Patho-Pharm Basics
a patient who has been taking 5 mg of hydromorphone for 3 weeks is no longer receiving adequate pain relief.
what is tolerance
1 thing you shouldn't take with Isoniazid and 2 ADRs
ADRs:
Liver damage (hepatitis & failure), Peripheral Neuropathy (B6 issues), N/V, CNS issues, DRESS
-Never take it with antacids, alcohol, increase liver tox with rifampin
-drink water with this medication and encourage fluid, helps thin secretions and help expectorate secretions!
-if a rash, DC
2 symptoms of left sided heart failure and 2 symptoms of right sided heart failure
Left-Sided Heart Failure (lungs = backing up into pulmonary system):
Dyspnea / shortness of breath
Crackles (pulmonary congestion)
Right-Sided Heart Failure (systemic venous backup):
Peripheral edema
Jugular vein distention (JVD)
2 major ADRs when taking atorvastatin
-Rhabdo/Myopathy
-Liver dysfunction
-also cataracts, HA, GI upset, Glaucoma
an example of Atrophy, hypertrophy, and hyperplasia
Atrophy → cells shrink
Example: muscle wasting in a cast, immobility
Hypertrophy → cells get bigger
Example: enlarged heart muscle from HTN, lifting
Hyperplasia → more cells
Example: uterus growth in pregnancy, BPH
This chemical mediator greatly assists the vascular phase of inflammation. Also, give an example of natural active immunity and natural passive immunity
-Histamine
Example of natural active immunity:
Immunity after recovering from an infection (like getting chickenpox and developing antibodies)
Example of natural passive immunity:
Maternal antibodies passed to a baby through the placenta or breast milk
the process of using a MDI (looking for at least 3 steps) and what you would do when giving both albuterol and a glucocorticoid
Shake the inhaler
Exhale fully before placing mouthpiece
Press inhaler while inhaling slowly (3-5 seconds) and deeply
Hold breath ~10 seconds
Wait ~1 minute between puffs if more than one dose
-Dilate then steroid
for propranolol, what do we want to monitor before giving this med and want to we want to teach when stopping the med and why
Monitor before giving:
Heart rate (below what is a concern?)
Blood pressure
Stopping teaching:
Do not stop abruptly — taper dose
Prevents rebound tachycardia, hypertension, chest pain, and MI
how does narcan work and what is a concern when giving this med to someone who has overdosed
-It knocks opioids off the opioid receptors (especially μ receptors) and reverses respiratory depression.
-Opioids withdraw symptoms (abstinence syndrome)
The purpose of both EC and ER meds and one thing you should never do to them
EC- Coating protects the stomach and allows the drug to dissolve in the intestine instead.
ER- Releases medication slowly over time to maintain steady drug levels and reduce how often it’s taken.
-Never chew, break, or crush them
Gentamycin is know to cause nephrotoxicity, what do we want to educate the patient to report, how long is the typical med regimen, and what is one other ADR for gentamycin
-Educate patient to report dilute urine (also encourage them to drink fluids). Gonna want frequent renal labs
-no longer than 10 days--> monitor peaks and troughs
-Vertigo and Ototoxicity
how does dextromethorphan work, what is something we should look for in the patients medical history pertaining to this med
How it works:
Suppresses the cough reflex by acting on the cough center in the medulla (central antitussive)
What to check in history:
History of substance misuse/abuse
(It’s found in cough syrups and can be misused in high doses.) also if they are taking CNS depressants
What is an important nursing intervention for the administration of Furosemide, give me 2 ADRs
Administer the medication slowly to avoid ototoxicity. ADRs can be electrolyte imbalance, dehydration, increase uric acid, hypotension, hyperglycemia
a patient with TB needs to be put in what room, also what are 2 ADRs and 2 ways it can be diagnosed
-airborne isolation, negative pressure room
-night sweats, bloody cough, fatigue, weight loss, afternoon sweats, crackles, pleuritic pain
-Chest x-ray, acid fast-sputum culture, QuantiFERON test, ppd
The difference between expressivity and penetrance
Penetrance → IF a gene shows up
How many people with the gene actually show the trait. Example: 80% penetrance = 8/10 people with the mutation have the condition.
Expressivity → HOW MUCH the gene shows
Degree or severity of symptoms
Example: Same disorder, one person mild symptoms, another severe.
The order of hormones that causes cortisol to be released and how that process comes to a halt and 2 effects that cortisol has on the body
Hypothalamic–Pituitary–Adrenal (HPA) Axis (order): CRH (hypothalamus) → ACTH (pituitary) → Cortisol (adrenal cortex)
How it stops: Negative feedback — rising cortisol suppresses CRH and ACTH release.
Two effects of cortisol:
Suppresses immune/inflammatory response, Raises blood glucose, Inhibits Osteoblast, body more responsive to catecholamines, suppresses protein and collagen synthesis, bronchioles dilate, CO increases
how long does ipratropium take to work (does not need to be exact), what disorder is it best at treating, and what are 2 ADRs
Ipratropium
Onset: fast acting but slower than albuterol
Best for: COPD (maintenance bronchodilation)
Two ADRs:
Dry mouth
Urinary retention (anticholinergic effect)
increased ocular pressure
This electrolyte imbalance potentiates digoxin toxicity, and name 3 signs of dig toxicity
What is hypokalemia, with signs such as nausea/vomiting, yellow-green visual halos, and bradycardia (dysrhythmias)?
a patient gets stung by a bee and has auditory wheezing-->what is the priority action for the nurse, what kind of hypersensitivity reaction is this, and what is it mediated by
-Give epi
-type 1
-igE
The 4 aspects of pharmacokinetics and one thing that effects each
A — Absorption- One thing that affects it: Route of administration
(Example: IV = immediate, oral slower due to GI factors)
D — Distribution, One thing that affects it: Plasma protein binding
(Drugs bound to albumin can’t easily leave the bloodstream)
M — Metabolism, One thing that affects it: First-pass effect in the liver
(Liver can metabolize oral drugs before they reach circulation)
E — Excretion, One thing that affects it: Renal function
(Kidneys filter drugs out; poor kidney function slows elimination)
The ASPIRIN pneumonic for ADRs
A - asthma
S - salicylates intolerance
P - peptic ulcers
I - intestinal/gastro bleeding
R - Reye’s syndrome (kids) I - increased GI discomfort
N - noise (tinnitus @ high dose = earliest sign of toxicity)
-Also want to monitor kidney labs, DC 7 days before surgery,
2 risk factors for Pneumonia, what it causes, 1 diagnosis, 1 treatment
2 Risk Factors for Pneumonia
Smoking
Impaired swallowing/aspiration risk
Chronic disease
immobility
immunosuppression
recent respiratory illness
Old age
What it causes:
Inflammation and fluid/pus in the alveoli → impaired gas exchange
1 Diagnosis:
-Chest X-ray
-Blood culture
-Sputum culture
1 Treatment:
-Antibiotics (if bacterial)
-IV fluids
-respiratory meds
The hallmark sign of pericarditis and 2 other clinical manifestation. 3 clinical Manifestations of endocarditis
Pericarditis:
Pericardial friction rub (audible sound) squeaky leathery sound– Hallmark sign of Pericarditis.
• Sharp chest pain with deep inspiration relieved by sitting up & leaning forward
• Dyspnea
• Tachycardia
• Edema
• Flu like symptoms (fever, rigors, myalgias)
• ST elevation in all leads
Endocarditis:
Flu like symptoms, symptoms related to
embolization (MI, PE, etc.), heart murmur,
petechiae, splinter hemorrhages under
nails
For gluccocorticoids, name 1 inhaled ADR and what you should do to prevent it, 3 oral ADRs, and 1 nasal ADR.
Inhaled- oral candidias--> rinse mouth after administration
Oral- suppression of adrenal glands (TAPER), bone demineralization, PUD, hyperglycemia, infection
nasal- dry membranes, sore throat, epistaxis, HA