UWorld NCLEX – Flashcards
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critically low platelet count
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<10 x 10^9/L risk of internal bleeding
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Partial thromboplastin time (PTT) during anticoagulation with heparin
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1.5-2 x normal (1.5-2x28-38s=42-76)
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after stroke thrombolytics are used within...
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4.5 hours of onset
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Cushing's triad : increased intracranial pressure
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Early: change in level of consciousness Late: bradycardia, increased systolic blood pressure with widening pulse pressure, Cheyenne stokes respirations.
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Meds for diabetic neuropathy
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Duloxetine, pregabalin, amitryptiline, and gabapentin.
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Critically ill glucose goal
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7.8-10
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Non critically ill glucose goal
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<7.8 fasting <10 random
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Neutropenia
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Absolute neutrophil count <1x10^9 <0.5 x10^9 is severe neutropenia, is critical
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Spontaneous surgical bleeding due to thrombocytopenia can occur when
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Platelets <50x10^9
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Lisinopril
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ACE inhibitor Risk of angioedema Persistent dry cough, orthostatic hypertension and hyperkalemia are side effects
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Chest tube drainage
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>100ml/hr reported to HCP
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high or low lab values
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cythemia= high anemia/ cytopenia= low
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high BP for thrombolytics
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>180/110 is a relative contraindication for thrombolytics
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IV KCl max infusion rate
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10 mmol/hr in peripheral vein 40 mmol/hr in central venous catheter
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normal CSF characteristics
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clear, colourless little protein little glucose minimal WBCs no RBCs no microorganisms pressure 60-150 mmH2O
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kidney pelvis catheters
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irrigated with gentle pressure NS </=5ml
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IV RBC infusion
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only with normal saline preferred 18 gauge IV, 20 gauge is acceptable
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LDL cholesterol
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<2.6 mmol/L
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positive orthostatic vital signs
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SBP drops min 20 mmHg DBP drops min 10 mmHg
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residual urine in bladder
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>100 mL should be reported to HCP due to potential urinary retention
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bleeding episode rarely occurs when platelets
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>50x10^9/L
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autonomic dysreflexia
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(throbbing, headache, flushing, hypertension) caused by sensory stimulation of clients with spinal injury at T6 or higher
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c-reactive protein
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<8 mg/L
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intermittent catheterization indicated for residual volume of
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300-400mL
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tracheostomy suction
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100-120 mmHg for adults, 50-75mmHg for children
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acrocyanosis
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peripheral cyanosis normal in newborn's first day of life or first 7-10 days when cold. Monitor temp, Skin to skin or warmer Xto treat.
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NSAIDS avoided in pregnancy...
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...starting at 30 weeks [risk of premature closure of ductus arteriosus and prolonged labour]
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magnesium sulfate prescribed in pregnancy for
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preeclampsia to prevent seizure activity. therapeutic magnesium level: 2.0-3.5 mmol/L
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HELLP
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severe form of preeclampsia Hemolysis Elevated Liver enzymes Low Platelets
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anemia in pregnancy
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<110 in 1st or 3rd trimester <105 in 2nd trimester
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pregnancy WBC
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<15x10^9
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newborn hypoglycemia
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<2.2 mmol/L
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gastric acid inhibitors
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ranitidine, famotidine, nizatidine
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proton pump inhibitor
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pantoprazole, esomeprazole
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angiotensin 2 receptor blockers
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-sartan
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proteinuria
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>0.3g/day, protein/creatinine ration>0.3, dipstick >or=1+
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oxytocin dosage
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125-200 miliunits/min IV
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severe anemia
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<70 Hgb
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iron deficiency anemia
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Hgb<110 Hct<0.33
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systolic BP goal after carotid endarterectomy
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100-150
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bowel sounds absent for__ hrs post bowel surgery
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24-48 hrs
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barium contrast medium causes white stools
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for up to 3 days following procedure
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excessive vomiting can lead to K disorder:
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hypokalemia
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tPA
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not administered: -within 2 weeks of surgery, -if Hx of intracranial hemorrhage -if client is actively bleeding -[if stroke or head trauma within 3 months] -[current anticoagulant use]
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celecoxib
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COX2 inhibitor NSAID risk of cardiovascular complications
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s3 heart sound
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heard when atrium pumps blood into noncompliant ventricle
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hip artroplasty drainage
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excessive if >250ml in 1st 8 hours
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adjust enteral feed if gastric residual volume
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>250 ml
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neonate rectal temperature
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36.0-38.0, red flag if out of normal
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TNF inhibitors
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-eg. etanercept, infliximab, adalimumab -cause immunosuppression
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sucralfate
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antiulcer -forms protective layer, better in low pH environment -better in empty stomach -other drugs 2 hrs before or after
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albuterol (Proventil)
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short acting beta agonist
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contricosteroids
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fluticasone, beclomethasone -rinse mouth to prevent thrush after metered dose use
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celecoxib, naproxen
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NSAIDs
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methotrexate
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Antineoplastic Agent, Antimetabolite (Antifolate); Antirheumatic, Disease Modifying; Immunosuppressant Agent
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warfarin and heparin
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warfarin takes 48-72 hrs to take effect, overlap between drugs for 5 days or until INR reaches therapeutic level
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dabigatran (Pradaxa)
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thrombin inhibitor
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levothyroxine
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take daily, in the morning, separately from other meds (calcium, iron, antacids...), dose dependent on BW
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levetiracetam
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anti seizure, few drug drug interactions
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dexamethasone
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contricosteroid, brain swelling
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antiplatelets
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aspirin, clopidogrel, prasugrel, ticagrelor clopidogrel infrequently causes increased liver enzymes
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diuretics
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furosemide, torsemide, bumetanide
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isoniazid
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for tuberculosis
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statins
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rosuvastatin, atorvastatin, need baseline liver enzymes
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terazosin
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alpha adrenergic blocker to treat urine retention in benign prostatic hyperplasia
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phosphodiesterase-5 inhibitors
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sildenafil, vardenafil increase smooth muscle relaxation
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carbamazepine
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antiseizure, effective against neuropathic pain associated with agranulocytosis [leukopenia] and infection risk
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alpha 2 agonists
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clonidine, methyldopa
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rifampin
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for TB side effects: hepatotoxicity, body fluid discoloration (red orange), increased drug metabolism (oral contraceptives, hypoglycemics, warfarin)
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theophyline
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bronchodilator narrow therapeutic range (10-20 mcg/ml), blood drawn 30 min after administration at medication peak meds that increase serum theophyline levels: cimetidine, ciprofloxacin
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NSAIDs side effects
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heart attack, stroke, high BP, heart failure with long term use. decrease effect of duiretics and BP meds. long term use associated with chronic kidney disease and peptic ulcers.
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hydrochlorthiazide and chlorthiadone thiazide diuretics
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side effects: -hypokalemia (muscle cramps) -hyponatremia (altered mental status, seizures) -hyperuricemia (worsens gout attacks) -hyperglycemia (adjust diabetic medications)
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azathioprine
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immunosuppresant
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baclofen
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antispasmodic, causes orthostatic hypotension
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cochicine
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decreases inflamattion and pain of gout
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phenazopyridine hydrochloride
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urinary analgesic, causes discoloration of urine and other body fluids
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tricyclin antidepressants
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amitriptyline, notriptyline, desipramine, imipramine -commonly used for neuropathic pain -side effects common in elderly: -orthostatic hypotension -anticholinergic (constipation, urinary retention) -neurological (drowsy, confused) -dermatological (photosensitivity)
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calcium channel blocker
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nifedipine, amlodipine, diltiazem
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grapefruit bad with
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calcium channel blockers and statins
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dicyclomine
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anticholinergic/ antispamsodic
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gabapentin
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anlgesic consult and anticonvulsant
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diphenhydramine
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anti histamine
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lithium
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0.6-1.2 therapeutic index for maintenance 1-1.5 for acute mania mood stabilizer risk factors for toxicity: -dehydration -decreased renal fn -low sodium diet -drug drug interactions (thiazide diuretics and NSAIDs) chronic toxicity leads to: -neurological manifestations -nephrogenic diabetes insipidus
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potassium sparing diuretics
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spironolactone triamterene amiloride eplerenone
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anticonvulsants
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carbamazepine, phenytoin, lamotrigine phenytoin reference 10-20 mcg/ml
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normal uric acid levels
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262-450 umol/L 137-393 umol/L
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macrolide antibiotics
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-micin can lead to prolonged QT interval hepatotoxic
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vancomycin infusion period
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min 60 minutes, min 100 minutes if greater than/= 1g draw trough levels (6.9-13.8 umol/L) 15-30 min before next infusion
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phosphate level
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0.78-1.42 mmol/L
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benztropine
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anticholinergic to treat extrapyramidal symptoms
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NSAIDs
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ketorolac, indomethacin, ibuprofen, naproxen
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bisphosphonates
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-dronate risedronate, alendronate drink lots of water and stay upright for 30 min treats osteoporosis
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nitro
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SPB>90 to administer
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hydralazine and isosorbide
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smooth muscle relaxant
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antimuscarinic/anticholinergic meds anti overactive bladder/ incontinence
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tolterodine, oxybutynin, solifenacin
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erectile dysfunciton drugs
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-fil
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alpha blockers
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terazosin, tamulosin -sin
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thiazolidiedone
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-glitazone increase insulin sensitivity increase fluid retention and risk of bladder cancer and MI
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methylphenidate
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CNS stimulant for ADHD side effects: high BP, tachycardia, appetite suppressant
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zyprasidone hydrochloride
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antipsychotic drug
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MAOI and SSRI combination
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risk of serotonin syndorme MAOI withdrawn 14 days min before starting SSRI
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MAOI monoamine oxidase inhibitors
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rasagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and. tranylcypromine (Parnate). -ine, isocarboxazid eliminate tyramine (aged cheeses and processed meats)
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SSRI selective serotonin reuptake inhibitors
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fluoxetine, paroxetine, citalopram, escitalopram, sertraline to treat major depression and anxiety side effect of sexual dysfunciton -ine, -pram
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furosemide slow infusion
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to prevent ototoxicity when >120 mg infusion must administer less than 4mg/min
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benzodiazepines
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alprazolam, -pam antianxiety increase GABA
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lab values to monitor with anticoagulats
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low molecular weight heparin (enoxaparin, apixaban): Hgb, Hct, platelets unfractionated heparin: PTT warfarin: INR
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aminoglycoside antibiotics
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-micin side effects: ototoxicity and nephrotoxicity
