Pharm II - FINAL

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TMill
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151281
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Pharm II - FINAL
Updated:
2012-05-01 22:54:07
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Comprehensive Review 1st 2nd semester Pharm
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5-2-2012
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  1. What are the 5 rights of the patient?
    • Right patient
    • Right drug
    • Right route
    • Right amount
    • Right time
  2. What is Pharmaceutics?
    How the drug dosage affects the body
  3. What is the 1/2 life of a drug?
    How long it takes 1/2 of the drug to go through pharmacokinetics
  4. Where does Absorption take place?
    (small) INTENSTINE
  5. Where does Distribution take place?
    Blood stream
  6. What is the first pass effect?
    It is where 1/2 of the drug is taken out by the liver before the body can use it
  7. Where does Metabolization take place?
    Liver
  8. Where does excretion take place?
    Kidney (& breast milk)
  9. The nurse is giving a medication with a high first pass affect. The Doctor changes the route from IV to PO - what does the nurse anticipate of the oral dose?
    A higher dose needs to be administered.
  10. What is a mechanism that knows no age?
    Pharmacodynamics
  11. What age related changes might be contributing to a different reaction to taking medicine?
    Pharmacokinetics
  12. What physiologic changes take place in pregnancy?
    Increased risk for drug toxicity because the mobility of the bowel has been decreased allowing for a longer time for absorption
  13. When do most teratogenic effects occur?
    1st trimester - (31-81days)
  14. What is physiologically different about infants related to medicine?
    They are at increased risk for adverse reactions because their organs are immature resulting in an increased sensitivity.
  15. When does gastric motility mature in infants?
    age 2
  16. Dosing in children: Under age 1 - ?
    give LOWER dose
  17. Dosing in children: Older than 1 year of age - ?
    Increase the dose
  18. What can glucocorticoids cause in children?
    Growth suppression
  19. What can Tetrcyclines cause in children?
    Discoloration of teeth
  20. What can Sulfonamides cause in children?
    Kernicterus (jaundice)
  21. What can Aspirin cause in children?
    Reye's Syndrome
  22. What can Fluorquinolones cause in children?
    Tendon Rupture
  23. Category X?
    Teratogenic
  24. Anytime an IV drug is changed to PO - what would you expect the dosage to be?
    Increased
  25. Which has a faster onset - PO or IV?
    IV
  26. What are the contraindications to Oral Contraceptives?
    • >35
    • Hypertension
    • Smoking
    • Family history of DVTs
    • Migraines
    • Epilepsy
    • Gall bladder
  27. What drugs decrease the effectiveness of Oral Contraceptives?
  28. Antibiotics
    • St. Johns Wart
    • Rifampin
    • Ritondvir
    • Troglitazone
    • Antiepileptic Drugs
  29. What drugs do Oral Contraceptives decrease the effectiveness of?
    • Warfarin
    • Insulin
    • Oral hypoglycemics
  30. What drugs do Oral Contraceptives increase the effectiveness of?
    • Theophylline
    • Impiramine
  31. What are Tocolytics (terbutaline, nitedipine, indomethacin) used for?
    Uterine relaxant to stop contractions
  32. When should taking Yaz be avoided?
    when taking drugs with K+ because it has aldosterone in it
  33. When should a vaginal suppository be given?
    At night due to itching & discharge
  34. What is a side effect on Heparin?
    osteoporosis
  35. What is Oxytocin given for?
    To induce labor or to stop PP hemorrhage
  36. What is an adverse effect of Oxytocin?
    Water intoxication
  37. How do you prevent STI?
    Condom & Abstinence
  38. How is Vulvovaginitis prevented?
    • Avoid bubblebaths, thongs, fragrant lubes
    • Wear cotton underwear
    • Void & wash after sex
  39. What is the treatment for Vulvovaginitis?
    • Clindamycin
    • Metronidazote topical or vaginal

    (Diflucan only given 1 day treatment)
  40. Pros of tight glycemic control?
    • Prevent organ damage
    • Neuropathy
    • Retinopathy
    • Nephropathy
  41. Cons of tight glycemic control?
    More at risk for hypoglycemic events
  42. Which type of diabetes is it more important to keep a tight glucose control?
    Type 1 Diabetes (70-110)
  43. What are the rapid acting insulins?
    • *Novalog
    • *Humalog
    • Apidra
  44. What are the Long acting insulins?
    *Lantus

    (take once daily - do not mix with IV)
  45. What are the regular insulins?
    • Humulin R
    • Novolin R
  46. Which insulins can you give IV?
    Regular (Humulin & Novolin)
  47. Which insulin should you never mix?
    Lantus
  48. What is significant about the drug interaction between insulin & beta blockers?
    Beta blocker mask the symptoms of hypoglycemia (tachycardia palpitations). Therefor the defense mechanisms of hypoglycemia are being altered - which makes hypoglycemia worse.
  49. How does drug dosage need to be altered for hypothyroidism during pregnancy?
    Drug dosage needs to be increased
  50. If not recieving appropriate amount of thyroid medication - what might it cause during the first semester?
    Neuropsychologic Deficits
  51. What does steroid use cause in relation to diabetes?
    Steroids cause hyperglycemia, so insulin dosages need to be increased.
  52. R131 Iodine Patient Teaching:
    • Must be over 30
    • CI in lactation & pregnancy
    • Half life is 8 days
    • 2-3 mos. for full effect
    • 3 ft. away from people
    • Avoid public places/services
    • Don't share items
  53. What occurs during the 3rd trimester of pregnancy for women?
    Renal blood flow is increased and excretion is increased.
  54. Why must Catecholines (epi, norepi) be given IV?
    Because they can't cross the blood brain barrier
  55. What drug is given to treat Parkinson's?
    Levodopa
  56. SE of Levodopa?
    • Dyskinesias
    • N&V
    • Cardio effects
    • Psychosis
    • Darken sweat & urine
    • Malignant melanoma
  57. CI of Levodopa?
    • Anti-psychotics
    • MAOIs
    • Anticholinergics
    • Pyridoxine
  58. What is specific to Levodopa that you do not do with any other drug?
    take Drug Holidays
  59. Normal "side effects" of Levodopa?
    On & Off Phenomona - first 2 years the drug works great then after that it starts to wear off and around year 5 it doesn't work anymore
  60. Antidote:

    Atropine
    Physostigmine
  61. Antidote:

    Magnesium Sulfate
    Calcium Gluconate
  62. Antidote:

    Tylenol
    Mucomist
  63. Antidote:

    Opioids
    Naloxone
  64. Antidote:

    Coumadin
    Vitamin K
  65. How should you mix insulins?
    Clear (regular) before Cloudy (NPH)
  66. Breastfeeding related to taking medicine?
    Breast feed immediately before taking medicines
  67. Antidote:

    Benzos
    Romazican
  68. Antidote:

    Beta blocker/calcium channel blockers
    Glucagon
  69. Antidote:

    Dopamine
    Rigitine
  70. Adverse effect of Cyclosporine?
    • *Nephrotoxicity
    • *Infection
    • *Hepatotoxicity
    • Lymphoma
    • Hypertension
    • Tremor
    • Hirsuitism
  71. What interacts with Cyclosporine?
    Grapefruit Juice
  72. What are some side effects on Nitroglycerin?
    • Headache
    • Hypotension
  73. What is the the therapeutic effect of Digoxin?
    Increases myocardial contractility - slows down heart rate & cardiac output is increased!
  74. Therapeutic range of Digoxin?
    0.5 - 0.8
  75. S/S of Digoxin Toxicity?
    • Halos around lights (visual probs)
    • Vomiting
    • Fatigue
    • Decreased LOC
    • Muscle Weakness
  76. Patient teaching for Nitroglycerin pill?
    Place under tongue to work - should tingle!

    • Store in original, dark container
    • Replace every 3 months
    • Store at room temperature
  77. Patient teaching for nitroglycerin patch?
    Take off 8 hrs/day to prevent tolerance
  78. What is nitroglycerin contraindicated with?
    • Horny pills
    • Beta & CC Blockers
  79. Patient teaching when taking Nitroglycerin?
    When having chest pain place under tongue (should feel tingle) & rest

    Take 1 every 5 minutes until pain is gone - may take a total of 3 pills
  80. Which drug has a "First Dose Effect"?
    Prazosin (alpha-1 antagonists)
  81. What are alpha-1 antagonists used to treat?
    • BPH & Hypertension
    • Pheochromocytema & Reynauds
  82. Side effects of Alpha-1 antagonists?
    • Reflex tachycardia
    • Nasal Congestion
  83. What is Adenosine used to treat?
    Paroxysmal Supraventricular Tachycardia (SVT)
  84. How should you give Adenosine?
    IV push RAPIDLY!
  85. SE of Adenosine?
    • Bradycardia
    • Dyspnea
    • Hypotension
    • Facial Flushing
    • Chest Discomfort
  86. When when you give Lidocaine?
    Ventricular Tachycardia (decrease PVCs)
  87. Therapeutic Range of Lidocaine?
    1.5 - 5
  88. What drug manages Lidocaine toxicity?
    Lorazepam
  89. What is DoButamine used to treat?
    CHF
  90. What is Dopamine used for?
    Shock - Increase CO & renal perfusion (protects kidneys)
  91. What are the side effects of Resperine?
    • *Depression
    • Bradycardia
    • Orthostatic Hypotension
    • Nasal Congestion
    • GI Involvement
    • Edema
  92. What is Resperine used for?
    • Hypertension (not preferred)
    • Psychotic states
  93. What do Beta Blockers end in?
    -LOL
  94. What do ACE Inhibitors end in?
    -PRIL
  95. Metaprolol is what type of beta blocker and where does it work on to reduce BP?
    Beta 1

    Reduces BP in the Heart
  96. Propanolol is what type of beta blocker and where does it work on to reduce BP?
    Beta 2

    Reduces BP in the Heart & Lungs
  97. Metaprolol or Propranolol??

    Contridicated in Asthma pts.
    Propranolol
  98. If someone is wanting to stop taking BetaBlocker what should they do?
    Contact physician and taper off of dose
  99. When should you hold a Beta Blocker?
    • BP <100
    • HR <60

    Call Doctor
  100. What is the drug of choice for anaphalactic shock?
    Epinephrine
  101. Adverse Effects of Epinephrine?
    • Hypertensive Crisis
    • Hyperglycemia
  102. When is Epinephrine used?
    • Anaphylactic Shock
    • -vasoconstriction & bronchialdilation
  103. Patient teaching for Alzheimers Disease?
    Drugs may slow the prognosis a little but will not prevent further damage from occuring
  104. What test is there for Lovanox?
    None
  105. What drug do you give for Torsaddes de Pointe?
    Magnesium Sulfate
  106. What does Methyldopa do?
    Decreases BP in sitting and standing individuals
  107. Macrocrytic or Microcrytic:

    Vitamin B12
    Macrocrytic
  108. Macrocrytic or Microcrytic:

    Folic Acid
    Macrocrytic
  109. Macrocrytic or Microcrytic:

    Iron Deficiency
    • Normocrytic (Early)
    • Microcrytic (LATE)
  110. Decresased MCV, MCH, and MCHC=
    iron deficiency anemia
  111. Increased MCV, MCH, and RDW=
    vitamin b12 and folic acid
  112. What is the treatment for Cardiac Arrest?
    • Morphine
    • Oxygen
    • Nitroglycerin
    • Aspirin
  113. If a patient does not have nitroglycerin and they are experiencing chest pain what should they do?
    Chew 325mg of Aspirin
  114. What lab measures Coumadin?
    PT/INR
  115. What lab measures Heparin?
    PTT
  116. Why do you use Heparin And Coumadin together?
    Heparin is a short term therapy that is used until Coumadin gets to its therapeutic level then wears off
  117. Complications of Heparin?
    • Hemorrhage
    • Thrombocytopenia
    • H ypersensitivity reaction
  118. When would you use Heparin?
    • Pulmonary Emboli
    • DVT
    • Stroke
    • etc.
  119. Populations at risk for anemia?
    • menstrating women
    • pregnancy
    • alcoholics
    • chronic blood loss
  120. How should you take iron?
    • empty stomach
    • straw
    • with vitamin C aids absorption
    • Ca blocks so dont take with milk
  121. What type of food should you avoid with nasal vitamin b 12 supplement?
    spicy foods
  122. Normal values for PTT
  123. How much Folic acid should you take if you aren't pregnant?
    400 mcg
  124. How much Folic Acid should you take if you are pregnant?
    600 mcg
  125. Normal PTT?
    30-45
  126. Normal Hemoglobin?
    11-16
  127. Normal Hematocrit?
    37-52
  128. Normal PT/INR?
    10-15
  129. Normal WBC?
    5,000 - 10,000
  130. Normal RBC?
    4.5-5
  131. Drug Dependence?
    A person needs the drug to function normally
  132. Drug tolerance?
    Physiological response to a stimulus after prolonged use

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