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Pharm Test 1 Hodges

TCC Pharm #1 Hodges

FFP Fresh Frozen Plasma / unconcentrated/ NOT for SVE/
HCP Pain Management Understand pain, listen to Pt., treat appropriately, stay in front of the pain curve.
Post-surgical pain managment PCA, opioids,agonists help, antagonists block receptors, check for resp. depression, ortho. hypotsn, ICP, urinary retention.
Morphine Sulfate (PTD) Use for narcotic, mod-severe pain, no upper dose limit.
Morphine Sulfate MOA Occupies receptors, alters perception of pain
Morphine Sulfate Adverse Effects Respiratory depression, pruritis,increased ICP
MS - Contras/ Precautions Not for preg, or premies/ Caution with elderly, hep or renal impairment, CNS depression, head injury, increased ICP, COPD
Overdose of Morphine Sulfate Naxalone
MS Nursing Implications Assess for pain, allergies, VS. / Monitor VS, esp. with elderly / Monitor I/O, constipation and O.H. (orthostatic hypotension)
Tramadol (PTD) Prototype of NSAIDS that act on the CNS. Also acts as an SRRI.
Gate Control Well-supported theory that you can flood the receptors with stimuli and this will shut the gate in the dorsal horn to further pain transmission.
Pain Perception impacted by many factors. Pain is transmitted through nociceptors. NSAIDS work at the peripheral level, opiates work on the CNS.
Sumatriptan (PTD) Migraine management. Cranial vessel constriction. Reduces transmission in tregiminal pain pathways.
Sumatriptan: Contra/ Precautions Any cardiac issue, HTN, cholesterol or renal/hep impairment
Sumatriptan: Drug Interactions Do NOT use within 2 weeks of MAOIs or SRRIs.
Sumatriptan: Nursing Implications Administer at first symptom/ Labs for liver functions/ Chest and Jaw monitoring for pain.
Serum osmolality Number of particles in 1kG/L of water. In body fluids, talking about sodium, glucose, urea.
Normal range for serum osmolality 275-295 mml/kg
Fluid resuscitation Keeping fluid levels balanced. Replace fluids. Lost H20? Use hypotonic. Loss of blood? Use blood products. Salt? Hypertonic.
What causes thirst? Osmoreceptors in hypothalamus sens ECF is hypertonic. Pit. releases ADH to retain water via distal kidneys.
Hypertonic IV Fluids being introduced are compared to body fluids. More solvent in IV, it is hyper to body. Less in IV, it is hypo to body.
T2Diab. Mellitus Majority of all diabetics. Capable of producing insulin, target cells are unresponsive. Life style impacts greatly. Obesity raises resistance to insulin.
Tx of T2 Dm Most do NOT require insulin. 3 classes of oral antidiabetics (1. Sulfyonureas - secretagogues 2. Biaguinides - stop liver from prod. glucose 3. Thiaz - increase uptake on cell.
Diagnosis of T2DM Primarily use FPG (fasting plasma glucose) now >100. OGTT (oral glucose tolerance test) saved for pregnancies.
Insulin drugs Rapid - Aspart, Lispro, Glulisine/ Short - Regular/ Interm - Isophane NPH/ Long - Demeter, Glargine
DKA Fatty acid metabolism ~ normally T1. Acidic ketones. 3 Ps. Hyerglycemia. Kussmauls Resp (deep and labored)
Glyburide (PTD) PTD of sulfonylurea (stim. secretion of insulin from pancreatic beta cells). Increases sensitivity of surrounding tissues.
Glyburide contras Allergies to sulfa or thiazide diuretics.
Beta B1 Adrenergic Antagonist HTN, more specific, fewer non-cardiac effects (safer for COPD and asthma),(less effect on glucose). Dec. HR, MC contraction, cardiac cond. Inh. sec. of renin and form. of AT2.
Verapamil with amlodipine Verapamil is a calcium channel blocker. So is amlodipine. Cumulative effect.
Verapamil with digoxin Vera. decreases dist/excret of digoxin. Risk of toxicity. Digoxin used for heart failure. Together can cause bradycardia as both affect AV node.
Verapamil with simvastatin Simvastatin is an inactive prodrug until changed to an active metabolite via the liver. Lowers cholesterol. RISK of myopathy increases greatly.
Calcium Channel Blockers (CCBs) CCBs. C.Channels facilitate card. contractions. Blocking it impacts smooth heart muscle. Some affect arteriolar smooth muscle. None affect serum level. Don't affect veins. Reduce force of myocardial contractions. 2 big classes - dihydropyridies and non.
RAAS Renin Angiotensin Aldosterone system.
ACE Angiotensin converting enzyme I to II (instantly).Also breaks down kinase (sometimes called kinase II)
ACE inhibitors Lower BP. Can cause increase in bradykinins due to blocking the breakdown. Increase in BK can cause angioedema and cough.
ARBS Angiotensin II receptor blockers. After AII created, stop it from activating target receptors.
ARBS MOA Cause vasodilation, drops BP. Work like ACE inhib. but no cough, angioedema, no accum of bradyk.MOre $, but prevent cardiac remodeling.
Cardiac remodeling hypertrophy of myocardial cells from AII. Collagen deposits in cardiac matrix like scar tissue. Increased morbidity/mortality.
Lisinoprol (PTD)(active, not a prodrug) PTD for ACE inhibitor. Heart Failure, Acute MI, HTN. 2-3 to achieve max. ther. benefit. Watch for hyperkalemia. Orthostatic hyper.NO ETOH, NSAIDS, drink 6-8 H2O daily.
HCTZ Most common thiazide type diuretic. Lowers reab. of NaCl, BVD, BP falls.
HCTZ adverse effects May precipitate gout attacks. Elect. imbal. Low chlor, mag, pot, sodium.
HCTZ drug interactions Increased risk of toxicity from NSAIDS and digoxin. Lowered excretion of lithium and Ca.
HCTZ Nursing Responsibilities Baseline/periodic serum electrolytes. CBC. BUN. Uric Acid.
HCTZ Pt teaching Eat K+ rich food. (green, leafy, vegetables - kale, collards, spinach, and turnip greens are the highest), Avoid direct sun 10-14 days.
Classification of microorganisms Stain, Shape, Oxygen preference.
2 Classification of Anti-Infectives Chemical Class - fundamental chem structure of a group/ Pharm Class refers to MOA. Predicts similar action, similar adverse effects.
Prophy ABx Stab wounds, HIV, heart valves, some surgeries, antimalarials, anti TB, antiretrovirals for infected HCP.
1 generation Cephalosporins Beta lactam ring like Penicillins. Good for Staph and strep. Don't cross BBB.
Cephalosporin Allergy most common adverse effect. 5-10 % of those allergic to pen. also allergic. Contra in pt. with anaphylaxis to peni.
Carbapenems largest group of cell wall inhibitin, bacteriocidal. Broadest spectrum. Resistant to beta lactamese. Parenteral. Low adverse effects.
Tetracyclines - Antibiotics that inhibit protein SYNTHESIS of the bacteria. Cycle around and ruin RNA/DNA. EMPTY stomach. Watch for pseudomembranous colitis.Hpylori and acne. Superinfections. Empty stomach and water.
Tetracycline - PTD Sumycin
Macrolide ABx Safe alternative to penicillin for many gram + infections. Whooping cough, diptheria, legionnaires. Inhibits synthesis of ribosomes.
Erythromycin - PTD macrolide. Destroys ribosomes, gram pos.
Aminoglycosides - effective against gram negative. . Mostly saved now for TB due to safer alternatives. Destroys ribosomes PTD - Gentamicin
Gentacimin - PTD Aminoglycosides. Gram neg. Ototoxic and nephrotoxic. Avoid anything else that interferes with 8th CN.
Minocycline 1-2 day dosing, w/or w/out food. Watch lab values for hepatoxicity.
Ciprofloxacin - PTD fluoroquinolones inhibits DNA replica. Anthrax. Tendonitis and tendon rupture.
Metronidazole - PTD antiprotozoan. Rosacea, trichomoniasis, parasites in colon.
Created by: TCC2013