Pharmacology Test 2 Cne

Front 1

Thrombus

Back 1

blood clot

Front 2

Embolus

Back 2

piece of blood clot breaks off and travels to the heart, brain, or lungs

Front 3

Anticoagulant vs antiplatelet vs thrombolytic

Back 3

Anticoagulant prevents in venous, platelet in artery

Thrombolytic lyse the thrombus

Front 4

Main ADE of anticoagulant, most serious effect and prototype

Back 4

bleeding, Heparin. Ordered in units

Serious: Platlets drop. Thrombocytopenia, platelet count drops below 1000

Front 5

How fast does heparin work

Back 5

IV - immediate, subQ starts in 20-30 min.

Front 6

Can Heparin be taken by mothers?

Back 6

Yes. Only lasts 4 hours and does not cross into milk or placenta.

Front 7

When is heparin used?

Back 7

Patients on bed rest for a while, post surgery, history, after GYN surgery and had birth control/estrogen before

Front 8

What is the PTT

Back 8

Partial Thrombolytic time. measure of how long clotting takes.

25 seconds before, up to 50 may be good. Above 50 may be a problem though -- bad side effects likely

NORMAL TIME IS 12-13 SECONDS

being changed to INR, 2.0-3.0 when on meds, high higher than 3.0, lower dose.

Front 9

What is the antidote to heparin?

Back 9

Protamine sulfate. Short acting

Front 10

What are fragmin and lovanox?

Back 10

Prophylactic heparin like drug with low molecular weight in pre filled syringe with air bubble to push out med. DONT POP THIS AIR BUBBLE

Front 11

Warfarin coumadin. How does it work?

Back 11

Stops clotting factor in the liver. Stops synthesis of vitamin K.

Takes 3-5 days to be effective, so heparin and coumadin often are given together while waiting for the coumadin to kick in.

régulante Vit K in diet!

Front 12

Coumadin and provaxa?

Back 12

highest ADEs

Front 13

2 Antiplatelet drugs and how they work

Back 13

Aspirin (binds to platelet for life of drug). Inhibits function of prostoglandins. Thromboxin A2 inhibitor.
Plavix can also be used like this for people who can't take aspirin

Nonsteroidals (only bind while in circulation -- short term)

Front 14

How does aggrastat work?

Back 14

Makes platelets slippery so they can't stick together

Front 15

When are antithrombotic drugs contraindicated

Back 15

recent abdominal surgery or pregnancy

Front 16

Thrombolytic prototype AND antidote

Back 16

alteplase

used when patient is at risk for fatality/no blood is going through

Reestablishes blood flow. Drip the drug in the artery right before the clot to clear it. can't be used in patient with active bleeding.

TIME IS TISSUE. "Door of the ER to needle time" should be less than 30 min.

Antidote = Amicar

Front 17

What is the cholesterol and tryglyceride level norm?

Back 17

less than 200. More in men than women

Front 18

Which drugs increase lipids? What else?

Back 18

steroids and sympathomimetic adrenergic

smoking, body weight, low fiber

Front 19

How does Mevacor work? Statin

Common and severe effects

Back 19

inhibits enzyme that forms cholesterol in the liver

Common: v/d cramps and constipation

serious: hepatoxicty (check liver enzymes) and rhabdomyolysis (severe muscular pain and damage

Front 20

When do you take a statin?

Back 20

In the evening, when most cholesterol is synthesized

Front 21

Colonization

Back 21

localized microorganisms without infecting a patient. Happens with MRSA.

Front 22

Bacteremia

Back 22

Blood infected with bacteria. Septic = infecting multiple organs -- kidneys, lungs etc.

Front 23

Latrogenic

Back 23

Acquired from surgery

Front 24

3 treatment for anaphylaxis from a drug

Back 24

preferably just antihistamine

steroid also for inflammation if needed

Front 25

normal WBC range

Back 25

5-10k

Front 26

How do penicillins, cephalosporins and vancomyacins work? What category are these?

Back 26

Beta Lactam -- inhibit cell wall synthesis

Front 27

Penicillin prototype and use. Use in women?

Back 27

Pen G. Often used as a first line, prophylaxis. Pipercillin has broader spectrum. Can be used in pregnancy but not with birth control

Front 28

penicillinase/beta lactamase and adjusted bacteria

Back 28

bacteria break up beta lactam ring.

cloxacillin or nafcillin have protective structure

unasyn has two components, stopping cleavage

Front 29

What does benemid do?

Back 29

Keeps penicillin in system longer

Front 30

Cephalosporin prototype

women? how given?

Back 30

cefazolin Im or iv. 75% with pen allergy are allergic to cephs too

DO CROSS PLACENTA AND MILK but not bbb

Can be given 30 min to 2h before surgery for proph. With milk or food if po

Front 31

What do you always do before giving antibiotics? How is it usually given

Back 31

Check C and S report!

Front 32

How must vancomycin be delivered?

Back 32

Must have infection disease consult and be given very slowly (over up to 2h) to avoid red man syndrome rash. ICUs were using too frequently. tx very bad infections

VRE resistent.

Front 33

3 antibiotics inhibiting protein synthesis

Why not given often?

Back 33

aminoglycosides (gentamyacin)

Macrolides

tetracyclines

second line because sequestered by tissues, greater toxicity chance

Front 34

When is gentamicin used?

cross the bbb? placenta? toxicity?

Back 34

bactericidal, but very toxic. Only used for hosp pneumonia and utis from e coli. Good for sepsis because hangs in blood stream. Backup for tb

No bbb, yes placenta and otobarrier, so very ear toxic!!!! Also nephrotoxic. Can be used on dialysis but not for patients with weakened kidney and no dialysis

Cholinesterase inhibiters to reverse

higher dose once a day is better than small dose throughout the day

careful with lasix

Front 35

What happens if pens are used with gents?

Back 35

if mixed first, pen kills gent. If given two hours apart, enhances one another

Front 36

Normal BUN range

Back 36

5-11 or up to 20

Front 37

Erythromycin - metabolism, bbb, women and where absorbed

Back 37

matabolized in liver and inhibits cyp450

no bob and yes placenta

PO absorbed in SI, give away from meal
NO GRAPEFRUIT

Front 38

TETRACYCLIN
bbb, women, sequestration, reduced absorption, toxic

Back 38

reduced with 2+ or 3+ ions (mg ca fe)

60-80 percent absorbed

crosses bbb and bad for women/kids under 9. Causes brown teeth

photo and nephrotoxic

Don't give with antacid - disactivates

Front 39

How do fluoroquinolones work?

Back 39

Inhibit nucleic acid synthesis. Absorbed in soft tissue

Front 40

When is fluoro not used?

Back 40

Affects joints, so not in kids and elderly or mama. tendon rupture can occur, so no working out!

aluminum, iron and zinc disactivate

Front 41

How do sulfonamides work?

Back 41

Inhibit metabolic pathway (EG stop folate function)

Front 42

When are sulfonamides used? Who can't use it?

Back 42

Not systemically -- for burns and superficially, UTIs bc quick urinary excretion

NOT FOR WOMEN in last term of pregs or hypoglycemics

Front 43

When is pyridium used?

Back 43

along with sulfos to help pain with UTIs. Changes urine color though, so don't be scared

Front 44

Stevens johnsons syndrom

Back 44

weepiness from skin and mucocytosis

most often in white men 10-30 and older

eye lip mouth ulceration

Front 45

C difficile. What brings it on? Symptoms?

Back 45

Superinfection

dehydration, water loss with blood and puss in poo and pee 10-15 times a day, no appetite

vancomycin works, but stool injection is best

c difficult must be cleaned with bleach specifically. contact isolation

Front 46

Symptoms of resp disorders

Back 46

bronchoconstriction/spasm

inflammation

mucosal edema

Mucus production

Front 47

What can be used to treat bronchodialators? 3 things, effects and order

Back 47

1) Adrenergic drugs (epinephrin, subq or albuterol, B2 selective and fewer heart effects). DO NOT USE IF PERSON HAS A TACKY HEART or make sure education is right

2) Anticholinergic - decrease mucus (DRYING) Atropine, second line, not good for soy allergy folks, not for acute treatment

3) Xanthines/ophyllines. Final line. Bronchodialator, also cns activation with breathing, anxiety, heart rate (pos ionotropic)
not for people with ulcers or cardio issues

Front 48

When is albuterol vs epi used?

Back 48

Epi - acute crisis, Albuterol - short acting and good for maintenance

Front 49

side effects of atropine

Back 49

Common: cough, constipation, dryness generally. anticholinergic
Serious -bronchospasm

Front 50

How to know side effects of ophyllines or intention?

Back 50

O2 sat, cyanosis

Front 51

Early vs late signs of resp distress

Back 51

early: increased breathing and HR, confusion and restlessness, accessory muscles

late: cyanosis, lower BP and lower HR

Front 52

3 anti inflammatory drugs, decreasing mucus as well

Back 52

1) corticosteroids, chronic use but trying to keep it short for kidneys, increase in acid, decreasing immune and increasing B2 receptor sensitivity

2) Mast cell stabilizers (intal) reducing histamine response, chronic use/prevention

3) Leukotriene inhibitors (Accolate) - not for acute attacks

Front 53

When are corticosteroids contraindicated

Back 53

with any infection because weakening of immune system

not for people with ulcers

can cause oral candidiasis in extreme, or just dry features

Front 54

Bronchodialators or corticosteroids first?

Back 54

bronchodialators first

Front 55

Common and serious effects from accolate?

Back 55

headache, serious - hepatic failure

Front 56

What to check with resp assessment?

Back 56

allergies, cardiac MI arrhythmia history, resp status, BP and HR, NV insomnia

Front 57

What do antihistamines do?

Back 57

Bronchoconstriction
Cough
increase capillary permeability
increase mucus production
Stimulation of sensory peripheral nerve endings
Dilation of capillaries

Front 58

Indications for antihistamine

Back 58

Allergic rhinitis
Anaphylaxis
If shock, need epinephrine
Drug allergies – decrease chance in advance
Blood transfusion reaction – decrease chance of reaction
Contact dermatitis

NOT FOR PEOPLE WITH BPH OR GLAUCOMA OR CNS DEPRESSANT

Front 59

NEOSYNEPHRINE what kind?

Back 59

topical, adrenergic, rebound effect

Front 60

what to do for productive vs non productive cough

Back 60

adrenergic (ephedrine), expectorant (guai, liquifies mucus), or mucolytics (overdose on tylenol too) vs antitussive (opiate or dextromethorphan)

Front 61

inhalant abuse causes

Back 61

stimulation then depressant

injury to all vital organs but especially lungs. Death from arrest and heart issues or occlusion of air

Front 62

How much does the heart pump per min?

Back 62

5-6L per min

Front 63

SA vs AV node rate vs ventricles

Back 63

60-100 vs 40-60 vs 30-40

Front 64

Percent of blood plasma

Back 64

55

Front 65

percent of blog solid

Back 65

45

Front 66

normal WBC #

Back 66

5-10k

Front 67

Albumin

Back 67

exerts osmotic pressure to hold things intravascularly.

NaCl and glucose do this as well

Front 68

Fibrinogen

Back 68

hemostasis/clotting

Front 69

gammoglobulin

Back 69

defense against infection

Front 70

Hematocrit and percentage

Back 70

percentage of RBCs
M 42-50
F 40-48

Front 71

Hemoglobin

Back 71

M13-18 F12-16

1:3 ratio hemoglobin:hematocrit

Front 72

What does digoxin do?

Back 72

Increases contraction (inotropic) and output but decreases HR (neg chronotropic). Indirect diuretic

Front 73

How is digoxin dosed?

Back 73

Loaded. First dose is divided by 3 and given every 6-8 hours to get heart rate up ASAP

Front 74

Where is digoxin metabolized?

Back 74

in the Liver, 30-40percent. Rest unchanged

Front 75

What does digoxin need to work?

Back 75

Normal electrolytes.

K most important and must be 3.5-5. When too low, more at risk for toxicity.

High Ca increases risk, higher than 10

Low Mg increases risk, lower than 1.3

Front 76

Normal K range

Back 76

3.5-5

Front 77

Normal Ca range

Back 77

8.5-10

Front 78

Indirect diuretic effect of digoxin

Back 78

increases blood flow generally, so kidney as well

Front 79

Tx and contraindications of digoxin

Back 79

for: CHF and arrhythmias. Sinus tach

not good for V tack/fib/block

Front 80

ADEs of digoxin

Back 80

NVAnorex

CNS vision issues/halos

CV bradychardia

Serious: Vent fibrilation

Front 81

PMI

Back 81

point of max impulse, listen for full 60 seconds in digoxin patients

left 5th intercostal space, at the point of intersection with the left midclavicular line

Less than 60, hold the digoxin

Front 82

nursing interventions for digoxin

Back 82

K+
Explain med regime
Administer w/ meals or water
UNLESS ON K+ SPARING
DIURETIC!! SEE LATER

Pt teaching
√ radial pulse daily,
hold if pulse < 60/min
Do not skip a dose or double a dose
Report ADEs

Front 83

What causes arrhythmias

Back 83

Change in automaticity
Change in conductivity
Or both


Hypoxia
Ischemia
K levels – high or low

Front 84

How do you treat sinus arrhythmias?

Back 84

BBlockers or digoxin

Front 85

What do you treat atrial arrhythmia

Back 85

Digoxin

Front 86

How is bradycardia treated?

Back 86

Atropine

Front 87

Class 1 NA channel blocker for arrhythmia

Back 87

Class IB: Prototype: lidocaine (Xylocaine). Sometimes causes bradycardia

Front 88

Class 2 Beta Blockers

Back 88

- Prototype: propranolol (Inderal)
ANTIARRYTHMIC USE, sometimes other beta blockers being used off label.

Front 89

Class 3 K Blocker

Back 89

Prototype: amiodarone (Cardarone)
This has now replaced lidocaine as first line of choice for v tach and v fib.

Front 90

Class 4 Ca blocker

Back 90

Slows depolarization, decreasing ventricular rate
Also for hypertension and angina, chest pain
Adverse effect most common: Constipation
- Prototype: verapamil (Calan)

Front 91

How does the pain from o2 deficit manifest?

Back 91

Deficit in o2 supplied or increase in need can cause pain. Radiates up to jaw or down through left arm

Front 92

What causes angina

Back 92

↑ myocardial O2 demand
Exercise
Stress, anxiety
Cold weather
Smoking

↓ O2 supply to myocardium
Atherosclerosis
Arteriosclerosis
Diabetes due to vascular changes

Front 93

3 classes of antianginal meds

Back 93

Nitrates
Beta Blockers (Inderol)
Calcium Channel Blockers (slows beat Calan)

all decrease o2 demand of heart or increase blood supply

Front 94

Nitrate prototype and physio

Back 94

nitroglycerine (Nitrostat)
Dilates veins  ↓preload
Dilates coronary arteries  ↑ myoc O2 flow
Dilates arterioles ↓afterload


Most common ADE – Hypotension and headaches

Contraindication – no viagra/levitra!!! Bio Phospholipid Diesterase lowers BP further. don't use if BP is under 90

Front 95

What is lasix used for

LOOP

Back 95

Rapid, immed diuresis!!!
Works in the loop

Front 96

What is diuril used for?

Back 96

NOT for immed diuresis -- daily
Careful with sulfa

Front 97

K Sparing

Back 97

Aldactone


NOT used in renal disease/ Do NOT use K supplements

Front 98

What is the osmotic diuretic

Back 98

Large molecules pulling fluid intravascularly, and kidneys excrete the fluids. Delivers extra fluid to kidneys – not acting directly on kidneys
Very specialized use. Only used in hospitals and for patients with intracranial pressure.
Short term IV use only