MITERM- NR566 study guide

MITERM- NR566 1 Know what meds you would give for asthma and COPD (LABA and intermittent use)  LABA- indacaterol (Arcapta). Indacaterol is a once-daily long-acting bronchodilator that has an onset of 5 minutes and a duration of 24 hours  FORMOTEROL/ SALMETEROL/ INDACATEROL 3 What to do when a patient calls you with hypoglycemia 4 How many gms of carb is needed during hypoglycemic episode- 15 what to tell patient to do for low blood sugar 5 how many mcg of dietary intake of iodine  Dietary iodine of about 100 to 150 mcg/d is required for normal thyroid hormone production. 6 alendronate (Fosamax) patient education- osteoporosis  PO meds should be taken first thing in the morning, at least 30 mins prior to medications.  Take it with 8oz plain water  Mineral water, coffee, OJ, and other beverages greatly reduce absorption.  Remain upright for least 30 mins after taking meds, which allows for passage out of the stomach and minimizes the risk for esophageal irritation.  GI distress and dyspepsia are the most common s/e's. if needed take aluminum and magnesium containing anatacids may be taken more than 2 hours fosomax.  Patients should eat a diet that has calcium and vitamin D 7 what medication decreases the T4 and the answer was Carbamazepime/ drug increases t4 (carbamazepine) 8 First choice for hypertension – which diuretic  thiazide-type diuretic has been typically chosen because in the landmark Chlorothiazide (Diuril) Chlorthalidone. Hydrochlorothiazide (Microzide) Indapamide. Metolazone. 9 Besides hypertension, BB are indicated for (I selected MI) Angina/ HTN/ MI prophylaxis/ glaucoma / migraine prophylaxis 10 Mechanism of action of Theophylline  Treats asthma (bronchodilator)  Work directly by an unknown mechanism believed to be mediated by selective inhibition of specific phosphodiesterases. This, in turn, produces an increase in cAMP, which then leads to bronchial smooth muscle and pulmonary vessel relaxation.  Theophylline and caffeine have an impact on most of the major body systems. They are powerful CNS stimulants, often causing insomnia and excitability. Although both drugs have cardiovascular effects, theophylline has a greater effect on the cardiovascular system. Theophylline directly stimulates the myocardium and increases myocardial contractility and heart rate. By relaxing vascular smooth muscle, theophylline dilates the coronary, pulmonary, and systemic blood vessels. 11 What should you test a patient c/o muscle pain, on atorvastatin  For all reductase inhibitors, muscle tenderness or pain may indicate a serious problem that may require discontinuance of the drug.  patient C/O muscle pain on atorvastin: check cK level. 12- 7 yo with pneumonia, what to give if already on amoxicillin  high-dose amoxicillin (90 mg/kg daily, divided in two doses) is the drug of choice for 7 to 10 days of outpatient treatment (Bradley et al, 2011)). If highly resistant pneumococci are in the community, the practitioner may choose between IV or IM ceftriaxone (50 mg/kg in one daily dose) or cefotaxime (150 mg/kg/d every 8 hours) followed by appropriate oral therapy after 1 or 2 doses 13 What to give for high cholesterol if cannot take statins – name of medication  Nicotinic acid (niacin) was always touted as effective in lowering total cholesterol and triglyceride levels and raising HDL levels 14 Which inhaler to give on asthma exacerbation  Ipratropium is an inhaled anticholinergic that may be used in combination with albuterol to treat asthma exacerbation in the emergency department (NAEPP, 2007). Hospital admission may be avoided by the addition of ipratropium to the treatment regimen in cases of exacerbation seen in the clinic or emergency department 15 Nicotine replacement drugs– bupropion should be avoided with what?  Bupropion is contraindicated in patients with seizure disorders, bulimia, and anorexia nervosa and within 14 days of the use of monoamine oxidase inhibitors (MAOIs).  Bupropion should not be used in patients with a history of stroke, brain tumor, brain surgery, or history of closed head injury.  Bupropion should be used with caution in patients with hepatic cirrhosis, with the dose decreased to 150 mg every other day.  The concurrent use of bupropion (Zyban) and Wellbutrin is contraindicated. Risk of suicide ideation and suicidality in children, adolescents, and young adults. Zyban is not approved for smoking cessation in children under 18 years of age. Patients prescribed Zyban should be monitored closely for signs of suicide ideation when treatment is started. 16 INH - risk for liver toxicity  INH has a Black-Box Warning regarding the development of severe and sometimes fatal hepatitis, even after many months of treatment.  .Increased risk for hepatitis is associated with daily alcohol use, chronic liver disease, and IV drug use. Black and Hispanic women, as well as any woman during the postpartum period who takes INH, may have increased risk of developing fatal hepatitis. nitro sublingual  All patients taking INH should have monthly symptom reviews to screen for hepatitis. Symptoms to screen for include unexplained anorexia, nausea, vomiting, dark urine, icterus, rash, persistent paresthesias of hands or feet, fatigue, weakness, fever longer than 3 days, or abdominal tenderness especially in the right upper quadrant.  Liver enzymes should be measured in patients over age 35 years prior to starting INH and then periodically throughout treatment.  They should report all flu-like illness immediately and see their health-care provider at least monthly during treatment. 17 Angina patient should be on ASA- aspirin  Atenolol, metoprolol, nadolol, and propranolol are indicated for long-term management of angina 18 Angina and diabetic should be on what 19 Which medication to take for SVT  Verapamil might be chosen for patients with supraventricular tachycardia who also have angina.  Type 1 CCBs (calcium channel blockers) are useful in treating selected supraventricular tachycardias because they slow AV nodal conduction. Verapamil (80 to 120 mg orally) can be used to terminate the rhythm. Conversion usually occurs in about 1 hour. Diltiazem (40 to 80 mg orally) can also be tried. Prophylaxis with verapamil (240 to 480 mg/d) is effective for patients with paroxysmal supraventricular tachycardia (PSVT) 20 MOA of nitroglycerine sublingual  Nitroglycerin (NTG) and its analogues act largely by providing more nitric oxide (NO) to vascular endothelium and arterial smooth muscle, resulting in vasodilation (Fig. 16-5). All parts of the vascular system, from larger arteries to large veins, relax in response to nitrates.  Sublingual absorption is dependent on salivary secretion. Dry mouth (including druginduced) decreases absorption.  The sublingual route avoids hepatic first-pass effect and is preferred for achieving a rapid blood level. 21 Goal for HgA1C when on tx; 7mg/dL 22 Glucagon route; How glucagon is given  Glucagon is well absorbed after parenteral administration. (IM) 23 MOA of insulin  once insulin arrives to the receptors, it creates changes within the cell membrane that result in translocation of certain proteins, such as glucose transporters from sequestered sites within the cell to the cell surface.  Insulin promotes the storage of fat as well as glucose and influences cell growth and metabolic functions in a wide variety of tissues.  Insulin acts on the liver to increase storage of glucose as glycogen and resets the liver after food intake by reversing the amt of catabolic activity.  Insulin reduces the circulation of free fatty acids and promotes storage of triglycerides in adipose tissue, done by the suppression of cAMP production and dephospherylation of the lipases in fat cells.