NURS 615 PHARM TEST 3 MARYVILLE EXAM 4 LATEST 2024 QUESTIONS AND DETAILED ANSWERS AGRADE.p, Exams of Nursing

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NURS 615 PHARM TEST 3 MARYVILLE EXAM 4

LATEST 2024 QUESTIONS AND DETAILED ANSWERS

AGRADE

Thiazolidinedione's- what are they? - ANSWER✔✔class of oral hypoglycemics used in patients with diabetes mellitus. Thiazolidinedione's, are - ANSWER✔✔insulin sensitisers that act as agonists of the peroxisome proliferator-activated receptors-gamma (PPARgamma) are Thiazolidinedione's used alone or in combination? - ANSWER✔✔May be used either as monotherapy or in combination with metformin or with sulphonylureas. Glargine (Lantus) - ANSWER✔✔Long-acting basal insulin once daily dose. Micro crystals that slow release, duration 18-21 hours with no peak Alpha glucosidase inhibitors dosing - ANSWER✔✔Initially 25 mg TID with FIRST BITE OF EACH MEAL (important) Week 5 increase dose as needed to 50. Mg TID Max dose = >60 kg = 100mg TID <60 kg = 50mg TID Max dose for poorly tolerated GIS = 50mg TID Pharmacodynamics of meglitinides - ANSWER✔✔Close ATP depending potassium channels in the beta cell membranes by binding at specific receptor sites. This depolarizers the beta cells and opens calcium channels increasing the secretion of insulin.

The peak effect of these drugs is 1 hour. Alpha-glucosidase inhibitors contraindications - ANSWER✔✔Do not use in patients with bowel disease such as inflammatory bowel disease, bowel obstruction, or chronic intestinal diseases. Not recommended for patients with renal impairment. Not recommended for children. Thyroid medication overview - ANSWER✔✔ PTU Mechanism of action summary - ANSWER✔✔inhibits the enzyme thyroperoxidase normally acts in thyroid hormone synthesis by oxidizing the anion iodide (I−) to iodine (I0), facilitating iodine's addition to tyrosine residues on the hormone precursor thyroglobulin. This is one of the essential steps in the formation of thyroxine (T4). does not inhibit the action of the sodium-dependent iodide transporter located on follicular cells' basolateral membranes. Inhibition of this step requires competitive inhibitors, such as perchlorate and thiocyanate. PTU adverse effects - ANSWER✔✔Fatal granulocytopenia first signs are fever and sore throat Vasculitis, a temporary alopecia, rash, aplastic anemia, and acute renal failure. Agranulocytosis, anca positive vasculitis, hepatotoxicity, and pancreatitis which is rare. PTU dosing for toxic goiter - ANSWER✔✔ 600 - 900 mg in 3 equally divided doses every 8 hours.

Signs of too much thyroid replacement - ANSWER✔✔Symptoms of hyperthyroidism- irritability, insomnia, nervousness, hyperthermia Signs of not enough thyroid replacement - ANSWER✔✔Bradycardia, lethargy, constipation, excessive fatigue & sleeping patient education for Synthroid - ANSWER✔✔Replacement therapy is lifelong, don't stop taking without consulting your doctor. If not tolerating medication a substitution may be made. You will need your TSH levels checked periodically for life It takes about a month for full effectiveness Take in the morning, 20 min before breakfast If three doses missed contact provider nursing implications for Synthroid - ANSWER✔✔Monitor for increase or decrease in pulse rate & rhythm Report abnormal vitals, especially HR higher than 100 bpm Methimazole (Tapazole) - ANSWER✔✔ Methimazole (Tapazole) adverse effects - ANSWER✔✔Teratogenic, in the fetus can cause aplasia cutis (congenital focal absence of the skin on the scalp) Fever, rash, puritus, dizziness, lost of taste, NV Toxic agranulocytosis (leukopenia) may occur up to 4 months after therapy Methimazole (Tapazole) mechanism of action- 2 - ANSWER✔✔Inhibits the enzyme thyroperoxidase, which normally acts in thyroid hormone synthesis by oxidizing the anion iodide (I−) to iodine (I2), hypoiodous acid (HOI), enzyme linked hypoiodate (EOI)

facilitating iodine's addition to tyrosine residues on the hormone precursor thyroglobulin, a necessary step in the synthesis of triiodothyronine (T3) and thyroxine (T4). Methimazole (Tapazole)- What is toxic goiter? - ANSWER✔✔Enlarged thyroid gland with nodules that produce too much TH. Symptoms: fatigue, frequent BMs, heat intolerance, increased appetite & sweating, muscle cramps, weight loss, & nervousness/restlessness Recommended treatment for toxic goiter - ANSWER✔✔Methimazole treats hyperthyroidism with toxic adenoma or goiter Propranolol (beta blocker) for symptoms Ultimately radioiodine therapy or surgery is needed antihypertensive medication - ANSWER✔✔Ideal BP 120/ Acceptable BP (60 or older) 150/90; (Under 60 or have CKD, DM, or CAD) 140/ Medications Used to Treat HTN Thiazide diuretics: Not discussed, hydrochlorothiazide (Microzide) Beta Blockers: (ends in - olol) Propanolol & Atenolol Angiotensin-converting enzyme (ACE) Inhibitors: (ends in - pril) Captopril, Enalapril, & Benazepril Angiotensin II Receptor Blockers (ARBs): text Calcium Channel Blockers (CCBs): Verapamil, Diltiazem, & Nifedipine Renin Inhibitors: not discussed, Aliskiren (Tekturna)

Benefits are decreased with low ejection fraction. Intolerant to these, poor kidney function, sometimes in blacks: combined hydralazine & long acting nitrate like isosorbide Reduced ejection fraction: can add hydralazine & isosorbide to ACE inhibitors or ARBs 2nd Line Medications Classes - CHF - ANSWER✔✔Digoxin (digitalis)- only used in a small number of patients with poor refractory symptoms with a-fib or chronic low BP Treatment of edema related to CHF - ANSWER✔✔Diuretics are the mainstay Loop diuretics, thiazide-like diuretics, & potassium sparing diuretics Spironolactone antagonists have limited efficacy and safety data ACE inhibitors - ANSWER✔✔ ACE inhibitor drugs - ANSWER✔✔"pril ending" Captopril (Capoten) Enalapril (Vasotec) Benazepril (Lotensin) mechanism of action of ACE inhibitors - ANSWER✔✔Suppresses formation of angiotensin II from the renin-angiotensin-aldosterone system, reduces peripheral resistance and improves cardiac output ACE inhibitors mechanism of action- detailed - ANSWER✔✔The renin-angiotensin system is systemically and locally driven. Systemic process triggered by kidneys' response to decreased effective blood volume. Begins with the secretion of insulin from the renal cortex.

Renin cleaves angiotensinogen to form angiotensin-I. This product in turn is catalyzed by ACE, formed primarily in the pulmonary vasculature and angiotensin-II. ACE-potent vasoconstrictor effects tissues and systems body wide, research shows that these vasoconstrictor effects are attenuated by ACE inhibition. systemic effects of angiotensin II - ANSWER✔✔Increased norepunephrine (central & peripheral) Decreased oxygen demand coronary vasoconstriction Decreased preload & afterload demand left ventricular mass (through growth factors) myocyte hypertrophy catecholamines from adrenal medulla sodium reabsorption from proximal tubule renal vasoconstriction renal sympathetic tone increased aldosterone benefits of ACE inhibition: increases - ANSWER✔✔Coronary blood flow ventricular relaxation cardiac output cardiac index

common side effects of Colchicine - ANSWER✔✔GI problems (diarrhea) Use with caution in elderly Can cause blood dyscrasias & abdominal pain patient education with Colchicine - ANSWER✔✔Can be given with food & milk to decrease GI issues Avoid excess alcohol Increase fluid intake: increases excretion of uric acid Avoid smoked meats & high-protein diets (alkaline diet) Dosage adjustments of maintenance drugs may be necessary Proximal muscle weakness R/T standard dosing may occur. Report these symptoms What constitutes an alkaline diet and when is it prescribed? - ANSWER✔✔Treatment of gout. Reduced sodium, refined sugars, oxalate rich foods (liver, kidney, anchovies, sardines, muscles, herring, bacon, codfish, scallops, trout, haddock, veal,venison, turkey) and excessive calcium intake as well as increase in oral fluids and dietary fiber.

Fluid intake of > 3000 mL/day reduces risk of renal calculi. Avoid large quantities of alcohol. Low dose of Colchicine - ANSWER✔✔1.2mg followed by 0.6mg one hour later or 1. milligrams total High dose of Colchicine - ANSWER✔✔1.2mg followed by 0.6mg every four to six hours; or 4.8mg total. Difference between high dose and low dose Colchicine - ANSWER✔✔low dose is as effective as high dose with a lower side effect profile. Lab values to monitor with Colchicine - ANSWER✔✔Check renal function test BUN Creatine Uric acid Patient education with Colchicine - ANSWER✔✔Almost always causes some degree of diarrhea, make sure patients are aware of this side effect Patient education with Febuxostat (Uloric) - ANSWER✔✔Gout may worsen with therapy initially Allopurinol (Zyloprim) - ANSWER✔✔Antigout maintenance drug Gout medications - ANSWER✔✔Allopurinol (zyloprim) Colchicine Probenecid (Ben Emil) Sulfinpyrazone (anturane)

IBD

suppress graft rejection Use corticosteroids cautiously with: - ANSWER✔✔Pregnancy kids HTN heart failure renal impairment infections resistant to treatment contraindications for corticosteroid treatment - ANSWER✔✔Systemic fungal infections & with live vaccine Patient education with corticosteroids - ANSWER✔✔Don't discontinue abruptly doses may need increased during stress symptoms of Cushing's and GI bleeding adrenal insufficiency, Problem with taking Corticosteroids for greater than 6 months - ANSWER✔✔osteoporosis can also worsen diabetic control patients should report any tarry black stools or abdominal pain. Other common side effects with Corticosteroids - ANSWER✔✔Peptic ulcers GI bleeding

edema hyperglycemia delayed wound healing fluid & electrolyte imbalances Why is it important to taper the corticosteroid?*** - ANSWER✔✔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 Corticosteroids - ANSWER✔✔Increased risk of cardiovascular thrombotic events, MI and stroke which can be fatal. What increases risk of black box warning occurring with NSAIDs. - ANSWER✔✔Risk increases with duration of use. Patients with cardiovascular disease or with risk factors for cardiovascular disease may be a greater risk. Elderly NSAIDs and GI system - 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. Take with food or milk. Ibuprofen: mechanism of action - ANSWER✔✔Exact mechanism of action unknown.

Converts arachidonic acid 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 - ANSWER✔✔blocking one part of the cox pathway can lead to a build up of different products acetaminophen Mechanism of action - ANSWER✔✔The main mechanism is performed a proposed is the inhibition of cox. 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. serious side effects of acetaminophen - ANSWER✔✔Overdose can cause potentially fatal liver damage. Acetaminophen has very limited anti-inflammatory activity: why? - ANSWER✔✔high level of peroxides present and inflammatory lesions maximum recommended dose of Acetaminophen - ANSWER✔✔The maximum recommended dose is 4 grams in 24 hours, from all sources. Additional teaching with Acetaminophen - ANSWER✔✔Remind patients that many OTC medicines contain acetaminophen antidiabetic medication - ANSWER✔✔ hypoglycemia - ANSWER✔✔dizziness

confusion diaphoresis tachycardia Hyperglycemia - ANSWER✔✔polyuria polydipsia weight loss. Diabetic Ketoacidosis - ANSWER✔✔fruity breath odor rapid respirations Neurologic symptoms including lethargy, focal sign, and obtundation can develop this can progress to coma in later stages. hypo and hyperglycemia visual - ANSWER✔✔ Lab tests and renal function with Metformin - 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. A1C should be checked periodically to monitor for effectiveness of treatment Nobiliary excretion. Diagnostic testing prior to metformin prescription - ANSWER✔✔CrCl and GFR. Contraindicated in women with CrCl >1.3, men > 1.

SGLT2 inhibitor dosing - ANSWER✔✔Canagliflozin - 100mg daily initially, 300mg daily max Dapagliflozin - 5 mg daily, 10 mg daily max Diagnostic testing prior to metformin prescription - ANSWER✔✔CrCl and GFR. Contraindicated in women with CrCl >1.3, men > 1. How do GLP agonists work - ANSWER✔✔Bind to glucagon-like peptide-1 receptors slowing gastric emptying Increase insulin secretion by pancreatic beta cells. Reduces the elevated glucagon secretion by inhibiting alpha cells of the pancreas. Known to be inappropriate in the diabetic patient. Normally secreted by L cells of the gastro intestinal mucosa in response to a meal. Renal dosing for Metformin - ANSWER✔✔Start with lower initial dose of 500mg then titration slowly Gliptin (Glucagon) mechanism of action - ANSWER✔✔Increases blood glucose levels and dpp-4 inhibitors reduced glucagon in blood glucose levels. SN***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 emptyin Decreases blood glucose levels. What is Exenatide administered for? - ANSWER✔✔Treats Type II DM

Enhances glucose-dependent insulin secretion by the pancreatic beta-cell Suppresses inappropriately elevated glucagon secretion Slows gastric emptying. It should be administered 60 minutes before breakfast and dinner. Adverse effects of propylthiouracil - ANSWER✔✔Most common adverse reaction is agranulocytosis and possible aplastic anemia. Risk is higher for patients with decreased bone reserves (older than 40) Dose higher than 40mg daily. Black box warning for propylthiouracil - ANSWER✔✔Liver failure Exenatide is a - ANSWER✔✔GLP agonist Acarbose dosage schedule - ANSWER✔✔Available 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. Exenatide and how it works - ANSWER✔✔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. Black box warning for propylthiouracil - ANSWER✔✔Liver failure