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62 Cards in this Set

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The nurse explains that B12 is required for: page 898
Cyanocobalamin (Vitamin B12) is required for nucleoprotein and myelin synthesis, cell reproduction, normal growth, and the maintenance of normal erythropoiesis. Cells that are mitotically very active such as epithelial cells, myeloid cells, and bone cells have a higher requirement for Vitamin B12
Which of signs should the nurse monitor for hypercalcemia? 902 in Lilley;page 571 Harkreader
hypercalcemia can cause cardiac irregularities, delirium, and coma.
what are the 'general' symptoms of hypercalcemia
harkreader 571
dehydration, polydipsia
what are the musculoskeletal symptoms of hypercalcemia? harkreader 571
weak, relaxed muscles; osteoporosis; osteomalacia; bone pain; pathological fractures
what are the cardiac symptoms for hypercalcemia? hark. 571
dysrhythmias, cardiac arrest, short QT intervals on ECG
what are the renal symptoms for hypercalcemia? hark. 571
polyuria, calculi, renal colic, flank pain
what are the neurological symptoms of hypercalcemia? hark 571
confusion, lethargy
What adverse effect may occur if calcium is given too rapidly in an intravenous infusion? page 902
Venous irritation can occur when calcium is administered intravenously
which water soluble vitamins act as a coenzyme for fat and carbohydrate metabolism and protein synthesis? page 902
vit c, b12, b6, b3, b2, b1
which fat soluble vitamins act as a coenzyme for fat and carb. metabolism and protein synthesis? page 902
vit A, vit. K
function of vitamin B12 and C
C: collagen (a protein) synthesis; tissue repair; maintenance of bone, teeth and capillaries; folic acid metabolism
Vitamin B12: (Cyanocobalamin)–synthesis of myelin (a nucleoprotein); cell reproduction; erythropoiesis
function of vitamin b 6 and b3
B6: (pyridoxine)–synthesis of GABA (a neuropeptide)
B3: (niacin / nicotinic acid)–plays an indirect role in the generation of ATP from glycolysis and the Krebs Cycle reactions by generating NAD/NADP (oxidation–reduction reactions); plays a role in lipid, protein, and purine metabolism
function of b2 and b1
B2 (riboflavin)–is converted into the coenzymes FMN and FAD and plays a role in the catabolism of carbohydrates
B1 (thiamine)–thiamine pyrophosphate combines with ATP to form a complex (thiamine pyrophosphate coenzyme) that is required for carbohydrate catabolism
function of Vitamins A and K
A: growth/development of bones and teeth, maintains integrity of epithelial and mucosal surfaces; cholesterol and steroid synthesis; (cis retinal) combines w/ the pigment opsin to form the visual pigment found in rods (for discernment of light intensity and color)
Vitamin K: prod. of vitamin K dependent clotting factors by the liver (II, VII, IX, and X).
Which vitamin facilitates the synthesis of Prothrombin (Factor II)?
Vit. K
Which preparation is given to newborns within 1 hour of birth? page 893
intramuscular injection of Vitamin K
Why is Vit. K administered IM to newborns? page 893
because the newborn liver doesn't always secrete enough bile (necessary for emulsification of fat-soluble substances such as Vitamin K) to support adequate absorption of the vit.K from the large intestine
Which vitamin is essential in the synthesis of and maintenance of heme? page 897
Vitamin B6 (pyridoxine) is important in the synthesis of heme and maintenance of the hematopoietic system.
What vitamin is used in the therapeutic treatment of gastrectomy and pernicious anemia?
Cyanocobalamin (Vitamin B12) is used to treat pernicious anemia
what is probably the most effective route of administration of Vit. B12 for pernicious anemia?
the parenteral route
What medication should a patient receive to prevent the neurological side effects of Isoniazid (INH)? page 897
Vitamin B6 (Pyridoxine)
Oral Contraceptives and Hydralazine use can cause deficiencies in what? pg 897
Vit. B6 (pyridoxine)
how do tums work?
by directly neutralizing HCl produced in the stomach
what can be a problem w/ overuse of tums?
Overuse can lead to states of metabolic alkalosis.
what might be administered to control minor occasional heart burn in a pt w/ CHF?
Famotidine (Pepcid)
why would famotidine be given to treat heart burn in a pt w/ CHF?
Famotidine has little or no effect on the cyotochrome P-450 microsomal enzyme system of the liver meaning that it won’t interfere w/ the metabolism of the other meds that a CHF patient will be taking
Why are H2 agonists good for treating heart burn in pts w/ CHF? And why, of H2 agonists, is famotidine best?
H2 antagonists have very good side effect profile, are safe for long-term use
Famotidine requires the smallest dose for equivalent dosing potency and can be dosed once daily.
why would someone not want to take aspirin w/ antacids?
i. Antacids will adsorb (stick to the surface of) other drugs thus reducing their absorption
ii. Antacids can inactivate other drugs by chelation, producing insoluble complexes
iii. increased stomach pH (alkalinity) increases absorption of basic drugs and diminishes absorption of acidic drugs
iv. increased urinary pH increases the excretion of acidic drugs and decreases the excretion of the basic drugs
what things might a nurse suggest a patient do if he/she is experiencing heart burn or stomach upset when on aspirin therapy?
aspirin will have less therapeutic effect when taken w/ an antacid and that he might want to contact his doctor about a prescription such as a PPI or H2 antagonist.
Or if the aspirin is causing the heartburn/dyspepsia he should wait at least 2 hours after taking and then have Maalox
What should the nurse include in this patient’s teaching plan about magnesium antacid preparations
May cause diarrhea, flatus, usual dose is 15 to 60 mL w/ water every 1-3 hours after meals and at bedtime, Avoid caffeine, alcohol, harsh spices, and black pepper, not for people w/ renal disease
why would someone taking milk of magnesia need to avoid caffeine, alcohol, harsh spices, and black pepper
because these substances might aggravate an underlying condition causing the heartburn
why would someone w/ a history of renal disease want to avoid taking milk of magnesia?
antacids would be contraindicated because the magnesium ions must be excreted by the kidney
how do antacids work?
directly neutralize the acidity ass. w/ overproduction of stomach acid; promotes gastric mucosal defense mechanisms at low doses by stimulating synthesis of mucous, prostaglandins, and bicarbonate ions from cells w/in gastric glands.
what is the purpose of mucus, prostaglandins and HCO3 in relation to stomach acid?
mucous is a mechanical buffer, PG’s prevent histamine from binding to receptors on parietal cells, and HCO3- neutralizes the acidity resulting from overproduction of HCl
Which acid controllers block all gastric acid secretions
The Proton Pump Inhibitors (PPI’s)
What are some examples of Proton Pump Inhibitors?
lansoprazole (Prevacid), omeprazole (Prilosec), rebeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).
Which acid controllers may be used to induce abortion?
Misoprostol (Cytotec) is a synthetic PG analog. It can be used in combination with methotrexate to induce an abortion early in pregnancy. Misoprostol in combination w/ another PG (RU 486) make up the “abortion pill” that is so controversial in our country.
What is the mechanism of action of proton pump inhibitors like Pantoprazole
PPI’s irreversibly bind to the H+ / K+ ATPase enzyme which prevents the movement of hydrogen ions out of the parietal cell into the stomach, thereby blocking all gastric acid secretions. PPI’s stop over 90% of 24 hour acid secretion which may lead to a state of achlorhydria (w/ out acid)
Which one of the acid controllers acts by binding to the proteins of gastric ulcers
Sucralfate (Carafate)
for what is Sucralfate (Carafate) used?
It's used for treatment of chronic stress ulcers and Peptic Ulcer Disease
List 3 examples of drugs that are Histamine 2 Receptor Blockers
Cimetidine (Tagamet), Famotidine (Pepcid), and Ranitidine (Zantac)
What should the nurse teach patients about smoking and H2 Receptor Blockers?
Smoking has been shown to impair the absorption of H2 antagonist drugs
Take H2 antagonists 1 hour before antacids
Which antidiarrheal acts by coating the walls of the GI tract, binding to the causative bacteria or toxin, and eliminating it via the stool
Adsorbent antidiarrheals
How do absorbant antidiarrheals work?
bind to causative bacteria and toxin molecules thus eliminating them via stool.
Name some absorbant antidiarrheals
Absorbent antidiarrheals include Attapulgite (Kaopectate) and Bismuth subsalicylate (Pepto-Bismol).
Which antidiarrheal acts by decreasing peristalsis and muscular tone of the intestine?
anti-cholinergic antidiarrheals
name some anticholinergic antidiarrheals
atropine, hyoscyamine, and hyoscine
atropine, hyoscymamine, and hyoscine are not only anticholinergic antidiarrheals, but also fall into the category of..
belladonna alkaloids
why must anticholinergic antidiarrheals (aka belladonna alkaloids) have a prescription for use?
because of the potential for unwanted anticholinergic effects
Which antidiarrheal lowers bowel motility and relieves pain
Opiate antidiarrheals
name some opioid antidiarrheals
codeine, diphenoxylate w/ atropine, loperamide, paregoric, and tincture of opium.
why is loperamide the only opioid antidiarrheal that is available OTC?
because the other opioid antidiarrheals can cause physical dependance and risk for severe CNS depression w/ overdose
Which laxative acts by increasing peristalsis via nerve stimulation in the colon
Stimulant laxatives
what's an example of a stimulant laxative?
Senna (senokot)
Which agent is commonly used before diagnostic or surgical bowel procedures to induce total cleansing of the bowel?
Polyethylene glycol (CoLyte, GoLYTELY, OCL). Powder is usually mixed with 1 gallon of fluid that the patient drinks over a certain time period the day before the procedure
What side effect from ondansetron (Zofran)might be most detrimental to a person on chemotherapy?
diarrhea because The patient on chemotherapy is already in a fragile hemodynamic state which could be aggravated by diarrhea. Also if the chemotherapeutic agent is taken orally the diarrhea may decrease absorption of the drug (this is a guess)
Which antiemetic agent may cause increased adverse cardiac effects when taken with quinidine?
Quinidine when taken with neuroleptic agents (i.e. phenothiazine) may cause adverse cardiac effects.
When should the nurse administer the antiemetic to effectively manage potential symptoms of nausea and vomiting? page 881
½ to 3 hours prior to chemotherapy session (ask the patient what works for him/her)
Which antiemetic agents have proven effective in preventing chemotherapy-induced and postoperative nausea and vomiting?
5HT3 antagonists
name some 5HT3 antagonists
Ondansetron and Granisetron
which is more potent, Ondansetron or Granisetron?
Granisetron is slightly more potent
What is important to emphasize when teaching about Diphenidol hydrochloride to someone w/ Ménière’s disease? Page 880
Diphenidol hydrochloride should be administered w/ food, water, or milk to decrease GI upset and should not be used with alcohol or other CNS depressants.