Pharmacology Final - Cumulative; 1075 Cards Total

Front 1

(def)

the study of the effects of chemical substances on living tissue

Back 1

pharmacology

Front 2

Digoxin is extracted from the _______ plant.

Back 2

foxgrove

Front 3

Where is (Premarin), a natural conjugated estrogen, derived from?

Back 3

the urine of pregnant mares

Front 4

Where is natural insulin derived from? What about genetically engineered insulin?

Back 4

Natural insulin = pancreas of pigs

Genetically engineered = DNA of E. Coli

Front 5

(def)

the application of pharmacology to prevent or treat disease

Back 5

Pharmacotherapeutics (aka clinical pharmacology)

Front 6

What act was passed in 1906 to protect the public by controlling sales of drugs which were altered, dangerous, and falsely labeled?

Back 6

Federal Food and Drug Act

Front 7

What publication was designated as the official publication for drug standards? Which was designated as the official listing of all drugs legally available in the US?

Back 7

US Pharmacopeia = drug standards

National Formulary = drugs legally available

Now combined as the USP/NF.

Front 8

How often is the USP/NF updated?

Back 8

every 5 years

Front 9

What is published quarterly by the FDA to impart new information to health practitioners involved in prescribing or dispersing drugs?

Back 9

"Food and Drug Administration Drug Bulletin"

Front 10

In 1912, what act was passed to prohibit drug companies from making false claims about their products?

Back 10

Federal Food and Drug Act - Sherley Amendment

Front 11

Which act, passed in 1914, defined the legal term "narcotic" and regulated the importation, manufacturing and sale of opium, cocaine and their derivatives?

Back 11

Harrison Narcotic Act

Front 12

Who is empowered to approve and recall drugs?

Back 12

FDA

Front 13

Which act, passed in 1951, distinguished between prescription drugs and OTC drugs?

Back 13

Federal Food, Drug, and Cosmetic Act - Durham-Humphrey Amendment

Front 14

What act, passed in 1962, required that drugs be effective as well as safe; included pregnancy categories?

Back 14

Federal Food, Drug, and Cosmetic Act- Kefauver-Harris Amendment

Front 15

What act, passed in 1970, categorized addictive drugs into five schedules according to their abuse potential?

Back 15

Comprehensive Drug Abuse Prevention and Control Act

Front 16

What department is responsible for the enforcement of legislation concerning controlled substances?

Back 16

Drug Enforcement Agency (DEA)

Front 17

What act was passed in 1982 after capsules of Tylenol were poisoned; OTC drugs have to be packaged in such as way that is is obvious if it had been opened?

Back 17

Tamper Proof Packaging Requirement

Front 18

What act, passed in 1983, offered substantial tax credits to pharmaceutical companies to develop drugs to treat rare diseases or which have a limited market?

Back 18

Orphan Drug Act

Front 19

What act, passed in 1984, enabled pharmaceutical companies to manufacture and market a drug under the generic name and to apply their own trade name once the patent held by the original manufacturer expired?

Back 19

Generic Drug Law

Front 20

A generic drug is considered bio-equivalent if the peak serum concentration and the plasma-concentration fall within what percent of the original drug?

Back 20

80-125%

Front 21

What act, passed in 1992, enabled the review process of investigational new drugs to be accelerated if the drugs will be used to treat HIV, AIDS, or cancer?

Back 21

Drug Relations Act

Front 22

What act, passed in 2003, required testing of certain drugs for safety and effectiveness in children?

Back 22

Pediatric Research Equity Act

Front 23

What act, passed in 2003, provides financial assistance to senior citizens to purchase prescription drugs?

Back 23

Medicare Prescription Drug Improvement and Modernization Act

Front 24

What agency in the US controls drug testing? Does this agency actively test these drugs?

Back 24

the FDA controls drug testing, however the actual testing is performed by the individual companies

Front 25

Historically, drugs could bypass the FDA if they were marketed as what? When did this change?

Back 25

If they were marketed as dietary supplements, however this changed in August, 2007

Front 26

What is granted to companies once the FDA is satisfied with the pre-clinical studies?

Back 26

an "Investigational New Drug Exemption" which permits testing on humans

Front 27

Clinical trials on humans progress through how many phases?

Back 27

4

Front 28

What population group is generally excluded from clinical trials?

Back 28

women of child-bearing age

Front 29

During which phase of clinical trials is the drug given to a small number of healthy volunteers?

Back 29

Phase I

Front 30

If a drug might have severe side effects (ex. anti-cancer agents), what population group is used for Phase I clinical trials?

Back 30

volunteers who have the disorder that the drug is intended to treat

Front 31

During which phase of clinical trials is the drug given to a small number of volunteers who have the disorder that the drug is intended to treat?

Back 31

Phase II

Front 32

During which phase of clinical trials is the drug prescribed to a large number of patients who have the disorder, typically taking place in medical research centers?

Back 32

Phase III

Front 33

What type of study may be conducted during Phase III Clinical trials?

Back 33

Double-blind study

Front 34

If Phase III of a clinical study is satisfactorily completed, the pharmaceutical company applies to the FDA for what?

Back 34

a "new drug application" (NDA)

Front 35

Which phase of clinical trials is referred to as post-marketing surveillance?

Back 35

Phase IV

Front 36

Adverse drug reactions should be reported to whom? Is this action mandatory or voluntary?

Back 36

Report to the FDA's medwatch program; this is a voluntary process (considered a flaw in the feedback system)

Front 37

It takes about 14 years at a cost often in excess of $980 million dollars to bring a new drug to market. What is done to help drug manufacturers recoup these costs?

Back 37

A patent is granted for approximately 13-17 years

Front 38

What are the three names assigned to drugs?

Back 38

1. chemical
2. generic
3. trade, brand or proprietary

Front 39

Which drug name(s) remain constant regardless of which company is marketing the drug?

Back 39

Chemical and generic names

Front 40

A suffix added to a drug name indicates what?

Back 40

some type of alteration to the drug (such as SR for sustained release or an additive such as Robitussin DM)

Front 41

Drugs are administered according to the "five rights". What are they?

Back 41

1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time

Front 42

Before a nurse can carry out a medication order, it must be determined that the order is valid. To be valid, the order must be written by the appropriate licensed professional and contain what information? (7)

Back 42

- Patient's name
- Time and date
- Drug name
- Dose of the drug
- Route of administration
- Time interval of drug
- Signature of prescriber

Front 43

Orders written by medical students are not valid without what?

Back 43

a co-signature by a licensed physician

Front 44

What are guidelines that you should follow when taking verbal orders from a physician?

Back 44

- repeat the order back to verify
- have the order co-signed within 24 hrs (or within agency policy timeframe)

Front 45

The nurse is legally responsible for knowing what information about drugs administered?

Back 45

The purpose, therapeutic effects, and possible adverse effects; also any drug-drug or food-drug interactions

Front 46

What are the 3 phases of drug activity in the body?

Back 46

- pharmaceutical phase
- pharmacokinetic phase
- pharmacodynamic phase

Front 47

What phase of drug activity applies only to drugs that are administered through the gastro-intestinal tract?

Back 47

pharmaceutical phase

Front 48

Which phase of drug activity are drugs that are taken disintegrated and dissolved by fluids in the stomach and small intestine?

Back 48

pharmaceutical phase

Front 49

Which phase of drug activity applies to all drugs and is characterized by movement of the drug?

Back 49

pharmacokinetic phase

Front 50

What are the 4 aspects of the pharmacokinetic phase of drug activity?

Back 50

- absorption
- distribution
- metabolism
- excretion

Front 51

Which aspect of the pharmacokinetic phase is the movement of a drug from its site of entry to the blood stream?

Back 51

absorption

Front 52

Which aspect of the pharmacokinetic phase is the movement of the drug from the blood stream to the interstitial space of tissues and then into cells?

Back 52

distribution

Front 53

Which aspect of the pharmacokinetic phase is when a drug undergoes enzymatic transformation in the liver?

Back 53

metabolism

Front 54

Which aspect of the pharmacokinetic phase is when the drug is transformed to a water-soluble form so it can be excreted by the kidneys?

Back 54

excretion

Front 55

Which phase of drug activity refers to the bio-chemical actions of drugs and the physiological response of the body to these drugs?

Back 55

pharmacodynamic phase

Front 56

What are 3 variables that may affect the pharmaceutical phase of drug activity?

Back 56

1. Type of drug preparation (ex. SR tablets, elixers, etc.)
2. pH of the Gastric fluid
3. Incomplete Swallowing

Front 57

(def)

the percentage of a drug does that reaches systemic circulation

Back 57

bioavailability

Front 58

Bioavailability is affected by what 3 things?

Back 58

1. the route of administration
2. the degree of first-pass effect
3. the degree of second-pass effect

Front 59

What route of drug administration offers the greatest rate of bioavailability? Which offers the least amount?

Back 59

IV = greatest amount because the drug is administered directly into the bloodstream

Oral = least amount due to the many factors that can affect the drug in the GI tract

Front 60

What is first-pass effect? Does this increase or decrease bioavailability?

Back 60

First-pass effect is the processing of a drug through the liver. This decreases bioavailability because the drug is partially inactivated by the liver.

Front 61

What is second-pass effect? Does this decrease or increase bioavailability of a drug?

Back 61

Second-pass effect occurs when the liver excretes unmetabolized drug into the bile, which can be reabsorbed by the gut. This increases bioavailability.

Front 62

What variables might affect absorption during the pharmacokinetic phase of drug activity?

Back 62

- the number of mucosal microvilli in the small intestine
- gastric motility
- presence or absence of food in the stomach
- food-drug and drug-drug interactions

Front 63

What variables might affect distribution during the pharmacokinetic phase of drug activity?

Back 63

- circulation of blood
- degree of plasma protein binding
- plasma protein levels
- presence of tumors or abscesses

Front 64

What might happen to a drug's absorption if the number of mucosal microvilli in the small intestine are decreased due to malnutrition or disease?

Back 64

the drug's absorption may be decreased

Front 65

What type of onset and duration would been seen in a drug that is highly protein bound? What about those with a low degree of protein binding?

Back 65

highly protein bound = slow onset of action and a long duration

low protein binding = rapid onset of action with a short duration

Front 66

Malnutrition can cause low levels of plasma proteins. How does this affect certain drugs?

Back 66

This will reduce the number of plasma protein binding sites which results in an increase in the amount of free drug; toxicity can occur

Front 67

What are 2 things that may impact metabolism during the pharmacokinetic phase?

Back 67

- liver disease
- the length of the half-life

Front 68

If a drug has a long half-life, it will take a _________ (longer/shorter) amount of time for the liver to metabolize the drug.

Back 68

longer

Front 69

What disorder might effect excretion during the pharmacokinetic phase of drug activity?

Back 69

renal disease

Front 70

What might happen when two highly protein-bound drugs are given at the same time?

Back 70

competition for binding sites occurs which may increase the amount of circulating free drug; could result in toxicity

Front 71

During the pharmacodynamic phase of drug activity, a drug will exert its biochemical effect by one of what (6) methods?

Back 71

1. binding with cellular receptors
2. inhibiting the action of enzymes or hormones
3. causing a chemical reaction
4. increasing osmolarity
5. combining with metals (chelating)
6. the presence of their physical properties

Front 72

The active ingredients in drugs that bind with receptors to exert their bio-chemical effect have a(n) _________ for reactive receptors on cells.

Back 72

affinity

Front 73

The greater the fit between a drug and the receptor site, the ______ (more/less) effective the drug will be.

Back 73

more

Front 74

Most drugs exert their bio-chemical effects using which method of the pharmacodynamic phase?

Back 74

binding with receptors

Front 75

Drugs that inhibit the action of a specific enzyme or hormone do so how? What are these drugs called?

Back 75

by causing the enzyme/hormone to bind with the drug rather than the target cell. These drugs are called anti-metabolites.

Front 76

What is the best example of a drug that exerts is bio-chemical effect by causing a chemical reaction by direct contact with body fluids?

Back 76

antacids

Front 77

How do chelating agents work?

Back 77

they combine with toxic metals to form a complex that can be excreted in the urine

Front 78

What is the best example of a drug that exerts its action due to its physical properties?

Back 78

a bulk laxative (such as Metamucil)

Front 79

What is polypharmacy? When is polypharmacy most dangerous?

Back 79

multi-drug administration; most dangerous when the client is using different doctors, or even worse, different pharmacies

Front 80

A drug dose that is too small is __________. One that is too large can be _______.

Back 80

too small = sub-therapeutic
too large = toxic

Front 81

What is drug tolerance?

Back 81

a phenomenon that occurs when a drug is taken for a long period of time and larger doses are needed over time to achieve the same effect

Front 82

The recommended dosage of a drug is targeted to a _____ pound person.

Back 82

150

Front 83

What two population groups usually require smaller doses of drugs and may metabolize drugs differently?

Back 83

children and the elderly

Front 84

True/False:

Women and men respond to many drugs differently.

Back 84

True

Front 85

True/False:

While gender and age can affect the effectiveness of a drug, race does not play a factor.

Back 85

False- age, gender, and race may all influence a person's reaction to a drug

Front 86

Could a person's knowledge of a drug and attitude towards taking it influence their biological response?

Back 86

Yes, the mind is greatly connected to the body, therefore attitude and feelings regarding a drug can greatly affect its effect

Front 87

Does the time of day a drug is taken have an effect on its action?

Back 87

In certain cases, yes. Some drugs have more effect in the morning while others have more effect in the evening. This is called diurnal response.

Front 88

(def)

the time it takes the drug to reach the minimum effective concentration after it is administered; pharmacological action begins at this time

Back 88

onset of action

Front 89

(def)

drug reaches its highest level of concentration in the plasma; most active at this time

Back 89

peak action

Front 90

(def)

the length of time a drug has a pharmacological effect

Back 90

duration of action

Front 91

(def)

the ratio between the effective dose and the lethal dose

Back 91

therapeutic index

Front 92

(def)

the ratio between the minimum effective concentration and the minimum toxic concentration

Back 92

therapeutic range

Front 93

(def)

a measurement of blood levels of a drug

Back 93

peak and trough levels

Front 94

To measure peak levels, when should blood be drawn?

Back 94

at the time the drug should reach its peak level

Front 95

To measure a trough level, when should blood be drawn?

Back 95

just before the next scheduled dose of drug administration

Front 96

(def)

the time it takes for one-half of the drug to be eliminated from the body

Back 96

biologic half-life

Front 97

(def)

a large initial dose that is given to quickly achieve a therapeutic blood level of a drug

Back 97

loading dose

Front 98

(def)

reaction caused by a drug interacting with an undesired receptor site

Back 98

side effect

Front 99

Are side effects always negative?

Back 99

No - for example Benadryl is intended to treat allergic reactions and a side effect is that it causes drowsiness; it is commonly used as a sleep aid, so in this case it would be a desired effect

Front 100

(def)

a physiological response to a drug that is harmful to the body; can be life-threatening

Back 100

adverse reaction

Front 101

(def)

an unexpected response from a drug

Back 101

idiosyncratic response

Front 102

(def)

repeated doses of a drug accumulate in the body resulting in a greater than desired pharmacological effect

Back 102

cumulation

Front 103

(def)

two or more drugs with similar actions are given simultaneously to increase the pharmacological effect

Back 103

summation

Front 104

(def)

two or more drugs with dissimilar actions are given simultaneously to create a pharmacological effect that is greater than the sum of the drugs when given independently

Back 104

potentiation

Front 105

(def)

there is an indication that a particular drug should not be given

Back 105

contraindication

Front 106

What are teratogenic effects?

Back 106

an effect of a drug that can cause developmental disorders of a fetus

Front 107

What are the 5 pregnancy safety categories issues by the FDA?

Back 107

A, B, C, D & X

Front 108

Which pregnancy safety category?

There is no evidence of risk to the human fetus.

Back 108

A

Front 109

Which pregnancy safety category?

Animal studies have not demonstrated a risk to the fetus. Well controlled studies in pregnant women are not available. It is assumed that there is little to no risk to the fetus.

Back 109

B

Front 110

Which pregnancy safety category?

Animal studies have shown an adverse effect on the fetus but there are no adequate studies in human or there are no animal reproduction studies. The drug may be given if the potential benefits to the mother outweigh the potential risks to the fetus.

Back 110

C

Front 111

Which pregnancy safety category?

There is evidence that there is risk to a human fetus. The drug may be given if the potential benefit to the mother outweighs the potential risk to the fetus.

Back 111

D

Front 112

Which pregnancy safety category?

Animal an/or human studies demonstrate fetal abnormalities or adverse reactions. The risk to the fetus outweighs the potential benefits to the mother.

Back 112

X

Front 113

True/False:

Drugs can pass into breast milk.

Back 113

True

Front 114

What is done by the FDA if a drug is known to cause a high incidence of iatrogenic effects?

Back 114

a "black box warning" is placed on the package insert; this highlights the problems associated with the drug

Front 115

There are 4 types of allergic reactions that can occur in a _______ _______ person.

Back 115

previously sensitized

Front 116

Which type of allergic reaction?

Occurs within minutes of exposure to the allergen; usually characterized by pruritis, rash, urticaria and/or edema

Back 116

Type I

Front 117

What are some serious Type I allergic reaction symptoms? (5)

Back 117

- apprehension
- tachycardia
- hypotension
- bronchospasm
- respiratory tract edema

Front 118

Serious type I allergic reactions are indicative of what?

Back 118

Anaphylactic shock (this can be fatal)

Front 119

What are type I allergic reactions treated with?

Back 119

- benadryl
- epinephrine
- corticosteroids

Front 120

Which type of allergic reaction?

characterized by an auto-immune response; hemolytic anemia, thrombocytopenia or lupus erythematosus can be seen

Back 120

Type II

Front 121

Are type II allergic reactions reversible?

Back 121

Yes, this reaction is usually reversible weeks to months after the drug is discontinued

Front 122

Which type of allergic reaction?

characterized by fever, swollen lymph nodes, arthralgia, and enlarged spleen. Usually occurs 1-3 weeks after exposure to the drug.

Back 122

Type III

Front 123

Which type of allergic reaction?

Caused by sensitized T lymphocytes; results in contact dermatitis; pruritis, rash and urticaria occurs when touching the allergen

Back 123

Type IV

Front 124

Many health care professionals have developed a Type IV allergic reaction to what?

Back 124

latex gloves

Front 125

What nervous system is known as the adrenergic system?

Back 125

sympathetic nervous system

Front 126

What are the primary neurotransmitters for the sympathetic nervous system?

Back 126

- norepinephrine
- epinephrine
- dopamine

Front 127

What nervous system is responsible for the "fight or flight" response and speeds up many physiological responses in the body?

Back 127

sympathetic nervous system

Front 128

What activates the "fight or flight" response?

Back 128

internal or external stress (ex. illness or danger)

Front 129

What nervous system is known as the cholinergic system?

Back 129

parasympathetic nervous system

Front 130

What is the primary neurotransmitter for the parasympathetic nervous system?

Back 130

acetylcholine

Front 131

Which nervous system slows down many physiological responses in the body?

Back 131

parasympathetic nervous system

Front 132

Which nervous system is known as the "rest and digest" system?

Back 132

parasympathetic nervous system

Front 133

What are the 4 categories of drugs used to influence the ANS?

Back 133

1. adrenergic agonists
2. adrenergic antagonists
3. cholinergic agonists
4. cholinergic antagonists

Front 134

How do adrenergic agonists work?

Back 134

they mimic norepinephrine, epinephrine, and/or dopamine and bind to adrenergic receptor sites

Front 135

What are the 5 receptor sites that adrenergic agonists act on?

Back 135

- Alpha 1
- Alpha 2
- Beta 1
- Beta 2
- dopaminergic

Front 136

Adrenergic agonists are also called what?

Back 136

sympathomimetics

Front 137

What receptor site, alpha 1 or alpha 2, increases activity in the sympathetic nervous system (increases cardiac contraction, increases BP, increases blood return to the heart, etc)?

Back 137

alpha 1

Front 138

What receptor site, alpha 1 or alpha 2, decreases the activity of the sympathetic nervous system to maintain homeostasis via a negative feedback system?

Back 138

alpha 2

Front 139

Which sympathetic receptor site, beta 1 or beta 2, acts on the heart by increasing cardiac contraction?

Back 139

beta 1

Front 140

Which sympathetic receptor site, beta 1 or beta 2, acts on the lungs by dilating bronchioles?

Back 140

beta 2

Front 141

What sympathetic receptor site acts by dilating the coronary arteries, renal blood vessels, and visceral blood vessels when dilated?

Back 141

dopaminergic

Front 142

Only _________ stimulates dopaminergic receptors.

Back 142

dopamine

Front 143

What are 2 side effects you must monitor for when administering sympathomimetics?

Back 143

1. tachycardia
2. hypertension

Front 144

Sympathomimetics should be used cautiously in clients who have what 2 disorders?

Back 144

1. Coronary artery disease
2. hypertensive disease

Front 145

IV dopamine and phenylephrine (sympathomimetics) should be infused how?

Back 145

through a central line

Front 146

What must you watch when administering IV dopamine and phenylephrine (sympathomimetics) through a peripheral vein?

Back 146

infiltration - the surrounding tissue will become vasoconstricted

Front 147

Vasoconstriction caused by the infiltration of a peripheral vein infusing either IV dopamine or phenylephrine (sympathomimetics) can be severe enough to cause what?

Back 147

gangrene of the area

Front 148

What should you do if you are infusing IV dopamine or phenylephrine (sympathomimetics) and infiltration occurs?

Back 148

- stop infusion immediately
- attempt to aspirate the solution through a syringe
- normal saline and phentolamine may be administered to vasodilate
- quickest way to vasodilate is to apply nitroglycerine paste

Front 149

Over use of vasoconstricting nasal sprays can cause what?

Back 149

rebound vasodilation of the nasal mucosa

Front 150

Drugs that block the effects of the sympathetic neurotransmitters are called what?

Back 150

sympatholytics (adrenergic antagonists, blockers)

Front 151

Which drug class of sympatholytic vasodilates arteries, relaxes smooth muscles of the urethra, and decreases the force of cardiac contraction?

Back 151

alpha adrenergic blockers

Front 152

Alpha adrenergic blockers (sympatholytics) are used for what 3 disorders?

Back 152

- hypertension
- peripheral vascular disease
- benign prostatic hypertrophy

Front 153

Because alpha adrenergic blockers (sympatholytics) decrease the force of cardiac contraction, they may predispose a client to what?

Back 153

Congestive heart failure

Front 154

What might occur if a person's blood pressure is decreased rapidly?

Back 154

reflex tachycardia

Front 155

Which drug class of sympatholytics slow the heart rate, decrease blood pressure through vasodilation, and decrease the release of renin from the kidneys?

Back 155

beta adrenergic blockers

Front 156

When using beta adrenergic blockers (sympatholytics), the _____ of the cardiac contraction is decreased.

Back 156

force

Front 157

Beta adrenergic blockers (sympatholytics) are useful in the treatment of what 3 disorders?

Back 157

- tachycardia
- hypertension
- coronary artery disease

Front 158

What may the use of beta adrenergic blockers (sympatholytics) predispose a client to? Why?

Back 158

Congestive heart failure due to the decrease in the force of cardiac contractions

Front 159

When using a sympatholytic, you should monitor a person for what? why?

Back 159

Monitor blood pressure - hypotension can occur

Front 160

What are 2 things you should specifically watch for in clients taking alpha adrenergic blockers (sympatholytics)?

Back 160

- watch for reflex tachycardia
- watch for signs of decreased cardiac output

Front 161

What are 3 things you should specifically watch for in clients taking beta adrenergic blockers (sympatholytics)?

Back 161

- watch for bradycardia
- watchy for signs of decreased cardiac output
- watch for bronchoconstriction

Front 162

What type of client is most vulnerable to respiratory compromise when taking beta adrenergic blockers (sympatholytics)?

Back 162

clients with COPD

Front 163

Cholinergic drugs stimulate what nervous system?

Back 163

parasympathetic nervous system

Front 164

What neurotransmitter do cholinergic drugs (cholinergic agonists) mimic?

Back 164

acetylcholine

Front 165

What are the 2 types of cholinergic receptors? Briefly describe the action when each is stimulated.

Back 165

1. muscarinic receptors- stimulate smooth muscle and slow heart rate when stimulated
2. nicotinic receptors- affect skeletal muscles when stimulated

Front 166

How do direct-acting cholinergic drugs work? How do indirect-acting cholinergic drugs work?

Back 166

direct acting - act directing on cholinergic receptors

indirect-acting - inhibit the action of acetylcholinesterase

Front 167

What physiological changes occur in the body when the cholinergic system is stimulated? (11)

Back 167

- heart rate decreases
- BP decreases (due to vasodilation)
- bronchoconstriction occurs
- bronchial secretions increase
- salivation increases
- peristalsis increases
- bladder tone increases
- sweating increases
- secretion of gastric acid increases
- urinary sphincter relaxes
- intra-ocular pressure decreases

Front 168

What problems might be experienced with the GI tract when taking parasympathomimetics (cholinergics)?

Back 168

- abdominal cramping
- diarrhea

Front 169

What should you specifically watch for in clients with COPD taking parasympathomimetics?

Back 169

bronchoconstriction and increased bronchial secretions

Front 170

What is a "cholinergic crisis"?

Back 170

Respiratory arrest caused by increased secretions and bronchoconstriction when taking parasympathomimetics.

Front 171

How do cholinergic antagonists, a.k.a. parasympatholytics, work?

Back 171

inhibit the action of acetylcholine by competing with it for space on the receptors

Front 172

What physiological changes do you see in the body when taking cholinergic antagonists, a.k.a. parasympatholytics?

Back 172

- heart rate increase
- bronchodilation occurs
- bronchial secretions decrease
- salivation decreases
- GI motility and GI secretions decreases
- bladder tone decreases
- urinary sphincter tone is increased
- intra-ocular pressure is increased

Front 173

What side-effect is likely to occur when a person is taking a parasympatholytic?

Back 173

dry mouth

Front 174

What are possible side effects for a person taking parasympatholytics?

Back 174

- dry mouth
- dehydration
- constipation
- urinary retention
- intra-ocular pressure
- blurry vision

Front 175

Parasympatholytics should be used very cautiously in clients with what disorder? Why?

Back 175

Glaucoma - due to the possible increase in intra-ocular pressure

Front 176

Excesses or deficiencies of neurotransmitters are implicated in what 3 types of problems?

Back 176

1. seizure disorders
2. mental health problems
3. perception/response to anxiety and pain

Front 177

Seizures are classified into what 2 major groups?

Back 177

1. generalized
2. partial

Front 178

(def)

seizures that begin in one part of the brain and rapidly spread throughout the brain

Back 178

generalized seizures

Front 179

What are 2 common types of generalized seizures?

Back 179

1. tonic-clonic seizures
2. absence seizures

Front 180

(def)

type of generalized seizure in which intense muscle contractions and loss of consciousness occur

Back 180

tonic-clonic seizure

Front 181

Seizures that continue for a protracted period of time of that recur frequently are referred to as what?

Back 181

status epilepticus

Front 182

Is status epilepticus dangerous?

Back 182

Yes, it can cause hypoxia

Front 183

(def)

type of generalized seizure involving a period of unconsciousness lasting 3-5 seconds

Back 183

absence seizure

Front 184

(def)

type of seizure that involves only part of the brain; may exhibit through a single muscle movement or through sensory alteration such as hallucinations

Back 184

partial seizure (a.k.a. focal seizures)

Front 185

Anti-seizure agents raise the seizure threshold by inhibiting excitatory activity in the brain. What are the 3 different mechanisms that anti-seizure drugs exert to accomplish this action?

Back 185

1. suppression of sodium influx
2. suppression of calcium influx
3. potentiation of GABA in the brain

Front 186

Why are some anti-seizure drugs also used fro mental health disorders and chronic pain?

Back 186

because many of the same neurotransmitters are involved

Front 187

How do hydantoins (anti-seizure agents) work?

Back 187

decrease excitability in the brain (motor cortex) by suppressing sodium influx

Front 188

What are 2 major concern with hydantoins (anti-seizure agents)?

Back 188

- they have a narrow therapeutic index, so they can be toxic

- hepatotoxicity a major concern

Front 189

What is the biggest benefit of hydantoins (anti-seizure agents) over other drugs in this class?

Back 189

they cause less drowsiness than some other anti-convulsants

Front 190

How do iminostilbenes (anti-seizure agents) work?

Back 190

suppress sodium influx

Front 191

While iminostilbenes (anti-seizure agents) can be used for generalized and partial seizures, they can also be used for what other disorder?

Back 191

bipolar affective disorder

Front 192

How do barbituates and barbituate-like agents (anti-seizure agents) work?

Back 192

potentiate GABA

Front 193

In addition to being used to treat generalized and partial seizures, what is another use for barbituates and barbituate-like agents (anti-seizure agents)?

Back 193

used as a sedative

Front 194

How do benzodiazepines (anti-seizure agents) work?

Back 194

potentiate GABA

Front 195

In addition to being used for seizures, what are 2 additional uses for benzodiazepines (anti-seizure agents)?

Back 195

- used as a sedative
- used for DTs

Front 196

How do valproic acids (anti-seizure agents) work?

Back 196

- suppress sodium and calcium influx
- potentiate GABA

Front 197

In addition to treating seizures, what are 2 additional uses for valproic acids (anti-seizure agents)?

Back 197

- bipolar affective disorder
- prophylaxis of migraine headaches

Front 198

Are valproic acids (anti-seizure agents) hepatotoxic?

Back 198

Yes, they are moderately hepatotoxic; liver enzymes must be drawn on a regular basis

Front 199

Valproic acids (anti-seizure agents) should be used cautiously in what population group?

Back 199

children and the elderly

Front 200

What type of seizure are succininides (anti-seizure agents) used to treat?

Back 200

absence seizures

Front 201

When giving anti-seizure agents for a seizure disorder, what should always be monitored?

Back 201

seizure activity

Front 202

When giving anti-seizure agents, what should be done if the agent given is sedating?

Back 202

watch for drowsiness

Front 203

When giving hydantions (anti-seizure agents) what are 2 things that must be monitored?

Back 203

- monitor therapeutic blood levels (narrow therapeutic index)
- monitor liver enzymes (hepatotoxic)

Front 204

What special care may be needed for a person taking hydantoins (anti-seizure agents)? Why?

Back 204

Special dental care may be indicated because gingival hyperplasia could occur

Front 205

What should be assessed when giving magnesium sulfate (misc. anti-convulsant)? (4)

Back 205

- assess for depressed deep tendon reflex
- assess for drowsiness
- assess for muscle weakness
- assess for depressed respirations

Front 206

What specific test should be done when administering magnesium sulfate (anti-convulsant)?

Back 206

frequent blood tests for magnesium levels

Front 207

Most anti-convulsants are what pregnancy safety category?

Back 207

C&D

Front 208

Anti-convulsants increase the loss of what in pregnant women? What should be done to counter this loss?

Back 208

increase the loss of folic acid, supplements should be given

Front 209

What 3 neurotransmitters are thought to be depleted in depression?

Back 209

serotonin, dopamine, and norepinephrine

Front 210

What is the goal of anti-depressive therapy?

Back 210

to increase the transmission of neurotransmitters thought to be lacking (serotonin, dopamine, and norepinephrine)

Front 211

Why is compliance an issue with anti-depressants?

Back 211

because these drugs often take 4-6 weeks to begin working

Front 212

How do Tricyclic and Tetracyclic Anti-depressants (TCAs) work?

Back 212

reduce the reuptake of serotonin and norepinephrine

Front 213

What are 6 problems associated with Tricyclic and Tetracyclic Anti-depressants (TCAs)?

Back 213

1. sedation
2. lowered seizure threshold
3. heart block with large doses
4. orthostatic hypotension
5. anti-cholinergic effects
6. increased appetite and weight gain

Front 214

Because Tricyclic and Tetracyclic Anti-depressants (TCAs) are sedating, how is dosage scheduled?

Back 214

If taking one dose, take at bedtime.

If taking more than one does, smaller doses during the day and a larger dose at bedtime

Front 215

Although Monoamine Oxidase Inhibitors (MAOIs), an anti-depressant, are very effective that have what major problems associated with them?

Back 215

- drug-drug and food-drug interactions that can raise BP to dangerous levels
- lower the seizure threshold
- have anti-cholinergic effects
- can cause orthostatic hypotension
- increase appetite and cause weight gain

Front 216

Concomitant use of Demerol with MAOIs can cause what?

Back 216

hyperpyrexia

Front 217

How do MAOIs (anti-depressants) work?

Back 217

they inhibit monoamine oxidase, an enzyme that destroys serotonin, dopamine, and norepinephrine

Front 218

How do Selective Serotonin Reuptake Inhibitors (SSRIs), an anti-depressant, work?

Back 218

decrease reuptake of serotonin

Front 219

Why do SSRIs (anti-depressants) have fewer side effects?

Back 219

because of their selective nature

Front 220

What are 2 common problems associated with SSRIs (anti-depressants)?

Back 220

- weight-loss
- decreased sexual function

Front 221

Fluoxetine (SSRI) can cause what in some individuals?

Back 221

aggression, especially in adolescents

Front 222

How long should you tell clients it will take to see the therapeutic effects of anti-depressants?

Back 222

4-6 weeks

Front 223

What should accompany the prescription of an anti-depressant for a person having depression?

Back 223

therapy for at least 6 months to 1 year to prevent an exacerbation of the depression

Front 224

What should you watch for in persons taking anti-depressants?

Back 224

watch for signs of suicidal ideation; many clients don't have the energy to commit suicide while depressed, however once anti-depressants begin to have an effect they may have the energy to carry out a plan

Front 225

What population group is most at risk for suicidal ideation when taking anti-depressants?

Back 225

teenagers

Front 226

Lithium carbonate (anti-manic agent) is used for what? How does it work?

Back 226

bipolar affective disorder - works by decreasing manic episodes by blocking the release of dopamine and norepinephrine

Front 227

What are the major problems associated with lithium carbonate (anti-manic agent)?

Back 227

- many drug-drug and food-drug interactions
- can cause hyponatremia
- very narrow therapeutic index

Front 228

What should be done to counter the hyponatremic effect seen with lithium carbonate (anti-manic agent)?

Back 228

- fluid intake of 2500-3000 mL per day along with an adequate fluid intake

Front 229

What pregnancy category is lithium carbonate (anti-manic agent)?

Back 229

D

Front 230

The category of drugs used to treat anxiety and sleep disorders include what 3 groups?

Back 230

1. anxiolytics
2. hypnotics
3. somnifacients

Front 231

Are drugs used to treat anxiety and sleep disorders analgesics?

Back 231

No, however they can be used as adjuncts to analgesia.

Front 232

How do benzodiazepines work?

Back 232

produce CNS depression by potentiating GABA and inhibiting impulses

Front 233

Benzodizaepines are generally used to treat what? What can they also be used for?

Back 233

Generally used to treat anxiety and insomnia.

Additionally are often used as sedation before surgeries or procedures.

Some can be used for seizures or DTs.

Front 234

Is dependence a risk for benzodiazepines?

Back 234

Yes, therefore they are controlled substances

Front 235

What should be done if coma or respiratory depression occur with the administration of a benzodiazepine?

Back 235

administer the antidote flumazenil

Front 236

How quickly does flumazenil work when given as an antidote to counter a problem associated with the administration of a benzodiazepine? What method of administration is used?

Back 236

works within 1-2 minutes, given IV

Front 237

What might occur to a person given flumazenil if they are benzodiazepine dependent?

Back 237

withdrawal syndrome

Front 238

What should you monitor for in a person receiving a non-benzodiazepine anxiolytic?

Back 238

monitor for extrapyramidal side effects, including abnormal movements such as those seen in Parkinson's Disease, dystonia and tardive dyskinesia

Front 239

How do non-benzodiazepine somnifacients work?

Back 239

potentiate GABA

Front 240

Which is thought to cause less dependence, benzodiazepines or non-benzodiazepines?

Back 240

Non-benzodiazepines

Front 241

Are non-benzodiazepine somnifacients controlled substances?

Back 241

Yes, schedule IV

Front 242

What hormone helps control the sleep-wake cycle?

Back 242

melatonin

Front 243

Drugs used to treat insomnia (non-benzodiazepine somnifacients), such as Sonata and Ambien, should be taken when?

Back 243

right before getting into bed, these drugs act very rapidly

Front 244

Should you take non-benzodiazepine somnifacients with or without food?

Back 244

Without, food in the stomach decreases bioavailability

Front 245

What might occur with zolpidem (Ambien), a non-benzodiazepine somnifacient?

Back 245

short-term amnesia if awakened during sleep

Front 246

What should be avoided when taking non-benzodiazepine somnifacients?

Back 246

alcohol intake - can cause psycho-motor impairments due to increased action of the drug

Front 247

How do agents used for psychosis and agitation work?

Back 247

decrease dopamine and serotonin levels

Front 248

What activity is responsible for the therapeutic effects as well as the many side-effects seen with agents used for psychosis and agitation?

Back 248

anti-dopaminergic activity

Front 249

What should be monitored when administering an agent used for psychosis and agitation?

Back 249

- monitor for a decrease in alertness
- monitor for anti-cholinergic effects
- monitor for abnormal movement disorders such as tardive dyskinesia, dystonia, akathisia, and pseudoparkinsonism

Front 250

What might be given to counter the abnormal movement disorders seen with agents used to treat psychosis and agitation? What problem is associated with this?

Back 250

- drugs such as benztropine or trihexiphenidyl may be given, however they increase anti-cholinergic effects

Front 251

How do narcotic analgesics (opioids) work?

Back 251

they bind with opiate receptors in the CNS altering the perception and emotional response to pain

Front 252

Besides reducing pain, opioids can be used for what 4 other things?

Back 252

1. suppress cough
2. slow respiratory rate
3. decrease peristalsis
4. pre-medication before surgery

Front 253

What 3 drug groups fall in the non-opioid classification of analgesics?

Back 253

1. non-steroidal anti-inflammatory agents (NSAIDS)
2. acetaminophen
3. salicylates

Front 254

What 3 drug groups may be used as adjuncts in the control of chronic pain?

Back 254

1. anti-depressants
2. anti-convulsants
3. skeletal muscle relaxants

Front 255

Assessment of pain includes what 8 factors?

Back 255

- location
- intensity
- quality
- pattern
- precipitating factors
- alleviating factors
- associated symptoms
- coping mechanisms

Front 256

Is there a distinction between acute and chronic pain?

Back 256

Yes, therefore medication regimens are different for each

Front 257

How is chronic pain best managed?

Back 257

with scheduled doses of pain medication around the clock rather thn by PRN administration

Front 258

What is the recommended agent for pain caused by terminal cancer? Why?

Back 258

Morphine because it has no dosage ceiling.

Front 259

Why is meperidine (Demerol) not recommended for chronic pain?

Back 259

after only a few days of use, it is converted to normeperidine which is a CNS toxin; causes a host of neurological problems including confusion, excitement, seizures, and hallucinations

Front 260

Why is patient controlled analgesia (PCA) beneficial?

Back 260

because pain is better controlled using this method

Front 261

What are the benefits of opioid agonist/antagonists over opioid agonists?

Back 261

They are thought to have a lower addiction potential because of their antagonistic properties; also less likely to cause respiratory depression

Front 262

What is a problem with opioid agonist/antagonists?

Back 262

they can cause withdrawal symptoms if given to a client who is opioid dependent

Front 263

What should you always check for prior to administering an opioid agent?

Back 263

allergies

Front 264

True/False:

analgesics should be taken when the pain becomes severe

Back 264

False- they should be taken prior to this, at the onset of pain

Front 265

Opioids should not be given in what 3 cases? Why?

Back 265

- head trauma (can mask symptoms)
- shock (can decrease BP)
- severe respiratory depression

Front 266

True/False:

If a person has a history of addiction, you should not give them opioids.

Back 266

False - although you should use them cautiously, you should not deny such a person pain relief

Front 267

Opioids should be used cautiously in what two cases?

Back 267

- in cases of urinary retention
- patients with asthma

Front 268

What is a likely side effect of opioid use?

Back 268

constipation

Front 269

What is used for opioid overdoses?

Back 269

opioid antagonists

Front 270

What is a problem with opioid antagonists?

Back 270

- if a person is dependent, these agents will put them in withdrawal
- for heroine overdoses, multiple doses will be needed because the heroine acts longer than the opioid antagonist

Front 271

What are centrally acting skeletal muscle relaxants used for?

Back 271

muscle spasticity

Front 272

Muscle relaxants are sometimes given concomitantly with what?

Back 272

analgesics

Front 273

How should baclofen (centrally acting muscle relaxant) be discontinued? Why?

Back 273

in tapering doses over a 1-2 week period to avoid psychosis and hallucinations

Front 274

What 2 things should be monitored with centrally acting muscle relaxants?

Back 274

- monitor for muscle weakness
- monitor for drowsiness

Front 275

Parkinson's disease is a degenerative disorder of the CNS caused by the destruction of what?

Back 275

neurons in the substantia nigra that produce dopamine

Front 276

Because dopamine is absent in Parkinson's disease, acetylcholine excessively stimulates the corpus striatum. What is the result of this?

Back 276

- tremors
- muscle rigidity
- postural instability
- bradykinesia

Front 277

What are 2 drug classes used to treat Parkinson's disease, and how does each one work?

Back 277

- Dopaminergic drugs = increases dopamine
- Anti-Cholinergic drugs = inhibits the stimulatory action of acetylcholine

Front 278

What special consideration should be followed when administering anti-Parkinson medications?

Back 278

- administer on time to avoid a worsening of symptoms

Front 279

Abrupt discontinuations of anti-Parkinson (dopaminergic) medications can lead to what?

Back 279

a Parkinsonian crisis

Front 280

What type of food should be avoided when taking anti-Parkinson (Dopaminergic) drugs? Why?

Back 280

Foods high in pyridoxine (B6) because they decrease the effects of the medications

Front 281

What should you advise clients to do when taking anti-Parkinson (dopaminergic) medications?

Back 281

- take medications on time
- avoid foods high in B6 (pyridoxine)
- change positions slowly to avoid faintness or dizziness

Front 282

What should you monitor in clients taking anti-cholinergic drugs for Parkinson's disease?

Back 282

- blurred vision
- dry mouth
- urinary retention
- constipation
- tachycardia

Front 283

Alzheimer's Disease is a degenerative process that occurs where? What other body system is involved?

Back 283

occurs in the cerebral cortex, ant the parasympathetic nervous system is also involved

Front 284

What neurotransmitter is decreased in clients with Alzheimer's Disease?

Back 284

acetylcholine

Front 285

What are 4 symptoms seen in Alzheimer's Disease?

Back 285

1. memory impairment
2. language impairment
3. confusion
4. agitation

Front 286

As Alzheimer's Disease progresses, what 3 essential abilities are lost?

Back 286

- ability to walk, feed one-self, and maintain continence are all lost

Front 287

Drugs used to treat Alzheimer's Disease are effective in what stages?

Back 287

Early to middle stages only

Front 288

Central Nervous System Stimulants are used to treat what 3 disorders?

Back 288

- ADD/ADHD
- Narcolepsy and other sleep disorders
- obesity

Front 289

Why do Central Nervous System Stimulants cause weight loss?

Back 289

because they increase metabolism

Front 290

What should you monitor in clients taking Central Nervous System Stimulants?

Back 290

- monitor for nervousness and insomnia
- monitor for nausea, anorexia and marked weight loss
- monitor for an increase in BP

Front 291

What should you specifically monitor in children taking Central Nervous System Stimulants?

Back 291

monitor growth milestones

Front 292

Are Central Nervous System Stimulants controlled substances?

Back 292

Yes, physical and psychological dependence can occur

Front 293

Which layer of the heart is responsible for its pumping action?

Back 293

myocardium

Front 294

(def)

heart condition where the myocardium has lost a certain degree of contractility

Back 294

Congestive heart failure (CHF)

Front 295

What chamber of the heart is affected most by CHF?

Back 295

the left ventricle

Front 296

(def)

the volume of blood that is pumped from the left ventricle in one minute

Back 296

Cardiac Output

Front 297

What 2 things determine cardiac output?

Back 297

stroke volume and heart rate

Front 298

(def)

the amount of blood that is ejected from the left ventricle on each contraction

Back 298

stroke volume

Front 299

What is a typical stroke volume? typical heart rate?

Back 299

typical stroke volume = 70 mL
typical heart rate = 72 bpm

Front 300

(def)

the amount of stretch exerted on the left ventricle; dependent on the amount of blood that is returned to the right side of the heart

Back 300

pre-load

Front 301

(def)

the amount of pressure the left ventricle must pump against to eject blood into systemic circulation

Back 301

after-load or peripheral vascular resistance

Front 302

Decreased cardiac output results in what?

Back 302

an accumulation of blood in the left ventricle which eventually backs up into the pulmonary circulation

Front 303

As CHF progresses, what signs and symptoms will be seen?

Back 303

- crackles and SOB
- congestion in the right side of the heart
- peripheral edema
- decrease in urine output
- increase in urine concentration

Front 304

CHF can be secondary to what types of conditions?

Back 304

- coronary artery disease (CAD)
- myocardial infarction (MI)
- hypertension (HTN)
- aortic stenosis
- cardiomyopathy
- renal disease

Front 305

Untreated CHF can lead to what?

Back 305

- pulmonary edema
- cardiogenic shock
- death

Front 306

What are the 5 primary goals of pharmacotherapy in CHF?

Back 306

1. increase contractility of the left ventricle
2. decrease edema
3. decrease pre-load
4. decrease after-load
5. decrease sympathetic nervous system response

Front 307

How do positive inotropic agents work in the treatment of CHF?

Back 307

increase the force of cardiac contraction

Front 308

What are the 3 different mechanisms positive inotropic agents exert to increase the force of cardiac contraction?

Back 308

- increase calcium influx
- increase concentration of catecholamines in the myocardium
- inhibit phosphodiesterase

Front 309

Does digoxin have a narrow or wide therapeutic index?

Back 309

digoxin has a very narrow therapeutic index; check dosage carefully

Front 310

True/False:

While serious, an overdose of digoxin is not fatal.

Back 310

False- an overdose of digoxin can definitely be fatal! Check dosage carefully when administering

Front 311

What should be done prior to the administration of digoxin?

Back 311

Count the apical pulse for 1 full minute

Front 312

You are preparing to administer digoxin. What situation would dictate that you need to withhold the drug and notify the physician?

Back 312

- a heart rate below 60 or over 110

Front 313

What 2 things should be monitored when a client is on digoxin?

Back 313

- monitor serum potassium levels; hypokalemia can occur
- monitor digoxin levels periodically

Front 314

Where would you like to see a client's potassium levels when they are on digoxin? Why?

Back 314

on the higher side of normal limits; this drug is potassium wasting, so hypokalemia can occur

Front 315

What are signs and symptoms of digoxin toxicty?

Back 315

- loss of appetite, nausea and vomiting
- seeing yellow spots or "yellow vision"

Front 316

What should be specifically monitored when administering catecholamines in the treatment of CHF? Why?

Back 316

- monitor for hypertension because these agents cause peripheral vasoconstriction

Front 317

Whether treating CHF with digoxin or catecholamines, you should always assess what?

Back 317

- assess breath sounds for crackles
- assess for SOB
- assess extremities and sacrum for edema
- monitor urine output
- perform daily weights
- monitor for activity intolerance

Front 318

What are 5 types of drugs that may be administered in the treatment of CHF?

Back 318

1. positive inotropic agents
2. diuretics
3. vasodilators
4. alpha and beta adrenergic blockers (in small doses)
5. anti-coagulants

Front 319

If positive inotropic agents increase renal perfusion and urine input, why are diuretics usually administered as well in the treatment of CHF?

Back 319

to decreases crackles in the lungs and reduce edema

Front 320

What type of diuretic is most frequently used in the treatment of CHF?

Back 320

Loop diuretics, specifically Lasix

Front 321

What is the purpose of administering vasodilators in the treatment of CHF?

Back 321

to decrease pre-load and after-load

Front 322

What is the preferred class of vasodilators in the treatment of CHF?

Back 322

angiotension-converting enzyme (ACE) inhibitors

Front 323

How does the body react to the decreased renal perfusion seen in CHF? Describe in detail the chain of events that occur.

Back 323

the body is fooled into thinking that it is in hypovolemic shock which causes the renin-angiotensin-aldosterone system to activate. This causes vasoconstriction and conserves sodium and water, thus increases pre-load and after-load. As a result, CHF becomes worse.

Front 324

What are 2 other types of vasodilators other than ACE inhibitors that may be used in the treatment of CHF?

Back 324

nitroglycerin and nesiritide

Front 325

How does nesiritide help acute CHF?

Back 325

increases sodium loss

Front 326

What is the current belief behind the treatment of CHF with Alpha and Beta Blockers?

Back 326

Historically these agents were contraindicated because they reduced myocardial contractility, however new findings show that they may be helpful in small doses.

Front 327

What should be monitored if treating CHF with an alpha or beta blocker?

Back 327

- monitor heart rate, beta blockers can cause bradycardia
- monitor BP, both can lower BP

Front 328

Why is anti-coagulant therapy often indicated in the treatment of CHF?

Back 328

because sluggish blood flow could predispose the client to clients

Front 329

What causes CAD?

Back 329

a decrease in the myocardial oxygen demand caused by one or more occlusions withing the coronary arteries

Front 330

Inadequate blood supply to the myocardium could result in what?

Back 330

ischemia and/or infarction

Front 331

(def)

a temporary lack of adequate blood blow to the myocardium

Back 331

ischemia

Front 332

Can ischemia be reversed?

Back 332

Yes, if there is a timely increase in oxygen supply or a reduction in oxygen demand

Front 333

Ischemia causes the chest pain referred to as what?

Back 333

angina pectoris

Front 334

If ischemia is left untreated, it can progress to what?

Back 334

myocardial infarction

Front 335

What are the 3 goals of pharmacotherapy in CAD?

Back 335

- increase myocardial oxygen supply
- decrease myocardial oxygen demand
- reduce serum lipid levels

Front 336

What 2 types of drugs are given in the treatment of CAD?

Back 336

- vasodilators
- anti-lipidemics

Front 337

How do vasodilators assist in the treatment of CAD?

Back 337

vasodilate the coronary arteries which results in better blood supply to the myocardium

Front 338

What is a problem with the administration of vasodilators in the treatment of CAD?

Back 338

- these agents vasodilate systemic arteries as well as coronary arteries, which can result in postural hypotension

Front 339

What 3 classifications of drugs are frequently used for CAD?

Back 339

- nitrates
- beta blockers
- calcium channel blockers

Front 340

How do nitrates work in the treatment of CAD?

Back 340

- relax vascular smooth muscle

Front 341

How do beta blockers work in the treatment of CAD?

Back 341

- inhibit beta1 activity which results in vasodilation and decreased myocardial contractility

Front 342

What should you monitor for when administering beta blockers and calcium channel blockers in the treatment of CAD?

Back 342

monitor for bradycardia

Front 343

How do calcium channel blockers work in the treatment of CAD?

Back 343

- decrease the influx of calcium into the myocardium resulting in vasodilation and decreased myocardial contractility

Front 344

(def)

disorder characterized by elevated lipid levels in the blood

Back 344

hyperlipidemia

Front 345

Lipids in the blood are classified as what? (3)

Back 345

- cholesterol
- triglycerides
- phospholipids

Front 346

Where are endogenous lipids manufactured? where are exogenous obtained from?

Back 346

endogenous = liver
exogenous = dietary intake

Front 347

What type of lipoproteins are associated with CAD?

Back 347

- LDLs and VLDLs

Front 348

What type of lipoprotein is considered cardioprotective? why?

Back 348

HDLs because they pick up remnants of fat in the periphery and remove them

Front 349

Total serum cholesterol should the less than ______ mg/dL.

Back 349

200

Front 350

LDL levels should be ____-____ mg/dL.

Back 350

100-129

Front 351

HDL should be greater than ____mg/dL.

Back 351

50

Front 352

Triglycerides should be less than ____ mg/dL.

Back 352

150

Front 353

How do statins (anti-lipidemics) work in the treatment of CAD?

Back 353

inhibit the synthesis of lipids in the liver

Front 354

How does ezetimibe, an anti-lipidemic, work in the treatment of CAD?

Back 354

inhibits the absorption of cholesterol from the small intestine

Front 355

How does niacin, an anti-lipidemic, work in the treatment of CAD?

Back 355

inhibits the release of fatty acid from the adipose while increasing the metabolism of tryglycerides

Front 356

How do fibrates, anti-lipidemics, work in the treatment of CAD?

Back 356

stimulates the breakdown of lipoproteins from the tissues and and inhibits the synthesis of triglycerides

Front 357

How do bile acid sequestrants, anti-lipidemics, work in the treatment of CAD?

Back 357

bind with acids in the small intestine and forming an insoluble complex causing cholesterol to be eliminated in the feces

Front 358

What should be monitored with statins (anti-lipidemics)?

Back 358

liver enzymes, these agents can be hepatotoxic

Front 359

A person taking statins (anti-lipidemics) should immediately report what side effect? why?

Back 359

muscle pain or weakness- could be a sign of rhabdomyolysis which can lead to renal failure

Front 360

What pregnancy category are statins (anti-lipidemics)?

Back 360

X

Front 361

What time of the day should statins (anti-lipidemics) be taken? why?

Back 361

take in the evening b/c that is when cholesterol synthesis is most active

Front 362

Although statins (anti-lipidemics) generally should be taken in the evening, which specific statin can be taken any time of the day?

Back 362

atorvastatin (Lipitor)

Front 363

What type of anti-lipidemics is probably safer to use in liver disease and pregnancy over others in that category?

Back 363

Cholesterol Absorption Inhibitors

Front 364

How do Niacin (B3) Preparations work in the treatment of CAD?

Back 364

inhibit the release of fatty acids and increases the metabolism of triglycerides

Front 365

What pregnancy category are Niacin Preparations when used in the treatment of CAD? why?

Back 365

C due to the high doses needed to reduce lipid levels

Front 366

What are 3 nursing considerations when using Niacin Preparations in the treatment of CAD?

Back 366

- severe flushing of the skin with a burning sensation is a common symptom
- may predispose someone to gout
- can be hepatotoxic due to the high doses needed to reduce lipid levels

Front 367

What pregnancy category are fibrates (anti-lipidemics) used in the treatment of CAD?

Back 367

C

Front 368

What are 2 nursing considerations for fibrates (anti-lipidemics) used in the treatment of CAD?

Back 368

- can be hepatotoxic, monitor liver enzymes
- can cause rhabdomyolysis, have client report any muscle pain or weakness

Front 369

Fibrates (anti-lipidemics) used in the treatment of CAD should be used cautiously in clients with what?

Back 369

pancreatitis

Front 370

How should Bile Acid Sequestrants (anti-lipidemics) be administered?

Back 370

Should be mixed with water or juice. Never administer in dry form.

Front 371

What are Bile Acid Sequestrants (anti-lipidemics) used off label for?

Back 371

Used to firm stool in clients with chronic diarrhea

Front 372

What pregnancy safety category are Bile Acid Sequestrants (anti-lipidemics)?

Back 372

C

Front 373

What will occur with Bile Acid Sequestrants (anti-lipidemics) and other PO medications? what should be done because of this?

Back 373

These agents will bind to other PO meds taken at the same time. Administer PO medications 1 hour before or 4-6 hours after administering a Bile Acid Sequestrant.

Front 374

(def)

hypertension that develops without apparent cause

Back 374

essential hypertension OR primary hypertension

Front 375

(def)

hypertension that is caused by underlying disorders

Back 375

secondary hypertension

Front 376

A hypertensive crisis is considered to be a diastolic blood pressure greater than ____ mm Hg.

Back 376

140

Front 377

If a hypertensive crisis is left untreated, what might occur?

Back 377

- heart failure
- renal failure
- retinopathy
- increased intercranial pressure
- encephalopathy

Front 378

In a hypertensive crisis, how long do you have to bring the diastolic BP down to prevent a devastating cerebral vascular accident?

Back 378

24 hours

Front 379

Why must you avoid reducing the BP too low or too quickly when treating a hypertensive crisis?

Back 379

doing so can cause hypoperfusion of the major organs

Front 380

In treating hypertension, a diet of no more than ___-___ g of sodium per day is recommended. What other diet recommendations accompany this?

Back 380

2-3 g of sodium per day

diet should also be low in cholesterol, saturated fat and total fat

diet should be rich in protein, magnesium, potassium, calcium, and fiber

Front 381

What exercise recommendations are made when treating hypertension?

Back 381

- aerobic exercise and mild aerobic exercise

Front 382

How does weight influence hypertension?

Back 382

maintaining weight WNL is essential to maintaining BP within the desired limits

Front 383

How do beta-adrenergic blockers (anti-hypertensives) work in the treatment of HT?

Back 383

blocks the action of the sympathetic nervous system (sympatholytic) which reduces vascular resistance and promotes vasodilation

Front 384

The blocking of beta1 can predispose a person to what?

Back 384

CHF

Front 385

Beta blockers are mild anti-hypertensives and often used as __________ drugs in the treatment of hypertension.

Back 385

first-line

Front 386

What effect do beta blockers have on the kidneys?

Back 386

reduces renin release (renin is a potent vasoconstrictor)

Front 387

When treating HT with beta blockers, you should monitor the client for what side effects?

Back 387

- hypotension
- bradycardia
- fatigue

Front 388

Beta blockers that block beta2 can cause what?

Back 388

bronchoconstriction with wheezing

Front 389

What consideration must be made for clients with CHF receiving beta blockers?

Back 389

- these agents decrease ventricular contractility, can be helpful in CHF in some situations, can exacerbate CHF in others

Front 390

How do Calcium Channel Blockers work in the treatment of HT?

Back 390

- inhibit the influx of calcium into the myocardium and smooth muscle cells. A reduction in smooth muscle cells promotes vasodilation.

Front 391

What population group often responds better to calcium channel blockers better than beta-blockers in the treatment of HT?

Back 391

African Americans

Front 392

What are 2 things that should be monitored when treating HT with calcium channel blockers?

Back 392

- monitor for hypotension (headache, dizziness, syncope)
- monitor for bradycardia

Front 393

What should be avoided when taking calcium channel blockers? why

Back 393

grapefruit juice, the presence of grapefruit juice can raise the level of calcium channel blockers to toxic levels

Front 394

Why can calcium channel blockers cause CHF?

Back 394

because these agents decrease ventricular contractility

Front 395

How do ACE inhibitors work in the treatment of HT?

Back 395

- suppress the renin-angiotensin system and reduces aldosterone release

Front 396

What problem is associated with the decrease in aldosterone associated with the use of ACE inhibitors?

Back 396

- potassium is retained, which could result in hyperkalemia

Front 397

Due to the potassium retention seen with the use of ACE inhibitors, what is often given as well?

Back 397

a diuretic

Front 398

How do angiotensin II receptor blockers (ARBs) work in the treatment of HT?

Back 398

blocks the binding of angiotensin II and diminishes aldosterone which promotes sodium and water excretion

Front 399

What can occur with the use of ARBs?

Back 399

hyperkalemia

Front 400

What are 3 problems associated with the use of ACE inhibitors and ARBs?

Back 400

- hypotension (headache, dizziness, syncope)
- angioedema (swelling of face, tongue, glottis, larynx)
- tickling sensation in throat and a dry cough

Front 401

What 3 levels may be increased with the use of ACE inhibitors or ARBs?

Back 401

potassium, BUN, and creatinine

Front 402

What type of supplement should be avoided when taking ACE inhibitors or ARBs?

Back 402

Potassium supplements

Front 403

How do alpha blockers work in the treatment of HT?

Back 403

block alpha1 receptors resulting in vasodilation and decreased BP, increase renal blood flow, decrease VLDL, LDL and increase HDL

Front 404

What are some problems associated with alpha blockers? (5)

Back 404

- orthostatic hypotension
- reflex tachycardia
- sodium and water retention resulting in edema
- nasal stuffiness
- GI disturbances

Front 405

When should alpha blockers be taken, especially at the beginning of therapy?

Back 405

- at hs because they can cause orthostatic hypotension, especially in the beginning of therapy

Front 406

How do 'alpha1 and beta1 adrenergic' blockers work in the treatment of HT?

Back 406

potent antihypertensives because they work on both alpha1 and beta1 receptors

Front 407

What are 3 problems associated with the use of 'alpha1 and beta1 adrenergic' blockers?

Back 407

- can cause orthostatic hypotension
- can reduce heart rate due to beta1 blocking action
- can cause fatigue

Front 408

How do Centrally Acting Adrenergic Blockers work in the treatment of HT?

Back 408

- potent antihypertensive that works by suppressing sympathetic activity in the brain so less norepinephrine is released; this reduces vasocostriction

Front 409

What are problems associated with the use of Centrally Acting Adrenergic Blockers?

Back 409

- drowsiness and depression
- bradycardia
- impotence
- urinary retention
- edema
- dry mouth

Front 410

What might have to be given with a Centrally acting adrenergic blocker to counter the edema caused by this drug?

Back 410

a diuretic

Front 411

How do direct-acting vasodilators work when treating a HT crisis?

Back 411

- very potent drug that relaxes the smooth muscles of the arteries which results in vasodilation

Front 412

What are 4 nursing considerations for the use of direct-acting vasodilators?

Back 412

- orthostatic hypotension
- sodium and water retention (diuretic may be given)
- reflex tachycardia
- nasal congestion

Front 413

What do diuretics do?

Back 413

increase urine output which in turn decreases circulating fluid volume

Front 414

What type of disturbances can occur with the administration of diuretics?

Back 414

- fluid and electrolyte problems
- acid-base disturbances

Front 415

Thiazide diuretics are derived from what? What type of client may have an issue with this?

Back 415

sulfonamides- clients allergic to sulfonamides may have a cross-allergy

Front 416

How do thiazide and thiazide-like diuretics work?

Back 416

they inhibit sodium, chloride and water reabsorption

Front 417

Thiazide and thiazide-like diuretics are considered to be _____ diuretics.

Back 417

mild

Front 418

What can become elevated when administering thiazide and thiazide-like diuretics?

Back 418

- calcium
- uric acid
- glucose
- serum lipid

Front 419

Thiazide diuretics are used for what type of clients?

Back 419

those with peripheral edema and mild HT who have normal renal function

Front 420

Which diuretic, Thiazide or Thiazide-like, can be used in renal dysfunction?

Back 420

Thiazide-like

Front 421

What time of the day should you administer Thiazide and Thiazide-like diuretics?

Back 421

in the morning to avoid urination at night

Front 422

What should be monitored for clients on Thiazide and Thiazide-like diuretics?

Back 422

- monitor urine output
- monitor for a drop in blood pressure
- monitor weight (be alert for a gain of more than 2 lbs in one day)
- monitor blood for sodium, chloride, potassium and magnesium losses
- monitor blood for calcium, uric acid, glucose, and lipid increases

Front 423

When administering diuretics, the loss of chloride can lead to what?

Back 423

metabolic alkalosis

Front 424

What might occur to urine with thiazide or thiazide-like diuretics? what problem might occur with this?

Back 424

urine can become alkaline which can cause UTIs

Front 425

What foods/supplements should be encouraged for patients on thiazide or thiazide-like diuretics?

Back 425

those rich in potassium and magnesium

Front 426

What specific parts of the kidney do loop diuretics work on?

Back 426

- proximal and distal tubules
- Loop of Henle

Front 427

Which is more potent, Thiazide/Thiazide-like diuretics or Loop Diuretics?

Back 427

loop diuretics

Front 428

What type of diuretic is often indicated when a large fluid loss is desired?

Back 428

Loop diuretic

Front 429

The loop diuretics that are most frequently used are derived from what?

Back 429

sulfonamides

Front 430

What time of the day should a person take a loop diuretic if they are on daily therapy? Why?

Back 430

Take in the morning to avoid nighttime urination

Front 431

What is the best indicator of whether or not a loop diuretic is working?

Back 431

urine ouput

Front 432

How quickly should diuresis occur when administering a loop diuretic IV?

Back 432

w/i 10-20 minutes

Front 433

What things should be monitored when administering loop diuretics? (7)

Back 433

- BP
- I&O
- Weight
- Blood (monitor for losses of sodium, potassium, magnesium, and calcium) (monitor for increases of glucose and uric acid)
- Monitor for ototoxicity **
- Monitor for dehydration
- Assess breath sounds

Front 434

The loss of chloride when taking loop diuretics might lead to what?

Back 434

metabolic alkalosis

Front 435

What special measurement would you monitor when administering a loop diuretetic to a client with ascites?

Back 435

daily abdominal girth measurements

Front 436

A client is on daily loop diuretic therapy. What special teaching would be included when addressing their diet?

Back 436

- teach the client about potassium and magnesium rich foods (potassium and magnesium losses occur with the use of loop diuretics)

Front 437

The IV administration of loop diuretics should be no faster than ___ mg over a 1-2 minute period.

Back 437

40

Front 438

Are Aldosterone inhibitors (Potassium-sparing diuretics) considered to be strong or mild diuretics?

Back 438

mild

Front 439

What specific part of the kidney do Aldosterone inhibitors (Potassium-sparing diuretics) work on?

Back 439

the distal tubule

Front 440

Aldosterone inhibitors are _______-sparing diuretics.

Back 440

potassium

Front 441

Potassium-sparing diuretics are often given with what?

Back 441

Potassium-wasting diuretics in the thiazide class to strike a balance b/t potassium retention and loss

Front 442

What time of the day should potassium-sparing diuretics be administered?

Back 442

- in the morning to avoid urination at night

Front 443

What should be monitored when administering aldosterone inhibitors (potassium-sparing diuretics)?

Back 443

- monitor urine output
- monitor BP
- monitor weight

Front 444

Any time you administer a diuretic, you should be alert to a gain of more than _____ lbs a day?

Back 444

2

Front 445

What type of nutritional supplement should be avoided when taking an aldosterone inhibitor (potassium-sparing diuretic)?

Back 445

potassium supplements

Front 446

Aldosterone Inhibitors (Potassium-sparing diuretics should not be used in renal insufficiency or failure. Why?

Back 446

Due to the inability of the kidneys to excrete potassium

Front 447

Aldosterone Inhibitors (Postassium-Sparing diuretics) should not be given with what other drug classification? Why?

Back 447

ACE inhibitors b/c they raise potassium levels

Front 448

How do Antiplatelet aggregators prevent clotting?

Back 448

Inhibits ADP release from platelets which keeps the platelets from clumping together

Front 449

Antiplatelet aggregators inhibit the release of ADP from the platelets. What 2 actions does this prevent?

Back 449

- clumping together of platelets
- vasoconstriction

(ADP is responsible for both)

Front 450

Antiplatelet aggregators are used prophylactically for clients at risk for what?

Back 450

arterial clots

Front 451

Antiplatelet drugs can cause what 2 problems?

Back 451

- GI irritation and bleeding

Front 452

What type of aspirin should be used to reduce the risk of GI irritation and bleeding?

Back 452

enteric coated aspirin

Front 453

What should you monitor when administering antiplatelet aggregators?

Back 453

- bruising
- bloody urine or sputum
- epistaxis
- tarry stools
- bleeding gums

Front 454

NSAIDS, coumarins or heparin can increase the risk of __________.

Back 454

bleeding

Front 455

amantadine

Back 455

blocks viral penetration/uncoating (m2 protein); buffer pH of endosome. causes the release of DA from intact nerve terminals.

use: prophylaxis and treatment for influenza A; Park disease.

toxicity: ataxia, dizziness, slurred speech.

Amantadine blocks influenza A, rubellA and causes problems with the cerebellA.

rimantidine is a derivative with fewer CNS effects, not cross BBB.

Front 456

What are anticoagulants used for?

Back 456

- prevention of intravascular clots or prevent the extension of existing clots

Front 457

True/False:

Anticoagulants dissolve existing clots.

Back 457

False- these agents do not dissolve, only prevent formation or extension of existing clots

Front 458

Anticoagulants are used in low doses prophylactically for what type of clients?

Back 458

- immobilized
- thrombophlebitis
- TIAs
- atrial fibrillation
- prosthetic heart valves
- after pelvic and vascular surgery

Front 459

Anticoagulants are used in high doses for what types of disorders?

Back 459

- myocardial infarction
- pulmonary embolism
- DVTs
- vascular occlusion
- disseminated intravascular clotting

Front 460

Why would parenteral anticoagulants be used on invasive equipment, such as IV lines and hemodialysis?

Back 460

- prevents clotting of blood flowing through this equipment

Front 461

What is the most frequently prescribed coumarin?

Back 461

Warfarin Sodium (Coumadin)

Front 462

What is unique about Coumadin, a courmarin?

Back 462

it is one of the few anticoagulants that is administered PO

Front 463

What is the onset of action for Coumadin, a coumarin? How long can it last after discontinuation?

Back 463

Onset = 3 days
Activity after discontinuation = 4-5 days

Front 464

What is the antidote for coumarins?

Back 464

Vitamin K

Front 465

True/False:

Coumarins should not be used during pregnancy b/c they cross the placental barrier

Back 465

True

Front 466

What should you monitor when giving coumarins?

Back 466

- monitor for bruising, bloody urine or sputum, epistaxis, tarry stool, bleeding gums
- monitor for hypoglycemia

Front 467

Coumarins should not be given with what other drug type unless prescribed by a physician?

Back 467

- NSAIDS or aspirin

Front 468

Clients on coumarin should avoid foods high in what?

Back 468

Vitamin K

Front 469

Clients taking sulfonylureas and coumarins should be monitored for what?

Back 469

hypoglycemia

Front 470

Clients taking coumarins and Dilantin should be monitored for what?

Back 470

toxicity (coumarin increases levels of dilantin)

Front 471

Heparin is a natural substance found where?

Back 471

in the liver

Front 472

Why must heparin be given parenterally?

Back 472

b/c exogenous heparin is destroyed by the liver when taken PO

Front 473

What 2 routes can Heparin be given?

Back 473

IV or SC

Front 474

Heparin derivatives are administered how?

Back 474

SC

Front 475

Heparin and Heparin derivatives are the anticoagulants of choice for vascular events during __________.

Back 475

Pregnancy

Front 476

Why are heparin and heparin derivatives the drug of choice for vascular problems during pregnancy?

Back 476

- quick onset, short duration
- does not cross the placental barrier

Front 477

Which are less likely to cause bleeding tendencies, heparin or heparin derivatives?

Back 477

heparin derivatives

Front 478

If bleeding occurs when using heparin, the antidote is what? How is it administered?

Back 478

Protamine Sulfate - administered IV

Front 479

What may be given in addition to protamine sulfate if serious bleeding occurs with the use of heparin?

Back 479

fresh frozen plasma and/or platelets

Front 480

fusion inhibitors

Back 480

enfuvirtide
bind viral gp41 and inhibit conformational change required for fusion with CD4. block entry and replication.

toxicity: hypersensitivity reactions, reactions at subcutaneous injection site, increased risk for bacterial pneumonia.

use: in patients with persistent viral replication in spite of antiretroviral therapy.

Front 481

What should be monitored when administrating Heparin and Heparin Derivatives?

Back 481

- Monitor for bruising, bloody sputum, epistaxis, tarry stools, bleeding gums

Front 482

True/False:

Heparin and Heparin derivatives should be taken with NSAIDS.

Back 482

False- these should be avoided unless prescribed by a physician

Front 483

Thrombolytic agents are sometimes referred to as what?

Back 483

clot busters

Front 484

How do thrombolytic agents work?

Back 484

by dissolving the fibrin in clots

Front 485

Thrombolytic agents must be given within ____ hours of a myocardial infarction or within ____ hours of a thrombotic stroke to prevent irreparable tissue necrosis.

Back 485

6 hours of a myocardial infarction
3 hours of a thrombotic stroke

Front 486

Thrombolytic agents are dangerous drugs that should only be used in what type of settings?

Back 486

ER, ICU, or CCU setting

Front 487

What is the antidote for thrombolytic agents?

Back 487

aminocaproic acid (Amicar)

Front 488

If severe bleeding occurs with thrombolytic agents, what might be given in addition to aminocaproic acid (Amicar)?

Back 488

fresh frozen plasma and/or platelets

Front 489

Bleeding with Thrombolytic agents will usually occur in the first 24 hours, but his can be longer if what happens?

Back 489

if platelet count drops

Front 490

What is increased if anti-platelet aggregators, coumarins, or heparin is given before, during, or within the 1st 24 hours after thrombolytic therapy?

Back 490

the risk for bleeding

Front 491

What should be monitored when administering thrombolytic agents?

Back 491

- monitor for bruising, bloody urine or sputum, epistaxis, tarry stools, bleeding gums
- monitor platelet count

Front 492

(def)

any deviation from the normal rate or pattern of the heart

Back 492

dysrhythmia

Front 493

What is the pharmacological goal of anti-dysrhythmic drugs?

Back 493

- restoration of a normal heart rate and pattern

Front 494

What determines the rhythm of the heart?

Back 494

- depolarization and repolarization

Front 495

What are 4 things you should monitor when administering anti-dysrhythmic drugs?

Back 495

- frequently monitor heart rate
- frequently monitor for irregularities
- frequently monitor for hypotension
- monitor for signs of toxicity (nausea, vomiting, faintness, dizziness)

Front 496

(def)

chronic metabolic syndrome characterized by a deficiency or absence of endogenous insulin secretion and/or poor cellular utilization of endogenous insulin

Back 496

Diabetes Mellitus

Front 497

______ ________ is the result of beta cell insufficiency or failure.

Back 497

Diabetes mellitus

Front 498

What do pancreatic beta cells secrete? what about alpha cells?

Back 498

beta cells = insulin
alpha cells = glucagon

Front 499

Diabetics have a greatly increased risk for what disorders?

Back 499

- myocardial infarction
- CVA
- renal failure
- foot and leg ulcers (may progress to gangrene)

Front 500

What are the 2 classifications of Diabetes?

Back 500

Type I and Type II

Front 501

What type of diabetes is characterized by markedly reduced or absent endogenous insulin?

Back 501

Type I

Front 502

Type I DM accounts for ___% of all diabetics.

Back 502

10

Front 503

What are 3 things that are thought to play important parts in the development of type II diabetes?

Back 503

- genetic pre-disposition
- obesity
- sedentary life-style

Front 504

In addition to type I and type II diabetes, what are 2 less common types of diabetes?

Back 504

- drug-induces
- gestational

Front 505

Is exogenous insulin ever needed for type II diabetes?

Back 505

Yes, in times of stress or as the disease advances

Front 506

Signs and Symptoms of Diabetes Mellitus include a blood glucose greater than or equal to _____ mg/dL 8 hours past a meal.

Back 506

126

Front 507

Signs and Symptoms of Diabetes Mellitus include a blood glucose greater than or equal to _____ mg/dL at any given time during the day.

Back 507

200

Front 508

A fasting blood glucose of ___-___ mg/dL is considered to be an "impaired fasting glucose".

Back 508

100-125

Front 509

What is the normal range for fasting blood glucose?

Back 509

70-100 mg/dL

Front 510

Signs and Symptoms of Diabetes Mellitus include the 3 P's. What are they?

Back 510

- Polyuria
- Polydipsia
- Polyphagia

Front 511

The presence of ketones in the urine is more common with what type of diabetes?

Back 511

type I

Front 512

Signs and Symptoms of Diabetes Mellitus include glucose in the urine. When does this usually occur?

Back 512

When the blood glucose is greater than 180 mg/dL

Front 513

What are some symptoms associated with diabetes mellitus?

Back 513

- delayed wound healing
- frequent infections, especially fungal infections
- pruritis
- recent weight loss
- fatigue and weakness

Front 514

What are 5 treatment measures for diabetes mellitus?

Back 514

- tight control of blood glucose
- ADA diet
- Weight loss with type II
- Regular schedule of meals, exercise, and sleep
- limited (preferably no) alcohol/tobacco

Front 515

What are 2 sources of exogenous insulin?

Back 515

- pancreases of pigs (pork insulin)
- recombinant DNA technology (human insulin)

Front 516

What is the only insulin that can be given IV?

Back 516

Regular insulin

Front 517

Describe the onset of action, peak action, and duration of action of Regular insulin.

Back 517

Quick onset of action
Quick peak action
Short duration of action

Front 518

When administering insulin, meals must be timed with the ______ of insulin action.

Back 518

onset

Front 519

An insulin overdose or lack of food can cause what?

Back 519

hypoglycemia

Front 520

What are 5 signs of hypoglycemia?

Back 520

- nervousness
- irritability
- confusion
- sweating
- tremors

Front 521

If a diabetic client is stuporous or comatose due to hypoglycemia, what is the best treatment inside and outside the hospital?

Back 521

- in the hospital, D5W IV push
- outside the hospital, glucagon IM or glucose gel buccally

Front 522

What are the only 2 insulins on a sliding scale?

Back 522

Lispro and Regular Insulin (short-acting insulins)

Front 523

What is the onset, peak, and duration of lispro insulin?

Back 523

onset= 5 minutes
peak= 30 minutes - 1 hour
duration= 2-4 hours

Front 524

What is the onset, peak, and duration of regular insulin?

Back 524

onset= 30 minutes-1 hour
peak= 2-4 hours
duration= 6-8 hours

Front 525

What is the onset, peak, and duratin of Lente insulin?

Back 525

onset= 2-4 hours
peak= 8-12 hours
duration= 18-24 hours

Front 526

What is the onset, peak, and duration of NPH insulin?

Back 526

onset= 1-2 hours
peak= 6-12 hours
duration 18-24 hours

Front 527

If mixing an intermediate insulin with a regular insulin, how should they be drawn up?

Back 527

regular before intermediate (clear before cloudy)

Front 528

Can long acting insulins, such as Insulin glargine or Insuline detemir be mixed with other insulin preparations?

Back 528

No, these cannot be mixed with any other insulin preparations

Front 529

What type of insulin is "peakless"?

Back 529

Insulin Glargine

Front 530

When are Insulin Glargine or Insulin Detemir given?

Back 530

@ bedtime or with the evening meal

Front 531

What is the duration of Insulin Glargine?

Back 531

24 hours

Front 532

What is the peak and duration of Insulin Detemir?

Back 532

peak= 6-8 hours
duration= 24 hours

Front 533

What 3 problems associated with sulfonylureas, oral anti-diabetic agents for type II diabetes?

Back 533

- hypoglycemia
- weight gain
- long term failure

Front 534

What is the onset, peak, and duration of sulfonylureas, oral anti-diabetic agents for type II DM?

Back 534

onset= 15-30 minutes
peak= 1-2 hours
duration= 24 hours

Front 535

How do sulfonylureas and meglitinides, oral anti-diabetic agents, work?

Back 535

stimulate the pancreas to secrete more insulin

Front 536

How do biguanides, oral anti-diabetic agents, work?

Back 536

- increases cellular usage of sugar

Front 537

How do thiazolidinediones (TZDs), oral anti-diabetic agents, work?

Back 537

- increases cellular utilization of insulin and decreases hepatic glucose output

Front 538

How does alpha glucosidase inhibitors help in the treatment of type II DM?

Back 538

- delays breakdown of carbohydrates

Front 539

How does incretin mimetic, a new class of anti-diabetic drugs, work?

Back 539

- improves insulin secretion, suppresses glucagon secretion, and slows gastric emptying

Front 540

When is hypoglycemia most likely to occur during insulin drug activity?

Back 540

when the drug peaks

Front 541

When administering insulins, meals and snacks should be scheduled to coincide with what?

Back 541

the onset of action

Front 542

Why should insulin injection sites be rotated?

Back 542

to avoid lipodystrophy

Front 543

What is humatrope, an exogenous pituitary hormone, used for?

Back 543

a growth hormone for children

Front 544

What is oxytocin (Pitocin), an exogenous pituitary hormone, used for?

Back 544

induce or enhance uterine contractions or facilitate milk let-down

Front 545

Humatrope, an exogenous pituitary hormone, must be given to children prior to the close of what?

Back 545

the epiphyseal plate

Front 546

Why might you have to administer insulin and thyroid hormone to a child receiving humatrope, an exogenous pituitary hormone?

Back 546

b/c it may elevate blood sugar and diminish the secretion of thyroid hormone

Front 547

What should be monitored for individuals taking anti-diuretic hormone, an exogenous pituitary hormone?

Back 547

intake and output

Front 548

What special measure should be taken when a mother is given oxytocin to induce labor?

Back 548

- fetal monitor should be used

Front 549

The goal of oxytocin is to achieve contractions that occur every __-__ minutes and last __-__ seconds.

Back 549

2-3 minutes and last 40-60 seconds

Front 550

Oxytocin can cause hypertonicity of the uterus. What 2 problems can this cause?

Back 550

- deprivation of oxygen to the fetus
- uterine rupture

Front 551

What is done to oxytocin that is used for post-partum hemmorrhaging?

Back 551

it is titrated to the amount of bleeding

Front 552

What should you monitor for a mother receiving oxytocin for post-partum hemmorrhaging?

Back 552

complaints of severe uterine cramping

Front 553

Large amounts of oxytocin can lead to what?

Back 553

water-intoxication b/c it has an anti-diuretic effect

Front 554

What are (7) signs/symptoms of hypothyroidism?

Back 554

- dry skin and hair
- lack of energy
- muscle weakness
- slowed thinking processes
- overweight
- constipation
- intolerance to cold

Front 555

What is the most commonly drug used to treat hypothyroidism?

Back 555

synthroid

Front 556

True/False:

Daily life-long replacement therapy is necessary for the treatment of hypothyroidism.

Back 556

True

Front 557

What time of the day should you take hypothyroidism medications? Why?

Back 557

in the morning to avoid insomnia

Front 558

When administering hypothyroidism medications, you should monitor the client for signs of what?

Back 558

drug-induced hyperthyroidism (nervousness, tachycardia)

Front 559

Iron supplements and estrogen can __________ (increase or decrease) the absorption of exogenous thyroid hormones.

Back 559

decrease

Front 560

Exogenous thyroid hormones may _________ (increase or decrease) the effectiveness of beta blockers, digoxin, insulin, and oral anti-diabetic agents.

Back 560

decrease

Front 561

Which is more therapeutic, the trade name Synthroid or the generic levothyroxin (hypothyroid treatment agents)?

Back 561

Synthroid

Front 562

What are 8 signs/symptoms of hyperthyroidism?

Back 562

- nervousness and hyperactivity
- insomnia
- tremors
- weight loss
- rapid heart rate
- sweating
- intolerance to heat
- exophthalmos

Front 563

All agents used to treat hyperthyroidism can cause what?

Back 563

hypothyroidism

Front 564

The concomitant use of ________ with hyperthyroidism treating agents can increase the occurrence of hypothyroidism.

Back 564

lithium

Front 565

The thiodmides, agents used to treat hyperthyroidism, can cause what? What should be monitored because of this?

Back 565

can cause blood dyscrasias- monitor CBC

Front 566

The thiomides, agents used to treat hyperthyroidism, can cause an _________ (increase/decrease) in the effects of coumadin, digoxin, and theophyllin.

Back 566

increase

Front 567

What are special client considerations when taking iodine and iodine solutions to treat hyperthyroidism?

Back 567

- drink agents through a straw to avoid the discoloration of teeth
- these agents should be diluted and taken after meals

Front 568

Potassium iodide used to treat hyperthyroidism should not be used with what 2 medication categories? Why?

Back 568

- should not be used with ACE inhibitors or potassium-sparing diuretics. Hyperkalemia could result.

Front 569

Hyperthyroid patients with exophthalmos will need what?

Back 569

eye lubricants to prevent drying of the corneas

Front 570

What are 5 symptoms of addison's disease?

Back 570

- weakness
- hypoglycemia
- hyponatremia
- hyperkalemia
- hypotension

Front 571

What are 2 causes of adrenal insufficiency?

Back 571

- sudden withdrawal of exogenous glucocorticoids
- idiopathic adrenal gland atrophy

Front 572

How long does therapy for Addison's disease last?

Back 572

it is life-long

Front 573

What should be done if adrenal gland hyposecretion is caused by the sudden withdrawal of an exogenous glucocorticoid?

Back 573

the client should be started on it again and withdrawn in tapering doses

Front 574

What time of the day should agents used to treat adrenal gland insufficiency be taken? Why?

Back 574

b/t 6-9 am to mimic the diurnal rhythm

Front 575

What are 8 signs/symptoms of Adrenal Gland hypersecretion (Cushing's Syndrome)?

Back 575

- hyperglycemia
- hypernatremia
- edema
- hypokalemia
- hypertension
- osteoporosis
- characteristic fat distribution
- possibly psychosis

Front 576

What are the 3 categories of antifungal drugs?

Back 576

1. polyenes
2. imadazoles
3. antimetabolites

Front 577

True/False:

Resistance to tetracyclines is increasing.

Back 577

True

Front 578

What type of structure does penicillin have?

Back 578

beta-lactum structure

Front 579

Most penicillins and cephalosporins are pregnancy category ____.

Back 579

B

Front 580

What should be monitored in a person taking aminoglycosides?

Back 580

- monitor for toxicity of the drug
- monitor for ototoxicity
- monitor for nephrotoxicity

Front 581

True/False:

Aminoglycosides have a high therapeutic index.

Back 581

False- they have a low therapeutic index, so toxicity is a problem

Front 582

Is resistance to erythromycin possible?

Back 582

yes

Front 583

Anti-infectives exerty one of two basic mechanisms to accomplish damage to foreign organisms. Describe each.

Back 583

1. destroy the structure that houses the invading organism
2. disabling the invading organism's ability to reproduce itself

Front 584

True/False:

Superimposed infections are common with penicillins and cephalosporins.

Back 584

true

Front 585

Why is antibiotic therapy often begun before the results of a C&S are received?

Back 585

b/c it takes 24-72 hours to receive the results and the infection could worsen to a critical point

Front 586

Tetracyclines are pregnancy category ____.

Back 586

D

Front 587

Why might a person who is allergic to penicillin be allergic to cephalosporins as well?

Back 587

B/C of their structural similarities (beta-lactum structures)

Front 588

Lincosamides should be stopped immediately if what occurs? What might this be?

Back 588

if bloody diarrhea occurs - this may be psuedomembranous colitis

Front 589

Even after finishing the medications, fluroquinolones may cause what?

Back 589

psychosis

Front 590

IV administration of fluroquinolones should be done over how long?

Back 590

a one hour period

Front 591

How long does TB therapy last?

Back 591

9 months to 2 years

Front 592

Tetracyclines should not be taken with products containing what? why?

Back 592

aluminum, calcium or iron b/c these will bind to the drug and inhibit absorption

Front 593

Why do antibacterial drugs often cause superimposed infections?

Back 593

b/c of the disruption of normal flora

Front 594

What must you advise a client on oral contraceptives who is prescribed a tetracycline?

Back 594

it may decrease the effectiveness of the contraceptive

Front 595

Penicillins are usually used for what 2 types of infections? They can additionally be used to treat what other 3 infections?

Back 595

- staphylococcal and streptococcal infections
- can additionally be used for gonorrhea, syphilis, and anthrax

Front 596

What drug should be avoided when an HIV person is taking a protease inhibitor? Why?

Back 596

St. John's wort - decreases the effectiveness of protease inhibitors

Front 597

Which class of antifungals is often given "swish and swallow" for GI candidiasis? (sometimes given "swish and spit")

Back 597

Polyenes

Front 598

True/False:

Antivirals to treat RSV are reserved for extremely bad cases because the drugs are extremely toxic

Back 598

True

Front 599

What pregnancy category is atovaqone? metronidazole?

Back 599

metronidazole = B
atovaquone = C

Front 600

What structure do cephalosporins have?

Back 600

beta-lactum structure

Front 601

Clients with renal disease taking cephalosporins are at an increased risk for what?

Back 601

nephrotoxicity

Front 602

Why is it important for a client to the entire prescription of an anti-infective agent?

Back 602

to avoid having the organism gain a foothold again; many organisms have developed resistance to anti-infectives due to misuse

Front 603

What is an example of an organism that has developed resistance to anti-infectives due to misuse?

Back 603

MRSA

Front 604

INH (prophylaxis for potential TB) has what major side effect? What should be taken to help prevent this?

Back 604

peripheral neuropathy - take B6 to help prevent this

Front 605

What type of toxicity can occur with INH therapy (prophylaxis for potential TB)?

Back 605

hepatotoxicity

Front 606

Antibacterial drugs have either a narrow spectrum or a broad spectrum. Describe each.

Back 606

Narrow-spectrum = effective against a limited number of organisms

Broad-spectrum = effective against a wider variety of organisms that are both gram-positive and gram-negative

Front 607

Vancomycin is pregnancy category ___.

Back 607

C

Front 608

Atovaquone, an anti-protozoal agent, has ___________ (increased/decreased) absorption when taken with food.

Back 608

increased

Front 609

Atovaquone, an anti-protozoal agent, is often given to patients who are allergic to what?

Back 609

Bactrim

Front 610

If giving penicillin or a cephalosporin in IV form, what must be done to it? Why?

Back 610

it must be diluted b/c it is irritating to the veins

Front 611

What is sometimes useful in helping a host cell fight off a virus?

Back 611

genetically engineered interferons

Front 612

What 3 things must be monitored when a person is taking vancomycin?

Back 612

monitor for ototoxicity
monitor for nephrotoxicity
monitor for blood dyscrasias

Front 613

Which generation of cephalosporin is often used peri-operatively as a prophylaxis?

Back 613

the first generation

Front 614

Clients with a multi-drug resistant strain of TB may need to be treated with what?

Back 614

a combination of first-line and second-line drugs; this may be 5-7 different drugs

Front 615

Most of the drugs used to fight infection are what class?

Back 615

antibacterial drugs

Front 616

Metronidazole, an anti-protozoal agent, is often used prophylactically for what?

Back 616

colorectal and abdominal surgeries

Front 617

Why are oral preparations of erythromycin designed to break down in the small intestine?

Back 617

b/c gastric acid destroys the drug

Front 618

True/False:

Resistance to cephalosporins is decreasing over time.

Back 618

false- it is increasing

Front 619

Taking cephalosporins with alcohol can result in a specific adverse reaction known as what?

Back 619

disulfiram reaction (flushing, dizziness, headache, muscle weakness)

Front 620

What should you ask a client if they state that they are allergic to a particular anti-infective?

Back 620

what signs/symptoms they experienced- clients often confuse common but harmless side-effects with allergic reactions

Front 621

Macrolides, lincosamides, and tetracyclines are often prescribed to a patient who has what type of allergy?

Back 621

penicillin allergy

Front 622

How are aminoglycosides given? Why?

Back 622

parenterally b/c they are not absorbed by the GI tract

Front 623

True/false:

You should take macrolides (ex. erythromycin) with food

Back 623

False- you should take them 1-2 hr AC or 2-3 hr PC b/c food decreases absorption

Front 624

What are the 3 types of drugs used to reduce the viral loads in HIV infections?

Back 624

1. reverse transcriptase inhibitors
2. protease inhibitors
3. fusion inhibitors

Front 625

Topical sulfonamides are used for what? What about ophthalmic?

Back 625

Topical = burns
Ophthalmic = eye infections

Front 626

Atovaquone, an anti-protozoal agent, is used for the treatment of mild to moderate ______ ______ ______.

Back 626

pneumocystis carinii pneumonia

Front 627

Anti-infective agents are designed to act on foreign organisms that have invaded the body without causing what?

Back 627

damage to the host cell

Front 628

Fluroquinolones are effective against what type of organisms?

Back 628

gram-positive and gram-negative

Front 629

______ disturbances are common with sulfonamides.

Back 629

GI

Front 630

What would you encourage a person to increase when taking fluroquinolones?

Back 630

fluid intake

Front 631

The use of sulfonamides may _________ (increase/decrease) the effects of anti-coagulants, anti-diabetics, and anti-seizure agents.

Back 631

increase

Front 632

Why should sulfonamides be followed by at least 8 oz of water?

Back 632

b/c crystalluria may occur (kidney stones)

Front 633

Why must be done to erythromycin IV preparations? Why?

Back 633

must be diluted with at least 100 mL of normal saline b/c they are extremely irritating to the veins

Front 634

As a nurse, what should you be alert to when a person is taking fluoroquinilones?

Back 634

- musculoskeletal problems such as joint pain or tendonitis
- behavioral changes (nervousness, insomnia)
- neurological problems (dizziness, seizures)

Front 635

When on penicillin or cephalosporins, urine may show a false positive for what?

Back 635

glucose

Front 636

Because erythromycin and dirithromycin are excreted in the bile/feces, they are contraindicated in what type of disease?

Back 636

liver disease

Front 637

In the 1980's, TB strains began to evolve and have developed into what?

Back 637

multi-drug resistant strains of TB

Front 638

Are tetracyclines effective against gram-negative or gram-positive bacteria?

Back 638

both

Front 639

Fluoroquinolones have been implicated in what (3) major side effects?

Back 639

- neurological damage
- behavioral changes
- joint and tendon problems (spontaneous rupture of the achilles tendon)

Front 640

Vancomycin should be used with extreme caution with ______ impairment.

Back 640

renal

Front 641

Lincosamides are effective against what 3 infections?

Back 641

1. streptococci
2. staphylococci
3. pneumococci

Front 642

What type of bacteria are aminoglycosides used to treat?

Back 642

gram-negative bacteria

Front 643

What might occur to the effectiveness of oral contraceptives with the use of penicillins or cephalosporins?

Back 643

they might be reduced

Front 644

Does vancomycin have a low or high therapeutic index?

Back 644

Low- toxicity is a problem

Front 645

A _________ taste may occur when taking metronidazole, an anti-protozoal agent.

Back 645

metallic

Front 646

In a C&S test, an organism is considered ________ to those anti-infectives that failed to inhibit it's growth.

Back 646

resistant

Front 647

What type of infections are fluroquinolones used to treat?

Back 647

UTIs, lower respiratory tract infections, skin, soft tissue, bone and joint infections

Front 648

What pregnancy category is aminoglycosides?

Back 648

C&D

Front 649

Why is compliance so important for HIV clients?

Back 649

b/c the virus replicates very quickly; missed doses can lead to an increase in viral load

Front 650

How do reverse transcriptase inhibitors interfere with HIV replication?

Back 650

alters the RNA of HIV

Front 651

True/False:

Resistance to vancomycin is decreasing.

Back 651

False- it is increasing

Front 652

What must be done with vancomycin due to it's low therapeutic index?

Back 652

peak and troughs must be drawn to monitor serum levels

Front 653

What is the largest problem with the treatment of TB?

Back 653

compliance

Front 654

What is a common and like side effect with the use of macrolides?

Back 654

GI disturbances

Front 655

What type of drugs are used to fight tuberculosis?

Back 655

anti-tubercular agents

Front 656

What is the oldest macrolide?

Back 656

erythromycin

Front 657

What are 3 drugs that may be given for penicillin/cephalosporin allergic reactions?

Back 657

- Benadryl
- epinephrine
- glucocorticoid (hydrocortisone)

Front 658

How do antivirals exert their action?

Back 658

they prevent replication of the virus

Front 659

What 6 side effects might occur with the use of penicillins and cephalosporins?

Back 659

- nausea
- vomiting
- stomatitis
- diarrhea
- furry tongue
- rash

Front 660

What pregnancy safety category are fluroquinolones?

Back 660

C (X at term)

Front 661

What are some negative side effects that may be experienced with tetracyclines? (4)

Back 661

- photosensitivity
- nephrotoxicity
- hepatotoxicity
- blood dyscrasias

Front 662

Erythromycin is the drug of choice for what 3 diseases?

Back 662

- legionnaires' disease
- mycoplasmal pneumonias
- chlamydia

Front 663

What is the biggest advantage of erythromycin and dirithromycin over other antibacterials?

Back 663

they are excreted in the bile and feces more than the urine, allowing them to be used in renal insufficiency

Front 664

(def)

an agent that inhibits the growth of bacteria

Back 664

bacteriostatic

Front 665

What are the 2 categories for anti-tubular agents?

Back 665

first-line and second-line agents

Front 666

Erythromycin is ________ active against some gram negative bacteria.

Back 666

moderately

Front 667

What pregnancy safety categories do macrolides fall in?

Back 667

B & C

Front 668

To obtain a culture, infected material is spread on a Petri dish and the organism is allowed to grow for how long?

Back 668

24-72 hours

Front 669

True/False:

Fluoroquinolones should be given on an empty stomach.

Back 669

True

Front 670

Why would penicillin/cephalosporin be given with probenicid, an anti-gout drug?

Back 670

to slow renal excretion and increase serum levels (basically extend the life of penicillin)

Front 671

How do protease inhibitors decrease HIV replication?

Back 671

disabling protease (an enzyme that makes viral particles)

Front 672

Metronidazole is both antibacterial and anti-protozoal. What are 5 infections it is used to treat?

Back 672

- systemic trichomoniasis
- vaginal trichomonas
- amebiasis
- helicobacter pylorie
- "other" anaerobic bacterial infections

Front 673

What is the best way to choose the appropriate anti-infective agent to treat an infection?

Back 673

obtain a specimen of infected material and perform a culture and sensitivity on it

Front 674

What are 5 side effects that may occur with sulfonamides?

Back 674

- hematuria
- blood dyscrasias
- rashes
- photosensitivity
- headache/dizziness

Front 675

How long does prophylactic treatment for TB usually last?

Back 675

6 months

Front 676

What is released by host cells in response to an infection by a virus?

Back 676

interferons

Front 677

What is the primary drug to treat MRSA?

Back 677

vancomycin

Front 678

(def)

an agent that kills bacteria

Back 678

bactericidal

Front 679

Systemic fungal infections are often opportunistic and occur when?

Back 679

when there is a decrease in immunity

Front 680

What is the purpose of sputum tests for acid-fast bacilli?

Back 680

to diagnose TB and to evaluate drug effectiveness

Front 681

How does a fusion inhibitor decrease the viral load of HIV?

Back 681

prevents the fusion of HIV with the human membrane

Front 682

Antifungal drugs exert their effect on the _________ on the fungi.

Back 682

membrane

Front 683

A specimen for a C&S test should be collected before an anti-infective agent is given to avoid what?

Back 683

false results

Front 684

What single drug can fight tuberculosis?

Back 684

None- there is not a drug that can act alone against tuberculosis; usually 2-3 drugs are given in combination

Front 685

What are 3 major problems with penicillins?

Back 685

- high incidence of serious allergic reactions that can lead to anaphylactic shock or death
- drug resistance
- narrow spectrum of many of the preparations

Front 686

Do fungal infections occur systemically or just to the skin/mucous membranes?

Back 686

can occur both ways

Front 687

___________ superinfections might occur with the use of anti-protozoal agents.

Back 687

candidiasis

Front 688

Sulfonamides are pregnancy category ____.

Back 688

C

Front 689

What might occur if you discontinue anti-tubercular drugs prematurely?

Back 689

the disease can be reactivated and it may make the remaining bacteria resistant

Front 690

True/False:

Viruses are easier to eradicate than other organisms.

Back 690

False- they are more difficult b/c they penetrate host cells

Front 691

When issuing a cephalosporin, you should ask the patient if they are allergic to what other type of drug?

Back 691

penicillin

Front 692

In HIV, there is a frequently occurring opportunistic infection called what?

Back 692

MAC (mycobacterium avium complex)

Front 693

Can a drug be both bacteriostatic and bactericidal?

Back 693

yes, depending on the dose

Front 694

What are some side effects of fluroquinolones?

Back 694

- photosensitivity
- GI disturbances (common)
- nephrotoxicity

Front 695

Peak and trough levels are usually drawn before the ______ dose of vancomycin is administered.

Back 695

third

Front 696

Macrolides can be _______ in high doses.

What should be done b/c of this.

Back 696

hepatotoxic - monitor liver enzymes in high doses

Front 697

How do physicians determine the anti-infective agent they will prescribe if it is not possible to obtain a specimen for a C&S test?

Back 697

they base the choice on the client's presenting signs and symptoms

Front 698

A single drug called ______ is often given as a prophylaxis for a person who's TB skin test has recently converted from neg. to pos.?

Back 698

INH (Isoniazid)

Front 699

In a C&S test, an organism is considered to be ___________ to those anti-infectives that inhibited it's growth.

Back 699

sensitive

Front 700

True/False:

Penicillins and cephalosporns have the same mechanism of action

Back 700

True

Front 701

What is a common side effect for anti-protozoal agents?

Back 701

GI disturbances (nausea, vomiting, diarrhea)

Front 702

What are 6 viral infections that antivirals are used to treat?

Back 702

1. influenza
2. herpes
3. HIV
4. RSV
5. cytomegalovirus (CMV)
6. hepatitis C

Front 703

True/False:

Tuberculosis always infects the lungs.

Back 703

False- although it usually infects the lungs, it can infect other parts of the body

Front 704

Why are aminoglycosides still used if they have such a low therapeutic index?

Back 704

b/c they are effective and inexpensive

Front 705

What is a likely side effect with erythromycin IV?

Back 705

phlebitis (inflammation of a vein)

Front 706

The PO form of vancomycin is not effective against MRSA and can predispose a person to what?

Back 706

VRE

Front 707

Erythromycin is active against most gram-positive bacteria except what?

Back 707

staphylococcus aureus

Front 708

Which is more toxic, macrolides or lincosamides?

Back 708

lincosamides

Front 709

How is vancomycin given?

Back 709

IV

Front 710

Of the macrolides, which is the most irritating?

Back 710

Zithromax

Front 711

Why are tetracyclines pregnancy cat. D?

Back 711

b/c they interfere with tooth and bone formation of the fetus

Front 712

_________ can occur with streptomycin and capreomycin, anti-tubular drugs.

Back 712

ototoxicity

Front 713

What are 2 advantages of cephalosporins over penicillins?

Back 713

1. broader antibacterial spectrum
2. resistance has not developed to the same extent

Front 714

What should be done when injecting penicillin or a cephalosporin IM?

Back 714

inject into a large muscle mass

Front 715

How many generations of cephalosporins are there? Which generation has the broadest spectrum?

Back 715

4 generations

- the 4th generation is the broadest spectrum

Front 716

Sulfonamides are used primarily for the treatment of what? What can they also be used for?

Back 716

- primarily for UTIs
- also given for ear infections and frequently given to HIV clients for prevention or treatment of pneumonia

Front 717

What may happen with an out-of-date tetracycline?

Back 717

it can be toxic

Front 718

What drug may cause erythema of the neck accompanied by fever, chills, and a decrease in BP (also known as red neck syndrome)?

Back 718

vancomycin

Front 719

What side effects may be experience when taking lincosamides?

Back 719

- GI disturbances
- rash

Front 720

Sulfonamides should never be administered with what?

Back 720

antacids

Front 721

Anti-infectives, aka anti-microbials, are substances that inhibit the growth of or kill what 5 things?

Back 721

- bacteria
- fungi
- viruses
- protozoa
- rickettsiae

Front 722

What pregnancy category are lincosamides?

Back 722

B

Front 723

True/False:

Penicillin may cause blood dyscrasia

Back 723

true

Front 724

In a C&S test, how do you determine the "sensitivity" of an organism?

Back 724

the organism is exposed to several pre-selected anti-infectives

Front 725

What were the first group of drugs used against bacteria?

Back 725

Sulfonamides

Front 726

(def)

a protective process of the tissues in response to irritation, infection, or injury

Back 726

inflammation

Front 727

What are 5 cardinal signs of inflammation?

Back 727

- redness
- increased warmth
- swelling
- pain
- varying degrees of loss of function in the inflamed area

Front 728

What 3 drug classes are used to treat inflammation?

Back 728

- anti-inflammatories
- immunosuppressants
- innumomodulators

Front 729

Is acetaminophen an anti-inflammatory?

Back 729

No, it's anti-inflammatory action is so weak it is not considered an anti-inflammatory drug

Front 730

What are 2 uses of acetaminophen?

Back 730

- antipyretic
- analgesic

Front 731

Why must corticosteroids be discontinued in tapering doses (5-10 days)?

Back 731

to prevent adrenal insufficiency

Front 732

Cox-2 selective inhibitors have been implicated in what negative disorders?

Back 732

increased incidence of cardiac disorders and strokes due to edema and hypertension

Front 733

What are the 3 types of drugs used to treat inflammation?

Back 733

1. anti-inflammatories
2. immunosuppressants
3. immunomodulators

Front 734

What are some negative effects of long-term corticosteroid treatments? (11)

Back 734

- impaired immune response
- hypernatremia
- edema
- hypertension
- hyperglycemia
- hypokalemia
- hypocalcemia
- osteoporosis
- mood swings
- weight gain
- changes in fat distribution

Front 735

What is the goal of the pharmacological therapy in the treatment of gout? (4)

Back 735

- decrease uric acid synthesis
- decrease inflammation
- decrease crystal deposit
- eliminate uric acid in urine

Front 736

DMARDs (disease-modifying antirhematic drugs) are used to treat what?

Back 736

rheumatoid arthritis

Front 737

Which category of DMARD is primarily used for malaria but used off label in the treatment of rheumatoid arthritis?

Back 737

anti-malarial drugs

Front 738

Corticosteroids are examples of what drug class?

Back 738

immunosuppresant drugs

Front 739

What 2 categories of DMARDs should not be used during an active infection and why?

Back 739

- immunosuppressant and immunomodulators because they decrease the immune response

Front 740

At what point would you use a DMARD in the treatment of rheumatoid arthritis?

Back 740

when less toxic remedies have not reduced the inflammatory response adequately

Front 741

How do corticosteroids decrease inflammation?

Back 741

they suppress the immune system

Front 742

True/False:

There is one NSAID that selectively inhibits COX-2.

Back 742

True

Front 743

The use of herbs along with NSAIDS and Salicylates can increase the risk for what?

Back 743

bleeding disorders

Front 744

Which category of DMARD are tumor necrosis factor antagonists and typically safer for long term use?

Back 744

immunomodulators

Front 745

What should be done to avoid stomach irritation with NSAIDS and salicylates?

Back 745

give with food

Front 746

What should be monitored for clients with diabetes and taking glucosamine/chondroitin (OTC herbs)?

Back 746

blood glucose levels

Front 747

In addition to inhibiting phagocytosis, corticosteroids also inhibit the release of what 3 things?

Back 747

- histamines
- leukotrienes
- prostaglandins

Front 748

Which category of DMARD is reserved for the most extreme cases of rheumatoid arthritis due to extreme adverse reactions (ex. damage to normal cells while stopping the diversion of abnormal cells)?

Back 748

immunosuppressants

Front 749

What can occur when a client takes salicylates in high doses?

Back 749

tinnitus (ringing in the ears)

Front 750

What is the problem with the inhibition of COX-1?

Back 750

can lead to bleeding disorders through anti-platelet aggregation

Front 751

The # of what is reduced in the blood when there is a higher # of corticosteroids?

Back 751

the number of circulating lympocytes, basophils, and monocytes

Front 752

Corticosteroids are hormonal substances produced by what?

Back 752

the adrenal cortex

Front 753

What is recommended with the use of all anti-gout drugs?

Back 753

increased fluid intake

Front 754

The levels of corticosteroids naturally in the body will rise in response to what?

Back 754

stress

Front 755

Colchicine, an anti-gout drug, can cause what negative side effect?

Back 755

diarrhea (GI disturbances)

Front 756

What part of the anatomy is most greatly affected by gout?

Back 756

the large toe

Front 757

Which category of DMARD is considered gold therapy?

Back 757

anti-inflammatory class (these are gold compounds)

Front 758

What 4 classifications of drugs fall under the DMARD category?

Back 758

- anti-inflammatories
- immunosuppressants
- immunomodulators
- anti-malarial drugs

Front 759

What are some of the side effects of the anti-inflammatory class of DMARDs?

Back 759

- GI disturbances
- allergic reactions
- respiratory distress
- blood dyscrasia

Front 760

What are the 2 causes of increased serum uric acid?

Back 760

- increased production of uric acid
- decreased renal excretion of uric acid

Front 761

True/False:

You still should take antacids or histamine blockers to avoid stomach irritation with the IV form of an NSAID.

Back 761

True

Front 762

What are 2 recommended exams for someone on long-term anti-malarial drug therapy?

Back 762

- baseline eye exam
- periodic eye exams thereafter

Front 763

True/False:

It is possible to have inflammation without infection or injury.

Back 763

True

Front 764

True/False:

Phagocytosis is enhanced with the use of corticosteroids.

Back 764

False- it is inhibited

Front 765

What 3 things can exogenous corticosteroids decrease?

Back 765

- decrease inflammation
- decrease the allergic response
- decrease the symptoms caused by an auto-immune disease

Front 766

Why should children who have viral infections avoid the use of salicylates?

Back 766

it can lead to potentially fatal Reye Syndrome

Front 767

The cardinal signs of inflammation are initiated by what type of cells? What do these cells specifically release in the body to produce such an effect?

Back 767

Mast Cells- these cells release biochemical mediators such as histamines, leukotrienes and prostaglandins

Front 768

(def)

a protective process of the tissues in response to irritation, infection, or injury

Back 768

inflammation

Front 769

Why are corticosteriods generally only for short term use?

Back 769

because they have many potentially serious adverse effects

Front 770

What can be caused by both NSAIDS and salicylates due to the inhibition of COX-1?

Back 770

Peptic Ulcers/Gastric bleeding

Front 771

What special consideration should be known about ketorolac, a NSAID?

Back 771

it is extremely potent, and can only be used for short term (5 days or less) due to a high potential for nephrotoxicity

Front 772

Prostaglandins are converted from arachidonic acid by the enzyme ________.

Back 772

cyclooxygenase (COX)

Front 773

Many clients must take what with NSAIDS and salicylates to counter stomach irritation?

Back 773

antacids and/or histamine blockers

Front 774

Glucosamine and Chondroitin are OTC herbs used for the treatment of what? How do they work?

Back 774

osteoarthritis- they inhibit cartilage degeneration

Front 775

What are the 2 forms of COX?

Back 775

COX 1 and COX 2

Front 776

What is the goal of the pharmacological therapy with agents such as salicylates and NSAIDS?

Back 776

to inhibit COX

Front 777

What is the largest concern with the use of corticosteroids?

Back 777

the suppression of the immune system

Front 778

What is a nursing consideration for a client with asthma and on salicylates?

Back 778

they can cause bronchospasms with wheezing, especially for a client with asthma

Front 779

What is the primary use for aspirin?

Back 779

used for anti-platelet aggregation in heart disease

Front 780

What does Sam-E, an OTC herb, claim to do?

Back 780

improve mood and flexibility of joints

Front 781

What 3 processes make up the inflammatory response?

Back 781

1. vasodilation
2. increased vascular permeability
3. migration of WBCs to the inflamed area

Front 782

True/False:

DMARDs are prescription only.

Back 782

True

Front 783

Edema may be caused by the use of NSAIDS. What might this lead to?

Back 783

hypertension

Front 784

True/False:

Acetaminophen is considered an anti-inflammatory drug.

Back 784

False- it is a prostaglandin synthesis inhibitor (thus decreases pain) but it's anti-inflammatory response is so weak that it is not considered an anti-inflammatory drug.

Front 785

Corticosteroids can cause what due to the inhibition of COX-1?

Back 785

peptic ulcers

Front 786

Salicylates and most NSAIDS inhibit COX-1, COX-2, or both?

Back 786

both

Front 787

True/False:

Certain drugs that treat inflammatory conditions have antipyretic effects.

Back 787

True

Front 788

Why were rofecoxib and valdecoxib, COX-2 selective inhibitors, taken off the market by the FDA?

Back 788

because there was an increase in cardiac disorders and strokes associated with these drugs

Front 789

What effect can NSAIDS and salicylates have on the kidneys?

Back 789

both can cause vasoconstriction of the kidneys which can lead to renal damage

Front 790

Drugs that inhibit ________ are more likely to cause gastric irritation with bleeding, especially in the elderly.

Back 790

COX-1

Front 791

How does gout develop from hyperuricemia?

Back 791

deposits of crystal are made in the joints and surrounding tissue

Front 792

______ (COX-1 or COX-2) is protective of the stomach lining.

Back 792

COX-1

Front 793

_______ and _______ damage can occur with the long-term use of hydroxychloroquine, an anti-malarial drug.

Back 793

retinal and corneal damage

Front 794

True/False:

Corticosteroids work quickly and are very effective.

Back 794

True

Front 795

Gout is a condition cause by increased levels of what?

Back 795

serum uric acid

Front 796

Which enzyme, COX-1 or COX-2, is most actively involved in prostaglandin formation at the site of inflammation?

Back 796

COX-2

Front 797

How do salicylates and NSAIDS exert their action?

Back 797

they inhibit prostaglandin

Front 798

It is not advisable to take SAM-E alond with what?

Back 798

St. John's wort or antidepressants

Front 799

What are the 5 cardinal signs of inflammation?

Back 799

- redness
- increased warmth
- swelling
- pain
- varying degrees of loss of function in that area

Front 800

What are the 2 primary uses for acetaminophen?

Back 800

antipyretic
analgesic

Front 801

What is the advantage of selective COX-2 inhibitors?

Back 801

they decrease the incidence of bleeding disorders

Front 802

True/False:

NSAIDS and salicylates work on inflammation relatively quickly, decreasing inflammation in a few hours.

Back 802

False- normally it takes days or weeks to reduce inflammation

Front 803

What drug class has a mechanism of action that can predispose the body to infection, decrease the ability to fight infection, and mask the signs and symptoms of infection?

Back 803

corticosteroids

Front 804

Which category of DMARD are gold compounds that decrease rheumatoid factor by inhibiting phagocytosis and lysosomal activity?

Back 804

anti-inflammatories

Front 805

Cancer is characterized by a growth of abnormal cells due to an alteration of what?

Back 805

DNA

Front 806

Why would you monitor a CBC for patients taking anti-cancer agents?

Back 806

b/c the medication can cause a decrease in RBCs, WBCs, and platelets

Front 807

One type of cancer fighting agent is anti-metabolites. What is its goal?

Back 807

disrupt cellular metabolic processes or inhibit enzyme synthesis

Front 808

(def)

spread of cancerous cells

Back 808

metastasis

Front 809

True/False:

Metastasis is life-threatening.

Back 809

True

Front 810

Cancer patient's often experience thrush and mouth sores. What might this lead to?

Back 810

a serious decrease in food and fluid intake due to the pain from the sores and/or the taste of food due to thrush

Front 811

(def)

candidiasis of the tissues of the mouth, characterized by creamy white patches of exudate on an inflamed tongue or buccal mucosa

Back 811

thrush

Front 812

One cancer fighting drug is alkylating agents. What is its goal?

Back 812

disrupt cellular DNA and cause cell death

Front 813

True/False:

Clients on anti-cancer agents should be monitored for anorexia.

Back 813

True- the medication is nauseating and therefore may lead to anorexia

Front 814

What type of protective gear should be worn when administering anti-cancer agents?

Back 814

gloves

Front 815

True/False:

Any nurse can give chemotherapy treatments.

Back 815

False- you must be certified to administer chemotherapy

Front 816

What is the primary goal of chemotherapy?

Back 816

halt the division and growth of abnormal cells

Front 817

Why should gloves be worn when administering anti-cancer agents?

Back 817

to prevent oncology nurses from having repeated exposure to anti-cancer agents

Front 818

What 3 things have been linked to the development of cancer?

Back 818

- lifestyle
- environment
- genetics

Front 819

Cancer is characterized by a growth of abnormal cells due to an alteration in DNA which results in what?

Back 819

malignant neoplasm or hematological alteration (such as leukemia)

Front 820

The primary goal of chemotherapy is to halt the division of abnormal cells. What is another goal in cancer treatment?

Back 820

boost the immune system

Front 821

What is monitored in clients receiving anti-cancer agents to reflect the client's hydration status?

Back 821

fluid and electrolyte levels

Front 822

Which anti-cancer agent kills cells as the cell division process begins?

Back 822

mitotic inhibitors

Front 823

What is a major challenge in the development of anti-cancer agents?

Back 823

developing one that will attack the abnormal cell but not severely injure normal, healthy cells

Front 824

Which anti-cancer agent blocks hormone receptors and is particularly useful in the treatment of breast and prostate cancers?

Back 824

hormones and hormone modulators

Front 825

Antineoplasmic antibiodtics are also anti-cancer agents that are used to do what?

Back 825

interfere with DNA synthesis

Front 826

What part of the brain controls nausea and vomiting?

Back 826

The medulla (specifically the chemoreceptor trigger zone and the emetic center)

Front 827

Which part of the medulla stimulates nausea and vomiting in the presence of intracranial pressure caused by a head trauma?

Back 827

the emetic center

Front 828

What 3 actions do anti-emetics exert to depress the incidence of nausea and vomiting?

Back 828

- depress local GI activity
- inhibit the CTZ (chemoreceptor trigger zone)
- inhibit dopamine

Front 829

The CTZ (chemoreceptor trigger zone) can cause nausea and vomiting if directly stimulated by what 2 actions?

Back 829

- increases in dopamine
- disturbances in the vestibular center of the inner ear

Front 830

Anti-emetics are used to treat nausea and vomiting, however what should always be a consideration when treating these symptoms?

Back 830

the cause of the nausea and vomiting should be determined and treated

Front 831

Bismuth subsalicylate (Pepto-Bismol) is related to what other drug?

Back 831

asprin

Front 832

What category of drug is used to treat nausea and vomiting?

Back 832

anti-emetics

Front 833

All anti-emetics work on the CNS except which category?

Back 833

antacids

Front 834

All of the anti-emetics that affect the CNS can cause what? What should be implemented b/c of this?

Back 834

can cause drowsiness, so safety measures should be implemented

Front 835

What is something you should monitor during episodes of vomiting in drowsy or debilitated clients?

Back 835

aspiration

Front 836

Diarrhea can cause losses of what 5 body fluids/electrolytes?

Back 836

- water
- potassium
- sodium
- magnesium
- bicarbonate

Front 837

The loss of bicarbonate in the body can lead to what?

Back 837

metabolic acidosis

Front 838

(def)

agents that slow GI motility and propulsion and/or decrease intestinal fluid

Back 838

anti-diarrheal drugs

Front 839

What body systems do anti-diarheal agents work on?

Back 839

- GI tract
- CNS

Front 840

The type of anti-diarrheal agent selected is based on what (4) factors?

Back 840

- amount
- frequency
- consistency
- cause

Front 841

What are 4 common organisms that cause diarrhea?

Back 841

- E. Coli
- Salmonella
- Shigella
- C. Difficile

Front 842

How can the presence of E.Coli, Salmonella, Shigella, and C. Difficile in the GI tract be confirmed?

Back 842

stool cultures

Front 843

What are 3 common causes of chronic diarrhea?

Back 843

- Colitis
- Chron's Disease
- Cancer of the Colon

Front 844

What (2) sub-categories of anti-diarrheal drugs work on the CNS?

Back 844

- Opiates
- Opiate related/anticholinergic

Front 845

What (3) sub-categories of anti-diarrheal drugs work on the GI tract?

Back 845

- opiate related
- opiate related/anticholinergic
- absorbents

Front 846

When should diarrhea NOT be treated?

Back 846

when toxins need to be eliminated in the stool

Front 847

What is a common cause of diarrhea in the elderly NOT related to organisms?

Back 847

fecal impaction

Front 848

What should be given if diarrhea is caused by an infectious process?

Back 848

anti-infectives

Front 849

What common side effect can anti-diarrheals cause?

Back 849

constipation

Front 850

What are (2) agents used to promote the passage of fecal matter?

Back 850

- stool softeners
- laxatives

Front 851

________ increase peristalsis by increasing the fluid contents of the stool through osmotic action, by irritating sensory nerve endings in the intestinal wall, and by forming bulk.

Back 851

laxatives

Front 852

______ reduce the surface tension of the interfacing liquid contents of the stool.

Back 852

stool softeners

Front 853

When are stool softeners indicated?

Back 853

for the passage of dry, hard stools

Front 854

True/False:

Stool softeners increase peristalsis.

Back 854

False- these agents act by incorporating additional liquids into the stool

Front 855

Mineral oil _______ (increases/decreases) water retention.

Back 855

increases

Front 856

Mineral oil absorbs fat soluble vitamins (A,D,E,K). For this reason, it is not recommended for what?

Back 856

regular use

Front 857

(def)

agents that pull water into the colon through osmosis and stimulate peristalsis

Back 857

osmotic laxatives

Front 858

(def)

agents that stimulate peristalsis by irritating sensory nerve endings in the intestine

Back 858

intestinal irritants

Front 859

Prolonged use of intestinal irritants may lead to what?

Back 859

loss of intestinal tone

Front 860

Bulk forming laxatives are made from what?

Back 860

fibrous substances

Front 861

How do bulk forming laxatives work?

Back 861

the fibrous substances absorb water in the intestine to form bulk which stimulates peristalsis

Front 862

What form do bulk laxatives come in? What must be done to these preparations?

Back 862

powder form, must be mixed with 8 oz of water or juice

Front 863

Why must bulk laxatives be mixed with at least 8 oz of water?

Back 863

b/c the fibers can solidify with inadequate fluid causing an obstruction in the throat or esophagus

Front 864

True/False:

Bulk laxatives can cause laxative dependence.

Back 864

False

Front 865

(def)

agent that decrease the acidity of gastric fluid and/or decrease gastric acid secretion

Back 865

anti-ulcer drugs

Front 866

What are 3 disorders that anti-ulcer drugs are used to treat?

Back 866

- hyperacidity
- PUD (peptic ulcer disease)
- GERD (gastrointestinal-esophogeal reflux disease)

Front 867

Chronic inflammation of the lower esophagus caused by the regurgitation of hydrochloric acid can lead to what?

Back 867

changes in the cellular structure of the esophagus

Front 868

Most anti-ulcer drugs are well tolerated but what must the nurse still monitor for?

Back 868

incidence of heartburn

Front 869

(def)

alkaline agents used to raise the pH of hydrochloric acid in the stomach

Back 869

antacids

Front 870

What are the 2 categories of antacids?

Back 870

- systemic
- nonsystemic

Front 871

Which type of antacid is comprised of sodium bicarbonate or calcium carbonate?

Back 871

systemic antacids

Front 872

Systemic antacids should be used cautiously b/c they can cause what (4) things?

Back 872

- hypernatremia
- water retention
- metabolic alkalosis
- acid-rebound

Front 873

Which type of antacid consists of aluminum and/or magnesium?

Back 873

non-systemic antacids

Front 874

What agent is found in some non-systemic antacid preparations?

Back 874

simethicone, an anti-gas agent

Front 875

Agents that act by blocking histamine 2 receptors in the stomach reduce what?

Back 875

gastric secretions

Front 876

Which is more effective, histamine 2 receptor blockers or proton pump inhibitors?

Back 876

proton pump inhibitors

Front 877

How often are proton pump inhibitors taken?

Back 877

once a day

Front 878

(def)

agents that inhibit pepsin and combine with protein to form a viscous substance that covers ulcers in the stomach

Back 878

pepsin inhibitors

Front 879

Pepsin inhibitors should be given ____ minutes before a meal.

Back 879

30

Front 880

In addition to being given prior to meals, what is another time frame for the administration of pepsin inhibitors?

Back 880

hs

Front 881

True/False:

Pepsin inhibitors are OTC

Back 881

False- they are prescription

Front 882

(def)

drug classification that reduces gastric acid and pepsin secretion, along with increasing protective mucus in the GI tract

Back 882

Prostaglandin Analog

Front 883

What pregnancy category are prostaglandin analogs?

Back 883

X - can stimulate uterine contractions

Front 884

What is an off-label use for prostaglandin analogs?

Back 884

inducing contractions for full term/post term pregnancies

Front 885

True/false

Prostaglandin analogs are prescription drugs and administered PO

Back 885

true

Front 886

Urinary tract antispasmodics exert __________ activity.

Back 886

anticholinergic

Front 887

How do urinary tract antispasmodics work?

Back 887

they decrease bladder tone which produces a spasmolytic effect

Front 888

What are 2 disorders that urinary tract antispasmodics are used to treat?

Back 888

-stress incontinence
-urinary frequency

Front 889

What types of side effects might a taking urinary tract antispasmodics experience?

Back 889

- anticholinergic effects such as dry mouth, constipation, urinary retention, blurred vision

Front 890

Urinary tract antispasmodics can reverse the effects of what type of medication?

Back 890

cholinergic drugs (such as anti-glaucoma eye drops)

Front 891

True/False:

Urinary tract antispasmodics are especially helpful in treating obstructive uropathies, such as an enlarged prostate.

Back 891

False- these agents should not be used in obstructive uropathies

Front 892

What are urinary tract anesthetics used to treat?

Back 892

burning with urination (often seen with UTIs or urethritis following invasive diagnostic or therapeutic procedures)

Front 893

How do urinary tract anesthetics work?

Back 893

the exert a local anesthetic effect on the urinary tract mucosa

Front 894

When urinary tract anesthetics are given for burning with urination, what else must be determined?

Back 894

the cause of the burning with urination needs to be determined and treated.

Front 895

Penazopyridine, a urinary tract anesthetic, should not be used for more than ____ days. Why?

Back 895

2 days because cumulation can occur.

Front 896

Phenazopyridine, a urinary tract anesthetic, will turn the urine what color?

Back 896

orange (can stain underclothing)

Front 897

What might occur if phenazopyridine, a urinary tract anesthetic, cumulates?

Back 897

the sclera can turn orange and contact lenses can be stained

Front 898

Phenazopyridine, a urinary tract anesthetic, should not be used in what disorder?

Back 898

renal insufficiency

Front 899

Drugs used to treat urinary retention exert _________ activity.

Back 899

cholinergic

Front 900

How do drugs used to treat urinary retention work?

Back 900

they stimulate urination by increasing bladder tone and decreasing the tone of the urinary sphincter

Front 901

What are two examples of situations where drugs used to treat urinary retention might be prescribed?

Back 901

- post-operative and post-partum urinary retention
- atony of the bladder due to neurogenic causes

Front 902

Why would you not want to use a drug to treat urinary retention in urinary retention caused by benign prostatic hypertrophy?

Back 902

Use of these agents in BPH will cause the bladder to contract against the obstruction caused by the enlarged prostate

Front 903

What type of side effects might be experienced with drugs used to treat urinary retention?

Back 903

- cholinergic effects, such as bronchoconstriction, increased bronchial secretions, increased gastric secretions, abdominal cramping and diarrhea

Front 904

Drugs used to treat urinary retention can reverse the effects of what other class of drugs?

Back 904

anticholinergics

Front 905

(def)

a non-cancerous enlargement of the prostate gland

Back 905

Benign Prostatic Hypertrophy

Front 906

BPH is a normal age-related change and starts around what age?

Back 906

40

Front 907

What is the goal of pharmacotherapy in the treatment of BPH?

Back 907

improve urine flow

Front 908

Drugs used to treat BPH work through one of two mechanisms. Describe each.

Back 908

1. decrease the size of the prostate by inhibiting the conversion of testosterone to androgen DHT
2. relax the smooth muscles of the bladder neck

Front 909

When treating BPH, what should be ruled out before beginning treatment?

Back 909

cancer of the prostate and UTI

Front 910

What should be obtained prior to beginning BPH pharmacotherapy?

Back 910

a baseline prostate-specific antigen

Front 911

Finasteride, a drug used to treat BPH, is pregnancy safety category ____.

Back 911

X

Front 912

What special handling might be indicated for Finasteride? Why?

Back 912

Use gloves when handling, should not ever be taken or touched by a women. It can be absorbed through the skin and cause androgenic effects.

Front 913

What special measures and monitoring should be implemented if a client is taking an Alpha Andrenergic Blocker for the treatment of BPH?

Back 913

These agents can cause orthostatic hypotension. BP needs to be monitored, and the clients should change positions slowly.

Front 914

Untreated or inadequately treated UTI can lead to what?

Back 914

urosepsis

Front 915

What are 6 causative agents for UTIs?

Back 915

- E. Coli
- Enterobacter
- Klebsiella
- Proteus
- Pseudomonas
- S. Saprophyticus

Front 916

How do urinary tract antiseptics work?

Back 916

- taken through the GI and become concentrated in the urine

Front 917

What are urinary tract antiseptics used to treat?

Back 917

- mild UTIs
- prevention of recurrent UTIs

Front 918

The time period for the treatment of UTIs with anti-infectives depends on what?

Back 918

The drug chosen

Front 919

What should be obtained before starting urinary tract antiseptic or anti-infective therapy?

Back 919

C & S

Front 920

Why should a prescription for anti-infectives in the treatment of urinary tract infections be completely finished?

Back 920

to prevent the recurrence of the UTI

Front 921

Why should you encourage fluid intake for a client with a UTI?

Back 921

to flush out the bladder

Front 922

(def)

a urinary tract disorder characterized by chronic inflammation of the bladder wall which causes severe urinary frequency and urgency

Back 922

interstitial cystitis

Front 923

What symptoms are seen in interstitial cystitis?

Back 923

- urinary frequency/urgency
- suprapubic pain/pressure

Front 924

Immunization is the process of stimulating _______ immunity in an individual by exposing them to weakened proteins associated with specific pathogens.

Back 924

active

Front 925

What (2) routes of administration are commonly used for immunizations?

Back 925

IM and SC

Front 926

What are the recommended routine immunizations for children? (7)

Back 926

- Diptheria, Tetanus, Pertussis (combo)
- Hepatitis B
- Haemophilus Influenza Type B
- Influenza
- Measles, Mumps, Rubella (combo)
- Inactivated poliovirus
- varicella

Front 927

What is the most important nursing consideration regarding vaccinations?

Back 927

Teaching: You should teach parents about the importance of routine immunizations. It is estimated that 1 of every 3 children have either not received the recommended immunizations or are behind schedule.

Front 928

______ __ ________ is often required for school entry.

Back 928

Proof of Immunizations

Front 929

How should you approach a parent who refuses to have their child immunized based on religious or philosophical reasons?

Back 929

Non-judgmentally

Front 930

What are common symptoms associated with immunizations? How long should these symptoms last?

Back 930

- Low grade fever
- aching and pain at the injection site

Should last no longer than 1-2 days

Front 931

Are serious allergic reactions possible with immunizations?

Back 931

Yes, including anaphylactic shock

Front 932

What is the "Vaccine Adverse Event Reporting System"?

Back 932

A reporting system for adverse effects to immunizations

Front 933

Where can you obtain information online regarding vaccine safety?

Back 933

www.cdc.gov (Centers for disease control)

Front 934

There is a concern that Thimerosal, a mercury-based preservative in vaccines, could be linked to what disorder?

Back 934

autism

Front 935

What are 2 controversies surrounding the HPV vaccine Gardasil?

Back 935

- adverse events have been reported
- mothers feel that the vaccine could promote sexual activity

Front 936

The common cold, rhinitis, sinusitis, tonsillitis, and laryngitis are examples of what types of infections?

Back 936

Upper Respiratory Tract Infections

Front 937

What are the (2) goals of pharmacotherapy for upper respiratory tract infections?

Back 937

- decrease inflammation and upper airway secretions
- vasoconstrict nasal blood vessels to shrink swollen membranes

Front 938

COPD, restrictive pulmonary disease, and cystic fibrosis are examples of what types of infections?

Back 938

Lower respiratory tract infections

Front 939

What 4 diseases fall under the category of COPD?

Back 939

- asthma
- chronic bronchitis
- emphysema
- bronchiectasis

Front 940

What is the goal of pharmacotherapy when treating the lower respiratory system?

Back 940

- bronchodilation; this allows better air flow through the bronchi

- decrease the synthesis and release of endogenous substances that cause bronchoconstriction

Front 941

What are 4 diseases that fall under the category of Restrictive Pulmonary Disease (RPD)?

Back 941

- pulmonary fibrosis
- lung tumors
- thoracic deformities
- thoracic muscular wall disorders

Front 942

Which is more difficult to treat, upper or lower respiratory infections?

Back 942

lower

Front 943

Acute bronchitis, pneumonia, and tuberculosis are examples of what?

Back 943

Infectious diseases of the lower respiratory tract

Front 944

___________ are H1 histamine antagonists.

Back 944

Antihistamines

Front 945

Histamines cause ________ (increased/decreased) secretions of the upper respiratory tract.

Back 945

increased

Front 946

How do anti-histamines work?

Back 946

they compete with histamines for the H1 receptor sites, thus decreasing upper respiratory tract secretions

Front 947

Would anti-histamines be considered cholinergic or anti-cholinergic agents?

Back 947

anti-cholinergic

Front 948

Diphenhydramine (Benadryl) causes a high incidence of what?

Back 948

drowsiness

Front 949

Which causes the least amount of drowsiness, first generation or second generation anti-histamines?

Back 949

second generation

Front 950

All anti-histamines have anticholinergic effects except which one?

Back 950

Allegra (fexofenadine)

Front 951

Anti-histamines can cause _________, especially in the elderly.

Back 951

dehydration

Front 952

Anti-histamines can cause what urinary issues, especially with enlarged prostates?

Back 952

urinary hesitancy or retention

Front 953

Anti-histamines may _______ respiratory secretions.

Back 953

thicken

Front 954

Anti-histamines can cause _________, so they should be used cautiously in clients with asthma.

Back 954

bronchospasms

Front 955

Anti-histamines should be used cautiously in clients with glaucoma. Why?

Back 955

b/c of their anti-cholinergic effects

Front 956

Decongestants are ___________ amines.

Back 956

sympathomimetic

Front 957

How do decongestants work?

Back 957

vasoconstrict the capillaries w/i the nasal mucosa

Front 958

What are 5 forms that decongestants come in?

Back 958

- nasal sprays
- drops
- tablets
- capsules
- elixirs

Front 959

Overuse of nasal drops and sprays can cause rebound vasodilation or irritation of the nasal mucosa. Because of this, they should be used no longer than ____ days.

Back 959

5

Front 960

What type of stimulation might occur with the use of decongestants?

Back 960

CNS stimulation

Front 961

What 2 adverse reactions could occur with decongestants?

Back 961

- increased BP
- increased heart rate

Front 962

What are the 2 categories of drugs used to treat coughs? How does each work?

Back 962

- antitussives - suppresses cough
- expectorants - loosens bronchial secretions

Front 963

Why should you monitor respiratory status in children and the elderly when administering antitussives?

Back 963

b/c these agents suppress the cough center in the CNS, and although doses are not high enough to normally cause respiratory depression, children and the elderly are more vulnerable

Front 964

How do sympathomimetics work in the treatment of respiratory disorders?

Back 964

- cause bronchodilation through sympathomimetic effects.

Front 965

When administering sympathomimetics in the treatment of respiratory disorders, we are trying to target ______ receptors.

Back 965

beta2

Front 966

What are 3 adverse effects seen when administering sympathomimetics (Alpha and Beta Adrenergic Agonists) for respiratory disorders?

Back 966

- increased heart rate
- increased BP
- nervousness

Front 967

How do anticholinergic agents work in the treatment of lower respiratory disorders?

Back 967

- bronchodilate by inhibiting the action of acetylcholine

Front 968

How do methylxanthines, agents used to treat lower respiratory disorders, work?

Back 968

relax the smooth muscles of the bronchi, bronchioles, and pulmonary blood vessels by increasing levels of cAMP

Front 969

Methylxanthines are used for ________ cases of bronchoconstriction.

Back 969

severe

Front 970

In addition to relaxing the smooth muscles of the bronchi, bronchioles, and pulmonary blood vessels, what else does aminophyline (methylxanthine) do?

Back 970

inhibits the release of histamine

Front 971

Methylxanthines, a drug used to treat lower respiratory disorders, stimulates the CNS and can cause ________.

Back 971

seizures

Front 972

What are 8 common symptoms seen with the use of methylxanthines, a drug used to treat lower respiratory disorders?

Back 972

- nausea
- vomiting
- nervousness
- palpitations
- increased heart rate
- increased OR decreased BP
- diuresis

Front 973

What should be monitored with sympathomimetics, anticholinergics, and methylxanthines?

Back 973

- heart rate (can increase with all of these agents)

Front 974

Monitor for an increase in what with sympathomimetics?

Back 974

BP

Front 975

Oral preparations of sympathomimetics, anticholinergics, and methylxanthines should be taken with food to decrease what?

Back 975

gastric distress

Front 976

What are 5 signs/symptoms should you watch for when administering sympathomimetics, antichoinergics, and methylxanthines?

Back 976

- nervousness
- irritability
- insomnia
- headache
- seizures

Front 977

What should be drawn with theophylline, a methylxanthine used to treat lower respiratory disorders?

Back 977

periodic therapeutic blood levels

Front 978

When administering a sympathomimetic, anticholinergic, or methylxanthine for lower respiratory disorders, the respiratory _____ and _____ should improve.

Back 978

rate and effort

Front 979

What are leukotriene receptor antagonists and leukotriene synthesis inhibitors used to treat in regards to the lower respiratory system?

Back 979

they are prophylactic for broncial asthma

Front 980

Abrupt discontinuation of leukotrienes, agents used to treat bronchial asthma, can result in what?

Back 980

bronchoconstriction

Front 981

What agents prevent the release of histamines and other bronchoconstricting substances when mast cells are stimulated by an antigen?

Back 981

Mast Cell Stabilizers

Front 982

True/False:

Leukotrienes and Mast Cell Stabilizers are taken on a daily basis and used as a prophylactic for bronchial asthma. They are not used for acute asthma.

Back 982

True

Front 983

Glucocorticoids (Corticosteroids) have an ____________ action.

Back 983

anti-inflammatory

Front 984

When treating respiratory disorders, at what point are glucocorticoids issued?

Back 984

if prior drug therapy (drug classifications with fewer adverse reactions) has not improved symptoms

Front 985

What type of glucocorticoid preparation can be used for long term therapy?

Back 985

inhalants used for lower respiratory treatments (although there are still some systemic effects with these preparations

Front 986

What are 4 nursing considerations when administering glucocorticoids for the treatment of respiratory disorders?

Back 986

- give with good to avoid gastric distress
- antacids or H2 receptor blockers should be ordered
- do not discontinue abruptly
- monitor for adverse effects seen with drugs used to treat inflammation

Front 987

How are aerosols used to treat respiratory disorders administered?

Back 987

via a nebulizer

Front 988

(def)

small, hand-held pressurized containers with a mouthpiece used to administer a medicated mist

Back 988

MDI (Metered dose inhaler)

Front 989

Each depression/pump of a MDI delivers what?

Back 989

a puff/actuation (dose of medicated mist)

Front 990

A client has 2 MDIs. The first is a bronchodilator, and the second a corticosteroid. Which should be administered first and why?

Back 990

The bronchodilator b/c it will open the lungs and allow better absorption of the corticosteroid

Front 991

(def)

inhaler that delivers a micronized powder into the lungs when inhaled

Back 991

DPI (dry powder inhaler)

Front 992

What should a client always do after using a MDI that contains corticosteroids? Why?

Back 992

Rinse the mouth to prevent thrush

Front 993

(def)

aerosols that are used to liquefy very thick secretions so they can be expectorated

Back 993

mucolytics

Front 994

Mucolytics are often used for what disease?

Back 994

Cystic Fibrosis

Front 995

What is a common side effect seen with mucolytics?

Back 995

runny nose

Front 996

Which Vitamin?

- Most likely to cause toxicity if taken in amounts much greater than the RDA.

Back 996

Vitamin A

Front 997

Which Vitamin?

- Can be stored in the liver and could cause liver damage in large amounts.
- Large doses can be teratogenic

Back 997

Vitamin A

Front 998

Which Vitamin?

Large doses can cause hypercalcemia and hyperphoshatemia

Back 998

Vitamin D

Front 999

Which Vitamin?

Intake of less than the RDA can cause a decrease in calcium and phosphorus absorption from the GI tract

Back 999

Vitamin D

Front 1000

Which Vitamin?

You should have exposure to UV rays for 15-20 minutes a day to activate this vitamin

Back 1000

Vitamin D

Front 1001

Which Vitamin?

- an important antioxident
- at high doses can cause anti-platelet aggregation which can lead to bruising and bleeding

Back 1001

Vitamin E

Front 1002

Which Vitamin?

Was once believed to prevent CAD and slow the progression of Alzheimer's, however both claims are being questioned

Back 1002

Vitamin E

Front 1003

Which Vitamin?

- Can be diminished with the use of broad spectrum antibiotics.

Back 1003

Vitamin K

Front 1004

Which Vitamin?

Large doses can increase clotting time and diminish the effects of anti-coagulants in the coumarin class.

Back 1004

Vitamin K

Front 1005

Which Vitamin?

Can lower cholesterol/triglyceride levels at doses of 500-1500mg per day, but can also be hepatotoxic at this high of a dose.

Back 1005

Niacin

Front 1006

Which Vitamin?

Is an important pre-natal supplement ideally started before conception or very early in the pregnancy.

Back 1006

Folic Acid

Front 1007

Which Vitamin?

Is thought to prevent neural tube deformities in the fetus such as spina bifida.

Back 1007

Folic Acid

Front 1008

Which Vitamin?

Often given IV to clients who have malnutrition due to alcoholism.

Back 1008

Folic Acid

Front 1009

Which Vitamin?

Thought to boost the immune system, but can predispose a person to renal stones if not taken with adequate water.

Back 1009

Vitamin C

Front 1010

Which Mineral?

May play a role in carbohydrate metabolism.

Back 1010

Chromium

Front 1011

Which Mineral?

Is responsible for carrying oxygen in the hemoglobin.

Back 1011

Iron

Front 1012

Which Mineral?

Is stored in drug reservoirs so toxicity is a problem, with young children especially prone to toxicity.

Back 1012

Iron

Front 1013

How is iron toxicity treated?

Back 1013

chelation

Front 1014

Which Mineral?

Large doses can be teratogenic in the first trimester of pregnancy, but supplementation is usually needed in the second and third trimester.

Back 1014

Iron

Front 1015

Which Mineral?

Large amounts of this mineral stored in older adults is being implicated in heart disease in adults

Back 1015

Iron

Front 1016

Which Vitamin?

Enhances the absorption of Iron.

Back 1016

Vitamin C

Front 1017

Milk reduces the absorption of what mineral?

Back 1017

iron

Front 1018

Iron supplements can cause what 2 problems with the GI tract?

Back 1018

- black stools
- constipation

Front 1019

What mineral is needed along with iron to form red blood cells?

Back 1019

copper

Front 1020

Which Mineral?

Plays a role in boosting the immune system and in wound healing.

Back 1020

Zinc

Front 1021

A large zinc intake can decrease _________ levels.

Back 1021

copper

Front 1022

What 3 forms does zinc come in?

Back 1022

IV, PO, and topical

Front 1023

What electrolyte?

Is found in table salt, cured meat, fish, cheese, pickles, canned goods, and processed foods

Back 1023

Sodium

Front 1024

What electrolyte?

May cause water retention

Back 1024

Sodium

Front 1025

What electrolyte?

low levels an result in neurologic and neuromuscular dysfunction

Back 1025

Sodium

Front 1026

What electrolyte?

Is found in bananas and citrus fruits

Back 1026

Potassium

Front 1027

Hyperkalemia could be a sign of what?

Back 1027

Renal insufficiency or failure

Front 1028

What often results from the administration from the administration of potassium wasting diuretics, such as lasix?

Back 1028

hypokalemia

Front 1029

How are potassium supplements given?

Back 1029

PO or IV, (NEVER IM)

Front 1030

What must be done to IV potassium chloride? Why?

Back 1030

they must be diluted and are never given IV push. Values of potassium above or below 3.5-5.0 mEq/mL could cause life threatening abnormal rhythms of the heart

Front 1031

What electrolyte?

Is found mostly in milk and cheese. Absorption is increased with vitamin D.

Back 1031

Calcium

Front 1032

________ can be caused from metastatic bone cancer or excessive intake of calcium and/or vitamin D.

Back 1032

Hypercalcemia

Front 1033

What are 3 pharmacotherapeutic treatments for hypercalcemia?

Back 1033

- loop diuretics
- phosphates
- drugs that decrease calcium release from the bone

Front 1034

What electrolyte?

Prolonged steroid use could cause a deficit.

Back 1034

Calcium

Front 1035

What electrolyte?

Peri-menopausal women should increase their intake

Back 1035

Calcium

Front 1036

What electrolyte?

Assists in the contraction of cardiac and skeletal muscles and helps regulate the sodium-potassium pump

Back 1036

Magnesium

Front 1037

What electrolyte?

Can be used as an anti-convulsant in eclampsia

Back 1037

Magnesium

Front 1038

What electrolyte?

Can decrease uterine contractions

Back 1038

Magnesium

Front 1039

What electrolyte?

is often used as a laxative

Back 1039

Magnesium

Front 1040

What electrolyte?

High levels are seen in renal failure, low levels often seen with loop diuretics due to its affinity for potassium

Back 1040

Magnesium

Front 1041

What electrolyte?

There is an inverse relationship with this electrolyte and calcium/phosphorus

Back 1041

Magnesium

Front 1042

What electrolyte?

Important in the acid-base balance. Excesses seen in acidosis

Back 1042

Hydrogen

Front 1043

Hydrogen excess (acidosis) can be treated with what?

Back 1043

bicarbonate

Front 1044

What electrolyte?

Important in the acid-base balance, excesses seen in alkalosis

Back 1044

bicarbonate

Front 1045

What misc. nutritional supplement?

is essential for the proper functioning of the thyroid gland, plentiful in seafood, and found in iodinized salt

Back 1045

iodine

Front 1046

What misc. nutritional supplement?

Evidence suggests that this agent is helpful in preventing CAD.

Back 1046

Omega-3 Fatty Acid

Front 1047

Intravenous solutions are not nutritional unless that are part of what?

Back 1047

TPN (Total parenteral nutrition)

Front 1048

What type of intravenous solution?

Have an osmolarity b/t 200-400 mOsm/L

Back 1048

Isotonic

Front 1049

What type of intravenous solution?

Have an osmolarity less than 200 mOsm/L

Back 1049

Hypotonic

Front 1050

What type of intravenous solution?

Have an osmolarity greater than 400

Back 1050

Hypertonic

Front 1051

What type of intravenous solution?

Used to dilute serum electrolytes

Back 1051

hypotonic

Front 1052

What type of intravenous solution?

Used to replace sodium and chloride, and pull water out of the cell

Back 1052

hypertonic

Front 1053

What type of intravenous solution?

Used to expand plasma volume and maintain normal tonicity.

Back 1053

Isotonic

Front 1054

What type of client normally has to receive TPN (total parenteral nutrition)?

Back 1054

those who cannot tolerate fluid and/or nutrients passing through the GI tract

Front 1055

What is the normal dextrose percentage found in TPN? What determines the % that will be selected for use?

Back 1055

10%-70%, selection depends on the caloric needs

Front 1056

In addition to glucose, what are 2 additional supplements included in TPN?

Back 1056

lipids and amino acids

Front 1057

Clients on TPN must be monitored for what?

Back 1057

hyperglycemia

Front 1058

Sudden discontinuation of TPN can result in what?

Back 1058

hypoglycemia

Front 1059

What are 4 problems associated with enteral feedings?

Back 1059

- malabsorption
- aspiration
- diarrhea
- dehydration

Front 1060

Which Herb?

Has estrogenic activity, may help with peri-menopausal discomfort

Back 1060

Black Cohosh (Estroven)

Front 1061

Which Herb?

Can increase stamina and is believed to slow the aging process.

Back 1061

DHEA

Front 1062

Which Herb?

Stimulates the immune system, so should not be taken by persons with auto-immune disorders or who are on immunosuppressant therapy

Back 1062

Echinacea

Front 1063

Which Herb?

Evidence that it has anti-lipidemic and anti-hypertensive effects at 400 mg/day

Back 1063

Garlic

Front 1064

Which Herb?

Can increase bleeding time and add to hypoglycemic effects of anti-diabetic drugs

Back 1064

Garlic

Front 1065

Which Herb?

thought to improve brain function by crossing the blood-brain barrier to dilate cerebral vessels, but has been implemented in brain hemorrhages when a client is on anti-coagulant therapy as well

Back 1065

Ginkgo Biloba

Front 1066

What special consideration should women taking DHEA, a herbal supplement, be aware of?

Back 1066

they must take smaller doses than men to avoid masculinization

Front 1067

Black Cohosh (estroven), a herbal supplement, might cause what adverse reaction?

Back 1067

hypotension

Front 1068

Which Herb?

- thought to improve energy levels and sexual performance
- can add to hypoglycemic effects of anti-diabetic drugs

Back 1068

Ginseng

Front 1069

Which Herb?

- thought to be a natural tranquilizer
- can cause extreme drowsiness, especially if taken with prescription sedatives

Back 1069

Kava

Front 1070

Kava, a herbal supplement, can be potentially toxic to what?

Back 1070

the liver (hepatotoxic)

Front 1071

Which Herb?

An ingredient in many OTC weight loss preparations, is sympathomimetic so can induce tachycardia and hypertension.

Back 1071

Ma Huang (Ephedra)

Front 1072

Which Herb?

Helps to induce sleep but may not last throughout the night

Back 1072

Melatonin

Front 1073

Which Herb?

Seems to be useful for mild to moderate depression, but can take several weeks to have an effect

Back 1073

St. John's Wort

Front 1074

Which Herb?

Thought to promote sleep, but can take 7 days before sleep is improved

Back 1074

Valerian

Front 1075

Valerian, a herbal supplement, should not be taken with what drug class?

Back 1075

benzodiazepines