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Pharm test 3! Quizlet! Woo!

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Very Fast Acting/short duration insulin
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Insulin with an onset of 10-130 minutes Peak 30 minutes-3 hours Must be given right before or after a meal Often on sliding scale and dependent on carbs eaten Duration 3-6.5 hours (needs to be combined with longer acting insulin for all day coverage)
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Slow acting/slow duration/REGULAR insulin
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Natural insulin R on label Onset 30-60 mins, peak 1-5 hours, duration 6-10 hours Give IV or SQ Clear solution *Only type used to treat ketoacidosis* Store room temperature 2-4 weeks, but avoid light Be careful to have food available when giving insulin
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Examples of Very Fast Acting/short duration insulin
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Lisopro (Humalong) Aspart (Novolog)
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Slow acting/slow duration/ REGULAR insulin (examples)
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Humulin R, Novolin R, Volusilin R, Iletin II regular
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Intermediate insulin
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Onset 60-180 minutes peak 6-14 duration 16-24+ NPH= regular +protein More chance of allergic reaction Watch for N on label
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Intermediate insulin examples
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Humulin N, Novolin N, Iletin II NPH
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long duration insulin
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Glargine =Lantus Has no peak Lasts for 24 hours Does not bring levels down fast Cant mix anymore Onset 70 minutes NO PEAK duration 24 (Levels are steady over 24 hour period) Clear solution, but only given SQ Also comes in pen Cannot be mixed in syringe with other insulins Timing may be morning or evening
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Oral Hypoglycemics
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for type 2 diabetics these drugs help pancreas create insulin examples: sulfonylureas, meglitinides, biguanides, thiazolidinediones, alpha-glucosidase inhibitors
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Sulfonylureas
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increase insulin production ex: orinase, glucotrol, micronase beta blockers will mask hypoglycemia can’t use with type 1 (b/c they don’t have a working pancreas)
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Meglitinides
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increase insulin production ex: prandin and starlix can’t use with type 1 diabetes (don’t have working pancreas)
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Biguanides
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increase insulin production ex: metaformin decrease glucose production from glycogen Also used to treat Polycystic Ovarian Disease *Drinking increases risk of lactic acidosis* Not as likely to cause hypoglycemia May cause GI problems (diarrhea)
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Thiazolidinediones
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increase insulin production ex: Avandia decrease insulin resistance –> decrease glycogenesis some people don’t use the insulin they do have causes fluid retention and effects plasma lipid levels
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Alpha-glucosidase inhibitors
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increase insulin production ex: Precose, Glyset inhibit carb digestion (lowers blood sugar, may cause GI problems like diarrhea) take with every meal
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hypoglycemia
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treat blood glucose <70 symptoms occur when blood glucose is <60mg/dl give oral glucose if conscious or IV glucose Glucagon: hormone that causes glycogenolysis
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Oral glucose (treats…)
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treats hypoglycemia consuming 15 g of carbohydrates and retesting blood glucose in 15 minutes 2-3 glucose tablets, 4-6 oz. of juice, 6-10 lifesavers
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Ketoacidosis (symptoms & treatment)
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In type 1 diabetes Symptoms: Fluid and electrolyte imbalance (massive fluid loss) High blood sugar levels Life threatening hyperglycemia Change in level of consciousness Fruity breath often noticed Insulin replacement (IV) bicarbonate for acidosis Water and sodium replacement (fluid boluses) Potassium replacement Normalization of glucose levels
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Prandial insulin
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bolus or mealtime insulin Short acting insulin Covers the anticipated sharp increase in blood glucose levels associated with meals Dosage is calculated on the amount of carbs eaten Peaks quickly, short half life Around 10-20% of the total daily insulin requirements at each meal
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Correction factor/sliding scale insulin
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Short acting insulin Corrects an elevated blood glucose level *NOT associated with meals* Follows a predetermined “correctional scale” May be given with meal time prandial insulin if blood glucose level is elevated before a meal
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Basal insulin
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Long acting insulin Decreases blood glucose level BETWEEN meals and overnight Covers basic metabolic needs (around 50% of the daily insulin needs) Rarely if ever based on blood glucose levels Does NOT cover meal intake No peak, lasts around 24 hours *Lantus can NOT be mixed with any other insulins*
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WBC values
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4,500-1000/mcl
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RBC values
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Male: 4.7-6.1 million cells/mcL Female: 4.2-5.4 million cells/mcL
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hemoglobin
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Male: 13.8-17.2 gm/dl Female: 12.1-15.1 gm/dl
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HCT (hematocrit)
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Male: 40.7-50.3% Female: 36.1-44.3%
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Infection
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invasion and multiplication of microorganisms in body tissues (which may be unapparent or the result of local cellular injury caused by competitive metabolism, toxins, intracellular replication, or antigen-antibody response)
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IgA
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Found in high concentrations in the mucous membranes, particularly those lining the respiratory passages and gastrointestinal tract, saliva, and tears In breast milk Helps to fight off things in food
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IgG
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*The most abundant type of antibody* Found in all body fluids and protects against bacterial and viral infections
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IgM
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Found mainly in the blood and lymph fluid First to be made by the body to fight a new infection
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IgE
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Associated mainly with allergic reactions Found in the lungs, skin, and mucous membranes Anaphylaxis
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IgD
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Exists in minute amounts in the blood Least understood antibody RhoGam is anti-[blank] Rh positive who give birth to Rh negative babies
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CBC (includes)
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WBC RBC platelets
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WBC differential
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neutrophil increase (sign of infection)
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drug level monitoring needed for what drugs?
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aminoglycosides & long term antibiotics (vancomycin) b/c they are ototoxic
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How does a nurse help prevent infections?
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hand hygiene remaining sterile when needed
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Anaphylaxis of serious antibiotic reactions
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IgE highest with penicillins and Sulfa Drugs
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Steven-Johnson syndrome
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Form of anaphylaxis Blistering rash Test: use eraser of a pencil and twist it against skin → if blister forms=bad sign, need to take to the hospital immediately
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Red man syndrome
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Commonly recognized adverse reaction of vancomycin Itching, erythema, angioedema, tachycardia, hypotension, muscle aches, and a rash that usually appears on the face, neck, and upper torso
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C Diff (Pseudomenranous colitis)
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Inflammation of the colon that occurs with people who take certain antibiotics Adverse reaction from macrolides
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What causes C-Diff and how do you treat it?
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Can be caused by macrolides Antibiotic kills off normal flora in intestines and the c. diff bacteria takes their place causing the illness Anaerobic bacteria treat with vancomycin (PO)
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Aminoglycoside
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Ex: gentamicin and vancomycin Inhibit protein synthesis Bacteriocidal Treats serious gram negative organisms Often GI, GU in nature or associated with cystic fibrosis E coli, pseudomnous, klebseiella, enterobact Given IV Must give slowly (30-60 minutes) High risk of renal toxicity and *ototoxicity* Require peak and trough levels Avoid other nephrotoxic drugs (NSAIDS) Often given with a beta-lactam Topicals used to treat eye infections
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Vancomycin
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Hearing loss (ototoxicity) Renal damage Low BP, flushing, red man syndrome Avoid in people allergic to corn
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Penicillins
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Narrow: penicillin G (IM/IV), penicillin V (PO) Broad: ampicillin (IV), amoxicillin (PO) Beta-lactamase inhibitors: Amoxillin/clavulate (PO), pipercillin/tazobactum (IV)
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Penicillin (teaching)
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Take on an empty stomach May decrease effectiveness of birth control Stop drug if S/S allergy and call provider Consider probiotics if prone to diarrhea Macrolides are used when patient is allergic to penicillin
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Cephalsporins
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Beta-lactam antibiotics Now 4 generations Newer ones better against gram negative Cross blood-brain barrier better Better resistance beta-lactamases First generation prototype: *cefazolin* (used for surgery prophylaxis) Third generation more common: *cefotaxime* Cross-sensitivities with other cephalosporin allergies 5-10% with penicillin May take with food to decrease nausea WARNING: Many look alike drug names
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Fluoriquinolones
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Ex: *Ciprofloxacin* Best against aerobic gram negative organisms Often used for sinusitis and infectious diarrhea Can treat anthrax Inhibit DNA replication PO and IV forms Calcium and iron interaction
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Fluoriquinolones (ex. Ciprofloxacin; Teaching)
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Take on an empty stomach or with juice Risk for photosensitivity May cause mild CNS symptoms including dizziness or headache May effect blood glucose Generally avoid in children Black box warning: risk for joint problems/Achilles tendon rupture
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Macrolides
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Ex: erythromycin, azithromycin Can be bactericidal or bacteriostatic Treat gram positive and atypical bacterium Chlamydia, mycoplasma, legionnaires Used when patients are allergic to penicillins Minor risk for ototoxicity, pseudomembranous colitis, and cardiac arrhythmias *Best on empty stomach Avoid grapefruit juice*
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tetracyclines
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Broad spectrum bacteriostatic agent Often used for acne and atypical bacterial infections Binds with aluminum, iron, zinc, Mg, Ca MUST take on empty stomach Can cause photo sensitivity Can cause tooth discoloration in children Pregnancy category D Not indicated for children under the age of 8 years Liver toxicity and renal toxicities
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Sulfa drugs
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[blank] effect folic acid
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Complications of strep throat
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rheumatic fever glomerulonephritis
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rheumatic fever
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occurs when strep is not treated inflammatory disease, affects the heart
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Glomerulonephritis
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occurs after an infection with strep inflammation on glomeruli, untreated can cause kidney damage
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Isoniazid
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interferes with RNA/DNA synthesis Risks for: Vitamin B6 deficiencies leading to peripheral neuropathy Elevated liver enzymes/liver damage Toxicity in the presence of alcohol CNS symptoms: dizziness, ataxia, psychosis, seizures
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Indications for changing treatment drugs for TB?
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Liver toxicity Excessive tiredness, weakness, lack of energy, dark yellow or brown urine, yellowing of the skin or eyes, vomiting, upset stomach
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Oseltamivir (Tamiflu)
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anti-viral drug for influenza A or B Given PO, prophylaxis 10 day and treatment 5 day Must start within 48 hours of symptoms
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PaO2
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75-100 mmHg
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PaCO2
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38-42 mmHg
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pH
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7.38-7.42
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SaO2
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94-100%
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HCO3
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22-28 mEq/L
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Steps in how to take an inhaler
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Shake Breathe out Put it in mouth Start to inhale Depress inhaler Breathe in slowly Hold breath Breathe out slowly Repeat in 1 minute if indicated
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Mild Intermittent Asthma
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Symptoms: difficulty breathing, wheezing, chest tightness, and coughing that occur in fewer than 2 days a week Do NOT interfere with normal activities Nighttime symptoms occur on fewer than 2 days a month Lung function tests (spirometry and PEF) are normal when the person is not having an asthma attack The results of these tests are 80% or more of the expected value and vary (PEF varies less than 20%) from morning to afternoon
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Mild Persistant Asthma
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Symptoms occur on more than 2 days a week, but not every day Attacks interfere with daily activities Nighttime symptoms occur 3 to 4 times a month Lung function tests are normal when the person is not having an asthma attack The results of these tests are 80% or more of the expected value and may vary a small amount (PEF varies 20-30%) from morning to afternoon
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Moderate persistant asthma
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Symptoms occur daily Inhaled short-acting asthma medication is used every day Symptoms interfere with daily activities Nighttime symptoms occur more than 1 time a week, but do not happen every day Lung function tests are abnormal (more than 60% to less than 80% of the expected value) and PEF varies more than 30% from morning to afternoon
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Severe persistant Asthma
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Occur throughout each day Severely limit daily physical activities Nighttime symptoms occur often, sometimes every night Lung function tests are abnormal (60% or less of expected value) and PEF varies more than 30% from morning to afternoon
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LABA
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Decreases effectiveness of short-acting drugs Cannot be used to relieve an immediate attack Used for maintenance therapy
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ICS (inhaled corticosteroid/glucocorticoids)
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Ex: budesonide and fluticasone Considered the most effective anti-asthma drugs available Reduce bronchial hyper-reactivity Also decrease airway mucus production and increase the number of bronchial beta 2 receptors as well as their responsiveness to beta 2 agonists Usually administered by inhalation, but IV and oral are also options Mechanism of action = suppress inflammation Decreased synthesis and release of inflammatory mediators Decreased infiltration and activity of inflammatory cells Decreased edema of the airway mucosa
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Leutroptriene modulator prototype drugs
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Suppress effects of leukotrienes Less effective than inhaled glucocoritcoids Available agents: Zileuton (Zyflo) Zafirlukast (Accolate) Montelukat (Singulair)
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allergic rhinitis
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Inflammatory disorder of the upper airway, lower airway, and eyes Symptoms: Sneezing, Rhinorrhea (runny nose), Pruritus (itching), Nasal congestion Some people: conjunctivitis, sinusitis, and asthma Seasonal and perennial Triggered by airborne allergens Allergens bind to immunoglobulin (IgE) on mast cells Inflammatory mediators released Histamine, leukotrienes, and prostaglandins
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Oral antihistamines
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ex: Loratadine and Azelastine Do not reduce nasal congestion Most effective if taken prophylacitically Adverse effects are mild: sedation with first generation (much less with second generation) Anticholinergic effects (constipation, dry mouth)
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Azelastine (nasal)
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Only intranasal antihistamine available Benefits equivalent to oral antihistamines Metered-spray device, leaves bitter taste Can lead to nosebleeds
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Becolmethasone
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intranasal glucocorticoides First choice (most effective for treatment and prevention of rhinitis) Mild adverse effects Drying of nasal mucosa or sore throat Nose bleeds Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
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Sympathomimetics
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Drugs: Phenylephrine (short acting), Oxymetazoline (long acting) Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching) Activate alpha1-adrenergic receptors on nasal blood vessels Adverse effects: CNS stimulation Cardiovascular effects and stroke Abuse (now behind counter because can be used to make meth) Factors in topical administration Should not use longer than 5 consecutive days Phenylephrine, ephedrine, pseudoephedrine Antihistamine-sympathetic combinations Ipratropium bromide (atrovent) Montelukast (singulair) Omalizumab (xolair)
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Mucolytics
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Make secretions watery Acetylcystein (treatment of Tylenol overdose) and saline Mainstay of cystic fibrosis
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expectorants
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Stimulate flow of secretions Guaifenesin
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Acetylcystein
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(treats Tylenol (acetaminophen) overdoses) Assess time and amount consumed Perform gastric decontamination if <2 hours since ingestion Draw acetaminophen levels 4 hours after ingestion Have to do it then to get the peak Give acetylcysteine if levels indicate
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Serum Sodium
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135-145mEq/L
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Serum Potassium
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3.7-5.2 mEq/L
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First line choice treatment for hypertension
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Beta-blockers
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Furosemide (Lasix)
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loop diuretic
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Loop Diuretics (treats)
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1. Widely used for edema and fluid build-up 2. Less commonly used for hypertension How to give: 4 mg per minute (IV)
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Loop Diuretics (mechanism of action)
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1. Inhibits sodium reuptake in the ascending loop of Henle 2. Increases the amount of fluid passed through the kidneys (increased urination)
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Loop Diuretics (good candidates)
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CHF, renal insufficiency
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Loop Diuretics (interactions)
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interactions: aminoglycosides, NSAIDs, digoxin, cisplatin, cyclosporine
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Loop Diuretics (Contraindication)
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contraindications for … kidney/liver disease, diabetes, gout, low BP, low blood volume, enlarged prostate
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Loop Diuretics (side effects)
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Dry mouth, diarrhea, blisters, peeling skin, ears ringing, SOB, chest pain
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loop diuretics (teaching points)
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May cause photosensitivity, don’t take if pregnant (category C), drink lot of fluids, have labs drawn before giving meds
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hydrochlorothiazide (category, side effects)
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Thiazide diuretics Sensitivity to light, don’t take if pregnant, dizziness or fainting can occur if sitting up too fast
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Thiazide diuretics (treats)
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1. High BP 2. Fluid retention/edema 3. Diabetes insipidus 4. Prevent kidney stones
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Thiazide diuretics (mechanism of action)
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1. Helps kidneys eliminate unneeded water and salt 2. Distal convoluted tubule 3. Prevents Na reabsorption and encourages Ca 4. Increased water in tubule (increased urination)
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Thiazide diuretics (candidates)
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individuals with heart, kidney, or liver diseases
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Thiazide diuretics (interactions and contraindications)
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Interactions: barbiturates, corticosteroids, insulin, lithium, NSAIDs, anti-hypertensives Contraindications: 1. Severe renal disease
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Thiazide diuretics (teaching points)
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1. May cause increased urination 2. Take in the morning 3. No rugs (fall risk) 4. Assess kidney function/levels 5. Long term med
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Spironolactone (example, )
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Potassium sparing diuretics
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Potassium sparing diuretics (treats)
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1. MI stiffness 2. Heart failure and prevents further progression of the disease 3. Decreases collagen deposition 4. Decreases left ventricular hypertrophy (in patient with hypertension) 5. Lowers BP (vasodilates blood vessels)
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Potassium sparing diuretics (mechanism of action)
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1. Conserves potassium levels in the body 2. Kidneys eliminate unneeded water and sodium, BUT reduces the loss of potassium from the body 3. Lowers BP 4. Balances aldosterone levels
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Potassium sparing diuretics (good candidates)
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1. CHF 2. Hypertension 3. Edema
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Potassium sparing diuretics (interactions, side effects)
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1. ACE inhibitors 2. ARBs side effects: Diarrhea, dizziness/drowsiness, dryness of mouth,, pale stools, unusual bleeding or bruising
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Potassium sparing diuretics (teaching points)
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1. Best used with a thiazide diuretic 2. Pregnancy Category C 3. Dehydration could cause harm with medicine 4. Tell doctor if your are taking a medication to lower your blood pressure 5. Take medication in the morning because of increased urine frequency 6. Do not try to increase potassium intake 7. Do not use alcohol
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Digoxin (cardio glycosides, treats)
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atrial fib heart failure
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Digoxin (mechanism of action)
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1. Shuts down Na/K pump 2. Slower heart rate, increased contractility (more blood is pumped out each time)
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Digoxin (nursing precautions)
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1. Monitor serum digoxin concentrations and electrolytes 2. Interactions: a. Warfarin (interacts on CPY450 pathway), ACE inhibitors, calcium channel blockers, beta blockers 3. Cant give medication if apical pulse is <60 4. Give loading dose 5. More than 1 mL of digoxin for a pediatric patient is wrong
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Digoxin (pt teaching)
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1. Low sodium diet and potassium supplement 2. Vomiting and diarrhea are signs of toxicity 3. Don’t give medicine with high fiber diet
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Beta Blockers
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Drug: Propranolol, Labetolol (used for preterm labor) Autonomic nervous system (blocks sympathetic) Treats: Migraines, anxiety, preterm labor, high BP, phechyromycytoma Contraindications: Pregnant, breastfeeding, slow HR, heart failure, problems with circulation, asthma Teaching points: Don’t take with beta agonist (albuterol), not approved for under 18 year olds, sexual side effects, don’t stop suddenly because it could cause hypertensive crisis or heart attack
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calcium channel blockers
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1. Drug: Verapamil, Amlodipine 2. Treats: a. Angina, atrial arrhythmias (a fib, a flutter, super ventricular tachycardia), hypertension, preterm labor, migraines 3. Best candidates: hypertensive with chest pains 4. Contraindications: a. Cystic fibrosis, cardiac diseases 5. Teaching points: a. Monitor HR 6. Interactions: colchicine, dofetilide, lomitapide
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ACE inhibitors
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1. Drug: Lisonpril, Captopril 2. Diuretic effect 3. Good candidates: high BP, person who just had MI 4. Teaching points: a. Black box warning, category D pregnancy, DON’T take with severe kidney disease b. First line medication for someone with diabetes because it preserves kidney function c. Will cause cough so make sure you tell patients ahead of time 5. Monitor: electrotypes, BP, renal function, jaundice, liver failure, potassium levels 6. Interactions: potassium sparing diuretics
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Angiotensin II receptor Blockers
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1. Drug: Losartan 2. Good candidate: hypertension, stroke risk, left ventricular hypertrophy, kidney disease in people with high BP, diabetes 3. Mechanism of action: a. Vasodilation (less than ACE inhibitors), prevents constriction 4. How to know it worked: a. Decreased BP, kidney maintenance, electrolyte balance 5. Monitor: a. BP, HR, renal function, electrolytes, lithium salts 6. Interactions: a. ACE inhibitors, potassium sparing diuretics, potassium supplements 7. Contraindications: a. Pregnancy, hypersensitivity, severe renal disease
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Nitroglycerin
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Works: Treats chest pain associated with angine (angina associated with CHF and congested artery disease) Vasodilates arteries to heart Interactions: Erectile dysfunction meds, phosphodieterase 5 inhibitor Teaching of patch: Develop a tolerance if you do not take a break in between transdermal patches for a few hours Take patch off at night Teaching points: Call 911 if they still have pain after 3 doses Headache from swelling Don’t want medication exposed to light
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A client with Type 2 diabetes mellitus visits your clinic for a routine visit. Blood tests that day reveal a blood glucose level of 100 mg/dL, and a Hbg A1C of 9%. These results indicate that: A. The blood glucose is well under control B. The blood glucose is low; the client needs to increase kcal intake C. The blood glucose is normal today, but has been significantly elevated during the last 3 months D. The blood glucose is high now, but has generally been normal in the last 3 months
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C Ranges Fasting plasma glucose: <110 A1C should be under 6.5%
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A patient recently diagnosed with Type 2 diabetes asks the nurse why he developed the condition. The nurses best response would be that: A. the condition is related to autoimmune destruction of the pancreatic cells. B. the condition is strongly related to genetics and obesity. C. the condition may be triggered by an infectious process. D. the disease is likely after abdominal trauma.
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B
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The nurse is assessing a newly diagnosed patient for short-term complications of diabetes. This assessment includes: A. signs and symptoms of hyper or hypoglycemia. B. cranial nerve testing for peripheral neuropathy. C. pedal pulse palpation for arterial insufficiency. D. auscultation of carotids for bruits associated with atherosclerosis.
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A (all are important but A is the only short term complication)
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Clients with diabetes mellitus can be taught to treat hypoglycemia with the 15-15 rule. This involves: A. consuming 15 g of carbohydrate and retesting blood glucose in 15 minutes B. resting 15 minutes before consuming 15 glucose tablets C. consuming 15 mL of orange juice and lying down for 15 minutes D. waiting 15 minutes and then consuming 15 oz of grape juice
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A
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Usually a high priority for nutritional therapy in type 2 diabetes is: A. careful adherence to the distribution plan for nutrients throughout the day B. protein intake at 250 percent of the RDA for individuals without diabetes C. achieving desirable glucose, blood pressure, and lipid levels, as well as weight control D. strict compliance with a meal pattern of three meals and three snacks per day
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C
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Which of the following interventions has been shown to delay the onset and slow the progression of diabetic retinopathy, nephropathy, and neuropathy? A. weekly visits to the clinic or physician’s office B. strict adherence to the American Diabetic Association diet C. intensive control of blood glucose levels D. self-monitoring of blood glucose
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C (Because they are micro problems, intensive helps these)
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One life threatening effect of ketoacidosis in a person with diabetes is: A. hyperactivity caused by muscle stimulation B. dehydration to osmosis C. fluid retention as the body attempts to dilute the blood D. alkalosis caused by the high blood level of ketones
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B
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Clients with diabetes may need to limit their usual milk because it contains A. calcium B. protein C. carbohydrate D. fat
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C
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Oral medications for diabetes may work in all but which way? A. Promoting insulin secretion B. reducing glucogenesis C. decreasing insulin resistance D. replacing natural insulin
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D