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155 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Jim's preference for assessing renal failure and how is it calculated?
CrCl = (140 - age) x IBW / (Scr x 72)
Name the 3 types of incontinence and examples of each type.
Stress-coughing, laughing
Urge-bladder spasms
Outflow-BPH
The mechanism of action of Proscar and Avodart is what?
5alpha-reductase enzyme converts testosterone to its most active form, this reduces the prostates exposure to testosterone, thereby it shrinks.
Name the alpha blockers that can be used in the tx of BPH
Terazosin, Prazocin, Doxazocin, Tamsulosin
What is the MOA of the alpha blockers in the urinary system?
vasodilator, urine flows easier
What side effect must you watch for when using alpha blockers in the tx of BPH?
must watch BP as it will vasodialate all vessels
What side effect do men c/o when taking Avodart or Proscar?
decreased libido and/or impotence
What do you give a pt. that presents with a kidney stone (list a possible 5) and tell why.
1) IV hydration-to dilute the toxins/crystals so that stones may pass
2) Pain mgt-iv narcotis, choice based on pt allergies and provider preference
3)Change urine pH-depending on the type of the stone, works better on chr. stone developers
4) Surgical removal-urology retrieves or percutaneously
5) Ultrasound destruction-lithotripsy, busts it up into sand
Why do CRF pts need erythropoietin injections?
To increase the rbc proliferation, as they have a shortened rbc life span
Name 3 meds given to increase erythropoietin and rbc's
Procrit, Epogen, Aranesp
10-40K units qwk
What is the target hgb for a CRF patient? target hct?
hgb 11-12
hct 30
What could happen to a CRF pt if their hgb got too high?
MI, CVA, DVT
Pts. that receive erythropoietin must also have adequate stores of what vitamins?
B-12, folic acid
What mineral may CRF patients need? But what must you becareful of when prescribing this med?
iron,
iron toxicity can be deadly
What is Venofer? What is Ferrlecit?
IV iron injections
Why must CRF patients monitor their Phosphate intake?
phosphate is renally excreted.
What happens to a CRF pt if their phosphate level gets too high?
then it meets up and binds to Ca and they can deposit all over the body
What water soluble vitamins must be provided to dialysis pts and why?
B and C as dialysis takes them out!
When a pt presents with hyperkalemia what should be your first priority?
protecting the heart from arrythmias
What can you give to tx hyperkalemia?
Calcium gluconate, sodium bicarb, insulin and glucose
What effect does sugar have on K?
forces it into the cells
What do you use sodium polystyrene sulfonate for?
binds up K in the gut, but watch out for hyponatremia
What is aluminum hydroxide (alternagel), calcium salts (citrate, carbonate, acetate) used to tx?
phosphate binder
why should CRF patients avoid MOM, Mylanta, Maalox, etc?
magnesium is eliminated thru the kidneys, CRF pts won't excrete and will develop hypermagnesia
Why must you becareful with ACEI in CRF pts?
renally excreted, due to the protective measures though they are worth a try
Name 3 drug therapies for the tx of ARF
1) Loop diuretics
2) Dopamine (low dose) although there is no evidence it works
3) Mannitol
Why/how does Mannitol work in the kidneys?
A sugar solution/osmotic diuretic that helps restore perfusion to the kidneys-limiting injury to the pt
Name the 4 goals of therapy when treating erosive GI dos
-decrease symptoms
-decrese frequency and duration of symptoms
-promote healing
-prevent complications
Name 6 rationale for the therapy of erosive GI dos
-increase sphincter tone of lower esophagus
-inc. esophageal acid clearance
-inc. gastric emptying
-protect mucosa
-decrease acidity
-dec. gastric volume available for reflux (doesn't work!)
Name the 3 major classes of drugs used to tx GERD
-antacids
-H2 blockers
-PPI's
What/when are antacids the drugs of choice for GI symptoms?
acute simple symptoms, or occasional symptoms
Name some antacids and identify which should not be given to ARF pts.
1) NaHCO3 (sodium bicarb) can cause constipation
2)Al(OH)3-aluminum hydroxide, can cause constip.
3)Mg(OH)2-magnesium hydroxide-can cause diarrhea***NO to ARF pts
4) CaCO3-calcium carbonate, constipation***NO to ARFpts
***ARF pts cant clear Mg***
How do H2's work?
block the secretion of hydrochloric acid in the gut
Name 4 of the top H2's
-Tagamet
-Pepcid
-Axid
-Zantac
Why/what must you becareful when prescribing H2's?
also blocks the metabolism of several drugs
Name 2 popular PPI's and what is their MOA?
-Prevacid
-Prilosec
*MOA effects the parietal cells in the stomach and inhibits the push of protons into the gut
What type of symptoms/and or relief are pts experiencing when you consider prescribing H2's?
Need relief in hours
What type of symptoms/relief are pts experiencing when you consider prescribing PPI's?
chronic relief
What are some other drugs that can be used in the treatment of GERD?
-reglan: for nausea, and is promotility (can cause diarrhea)
-bethanechol (urecholine)-cholinergic agonist that stimulates peristalsis
-sucralfate (carafate)-binds to ulcers or injury, coating/protecting (can also bind some other drugs, so becareful)
What is PUD?
peptic ulcer disease
What are 3 main causes of PUD?
-Nsaids-reduce prostaglandin synthesis, prostaglandins are protective in the gut
-smoking
-H. pylori
Name 4 goals/rationale for the tx of PUD
-dec. acid secretion
-protect mucosa
-replacement treatment
-antibiotics
What types of drugs can be used in the tx of PUD? (there are 6 listed!)
-antacids
-H2 blockers
-PPI's
-misoprostol (cytotec)
-sucralfate (carafate)
-antibiotics (pick 2)
What is the main line treatment for motility disorders?
find and treat the cause
What are some types of treatment for constipation? there are 5 listed....
-bulk laxatives (metamucil)
-stimulant/irritant
-stool softener/surfactant
-lubricant
-osmotic laxative-draws H20 into the colon
What is the number tx of diarrhea?
find and treat the underlying cause
Name 2 drugs that are used in the tx of diarrhea
-Lomotil (atropine+diphenoxylate) is an anticholinergic that acts like a narcotic
-Imodium (loperamide)
Name 3 drugs that can be used in the tx of N/V and their s/e
-prochlorperazine (compazine)-can cause confusion esp. in the elderly, also can cause tortocollis that you tx with benadryl
-promethazine (phenergan)-has antihistamine properties, causes sedation
-metoclopramide (reglan)-can get movement dos, tx with benadryl
Name 2 serotonin antagonists that can be used in the tx of N/V
-ondansetron (zofran)
-granisitron (kytril)
In the treatment of UC (ulcerative colitis) and Crohn's disease (CD) what is MOA for all the meds?
-all metabolize to a compound of mesalamine, local anti-inflammatory
Name 4 drugs/dosages of meds in the tx of UC and CD
-sulfasalazine (azulfidine) 500mg
-mesalamine (asacol) 400mg
-olsalazine (dipentum) 250mg
-mesalamine (pentasa) 250mg
Sulfasalzine, asacol, and dipentum work/release where in the gut?
all release at the terminal ilium
In a pt. with a sulfa allergy, you must becareful when prescribing which drug in the tx of UC and why?
sulfasalazine-as it is mesalamine attached to a sulfa group. Could have allergic rxn
What is special about Pentasa?
works t/o the entire gut, so its is effective for dx outside the colon as well as inside
What other types of drugs are used in the treatment of UC and CD?
steroids-antiinflammatory
infliximab (remicade) a mono-clonal antibody that works against TNF
What is Entocort?
the only steroid that is released and effective only in the colon. used in combo with mesalamine. no systemic side effects of steroids
What are some problems that are experienced with Remicade therapy?
-EXPENSIVE!!!
-by decreasing TNF (inflammatory regulator) the pts can begin developing strange infxn's that the TNF would normally handle without problem
What is a bad outcome of gallstones?
gall stone pancreatitis
What is primarily the PA role in the treatment of pancreatitis?
IV nutrition, pain management, consult surgery
What is AAC? What is the bug involved?
diarrhea from hell, clostridium difficile
What are the most common abx's that cause AAC?
-Ampicillin
-Rocephin (ceftriaxone)
-Cleocin (clindamycin)
-FQ's
What must every healthcare worker do to prevent the transmission of AAC to themselves or others?
WASH YOUR HANDS!, hand gel does not work
What is the number 1 way to tx AAC?
remove the offending agent if possible
Name 3 drug therapies that tx AAC
-metronidazole (flagyl) IV or PO
-vancomycin PO only!
-questran (cholestyramine)-binds up the toxins in the colon
What is traveler's diarrhea caused by?
parasites in water, generally self limiting, but can cause dehydration requiring hospitalization
Name 3 drugs used in the tx of traveler's diarrhea
-tetracycline
-bactrim
-ciprofloxacin
What is a side effect of all 3 drugs used in the tx of traveler's diarrhea?
photosensivity-but of the 3 cipro is the safest
Define pancreatitis
-hurts like hell
-usually caused by ETOH & gallstones.
-blockage of the pancreatic ducts cause a backup of pancreatic enzymes which begin eating away at the pancreas
How do you treat pancreatitis?
Stop the offending agent (ETOH)
IV nutrition/hydration
IV narcotics
consult surgery
bowel rest
How does cystic fibrosis affect the gut?
thick secretions in the GI tract that can clog up the pancreatic duct and develop pancreatitis, diabetes type I due to pancreatic damage. sometimes need pancreatic supplements to help with digestion
How do you determine what type of IV fluid to order for a pt?
Where does the pt most need fluid replacement
The body is ___-___% water. what are its distributions?
50-70 %
-intracellular-35% by wt
-intravascular-5% by wt
-interstitial-16% by wt
-lymph, CSF, etc
What are the number 1 & 2 intracellular cations
#1 potassium
#2 magnesium
What are the top 2 intracellular anions?
#1 phosphate-needed to make ATP from ADP
#2 bicarbonate-needed to maintain acid/base balance
What are the number 1 & 2 extracellular cations?
#1 sodium
#2 potassium
What are the # 1 & 2 extracellular anions?
#1 chloride
#2 bicarbonate
What is the tonicity of blood?
osmolality is 300mOsm-isotonic
What does hypotonic mean?
What does hypertonic mean?
What happens to the blood cells with these solutions?
hypo- <300 mOsm, rbc's swell as the fluid goes into them
hyper->300 mOsm, rbc's shrivel up as fluid is drawn out of them
Which IVF is the most isotonic? and where does it distribute?
D5W-as isotonic as you can get, it goes everywhere: cells, vascular, interstitial. and what glucose is not used is stored.
Lactated ringers is what type of solution? What is included in LR? Why do surgeons prefer LR?
isotonic
LR has sodium, potassium, calcium, lactate, and chloride.
surgeons love it as it is good for vascular support
What type of solution is 0.9% normal saline?
isotonic-is really good for tissue hydration, with some going into cells also
D5NS is a good fluid for what?
helps maintain vascular volume with some going into interstitial spaces
Which saline solutions should never be given by themselves? and why?
1/3 NS and 1/4 NS as they are too hypotonic and could/will hurt someone, must be given with other fluids!
True or false...the more concentrated the NS the more dangerous it is
false, the more dilute the NS the more dangerous it is...
If your pt needs intravascular volume, (intravascular hypovolemia) what solutions could/should you use?
NS or LR (crystalloids) as the pt needs vascular volume and these primarily stay in vascular spaces
If your patient has intracellular dehydration, what must be added to whatever IV solution you order?
D5W, it goes into the tissues...
so D5NS, D5LR, or just D5W
If your pt. needs less than 1 liter of IV fluids a day what should you do? what rate?
discontinue it!
How do you figure out how much fluid a pt needs a day?
what is there estimated total volume/24 hours
If a pt needs 3000cc's of fluid per day what is the IV rate?
3000/24=125cc/hr
What does TPN stand for?
total parenteral nutrition
What are long term indications for TPN?
short gut syndrome, inability to absorb vitamins/minerals, cant eat for whatever reason
What are some short term indications for TPN?
pancreatitis, if the pt needs bowel rest
How long can you wait before starting TPN on a patient?
4-7 days depending on the state of your patient
What must you have before initiating TPN therapy?
baseline labs- such as cbc, cmp, lft's, liver profile, ca, mg, pt/ptt
You can feed a pt TPN peripherally for about a week before you will need _____?
central venous access
Name the 4 macronutrients of TPN and the daily requirements of each
-protein 1gm/kg/day
-fluids 30cc/kg/day
-fats 500cc 3-7 days qweek
-carbohydrates 25-35 cal/kg/day
Protein added to TPN is important for what?
-maintaining muscle mass
-making hormones
Carbs added to TPN are needed for what? What must you do with carbs for pt. in a catabolic state?
-needed for cell nrg
-catabolic pt's need more nrg, may have to increase carbs to 50cal/kg/day
What 'other' components are/should be included in TPN?
electrolytes, Mg, PO4, Ca, vitamins, trace elements and if needed insulin, vitamin K, folic acid, H2 receptor antagonist
other than dextrose and protein
What percentage of protein should be included in every bag of TPN?
5%
What is the standard % of dextrose in TPN?
18%
What can you count on doing for many days after the initiation of TPN therapy?
change, change, change. you will have to alter a lot, most in first 3 days.
What do you want to keep in mind as you are adding more drugs to a pts TPN? what do you want to avoid?
the more you add, the more chance for a snow globe!
What laboratory and clinical monitoring must be done in pts receiving TPN?
-lab work (glucose, lft, lytes, mg, triglycerides, Ca, renal fcn tests, cbc, pt/ptt, etc)
-daily wt
-I & O
-clinical/venous status
-protein status
What is the best marker of nutritional status? Which marker is traditionally used but is not the best?
prealbumin is the best marker but is rarely used, typically albumin level is checked but isn't the best
What 3 people must you consult if your pt needs TPN?
-surgery
-nutritionist
-pharmacist
what are the 4 major complications to TPN therapy?
-electrolyte derangements-count on it, and adjust
-fatty liver-lft's will creep up, decrease dextrose calories and inc. fat and protein calories
-sepsis-line infection
-refeeding syndrome-start food back very slowly.
S/S of hypo Na are what?
How do you treat it?
depressed CNS and depressed muscle fcn
-fluid restriction, correct the cause, NS IV, diurese if over hydrated
s/s of hyper Na? how do you treat?
dehydration symptoms, tachycardia
-tx with dietary Na restriction, non-saline IVF to rehydrate sodium, desmopressin, or vasopressin if need ADH
S/S of hypo K are what? and how do you tx?
confusion, weakness, arrhythmias.
-tx by correcting the cause, give PO K+ if asymptomatic (10-50 mEq) 1-6 x's QD, or IVPB if NPO or symptomatic, (20-40 mEq boluses) with K+ also added to base IVF.
If after you give K+ IV and the level still has not come up sufficiently, what should you do next?
check the Mg level, if low give will increase the retention of the K+
S/S of hyper K? how do you treat it?
weakness (paralysis), arrhythmias
-correct the cause (drugs, acidosis, etc) give...
-sodium polystyrene sulfonate
-insulin/dextrose
-correct pH if acidotic
-Ca gluconate if K >7.0
Hypomagnesia is usually a result of _______?
a dietary problem
s/s of hypo Mg are what? how do you treat?
-correct the cause and feed them Mg, or give IVPB/IM 2-4 gms as needed
s/s of hyper Mg are what? in what population must this be checked frequently? and how is it fixed?
hypotension, n/v, confusion, paralysis
check OB pts frequently
correct the cause, +saline, IV Ca gluconate if cardiac or resp distress
s/s of hypocalcemia are what? how do you fix?
paresthesias, seizures, tetany
fix with Ca p.o. or IV
What else must be done in pts. with hypocalemia?
check Mg, albumin, and vitamin D levels and then give all to them!
what pt's are susceptible to hypercalcemia?
CA pt's especially with bone mets
s/s of hyper Ca? how do you tx?
-malaise, weakness, anorexia, n/v, constipation, hyporeflexia
-tx with calcitonin nasal spray or subq or pamidronate
-aggressive IV hydration to dilute the concentration
what usually causes hypo PO4?
we do, its iatrogenic
how do you treat hypo PO4?
neutrophos (2-4 caps, po, bid) or ivpb
what are s/s of hyperPO4? what pt. population is it seen in most often? how do you tx?
-calcium phosphate deposits, hypocalcemia
-renal dialysis pts
-restrict PO4 in diet, dietician consult, give PO 4 binders, IV NS + diuretics
Name the water soluble vitamins
B1-thiamine, alcoholics need
B2-riboflavin-dont care
B6-pyridoxine, seen in INH therapy, hyperemesis gravidarum, linezolid neuropathy (put on B6)
B12-cyanocobalamin)
folic acid-macrocytic anemia
niacin-antilipemic agent
C-ascorbic acid
Name the fat soluble vitamins
a-gd for skin and eyes
d-gd for ca and po4 absorption
e-gd as antioxidant
k-gd for coagulation
Acid/base balance...buffers soak up ____ ions
hydrogen
the kidney's regulate what in regards to acid/base balance?
hydrogen and bicarb
the respiratory system regulates what in regards to acid/base balance?
CO2
what are 3 important buffers in the body?
-PO 4
-hgb
-proteins
what are 3 important 'blood elements' in regards to acid/base balance?
-HCO3
-pCO2
-buffers (PO4, hgb, proteins)
what is the normal pH of the blood?
7.35-7.45
If a pt's pH is 7.29, this means they are _?
acidotic
What is the range in which the pH is 'incompatible with life'?
<6.8 or >7.8
if a pt's pH is 7.62, this means that they are__?
alkolotic
what is the normal pO2 level?
80-100
what is the normal pCO2 level?
35-45
what is the normal bicarb level?
22-26
What is rule number one in the treatment of acid/base disorders?
treat the underlying cause!
what is the normal anion gap?
10-14
how do pt's try to compensate for acid/base disturbances?
-resp. rate, either blowing off or retaining CO2
-kidneys get involved by secreting H+ ions or bicarb into the blood stream
how are acid/base disturbances named?
1st-the source of the problem
2nd-via the pH
a pt with a pH of 7.44, pCO2 of 31, bicarb that is normal then goes low due to hyperventilation is in ______?
respiratory alkalosis-inc. pH and dec. CO2 due to hyperventilation, the bicarb level goes down as the kidneys begin to secret bicarb to help regulate the pH.
what is the treatment of respiratory alkalosis?
treat the cause, the pain, anxiety, etc...give them a paper sack so that they can rebreath their co2.
What is a classic sign of respiratory alkalosis?
perioral parasthesias
a pt with a pH of 7.33, pCO2 of 51, bicarb is normal then goes high due to respiratory failure is in _?
respiratory acidosis-due to hypoventilation the body is not able to expire CO2, so the kidneys begin to retain bicarb to compensate for the for the low pH
what is the treatment of respiratory acidosis?
-ventilate the patient so that the lungs can exchange O2 for CO2
-if the pH is <7.0 can give Na bicarb, if not <7.0 you could over shoot,and cause other problems.
a pt. presents with a pH of 7.27, pCO2 normal then goes low to 28, bicarb 19, this pt is in __?
metabolic acidosis
metabolic acidosis is usually a result of what?
DKA, ASA overdose, sepsis
what respiratory problem can lead to metabolic acidosis?
kussmaul respirations
what is the tx of metabolic acidosis?
treat the underlying cause, IVF, Na bicarb if the pH is<7.0 but watch the K+ closely
a pt presents with a pH of 7.54, pCO2 that is normal at first then goes high at 53, bicarb high at 33 what is this?
metabolic alkalosis due to usually alkali overdose (tums) or loop diuretics
what is the tx of metabolic alkalosis?
-remove the offender
-can give PPI to decrease the H+ release in the gut
combined acidosis is described as what?
low pH, high pCO2, low bicarb, must tx both problems or pt. dies, very poor outcome and the pt may not return to baseline if you do save them
combined alkalosis is described as what?
high pH, low pCO2, high bicarb, very rare!
resp. alkalosis/metabolic acidosis, what might the bld gases show?
ph-normal, pCO2-low, HCO3-low. pt may be partially or totally compensated
respiratory acidosis/metabolic alkalosis, what might the bld gases show?
pH-normal, pCO2-high, bicarb-high will see in chr. copd pts. tx the acute illness (such as in pneumonia)