Pharmacology Unit 4

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1

Humoral immunity

antigen stimulates antibody response by the body B cell

chicken pox measles

2

Cell mediated immunity

T cell lymphocytes antigen sensitizes the T lymphocytes and a series of immune responses occur to destroy the antigen (macrophages, direct attack by t cells

3

Active immunity

use of agent to build up immunity or stimulate antibodies

natural (exposed to it) or artificial chicken pox (given weakened antigen) vaccine

4

passive immunity

injection of ready made antibodies found in the serum of an immune person

immune globulins or antivenins are gvien

ready made antibody

5

Identify the signs and symptoms of fluid overload

jugular vein distention SOB rapid breathing crackles weight gain wheezing drowsiness confusion weakness headache blurred vision hyperemia

6

1. headache "someone is sitting on top of me"
2. "feel puffy"
3. SOB
4. Edema +3/4
5. Fluid in lung
6. hyperventilating
7. 02- 88%
8. pulse: 121
9. BP: 144/118

signs and symptoms of fluid overlaoad

7

What focused assessment do you do for fluid overload? (4)

. Lung sounds (crackles-fluid)
2. Turgor
3. Peripheral edema
4. pulses

8

1. Administer 02
2. elevate legs for edema
3. elevate HOB for SOB
4. I & O (amount of fluids that have been given)
5. Reassess lungs
6. Check chem panel (NA, K, creatinin, BUN)
7. will show hydration level by function of kidneys

What are interventions for fluid overload? (7)

9

Factors that cause electrolyte imbalances

disorder , vomiting , surgery, diagnostic tests, and drug treatment

10

Plasma protein fractions are contraindicated for

patients with allergy to albumin , anemia and cardiac failure

11

What plasma protein is the main contributor to colloidal osmotic pressure?

Albumin

12

When is Dextran used for?

Dextran is a nonprotein plasma expander and is given to patients who have lost about 20% to 50% of blood slowly.

13

Contraindications of Plasma Protein fractions

anemia cardiac failure and reactions to albumin

14

Contraindications of plasma expanders

HF renal Failure oliguria anuria

15

Problems associated with excessive Bicarbonate or ammonium chloride

metabolic acidosis and and loss of electrolytes

16

The alkalinizing drug, bicarbonate is used to treat

metabolic acidosis

17

Excessive use of bicarbonate results in

nevada pain discomfort and gas orally results in systemic alkalosis

18

Bicarbonate when given with fluoroquinolones results in what response

crystalluria

19

You shouldn't give a patient with hyperkalemia, renal failure oliguria and azotemia

potassium

20

Pre administration assessment before giving electrolytes

check electrolyte imbalances

vitals

21

Before administering calcium you should

warm solution to body temperature

22

Name two types of active immunity

naturally acquired active measles chickenpox

artificially acquired active flu shot booster shot

23

A patient with a bite from an animal would receive antivenins for

spider bite scorpion and snake

24

Toxins are

poisonous substances produced by a bacterium (tentanus) and are able to cause the body to produce antitoxins

25

BCO vaccines prevent what disease

TB

26

A woman wanting to get pregnant should wait how long before receiving a vacccine

12weeks

27

Aspirin causes what adverse reactions

hair loss and thrombocytopenia

28

Salicylates given with a varicella vaccination or chicken pox puts a patient at risk for?

Reye syndrome develops

29

A patient has just recevied a vaccine what should you do?

wait 30 minutes to observe for signs of hypersensitivity

30

After administering a vaccination, what should one document or chart?

Date of vaccination, route and site vaccine type and manufacturer AND ARM LOCATION

31

Vinca alkaloids interfere with what phase

amino acid production in the s phase

32

Patient prescribed an antimetabolite, and wants to know how it works. What will you tell them?

incorporate themselves into the cell during the S phase of division to interfere with synthesis of RNA and DNA

33

alkylating agents affect cells by

by making the environment more alkaline, which damages the cells

34

Antineoplastic antibiotics

interfere with DNA and RNA synthesis delaying or inhibiting cell division

35

Explain oral care for patients receiving chemotherapy. Explain the importance of factors such as white blood cell count.

Before Chemo:
Eliminate and or manage infection.
Control periodontal disease.
Provide OHI

During Chemo:
Schedule appointment just before next chemo.
Consult with oncologist before nay procedure.
Document hematologic status (laboratory test)
Treat only if neutrophil count is greater than 1000/mm
Institute oral hygiene program
Culture lesions for infection

After chemo:
Follow and maintain oral health

Low white blood cell count is an indication of immunosuppression. With increased immunosuppression comes increased risk of infection and dental procedure any manipulation of gingival tissues, stress, etc. need to be avoided for the patients safety. Platelets may also be low and cause increased bleeding.

36

List the types of drugs used in the treatment of neoplastic diseases

Cell Cycle-Specific Drugs:
- Plant alkaloids (Vinca alkaloids, taxanes, and podophyllotoxins)
- Antimetabolits

Cell Cycle-Nonspecific Drugs:
- Alkylating agents
- Antineoplastic antibiotics
- Miscellaneous antineoplastic drugs

37

Preassessment for Antineoplastic drugs

type and location lesion

stage

general condition emotional response

anxiety and fears

previous and concurrent treatments

current malignant disease or disorder

knowledge and understanding of therapy

38

What would you expect to observe in a patient with adverse reaction to a flu shot

mild fever

rash

cough

rhinitis

39

What priority signs and symptoms would you expect to see in a person who has just received and injection of Ferrous

Gi irritation

Nevada

constipation

allergic reaction

40

Mechanism of Action: Ferrous Sulfate

Iron is an essential component in the physiological formation of hemoglobin, adequate amounts of which are necessary for effective erythropoiesis and the resultant oxygen transport capacity of the blood. Iron is necessary for catecholamine metabolism and the proper functioning of neutrophils

41

Side Effects: Ferrous Sulfate

nausea, constipation, dark stools, diarrhea , stains teeth

42

Indication: Ferrous Sulfate

provides the iron needed by the body to produce red blood cells. It is used to treat or prevent iron-deficiency anemia because of pregnancy, poor diet, excess bleeding, or other medical problems.

43

Assessment for vitamin B12 deficiency

- Assess for S&S of B12 deficiency (anorexia, fatigue, pallor, insomnia, irritability, palpitations on exertion)
- assess for HF, pul. edema, hypokalemia in cardiac pt's receiving subq/IM therapy
- monitor serum potassium, B12, increased reticulocyte count
- teach to report symptoms of infections, eat foods rich in B12 (clams, oysters, muscle meats, dairy products)

44

Uses: Cyanocobalamin (vitamin B12)

- tx of anemia
- B12 deficiency due to malabsorption disease
- increase B12 requirement due to preg.
- thyrotoxicosis
- hemorrhage
- malignancy
- hepatic renal disease

45

Ongoing assessment for cyanocobalamin Vitamin B12

HR BP RR

Check adverse reaction (about)

Rbc levels

monitor relief, fatigue, pallor, SOB, sore tongue, headache

PCP notification with diarrhea or constipation

dark stool will occur with parental injections notify HCP

Address soreness at injection site

Check injection site for swelling and abscess

Pertinent lab tests

S/S bleeding

CSF

46

Hemopoetic factors or anemic patient shows signs of low iron is given Dextran IV was assessment will you initiate prior?

health history

symptoms of anemia

for bleeding or infection

Oozing from gums

Lab tests PHP

Cancer patients blood counts for titrating

Vitals

ADL ability

allergies

weight

hemoglobin levels

47

Patient is receiving Amifostine for chemotherapy for ovarian cancer who is also receiviing Cisplastin. Why is cisplatin given?

It helps to protect the kidneys

because amifostine decreases renal funciton

48

A patient is receiving iron, what priority assessment should the nurse look for when giving ascorbic acid?

increased iron absorption

49

Common symptoms of anemia

arthralgia or joint paint

50

Leuvcovorin is being used to treat Megaloblastic anemia is contraindicated for

pernicious anemia

51

Epoetin alfa is administered to a patient with iron defiency to stimulate erythopoesis, select the items needed for preassessment

General health

bleeding

infection

fatigue

oozing from the gums

cough

vitals BP

evaluate activities ADLs

52

Epoetin alfa is administered to a patient with iron defiency to stimulate erythopoesis, select the items needed for patient teaching

take three times a week

Keep appointments blood tests

adhere to antihypertensive drugs

report drowsiness headaches fatigue and joint paint

53

Priority assessment of what conditions for use of Potassium

hypekalemia

hypokalemia

dogoxin increases toxicity

54

Adverse reaction of ammonium chloride

loss of K

metabolic acidosis

55

Dextran, plasma expander when used with a patient, a nurse priority assessment should be

IV line

site

infuse nonirrigating fluid

alert and oriented every 4 hours

infuse critical patients unable to notify nurse every 1 to 2 hrs

neonate every 1hours

infuse vessicant and vasoconstrictive solutions every 5 to15 minutes

inspect needle site

CVP line for critical patients

Fluid electrolytes given check BP RR PR continuously

56

Vitamin B12 is contraindicated for

allergic to cyanocobalamin

pregnancy

alcohol

neomyocin

colanamines

57

CBC shows a patient with neutropenia what count will the AnC reach to be considered low

10, 000

58

Digoxin and K interact in what way

digoxin toxitiy increases

59

Patient wants to know why albumin is being used

can restore blood volume quickly

increases osmotic pressure

carries metabolites

60

Wbc count

5000 to 10000

61

What is the action visticristine?

Kizz

altoids

luke lifesaver

stop cell cycle stage S inhibits microtubules

62

etoposide preadmission assessment

eat tadpoles anticancer

type location and size

stage

general condition

emotion anxiety fears

previous and currrent treatments

understanding

age and financial and state

63

Gemcitabine, an antimetabolite ongoing assessment

general condition

response to meds

follow HCP guidelines

review labs periodically

CBC check bone marrow

check kidney function reduce if depression occurs

64

Mephalan (alkalating actions)

inhibit cell growth by making the environment alkaline

65

Role of Leucovorin

Rescues folate for healthy cells
NO EFFECT on levels of Methotrexate, but should be given with high doses of MXT

66

Antimetabolites

purine analogs, pyrimidine antimetabolites, antifolates; MOA: Unlike alykylators, they are cell cycle specific. Work primarily in the "s" phase of the cell-cycle. Inhibit DNA synthesis by acting as a false pyramidine or purine and incorporating into DNA, or by inhibiting some essential enzyme needed for DNA synthesis (i.e. polymerases, ribonucleotide reductase, etc

67

Visblastine (antineo) cell cycle specific cant go past metaphase

Interaction Warfarin

Warfarin metabolism increases

effects increase

68

Adverse reactions of Ferrous sulfate

Gi irritation

Diarrhea

Dark stool

Ascorbic acid increases absorption

nausea

vomiting

69

Leucovorin treats

pernicous anemia

70

Range for potassium

3.5 to 5.0

71

Vitamin B12 in contraindicated for

Pulmonary Disease

72

Mephalan (alkalating agent) action

changes the cell environment more alkaline to damage cell