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pharm II exam 1


what anesthesia is used for oral surgeries, small wounds (excision), I&D, small impalements (nail in foot), triple lumen catheter (around puncture site); essentially for local (small) areas Local anesthesia
Primary drug for local anesthesia is Lidocaine- has epinephrine in it- vasoconstriction- keeps it localized
What should you worry about with general anesthesia? worry about airway and respiratory system b/c patient cant breath on their own with NMBA(neuromuscular blocking agent aka paralytics) & can’t maintain their own airway openwhen so using paralytics patient need endotracheal tube (artificial airway).
What does patient need when using paralytics? when using paralytics patient need endotracheal tube (artificial airway).
General anesthesia is usually a cocktail of three types of drugs? sedating/hypnotics, paralytics (neuromuscular blocking agents), and pain medication.
Biggest/most severe complication with general anesthesia? malignant hyperthermia
What is also known as moderate sedation? Conscious sedation
anesthesia used in EGD, endoscopy, certain oral procedures; difference between this and general anesthesia is that general anesthesia patients must have airway maintained for them, while these patients can maintain airway. Conscious sedation
What causes malignant hyperthermia? paralytics (neuromuscular blocking agents)
What is the treatment for malignant hyperthermia? dantraline- skeletal muscle relaxant (reverses muscle rigidity)
What are the considerations when using- Neuromuscular blocking drugs: (paralytics)? must be able to maintain airway through endotracheal tube, etc)
Name of appetite suppressants; used for people who eat too much; help maintain or return to nice stable body weight. Anorexiants
Anorexiants drug classification: CNS stimulants- increase HR, BP, etc- everything speeds up and body doesn’t feel like it needs to eat.
drug suppresses signal in brain that tells you you’re hungry Anorexiants
Used for sleep; benzodiazepines Hypnotic agents
This drug is a benzodiazepine (Resteril) used primarily for sleep/insomnia (take 1 hour prior to bed b/c it has long onset of action). Temazepam
Classifications of pain: Acute, Chronic, Somatic and Superficial
Name this classifications of pain: sudden onset, short duration; type of pain that once cause is corrected it goes away Acute pain
Name this classifications of pain:long term pain; may not have something you can fix (i.e. pain related to cancer) Chronic pain
Name this classifications of pain: skeletal muscle pain Somatic pain
Name this classifications of pain:short duration; paper cut, stubbed toe, sun burn, less degree acute pain etc. Superficial pain:
Used for mild to moderate pain Non-opioid analgesics
Used for moderate to severe pain Opioid analgesics
Type of opioid analgesics (aka narcotics) Naloxone (Narcan)
Major side effect of opioid analgesics (aka narcotics) Constipation
Used for anxiety/to prevent anxiety Antianxiety medications
3 types of antianxiety medications alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan)
benzodiazepines- reversal agent flumazenil (Romazicon-monitor patient who take reversal agent))
Phenobarbital is a Barbituates
What is used for primarily seizures, in the past used for sedating, anxiety, some migraines Phenobarbital
cautions: major additive of CNS depression with ETOH or any other CNS depressants,deprives patient of REM sleep Phenobarbital
Uses: seizures and anxiety Barbituates
cautions: deprives patients of REM sleep causing hangover effect (also happens with benzos); major additive CNS depression enhanced with ETOH or other CNS depressant Barbituates
Cyclobenzaprine(Flexeril)is used as a skeletal muscle relaxant
Nursing implications For ? :don’t drive, notifies that pt has muscle spasms or skeletal muscle injury, potentiate effects of other CNS depressants Cyclobenzaprine(Flexeril)-nursing implications
Nursing implications for ? sometimes prescribed with opiod analgesic so part of patient teaching include notifying patient it will make narcotic stronger and if you drink alcohol on top of that you may not wake up. Cyclobenzaprine(Flexeril)-nursing implications
Drug class of Ritalin (synthetic amphetamine- CNS stimulant) Methylphenidate hydrochloride
Methylphenidate hydrochloride is used for ADHD
Methylphenidate hydrochloride Nursing implications: educate patient to take 4-6 hours before bedtime to prevent insomnia, preferable taken in the morning
Drugs used to prevent seizures Antiepileptic drugs:
Antiepileptic drugs Cautions: not short term therapy (lifelong usually); must take at same time every day- keep seizure threshold reduced; do not abruptly stop
Antiepileptic drugs nursing implications: not short term therapy (lifelong usually); must take at same time every day- keep seizure threshold reduced; do not abruptly stop; patient can discontinue drug if they have been seizure free for more than 2 years,by slowly tappering med
Drug of choice for treatment of Status epilepticus: Ativan (lorazepam) or Valium (diazepam)
Gabapentin (Neurontin)Uses: neuropathic pain; peripheral nerve pain, seen in patients like noncompliant diabetics b/f nerve is totally dead
Prevent “cheese effect” by avoiding what? Tyramine—which is found in aged cheeses, yeast, red wine, beer
“cheese effect” occurs with what drug? MAOI (monoamineoxidase inhibitors)-used for depression and Parkinson’s)
MAOIs are used to treat? Depression and Parkinson’s
Levodopa-carbidopa (Sinemet)used for Parkinson’s Disease
Levodopa-carbidopa (Sinemet)nursing implications - patient education about combination.
Levodopa-carbidopa (Sinemet)-Why use a combination drug? Levodopa precursor to dopamine- cannot cross BBB (blood brain barrier)without Carbidopa- bringing it to brain but does cross only levadopa crosses. Brain changes levadopa to dopamine increasing dopamine levels in brain.
What are benefits of use of COMT inhibitors? less drug interactions and prolonged action over MAOIs with Parkinson’s (prolongs action of Levodopa)
Therapeutic effects of antipsychotic drugs: treatment of behavioral and psychotic disorders; controlled behavior- decreases psychotic tendencies
What are extrapyramidal symptoms: motion disorders similar to actions seen in Parkinson’s Disease; side effects of many antipsychotic medications
Uses of MAOIs: Used to treat depression and Parkinson’s
Precautions for MAOIs: cheese effect, many drug-drug interactions with other medications and OTCs
What is the class of newer age antidepressant medications; Lexapro, Zoloft, etc- increase serotonin levels in brain the class SSRIs: (selective serotonin receptor inhibitors)
SSRI Precautions: higher incident of suicidal thoughts especially within the first 2-3 weeks; serotonin syndrome
SSRI is used for? used for depression
What isSerotonin Syndrome? too much serotonin in brain b/c too much inhibition of uptake; symptoms- agitation, delirium, tachycardia, shivering; when drug d/c it reverses; make sure to wait 2-5 week period with no medication being taken to avoid this after MAOI is switched to SSRI,
What is St. John’s Wort? herbal medication, causes serotonin syndrome when taken with SSRIs
What causes Serotonin Syndrome? combining SSRI with St. John Wort
Uses of Desmopressin (Posterior pituitary drugs): : treatment of diabetes insipidus caused by a deficiency of vasopressin. ; Used for dose-dependent treatment of blood disorders; also used for nocturnal enuresis
Desmopressin Nursing implications: monitor for therapeutic response: should reduce severe thirst and decrease urinary output, do not discontinue abruptly
Somatropin (Anterior pituitary drugs) -It’s a recombinantly made growth hormone (GH)-Uses: Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism
Nursing implications Somatropin: Monitor for therapeutic effects: should increase growth in children, do not discontinue abruptly, parents of children who are receiving growth hormones should keep a journal reflecting the child’s growth
Cosyntropin(Cortrosyn)(Anterior pituitary drugs)Uses: Used for Adrenocortical insufficiency.Stimulates release of cortisol from adrenal cortex, antiinflammatory effect, promotes renal retention of sodium; may result in edema and HTN
Nursing implications - Cosyntropin(Cortrosyn):( maintain adequate hydration, dec. NA & K intake, void vaccinations during drug therapy. Monitor for therapeutic effects: should eliminate pain assoc. with inflammation and produce increased comfort and muscle strength in patients with multiple sclerosis
Levothyroxine(Synthroid, Levothyroid)- Synthetic thyroid hormone T4- Uses : treat all 3 forms of hypothyroidism;“Euthyroid" ;Used as thyroid replacement therapy in patients whose thyroid glands have been surgically removed or destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidism
Levothyroxine(Synthroid, Levothyroid)-Synthetic thyroid hormone T4 -Nursing implications: switching between different brands during treatment can destabilize the course of treatment and should be minimized. Thyroid drug test result should be monitored more carefully when switching is necessary. Watch for med error (dose in microgram).
Propylthiouracil Uses: antithyroid drug; short term use
Propylthiouracil Nursing implications: can cause liver damage and bone marrow toxicity
Primary hypothyroidism is problem with the thyroid itself
•Lispro insulin (rapid acting insulin): Onset: Peak: Duration: Onset: 15 min Peak: 1-2 hr Duration: 3-5 hr
Hypoglycemia is a Medical emergency; General information: Abnormally low blood glucose level (below 50 mg/dL); Mild cases can be treated with diet—higher intake of protein and lower intake of carbs. Symptoms: Early -Confusion, irritability, tremor, sweating; Late-Hypothermia, seizures, coma and death.
Teaching points regarding self-administration of insulin: Timing of doses, monitoring blood glucose levels, and injection site rotations. Return demonstration to make sure person has reached a competent level of self- administration of insulin
Therapeutic responses to antidiabetic drugs: Decrease in blood glucose levels to the level prescribed by physician
IV insulin: (Humulin R) Short-acting; Onset 30 to 60 minutes.The only insulin product that can be given by IV bolus, IV infusion, or even IM
Prednisone therapy(Synthetic intermediate-acting glucocorticoid i.e.(Deltasone)Uses: Wide variety of endocrine disorders (including adrenocortical insufficiency) and rheumatic, collagen, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplatic, GI, and nervous system disorders; edematous states.
Prednisone therapy(Synthetic intermediate-acting glucocorticoid i.e.(Deltasone)Cautions: Chronic treatment (will lead to adrenal suppression; use lowest possible dose for shortest period of time)
Prednisone therapy drug Deltasone
Aminoglutethimide: (Antiadrenals)Adrenal steroid inhibitor-Uses: Used in the treatment of Cushing’s syndrome, metastatic breast cancer, and adrenal cancer
Aminoglutethimide: (Antiadrenals)Adrenal steroid inhibitor-Nursing implications: Obtain baseline assesments, Assess for edema, serum glucose and electrolyte levels, Oral forms should be given w. food or milk to minimize GI upset,avoid contact w. people w. infections, Take same time every day, mainly in morning, w. meals or food.
Created by: lalad13