Pharm - 11-16 Review (1).pdf

Module 11: Endocrine Agents What does thyroid replacement do? To raise abnormally low levels of natural thyroid hormones in the body. This is given because of an under active thyroid that is secreting little or no thyroid hormones. What are symptoms of a thyroid storm? • high fever • palpitations •...

Module 11: Endocrine Agents What does thyroid replacement do? To raise abnormally low levels of natural thyroid hormones in the body. This is given because of an under active thyroid that is secreting little or no thyroid hormones. What are symptoms of a thyroid storm? • high fever • palpitations • vomiting • diarrhea • agitation What medications are used to treat hyperthyroidism? Thiomides - which works by inhibiting T4’s conversion into T3, therefore decreasing the signs and symptoms of hyperthyroidism (Methimazole (Tapazole)) What are glucocorticosteroids used to treat? (From the pancreas) Allergy, asthma, arthritis, inflammatory bowel disease and cancer metastasis or exacerbation Major S/E and A/E of glucocorticoids Hypertension, Hyperglycaemia, osteoporosis, cushanoid changes, GI upset Why should patient’s be tapered off these drugs slowly? It could cause a withrawal Name the classification of insulin and give one example of a brand name for each: Rapid-Acting: Humalog/Novorapid Short-Acting/Regular: Humulin R/Novolin GE Toronto Intermediate-Acting: Humulin N/Novolin GE NPH Long-Acting: Lantus Levemir What could occur at the peak action of insulin, and is a common adverse effect Hypoglycaemia What combination of insulin can be mixed in an insulin syringe? Fast-Acting and Slow-Acting Why are onset, peak, and duration of insulin action important to know? To choose and schedule mealtimes and other spect of daily routine What is the difference between Type 1 and 2 Diabetes? Type 1 - Is the destruction of insulin producing cells Abrupt, rapid onset; little or none insulin production; ideal body weight Type 2 - Is where the cell/receptor site becomes resistant to insulin Insidious, slow onset; below to above normal insulin; 85% over-weight What medication is given for each type of diabetes and why? Type 1 only requires one: Insulin Replacement Type 2 can be managed with diet, weight loss, medications (oral) and/or insulin Ideally when should insulin be given? Before meal How do acute illnesses change blood glucose levels? Patient’s stabilized on a diabetic regimen who are exposed to trauma, infection, or surgery may require administration of insulin during the acute episode What lab tests are used to diagnose Diabetes’ Mellitus? A1C Test, fasting blood sugar test, glucose tolerance test, random. blood sugar test. What lab tests and assessments are used to monitor a patient’s DM status? Glucose Screening Tests and A1C tests in the span of 3 months S/E and Contraindications of oral contraceptives and how do they work? The pill prevents the ovaries from releasing an egg each month, which thickens the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an eggs. S/E: headaches, nausea, sore breast, abdominal cramping, breast tenderness. Contraindication: smokers, adequately controlled hypertension, mild cirrhosis, symptomatic gallbladder disease What are different types of oral contraceptives and how do they work? Implants, cream & gels, sprays, pills & tablets, skin patches, vaginal rings & suppositories - they work by relieving symptoms of hormonal imbalance, most commonly during menopause What other reasons beside birth control would a woman take an oral contraceptive? menopause, endocrine, somatic and psychological changes, progressive decrease in estrogen What other routes of contraception are available for women? Implantable rod, hormonal IUD, shot, ring S/E? • headaches & nausea • bloating * indigestion • cramping • spotting & vaginal discharge • fluid retention • breast pain Nursing Considerations • increases risk of DVT • increases risk of developing cancer (breast or genital) • Increased risk of cardiovascular issues (MI, CVA, Hypertension) • Taken with food to avoid GI upset • Evaluate the effectiveness What are some symptoms accompanying menopause? Hot flashes and night sweats Pharmacologic Management and Medications used to treat symptoms Hormone therapy, vaginal estrogen Common side effect of Hormone Replacement Therapy? Breakthrough Bleeding What assessments and health teaching are appropriate for patient’s prescribed medications for impotence? Blood test, urinalysis are going to be used "Take this medication as needed before sexual activity” What is erectile dysfunction? This the inability to develop and maintain a full erection - increases with age - low testosterone How do we treat this? Phosphodiesterase-5 (PDE-5) Inhibitors (Sildenafil Citrate (Viagra), Tadalafil (Cialis) and Vardenafil Hydrochloride (Levitra)) MOA - Maintain relaxation in the smooth muscle of the penis, which enhances an erection A/E & S/E • nasal congestion, headache, facial flushing, dizziness • vision abnormalities, myalgia, decreased BP, potential for priapism What is Benign Prostate Hypertrophy and how is it treated? Abnormal enlargement of the prostate, which is most common benign neoplasm in men, this obstructs urethra causing difficult urination Treatment are: • 5-Alpha Reductase Inhibitors (Finasteride (Proscar)) which blocks the enzyme that converts testosterone to DHT (which increases prostate size) • Alpha 1 Adrenergic Blockers - causes relaxation of the smooth muscle of the prostate (common A/E of Tamsulosin is abnormal ejaculation) Module 12 - GastroIntestinal Tract Agents What is Famotidine (Pepcid AC) used to treat? and what are some health teachings? This inhibits histamine at H2-receptor sites in parietal cells, which decreases gastric acid secretions. This is used to treat symptoms of Peptic Ulcer Disease and Gerd. "take this 30 minutes prior to eating” What do proton pump inhibitors do? Reduce acid secretion in the stomach What antiemetics is given before chemotherapy? Why? Serotonin Receptor Blockers (Ondansetron) - used for nausea and vomiting - this binds at the serotonin receptor in a GI tract AND chemoreceptor trigger zone (brain) What are some S/E of antiemetics? Nursing Implications S/E: constipation, diarrhea, headaches Nursing Implications: monitor for serotonin syndrome What might an opiate be used to treat diarrhea? Coats the wall of the GI tract and absorbing/inhibit the activity of bacteria or toxins What are some important teachings for patient’s on antidiarrheal agents? The medication may cause dizziness and drowsiness. Frequent oral hygiene may alleviate discomfort for dry mouths. Do opiates that are used to treat diarrhea have an effect on the entire CNS? or only the GI tract? Antidiarrheal agents can act on both systemic and locally Name the laxatives and their indications • Osmotic Laxatives (Hyperosmotic Agents) - Not absorbed in the intestine but instead they pull water into the feces from surrounding body tissues. This provides increased water content of the stools making them softer and easier to pass (through peristalsis) • Bulk-Forming Laxatives - Absorb liquid in the intestines and swell to form soft bulky stoll • Emollients (Stool Softener) - encourage bowel movements by helping liquids to mix in the stool acting as a lubricant preventing dry hard stool • Stimulant Laxatives - Trigger contractions in intestinal muscles by irritating sensory nerve endings (cramping is a common S/E). This also increases water in the stool, either by reducing absorption of water in the colon or causing active secretion of water in the small intestine. How might laxatives and antacids affect the absorption of other medications? Antacids influence drug absorption by alteration of ionization state or solubility, factors dependent upon pH Laxatives decrease the intestinal/colonic transit time, modifications of the gastric pH. What are some nursing interventions for pts at high risk of developing constipation? Encourage high fibre diet, promote increased fluid intake, avoid caffeine and alcohol What are adsorbents often used to prevent? Treatment of acute poisoning Module 13 & 14: Antibacterial, Antiviral Agents, Immunizations What is bacterial Culture test? To determine the type of bacteria and what treatments are required Should it be done before or after antibiotics are administered? BEFORE, we want to make sure that the C&S we send are in there original state What assessment are appropriate for a patient who is prescribed an antibiotic • allergies • ensure C&S has been collected prior to first dose • history of liver or kidney disease • vital signs • oral contraceptives can interfere and inhibit the medicine Why do antibiotics have an automatic stop date? to ensure that antimicrobials are continued no longer than necessary, to prevent unnecessary consequences from lack of appropriate therapeutic reevaluation Why should a client complete taking all of their antibiotic ordered? Stopping the full course of antibiotic treatment will fail to kill the target organisms to the expected levels but also facilitate the development of drug-resistant variants of the bacteria within the body. A client may take erythromycin if they are allergic to penicillin. What are some other names for penicillin or penicillin derivatives they need to avoid? amoxicillin, ampicillin, amoxicillin-clavulanate, dicloxacillin, nafcillin, pipercillin-tazobactam, and cephalosporin classes. Describe antibiotic treatment regimen for tuberculosis Isoniazid INH in combination with three other drugs - Rifampin, Pyrazinamide and Ethambutol What is viral meningitis and how is it treated? Viral Meningitis is an inflammation of your meninges (area around your brain and spinal cord) caused by a virus; the most common causes are enteroviruses and herpes simplex virus. There is no specific treatment for viral meningitis. Pharmacotherapy medications can include: Acyclovir (Zovirax), Valacyclovir (Valtrex) which can be nephrotoxic and usage of gloves is required when applying topical meds. What is the major S/E of Aminoglycosides (Gentamicin)? High risk of ototoxicity (hearing or balance problems), nephrotoxicity What is a major S/E of Cephalosporins? Gastrointestinal disturbances (may cause pseudomembranous colitis caused by C. Diff), allergic reactions (cross-reactivity with penicillins) What lab tests are used to monitor toxicity of strong antibiotics? Full CBC and serum creatinine. What antiviral vaccine are healthcare workers often required to take each year? Influenza Vaccinations What patient teachings are appropriate for a patient taking antiretroviral medications? • adherance to medication regiment • HIV in pregnant, pediatric, and geriatric populations - Combination antiretroviral therapy is the standard for pregnant women, but safety of drugs is yet to be established - The younger the age at which the child acquires HIV, the poorer the prognosis • keep appointment for lab tests How do Immunizations work? Vaccines are made up of killed or weakened (attenuated) infectious agents of mRNA to stimulate an immune response What is the difference between passive and active immunity? Active Immunity - results when we are exposed to an infectious agent. It is typically long-lasting, and sometimes life-long Natural Active Immunity - exposed to the bacteria Artificial Active Immunity - vaccinations Passive Immunity - is given where we are given antibodies. Placental transfer and Immunoglobulins Natural Passive Immunity - Maternal Antibodies Artificial Passive Immunity - Monoclonal antibodies What is the difference between killed or weakened vaccines vs mRNA vaccines? mRNA vaccines makes proteins in order to trigger an immune response, and contains no live virus, no risk of causing disease in the person Inactivated vaccines contains a the virus, and will set off a immune response Why are different immunizations needed for travel? Because other countries will have different sets of diseases that we are not introduced here in Canada What booster immunizations do adults need? Tetanus, Diphtheria, Acellular Pertussis (dTap) Module 15: Musculoskeletal, Eye, Ear, Skin Agents What are nursing considerations when administering eye drops? New or unusual redness or drainage What is Glaucoma? Intraocular pressure is increased enough to cause optic nerve damage, this can lead to visual field loss and advance to blindness. Review eye drops that are used to treat Glaucoma. What are the actions • Cholinergic Agonists/Miotics (Pilocarpine (Miocarpine)) - cause constriction of the pupil, which allow greater outflow and aqueous humour and lowers IOP. • Prostaglandins - decrease aqueous humour formation and increase outflow in open-angle glaucoma. Latanorpost (Xalatan), Bimatoprost (Lumigan). S/E: cycloplegia, local irritation, stinging in the eyes. • Beta-Adrenergic Blockers - drug of choice for open-angle glaucoma. Decrease production of aqueous humour, thus decreasing IOP. Produces less adverse effects than cholinergic agonist. Timolol (Timoptic). • Alpha 2-Adrenergic Agonist - used for long term therapy. Bromonidine (Alphagan). S/E: headache, drowsiness, dry mucous membranes • Carbonic Anhydrase Inhibitors - second choice if beta-adrenergic blockers have not produced therapeutic results. Brinzolamide (Azopt) • Osmotic Diuretics - can reduce the plasma volume quickly What are Signs & Symptoms of Streptococcus and what is the treatment method? • throat pain • painful swallowing • red and swollen tonsils (white patches or streaks of pus) • tiny red spots on the area at the back of the mouth • swollen, tender lymph nodes in your neck • fever Penicillin or Amoxicillin is the antibiotic choice Patient teachings once eye drops/ear drops are administered • DO NOT stand up without assistance What are S/E & A/E of antibiotics? S/E - Nausea, vomiting, diarrhea (antibiotics can disrupt the normal flora) A/E - organ toxicity, anaphylaxis, super infection (resistance microorganism) What is Acne? A skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads, or pimples. What is the difference between miosis and mydriasis? Miosis - Excessive constriction of the pupil Mydriasis - Dilation of the pupil What are common ear conditions? Briefly state pharmacologic management. Otitis External (Inflammation or Infection of the External Ear) - analgesics, antibiotics, corticosteroids Otitis Media (Inflammation of the Middle Ear) - Analgesics, antihistamines, corticosteroids, decongestants, NSAIDs, systemic antibiotics How does Benzoyl Peroxide Work? MOA - has a keratolytic effect (dries and sheds - outer layer of epidermis), suppresses sebum and kills bacteria. What are Retinoids? MOA - Reduce the size of sebaceous glands. Decreases oil production and the occurrence of clogged pores. Causes sun sensitivity and can be combined with antibiotics What is the difference between Osteoporosis and Osteoarthritis? Osteoporosis - Changes due to disrupted bone homeostasisL Bone reabsorption outpaces bone deposition Osteoarthritis - Progressive degenerative joint disease leading to breakdown of articular cartilage. Wear and tear of joint causes inflammation of synovial membrane, thinning of cartilage. Tends to be non-symmetrical in presentation. Onset is gradual and typically appears later in life. What is the most common type of medication used to treat osteoporosis? • Biphosphonates - Inhibit bone reabsorption by suppressing osteoclast activity, which increases bone density and decreases fracture incidence by 50% Explain Rheumatoid Arthritis. What is the first line of treatment for flare ups? It is a chronic, progressive autoimmune disease. Rheumatoid factor attack cells of the synovial membrane (synovium) and blood. Causes inflammation of joints. Tends to be symmetrical in presentation. Affects females more often than males. Treatment: NSAIDs, Acetaminophen, Corticoidsteroids, Disease Modifying Anti-Rheumatic Drugs (DMARDs) What are DMARDs used to treat? Describe each kind of DMARD Rheumatoid Arthritis • Conventional (cDMARDs) - suppression of the overall immune system • Biologic (bDMARDs) - blockade of a specific part of the immune system (protein that promotes inflammation) • Targeted Synthetic (tsDMARDs) - stop or block particular cells in the immune system from triggering inflammation What is gout? What kind of accumulation is this made up of? Acute arthritis caused by accumulation of uric acid crystals in joints; May be primary (genetic) or secondary (caused by disease or drugs) Treatment for Gout: NSAIDs, Uric-Acid Inhibiting Drugs (Allopurinol) How do we know if a patient has hyperuricemia? When the serum level of uric acid is above normal Module 16: Diagnostic Imaging Contrast Agents What are some examples of diagnostic imaging? • X-ray • fluoroscopy • CT (computed tomography) • MRI (magnetic resonance imaging) • Ultrasounds Why do we need to used contrasts? Improves visibility of organs, blood vessels, or tissues. Negative - turns areas black (water or air) Positive - turns areas white What are the 3 types of contrast agents & when would you use each one • Barium-Suplhate Compounds (Swallow & Enema) - for CT and X-ray images of the GI tract S/E: stomach cramps, diarrhea, nausea, vomiting, constipation A/E: allergic reactions increased with history of asthma, hay fever, or other allergies Contraindications: Patient who have cystic fibrosis, severe dehydration, suspected intestinal perforation or blockage • Iodine-Based Agents (given orally or IV) - enhance X-ray and CT images; higher rate of allergic reactions and premedications of antihistamines or steroids may be given S/E: nausea, vomiting, headache, itching, flushing, skin rash, hives • Gadolinium-Based Agents (IV) - used for MRI; used on a daily basis, less risk for reactions and it’s generally used for kidney function test How do you administer contrast agents? • IV • Oral • Rectal Common S/E of contrast agents • nausea and vomiting Why do we need to ask patients if they are taking metformin when we administer contrast agents? There is a potential to precipitate LACTIC ACIDOSIS = high mortality rate DO NOT take for minimum 48 hours after receiving contrast agent if decreased kidney function What potential S/E can be caused? • headache, sleepiness, confusion, loss of consciousness, coma • seizures, weakness • diarrhea • shortness of breath, coughing • arrhythmia, tachycardia • nausea and vomiting Module 12: Extra shit Non-Biological DMARDs: Hydroxychloroquine A/E • irreversible retinal damage Biologic DMARDs: Anti-tumor necrosis factor • potent immunosuppresants • anti-inflammatory Ear Wax Medication Cerumenolytics are used to soften ear wax it can be water based (water or saline like Triethanolamine, sodium bicarbonate, hydrogen peroxide), oil-based agents (olive oil) or non-water oil-based solutions (carbamide peroxide (Debrox)) Skin Medication Accutane-Isotretinoin - an oral retinoid medication. Same action as retinoids and benzoyl peroxide. Pregnancy category X - education re:birth control. Negative pregnancy test required to start treatment.