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NR565 Final Exam Study Guide
This study guide covers content for the question bank for this course. There are 100 questions on the exam and more content in the exam study bank than will be seen on any given exam. Therefore, you may note more than 100 topic items noted in this study guide. However, there may also be more than one question for a topic listed so you should know each one well. Some items listed are more specific than others. If the item listed seems vague, if it’s a more general question and to be more specific would be to risk the integrity of the question itself.
Number of Questions on Exam: 100
Point Value of Each Question: 2
Styles of Questions of Exam: Multiple Choice Only
Knowledge Levels: Various (remember, understand, apply)
Time Limit: 150 minutes
Number of Attempts: 1
Use of Support Materials: Not Allowed
Platform Used for Exam: ExamSoft/Examplify
Exam Expectations: Review Exam Expectations in Course
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Chapter 48 Glycemic Goals in Type 2 Diabetes : Primary goal of 1&2 is prevention of long-term complications. T2DM requires a comprehensive tx plan of lifestyle (diet & physical activity), and drug therapy. Screening and tx of comorbidities HTN, nephropathay, retinopathy, neuropathy, and dyslipidemias. Glycemic control is started with both lifestyle and medication. Glycemic controls goals should be individualized and based off of: duration of diabetes, Age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness,, however the general targets are A1c <7.0%, Premeal plasma glucose 70-130, and peak postmeal plasma glucose <180. Diabetic Nephropathy Prevention: Vitamin B 1st generation vs 2nd generation Sulfonylurea : Both reduce glucose levels to the same extent. 2nd Gen are much more potent, so doses are lower (as much as 1K times lower), significant drug-drug interactions are LESS common and the outcomes tend to be milder. Due to this, 2nd^ Gen have nearly completely replaced 1st^ Gen. 1st^ Gen: Tolbutamide, Tolazamide, and Chlorpropamide. 2nd^ Gen: Glipizide (immediate release- Glucotrol, sustained released- Glucotrol XL), Glyburide (nonmicronized- DiaBeta, micronized- GLynase PresTab, Glimepiride (Amaryl). DDP4I: Adverse Effects : Pancreatitis (s/s severe and persistent abd pain with or without vomiting) including hemorrhagic or necrotizing pancreatitis. Hypersensitivity reactions, Upper respiratory infections, headache, inflammation of nasal passages and throat. Small risk of hypoglycemia DDP4I: MOA: Enhances action of incretin hormones to stimulate glucose dependent insulin and suppresses postprandial release of glucagon GLP-1 receptor agonists: MOA: incretin mimetic that acts by activates receptors for GLP-1 slowing gastric emptying, inhibits glucagon, suppresses appetite, and stimulates glucose-dependent release of insulin, inhibits postprandial release of glucagon. These actions collectively improve glucose control and can induce weight loss. GLP-1 receptor agonists: Monitoring: BMP for kidney function and blood glucose levels to adjust dosing accordingly; HgB A1c will provide information on the effectiveness of the treatment. random plasma glucose, fasting plasma glucose, A1c, serum electrolytes, urinary glucose, ketones. Pts should monitor glucose regularly. Evaluating therapeutic effects: improvement in sx, including decrease in urination, fatigue, weight loss, and decrease in plasma glucose levels and A1C. Chapter 49 Hypothyroidism Treatment in Infants: Levothyroxine dosage is adjusted for age and weight, decreasing as the child grows. Initially higher doses may be required for infants with congenital hypothyroidism with adjustments made to maintain normal TSH and T levels. Levothyroxine Administration: indicated for all forms of hypothyroidism regardless of cause: congenital hypothyroidism, myxedema coma, simple goiter, and primary hypothyroidism, hypothyroidism resulting from insufficient TSH secondary to pituitary malfunction and secondary to hypothalamic malfunction, maintain proper levels of THS after thyroid surgery, irradiation, and tx w/antithyroid drugs. Administered by mouth, once daily on empty stomach to enhance absorption, dosing is usually done in the morning at least 30-60 minutes before eating. IV is used for myxedema coma and pts who cannot take PO and doses are approx. 50% of the size of oral. Maintain consistency in timing of their dose to ensure stable thyroid hormone levels, Use caution in those with CVD and start with lower doses in older adult pts. Levothyroxine: Drug interactions ; reduced absorption of levothyroxine : histamine 2 (H2) blockers: cimetidine (Tagamet), proton pump inhibitors (lansoprazole:prevacid), sucralfate (caragate), colestipol (colestid), cholestyramine (questran), aluminum-containing antacids (Maalox, Mylanta), calcium supplements (tums, os-cal), iron supplements (e/g/ ferrous sulfate), magnesium salts, orlistat (Xenical)- Should separate administration of any of these meds with levothyroxine by at least 4 hrs. Drugs that accelerate levothyroxine metabolism : phenytoin (Dilantin), carbamazepine (Tegretol, carbatrol), rifampin (fifadin), sertraline (zoloft), and phenobarbital- May need in INCREASE levothyroxine dosage while taking these meds. Levothyroxine accelerates the degradation of vitamin-K dependent clotting factors leading to the enhancement of warfarin- the dosage of warfarin may need to be reduced while concurrently taking levothyroxine. Catecholamines: thyroid hormones increase cardiac responsiveness to catecholamines, thereby increasing the risk for catecholamine- induced dysrhythmias: caution must be exercised when administering catecholamines and thyroid meds together. Can increase requirements for insulin and digoxin- when converting pts from hypothyroid to euthyroid dosages of insulin and digoxin may need to be increased.
LATER than 30 minutes AFTER taking the drug. S/S of hypoglycemia. In pt with liver dysfunction- metabolism will be slowed leading to hypoglycemia. SGLT-2 inhibitors: Adverse Effects: female genital fungal infections, UTIs, increased urination, dehydration; in older adults: postural hypotension and dizziness. Minimize effects by educating pts on S/S of hypoglycemia, stay hydrated. SGLT-2 inhibitors: MOA: high-capacity, low-affinity transporter expressed chiefly in the kidney that accounts for approximately 90% of glucose reabsorption in the kidney; block the reabsorption of filtered glucose, leading to glucosuria (excretion in the urine). Associated w/caloric loss, thus providing a potential benefit of weight loss. SGLT-2 inhibitors: Therapeutic Goal: management of blood glucose in pt with T2DM; look for improvement in symptoms, including decrease in fatigue, plasma glucose, and A1c Sitagliptin: Side Effects: upper respiratory tract infection (most common), pancreatitis (manifested by abd pain and vomiting), Hypersensitivity (anaphylaxis, angioedema, stevens-Johnson syndrome). Use precaution in clients w/a history of pancreatitis or hypersensitivity. No contraindications. No drug interactions. Sulfonylurea : Sulfonylurea 1st^ gen & 2nd^ gen Both reduce glucose levels to the same extent. Contraindications : pregnancy & breastfeeding. Use with CAUTION in pts with renal or hepatic dysfunction Sulfonylurea: MOA : primarily by stimulating the release of insulin from pancreatic islets- if the pancreas is incapable of insulin synthesis, sulfonylureas will be ineffective (why they don’t work in T1DB ). Promote insulin release by binding with and thereby blocking ATP-sensitive K+ channels in the cell membrane, resulting in depolarization of the cell membrane permitting influx of Ca+, in turn causes insulin release. The extent of release is glucose dependent and diminishes when plasma glucose declines. Sulfonylurea: Pregnancy: Contraindicated during pregnancy and breast-feeding. Sulfonylurea: Side Effect : May increase target cell sensitivity to insulin. Hypoglycemia - regardless of the glucose level, it will go lower. This is more likely in pts with kidney or liver dysfunction because sulfonylureas are eliminated by hepatic metabolism and renal excretion. Use with caution in pts with renal or hepatic dysfunction. Cardiovascular toxicity : this is a concern with 1st^ gen sulfonylureas only. Thiazolidinediones (TZDs): Adverse Effects: Hypoglycemia but only in the presence of excessive
insulin (low risk with monotherapy). HF (black box warning)- can be precipitated or exacerbated secondary to fluid retention. Bladder cancer - will have painful urination or increased urgency (with prolonged high doses). Fractures (increased in women)- clients should take vitamin D and calcium and ensure adequate exercise and medications for osteoporosis if applicable. risk increases with long- term high dose therapy. Ovulation in premenopausal women can cause possible unintended pregnancy. Liver failure - rare but need to monitor LFTs. Contraindicated in clients with severe HF and hx of bladder cancer. Combining thiazolidinediones with insulin increases the risk of HF due to fluid retention.
half=life is prolonged 26 days. Black Box warning : carries a risk for anaphylaxis that may occur at any time during the course of tx. Pt should be notified of s/s that necessitate seeking medical care. Pts should be routinely monitored after administration in health care settings. Adverse effects: Most common are infection-site reactions, viral infection, URI, sinusitis, HA, and pharyngitis. Very small risk for cardiovascular problems and malignancy. Life-threatening anaphylaxis= urticaria and edema of the throat and/or tongue. Will most likely occur during the 1st^ dose but can occur after. Pts should be observed for 2hrs after the 1st^ 3 doses and 30mins after all subsequent doses in a facility equipped to handle emergencies. P. 565 Bronchodilators: provide symptomatic relief in pt w/asthma and COPD but do not alter the underlying inflammation. This is why most who require a bronchodilator also use an inhaled glucocorticoid for long-term suppression of inflammation. Monotherapy w/a bronchodilator is appropriate only when asthma is very mild and attacks are infrequent. B2 adrenergic agonists are the most effective for relieving acute bronchospasm and preventing EIB. Virtually all pts with asthma use these 1st^ line as a component of an asthma management regimen. They are approved for children 2+, may cause uterine relaxation so use caution in pregnancy , is NOT contraindicated in breast feeding however use caution. MOA : sympathomimetic drugs that activate B adrenergic receptors in smooth muscle of the lungs and promote bronchodilation and thus relieve bronchospasm. Can be administered oral or inhaled, effects may be brief or prolonged (all oral agents are long acting). SBAs are taken PRN to abort an ongoing attack. With EIB they are taken prior to exercise to prevent an attack. For severe acute attack in the hospital, SABA is nebulized. LABA is for those who experience frequent attacks for long-term control. Dosing is done on a fixed schedule NOT PRN. LABAS are preferred over SABA for pt with stable COPD. In asthma LABAs are not 1st^ line therapy and must always be combined with a glucocorticoid and never used alone as monotherapy due to associated death. Adverse effects of inhaled SABA: systemic effects of tachycardia, angina, and tremor. AE LABA: increase risk for severe asthma and asthma-related death when used as monotherapy for long-term control. Pt education : use proper technique, use spacer only 1 anti-TB agent is employed. 2+ drug therapy also reduces incidence of relapse. It is imperative to determine drug sensitivity in isolates from each pts at tx onset, unfortunate the process is slow. Initial drug selection is empiric based on patterns of drug resistance in the community and the immunocompetence of the pt. after test results have become available, the regimen should be adjusted accordingly. Int the even of tx failure, sensitivity tests should be repeated. Drug selection is based largely on the susceptibility of the infecting organism and the immunocompetence of the host. Life- span considerations are also a factor. Children: 1st^ line antitubercular drugs with the exception of rifapentine are approved for children 12+ yo. Ethambutol is usually reserved for children 8+. Pregnant: rifabutin is deemed safest. Primary Goal of Treatment: Cure the disease, decrease its transmission, and prevent development of antimicrobial resistance Pyrazinamide Indications : Bactericidal to M. Tuberculosis particularly those that are dormant. Currently the combination of pyrazinamide with rifampin, isoniazid, and ethambutol is a preferred regimen for initial therapy of active disease caused by drug-sensitive M. Tuberculosis. Rifabutin: Adverse Effects: Most common SE: rash, GI disturbance, and neutropenia. Other: Bodily fluid color change: red-orange urine, sweat, saliva, and tears. Uveitis and should be discontinued if ocular pain or blurred vision develops. Myositis, hepatitis, arthralgia, chest pain with dyspnea, and flu-like symptoms. Major SE: hepatotoxicity Rifampin: Adverse Effects : Generally tolerated well; at recommended dosages rarely causes significant toxicity. hepatotoxicity leading to hepatitis. Asymptomatic elevation of liver enzymes occurs in about 14% of pts, however the incidence of hepatitis is less than 1%. Hepatotoxicity is most likely in heavy ETOH drinker, and those with preexisting liver disease. Discoloration of body fluids: red-orange urine, sweat, saliva, and tears- it is harmless but can permanently stain soft contacts. GI disturbances: anorexia,
for those with difficulty with hand-breath coordination, assess peak expiratory flow daily and compare with personal best, keep records of theses assessments along with symptom frequency and symptom intensity, nighttime awakenings, effect on normal activity and SABA use. Those using metered-dose or dry-powder, when two inhalations are needed wait at least 1 minute between puffs. Report chest pain associated with changes in HR or rhythm as this could indicate cardiac stress secondary to adrenergic effects. Do not exceed prescribed dosage and if sx require increased frequency of SABA, notify provider. LABAs should be taken on a fixed schedule and always in combo with an inhaled glucocorticoid. Those taking oral b2s should be on a fixed schedule not PRN and sustained-release tabs should be swallowed intact. Oral b2 agonists: only used for long-term control and are NOT 1st^ line therapy. Methylxanthines: theophylline, caffeine and others. Most prominent action of these frugs are CNS excitation and bronchodilation with others including cardiac stimulation, vasodilation, and diuresis. Theophylline is the principal methylxanthine use in asthma with benefits of bronchodilation. It has a narrow therapeutic range, so dose must be carefully controlled. It is usually administered PO but may also be admined IV. MOA : produces bronchodilation by relaxing smooth muscle of the bronchi by most probable blockade of receptors for adenosine. PO is used for maintenance therapy of chronic stable asthma. Has a longer duration of action when administered in sustained-release formulation than b2. Can decrease frequency and severity of attacks when used regularly. Most appropriate for pts with nocturnal attacks. No longer routinely recommended in COPD. IT is metabolized in the liver and rates are affected by age, disease, drugs and show wide individual variation. Smoking accelerates metabolism and decreases the half life. Average half-life in children is 4hrs. Metabolism is slow in those with heart disease, liver disease, prolonged fever. Cimetidine, fluroquinolone decrease theo metabolism. Phenobarbital accelerates metabolism. Approved for children of all ages, including neonates but it is important to consider variable drug clearance across age ranges when dosing. Use caution in pregnancy, can use when breastfeeding as long as toxic levels are not detected. May cause toxic level in older adults. Toxicity sx: n/v/d, insomnia, restlessness, dysrhythmias (v-fib), convulsions nausea, abd discomfort, cutaneous reactions: flushing, itching, rash. High-dose therapy can cause flu-like ie: fever, chills, muscle aches, HA, and dizziness, SOB, thrombocytopenia, hemolytic anemia, shock, and acute renal failure. Rifampin: MOA : inhibits bacterial DNA- dependent RNA polymerase and thereby suppresses RNA synthesis and, consequently, protein synthesis. The results are bactericidal. The drug is lipid soluble and hence has ready access to intracellular bacteria. Because mammalian RNA polymerase are not affected, rifampin is selectively toxic to microbes. TB and HIV Coinfection : Infection with multi-drug-resistant organisms greatly increases the risk for death, sepecially among pts with AIDS. Treatment Regimens: Antituberculosis regimes must always contain 2+ drugs to which the infecting organism is sensitive- this reduces the risk for drug resistance, and incidence of relapse.
to a decrease in vascular permeability) this reduce bronchial hyperreactivity and decrease airway mucus production. May increase the number of bronchial B2 receptors as well as their responsiveness to B2 agonists. Inhaled glucocorticoids are 1 st^ line therapy for management of the inflammatory component of asthma. Oral glucocorticoids may be required for pts with moderate to severe persistent asthma or management of acute exacerbations of asthma or COPD- these are only prescribed when sx cannot be controlled with inhaled glucocorticoid or inhaled b2 agonists. Duration is short. Adverse effects : oropharyngeal candidiasis and dysphonia, with long-term use adrenal suppression may develop, can slow growth in children and adolescents (bone loss with less inhaled), prolonged therapy may increase risk for cataracts with high-dose inhaled glucocorticoids. Monitoring FEV1, peak flow, assess for candidiasis and glaucoma, adrenal insufficiency (hypoglycemia, hypotension, mental status changes especially in times of stress), growth patterns and adrenal suppression in children if taking inhaled glucocorticoids for >6 months. GOAL : use the lowest effective dose for the shortest duration (typically less than ten days in acute exacerbation) to manage symptoms effectively while minimizing risks. Monoclonal Antibodies Black Box Warning : Omalizumab- anaphylaxis that may occur at any time during the course of treatment (uticaria and edema of the throat and/or tongue) most likely with the 1st^ dose but can occur after receiving repeated doses with no apparent sensitivity. Pts should be observed for 2hrs after the first 3 doses and for 30mins after all subsequent doses. Asthma Control Assessment: p. 574 Asthma & COPD IA2:E44nhalation Devices Inhalation Devices: MDI, DPI, spacer, nebulizer. DPI used for dry, micronized powder directly to lungs and are breath activated, do not require hand-breath coordination needed with MDIs making them easier to use. DPIs deliver more drug to the lungs and less to the oropharynx and spacers are not needed. MDI : small hand-held pressurized devices that deliver a measured dose of drug with each actuation, dosing is accomplished with one or two inhalations and should be one minute apart. Hand-breath coordination is needed making it difficult to use correctly. With optimal use only
approximately 10% of the dose reaches the lungs and approx. 80% affects the oropharynx and is swallowed and the remaining 10% is left in the device or exhaled. Spacers attach directly to the MDI to increase delivery of the drug to the lungs and decrease the deposition of the drug on the oropharyngeal mucosa. Some spacers contain one-way valves that activates on inhalation obviating the need for good hand- breath coordination and some spacers contain an alarm whistle that sounds off when inhalation is too rapid, then maximizing effective drug administration. They can also prevent bronchospasm that may occur with sudden intake of an inhaled drug. Inhaled Glucocorticoids : some inhaled corticosteroids including budesonide, fluticasone, and memetasone can have drug interactions with CYP3A4 inhibitors including ketoconazole, itraconazole, clarithromycin, erythromycin, ritonavir, atazanavir, nelfinavir, saquinavir, and telithromycin, potential causing toxicity. Dosing: varies based on condition, severity, and client response, individualized, scheduled dosing NOT PRN, use with MDI, MDI with spacer, nebulizer. Administration : oral inhalation or nebulization. Client teaching: take after bronchodilator inhaler, proper technique, cleaning inhaler and mouthpiece regularly, rinse mouth after use to prevent irritation, monitor peak expiratory flow and symptoms regularly. Adverse reaction : oropharyngeal candidiasis, dysphonia, adrenal suppression (much lower risk than systemin- oral-glucocorticoids, but can occur with prolonged use, slowed growth in children. Precautions : long-term use may lead to bone loss and cataracts and glaucoma at high doses. Systemic Glucocorticoids - Should be use short-term (10 days or less), when they are used long-term, severe adverse effects are likely. Adrenal suppression is of concern, osteoporosis, hyperglycemia, peptic ulcer disease, and in young pts, growth suppression. During high levels of stress, glucocorticoids must be given at increased doses of oral or IV or failure to do so can prove fatal. IF prolonged use, the adrenal glands decrease their endogenous production of glucocorticoids and if meds are stopped suddenly as when switching from oral to inhalation, the pt can die. Oral Leukotriene Receptor Antagonists : Anti-inflammatory; zafirlukast or montelukast. MOA : inflammatory mediators released from leukocytes in response to an inhaled allergen.
30 mins after inhalation, peak in 3hrs, and persist about 24hr effective and dosing schedule is more convenient. Indicated only for long-term maintenance. AE : most common is dry mouth. Systemic anticholinergic effects (constipation, urinary retention, tachycardia, blurred vision). Adverse cardiovascular events. Phosphodiesterase-4 Inhibitors MOA: roflumilast is approved for management of CCOPD. It is NOT a 1st^ line drug, it is used for exacerbation prophylaxis in pts with severe CODP with primary chronic bronchitis component and a history of frequent exacerbations. Adverse Effects of LAMAs : when used along, may increase risk for severe asthma attack sand asthma-related death (not a concern with COPD)
Chapter 64 GERD PPIs: MOA : prodrug that converts to its active form inside the parietal cells, where it permanently binds to and deactivates the proton pump, where gastric acid is made, halting basal and stimulated gastric acid production. This blockade lasts until the body synthesizes new enzymes. PPIs take 2-3 days to reach maximum effect and are acid- activated. They irreversibly inhibit the H+, K+-ATPase enzyme system (Proton pump) in the stomachs parietal cells. Discontinuation of PPIs: relapse rate is high occurring in 80-90% of pts within 6- month for those with GERD. PPIs: Adverse Effects : Pneumonia (reduced gastric acidity can facilitate bacterial colonization of the stomach and respiratory tract, potentially causing this respiratory infection). Fractures (long-term use, especially in high doses, may increase the risk of osteoporosis due to decreased calcium absorption, which can lead to this adverse effect). Rebound Acid Hypersecretion (discontinuing PPIs can lead to dyspepsia from this side effect. To reduce this risk, clients should take the lowest dose for the shortest time). Hypomagnesemia (long-term therapy may reduce magnesium levels by reducing magnesium absorption, leading to this side effect and muscle cramps, seizures, and dysrhythmias). C. Diff (PPI use is associated with an increased risk of infection, potentially causing severe diarrhea). GI upset (Short-term therapy can lead to nausea, vomiting, and diarrhea). PPIs: Therapeutic Use : alleviation of symptoms, promotion of healing, and preventing complications and recurrence. most effective drugs for suppressing gastric acid secretion. PUD : cant treat (and prevent ulcers in ICU settings) by reducing acidity in the stomach and duodenum. GERD : used to alleviate sx of GERD by decreasing acid reflux into the esophagus. Zollinger-Ellison Syndrome : effective in managing sx and promoting ulcer healing due to acid hypersecretion in Zollinger-Ellison Syndrome. Therapeutic Use of Omeprazole : Used to treat PUD, GERD, Zollinger-Ellison Syndrome Sucralfate: Drug Interactions: Antacids (can reduce sucralfate effectiveness by increasing gastric pH above 4. Will hinger Chapter 66 Diarrhea Opioids: most effective antidiarrheal agents. Doses employed to relieve diarrhea, subjective and dependence do not occur. Diphenoxylate, difenoxin, loperamide, paregoric, and opium tincture are approved for diarrhea. Diphenoxylate and lopermide are most frequently prescribed. Opioids: MOA : opioid receptor in the GI tract are activated, these drugs decrease intestinal motility and thus slow down intestinal transit, which allows more time for absorption of fluid and electrolytes. Also, it decrease secretion of fluid into the small intestine and increases absorption of fluid and salt. The net effect is to present the large intestine with less water. As a result the fluidity and volume of stools are reduced and is the frequency of defecation. Inflammatory Bowel Disease (IBD) Glucocorticoids: dexamethasone and budesonide can relieve sx os UC and crohns. Benefits derive from anti-inflammatory actions. Prolonged use can cause severe adverse effects including adrenal suppression, osteoporosis, increased susceptibility to infection and cushing syndrome. Are indicated primarily for the induction of remission- NOT for long-term maintenance. IV or PO. PO budesonide is approved for mild to moderate crohs that involves the ileum and ascending colon. Immunosuppressants: used for long-term therapy in selected pts with UC and crohs. Experience is greatest with azathioprine and mercaptopurine. Induce and maintain remission in both. Onset of effects may be delayed for up to 6 months, these agents cannot be used for acute monotherapy. These are potentially more toxic than aminosalicylates or glucocorticoids, they are generally reseved for pt who have not responded to traditional therapy. Major AE are pancreatitis and neutropenia (secondary to bone marrow suppression). At does used for IBD, these are neither carcinogenic nor teratogenic. Infliximab : monoclonal antibody designed to neutralize TNF-a a key immunoinflammatory modulator. It is indicated for moderate to severe crohns and UC. AE: infections and infusion reactions (fever, chills, pruitius,
Pneumonia (reduced gastric acidity can facilitate bacterial colonization of the stomach and respiratory tract, potentially causing this respiratory infection ). Cardiac effects (hypotension and dysrhythmias can occur with IV administration). Candida in the stomach (reduced gastric acidity can cause this fungal infection in the stomach). Hematologic effects (neutropenia, leukopenia, and thrombocytopenia can rarely occur). Cimetidine: MOA : H2Ras block H histamine receptors on the parietal cells in the stomach lining, reducing gastric acid volume and hydrogen ion concentration. This results in suppressed gastric acid secretion. H2Ras do not affect H1 receptors and, therefore, do not impact allergic responses. Cimetidine: Therapeutic Goal: relieve pain, promote healing, prevent ulcer recurrence, and prevent complications of PUD. promotes healing of gastric and duodenal ulcers. treatment of GERD and PUD: inhibit the action of histamine on the receptors of gastric parietal cells, reducing gastric acid secretion. Combination Antibiotic Therapy Drug Selection: all pts with gastric or duodenal ulcers and documented H. Pylori should be treated with abx (clarithromycin, amoxicillin, bismuth, tetracycline, metronidazole, and tinidazole) NSAID-induced ulcer prophylaxis: for those with risk factors for ulcer development (60+ yo, hx of ulcers, high-dose NSAID therapy) PPIs (omeprazole) are preferred. Misoprostol is also effective but can cause diarrhea. Antacids, sucralfate, and H receptor blockers are not recommended. PPI Alternatives : (Prilosec, Prilosec otc, zegerid, zegerid otc, losec,) antacids Chapter 65used in combination Constipation Laxatives in Pregnancy ; loperamide has advise against it. Laxatives can induce labor through GI stimulation and should be used cautiously. Osmotic Laxatives : Contraindications : magnesium salts use in pts with kidney disease sodium phosphate is contraindicated for clients with HF, HTN, edema, and those at risk of acute renal failure. Lubiprostone Indications: IBS-C in women. amnestic qualities. Cannabinoids : Cautions: temporal disintegration, dissociation, depersonalization, and dysphoria. Tachycardia, hypotension- must be used in caution in pts with cardiovascular diseases. Drowsiness and should not be combined with etoh, sedatives, or CNS depressants. Contraindicated for pts with psychiatric disorders. Cannabinoids : Indications: both dronabinol an nabilone are approved for suppressing CINV, are considered 2nd^ line drugs for CINV, dronabinol is approved for stimulating appetite in pts with AIDS. Serotonin receptor antagonists : Ondansetron: MOA: block type 3 serotonin receptors (5-HT3 receptors) located in the CTZ of the medulla and on afferent vagal neurons in the upper GI tract, effectively preventing nausea and vomiting. Primary function : most effective meds for treating N/V caused by cancer treatment, anesthesia, viral gastritis, and pregnancy. Adverse reactions: HA, dizziness (most common side effect). Diarrhea, Prolong QT interval (abnormality on ECG can cause torsades de pontes, a life-threatening arrhythmia. Should not be given to clients with prolonged QT intervals.
Selective activation of choride channels of the intestine. Patient Education Laxative Abuse Laxative Abuse Cause
colon, bacteria convert these lignans into enterolactone and enterodiol, compounds that have both mild estrogenic and antiestrogenic action. The antiestrogenic actions can decrease cellular proliferation in breast tissue. Garlic Drug Interactions: antiplatelet effects. It can increase the risk for bleeding in pts taking antiplatelet drugs ie: aspirin or anticoagulants ie: warfarin and heparin. Can reduce levels of at least two drugs: cyclosporine (and immunosuppressant) and saquinavir (a protease inhibitor used to treat HIV). and chronic COPD) and Pde inhibitors are proving to be important drugs in managing these. Role of marketing Saw Palmetto Indications : relieve urinary symptoms associated with PBH and for the treatment of adrogenic alopecia. Soy Indications and Cautions : indications prevention of breast cancer and in postmenopausal woman treatment of vasomotor symptoms (hot flashes) and prevention of osteoporosis. Cautions : GI bloating, nausea, constipation, diarrhea are most common. Rarely can cause migraine probably due to its estrogenic effects. Large amounts may increase risk for oxalate kidney stones. Goiter and hypothyroidism in infants who drank soy formula. Should NOT be combined with tamoxifen and other drugs that can block estrogen receptor. By killing intestinal flora, abx may reduce conversion of isoflavones to their active form, thus decreasing any potential positive effects of soy. Should not be combined with MAO inhibitors. St. John's wort Indications : used PO for mild to moderate depression and relieve pain and inflammation and topically to manage local infection. St. John's wort Side Effects : allergic skin reaction especially in people allergic to ragweed and daisies. May cause CNS effects (insomnia, vivid dreams, restlessness, anxiety, agitation, and irritability), GI discomfort, fatigue, dry mouth, and headache. High-dose therapy may pose a risk for phototoxicity. Valerian Contraindication : performing dangerous activities. Caution by people with psychiatric illnesses. Should not be used in pregnancy or breastfeeding. Valerian Drug Interactions : CNS- depressants ie: ETOH, benozos, barbiturates, opioids, antihistamines and centrally acting skeletal muscle relaxants.
Week 1 Blood Flow Impact on Distribution : the drugs ability to exit the vascular system and enter cells, and the degree of plasm protein binding. Well-perfused organs and tissues like the heart, liver, and kidneys, generally receive drugs more rapidly. Pathological conditions like abscesses or tumors can be difficult to treat with drug therapy due to their low regional blood flow. Blood-Brain Barrier Impact First-Pass Effect : the concentration of a drug is significantly reduced after metabolism in the liver before it reaches systemic circulation. This is particularly important for oral drugs, which pass through the liver and may be extensively metabolized, reducing their bioavailability. Lipid Solubility and Absorption Medication Administration Placental Drug Transfer Week 3 Adverse Psychological Effects of High- Dose Marijuana: hallucination, delusion, and paranoia. Euphoria may be displaced by intense anxiety and dissociative state may occur in which the user feels outside of himself or herself. In extremely high doses it can produce a state resembling toxic psychosis which may persist for weeks. Codeine and Analgesic Efficacy : indicated for relief of mild to moderate pain. It is formulated alone and in combination with nonopioid analgesics. The combination can produce greater pain relief than either agent alone. Fentanyl Transmucosal Use : approved only for breakthrough cancer pain in pts at least 18 yo who are already taking opioids round- the-clock and have developed some degree of tolerance, defined as needing for 1 week or longer at least 60mg or PO morphine a day or 30mg of PO oxycodone a day or 25mg of PO Oxymorphone a day or 8mg PO hydromorphone a day or 25mcg of fent per hour or an equianlgesic dose of another opioid. Must not be used for acute pain, postop pan, HA, or athletic injuries. These are not interchangeable on a microgram for microgram baisis. Opioid Withdrawal Opioids in Pregnancy : taking opioids in early pregnancy can increase the risk for congenital heart defects, spina bifida, and gastrochisis. Week 2 ACE Inhibitors : (lisinopril).interferes with the renin-angiotensin-aldosterone system (RAAS). Treat HTN, HF, and diabetic nephropathy, are indicated for MI and prevention of cardiovascular events in pts at risk. ACE Inhibitors Advantages. P Loop Diuretics MOA : inhibiting Na and Cl reabsorption in the nephrons loop of henle to produce significant diuresis and subsequent fluid volume reduction. Regulation of Arterial Pressure Spironolactone: MOA : blocks receptors for aldosterone but also binds with receptors for other steroid hormones (glucocorticoids, progesterone, androgens). Blockade of Week 4 Alendronate: primarily used in the prevention and tx of osteoporosis in postmenopausal women and is approved for the tx of osteoporosis in men. Is 1st^ choice for the prevention and tx of GIOP a common complication of glucocorticoid therapy in that it helps restore lost bone and many reduce the risk for fractures in this instance. Also is 1 st^ line tx for Paget disease. MOA ; approx. 50% is taken up rapidly by bone and after it has become incorporated into bone it remains there for years and sometimes decades. It suppresses resorption of bone by decreasing both the number and activity of osteoclasts. As osteoclasts begin to resorb alendronate- containing bone, the infest some of the drub
