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Questions and Answers
What is a primary function of Vitamin K?
What is a primary function of Vitamin K?
Which diuretic is particularly noted for causing severe hearing loss?
Which diuretic is particularly noted for causing severe hearing loss?
What condition is NOT treated with diuretic therapy?
What condition is NOT treated with diuretic therapy?
How does pyridoxine (Vitamin B6) affect Parkinson's medications?
How does pyridoxine (Vitamin B6) affect Parkinson's medications?
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Which statement about potassium-sparing diuretics is true?
Which statement about potassium-sparing diuretics is true?
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Which is NOT a desirable use for loop diuretics?
Which is NOT a desirable use for loop diuretics?
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Which role of the kidney is related to fluid balance?
Which role of the kidney is related to fluid balance?
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What is a common adverse effect of diuretic therapy?
What is a common adverse effect of diuretic therapy?
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In relation to loop diuretics, which statement is accurate?
In relation to loop diuretics, which statement is accurate?
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Which statement about body fluid compartments is true?
Which statement about body fluid compartments is true?
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What is the primary consequence of an imbalance in fluid intake and output?
What is the primary consequence of an imbalance in fluid intake and output?
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Which electrolytes are considered most important for homeostasis?
Which electrolytes are considered most important for homeostasis?
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What is a common indicator of hypernatremia?
What is a common indicator of hypernatremia?
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What is considered hyperkalemia in terms of serum potassium levels?
What is considered hyperkalemia in terms of serum potassium levels?
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What is a usual cause of hypokalemia?
What is a usual cause of hypokalemia?
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What role does insulin play concerning potassium in the body?
What role does insulin play concerning potassium in the body?
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What abnormality is likely to occur if sodium levels rise above normal?
What abnormality is likely to occur if sodium levels rise above normal?
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What is the recommended treatment approach for electrolyte imbalances?
What is the recommended treatment approach for electrolyte imbalances?
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What is the primary treatment goal for pharmacotherapy in Parkinson's disease?
What is the primary treatment goal for pharmacotherapy in Parkinson's disease?
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What serum level defines hypermagnesemia?
What serum level defines hypermagnesemia?
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Which of the following conditions is a contraindication for the use of calcium supplements?
Which of the following conditions is a contraindication for the use of calcium supplements?
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Which cholinesterase inhibitor is known for its serious side effects affecting the gastrointestinal system?
Which cholinesterase inhibitor is known for its serious side effects affecting the gastrointestinal system?
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What is a common adverse effect of benztropine?
What is a common adverse effect of benztropine?
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Advanced renal failure is the only major cause of which electrolyte imbalance?
Advanced renal failure is the only major cause of which electrolyte imbalance?
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What is a potential serious adverse effect of Donepezil?
What is a potential serious adverse effect of Donepezil?
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In which condition does muscle spasticity occur?
In which condition does muscle spasticity occur?
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What is an important safety consideration for patients taking pramipexole?
What is an important safety consideration for patients taking pramipexole?
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Which medication is used to address muscle spasms stemming from CNS disorders?
Which medication is used to address muscle spasms stemming from CNS disorders?
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Study Notes
Vitamin K (AquaMEPHYTON)
- Used to produce red blood cells (RBCs) and synthesize clotting factors
- Treats neonatal hemorrhagic disease
- Chosen antidote for warfarin overdose
- Takes 3-8 hours to stop bleeding
Vitamin B6 (Pyridoxine)
- Caution with Parkinson's medications; decreases their effectiveness
- Drug interactions affect levodopa
Vitamin C (Ascorbic Acid)
- Enhances iron absorption
- Used to improve wound healing
Renal Physiology
- Kidneys are major organs for excretion and homeostasis
- Maintain:
- Fluid balance (influencing heart rate/blood pressure)
- Electrolyte balance (preventing arrhythmias)
- Acid-base balance (regulating K+/H+ levels)
- Endocrine functions:
- Renin production
- Erythropoietin production
- Calcitrol (Vitamin D) synthesis
Diuretic Therapy
- Desirable for: edema, hypertension, heart failure, renal failure, liver failure/cirrhosis, pulmonary edema
- Common adverse effects:
- Electrolyte imbalances (especially potassium)
- Dehydration
- Hypotension (monitor blood pressure and heart rate)
Loop (High Ceiling) Diuretics
- Block sodium reabsorption at the loop of Henle
- Administered orally or parenterally
- Extensively bound to plasma proteins
- Indications include edema
Loop (High-Ceiling) Diuretics - Considerations
- Complete health history necessary
- Monitor vital signs (apical pulse, rhythm, blood pressure)
- Establish safety precautions
- Observe older adults carefully
- Ensure ready access to bathroom
- Administer early in the day
- Monitor potassium levels!
Loop (High-Ceiling) Diuretics - Drugs Similar to Furosemide (Lasix)
- Bumetanide (Bumex): for ascites and peripheral edema
- Ethacrynic Acid (Edecrin): alternative for sulfonamide allergies; can cause severe hearing loss
- Torsemide (Demadex): twice as potent as furosemide
Thiazide and Thiazide-Like Diuretics - Considerations
- Encourage water intake over alcohol or caffeinated drinks
- Caution with electrolyte drinks
- Baseline and periodic electrolyte measurement
- Measure blood pressure before and during therapy
- Monitor intake and output (I&O)
- Monitor for therapeutic effectiveness
- Monitor for adverse effects
Potassium-Sparing Diuretics - Drug Interactions
- Acidosis with ammonium chloride decreases diuretic effects
- Aspirin and salicylates decrease diuretic effects
- Digoxin effects are decreased
- Hyperkalemia with potassium supplements, ACE inhibitors, and ARBs
- Additive hypotensive effects with other antihypertensives
Principles of Fluid Imbalance
- Body fluids constantly exchange between intracellular and extracellular compartments (ICF, ECF)
- Imbalance between intake and output can cause fluid imbalance disorders (e.g., shock, dehydration)
Principles of Fluid Imbalance - Electrolytes
- Electrolytes (charged substances) are essential for homeostasis
- Imbalances signal underlying medical conditions; treatment focuses on correcting the cause.
- Important electrolytes: sodium (Na+), potassium (K+), magnesium (Mg2+), calcium (Ca2+)
Pharmacotherapy of Electrolyte Imbalances - Adverse Effects
- Hypernatremia: monitor neurological status/level of consciousness (LOC)
- Symptoms of hypernatremia include: lethargy, confusion, muscle tremor/rigidity, hypotension, restlessness, pulmonary edema
Pharmacotherapy of Electrolyte Imbalances - Potassium (K+)
-
Most abundant intracellular cation
-
Insulin is key for maintaining potassium balance.
-
Hyperkalemia (serum > 5 mEq/L): caused by excessive consumption or renal problems
-
Hypokalemia (serum < 3.5 mEq/L): usually due to diuretic therapy (loops and thiazides)
Pharmacotherapy of Electrolyte Imbalances - Potassium (K+) Indications for Admin
- Preventing hypokalemia
- Treating hypokalemia
- Treating mild alkalosis
Pharmacotherapy of Electrolyte Imbalances - Magnesium (Mg2+)
-
Second most abundant intracellular cation
-
Essential for neuromuscular function
-
Kidney regulates magnesium levels
-
Hypomagnesemia (serum < 0.65 mmol/L): caused by renal problems and diuretics
-
Hypermagnesemia (serum > 1.05 mmol/L): mainly caused by advanced renal failure
Pharmacotherapy of Electrolyte Imbalances - Magnesium (Mg2+) Adverse Effects
- Adverse effects: diarrhea, magnesium overdose, skin flushing, sedation, confusion, intense thirst, muscle weakness
- Serious adverse effects: neuromuscular blockade, respiratory paralysis, heart block, circulatory collapse
Pharmacotherapy of Electrolyte Imbalances - Calcium (Ca2+)
-
Most abundant mineral in the body
-
Hypercalcemia (serum > 2.5 mmol/L): often from overactive parathyroid glands
-
Hypocalcemia (serum < 2.1 mmol/L): signs of underlying pathology; caused by calcium/vitamin D deficiency, hypothyroidism, drug therapy
Pharmacotherapy of Electrolyte Imbalances - Calcium (Ca2+) Adverse Effects
- Adverse effects: constipation, nausea, vomiting, metallic taste
- Serious adverse effects: hypercalcemia, dysrhythmias, cardiac arrest, confusion, delirium, stupor, coma
Pharmacotherapy of Electrolyte Imbalances - Calcium (Ca2+) Contraindications/Precautions
- Hypercalcemia, hyperparathyroidism, digoxin toxicity, renal/cardiac insufficiency
- Dysrhythmias, dehydration, diarrhea, sarcoidosis (metastatic bone disease), renal calculi, hyperphosphatemia
Neurodegenerative Diseases
- Progressive, irreversible loss of neurons
- Affects any age group
- Pharmacotherapy treats symptoms (no cure)
- Depression common
Pharmacotherapy of Parkinson's Disease
- Goal: balance dopamine and acetylcholine
- Treatment may take 2-3 weeks to see benefits
Parkinson's Disease - Dopamine Agonists
- Increase available dopamine by replacing, decreasing breakdown, increasing release, activating dopamine receptors
Parkinson's Disease - Anticholinergic Drugs
- Block acetylcholine's excitatory action, reducing abnormal muscle movements
Levodopa - Considerations
- Take on an empty stomach
- Avoid multivitamins/B6 and high-protein diets
- Safety precautions for ambulation due to potential dizziness; assist with activities of daily living (ADLs)
- Monitor liver and kidney function
- Avoid alcohol
- Watch for mood/behavioral changes (e.g., aggression, confusion)
Pramipexole - Considerations
- Assess baseline vital signs and Parkinson's Disease (PD) symptoms
- Monitor for orthostatic hypotension
- Monitor for tardive dyskinesia
- Assess mental status
- Alert patient/family about sleep attacks
- Ensure family understands that PD treatment is not a cure but might help symptoms for a time
Benztropine - Adverse Effects
- Adverse effects: sedation, constipation, blurred vision, dry mouth, decreased sweating, urinary retention, confusion
- Serious adverse effects: paralytic ileus
Benztropine - Contraindications/Precautions
- Closed-angle glaucoma, myasthenia gravis, tardive dyskinesia, GI/urinary obstructions, prostatic hypertrophy, peptic ulcers, tachycardia, alcohol
Benztropine - Drug Interactions
- Additive toxicity (antihistamines, tricyclic antidepressants, phenothiazines, MAOIs, quinidine)
- Additive sedative effect (alcohol, CNS depressants)
- Slow GI motility/decreased absorption (antidiarrheals)
Benztropine - Pregnancy Category C; Treatment of Overdose
- Treatment of overdose: physostigmine (1-2 mg subcutaneous or IV) to reverse anticholinergic intoxication
Pharmacotherapy of Alzheimer's Disease
- Modest results only; ineffective at stopping disease progression
Cholinesterase Inhibitors
- Tacrine, other reversible inhibitors
- Increase acetylcholine concentrations in the brain
- Goal: improve ADLs, behavior, cognition
- All drugs in this class are equally effective
- Gastrointestinal (GI) system most affected (nausea, vomiting, diarrhea)
Cholinesterase Inhibitors-Nursing Considerations
- Cognition, safety, independence, symptoms, baseline labs, vital signs (VS), vision, weight, liver and kidney function
Donepezil - Adverse Effects
- Adverse effects: Nausea, vomiting, diarrhea (N/V/D), anorexia, muscle cramps, syncope, ecchymosis, fatigue, arthralgia, abnormal dreams/hallucinations/confusion/depression, headache
- Serious adverse effects: life-threatening dysrhythmias, sinus bradycardia, seizures, renal failure, hepatotoxicity (monitor liver enzymes)
Donepezil - Treatment & Considerations
- Treatment of overdose: anticholinergic drugs to reverse
- Considerations: cognitive function/safety, baseline lab tests (especially liver/renal), symptoms, depression, agitation, anxiety, aggression/confusion
- Alert family to monitor for irregular heartbeat or chest discomfort.
- Evaluate alternative living arrangements, support groups (patient and family).
- Avoid alcohol
Multiple Sclerosis
- Unknown cause; characterized by demyelination secondary to inflammatory response (autoimmune)
- Leading cause of neurologic disability in 20-40 age group
- Symptoms include difficulty balancing, muscle weakness; exacerbation/remission pattern
Muscle Spasms
- NSAIDs and skeletal muscle relaxants used for treatment
Cyclobenzaprine - Considerations
- History and physical (including vital signs)
- Baseline neurologic status
- Assess for pain
- Protect from injuries (falls from drowsiness)
- Assess for skin reactions (urticaria, rash, pruritus)
- Inform patient not to drive.
Cyclobenzaprine - Similar Drugs
- Methocarbamol (Relaxin, Robaxin) - adjunct to physical therapy
- Metaxalone (Skelaxin) - ineffective against spasticity-related neurological disorders
- Orphenadrine (Banflex, Myophen, Norflex) - anticholinergic
- Tizanidine (Zanaflex) - for spasticity related to injury/MS
Muscle Spasticity
- Continuous contraction
- Pain more intense than spasms; causes greater impairment
- Irritable deep tendon reflexes, scissoring movements (lower extremities), fixed joint movement
- Caused by neuromuscular diseases, not a disorder itself
Dantrolene - Considerations
- History and physical (baseline neurologic/pain)
- Monitor VS during IV administration
- Assess for cardiopulmonary changes
- Watch liver function (liver function tests)
- Report jaundice
- Avoid alcohol
- Teach patient not to drive
Non-Pharmacologic Therapies
- Physical therapy (increases movement, prevents contractures)
- Herbal remedies (e.g., black cohosh, castor oil packs, capsaicin)
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Description
Test your knowledge on the important roles of Vitamin K, B6, and C, as well as their interactions and uses in medical contexts. Additionally, explore key concepts related to renal physiology and diuretic therapy. This quiz covers essential topics in pharmacology and body homeostasis.
