excessive urine)
polydipsia (excessive thirst)
polyphagia (excessive appetite)
what comorbid conditions are linked to type 2 diabetes?
obesity, CAD, dyslipidemia, HTN, microalbuminurfia, increased risk for thrombotic events
how do we determine if a patient with diabetes is being compliant or adhering to their anti diabetic drug therapy over time?
-HbA1c of less than or equal to 6.5% indicates they are being compliant
when can regular insulin be given IV?
-diabetic ketoacidosis (fruity breath)
-coma associated with uncontrolled type 1 DM
what is the onset of action of rapid acting insulin? how should pt take this medication?
-onset within 15 minutes
-pt must have food within 15 minutes of taking this medication
which insulins are long acting and given once a day?
which insulins are long acting and given twice a day?
how to know if a patient's blood sugar is high
pt will be hot and dry
how to know if patents blood sugar is low
"cold and clammy need some candy"
what does metformin do? what does it not produce on its own?
inhibits glucose production (it does not simulate insulin on its own so it does not produce hypoglycemia by itself)
patient teaching regarding a pt who is taking metformin who needs IV Contrast for a procedure.
what if pt does not follow this?
-d/c metformin for 48 hours before and after the test
-the interaction between the two is associated with increased risk for acute renal failure and lactic acidosis
what is the biggest concern with a patient starting a new anti diabetic drug?
the risk for hypoglycemia
indications for glucocorticoids
-most effective antistatic drug
adverse effects of glucocorticoids
Cushing syndrome (moon face), HF, edema, nervousness, headache, growth suppression, abdominal distention, fragile skin, poor wound healing
what is the biggest concern with glucocorticoids
because they decrease the immune response, the patient is at risk for infection
what are drug interactions with glucocorticoirds
-non-potassium sparing diuretics
-aspirin and other ulcerogenic NSAIDS
what can glucocorticoids do to blood sugar?
they can raise blood sugar, use cautiously in diabetics
patient teaching for glucocorticoids
-avoid ppl with infection
-take with food or milk
-may cause thinning of skin so be careful with tape
-never stop abruptly
what is a "stress dose"
patients on long term therapy of steroids like prednisone require an extra dose of the steroids when undergoing surgery
what is the hormone replacement therapy for women experiencing menopause
what is hormone replacement therapy for males?
when would hormone replacement therapy for men be given to women?
to suppress tumors of the reproductive organs such as giving an androgen for treating breast or uterine cancer
what are the drugs for osteoporosis?
bisphosphonates (alendronate, ibandronate)
what are the adverse effects of bisphosphonates
head ache, GI upset, joint pain, risk for esophageal burns, osteonecrosis of the jaw
patient teaching for bisphosphonates
-do not crush/break tablet
-take 30 min before breakfast/first drink of the day
-take with at least 8oz of water
-remain upright for 30 min after taking
what is the black box warning for HRT and oral contraceptives
they increase the risk for thromboembolic events (MI, venous thrombosis, stroke)
what is amenorrhea?
absence of menstruation
what are the drugs for treating BPH?
5-alpha reductase inhibitors (-asteride)
alpha 1 blockers (-zosin)
What is the MOA of 5-alpha reductase inhibitors?
(finasteride and dutasteride)
-decreasing DTH which shrinks the prostate gland and helps with urinary elimination
patient teaching regarding pregnancy and finasteride for BPH
it is considered dangerous of pregnant women to handle crushed or broken tablets
-pregnancy category X
patient teaching for men taking nitrates
-do not take drugs for erectile dysfunction (sildenafil, tadalfil)
-prolonged erections longer than 4 hours must be reported immediately
what are the first generation antihistamine drugs?
what are the indications for antihistamines?
-hay fever (allergic rhinitis)
-relieve symptoms of a common cold
what are the adverse effects of the first generation antihistamines?
-dry mucous membranes
-impairment equal to illegal blood alcohol
Pros and Cons to topical adrenergic decongestants
pros: rapid and intense (afrin)
cons: rebound congestion, if used in large amounts it can be systemic
pros and cons of systemic (oral) adrenergic decongestants
pros: no rebound congestion
con: takes longer, has systemic effects which increases cardiovascular risks
what are the albuterol drugs used for? (levalbuterol, pirbuterol)
"rescue" treatment in an acute asthma attack
what are fluticasone/salmeterol, Advair used for?
prophylactically for asthma
what do steroids, mast cell stabilizers, and leukotriene inhibitors used for?
used to reduce the inflammatory process, not used to cause bronchodilator
what is the drug of choice for severe allergic reactions? what does it do?
-it opens the airways
patient teaching for using an inhaler
-rinse mouth after to prevent candida infection (fungal infection of the mouth and throat)
patient teaching for using a metered dose inhaler (MDI)
-if a 2nd puff of the same med is ordered, instruct the pt to wait 1-2 min between puffs
-if a 2nd puff of a different med is ordered, instruct the patient to wait 2-5 min between puffs
what are antitussives?
-pt teaching regarding these meds
(codeine, hydrocodone, detromethorpan)
-pt needs to increase fluid intake to help thin secretions
pt teaching regarding oral contraceptives and antibiotics, antifungals, or antivirals
may need to use second method of birth control bc theses meds make birth control ineffective
anti fungal and antiviral can damage the liver, pt teaching regarding this
-teach pt to report any jaundice, nausea, vomiting, clay-colored stools, and/or dark urine to provider
what to do if a patient says they are allergic to an antibiotic
ask what kind of reaction they get
if a patient had a severe reaction to penicillins, what med should they avoid?
what is empiric therapy?
treatment of an infection with an antibiotic before the causative agent is identified
what is an example of a supra infection? what are the signs and symptoms of this
-c. diff colitis
-low grade temp, watery diarrhea, perineal itching
what are the signs and symptoms of anaphylaxis?
-flushing, itching, hives, anxiety, tachycardia, throat and tongue swelling, laryngeal edema, bronchoconstriction
what is the through level?
drawn just before the next dose to get the serum drug level
(should be low)
what can ahminoglycosides and vancomycin cause?
-what labs should you monitor?
they can cause ototoxicity and nephrotoxicity
-monitor BUN and Creatinine
-BUN: 8-20, Creatinine: 0.6-1.2
nursing consideration for a patient with nephrotoxicity
make sure patient has adequate hydration
What is red man syndrome?
-too rapid of an infusion of vancomycin
-may lead to flushing or rash of upper body, dyspnea, itching, hypotension
what assessment data should the nurse use to evaluate the effectiveness of antiretroviral therapy in pt being treating for HIV?
a viral load of less than 50
T-cell counts will be increased
when is treatment of influenza most effective?
when treatment of oseltamivir and zanamivir begin within 2 days of symptoms onset
what is isoniazid used for? what can this medication cause?
used to treat TB, can cause pyridoxine (vitamin B6 deficiency) which can produce peripheral neuropathy (numbness, burning, tingling of extremities)
how does a nurse evaluate for a therapeutic response to treatment of TB?
absence of mycobacterium in sputum and failure to colonize in culture. patient symptoms will be resolves and chest X-ray will be clear
nursing consideration for the drug ethambutol
check the patients eyes
what is amphotericin B used for?
systemic mucuses (fungal infection in the blood)
what are the side effects of amphotericin B, how to pretreat?
-tachycardia, malaise, muscle and joint pain, nausea, rigors
-pretreat with analgesics (Tylenol), antihistamines, antiemetics, and corticosteroids
-check serum K+ levels
what is nadir?
-lowest point that blood counts reach prior to recovery after chemo is given;
-occurs approximately 10 days after treatment
why is the "rescue" drug leucovorin given after high-dose methotrexate?
because methotrexate gets rid of folic acid, nd leucovorin provides the body with active folic acid, which prevents the death of normal cells
what can cisplatin and other antineoplastic drugs cause? how to prevent this?
can cause nephrotoxicity, to prevent this, adequately hydrate the patient with IV fluids
what does oprelveskin stimulate?
when is this drug used? what should the nurse suspect if a patient has low platelets?
-indicated for chemotherapy-induced thrombocytopenia. pt will be more susceptible to bleeding if they have low platelets
what do drugs ending in (-stim) stimulate?
what do they help to recover?
-helps to recover bone marrow production of blood cells after chemo
when is filgrastim usually discontinued?
when a patients neutrophil count rises above 10,000mm
What is thrombocytopenia?
low platelet count, an adverse effect of chemo therapy, it increases the risk for bleeding
how should a nurse assess for bleeding in a patient after chemo therapy?
-assess for bleeding from the mouth, gums, and nose. check for bleeding occurring with brushing teeth and encourage pt to report excessive bleeding to provider
-when monitoring BP be efficient and quick, do not overinflated the cuff because that may cause bruising
-monitor the after the procedure at the aspiration site
what is the black box warning for azathioprine?
myelosuppresion and risk of infection due to reduction in the number of WBC's
What are the rapid acting insulin drugs?
lispro, aspart, glulisine
What are the short acting insulins?
Humulin R, Novolin R
(regular, 30-60 min before meals)
What are the long acting insulins?
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