pharmacology exam 2

what precautions should be taken while a patient is on tacrolimus (prograf)

Avoid grapefruit juice and take on an empty stomach. Avoid high fat and carbohydrate foods which may negatively impact absorption

what are some adverse effects of colchicine (Colcrys)

bleeding into GI or urinary tracts, contraindicated in renal, gi, hepatic, cardiac disorders, blood dyscrasias

what are some adverse effects for metformin

bloating, nausea, cramping, diarrhea, etc... usually subsides with use

if an adult is taking 81mg of asprin, which is the usual baby dose, what could that indicate?

cardiac history, treatment and prevention of acute MI and other thromboembolic disorders

your patient is unconscious and has an IV in the left antecubital space, but appears hypoglycemic. what would you do?

check blood sugar to confirm, and administer D50W (50% dextrose in water) by IV

your patient is awake and able to swallow, but appears hypoglycemic. what would you do?

check blood sugar to confirm, and administer an oral concentrated form of glucose- buccal tablet/semisolid gel

if potassium is given to a patient who is on non-K+ sparing diuretics, amphotericin B, and mineralocorticoids, what would happen?

hypokalemia

why would potassium phosphate be given

if phosphate level is low

mycophenolate mofetil (CellCept) is what kind of drug

immunosuppressant- antimetabolite

cyclosporine (Sandimmune) is what kind of drug

immunosuppressant- calcineurin inhibitor

tacrolimus (Prograf) is what kind of drug

immunosuppressant- calcineurin inhibitor

when is acarbose (precose) contraindicated?

in all bowel diseases, bc works in bowel--> inflammatory BD, malabsorption syndrome, intestinal obstruction *does not cause hypoglycemia, hyperinsulinema, or weight gain like most other drugs*

what are important nursing implications for antigout drugs

increase fluids 3L/day, avoid alcohol and caffeine

your patient has difficulty swallowing, is unconscious and has no IV access, but appears hypoglycemic. what would you do?

check blood sugar to confirm, roll pt onto side, and administer glucagon injection

when should pioglitazone (actos) NOT be given

class 3 or 4 heart failure, be cautious in pts. with renal/hepatic disease, bc this drug works in the liver and is excreted by kidneys

what kind of therapeutic effects do we look for when a patient is on somatropin

increased growth in children

what is the general therapeutic effect of diuretics?

increased urine output

mechanism of action for acarbose (precose)

inhibits alpha glucosidase enzyme--> stops transformation of polysaccharides to glucose--> causes delayed absorption of glucose *prevents postprandial spikes, but not good for controlling glucose all day, usually used w/ another drug*

mechanism of action for canagliflozin (invokana)

inhibits glucose reabsorption in proximal renal tubules *completely independent of insulin, so can also be used in type 1*

what is the primary treatment for type 1 diabetes?

insulin

name a gliptin that can increase digoxin toxicity

januvia (stagliptin)

black box warning for metformin

lactic acidosis, renal failure

bumetanide (Bumex) and furosemide (Lasix) are which kind of diuretics?

loop diuretics

which class of diuretics is most potent?

loop diuretics

name an oral antidiabetic from the biguanide class that does not increase insulin secretion from the pancreas

metformin

fludrocortisone acetate (Florinef) is what kind of drug

mineralocorticoid, adrenal drug

vasopressin (Pitressin) and Desmopressin(DDAVP) are what types of pituitary drugs and what do they do

posterior pituitary, mimics action of ADH

which kind of diuretic is spironolactone (Aldactone)

potassium sparing

which class of diuretics is least potent?

potassium-sparing diuretics

what is mycophenolate mofetil (CellCept) used for

prevention and treatment of organ rejection in kidney, liver and heart transplantation

how does mycophenolate mofetil (cellcept) work

prevents proliferation of T cells by inhibiting intracellular purine synthesis

what kind of NSAID is Ibuprofen (Motrin, Advil) and Naproxen (Naprosyn, Aleve)

propionic acid derivatives

what is the MOA for loop diuretics

work along the ascending limb of the loop of Henle block chloride and 2nd sodium resorption activate renal prostaglandins

a nurse is preparing to give a mixed insulin to her patient. she first draws 70% NPH into the syringe, and then 30% novolog. what did she do wrong?

wrong order. always draw regular/rapid acting insulins first, then intermediate/long acting

most/all sulfonylurea drugs end in...?

"-ide"

corticosteroids (adrenal drugs) all end in what?

"-one"

MOA for corticosteroids

-exert their effects by modifying enzyme activity, inhibit or help control inflammatory and immune responses -differ in their potency, duration of action, and the extent to which they cause salt and water retention

what are normal AST levels

0-35

describe the crystalloid half-normal saline

0.45% NaCl, Hypotonic- Solutions with lower concentrations are available (may cause lysis of RBCs). Fluid moves from vein into tissues/cells.

what is the normal level for creatinine

0.6 to 1.5 mg/100 mL

describe the crystalloid normal saline

0.9% NaCl, Isotonic- Physiologically normal concentration. No net fluid movement from vein into tissues/cells.

what is the peak for rapid acting insulin

1-2 hours (5-15 minutes feels like 1-2 hours during 3-5 rapid admissions)

what is the onset of NPH insulin

1-2 hours (nurses play hero once or twice every 4-8 hours to kids 10-18 years old)

what is the onset of long acting insulins?

1-2 hours (one of the 2 long nursing shifts never peaked but lasted 24 hours)

insulins premixed in syringes can be stored for how long?

1-2 weeks under refrigeration in a vertical position, needles pointing up

how would you treat a potassium OD

1. IV dextrose and insulin, sodium bicarbonate and calcium gluconate or chloride. Cause a rapid intracellular shift of K+ ions reducing the serum potassium concentrations. 2. Sodium polystyrene sulfonate (Kayexalate) 3. hemodialysis- for extremes

what is the duration of NPH insulin

10-18 hours (nurses play hero once or twice every 4-8 hours to kids 10-18 years old)

what is the normal range for sodium

135-145mEq/L

why would you use a thiazide or thiazide like diuretic

1st line HTN drug Edema Idiopathic hypercalciuria Diabetes insipidus Hepatic cirrhosis

what is the peak for humulin r (regular insulin)

2.5 hours (short staffed nurses went from 30-60 patients in 2.5 hours during their 6-10hr shift)

what is the duration of long acting insulins

24 hours (one of the 2 long nursing shifts never peaked but lasted 24 hours)

describe the crystalloid high alert saline

3% NaCl, Hypertonic-If infused too rapidly leads to osmotic demyelination syndrome and irreversible brainstem damage. Fluids move from interstitial fluid to veins

what is the duration of rapid acting insulin

3-5 hours (5-15 minutes feels like 1-2 hours during 3-5 rapid admissions)

what is the normal range for potassium

3.5-5.mEq/L

when should metformin be administered

30 minutes before breakfast and dinner

what is the onset of humulin r (regular insulin)

30-60 min (short staffed nurses went from 30-60 patients in 2.5 hours during their 6-10hr shift)

what is the normal urine output measurement

30cc/hr. 240cc/8 hrs

what is the peak for NPH insulin

4-8 hours (nurses play hero once or twice every 4-8 hours to kids 10-18 years old)

what is the onset for rapid acting insulin

5-15 minutes (5-15 minutes feels like 1-2 hours during 3-5 rapid admissions)

what is the duration of humulin r (regular insulin)

6-10 hours

what is the normal total body protein level

7.4g/dL

what is the normal BUN level

8 to 25 mg/100 mL

what are normal hemoglobin A1C levels

<7% (6% is better)

A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible for hypoglycemia? A. 1900 B. 1300 C. 1130 D. 1500

A. 1900

You administered 5 units of Humalog at 0800. What is the ONSET and DURATION of this medication? A. Onset: 15 minutes, Duration: 3 hours B. Onset: 2 hours, Duration: 16 hours C. Onset: 30 minutes, Duration: 1 hour D. Onset: 2 hours, Duration: 24 hours

A. Onset: 15 minutes, Duration: 3 hours

why would Cryoprecipitate and plasma protein factors (PPF) be given

Acute bleeding (greater than 50% slow blood loss or 20% acutely)

A patient newly diagnosed with diabetes is about to be discharged home. You are watching the patient administer insulin. Which of the following actions causes you to re-educate them? A. They massaged the site after administering the insulin. B. They injected into the fat of their thighs. C. They used an opposite side for injection compared to the last insulin injection. D. They engaged the safety after administering the medication.

A. They massaged the site after administering the insulin.

what labs should be checked when a patient is on Actos

AST and ALT

what are corticosteroids used for

Adrenocortical deficiency Cerebral edema Collagen diseases Dermatologic diseases GI diseases Exacerbations of chronic respiratory illnesses, such as asthma and COPD Organ transplant (decrease immune response) Palliative management of leukemia and lymphoma Spinal cord injury

what are some adverse effects of tacrolimus (prograf)

Agitation, anxiety, confusion, hallucinations, neuropathy, albuminuria, dysuria, acute renal failure, renal tubular necrosis, post transplant diabetes mellitus.

what are the 2 most commonly used colloids

Albumin 5% and 25% (from human donors) Dextran 40, 70, or 75 (a glucose solution) Hetastarch (synthetic, derived from cornstarch)

what do NSAIDs interact with?

Alcohol=increased gi bleeding Anticoagulants=increased bleeding Corticosteroids, other ulcerogenic drugs Protein bound drugs=competes for binding

NSAIDs indications

Analgesia (mild to moderate) Antigout effects Antiinflammatory effects Antipyretic effects Relief of vascular headache Platelet inhibition (aspirin)

what are NSAIDs used for

Analgesic Antiinflammatory Antipyretic Antiplatelet

when would you not use a thiazide or thiazide like diuretic

Anuria, severe renal failure

A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of mixing these insulins? A. These insulins cannot be mixed, therefore, should be drawn up in different syringes. B. Draw-up the Humulin R insulin first and then the NPH insulin. C. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of NPH. D. Draw-up the NPH insulin first and then the Humulin R insulin

B. Draw-up the Humulin R insulin first and then the NPH insulin. - remember "clear to cloudy", regular(short acting) to NPH intermediate

A patient is scheduled to take a morning dose of Metformin. The patient is scheduled for surgery tomorrow. Which of the following nursing interventions are correct? A. Administer the medication as ordered. B. Hold the dose and notify the doctor for further orders. C. Administer the medication as ordered but hold the next day's dose. D. Check the patient's blood glucose prior to administering the medication.

B. Hold the dose and notify the doctor for further orders.

when is canagliflozin (invokana) contraindicated

DKA, renal impairment

what are some things to keep in mind while a patient is on an antithyroid drug

Better tolerated when given with food Give at the same time each day to maintain consistent blood levels Never stop these medications abruptly Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)

why are crystalloids used

Burns Shock- causes BP to drop Hemorrhage Mild hyponatremia Severe vomiting or diarrhea, dehydration Metabolic disorders i.e. Diabetic Ketoacidosis Administration of blood products -just to maintain body systems

A patient is scheduled to take 7 units of Humulin R at 0830. You administer Humulin R at 0900 in the right thigh. When do you expect this medication to peak? A. 1300 B. 0930 C. 1100 D. 1700

C. 1100

After the patient on cyclosporine (Sandimmune) gets home, she calls the office to ask about eating grapefruit. I thought the doctor said I could have a little bit. I have a wonderful grapefruit tree in my backyard, and I love fresh grapefruit juice. What should I do?" What is the nurse's best answer?

DO NOT EAT THE GRAPEFRUIT. CUT THE TREE DOWN

Which of the following insulins has no peak but a duration of 24 hours? A. NPH B. Novolog C. Lantus D. Humulin N

C. Lantus

A patient taking the medication Precose asks when it is the best time to take this medication. Your response is: A. 1 hour prior to eating B. 1 hour after eating C. With the first bite of food D. At bedtime

C. With the first bite of food

Which of the following insulins can be administered intravenously? A. NPH B. Lantus C. Humulin R D. Novolog

C. humulin R

what kind of NSAID is celecoxib (Celebrex)

COX 2 inhibitor

how is celecoxib (Celebrex) different from other NSAIDs

COX 2 inhibitor, less GI effects, but same anti-inflammatory benefits

what are some adverse effects of levothyroxine (synthroid)

Cardiac dysrhythmia is the most significant May also cause: Tachycardia, palpitations, angina, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss, appetite changes, sweating, heat intolerance, others

what are some adverse effects of corticosteroids

Cardiovascular- Heart failure, cardiac edema, hypertension—all caused by fluid retention and electrolyte imbalances (hypokalemia, hypernatremia) CNS- Convulsions, headache, vertigo, mood swings, nervousness, insomnia, "steroid psychosis," others Endocrine- Growth suppression, Cushing's syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others GI- Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others Integumentary- Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria Musculoskeletal- Muscle weakness, loss of muscle mass, osteoporosis Ocular- Increased intraocular pressure, glaucoma, others

what are some adverse effects of antithyroid drugs

Central nervous Drowsiness, headache, vertigo, paresthesia Gastrointestinal Nausea, vomiting, diarrhea, hepatitis, loss of taste Genitourinary Smoky urine, decreased urine output Hematologic Agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, lymphadenopathy, bleeding Integumentary Rash, pruritus Musculoskeletal Myalgia, arthralgia Renal Increased blood urea nitrogen and serum creatinine levels Other Enlarged thyroid gland, nephritis

what are some signs of possible thyroid toxicity

Chest pain, weight loss, palpitations , tremors, sweating, nervousness, shortness of breath or insomnia

what is the black box warning fro mycophenolate mofetil (cell cept)

Congenital malformations and spontaneous abortions when used in pregnancy

what are some adverse effects of osmotic diuretics

Convulsions Thrombophlebitis Pulmonary congestion exfolative dermatitis

what kind of oral antidiabetic is stagliptin (januvia)

DPP-IV inhibitor (gliptins)

what therapeutic effects are we looking for with loop diuretics

Decreased fluid volume causes a reduction in: Blood pressure Pulmonary vascular resistance Systemic vascular resistance Central venous pressure Left ventricular end-diastolic pressure

what do thiazide and thiazide-like diuretics interact with

Corticosteroids, digitalis, oral hypoglycemics

A patient has a blood glucose of 45 and is sweating, cold, and clammy. The patient is conscious. What is your next nursing intervention? A. Recheck the blood glucose in 5 minutes. B. Call the doctor for further orders. C. No intervention is needed because this is a normal blood glucose. D. Give the patient 3 graham crackers to eat.

D. Give the patient 3 graham crackers to eat.

when would you not give a patient potassium

Known allergy Hyperkalemia Severe renal disease Acute dehydration Untreated Addison's disease Severe hemolytic disease Extensive tissue breakdown (multiple trauma, severe burns)

what are some adverse effects of potassium sparing diuretics

Dizziness Headache GI - cramps, NVD Hyperkalemia Gynecomastia Amenorrhea Irregular menses Postmenopausal bleeding

when should corticosteroids not be given

Drug allergies Serious infections, including septicemia, systemic fungal infections, and varicella Cautious use in patients with Gastritis, reflux disease, ulcer disease, Diabetes- can cause hyperglycemia, Cardiac/renal/liver dysfunction- can cause fluid retention=overload

why would you use an osmotic diuretic

Early, oliguric (low urine o/p) phase of acute renal failure (ARF). Increase in renal blood flow resulting from dilation of vessels supplying blood to the kidneys= allows more filtration to take place=more urine Promote excretion of toxic substances Reduce intracranial pressure and cerebral edema from trauma

when would you not give a patient sodium

Elevated serum sodium levels, edema, HTN

T or F misoprostol (Cytotec) is the only NSAID that is safe for pregnant women

FALSE- never safe for pregnant women, causes abortions

what are some adverse effects of octreotide (sandostatin)

GI disturbances, hypo/hyperglycemia

when should pramlintide (symlin) not be used

Gastroparesis With other meds that alter GI motility

what is octreotide (Sandostatin) used for

Gigantism in children, acromegaly in adults, carcinoid tumors and esophageal varicies

how to you avoid most GI effects when giving an NSAID, such as asprin?

Give asprin with food, milk or meals to avoid GI irritation

what forms are loop diuretics given in

Given IV or orally, initially IV, sent home on oral

what are some adverse effects with sulfonylureas

HYPOglycemia (from an OD, not eating), weight gain, epigastric fullness, heartburn, allergies

what are some adverse effects of somatropin (humatrope)

Headache, hyperglycemia, hypothyroidism, hypercalciuria, rash, urticaria (hives), flu like symptoms

why would you use a potassium sparing diuretic

Hyperaldosteronism- bc. blocks it Hypertension Reversing potassium loss caused by potassium-losing drugs HF due to diastolic dysfunction Children with heart failure (often accompanied by excess secretion of aldosterone) Ascites from cirrhosis of the liver

when would you not use potassium sparing diuretics

Hyperkalemia, level exceeding 5.5 Severe renal failure Anuria- no urine o/p

what are some adverse effects of thiazide and thiazide like drugs and how are they controlled

Hypokalemia Elevate levels of calcium, lipids, glucose, uric acid Headache, impotence, decreased libido- more subjective complaints Metolazone: dizziness and vertigo -usually from excessive fluid and electrolyte loss which are usually dose related and controlled by titration

what are some adverse effects of loop diuretics

Hypokalemia-may need K+ supplement ototoxicity nephrotoxicity/neurotoxicity increased effects with thiazides

what do blood products do

Increase colloid osmotic pressure and plasma volume Increase body's supply of various products (e.g., clotting factors, hemoglobin) Pull fluid from extravascular space into intravascular space (plasma expanders) Red blood cell (RBC) products also have the ability to carry oxygen. Can maintain COP for hours to days- long lasting

how would you treat hypernatremia

Increase fluid intake Dietary restriction of sodium D5W or D10W Too rapid correction may cause brain edema.

why would diabinese and other antidiabetics from the sulfonylurea class produce weight gain?

bc stimulates beta cells of pancreas to produce more insulin, insulin=fat hormone

NSAIDs mechanism of action

Inhibition of the leukotriene pathway, the prostaglandin pathway, or both

how does tacrolimus (prograf) work

Inhibits T-cell activation, possibly by binding to an intracellular protein known as FKBP-12

how does cyclosporine (sandimmune) work

Inhibits activation of T cells by blocking the production and release of IL2(interleukin 2)

what should you teach your patient to report when giving NSAIDs?

Instruct patient to report black or tarry stools, bleeding around gums, petechiae, ecchymosis (bruising), purpura(big purple spots)

metformin (glucophage) is what type of oral antidiabetic?

biguanides

what does potassium interact with

K+ sparing diuretics ACE inhibitors Non K+ sparing diuretics Amphotericin B Mineralocorticoids

why would potassium chloride be given

Low chloride is often associated with low potassium

how would you treat hyponatremia

Mild - oral administration of NaCl tablets /fluid restriction Severe - IV normal saline/lactated Ringer's solution Hypertonic saline is sometimes used. Conivaptan (Vaprisol) - inhibits the effectiveness of ADH

what is the mechanism of action for pramlintide (symlin)

Mimics the natural hormone amylin-->Slows gastric emptying-->Suppresses glucagon secretion, reducing hepatic glucose output helps with appetite and satiety, used when other drugs have not achieved adequate glucose control

why is potassium so important in the body

Muscle contraction Transmission of nerve impulses Pacemaker function of the heart Maintenance of acid-base balance Isotonicity Maintain electrodynamic characteristics of the cell

which insulin is intermediate acting

NPH (isophane insulin suspension- cloudy)

what are the adverse effects of pramlintide (symlin)

Nausea, vomiting, Anorexia, Headache

what are some adverse effects of giving sodium

Nausea, vomiting, cramps if given orally IV administration can cause Venous phlebitis

how do you avoid most GI effects when giving an NSAID that is not asprin?

Non-aspirin NSAIDS may be taken with antacids to decrease GI upset

how does gout form?

Overproduction of uric acid or decreased excretion or combo of both= Hyperuricemia= uric acid crystals collect in tissues and joints=inflammation and pain

what are some important things to assess before administering crystalloids

Patients medical hx, Esp GI, Renal Cardiac Hepatic system Medication hx, dietary hx- for all drugs Fluid vol and electrolyte status (older adults and peds have increased sensitivity to fluids and electrolytes) Assess skin turgor

why would whole blood be given

Same as for PRBCs, except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume because whole blood also contains plasma and increases the circulating blood volume. Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues Useful in acute blood loss (Trauma or surgery) Volume expansion in extensive burns, dehydration or shock.

what are some things that should be considered when administering octreotide (sandostatin)

Use with caution in patients with renal impairment. Monitor glucose levels in patients with diabetes and even in those who do not have diabetes. Can be given intravenously, intramuscularly, or subcutaneously. Give injections without food or at bedtime to minimize symptoms

what therapeutic effects are we looking for with osmotic diuretics

Vasodilation, increasing glomerular filtration and renal plasma flow, prevents kidney damage during acute renal failure Reduces intracranial pressure or cerebral edema associated with head trauma- go to diuretic for increased ICP Reduces intraocular pressure

what is tacrolimus (prograf) used for

Prevention of organ rejection and other unlabeled uses in autoimmune diseases and severe psoriasis

what is cyclosporine (sandimmune) used for

Prevention of organ rejection, treatment of rheumatoid arthritis and psoriasis

what are some adverse effects of cosyntropin (cortrosyn)

Renal retention of sodium, edema, hypertension

canagliflozin (invokana) belongs to which class of oral antidiabetics

SGLT2 inhibitors

what kind of NSAID is asprin

Salicylates

why would you give a patient potassium

Treatment or prevention of potassium depletion when dietary means are inadequate Stop irregular heartbeats Management of tachy-dysrhythmias that can occur after cardiac surgery

what are some signs of hypokalemia

Serum K+ level < 3.5mEq/L Hypotension Lethargy Mental confusion Muscle weakness Nausea Increase digoxin toxicity and cause serious arrhythmias Later: cardiac arrhythmias, neuropathies and paralytic ileus

what are some signs of hyperkalemia

Serum level K+ > 5.5 mEq/L Generalized fatigue, often related to the heart Weakness Paresthesia, Palpatations Paralysis

what are some signs of hyponatremia

Serum sodium levels < 135 mEq/L Lethargy/fatigue Hypotension Stomach cramps Vomiting Diarrhea Seizures anorexia confusion headache

what are some signs of hypernatremia

Serum sodium levels > 145 mEq/L Anorexia, restlessness Lethargy Muscle weakness Nausea Thirst Elevated Blood Pressure Edema

why would you administer colloids

Shock Burns When plasma volume expansion is needed Rapid onset, long duration

what does a basic metabolic panel consist of

Sodium Na PotassiumChloride KCL Carbon dioxide CO2 Glucose BUN Creatinine

why would you give a patient sodium

Sodium is primarily administered for Treatment or prevention of sodium depletion when dietary measures are inadequate

what are crystalloids

Solutions containing fluids and electrolytes that are normally found in the body- DO NOT CONTAIN PROTEINS

what is somatropin (humatrope) used for

Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism Long term replacement therapy for children who have growth failure because of inadequate endogenous growth hormome wasting associated with HIV

what is cosyntropin (cortrosyn) used for

Stimulates release of cortisol from adrenal cortex Antiinflammatory effect Used to diagnose adrenocortical insufficiency Wasting associated with HIV Promotes renal retention of sodium

what do we need to teach patients when they are prescribed levothyroxine (synthroid)

Teach patient to take thyroid drugs once daily in the morning, ½ - 1 HOUR before breakfast on an EMPTY stomach- for best absorption, take meds at the same time every day and do not switch brands, report any unusual symptoms, chest pain, or heart palpitations, do not take over-the-counter medications without physician approval, effects may take several months to occur, alert health care providers of thyroid medication use bc can enhance activity of anticoagulants, need increased dosages of hypoglycemic meds, decrease serum digoxin levels

what is the primary side effect of immunosuppressant medications

The primary side effect of immunosuppressant medications is the development of opportunistic infections

why would packed red blood cells be given

To increase oxygen-carrying capacity in patients with: anemia, substantial hemoglobin deficits, and who have lost up to 25% of their total blood volume- don't add much to BV

how do potassium sparing diuretics work?

Work in collecting ducts and distal convoluted tubules; block the aldosterone receptors used as adjuncts to thiazides

how do thiazide and thiazide-like diuretics work

Work in the distal convoluted tubule to inhibit resorption of sodium, potassium and chloride Osmotic water loss Relax small blood vessels Reduced peripheral vascular resistance (afterload) Decreased preload or filling pressures Decreased afterload (force ventricles must overcome to eject the volume of blood they contain)

how do osmotic diuretics work

Works in the proximal tubule and descending loop of henle Increases osmotic pressure in the glomerular filtrate which pulls water into the renal tubules from the surrounding tissues =Inhibits tubular resorption of water and solutes, thus producing rapid diuresis

what are some signs of lactic acidosis

abdominal discomfort, decreased appetite, diarrhea, fast/shallow breathing, muscle pain/cramping, sleepy/tired

what kind of NSAID is ketorolac (Toradol)

acetic acid derivatives

what are some adverse effects of allopurinol (Zyloprim)

agranulocytosis, aplastic anemia, steven-johnsons skin condition

why would you not administer colloids

allergy, hypervolemia, heart failure

acarbose (precose) belongs to which class of oral antidiabetics

alpha-glucosidase inhibitors

what kind of injectable antidiabetic is pramlintide (Symlin)

amylin agonist (mimetic)

Somatotropin (Serostim, Humatrope) is what kind of pituitary drug and what does it do

anterior pituitary, mimics growth hormone

Cosyntropin (Cortrosyn) is what kind of pituitary drug and what does it do

anterior pituitary, stimulates production of hydrocortisone

what is allopurinol (Zyloprim) used for?

antigout- Inhibits enzyme xanthine which prevents uric acid production, indicated for patients whose gout is from excess production of uric acid

what is colchicine (Colcrys) used for?

antigout-Reduces inflammatory response to deposits of urate crystals in joint tissue. Used in short-term treatment of acute gout

what do methimazole (Tapazole) and propylthiouracil (PTU) do

antithyroid drugs, not to cure hyperthyroidism but to palliate it. inhibits iodine=stops formation of thyroid hormone

what are some early signs of an allergic reaction to a blood transfusion

anxiety, swelling, difficulty breathing, joint/back pain

what is the preferred method of insulin treatment for hospitalized patients?

basal-bolus insulin dosing. delivers basal insulin constantly (mimics pancreas), and then as needed as a bolus. basal insulin is a long acting (lantus), and bolus is a rapid acting (humalog)

why would potassium acetate be given

corrects acidosis

when should stagliptin (januvia) be given

daily

when should sulfonylureas be given?

daily with breakfast

what are some signs of renal failure?

decreased urinary output, edema, unusual creatinine/BUN levels

what is the mechanism of action of metformin

decreases production of glucose in the liver--> decreased glucose absorption in intestines--> improves insulin receptor sensitivity

what is the mechanism of action for stagliptin (januvia)

delays breakdown of incretin (stimulates insulin prod. after eating) hormone--> increases insulin synthesis--> lowers glucagon secretions--> slows gastric emptying time *results in better, longer lasting incretin*

what is Radioactive iodine (I131) used for

destroys thyroid gland in cases of hyperthyroidism

what are vasopressin (Pitressin) and desmopressin (DDAVP) used for

diabetes insipidus, vasopressin is also used for Hypotensive emergencies such as vasodilatory shock (septic shock), Advanced Cardiac Life Support (ACLS), stop bleeding of esophageal varices, because it is a potent vasoconstrictor. desmopressin can also be used for blood disorders; and nocturnal enuresis

what does stagliptin (januvia) interact with

digoxin levels, some other drugs may not be metabolized correctly

how long should you wait between metformin and a test with contrast dye

discontinue day of test and 48 hours after

what kind of precautions should be taken for a patient that is on cyclosporine (sandimmune)

do not interchange brand names with generic, avoid grapefruit juice, do not use Styrofoam containers, very narrow therapeutic index so monitor patient's BUN, LDH, AST, and ALT closely

after administering insulin, when is the patient most at risk for hypoglycemia?

during the peak time of the insulin drug

mechanism of action for pioglitazone (actos)

enhances sensitivity of insulin receptors= increase in glucose uptake, and storage and use in skeletal muscles. inhibits glucose and triglyceride production in liver *because this drug affects gene regulation, it takes several weeks/months to see affects*

what kind of NSAID is meloxicam (Mobic)

enolic acid derivative

T or F during pregnancy, treatment for hypothyroidism should stop and then start again after the child is born

false- should be continued throughout entire pregnancy to avoid severe growth retardation

T or F oral antidiabetics are mainly used for type 1 diabetes

false- used for type 2

what are some adverse effects of acarbose (precose)

flatulence, abdominal pain, diarrhea, anemia, hepatotoxicity with long term use

what are some adverse effects of fludrocortisone acetate (florinef)

generally related to water retention heart failure hypertension elevated intracerebral pressure (e.g., leading to seizures) Systemic fungal infections

what are some adverse effects of canagliflozin (invokana)

genital yeast infections, UTI, urinary incontinence, hypotension, hypovolemia, hyperkalemia, increased LDL cholesterol

which insulins are long acting?

glargine (lantus) and detemir (levemir)

what type of oral antidiabetic is repaglinide (prandin)

glinide

why choose a glinide antidiabetic over a sulfonylurea antidiabetic

glinides are good for erratic/bad eaters because when a meal is skipped, a dose is skipped

what are some adverse effects for glinides

headache, dizziness, nausea, joint pain, weight gain, upper respiratory infection/flu-like symptoms, hypoglycemic effects most common

when would you not use a loop diuretic

hepatic coma severe electrolyte loss allergy to sulfonamide antibiotics (may still be given in practice) **caution in elderly**

which 2 insulins are rapid acting?

humalog and novolog

which insulin is short acting?

humulin R (regular insulin)

if potassium is given to a patient who is on K+ sparing diuretics and ACE inhibitors, what would happen?

hyperkalemia

octreotide (Sandostatin) is what kind of pituitary drug and what does it do

hyperpituitarism drug, antagonist to growth hormone by inhibiting its release

what are some adverse effects of cyclosporine (sandimmune)

hypertension, neurotoxicity, hepatotoxicity, nephrotoxicity, post transplant diabetes mellitus, gingival hyperplasia and hirsutism

what are some adverse effects of mycophenolate mofetil (cellcept)

hypertension, peripheral edema, tachycardia, pain, headache, hyperglycemia, hyperlipidemia, electrolyte disturbances, abdominal pain, leukopenia, thrombocytopenia, cough and dyspnea

what is the most common problem/adverse effect in diuretics?

hypo/hyperkalemia

why would you give a patient mixed insulin instead of other unmixed insulins?

mixed insulin is cheaper, fewer Accu-Cheks, easier

what are some adverse effects of pioglitazone (actos)

moderate weight gain, peripheral edema, mild anemia, hepatic toxicity (monitor ALT and AST levels), elevations in LDL cholesterol

a nurse is preparing to give insulin to her patient. she is going to give NPH, a cloudy solution. before giving the intermediate insulin, she shakes the vial to mix the suspension. what did she do wrong?

never shake vials, gently roll to mix

with parental potassium, how fast should you infuse it

no faster than 10mEq/hr

what is the peak for long acting insulins?

no peak (one of the 2 long nursing shifts never peaked but lasted 24 hours)

what are some adverse effects of blood products

none very common, but: Incompatibility with recipient's immune system resulting in acute hemolytic reaction Febrile nonhemolytic reactions Mild allergic reactions Circulatory overload Anaphylaxis Transmission of pathogens to recipient (hepatitis, HIV) or sepsis Iron overload with whole blood or PRBC

what are normal ALT levels

normal range, 4 to 36 units/L

what are normal LDH levels

normal range, 45 to 90 units/L

when should canagliflozin (invokana) be given

once a day before breakfast

when should pioglitazone (actos) be given

once daily or in two divided doses

chloropropamide (diabenese) belongs to which diabetic drug class?

oral antidiabetic sulfonylurea

glipizide (glucotrol) belongs to which diabetic drug class?

oral antidiabetic sulfonylurea

mannitol (osmitrol) is what kind of diuretic

osmotic

fludrocortisone acetate (Florinef) is used for...?

partial replacement therapy for adrenocortical insufficiency in Addison's disease treats salt-losing adrenogenital syndrome

When is a patient most susceptible to hypoglycemic symptoms after the administration of insulin?

peak

why would fresh frozen plasma (ffp) be given

plasma expander and increases clotting factors- also good for bleeding

what are colloids

protein substances-Increase COP, Move fluid from interstitial compartment to plasma compartment by pulling fluid into the blood vessels (when plasma protein levels are low) Increase the blood volume, sometimes called plasma expanders bc they keep fluid inside the blood vessel.

A patient received cyclosporine (Sandimmune) yesterday. Today another nurse comes in with the patient's morning medications. The patient says, "You can't give me the medicine like that. Don't you know how to mix it?" What do you think the nurse did wrong?

put the med in a Styrofoam cup

how long does it take for a loop diuretic to kick in, and how long does it last?

rapid acting, even in single daily dose. effects last at least 2 hours

your patient has been taking prandin for a few days, and is concerned because he is not noticing any differences in his health or seeing any effects of the drug. what do you tell him?

remind him that prandin (glinides) take a few weeks to kick in fully

what should metformin NOT be taken

renal failure, heart failure, alcoholism, metabolic acidosis, hepatic disease, other tissue hypoxia disorders

which diabetic drug would you give to a patient who has a crazy work schedule and eating habits?

repaglinide (prandin)

what is the most important thing to keep in mind while a patient is on corticosteroids

risk for infections bc suppressed immune system. make sure patient avoids crowds, stays away from sick people, report any fever, increased weakness, lethargy, or sore throat

what are normal glucose levels

serum levels of 70 to 100 mg/dL

when would you not use an osmotic diuretic

severe renal disease- acts in EARLY stages, not severe pulmonary edema (use loop)- bc of way it affects lungs active intracranial bleeding Not indicated for patients with peripheral (feet, ankles, body) edema because it does not promote sufficient sodium excretion

what kind of therapeutic effects do we look for when a patient is on octreotide

should decrease diarrhea associated with carcinoid syndrome

what kind of therapeutic effects do we look for when a patient is on Desmopressin and vasopressin

should reduce severe thirst and decrease urinary output in diabetes insipidus

mechanism of action for glinides

similar to sulfonylureas, but shorter duration. increase insulin secretion from beta cells in pancreas

mechanism of action for sulfonylureas?

stimulate insulin secretion from beta cells, causes decreased glucagon secretion *must have functioning beta cells*

how is NPH insulin administered

subQ b.i.d. w/ meals (may be combined)

how/when do you administer rapid acting insulin

subQ injection or pump, pt must eat after admin

how is humulin r administered

subQ, intramuscular, or IV- only drug w/ IV

when should pramlintide (symlin) be given

subcutaneous injection, at least 1 hour before oral meds *may have to reduce rapid/short insulin doses by 50%*

what class of drugs should not be used with glinides

sulfonylureas- same MOA

what kind of diuretic is hydrochlorothiazide (Esidrix, Hydrodiuril)

thiazide diuretic Most common, least expensive, numerous combinations with antihypertensives, sometimes used alone for HTN *Doses over 50 mg a day rarely produce additional results, ceiling effect, many ppl only on 25mg/day *Oral route only

what kind of diuretic is metolazone (Zaroxolyn)

thiazide-like diuretic

pioglitazone (actos) belongs to which class of oral antidiabetics?

thiazolidinediones (TZDs) (glitazones)

when on loop, osmotic, thiazide or thiazide-like diuretics, what types of foods show you instruct your patient to eat

those high in potassium, bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes

what kind of a drug is levothyroxine (Synthroid) and what does it do

thyroid replacement drug, given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid), for all three forms of hypothyroidism

when should adrenal drugs be taken

to take all adrenal medications at the same time every day, usually in the morning, with meals or food Patients should not take with alcohol, aspirin, or NSAIDs

T or F Most glucocorticoids have some mineralocorticoid activity

true

T or F adrenal drugs (corticosteroids) are considered immunosuppressants

true

T or F normal saline is the only fluid compatible with blood products

true

T or F pramlintide (symlin) can be used in both type 1 and type 2 diabetes

true

vials of premixed insulin can be stored for how long?

up to 3 months in the refrigerator

what are some adverse effects of stagliptin (januvia)

upper respiratory infection, headache, diarrhea, hypoglycemia (bc. making insulin produce more), some cases of pancreatitis

why would you use a loop diuretic

useful in treatment of edema associated with heart failure, hepatic cirrhosis (ascites), and renal disease Used especially when rapid diuresis is needed. pulmonary edema, edema with HF, liver disease, ascites, hypertension increase renal excretion of calcium in patients with hypercalcemia

when should acarbose (precose) be given

with the first bite of a meal, three times a day