MID TERM STUDY GUIDE

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School

West Coast University, Los Angeles *

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Course

N120

Subject

Medicine

Date

Apr 3, 2024

Type

docx

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Uploaded by AgentDolphin4069 on coursehero.com

MIDTERM STUDY GUIDE ● When a patient refuses to take medicine what do we do? Do we notify the healthcare provider what we do? ○ Clients have the right to refuse medication. Determine the reason for refusal, provide information regarding the risk of refusal, notify appropriate health care personnel, and document the refusal and actions taken. ● Pharmacokinetics - understand what pharmacokinetics ○ study of the absorption, distribution, metabolism and excretion of drugs ■ What the body does to the drug ■ Study of drug movement throughout the body ○ Absorption - the movement of a drug into the bloodstream after administration ○ Distribution -movement of a drug from the circulation to body tissues ○ Metabolism -the process by which the body chemically changes drugs into a form that can be excreted ○ Excretion -elimination of drugs from the body through the kidneys, bile lungs, sweat and breast milk ● Review what a blackbox warning is - why some medications are classified as blackbox warning ○ intended to provide alert regarding high risks associated with drug ■ FDA mandate ■ Potential adverse events, drug interactions, dosing information, monitoring & administration requirements, and at-risk populations. ● What is the action of lantus and levemir (insulins) - (Commonly prescribed controlled basal rate control) - how often do we give these long acting insulins? ○ Long acting insulins ○ Subcutaneous - given once daily - given at the same time each day (lantus) or with evening meal or at bedtime (levemir) ○ Gradual onset Over 24 hours ○ Duration 10-24 hours ● What do we tell someone whose going to have surgery and is taking oral contraceptives - how do we tell them how soon do they need to stop taking contraceptives ○ Stop taking at least 4 weeks before any surgery that increases risk of thromboembolic events. ● If someone misses an oral contraceptive - what type of teaching do we tell them - Concept of missing 1 pill, 2 pills, 3 pills, what do we need them to do? (oral contraceptive) ○ Follow the manufacturer’s instructions for missed pills: ■ 1 missed pill: take one missed pill with the next pill ■ 2 missed pills: two pills for 2 consecutive days ■ 3 or more missed pills: start new cycle 7 days later ● Women that are 35 years old and smoke - why we shouldnt give them contraceptives ○ Cardiovascular effects (hypertension, myocardial infarction, hemorrhagic stroke, venous thrombosis) ○ Breast (mainly BRCA1 +), Hepatocellular, and Cervical Cancers

○ Endocrine and Metabolic effects ○ Should be avoided in woman that smoke over 35 years old/ or History of blood clot ● What do patient's need to avoid if they are getting/taking spironolactone (Aldactone) ○ Monitor possibility of hyperkalemia ○ Potassium - sparing diuretic ■ Educate patient to stay away from high potassium containing food ■ Avoid use of potassium-based salt substitutes ■ When in direct sunlight, use sunscreen ■ Avoid performing tasks that require mental alertness ■ Do not eat excess number of foods high in potassium ○ Spironolactone may decrease effectiveness of anticoagulants. ● Mannitol (osmotic diuretic) how does it produce diuresis and mechanism of action - where do it work? Do we use it for intracranial pressure? What other reasons do we use it ○ Mannitol decreases intracranial pressure ○ Quickly reduce plasma volume ○ Mannitol is used to reduce intracranial pressure due to cerebral edema ○ Mannitol is also used to maintain urine flow in prolonged surgery, acute renal failure, or severe renal hypoperfusion ○ Osmotic diuretics act on the proximal tubule of the loop of henle to create osmotic force that pulls water into the nephron and increases the excretion of nearly all electrolytes ● LASIX - loop diuretic - idea of ototoxic - can lead to hearing loss - what do we assess the patient for (what they didnt tell us) ○ Assess for circulatory collapse, dysrhythmias, hearing loss, renal failure, and anemia ○ Monitor blood urea nitrogen (BUN), serum creatinine, uric acid, and blood- glucose levels ○ Monitor urinary output and weight to determine body fluid gain or loss. ○ Monitor vital signs and note decrease in BP. ○ Administer IV furosemide slowly, hearing loss may occur if it is rapidly injected. ○ Observe for evidence of hypokalemia. ○ Monitor potassium levels, especially when a patient is taking digoxin. ○ Monitor for side effects—orthostatic hypotension, hypokalemia, hyponatremia, polyuria ● Thiazide - thiazide diuretics (work at the distal part of the nephron ) - they can increase uric acid levels and lead to hyperuricemia can be a problem in patient's who have gout ● Hyperglycemia - side effect of glucocorticoids - discussed glucocorticoids such as prednisone - what we need to take into account? Do we stop it abruptly or taper down slowly? ○ Because corticosteroid drugs cause adrenal atrophy with long term therapy, these drugs must be tapered down slowly when discontinuing therapy

○ Glucose intolerance: Hyperglycemia and glycosuria/ make sure to monitor glucose ○ Suppression of adrenal gland function, hyperglycemia ○ Mood changes, cataracts, peptic ulcers ○ Electrolyte imbalances, osteoporosis ● Acetaminophen (tylenol) ○ to treat fever at the level of the hypothalamus; causes dilation of peripheral blood vessels, enabling sweating and dissipation of heat ○ Affect the CNS BY INHIBITING PROSTAGLANDIN PRODUCTION IN THE BRAIN ○ use with caution with patient who consumes large amounts of alcohol or have liver disease ○ caffeine increases analgesic effect ○ Different concentrations baby and infant. Can not exchange FORMULATIONS ○ Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin) ● Reglan (prokinetic drug) - categories and how it works ○ Metoclopramide (Reglan)/ Prokinetic Drug ○ Causes muscles in the upper intestine to contract ○ Used to treat PUD (peptic ulcer disease) ● Risk factors for peptic ulcer disease ○ Smoking (tobacco use) ○ Caffeine ○ Glucocorticoids and NSAIDs ○ Type - O blood, family history ○ Stress ● Breastfeeding - if a women is taking medications - has to be aware of what medicines cross into the milk - they cannot take any medications that is not prescribed by the doctor ○ Drugs that are ionized, water soluble, or bound to plasma proteins are less likely to enter breast milk. ○ Category X drugs - The drug is contraindicated in women who are or may become pregnant. ● H. Pylori - what is H. Pylori - directly related to peptic ulcers ○ Bacteria that causes PUD (peptic ulcer disease) ○ Primary cause of peptic ulcers ○ Gram-negative bacterium ○ Goals of treatment ■ Primary Goal: bacteria completely eradicated ■ Ulcers heal more rapidly ■ Ulcers remain in remission longer ■ Very high reoccurrence when H. pylori not eradicated ■ Infection can remain active for life if not treated

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