Adrenergic
DH who has a Hx of hormonal imbalance, is admitted for septic shock, and the PCP prescribed dopamine. However, you are double-checking the pts. Hx before administering the drug. What condition may be a contraindication to dopamine?
A tumor that secretes catecholamines, such as a pheochromocytoma
A pt. is on a cardiac step-down unit and receiving a dopamine IV infusion. When you check the IV line, it has dislodged, and the infusion has infiltrated.
A. What could happen as a result? Is this serious?
B. What treatment will you expect to be ordered?
C. Describe the procedure and provide the rationale.
A. Extravasation can cause vasoconstriction and ultimately tissue death.
B. Phentolamine, an alpha blocker, can reverse the vasoconstriction and restore blood flow.
C. Phentolamine is injected SQ in a circular fashion around the extravasation site. This increases blood flow to the area and prevents permanent damage.
Benzoyl peroxide takes how long to produce positive results?
4-6 weeks
Allergy to sulfa drugs
What patient history would contraindicate the use of estrogen therapy?
Hx of hormonally driven cancers, such as endometrial, ovarian, or breast cancer.
G and C are both on dopamine drips. G's is at a low rate and C's is at a high rate. Why might the infusion rates be different?
The action of dopamine depends on the dosage. Ata low rates, it can dilate blood vessels in the brain, heart, kidneys, and mesentery increasing blood flow. Increased renal flow may help remove excess fluid volume. At higher infusion rates, dopamine can improve contractility and cardiac output.
M. has been prescribed a beta blocker and is about the be DC'd from the hospital, but first you are giving her instructions about taking her BP and apical pulse 1 full minute.
A. Why are you having her to do this?
B. What should M. be looking for?
C. Is there anything she should report to the PCP?
A. Cardiac depression can occur.
B. Apical pulse if SBP <100 or P< 60, hold medication and contact PCP.
C. Any wt gain, esp. 2 lb or >/24 hr period. or 5 lb/1 week, or any weakness, SOB, or edema.
What are emoliient properties in a medication?
Soothes dryness or irritation, create a barrier by forming a film on the skin through use of an oil.
What effect does ophthalmic acetylcholine have on the eye?
Miosis (constriction of pupil)
What is an indication for dinoprostone cervical gel?
Cervical ripening for labor induction
A patient in the ICU had received too high a dose of epinephrine.
A. What effects will you monitor for?
B. What will you expect to do for this patient?
A. An extension of the common AEs of adrenergic drugs: seizures, hypotension/HTN, dysrhythmias. But the 2 most life-threatening effects include the CNS and CV systems.
B. Stopping the medication (has a short half-life). Seizures-diazepam, HTN-beta-adrenergic blocking drug
S. a 78 y/o, has a new prescription for tamsulosin due to BPH.
A. What concern, if any, is there with this drug?
B. What teaching will he need?
A. A common problem with alpha blockers, such as tamsulosin, is when a pt. first begins the drug they may experience lightheadedness and orthostatic hypotension. They usually quickly develop a tolerance to this effect.
B. Take care with position changes to prevent falling. Taking the first dose at bedtime may help. Other AEs are: blurred vision, dizziness, and drowsiness.
A. What is a concern for the use of isotretinoin in childbearing age?
B. What would be required while taking the drug?
A. Tetragenetic
B. Use two forms of birth control.
Concern with latanoprost eyedrops?
Permanent eye color changes (light eye colors ot brown)
A. What lab test would you follow in a pt. receiving Finasteride
B.The pts. wife is PG Any teaching that you would need to include?
C. Potential AEs of finasteride?
A.PSA, pre-lab needs to be obtained prior to initial administration.
B. Do not handle the medication
C. Gynemastia, difficulty maintaining an erection, and ejaculatory disfunction
A patient is in the urgent care for the treatment of a leg laceration. Just after a dose of IV penicillin is started the patient begins to wheeze and says, "Oh, I just remembered, I'm allergic to penicillin."
A. What is happening?
B. What will you do first?
C. What drug will be given in this situation?
A. Anaphylactic reaction
B. Stop the medication, stay with pt and monitor ABCs and have someone else contact PCP.
C. Epinephrine is drug of choice for anaphylaxis.
The mechanism of action of tamsulosin in treating BPH?
It causes the smooth muscle fibers in the bladder and prostate gland to relax, improving the urinary flow.
What allergy would be a concern when using povidone-iodine?
Shellfish
What type of treatment would be required for middle ear infection?
A. Topical steroids
B. Systemic steroids
C. Topical antibiotics
D. Systemic antibiotics
D. Systemic Antibiotics
What type of drugs would be a concern with a new prescription of sildenafil?
CV drugs that lower BP or nitrates
The PCP gives a prescription for salmeterol inhaler. What is important that you teach the patient about this medication?
1. This drug is not to be used for the relief of acute symptoms.
2. Dosage
3. If used in conjunction with a steroid inhaler, the bronchodilator is used first.
4. Rinse mouth with warm water after use.
BH. has been prescribed a beta-blocker, atenolol, after an MI. At his 3-month check-up, he wants to stop this drug.
A. Should this medication be stopped abruptly?
B. What do you think may be the reason BH. wants to stop the drug?
A. No, the patient should be weaned off slowly due to possible rebound HTN or CP that rapid withdrawal can precipitate.
B. Beta blockers may cause impotence. But, you need to ask the patient the reason.
Silver sulfadiazine is used with what diagnosis?
Burns
A. What type of medication would you expect to be recommended for cerumen build?
B. Is there any condition that would contraindicate eardrums?
A. Wax emulsifier
B. Eardrum perforation
Situations in which androgens would be prescribed to a female (other than female-to-male transition)?
fibrocystic breast disease
endometriosis
inoperable breast cancer