WillWallace Adv Test Flashcards

Terms Definitions
HYPERTENSION
BP>140/90
MUCOMYST
DYSULFIDE BONDS
Normal BP
<140/90
q4h
every 4 hours
qid
4 times daily
*NE
norepinephrine, neurotransmitter of sympathetic nervous system, neuroeffector sites are smooth muscle and cardiac muscle, receptor are a, B1 and B2
Drug info
USP, NF, PDR
*Combivent
Ventolen(albuterol) + atrovent combination sympathomimetic and anticholinergic, best with copd’er
LD 50
median lethal dose
*Acetaminophen
Tylenol, nonsalicylate non-narcotic, analgesic, antipyresis, not an anti-inflammatory
zafirlukast
aka AccolaTe, anti-asthmatic, selective and competitive antagonist of leukotriene receptors, hazard is renal failure, can’t be taken with food, so poor pt compliance
*SVN particle size
1-5 microns
fluticasone
aka Flovent, aerosol corticosteroid,
ACH
aka acetylcholine, aka cholinergic, neurotransmitter of parasympathetic, receptor site M, action < HR, < BP, bronchoconstriction, neuroeffector site is smooth muscle, cardiac muscle and glands.
*Barbiturate drugs
thiopental, pentobarbital and Phenobarbital (Luminal)-long acting anticonvulsant
Mucolytics drugs
dornase alfa (Pulmozyme), n-acetylcysteine (Mucomyst), sodium bicarb
*Phosphodiesterase
enzyme that breaks up cAMP
Topical
transdermal, cream patch ointment, inhaled, MDI, DPI, SVN, USN, atomized, vaporized
beclamethasone
Vanceril, high dose topical corticosteroid, low systemic, rapid metabolism, MDI, 2 puff 400ug, qid or qit, 5-10mg
Hypertension TX
diuretics, Beta-blockers, ace inhibiters aka Ace-I’s (a antagonists)
CHF
loss of contractility causes inefficient pump causes enlarged heart and loss of blood to organs and fluid accumulation (pulm edema) 3rd spacing
T wave
repolarization of the atria
Types of aerosols
bronchodilators, decongestants, antibiotics, anti-inflammatory agents, mucolytics, wetting agents, surface active agents (ethyl alcohol) and anti-asthmatics (cromolyn sodium)
triamcinolone
Asthmacort, 2 puffs qid, corticosteroid
*Dornase Alfa
aka Pulmozyme, mucolytic, lyces bacteria and cellular debri DNA, most often used with CF & bronchiectisis, never mix with other drugs, need special jet neb (maint drug)
Dose-response curve
graphic representation of the relationship between dose in mg and the response to or effect of the drug.
Meperidine
synthetic agonist narcotic, 1/10 to 1/5 as potent as morphine, dose 50-100 mg, mod-high addiction, high resp suppression, few side effects
*Epilepsy
paroxysmal (sudden onset) increase in CNS activity that is recurrent, has stereotypic clinical characteristics and associated massive discharge of elec activity that is self limiting
*Sedative
calming effect, decrease CNS activity and drowsiness
*Muscarinic
receptor site of ACH, parasympathetic, class of drugs that stimulate ACH, action is decreased HR, bronchoconstriction and vasodilation
*a action
vasoconstriction, increased BP, stops bleeding, decreases swelling,
Tachyphylaxis
rapidly developing tolerance to a drug
Agonists
drugs that combine with specific receptors to cause a drug action, drugs that stimulate action
Carcinogens
drugs that cause malignant neoplasms (cancer)
*Anticholinergic bronchodilators
blocks ACH-blocks SLUD, causes <secretions, >HR, bronchodilation, prototype is atropine (bad side effects) Ipratropium is safer alternative, good choice for bronchospasm in COPD with B2 agonist
An arrhythmia can cause symptoms ranging from mild palpitations to cardiac arrest T or F
True
*Singular
montelukast, available down to 12 months age (RAD), chronic, exercise and very safe, leukotrine blocker, competitive antagonist
Static angina
predictable, caused by exercise, stress, excitement, or digestion of heavy metal, usually relieved by rest
*Mast cell stabilizers
prophylactic-prevent extrinsic asthma by stabilizing mast cell wall so it will not burst, Intal aka cromolyn sodium and Tilade aka nedocromil sodium
*Thiazides
diuretic, FIRST LINE W/B-AGONIST used in mgmt of hypertension, inhibits reabsorbtion of sodium (K+)
*Can a sedative drug become hypnotic by increasing the dose?
yes
*Parkinsonism
middle age and progressive, lack of dopamine-containing neurons in the substantia nigra area of one of the cerebral nuclei (in CNS), causes lack of balance in excitatory and inhibitory neurons
Inhaled general anesthetics are
gases-nitrous oxide and cyclopropane(no longer used), Volatile liquids-ether, halothane, methoxyflurane
Potentiation
special case of synergism where one has no effect but can increase the effectiveness of the other 1+0 eq 2
how often can we give Vaponephrine
every hour
*The most effective method of mucolysis is
aerosolized mucolytics
MDI advantages
convenient, inexpensive, no prep, new MDIs are patent actuated and assures proper aspiratory flow and pattern
*saligenin drugs are
albuterol, levalbuterol, (Xopenex) and salmeterol (Serevent)
*Xopenex/levalbuterol dosage
SINGLE ISOMER SD .63mg/3mL, q4-6, exacerbation-adult 1.25-2.25mg 20 mins x3 then same q1-4 no cont neb (need to double ck max),
Aerosolized drugs that reduce inflammation and selling in the airways are
anti-inflammatory and anti-asthmatics
*Spacers/chambers
improve med deliver for MDI’s by holding aerosol in suspension for a longer period, FOR BETTER DISTRIBUTION
Direct installation drugs
Epi-cardiac arrest, NS-sputum sample, B2, mucomyst, surfactant in preemies.
*Positive inotropic effect
increased force of contractions (contractility) from sympathic NE causes increased stroke volume
Anti-platelets are
aspirin, plavix and fish omega 3
Antagonists
aka blocker, drugs that combine with a specific receptor and cause no action
*The major side effect of TCA’s and MAO inhibitors that is of greatest concern is
hypertension
Metabolism
liver * alphabetically e and k come first in alphabet fallowed by l and m, so excretion- kidney and liver-metabolism
prototype
"a drug that acts like" i.e. atropine is prototype anticholinergic and epinephrine is prototype adrenergic
Pharmacology
study of drugs and their origin plants animals and minerals
Choline esters action
stimulate m receptors and mimic effects of ACH, causes bronchoconstriction and SLUD
Aerosol steroid disadvantage
increased expense, not for status asthmaticus, increased risk of superinfection, horseness, cough, requires pt effort and coordination
*Asthma attack anatomy
mast cell exposed to allergen (antigen-antibody), mast cell degranulates releasing histamines (edema, mucus, constriction), cytokines (recruiters-cause late stage) and leukotrines (inflammatory mediator)
Therapeutic dose
recommended amount of a drug that should be used to obtain the desired clinical effect.
Catecholamines bronchodilators
naturally produced in the body in response to stress, epinephrine, receptor is a, B1, B2, metabolized by MAO & COMP (sympathetic, adrenergic, cholinergic)
Teratogens
drugs that are known to cause birth defects
*Group II anti-arrhythmic drug
propranolol (Inderal), Beta blocker, used to treat supraventricular tachycardia, <HR
WHAT HORMONE IS A POTENT VASOACTIVE CHEMICAL CAUSING HYPERTENSION
ANGIOTENSIN II
Increased BP bottom line
>blood volume along with >vasoconstriction, 10-15% of population has it, leading cause of heart attack, stroke and kidney disease.
*Anti-asthmatic drug classes
mast cell stabilizers & leukotriene blockers
*salmeterol + fluticasone
Advair, CHRONIC ASTHMA MAINT, B2 agonist (bronchodilator) + anti-inflammatory (corticosteroid) (1+1 EQ 3) POTENTIATE
*Calculating dose
mg eq mL x % x 10
*What are the contraindications for the use of Mucomyst
administration without a bronchodilator, administration to semicomatose pt without suction equip and monitoring
*R-Isomer or single isomer drugs
levelbuteral (Xopenex), also a saligenin but has no B1, and considered a LABA long acting beta agonist
*Anesthesia Stage III Surgical Anesthesia
via inhalation, intubation, for surgery, 4 planes (only seen when using ether)
Mucomyst dose
unit dose 10% or 20% solution, 20% solution can be mixed 1:1 with distilled water or NS if needed, refrig extra, date and discard after 4 days, 3-4mL/tx q4h with bronchodilator.
what is Bronchoconstriction
REDUCED AIRWAY LUMEN, caused by smooth muscle bronchospasm, swelling and edema, excess secretions
*Functional antagonist
effects of two drugs cancel each other out
Factors that alter drug effects
pt compliance, placebo effect, pathological state, time of admin, sex, age, genetic variations, drug interactions
*Sterile distilled water
most common solution in LVN for humidification of airway, also used as a dilute in SVN-TRACH PTS
Angina pectoris
chest pain, caused by lack of blood flow to heart from lack of o2 (ischemia) for contractions-early warning
*Single most important variable in effective aerosol administration
pt breathing pattern-BREATH HOLD
Direct installation
giving meds directly down ET tube or trach, (1 bolus) 3-5 ml normal dose, no guarantee of dose, most often used for mucus plugging.
Finding desired dose
desired dose/dose on hand eq amount/X example morphine in 10 mg/5mL vial, need 4 mg..10/5 eq 4/X so 10X/10 eq 20/10.....X eq 2 vials
When are steroids at their peak in the body
8am
*Anesthetic delivery
generals are for body core, IV and IV nerve blocks are for peripheral
Anesthesia Stage I Analgesia
aka twilight, midbrain and some spinal cord
Routes of administration
PO aka oral (most common and safest), parenteral aka IM or IV, topical aka svn
Additive effect
two drugs act on receptors to have a combined effect that is the sum of the two drugs effect 1+1 eq 2
*Albuterol dosage
SD 2.5 mg/3mL or .5mL in 2.5cc NS q4-8, Exacerbation 2.5-5mg 20mins x 3 or 10-15mg/hr cont
*Pulmozyme dose
unit dose 2.5 mL, contain 1 mg dornase alfa/mL solution (1mg is 2.5 mL), use separate neb, q1 or q2, (refrig and protect from light)
Mechanism of action for leukotriene blockers
stops arcodonic from becoming leukotrines
*Nitrates and nitrites
drugs that improve flow of O2 to myocardium, cause peripheral and coronary vasodilation by relaxing entire vasculature, <cardiac work so <need for O2 so <pain and <BP. In variant type the drugs relieve vasospasm and increase blood flow.
*advantages of steroids by aerosol
rapid absorption at site of action with reduced systemic side effects
CO
70mL per stroke x 80 HR is equal to CO of 5.6L/min
Chronic atrial fib causes
blood clots that lead to stroke, treat with anticoagulants
MDI on Mechanical Vent
medial to pt on circuit, actuate at end expiration adjust dosage as needed, minimum 8 puffs may go to 20, 15 seconds between puffs
Sedation and hypnotic are related how?
by dose, >sedation can cause sleep, <hypnotic can cause sedation
Mech vent and SVN
meds tend to stick to tube or baffle, 1.5 to 3% make it to airway, SVN should be distal to pt in circuit (close to flow source) often requires double dose
*Blood supply of the heart
O2 rich from left ventricle to aorta branches to coronary artery and is dependent on the force of contractions of myocardium
*What is the caution with morphine with COPD
reduced resp of morphine can cause death in copd’er with normal dose
*What is digitalis used to treat
primarily CHF, but also atrial fib and flutter, TI is low and toxicity is very high, CARDIAC GLYCOSIDE
DRUG IS AVAIL IN 250MG/10ML SOLUTION, WHAT % STRENGTH IS THIS?
2.5%, MG EQS MLx%x10, so 250 eq 10mlx%x10, so 250mg eqs 100%, solve for %, 250/100 eqs 100%/100 so 2.5 eqs % or 2.5%
*When should RT use sterile distilled water as dilute instead of NS with bronchodilator
with pt is like Kay and has a salt restriction
How many mg per ml are in a 2.25% solution
mg eq ml*%*10 so mg eq 1ml*2.25%*10 or 22.5
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