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Final test Pharm UTA
Final test Pharm UTA Fall 2010 (part 1)
| Question | Answer |
|---|---|
| primary hypertension | meaning there is no known problem causing the HTN, and we don’t know the exact mechanism for the HTN also named essential or idiopathic HTN, |
| secondary | there is a known cause. These causes may include chronic alcoholism, pregnancy, renal problems (like renal artery narrowing), or a tumor in the adrenal gland |
| Hypertensive crisis | an emergency! It is usually defined as a diastolic blood pressure greater than 120 mmHg. If it is not treated within one hour, it can result in acute damage to the organs, including acute stroke from hemorrhage into the brain, or myocardial infarction. |
| atherosclerosis | When BP increases for a prolonged time, the endothelium (inside lining of blood vessel) becomes damaged,thickened, and hard Hypertension leads to heart, brain, kidney, and blood vessel damage. |
| Goal of anti HTN Drugs | our goal is to get the BP (blood pressure) down into an acceptable range! We would like it to fall to <140/90.we must balance blood pressure and side effect of drug therapy. hypertension caused end organ damage, |
| 3 components of SV (Stroke Volume) | Preload, Afterload, and Contractility. |
| Drugs that decrease preload. HTN | diuretics and ACE inhibitors |
| Drugs that decrease afterload HTN | vasodilators such as alpha 1 blockers, ACE inhibitors, alpha 2 agonists, and calcium channel blockers |
| Drugs that decrease contractility HTN | certain calcium channel blockers and beta blockers |
| inotrope positive and negative | any drug, or naturally-occurring molecule in the body, that impacts contractility. Norepinephrine and epinephrine are normally found in the body. Both of these are considered positive inotropes,beta blockers are negative inotropes |
| dromotrope positive and negative | impacts conduction through the AV and SA nodes. A positive dromotrope would be NE. beta blocker would be a negative dromotrope |
| chronotrope positive and negative | has to do with the heart rate Drugs that increase Heart rate are positive. drugs that reduce heart rate are negative |
| Alcohol & Beta Blockers | we must be aware of when patients are taking beta blockers. Alcohol, in general, will reduce the absorption of the beta blocker and increase elimination, keeping less in the body and decreasing effectiveness. |
| allergy test and beta blocker | hold their beta blocker 24 hours before testing |
| Beta Blocker Side Effects | Hypersomnia Depressed mood Bronchospasm Sexual dysfunction (impotence) |
| patients going for treadmill tests while taking Beta blockers | HOLD their beta blocker the day before the test! Bradycardia can occur in patients taking either the cardioselective or the noncardioselective beta blockers (because they both block beta 1). |
| B4 and during beta blockers therapy | assessed for subjective complaints of chest pain, shortness of breath, edema, decreased energy, and depression.auscultation of the lungs, extremities for pedal edema, vital signs,regularity of the pulse |
| Insulin + Beta blocker Interaction | Hypoglycemia |
| Orthostatic hypotension concern | an cause dizziness, syncope, and patient falls. |
| beneficial side effect of alpha 1 blocker | decreased prostatic smooth muscle pressure on the urethra, thus increased ability to urinate. |
| common adverse effect of ACE inhibitors | cough |
| ACE inhibitor life threating side effect | Hypercalemia |
| NAIDS and ACE inhibitors | NSAIDs will decrease the effect of the ACE inhibitors, because the NSAIDS will decrease the prostaglandin bradykinin, which is one of the most important ways ACE inhibitors actually do their job. |
| Ace inhibitors and potassium supplements | Can increase risk of hypercalemia, very carefully monitor the patient’s serum potassium |
| ACE inhibitors and pregnancy | Contraindicated in the second and third trimester |
| dihydropyridines | calcium channel blockers drugs that cause arteriolar vasodilation, but do not affect cardiac muscle. remember that dihydros dilate (D-D) |
| nondihydropyridines | calcium channel blockers affect both the cardiac and the arteriolar smooth muscles. You can remember that NONdihydros affect the nodes (N-N). |
| beta blockers and nondihydropyridines | depress contractility and can lead to acute heart failure and resultant fluid in the lungs |
| Antihypertensives and OTC products | Diet pills and caffeine! Cold medications (sympathomimetics) Nicotine known to increase SNS activity will decrease the effect of the antihypertensive medications |
| Loop diuretics and warfarin | loop diuretic have higher affinity for the albumin receptor than warfarin. TOXICITY From warfarin |
| EARLY signs of hypokalemia | Muscle weakness, nausea, and vomiting |
| glucose levels in diabetics taking loops | hey may need extra coverage for blood sugars. loop diuretics can impair the cell’s ability to utilize glucose |
| the major reason for digoxin toxicity | loop-induced hypokalemia |
| ommon side effect of thiazides | Skin rash due to photosensitivity |
| interaction of loop diuretics, thiazides with lithium | decrease clearance of lithium; therefore, lithium toxicity can occur. |
| most life-threatening side effect with potassium sparing diuretics | hyperkalemia |
| most serious consequence of triamterene therapy. (potassium sparing) | Megaloblastic anemia caused by folic acid deficiency. be suspicious of folic acid deficiency if the red blood cell count drops below normal |
| Uses of Spironolactone | used for heart and liver failure |
| Uses of triamterene | used for HTN and edema. |
| Nitrates | used IV, arterial vasodilation can occur, which will increase supply to the coronary arteries. Therefore, nitrates (except IV) will reduce demand, increase supply (IV), therefore, reducing angina. |
| short acting nitrates | use for treatment of chest pain can be sublingual, translingual spray and transmucosal which it will also last much longer than translingual or sublingual. |
| important that patients be taught how to use the short acting drugs | bottle should not allow light through; however, if exposed to light or extreme heat, the nitroglycerin will not be effective. always carry nitroglycerin with them everywhere they go. |
| Uses of Long-acting nitrates | used for daily prevention of chest pain. |
| IV Nitrates | will reduce demand and increase coronary artery perfusion (supply). When giving nitroglycerin IV, it must be on an infusion pump. |
| Beta Adrenergic Blockers | Long term prevention of STABLE angina b/c they decrease demand on the heart. Block beta receptor sites in the heart Suppresses reflex tachycardia |
| Calcium Channel Blockers | Angina caused by vasospasm Long term protection effective in prevention of angina. Not for unstable angina |
| Big 3 | Communicate Be proactive teach |
| Drug | Any chemical substance that cause a change in the body |
| Pharmacokinetics | what the body does to the drug, how the drug moves trough the body includes ADME Absorption Distribution MEtabolism |
| Safest drug name | GENERIC name |
| What to do when you cannot read the name of a drug clearly | Ask the physician what drug was prescribed |
| Factors affecting drug metabolism | Life span Nutrition (grape fruit Inhibits CYP) Obesity(need higher doses) Dietary intake Nicotine exposure (CYP Inducer) Other medications that increase or decrease CYP enzyme system |
| Breast feeding mothers | Must be warned that some drugs can enter breast milk |
| Suspensions | Are never given IV |
| DO NOT CRUSH | Enteric coated Extended release |
| Serum creatine | When serum creatine increases clearance decreases = potential for TOXICITY |
| Half life | time required for total amount of drug in body to be decreased by one-half |
| steady state | amount of drug excreted by the body equals the amount ingested |
| Afinity | The degree of attraction between a drug and a receptor |
| First pass effect | increasing a drug dosage due to the metabolism of the drug when administered PO. IV administration has no fist pass effect therefore, dosage in lower |
| Most common and serious adverse effect of amphotericin (antifungal drug) | Nephrotoxicity. Nephotoxixity can occur in 80% of the patients who receive this drug |
| half life and steady state of levothyroxine drugs | Half life 7 days Steady state (7x4=28) 28 to 35 days |
| Patient teaching for patients on dopaminergic drugs for Parkinson's disease | keep protein intake low, and spread protein through the 3 meals of the day. Spreading protein through the day there is a less chance of an on-off phenomenon |
| INH metabolism | genetically predetermined.patients will metabolize the drug slowly, while others will metabolize is rapidly. Those who metabolize the drug slowly are more prone to hepatotoxicity. Those who metabolize it faster are prone to peripheral neuropathy. |
| harmless side effect of patient taking Rifampin drug to treat tuberculosis | cause the urine to turn an orangish color. teach patient about this side effect |
| tuberculosis drug rifampin and estrogen-containing contraceptives | Use an alternative method of birth control Rifampin is a CYP450 inducer, which increases metabolism of estrogen and progestin-containing contraceptives decreasing its effect |
| Signs of improving hypothyroidism | improved energy, regulation of body temperature, requirement of less sleep, and weight loss. |
| On-off phenomenon | is unpredictable and occurs usually due to too much protein in the diet |
| Wearing off phenomenon | is predictable. caused by a drop in blood concentration near the time of the next dose, which exacerbates symptoms. |
| amphotericin B intravenously for a systemic infection | fever, chills, and headache during the infusion are common. reason we premedicate with acetaminophen and Benadryl prior to infusing the amphotericin. |
| Why are multiple drugs used to treat an active tuberculosis infection? | To decrease the emergence of resistant tuberculosis organisms. |
| what to teach patients with herpes simplex virus | Wear condoms even when no lesions are present. |
| what should be checked by the nurse before administration of Amphotericin B. | The serum creatinine. Amphotericin B is well known to cause renal tubular damage, or nephropathy. |
| S&S of levothyroxine overdose. | Tachycardia indicates the patient is taking too much levothyroxine, and perhaps developing toxicity, which looks like hyperthyroidism. |
| administration of penicillin for strep throat | hake the container, mix the drug around in your mouth and then swallow. suspension will be ordered as either "swish and swallow" or "swish and spit." The nurse must know how it is ordered to administer it correctly. |
| Most serious side effect of tuberculosis drugs | Weight loss, anorexia, and extreme fatigue. The most dangerous complication of multiple drugs for tuberculosis is hepatotoxicity. |
| What is the most common side effect relater with enteral nutrition | Diarrhea Because enteral feeding can be hyperosmolar |
| What is the most serious side effect of estrogen replacement | Jaundice Due to liver dysfunction |
| Most serious effect of estrogen replacement | Thromboembolitic events |
| SERMs selective estrogen receptor medulator | used to treat osteoporosis estimulating estrogen receptors in bone, increasing bone density Similar adverse effects of estrogen therapy |
| Hypervitaminosis | TOXICITY due to some vitamins and minerals |
| Folic acid IV infused | deficiency is common in alcoholics and malnutrition |
| B12 deficiency | Lead to pernicious anemia Chronic condition usually replaced by IM injection each month Results in neurological symptoms such as numbness and tingling lack of intrinsic factor malabsorption of B12 |
| patients taking estrogen containing contraceptives are at risk of | STROKE Estrogen is a procoagulant increasing the risk for clots |
| Bile sequestrants common Side effect | Constipation Tell patient to drink plenty of water inhibit absorption of fat-soluble vitamins |
| Statins | Category X drugs |
| advice to patient taking Niaspan | to prevent the side effects of niaspan take an aspirin 30 minutes taking niaspan to stop prostaglandis related to niaspan |
| Test to determine statins therapy | LDL cholesterol Reduction of this lipoprotein is an indicator of the therapeutic effect of statin |
| Foods that increase iron absorption | Cytrus fruits (Vit. C) |
| Calcium therapy | Calcium salt is not elemental calcium Calcium IV in a pheripheral IV can cause severe tissue damage if infiltrates Not all the calcium is the same |
| TPN and PPN | Hyperalimentation TPN total nutrition PPN partial supplementa nutrition |
| Drugs to treat iron deficiency anemia | Ferrous gluconate or ferrous sulfate |
| Patient teaching on biphosphate boniva | Do not lie down for 30-60 minutes after taking the drug to reduce risk of esophagitis. drink at least 8 onz of water to prevent medication to adhere to esophagus |
| highest priority assessment for a patient taking estrogen contraceptives | Blood pressure Hypertension is a common side effect of contraceptive drugs |
| OTC drugs | Report them to prescriber or life threating side effect can occur Never assume that patient knows how to read OTC drugs |
| Drug categories for pregnancy | D: fetal risk benefits have to overcome risk X: Never given to pregnant women |
| #1 obstacle for patient teaching | Language |
| infants and pharmacokinetics | Infants are at high risk from highly protein bound drugs infants have a lower serum albumin, thus can potentially experience significant drug interactions when administered a highly protein bound drug. |
| Groups of patients at highest risk for drug toxicity | Children and elderly |
| Supplements Vs OTC | Supplements do not contains same label information as OTC. |
| Clinical trials phases | Phase 1: normal healthy adults received the drug In phase 2 and 3; the drug is given to individuals who have the disorder or illness in which the drug is intended to treat |
| Dosage calculation for pediatric patients | most commonly prescribed according to kilograms |
| Confusion and agitation in the elderly | first always be blamed on medications - either side effects, drug interactions, or toxicity |
| Administering drugs in a clinical trial | STOP when you are in doubt. Seek clarification from the patient about their understanding of what they were told in the informed consent process |
| Genetic polymorphisms | well-known to alter CYP450 enzyme function. resulting in a change in metabolism of some drugs. |
| Medication reconciliation | process which allows the healthcare providers, nurses, pharmacists, and patient to communicate about the medications the patient takes. |
| Patient teaching in readmitted patients | NEver assume that patient has enough patient teaching before you Always assess what the patient knows and what they need to know |
| Best way to determine if a drug has a potential side effect | Mutations affecting drug metabolism are often genetic polymorphisms Ask if anyone else in the family had had a similar reaction to a similar drug |
| A drug is safe and effective... | when the drug is approved by the FDA and available to the general public |
| Infants and topical drugs | Infants are very susceptible to absorption of medication through skin. Consult physician before using topical creams on infants |
| Scheduled drugs, or controlled substances | have the potential for addiction The most addictive of the scheduled drugs are the schedule I and II drugs. |
| Way to reduce medication errors | Involve patients and families to reduce medical errors. It should be encouraged to speak up when they have concerns or questions. |
Created by:
EArteaga
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