Nursing Pharmacology Semester 1 – Flashcards

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Pharmacokinetics
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refers to how medications travel through the body.
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Absorption
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Transmission of medication from location of administration to the blood stream.
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Distribution
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Transportation of medications to site of action by body fluids.
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Metabolism
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Changes medications into less active forms or inactive forms by enzymes. Primarily happens in the liver.
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Excretion
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Elimination of medications from the body. Usually the kidneys but can be liver, lungs, bowel and exocrine glands.
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protein, target tissues
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The ability of a medication to bind to a ___ can effect how the medication will leave and travel to ___
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Low Therapeutic Index
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Medications have this and they must be monitored by serum medication level monitoring
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Trough Levels
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Drawn immediately before the next medication dose, regardless of the route of administration.
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Half Life
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Refers to period f time needed for the medication in the body to be reduced by 50%
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Long Half Life
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Medications leave the body more slowly; more than 24 hours. Greater risk for medication accumulation and toxicity.
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Agonist
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Medication that can mimic the receptor activity regulated by endogenous compounds. i.e. morphine because it activates the receptors that produce analgesia, sedation, constipation, and other effects. drug that produces a response
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Antagonist
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Medication that can block normal receptor activity regulated by endogenous compounds or receptor activity caused by other medications. i.e. losartin works by blocking angiotensin II receptor blockers on blood vessel, which prevents vasoconstriction. Drug that blocks a response
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Partial Agonists
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May act as agonist/antagonist. Limited affinity to receptor site. i.e. nalbuphine acts as an antagonist at mu receptors and an agonist at kappa receptors, causing analgesia at low doses, with minimal respiratory depression.
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Non-parenteral routes of Administration
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Oral, sublingual, transdermal, topical, opthalamic, otic, rectal, vaginal, nasal.
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Therapeutic Effect
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This is the preferred and expected effect for which the medication is administered to a specific client.
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Side Effects
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Usually expected and inevitable when a medication is administered at a therapeutic dose.
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Adverse Effects
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There are undesired, inadvertent, and unexpected dangerous effects of the medication.
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Toxic Effects
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Medications can have specific risks and manifestations of toxicity.
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Components of a prescription
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Clients full name, date and time of prescription, name of medication, dosage of medication, route of administration, time and frequency, signature of provider.
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Six Rights of Safe Medication Administration
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Right Client, Right Drug, Right Dose, Right Time, Right Route, Right Documentation.
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Diabetes mellitus
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Chronic illness that results from an absolue or relative deficiency of insulin, often combined with cellular resistance to insulin's actions.
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Rapid-acting
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Humalog. Onset less than 15 minutes; peak 30min-1hr; Duration 3-4 hours
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Short-acting
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Regular (Humulin R). Onset 30min-1hr; Peak 2-3 hr; Duration 5-7hr
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Intermediate-acting
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NPH (Humulin N). Onset 1hr; Peak 4-12 hr; duration 18-24 hr.
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Long-acting
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insulin glargine (Lantus,Levemir). Onset 1hr; has no peak; duration 24hr
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The purpose of insulin
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promote cellular uptake of glucose, converts glucose into glycogen, and moves potassium into cells (along with glucose).
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Diabetic Ketoacidosis
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One of the most serious complications of hyperglycemia. Caused by drawing fluid out of the cell into circulation, excreted by kidneys. Results in Polyuria, dehydration & electrolyte imbalance. This increases fat metabolism and ketones, resulting in metabolic acidosis.
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Hyperglycemic nonketotic syndrome
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blood glucose level about 600mg/dl resulting in diabetic coma
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Hypoglycemia acute onset
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low blood glucose level. symptoms in include; tachycardia, palpitations, diaphoreses, shakiness
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Hypoglycemia gradual onset
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low blood glucose level. symptoms include; headache, tremors, weakness,
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Metformin (Glucophage)
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Reduces production of glucose from the liver by suppression of gluconeogenesis. In a nut shell it prevents glucose from being made and forces body to use what is in storage. used as first medication in diabetes 2 because drug does not induce weight gain or hypoglycemia and has few adverse effects.
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Thiazolidinedionesn (Glitazones)
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Increase cellular response to insulin by decreasing insulin resistance.
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Alpha glucosidase inhibitors (Precose, Glyset)
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Slows carbohydrate absorption and digestion
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Hepatotoxicity
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Liver toxicity due to drug accumulation. most drugs are metabolized in the liver and it is vulnerable to drug-induced injury.
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Extrapyramidal symptoms (EPS)
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Abnormal body movements such as tremors, rigidity, uncontrolled restlessness, spastic movement of head, neck, eyes, and it can take months to develop. Common with mental disorder meds
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Anticholinergic Effects
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(drying effect). Dry mouth, photophobia, urinary retention.
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Toxicity
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is severe or a life threatening condition. It can be caused by excessive dose but can occur at therapeutic levels.
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Allergic Reaction
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is an immune response to a medication. You have to have been previously exposed and develop antibodies. Can be minor or serious; rash and hives to anaphylaxis.
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Immunosuppression
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Is a decreased or absent immune response.
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Central Nervous System Effects
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may result from stimulation or depression of the CNS.
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Cardiovascular Effects
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may involve blood vessels and the heart. Antihypersensitives can cause orthostatic hypotension.
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Gastrointestinal Effects
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may result from local irritation of the GI tract. Stimulation of the vomiting center also results in adverse effects.
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Hematologic Effects
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relatively common and potentially life-threatening with some groups of medications. Bone marrow depression, anticancer drugs, anticoagulants, thrombolytics.
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Nephrotoxicity
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may occur with a number of medications, but is primarily the result of antimicrobial agents and NSAIDs. Impaired kidney function may interfere with excretion, leading to accumulation and adverse effects.
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Anaphylactic Reaction
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Life threatening immediate allergic reaction that causes respiratory distress, severe broncho-spasm, and cardiovascular collapse.
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Consuming foods with tyramine
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while taking MAOIs can lead to hypersensitve crisis.
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Vitamin K
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can decrease the therapeutic effects of warfarin (Coumadin) and place clients at risk for developing blood clots.
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Tetracycline
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can interact with a chelating agent such as milk, and form an insoluble, unabsorbable compound.
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Grapefruit Juice
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seems to act by inhibiting presystemic medication metabolism in the small bowel, thus increasing absorption of certain oral medications such as nifedipine (Procardia) a calcium channel blocker. may cause drug toxicity.
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Morphine (Duramorph)
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depresses respiratory function, so it should be used cautiously with asthma or impaired respiratory function.
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Pregnancy Category A
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There is no evidence of risk to the fetus during pregnancy based on adequate and well-controlled studies
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Pregnancy Category B
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There is no evidence of risk to animal fetus based on studies but there are no adequate and well controlled studies in pregnant women or there is risk in animal fetus but studies in pregnant women show no risk to the fetus
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Pregnancy Category C
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Adverse effects have been demonstrated on animal fetuses, but there are no adequate and well controlled studies in pregnant. The use of these medications during pregnancy may be warranted based on potential benefits/
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Pregnancy Category D
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Adverse effects have been demonstrated on human fetuses. use may be warranted on potential benefits.
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Pregnancy Category X
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Adverse effects have been demonstrated on animal and human fetuses. The use of these medications are contraindicated during pregnancy because risks outweigh benefits.
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Liver and Kidney Function
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are immature in young children and often decreased in older adults.
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Tolerance
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Responsiveness to a medication is reduced and may require higher doses.
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Inadequate gastric acid
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inhibits the absorption of medications that require acid to dissolve
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Diarrhea
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causes oral medications to pass through the GI tract too quickly to be absorbed
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Vascular insufficiency
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prevents distribution of medications to affected tissue
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Liver disease/failure
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impairs medication metabolism, which may cause toxicity
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Kidney disease/failure
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prevents or delays medication excretion, which may cause toxicity.
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Medication error
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an event that results in a patient receiving inappropriate medication or failing to receive it as prescribed
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Parenteral Routes of Administration
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intramuscular, subcutaneous, intradermal, intravenous, intratracheal, and epidural.
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Accumulation
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Process which occurs when the rate of drug administration exceeds drug excretion resulting in gradual increase in the blood level of the drug
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Bioavailability
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The percentage of an administered dose which is absorbed. The rate and extent to which an active drug or metabolite enter the general circulation, permitting access to the site of action.
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Cross-tolerance
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a situation in which the development of tolerance to one drug creates a tolerance to other drugs with similar pharmacological effects
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Efficacy
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The ability of a drug to produce a specific result, regardless of dosage.
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Hepatic First Pass effects
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a phenomenon which occurs whereby a drug which has been absorbed by the GI system is extensively metabolized by the liver prior to reaching the systemic circulation
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Idiosyncratic reactions
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An unusual response to a drug. It can manifest as an accelerated, toxic, or inappropriate response to the usual therapeutic dose of a drug
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peak drug level
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the highest plasma concentration of a drug at a specific time
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Pharmacodynamics
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Study of drug concentration and its effect on a living organism
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Pharmacogenetics
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Area of pharmacology that examines the role of genetics in drug response.
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Placebo
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a physiological benefit from a compound that may not have the chemical structure of a drug effect
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insulin lipodystrophy
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the loss of local fat deposits in patients with diabetes as a complication of repeated insulin injections into the same subcutaneous tissue
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sustained release and enteric coated capsules
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must be swallowed whole to be effective.
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Deltoid
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the site that is easily accessible but not suitable for repeated injections or injections of more than 2 ml
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Following rectal insertion of suppository
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client should remain in a side-lying position for 5-10 minutes
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intradermal
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3/8-5/8 inches in length needle
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Intramuscular
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1/2-1 1/2 inch needle
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Subcutaneous
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1/2-5/8 inch in length needle
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Pharmacokinetic factors specific to children
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Decreased gastric acid, slower gastric emptying, decreased first pass metabolism, increased absorption of topical medication, lower blood pressure, higher body water content. Decreased serum protein binding sites until 1 year.
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Pharmacokinetic factors specific to older adults
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increased gastric pH (alkaline), decreased GI motility and gastric emptying, decreased blood flow through cardiovascular system, liver, and kidneys, decreased hepatic enzyme function, decreased kidney function and glomerular filtration rate, decreased protein binding sites, decrease body water, increased body fat, and decreased lean body mass.
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vancomycin
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is excreted unchanged in the kidneys and should be used cautiously in a client who has renal impairment
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digoxin
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clients taking __ should be monitored closely for dysrhythmias. Hyperkalemia places client at higher risk for toxicity
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Safety of insulin therapy in older adults
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may be affected by reduced vision, mobility and coordination problems, and decreased memory.
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Insulin
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is a small protein that is destroyed by stomach acids and intestinal enzymes. that is why it should be injected
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48 hours
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metformin should be withheld for __ before and after using contrast material and surgical procedures requiring anesthesia.
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Kidney disease
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Metformin should not be given to anyone with ___ and elevated creatnine levels. most common side effects are abdominal discomfort and diarrhea.
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conditions that decrease drug clearance
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Metformin is contraindicated in___ ___ __ __ ___ , such as liver disease, alcoholism, or severe congestive heart failure
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lactic acidosis
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Meformin can cause __ __ in patients with renal insufficiencies with presenting symptoms; fatigue, unusual muscle pain, difficulty breathing, unusual or unexpected stomach discomfort, dizziness lightheadedness, or irregular heartbeats.
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fluid retention
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Major side effects in TZD treatment are an increase in adipose tissue and __ ___
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abdominal discomfort
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The most common side effects of Alpha-Glucoidase Inhibitors (Acarbose) include; flatulence, diarrhea, and ___ ___ .
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Black Box Warning
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is a government designation indicating that a drug has at least one serious side effect and must be used with caution.
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0.5- 1
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A usual starting dose of insulin is between__ unit/kg of body weight per day.
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blood glucose
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The patients patterns__ __ determines insulin dosage
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more normal
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Mixture of short and intermediate acting insulins produce a__ __ blood glucose response in some patients than does a single dose.
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mixed insulin
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Patients response to__ __ may differ from the response to the same insulins given seperately.
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shorter acting
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When rapid acting or short acting insulin is mixed with a longer acting insulin, draw the ___ ___ dose first.
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15 minutes
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When rapid acting insulin is mixed with an intermediate acting or long acting, the mixture should be given with ___ __ before a meal.
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lipoatrophy
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is a loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin
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Lipohypertrophy
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is an increased swelling of fat that occurs at the site of repeated insulin injections
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Dawn Phenomenon
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fasting hyperglycemia that results from nighttime release of growth hormone. it is managed by providing more insulin for the overnight period.
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When should patients be instructed to take antacids for optimal effect
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At least one hour apart from other medications. They may interfere with absorption of other medications if taken together
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How long can unopened insulin be stored and where?
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in the fridge until expiration date.
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How long can premixed insulin be stored?
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3 months
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How do you store premixed insulin in syringes?
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1-2 weeks, vertical with needle up and should be rotated to mix before administering.
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How should an opened vial of insulin be stored?
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At room temperature; no sunlight or heat and discard after 1 month.
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Why are alpha receptor blockers and angiotensin converting enzyme inhibitors less effective in African Americans?
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They have abnormally low levels of the enzyme that metabolizes these drugs. Diuretics are more commonly used to treat their hypertension.
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How do diuretics lower blood pressure?
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They help rid you body of sodium and water. They decrease the amount of fluid by pulling it from the vessels and excreting it through the kidneys. The lesser amount of fluid flowing through the blood vessels decreases the pressure of the blood on arterial walls.
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Why are inhaled steroids not recommended for acute asthmatic episodes?
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They do not produce immediate effects. They are better used for prophylactic measures.
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diabetes insipidous
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disorder of the posterior lobe of the pituatary gland that causes excessive thirst and excretion of large volumes of dilute urine
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non-sulfonylurea secretagogue
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type of oral anitidiabetic agent that stimulates insulin release; also called glinide
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polydipsia
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excessive thirst and fluid intake
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polyphagia
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excessive hunger
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polyuria
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excess urination
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