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The glomerular filtrations rate (GFR) is considered the best measure of renal function. What lab value is used to estimate GFR?
People with chronic kidney disease have impaired immune function related to infection due to high levels of urea and metabolic wastes in the blood. Which of the following functions of the immune system are impaired in renal patients?
Failure to develop a fever when infection occurs
Urinary incontinence can be helped by a bladder training program. When using this method with an elderly person, how often should the client be voiding?
What is NOT a function of growth hormone?
Acromegaly is excessive growth hormone in an adult. Which of the following best describes physical features of acromegaly?
Lab tests indicate thyroid autoantibodies. What is the suspected diagnosis?
An elderly woman has sudden onset of confusion. She is intolerant of cold and is lethargic. Physical assessment reveals husky voice, puffy eyes and enlarged tongue. What diagnosis is most likely?
Glucose that is not needed for energy is removed from the blood, converted to fat or stored as
What inhibits the release of insulin and glucagon?
A client has developed a cycle of insulin-induced post hypoglycemic episodes. This is called
Class: glycopeptide- cell wall syn inhibitor
MOA: inhibits peptidoclyan cross linking/elongation; inhibits step in which disaccharide precursor is added to growing chain
ind: staphylococcal or enterococcal endocarditis, etc caused by MRSA; occasionally in the tx of C. diff-given orally
contra: allergy to vancomycin
Adverse: Red Man Syndrome, ototoxicity, nephrotoxicity
*Taken parenterally, excreted renally
measure of the amount of drug (dose) needed to produce a given degree of effect.
decreased metabolism = higher levels = increased effects, adverse effects, & toxicity.
fraction of the drug available in the blood stream after administration as compared to IV route.
body composition of infants has a larger % water & lesser % muscle mass than adults, obesity, malnourishment, significant changes in body weight or composition, permeability of blood brain barriers.
IV-100 (most rapid onset)
Oral, rectal, and inhaled vary
Definition-fraction of drug administered reaching the SYSTEMIC circulation
Significance: dosage of drugs with a high hepatic extraction
Distinguish between a serum concentration graph for oral and an IV dose
Discuss the general mechanisms of drug interaction and strategies to avoid them.
1. Chemical Name- actual chemicals in drug
2. Generic Name- patented name, in lower case
3. Trade/Brand name- every manufacturer has different brand names
Acts on alpha 1 & 2, beta 1 & 2
Alpha 1 delays absorption of local anesthetics
Alpha and Beta-Good for treatment of anaphylactic shock prevents cardiovascular collapse also
prevent breakdown of ACh and thereby increase the availability of ACh at cholingeric synapses
result = enhanced transmission by central cholinergic neurons that have not been destroyed
may slow progress of AD by a few months (does NOT cure and does NOT stop progression)
Discuss the efficacy expectations of the medications used to treat Alzheimer’s dementia.
α 1- vasculature of skin mucus membranes eye, vasoconstriction dilation of eye
α 2 – presynaptic neurons, stops norepirelease
β 1 – Heart, positive inotrope
β 2 – lungs bronchodilation, liver increaseglucose, vasculature of organs vasiodilation, uterus relax contractions
List the primary tissue locations for each adrenergic receptor.
- end in "sartan"
- Do not cause irritating cough.
- blocks the release of aldosterone. Causes vasodilation and decrease peripheral resistance.
examples = losartan potassium (Cozar)
Binds to renin and prevents the conversion of angiotensinogen to angiotensin I.
Aliskiren- avoid with high fat meals (decreases absorption)
Side effects- similar to ARBs. Most common: diarrhea
associated with dangerous ping ponging BP
-not reccomended for PRN use
Selective- blocks B1 receptors, safer in pt with asthma, COPD, diabetes
Non-Selective- Blocks B1 and B2, increases B2 side effects, prolonged hypoglycemia in diabetics
· Chronic hypertension
· Chew & swallow oral tablets for hypertensive urgencies.
· Congestive heart failure: Slows the progression of CHF & improves the patient’s quality of life.
· Diabetes: Slows the progression of renal failure in diabetics, even without HTN.
List which class of diuretics is the most powerful at removing fluid & discuss why
Loop Diuretics- Act in the ascending limb of the loop of Henle. Loop of Henle is responsible for 25 – 30 % of all Na+ reabsorption. This is why loop diuretics are the most powerful diuretics.
Aspirin (acetylsalicylic acid)
MOA: Irreversibly inhibits the enzyme, cyclooxygenase;
effect lasts life of the platelets (7-10 days)
Adverse effects: upset stomach, GI discomfort, GI ulcers, excessive bleeding DI: Ibuprofen may block the antiplatelet benefits of aspir
MOA: Inhibits the binding of platelets to each other by interfering w/ ADP; blocks ADP receptors
3-7 day lag time for onset of action
adverse effects: GI disturbance, diarrhea, abdominal pain, dizziness, headache, excessive bleeding
Extended release Dipyridamole 200mg + Aspirin (Aggrenox)
MOA: dipyridamole inhibits phosphodiesterase, which leads to accumulation of cAMP & cGMP
More expensive than aspirin = $250 per month
Adverse effects: those from aspirin and N/V, diarrhea, dizziness, & excessive bleeding
Primary prevention: patients who haven't experienced clots (Aspirin 75-162mg)
Secondary prevention: patients who have experienced clots; MI, angina, stent placement, etc. (drug choice depends on type of clot)
Acute coronary Syndrome (chew and swallow
List of anticoagulants: inhibits part of the coagulation cascade
*Heparin (unfractionated heparin)
*Low Molecular Weight Heparins (LMWH)
MOA: binds to antithrombin III & inhibits fibrin formation; quick onset of action but short durationAntidote: protamine 1mg reverses ~ 100units
Uses: acute stroke, acute MI, DVT, PE; prevent DVT & PE following surgery, central line IV flush, prevent
Low-molecular-weight heparins (LMWH)
Composed of shorter molecules than Heparin; Duration of action is two to four times longer than heparin; produce more stable responses.
SE: similar to heparin but less likely to cause thrombocytopenia
does not require monitoring; pt can go home
warfarin (Coumadin) "Oral anticoagulant"
Action: coagulation suppression by antagonist of Vit. K Use: long-term prophylaxis of thrombosis VENOUS; PE; Prosthetic heart valves; recurrent TIA's Effect: decrease in thrombosis formation
AE: hemorrhage; teratogenesis category X
D/D: drugs tha
More about Warfarin (Coumadin)
Delayed onset of action (3-5 days because Warfarin inhibits synthesis of new clotting factors only)
Narrow therapeutic window, PT/INR monitoring critical!
Measures how anticoagulant the patient is
Normal INR = 1.0
Warfarin Patient education is essential!
*Explain PT/INR importance
* Suggest wearing medical alert bracelet
* Know signs and symptoms of bleeding and of clots
* all health care providers need to know you are on warfarin
* always check refills for correct color tablet
*Do not skip doses and
Dabigatran (Pradaxa) - anticoagulant
MOA: direct thrombin inhibitor - binds to thrombin preventing conversion of fibrinogen to fibrin
Use: prevention of stroke in Atrial Fib
SE: minor bleeding, major bleeding, GI disturbances: abdominal pain, bloating, N/V, GERD (take with food)
direct Xa inhibitor indications: prevention of DVT and PE following total hip or knee replacement & prevention of stroke in patients w/ atrial fibrillation use w/ caution in those w/ hepatic or renal impairment & do not use during pregnancy
Antidote for Warfarin?
Foods high in vitamin K include leafy green veggies, cabbage, spinach, broccoli, etc
Warfarin users: do not use Aspirin or other NSAIDs
Educate pt to check cough and cold over the counter meds bc many contain aspirin or NSAIDs. Rarely, pt on warfarin may be prescribed low dose Aspirin too.
International Normalized Ratio - INR
how anticoagulant effect is monitored in Warfarin pts. Prothrombin time (PT) measure the amount of time in seconds required to produce clot. Normal INR 1.0, therapeutic INR 2.0-3.0, elevated INR associated with increased risk of bleeding
Activated partial thromboplastin time (APTT) - Heparin monitoring
Monitoring every 4-6 hours
Measures the length of time it takes a clot to form.
Normal= 30-40 seconds (no heparin)
therapeutic= 1.5-2 times normal time
what ending do calcium blockers have?
calcium channel blockers inhibit what?
entrance of calcium into smooth muscle cells of coronary and arterial vessels
calcium channel blockers are vascular what?
therapeutic uses for calcium channel blockers
treats chronic hypertension and angina
adverse affects of ccb's
flushing, edema, headache, constipation
def of diuretics
drugs inducing state of increased urine production by the kidneys
primary functions of kidneys (3)
cleans blood, maintains acid base balance, maintain fluid balance
what do diuretics block?
tubular reabsorption of sodium at different sites within the nephron
what do loop diuretics do?
act in ascending loop of henle
onset or action for loop diuretics?
30 minutes after oral dose, 5 after iv
therapeutic use of loop diuretics
treats edema, treats HT
adverse effects of loop diuretics
hypotension, dehydration, hypokalemia
how do you enhance loop diuretics?
use a thiazide as well
mechanism of action for thiazide diuretics
enter the nephron via the organic acid pathway
therapeutic uses of thiazide diuretics
treatment of hypertension, edema
adverse effects of thiazide diuretics
mechanism of action for potassium sparing diuretics
compete with aldosterone at renal receptor sites
what do PSD cause?
sodium elimination and potassium reabsorption
therapeutic use of psd?
retains K, prevent hypokalemia
adverse effects of psd?
Acute coronary syndrome, MI and angina
platelets clumping together
formation of unwanted clot
deep vein thrombosis, clots in the legs
pulmonary embolism, clot in lungs
A : THE SAFEST CATEGORY
no risk in later trimester nor first
B : no risk shown on animals, no studies on human
C : on animals- showed adverse effects but NOT in humans
D : +risk (potential benefits may earrant use of the drug in pregnant women)
X : fetal abnormalities in both animas and humans; no benefits NO NO NO
Increased Peripheral Resistance
Classification of BP in Adults
-Normal: SBP < 120, DBP< 80
-Pre-HTN: SBP 120-139, DBP 80-89
-Stage 1 HTN: SBP 140-159, DBP 90-99
-Stage 2 HTN: SBP >/= 160, DBP >/= 100
Therapeutic Uses: HTN, urinary retention associated with BPH, and Raynaud's disease
Adverse Effects: orthostatic hypotension and dizziness
- Act in ascending loop of henle to block Na resorption (responsible for ~20% of all Na re absorption)
Tachycardia, palpitations, sweating, anxiety, tremor, nervousness, headache, confusion, drowsiness and fatigue. Severe – Seizures, coma, and death.
Treatment – BG > 60 = milk, crackers cheese. BG 20-60 non diet soda, honey, juice, candy
Advantages – lower rates of complications, reduces overall healthcare.Disadvantages – More injections, increased risk of hypoglycemic episodes, compliance is harder and increase cost of meds
Delay absorption of carbs from small intestine
Taken with 1st bite of each meal
Most effective at lowering postprandial glucose
SE: flatulence, abd discomfort, diarrhea
Treat hypoglycemia with glucose tablet, glucose gel or low fat milk
sulfonylureas, Biguanides, meglitinides, alpha-glucosidase inhibitors, Gliptins, Amylin mimetics, Incretin mimetics, Thiazolidinediones
Lispro Insulin (Humalog) – Fast/Short
Aspart insulin (Novolog) – Fast/Short
Glulisine insulin – Fast/Short
Regular insulin– Fast/Short
NPH insulin– intermediate
Insulin detemir– Long/ Slow
Glargine insulin– Long/Slow
Biguanides (metformin) – contraindicated in patients with poor renal function. Avoid >85 years old due to impaired renal function. Avoid in clinical situations.
-Frequent association w/GI superinfection (Clostridium difficile--> pseudomembranous colitis)
-Used to treat anaerobic infections
Suprainfection caued by antiboides because it alters the normal GI flora
Symptoms diarrhea, watry stools with blood and mucus, fever, abdominal pain
C. Diff is contagious!!
Treatment: stop antibiotic start metronialzole or oral vancomycin.