NR 292 STUDY GUIDE EXAM 2 WITH ANSWERS.

NR 292 STUDY GUIDE EXAM 2 WITH ANSWERS Chapter 30: Pituitary Drugs • Therapy is lifelong • Examples of drugs o Anterior: Cosyntropin, Somatropin, Somatrem, Octreotide  Cosyntropin: synthetic cortisol – used in diagnosis of adrenal insufficiency, stimulates release of cortisol from adrenal cortex, cortisol has anti-inflammatory effect and renal retention of sodium  Somatropin and Somatrem: mimic Growth Hormone, effects on skeletal and cellular growth (stimulate skeletal growth in pts with deficient GH such as hypopituitary and dwarfism, replacement for adults with pituitary disease  Octreotide: antagonizes the effects of GH by inhibiting release, decrease plasma concentrations of vasoactive intestinal polypeptide (reduces severe diarrhea associated with VIP tumors), also used to treat esophageal varices o Posterior: Vasopressin, Desmopressin, Oxytocin  Desmopressin: increases factor VIII – useful for some bleeding disorders, nocturnal enuresis, diabetes insipidus  Vasopressin: potent vasoconstrictor in large doses – hypotensive crisis, esophageal varices, diabetes insipidus  Oxytocin: mimics uterine contractions by stimulating uterine smooth muscle, used for induction of labor and postpartum bleeding, vasopressor and antidiuretic effects • Got to Know o Octreotide  Suppresses secretion of GH, insulin, and glucagon  Used for diarrhea management for pts with AIDS  Can cause hypotension r/t reabsorption of fluids/electrolytes o Vasopressin & Desmopressin  Avoid used of alcohol as it decreases ADH hormone effect  Monitor for s/s of hypervolemia o Somatropin  Maintain growth chart for children being treated for primary dwarfism Chapter 31: Thyroid and Antithyroid Drugs • Thyroid Replacement Drugs o Natural – dessicated (dried up animal T3&T4): not as predictable and not as commonly used • Hyperthyroid Drugs: Methimazole, Propylthiouracil o Methimazole blocks iodine from getting to the thyroid so less T3 and T4 is made • Got to Know o Levothyroxine  TSH is high when thyroid function is low  Full effects may not be felt for up to 3-4 weeks  Once daily dosing due to long half life  Dose in AM due to insomnia (same time each day) • Take on empty stomach with full glass of water  ^metabolism = ^HR = ^O2 demand = ^ risk for cardiac issues  ^ blood glucose levels and interferes with: insulin, oral antidiabetics, digoxin, phenytoin, phenobarbital (highly protein bound meds) o Methiamazole & Propylthiouracil (PTU)  May cause drowsiness  Can cause liver toxicity – monitor LFTs  May cause bone marrow suppression  Avoid foods containing Iodine (seafood, soy sauce, tofu, and iodized salt) o Levothyroxine is measured in mcg and Dessicated is measured in mg Chapter 32: Antidiabetic Drugs • See notecards Chapter 33: Adrenal Drugs • Mineralocorticoid: Fludrocortisone o Treatment of sodium loss associated with adrenocortical insufficiency o Adv Eff: fluid and electrolyte imbalance, weight gain, delayed wound healing • Glucocorticosteroids: (Methyl)Prednisone o Systemic and local treatment of inflammatory disease/conditions and adrenal insufficiency o Adv Eff: depression, psychosis, PUD, hyperglycemia, fluid retention, hypokalemia, delayed wound healing, osteoporosis • Got to Know o Teach pts on corticosteroids to avoid contact with people who have infections and to report any fever, increased weakness, lethargy, or sore throat o Teach pts to take all adrenal meds at the same time every day, usually in the morning, with meals or food o Pts should not take with alcohol, aspirin, or NSAIDs o Sudden discontinuation of these drugs can precipitate an adrenal crisis caused by a sudden drop in serum levels of cortisone: must taper o After using an orally inhaled corticosteroid, instruct pts to rinse mouth to prevent possible oral fungal infections Chapter 20: Cholinergic • Description: mimic effects of the PSNS neurotransmitter Acetylcholine (Ach) o Stimulate intestine and bladder o Stimulate pupils (constriction – miosis), reduced intraocular pressure o AKA cholinergic agonists, parasympathomimetics, anticholinesterase inhibitors o SLUD (Salivation, Lacrimation, Urination, Defication) o “Rest and digest”, “feed and breed” • Uses o Direct-acting drugs:  Reduce intraocular pressure: glaucoma and intraocular surgery • Echothiophate, Carbachol, Pilocarpine  Increase tone and motility of bladder and GI tract • Bethanechol  Relaxes sphincters in bladder and GI tract allowing them to empty: helpful for postsurgical atony of the bladder and GI tract o Indirect-acting drugs  Cause skeletal muscle contractions: • Diagnosis and treatment of myasthenia gravis o Pyridostigmine • Reverse neuromuscular blocking drugs • Reverse anticholinergic poisoning o Physostigmine • Treatment of Alzheimer’s o Donepezil, Rivastigmine, Memantine (not anticholinergic), Ginko • Got to Know o Monitor for Therapeutic Effects  In postoperative pts with decreased GI peristalsis monitor for: increased bowel sounds, passage of flatus, occurrence of bowel mvts  In pts with urinary retention/hypotonic bladder, urination should occur within 60 mins of bethanechol admin  In pts with Alzheimer’s: improvement in symptoms, improvement in mood and decrease in confusion  Alleviated signs and symptoms of myasthenia gravis o Pt Teaching