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;
60 Cards in this Set
- Front
- Back
|
which antiemetics can cause extrapyraidal symptoms (EPS) can look like Parkinson's? |
Dopamine Antagonists *metoclopramide (Reglan) *droperidol (Inapsine) * prochlorperazine (Compazine) *haloperidol (Haldol) |
|
|
what actions are expected when lorazepam (Ativan) is given when another antiemetic such as metoclopramide (Reglan)? |
lorazepam produces sedation, amnesia, and suppression of emesis. it usually is administered with an antiemetic such as metoclopramide and may help control the EPS caused by drugs like metoclopramide |
|
|
which antiemetic relieve nausea and vomiting but also stimulate the appetite and can help patients gain weight? |
cannabinoids are used to suppress chemotherapy-induced nausea and vomiting (CINV). it is a appetite stimulant and can prevent or reverse weight loss. *dronabinol (Marinol) *nabilone (Cesamet) |
|
|
when should activated charcoal be used instead of syrup of ipecac? |
activated charcoal (CharcoAid) is given when vomiting is contraindicated. vomiting is not induced if caustic substances, such as ammonia, chlorine bleach, lye, battery acid or toilet cleaners, have been ingested. these substances will cause addtl injury to the esophagus if vomiting is induced. if a petroleum product; such as gasoline, kerosene, paint thinner, or lighter fluid; is ingested, vomiting can cause aspiration with a resultant severe pneumonia |
|
|
which opioid antidiarrheal drug causes the least CNS depression? |
loperamide (Imodium) causes less CNS depression than diphenoxylate and difenoxin because it is poorly absorbed and does not readily cross the blood brain barrier *(better choice for elderly) (reduces fecal volume and decreases intestinal loss of fluid and electrolytes)* |
|
|
when are laxatives beneficial and indicated? |
laxative use is highly beneficial and indicated in specific situations such as in patients with hemorrhoids or anorectal lesions to ease the pain of elimination. patients with cardiovascular disease should avoid straining to have a bowel movement because is can cause dangerous arrhythmias or hypertension. patients who are scheduled for surgery or a diagnostic procedure of the colon need to empty the bowel compeletly. laxatives can be used to prevent fecal impaction in bed ridden patients, remove ingested poisons, and correct constipation associated with pregnancy or certain drugs. |
|
|
when are laxatives contraindicated? |
laxative use is contraindicated in patients with certain disorders of the bowel. if a pt has abd pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, or ulcerative colitis, laxative use must be avoided. pt with fecal impaction or bowel obstruction must also avoid the use of laxatives. |
|
|
which laxatives should be avoided in patients with kidney dysfunctions? |
magnesium salts (magnesium hydroxide, magnesium citrate, and magnesium sulfate), sodium salt (sodium phosphate); and polyethylene glycol (Miralax). magesium is mainly excreted by the kidney and pt with poor renal function can develop magnesium toxicity. sodium phosphate can cause fluid retention, so it should be avoided in pts with heart failure, hypertension, and edema. sodium phosphate should be avoided in pt with kidney dysfunction, because it promotes dehydration and precipitation of calcium and phosphates in the renal tubes that can cause acute renal failure. (both are osmotic laxatives) |
|
|
what instructions should be given to a patient taking bisacodyl (Dulcolax) tablets for constipation? |
administered orally or rectally (suppository). oral tablets are enteric coated to prevent gastric irritation and should not be chewed or crushed. milk and antacids dissolve the enteric coating, so tablets should be administered at least one hour after ingestion of these substances. suppositories can cause a burning sensation and with prolonged use, proctitis can develop |
|
|
which patient should not take castor oil for constipation? |
castor oil should not be given in early pregnancy because it can stimulate uterine contractions and spontaneous abortions |
|
|
what instructions should be given to a patient who is taking polycarbophil (FiberCon) Bulk-forming laxative everyday? |
it promotes large, soft stools by absorbing water into the colon, increasing fecal bulk and promoting peristalis. should be admistered with a full glass of water or juice. esophageal obstruction can occur if swallowed with insufficient fluid. the drugs can also solidify in the intestine if inadequate fluid intake occurs, causing bowel obstruction. the group of laxatives does not cause laxative dependence and can be used by patients with diverticulosis, IBS, ileostomy and colostomy
*polycarbophil (FiberCon) *methylcellulose (Citrucell) *psyllium (Metamucil) |
|
|
which laxatives are commonly used to prevent straining after surgery or after a myocardial infarction? |
surfactant laxatives or stool softeners are commonly used to prevent straining of a bowel movement. *docusate calcium (Surfak) *docusate sodium (Colace) |
|
|
what causes gastric ulcers? |
they occur when there is a breakdown of the gastric mucosal barrier because of inadequate mucous to form a barrier, inadequate bicarbonate to neutralize the acid and pepsin, or insufficient blood flow to the mucosa |
|
|
what is the most common cause of peptic ulcers? |
Helicobacter pylori (H. pylori) infection is the most common cause and is present in 60% to 75% of patients with peptic ulcer disease, especially duodenal ulcers
second most common cause is NSAIDs |
|
|
what drug regimen is used to treat an H. pylori infection? |
Antibacterial Agents: *amoxicillin *clarithromycin *bismuth *metronidazole *tetracycline at least two antibiotics, preferably three, are used to prevent resistance. in addition, an agent to reduce the secretion of acid is also given, such as a histamine2 recpetor antagonist or proton pump inhibitor. combination is given for 10 to 14 days. |
|
|
what adverse effects can be caused by all H2 blockers (-tidines)? |
increase the risk of pneumonia. when gastric acidity is reduced, more bacteria will grow in the stomach; therefore, more bacteria will inhabit the respiratory tract. cimetidne: gynecomastia, reduced libido, and impotence; all of which can be reversed if the drug is discontinued. |
|
|
which adverse effects can be caused by proton pump inhibitors (-prazoles)? |
long term therapy with proton pump inhibitors, especially in high doses, may increase the risk of osteoporosis and fractures. reducing the secretions of acid causes a decrease in calcium absorption which promotes osteoporosis. can also increase the risk of pneumonia by elevating gastric pH. |
|
|
which antacid can change the pH causing alkalosis? |
sodium bicarbonate is systemically absorbed, it can alter systemic pH causing alkalosis (excessive bicarbonate). the sodium can cause water retension which an exacerbate hypertension and heart failure. sodium bicarbonate is rarely used as an antacid because of the adverse effects; however, it is very effective in raising the blood pH in acidosis and the urinary pH in overdose (to promote excretion of acidic drugs). |
|
|
why are aluminum antacids commonly combined with magnesium antacids? |
the combination of aluminum and magnesium helps to avoid constipation and diarrhea. most common adverse effect of aluminum antacids is constipation, while diarrhea is the most common with magnesium. |
|
|
why is aluminum given to patients with renal failure? |
it also will bind phosphate which can result in low blood phosphate levels (hypophophatemia); however, it can be used to treat hyperphosphatemia which commonly occurs in patients with renal failure. magnesium hydroxide can cause hypermagnesemia in renal patients because magnesium is manily excreted by the kidney |
|
|
what are common anticholinergic side effects caused by glycopyrrolate (Robinul)? |
most common is dry mouth. other side effects are constipation, visual disturbances (pupil dilation), and urinary retension |
|
|
what teaching should be given to a patient taking sulcralfate (Carafate) for an ulcer? |
sulcralfate (Carafate), a mucosal protectant, promotes ulcer healing by formin a barrier to protect the ulcer from acid and pepsin. it does not neutralize acid or decrease acid secretion. the most common side effect is constipation. drug interactions can occur inlcuding decreased absorption of some drugs - phenytoin, theophylline, digoxin, warfarin, and fluoroquinolones (antibacterial agents). these interactions can be minimized by adminstering sucralfate 2 hours apart from these other drugs. antacids interfere with sucralfate's effects and should be given at least 30 minutes apart |
|
|
what drug is used to prevent gastric ulcers caused by NSAIDs? |
misoprostol (Cytotec) which is a prostaglandin E1 analogue |
|
|
what is the approved use of alosetron (Lotronex)? |
alosetron (Lotronex) is approved for severe IBS-D (with diarrhea) in women who have had symptoms for at least 6 months that have not responded to conventional drugs |
|
|
how does budesonide (Entocort) work to improve symptoms of inflammatory bowel disease? |
anti-inflammatory effects by suppressing the immune system (treatment for Crohn's Disease) |
|
|
what should the patient taking infliximab (Remicade) be told to go report? |
signs of infection including TB, fever, redness, night sweats, weight loss, fatigue, nausea, vomiting, swelling, and coughing |
|
|
what is the daily fluid requirement for a patient weighing 84kg with a temperature of 103.1F? he vomited several times in the last 24 hours for a total of 450 mL. |
see study guide |
|
|
give examples of crystalloid solutions. |
IV solution that contains electrolytes and other substances that closely resembles the body's extracellular fluid. contain dextrose soduim or a combination in the IV solution *5% dextrose in water (D5W) *10% dextrose in water (D10W) |
|
|
identify IV solutions that are hypotonic, isotonic, and hypertonic. |
hypotonic *0.45% NaCl *5% D5W (if given rapidly or continuously) isotonic *dextrose in 0.2% NaCl *Lactated Ringer's (LR) *D5W dextrose in water *0.9% NaCl hypertonic *D10W 10% dextrose in water *D5 in 0.9% in NaCl *5% dextrose in Lactated Ringer's (D5LR) *3% NaCl |
|
|
where does the fluid go with each type |
hypotonic *water leaves the intravascular compartment and goes into the cells isotonic *stays in the blood stream and expand the blood volume hypertonic *pulls fluid from the ISF and the cell into the blood stream. expanding the blood volume |
|
|
what situations are each type used for? |
hypotonic *cellular dehydration isotonic *dehydration when the blood pressure is low from fluid loss: diarrhea, vomiting, or surgical procedures hypertonic *treat cellular edema, cerebal edema, or increased intraocular pressure (full fluid from the cells into the blood vessel) |
|
|
what adverse effects can occur with each type? |
hypotonic *hypotension (depletion of the intravascular compartment), peripheral edema (too much expansion of the intracellular compartment), water intoxication isotonic *fluid overload in the blood vessels, hypertension hypertonic *dehydration can occur from the pulling fluid from the cells to the kidney to be excreted |
|
|
what causes hyperosmolality (greater than 295 mOsm/kg)? |
severe diarrhea, increased salt intake, inadequate water intake, diabetes, or sweating |
|
|
which solutions will expand the blood volume and replace plasma proteins? |
colloids are large molecules like proteins and starches that say in the blood because they are too big to easily cross the capillary membrane. they have the same effects as hypertonic solutions expand the blood volume by pulling water from the cells and into the intervascular space. this occurs because they increase the plasma's osmolality and pull water into the blood through osmosis. they are also called plasma volume expanders and are used to treat hypovolemic shock due to burns, hemorrhage, and surgery. the most commonly used colloid is albumin and plasma protein fraction. |
|
|
what adverse effects can occur with hetastarch? |
if it stays in the body for weeks it can cause decreased platelet and hematocrit counts. it is contraindicated in pts with bleeding disorders, heart failure, and renal dysfunction |
|
|
a patient has a hematocrit of 32% and hemoglobin of 10 g/dL. what are the expected levels after the patient receives 3 units of packed red blood cells? |
for each unit the hematocrit is going to raise 3-4% and the hemoglobin will increase by 1 gram. 35-36% hematocrit and 13 grams hemoglobin |
|
|
which blood products must be typed and crossmatched before they are given? |
platelets can be given noncrossmatched. packed red blood cells and whole blood have to be given matched and crossmatched |
|
|
how should oral potassium be given? |
oral potassium is very irritating to the gastric and intestinal mucosa, so it must be given with at least a half glass of fluid, preferrably a full glass of fluid (either juice or water) |
|
|
which blood product will most benefit a patient with low oxygen levels, low plasma protein levels, and low clotting factors? |
whole blood |
|
|
what IV solution will correct a sodium level of 127 mEq/L? level of 115 mEq/L? |
Normal Saline (0.9% NaCl) hypertonic saline solution (0.3% NaCl) |
|
|
how should IV potassium be given through a peripheral IV? |
DILUTED in IV fluids and NEVER given via IV push. it should always be given slowly and NEVER in IV bolus. it is irritating to the veins so it should not be given more than 40 mEq/L of IV fluid in a peripheral vein and no faster than 10 mEq per hour in adults |
|
|
what drugs are used to treat hyperkalemia above 5.5 mEq/L? |
serum sodium levels can be decreased by giving insulin and glucose, which causes potassium to intravascular space and go into the cells. sodium bicarbonate may be given to correct any acidosis because potassium leaves the cell when acidosis is present. calcium gluconate is administered to the counteract the effects of potassium on the heart. these measures are all temporary and do not cause potassium to be excreted from the body. oral or rectal administration of polystyrene sulfonate (keyexelate) will cause potassium excretion from the intestines
|
|
|
what can cause hypercalcemia? |
hypercalcemia can result from the hyperparathyroidism, hypophosphatema, bone tumors, prolonged immobilization, multiple fractures, and drugs such as thiazide diuretics. |
|
|
what signs will be manifested in hypocalcemia? what treatment will be given? |
hyperexcitability of the nerve and muscle fibers vitamin D. calcium preparations delivered orally or IV. calcium carbonate is an oral drug that can be given that can cause GI upset because of the release of carbon dioxide. take oral calcium 30 minutes before meals. calcium for IV use should be mixed with D5W, not saline solution. reduce sodium because it causes a loss of calcium. rapid infusion of calcium may cause a tingling warm sensation and metallic taste. (when giving oral calcium make sure they have vitamin D given at the same time to absorb it.) |
|
|
what electrolyte imbalances are commonly seen with hypomagnesemia? |
when there is a loss of potassium, there is also a loss of magnesium. there is frequently also hypokalemia and hypocalcemia. (magnesium has to be replaced first) |
|
|
which patients are at risk for hypermagnesemia due to excessive magnesium intake? |
renal dysfunction or use of antacids or laxatives |
|
|
what are the main acids in the body? what is the primary buffer for acids in the body? |
*carbon dioxide *hydrogen *bicarbonate |
|
|
what adverse effects can occur with a sodium bicarbonate infusion? |
sodium bicarbonate infusion to neutralize the acid can be administered. the pt must be monitored carefully to avoid overcorrection, causing alkalosis. electrolyte levels should also be monitored during a sodium bicarbonate infusion because the sodium can cause hypernatremia and retention of fluid. high levels of bicarbonate cause potassium excretion in the renal tubules which may lead to hypokalemia. pH is increased |
|
|
what are CNS signs of acidosis and alkalosis? |
metabolic alkalosis can be caused by excessive loss of gastric acid (through vomiting or suctioning) or administration of alkaline agents such as sodium bicarbonate. like acidosis, alkalosis has a profound effect on the CNS, including nervousness, hyperactive reflexes, and seizures metabolic acidosis is most often caused by chronic renal failure, severe diarrhea (loss of bicarbonate), or overproduction of acids (ketoacidosis in diabetes or lactic acidosis). the most profound symptoms of acidosis affect the CNS, including lethargy, confusion, and CNS depression leading to coma. deep rapid respirations an be seen in metabolic acidosis as the lungs are trying to rid the body of excess acid (carbon dioxide). treatment consists of correcting the underlying cause of acidosis |
|
|
hypovolemia can cause which acid-base imbalance? |
alkalosis leading to hypercalcemia and hypokalemia |
|
|
alkalosis can cause which electrolyte imbalances? |
hypocalcemia and hypokalemia |
|
|
antibacterial agents |
*amoxicillin *clarithromycin *bismuth *metronidazole *tetracycline |
|
|
histamine2 recepter antagonisits or H2 Blockers |
promote ulcer healing by suppressing gastric acid secretion. Used to promote healing of gastric and duodenal ulcers, prevent duodenal ulcers, treat symptoms of GERD, and treat hypersecretion of gastric acid (such as in Zollinger-Ellison syndrome). OTC to treat heartburn, acid indigestion, and sour stomach. *cimetidine (Tagamet) *ranitidine (Zantac) *famotidine (Pepcid) *nizatidine (Axid) |
|
|
proton pump inhibitors |
most effective drugs for supressing secretion of gastic acid. Used to treat gastric and duodenal ulcers, GERD, and hypersecretory conditions (Zollinger-Ellison syndrome) *omeprazole (Prilosec) *esomeprazole (Nexium) *lansoprazole (Prevacid) *rabeprazole (Aciphex) *pantoprazole (Protonix) |
|
|
normal serum sodium |
135 to 145 mEq/L *less than 135 hyponatremia *greater than 145 hypernatremia |
|
|
normal serum potassium |
3.5 to 5.3 mEq/L *less than 3.5 hypokalemia *greater than 5.3 hyperkalemia |
|
|
normal serum calcium |
4.5 to 5.5 mEq/L *less than 4.5 hypocalcemia *greather than 5.5 hypercalcemia |
|
|
normal serum ionized calcium (iCa) |
2.2 to 2.5 mEq/L |
|
|
normal serum magnesium |
1.5 to 2.5 mEq/L *less than 1.5 hypomagnesemia *greater than 2.5 hypermagnesemia |
|
|
normal pH of plama and most body fluids |
7.35 to 7.45 *less than 7.35 acidosis *greater than 7.45 alkalosis |
