NSG 511 EXAM 2 REVIEW

Pathways to airflow limitation in asthma Airflow limitation in asthma is caused by bronchospasm and/or inflammation Bronchitis (COPD) pathway to airflow limitation Emphysema (COPD) pathway to airflow limitation Consi ...

Pathways to airflow limitation in asthma Airflow limitation in asthma is caused by bronchospasm and/or inflammation Bronchitis (COPD) pathway to airflow limitation Emphysema (COPD) pathway to airflow limitation Considerations for metered dose inhalers (mdis) Considerations for dry powder inhaler (dpis) Considerations for nebulizers Considerations for Respimat’s Uses for pulmonary glucocorticoids Routes for pulmonary glucocorticoids Mechanism of pulmonary glucocorticoids Pulmonary glucocorticoid prototypes (and their routes) Indications for pulmonary glucocorticoids Prophylaxis for obstructive airway diseases temporary use for severe obstructive disease when unable to deliver drug via inhalation Side effects for pulmonary glucocorticoids why are side effects of inhaled glucocorticoids rare (other than thrush)? Short acting beta agonists (SABA) prototype and route Long-acting beta agonists (LABA) prototype "-terol" mechanism of action Short acting beta agonist (SABA) indications Long-acting beta agonist (LABA) indications Side effects of -terols Types of bronchodilators Pulmonary muscarinic antagonist prototypes and route Pulmonary muscarinic antagonist mechanism of action Leukotriene modifiers for asthma prototype drug Montelukast mechanism of action Indications and route for montelukast Montelukast side effects Cromolyn mechanism of action Cromolyn indications and route Phosphodiesterase inhibitor prototypes Theophylline mechanism of action Indications for theophylline Considerations for theophylline Theophylline drug levels What is the normal half-life for theophylline and what causes variability in this number? Roflumilast mechanism of action Indications for roflumilast Considerations for roflumilast Side effects of roflumilast How is asthma classified? What are the variables when examining degree of impairment with asthma? Goals of asthma therapy Considerations for asthma treatment How often do you evaluate asthma therapy? A patient requiring oral corticosteroids for asthma is considered: What is the sole treatment for intermittent asthma? What is used for management of an acute asthma attack? What drug is used in every step of asthma treatment? What is the progression of drugs used for persistent asthma? When to step up asthma therapy? When to step down asthma therapy? What does it mean if asthma is "well controlled"? True or false a patient with well controlled persistent moderate asthma should stop using inhaled corticosteroids or LABA COPD is (more/less?) complex than asthma There are (more/less?) Treatment options for COPD than asthma Why are long-acting muscarinic antagonists (lamas) commonly used to treat COPD? T/f cough and cold medicines should not be used in children less than 6 years old T/f home remedies for upper respiratory symptoms (common cold, viral illness, etc.) are less effective than abx or cold and flu medicines Home remedies for upper respiratory symptoms do not give honey to infants under 1 year old What is allergic rhinitis? Drug treatments for allergic rhinitis Prototype antihistamines Prototype nasal decongestant Nasal decongestant mechanism of action Considerations for nasal decongestants Side effects of pseudoephedrine What are antitussives? What are used as antitussives? What are tussives? Antitussive prototype Expectorant prototype Mucolytic prototype Bonus effect of acetylcysteine What cold/flu meds are prn? What cold/flu meds should be taken on a regular schedule? What cold/flu meds cause sedation? What cold/flu meds are stimulants? Pathophysiology of Alzheimer's Main theories for neuronal degeneration in AD Drugs to treat Alzheimer's Disease Donepezil mechanism of action Considerations for donepezil Predictable side effects of donepezil Pathophysiology for Parkinson’s disease Parkinson’s disease presentation mnemonic Pharmacological therapy for Parkinson’s Why is carbidopa-levodopa preferred over levodopa alone? What is the efficacy of levodopa/carbidopa? Considerations for carbidopa/levodopa therapy Side effects of carbidopa/levodopa Nociceptive pain Neuropathic pain Who uses DVPRS pain scale? Who uses CPOT pain scale? How is the CPOT scale used? Considerations for pain interventions Prototype opioid agonist Prototype opioid agonist-antagonist Prototype opioid antagonist Prototype cyclooxygenase (COX) inhibitors Combination analgesic prototype Cancer pain adjuvant prototypes Opioid definition Three main types of opioid receptors are: Important responses to activation of mu receptors Important responses to activation of kappa receptors Indications for morphine Morphine mechanism of action Morphine pharmacokinetics/dynamics What to check when reassessing pain after giving morphine? Morphine adverse effects Considerations for morphine What opioid effects do patients build a tolerance to? Discuss physical dependence of morphine (opioids) Abstinence syndrome symptoms Substance abuse disorder (as opposed to addiction) Pentazocine - never give to a cancer patient, immediately puts them into withdrawal Naloxone (Narcan) Stomach cox isoform, response, and effects of inhibition Platelet cox isoform, response, and effects of inhibition Blood vessels cox isoform, response, and effects of inhibition Kidney cox isoform, response, and effects of inhibition Injured tissue cox isoform, response, and effects of inhibition Brain cox isoform, response, and effects of inhibition Colon/rectum cox isoform, response, and effects of inhibition Cox inhibitors First generation NSAIDs Second generation NSAIDs Non-anti-inflammatory Cox inhibitor Aspirin mechanism of action Aspirin indications Side effects/adverse reactions of aspirin Nursing considerations for aspirin Ibuprofen class and mechanism of action Indications for ibuprofen Ibuprofen considerations/side effects Celecoxib mechanism of action Celecoxib side effects Indications for celecoxib Acetaminophen mechanism of action Acetaminophen indications Acetaminophen pharmacokinetics Acetaminophen dosing Acetaminophen side effects Considerations for pain r/t cancer and cancer treatments Considerations for combined opioids (opioid + acetaminophen) for cancer related pain Considerations for non-opioid analgesics for cancer pain T/f while all cancer patients with chronic opioid use develop dependence, <1% develop addiction Amitriptyline Gabapentin The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? a. At least 30% of the U.S. population is prone to drug addiction and abuse. b. The development of opioid dependence is rare when opioids are used for acute pain. c. Morphine is a common drug of abuse in the general population. d. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction. Opioid analgesics are indicated for all of the following situation except (select all that apply) a. Acute post operative pain b. Back pain from cancer metastasis c. Burning pain in the feet from peripheral neuropathy d. Lumbar pain secondary to muscle strain The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? a. Hives b. Hematemesis c. Dysmenorrhea d. Jaundice A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? a. Alcoholic drinks b. Leafy green foods c. Bananas d. Dairy products Which prescription would be the most appropriate for treating persistent cancer pain? a. Morphine [Duramorph] 10 mg orally (PO) as needed (PRN) b. Meperidine [Demerol] 100 mg PO every 4 hours c. Pentazocine [Talwin] 75 mg intramuscularly (IM) every 3 to 4 hours PRN d. Morphine [Duramorph] 30 mg every 3 to 4 hours 1. The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory data would warrant immediate intervention by the nurse? a. WBC 15,000 b. Hb 13 g/dL c. HCT 39% d. Glucose 138 mg/dL e. Creatinine 1.2 mg/dL 2. A client diagnosed with COPD is being discharged and is prescribed prednisone. Which scientific rationale supports why the nurse instructs the client to taper off the med? A. The pituitary gland must adjust to the decreasing dose B. The beta cells of the pancreas have to start secreting insulin C. This will allow the adrenal glands time to start functioning D. The thyroid gland will have to start producing cortisol 3. A client diagnosed with status asthmaticus is prescribed IV theophylline. Which assessment data would warrant immediate intervention? A. The theophylline level is 12 mcg/mL B. The client has expiratory wheezing C. The client complains of muscle twitching D. The client is refusing to eat the meal Which is the scientific rationale for prescribing decongestants for a client with a cold? A. Decongestants vasoconstrict the blood vessels, reducing nasal inflammation. B. Decongestants decrease the immune system's response to a virus. C. Decongestants activate viral receptors in the body's immune system. D. Decongestants block the virus from binding to the epithelial cells of the nose. Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma? A. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication. B. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustained- relief theophylline. C. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments. D. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed. Patients with Alzheimer disease are prescribed __________ which increases the level of __________. Options for 1st blank A. Levodopa/Carbidopa B. Donepezil Options for 2nd blank A. Acetylcholine B. Dopamine A patient is receiving gabapentin (Neurontin), an anticonvulsant, but has no history of seizures. The nurse expects that the patient is receiving this drug for which condition? A. Inflammation pain B. Pain associated with peripheral neuropathy C. Depression associated with chronic pain D. Prevention of seizures 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with the rate of 7 per minute. The nurse prepares for which priority action at this time? A. Assessment of the patient's pain level B. Immediate intubation and artificial ventilation C. Administration of naloxone (Narcan) D. Close observation of signs of opioid tolerance 9. The nurse is assessing a patient for contraindications to drug therapy with acetaminophen (Tylenol). Which patient should not receive acetaminophen? A. A patient with a fever of 101 F. B. A patient who is complaining of a mild headache C. A patient with a history of liver disease D. A patient with a history of kidney disease The nurse should instruct a patient receiving NSAIDs to report which of the following adverse effects? A. Blurred vision B. Nasal stuffiness C. Urinary retention D. Black or tarry s