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NUR112 exam 4

resp, GI and endocrine systems

QuestionAnswer
Proton pump inhibitor common SE/ASE SE:GI symptoms, belching, gas, abd pain, malaise long term use: stomach infection due to blocking stomach acid, anemia from ↓ protein absorption ADE: allergy, edema, joint pain, blurred vision, depression
pantoprazole proton pump inhibitor preg category C
esomeprazole proton pump inhibitor
rabeprazole proton pump inhibitor additional ADE: dizziness, photosensitivity pregnancy category C
lansoprazole proton pump inhibitor dizziness
omeprazole proton pump inhibitor dizziness category C
H2 Blockers common SE/ASE confusion, dizziness, drowsiness, HA, altered taste, GI symptoms, impotence, ↓ sperm count, anemia, neutropenia, thrombocytopenia ASE: arrhythmia, ↓WBC, ↓production of RBC (aplastic anemia)
cimetidine H2 Blocker Drug induced hepatitis
ranitidine H2 Blocker black tongue and dark stools
famotidine H2 Blocker
nizatidine H2 Blocker drug induced hepatitis
proton pump inhibitors consideration for older adults ↑ risk for hip fx due to decreased calcium absorption, ↓ B12 absorption
antacid common SE/ASE calcium or aluminum: constipation magnesium: diarrhea ↑ risk of HF with sodium containing antacids Do not take if having abd pain
mag hydroxide/aluminum hydroxide/simethicone Category C aluminum ↑ risk for Alzheimers
calcium carbonate constipation Category C
bismuth subsalicylate Pepto-bismal cytoprotective: coats stomach and intestine inhibits H. pylori contains aspirin ↑ risk of bleeding with coumadin grey/black stools and tongue, stool impaction category C
sulcrafate cytoprotective to open sore area, makes a thick coating, stops the effect of pepsin SE: constipation, GI symptoms, gas category B
metoclopramide promotility drug SE: fatigue, restlessness, CNS symptoms, supraventricular tachycardia, ↑or↓ BP, gynecomastia ASE: neuroleptic malignant syndrome, tardive dyskinesia
antibiotics for H. pylori clarithromycin metronidazole tetracycline amoxicillin
insulin beta cells
glucagon alpha cells
clear and colorless insulin rapid-acting short-acting glargine (Lantus) long detemir (levemir)
cloudy insulin intermediate acting NPH
insulin considerations in older adults ↑ hypoglycemia due to beta-adrenergic blocking drugs, warfarin
Incretin analog MOA similar to glucagon-like peptide 1 (GLP-1) pancreas releases more insulin makes pt feel full, slows gastric emptying weight loss
exenatide Incretin analog SE: GI symptoms ASE: hypoglycemia do not use in children, pregnant or breast feeding women
liraglutide Incretin analog SE: GI symptoms ASE: hypoglycemia do not use in children, pregnant or breast feeding women
DDP-IV inhibitor MOA slows inactivation of incretin hormone improves beta cell function
sitagliptin DDP-IV inhibitor SE: runny nose, sore throat, URI ASE: anaphylaxis, angioedema, Stevens-Johnson syndrome Not for use in children, pregnant or breast feeding women
thiazolidinediones MOA makes insulin receptors more sensitive
pioglitazone thiazolidinedione SE: URI, HA, muscle aches, edema, anemia ASE: liver problems, CI in liver disease
rosiglitazone thiazolidinedione SE: URI, HA, muscle aches, edema, anemia ASE: liver problems, ↑ HF due to edema, CI in liver disease
alpha-glycosidase MOA slows digestion of starches and complex carbs by inhibiting the enzyme that breaks them down
carabose alpha-glycosidase inhibitors ASE: liver problems, difficulty digesting fatty meals, CI in liver disease Do not use in children
miglitol alpha-glycosidase inhibitors ASE:liver problems, difficulty digesting fatty meals, CI in liver disease Not for use in children
thiazolidinedione MOA works with insulin to reduce BG, makes receptors more sensitive Not for children
sulfonylureas MOA triggers beta cells to release small amount of preformed insulin similar to sulfonamide
sulfonylureas SE/ASE photosensitivity, blurred vision, edema, anemia ASE: hypoglycemia
glimepridine sulfonylureas
glipizide sulfonylureas
glyburide sulfonylureas
biguanide MOA causes release of glucose from glycogen, increases sensitivity of receptors, reduces absorption of glucose, does not act directly on beta cells, does not cause hypoglycemia
metformin biguanide bloating, gas, abd pain, HA ASE: lactic acidosis, slow irregular HR if pt is to have surgery or contrast dye xay, do not give metformin for 48 hours afterwards
meglitinde MOA acts directly on beta cells, causes brief, burst-like release of insulin
meglitinide SE/ASE dizziness, back pain, URI, flu-like achiness ASE: hypoglycemia
nateglinide meglitinide
repaglinide meglitinide
amylin analog MOA delays gastric emptying, triggerrs satiety in brain, suppresses glucagon release
amylin analog drug pramlintide SE: GI symptoms, hypoglycemia not for use in children, pregnant or breast feeding women
nursing considerations for insulins PINCH drug! test BG before giving, make sure pt can eat within 15-30 minutes, do not interchange insulins, check vial for color and clarity, do not shake vial, 28-30 guage needles, check and recheck!, do not use 2 inch radius around umbilicus, 90 degree angle, check pt hourly for hypoglycemia
nursing considerations for oral antidiabetic drugs ask about allergies to sulfa if giving a sulfonylurea, give with first bite of meal if giving alpha-glucosidase drugs, check for hypoglycemia if pt is also taking aspirin, NSAIDs, warfarin, beta-adrenergic blockers, fluoroquinolone, antibiotis, probenecid, or azole andtifungal drugs, check hourly for S&S of hypoglycemia,
insulin hormone of plenty
glucagon hormone of starvation
S&S of diabetes excessive hunger, thirst, polydipsia, polyuria, weight loss, fatigue
S&S of hypoglycemia confusion, cool and clammy skin, tremors, HA, hunger, sweating
nursing considerations for drugs that increase incretins and amylin teach s&s of hypoglycemia, take before meals, drug losses effectiveness if it is frozen or warm, ETOH will increase hypoglycemia, notify provider or go to ER if allergic reaction occurs
peak expiratory rate flow (PERF) established by age, size and gender, emergent if PERF drops below 50%
wheeze squeaky or snorelike sound
beta-adrenergic agonist MOA bronchodilator bind to receptors and cause an increase in cAMP, SABAs = rescue drugs LABAs = prevention
cholinergic antagonist MOA bronchodilator block parasympathetic NS, this allows a person's natural epinephrine and norepinephrine to bind to smooth muscle receptors, causes bronchodilation and decreases secretions
albuterol SABA
terbutaline SABA
pirbuterol SABA
arformoterol LABA
salmeterol LABA
ipratopium cholinergic antagonist
tiotropium cholinergic antagonist
aminophylline methylxanthine
theophylline methylxanthine
methylxanthine MOA bronchodilator given systemically, increase cAMP, used only when other types of management are ineffective, cause cardiac and CNS overstimulation
common SE/ASE of bronchodilators heavy use allows drug to enter mucous membrane and act systemically - ↑BP, nervousness, insomnia; dry mouth and throat, bad taste, ASE: allergic reaction within a few minutes of using inhaler, angina, MI,
anticholinergic agents SE/ASE urinary retention, blurred vision, eye pain, nausea, HA
methylxanthine SE/ASE dysrhythmias,
nursing considerations for bronchodilator ask pt to demonstrate or describe technique, auscultate lungs before and after to determine effectiveness, assess temp and mental status if giving methylxanthines
anti-inflammatory drugs for Resp problems MOA corticosteroids- decrease production of chemicals that trigger inflammation
anti-inflammatory drugs for Resp problems MOA mast cell stabilizers - prevent the release of histamines
anti-inflammatory drugs for Resp problems MOA leukotriene inhibitors - prevents leukotriene production in WBCs, block leukotriene receptors on inflammatory cells
beclomethasone corticosteriod
budesonide corticosteriod
flunisolide corticosteriod
fluticasone corticosteriod
triamcinolone corticosteriod
cromolyn sodium mast cell stabilizer
nedocromil sodium mast cell stabilizer
montelukast leukotriene inhibitor
zafirlukast leukotriene inhibitor
zileuton leukotriene inhibitor
inhaled anti-inflammatory drug common SE/ASE bad taste and dry mouth, ↑ risk for oral infection, HA, abd pain ASE: when heavily used can cause adrenal gland suppression, liver impairment, allergic reaction
nursing considerations anti-inflammatory drug inspect pt mouth and throat for infection, wait at least 5 minutes after bronchodilator to give this med, prime canister, assess for s&s of decreased liver function, these drugs are for prevention not for rescue, rinse mouth,
mucolytic MOA breaks connections that hold protein and mucus molecules
mucolytics guaifenesin, acetylcysteine
acetylcysteine delivered with a nebulizer, has very unpleasant odor, may cause broncospasms, aspiration pneumonia due to not being able to cough up secretions
antidote for acetaminophen overdose acetylcysteine
phenothiazine MOA block dopamine receptors in chemotrigger zone of the brain
anticholinergic MOA inhibit intestinal cramping and inhibit vestibular input into CNS
antihistamines block histamine at H1 receptor sites, inhibit intestinal cramping and inhibit vestibular input into CNS, depress inner ear excitability
5HT3 receptor antagonists bind to and block serotonin receptors in the intestinal tract and chemotrigger zone of the brain - used in chemotherapy
dopamine antagonists block dopamine from binding to receptors in the chemotrigger zone and intestinal tract, food moves more quickly
promethazine (phenergan) phenothiazine; confusion, disorientation, dizziness, dry mouth, nausea, vomiting, rash, sedation, neuroleptic malignant, syndrome, tardive dyskinesia, neutopenia, sever tissue necrosis with IV push, respiratory depression
prochlorperazine (compazine) phenothiazine; blurred vision, constipation, dizziness, dry eyes, dry mouth, involuntary muscle spasms, bitterness, mouth puckering, neuroleptic malignant syndrome, neutopenia, severe tissue necrosis with IV push
scopolamine anticholinergic; blurred vision , constipation, dilated pupils, dizziness, drowsiness, dry mouth, rash, urinary retention, respiratory depression
meclizine antihistamine; drowsiness
granisetron 5HT3 receptor antagonist
ondansetron (zofran) 5HT3 receptor antagonist; abd pain, constipation, fatigue, HA
metoclopramide dopamine antagonist; drowsiness, fatigue, increased depression, restlessness, tardive dyskinesia
trimethobenzamide dopamine antagonist; blurred vision, diarrhea, drowsiness, cramps, headache, hypotension, rectal irritation with supp, coma and seizures,
cyclizine antihistamine; drowsiness, dry mouth, hypotension, respiratory depression
nursing consideration: antiemetics check body temp, BP, HR and rhythm, resp rate, loc, auscultate for active bowel sounds, assess for abd distention, hx of depression, weigh daily, report resp depression immediately, metoclopramide may cause mild to severe depression, children may have muscle spasms of jaw, neck and back and balance issues, elderly are more likely to develop CNS effects
S&S of neuroleptic malignant syndrome high fever, resp distress, tachycardia, seizures, diaphoresis, BP changes, pallor, fatigue, severe muscle stiffness and loss of bladder control
S&S of constipation fewer than 3 BMs in a week, sudden decrease in BMs, hard stools, bowels feel full even after BM, bloated sensation
bulk-forming drugs adds bulk which increases mass that stimulates peristalsis
methycellulose bulk-forming drugs
psyllium bulk-forming drugs; bronchospasm, GI cramps, intestinal or esophageal obstruction, nausea, vomiting
emollient with stimulant allow the stool to mix with fatty substances
docusate sodium and casanthranol emollient with stimulant; diarrhea, rash, stomach cramps, throat irritation
stimulants increase peristalsis
bisacodyl stimulant; abd cramps, diarrhea, hypokalemia, muscle weakness, nausea, rectal burning, hypokalemia
osmotic laxative cause retention of fluid in the bowel, increasing water content of stool
lactulose osmotic laxative; abd distention, belching, diarrhea, gas, GI cramps, hypoglycemia in diabetics, hyperglycemia
lubiprostone osmotic laxative; abd pain and distention, diarrhea, dizziness, dry mouth, gas, HA, nausea, peripheral edema, reflux
magnesium hydroxide osmotic laxative; diarrhea, flushing, sweating
polyethylene glycol osmotic laxative; abd bloating, cramping, gas, nausea
sodium phosphate osmotic laxative; abd bloating, abd pain, dizziness, electrolyte imbalances (hyperphosphatemia, hypocalcemia, hypokalemia,sodium retention, GI cramping, HA, nausea, vomiting
castor oil lubricant; belching, cramping, diarrhea, nausea
glycerin supp lubricant; abd cramps, hyperemia or rectal mucosa, rectal discomfort
docusate emollient; mild GI cramps, throat irritation, rash
antimotility drugs MOA slow the movement of stool through the bowel allowing more time for water and essential salts to be absorbed
difenoxin with atropine antimotility drug; blurred vision, constipation, confusion, dizziness, drowsiness, dry eyes, dry mouth, flushing, GI distress, HA, insomnia, nausea, nervousness, tachycardia, urinary retention, vomiting
diphenoxylate with atropine antimotility drug; blurred vision, constipation, confusion, dizziness, drowsiness, dry eyes, dry mouth, flushing, GI distress, HA, insomnia, nausea, nervousness, tachycardia, urinary retention, vomiting, flushing
loperamide antimotility drug; abd pain, allergic reaction, constipation, distention, dizziness, drowsiness, dry mouth, nausea, vomiting
paregoric antimotility drug; abd pain, constipation, loss of appetite, nausea, vomiting
adsorbent/adsorbent drugs MOA remove substances that cause diarrhea from the body
attapulgite adsorbent/adsorbent drugs; constipation, bloating, feeling of fullness
calcium polycarbophil adsorbent/adsorbent drugs; abd fullness, gas, laxative dependence with long term use
antisecretory drugs decrease secretion of intestinal fluids and slow bacterial activity
bismuth subsalicylate antisecretory drugs; constipation, gray-black stools, impaction in infants and debilitated pts, tinnitus,
nursing considerations: antidiarrheal drugs obtain baseline weight and vitals, auscultate for active bowel sounds, ask about allergies or unusual reactions to aspirin, reassess q 4-8 hours, check resp status due to possible resp depression, watch for toxic megacolon, document consistency, ordor and appearance of stools, may cause dizziness- don't drive, notify provider if diarrhea doesn't go away in days or if they develop a fever, abd pain, or distention, no ETOH, bismuth sbsalicylate and calcium polycarbophil are not for small children
thyroid hormones thyroxine (T4), triiodothyronine (T3)
lithium reduces thyroid function
levothyroxine thyroid hormone replacement drug
liothyronine sodium thyroid hormone replacement drug
thyroid hormone replacement drug SE/ASE side effects are from overdose and symptoms will be those of hyperthyroidism, ASE: over work of heart leading to angina, MI, HF, increased activity of CNS can cause seizures, enhance anticoagulants, especially warfarin,
s&s of hyperthyroidism being too warm, sweating, difficulty sleeping, weight loss, increases number of BMs per day
S&S of hypothyroidism constipation, excess facial and body hair, edema of face and shins, feels cold, fatigue, low body temp, decreased libido, bradycardia, bradypnea, thick tongue, weight gain
nursing considerations: thyroid hormone replacement assess BP, HR and resp rate, reassess, ask about CP, check for increased bleeding if pt is on warfarin, teach pt to check their pulse- increase of 20 bpm for a week or dysrhythmia - contact provider, do not take with fiber supplement,
Grave's disease most common cause of hyperthyroidism, body makes antibodies to TSH and binds with receptors on thyroid cells, acts as agonist and turn on the thyroid cells causing them to divide and form a goiter
thyroid suppressing drugs MOA enter thyroid gland, combine with enzyme that connects idoine and tyrosine to make T3 and T4
thyroid suppressing drug SE/ASE rash, loss of taste sensation, HA, muscle and joint pain, itchiness, drowsiness, n/v, lymph node enlargement and edema ASE: bone marrow suppression, hepatotoxic, kidney damage
nursing considerations: thyroid suppressing drug check liver functions, check dose and medication carefully, check pt that also takes warfarin for increased bleeding, check daily for jaundice, check WBC, category D,
methimazole thyroid suppressing drug
propylthiouracil thyroid suppressing drug
estrogen main female sex hormone, excreted by ovaries and adrenal gland
FSH cause the ovaries to secrete estrogen and allows one ovum to mature each month, GnRH triggers the pituitary gland to release LH
corpus luteum releases progesterone
hypothalamus secretes GnRH--triggers anterior pituitary to release FSH and LH-- LH triggers ovulation and activation of corpus lutem
menopause high levels of FSH act on blood vessels making them dilate = hotflash
HRT MOA inhibits the feedback system and lowers levels of FSH
S&S of reduced estrogen levels atrophy of vaginal tissue, dry skin, increased rate of osteoporosis, painful intercourse,
S&S of high FSH levels decreased mental concentration, hot flashes, night sweats, sleep problems
HRT SE/ASE breast tenderness, breakthrough bleeding, fluid retention, weight gain, acne, hypertension due to fluid retention ASE: MI risk is higher, increase blood clotting, excessively think uterine lining causing excessive bleeding, increase growth of cancers that are hormone sensitive, liver impairment, gallbladder disease, pancreatitis
nursing considerations: HRT encourage yearly screenings, quit smoking, check for jaundice every day, go to ER for CP, swelling in one leg, or symptoms of a stroke
Created by: nursingTSJC2013