NURS 615 Exam 3 Questions with Complete Answers (Graded A+)

NURS 615 Exam 3 Questions with Complete Answers (Graded A+) Gout - med treatment, first line - Answers Allopurinol - first line agent for lowering urate levels. Xanthine oxidase inhibitor - Inhibits the enzyme responsible for conversion of hypoxanthine and xanthine to uric acid Gout - therapy goals - Answers Management of pain associated with acute attacks, lowering uric acid levels, lifestyle management Opioid FULL agonist - Answers activate opioid receptor fully; Heroin, morphine, codeine, methadone; Affinity PLUS efficacy Opioid PARTIAL agonist - Answers activate opioid receptor to a lesser degree - you can increase these drug doses but it usually does not help decrease the pain/effects. Meds: Buprenorphine & tramadol. Affinity but low efficacy Opioid antagonist - Answers bind to opioid receptors without activating them. Naloxone (Narcan). Affinity but no efficacy Gout caused by - Answers Caused by alteration in purine metabolism, leads to uric acid buildup. Hyperuricemia and deposit crystals in joints and tissues Allopurinol adverse effects - Answers Hepatotoxicity, gout flair at initiation of therapy, skin rash, multiple drug interactions Gout LABS to check - Answers LFT, BUN, Creatinine, Uric acid level, CBC - check these until they are stable Gout flair up meds - Answers Colchicine, NSAIDs (naproxen is typical), and glucocorticoids Colchicine adverse effects - Answers GI - Diarrhea, N/V, Abdominal cramping; Anemia. Low dose is preferable to high dose Corticosteroids - Answers Hormones produced by adrenal cortex, affect almost all organs in the body maintaining homeostasis, disease results from inadequate or excess secretion Corticosteroids - Answers Decrease peripheral uptake of glucose, glucogenesis in liver Decrease protein synthesis in muscle, lymph tissue, skin, bone Lipolysis in fat tissue in extremities; lipogenesis in face & trunk Decreased circulating eosinophils, lymphocytes, monocytes; increased PMNs Blocks generation of fever Promotes gastric acid secretion; enhances urinary excretion Decreased proliferation of fibroblasts in conn tissue; delay healin Maintains normal contractility of skeletal & cardiac muscle Increases osteoclastic activity; decreases osteoblastic activity Maintains normal BP; increases response of arterioles to NE Modulates emotional and perceptual function; essential for normal arousal Corticoidsteroid principles of Therapy - Answers Risk to benefit should always be considered. Short term use for self-limiting, acute conditions. Long term used reserved for life-threatening conditions (adrenal insufficiency) or severe disabling symptoms (COPD, but not as common). Use local over systemic steroid therapy when possible - ex: poison ivy Do not abruptly withdraw corticosteroids (for chronic use) d/t HPA-axis suppression - hypothalamic pituitary adrenal suppression - can cause withdrawal syndrome Corticosteroid adverse effects - Answers Osteoporosis Poor wound healing Peptic ulcers/GI upset Hyperglycemia Increased risk of infection Cataracts Mood changes/depression Insomnia Type 1 DM - Answers Cannot produce insulin on their own Type 2 DM - Answers Beta cell function goes down over time, will eventually require insulin therapy Biguanides and TZD - Answers Both improve insulin sensitivity What med is a Biguanides - Answers Metformin (Glucophage) Metformin (Glucophage) - Answers First lie med for T2DM. It improves insulin sensitivity and physiological factors related to metabolic syndrome. Used for metabolic syndrome-type disorder such as PCOS Metformin MOA - Answers Improved insulin sensitivity; Decreased hepatic gluconeogenesis; Decreased absorption of glucose by the intestines (i.e., it addresses major pathophysiologic processes in type 2 DM); Sometimes weight loss but otherwise weight neutral (desirable re weight loss in many cases); Inhibition of platelet aggregation; Decreased blood viscosity; Favorable lipid effects such as decreased triglycerides, increased HDL cholesterol, and decreased LDL cholesterol (triglycerides improve in general with better glycemic control) Metformin Adverse effects - Answers Mainly GI - N/V, diarrhea, bloating, abd cramping Take with food to decrease side effect Titrate dose slowly Lactic acidosis (black box warning) - rare, but likely in patients with renal disease, dehydration, and elderly Enzyme is blocked in skeletal muscle What drugs are Thiazolidinediones? - Answers Both used for T2DM: Pioglitazone (Actos) Rosiglitazone (Avandia) These activate the PPAR-gamma gene transcription is regulated so that proteins are produced in the cell that help insulin to act in the cell Pioglitazone (Actos) & Rosiglitazone (Avandia) Adverse effects - Answers Weight gain and edema due to fluid retention and plasma volume expansion Pioglitazone (Actos) & Rosiglitazone (Avandia) PRECAUTIONS - Answers TZDs may cause ovulation to occur - be sure they're on birth control Should NOT be taken by pregnant or lactating women What med is an Alpha Glucosidase Inhibitor? - Answers Acarbose (Precose) Used in T2DM Used in combination with other meds Acarbose (Precose) MAO - Answers Acts at the brush border of the small intestine to compete with complex carbs for digestion Ideal to lower postprandial blood glucose Acarbose (Precose) adverse effects - Answers GI symptoms - titrate slowly Acarbose (Precose) contraindications - Answers ANY inflammatory bowel disease/GI issues Hx bleeding ulcers, obstruction Renal impairment Pregnancy/lacation Pt education for Acarbose (Precose) - Answers Take with FIRST BITE of food. Will not work if taken after a meal Selective Sodium Glucose Co-Transport 2 Inhibitors (SGLT-2 Inhibitor) drugs - Answers Cangliflozin (Invokana) Empagliflozin (Jardiance) Dapagliflozin (Farxiga) These are all taken for T2DM as monotherapy or in SGLT-1 inhibitor MOA - Answers They inhibit reabsorption of glucose in the kidney proximal tubule - increasing excretion of glucose in the urine Osmotic fluid loss is a result SGLT-1 Inhibitor Adverse effects / precautions - Answers Genital infections - fungal and bacterial (Yeast infection most common) UTI Hypovolemia/hypotension Osteoporosis/fractures Lower extremity infection/amputation Precautions: Fournier's gangrene (black box warning) Leg and foot amputations Ketoacidosis **teach patient to come in if they cut their lower extremities to help prevent