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Pharmacology Exam 2
| Question | Answer |
|---|---|
| What is the MOA of Metronidazole (Flagyl)? | Eradication of H. Plyori |
| Explain the nursing care for Metronidazole (Flagyl) | 1. Used w/ antibiotics for 14 days 2. Give w/ food 3. N/D 4. Alcohol rules |
| Interactions of Metronidazole (Flagyl) and Alcohol | 1. Don't have alcohol for 72 hours after last dose 2. Cause tachycardia, SOB, N/V, flush & redness of skin |
| What is the MOA of Sucralfate (Carafate)? | Stomach acids changes Sucralfate into protective barrier and adheres to the ulcer |
| Explain the nursing care for Sucralfate (Carafate) | 1. Take 30min before antacids 2. Take QID, 1 hr before meals & hs 3. Do not chew or crush |
| Explain the nursing care for Erythropoietic growth factor | 1. Baseline BP & monitor frequently 2. SubQ & IV based on weight 3. Don't mix medications in syringe 4. Dosage 3x week 5. Monitor iron levels 8. Monitor Hgb & Hct twice weekly till in range 6. Prophylactic anticoagulant |
| Hgb Levels | M: 14-17 W: 11-15 |
| Hct Levels | M: 42-54 W:36-48 |
| Signs and Symptoms of Gradual Onset Hypoglycemia | 1. Headache 2. Tremors 3. Weakness 4. Lethargy 5. Disorientation |
| Signs and Symptoms of Sudden Onset Hypoglycemia | 1. Tachycardia 2. Diaphoresis 3. Palpations 4. Shakiness |
| What can mask the S/S of Hypoglycemia? | Beta Blockers |
| What blood glucose levels qualify as Hypoglycemia? | Less than 70 mg/dL |
| What can cause Hypoglycemia? | 1. Toxic dose of insulin 2. Too little food 3. Vomiting/ Diarrhea 4. Alcohol intake 5. Strenuous exercise 6. Childbirth |
| 1-4 year olds are energized 24 long hours nonstop | Long Acting O: 1-4 hr P:No peak D: 24 hr Lantus (Glargine) Levemir (Determir) |
| What is the Gold Standard for Sulfonylureas? | Glyburide (DiaBeta, Glynase) |
| MOA of Sulfonylureas | Insulin release form the pancreas; can increase tissue sensitivity to insulin over time |
| Sulfonylureas Nursing Care | 1. DC pregnancy/lactation 2. Avoid alcohol 3. NSAIDS additive effect of hypoglycemia 4. Beta blockers mask hypoglycemia 5. Best taken 30 min before breakfast |
| If patient is taking a beta blocker and oral anti diabetic what nursing interventions need to be in place? | 1. Monitor glucose regularly 2. Don't rely on symptoms of hypoglycemia 3. Maintain a regular eating schedule |
| MOA of Pioglitazone (Actos) | Increases cellar response to insulin by decreasing insulin resistance Increases glucose up take and decrease glucose production |
| Black box warning for Pioglitazone (Actos) | Warning for HF and at increased risk for MI |
| Side effects of Pioglitazone (Actos) | 1. Fluid retention 2. Elevation in LDL 3. Hepatotoxicity 4. Ovulation in women who were not ovulating |
| When do you take Repaglinide (Prandin)? | TID 30 min before meal |
| Nursing Care for Acarbose (Precose)? | 1. take with first bite of food, TID 2. Dont double doses |
| MOA of Acarbose (Precose) | Slows carbohydrate absorption and digestion |
| Gastrointestinal side effects of Acarbose (Precose) | 1. Abdominal distention 2. cramping 3. hyperactive sounds 4. diarrhea 5. excessive gas |
| MOA of Metformin (Fortamet, Glucophage) | 1. Reduce production of glucose from liver 2. Increase glucose uptake and use in fat & skeletal muscles 3. Decrease glucose absorption in GI tract |
| Nursing Care of Metformin (Fortamet, Glucophage) | 1. Avoid alcohol 2. DC 24-48 before procedure; continue 48 hr after procedure 3. Fasting blood glucose levels every 3 months 4. Can cause false positive for urine ketones |
| What are two deficiencies that Metformin (Fortamet, Glucophage) can cause? | Folic acid and Vitamin B12 |
| Ca Level | 6-10 |
| Mg Level | 1.5-2.5 |
| Phosphorus Level | 3.5-4.5 |
| What type of Laxative is Magnesium Sulfate? | Saline |
| Type 1 Diabetes | Insulin Dependent; Caused by autoimmune destruction of pancreatic beta cells creating a lack of insulin secretion |
| Signs and Symptoms of Type 1 Diabetes | 3 P's- Polyuria, Polyphagia, Polydipsia Hyperglycemia, Glucosuria, Fatigue, Weight Loss |
| Type 2 Diabetes | Insulin resistant/not enough; target cells have become unresponsive to insulin |
| Neil Patrick Harris show is on 1-2 times a week for 4-14 hrs. 18-24 yr olds love it especially on a cloudy day | Immediate Acting; NPH O: 1-2hr P: 4-14 D: 18-24 hr Appearance is cloudy |
| Patient Education for Oral Anti-diabetics | 1. Dietary plan 2. Always carry quick acting carbohydrate 3. Report any edema, dyspnea, or excessive fatigue 4. Beta blocker = frequent monitoring 5. Take 30 min before first meal 6. Can decrease effectiveness of oral contraceptives |
| -prazole | Proton pump inhibitors |
| MOA of Proton pump inhibitors | Block acid production and reduce gastric acid secretion |
| What are some serious long term effects of Proton pump inhibitors? | 1. C. Diff 2. Osteoporosis/fractures 3. Rebound acid hyperscretion |
| How long is an active ulcer treated with Proton pump inhibitors? | 4-8 weeks |
| -vastatins | HMG-Coa Reductase inhibitors |
| MOA of HMG-Coa Reductase inhibitors | 1. Decrease LDL & VDL cholesterol 2. Increase production of HDL 3. Promote vasodilation 4. Decrease plaque inflammation |
| Nursing Care of HMG-Coa Reductase inhibitors | 1. Give with evening meal 2. Avoid alcohol and grapefruit juice 3. Can cause myopathy and hepatoxicity |
| Prototype of Cholesterol Absorption inhibitor | Ezetimbie (Zetia) |
| Nursing Care of Cholesterol Absorption inhibitor | 1. Take 2 hrs before or 4 hrs after bile sequestrates 2. Follow low fat, low cholesterol diet |
| MOA of Cholesterol Absorption inhibitor | Inhibits reabsorption of cholesterol secreted in bile and absorption of cholesterol from food |
| MOA of Gemfibrozil (Lopid) | Decrease LDL and Increase HDL |
| Nursing Care for Gemfibrozil (Lopid) | 1. Observe for gallstones - RUQ pain, bloating 2. Take 30 min before breakfast or dinner |
| -tidine | Histamine 2 receptor antagonist Cimetidine (Tagmet) |
| Nursing care for Histamine 2 receptor antagonist | 1. Don't take anaitcds 1 hr before or after 2. Full effect = several days/weeks 3. BID until healing then maintenance dose hs 4. Watch for occult GI bleeding 5. increase fiber/fluids 6. monitor for effectiveness |
| Why do you use Histamine 2 receptor antagonist ? | Use in conjunction with antibiotics to treat ulcers caused by H. Pylori |
| S/S of hyperglycemia | 1. Dry mouth 2. Increased thirst 3. Weakness 4. Headache 5. Blurred Vision 6. Frequent urination |
| What patient teaching needs to be done with Insulin and exercise? | Exercise should occur 1 hr after a meal or after have a 10-15 g carbohydrate snack; Prolonged exercise needs to have a small frequent carbohydrate every 30 min to prevent hypoglycemia |
| How often do you rotate injection sites for insulin? | Weekly |
| What is the main concern with Bile acid Sequestrates? | They interact with a lot of things |
| When to take Bile acid Sequestrates? | 1 hr before or 4 hrs after other meds and take with 8 oz of water or food |
| Prototype for Bile acid Sequestrates? | Colesevelam (Welchol) |
| Regular shifts are 8 hrs but with 30-60 extra staff we have shorter shifts that last 2-4 hr | Short Acting O:30-60 min P: 2-4 hr D: 8 hrs Regular (Humulin R, Novolin R) |
| Rapid roller coasters only take 15-30 min and the lines are 1 hr but it feels like 3-5 hrs | Rapid Acting O:15-30 min P:1 hr D: 3-5 hr Humalog (Lispro) Novolog(Aspart) Apidra(Glulisine) |
| -azine | Dopamine Antagonists |
| MOA of Dopamine Antagonists | antiemetic effects results from blocking dopamine receptors in the medulla oblongata |
| Uses of Dopamine Antagonists | Prevent emesis r/t chemotherapy, toxins, and postoperative recovery |
| Nursing Care for Dopamine Antagonists | 1. Obtain orthostatic BP, HR, RR, ECG 2. Monitor QT wave changes 3. Decrease noxious stimuli (strong odors, rapid changes in position). 4. Limit physical activity during active periods of N/V |
| Nursing Care for Dopamine Antagonists Continued... | 5. Encourage fluid increase gradually with small sips & clear liquids 6. Take 30-60 min before anticipated nausea inducing travel, drug, before breakfast |
| Side effects of of Dopamine Antagonists | 1. EPS 2. Hypotension 3. Sedation 4. Anticholinergic effects |
| Anticholinergic Effects | 1. Dry mouth 2. Constipation 3. Urinary retention |
| MOA of Osmotic Laxatives | Draw water into the intestine to increase the mass of stool, stretching muscles, resulting in peristalsis |
| Why would you give someone a low dose of Osmotic Laxatives? | Prevent painful elimination (episiotomy or hemorrhoids) |
| Why would you give someone a high dose of Osmotic Laxatives? | Preparation for a procedure (colonoscopy) |
| Biggest concern with Osmotic Laxatives | Dehydration; increase water intake to 8-10 glasses a day |
| Bisacodyl | Stimulant Laxatives |
| Concern if you use Bisacodyl regularly | Rectal during sensation leading to proctitis (inflamed rectum) |
| Uses of Bisacodyl | 1. Bowel preparation for surgery or diagnostic test 2. Short term treatment for constipation from opioids or slow intestinal transit |
| MOA of Bisacodyl | Stimulate intestinal peristalsis and increase the volume of water and electrolyte in the intestines |
| Nursing Care for Bisacodyl | 1. take 1 hr apart from milk and antacids 2. Don't use on regular basis 3. Give at bedtime for results in 6-12 hours |
| MOA of Surfactant Laxatives | Lowers the surface tension of the stool to allow penetration of water this softens the stool so it can be passed easily |
| Use of Surfactant Laxatives | 1. Treatment of constipation 2. Softening fecal impaction |
| Nursing care for laxatives | 1. Complete Hx of laxative use, & last bowel movement 2. Bulk forming & surfactant taken with 8 oz if H2O 3. Promote high fiber diet and increasing fluids 4. Use occasionally not everyday 5. exercise 6. Bedside commode |
| High fiber foods | bran, vegetables, and fresh fruits |
| Docusate Sodium | Surfactant laxative |
| Psyllium (Alrmucil, Cillium) | Bulk forming laxative |
| MOA of Bulk Forming Laxatives | Softens fecal mass and increases bulk, which is identical to dietary fiber |
| Use of of Bulk Forming Laxatives | 1. Temporary constipation 2. Decrease diarrhea in clients with IBS or Diverticulosis 3. Control stool for client with ileostomy or colostomy |
| Side effect of of Bulk Forming Laxatives | Obstruction of esophagus or intestines |
| Diabetic Keto-Acidois | 1. Onset 4-10 hrs 2. Hx of lack of insulin, GI upset, Febrile illness 3. Type 1 4. Age 20-29 |
| Diabetic Keto-Acidois S/S | 1. Breath smells fruity 2. Kussmaul respirations 3. thirsty, dehydration 4. BS >240 5.Hyperkalemia 6. Polyuria 7. Ketones in urine 8. Acidic urine |
| Treatment for Diabetic Keto-Acidois | hi...e. Hydration, Insulin, Electrolyte replacements |
| Hyperosmolar Hyperglycemic State S/S | 1. BS > 600 2. Profound dehydration 3. Extreme thirst 4. Polyuria 5. Non-sweaty but warm skin 6. Fever 8. Sleepiness/confusion 9. loss of vision |
| Hyperosmolar Hyperglycemic State | 1. Onset over several day/weeks 2. Type 2 3. Higher mortality rate 4. Age 57-70 |
| S/S of Hepatotoxicity | 1. Clay colored stool 2. Inflammation/ abdominal pain 3. Jaundice (late sign) |
| Nursing care for polyethylene glycol electrolyte (Golytely) | 1. Give jug at 8-9pm 2. Beside commode w/ side rail down 3. Usually wont drink anything else after than |
| Nursing Care for Oral Potassium supplements | 1. Mix w/ 90-240 mL of cold water or juice 2. Drink over 5-10 minutes 3. Take with meal 4. Don't crush or chew |
| Nursing Care for IV Potassium supplements | 1. Cardiac monitoring 2. Monitor local irritation, phlebitis, and infiltration 3. Measure I/O |
| Why does a pt receive Potassium supplements? | 1. Hypokalemia 2. Receiving diuretics resulting in low potassium 3. Potassium loss due to excessive or prolonged diarrhea, vomiting, excessive use of laxative |
| S/S of vitamin B12 deficiency | 1. Beef red tongue 2. Pallor 3. Neuropathy |
| Nursing care of vitamin B12 deficiency | 1. Baseline B12, Hgb, Hct, RBC, Folate level 2. Intranasal, IM, SC, Oral 3. Intranasal 1 hr before/after hot foods 4. Encourage dairy products 5.Monitor B levels q 3-6months |
| What does Vitamin B12 do in the body? | 1. Needed to convert folic acid from inactive to active 2. Prevent/Correct deficiency r/t megaoblastic anemia |
Created by:
hhawk
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