Term
| Activation of what adrenergic receptor is useful for asthma? |
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Definition
| B receptors - particularly B2 |
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Term
| Why are Beta Adrenergic Agonists not effective by themselves in treathment of asthma? |
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Definition
| Only cause bronchodilation, not antinflammatory effect |
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Term
| In what disease states are Beta Adrenergic Agonists problematic? |
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Definition
| Acute asthma attacks (long-acting); cardiac disease (tachycardia); seizures (stimulant); anti-depressants (additive effect); DM (hyperglycemia) |
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Term
| How does Ipratropium differ from Salmeterol? |
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Definition
| Ipratropium is a muscarinic antagonist with fewer side effects (only anticholinergic), but slower than B andrenergic drugs |
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Term
| How does Albuteral differ from Salmeterol? |
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Definition
| Both are B adrenergic agonists. Albuterol's is in 3 minutes; while Salmeterol requires 30 minutes. Albuterol would be used in acute asthma attacks. |
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Term
| Proper procedure for inhaler use |
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Definition
| Shake container > Sit upright > Deep breath > Exhale completely > Position just outside mouth > Inhale slowly as dose > Inspire as deeply as possible (3-5s) > Hold inspiration {10s} > Exhale > Wait 2-3 min before next dose > Rinse mouth/equipment |
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Term
| Why aren't Methylxanthines used much today? |
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Definition
| Narrow therapuetic range. Interfere with many drugs. Stimulant. |
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Term
| Major drug classification of therapy for maintenance/prevention of asthma? |
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Definition
| Steriods = Inhaled glucocorticoids |
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Term
| What role do steroids play with asthma? |
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Definition
| Antinflammation. Sensitize receptor to B agonists. Inhibits neutrophils/ eosinophils/ histamine/ leukotrienes/ prostaglandins |
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Term
| Why are topical steroids preferred in asthma therapy? |
|
Definition
| Decreased systemic effects compared to PO. Maintenance. |
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Term
| Why aren't steroids used in acute attacks? |
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Definition
| May take 4-6 weeks for full effect. Maintenance drug for antinflammation. Not rapid-acting. |
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Term
| What are concerns related to systemic steroids? |
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Definition
| Hypokalemia (Na/H2O retention); DM (hyperglycemia); Osteoporosis (suppressed osteoblasts); PUD (inhibit prostaglandins); infection (blunt inflammatory response); candidiasis |
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Term
| How do Leukotriene Modifiers and Mast Cell Stabilizers help manage asthma? |
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Definition
| Block leukotrienes responsible for edema/inflammation/bronchoconstricion/mucous production. Stabilize mast cells to decrease histamine release. Minimize inflammation. Used for prevention of asthma. |
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Term
| Leudotriene Modifiers are metabolized extensivley by the liver... Concern? |
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Definition
| Sxs of hepatic compromise. Monitor LFTs. |
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Term
| What added concern for elderly using Leukotriene Modifiers? |
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Definition
|
|
Term
| MOA of Mast Cell Stabilizers |
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Definition
| Stabilize mast cells. Decrease histamine release. Similar to leukotriene modifier MOA. Minimize inflammatory response. Preventative. |
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|
Term
| Which therapies are useful in COPD? |
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Definition
| Inhaled anticholinergic/antihistamine (Ipatropium/Atrovent). |
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Term
| What should be taught to all clients using respiratory drugs? |
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Definition
| Use B agonist first to dilate bronchioles, then use glucosteroid for antinflammation. Check lung capacity daily. Proper administration technique. Multiple drug regimen. Minimal symptoms/exacerbation/emergency incidents. Decrease long-term remodeling. |
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Term
| How are antihistamines effective in the treatment of rhinitis? |
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Definition
| Block histamine-1 receptors. Prevent inflammatory response. |
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Term
| What significant side effects are associated with antihistamines? |
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Definition
| Sedation (1st gen), anticholinergic, photsensitivity, GI upset, HA |
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Term
| How do first and second generation antihistamines differ? |
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Definition
| Second generation do NOT cross the blood-brain barrier, so decreased CNS depression. Therefore, less sedation/drowsiness. Second generation are more expensive. |
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Term
| When are antihistamines contraindicated? |
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Definition
| Anticholinergic, CNS depression (1st gen), seizures |
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|
Term
| Antihistamine pt education |
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Definition
| Anticholinergic side effects. No OTCs/ETOH. May cause drowsiness (1st gen) |
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|
Term
| How do glucocorticoids work to treat rhinitis and asthma? |
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Definition
| Anti-inflammatory = inhibit neutrophils/leukotrienes/histamine/prostaglandins. Sensitize receptors to B agonists. |
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Term
| Proper procedure for nasal spray |
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Definition
| Blow nose > Shake container > Do not swallow dose > Administer decongestant first > Don't blow nose after. |
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|
Term
| How long will it take steroids to reach maximum effect? |
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Definition
|
|
Term
| The activation of which adrenergic receptor is useful for treating nasal congestion? |
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Definition
|
|
Term
| What contraindications are there for the activation of A1 recptors? |
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Definition
| hyperthyroidism, HTN, DM, CV disease, caution in BPH, excoriated nares |
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Term
| What is the biggest concern for intranasal dispensing of decongestants? |
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Definition
|
|
Term
| How long should intranasal dispensing decongestants be used for? |
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Definition
|
|
Term
| How do opioids and antitussives work to relieve coughing? |
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Definition
| Blunt cough centers in CNS |
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|
Term
| Should a cough always be surpressed? |
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Definition
| No. Necessary to move secretions out of lungs. |
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|
Term
| How long should a person use an OTC antitussive? |
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Definition
|
|
Term
| What is the difference between mucolytic and expectorant? |
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Definition
| Mucolytic = Disrupts molecular structure of mucous and acts as a detergent. Expectorant = Changes surface tension of mucous to liquefy secretions. |
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|
Term
| Besides being a mucolytic, what therapeutic use does acetylcysteine have? |
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Definition
| Antidote for acetaminiphine OD. Prevents tylenol from binding to hepatocytes. |
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|
Term
| What is the source of releasing hormones? |
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Definition
| Ultimately the hypothalamus... > pituitary gland > target organ |
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|
Term
|
Definition
| GH deficiency, short stature |
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|
Term
| Somatropin contraindications |
|
Definition
| closed epiphyses, obesity |
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Term
| What monitoring tests are required for somatropin therapy? |
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Definition
| height, weight, glucose tolerance, thyroid function |
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|
Term
| What is the function of ADH? |
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Definition
| Stimulate water retention by the kidneys |
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|
Term
| What are the indications for vasopressin (Pitressin)? |
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Definition
|
|
Term
| What monitoring should be done for a pt taking vasopressin? |
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Definition
| BP, CRT, chest pain, palpitations, thirst, SG, I/O, weight, edema, electrolytes, Na, HA, MS, seizures |
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|
Term
| Vasopressin contraindications |
|
Definition
|
|
Term
| What element is essential for thyroid function? |
|
Definition
|
|
Term
|
Definition
| weight gain, cold intolerance, bradycardia, fatigue, poor concentration, constipation, brittle hair, edema, mestrual spotting |
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|
Term
|
Definition
| weight loss, heat intolerance,tachycardia, palpitations, agitation/fatigue, diarrhea/constipation, fine hair, exophthalamus, absent menses |
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|
Term
|
Definition
| Severed hypothyroidism in adulthood |
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|
Term
| Which synthetic thyroid hormone is most likely to be used for thyroid replacement? |
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Definition
|
|
Term
| What are the risks for children who dod not make thyroid hormone? |
|
Definition
| Cretinism. TH required by every cell of body. Affect CNS development > retardation. |
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|
Term
| In what conditions is TRT contraindicated? |
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Definition
| adrenal insufficiency, hyperthyroidism |
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Term
|
Definition
| weight, VS, TFTs, cholesterol, sxs hypothyroidism/hyperthyroidism |
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|
Term
| How long does it take for TRT to take effect? |
|
Definition
| 4-6 weeks to reach therapeutic range |
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|
Term
|
Definition
| Overactive thyroid. Goiter. |
|
|
Term
| Prototype antithyroid drug? |
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Definition
|
|
Term
|
Definition
| Inhibits conversion T4 to T3 in target tissues |
|
|
Term
|
Definition
| Hypothyroidism, BMD, hepatotoxicity |
|
|
Term
| 3 categories of adrenal hormones |
|
Definition
| Gonadocorticoids, mineralcorticoids, glucocorticoids |
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|
Term
|
Definition
| reproduction, secondary sex characteristics |
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|
Term
|
Definition
| fluid/electrolyte status per BP |
|
|
Term
|
Definition
| Ability adapt to stress, BP, glucose, immunity, inflammatory response |
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|
Term
|
Definition
| Fludrocortisone (Florinef) |
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|
Term
| Fludrocortisone (Florinef) indication |
|
Definition
| Primary HTN, additional water retaining effect in persons with Addison's disease |
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|
Term
| Prednisone (Deltasone) indication |
|
Definition
| long-term therapeutic anti-inflammatory, immune, hypersensitivity, Addison's disease replacement, hypercalcemia, transplants, cancer |
|
|
Term
| Hydrocortisone (Cortef) indication |
|
Definition
| replacement in Addison's, acute inflammatory/allergic reactions |
|
|
Term
| Why must glucocorticoid therapy be tapered? |
|
Definition
| Cause adrenal criss = addison's disease |
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|
Term
| Advantage using glucocorticoid without mineralcorticoid effect? |
|
Definition
| Lessen side effects of HTN, water retention, hypokalemia because no fluctuate electrolyte/fluid status |
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|
Term
| How does alternate day dosing benefit pt receiving therapeutic glucocorticoids? |
|
Definition
| Prevents atropy of adrenal gland, which occurs with continuous circulation of adrenal hormones. |
|
|
Term
| Risks of long-term glucorticoid use |
|
Definition
| steroid-induced diabetic, Cushing's effect, infections, HTN, PUD, osteoporosis, phychoses, hypokalemia |
|
|
Term
| Dietary modifications for glucocorticoids |
|
Definition
| Minimize salt, increase K, sxs hypoglycemia, |
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|
Term
| How do steroids affect appearance? |
|
Definition
| muscle wasting, poor wound healing, phychoses, thinning skin, vessel fragility, cataracts, moon face, facial hair, blunt growth, increase fatty deposition |
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|
Term
| Onset of action for regular insulin? |
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Definition
|
|
Term
| Peak action of regular insulin |
|
Definition
|
|
Term
| How do novolog and humalog differ from regular insulin? |
|
Definition
| All rapid acting. But novolog and humalog have quicker onset at 10-15 minutes compared to 30 minutes for regular insulin. |
|
|
Term
| In what order should insulin be drawn when mixing types? |
|
Definition
| Draw rapid-acting first, then long-acting. Only contaminat long-acting. |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| rapid-acting = novolog, humalog, humalin R |
|
|
Term
| Unique about glargine insuline? |
|
Definition
|
|
Term
| Why do we need to know the onset of action of insulin? |
|
Definition
| Help plan around meal times so stabilized blood sugar upon eating |
|
|
Term
| Why do we need to know the peak of aciton of insulin? |
|
Definition
| Most at risk for hypoglycemia. Give snack and monitor. |
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|
Term
|
Definition
|
|
Term
| How do we treat hypoglycemia? |
|
Definition
|
|
Term
| How do we measure short-term glycemic control? |
|
Definition
|
|
Term
| How do we measure long-term glycemic controL? |
|
Definition
|
|
Term
| Which OHA stimulates insulin release from pancreas? |
|
Definition
Glipizide (Glucotrol) = sulfonylurea.
Netaglinide (starlix) = meglitinides. |
|
|
Term
| Which OHA should be d/c before high-risk procedures due to the risk of lactic acidosis? |
|
Definition
| Metformin (Glucophage) = biguanide |
|
|
Term
| Which OHA may contribute to HF in at-risk pts? |
|
Definition
| Prioglitazone (Actos) = thiazolidinediones |
|
|
Term
| Which OHA should be given with the first bite of the meal? |
|
Definition
| Acarbose (Precose) = Alpha-glucosidase inhibitor. Since it slows carbohydrate absorption. |
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