Maryville NURS 615 Pharm 3 exam with all the correct answers (100% Verified 2020/2021 exam)

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Maryville NURS 615 Pharm 3 exam with all the correct answers (100% Verified 2020/2021 exam) How do antigout medications work? Correct Answer- by inhibiting the infiltration and phagocytosis of leuk... ocytes, thus decreasing the breakdown of uric acid to urate crystals. Deposition of urate crystals causes Correct Answer- pain and inflammation What is Colchicine Correct Answer- anti-gout medication how does Colchicine work? Correct Answer- Works by inhibiting inflammation, reducing pain and swelling common side effects of Colchicine Correct Answer- GI problems (diarrhea) use with caution in elderly Also can cause blood dyscrasias & abdominal pain patient education with Colchicine Correct Answer- Can be given with food & milk to decrease GI issues Avoid beer, ale, & wine: may cause gout attack Increase fluid intake: increases excretion of uric acid Avoid smoked meats & high-protein diets Low dose of Colchicine Correct Answer- Low dose colchicine is 1.2mg followed by 0.6mg one hour later or 1.8 milligrams total High dose of Colchicine Correct Answer- high dose colchicine is 1.2mg followed by 0.6mg every four to six hours; or 4.8mg total. Difference between high dose and low dose Colchicine Correct Answer- The difference between the two is low dose is as effective as high dose with a lower side effect profile. Lab values to monitor with Colchicine Correct Answer- Check renal function test, BUN, CreatinePatient education with Colchicine Correct Answer- Almost always causes some degree of diarrhea, make sure patients are aware of this side effect Patient education with Febuxostat (Uloric) Correct Answer- Gout may worsen with therapy initially Dietary changes to decrease gout attacks and uric acid deposits. Correct Answer- Avoid beer, ale, & wine Increase fluid intake: increases excretion of uric acid Avoid smoked meats & high-protein diets WHO 3 step ladder for pain medication Correct AnswerWhat is not a first line for pain medication? Correct Answer- Narcotics Recommendations for pain treatment Correct Answer- You want to start with NSAIDs first and then work your way up from there. types of Corticosteroid treatment Correct Answer- Prednisone, Cortisone, Dexamethasone how do Corticosteroids work? Correct Answer- Suppress the inflammatory & immune systems by inhibiting the synthesis of chemical mediators. what are the chemical mediators that Corticosteroids work on? Correct Answer- Prostaglandins, leukotrienes, & histamines Corticosteroids and inflammation Correct Answer- Decreases inflammation which decreases swelling, warmth, redness, & pain. Uses for corticosteroid treatment Correct Answer- Addison's disease, hormone replacement, cancer therapy SLE, arthritis, IBD, & to suppress graft rejectioncontraindications for corticosteroid treatment Correct Answer- Systemic fungal infections & with live vaccine Use corticosteroids cautiously with: Correct Answer- Pregnancy, kids, HTN, heart failure, renal impairment, & with infections resistant to treatment Patient education with corticosteroids Correct Answer- Don't discontinue abruptly, doses may need increased during stress, symptoms of Cushing's and GI bleeding Problem with taking Corticosteroids for greater than 6 months Correct Answer- The main thing you want to worry about is osteoporosis it can also worsen diabetic control and patients should report any tarry black stools or abdominal pain. Other common side effects with Corticosteroids Correct Answer- Peptic ulcers, GI bleeding, edema, hyperglycemia, delayed wound healing, fluid & electrolyte imbalances Why is it important to tapper the corticosteroid? Correct Answer- Tapering must be done carefully to avoid both recurrent activity of the underlying disease process and possible cortisol deficiency resulting from the hypothalamic-pituitary-adrenal axis or HPA suppression during the period of steroid therapy Black box warning Correct Answer- Increased risk of serious cardiovascular thrombotic events, myocardial-infarction and stroke which can be fatal. What increases risk of black box warning occurring with NSAIDs. Correct Answer- Risk increases with duration of use. Patients with cardiovascular disease or with risk factors for cardiovascular disease may be a greater risk. NSAIDs and GI system Correct Answer- Increased risk of serious gastrointestinal adverse effects including: bleeding, ulceration, and perforation the stomach or intestines can be fatal. Can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious GI events.Ibuprofen and mechanism of action Correct Answer- Exact mechanism of action is unknown. A non-selective cox-2 inhibitor in that it inhibits two isoforms of psychologic oxygenase cox-1 and cox-2. A non-selective inhibitor of cyclooxygenase, believed to be due to inhibition of cox-2 which decreases the synthesis of prostaglandins in mediating the inflammation pain, fever, and swelling. Ibuprofen and antipyretic effects Correct Answer- Antipyretic effects may be due to action on the hypothalamus resulting in an increase of peripheral blood flow, basil dilation, and subsequent heat dissipation. Ibuprofen versus NSAIDs Correct Answer- The analgesic and antipyretic and anti-inflammatory activity of NSAIDs appear to operate mainly through inhibition of cox-2. Resident inhibition of cox-1 would be responsible for the unwanted effects on the GI tract. Inhibition of cox-1 is thought to cause some of the side effects of ibuprofen including GI ulceration like aspirin and indomethacin. Ibuprofen versus NSAIDs Correct Answer- like aspirin and indomethacin. Ibuprofen is also a reversible inhibitor of the cox pathway. On the other hand, aspirin is a non-reversible inhibitor of the cox pathway. cox enzyme pathway - Cyclooxygenase is: Correct Answer- the prostaglandin-endoperoxide synthase (PTGS) Cyclooxygenase is the prostaglandin-endoperoxide synthase (PTGS)- what does it do? Correct AnswerInhibits the formation & release of prostaglandin. PTGS converts arachidonic to PGH2 which is converted to other prostaglandins that mediate pain, inflammation, & fever. PGH2 is also converted to thromboxane-A2 which stimulates platelet aggregation leading to formation of blood clots. What happens when one part of the cox pathway is blocked Correct Answer- Understand that blocking one part of the cox pathway can lead to a build up of different products acetaminophen Mechanism of action Correct Answer- The main mechanism is performed a proposed is the inhibition of cox. And recent findings suggest that it's highly selective cox-2.Selectivity for cox-2 it does not significantly inhibit the production of pro clotting thromboxanes. Acetaminophen and Peripheral anti-inflammatory activity is limited by several factors Correct Answerhigh level of peroxides present and inflammatory lesions serious side effects of acetaminophen Correct Answer- Acute overdoses of acetaminophen can cause potentially fatal liver damage. maximum recommended dose of Acetaminophen Correct Answer- The maximum recommended dose is 4 grams in 24 hours, from all sources. Additional teaching with Acetaminophen Correct Answer- Remind patients that many OTC medicines contain acetaminophen antidiabetic medication Correct Answerhypoglycemia Correct Answer- dizziness, confusion, diaphoresis, and tachycardia Hyperglycemia Correct Answer- polyuria, polydipsia, and weight loss. Diabetic Ketoacidosis Correct Answer- fruity breath odor, and rapid respirations. Neurologic symptoms including lethargy, focal sign, and obtundation can develop this can progress to coma in later stages. hypo and hyperglycemia visual Correct AnswerMetformin mechanism of action Correct Answer- Major effect is to decrease hepatic glucose output by inhibiting gluconeogenesis. Also increases insulin mediated glucose utilization in peripheral tissues such as the muscle and liver (particularly after meals) Has a anti-lipolytic effect that lowers serum phreatic concentrations—thereby reducing substrate availability for gluconeogenesis. It's also used in diabetics to decrease their cholesterol and triglyceride levels.Lab tests and Metformin Correct Answer- A1C should be checked periodically to monitor for effectiveness of treatment Lab tests and renal function with Metformin Correct Answer- Metformin is not metabolized. It is cleared from the body via tubular secretion and excreted unchanged in the urine. You should order a serum creatinine to assess for impaired renal function. Gliptin (Glucagon) mechanism of action Correct Answer- Glucagon increases blood glucose levels and dpp-4 inhibitors reduced glucagon in blood glucose levels. The mechanism of action of the dpp-4 inhibitors is to increase incretin levels—which inhibit glucagon release which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels. Gliptin (Glucagon) drug class Correct Answer- Inhibitors Dipeptidyl peptidase-4 (DPP4), or dpp-4 inhibitors or gliptins, are a class of oral hypoglycemics that block DPP-4. They can be used to treat diabetes mellitus type II. Exenatide is a Correct Answer- GLP agonist How do GLP agonists work Correct Answer- Glucagon-like peptide-1 receptor agonist. Bind to glucagonlike peptide-1 receptors slowing gastric emptying, increasing insulin secretion by pancreatic beta cells. Simultaneously the compound reduces the elevated glucagon secretion by inhibiting alpha cells of the pancreas, which is known to be inappropriate in the diabetic patient. GLP-1 is normally secreted by L cells of the gastro intestinal mucosa in response to a meal. What is Exenatide used for and what is an advantage of it Correct Answer- This class of drugs is used for treatment of type 2 diabetes. One of their advantages over older insulin secretagogues such as sulfonylureas or meglitinides is that they have a lower risk of causing hypoglycemia. Exenatide and how it works Correct Answer- Exenatide is a synthetic version of exendin-4 hormone found in the saliva of the Gila monster. It displays biological properties similar to human glucagon-like peptide or GLP-1, a regulator of glucose metabolism and insulin secretion.What is Exenatide administered for? Correct Answer- Exenatide enhances glucose-dependent insulin secretion by the pancreatic beta-cell, suppresses inappropriately elevated glucagon secretion and slows gastric emptying, although the mechanism of action is still under study. It should be administered 60 minutes before breakfast and dinner. How is Acarbose used? Correct Answer- May be used in conjunction with metformin, a sulfonylurea, or alone When is Acarbose taken? Correct Answer- Take with the first bites of a meal because it interferes with absorption of carbohydrates Function of Acarbose Correct Answer- Inhibits the alpha-glucosidase enzyme. This action slows the digestion of carbohydrates, reducing the postprandial rises in blood glucose. Acarbose dosage schedule Correct Answer- vailable in 50 & 100mg tablets and should be taken with the first bite of each meal. Usually begin with 50 mg three times daily. Flatulence, diarrhea, and abdominal discomfort are dose-related and almost always resolve if the dose is decreased. Few people tolerate more than 300mg daily. contraindications for Acarbose Correct Answer- Patients with inflammatory or irritable bowel syndrome. Thiazolidinedione's are also called Correct Answer- Glitazones Thiazolidinedione's- what are they? Correct Answer- class of oral hypoglycemics used in patients with diabetes mellitus. Thiazolidinedione's, are Correct Answer- insulin sensitisers that act as agonists of the peroxisome proliferator-activated receptors-gamma (PPARgamma) are Thiazolidinedione's used alone or in combination? Correct Answer- May be used either as monotherapy or in combination with metformin or with sulphonylureas.can Thiazolidinedione's be used with Insulin? Correct Answer- Not recommended for use with insulin's what are the two Thiazolidinedione's? Correct Answer- Actos and Avandia black box warning for TZDs Correct Answer- Water retention leading to edema is uncommon but of major concern in pts with unrecognized or diagnosed heart failure, especially with decreased ventricular funcation Potentially with significant water retention leading to a decompen [Show More]

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