• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/59

Click to flip

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;

59 Cards in this Set

  • Front
  • Back
H1 receptors
smooth muscle ctx & capillary dilation
H2 receptors
gastric acid secretion & acceleration of heart rate.
H1 antagonists (blockers)
called antihistamines, used for nasal allergies & common cold S&S
H2 antagonists or blockers
act on GI tract
H1 antihistamines-
Have an anticholinergic effect- drying effect.
Antihistamines are more effective in blocking an allergic reaction than stopping one.
histamine & other substances released from mast cells, basophils, etc. in response to antigens. histamine then binds to other cells in nose, eyes, respiratory tract, GI tract & skin. This produces S&S of an allergy attack
Antihistamines Side Effects
Drowsiness
Anticholinergic (drying)
anesthetic effect causes-arrhythmias, hypotension, syncope, dizziness
Antihistamines- nursing
Antihistamines are also used for motion sickness and vertigo
Offer hard candy, gum etc. if dry mouth
Take with meals to decrease GI effect
Caution with heavy machinery- drowsiness
Caution with ETOH
Decongestants
PO
Slower onset but longer relief
e.g. pseudoephedrine (Sudafed) OTC
Usually not a problem with rebound congestion

Inhaled intranasal steroids
Usually not a problem with rebound congestion

Topically (nasal spray)
Problems with rebound congestion
Decongestants Side effects
nervous or jittery with adrenergic agents (stimulate sympathetic nervous system- adrenaline)
Intranasal steroids- dryness or mucosal irritation
Caution with pts. with diabetes, cardiac, thyroid.
Usually small amount of systemic effects
Caution with ETOH, caffeine
Antitussives
2 main categories-
Opioid antitussives- act on cough center, drying
Codeine (Robitussin A-C)
hydrocodone
Non-opiod antitussives- combinations and OTC
dextromethorphan (Vicks Formula 44, Robitussin-DM)- acts on cough center & dries.
Antitussives Side Effects
Side effects:
codeine- & hydrocodone- sedation, N/V, lightheadedness, constipation. Potentially addictive.
dextromethorphan- dizziness, drowsiness & nausea
diphenhydramine- sedation, dry mouth, other anti-cholinergic effects
benzonatate- dizziness, H/A, sedation, nausea, constipation, pruritus, & nasal congestion
If taking lozenges avoid fluids for 30” to keep from washing away effect.
Watch for change in color of sputum
Caution with heavy machinery- drowsiness
Caution with ETOH
Expectorants
Encourage fluids to help loosen secretions
Asthma attack
- mediated by antibodies- specialized immune proteins = immunoglobulins (IgE usual)
Bronchodilators
Beta agonists- acute phase of asthma- quickly reduces airway constriction. Imitate effect of NE on receptors.
Bronchodilators- Xanthines
Xanthine derivatives- stimulates CNS- includes caffeine. Cause bronchodilation by increasing levels of cAMP, by inhibiting phosophodiesterase (use to breakdown cAMP). cAMP helps maintain open airways. More prevention than acute.
Bronchodilators-Anticholinergics
Prevents bronchoconstriction by blocking ACh receptors-indirectly causing airway dilation
Side effects: dry mouth/throat, GI distress, H/A, coughing & anxiety
Antileukotriene agents
Leukotrine receptor antagonist-
Prophylaxis & chronic treatment > than 12.
See improvement in one week
Side effects:
Zileuton- H/A, dyspepsia,nausea, dizziness, insomnia
Zafirlukast- H/A, nausea, diarrhea.
Montelukast- destruction of blood vessels, (may use > 2 yrs old.)
Nursing, monitor liver enzymes, offer hard candies, gum for dry mouth, teach to take even without symptoms
Corticosteroids/glucocorticoids
Enhances activity of beta-agonists, reduces inflammation. Stabilize WBC’s, keep leukocytes from releasing bronchoconstricting histamine
Inhaled avoids the systemic effects of steroids, works in lungs
Side effects:
Pharyngeal irritation, cough, dry mouth, oral fungal infections
Nursing: if on systemic steroids, wean slowly, may die from adrenal gland failure! Inhaled agents do not usually wean! Teach rinse mouth with water, don’t swallow after inhalers.
Nursing, have pt. wear med alert bracelet.
Cushingoid S&S: moon face, acne, edema, increase in fat pads. Report.
Addison’s S&S (adrenal insufficiency): nausea, dyspepsia, joint pain, weakness, fatigue. Report.
Pituitary
Anterior lobe- Pituitary controlled by the hyperthalmus to either release or not release a specific hormone.
Growth Hormone- GH
Follicle Stimulating Hormone (FSH), LH- Luteinizing Hormone
TSH- Thyroid Stimulating Hormone
ACTH- Adrenal Gland (Glucocorticoids)
PRL- prolactin (milk production)
Posterior Lobe- stores & secretes two effector hormones (produce an effect when stimulated) made in hypothalmus stored in pituitary
Oxytocin
Vasopressin = ADH – antidiuretic Hormone- tells kidneys to conserve water.
Hypothyroidism
Primary- abnormal thyroid gland cannot perform it’s function- most common
Secondary- pituitary gland decreases the secretion of TSH
Tertiary- decreased levels of TRH (thyrotropin releasing hormone) from hypothalamus
Antileukotriene agents
Leukotrine receptor antagonist-
Prophylaxis & chronic treatment > than 12.
See improvement in one week
Side effects:
Zileuton- H/A, dyspepsia,nausea, dizziness, insomnia
Zafirlukast- H/A, nausea, diarrhea.
Montelukast- destruction of blood vessels, (may use > 2 yrs old.)
Nursing, monitor liver enzymes, offer hard candies, gum for dry mouth, teach to take even without symptoms
Corticosteroids/glucocorticoids
Enhances activity of beta-agonists, reduces inflammation. Stabilize WBC’s, keep leukocytes from releasing bronchoconstricting histamine
Inhaled avoids the systemic effects of steroids, works in lungs
Side effects:
Pharyngeal irritation, cough, dry mouth, oral fungal infections
Nursing: if on systemic steroids, wean slowly, may die from adrenal gland failure! Inhaled agents do not usually wean! Teach rinse mouth with water, don’t swallow after inhalers.
Nursing, have pt. wear med alert bracelet.
Cushingoid S&S: moon face, acne, edema, increase in fat pads. Report.
Addison’s S&S (adrenal insufficiency): nausea, dyspepsia, joint pain, weakness, fatigue. Report.
Pituitary
Anterior lobe- Pituitary controlled by the hyperthalmus to either release or not release a specific hormone.
Growth Hormone- GH
Follicle Stimulating Hormone (FSH), LH- Luteinizing Hormone
TSH- Thyroid Stimulating Hormone
ACTH- Adrenal Gland (Glucocorticoids)
PRL- prolactin (milk production)
Posterior Lobe- stores & secretes two effector hormones (produce an effect when stimulated) made in hypothalmus stored in pituitary
Oxytocin
Vasopressin = ADH – antidiuretic Hormone- tells kidneys to conserve water.
Hypothyroidism
Primary- abnormal thyroid gland cannot perform it’s function- most common
Secondary- pituitary gland decreases the secretion of TSH
Tertiary- decreased levels of TRH (thyrotropin releasing hormone) from hypothalamus
Hypothyroidism
Cretinism- hyposecretion of thyroid hormones during youth. Decreased basal metabolic rate.
Myxedema- hyposecretion of thyroid hormones as an adult. Decreased basal metabolic rate.
Goiter- increased levels of TSH d/t lack of T3/T4 enlarges thyroid gland. Used to be caused by a lack of iodine in the diet.
Overactive Thyroid (Hyperthyroidism)
Trouble sleeping  
Eye protrusion  
Diarrhea      
Nervousness    
Hair loss  
Weight loss
  Intolerance to heat  
Under active Thyroid (Hypothyroidism)
Sleepiness
Constipation
Puffy face   
Lethargy
Thick, rough, dry skin
Weight gain  
Intolerance to cold
Hypothyroid (replacement) agents
Natural thyroid replacement from animals (beef, pigs) = thyroid desiccated (dried)
Synthetic-
**Levothyroxine (Synthroid)- once a day dosing, T4, ½ life is 10 days, peak at 4 weeks
Side effects of hypothyroid agents:
CV: dysrrthymias, tachycardia, palpitations, angina, hypertension, cardiac arrest
CNS: Insomnia, tremors, H/A, anxiety
GI: Nausea, diarrhea, change in appetite, cramps
Side effects of anti-thyroid (HYPER-THYROID) agents
CNS: drowsiness, H/A, vertigo, fever
GI: N/V, diarrhea, jaundice, hepatitis, loss of taste
GU: smoky colored urine, decreased urine output
Blood: agranulocytosis, leukopenia, thrombocytopenia, lymphadenopathy, bleeding
Musculoskeletal: myalgia, arthralgia, nocturnal muscle cramps
Liver and bone marrow problems
Thyroid Agents, Nursing
Nursing
Give same day every day, AM preferred
Antithyroid with meals, don’t use iodized salt, soy, fish etc.
Never stop either abruptly- usually life long therapy
Don’t switch brands unless ordered
No OTC medications without MD approval
Glucocorticoids
are synthesized as needed, controlled by a negative feedback loop. Regulated by the Hypothalamus/Pituitary
Mineralocorticoids
regulate electrolytes. Maintains K+ levels and pH of blood
Side Effects: Edema and HTN
Corticotropin
from pituitary-ACTH (adrenal cortex stimulating hormone) – makes adrenal gland secrete cortisol.
Must WEAN
Notify HCP for 12 months after therapy
Avoid immunizations during therapy (Because is an immosuppressent)
Corticosteroids
Action:
steroid hormones bind to receptor. Goes into the cell and stimulates cell to produce RNA (messenger).
RNA synthesis of a specific protein which modifies enzyme activity.
Contraindications:
Serious infections- septicemia, varicella, Db, cataracts, PUD, mental health. May intensify
Interactions:
With diuretics-hypocalcemia & hypokalemia
With aspirin & NSAID’s increased GI
Hypoglycemics- reduce affect.
Cardiovascular: heart failure, cardiac edema, hypertension (electrolyte imbalances)
CNS: convulsions, H/A, vertigo, mood swings
Endocrine: Cushing’s, growth suppression,
GI: peptic ulcers, pancreatitis
Integument: fragile skin, petechaie, ecchymosis
Musculoskeletal: muscle weakness, osteoporosis
Other: weight gain, increased ocular pressure
Hypersecretion of Glucocorticoids
S&S: redistributes body fat from arms & legs to face, shoulders, trunk & abdomen. “Moon face”
Hypersecretion of aldosterone
S&S: increased water retention and muscle weakness (from potassium loss)
Addison’s Disease
Due to under secretion of adrenocortical hormones
All 3 adrenal corticosteroids are reduced (glucocorticoids, mineralocorticoids, androgens)
Decreased blood sodium levels, decreased blood glucose, increased potassium levels, dehydration & weight loss
Treat with a mineralcorticoid (fludrocortisone) & a glucocorticoid (prednisone)
Adrenal agents, nursing
Assess:
Baseline weight, >2 lbs/day or >5 lbs/week report ASAP
BP, regularity of pulse
Suppressed immune system- avoid people with infections,
Take same time every day, once a day take in AM to decrease adrenal suppression
Encourage a journal of S&S, events, triggers, etc.
Inhalers- rinse mouth
WEAN! Can precipitate an adrenal crisis

Labs: Na, K, BUN (Blood urea nitrogen), Hgb, Hct, baseline blood glucose (elevates)
Mental status: aggression, depression, psychosis
Estrogen
synthesized from cholesterol in ovaries
HRT- hormone replacement therapy
Lowest effective doses for shortest period of time d/t health risks
Estrogen-progesterone mix
Risk for breast cancer, heart disease, stroke & blood clots
Decreased risk of hip fractures & colon cancer
Estrogen only
Increased risk of stroke
Reduced hip fracture
Recommend topical Tx versus systemic Tx
Estrogen replacement
Side Effects and Interactions
Adverse effects:
thrombolytic events, Stevens-Johnson syndrome,
nausea, vomiting, diarrhea, constipation
photosensitivity, choasma (brown face mask), hirsuitism, alopecia
HTN, thrombophlebitis, edema
Interactions
Decrease warfarin effects
TCA’s (tricyclic antidepressants) may become toxic
Smoking adds to risk of blood clots
Progesterone- from corpus luteum
Adverse effects
Liver dysfunction
Thrombophlebitis, thromboembolytic disorders
N/V, amenorrhea, edema, weight gain,
Women's Health- nursing
Take hormones with food or milk to reduce GI distress
Report chest pain, leg pain, blurred vision, H/A, neck pain or stiffness, edema, abnormal vaginal bleeding, yellow coloring
Report 2 lbs/day, 5 lbs/week gain
Avoid sunlight, use sunscreen
Men’s health- androgens
Contraindications:
To erectile drugs- Major cardiovascular disorders, esp. with nitrates like NTG
Androgen responsive tumors
Caution with oral anticoagulants
Adverse effects:
Liver-
Can cause blood filled cavities
Cancer, cholestatic hepatitis, jaundice
Fluid retention- weight gain
Priapism- abnormal prolonged erection
May interfere with bone growth & elevate electrolytes
Mens’ Health- nursing
Special handling of some androgens d/t teratogenic effects (e.g. finasteride for BPH)
Watch for H/A, flushing, diarrhea, UTI, rashes, dizziness
ED drugs- need arousal to be effective.
Do NOT abruptly withdraw from androgens like testosterone
May take 6-12 months to see effect of many men’s health drugs
Osteoporosis- Three Types of Drugs
3 classes of drugs:
Bisphonates- e.g. alendronate
Inhibit osteoclast bone resorption
SERM’s- selective estrogen receptor modifiers- e.g raloxifene (Evista) & tamoxifen (Nolvadex)
Stimulates estrogen receptors on bone & increase bone density
Calcitonin- hormone (salmon derived)
Directly inhibits osteoclastic activities
Osteoporisis drug side effects
Adverse effects:
Bisphosphonates- H/A, GI distress, joint pain.
SERM’s- hot flashes, leg cramps
Calcitonin- flushing of face, N/V, diarrhea and anorexia
Teriparatide- chest pain, N/V, dizziness, hypercalcemia, arthralgia
Bisphosphonates- risk of esophageal burn, remain upright for 30” and take with water. Take 30” before other food/drink
SERM’s- can drop white cell count at risk for infections
Check with HCP if should take calcium/Vitamin D with these drugs
Laboratory Results- Diabetes
FBS 70-100 mg/dL - Euglycemia
FBS 110-126 –impaired “pre-diabetic”
Greater than 200 mg/dL - anytime problem!
Pancreas cell functions
Alpha– secrete glucagon, which makes cells release stored food into the blood.
Beta cells – secrete insulin, which makes cells take up food from the blood
Classifications of Diabetes
Type 1 diabetes
Beta cell destruction
Immune mediated
Type 2 diabetes
Insulin resistance with a relative insulin secretory defect to complete insulin deficiency
Vast majority are obese
Insulin-Human recombivent
Rapid- subcutaneously (clear)
*aspart- (Novalog) (preg C)
** lispro- (Humalog) (preg B)
Gluligine (Apidra)
Regular- Short acting-(preg B) (clear) subcutaneously – may be continuous IV *
**Humulin R
Novalin R
Intermediate-(preg B) subcutaneously (cloudy)
**isophane insulin suspension (NPH, Humulin N, Novalin N)
*insulin zinc suspension- (Humulin L, Novalin L)
Insulin glargine (Lantus)
(preg C) (clear) must be given alone! Do NOT mix
Side Effects-Hypoglycemia
Hypoglycemia results from
Too much insulin or too little insulin?
S & S of Hypoglycemia
Blood Sugar less than 50 mg/dl
Confusion, abnormal behavior or both, such as the inability to complete routine tasks
Visual disturbances, such as double vision and blurred vision
Seizures, though uncommon
Loss of consciousness, though uncommon
Hypoglycemia may also cause these other signs and symptoms:
Heart palpitations
Tremor
Anxiety
Sweating
Hunger
Hyperglycemia S&S
Hyperglycemia = FBS (or FBG) of >126 mg/dl
Increased pulse, abnormal breathing, fruity acetone breath
confusion
Diabetic Ketoacidosis
Signs:
Hyperglycemia
Dehydration
Low BP
Hyperketonemia
Ketonuria
Glucosuria
Electrolyte imbalances
Rapid Respierations
Insulin Side Effects
Cardiovascular- tachycardia, palpitations
CNS: H/A, lethargy tremors, weakness, fatigue, delirium, sweating
Metabolic: hypoglycemia
Other: blurred vision, dry mouth, hungre, nausea, flushing rash, urticaria, anaphyylaxis
Avoid sun- wear sunglasses
90 degree angle subcutaneous, 45 degrees if emaciated
30 days in room air, 3 months in fridge. Filled syringes upright.
Never use a solution that appears colored or inappropriately cloudy
Never switch types of insulin- Cannot give porcine and human!
ALWAYS have another nurse check your insulin dose and order!
Most insulin is 100 units per mL- BUT CHECK!
Be aware dosing may be in the form of a sliding scale