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PathopharmA 2 final

Ch.12-14;16-20; 24-25;32-36;41-47;49-52;54-60;67,69;73-77;94-96,101,104-106,108

QuestionAnswer
Chapter 101
CANCERS Among the top 4 causes of death for all ages except for less than 1 year old IN WOMEN breast, lung, colorectal, and uterine IN MEN prostate, lung, colorectal, and bladder
Basic Principles of Cancer Chemotherapy Unregulated cellular proliferation  Treatment modalities  Surgery: Solid cancers  Radiation
 Drug therapy Treatment of choice for disseminated cancers (leukemia, disseminated lymphomas, widespread metastases)
Drug classes-Cytotoxic agents: Used most often  Hormones and hormone antagonists  Biologic response modifiers  Targeted drugs
Characteristics of Neoplastic Cells Persistent proliferation: unresponsive to feedback mechanisms that happens in healthy tissue  Invasive growth: differentiation ceases  Formation of metastases: unique ability for migration, implantation, and growth  Immortality
Etiology of Cancer Malignant transformation results from a combination of activating oncogenes (cancer-causing genes) and inactivating tumor suppressor genes (genes that prevent replication of cells that have become cancerous)=alterations in their DNA
Growth Fraction and Its Relationship to Chemotherapy Cell cycle  Four major phases  G̥: resting (ratio of active cells to resting cells is growth fraction) G AND 4 ACTIVE CELLS MORE ACTIVE CELL, LESS G CELL=HIGH GROWTH FRACTION= CHEMO LESS EFFECTIVE ON THE RESTING CELLS
Growth fraction Impacts responsiveness to chemotherapy  Chemotherapeutic drugs are much more toxic to tissues with a high growth fraction than to tissues with a low growth fraction
Chemotherapeutic drugs are more toxic to tissue with a high growth fraction:  Bone marrow  Skin  Hair follicles  Sperm  Gastrointestinal tract
Obstacles to Successful Chemotherapy Toxicity to normal cells  Cure requires 100% cell kill  Kinetics of drug-induced cell kill
Host defenses contribute little to cell kill Cells look enough like normal cells to the immune system • Anti-cancer drugs and some cancers affect the immune system Absence of truly early detection(hard to see on mammogram)  Solid tumors respond poorly  They grow slowly
WHEN SHOULD TREATMENT STOP?
Drug resistance to chemotherapy
Obstacles to Successful Chemotherapy Heterogeneity of tumor cells  Different types of cells with different responses  Limited drug access to tumor cells  Poor vascularity or blood brain barrier
CHEMO MORE ACTIVE ON LIVING CELL
LOW NEUTROPHILS COUNT NO FRESH FRUIT OR VEGETABLE OR FLOWER
LOW PLATELET NO UNECESSARY PROCEDURE EXTEND IV FOR 72HR(WITH ORDER)
LOW RBC ERYTHROPOEITEIN PLAIN REST PERIOD IRON-CONTAINING FOOD PRIORITIZING CARE
Strategies for Achieving Maximum Benefits from Chemotherapy Intermittent chemotherapy  Allows non cancer cells to repopulate but cancer cells may too  Combination chemotherapy  Benefits of drug combinations  Suppression of drug resistance  Increased cancer cell kill  Reduced injury to normal cells
Guidelines for drug selection: Each drug should be effective by itself  Each drug should have a different mechanism of action  Drugs should have minimally overlapping toxicities  Dosing schedules
Regional drug delivery Intra-arterial  Intrathecal • Into subarachnoid space  Other specialized routes • Into the bladder
Major Toxicities of Cancer Chemotherapy ARE
Myelosuppression (bone marrow suppression) Reduces the number of circulating neutrophils, platelets, and erythrocytes  Loss of these cells has three major consequences: • Infection (from loss of neutrophils) • Bleeding (from loss of platelets) • Anemia (from loss of erythrocytes)
Neutropenia Reduction in circulating neutrophils  Incidence and severity of infection are increased  Patient care • INFECTION PREVENTION! NOT EAT FRESH FRUIT/VEGETABLE THAT ARE NOT PEELED, COOKED OR BAKED AVOID FRESH FLOWERS IN ROOM/BRING BALLON NO VISITORS
Thrombocytopenia SOFT TOOTHBRUSH, PREVENT FALL  Reduction in circulating platelets, which increases the risk of serious bleeding  Patient care • BLEEDING PREVENTION! • Use caution when performing procedures that might promote bleeding • Avoid IM injections-LEAVE IV INPLACE-ELECTRIC RAZOR,
Anemia  Reduction in the number of circulating erythrocytes (red blood cells)  Patient Care • Oxygenation • Fatigue DECREASE IN ENERGY EXPENDITURE-PLENTY OF REST
Digestive tract injury -INCREASE RISK OF INFECTION DUE TO NUTRITION DEFICIT  Diarrhea • Treatment: Oral loperamide  Stomatitis (inflammation of oral mucosa) • TrT mild stomatitis: Mouthwash containing a topical anesthetic (eg, lidocaine) plus an antihistamine (eg, diphenhydramine) • TrT severe stomatitis: Systemic opioid
Nausea and vomiting GIVE MED BEFORE CHEMO THERAPY Treatment: Premedication with antiemetics reduces nausea and vomiting • Combinations of antiemetics are more effective than single- drug therapy • Aprepitant [Emend], dexamethasone, and a serotonin antagonist, such as ondansetron [Zofran]
Alopecia Hyperuricemia: Prophylaxis with allopurinol BANK EGG OR SPERM BEFORE CHEMO(IF WANT TO HAVE CHILDREN AFTERWARD) BECAUSE IF CHEMO IS GIVEN, NO RETURN GIVEN IN LARGE VEIN TRT=TO OTHER CANCER NEOPLASTIC  Reproductive toxicity  Local injury from extravasation of vesicants  Unique toxicities  Daunorubicin: Can cause serious injury to the heart  Cisplatin: Can injure the kidneys  Vincristine: Can injure peripheral nerves  Carcinogenesis
Making the Decision to Treat-Karnofsky Performance Scale  Benefits of treatment must outweigh risks  Patient must be given some idea of benefits of proposed therapy  One of these three should be possible:  Cure  Prolongation of life  Palliation-NO INTENTION TO CURE-JUST IMPROVE QUALITY OF LIFE
A patient is receiving chemotherapy. Which laboratory result will most likely require chemotherapy to be withheld? Neutrophil count of 375/mm Severe neutropenia (neutrophil count less than 500/mm3) is an indication for withholding chemotherapy. Severe neutropenia may result in life-threatening infection.
The nurse knows that severe nausea and vomiting from chemotherapy are caused by what? Nausea and vomiting are caused by direct stimulation of the chemoreceptor trigger zone by chemotherapeutic agents.
A patient receiving chemotherapy is anemic. Which medication does the nurse anticipate administering to this patient? Erythropoietin Anemia can be treated with a transfusion or with erythropoietin (epoetin alfa or darbepoetin alfa), a hormone that stimulates production of red blood cells.
Colony-stimulating factors can minimize neutropenia. All three drugs act on the bone marrow to enhance granulocyte (neutrophil) production granulocyte colony- stimulating factor (filgrastim), long-acting granulocyte colony-stimulating factor (pegfilgrastim), and granulocyte -macrophage colony-stimulating factor (sargramostim).
Platelet production can be stimulated with oprelvekin [Neumega].
Chapter 108
Complementary and Alternative Therapy Regulation of Dietary Supplements
Dietary Supplement Health and Education Act of 1994 (DSHEA) ADR  Presumed safe until proven otherwise Package labeling  “This product is not intended to diagnose, treat, cure, or prevent any disease.”  Can make claims about the product’s ability to favorably influence body structure or function (“Supports the immune system”)
Dietary Supplement Health and Education Act of 1994 (DSHEA) Impurities, adulterants, and variability  Not addressed by DSHEA but 2007 ruling addressed  Good manufacturing practices ruling
Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006  Mandates reporting of serious adverse events from non-prescription drugs and dietary supplements Regulation of Dietary Supplements
Black Cohosh *Potentiate antihypertensives and antidiabetics* Cimicifuga racemosa  Used to treat symptoms of menopause  Mechanism of action (MOA) unknown  Effectiveness  Some studies have shown it to be as effective as estrogen  Has not been evaluated for long-term use
Coenzyme Q-10 (CoQ-10) Potent antioxidant in the body; participates in the production of adenosine triphosphate (ATP) at the mitochondrial level
Therapeutic uses Mitochondrial encephalomyopathies, congestive heart failure (CHF), and myopathies due to 3-hydroxy-3- methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) Antagonist to heparin
Cranberry Juice Therapeutic use  Prevents urinary tract infection (UTI)  Proanthocyanidins interfere with bacterial adhesion to urinary tract
Effectiveness Daily intake helps prevent UTI in women in their teens or 20s and in elderly women, not in older adults or young girls  May increase the international normalized ratio (INR) of warfarin patients
Echinacea(Echinacea angustifolia, Echinacea purpurea, Echinacea pallida) Used orally and topically  Produces antiviral, anti-inflammatory, and immunostimulant effects  Widely taken, but effectiveness is highly questionable  May interfere with immunosuppressant drugs
Feverfew Used primarily for prophylaxis of migraine  MOA is not well understood  Adverse effects  Well tolerated, no serious effects  Mild GI reactions
Drug interactions: By suppressing platelet aggregation, feverfew can increase the risk of bleeding in patients taking antiplatelet drugs (eg, aspirin) or anticoagulants (eg, warfarin or heparin)
Flaxseed Used to treat dyslipidemia and constipation  Soluble plant fiber  Seems to reduce total cholesterol and low-density lipoprotein (LDL), similar to other fiber products
Flaxseed 1-2 tablespoons a day is considered a healthy amount. One tablespoon of ground flaxseed contains 37 calories, 2 grams of polyunsaturated fat (includes the omega-3 fatty acids), 0.5 gram of monounsaturated fat and 2 grams of dietary fiber. Does not affect high-density lipoprotein (HDL) cholesterol or triglycerides  Adverse effects are GI related (eg, bloating, cramping)  Should be taken 1 hour before or 2 hours after other medications
Garlic Used primarily for cardiovascular system effects  To reduce levels of triglyceride (TG) and LDL and to raise HDL Significant anti-platelet effects, Can reduce level of cyclosporine
Garlic reduce blood pressure, suppress platelet aggregation, increase arterial elasticity, and decrease the formation of atherosclerotic plaque; antimicrobial and anticancer effects
Ginger Root Primary uses  To treat vertigo and to suppress nausea and vomiting associated with motion sickness, morning sickness, seasickness, chemotherapy, and general anesthesia
Ginger Root  Anti-inflammatory and analgesic properties that may help people with arthritis and other chronic inflammatory conditions
Ginger Root Can suppress platelet aggregation  Can lower blood sugar and therefore may potentiate the hypoglycemic effects of insulin and other drugs for diabetes
Ginkgo Biloba Ginkgo biloba  Can increase pain-free walking distance in patients with peripheral arterial disease  May suppress coagulation, may promote seizures
Glucosamine and Chondroiton  Used widely to treat osteoarthritis of the knee, hip, and wrist  Use with caution in patients with shellfish allergy  Adverse effects: GI disturbances, such as nausea and heartburn  May increase risk of bleeding
St. John’s Wort Widely used to treat depression  Limited clinical studies show that St. John’s wort is useful for mild to moderate depression, not for severe depression
St. John’s Wort No prescription needed in the United States  Interacts adversely with many drugs  Induction of cytochrome P450 enzymes  Induction of P-glycoprotein  Intensification of serotonin effects
Additional SupplementS POWDER PROBIOTICS CAN START AN INFECTION IN SEVERE ILL PATIENTS Green Tea  Multiple interactions  Probiotics  Generally well tolerated, with some GI effects  Infection in severely ill or immunocompromised patients-
Additional Supplements Saw palmetto  Conflicting results in treatment of benign prostatic hyperplasia (BPH)  May have antiplatelet effects
Additional Supplements Soy  Should not be used with antiestrogenic medications (tamoxifen)  Valerian  Generally well tolerated  Does not seem to potentiate central nervous system (CNS) depressant effects of alcohol, but this may occur
Harmful Supplements Comfrey  Contains pyrrolizidine alkaloids that are associated with veno-occlusive disease  Kava  Can result in severe hepatic damage  Ma huang (ephedra)  Can elevate blood pressure (BP) and stimulate the heart and CNS
MANY DRUGS INTERACT WITH BLOOD THINNER (ASPIRIN, WARFARIN , COUMADIN) CAUSE DECREASE IN BLOOD SUGAR AS WELL ASK PATIENT FOR SUPPLEMENTALS DRUGS
It is most important for the nurse to inform which patient NOT to use ginkgo biloba? A patient with atrial fibrillation taking warfarin [Coumadin] Gingko biloba suppresses coagulation and should be used with caution in patients taking antiplatelet drugs, anticoagulants (such as warfarin), and heparin.
A patient with diabetes mellitus type 2 is taking an oral hypoglycemic agent. The patient tells the nurse that he wants to start taking garlic supplements. It is most important for the nurse to do what? Warn the patient that garlic can potentiate the effects of the oral hypoglycemic agent. Garlic can increase insulin levels and thus potentiate the hypoglycemic effects of drugs for diabetes.
Which statement about St. John’s wort does the nurse identify as true? Serotonin syndrome is a potential adverse effect of therapy with St. John’s wort.
A patient plans to take saw palmetto. Which statement should the nurse include when teaching the patient about this supplement? Saw palmetto should be used with caution in patients taking antiplatelet drugs.
CHAPTER 104
GLAUCOMA Visual field loss secondary to optic nerve damage  Leading cause of preventable blindness in the United States  Of the 4 million Americans with glaucoma, only 50% are diagnosed  90% could have saved their sight with timely treatment
Forms Primary open-angle glaucoma (POAG)  Acute angle-closure glaucoma
AQUEOUS HUMOR Produced in ciliary body  Secreted into posterior chamber of the eye  Circulates around the iris into the anterior chamber  Exits the anterior chamber via the trabecular meshwork and the canal of Schlemm
PRIMARY OPEN-ANGLE GLAUCOMA Characteristics  Most common form of glaucoma in the United States  Progressive optic nerve damage, with eventual impairment of vision  Devoid of symptoms until significant and irreversible optic nerve injury has occurred
Risk factors Elevation of intraocular pressure (IOP)  Family history of POAG  Advancing age  African and South American ancestry
Treatment Directed at reducing elevated IOP (the only modifiable risk factor)  Principal method: Chronic therapy with drugs
ANGLE-CLOSURE GLAUCOMA known as narrow-angle glaucoma  Precipitated by displacement of the iris, prevents the exit of aq.humor  Develops suddenly and is extremely painful  No treatment; irreversible loss of vision in 1 to 2 days less common than open-angle glaucoma
ANGLE-CLOSURE GLAUCOMA Treatment  Drug therapy  Corrective surgery  Laser iridotomy  Iridectomy
DRUG THERAPY FOR GLAUCOMA
Drugs lower IOP by:  Facilitating aqueous humor outflow  Reducing aqueous humor production  Preferred route: Topical  Systemic effects relatively uncommon
Drugs lower IOP by: Combined therapy more effective than monotherapy  If drugs are ineffective, surgical intervention is needed to promote outflow of aqueous humor  Laser trabeculoplasty  Trabeculectomy
First line Beta-adrenergic blocking agents  Timolol  Alpha2-adrenergic agonists  Brimonidine [Alphagan]  Prostaglandin analogs  Latanoprost [Xalatan]
Second line Cholinergic agonists  Carbonic anhydrase inhibitors  Beta blockers [timolol]  Alpha2 agonists [brimonidine]  Prostaglandin analogs [latanoprost]
BETA-ADRENERGIC BLOCKING AGED Betaxolol, carteolol, levobunolol, metipranolol, and timolol  Lower IOP by reducing production of aqueous humor  Used primarily for open-angle glaucoma  Initial therapy and maintenance therapy
Adverse effects  Local: Usually minimal  Systemic: Heart and lungs if absorbed in sufficient amounts (bradycardia, bronchospasm)  Cardioselective agents (betaxolol and levobetaxolol) recommended for asthma patients
PROSTAGLANDIN ANALOGS Latanoprost  Lowers IOP by facilitating aqueous humor outflow  As effective as beta blockers, with fewer side effects  Can cause harmless brown pigmentation of the iris
ALPHA2-ADRENERGIC AGONISTS Two agents approved for use Apraclonidine: Only for short-term therapy  Lowers IOP by reducing aqueous humor production and possibly by increasing outflow not cross BBB,therefore does not promote hypotension Brimonidine [Alphagan]: First-line drug for long-term therapy
ALPHA2 AGONIST/BETA BLOCKER COMBINATION Combigan: 0.2% brimonidine and 0.5% timolol  Treatment: 1 drop applied to affected eye twice daily (about every 12 hours)  Benefits and adverse effects are about equal to those seen when the two drugs are applied separately
PILOCARPINE Direct-acting cholinergic agonist that causes:  Miosis  Contraction of the ciliary muscle  Now considered a second-line drug for open-angle glaucoma  Emergency treatment of acute angle-closure glaucoma
CHOLINESTERASE INHIBITOR (Echothiophate (phospholine iodide)  Long duration of action  No longer a first-line drug  Cataracts  Inhibits the breakdown of acetylcholine (ACh), promotes accumulation of ACh at muscarinic receptors  on eye: Miosis, focusing of the lens for near vision, reduction of IOP ADR  Myopia; absorption into the system = parasympathomimetic responses
CARBONIC ANHYDRASE INHIBITORS (CAIS)-Dorzolamide [Trusopt] topical  Reduces IOP by decreasing production of aqueous humor well tolerated: Ocular stinging, bitter taste, allergic reaction in 10% -15% of PTS  Acetazolamide and methazolamide: Systemic CAIs  Adverse effects  NVS, teratogenic, acid-base disturbanc
CYCLOPLEGICS AND MYDRIATICS Cycloplegics: Paralyze ciliary muscles  Mydriatics: Dilate the pupil  Uses  Adjunct to measurement of refraction  Intraocular examination  Intraocular surgery  Treatment of anterior uveitis
Adverse effects Blurred vision and photophobia  Precipitation of angle-closure glaucoma  Systemic effects
Phenylephrine: Adrenergic agonist Mydriatic agent (pupil dilation)  Does not cause cycloplegia  Adverse effects
ALLERGIC CONJUNCTIVITIS-Inflammation of the conjunctiva in response to an allergen  Seasonal or perennial  Itching; burning; thin, watery discharge  Results from biphasic immune response  Symptoms peak 20 minutes after allergen exposure, abate 20 minutes later, reappear after 6 hours
DRUG-ETIOLOGY Mast-cell stabilizers  H1-receptor antagonists  Nonsteroidal anti-inflammatory drugs (NSAIDs)  Glucocorticoids (short term)  Ocular decongestants
AGE-RELATED MACULAR DEGENERATION Painless, progressive disease that blurs central vision and limits perception of fine detail  Leading cause of blindness in older Americans: Affects about 15 million
AGE-RELATED MACULAR DEGENERATION Dry ARMD: Drusen (yellow deposits under the retina)  Wet (neovascular) ARMD: Growth of new subretinal blood vessels, which are often fragile and leaky; fluid leakage lifts the macula from its normal place, which quickly causes permanent injury
Stages Early  Intermediate  Advanced
Management of dry ARMD Antioxidants and zinc, multiple vitamins High doses of antioxidants and zinc
Management and treatment of wet ARMD Laser therapy  Photodynamic therapy (PDT) -Verteporfin [Visudyne]  Angiogenesis inhibitors  Pegaptanib [Macugen]  Ranibizumab [Lucentis]  Aflibercept [Eylea]  Bevacizumab [Avastin]
ADDITIONAL OPHTHALMIC DRUGS
Opthalmic demulcents [Artificial Tears] sotonic solutions: Polyvinyl alcohol, cellulose esters  Topical cyclosporine ophthalmic emulsions [Restasis]: Suppresses the immune response, promoting resumption of tear production
Ocular decongestants Weak solutions of adrenergic agonists applied topically to constrict dilated conjunctival blood vessels  Phenylephrine, naphazoline, oxymetazoline, and tetrahydrozoline
Glucocorticoids-IS PART OF THE MEDICATION GIVEN Dyes: Fluorescein, rose bengal, lissamine green  Antiviral agents: Trifluridine, vidarabine, ganciclovir, and idoxuridine
A patient is admitted to the hospital for treatment of symptomatic bradycardia and atrioventricular (AV) heart block. Which topical medication for the eye should the nurse withhold and discuss with the healthcare provider before administration? Timolol
A patient is receiving ocular injections of pegaptanib [Macugen] to treat neovascular age-related macular degeneration (ARMD). The nurse should teach the patient to immediately report symptoms that indicate an eye infection. The symptoms of eye infection include what? Redness, light sensitivity, and pain
A patient has been prescribed latanoprost [Xalatan], an analog of prostaglandin F2 alpha for treatment of glaucoma. The nurse should include which statement when teaching the patient about this drug? This drug works by decreasing the amount of fluid your eye produces.
CHAPTER 105
Drugs for the Skin
Topical glucocorticoids (cream, ointment, or gel) Uses  To relieve inflammation and itching  Drying agent Administration  Apply in a thin film and gently rub into the skin  Do not use occlusive bandages (or tight-fitting diapers and plastic pants
Adverse effects Local reactions  Thinning of the skin  Stretch marks  Purpura  Telangiectasia  Hypertrichosis  Possible systemic toxicity
Systemic toxicity  More likely with higher doses and long -term therapy  Growth retardation in children  Adrenal suppression
Keratolytic Agents Promote shedding of horny layer of the skin  Primary agents and uses  Salicylic acid: Warts, corns  Sulfur: Acne, dandruff, psoriasis, seborrheic dermatitis  Benzoyl peroxide
Treatment for Acne TOPICAL Nondrug therapy  Cleansing  Drug therapy  Benzoyl peroxide  Antibiotics  Topical: Clindamycin+ Erythromycin  Retinoids  Tretinoin  Adapalene Tazarotene Azelaic acid
ORAL Antibiotics  Agents of choice  Doxycycline [Vibramycin], minocycline [Minocin]  Alternatives (resistance is common)  Tetracycline [Sumycin], erythromycin [Ery-Tab]
ORAL Isotretinoin  Used to treat severe nodulocystic acne vulgaris  Teratogenic  Triglyceride levels must be monitored  Adverse effects Hormonal agents  Spironolactone [Aldactone]
Sunscreens (UVA) UVA penetrates the epidermis and deep into the dermis  UVA penetrates much deeper than UVB  UVA is the primary cause of immunosuppression, photosensitive drug reactions, and photoaging of the skin
Sunscreens (UVB) UVB penetrates into the epidermis but goes no deeper  Tanning and sunburn are caused primarily by UVB
Sunscreens (UVA & UVB) Both UVA and UVB promote damage to DNA, so both can cause premalignant actinic keratoses, basal cell carcinoma, squamous cell carcinoma, and malignant and nonmalignant melanoma
Sunscreens ARE Can also reduce the risk of actinic keratoses, squamous cell carcinoma, and melanoma Impede penetration of UV radiation to viable cells of the skin  Can protect against sunburn, photoaging of the skin, and photosensitivity reactions to certain drugs (eg, tricyclic antidepressants, phenothiazines, sulfonamides, sulfonylureas)
Organic screens Also known as chemical screens  Absorb UV radiation and then dissipate it as heat  15 of approved sunscreens
Inorganic screens Also known as physical screens  Scatter UV radiation  Titanium oxide and zinc oxide  Now micronized and clear for applying to skin
Sun Protection Factor (SPF) SPF is an index of protection against ultraviolet B (UVB) radiation  SPF does not address ultraviolet A (UVA) protection
Sun Protection Factor (SPF) Methods for obtaining SPF are not precise  Relationship between SPF and protection against sunburn is not linear (SPF 30 is not twice as much protection as SPF 15)
Water and sweat resistance  Adverse effects of sunscreens Rules for labeling  Range of UV protection and SPF  Water/sweat resistance  Safe sun exposure
 Adverse effects of sunscreens Water and sweat resistance  Adverse effects of sunscreens  Proposed changes regarding sunscreen testing and labeling  UVB rating and labeling  Using a sunscreen effectively
Psoriasis Red patches with silver scales  Common, chronic inflammatory disorder that follows an erratic course  Initial episode usually develops in early adulthood  Subsequent attacks may occur spontaneously or in response to triggers
Psoriasis Varying degrees of severity  Symptoms result from:  Accelerated maturation of epidermal cells  Excessive activity of inflammatory cells
Treatment for Psoriasis Most antipsoriatic drugs suppress activity of inflammatory cells
Topical drugs Glucocorticoids  Vitamin D analogs: Calcipotrien, calcitriol  Vitamin A derivative: Tazarotene  Anthralin  Tars
Systemic drugs (conventional agents) Methotrexate  Acitretin  Glucocorticoids  Cyclosporine
Biologic agents  Etanercept  Infliximab  Adalimumab  Ustekinumab  Procedures  Photochemotherapy  Coal tar + ultraviolet B irradiation
Actinic Keratoses (AKs) Rough, scaly, red or brown papules caused by chronic exposure to sunlight  Half of all skin cancers in the United States begin as AKs
Drugs for AK Fluorouracil  Diclofenac sodium  Imiquimod  Aminolevulinic acid + blue light
Drugs for Atopic Dermatitis (Eczema) Glucocorticoids  Topical immunosuppressants  May cause skin cancer or lymphoma  Tacrolimus  Pimecrolimus
Agents Used to Remove Venereal Warts Physical measures  Cryotherapy, electrodesiccation, laser surgery, and conventional surgery  Topical drugs (must be applied by provider)  Podophyllin (must be applied by provider)  Bichloroacetic acid (BCA) and trichloroacetic acid (TCA)
Topical drugs (can be applied at home) Imiquimod  Podofilox  Kunecatechins
Common Warts Verruca vulgaris: Hard, rough, horny papules  Majority of common warts are caused by just three types of human papillomavirus (HPV): HPV-1, HPV-2, and HPV-3
Physical measures for removal Cryotherapy, electrodesiccation, curettage, and laser therapy
Topical drugs Salicylic acid, podophyllin, podofilox, imiquimod, trichloroacetic acid, and topical fluorouracil
Miscellaneous Drugs for Skin-Antiperspirants: Aluminum chlorohydrate, aluminum chloride, and buffered aluminum sulfate; these agents can reduce the flow of eccrine sweat by 20% to 50%
Deodorants: Carbanilide, triclocarban, and triclosan inhibit the growth of the surface bacteria that degrade components of apocrine sweat into malodorous products; they do not suppress sweat formation
Drugs for seborrheic dermatitis and dandruff Pityrosporum ovale, a microbe in the yeast family  Symptoms respond rapidly to topical treatment with ketoconazole, an antifungal drug with activity against yeast
Drugs for Hair reatment of hair loss  Topical minoxidil  Finasteride [Propecia]  Treatment of unwanted facial hair  Eflornithine [Vaniqa]
Impetigo Most common bacterial infection of the skin: Staphylococcus aureus  Usually seen in children 2 to 5 years of age  Two forms:  Bullous  Nonbullous  Impetigo is treated with antibiotics
Local Anesthetics Can be applied topically to relieve pain and itching associated with skin disorders  Benzocaine  Lidocaine  Pramoxine
A patient has used a topical glucocorticoid preparation daily for several years. It is most important for the nurse to assess the patient for which adverse effect of long-term topical glucocorticoid therapy? Atrophy of dermal and epidermal layers
Which statement should the nurse include when teaching a patient about sunscreens? The intensity of UVB radiation is greatest between the hours of 10:00 AM and 4:00 PM.
A 22-year-old female patient is prescribed isotretinoin for severe acne vulgaris. What statement will the nurse include in patient teaching? Pregnancy must be avoided while taking this medication.
The risk for skin damage from the sun is highest with exposure between 10 AM and 2 PM. No sunscreen is completely water resistant. Sunscreens classified as water resistant sunscreens still need to be reapplied after swimming. Sunscreen with an SPF of at least 15 is recommended for people at normal risk for skin cancer. Although gradually increasing sun exposure may decrease the risk for burning, the risk for skin cancer is not decreased.
The nurse is administering efavirenz [Sustiva] to a patient with AIDS. What will the nurse do? Give the medication without regard to meals
Which statement about enfuvirtide does the nurse identify as true?
Created by: Seka_nurse
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