Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
166 Cards in this Set
- Front
- Back
|
GABA-potentiating barbiturates
|
Phenobarbital--> enhances GABA inhibitory neurotransmitter
|
|
|
Benzodiazepines-- potentiating GABA action
|
Lorazepam, Clonazepam, Diazpam--> intensifies GABA, short term therapy for ABSENCE, MYOCLONIC, and to terminate status elpitcus
|
|
|
Succinmides
|
act by delaying influx of calcium (Ethozuxmide Zarontin-- ABSENSE
|
|
|
Hydantoin delay...
|
the influc of sodium into neuron, Phenytoin, Dilantin... DONT USE ON ABSENCE
|
|
|
monitor pt on Valproic acid (depakene for
|
restlessness and agitation (kids)
|
|
|
Report bleeding and bruising to health care ASAP if on...
|
Carbamazepine (Tegretol)--> all seisures except absence
|
|
|
What meds treat partial seisures
|
Phenytoin-dilantin
Valproic acid- depakene Carbamazepine - tegretol |
|
|
Regional loss of sensation is achieved by...
|
local anesthetics- topically, infiltration, nerve block, spinal or epidural
|
|
|
Local anesthetics
|
block sodium channels in neurons
|
|
|
Local anesthetics are classfied as
|
amids or esters
|
|
|
Ester...
|
are being replaced by AMIDES (Lidocaine) Xylocaine bc they are safer
|
|
|
General anesthsia-->
|
complete oss of sensation w/ loss of consciousness (acheived through multiple meds)
|
|
|
INhaled general anesthetics-->
|
maintain surgical anesthetics
|
|
|
Nitrous oxide
|
inhaled general anesthtic with low efficacy
|
|
|
Halothane (Fluthane
|
induces deep anesthesia
|
|
|
Return of gag reflex should be prirority nursing assessment when
|
pt recieved lidocaine vicous before a gastroscopy
|
|
|
Epinephrine can..
|
prolong duration of anesthetics action
|
|
|
When used as adjunct anesthesia succinylcholine (Anectine) look for what side effect
|
bradycardia, resp depression
|
|
|
after recieving Katamine (Ketalar) a pt should be
|
put into a quiet place with low lights and away from npisy pt// equipement
|
|
|
Nerve block
|
direct injection into tissues, affects nerve bundles, used on limbs/face
|
|
|
Spinal anesthsiea
|
injected into CSF, affects large regonal areas EX lower abdomen and leegs... orthopedic procedures
|
|
|
Infiltration (field block(
|
injected into tissue right where surgrey is happening
|
|
|
Epidural
|
inject into epidural space used with l &d
|
|
|
When to use CSF combined spinal epidural
|
othropedics, lower limbs, amputation, female pelvi surgery,
|
|
|
Epidural anesthsia w/ general
|
pediatric surgrey, throacic surgrey
|
|
|
general anesthetics
|
in a few seconds- 1. loss of pain, 2. excitement and hyperactivity, 3. surgical anesthsia, 4 paralysis of medulla
|
|
|
local anesthics adverse effects
|
CNS stimulant at first then CNS depressant
|
|
|
Monitor--> local and general anesthsia
|
cardio/ resp side effects, length of effectiveness, DI and GU effects, client safety, vitals, recovery from anestsia
|
|
|
3 layers of skin
|
epidermis, dermis, sub q layer
|
|
|
stratum basale
|
deepest, supplies new cells to dermis, takes 3 weeks for production
|
|
|
Melanocytes
|
in deeper layes, secretes the dark pigment melanin, protects skin from sun
|
|
|
Dermis
|
2nd layer foundation of hair and nails, nerve endings, pild glands,sweat glands, blood vessels found here
|
|
|
Sub q layer
|
hypodermis, adipose tissue,
|
|
|
MRSA treat with
|
Mupirocin Batroban
|
|
|
Herpes tx
|
acyclovir zovirax
|
|
|
Lice and scabies tx with
|
Permethrin- nix, acticin, elimite,
|
|
|
Tx sunburn w/
|
topical lidocaine
|
|
|
Seborrhea and androgens=
|
factors associated w/ acne
|
|
|
Acne tx
|
OTC- benzoyle, keraolytic effect
Treinoin--> vitamin A Oral contraceptive-- ethinyl estradiol antibiotics |
|
|
Rosacea tx
|
benzoyl, retinoids
|
|
|
dermatitis
|
atopic or hypersensitivity- Topical glucocorticoids
|
|
|
Open angle gluacoma
|
damage to the optic nerve painless and slow that a large portion of vision can be lost. Bi optic, most common form, it is called OPEN bc the iris does not cover the trabecular meshwork, it remains OPEN, final disease state= halos around eyes fatigue and discomfort. Tunnel vision and loss of peripheral vision is first reportable signs
|
|
|
Acute close angel glucoma
|
caused by stress, impact injurt or meds. pressure inside the anterior chamger increases suddenly bc the iris is pushed over the area where the aqueous fluid normally drains S/S headache, difficulty concentration, bloodshot eyes, blurred vision, buldging iris, SUDDEN inc in IOP
|
|
|
Drugs for glaucoma
|
DEC IOP by INC outflow of aqueour humor
DEC formation of aquemos humor many affect autonomic nervous system |
|
|
Protaglandins & gloacoma
|
-long durations of action and produce fewer adverse effects then other drugs,may be combined with beta adrendic blockers to produce additive reduction of IOP in px with resistant glaucoma..
DECREASE OP by increase AQUEOUS HUMOR outflow--> Lantanoprost (Xalatan).... TREATS OPEN ANGLE |
|
|
Beta adrenergic blockers
|
before prostaglandins beta blockers were drug of choice for open angle glaucoma
- DECREASE production of aqueous humor by the ciliary body and can lower IOP - A/E bronchoconstriction, dyrythmias, hypotension, (cautious with asthma and heart failure) |
|
|
Beta adrenergic blockers
|
Prototype--> timolol (timpotic)
- reduces FORMATION of aqueous humor, reduce elated intraocular pressure in chronic open angle glaucoma |
|
|
Alpha 2 anrenergic agonist
|
Brimonidine (Alpagan)- dec production of aqueous humor
|
|
|
Non selective sympathomimetics
|
Dipivefrin HCL (propine) activate the sympathetic nervous system (mydriatics)- dilate pupil to increase outflow, not as effective as beta blocker or prostaglandins may INC BP or HR
|
|
|
Cholinergics agonist (miotics)
|
Pilocarpine (isotoscarpine) constricts pupil to allow room for outflow, by activating cholinergic receptors in the eye creast miosis contraction of the pupular and contraction of the cilary muslce
|
|
|
Osmotic diuretics
|
reduce formation of aqueous humor Mannitol (Osmitrol) Acute close angle
|
|
|
Prostaglandin drops may
|
cause brown pigmentation
|
|
|
If using beta adrenegic agents to treat glaucoma
|
teach pt and family to monitor pulse and blood pressure
|
|
|
Eye drops
|
into conjunctival sac
hold slight pressure on tear duct 1 min after using drops avoid direct contact |
|
|
The myocardiym requires continous supply of oxygen from the
|
coronary arteries to fx properly.
|
|
|
Coronary <3 disease=
|
both angina &mycardal infarction... caused by narrowing of the arterial lumen due to atherosclerotic plaque
|
|
|
Angina pectoris is
|
the narrowing of a coronary artery resulting in lack of enough oxygen to the <3 muscle... chest pain during activity
|
|
|
Chronic stable angina
|
exertional pain is generally related to plaque which limits blood flow CAD gnerally treated with NTG
|
|
|
Variant angina
|
prinzemetal/vasospastic... pain is related to arterial spasm. again treated with NTG but the effect is vasodilatory in nature creating inc blood flow and deleivery of O2
|
|
|
Unstable angina
|
medical emergency--. t/t plauq, vasospasm, platlet aggregation. MONA morphine, o2, nitrates, asa.
|
|
|
SA node is the
|
pacemaker
|
|
|
from SA node impulses travel down to the
|
AV node
|
|
|
At the AV node is where
|
the impulse is held until the ventrcles are at the optimal state of readiness
|
|
|
heart has 2 types of action potentials
|
Fast action potentals occur in the His purkenje system, the atrial muslc and ventrucles (CONTRACTION
Slow action potentials occur in the SA and AV nodes (rate) |
|
|
Antidysrthmic drugs work by
|
impeding enhancing or blocking impulse creation/condution
|
|
|
Angina management
|
diet, lifestyle mods, angioplasty
|
|
|
goals for therapy of angina
|
terminate acute attacks and preventing futrue attacks--> reduce cardiac work load
|
|
|
organic nitrates releive angina by
|
dilating veins and coronary arteries... drug of choice for terminating acute episode of stable angina
|
|
|
BBlocker relieve anginal pain by
|
decreasing the oxygen demands on the heart... drug of choice for prophylaxis of stable angina
|
|
|
CCB relieve angina by dilating the
|
coronary vessels and reducing the workload on the <3. First drug of choice for tx of vasospastic angina
|
|
|
Nitrates work so well with angina tx b/c
|
they decrease the afterload so the workload of the <3 decreases
|
|
|
Beta blockers....
|
slow heart rate and decrease contractility
|
|
|
Pt should take off nitroglycerin patch at night to..
|
delay develoment of tolerance
|
|
|
Px experiencing chest pain you..
|
assess the loaction quality and intensity, assess RH and BP, administer NTG, document interventions and outcomes
|
|
|
Changes in sodium and potassium levels generate...
|
the Action potential in myocardial cells
|
|
|
Depolarization occurs when
|
sodium calcium rush in
|
|
|
Repolarization occurs
|
when sodium ions are remvoed and potassium ions are restored inside the cells
|
|
|
Sodium channel blockers--> antidysrthymic
|
largest group, act by slowing the rate of impulse conduction across the heart
|
|
|
Beta adrenergic blockers
|
antidysrhythmics... act by reducing automaticity as well as by slowing conduction velocity across myocardium
|
|
|
Potassium channel blockers
|
act by prolonging the refractory period of the <3
|
|
|
Calcium channel blockers... act by
|
reducing automaticity and by slowing myocardial conduction velocity. their actions are similar to beta blockers
|
|
|
Beta blockers can mask...
|
symptoms of hypoglycemia
|
|
|
monitor HR when taking
|
antidysrhyhmic agents
|
|
|
Verapamil is contradicted in
|
px with <3 failure
|
|
|
adverse effects of antidysrhymics
|
hypotension, dizziness, weakness
|
|
|
So not stop taking propanolol (inderal)
|
abruptly
|
|
|
Digoxin (Lanoxin)
|
Misc. - generally used for HF, prescribed for certain atrial dysrhythmias. Dec automaticity of SA node & slows conduction through the AV node. Monitor px carefully
|
|
|
Hemostasis is a
|
complex process enzymes and clotting factors that the final product ends up with a fibrin clot
|
|
|
Fibrinolysis is the
|
removal of a blood clot= an enzymatic process initiated by the release of TPA... plasmins digests the fibrin stands... restoring circulation to the injured area
|
|
|
Anticoagulatnts are used to
|
prevent thrombi from forming or enlarging--> primary drugs are heparin (parenteral), warfarin (oral
|
|
|
Several drugs prolong bleeding time by interfereing with aggrigation of platelets
|
antiplatelet drugs- aspirin, ADP blockers, glycoprotein IIb/IIa receptor antagonist and miscellaneous agents to treat claudication
|
|
|
Thrombolytics are used to
|
dissolve esxsisting clots in pt with MI or CVA
|
|
|
Hemostatics or antifibrinolytics
|
are used to promote the formation of clots in patients with excessive bleeding from surgical sites
|
|
|
Which clotting factors are formed after injury to the vessel?
|
Thrombin, fibrin
|
|
|
Pt asks how heparin is a "blood thinner" you respond
|
hepearin does not thin the blood but prevents clots from forming as easily in the blood vessels
|
|
|
Pt receiving thrombolytic agent alteplase (activase) after a myocardial infarction what finding is most likely due to being on thrombolytic agent
|
bruising and epistaxis
|
|
|
Intrinsic clotting cascade beings in the blood stream.. it is activated with blood is exposed to
|
collagen
|
|
|
Factor XII is activated to
|
XIIa by exposed collagen
|
|
|
Extrinsic pathway beings in the vessel wall... damaged endothelial cells will release
|
Factor III (tissue factor)
|
|
|
Arterial thrombus begin with formation of
|
a platlet plug
|
|
|
venous thrombus begin with the formation of
|
fibrin which then snares RBCs and platelets
|
|
|
Arterial thrombi are best prevented with
|
antiplatlet drugs
|
|
|
Venous thrombi are best prevented with
|
Anticoagulants (heparin, warfarin)
|
|
|
Heparin supprsses coagulation by helping inactivate
|
thrombin and factor Xa
|
|
|
Antidote for heparin
|
Promate sulfate
|
|
|
Antidotes for warfarin
|
vitamin K
|
|
|
Anticoagulants
|
durgs that inhibit clotting factors and prevent clot formation and extension. DO not break down clots
|
|
|
Antiplatelet
|
Drugs that bind to receptors on the surface of the platelet and inhibit platlete activity
|
|
|
Thrombolytic
|
Drugs that dissolve exsisting clots
|
|
|
Warfarin (coumadin)
|
Anticoagulant--> blocks clotting cascade.. venous thrombi prevention, monitored by Protime (PT with an INR goal is 2-3.. eat green leafy veggies, avoid NSAIDS
|
|
|
Heparinoid
|
Anticoagulant properties r/t inhibitoion f circulating factor Xa and IIa..cofactor to antithrombin
|
|
|
Unfractionated heparin
|
alters the shape of antithrombin-- allowing the thrombin to accept the drug
|
|
|
low molecular eight heparin
|
lays along the base of antithrombin, inhibition more specific to factor X. 2-4xs longer duration, less likely to cause thrombocytopenia, prevention of DVTs
|
|
|
The panceras is 2 types of glands
|
endocrine and exocrine- it secretes as well as stimulates release of hormones
|
|
|
insulin LOWERS...
|
BLOOD glucuse levels
|
|
|
glucagon RAISES
|
blood glucose levels
|
|
|
what is the primary responsible for stable serum glucose levels
|
Glucagon
|
|
|
Type 1 diabetes
|
is autoimmune in nature, beta cells are destroyed in the pancrease causing consistently HIGH levels of serum GLUCOSE
|
|
|
B/c glucose levels are high in ciculating serum the body is required to use
|
lipid stores for energy thus increasingly high levels of by products.. ketones
|
|
|
Type 2 is caused by lack of responses of
|
insulin receptors
|
|
|
TX for DMII
|
oral agents and lifestyle management
|
|
|
Glucagon is release when what decreases
|
glucose
|
|
|
insulin is released when what increases
|
blood glucose
|
|
|
islet of Langerhans
|
are resoponsible for the endocrine fx which is release of insulin and glucagon
|
|
|
Regular insulin...
|
is to promote entry of glucose into the cells there by lowering glucose
|
|
|
Insulin causes potassium to move into cells which could cause
|
hypokalemia
|
|
|
DM 2 you produce insulin but what
|
you cant use it
|
|
|
Rapid insulins
|
Lispro (Humalog)
Glulisine (Apidra) Aspart Novolog) - inject about 10 mins before a meal |
|
|
Short insulins
|
Regular (Humulin R, Novolin R)
- 30 to 60 before a meal |
|
|
Intermediate insulins
|
isophane susp (NPG, Humulin N)- 1 hour before a meal
|
|
|
Long insulins
|
Insulin detemir (levemir)
insulin glargine (lantus) |
|
|
Sulfonylureas
|
stimulates beta cells to produce more insulin, stimulate release of insulin from pancreatic cells, inc sensitivity of insulin receptors, used used for Hyperglycmia...
|
|
|
Biguandes
|
Metformin (Glucophage)
dec hepatic production of glucose |
|
|
Alpha Glucosidase inhibitors
|
Acarbose (Precose)
Miglitol (Glyset) block enzymes in the small intestines breaking down complex carbs into monosaccharides |
|
|
Thiazloidinediones (Glitazones
|
Rosiglitazone (Avandia)
Pioglitazone (Actos) reduces blood glucose by dec insulin resistance.. inc glucose utilization and dec glucose production |
|
|
other agents
|
Exenatide (Byetta)
Pramlintide (Symlin) for type 1 and 2 |
|
|
meglitinides hypoglycemics type 2
|
Repalinide (prandin)
Nateglinide (Starlix) |
|
|
hypothalamus secretes
|
RELEASING hormone that travel via blood vessels a short distance to the pituitary gland these hormones specify which hormone is to be released by the pituitary--> Pituitary secretes STIMULATING hormone
|
|
|
Anterior Pituitary (growth, reproduction, metabolism) consists of glandular tissue and stimulates what?
|
- Growth hormone (GH): stimulates the growth and metabolism of nearly every cell in the body. Def in kids = short stature/dwarfism
- Follical stimulating hormone (FSH) - Luetuenizing hormone (LH - Prolactin (PRL) - Thyroid stimulating hormone (TSH) - Adrenocorticotrpoic hormone (ACTH) |
|
|
Growth Hormone target
|
- bone, muslc, other tissue
|
|
|
Follical stimulating homrone target is
|
testes and ovarys
|
|
|
luteinzing hormone target is
|
ovaries
|
|
|
thyroid stimulating hormone target is
|
thyroid
|
|
|
Prolactin targets
|
mammary glands
|
|
|
ACTH's target is
|
adrenal glands which tells the medulla to secrete glucocorticoids and epinephrine
|
|
|
Posterior pituitary secretes
|
Antiduiretic hormone (kidneys)
Oxytocin (uterus, mammories, and prostate) |
|
|
Hypothalamix release factors are used mostly for
|
diagnostic and tx of cancer
- Leuprolide (lupron) inhibits premature luteizing hormone surge in woman under going fertillity tx, dx of endometeriosis - Corticotrophin -releasing homrone= used in the dx of CUSHING disease |
|
|
GH antagonist
|
octretide (sandostain) treat acromegaly
|
|
|
GH agonist
|
somatatropin (nutropin) tx of ppl with growth homrone deficit
|
|
|
Thyrogen
|
adjucnt tx after abalation of thyroid
|
|
|
Corticiotropin (athcar)
|
dx of adrenal fx
|
|
|
Desmopressin DDAVP (posterior pit)
|
use w/ pt to control acute symptoms of DI who have insufficent ADH, long duration, 20 hours, usually sublingual or nasal
|
|
|
Vasopressin (pitressin) and lypressin (diapid)
|
short duration 2.8 hours given only if we think we can control DI , enhancing water reabsorption
|
|
|
Hypothyroidism (Myexdema)
|
s/s weakness, muscle cramps, dry skin... Severe S/S slurred speach, low HR, weight inc, DEC sense of taste and smell, intolerance to cold, ELEVATED TSH diminished T3 and T4
|
|
|
Most common cause of hypOthyroidism in US
|
destruction of thyroid gland due to chronic autoimmune
|
|
|
Hyperthyroidism
|
S/S increase body metabolism, inc HR, weight loss, elevated temp, and anxiety//
|
|
|
Graves Disease
|
Hyperthyroidism... most common cause of hyperthyroidism
|
|
|
TX for hyperthyroidism
|
Administer thiomides which decrease acvitity of thyroid
- Propylthiouracil PTU, methimazole (tapazole) - radio active iodine (sodium 131 |
|
|
Addison's disease
|
Primary ADRENALCORTICAL insufficency.. S/S n&v, lethargy, confusin, coma, low plasma cortisol level, w/ high plasma ACTH levels, dehydration, serium sodium dec, serum K inc, vascular collapse, renal shut down, hypoglycemia, postural hypotension, weight loss, bronze pig of skin
|
|
|
Cushings syndrome
|
-due to prolong high levels of glucocorticoids in the body, adrenal atrophy, osteoporosis, hTn, in risk to infection**, delyaed wound healing, ance, peptic ulcer, moon face, buffalo bump,
|
|
|
tx of cushings
|
metyrapone (metopirone)
kryoconazole (nizoral) antifungal mifepristone (mifepprex) steroids ocupies glucocorticoid receptor |
|
|
estrogens
|
secreted by ovarian follicles, prepare endo for implantation
|
|
|
progestin
|
secreted by corpus luteum, prepare for endo for implantation
|
|
|
estrogen/ progestin contraceptives
|
shut down LH and FSH
|
|
|
progestin only pill
|
produce thick mucus
|
|
|
72 hours plan B
|
mifepristone
misoprostol cytoec |
