Nur 641 E Final Exam Study Guide Grand Canyon University ALL SOLUTION 2025 EDITION GUARANTEED GRADE A+

Nur 641 E Final Exam Study Guide Grand Canyon University ALL SOLUTION 2025 EDITION GUARANTEED GRADE A+ absorption, distribution, metabolism, excretion Pharmacokinetics involves absorption from the administration site either directly or indirectly in the blood plasma Pharmacokinetic absorption reversibly or irreversibly move from the bloodstream into the interstitial and intracellular fluid Parmacokinetic distribution biotransformed via hepatic metabolism or by other tissue Pharmacokinetics metabolism 1. highest bioavailability 2. places entire does into venin thus bypassing absorption 3. avoids hepatic first pass metabolism in the liver Intravenous medications usually reached within 4-5 half lives of the drug steady state medication time required for the elimination process to reduce concentration of the drug to one half what it was at initial administration mines drug frequency 4. predicts length of toxic effects 5. constant first order pharmacokinetics of a drug drug half life drug is metabolized at a constant rate per unit zero order (nonlinear) metabolizes 50% drugs inhibit: grapefruit juice - increase drug - adverse effects may have enhanced activity with any other CYP3A4 CYP3A4 1. discovery or laboratory for development 2. Phase 1 begins with animal testing 3. phase 2 human subjects 4. compare drug to placebo or other drug that is effective 5.FDA then reviews result and determines approval 6. Post market study to determine other side effects that were not seen while lab testing Six steps in drug development process 1.Institute of Safe mediation Practice 2. Institute of Medicine 3. Joint commission 4.National Coordinating Council form mediation error reporting and prevention 5. Food and Drug Administration (safe use initiative) organizations for medication safety 1.Also known as a side effect, an undesirable reaction that accompanies the principal response for which the drug was taken include allergic reactions and adverse drug effects 2. Either pharmacological or idiosyncratic 3. 85-90% of ADRs are pharmacological 4. Reporting is not mandated by FDA thus are not commonly reported 5. usually preventable occur in hospital and nursing homes due to med errors 6. Polypharmacy, multiple doctors and multiple pharmacies increase risk Adverse Drug Reaction (ADR) 1. end in pril: lisinopril, captopril, enalapril, ramipril, benazepril and fosinopril 2. suppress release of angiotensin converting enzyme 3. side effects include cough and angioedema, with angioedema the medication should be discontinued Angiotensin-converting enzyme (ACE) inhibitors 1. -sartan: candesartan, eprosartan, ibesartan, Isosartan, telmisartan, valsartan angiotensin 11 receptors Angiotensin II Receptor Blockers (ARBs) Essential HTN accounts for 90% of cases and is also called primary, secondary may be caused by CKD Essential vs Secondary HTN use: angina pectoris action: dilate veins and arteries and thereby reducing ischemia and relieving pain by decreasing myocardial O2 consumption Side effects: throbbing HA, flushing, hypotension tachycardia available: IV, SL, topical ointment and transdermal patch contraindicated with PDE-5 (sildanfil and vardenafil) Nitroglycerin (Nitrate) 1. antiarrhythmic of choice when there is coexisting heart failure 2. can cause thyroid and pulmonary toxicity Amiodarone vasoconstriction and increased blood pressure Alpha 1 adrenergic stimulation results Decrease sympathetic stimulation causing vasodilation and decreased blood pressure alpha 1 blockade stimulation by beta agonists (isoproterenol) result in increased heart rate, blood pressure and cardiac output 2. blockade results in decreased heart rate, bp, and cardiac output beta 1 adrenergic The heart does not adequately circulate blood to systemic system. Due to pressure overload or volume overload causing a reduction of oxygenated blood to body tissue left heart failure 1.Associated with pulmonary disease and increased pulmonary vascular resistance 2.The heart does not adequately circulate blood to the pulmonic system. Can be due to volume overload or regurgitation in Tricuspid Valve or Pulmonic Valve. Can lead to systemic edema, back up of blood in liver and lower extremities Right heart failure 1.Inhibit water transport across Loop of Henle work on receptors in ascending renal loop it reabsorption of NaCL at site in kidney 3. potent diuretic (Lasix) can cause hypokalemia Loop diuretics MOA spironolactone, triamterene, amiloride Potassium sparing diuretics phosphodiesterase inhibitor used to treat acute heart failure Milrinone (Primacor) children squat to compensate for hypoxia Tetrallogy of Fallot squatting geway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth 2. continuous machine like murmur heard over left upper sternal border in both systole and diastole 3. pulse is bounding and has thrill during palpation 4. Treated with IV NSAIDs such as indomethacin patent ductus arteriosus (PDA) a peripheral arterial (arteries and arterioles in fingers mostly) occlusive disease in which intermittent attacks are triggered by cold or stress 2. vasospastic 3. Treated with dihydropyridine type calcium channel blockers (nifedipine) bc they cause vasodilation Raynaud's disease episodes of breathing difficulty due to narrowed or obstructed airways, mucus production, hyperactivity of the bronchial tissue and inflammation Asthma Symptoms occur 2x/wk, but not daily treated with short acting beta 2 agonist (SABA) plus inhaled corticosteroid mild persistent asthma Daily symptoms occur w/ exacerbations 2x/wk treated with inhaled low dose corticosteroid and long acting bronchodilator moderate persistent asthma Symptoms occur continually, along w/ frequent exacerbations that limit physical activity & QOL treatment (LABA) long acting beta 2 agonist plus high potency inhaled corticosteroid and oral corticosteroid severe persistent asthma PRN only used in combination with inhaled corticosteroid for mild asthma SABAs used in acute asthma attacks but cause increased heart rate, tremors, nervousness and reduced serum potassium level Inhaled short-acting beta2 agonists (SABAs) indications LABA never used in acute asthma exacerbation where SABAs such as albuterol are used Salmeterol (Serevent) rinse mouth after use Instruction for inhaled corticosteroids fluticasone and salmeterol Asthma/COPD and is a corticosteroid Advair Diskus umeclidinium/vilanterol LAMA/LABA for COPD also an anticholenergic medication Anoro Ellipta albuterol/ipratropium SABA and anticholenergic Combivent, DuoNeb long acting anticholinergic bronchodilator not for acute asthma attack QD for asthma and COPD Tiotropium (Spiriva) 1. pulmonary disorder seen in childhood, noted increase in production of a protein producing thick mucus that blocks the airway, pancreatic ducts, sweat gland ducts and vas deferens cystic fibrosis AKA fibrocystic disease of pancreas a severe respiratory disease that is characterized by rapid respiratory failure, increased pulmonary resistance and surfactant deficiency respiratory distress syndrome (RDS) - anti-inflammatory, antipyretic, and analgesic properties - used for reducing pain, stiffness, swelling, redness, and fever associated with local inflammation - pros: fewer side effects and longer duration of actions -NSAIDs are associated with an increased risk of adverse cardio events like stroke, MI, and hypertension NSAIDs analgesic, antipyretic but does not reduce inflammation Acetaminophen (Tylenol) NSAID safe for patient with heart disease Naproxen (Aleve) Nsaids and corticosteriods to reduce inflammation Allopurinol - Reduces uric acid. Doesn't relieve acute gout attacks. Increase fluid intake May cause hypoglycemia. Colchicine - Used for initial prevention and chronic attacks. Decreases WBCs response to urate crystals. Avoid grapefruit juice. Allopurinol and febuxostat work on pathophysiological cause of gout Gout Medications renal calculi Comorbid condition in patient with gout 1. reduces inflammation by inhibiting synthesis of leukocyte microtubules 2. reduces pain in acute attack 3. does not stop gout from becoming chronic gout arthritis 4. efficacy is affected by incidence of adverse effects Colchicine (Colcrys) - Inhibits production of uric acid and only anti gout to inhibit xanthine oxidase - Used to treat gout and/or kidney stones of that nature - Watch for kidney toxicity - Contraindicated with Warfarin & oral hypoglycemic (increases effects of meds) Allupurinol 1. can initiate an acute gout attack cine, NSAIDs or corticosteroids are used with ULT drugs to decrease the incidence of ULT induced gout attacks Urate lowering therapy 1. gout 2. high serum urate levels with underlying renal dysfunction 3. urinary calculi 4. histor of tophaceous gout Allupurinol (Zyloprim) Treats NSAIDs : indomethacin ibuprofen, naproxen and sulindac Acute gout attacks preferred treatment 1. GI bleed ( dark stools and epigastric pain) 2. to reduce side effects switch to COX2 inhibitor or Celecoxib NSAID side effects chronic, progressive arthritis with stiffening and fusion of joints, primarily of the spine and sacroiliac joints ankylosing spondylitis 1. caused by acetaminophen overdoses 2 acute hepatitis or hepatoxicity Acute liver disorders bone forming cells osteoclast cause bone breakdown osteoblasts vs osteoclasts insufficient mineralization of the adult skeleton or softening of the bone osteomalacia loss of bone density/mass Osteoporosis bone cancer Osteosarcoma a bone disease of unknown cause characterized by abnormal new bone growth, increased reabsorption of spongy bone tissue Paget's disease site of pre-existing bone abnormality occurs with force that is considerably less than what would happen if regular or normal bone A pathologic fracture occurs when: 1. synthesized in hypothalamus 2. cause reabsorption of water in the distal tubule and collecting duct of the kidney antidiuretic hormone (ADH) standing upright cause decrease of 20 mmHg systolic or 10 mm Hg diastolic within three minutes of standing side effect of diuretic Orthostasis (orthostatic hypotension) 1. low potassium intake, insufficiency mic lupus erythematosus ons disease sium sparing diuretics Hyperkalemia causes 1. calcium gluconate 2. loop diuretics 3. patiromer (Veltassa) 4. Thiazide diuretics 5. Sodium polystyrene sulfonate (Kayexalate) 6. regular insulin IV 7. inhaled albuterol Hyperkalemia treatment move potassium from bloodstream into the cells, insulin also increases the transport of glucose from the bloodstream into the cells Insulin and Beta 2 inhalers for hyperkalemia parathyroid hormone vitamin D calcitonin calcium phosphate homeostasis is affected by: ipation 2. headache 3. prolonged QT interval AKA heart conduction irregularity Ondansetron (Zofran) side effects inhibit serotonin receptors inside the chemoreceptor trigger zone and inhibit serotonin receptors on val nerve terminal this reduces N/V Examples: Ondansetron Granisetron Dolasetron Palonosetron 5HT3 antagonists histamine 2 receptor antagonist Cimetidine (Tagament) Ranititidine (zantac) Famotidine (pepcid) nizatidine (Axid) H2RA 1. trap ammonia ion, reduce blood ammonia by execration of ammonia by stools hepatic encephalopathy lactulose (Cephulac) Esomeprazole (Nexium) Iansoprazole (Prevacid) Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (Aciphex) Overuse cause Clostridium difficile infection Proton Pump Inhibitors medications and C-Diff Heart patients on plavix should avoid prilosec as it blocks enzymatic conversion of clopidogrel to its active metbolite Clopidogel (Plavix) avoiding omperazole 1. pantoprazole 2. rabeprazole 3. Iansoprazole H2RA that do not interact with plavix (clopidogrel) constipation (treated with ducosate stool softner) addiction overdose sedation impaired daily function Opioids effects on the body autoimmune disorder Diarrhea, malabsorption, weight loss Gluten restriction certain cereal proteins cannot be absorbed Celiac Sprue (Gluten-sensitive enteropathy) Rapid emptying of gastric contents into small intestines. High osmotic gradient, rapid movement of fluid from blood vessels into the intestinal lumen Client experience rapid pulse, hypotension, pallor, weakness, sweating and faintness Dumping syndrome adaptive mechanism that enables certain organs to regenerate liver is the only internal organ that regrows to original size compensatory hyperplasia increases risk of pernicious anemia Gastrectomy and B12 deficits unfractionated heparin UFH low molecular weight heparin Lovenox ( Enoxaparin) inhibits factor Xa LMWH Form complex with Antithrombin III inhibits factors IXa, Xa, Xii a and Xiii Heparin MOA Monitor aPTT (should be 1.5-2 times 30-40 seconds), have protamine sulfate ready Low dose SC heparin (5000 units BID) does not require PTT monitoring Heparin monitoring inhibits action of Vitamin K, affecting II, VII, IX, X takes several days to become effective Warfarin (Coumadin) MOA Causes of hypercalcemia 1. bone hyperplasia 2. neoplasms 3. thiazide diuretics Hypercalcemia treatment 1. calcitonin 2. pamidronate 3. Zoledronic acid Vitamin D insufficiency causes? 1. cardiovascular disease 2. osteoporosis 3. rickets Vitamin B12 dietary insufficiency causes? Pernicious anemia Symptoms of partial compensatory metabolic acidosis include? 1. fatigue 2. cool pale hands and feet 3. new onset systolic heart murmur 4. vomiting coffee ground looking material The following toxicity is associated with hypokalemia Digoxin Hyperaparathyroidism causes secondary renal failure Cause of primary hyperparathyroidism tumor in the parathyroid gland Hyperglycemia occurs with 1. increased release of cortisol 2. increased release of epinephrine 3. increased glucagon 4. increased growth hormone in the bloodstream Causes of hypogylcemia starvation increased exercise Diabetic patient that exercises heavily may experience? 1. hunger 2. headache 3. lightheadness 4. confusion 5. tachycardia CONTINUED..