List the 7 drug classes used as antiemetics and antinausea drugs."<div><span style=""color: rgb(183, 30, 66);"">•</span>Anticholinergic drugs </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Antihistamines (histamine 1 [H1] receptor blockers) </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Antidopaminergic drugs</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Neurokinin antagonists</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Prokinetic drugs</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Serotonin blockers</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Tetrahydrocannabinoids</div>"
What is the general indication for any type of antiemetic?"<div><span style=""color: rgb(183, 30, 66);"">•</span>General use for each type: prevention and reduction of nausea and vomiting</div>"
What's the commonest mechanism of action among the different antiemetic drug classes?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Most work by blocking one of the vomiting pathways, thus blocking the stimulus that induces vomiting.</div>"
Whats the mechanism of action of anticholinergic drugs&nbsp;(acetylcholine [ACh] blockers)&nbsp;used as antiemetics?"<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Bind to and block </span><span style=""background-color: yellow;"">ACh</span><span style=""background-color: yellow;""> receptors in the inner ear labyrinth</span></div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Block transmission of nauseating stimuli to CTZ </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Also block transmission of nauseating stimuli from the reticular formation to the VC</div>"
Give an example for anticholinergic drugs&nbsp;(acetylcholine [ACh] blockers)&nbsp;used as antiemetics?"<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Scopolamine</span> (Transderm-Scōp, Scopace) </div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">72-hour transdermal patch that releases 1 mg&nbsp;</span></div>"
"<div>The nurse is preparing to administer scopolamine to a patient. It is most important for the nurse to determine if the patient has a history of which condition?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>Cataracts</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>Narrow-angle glaucoma </div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>Presbyopia</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>Detached retina</div>"<div>ANS: B</div><div><br></div> <div></div> <div>The nurse should only administer the anticholinergic drug scopolamine after careful assessment of the patient’s health history and medication history. One very important concern to reemphasize with scopolamine, which is commonly administered in patch form to prevent motion sickness, is the contraindication to its use in patients with narrow-angle glaucoma. If the patient has a history of this disorder, then another antiemetic or antinausea drug should be used.&nbsp;</div>
What's the mechanism of action of antihistamine drugs used as antiemetics?"<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Inhibit </span><span style=""background-color: yellow;"">ACh</span><span style=""background-color: yellow;""> </span>by binding to H1 receptors</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Prevent cholinergic stimulation in vestibular and reticular areas, thus preventing nausea and vomiting</div>"
What indications are there for using antihistamine drugs other than as antiemetics?"<span style=""background-color: yellow;"">motion sickness<br></span>nonproductive cough<br>allergy symptoms<br>sedation"
Give examples for antihistamine drugs used as antiemetics."<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Dimenhydrinate (Dramamine)</span></div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Diphenhydramine (Benadryl)</span></div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Meclizine (Antivert)</span></div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Hydroxyzine (Vistaril)</span></div>"
"<div><span style=""background-color: yellow;"">Hydroxyzine (Vistaril) is administered via&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow;"">or&nbsp;</span><span class=cloze>[...]</span>&nbsp; routes&nbsp;<span style=""background-color: yellow;"">only, never via&nbsp;</span><span class=cloze>[...]</span> route.</div>""<div><span style=""background-color: yellow;"">Hydroxyzine (Vistaril) is administered via&nbsp;</span><span class=cloze>PO</span>&nbsp;<span style=""background-color: yellow;"">or&nbsp;</span><span class=cloze>IM</span>&nbsp; routes&nbsp;<span style=""background-color: yellow;"">only, never via&nbsp;</span><span class=cloze>IV</span> route.</div><br> "
What's the mechanism of action of Antidopaminergic drugs used as antiemetics?"<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Block dopamine receptors in the CTZ</span></div>"
Give examples for Antidopaminergic drugs used as antiemetics."<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Prochlorperazine (Compazine)</span></div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Promethazine (Phenergan)</span></div><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Amisulpride (Barhemsys)--newest</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Droperidol</div></div>"
Give indications use of Antidopaminergic drugs other than as antiemetics."<span style=""background-color: yellow;"">psychotic disorders<br>intractable hiccups</span>"
"Regarding the routes of administration of promethazine,<br><div><span style=""color: rgb(183, 30, 66);"">•</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow;"">&amp;&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow;"">routes preferred;&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow;"">route common,</span> not preferred</div>""Regarding the routes of administration of promethazine,<br><div><span style=""color: rgb(183, 30, 66);"">•</span><span class=cloze>PO</span>&nbsp;<span style=""background-color: yellow;"">&amp;&nbsp;</span><span class=cloze>IM</span>&nbsp;<span style=""background-color: yellow;"">routes preferred;&nbsp;</span><span class=cloze>IV</span>&nbsp;<span style=""background-color: yellow;"">route common,</span> not preferred</div><br> "
"Regarding the routes of administration of promethazine,<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Never administer via <span class=cloze>[...]</span> route.</div>""Regarding the routes of administration of promethazine,<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Never administer via <span class=cloze>intraarterial</span> route.</div><br> "
<div>Droperidol use is controversial because of associated <span class=cloze>[...]</span>.</div><div>Droperidol use is controversial because of associated <span class=cloze>cardiac dysrhythmias</span>.</div><br> "<div>What's the mechanism of action of&nbsp;<span style=""background-color: yellow;"">Neurokinin</span><span style=""background-color: yellow;""> receptor antagonists?</span></div>""<div><span style=""color: rgb(183, 30, 66);"">•</span>Inhibit substance P/neurokinin 1 receptors in the brainstem</div>"
"<div>Give examples for&nbsp;<span style=""background-color: yellow;"">Neurokinin</span><span style=""background-color: yellow;""> receptor antagonists.</span></div>"<div>Aprepitant</div><div>Fosaprepitant</div><div>Rolapitant</div>
Neurokinin receptor antagonists are used in conjunction with serotonin blockers and glucocorticoids to inhibit acute and delayed phases of <span class=cloze>[...]</span>&nbsp;"Neurokinin receptor antagonists are used in conjunction with serotonin blockers and glucocorticoids to inhibit acute and delayed phases of <span class=cloze><span style=""background-color: yellow;"">chemotherapy-induced emesis</span>.</span>&nbsp;<br> "
"Neurokinin receptor antagonists are used in conjunction with <span class=cloze>[...]</span> and <span class=cloze>[...]</span> to inhibit acute and delayed phases of <span style=""background-color: yellow;"">chemotherapy-induced emesis</span>.&nbsp;""Neurokinin receptor antagonists are used in conjunction with <span class=cloze>serotonin blockers</span> and <span class=cloze>glucocorticoids</span> to inhibit acute and delayed phases of <span style=""background-color: yellow;"">chemotherapy-induced emesis</span>.&nbsp;<br> "
Outline the mechanism of action of prokinetic drugs used as antiemetics."<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Block dopamine receptors </span>in the CTZ</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Cause CTZ to be desensitized to impulses it receives from the gastrointestinal (GI) tract</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents</div>"
What are the indications for using prokinetic drugs other than as antiemetics?"<span style=""background-color: yellow;"">gastroesophageal reflux disease<br>delayed gastric emptying</span>"
Give examples for prokinetic drugs used as antiemetics."<div><span style=""background-color: yellow;"">Metoclopramide (Reglan)</span></div>"
State one side effect that can be caused by long term use of Metoclopramide."<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Long-term use may cause irreversible tardive dyskinesia.</span></div>"
"<div>A patient is receiving a continuous tube feeding via a percutaneous endoscopic gastrostomy tube. Which drug would most likely be prescribed for this patient? </div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>Metoclopramide</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>Meclizine</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>Aprepitant</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>Phosphorated carbohydrate solution</div>"<div>ANS: A</div><div><br></div> <div></div> <div>Metoclopramide is a prokinetic drug that promotes the movement of substances through the GI tract and increases GI motility. This action is helpful in preventing aspiration in those receiving tube feedings.</div>
What's the mechanism of action of Serotonin blockers used as antiemetics?<div>Block serotonin receptors in the GI tract, CTZ, and VC</div>
What are the indications for Serotonin blockers used as antiemetics?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Used for nausea and vomiting in patients receiving <span style=""background-color: yellow;"">chemotherapy and for postoperative nausea and vomiting</span></div>"
What are the risks of using Serotonin blockers as antiemetics?"<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Risk of </span><span style=""background-color: yellow;"">bradyarrhythmias</span><span style=""background-color: yellow;"">/QT prolongation</span></div>"
Give examples for Serotonin blockers used as antiemetics."<div><span style=""color: rgb(183, 30, 66);"">•</span>Dolasetron (Anzemet)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Granisetron (Kytril)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Ondansetron</span><span style=""background-color: yellow;""> (Zofran)</span></div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Palonosetron (Aloxi)</div>"
"<div><span style=""color: rgb(0, 0, 6);"">What's the major <span style=""background-color: yellow;"">psychoactive substance in marijuana?</span></span></div>""<span style=""background-color: yellow;"">Tetrahydrocannabinoids</span>"
"<div><span style=""color: rgb(0, 0, 6);"">What's the&nbsp;<span style=""background-color: yellow;"">Synthetic form of&nbsp;</span><span style=""background-color: yellow;"">Tetrahydrocannabinoids?</span><span style=""background-color: yellow;"">&nbsp;</span></span></div>""<span style=""background-color: rgb(255, 255, 0);"">Dronabinol</span>"
"<div><span style=""color: rgb(0, 0, 6);"">What's the&nbsp;<span style=""background-color: yellow;"">mechanism of action of&nbsp;</span><span style=""background-color: yellow;"">Tetrahydrocannabinoids as antiemetics?</span><span style=""background-color: yellow;"">&nbsp;</span></span></div>""<div><span style=""color: rgb(183, 30, 66);"">•</span>Inhibitory effects on reticular formation, thalamus, cerebral cortex</div> <div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Alter mood and body’s perception of its surroundings, which may help relieve nausea and vomiting</span></div>"
"<span style=""color: rgb(0, 0, 6);"">What are the&nbsp;</span><span style=""color: rgb(0, 0, 6); background-color: yellow;"">indications for using&nbsp;</span><span style=""color: rgb(0, 0, 6); background-color: yellow;"">Tetrahydrocannabinoids other than as antiemetics?</span><span style=""color: rgb(0, 0, 6); background-color: yellow;"">&nbsp;</span>""<span style=""background-color: yellow;"">appetite stimulant in HIV/AIDS<br>cancer anorexia</span>"
"<font color=""#000006"">Give one indication for the use of&nbsp;</font>Phosphorated carbohydrate solution <span style=""background-color: yellow;"">(</span><span style=""background-color: yellow;"">Emetrol</span><span style=""background-color: yellow;"">).</span>"<div>Used off label for treatment of morning sickness</div>
"<font color=""#000006"">Give one contraindication for the use of&nbsp;</font>Phosphorated carbohydrate solution <span style=""background-color: yellow;"">(</span><span style=""background-color: yellow;"">Emetrol</span><span style=""background-color: yellow;"">).</span>"diabetes
"<font color=""#000006"">What's the mechanism of action of&nbsp;</font>Phosphorated carbohydrate solution <span style=""background-color: yellow;"">(</span><span style=""background-color: yellow;"">Emetrol</span><span style=""background-color: yellow;"">)?</span>""<div><span style=""color: rgb(183, 30, 66);"">•</span><span style=""background-color: yellow;"">Reduces GI smooth muscle contractions</span></div>"
"<div>A patient with terminal cancer has not had chemotherapy for a few weeks and has had no nausea or vomiting since then. However, he is taking dronabinol twice a day. What rationale should be considered by the nurse?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>Prevents recurrence of the chemotherapy-induced nausea and vomiting</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>Prevents stress ulcers</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>Improves his mood</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>Stimulate his appetite</div>"<div>ANS: D</div><div><br></div> <div></div> <div>Dronabinol is used as an appetite stimulant in patients who are experiencing nutritional wasting caused by cancer and cancer treatment.</div>
"<div>A patient is 2 months pregnant. She comes to the clinic complaining of severe morning sickness. She has tried numerous nonpharmacologic measures to relieve the morning sickness, but they have not worked. The nurse anticipates the use of which antinausea drug? </div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>Phosphorated carbohydrate solution</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>Aprepitant</div> <div><span style=""color: rgb(183, 30, 66);"">A.</span> Dronabinol</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>Dolasetron</div>"<div>ANS: A</div><div><br></div> <div></div> <div>Phosphorated carbohydrate solution (Emetrol) is a mint-flavored, pleasant-tasting oral solution used to relieve nausea. It works by direct local action on the walls of the GI tract, where it reduces cramping caused by excessive smooth muscle contraction. It can be used to control mild cases of nausea and vomiting. It does not have a pregnancy category rating, but one of its listed unlabeled (not approved by the U.S. Food and Drug Administration) uses is for treatment of morning sickness during pregnancy. The other drugs are not indicated for use in pregnancy.</div>
"<div>Which group of drugs used to treat nausea does the nurse identify as most likely to cause a prolonged QTc interval?</div><div></div><div><span style=""color: rgb(183, 30, 66);"">A.</span>Prokinetics</div><div><span style=""color: rgb(183, 30, 66);"">B.</span>Antidopaminergics</div><div><span style=""color: rgb(183, 30, 66);"">C.</span>Tetrahydrocannabinoids</div><div><span style=""color: rgb(183, 30, 66);"">D.</span>Serotonin blockers&nbsp;</div>"<div>ANS: D</div> <div></div> <div>The serotonin blockers have the potential to cause prolonged QTc interval.</div>
"<div>A patient tells the nurse that he takes ginger almost every day for nausea. It is most important for the nurse to determine if the patient is taking which medication? </div> <div><br></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>Furosemide</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>Acetaminophen</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>Warfarin</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>Calcium supplements</div>"<div>ANS: C</div><div><br></div> <div></div> <div>Use of ginger can increase absorption of all oral medications and may theoretically increase bleeding risk with anticoagulants (e.g., warfarin [Coumadin]) or antiplatelet drugs (e.g., clopidogrel [Plavix]).</div>
What are the indications for using herbal products such as ginger?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Used for nausea and vomiting, including that caused by chemotherapy, morning sickness, and motion sickness</div>"
What are the adverse effects of using herbal products such as ginger?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Anorexia, nausea and vomiting, skin reactions</div>"
What are the drug interactions caused when using herbal products such as ginger?"<div><span style=""color: rgb(183, 30, 66);"">•</span>May increase absorption of oral medications</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increase bleeding risk with anticoagulants</div>"
"Regarding nursing implications of using antiemetics,<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Many of these drugs cause <span class=cloze>[...]</span> (antihistamines, prokinetics, THC); warn patients about driving or performing any hazardous tasks.</div>""Regarding nursing implications of using antiemetics,<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Many of these drugs cause <span class=cloze>severe drowsiness</span> (antihistamines, prokinetics, THC); warn patients about driving or performing any hazardous tasks.</div><br> "
"Regarding nursing implications of using antiemetics,<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Many of these drugs cause severe drowsiness (antihistamines, prokinetics, THC); warn patients about <span class=cloze>[...]</span></div>""Regarding nursing implications of using antiemetics,<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Many of these drugs cause severe drowsiness (antihistamines, prokinetics, THC); warn patients about <span class=cloze>driving or performing any hazardous tasks.</span></div><br> "
"Regarding nursing implications of using antiemetics,<br><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Taking antiemetics with alcohol may cause severe <span class=cloze>[...]</span>.</div></div>""Regarding nursing implications of using antiemetics,<br><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Taking antiemetics with alcohol may cause severe <span class=cloze>central nervous system depression</span>.</div></div><br> "
"Regarding nursing implications of using antiemetics,<br><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Teach patients to change positions slowly to avoid <span class=cloze>[...]</span>.</div></div>""Regarding nursing implications of using antiemetics,<br><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Teach patients to change positions slowly to avoid <span class=cloze>hypotensive effects</span>.</div></div><br> "
"Regarding nursing implications of using antiemetics,<br><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Monitor for adverse effects- <span class=cloze>[...]</span>, <span class=cloze>[...]</span>, <span class=cloze>[...]</span>.</div></div>""Regarding nursing implications of using antiemetics,<br><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Monitor for adverse effects- <span class=cloze>dehydration</span>, <span class=cloze>diarrhea</span>, <span class=cloze>headache</span>.</div></div><br> "
What are the features of acute diarrhea?Sudden onset in a previously healthy person&nbsp; <br>Lasts from 3 days to 2 weeks <br>SelfIimifing&nbsp; <br>Resolves without sequeloe
What are the features of chronic diarrhea?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Lasts for more than 3 to 4 weeks</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness</div>"
What are the causes of chronic diarrhea?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Tumors</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Diabetes mellitus</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Addison’s disease</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Hyperthyroidism</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Irritable bowel syndrome</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>AIDS</div>"
What are the causes of acute diarrhea?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Bacteria</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Viruses</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Drug induced</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Nutritional factors</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Protozoa</div>"
What are the goals of diarrhea treatment?Stopping the stool frequency <br>Alleviating the abdominal cramps <br>Replenishing fluids and electrolytes&nbsp; <br>Preventing weight loss and nutritional deficits&nbsp; from malabsorption
What are the 3 types of antidiarrheals?Adsorbents<br>Antimotility drugs (anticholinergic and opiates)<br>Probiotics
What is the mechanism of action of adsorbents?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Coat the walls of the gastrointestinal (GI) tract</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Bind to the causative bacteria or toxin, which is then eliminated through the stool</div>"
What is the mechanism of action of&nbsp;Antimotility drugs: anticholinergics?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Decrease intestinal muscle tone and peristalsis of GI tract</div><div><div><span style=""color: rgb(65, 85, 136);"">•</span>Slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Drying effect</div><span style=""color: rgb(65, 85, 136);"">•</span>Reduce gastric secretions<br></div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Result: slows the movement of fecal matter through the GI tract</div>"
What is the mechanism of action of&nbsp;Antimotility drugs: opiates?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Decrease bowel motility and reduce pain by relief of rectal spasms</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed</div>"
What is the mechanism of action of Probiotics?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Bacterial cultures of <span style=""font-style: italic;"">Lactobacillus</span> organisms <br> work by:</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Supplying missing bacteria to the GI tract</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Suppressing the growth of diarrhea-causing bacteria</div>"
Give examples for Probiotics used as antidiarrheals."<span style=""font-style: italic;"">Lactobacillus</span> <span style=""font-style: italic;"">acidophilus </span>(Bacid)"
Give examples for anticholinergic drugs used as antidiarrheals.belladonna alkaloids
Give examples for adsorbents used as antidiarrheals.bismuth subsalicylate (Pepto-Bismol), activated charcoal, and antilipemic drugs colestipol and cholestyramine&nbsp;
Give examples for opiates used as antidiarrheals.<div>paregoric</div><div>opium tincture</div><div>codeine</div><div>over-the-counter (OTC) loperamide</div><div>diphenoxylate</div>
"<div>The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. What is the purpose of the additive, atropine?</div> <div></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>Enhance the effects of the diphenoxylate.</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>Discourage recreational use of the opiate diphenoxylate.</div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Counteract the adverse effects of the diphenoxylate.</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>Act as an adsorbent for bacteria in the bowel.</div>"<div>ANS: B</div><div><br></div> <div></div> <div>A small dose of atropine, combined with diphenoxylate, discourages recreational use of this drug because if taken in large doses, a person will experience unpleasant anticholinergic effects such as dry mouth, abdominal pain, blurred vision, and tachycardia.&nbsp;</div>
List indications for the use of each type of antidiarrheals.Adsorbents: milder cases<br>Anticholinergics and opiates: more severe cases<br>Probiotics: antibiotic-induced diarrhea
"<div>A patient is experiencing diarrhea while completing a course of antibiotic therapy. Which of the following agents does the nurse anticipate administering to the patient?</div> <div></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span><span style=""font-style: italic;"">L. acidophilus</span></div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>Bismuth subsalicylate</div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Diphenoxylate with atropine</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>Loperamide</div>""<div>ANS: A</div><div><br></div> <div></div> <div><span style=""font-style: italic;"">L. acidophilus </span>is a probiotic often used in the treatment of antibiotic-induced diarrhea. The other agents are usually not used in the treatment of antibiotic-induced diarrhea.</div>"
List the adverse effects of adsorbents used as antidiarrheals."<div><span style=""color: rgb(65, 85, 136);"">•</span>Increased bleeding time</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Constipation, dark stools</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Confusion</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Tinnitus</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Metallic taste</div> Blue tongue<br>"
List the adverse effects of Anticholinergics used as antidiarrheals."<div><span style=""color: rgb(65, 85, 136);"">•</span>Urinary retention, impotence</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Headache, dizziness, confusion, anxiety, drowsiness, confusion</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Dry skin, flushing</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Blurred vision</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Hypotension, bradycardia</div>"
List the adverse effects of Opiates used as antidiarrheals."<div><span style=""color: rgb(65, 85, 136);"">•</span>Drowsiness, dizziness, lethargy</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Nausea, vomiting, constipation</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Respiratory depression</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Hypotension</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Urinary retention</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Flushing</div>"
List drug interactions caused by adsorbents.<ul><li>Adsorbents decrease the absorption of many drugs, including digoxin, quinidine, and hypoglycemic drugs.&nbsp; </li><li>Adsorbents cause increased bleeding time and bruising when given with anticoagulants (warfarin). </li><li>Toxic effects of methotrexate are more likely when given with adsorbents.</li></ul>
"<div>A patient who takes warfarin has been prescribed an adsorbent for diarrhea. It is important for the nurse to assess the patient for bruising because use of warfarin with adsorbents interferes with the absorption of which vitamin?</div> <div></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>A</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>D</div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>E</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>K</div>"<div>ANS: D</div><div><br></div> <div></div> <div>The oral anticoagulant warfarin is more likely to cause increased bleeding times or bruising when co-administered with adsorbents. This is thought to be because the adsorbents bind to vitamin K, which is needed to make certain clotting factors. Vitamin K is synthesized by the normal bacterial flora in the bowel.</div>
Do not give bismuth subsalicylate to children or teenagers with <span class=cloze>[...]</span> or <span class=cloze>[...]</span> because of the risk of <span class=cloze>[...]</span>.Do not give bismuth subsalicylate to children or teenagers with <span class=cloze>chickenpox</span> or <span class=cloze>influenza</span> because of the risk of <span class=cloze>Reye's syndrome</span>.<br> Do not give <span class=cloze>[...]</span> to children or teenagers with chickenpox or influenza because of the risk of Reye's syndrome.Do not give <span class=cloze>bismuth subsalicylate</span> to children or teenagers with chickenpox or influenza because of the risk of Reye's syndrome.<br> "<div>Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition?</div> <div><br></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>Anemia</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>Diabetes mellitus </div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Myasthenia gravis</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>Hypertension&nbsp;</div>"<div>ANS: C</div><div><br></div> <div></div> <div>Use of the belladonna alkaloid preparations is contraindicated in patients who have shown a hypersensitivity to anticholinergics and in patients with narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon.&nbsp;</div>
In what groups of patients should adsorbents be used with caution?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Use adsorbents carefully in older patients and those with decreased bleeding time, clotting disorders, recent bowel surgery, or confusion.</div>"
List contraindications for the use of anticholinergic as antidiarrheals.patients with a history of narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, or toxic megacolon.
"<div>Which antidiarrheal does the nurse associate with the development of adverse effects of urinary retention, headache, confusion, dry skin, rash, and blurred vision?</div> <div><br></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>Anticholinergics</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>Adsorbents </div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Probiotics</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>Opiates&nbsp;</div>"<div>ANS: A</div><div><br></div> <div></div> <div>Anticholinergics work by decreasing GI peristalsis through their parasympathetic blocking effects. Adverse effects include urinary retention, headache, confusion, dry skin, rash, and blurred vision.</div>
List 3 types of nonsurgical treatment options to treat constipation.- Dietary (e.g., fiber supplementation)&nbsp; <br>- Behavioral (e.g., increased physical activity)&nbsp; <br>- Pharmacologic
List 5 types of laxatives.Bulk forming <br>Emollient (stool softeners, lubricant laxatives) <br>Hyperosmotic&nbsp; <br>Saline&nbsp; <br>Stimulant&nbsp;
What is the mechanism of action of bulk forming laxatives?"<div><span style=""color: rgb(65, 85, 136);"">•</span>High fiber</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Absorb water to increase bulk</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Distend bowel to initiate reflex bowel activity</div>"
What is the mechanism of action of Emollient&nbsp;laxatives?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Stool softeners and lubricants</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Promote more water and fat in the stools</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Lubricate the fecal material and intestinal walls</div>"
What is the mechanism of action of Hyperosmotic laxatives?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Increase fecal water content</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Results in bowel distention, increased peristalsis, and evacuation</div>"
What is the mechanism of action of Saline laxatives?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Increase osmotic pressure within the intestinal tract, causing more water to enter the intestines</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Results in bowel distention, increased peristalsis, and evacuation</div>"
What is the mechanism of action of Stimulant laxatives?"<div><span style=""color: rgb(65, 85, 136);"">•</span>Increases peristalsis via intestinal nerve stimulation</div>"
List examples of Stimulant laxatives."<div><span style=""color: rgb(65, 85, 136);"">•</span>Senna (Senokot)</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Bisacodyl (Dulcolax)</div>"
List examples of Saline laxatives."<div><span style=""color: rgb(65, 85, 136);"">•</span>Magnesium hydroxide (Milk of Magnesia)</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Magnesium citrate</div>"
List examples of Hyperosmotic laxatives."<div><span style=""color: rgb(65, 85, 136);"">•</span>Polyethylene glycol (PEG)</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Sorbitol, lacitol, glycerin</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Lactulose&nbsp;</div>"
List examples of Emollient laxatives."<div><span style=""color: rgb(65, 85, 136);"">•</span>Stool softeners: docusate salts (Colace, Surfak)</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Lubricants: mineral oil</div>"
"List examples of <span style=""color: rgb(0, 0, 6);"">bulk</span><span style=""color: rgb(65, 85, 136);"">&nbsp;</span>forming laxatives.""<div><span style=""color: rgb(65, 85, 136);"">•</span>Psyllium (Metamucil)</div> <div><span style=""color: rgb(65, 85, 136);"">•</span>Methylcellulose (Citrucel)</div>"
State one indication for the use of Peripherally Acting Opioid Antagonists&nbsp;as a laxative.Treatment of constipation related to opioid use and bowel resection therapy.
State the mechanism of action of Peripherally Acting Opioid Antagonists.Block entrance of opioid into bowel
State 3 examples for Peripherally Acting Opioid Antagonists.Methylnaltrexone (Relistor) <br>Alvimopan (Entereg) <br>Naloxagol (Movantik)
What are the indications for using bulk forming laxatives?Acute and Chronic constipation<br>irritable bowel syndrome<br>diverticulosis
What are the indications for using emollient laxatives?Acute and chronic constipation<br>fecal impaction<br>facilitation of bowel movements in anorectal conditions
What are the indications for using hyperosmotic laxatives?Chronic constipation<br>diagnostic and surgical preps
What are the indications for using saline laxatives?Constipation<br>diagnostic and surgical preps
What are the indications for using stimulant laxatives?Acute constipation<br>diagnostic and surgical preps
"<div>A patient is taking lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose?</div> <div></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>Cleansing the bowel before a procedure</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>Removal of helminths</div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Reduction of high ammonia levels associated &nbsp; with liver failure</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>Daily maintenance to prevent constipation</div>"<div>ANS: C</div><div><br></div> <div></div> <div>Lactulose helps to reduce blood ammonia levels by converting ammonia to ammonium, which can then be eliminated by the body.</div>
List the adverse effects of bulk forming laxatives.- Impaction&nbsp; <br>- Fluid disturbances&nbsp; <br>- Electrolyte imbalances <br>- Esophageal blockage
List the adverse effects of emollient laxatives.-Skin rashes&nbsp; <br>- Decreased absorption of vitamins <br>- Electrolyte imbalances&nbsp; <br>- Lipid pneumonia
List the adverse effects of hyperosmotic laxatives.- Abdominal bloating <br>- Electrolyte imbalances <br>- Rectal irritation
List the adverse effects of saline laxatives.- Magnesium toxicity (with renal insufficiency) <br>- Cramping&nbsp; <br>- Electrolyte imbalances&nbsp; <br>- Diarrhea&nbsp; <br>- Increased thirst
List the adverse effects of stimulant laxatives.- Nutrient malabsorption <br>- Skin rashes&nbsp; <br>- Gastric irritation&nbsp; <br>- Electrolyte imbalances <br>- Discolored urine&nbsp; <br>- Rectal irritation
State one adverse effect common to all types of laxatives.All laxatives can cause electrolyte imbalances!
"<div>A hospitalized patient is experiencing diarrhea. Which of the following does the nurse identify as adverse side effects of diphenoxylate with atropine therapy? (<span style=""font-style: italic;"">Select all that apply.</span>)</div> <div></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>Increased salivation</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>Abdominal pain</div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Bradycardia</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>Blurred vision</div>"<div>ANS: B, D</div><div><br></div> <div></div> <div>When administering diphenoxylate with atropine, the nurse should assess the patient for adverse effects, including dry mouth, abdominal pain, tachycardia, and blurred vision.&nbsp;</div>
What are the effects of longterm usue of laxatives?Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.
Give bisacodyl with <span class=cloze>[...]</span> because of interactions with <span class=cloze>[...]</span>Give bisacodyl with <span class=cloze>water</span> because of interactions with <span class=cloze>milk, antacids, and juices.</span><br> "<div>A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient?</div> <div></div> <div><span style=""color: rgb(65, 85, 136);"">A.</span>Milk of Magnesia</div> <div><span style=""color: rgb(65, 85, 136);"">B.</span>A bulk-forming laxative</div> <div><span style=""color: rgb(65, 85, 136);"">C.</span>Mineral oil</div> <div><span style=""color: rgb(65, 85, 136);"">D.</span>No laxative should be given at this time.</div>"<div>ANS: D</div><div><br></div> <div></div> <div>These laxatives are contraindicated in the presence of undiagnosed abdominal pain because taking a laxative in cases of intestinal obstruction could be very harmful to the patient. No laxatives should be given if the patient has undiagnosed abdominal pain.</div>
List the drugs infdicated for IBS-D.Alosetron (Lotronex) <br>Rifaximin (Xifaxan) <br>Eluxadoline (Viberzi)
List the drugs infdicated for IBS-C.Lubiprostone (Amitiza) <br>Linacotide (Linzess)
List 3 types of acid controlling drugs."<div><span style=""color: rgb(183, 30, 66);"">•</span>Antacids</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> H2 antagonists</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> PPIs</div>"
What's the mechanism of action of antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Do not prevent the overproduction of acid but instead help to neutralize acid secretions</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Promote gastric mucosal defense mechanisms</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Stimulate secretion of:</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Mucus: protective barrier against HCl</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Bicarbonate: helps buffer acidic properties of HCl</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Prostaglandins: prevent activation of proton pump</div>"
What are examples for antacids?<div>Salts of aluminum, magnesium, calcium, and/or sodium</div>
Why is Magnesium included in many aluminium and calcium based formulations of antacids?-contributes to the acid-neutralizing capacity<br>-counteracts the constipating effects of aluminum and calcium.
<div>Many antacid preparations also contain the antiflatulent (antigas) drug <span class=cloze>[...]</span>.&nbsp;</div><div>Many antacid preparations also contain the antiflatulent (antigas) drug <span class=cloze>simethicone</span>.&nbsp;</div><br> <div>Antacids containing magnesium must be avoided in patients with <span class=cloze>[...]</span>.&nbsp;</div><div>Antacids containing magnesium must be avoided in patients with <span class=cloze>renal failure</span>.&nbsp;</div><br> Calcium antacids may lead to the development of <span class=cloze>[...]</span> and <span class=cloze>[...]</span>.Calcium antacids may lead to the development of <span class=cloze>kidney stones</span> and <span class=cloze>increased gastric acid secretion</span>.<br> What are the drug effects of antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Reduction of pain associated with acid-related disorders</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Raising the gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Reducing acidity reduces pain as a result of:</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Base-mediated inhibition of the protein-digesting ability of pepsin</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increase in the resistance of the stomach lining to irritation</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increase in the tone of the cardiac sphincter</div>"
What are the indications for use of antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity, and heartburn</div>"
What are the contraindications for use of antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Known allergy to a specific drug product</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Severe renal failure or electrolyte disturbances: potential toxic accumulation of electrolytes in the antacids themselves</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>GI obstruction: antacids may stimulate GI motility when they are undesirable because of the presence of an obstructive process requiring surgical intervention</div>"
What are the available Over-the-counter (OTC) formulations&nbsp;of antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Capsules and tablets&nbsp; </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Powders</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Chewable tablets</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Suspensions</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Effervescent granules and tablets</div>"
What are the examples of aluminium salts used as antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Aluminum carbonate: Basaljel</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Hydroxide salt: AlternaGEL</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel</div>"
Name one side effect of using aluminium salts as antacids&nbsp; and how it's counteracted."<div><span style=""color: rgb(183, 30, 66);"">•</span>Have constipating effects</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Often used with magnesium to counteract constipation</div>"
Name one indication for using aluminium salts as antacids."<div><span style=""color: rgb(183, 30, 66);"">•</span>Often recommended for patients with renal disease (more easily excreted)</div>"
Name one common adverse effect of magnesium salt antacids and how its counteracted."<div><span style=""color: rgb(183, 30, 66);"">•</span>Commonly cause diarrhea; usually used with other drugs to counteract this effect</div>"
Name one cautionin using magnesium salt antacids."<div><span style=""color: rgb(183, 30, 66);"">•</span>Dangerous when used with renal failure; the failing kidney cannot excrete extra magnesium, resulting in accumulation</div>"
Give 3 examples for magnesium salt antacids."<div><span style=""color: rgb(183, 30, 66);"">•</span>Hydroxide salt: magnesium hydroxide (Milk of Magnesia)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Carbonate salt: Gaviscon (also a combination product)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Combination products such as Maalox, Mylanta (aluminum and magnesium)</div>"
What's the most common form of calcium salt antacids?carbonate
What are the adverse effects of calcium salt antacids?constipation<br>kidney stones
What are the contraindications for calcium salt antacids?not recommended for patients with renal disease—may accumulate to toxic levels
What is the adverse effect of long term use of calcium salt antacids?<div>Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound)</div>
What is an example for calcium salt antacids?Tums (calcium carbonate)
What is the mechanism of action of sodium bicarbonate antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Buffers the acidic properties of HCl</div>"
What are the adverse effects of sodium bicarbonate antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>May cause metabolic alkalosis</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Sodium content may cause problems in patients with heart failure (HF), hypertension, or renal insufficiency.</div>"
"<div>A patient who has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>A magnesium-containing antacid</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>A calcium-containing antacid</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>An aluminum-containing antacid</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>Because of renal problems, the patient should not take antacids for this problem.</div>"<div>ANS: C</div><div><br></div> <div></div> <div>Aluminum- and sodium-based antacids are recommended for patients with renal compromise because they are more easily excreted. Both calcium- and magnesium-based antacids are more likely to accumulate to toxic levels in patients with renal disease and are often avoided in this patient group.</div>
What are the drug interactions of antacids?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Adsorption of other drugs to antacids</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Reduces the ability of the other drug to be absorbed into the body</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Chelation</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Chemical binding, or inactivation, of another drug</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Produces insoluble complexes</div> Result: reduced drug absorption<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Increased stomach pH</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increased absorption of basic drugs</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Decreased absorption of acidic drugs</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increased urinary pH</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increased excretion of acidic drugs</div> Decreased excretion of basic drugs<br>"
What is the mechanism of action of Histamine 2 (H2) Receptor Antagonists as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Competitively block the H2 receptor of acid-producing parietal cells</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Reduced hydrogen ion secretion from the parietal cells</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Increase in the pH of the stomach </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Relief of many of the symptoms associated with hyperacidity-related conditions</div>"
What are the examples of Histamine 2 (H2) Receptor Antagonists as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Cimetidine (Tagamet)&nbsp; </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Nizatidine (Axid)&nbsp; </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Famotidine (Pepcid)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Ranitidine (Zantac) was taken off the market in 2020</div>"
What is the drug effect of Histamine 2 (H2) Receptor Antagonists as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Suppressed acid secretion in the stomach</div>"
What are the indications of Histamine 2 (H2) Receptor Antagonists as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Gastroesophageal reflux disease (GERD)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>PUD</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Erosive esophagitis</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Adjunct therapy to control upper GI bleeding</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Zollinger-Ellison syndrome</div>"
What are the adverse effects of Histamine 2 (H2) Receptor Antagonists used as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Overall, very few adverse effects</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Central nervous system adverse effects in elderly patients include confusion and disorientation.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Cimetidine may induce impotence and gynecomastia.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Thrombocytopenia has been reported with famotidine.</div>"
What are the drug interactions of H2 Antagonists&nbsp;used as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">• </span><span style=""color: rgb(0, 0, 6);"">Cimetidine&nbsp;</span>Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption.</div><div><div><span style=""color: rgb(183, 30, 66);"">•</span>Smoking has been shown to decrease the effectiveness of H2 blockers.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>For optimal results, H2 receptor antagonists are taken 1 to 2 hours before antacids.</div></div>"
"<div><span style=""color: rgb(183, 30, 66);"">•</span>Because of its potential to cause drug interactions, cimetidine has been largely replaced by famotidine.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Cimetidine is still used to treat <span class=cloze>[...]</span>.</div>""<div><span style=""color: rgb(183, 30, 66);"">•</span>Because of its potential to cause drug interactions, cimetidine has been largely replaced by famotidine.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Cimetidine is still used to treat <span class=cloze>certain allergic reactions</span>.</div><br> "
"<div><span style=""color: rgb(183, 30, 66);"">•</span>Because of its potential to cause drug interactions, cimetidine has been largely replaced by <span class=cloze>[...]</span>.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Cimetidine is still used to treat certain allergic reactions.</div>""<div><span style=""color: rgb(183, 30, 66);"">•</span>Because of its potential to cause drug interactions, cimetidine has been largely replaced by <span class=cloze>famotidine</span>.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Cimetidine is still used to treat certain allergic reactions.</div><br> "
"<div>When working with an older patient who has been admitted for a possible GI bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>An antacid</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>A PPI</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>An H2 antagonist</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>A mucosal protectant</div>"<div>ANS: C</div><div><br></div> <div></div> <div>H2 antagonists may cause confusion and disorientation in older adults.</div>
<div>What's the mechanism of action or proton pump inhibitors?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>Irreversibly bind to H+/K+ ATPase enzyme</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>This bond prevents the movement of hydrogen ions from the parietal cell into the stomach.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Results in achlorhydria—<span style=""font-style: italic;"">all</span> gastric acid secretion is temporarily blocked.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>To return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase.</div>"
<div>What are examples for proton pump inhibitors?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>Lansoprazole (Prevacid)&nbsp; </div> <div><span style=""color: rgb(183, 30, 66);"">•</span> Omeprazole (Prilosec)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> Rabeprazole (AcipHex)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> Pantoprazole (Protonix) </div> <div><span style=""color: rgb(183, 30, 66);"">•</span> Esomeprazole (Nexium)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> Dexlansoprazole (Dexilant)</div>"
<div>What are the indications for proton pump inhibitors?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>GERD </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Erosive esophagitis</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Short-term treatment of active duodenal and benign gastric ulcers</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Zollinger-Ellison syndrome</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Nonsteroidal antiinflammatory drug (NSAID)–induced ulcers</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Stress ulcer prophylaxis</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Treatment of <span style=""font-style: italic;"">H. pylori</span>–induced ulcers</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Given with an antibiotic</div>"
<div>What are the adverse effects of proton pump inhibitors?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>PPIs are generally well tolerated.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Possible predisposition to GI tract infections: <span style=""font-style: italic;"">Clostridium difficile</span> </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Osteoporosis and risk of wrist, hip, and spine fractures in long-term users</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Pneumonia</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Depletion of magnesium </div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Link between PPIs and dementia as well as development of systemic lupus erythematous</div>"
<div>What are the drug interactions of proton pump inhibitors?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>Increase serum levels of diazepam and phenytoin</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Warfarin: increased chance of bleeding</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Absorption of ketoconazole, ampicillin, iron salts, and digoxin</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Clopidogrel</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Sucralfate: may delay the absorption of PPIs</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Food may decrease absorption of the PPIs.</div>"
<div>What are examples for miscellaneous acid controlling drugs?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>Sucralfate (Carafate)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Misoprostol (Cytotec)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Simethicone (Mylicon)</div>"
<div>What are indications for the use of sucralfate?</div>stress ulcers, peptic ulcer disease
<div>What is the mechanism of action of sucralfate?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>Cytoprotective drug (mucosal protectant)</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Attracted to and binds to the base of ulcers and erosions, forming a protective barrier over these areas</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)</div>"
<div>What are the adverse effects of sucralfate?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>May cause constipation, nausea, and dry mouth</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>May impair absorption of other drugs; give other drugs at least 2 hours before sucralfate</div>"
<div>What is the indication for use of sucralfate in chronic renal failure?</div>"<div><span style=""color: rgb(183, 30, 66);"">•</span>Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels</div>"
"<div>When teaching a patient about sucralfate (Carafate) therapy, which of the following statements will the nurse include?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>“Take sucralfate 1 hour before your other medications.”</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>“Sucralfate is administered once daily upon waking up.”</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>“Sucralfate acts systemically to heal gastric ulcers.”</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>“Sucralfate promotes ulcer healing.”</div>"<div>ANS: D</div><div><br></div> <div></div> <div>Sucralfate forms a protective barrier that can be thought of as a liquid bandage, binds to the exposed proteins of ulcers and erosions, and limits the access of pepsin. Pepsin is an enzyme that normally breaks down proteins in food but can have the same effect on GI epithelial tissue, either causing ulcers or making them worse. Sucralfate also binds and concentrates epidermal growth factor, present in the gastric tissues, which promotes ulcer healing. Other drugs should be taken at least 2 hours ahead of sucralfate. Its effects are transient and multiple daily dosing (up to four times daily) is therefore needed. Sucralfate acts locally, not systemically, binding directly to the surface of an ulcer.</div>
What is the mechanism of action of misoprostol as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Prostaglandin E analogue</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Prostaglandins have cytoprotective activity.</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Promote local cell regeneration</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Help to maintain mucosal blood flow</div>"
What indications for using misoprostol as an antiacid drug?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Used for prevention of NSAID-induced gastric ulcers</div>"
"Regarding misoprostol as an antiacid drug:<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Doses that are therapeutic enough to treat duodenal ulcers often produce <span class=cloze>[...]</span> and <span class=cloze>[...]</span>.</div>""Regarding misoprostol as an antiacid drug:<br><div><span style=""color: rgb(183, 30, 66);"">•</span>Doses that are therapeutic enough to treat duodenal ulcers often produce <span class=cloze>abdominal cramps</span> and <span class=cloze>diarrhea</span>.</div><br> "
What is the mechanism of action of simethicone?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Antiflatulent drug</div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones<br></div> <div><span style=""color: rgb(183, 30, 66);"">•</span>Result is decreased gas pain and increased expulsion via mouth or rectum.</div>"
What is the indication for the use of simethicone?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Used to reduce the discomforts of gastric or intestinal gas (flatulence)</div>"
"<div>Simethicone (Mylicon) is often combined with calcium carbonate antacids because of what effect?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>An increased antacid effect will result when these drugs are given in combination.</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>Simethicone helps to reduce the gas that is caused by the calcium antacids.</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>Simethicone reduces the diarrhea that is caused by the calcium.</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>Simethicone improves the taste of the calcium tablets, which must be chewed.</div>"<div>ANS: B</div><div><br></div> <div></div> <div>Calcium carbonate neutralization will produce gas and possibly belching, so the addition of simethicone is intended to reduce this effect. Simethicone alters elasticity of mucus-coated gas bubbles, breaking them into smaller ones, resulting in decreased gas pain and increased expulsion via mouth or rectum.</div>
List 5 preexisting conditions that may restrict the use of antacids."<div><span style=""color: rgb(183, 30, 66);"">•</span>Fluid imbalances</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> Renal disease</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> GI obstruction</div> <div><span style=""color: rgb(183, 30, 66);"">•</span> HF&nbsp; </div> &nbsp;Pregnancy&nbsp;&nbsp;<br>"
List 2 preexisting conditions that are contraindications for the use of antacids with high sodium content.HF<br>hypertension
When should H2 antagonists be used with caution as antiacid drugs?"<div><span style=""color: rgb(183, 30, 66);"">•</span>Use with caution in patients who are confused, disoriented, or older.</div>"
List the drug interactions of proton pump inhibitors.<div>May increase serum levels of diazepam and phenytoin</div><div>may increase chance for bleeding with warfarin</div>
"<div>When providing education regarding the use of PPIs, which statement will the nurse include?</div> <div></div> <div><span style=""color: rgb(183, 30, 66);"">A.</span>“Take the medication along with the first meal of the day.”</div> <div><span style=""color: rgb(183, 30, 66);"">B.</span>“Take the medication on an empty stomach, 30 to 60 minutes before eating.”</div> <div><span style=""color: rgb(183, 30, 66);"">C.</span>“Take the medication when you have symptoms of heartburn.”</div> <div><span style=""color: rgb(183, 30, 66);"">D.</span>“Take the medication at bedtime with a snack.”</div>"<div>ANS: B</div><div><br></div> <div></div> <div>Food may decrease absorption of the PPIs, and it is recommended that they be taken on an empty stomach. They are taken on a daily basis, not as needed for heartburn.</div>
What are the different routes of administration of glucocorticoids?<div>Topical, systemic, inhaled</div>
What is the route of administration of mineralocorticoids?Systemic
What is the route of administration of&nbsp;Adrenal steroid inhibitors?Systemic
List examples for glucocorticoids."<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Adrenocorticotropic hormone</span></div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Betamethasone</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Cortisone</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Dexamethasone</div> <div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Hydrocortisone (cortisol in natural form)</span></div> <div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Methylprednisolone</span></div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Prednisolone</div> Triamcinolone<br>"
List examples for mineralocorticoids."<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Aldosterone</span></div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Desoxycorticosterone</div> <div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Fludrocortisone</span></div>"
List examples for catecholamines."<div><span style=""background-color: yellow;"">Epinephrine</span>, norepinephrine</div>"
What's the mechanism of action of corticosteroids?"<div><span style=""color: rgb(165, 48, 16);"">´</span>Action of corticosteroids is related to the involvement in the synthesis of certain proteins.</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Most corticosteroids exert their effects by modifying enzyme activity.</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids differ in their potency, duration of action, and the extent to which they cause salt and fluid retention.</div> <div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Glucocorticoids inhibit or help control inflammatory and immune responses.</span></div>"
What are the indications for the use of corticosteroids?"<div><span style=""color: rgb(165, 48, 16);"">´</span>Adrenocortical deficiency</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Adrenogenital syndrome</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Bacterial meningitis </div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Cerebral edema</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Collagen diseases (e.g., systemic lupus erythematosus)</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Dermatologic diseases (e.g., exfoliative dermatitis, pemphigus)</div> Endocrine disorders (thyroiditis)<br><div><span style=""color: rgb(165, 48, 16);"">´</span>Gastrointestinal (GI) diseases (e.g., ulcerative colitis)</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Exacerbations of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Hematologic disorders (reduce bleeding tendencies- reduce antibodies against platelets) ITP</div> Ophthalmic disorders (inflammation like scleritis)<br><div><span style=""color: rgb(165, 48, 16);"">´</span>Organ transplantation (decrease immune response to prevent organ rejection)</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Leukemias and lymphomas (palliative management)</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Nephrotic syndrome (remission of proteinuria)</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Spinal cord injury</div>"
"<div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids administration </div> <div><span style=""color: rgb(165, 48, 16);"">´</span>By <span class=cloze>[...]</span> for control of steroid-responsive bronchospastic states (fluticasone, mometasone, etc)</div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids administration </div> <div><span style=""color: rgb(165, 48, 16);"">´</span>By <span class=cloze>inhalation</span> for control of steroid-responsive bronchospastic states (fluticasone, mometasone, etc)</div><br> "
"<div><div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids administration&nbsp;</div></div><div><span style=""color: rgb(165, 48, 16);"">´</span><span class=cloze>[...]</span> for rhinitis and to prevent the recurrence of polyps after surgical removal (fluticasone-flonase; triamcinolone-Nasacort, etc)</div>""<div><div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids administration&nbsp;</div></div><div><span style=""color: rgb(165, 48, 16);"">´</span><span class=cloze>Nasally</span> for rhinitis and to prevent the recurrence of polyps after surgical removal (fluticasone-flonase; triamcinolone-Nasacort, etc)</div><br> "
"<div><div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids administration&nbsp;</div></div><div><span style=""color: rgb(165, 48, 16);"">´</span><span class=cloze>[...]</span> for inflammations of the eye, ear, and skin (hydrocortisone, triamcinolone, etc)</div>""<div><div><span style=""color: rgb(165, 48, 16);"">´</span>Glucocorticoids administration&nbsp;</div></div><div><span style=""color: rgb(165, 48, 16);"">´</span><span class=cloze>Topically</span> for inflammations of the eye, ear, and skin (hydrocortisone, triamcinolone, etc)</div><br> "
"<div><div><span style=""color: rgb(0, 0, 0);"">List contraindications for the use of corticosteroids.</span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Drug allergies</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Serious infections, including septicemia, systemic fungal infections, and varicella</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory central nervous system (CNS) damage.</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">List groups of patients in whom corticosteroids should be used with caution.</span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Gastritis, reflux disease, ulcer disease</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Diabetes</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Cardiac, renal, or liver dysfunction</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">List the cardiovascular adverse effects of corticosteroids.</span></div></div>""<div>Cardiovascular: <span style=""background-color: yellow;"">edema</span>, <span style=""background-color: yellow; font-weight: bold;"">hypertension</span>—all caused by <span style=""background-color: yellow;"">electrolyte imbalances </span>(hypokalemia, hypernatremia)</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">List drug interactions of corticosteroids.</span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""font-weight: bold;"">Non–potassium-sparing diuretics (e.g., thiazides, loop diuretics) can lead to severe hypokalemia.</span></div> <div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""font-weight: bold;"">Aspirin, other nonsteroidal </span><span style=""font-weight: bold;"">antiinflammatory</span><span style=""font-weight: bold;""> drugs (NSAIDs) can produce additive GI effects and an increased chance of gastric ulcer development.</span></div><div><div><span style=""color: rgb(165, 48, 16);"">´</span>Corticosteroids <span style=""background-color: yellow;"">inhibit the immune response </span>when given in combination with biologics</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Antidiabetic drugs may have reduced hypoglycemic effects and result in <span style=""background-color: yellow;"">elevated blood glucose levels.</span></div></div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">Why shouldn't you stop steroids abruptly?</span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Adrenal suppression can lead to adrenal crisis ( medical emergency due to lack of cortisol.&nbsp; Lightheadedness, dizziness, weakness, sweating, abdominal pain, nausea and vomiting, MS changes.&nbsp; Life threatening condition stemming from Addison’s disease</span></div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">What are the adverse effects of mineralocorticoids?</span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Generally relate to water retention</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Heart failure, hypertension, and elevated intracerebral pressure</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Skin rash, peptic ulcers, hyperglycemia, hypokalemia</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Muscle pain, weakness, compression bone fractures</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">What are the indications for the use of mineralocorticoids?<br></span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""font-weight: bold;"">Addison’s disease </span>and treatment of salt-losing adrenogenital syndrome (rare genetic disorder)</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">What is the&nbsp;</span><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Most commonly used oral glucocorticoid </span>for antiinflammatory or immunosuppressant purposes?<br></div></div>"Prednisone
"<div><div><span style=""color: rgb(0, 0, 0);"">What are the indications for the use of prednisone</span>?<br></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Most commonly used oral glucocorticoid </span>for antiinflammatory or immunosuppressant purposes</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Also used to treat exacerbations of chronic respiratory illnesses</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">What is the primary use of&nbsp;</span>Methylprednisolone?<br></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Primary use: antiinflammatory or immunosuppressant drug</div>"
"<div><div><span style=""color: rgb(0, 0, 0);"">What is the&nbsp;</span><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Most commonly used injectable </span>glucocorticoid drug?<br></div></div>"Methylprednisolone
"<div><span style=""color: rgb(165, 48, 16);"">´</span>Most injectable formulations of Methylprednisolone contain a preservative (benzyl alcohol) that cannot be given to <span class=cloze>[...]</span></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Most injectable formulations of Methylprednisolone contain a preservative (benzyl alcohol) that cannot be given to <span class=cloze>children younger than 28 days of age.</span></div><br> "
"<div><span style=""color: rgb(165, 48, 16);"">´</span>Assess for contraindications to adrenal drugs, especially the presence of <span class=cloze>[...]</span> before giving glucocorticoids.</div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Assess for contraindications to adrenal drugs, especially the presence of <span class=cloze>peptic ulcer disease</span> before giving glucocorticoids.</div><br> "
<div>When&nbsp;giving glucocorticoids, be aware that these drugs may alter serum <span class=cloze>[...]</span> and <span class=cloze>[...]</span> levels.</div><div>When&nbsp;giving glucocorticoids, be aware that these drugs may alter serum <span class=cloze>glucose</span> and <span class=cloze>electrolyte</span> levels.</div><br> "<div>When&nbsp;giving glucocorticoids,&nbsp;<span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">Oral forms should be given with&nbsp;</span>food&nbsp;<span style=""background-color: yellow; font-weight: bold;"">or&nbsp;</span>milk</div> <div><span style=""background-color: yellow; font-weight: bold;"">to minimize&nbsp;</span><span class=cloze>[...]</span><span style=""font-weight: bold;"">.</span></div>""<div>When&nbsp;giving glucocorticoids,&nbsp;<span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">Oral forms should be given with&nbsp;</span>food&nbsp;<span style=""background-color: yellow; font-weight: bold;"">or&nbsp;</span>milk</div> <div><span style=""background-color: yellow; font-weight: bold;"">to minimize&nbsp;</span><span class=cloze>GI upset</span><span style=""font-weight: bold;"">.</span></div><br> "
"<div>When&nbsp;giving glucocorticoids,&nbsp;<span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">Oral forms should be given with&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow; font-weight: bold;"">or&nbsp;</span><span class=cloze>[...]</span></div> <div><span style=""background-color: yellow; font-weight: bold;"">to minimize&nbsp;</span>GI upset<span style=""font-weight: bold;"">.</span></div>""<div>When&nbsp;giving glucocorticoids,&nbsp;<span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">Oral forms should be given with&nbsp;</span><span class=cloze>food</span>&nbsp;<span style=""background-color: yellow; font-weight: bold;"">or&nbsp;</span><span class=cloze>milk</span></div> <div><span style=""background-color: yellow; font-weight: bold;"">to minimize&nbsp;</span>GI upset<span style=""font-weight: bold;"">.</span></div><br> "
"<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">After using an orally inhaled corticosteroid, instruct patients to&nbsp;</span>rinse their mouths<span style=""background-color: yellow; font-weight: bold;"">&nbsp;to prevent&nbsp;</span><span class=cloze>[...]</span><span style=""background-color: yellow; font-weight: bold;"">.</span></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">After using an orally inhaled corticosteroid, instruct patients to&nbsp;</span>rinse their mouths<span style=""background-color: yellow; font-weight: bold;"">&nbsp;to prevent&nbsp;</span><span class=cloze>possible oral fungal infections</span><span style=""background-color: yellow; font-weight: bold;"">.</span></div><br> "
"<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">After using an orally inhaled corticosteroid, instruct patients to&nbsp;</span><span class=cloze>[...]</span><span style=""background-color: yellow; font-weight: bold;"">&nbsp;to prevent&nbsp;</span>possible oral fungal infections<span style=""background-color: yellow; font-weight: bold;"">.</span></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow; font-weight: bold;"">After using an orally inhaled corticosteroid, instruct patients to&nbsp;</span><span class=cloze>rinse their mouths</span><span style=""background-color: yellow; font-weight: bold;"">&nbsp;to prevent&nbsp;</span>possible oral fungal infections<span style=""background-color: yellow; font-weight: bold;"">.</span></div><br> "
"<div><span style=""color: rgb(165, 48, 16);"">´</span>Patients should not take adrenal medications with alcohol, <span class=cloze>[...]</span>, or NSAIDs.</div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Patients should not take adrenal medications with alcohol, <span class=cloze>aspirin</span>, or NSAIDs.</div><br> "
"<div><span style=""color: rgb(165, 48, 16);"">´</span>Patients should not take adrenal medications with <span class=cloze>[...]</span>, aspirin, or <span class=cloze>[...]</span>.</div>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Patients should not take adrenal medications with <span class=cloze>alcohol</span>, aspirin, or <span class=cloze>NSAIDs</span>.</div><br> "
"<span style=""color: rgb(0, 0, 0);"">List patient advices to be given when taking corticosteroids.</span>""<div><span style=""color: rgb(165, 48, 16);"">´</span>Teach patients taking corticosteroids to avoid contact with people with infections and to report any fever, increased weakness, lethargy, or sore throat.</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Patients should be taught to take all adrenal medications at the same time every day, usually in the morning, with meals or food.</div> <div><span style=""color: rgb(165, 48, 16);"">´</span>Patients should not take adrenal medications with alcohol, aspirin, or NSAIDs.</div>"
"<span style=""color: rgb(0, 0, 0);"">What's the best time to give glucocorticoids?</span>""<span style=""color: rgb(64, 64, 64); background-color: yellow;"">The best time to give glucocorticoids is early in the morning (6 AM to 9 AM)&nbsp;</span>"
"<span style=""color: rgb(0, 0, 0);"">Why are glucocorticoids best given in the morning?</span>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""color: rgb(64, 64, 64); background-color: yellow;"">The best time to give glucocorticoids is early in the morning (6 AM to 9 AM) to minimize the amount of adrenal suppression.&nbsp;</span></div>"
"<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Sudden discontinuation of glucocorticoids can precipitate an&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow;"">caused by a sudden drop in serum levels of glucocorticoids.</span></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Sudden discontinuation of glucocorticoids can precipitate an&nbsp;</span><span class=cloze>adrenal crisis</span>&nbsp;<span style=""background-color: yellow;"">caused by a sudden drop in serum levels of glucocorticoids.</span></div><br> "
"<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Sudden discontinuation of glucocorticoids can precipitate an&nbsp;</span>adrenal crisis&nbsp;<span style=""background-color: yellow;"">caused by a sudden drop in serum levels of glucocorticoids.</span></div><div><div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Doses are usually&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""background-color: yellow;"">before the drug is discontinued.</span></div></div>""<div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Sudden discontinuation of glucocorticoids can precipitate an&nbsp;</span>adrenal crisis&nbsp;<span style=""background-color: yellow;"">caused by a sudden drop in serum levels of glucocorticoids.</span></div><div><div><span style=""color: rgb(165, 48, 16);"">´</span><span style=""background-color: yellow;"">Doses are usually&nbsp;</span><span class=cloze>tapered</span>&nbsp;<span style=""background-color: yellow;"">before the drug is discontinued.</span></div></div><br> "
"<div>The nurse should teach a patient taking an oral corticosteroid to take the medication at what time?</div> <div></div> <div><span style=""color: rgb(165, 48, 16);"">A.</span>0800</div> <div><span style=""color: rgb(165, 48, 16);"">B.</span>1200</div> <div><span style=""color: rgb(165, 48, 16);"">C.</span>1700</div> <div><span style=""color: rgb(165, 48, 16);"">D.</span>2000</div>"<div>ANS: A</div><div><br></div> <div></div> <div>Oral corticosteroids should be taken in the morning to minimize adrenal suppression.</div>
"<div>A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone?</div> <div></div> <div><span style=""color: rgb(165, 48, 16);"">A.</span>Furosemide</div> <div><span style=""color: rgb(165, 48, 16);"">B.</span>Levothyroxine</div> <div><span style=""color: rgb(165, 48, 16);"">C.</span>Proton pump inhibitor</div> <div><span style=""color: rgb(165, 48, 16);"">D.</span>Antacid&nbsp;&nbsp;</div>"<div>ANS: A</div><div><br></div> <div></div> <div>Co-administration of a loop diuretic with a corticosteroid may result in hypokalemia because of the potassium loss caused by both drugs.</div>
"<div>A patient is taking an inhaled corticosteroid for asthma. After the patient takes a dose of the inhaler, what is a priority intervention?</div> <div></div> <div><span style=""color: rgb(165, 48, 16);"">A.</span>Listen to the patient’s breath sounds.</div> <div><span style=""color: rgb(165, 48, 16);"">B.</span>Have the patient rinse his mouth with warm water.</div> <div><span style=""color: rgb(165, 48, 16);"">C.</span>Instruct the patient to cough and deep breathe.</div> <div><span style=""color: rgb(165, 48, 16);"">D.</span>Take the patient’s apical pulse for 1 minute.</div>""<div>ANS: B</div><div><br></div> <div></div> <div>The patient should rinse his mouth with water immediately after taking an inhaled corticosteroid to avoid oral fungal infections and other oral irritations.</div> <div><span style=""color: rgb(165, 48, 16);"">´</span></div>"
"<div>Which of the following should the nurse include when teaching a patient about glucocorticoid therapy?</div> <div></div> <div><span style=""color: rgb(165, 48, 16);"">A.</span>Do not abruptly stop taking the drug.</div> <div><span style=""color: rgb(165, 48, 16);"">B.</span>Take the medication on an empty stomach.</div> <div><span style=""color: rgb(165, 48, 16);"">C.</span>Avoid use of antiulcer medications when taking glucocorticoids.</div> <div><span style=""color: rgb(165, 48, 16);"">D.</span>When used long term, alternate-day dosing of glucocorticoids will help minimize thyroid suppression.&nbsp;</div>"<div>ANS: A</div><div><br></div> <div></div> <div>With oral and all other forms of glucocorticoids that are given short or long term, abrupt withdrawal must be avoided. Abrupt withdrawal of adrenal drugs (e.g., prednisone, methylprednisolone) may lead to a sudden decrease in, or no production of, endogenous glucocorticoids, resulting in adrenal insufficiency. It is recommended that oral dosage forms be given with a snack or meal to help minimize GI upset. An order for an H2 receptor antagonist or a proton pump inhibitor may be prescribed to minimize GI upset and to minimize ulcer formation because these drugs are ulcerogenic. In long-term therapy, alternate-day dosing of glucocorticoids, if possible, will help minimize the adrenal suppression.</div>
What is active immunization?"<div><span style=""color: rgb(0, 0, 0);"">Active immunization= development of long- lasting immunity with exposure to antigen</span></div>"
What are the two types of active immuniation?"<div><span style=""color: rgb(0, 0, 0);"">-Artificial active immunization (receiving vaccine or toxoid)</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Natural active immunization (having the disease)</span></div>"
What is the mechanism of active immuniation?"<div><ul><li><span style=""color: rgb(0, 0, 0);"">Antigen (Ag) presents itself</span></li><li><span style=""color: rgb(0, 0, 0);"">Ag binds to B cells (B lymphocytes) in the humoral immune system</span></li><li><span style=""color: rgb(0, 0, 0);"">B cells differentiate into memory cells and plasma cells which produce antibodies.</span></li><li><span style=""color: rgb(0, 0, 0);"">Antibodies (Ab) are immunoglobulin molecules with antigen-specific amino acid sequences.</span></li><li><span style=""color: rgb(0, 0, 0);"">Immunoglobulins are synthesized by immune system to destroy foreign substances.</span></li></ul></div><span style=""color: rgb(0, 0, 0);""> </span><span style=""color: rgb(0, 0, 0);""> </span><span style=""color: rgb(0, 0, 0);""> </span><span style=""color: rgb(0, 0, 0);""> </span>"
Name 3 types of biologics."<div><span style=""color: rgb(0, 0, 0);"">Antitoxins</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Antisera</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Toxoids and vaccines (treated)</span></div>"
What are the indications for using biologics?"<div><span style=""color: rgb(0, 0, 0);"">Used to prevent, treat, or cure infectious diseases</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Toxoids and vaccines are known as&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">, and they target a particular infectious microorganism.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">Toxoids and vaccines are known as&nbsp;</span><span class=cloze>immunizing biologics</span><span style=""color: rgb(0, 0, 0);"">, and they target a particular infectious microorganism.</span></div><br> "
<div>What is the mechanism of action of toxoids?</div>"<div><span style=""color: rgb(0, 0, 0);"">Stimulate one’s immune system to produce a specific antibody</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Artificial active immune response</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">These antibodies protect against future exposures.</span></div>"
<div>Give two indications for the use of toxoids.</div>"<div><span style=""color: rgb(0, 0, 0);"">Example: diphtheria and tetanus caused by <span style=""font-style: italic;"">toxin</span>-producing bacteria</span></div>"
<div>Give two examples for the use of vaccines.</div>"<span style=""color: rgb(0, 0, 0);"">influenza and pneumonia vaccines</span>"
<div>Outline the mechanism of action of vaccines.</div><div>Suspensions of live, attenuated (weakened) or killed (inactivated) microorganisms</div><div>These slight alterations in the bacteria and viruses allow protection from a disease.</div><div>Can stimulate production of antibodies against the organism.</div><div><div>Vaccinations with live bacteria or virus provide lifelong immunity.</div><div>Vaccinations with killed bacteria or virus provide partial immunity, and booster shots are needed periodically.</div></div>
<div>Whats the indication for a booster shot of vaccine?</div>"<div><span style=""color: rgb(0, 0, 0);"">Booster shot: another dose of the vaccine is given to restore the antibody titers to a level that can protect the person against the infection&nbsp;</span></div>"
"<div><span style=""color: rgb(0, 0, 0);"">List examples for&nbsp;Active Immunizing Drugs.</span></div>""<div><span style=""color: rgb(138, 208, 214);"">-</span>Bacillus Calmette-Guérin vaccine (tuberculosis)</div> <div><font color=""#8ad0d6"">-</font>Diphtheria, tetanus, and pertussis toxoids: several forms (contra: if prior neurologic reaction)</div> <div><font color=""#8ad0d6"">-</font><span style=""font-style: italic;"">Haemophilus</span><span style=""font-style: italic;""> </span><span style=""font-style: italic;"">influenzae</span><span style=""font-style: italic;""> </span>type B conjugate vaccine</div> <div><font color=""#8ad0d6"">-</font>Hepatitis A and B virus vaccines (contra: if yeast sensitivity for Hep B vaccine)</div><div><div><span style=""color: rgb(0, 0, 0);"">-Measles, mumps, and rubella virus vaccine, live: several forms (contra: immediate reaction to egg ingestion, neomycin, pregnancy)</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Pneumococcal bacterial vaccines</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Human papilloma virus vaccine (Gardasil)- (contra: hypersensitivity to yeast)</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Poliovirus vaccine: several forms</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Rabies virus vaccine</span></div></div>"
"<div><span style=""color: rgb(0, 0, 0);"">Which groups of people should live attenuated vaccines be avoided with?</span></div>""<div><span style=""color: rgb(0, 0, 0);"">-Immunocompromised people including</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-People on daily high dose steroids</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-People undergoing chemotherapy</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Organ transplant recipients</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-People with advanced HIV/AIDS</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Pregnancy category B or C- use with caution</span></div>"
"<div>Which reported allergy would be important for the nurse to identify before administering Gardasil?</div> <div></div> <div><span style=""color: rgb(138, 208, 214);"">A.</span>Yeast</div> <div><span style=""color: rgb(138, 208, 214);"">B.</span>Milk</div> <div><span style=""color: rgb(138, 208, 214);"">C.</span>Eggs</div> <div><span style=""color: rgb(138, 208, 214);"">D.</span>Penicillin</div>""<div>ANS: A</div><div><br></div> <div></div> The nurse should not administer the papillomavirus<span style=""font-style: italic;""> </span>vaccine (Gardasil, Cervarix) to patients with allergies to yeast or patients who have a documented allergic reaction to the first injection of the vaccine<br>"
"<div>A patient has an order for the varicella vaccine. What priority patient history will the nurse want to assess?</div> <div></div> <div><span style=""color: rgb(138, 208, 214);"">A.</span>Use of high dose systemic steroids in the past month</div> <div><span style=""color: rgb(138, 208, 214);"">B.</span>Allergy to aspirin</div> <div><span style=""color: rgb(138, 208, 214);"">C.</span>Allergy to eggs</div> <div><span style=""color: rgb(138, 208, 214);"">D.</span>History of hypertension</div>"<div>ANS: A</div><div><br></div> <div></div> <div>Varicella vaccine is not to be given to immunodeficient patients or to patients who have received high doses of systemic steroids in the previous month. It is also recommended that salicylates be avoided for 6 weeks after administration of varicella vaccine because of the possibility of Reye’s syndrome.&nbsp;</div>
What is artificial passive immunization?"<span style=""color: rgb(0, 0, 0);"">administration of serum or concentrated immunoglobulins</span>"
What is the mechanism of artificial passive immuniation?"<div><span style=""color: rgb(138, 208, 214);"">-</span>Serum or concentrated immunoglobulins from humans or animals are injected into a person.</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>The substances needed to fight off invading microorganisms are given directly to a person.</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>The immune system is bypassed.</div>"
What are examples for artificial passive immuniation?immunization with tetanus immunoglobulin, hepatitis immunoglobulin, rabies immunoglobulin, and snakebite antivenin
What are the three types of artificial passive immuniing drugs?"<div><span style=""color: rgb(0, 0, 0);"">-Antitoxins: purified <span style=""font-style: italic;"">antiserum</span> that is usually obtained from horses inoculated with the toxin</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Immunoglobulins: concentrated preparation containing predominantly immunoglobulin G and is harvested from a large pool of blood donors; available in IM and IV forms</span></div><div><span style=""color: rgb(0, 0, 0);"">-Snake and spider antivenins (antivenom):&nbsp; &nbsp;</span><br></div>"
What are examples for artificial passive immunizing drugs?"<div><span style=""color: rgb(138, 208, 214);"">-</span>Antivenins</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Pit viper, coral snake</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Black widow spider</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Hepatitis B immune globulin</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Immunoglobulin, various forms</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Rabies immunoglobulin (human)</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Rho(D) immune globulin (RhoGAM)</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Tetanus immunoglobulin</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Varicella-zoster immunoglobulin&nbsp;</div>"
What are the FDA aproved indications for immunoglobulin?"<div><span style=""color: rgb(138, 208, 214);"">-</span>Pediatric HIV infection</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>B-cell chronic lymphocytic leukemia</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Bone marrow transplantation</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Hepatitis A</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Idiopathic thrombocytopenic purpura</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Kawasaki disease</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Immunoglobulin deficiencies</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Measles</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Primary immunodeficiency diseases</div> <div><span style=""color: rgb(138, 208, 214);"">-</span>Rubella</div> -Varicella<br>"
"<div>A patient with AIDS was cut by a rusty piece of metal while walking outside. He recalls that his last tetanus booster was more than 20 years ago. Which immunization therapy will he receive at this time?</div> <div></div> <div><span style=""color: rgb(138, 208, 214);"">A.</span>He cannot receive any type of immunization therapy.</div> <div><span style=""color: rgb(138, 208, 214);"">B.</span>Tetanus immunoglobulin</div> <div><span style=""color: rgb(138, 208, 214);"">C.</span>Tetanus toxoid, adsorbed</div> <div><span style=""color: rgb(138, 208, 214);"">D.</span>Tetanus and diphtheria toxoid (Td) booster</div>"<div>ANS: B</div><div><br></div> <div></div> <div>Vaccines and toxoids rely on a person’s immune system to work. Patients who are immunocompromised (as in those receiving immunosuppressive therapy and those with AIDS) may not benefit from vaccines or toxoids because they are unable to mount an immune response. In these situations, passive immunizing drugs such as immunoglobulins are warranted.</div>
What's the single most important influenza control measure?Influenza vaccine
When should the influenza vaccine be given?<div>Needs to be given each year before the influenza season begins</div>
Which groups of people should be given the influenza vaccine according to the CDC?<div>all people older than 6 months of age should receive the influenza vaccine.</div>
Which influenza vaccine is specifically indicated for older adults?Newer formulations of the influenza vaccine: “high-dose” Fluzone
"<div>The zoster vaccine (Shingrix) is used in which situation?</div> <div></div> <div><span style=""color: rgb(138, 208, 214);"">A.</span>To prevent chickenpox in children</div> <div><span style=""color: rgb(138, 208, 214);"">B.</span>To prevent chickenpox in children who have been exposed to herpes zoster</div> <div><span style=""color: rgb(138, 208, 214);"">C.</span>To prevent postherpetic neuralgia in patients who have shingles</div> <div><span style=""color: rgb(138, 208, 214);"">D.</span>To prevent shingles in adult patients</div>"<div>ANS: D</div><div><br></div> <div></div> <div>The herpes zoster vaccine (Shingrix) is a vaccine for the prevention of herpes zoster, the virus that causes shingles. The vaccine is recommended for adults and is given in a two-dose series. The vaccine is not be used for the prevention of chickenpox and should not be given to children.</div>
What are the minor adverse effects of immunization?<div>Fever, minor rash, soreness at injection site, itching, adenopathy</div>
What are the severe adverse effects of immunization?<div>Fever higher than 103°F, encephalitis, convulsions, anaphylactic reaction, dyspnea, others</div>
What is the treatment for minor adverse effects of immunization?<div>Treated with acetaminophen and rest</div>
What are some serious or unusual reactions of immunization?"<div><span style=""font-weight: bold;"">Serum sickness( edema of the face, tongue, throat: rash, arthritis, adenopathy; fever</span></div>"
What should you do in the event of serious or unusual reactions of immunization?<div>Report serious or unusual reactions to the Vaccine Adverse Event Reporting System (VAERS) within the CDC</div>
"<div>After immunizations at a well-baby check-up, a mother notes that her infant has redness and swelling at the injection site, is irritable, and has a fever of 99.9°F. She calls the clinic and is worried about her baby. Which action by the nurse is appropriate?</div> <div></div> <div><span style=""color: rgb(138, 208, 214);"">A.</span>Tell the mother there’s nothing to worry about and that these symptoms are normal and will go away.</div> <div><span style=""color: rgb(138, 208, 214);"">B.</span>Tell the mother that she should bring her baby in to the office for an examination.</div> <div><span style=""color: rgb(138, 208, 214);"">C.</span>Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after &nbsp; &nbsp;&nbsp;immunizations.</div> <div><span style=""color: rgb(138, 208, 214);"">D.</span>Complete a VAERS form.</div>""<div><span style=""color: rgb(0, 0, 0);"">ANS: C</span></div><div><span style=""color: rgb(0, 0, 0);""><br></span></div><span style=""color: rgb(0, 0, 0);""> <div></div> </span><div><span style=""color: rgb(0, 0, 0);"">These minor reactions may be treated with acetaminophen and rest, warm compress to site. Reactions that are more serious or unusual should be reported with a VAERS form.</span></div>"
Name one contraindication for vaccinations.Immunosupresion.
"<div><span style=""color: rgb(0, 0, 0);"">If discomfort occurs at the injection site, apply&nbsp;</span>warm compresses<span style=""color: rgb(0, 0, 0);"">&nbsp;and give&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">.</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Do not give&nbsp;</span>aspirin&nbsp;<span style=""color: rgb(0, 0, 0);"">to children.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">If discomfort occurs at the injection site, apply&nbsp;</span>warm compresses<span style=""color: rgb(0, 0, 0);"">&nbsp;and give&nbsp;</span><span class=cloze>acetaminophen</span><span style=""color: rgb(0, 0, 0);"">.</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Do not give&nbsp;</span>aspirin&nbsp;<span style=""color: rgb(0, 0, 0);"">to children.</span></div><br> "
"<div><span style=""color: rgb(0, 0, 0);"">If discomfort occurs at the injection site, apply&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">&nbsp;and give&nbsp;</span>acetaminophen<span style=""color: rgb(0, 0, 0);"">.</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Do not give&nbsp;</span>aspirin&nbsp;<span style=""color: rgb(0, 0, 0);"">to children.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">If discomfort occurs at the injection site, apply&nbsp;</span><span class=cloze>warm compresses</span><span style=""color: rgb(0, 0, 0);"">&nbsp;and give&nbsp;</span>acetaminophen<span style=""color: rgb(0, 0, 0);"">.</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Do not give&nbsp;</span>aspirin&nbsp;<span style=""color: rgb(0, 0, 0);"">to children.</span></div><br> "
"<div><span style=""color: rgb(0, 0, 0);"">If discomfort occurs at the injection site, apply&nbsp;</span>warm compresses<span style=""color: rgb(0, 0, 0);"">&nbsp;and give&nbsp;</span>acetaminophen<span style=""color: rgb(0, 0, 0);"">.</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Do not give&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""color: rgb(0, 0, 0);"">to children.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">If discomfort occurs at the injection site, apply&nbsp;</span>warm compresses<span style=""color: rgb(0, 0, 0);"">&nbsp;and give&nbsp;</span>acetaminophen<span style=""color: rgb(0, 0, 0);"">.</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">Do not give&nbsp;</span><span class=cloze>aspirin</span>&nbsp;<span style=""color: rgb(0, 0, 0);"">to children.</span></div><br> "
<div>What are the properties of NSAIDS?</div>"<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Analgesic</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Anti-inflammatory</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Antipyretic</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Aspirin-platelet inhibition</span></div>"
List indications for the use of NSAIDS."<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Mild to moderate headaches</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Myalgia</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Neuralgia</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Arthralgia</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Alleviation of postoperative pain</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">The pain associated with arthritic disorders, such as rheumatoid arthritis (RA), juvenile arthritis, </span><span style=""color: rgb(64, 64, 64);"">ankylosing</span><span style=""color: rgb(64, 64, 64);""> spondylitis, and osteoarthritis (OA)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Treatment of gout and </span><span style=""color: rgb(64, 64, 64);"">hyperuricemia</span><span style=""color: rgb(64, 64, 64);""></span></div>"
List 3 properties shared by all NSAIDS."<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Antipyretic</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Analgesic</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Anti-inflammatory&nbsp;</span></div>"
Give examples for salicylates."<div><span style=""color: rgb(64, 64, 64);"">Aspirin, Diflunisal (</span><span style=""color: rgb(64, 64, 64);"">Dolobid</span><span style=""color: rgb(64, 64, 64);"">), others</span></div>"
Give examples for acetic acid derivatives.Diclofenac sodium (Voltaren) <br>Indomethacin (Indocin) <br>Sulindac (Clinoril)&nbsp; <br>Tolmetin (Tolectin)&nbsp; <br>Etodolac (Lodine)&nbsp; <br>Ketorolac (Toradol)
"<span style=""color: rgb(0, 0, 0);"">Give examples for&nbsp;<span style=""text-indent: -0.38in;"">Cyclooxygenase-2 (COX-2) inhibitors</span>.</span>"Celecoxib (Celebrex)
"<span style=""color: rgb(0, 0, 0);"">Give examples for&nbsp;</span>Enolic acid derivatives<span style=""color: rgb(0, 0, 0);"">.</span>"Nabumetone (Relafen) <br>Meloxicam (Mobic)<br>Piroxicam (Feldene)
What's the half life of Celecoxib?11 hours
What's the half life of Meloxicam?Upto 20 hours
Give an indication for the use of aspirin."<div><span style=""color: rgb(144, 194, 38);"">●</span><span style=""color: rgb(64, 64, 64);"">Shown to reduce cardiac mortality and reinfarction</span></div> <div><span style=""color: rgb(144, 194, 38);"">●</span><span style=""color: rgb(64, 64, 64);"">Typically administered at the first sign of MI- 160-325 mg chewed if possible</span></div> <div><span style=""color: rgb(144, 194, 38);"">●</span><span style=""color: rgb(64, 64, 64);"">If not given before arriving in the emergency department, aspirin is one of the first drugs given if there are no contraindications.&nbsp;</span></div>"
Give examples for Propionic acid derivatives."<div><span style=""color: rgb(64, 64, 64);"">Fenoprofen</span><span style=""color: rgb(64, 64, 64);""> (Nalfon)</span></div> <div><span style=""color: rgb(64, 64, 64);"">Flurbiprofen</span><span style=""color: rgb(64, 64, 64);""> (Ansaid)</span></div> <div><span style=""color: rgb(64, 64, 64); background-color: yellow;"">Ibuprofen (Motrin, Advil, others)</span></div> <div><span style=""color: rgb(64, 64, 64);"">Ketoprofen</span><span style=""color: rgb(64, 64, 64);""> (Orudis KT)</span></div> <div><span style=""color: rgb(64, 64, 64); background-color: yellow;"">Naproxen (Naprosyn, Aleve)</span></div> <div><span style=""color: rgb(64, 64, 64);"">Oxaprozin</span><span style=""color: rgb(64, 64, 64);""> (Daypro)</span></div>"
Outline the mechanism of action of NSAIDS."<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Inhibition of the leukotriene pathway, the prostaglandin pathway, or both</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Blocking the chemical activity of the enzyme COX</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">COX-1: has a role in maintaining the gastrointestinal (GI) mucosa; also involved in kidney and platelet function (mediates renin release, regulates sodium excretion)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">COX-2: primarily found at sites of inflammation</span></div>"
Outline the mechanism of action of Aspirin.Irreversible inhibitor of COX-1 receptors withi platelets themselves <br>Reduced formation of thromboxane A2, a substa that normally promotes platelet aggregation <br>Other NSAIDs lack these antiplatelet effects.
List contraindications for the use of NSAIDS.Known drug allergy <br>Patients with documented aspirin allergy) not receive NSAIDs. <br>Conditions that place the patient at risk for bleeding: <br>&gt; Vitamin K deficiency <br>&gt; Peptic ulcer disease
List adverse effects of NSAIDS."<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">GI: heartburn to severe GI bleeding</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Acute renal failure </span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Noncardiogenic</span><span style=""color: rgb(64, 64, 64);""> pulmonary edema</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Increased risk of MI and stroke</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Altered hemostasis</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Hepatotoxicity</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Skin eruption, sensitivity reaction</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Tinnitus, hearing loss</span></div>"
What is the use of misoprostol with NSAIDS?"<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Misoprostol (</span><span style=""color: rgb(64, 64, 64);"">Cytotec</span><span style=""color: rgb(64, 64, 64);"">): prevents GI bleed</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Synthetic prostaglandin </span><span style=""color: rgb(64, 64, 64);"">E</span><span style=""color: rgb(64, 64, 64);"">1</span><span style=""color: rgb(64, 64, 64);""> analogue: inhibits gastric acid secretion and has a </span><span style=""color: rgb(64, 64, 64);"">cytoprotective</span><span style=""color: rgb(64, 64, 64);""> component</span></div>"
Which groups of drugs, when given in combination with NSAIDS, can cause serious interactions?Anticoagulants&nbsp; <br>Aspirin&nbsp; <br>Corticosteroids and other ulcerogenic drugs <br>Protein bound drugs&nbsp; <br>Diuretics and ACE inhibitors&nbsp; <br>Others
Which groups of patients are at risk of renal toxicity with NSAIDS?"<div><span style=""color: rgb(64, 64, 64);"">Renal toxicity can occur in patients with dehydration, heart failure, liver dysfunction, or use of diuretics or angiotensin-converting enzyme (ACE) inhibitors.</span></div>"
What does the black box warning of NSAIDS include?"<div><span style=""color: rgb(64, 64, 64);"">All </span><span style=""color: rgb(64, 64, 64);"">NSAIDs</span><span style=""color: rgb(64, 64, 64);""> (except aspirin) share a black box warning regarding an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke.&nbsp;</span></div>"
"<div><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">may counteract the cardioprotective effects of aspirin.&nbsp;</span></div>""<div><span class=cloze>NSAIDs</span><span style=""color: rgb(0, 0, 0);"">may counteract the cardioprotective effects of aspirin.&nbsp;</span></div><br> "
"<div><span style=""color: rgb(64, 64, 64);"">The nurse is administering medications. One patient has an order for aspirin 81 mg by mouth daily and another patient has an order for aspirin </span><span style=""color: rgb(64, 64, 64);"">650 mg 4 to 6 times daily (maximum 4 g/day)</span><span style=""color: rgb(64, 64, 64);"">. What indication for the 325 mg should&nbsp; the nurse recognize?</span></div> <div><span style=""color: rgb(64, 64, 64);"">&nbsp;</span></div> <div><span style=""color: rgb(144, 194, 38);"">A.</span><span style=""color: rgb(64, 64, 64);"">Pain management</span></div> <div><span style=""color: rgb(144, 194, 38);"">B.</span><span style=""color: rgb(64, 64, 64);"">Fever reduction</span></div> <div><span style=""color: rgb(144, 194, 38);"">C.</span><span style=""color: rgb(64, 64, 64);"">Treatment of OA</span></div> <div><span style=""color: rgb(144, 194, 38);"">D.</span><span style=""color: rgb(64, 64, 64);"">Thromboprevention</span></div>""<div><span style=""color: rgb(64, 64, 64);"">ANS: D</span></div><div><span style=""color: rgb(64, 64, 64);""><br></span></div> <div></div> <div><span style=""color: rgb(64, 64, 64);"">“Low-dose” aspirin, such as 81 or 325 mg once daily, is given for thrombo-prevention. Dosages for pain, fever, or arthritis are much higher usually.</span></div>"
"<div><font color=""#404040"">Give indications for the use of aspirin.</font></div>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Headache, neuralgia, myalgia, and arthralgia</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Pain syndromes resulting from inflammation: arthritis, pleurisy, and pericarditis</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Systemic lupus </span><span style=""color: rgb(64, 64, 64);"">erythematosus</span><span style=""color: rgb(64, 64, 64);"">: </span><span style=""color: rgb(64, 64, 64);"">antirheumatic</span><span style=""color: rgb(64, 64, 64);""> effects</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Antipyretic action</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Effective after MI, coronary artery disease</span></div>"
"<div><font color=""#404040"">Name one&nbsp;</font><span style=""color: rgb(64, 64, 64);"">Acute and potentially life-threatening condition caused by aspirin.&nbsp;</span></div>""<span style=""color: rgb(0, 0, 0);"">Reye’s Syndrome</span>"
"<div><font color=""#404040"">What triggers reye's syndrome?</font></div>""<div><span style=""color: rgb(64, 64, 64);"">Triggered by viral illnesses such as influenza as well as by salicylate therapy itself in the presence of a viral illness&nbsp;</span></div>"
"<div><span style=""color: rgb(64, 64, 64);"">A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity?</span></div> <div></div> <div><span style=""color: rgb(144, 194, 38);"">A.</span><span style=""color: rgb(64, 64, 64);"">Bradycardia</span></div> <div><span style=""color: rgb(144, 194, 38);"">B.</span><span style=""color: rgb(64, 64, 64);"">Hypoventilation</span></div> <div><span style=""color: rgb(144, 194, 38);"">C.</span><span style=""color: rgb(64, 64, 64);"">Constipation</span></div> <div><span style=""color: rgb(144, 194, 38);"">D.</span><span style=""color: rgb(64, 64, 64);"">Hyperglycemia</span></div>""<div><span style=""color: rgb(64, 64, 64);"">ANS: D</span></div><div><span style=""color: rgb(64, 64, 64);""><br></span></div> <div></div> <div><span style=""color: rgb(64, 64, 64);"">Manifestations of salicylate toxicity include </span><span style=""color: rgb(64, 64, 64);"">increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating, thirst, hyperventilation, and hypoglycemia or hyperglycemia.</span></div>"
What are the cardiovascular effects of salicylate toxicity?"<span style=""color: rgb(64, 64, 64);"">increased heart rate</span>"
What are the CNS effects of salicylate toxicity?"<span style=""color: rgb(64, 64, 64);"">tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness</span>"
What are the GI effects of salicylate toxicity?"<span style=""color: rgb(64, 64, 64);"">nausea, vomiting, diarrhea</span>"
What are the metabolic effects of salicylate toxicity?"<div><span style=""color: rgb(64, 64, 64);"">sweating, thirst, hyperventilation, hypoglycemia, or hyperglycemia</span></div>"
What are the indications for use of Indomethacin?"<span style=""color: rgb(64, 64, 64);"">RA, OA, acute bursitis or tendonitis, </span><span style=""color: rgb(64, 64, 64);"">ankylosing</span><span style=""color: rgb(64, 64, 64);""> spondylitis, acute gouty arthritis, PDA, and treatment of preterm labor</span>"
What are the properties of Indomethacin?"<div><span style=""color: rgb(64, 64, 64);"">Analgesic, anti-inflammatory, anti-rheumatic, and antipyretic properties</span></div>"
What are the routes of administration of Indomethacin?"<div><span style=""color: rgb(64, 64, 64);"">Oral, rectal, intravenous use&nbsp;</span></div>"
"<span style=""color: rgb(0, 0, 0);"">What are the indications for the use of&nbsp;Ketorolac (Toradol)?</span>""<span style=""color: rgb(64, 64, 64);"">short-term use (up to 5 days) to manage moderate to severe acute pain</span>"
"<span style=""color: rgb(0, 0, 0);"">What are the adverse effects of&nbsp;Ketorolac (Toradol)?</span>""<span style=""color: rgb(0, 0, 0);"">renal impairment, edema, GI pain, dyspepsia, and nausea</span>"
"<span style=""color: rgb(0, 0, 0);"">What is the primary use of&nbsp;Ketorolac (Toradol)?</span>""<div><span style=""color: rgb(0, 0, 0);"">Used primarily for its powerful analgesic effects which are comparable to those of narcotic drugs such as morphine</span></div>"
"<div><span style=""color: rgb(64, 64, 64);"">A hospitalized patient has an order for ketorolac</span><span style=""color: rgb(64, 64, 64);"">. The</span><span style=""color: rgb(64, 64, 64);""> nurse notes that the order is only for 5 days. What is the rationale for this?</span></div> <div></div> <div><span style=""color: rgb(144, 194, 38);"">A.</span><span style=""color: rgb(64, 64, 64);"">The patient’s pain should subside by that time.</span></div> <div><span style=""color: rgb(144, 194, 38);"">B.</span><span style=""color: rgb(64, 64, 64);"">There are concerns about addiction to the drug.</span></div> <div><span style=""color: rgb(144, 194, 38);"">C.</span><span style=""color: rgb(64, 64, 64);"">The drug can cause severe renal and GI effects.</span></div> <div><span style=""color: rgb(144, 194, 38);"">D.</span><span style=""color: rgb(64, 64, 64);"">The drug loses its effectiveness over time.</span></div>""<div><span style=""color: rgb(64, 64, 64);"">ANS: C</span></div><div><span style=""color: rgb(64, 64, 64);""><br></span></div> <div></div> <div><span style=""color: rgb(64, 64, 64);"">The main adverse effects of ketorolac include renal impairment, edema, GI pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and GI tract.</span></div>"
What's the most commonly used NSAID?Ibuprofen
What are the indications for the use of Ibuprofen?"<span style=""color: rgb(0, 0, 0);"">analgesic effects in the management of RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, antipyretic actions</span>"
What are the indications for the use of Celecoxib?"<span style=""color: rgb(0, 0, 0);"">OA, RA, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea</span>"
What are the adverse effects of Celecoxib?"<div><span style=""color: rgb(0, 0, 0);"">headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema, and hypertension</span></div>"
What are the contraindications for using Celecoxib?"<div><span style=""color: rgb(0, 0, 0);"">Celecoxib is not to be used in patients with known sulfa allergy.</span></div>"
"<span style=""color: rgb(0, 0, 0);"">What is the first and only remaining COX-2 inhibitor?</span>""<div><span style=""color: rgb(64, 64, 64);"">Celecoxib</span><span style=""color: rgb(64, 64, 64);""> (Celebrex)</span></div>"
"<span style=""color: rgb(0, 0, 0);"">What is the second most commonly used NSAID?</span>"Naproxen
"<div>Naproxen<span style=""color: rgb(0, 0, 0);"">has a somewhat better adverse effect profile than ibuprofen.&nbsp;Fewer drug interactions with&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">&nbsp;given for hypertension</span></div>""<div>Naproxen<span style=""color: rgb(0, 0, 0);"">has a somewhat better adverse effect profile than ibuprofen.&nbsp;Fewer drug interactions with&nbsp;</span><span class=cloze>ACE inhibitors</span><span style=""color: rgb(0, 0, 0);"">&nbsp;given for hypertension</span></div><br> "
"<div><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">has a somewhat better adverse effect profile than ibuprofen.&nbsp;Fewer drug interactions with&nbsp;</span>ACE inhibitors<span style=""color: rgb(0, 0, 0);"">&nbsp;given for hypertension</span></div>""<div><span class=cloze>Naproxen</span><span style=""color: rgb(0, 0, 0);"">has a somewhat better adverse effect profile than ibuprofen.&nbsp;Fewer drug interactions with&nbsp;</span>ACE inhibitors<span style=""color: rgb(0, 0, 0);"">&nbsp;given for hypertension</span></div><br> "
"<div><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">is better tolerated gastrointestinally than some other NSAIDs.</span></div>""<div><span class=cloze>Nabumetone</span><span style=""color: rgb(0, 0, 0);"">is better tolerated gastrointestinally than some other NSAIDs.</span></div><br> "
What are the indications for the use of enolic acid derivatives?"<div><span style=""color: rgb(0, 0, 0);"">Used to treat mild to moderate OA, RA, and gouty arthritis</span></div>"
"<div><span style=""color: rgb(64, 64, 64);"">An 82-year-old woman is taking ibuprofen (Motrin) </span><span style=""color: rgb(64, 64, 64);"">3200 mg divided three times daily as treatment for arthritis.</span><span style=""color: rgb(64, 64, 64);""> She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy?</span></div> <div></div> <div><span style=""color: rgb(144, 194, 38);"">A.</span><span style=""color: rgb(64, 64, 64);"">Blood sugar</span></div> <div><span style=""color: rgb(144, 194, 38);"">B.</span><span style=""color: rgb(64, 64, 64);"">Liver function studies</span></div> <div><span style=""color: rgb(144, 194, 38);"">C.</span><span style=""color: rgb(64, 64, 64);"">Assessment of hearing</span></div> <div><span style=""color: rgb(144, 194, 38);"">D.</span><span style=""color: rgb(64, 64, 64);"">Renal function studies</span></div>""<div><span style=""color: rgb(64, 64, 64);"">ANS: D</span></div><div><span style=""color: rgb(64, 64, 64);""><br></span></div> <div></div> <div><span style=""color: rgb(64, 64, 64);"">NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and older patients are at greater risk for this adverse drug reaction.</span></div>"
List examples for antigout drugs."<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Allopurinol (</span><span style=""color: rgb(64, 64, 64);"">Zyloprim</span><span style=""color: rgb(64, 64, 64);"">)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Febuxostat</span><span style=""color: rgb(64, 64, 64);""> (</span><span style=""color: rgb(64, 64, 64);"">Uloric</span><span style=""color: rgb(64, 64, 64);"">)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Colchicine (</span><span style=""color: rgb(64, 64, 64);"">Colcrys</span><span style=""color: rgb(64, 64, 64);"">)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Probenecid</span><span style=""color: rgb(64, 64, 64);""> (</span><span style=""color: rgb(64, 64, 64);"">Benemid</span><span style=""color: rgb(64, 64, 64);"">)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Lesinurad</span><span style=""color: rgb(64, 64, 64);""> (</span><span style=""color: rgb(64, 64, 64);"">Zurampic</span><span style=""color: rgb(64, 64, 64);"">)</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Sulfinpyrazone</span><span style=""color: rgb(64, 64, 64);""> (</span><span style=""color: rgb(64, 64, 64);"">Anturane</span><span style=""color: rgb(64, 64, 64);"">)</span></div>"
List indications for the use of allopurinol."<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Used to prevent uric acid production and to prevent acute tumor </span><span style=""color: rgb(64, 64, 64);"">lysis</span><span style=""color: rgb(64, 64, 64);""> syndrome</span></div>"
"Outline the mechanism of action of&nbsp;<span style=""color: rgb(64, 64, 64);"">Probenecid</span>.""<div><span style=""color: rgb(64, 64, 64);"">Inhibits the reabsorption of uric acid in the kidneys and thus increases the excretion of uric acid&nbsp;</span></div>"
"Outline the mechanism of action of&nbsp;<span style=""color: rgb(0, 0, 0);"">Colchicine</span>.""<div><span style=""color: rgb(0, 0, 0);"">Reduces inflammatory response to the deposits of urate crystals in joint tissue&nbsp;</span></div>"
"Give examples for&nbsp;<span style=""color: rgb(0, 0, 0);"">Colchicine</span>.""<div><span style=""color: rgb(0, 0, 0);"">Colcrys, Gloperba, Mitigare</span></div>"
"Give 4 contraindications for&nbsp;<span style=""color: rgb(0, 0, 0);"">Colchicine</span>.""<div><span style=""color: rgb(0, 0, 0);"">known severe renal GI, hepatic or cardiac disorders and blood dyscrasias.</span></div>"
"Give 2 adverse effects of&nbsp;<span style=""color: rgb(0, 0, 0);"">Colchicine</span>.""<div><span style=""color: rgb(64, 64, 64);"">May cause short-term leukopenia and bleeding into the GI or urinary tracts</span></div>"
"Give one indication for&nbsp;<span style=""color: rgb(0, 0, 0);"">Colchicine</span>.""<div><span style=""color: rgb(0, 0, 0);"">Used for short-term management or prevention of gout</span></div>"
"<div><span style=""color: rgb(64, 64, 64);"">Which drug does the nurse associate with the development of </span><span style=""color: rgb(64, 64, 64);"">potentially life-threatening skin adverse effects of </span><span style=""color: rgb(64, 64, 64);"">exfoliative</span><span style=""color: rgb(64, 64, 64);""> dermatitis, Stevens-Johnson syndrome, and toxic epidermal </span><span style=""color: rgb(64, 64, 64);"">necrolysis</span><span style=""color: rgb(64, 64, 64);"">?</span></div> <div><span style=""color: rgb(64, 64, 64);"">&nbsp;</span></div> <div><span style=""color: rgb(144, 194, 38);"">A.</span><span style=""color: rgb(64, 64, 64);"">Probenecid</span><span style=""color: rgb(64, 64, 64);""> </span></div> <div><span style=""color: rgb(144, 194, 38);"">B.</span><span style=""color: rgb(64, 64, 64);"">Colchicine </span></div> <div><span style=""color: rgb(144, 194, 38);"">C.</span><span style=""color: rgb(64, 64, 64);"">Febuxostat</span><span style=""color: rgb(64, 64, 64);""> (</span><span style=""color: rgb(64, 64, 64);"">Uloric</span><span style=""color: rgb(64, 64, 64);"">) </span></div> <div><span style=""color: rgb(144, 194, 38);"">D.</span><span style=""color: rgb(64, 64, 64);"">Allopurinol (</span><span style=""color: rgb(64, 64, 64);"">Zyloprim</span><span style=""color: rgb(64, 64, 64);"">)</span></div>""<div><span style=""color: rgb(64, 64, 64);"">ANS: D</span></div><div><span style=""color: rgb(64, 64, 64);""><br></span></div> <div></div> <div><span style=""color: rgb(64, 64, 64);"">If the patient is taking allopurinol, assess the integrity of the skin because of potentially life-threatening skin adverse effects of </span><span style=""color: rgb(64, 64, 64);"">exfoliative</span><span style=""color: rgb(64, 64, 64);""> dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.</span></div>"
List adverse effects of allopurinol.Exfoliative&nbsp;dermatitis<br>Stevens-Johnson syndrome<br>Toxic epidermal&nbsp;necrolysis
What's the mechanism of action of proebnecid?"<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Inhibits the reabsorption of uric acid in the kidney, increasing the excretion of uric acid</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Uricosuric – drug promotes excretion of uric acid</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Must have good renal function</span></div>"
"<span style=""color: rgb(0, 0, 0);"">What are the adverse effects of&nbsp;Glucosamine and Chondroitin?</span>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">GI discomfort</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Drowsiness, headache, skin reactions (glucosamine)</span></div>"
"<span style=""color: rgb(0, 0, 0);"">What are the drug interactions of&nbsp;Glucosamine and Chondroitin?</span>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Enhances effects of warfarin</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">May increase insulin resistance (glucosamine)</span></div>"
"<span style=""color: rgb(0, 0, 0);"">Name one indication for the use of&nbsp;Glucosamine and Chondroitin.</span>""<div><span style=""color: rgb(64, 64, 64);"">Used to treat the pain of OA&nbsp;</span></div>"
"<span style=""color: rgb(0, 0, 0);"">List two contraindications for NSAIDS that should be assessed for before beginning therapy.</span>""<div><span style=""color: rgb(0, 0, 0);"">-GI lesions or peptic ulcer disease</span></div><span style=""color: rgb(0, 0, 0);""> </span><div><span style=""color: rgb(0, 0, 0);"">-Bleeding disorders</span></div>"
"<div><span style=""color: rgb(64, 64, 64);"">A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen?</span></div> <div></div> <div><span style=""color: rgb(144, 194, 38);"">A.</span><span style=""color: rgb(64, 64, 64);"">Increased bleeding tendencies</span></div> <div><span style=""color: rgb(144, 194, 38);"">B.</span><span style=""color: rgb(64, 64, 64);"">Increased chance for GI bleeding</span></div> <div><span style=""color: rgb(144, 194, 38);"">C.</span><span style=""color: rgb(64, 64, 64);"">Increased nephrotoxic effects</span></div> <div><span style=""color: rgb(144, 194, 38);"">D.</span><span style=""color: rgb(64, 64, 64);"">Reduced </span><span style=""color: rgb(64, 64, 64);"">antiinflammatory</span><span style=""color: rgb(64, 64, 64);""> effects of the NSAID</span></div>""<div><span style=""color: rgb(64, 64, 64);"">ANS</span><span style=""color: rgb(64, 64, 64);"">: B</span></div><div><span style=""color: rgb(64, 64, 64);""><br></span></div> <div></div> <div><span style=""color: rgb(64, 64, 64);"">NSAIDs taken with alcohol may result in increased risk of GI bleeding.</span></div>"
"<div><font color=""#404040"">What advices should be given to patients when giving NSAIDS?</font></div>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks.</span></div><div><div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Educate patients about the various adverse effects of </span><span style=""color: rgb(64, 64, 64);"">NSAIDs</span><span style=""color: rgb(64, 64, 64);""> and inform them to notify their prescribers if these effects become severe or if bleeding or GI pain occurs.</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Inform patients to watch closely for the occurrence of any unusual bleeding, such as in the stool.</span></div> <div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Advise patients that enteric-coated tablets should not be crushed or chewed.</span></div></div>"
"<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Do </span><span style=""color: rgb(64, 64, 64); font-style: italic;"">not</span><span style=""color: rgb(64, 64, 64);""> give&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""color: rgb(64, 64, 64);"">to&nbsp;</span>children and teenagers<span style=""color: rgb(64, 64, 64);"">&nbsp;because of the risk of&nbsp;</span>Reye’s syndrome<span style=""color: rgb(64, 64, 64);"">.</span></div>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Do </span><span style=""color: rgb(64, 64, 64); font-style: italic;"">not</span><span style=""color: rgb(64, 64, 64);""> give&nbsp;</span><span class=cloze>salicylates</span>&nbsp;<span style=""color: rgb(64, 64, 64);"">to&nbsp;</span>children and teenagers<span style=""color: rgb(64, 64, 64);"">&nbsp;because of the risk of&nbsp;</span>Reye’s syndrome<span style=""color: rgb(64, 64, 64);"">.</span></div><br> "
"<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Do </span><span style=""color: rgb(64, 64, 64); font-style: italic;"">not</span><span style=""color: rgb(64, 64, 64);""> give&nbsp;</span>salicylates&nbsp;<span style=""color: rgb(64, 64, 64);"">to&nbsp;</span>children and teenagers<span style=""color: rgb(64, 64, 64);"">&nbsp;because of the risk of&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(64, 64, 64);"">.</span></div>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Do </span><span style=""color: rgb(64, 64, 64); font-style: italic;"">not</span><span style=""color: rgb(64, 64, 64);""> give&nbsp;</span>salicylates&nbsp;<span style=""color: rgb(64, 64, 64);"">to&nbsp;</span>children and teenagers<span style=""color: rgb(64, 64, 64);"">&nbsp;because of the risk of&nbsp;</span><span class=cloze>Reye’s syndrome</span><span style=""color: rgb(64, 64, 64);"">.</span></div><br> "
"<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Do </span><span style=""color: rgb(64, 64, 64); font-style: italic;"">not</span><span style=""color: rgb(64, 64, 64);""> give&nbsp;</span>salicylates&nbsp;<span style=""color: rgb(64, 64, 64);"">to&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(64, 64, 64);"">&nbsp;because of the risk of&nbsp;</span>Reye’s syndrome<span style=""color: rgb(64, 64, 64);"">.</span></div>""<div><span style=""color: rgb(144, 194, 38);"">-</span><span style=""color: rgb(64, 64, 64);"">Do </span><span style=""color: rgb(64, 64, 64); font-style: italic;"">not</span><span style=""color: rgb(64, 64, 64);""> give&nbsp;</span>salicylates&nbsp;<span style=""color: rgb(64, 64, 64);"">to&nbsp;</span><span class=cloze>children and teenagers</span><span style=""color: rgb(64, 64, 64);"">&nbsp;because of the risk of&nbsp;</span>Reye’s syndrome<span style=""color: rgb(64, 64, 64);"">.</span></div><br> "
"<div><span style=""color: rgb(0, 0, 0);"">NSAIDS generally cause GI distress, so they are often better tolerated if taken with&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">,&nbsp;</span><span class=cloze>[...]</span><span style=""color: rgb(0, 0, 0);"">, or an&nbsp;</span>antacid&nbsp;<span style=""color: rgb(0, 0, 0);"">to avoid irritation.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">NSAIDS generally cause GI distress, so they are often better tolerated if taken with&nbsp;</span><span class=cloze>food</span><span style=""color: rgb(0, 0, 0);"">,&nbsp;</span><span class=cloze>milk</span><span style=""color: rgb(0, 0, 0);"">, or an&nbsp;</span>antacid&nbsp;<span style=""color: rgb(0, 0, 0);"">to avoid irritation.</span></div><br> "
"<div><span style=""color: rgb(0, 0, 0);"">NSAIDS generally cause GI distress, so they are often better tolerated if taken with&nbsp;</span>food<span style=""color: rgb(0, 0, 0);"">,&nbsp;</span>milk<span style=""color: rgb(0, 0, 0);"">, or an&nbsp;</span><span class=cloze>[...]</span>&nbsp;<span style=""color: rgb(0, 0, 0);"">to avoid irritation.</span></div>""<div><span style=""color: rgb(0, 0, 0);"">NSAIDS generally cause GI distress, so they are often better tolerated if taken with&nbsp;</span>food<span style=""color: rgb(0, 0, 0);"">,&nbsp;</span>milk<span style=""color: rgb(0, 0, 0);"">, or an&nbsp;</span><span class=cloze>antacid</span>&nbsp;<span style=""color: rgb(0, 0, 0);"">to avoid irritation.</span></div><br> "
List the CNS adverse effects of corticosteroids.<div>convulsions, headache, vertigo, mood swings, nervousness, insomnia</div>
List the endocrine adverse effects of corticosteroids."<div>Endocrine: growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance,&nbsp;<span style=""background-color: yellow; font-weight: bold;"">hyperglycemia</span><span style=""background-color: yellow;"">,</span>&nbsp;hypothalamic–pituitary–adrenal axis suppression</div>"
List the intergumentary adverse effects of corticosteroids."<div>GI:&nbsp;<span style=""background-color: yellow; font-weight: bold;"">peptic ulcers</span>, pancreatitis, ulcerative esophagitis, abdominal distension<br></div><div><br></div>"
List the intergumentary adverse effects of corticosteroids."<div>fragile skin, petechiae, ecchymosis, facial erythema,&nbsp;<span style=""background-color: yellow; font-weight: bold;"">poor wound healing</span>, hirsutism, urticaria</div>"
List the musculoskeletal adverse effects of corticosteroids.<div>Musculoskeletal: muscle weakness, loss of muscle mass, osteoporosis</div>
List the ocular adverse effects of corticosteroids.<div>increased intraocular pressure, glaucoma, cataracts</div>