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Nurs572 Exam 2 part1
bone, immun,glauc, antihist, antimicrob, chemorx
| Question | Answer |
|---|---|
| Four live attenuated vaccines | LAIV, MMR, Varicella, Rotavirus |
| contraindications live attenuated virus vaccine | pregnancy, immmunocomp, HIG / whole blood recipient |
| LAIV | live attenuated influenza virus |
| which influenza vaccine is live attenuated? | LAIV - nasal admin |
| which influenza vaccine is inactivated | TIV - IM, ID admin |
| MMR | live attenuated measles, mumps, rubella |
| which vaccine is most likely to cause anaphylaxis | MMR |
| varicella | live attenuated varicella virus |
| which immunization is contraindicated for ASA/salicylates that can lead to Reyes | Varicella vaccine |
| Rotavirus-1 | live, attenuated, ORAL admin (1), pentavalent |
| Rotavirus-2 | live, attenuated ORAL admin (2 dose), monovalent |
| Which vaccines are conjugated? | HIB, PCV, MCV4 |
| HIB | hemophilus influenza type b |
| PCV | pneumoccoal conjugate vaccine |
| MCV4 | meningococcal conjugate vaccine - tetravalent |
| Example of toxoid vaccine | DTaP |
| DTaP | Diptheria, Tetanus, Acellular Pertussis |
| Which is adult toxoid immunization | TDap = tetanus toxoid, diptheria toxoid, acellular pertussis |
| What is DTwP? | Diptheria, tetanus and WHOLE CELL Bordatella Pertussis - -which leads to more serious ADRs |
| What are the 4 inactivated vaccines | IPV, Hep A, Hep B, TIV (inactivated influenza) |
| IPV | inactivated poliovirus |
| Does IPV cause poliovirus? | No, it is inactivated. Only the previous oral poliovirus vaccine was active, no longer available |
| HepB | has HepB surface antigen |
| How do we administer HepB to newborns? | If mom is HepB+ then newborn gets both HBIGs and vaccine. If mom is HepB- then newborn gets vaccine only |
| HepA | inactivated HepA virus |
| Who do we administer HepA to? | In Arizona, a high risk region, it is recommended routinely for kids |
| TIV | inactivated influenza, given IM, ID |
| What vaccine is inactive virus-like particles? | HPV |
| HPV recommended age admin | 9-26, ideally start 3 IM doses at 11-12 yo |
| mild allergic response mediated by | histamine |
| anaphylaxis mediated by | leukotrienes, prostaglandins |
| Which antihistamine generation has fewest side effects | 2nd generation antihistamines |
| Do H1 antagonists bind at H2 receptors? | No, they only bind H1 receptors |
| What is the MOA of H1 antagonists? | selective binding to H1 receptor preventing them from activation; also anticholinergic in CNS and PNS |
| How do some antihistamines treat for motion sickness? | the anticholinergic effects in the vomit center of medulla, CN VIII vestibular apparatus |
| Besides allergic related disorders, what are other uses for antihistamines? | transfusion reactions, motion sickness, insomnia, URIs |
| How does antihistamine help in treatment of common cold? | anticholinergic effect prevents secrtions which leads to drying of mucous membranes |
| What is the most common compliance related side effect | sedation |
| Antihistamine drug interaction with this class of drugs | CNS depressants, has additive effect |
| Which generation of anthistamines has the greates anticholinergic effect | first generation anthistamine |
| Side effects of antihistamines | CNS - sedation, dizzy, confusion. GI - A,N,V,D,C. anticholinergic, cardiac dysrhythmias |
| Four First Generation H1 antagonists | diphenydramine, chlorpheniramine, cyproheptadine, promethazine (antipsychotic) |
| one of the first antihistamines | diphenhydramine(1st gen) |
| antihistamine that is less sedating, better tolerated | chloropheniramine (1st gen) |
| antihistamine that adds appetite stimulation action | cyproheptadine (1st gen) |
| Antihistamine that is also anti-nausea, antipsychotic class | promethazine (1st gen) |
| Which class of antihistamines is less effective for URI? | Second generation less effective because of lower anticholinergic effects |
| which class of antihistamines should not be used for insomnia | second generation less effective because they are less sedating |
| what are the 7 second generation antihistamines | certirizine, levocertirizine, fexofenadine, loratadine, desloratidine, azelastine, olopatadine |
| 2nd generation racemic mixture antihistamines | certirizine, levocertirizine |
| 2nd generation metabolite of terfenandine, no indication of torsade de pointes | fexofenadine |
| 2nd generation antihistamine that I take | loratadine |
| 2nd generation antihistamine that is longer acting metabolite of loratadine | desloratadine |
| 2nd generation antihistamines (2) nasal sprays | azelastine, olopatadine |
| side effect of calcium, Vit D products | constipation |
| What class of drugs cause decreased absorption of Vit D and calcium products | corticosteroids |
| Oral forms of calcium | calcium salts, usually calcium carbonate, which has highest percent calcium, cheapest |
| other forms of calcium salts | calcium -- chloride, gluconate, glucepate, acetate, lactate, citrate |
| what is the oral form of calcium | calcium glubionate |
| what is the inactive form of vitamin D | cholecalciferol |
| Which activated form of Vitamin D is given either po or injection | calcitriol |
| what form of activated vitamin D is given ONLY po and is synthetic | doxercalciferol |
| what form of activated Vitamin D is given ONLY INJECTION and is synthetic | paricalcitol |
| What is the MOA of bisphosphonates | poorest bioavailability absorbs into bone to inhibit osteoclasts |
| What are bisphosphonates used for | prevention and treatment of osteoporosis in periomenopausal, osteoporosis in males, anyone with corticosteroid induced osteoporosis |
| what is a dangerous ADR with bisphosphonates | esophagitis |
| special admin instructions for bisphosphonates | first thing in AM before food, with full glass of water, stay upright with no food for at least 30 minutes |
| name 3 bisphosphonates | alendronate, risedronate, ibandronate |
| Which bisphosphonates are given daily or weekly | alendronate, risedronate |
| Which bisphosphonate is given daily or monthly | ibandronate |
| What SERM is commonly used for osteoporosis and may also protect against estrogen-receptor-positive breat cancer | raloxifine |
| what is the MOA of calcitonin | major role to inhibit osteoclasts --> decreased bone resorption |
| what is the minor role of calcitonin | inhibits renal reabsorption of calcium --> decreased serum calcium levels |
| what is an unusual ADR for some calcitonin long-term patients | they can develop antibodies to this product |
| What is the only drug to increase bone formation | teriparatide |
| how does teriparatide increase bone formation | it is a recombinant form of PTH that increases osteoblast activity > it increases osteoclast activity. Net effect is more bone formation than reabsorption |
| what drug is a calcimemetic | cinacalcet |
| What is cinacalcet's MOA | increases sensitivity of calcium sensing cells in parathyroid --> negative feedback to decrease PTH secretion at lower levels of calcium than usual |
| what is cinacalcet given for | hypercalcemia - by keeping calcium on the bone by increasing PTH receptor sensitivity |
| most common type of glaucoma | primary open angle glaucoma (POAG) |
| What are two mechanisms to treat glaucoma | Decreased aqueous production (ABC) and Increased outflow (PP) |
| The classes of drugs that decrease aqueous humor production | Alpha-2 agonists, Beta Blockers, Carbonic Anhydrase Inhibitors |
| Classes of drugs that increase aqueous outflow | prostaglandins, parasympathomimetics |
| Drug in Alpha 2 agonist glaucoma | brimonidine |
| Which Beta blocker drugs are more effective in treating glaucoma | non-selective B1B2 are more effective, thought to be Beta-2 receptor that mediates aqueous production |
| What are the non-selective beta blockers for glaucoma | timolol, carteolol, levobunolol, metipranolol |
| What is the selective Beta-1 blocker for glaucoms | betaxolol |
| What class is the first line agents in glaucoma treatment | Beta Blockers used first |
| What are general side effects for ABC drugs | Occular: burn, sting, hyperemia Systemic: HA, fatigue, xerostomia, cross BBB |
| What are general ADRs for CAIs | occular: burt, sting, allergy, dry Systemic: metallic taste, asthenia, paresthesias |
| CAIs - topical admin | dorzolamide, brinzolamide |
| CAIs - systemic admin | acetazolamide, methazolamide, dichlorphenamide |
| What class of drugs that increase outflow of aqueous humor are also considered by many to be a first-line treatment along with Beta Blockers? | prostaglandins also considered this |
| Advantages of prostaglandin admin | daily dosing, equally effective to beta blockers |
| What are most common occular s/e of prostaglandins | racoon pigmentation around iris, eyelids, skin near eye. eylash growth, and the usual others |
| Name 3 prostaglandins | latanoprost, travoprost, bimatroprost |
| prostaglandin 1 of 3 | latanoprost |
| prostaglandin 2 of 3 | travoprost |
| prostaglandin 3 of 3 | bimatroprost |
| What is MOA of parasympathomimetic for glaucoma | miosis pulls iris away from lining of sclera, opening the drain |
| What class is considered SECOND TO LAST resort for glaucoma | parasympathomimetics |
| What two classes of parasympathomimetics for glaucoma | direct acting cholinergics, indirect action AChE inhibitors |
| What are unusual occular s/e of parasympathomimetics | brow ache, ciliary muscle spasm, miosis, iris pigmentation, cataracts |
| Name 2 direct acting parasympathomimetic drugs for glaucoma | pilocarpine, carbachol |
| Name 1 indirect acting parasympathomimetic drug for glaucoma | echothiophate |
| name 1 non-selective adrenergic hardly ever used for glaucoma | dipivefrin |
| What are the general MOAs of antibiotics | cell wall synthesis, membrane permeability, protein/nucleic acid synthesis, antimetabolites, viral enzyme inhibitors |
| the term chemotherapy, in general | traditionally applies to cancer therapy, but applies equally to therapy of infectous disease |
| narrow spectrum vs. broad spectrum | narrow targets a few microbes, broad targets many microbes |
| bactericidal vs. bacteriostatic | cidal kills the bug, static slows its growth, giving immune system better odds to overcome |
| mechanisms microbial resistance | resistance to drug metabolizing enzymes, drugs ability to penetrate cell, microbial receptor alteration, efflux pumps remove drug from cell, synthesis of antagonistic substances |
| slogan for antimicrobial resistance | cure the patient today; protect the community tomorrow . . .and . . .don't medicate instead of educate |
| selection of antibiotic - triad concept | bug-drug-patient |
| selection of antibiotic - factors | identify likely organism, its susceptibility, host factors, drug factors |
| special circumstances where broad spectrum may be advisable | fever unknown origin, surgical drainage/prophylactic tx, immunosuppressed host, difficult locale of pathogen (CSF, endocardum, osteomyelitis) |
| prophylactic antibiotics administered when | first dose before incision of clean and clean/microbial contaminated surgery. agent must cover spectrum of usual etiological agents. |
| who long do we admin prophylactic antibiotics | intra-op doses only if duration of procedure > serum level of agent used. RARELY are post-op doses necessary, may be counterproductive |
| classes of cancer drug therapies | cytotoxic agents, hormones, biologic response modifiers |
| chemotherapy drugs more toxic to tissue with | more toxic to tissues with high growth factors-> act more on actively growing cells |
| Types of fast-growing cells targeted by chemorx | tumor cells, bone marrow, GI tract, skin/hair follicles, sperm |
| types of chemorx strategies | intermittent chemo, combination chemo, optimizing dosage schedules, regional drug delivery |
| intermittent chemo objective | results in regrowth of normal cells faster than regrowth of tumor cells |
| chemo side effects- bone marrow suppression | neutropenia, thrombocytopenia, anemia (least significant) |
| chemo side effects - GI | stromatitis (ulcers), n/v some d |
| chemo side effects - hair | alopecia |
| chemo side effects - hyperuricemia | cell death increases byproducts resulting in increased uric acid |
| chemo side effects - extravasation | admin needle exits vessel--> toxic chemo into tissues |
| chemo side effects- reproductive | fetotoxic (inhibits embryogenesis), some irreversible sterility in males |
| chemo side effects - carcinogenesis | many agents cause other cancers long-term |
| chemo side effects - unique toxicities | cardiotoxicity, nephrotoxicity, neuropathy |
Created by:
lorrelaws
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