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MEPN Pharm
MEPN Pharmacology
| Question | Answer |
|---|---|
| Opiates | Morphine |
| pulmonary edema: morphine; vaso and bronchodilitation,never used with head trauma for accurate assessment, non-productive cough | opiates |
| morphine agonist | Narcan |
| Non-Opiates | Acetaminophen(tylenol), ASA (aspirin) |
| acetaminophen | analgesic, antipyretic, good for kids |
| ASA Salicylate (aspirin) | tinnitis, no kids, analgesic,anti -pyretic,-inflammatory-thrombitic |
| NSAID’s | ibuprofen |
| ibuprofen | tinnitis, no kids, analgesic, anti -pyretic-inflammatory-thrombitic (OK for kids) |
| Benzodiazepine | Diazepam (valium) |
| diazepam | anti-seizure as well as benzo |
| anti-anxiety | Flumazenil, recover depressed respiratory |
| Sedative/Hypnotics | Barbiturates |
| Barbiturates | Seconal/Phenobarbital |
| seconal/phenobarbital | anti-seizure as well as barbs, however, block REM sleep |
| SNS -mimetics | Epinephrine(adrenaline) |
| epinephrine | >HR/RR , >eye (mydriasis), <vassodil ,>blood sugar & fats, >sweat, >blood coag,contra-indicators: MI, stroke, diabetes. Hypotension Shock Cardiac arrest Asthma |
| non-catecholamines | Sudafed, Ephedrine |
| Alpha Blockers | Regitine (vaso skin dilitation, skin necrosis) |
| Beta Blockers | Propranolol/Inderal decrease HR/RR |
| PSNS -mimetics | Neostigmine/Prostigmine |
| WET, lowers HR & RR Glaucoma, bladder atony/voiding, glaucoma, Myasthenia Gravis, alzheimers, GI atony; contraindicates: urinary GI obstruc, asthma, ulcer,CAD, Hypertension Angina Arrhythmias MI BPH Raynauds, frostbite | cholinergics |
| Cholinergic Blocker | Atropine |
| Antispasmodics Tx Parkinson’s, Asthma, Bradycardia Pre-op: ↓ Vagal stimulation | anticholinergics |
| Adenergics | (SNS) |
| Cholinergic | (PSNS) |
| Adrenergic | Epinephrine/Proventil |
| Anti-cholinergic | Atropine |
| Corticosteroid | Prednisone |
| Leukotriene Inhibitor | Zyflo |
| Mast Cell Stabilizer | Intal |
| Bronchodilators | Xanthines |
| 1st generation antihistamine | Diphenhydramine (Benadryl) |
| 2nd generation antihistamine | Zyrtec (claritan) |
| Adrenergics | Epinephrine(Adrenaline) |
| Sympathomimetics (stimulates SNS) | Adrenergics |
| Adrenergic Blockers | Inderal, Regitine |
| Alpha adrenergic blockers | regitine |
| Beta adrenergic blockers | inderal |
| Sympatholytics (inhibitis SNS) | Adrenergic Blockers |
| Parasympathomimetics (stimulates PSNS) | Cholinergics |
| Cholinergics | WET neostigmine |
| Parasympatholytics (inhibits PSNS) | Anti-cholinergics |
| Anti-cholinergics | DRY atropine |
| Drug | substance that affects health/well-being in positive or negative way |
| Medication | substance with positive effects |
| class I drugs | most highly addictive; all accounted for and signed out; LSD, heroin |
| class II drugs | narcotic analgesics |
| class III drugs | sedatives, anabolic steroids |
| class IV drugs | sedative-hypnotics |
| class V drugs | partially controlled; ex. Lomotil (OTC, but limited) |
| Pharmacokinetics | how medication gets into bloodstream to site of action and breaks down |
| Absorption, distribution, biotransformation, elimination | pharmacokinetics |
| PO meds biotransform before systemic circulation | first-pass effect |
| Enzyme induction | tolerance develops; liver produces more enzymes, need higher doses |
| Enzyme inhibition | two competing medications for same set of enzymes |
| Main organ of elimination; requires adequate blood supply and BP | kidney |
| Time it takes blood concentration of medication to drop by 50% | serum half-life |
| Therapeutic use (TU) | reason for giving the drug |
| Palliative | relieves symptoms/pain |
| Curative | cures; ex. Antibiotics |
| Supportive | support body system; ex. BP meds |
| Substitutive | replaces; ex. Insulin |
| Chemotherapeutic | destroy malignant cells |
| Restorative | vitamins/minerals |
| Fetus drug effects class A | studies done on pregnant women; no harm, risk, or ill-effects |
| Fetus drug effects class B | animal studies; no problems |
| Fetus drug effects class C | animal studies; some harm to developing fetus |
| Fetus drug effects class D | evidence of human fetal risk |
| Fetus drug effects class X | risk outweighs any potential benefit |
| Opiates/narcotics | morphine |
| Non-opiates | Acetaminophen, Salicylates (ASA), NSAIDs |
| Adjuvant analgesics | Benzodiazopines, TCA, Corticosteroids |
| To relieve pain | analgesic |
| To assist in pain relief | adjuvant |
| 5th vital sign | pain |
| Pain assessment PQRST | precipitate, quality, radiation, severity, timing |
| Agonists | same action as; ex. morphine, Demerol, Codeine, Dilauded |
| Agonists/Antagonists | different at some receptors: Nubain, Stadol, Talwin (antagonist released when crushed) |
| Actions of Narcotics | interferes with pain impulses; depresses CNS and GI tract; euphoria |
| Used for severe non-productive cough | Codeine/Narcotics |
| Narcotic Antagonist | Narcan |
| Tx for narcotic withdrawal | Methadone, Buprenorphine (Suboxone) |
| ASA | aspirin: analgesic, anti-inflammatory, antipyretic, anti-thrombotic (binds irreversibly to platelets for the life of the platelet- 7-10 days) |
| ASA ADEs | tinnitus, Reye’s, N/V, bleeding, ulcers |
| NSAIDs use | analgesic, anti-inflammatory, antipyretic, anti-thrombotic (binds to platelets as long as NSAID is in circulation- 4-6 hours) |
| NSAIDs ADEs | CNS dizzy, drowsy, tinnitus, bleeding ulcers, renal |
| Acetaminophen use | analgesic, antipyretic, DOC fever/pain in children <12 |
| Acetaminophen main ADE | Hepatotoxicity |
| Tx for Hepatotoxicity | Mucomyst |
| Anti-anxiety and sedatives primary use | relaxation |
| Large doses of anti-anxiety and sedatives | induce sleep |
| Hypnotics primary use | sleep |
| Small doses of hypnotics | promote sedation |
| Stress response to threatening situation | anxiety |
| Inability to sleep | insomnia |
| Slowing of mental activity | sleep |
| Barbiturates classification | sedative-hypnotics and anti-convulsants |
| Barbiturates prototype | seconal, Phenobarbital |
| Interferes with REM sleep cycles | barbiturates |
| Benzodiazepines classification | anti-anxiety, anoxiolytic |
| Benzodiazepines prototype | Diazepam (Valium) |
| Does not interfere with REM sleep cycle | benzodiazepines |
| Other anti-anxiety meds | buspar, hydroxzine (vistaril) |
| Other sedative-hypnotics | choral hydrate, zolpidem (ambien) |
| Barbs, benzos, actions | depress CNS, skeletal muscle relaxation, sedative effect, anti-convulsant |
| Synergistic effect with alcohol | benzodiazepines |
| Antidote for benzodiazepines | flumazemil (romazicon) |
| SNS neurotransmitter | Norepinephrine |
| PSNS neurotransmitter | Acetylcholine |
| adrenergic effects | >HR, vasoconstriction peripherally, bronchodilator, dilates pupils, < GI activity, > BS and fatty acids, >sweat, CNS tension/anxiety |
| adrenergic uses | hypotension, shock, cardiac arrest, asthma |
| anti-adrenergic effects | <HR, vasodilatation or arterioles and veins, bronchoconstriction, constricts pupils, >GI motility, < VS, < UA ret to > flow, CNS depression, weakness, lethargy |
| anti-adrenergic uses | hypertension, angina, arrhythmias, MI, BPH, Raynauds, frostbite |
| Cholinergic effects | <HR, vasodilatation, bronchoconstriction, >secretions/salvation, constrict pupils, < IOP, > motility/secretions, >sweating, voiding |
| Cholinergic uses | UA retention, Myasthenia Gravis, Alzheimer’s, Glaucoma |
| Anti-cholinergic effects | >HR, bronchodilator, <secretions/salivation, dilate pupils, >IOP, < GI motility/secretions, < sweat, retentions, stimulates CNS: depression in large doses |
| Anti-cholinergic uses | antispasmodics, Parkinson’s, asthma, bradycardia, pre-op: < vagal stimulation |
| Positive chronotropic and inotropic | adrenergics |
| Refers to Arms and Legs | ALpha |
| Refers to cardiac function (1 heart) | beta 1 |
| Refers to pulmonary vessel effects (2 lungs) | beta 2 |
| Catecholamines | epinephrine, norepinephrine |
| Non-catecholamines | ephedrine, Sudafed |
| Used in IV infiltrations of adrenergics | regitine injection |
| Negative chronotropic and inotropic | adrenergic blockers |
| In motor nerves and skeletal muscles; muscle contraction | nicotinic receptors |
| In most internal organs; secretions | muscarinic receptors |
| Nicotinic and muscarinic receptors | fibers in vasovagul response |
| tachycardia, dyspnea, use of accessory muscles, hypoxia | respiratory distress |
| early- confusion, restlessness, >HR/RR; late- cyanosis, < BP/HR | hypoxia |
| Bronchodilators | adrenergic, anticholinergic, corticosteroids, leukotriene inhibitors, mast cell stabilizers |
| Leukotriene inhibitors | zyflo, accolade |
| Mast cell stabilizers | intal, tilade |
| Xanthines (ophyllines) prototype | aminophylline, theophylline, caffeine |
| Xanthine uses | asthma, chronic bronchitis, emphysema, neonatal apnea |
| Actions of xanthines | bronchodilate, CNS stimulate, >HR/RR, positive chronotropic, >gastric secretions |
| xanthines ADEs | tachycardia, palpitations, CNS: nervousness, restlessness, anxiety, tremors, HA, N/V, GI bleeding |
| Type I Allergic rxn | immediate hypersensitivity (Humoral response) |
| Type II allergic rxn | blood transfusions |
| Type III allergic rxn | complex; AI disorders |
| Type IV allergic rxn | delayed hypersensitivity; transplant rejection |
| antihistamine prototype | diphenhydramine (benadryl) |
| Histamine relief causes: | bronchoconstriction, cough, > capillary permeability and mucus production, stimulation of sensory peripheral nerve endings, dilation of capillaries |
| antihistamine actions | sedation, decreased seizure threshold, dry mouth/nose/throat, UA retention, anorexia, N/V, constipation, blurred vision, poss. paradoxical rxn |
| antitussives | narcotic- codeine, nonnarcotic- dextromethophran |
| expectorant | guaifenesin (robitussin) |
| mucolytics | normal saline and acetylcysteine |
| cold remedy makeup | antihistamine, decongestant, and analgesic |
| most commoon age for inhalant abuse | 15-16 |
| physiological adaptation to chronic use to avoid npleasant s/s if drug is stopped | physical dependence |
| feelings of statisfaction and pleasure | psychological dependence |
| blood alcohol levels | <0.05%- sober0.051%-0.149%-impairment (VT0.08%)>0.15-unquestioned impairment |
| 120 mg of ethanol per 1 kg of body wt OR 10 mL/hr | rate of alcohol metabolism |
| inactivated ETOH in GI tract | alcohol dehydrogenase |
| tx for alcohol withdrawal | benzodiazepines |
| tx for alcohol addiction | antabuse |
| tx for benzodiazapine abuse | romazicon |
| ethanol uses | beverages, dilutant base, destroy nerve fibers in chronic pain, appetite stimulant, astringent and antiseptic |
| methanol uses (isopropyl) | antiseptic, sponge baths |
| s/s of withdrawal | delirium tremors, agitation, anxiety, fever, sweating, nervousness, postural hypotension |
| #1 users of amphetamines (larger problem than heroin) | Supermoms |
| ETOH synergist, date rape drug, benzodiazepine | Rohyphenal |
| amphetamine made from pseudoephedrine cough medicine | MDMA/ecstasy |
| actions of amphetamines | >HR/BP/BMR/T, > libido (male impotence), mydriasis, paranoid schizophrenia, reduces fatigue, depresses appetite, >aggressiveness/competitiveness/alertness, enhances self-confidence |
| mydrasis | excessively dilated pupils |
| TU of amphetamines | narcolepsy, wt. loss, ADHD, depression |
| amphetamine prototype | ritalin |
| CNS stimulant more powerful than amphetamines | cocaine |
| cocaine effects | >HR/BP/BMR/T,dilated pupils, paranoid schizophrenia, reduces fatigue, depresses appetite, >aggressiveness/competitiveness/alertness, enhances self-confidence |
| assessment of cocaine addict | nasal congestion, wt. loss, declining social status, behavior changes, mood swings, needle tracts |
| "crack heart" | >HR/BP, MI, HTN crisis leading to CVA, sudden death |
| "crack lung" | pulmonary hemorrhage, <lung capacity, chronic inflamed throat, chronic cough, pneumonias |
| cocaine OD tx | no antidote, tx symptomatically |
| nicotine tx | nicotine patches, zyban (antidepressant), gum |
| uppers | stimulate |
| downers | depress |
| mind-altering drugs | distort reality |
| LSD | lysergic acid diethylamide |
| risk of injury from uncontrolled behavior with this drugs use | LSD |
| LSD tx | no antidote; quiet environment, reassurance, safety, keep body between patient and door |
| marijuana effects | dreamlike, confused, detached, aloof, relax, inner focused, no sense of time |
| DOC for 10-17 yo's and stilletto stoners | Marijuana |
| marijuana physiological effects | >HR, <IOP (TU for glaucoma), >appetite, <nausea (chemo pt.s) |
| drug used in the 40's to originally treat schizophrenia | LSD- lysergic acid diethylamide |
| microbe invades and multiplies; pathogenic | infection |
| may not have s/s of infection | colonization |
| bodily protective response to infection | inflammation |
| viable bacteria in blood stream | bacteremia |
| infection with multiple organ involvement | sepsis |
| bacteria once destroyed with antibiotics now resistance | acquired resistance |
| secondary infection from antibiotic use: ex. vaginitis, thrush, diarrhea | super infection |
| hospital acquired infection | nosocomial |
| infection result from a procedure | iatrogenic |
| sterile bodily areas | blood, CSF, urine synovial fluid, lower respiratory tract, musculoskeletal system |
| stops or inhibits growth of bacteria | bacteriostatic |
| kills bacteria | bacteriocidal |
| contributing factors of bacteria resistance | widespread use, interruption of tx, location, increased number of high risk patients |
| methicillin resistance staph aureus | MRSA |
| vancomycin resistant enterococcus | VRE |
| multi-drug resistant TB | MDR-TB |
| breaks in the skin, impaired blood supply, malnutrition, poor hygiene, suppression of normal flora, suppression of immune system, chronic disease, advanced age | factors that impair host defense |
| specific for particular organism | narrow spectrum |
| covers many types of organisms | broad spectrum |
| antidiarrheal BRATT | bananas, rice, applesauce, toast, tea |
| beta-lactum antibiotics | penicillin and cephalosporin |
| penicillin prototype | penicillin G |
| antibiotic used for many upper airway infections, syphyllis, and prophylaxis in valvular disease for dental work | penicillin |
| antibiotic assessment | culture and sensitivity, allergies, superinfection, renal and liver function |
| cephalosporin prototype | keflex |
| antibiotic for surgical prophylaxis, infections of: respiratory tract, skin and soft tissue, bones and joints, bloodstrea, urinary tract | cephalosporins |
| cephalosporins | antabuse AE with ETOH use |
| aminoglycoside prototype | garamycin (gentamycin) |
| uses for aminoglycosides | serious systemic infections, TB, bowel prep, tx of hepatic coma or hepatic encephalopathy |
| aminoglycoside toxicity | ototoxicity, nephrotoxicity, potentiates anesthetic neuromuscular blockers |
| works within the cell wall of gram negative bacteria | aminoglycodes; garamycin (gentamycin) |
| antibiotic that crosses the placenta; class C teratogenic, avoid diuretics | aminoglycosides CI |
| fluoroquinolone prototype | ciprofloxacin (cipro) |
| fluorquines uses | TB, anthrax, infections of: respiratory tract, GU, GI, bones, joints, skin and soft tissue |
| Floroquines patient teaching | inactivated by: Al, Mg, Fe, Zn; increase fluids, avoid sunlight, avoid high-impact exercise |
| tetracycline prototype | tetracycline (achromycin) |
| broad spectrum bacteriostatic | tetracycline use |
| DOC for tx of acne in adolescents | tetracycline |
| teratogenicity of tetracycline | hepatic necrosis in mother, effects bones and teeth in fetus, CI when lactating, class D |
| tetracycline patient teaching | avoid: Fe, Ca, Mg, Al; take with full glass of water, avoid sun, and report s/s of superinfection |
| sulfonamide prototype | sulfamethoxazole, trimethoprim (bactrim, septra) |
| DOC for UTI tx | sulfonamides |
| pyridium use | decrease pain upon urination until antibiotics kick in |
| used with sulfa drugs in UTI's that changes the color of urine to orange-red | pyridium |
| can cause kernicterus in late pregnancy; class B-D, <2mos. old, lactating women, renal failure | sulfa drugs CI |
| macrolides prototype | erythromycin |
| mostly excreted in bile | macrolides; erythromycin |
| metronidazole (flagyl) | used in C.Diff and colorectal sx |
| vancomycin | IV for severe infections: MRSA, C. Diff., ICU resistance |
| vancomycin AE | Red Men syndrome (histamine- patient turns red) |
| most antibiotics interfere with what form of birth control | the pill |
| high levels of bilirubin in the mother can cause jaundice in the fetus | kernicterus |
| CI for flu shot | fever, immunocompromised, egg allergy, Hg allergy, and hx of Guillan-Barre (Epstein-Barr) |
| T/F antivirals eliminate viruses | False, antivirals do NOT eliminate viruses |
| meds used for herpesvirus | acyclovir (zovirax) |
| meds for HIV & AIDs | AZT, Rescriptor, viracept |
| Herpesvirus type I | genital warts |
| Herpesvirus type II | shingles over dermatomes |
| meds for influenza | amantadine (symmetrel), rimantadine (flumadine) |
| medication used prophylactically if already exposed to flu virus to shorten disease course | tamiflu |
| AE of tamiflu | anorexia, N/V, hallucinations, seizures |
| purpose of antiviral medication | to relieve symptoms; NOT CURATIVE |
| increases the force of myocardial contraction | inotropics |
| Inotropics Prototype | Digoxin (Lanoxin) |
| SA node conduction | 60-100 bpm |
| located in R atrium | SA node |
| AV node conduction | 40-60 bpm |
| backup rate transmitter if SA node fails | AV node |
| Ventricle conduction | 20-40 bpm |
| percent of blood that is plasma | 55% |
| percent of blood that is solid particles | 45% |
| solid particles in blood | RBC, WBC, thrombocytes |
| HCT:HGB ratio | 3:1 |
| main nutrition in plasma that exerts osmotic pressure | albumin |
| HCT | M: 42-50%, W: 40-48% |
| HGB | M: 13-18, W: 12-16 |
| WBC count | 5,000 - 10,000 |
| Thrombocyte count | 100,000 - 400,000 |
| Digitalize "loading dose" | 0.75mg: 1.0 mg over 3 doses (b/c of 1st pass effect) |
| cardiotonic dependent on normal electrolytes | Digoxin |
| Digoxin action | positive inotropic, negative chronotropic, antiarrhythmic, indirect diuretic, >CO |
| K+ | 3.5-5.0 |
| increase in this electrolyte can lead to dig tox | Ca++ |
| decrease in these electrolytes can lead to dig tox | K+, Mg+ |
| Digoxin tx use | CHF, atrial arrhythmias, sinus tachycardias from SA node |
| CI for Dig use | V-tack, V-fib., heart block (2nd or 3rd degree) |
| Digoxin therapeutic level | 0.5 - 2 |
| diplopia | double vision |
| Dig tox antidote | Digibind |
| action of Digibind | binds with dig in system for fecal excretion |
| ADEs of Digoxin | Bradycardia, tachycardia, PVC (premature ventricular contractions), V-arrhythmias, blurred vision, diplopia, halos, N/V, anorexia |
| test before administering Dig | apical rate for full 60 sec. with stethoscope; hold if <60 |
| risks for Dig tox | calcium channel blockers (b/c >Ca++ levels), large loading/maintenance dose, hypokalemia, hypothyroidism, renal/liver failure, hypoxia, infants and elderly |
| group of individuals at increased risk for pretty much everything | elderly |
| used for outpatient tx of CHF | Milrinone (primacar) |
| four types of dysrhythmias | sinus (SA node origination), atrial (A. fib/flutter), nodal (AV node; aka junctional), ventricles (V. tack/fib) |
| without rhythm | antiarrhythmics |
| disease of rhythm | dysrhythmias |
| Na-K pump impulse propagation stages | 1. polarized or resting or steady state 2. depolarization or discharge state 3. repolarization or recovery state |
| ready state electrolyte movement | Na and Ca extra-cellular/K intracellular; resting |
| depolarization electrolyte movement | Na and Ca move intracellular/K extracellular; P wave and QRS |
| repolarization electrolyte movement | Na and Ca move back extracellular/K intracellular; T wave |
| Class I antiarrhythmics | Na Channel blockers |
| Class IA prototype | Quinidine |
| Class IB prototype | Lidocaine |
| Class IC prototype | Flecanide (Tambor) |
| Class II antiarrhythmics | Beta Adrenergic Blockers |
| Beta Adrenergic Blockers Prototype | Propranolol (Inderal) |
| Class III antiarrhythmics | K channel Blockers |
| K-channel Blockers prototype | Amiodarone (Cardarone) |
| Class IV antiarrhythmics | Calcium channel blockers |
| Calcium channel blocker prototype | Verapamil (Calan) |
| antiarrhythmic class that affects depolarization | Class I; Na channel blockers |
| class of antiarrhythmics that block SNS | Class II; beta adrenergic blockers |
| class of antiarrhythmics that slow potassium back out of cell and affect depolarization | Class III; K channel blockers |
| class of antiarrhythmics that slow Ca++ intracellular movement rate and affect repolarization | Class IV; calcium channel blockers |
| increases vagal tone of body and innervates the PSNS to decrease HR | Valsalva maneuver |
| non-pharmacological tx of arrhythmias | tx underlying disorder, valsalva or carotid artery massage, defibrillate, pacemakers, ablation |
| surgical removal of problem tissue | ablation |
| classes of antianginal medication | organic nitrates, beta adrenergic blockers, calcium channel blockers |
| organic nitrates prototype | nitroglyceride |
| actions of nitroglyceride | dilates veins- decreases preload dilates coronary arteries- increase myocardial flow dilates arterioles- decrease afterload |
| non-pharmacological therapy for angina | stop, rest, stop smoking, wt. loss, decrease fat in diet, relaxation, stress mgt. |
| sublingual | under tongue |
| calcium channel blocker prototype | verapamil (calan) |
| calcium channel blocker action | slows mvt of Ca++ into cell; coronary and periph. art. dilation; decrease afterload/myoc. contraction; neg. inotropic; conduction sys. is depressed; neg. chronotropic |
| Thiazide diuretics prototype | Chlorothiazide (Diuril) |
| Loop diuretics prototype | Furosemide (Lasix) |
| K+ Sparing diuretics prototype | Spironolactone (Aldactone) |
| Osmotic diuretic prototype | Mannitol (Osmitrol) |
| Thiazides, Loop and Osmotic diuretics | loses water, K+, Na and Cl |
| Diuretics used to treat HTN | thiazides, loop, and K+ sparing |
| diuretics used for edema and CHF | thiazides and loop |
| Diuretic used for rapid, immediate diuresis; used in renal diuresis | loop diuretics (lasix) |
| diuretic NOT for immediate diuresis | thiazides (diuril) |
| diuretic used in short term IV use | osmotic diuretics |
| diuretic used to tx liver disease; NOT in renal disease | K+ sparing (aldactone) |
| K+ sparing gains | retains K+ levels; NOT to be used with K supplements |
| diuretic used to decrease ICP, tx glaucoma, oliguria/anuria | osmotic diuretic (mannitol) |
| Diuretic CI if allergic to sulfa drugs | Thiazides |
| Diuretic that works better when Na intake is decreased to <2g/1800mg | Loop |
| Diuretic that is an aldosterone antagonist; prevents/stops action of aldosterone | K+ Sparing |
| sodium replacements base | K+; use can cause hyperkalemia if using K+ sparing diuretics |
| oliguria | <400 mL urine/24h |
| anuria | <100 mL urine/24h |
| 1L fluid; baseline for how much fluid getting off pt. | 2.2 lbs = 1 kg |
| HTN increases the risk for | MI, CHF, CVA and hemorrhage, renal disease |
| CO = | HR x SV |
| 'norm' CO | 80 x 70 = 5.6 L or 5600 mL |
| fast-acting regulation of BP | nervous and hormonal system |
| slow-acting regulation of BP | renal system; RAAS |
| decrease CO values | tachy: 120x30 = 3.6L brady: 40x90 = 3.6L |
| renal response to hypotension | decreased BP triggers baroreceptors to increase SNS stimulation; release renin |
| renin release; conversion of Ang I to Ang II | constricts arterioles to increase PVR, BP and afterload |
| renin release; secretion of aldosterone causing kidneys to hold on to Na and H2O | increases blood volume, CO, BP and preload |
| hypertension classification | systolic P > 140 mmHg diastolic P > 90 mmHg |
| prehypertension | 120-139/80-89 |
| primary or essential HTN | HTN with no direct cause; 90-95% of pt.s |
| secondary HTN | HTn as a result of renal/endocrine/CNS disease/disorders; AE of meds, Na retention |
| HTN effects | increases cardiac workload and causes arteriosclerosis |
| arteriosclerosis | thickening of arterial walls; hypertrophy; overworked muscle failure |
| atherosclerosis | plaque formation |
| main symptom of HTN | asymptomatic; usually found at random check-up |
| Stepped tx program for HTN | 1.lifestyle mods 2.diuretics 3.antiadrenergics 4.direct acting vasodilators 5.ACE inhibitors 6.ARBs 7.Ca channel blockers |
| antiadrenergics alpha 1 blockers prototype; BPH decrease sphincter tension; syncopy, 1st dose phenomenon, orthostatic hypotension | cardura |
| antiadrenergics alpha 2 agonists prototype; dilates peripheral arterioles, decrease PVR, fluid retention | methyldopa (aldomet) |
| antiadrenergics alpha-beta blockers prototype; bronchoconstriction | coreg (carvedilol) |
| antiadrenergics beta blockers prototype; inhibits SNS, decreases HR/CO/Renin | propranolol (inderal) |
| direct acting vasodilators prototype; decreases PVR | hydralazine (apresoline) |
| syncopy | fainting |
| Angiotensin Converting Enzyme (ACE) Inhibitor prototype | Captopril (Capoten) |
| Angiotensin II Receptor Blockers (ARBs) prototype | Losartan (Cozaar) |
| Calcium Channel Blockers prototype; dilate peripheral A's | Verapamil (Calan) |
| forward failure (L ventricular failure) | cannot push blood forward; hypoxia: oxygenated blood not reaching tissues |
| backward failure (L ventricular failure) | L ventricle build-up of blood; increased pressure in L atrium; pulmonary vasculature back-up; pulmonary hypertension; fluid out of capillaries and into alveoli leading to PE/congestion and decrease in oxygen exchange (tachypnea) |
| CHF caused by MI/HTN | anything that decreases the pumping ability or the workload of the heart; <CO |
| <CO compensatory mechanisms | increased symptomatic activity (increase workload), activation of RAAS (increase afterload and preload), ventricular hypertrophy |
| manifestations of pulmonary congestion/edema | rales, crackles, tachypnea |
| goals of drug therapy for CHF | improve myocardial function; alter compensatory mechanisms |
| drug therapy for CHF | ACE inhibitors, Diuretics, Cardiotonics, Beta Blockers (only Carvedeloll and Metoprolol), Vasodilators |
| Cardiotonics prototype | Digoxin (increase force of contractility while neg. chrono) |
| venous dilators prototype | nitrates (decrease preload) |
| arterial dilators prototype | hydralazine (decrease afterload) |
| prevent venous clots | anticoagulant |
| antiplatelet | prevent arterial thrombus |
| thrombolytic | lyse thrombi |
| anticoagulant meds | heparin, fragmin/lovenox, coumadin |
| Heparin antidote | Protamine Sulfate |
| Monitor PTT labs | Heparin |
| low molecular weight heparins | fragmin and lovenox |
| Coumadin antidote | Vitamin K |
| Monitor PT/INR labs | Coumadin |
| Antiplatelet meds | ASA, NSAIDs, Ticlid, Plavis, Glycoprotein 11b/111a Receptor Antagonists, Miscellaneous (Dyprimadole/Persantin) |
| Glycoprotein 11b/111a Receptor Antagonist prototype; IV thrombus prev/tx | Aggrasat |
| Thrombolytic prototype | Alteplase (Activase) |
| goal of thrombolytics | reestablish blood flow and prevent tissue damage |
| Alteplase (Activase) antidote (thrombolytics) | Amicar |
| Hyperlipidemia tx | Statins, Bile acid sequestrants, fibrates, niacin |
| Statins prototype | Lipitor |
| Statins ADEs | rhabdomyolysis, hepatotoxicity |
| decrease cholesterol production | statins; lipitor |
| rhabdomyolysis | breakdown of muscle fibers resulting in the release of muscle fiber contents (myoglobin) into the bloodstream |
| Bile acid sequestrants prototype | Questran |
| binds with BA in intestine to be secreted so that lipis cannot be absorbed | Bile acid sequestrants; questran |
| Fibrates prototype | Lopid |
| increases triglycerides >1000; ADE GI dia. gallstones | Fibrates; lopid |
| Niacin prototype | Nicotinic Acid |
| OTC dosage too low to be effective; ADE red skin, pruritis | Niacin |
| HDL goal | >60 |
| LDL goal | <100 |
| triglycerides goal | <200 free fatty acids in adipose tissue |
| may increase cholesterol/blood lipids | steroids and beta blockers |
| disordered thought process | psychosis |
| sensory perception of people or objects that are not present | hallucination |
| false belief without reason or evidence | delusions |
| chronic increase of dopamine and/or serotonin activity | schizophrenia |
| minor tranquilizers | benzodiazepines (valium); anoxiolytics |
| major tranquilizers | antipsychotic drugs |
| Typical or 1st generation phenothiazines prototype | Chlorpramazine (Thorazine), Stellazine, Compazine, Mellaril, Pheregan, Haldol |
| occupy or block dopamine receptors; increased concentration in brain/body tissues; no phys./psych. dependence | Phenothiazines; Chlorpramazine (Thorazine) |
| fast-acting chemical restraint | phenothiazines; Haldol |
| Phenothiazines uses | schizophrenia, antiemetic, intractable hiccups, brain impairment from TBI, trauma, tumor, ETOH withdrawal, CVA; hyperarousal states |
| Extra Pyramidal Effects of Phenothiazines (can be permanent) | diskinesia, dystonia, pseudoParkinsonism, tardive |
| fast mouth movements; tongue in/out; blow cheeks | dyskinesia |
| involuntary chronic face movement | tardive |
| pseudoParkinsonism traits | pill-rolling finger movements; shuffling gait |
| bizarre movement; back/neck rigidity; sustained muscle contractions cause twisting and repetitive movements or abnormal postures | dystonia |
| Phenothiazines ADEs | ANS Depression: antiadrenergic effects, anticholinergic effects; CNS depression, extra pyramidal effects, hematological: agranulocytosis, leukopenia |
| decreased WBC count; prone to infection | leukopenia |
| phenothiazines decrease BP/HR; lethal combination with what drug | epinephrine; leads to cardiac arrest |
| Atypical or Non-phenothiazines prototype | Clozapine (Clorazil) |
| 1st DOC for schizophrenia tx | Clozapine (Clorazil); blocks both dopamine and serotonin receptors |
| ADEs of Clozapine (Clorazil) | Agranulocytosis and increased blood sugars (much less than phenothiazines) |
| affective disorder of all age groups; most common illness | depression |
| lack of life rhythm; chronic type of depression in which a person's moods are regularly low | dysthymia |
| neurotransmitters involved in depression | norepinephrine and serotonin |
| endocrine factors that affect depression | thyroid, DM |
| Primary Depression | no identifiable cause; effects mood, energy, indecisiveness, concentration, life interest, sleep |
| Secondary Depression | R/t meds, alcohol, environmental stress, antiarrhythmics, beta-blockers, birth control pills, opiates, birth, death, divorce, CVA |
| possible routes of tx for depression | MAOIs, TCAs, Lithium, SSRIs |
| Monoamine Oxidase Inhibitors (MAOIs) prototype | Marplan, nardil, Parnate |
| amount of time before clinical improvement is seen with MAOIs | 1-2 weeks |
| what foods block/deactivate the absorption of MAOIs | food with tyramine; aged foods, cheeses, wines, beers, pickled products, smoked meats, caffeine, yogurt, sour cream, chocolate |
| sensation of numbness or tingling on the skin; impaired circulation | paresthesia |
| MAOIs ADEs | impotence, HTN crises, paresthesias, sedation/insomnia, orthostatic HTN; anticholinergic DRY effect |
| meds used to treat bipolar disorder | MAOIs, TCAs |
| MAOIs action | enzyme transmits neurotransmitters at receptor sites; decreases metabolism; increases serotonin/dopamine |
| Trycyclic Antidepressants (TCAs) prototype | Elavil |
| TCAs action | blocks reabsorption of serotonin, norepinephrine, and some dopamine |
| onset timeline of TCAs | 10-30 days |
| TCAs ADEs | orthostatis HTN, dysrhythmias, impotence, leukopenia, sedation, anticholinergic effects |
| drug used in the 1800s to treat gout | lithium |
| used to treat bolemia, phobias, neurogenic pain | TCAs, Elavil |
| Lithium use | bipolar: manic/depression, bolemia, cluster HAs |
| Lithium prototype | Lithium |
| onset timeline of Lithium | 6 days |
| Lithium biotransformation | not metabolized; entirely excreted by kidneys |
| Lithium ADEs | GI upset; metallic taste, wt. gain; tremors, ataxia, incoordination, polyuria, polydipsia, leukocytosis, sodium imbalance |
| Sodium effect on Lithium; reabsorbed in proximal tubules | >Na- <Lithium circulating <Na- >Lithium absorption leading to toxicity |
| Lithium monitoring difficulties | therapeutic vs toxic levels for each individual |
| Selective Serotonin Reuptake Inhibitors (SSRIs) prototype | Prozac, Zoloft, Paxil |
| antidepressant DOC; Px >than all others combined | SSRI's, Prozac |
| SSRI advantages | few AEs, tolerated, increased compliance, one dose daily, difficult to OD |
| SSRI uses | depression, OCD, bolemia |
| SSRIs ADEs | few: skin rash more/less over time, minor GI nausea, anorexia, wt. loss (loss of appetite), CNS stim. anxiety |
| special considerations with antidepressants | suicide watch b/c of depression for first 3 weeks or px; will subside over time (teens) |
| SNRIs action | block reuptake of norepinephrine and serotonin |
| Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) prototype | Cymbalta, effexor |
| antidepressants summary | effective in depression tx, significant 1st pass effect, interact with many other drugs |
| pre-op considerations for antidepressants | taper dose and d/c one week pre-op, resume when pt. is taking PO fluid and food; interaction with many pain meds/anesthesia |
| antidepressants pt. teaching | avoid hazardous activity, alcohol, compliance, onset, medic alert bracelet, check before ALL OTC Meds b/c of interactions |
| episode of abnormal brain electrical activity | seizure |
| sustained contractions; increased muscle tone | tonic |
| jerking movements | clonic |
| epilepsy | abnormal EEG; w/w of seizure activity |
| one seizure right after another without regain of consciousness between | status epilepticus |
| breathing, but not/semi- responsive | postictal state |
| effects of status epilepticus | hypoxia, cyanosis, brain damage, BP spike/drop, arrhythmias |
| status epilepticus tx | benzo IV; breaks sz cycle |
| major inhibitory neurotransmitter in brain | gamma-aminobutyric acid (GABA) |
| Antiepileptic Drugs (AEDs) prototype and DOC | Phenytoin (Dilantin) |
| seizure mechanisms | block mvt of Na into nerve cell (dcr response to stimuli/excitability; incr threshold of sz activity); enhance activity of GABA |
| AEDs also used for nerve pain | Carbamazepin (Tegretol), Clonazepam (Klonopin) |
| AEDs ADEs | ataxia, lethargy, N/V, gingival hyperplasia |
| gingival hyperplasia | overgrowth of the gingiva (gum tissue) |
| are padded tongue blades used to provide an airway in seizing patients | no! you want to break their teeth or get your fingers cut off? silly |
| number one priority in a seizing patient | protect from injury |
| seizure interventions | observe and record movements, lower to floor, pillow/blanket under head, loosen ties/scarves/necklaces, keep space, let go (don't hold down), turn to side to drain saliva, talk and reorient calmly after |
| used in animal hospitals to increase appetite post-op | long acting barbs; phenobarbital |
| will precipitate when mixed with dextrose | no dilantin in dextrose |
| given IV; mixed with saline only | dilantin |
| metabolic changes in DM | changes in metabolism of CHOs, fats, and protein that increase blood sugars |
| vascular changes in DM | atherosclerosis and changes in microcirculation |
| leading cause of blindness in U.S. | retinopathy secondary to DM |
| Type I DM | no insulin production; AI disease destroys beta cells; insulin-dependent; early/sudden onset; harder to control |
| Type II DM | decreased insulin production and/or resistance; any age/gradual onset |
| Diabetes Mellitis (DM) s/s | 3 P's: polyuria, polydipsia, polyphagia |
| increased output | polyuria |
| increased thirst | polydipsia |
| increased hunger | polyphagia |
| insulin therapy goals | BS 70-110; prevention complications r/t hyperglycemia; prevent hypoglycemia |
| exogenous insulin | added or administered; put in |
| indogenous insulin | self-made; original |
| first course of tx with Type II DM | dietary counseling, exercise |
| IV tx for hyperkalemia | VI dextrose + insulin; forces K+ intracellularly; temporary fix until other 'cure' |
| cold and clammy | needs candy |
| hot and dry | too high |
| s/s of hypoglycemia | tachycardia, palpitations, diphoresis, cool, clammy skin, tremors, shaking, confused, irritable; need sugar |
| s/s of hyperglycemia | 3 P's, dry skin, infections, wounds that won't heal |
| type of insulin that should NOT be mixed with any other insulin | glargine (LANTUS) |
| Rapid acting insulin (clear) | Humalog (Lispro) |
| Short acting insulin (clear) | Regular "R" |
| Intermediate acting (cloudy) | NPH "Humulin N", Lente "Humulin L" |
| Long acting (cloudy) | Ultralente "UL" |
| Long acting (clear) | glargine (Lantus) |
| Rapid acting insulin onset, peak, duration | 10-15 min, 1h, 3h |
| rapid acting insulin indicated | rapid reduction of BS |
| short acting insulin onset, peak, duration | 1/2-1h, 2-3h, 4-6h |
| short acting insulin indicated | give 20-30 min. ac (before meals) |
| intermediate acting insulin onset, peak, duration | 3-4h, 4-12h, 16-20h |
| intermediate acting insulin indicated | give pc (after meals); to cover subsequent meals |
| long acting insulin (cloudy) onset, peak, duration (UL) | 6-8h, 12-16h, 20-30h |
| long acting insulin use | control FPG; provide relatively constant level of insulin and act as a basal insulin |
| long acting insulin (clear) onset, peak, duration (glargine) | 1h, no peak, 24h |
| label written out because of confusion between u and 0 | units |
| only insulin that can be given IV | Regular Insulin |
| when mixing insulin types | clear to cloudy |
| insulin injection patient teaching | clean, dry, rotate site |
| impaired insulin production oral hypoglycemics action | stimulate the production of insulin from the pancreas |
| class of oral hypoglycemics with cross sensitivity to sulfa antibiotics | sulfanylureas |
| oral hypoglycemics use and pregnancy | not used in pregnancy; can lead to fetal hypoglycemia and death; gestational diabetes controlled with insulin |
| oral hypoglycemics prototype | Glucotrol (glipizide) |
| Impaired insulin production meds | Sulfanylureas: Glucotrol (glipizide), Diabinase, Tolinase, Micronase (glyburide); Meglitinidines: Prandin |
| decreased sensitivity of the tissues to insulin | insulin resistance |
| insulin resistance meds | Thiazolidines or Glitazones: Actos, Avandia; Diguanide: Glucophage (metformin); oral alpha glucosidase inhibitors: precose, glyset |
| insulin resistance med prototype | glucophage (metformin) |
| glucophage (metformin) CI | use when having scans with contrast dye; combination causes sever RF/death; stop 48h before test; use temporary insulin |
| increased muscle in DM | increases utilization of insulin effectiveness |
| 3 hormones produced by thyroid gland | Thyroxine (T4) Triiodothyromine (T3) Calcitonin |
| action of thyroid hormones | controls cellular metabolism; regulates BMR; required for growth and development |
| iodine deficiency that results in enlargement of the thyroid gland | goiter |
| congenital hypothyroidism | creatinism |
| Hypothyroid Medication | Synthroid |
| Synthroid therapeutic action | Increases: HR, Body Temp, Activity level, and appetite to WDL; acts on thyroid to increase BMR; usually taken for life once started |
| Hypothyroidism s/s (too little Synthroid or too much Tapazole) | decrease in: HR, Body Temp, activity level, and appetite; wt. gain, but eat little |
| Hyperthyroidism s/s (too much Synthroid or too little Tapazole) | excessive: HR, Body Temp, activity level, appetite; wt. loss, but eat lots |
| Hyperthyroid Medication prototype | Tapazole, Propylthiouricil (PTU) |
| hallmark of hyperthyroidism | exophthalamus: protruding eyeballs |
| protruding eyeballs | exophthalamus |
| medications that stop the release of thyroid hormones before surgery | Saturated Solution of Potassium Iodide (SSKI), Lugol's |
| adrenal cortex hormones | androgens, estrogens |
| adrenal medulla hormones | epinephrine, norepinephrine |
| mineral corticoids | aldosterone; conserves Na and H2O |
| Addison's Disease | decreased aldosterone levels: <Na, <H2O, >K |
| Cushing's Disease | increased aldosterone levels: >Na, >H20, <K |
| Glucocorticoids "Steroids" actions | CHO metabolism (makes cells insulin-resistant, >BS), supresses immune system, decreases NS excitability, mood changes, GI ulcers/bleeding, muscle wasting, hypokalemia, osteoporosis, edema, HTN, incr resp to bronchodilators |
| long term steroid use effects | fat redistribution, "moon face", "buffalo hump", rounded body with thin limbs |
| ways to decrease ADEs of glucocorticoids | local use (topic agents), short course, taper dose to prevent adrenal shutdown, ADT or double dose every other day for chronic use |
| anti-inflammatory steroid; prototype; also for GI disorders | Prednisone |
| neurological steroid | decadron; decreases cerebral edema |
| allergic disorder steroid | medrol; with epi in severe rxns |
| endocrine disorders steroid | cortisone; tx of Addison's |
| immunosuppressant steroids | prednisone, cortisone |
| cautious steroid use with | pregnancy, DM, peptic ulcer disease, renal insufficiency, psychosis, >BP, CHF |
| CI for steroid use | systemic fungal infections, TB |
| blood in stool; us. from bleeding ulcers | occult blood |
| Anabolic Androgen Steroids (AAS) uses | stimulation of bone marrow and sexual development, palliative tx, and tx of tisue wasting |
| developed after WWII to build up concentration camp survivors | AAS- anabolic androgen steroids |
| types of AASs | oil based- 'safer', but 6-9 mos. to clear body water based- mor AEs, but cleared from body within 1-2 days |
| Reversible ADEs of AASs; s/s stop when drugs stopped | acne, aggressiveness, HTN, sterility, dysuria secondary to male prostatic enlargement |
| Irreversible ADEs of AASs | impotence, baldness, gynocomastia, stunted long bone growth, enlarged clitoris, menses disruption, W: hair growth/deeper voice, psychological changes/temper, heart disease, liver cancer/cell destruction |
| increased size of breast tissue | gynocomastia |
| steroid rage | psychological changes assoc. with AASs; anger, temper, aggressiveness/appetite for food and sex, destructive behavior |
| effects when AASs are withdrawn | lose muscle mass, depression, lethargic, weakness, turn to others for comfort |
| Human Growth Hormone (HGH) | taken from cadavers to increase height |
| blood transfusions in sports | used in high altitude competition; increases RBCs to increase oxygen carrying capacity |
| "brake drugs" | stop estrogen production in females; commonly used in gymnastics and figure skaters to delay puberty changes; hips/breasts affect balance |
| beta blockers in sports | decrease HR; more controlled aiming; trigger between heartbeats |
| diuretics in sports | used to make weight; jockeys, wrestling, weight lifting; can cause hypokalemia in high doses |
| areas most susceptible to peptic ulcer disease | esophagus, stomach, duodenum |
| peptic ulcer disease process | areas exposed to HCl- acid and pepsin; inflammation, erosion, ulcer |
| Gastro-esophageal Reflux Disease (GERD) | stomach content relapses up into esophagus |
| causes 75% of gastric ulcers and 90% of duodenal ulcers | Helicobacter pylori (H. pylori) |
| doctor who studied the effects of hand washing after observing rates of purpura fever in babies delivered by docs (more)vs. midwives (less) | Semmelweiss; washing hands decreased purpura fever cases in babies delivered by docs |
| stress, trauma, major sx, burns, shock, TBI, illness action on GI tract | decreases blood flow to GI tract; predisposing pt. to ulcers/GERD |
| medications that can cause ulcers/GERD | NSAIDs, ASA, steroids |
| GI tract meds for cell destruction | gastric acid (HCl): acetylcholine, histamine II pepsin, H. pylori |
| GI tract meds for cell protection | mucus, dilution of HCl-, tight cardiac sphincter, cytoprotective prostaglandiins, alkalinization |
| types of anti-ulcer meds | antacids, ulcer adherent, histamine 2 receptor blockers, proton pump inhibitors, H. pylori agents |
| OTC alkalizing agents; neutralize acid | Antacids |
| Aluminum Hydroxide Antacid | Amphogel; quick-acting withing minutes, but constipating |
| Magnesium Antacid | Milk of Magnesia; can cause diarrhea |
| Aluminum and Magnesium Antacids | Gelusol, Maalox, Mylanta, Di-Gel |
| Sodium Bicarbonate Antacids; high in sodium; CI in HTN and Na-restricted diet | Alka-Seltzer and Bromo-Seltzer |
| Calcium Carbonate Atacid | Tums |
| Tums AE | acid rebound when stop taking; need more once start |
| therapeutic effects of antacids | chemical neutralization, decrease epigastric burning pain, prevent and tx ulcers/GERD |
| antacids interventions | take with full glass of water to get past esophagus, shake before administering (contents precipitate out), not to be given with other meds (many interactions), give 1h after meals (decr effectiveness on empty stomach) |
| Ulcer adherent prototype | Sucralfate (Carafate) |
| cumbersome schedule of sucralfate | 1-2h ac and hs; on empty stomach 4-8 wks duration |
| ulcer adherent action | local; adheres to site of ulceration/paste |
| ADEs of sucralfate ulcer adherent | N, constipation, metallic taste, dry mouth |
| Histamine II receptor Blocking Agent prototype | Tagamet |
| Histamine 1 | bronchoconstriction, edema, redness, pain (antihistamines only work on H1) |
| Histamine 2 | increases gastric acid production; only in stomach |
| action of H2 blockers; tagamet | stop H2 release; decreases amount and acidity of gastric juices |
| Histamine 2 receptor blocking agents ADEs; interventions | elderly mental confusion, N/D; quit smoking (smoking >HCl prod), stress, given without regard to meals |
| Proton Pump Inhibitor prototype | Prilosec, Prevacid, Nexium, Protonix |
| proton pump inhibitor DOC for ulcer tx | Prevacid |
| proton pump inhibitor action | prevent or stop 'pumping' or release of gastric acid |
| H. pylori agents combination | proton pump inhibitor (prevacid or an H2 blocker) and antibiotics: 2 of 4: amoxicillin, biaxin, flagyl, tetracycline |
| ingredients of a Previpak; H. pylori agent | 1 Prevacid, 2 Amoxicillin, 1 Biaxin |
| mild effect on GI tract for soft-formed stools | laxatives |
| stronger GI effect for liquid to semi-liquid stool | cathartic |
| bulk forming laxatives | Metamucil, Fibercon |
| metamucil, fibercon | adds bulk to increase peristalsis; acts within 24 h; adds fiber to diet |
| surfactant or stool softeners; no laxative effect | Colace |
| Saline Cathartic | Fleets, GoLYTELY |
| Fleets, GoLYTELY | inceases osmotic pressure for rapid bowel cleaning (before colonoscopy/sx); draws water into bowel to increase peristalsis |
| Irritant or stimulant cathartic | Cascara, Senokot, Dulcolax |
| Senokot, Dulcolax | irritates the GI mucosa to pull water/fluid into bowel; incr peristalsis/diarrhea; strongest and most abused; quicker than bulk forming; works within a few hours |
| Lubricant laxatives | Mineral Oil |
| Mineral oil | lubricates the intestines; decreases absorption of water/nutrients; coats BM on way through; works within 8h |
| Colace | softens stool to prevent straining/valsalva maneuver; used esp. pt. with MI, TBI, neuro, CVA |
| leaches electrolytes through bowel cleaning | enemas |
| for bowel regularity | need fiber from diet, exercise, water, fluids |
| risks for constipation | immobility, narcs, pain, hospitalization |
| recommended amount of fiber | 25g/day; avg Am gets 9-11g/day |
| expulsion of semi-/liquid stool | diarrhea |
| anti-diarrheal; nonspecific therapy: acute, chronic, ST, LT, mild, severe | opiate derivatives: Paragoric, Lomotil, Imodium Misc: Pepto-Bismol, Kaopectate Anticholinergics: Lomotil |
| anti-diarrheal; specific therapy | Antibiotics, Digestive Enzymes |
| diarrhea assesment | skin turgot, wt., I/O, #/looseness of stools |
| Probiotics | Lactobacillus |
| tx of N/V; better at preventing than treating | anti-emetics; compazine, zofran |
| anti-emetic assessment | bowel sounds; rule out obstruction |
| anti-emetic tx | phenothiazines: thorazine, compazine, phenergen; antihistamines; SSRIs: zofran, kytril; benzo's: ativan, valium |
| anti-emetics for motion sickness | antihistamines; vistaril, dramamine, antivert |
| benzodiazepines part of anti-emetic multidrug regime | promote relaxation and decrease in N/V |
| anti-emetic most often used with chemotherapy patients | SSRI, zofran; 1/2h drip before chemo |
| DOC for ca URI | zithromax; macrolides |
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