Mechanisms of Action and Side Effects of Common Medications for Diabetes and Hypertension, Exams of Nursing

Download Mechanisms of Action and Side Effects of Common Medications for Diabetes and Hypertension and more Exams Nursing in PDF only on Docsity! Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING Differentiate between low dose and high dose colchicine. - correct answers low dose is just as efficacious and much less likely to cause adverse effects as high dose is. N/V, diarrhea can occur at either dose. Might have to adjust dosage if there is any renal or hepatic dysfunction What lab values should be monitored with gout? - correct answers Monitor for how they are responding to the therapy, serum uric acid levels, LFTs, RFP, platelet dysfunction, anemia - CBC, acid base overall What patient education should you provide when prescribing colchicine? - correct answers they should take it as you prescribe it and take any missed dose as soon as they remember. If they have any serious adverse effects they should call provider. May help to take with food or milk to decrease GI effects. Never just stop drug without the advice of provider. They should report any muscle pain, weakness, or neuropathic symptoms. Describe an alkaline diet and to drink plenty of fluids, avoid alcohol. If any hypersensitivity reaction occurs they should notify provider. What are the adverse effects of corticosteroids if administered for six months or more? - correct answers multiple body systems that can be effected. topical steriods (hydrocortisone is more weak) the more potentcy you add, you run the risk of systemic absorption, possible thinning of skin (irreversible). Hair loss, acne on face, poor healing due to immune suppression, could activate TB, Striae, skin can fall off, muscle pain/weakness, muscle wasting, truncal obesity, osteoporosis (bone density loss), cataracts, glaucoma, optic nerve damage, GI - peptic ulcer disease, can prophylaxis with PPI, CV - cause HTN, electrolyte distubances, CNS - delirium and agitation, avoid before bedtime due to insomnia, depression, endocrine - adrenal suppression, glucose can be all over the place (usually hyperglycemia). Will need to taper if they have been on it a while. If treating asthma exacerbation - if they are on it 3 weeks or less and they are back to baseline and on a controller med, then you can suddenly stop it and not taper. Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING Why is it important to taper the corticosteroid? - correct answers the adrenal gland has been suppressed so it must be tapered in order to reactivate it and it can start producing it's normal hormones again. What are the black box warnings on NSAIDS? - correct answers avoid long term use due to their adverse effects. the more you use them, the longer you use them it will increase adverse effects. best used intermittently, increased risk for CV events like heart attack, GI effects like perforating ulcer, in older individuals they may not even manifest any symptoms first. What are the recommendations in the treatment of pain? - correct answers try to avoid opioids and opiates if possible, use an NSAID if there aren't any contraindications, acetaminophen there is increased risk of liver injury and kidney toxicity, it is an analgesic but not an anti-inflammatory. Think about comorbidities first. Only use as much as needed, avoid long term use. What is the mechanism of action of ibuprofen? - correct answers NSAIDS inhibit COX, celebrex is an example. What are the serious side effects associated with acetaminophen? - correct answers accidental and intentional overdose can occur and it is an emergency, necrosis of liver with doses of 10-15grams and death usually occurs at over 25 grams, N/V, obtunded presentation (can't express themselves clearly, sleepy), liver tenderness, renal failure, symptoms can persist for a while, anemia, neutropenia, & pancytopenia Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis - correct answers hypoglycemia - brain can't function well without glucose, this will activate SNS - sweating, palpitations, tremors, anxiety, hunger, confusion, trouble concentrating, hallucinations, focal deficits - weakness, tingling, coma then death if not treated (if someone is on a nonselective beta-blocker, the only SNS symptom in hypoglycemia is sweating). Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING What is the mechanism of action of the meglitinides? - correct answers they bind to receptors on pancreatic beta cells and when that happens it causes closing of the ATP dependent potassium channels, when they close the beta cell will depolarize which causes the beta cell calcium channels to open so calcium will enter the beta cells which causes more insulin to be secreted. onset of action is quick and duration of action is short, should be taken with meals. What is the mechanism of action of propylthiouracil? - correct answers inhibit thyroid hormone from being made at the thyroid and it prevents T4 from being transformed to T3 in the peripheral tissues. it Interferes with the enzyme thyroid peroxidase and because of this, the iodide is unable to be oxidized and the iototyrosines cannot be formed and they will not have any coupling reactions and therefore T3 and T4 cannot be formed at the thyroid gland. If there has already been T3 and T4 made, stored in the thyroid, or circulating in the bloodstream it will not be affected by PTU. If you're giving exogenous levothyroxine it will not be affected by PTU. What are the contraindications to therapy with alpha-glucosidase inhibitors? - correct answers they are contraindicated in disorders of the intestines (IBD, UC, intestinal obstruction or risk factors for it, digestion disorder, increased gas formation), If anyone has had a hypersensitivity reaction, DKA, or cirrhosis What patient education is important relative to the administration of levothyroxine? - correct answers most important is that they should take it in the morning on an empty stomach, take missed dose as soon as remembered, if missed multiple doses (3 or more) then notify prescriber, don't change brands even if receiving generic form. Caution against possible side effects - signs and symptoms of hyper and hypothyroidism. What black box warning has the FDA issued regarding the administration of TZDs? - correct answers thiazolidinediones - possibility of fluid retention and then peripheral edema or heart failure. If insulin is being administered Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING with a TZD then this risk is increased. TZDs bind to and activate PPARgamma so the reason for the edema when TZD stimulate the PPARgamma in the nephron then they are going to stimulate sodium reabsorption in the sodium channels and therefore your fluid volume will increase. What symptoms may indicate that a patient is taking too much thyroid replacement hormone? - correct answers atrial fib, atrial flutter, tachycardia, angina pectoris, acute coronary syndromes, myocardial infarction especially in older adults What is the mechanism of action of metformin? - correct answers first line therapy is metformin for most type 2 DM unless there is a contraindication. Start low and increase slow to avoid adverse side effects. it acts by inhibiting production of the glucose by the liver. It also helps tissues be less insulin resistant, it lowers serum free fatty acids and when it dose this it makes gluconeogensis less likely to happen and promotes weight loss. What lab values will be used to monitor a patient on levothyroxine? - correct answers Check TSH, maybe free T4, Hypothyroidism - If TSH is elevated then you need to give higher dose of levothyroxine, if TSH below normal then levothyroxine needs to be lowered What is the mechanism of action and side effects of selective sodium glucose co-transporter 2 inhibitors? - correct answers SGLT-2 are in the proximal tubule of kidneys and their function is to reabsorb glucose that comes in contact with them, they typically reabsorb 90% of the glucose that comes to them. If you are inhibiting SGLT-2 then more glucose will be excreted in the urine instead of going into the blood so it will lower blood glucose levels. They can only filter what glucose arrives at that proximal tubule. These drugs typically don't cause hypoglycemia unless combined with other drugs that can cause hypoglycemia. As more glucose is going out, it can help lower BP and assist with weight loss. Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING What is the onset of action, peak of action, and duration of action of each insulin preparation? - correct answers Rapid Acting - onset = 30 min, peak = 1-3 hours, duration = 3-5 hours Short Acting - onset = 30-60 min, peak = 2-4 hours, duration = 3-7 hours Intermediate Acting - onset = 1-2 hours, peak = 4-12 hours, duration = 10- 16 hours Long Acting - onset = 2-6 hours, peak = 3-12 hours, duration = 24 hours Human Insulin - correct answers NPH & regular insulin - NPH is more intermediate in duration of action and regular has a shorter duration of action. Insulin analogs - correct answers going to mimic the endogenous insulin and is closer to the normal insulin in our bodies. They can be preferred, but sometimes insurances do not cover them and cost can be an issue. If taking premeal insulins they don't hang around as long and they act faster. The other insulin analogs have a longer and flatter profile meaning they are longer acting and some don't have peaks - they are less likely to drop the BG too low. Insulin glargine - acts for about 24 hours, no peaks, less likely to drop BG, cannot mix with rapid-acting insulins insulin detemir - does have a peak and is usually not 24 hours in action, if dosing a type 1 DM you usually have to dose twice per day. cannot mix with rapid-acting insulins Insulin degludec - long duration of action, more than 40 hours and will cut down on any variability in the drugs plasma concentration, give once per day, this is the only one you CAN mix with rapid-acting insulins Information about DM - correct answers type 1 DM will always need insulin unless they receive pancreas transplant, type 2 DM beta cell function decreases over time so they will need insulin therapy at some point. Might encounter insulin resistance in your patients. Cost can effect therapy. When receiving insulin patients are less likely to have side effects of DM since they Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING What are the adverse effects of dihydropyridine-type calcium channel blockers? - correct answers because of the peripheral arterial vasodilation they may have headaches, feel lightheaded, be flushed, can cause reflex tachycardia, peripheral edema, hypotension, syncopy, orthostatic changes, gingival hyperplasia, caution in use with hepatic impairment, avoid in pregnancy and lactation as well as unstable angina patients. non-dihydropyridine side effects - constipation, bradycardia, decreased cardiac output, avoid in left ventricular dysfunction, gingival hyperplasia What are the mechanisms of action and adverse effects of statins? - correct answers reductase inhibitors, inhibit liver enzyme, hmg coa reductase, because of this cholesterol is not made which causes more LDL receptors and they combine the LDL so that circulating LDL is reduced. adverse effects - use cautiously, muscle issues like myopathy, myositis, rhabdomyolysis, GI symptoms - N/V, constipation, diarrhea, upset stomach, sleep disturbances, implicated in increasing liver enzymes (check on initiation and if there is any clinical indication for it). behavioral and cognitive changes are also possible, risk of developing DM What patient education will you provide for a client for which you have prescribed a statin? - correct answers lifestyle modification, glycemic control in diabetics, exercise and lean body weight, eliminate saturated and transfat foods, increase viscous fiber, modify CV disease risk factors (stop smoking), control HTN, risk for CV disease, know how and when to take medication, lovostatin must be taken at the same time every day. adverse effects and what to report (muscle aches), when labs will be checked again and what the goal is, follow hemoglobin A1C and LFTs What are the mechanisms of action and adverse effects of the cholesterol absorption inhibitor? - correct answers ezetimibe - it stops any of the cholesterol that you take in by mouth it will stop the absorption and Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING therefore more cholesterol is taken out by the gut, try to keep statin dose lower and then add ezetimibe if LDL is not at goal adverse effects - GI upset, diarrhea, liver enzymes elevated, joint aches, fatigue What are the mechanisms of action and adverse effects of the fibric acid derivatives? - correct answers gemfibrozil & fenofibrate, they cause increased glycolysis of triglycerides by using lipoprotein lipase - results are that triglycerides will be decreased and decrease risk of pancreatitis, decreased vLDL because less is secreted by the liver, in initial therapy they may actually increase LDL levels, they cause some increase in HDL because of the decreased triglycerides adverse affects - GI upset, pain, diarrhea, gallstones (if found, then DC med) may also increase hematocrit and WBCs but usually goes away with long term use What are the mechanisms of action and adverse effects of the bile acid sequestrants? - correct answers Cholestyramine and Colestipol; take chloride ions and exchange them for bile acids that are negatively charged to make more of these bile acids go out in the gut. so more of the cholesterol to bile acids will be done in the liver, more LDL is taken up by LDL receptors especially at the liver, LDL levels will be lower, slight increase in HDL levels, no real effect on triglycerides adverse effects - GI, constipation is prominent, gassy, N/V, abdominal pain, headache, folate levels reduced - supplement with folic acid, avoid in PKU Beta blockers (BBs) are generally contraindicated in which patient? - correct answers The patient who has unstable asthma; BBs are generally contraindicated for patients with unstable bronchospastic disorders such as asthma Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING Which drug inhibits the enzyme that converts T4 to T3, has iodine as a major component, and has a risk for patients with underlying predisposition to thyroid disease to develop thyrotoxicosis or hypothyroidism? - correct answers Amiodarone; Amiodarone inhibits the enzyme that converts T4 to T3, and iodine is a major component of this drug. Therefore, about 5% of patients with an underlying predisposition to thyroid disease may develop thyrotoxicosis or hypothyroidism. If this drug must be used to treat the rhythm disturbance, careful monitoring and treatment of the thyroid disorder must be undertaken. A frail, 78-year-old female patient with a history of type 2 diabetes mellitus (DM), obesity, chronic obstructive pulmonary disease, and coronary artery disease is returning for a follow-up evaluation. She has a previous history of hypoglycemia. Her current medication regimen includes maximum dose of a biguanide and a dipeptidyl peptidase-4 (DPP-4) inhibitor. Her HbA1c is 7.8%. Which action is most appropriate for the APN to take? - correct answers Prescribe no additional medication. According to the American Diabetic Association (ADA) guidelines, a less stringent A1c goal of less than 8% may be appropriate for a patient with extensive comorbid conditions. A 32-year-old patient with ulcerative colitis and type 2 diabetes mellitus (DM) should avoid which medication? - correct answers Alpha-glucosidase inhibitor; Alpha-glucosidase inhibitors should not be used for patients with bowel disease, such as inflammatory bowel disease, or for patients at risk for bowel obstruction, colonic ulceration, chronic intestinal disease associated with marked digestive disorders, or conditions that may deteriorate as a result of increased gas in the intestine. Alpha-glucosidase inhibitors function by which primary mechanism of action? - correct answers Delaying the absorption of complex carbohydrates (CHO); Alpha-glucosidase inhibitors delay the absorption of complex CHO from the small bowel. Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING The purpose of an antithyroid agent is to have which action? - correct answers Inhibiting the synthesis of thyroid hormone; A patient with type 2 diabetes mellitus and a history of cardiomyopathy has an ejection fraction (EF)% of 35%. The patient is currently taking metformin and canagliflozin (Invokana). Which laboratory finding would indicate immediate treatment? - correct answers Positive nitrates on dipstick; Positive nitrates on dipstick are an indication of urinary tract infection (UTI). A UTI will require immediate treatment. A patient presents today for initiation of medication for his hypertension. He has a history of gout and takes antigout medication. Which medication can cause hyperuricemia in this patient? - correct answers Thiazide diuretics; For patients with a history of gout or renal calculi, cautious use of diuretics is suggested because of the potential for hyperuricemia. High levels of uric acid may occur with all diuretics. Thiazide and loop diuretics and spironolactone are the most likely to cause it, and indapamide (Lozol) is the least likely. The APN prescribed exenatide for a 56-year-old female patient with a history of type 2 diabetes mellitus (DM) on her last visit. The APN should be concerned if the patient reports which symptom? - correct answers Abdominal pain and nausea; Persistent, severe abdominal pain that may be accompanied by vomiting are hallmark symptoms of pancreatitis and would be a cause for concern. Testing of which levels best monitors the effectiveness of thyroid replacement? - correct answers Thyroid-stimulating hormone (TSH); Thyroid function in hypothyroidism is monitored with TSH and free T4 What classes of medications are used in the treatment of heart failure with reduced ejection fraction? - correct answers pg 1102, be sure to provide therapy for any other diseases that might contribute. HFrEF initial therapy should include diuretic specifically a loop diuretic like furosemide, torsemide, Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING or bumetanide. this is too address the volume overload, you also want a renin angiotensin aldosterone system blocker (RAAS blocker) which includes ARNIs, ACE inhibitors, or angiotensin receptor blocker to address the RAAS activation and halt the cardiac remodeling that occurs during heart failure. the neprilysin inhibition with the ARNIs - neprilysin inhibitor plus an ARB. the Neprilysin inhibition will provide more of the natrietic peptides that act against the neurohormonal activation that happens. Beta blocker carvedilol, metroprolol to address teh RAAS activation and SNS activation, they help orevent arryhtmias and act against cardiac remodeling that occurs. For first line therapy - if someone is not able to tolerate one of the RAAS blockers then you can give hydralazine plus nitrate - decrease afterload and preload and increase nitric oxide to help vasodilate. Second line therapy may include mineralocorticoid receptor antagonist to reduce preload, diuresis, lower BP, decrease afterload, and hang on to the potassium so potassium excretion is decreased, inhibit the effects of aldosterone on the myocardium so there is decreased remodeling of the heart like hypertrophy and increased fibrosis. Another drug you may use is digoxin - works on inhibiting the sodium-potassium ATP pump so less sodium moves from inside the myocytes to the extracellular space this then produces less sodium-calcium exchange and results in more intracellular calcium which then helps improve myocardial contractility and improve left ventricular function but if it becomes toxic it could promote arrhythmias, It also decreases the SNS activation and increases the par Discuss the overactive neurohormonal signaling that characterizes the pathophysiology in heart failure. - correct answers ph 1102, figure 38.1, HFrEF - the heart is not able to adequately provide blood flow or oxygen and other nutrients to the tissues because of the left ventricular dysfunction so this results in a series of events that should be corrected by the body, but instead, they become maladaptive and eventually they will overall worsen the heart's function. Both the RAAS and the SNS are activated and in addition, natriuretic peptides are increased in production which is a good thing, with the RAAS activation, more angiotensin 2 is produced as well as aldosterone, the increased angiotensin 2 means more vasoconstriction and less natriuresis and diuresis. so the heart is working with higher afterload and preload. The increased aldosterone means fluid overload occurs and Pharm Exam 3 71QUESTIONS AND ANSWERS BRAND NEW LATEST 2024/2025 GRADED A+ BEST EXAM FOR NURSING preload increases. RAAS activation causes SNS activation - causes norepi to be released and adrenergic nerves not to uptake the norepi. it also causes cardiac remodeling. SNS activation causes faster HR, eventually, the heart cannot sustain this overstimulation and the left ventricular dysfunction becomes worse. B-type natriuretic peptide causes more vasodilation which can counteract some effects. What is the mechanism of action of the angiotensin receptor neprilysin inhibitor medication? - correct answers pg 272, Valsartan is an angiotensin receptor blocker, it blocks the RAAS it blocks the binding of angiotensin 2 to its receptors and there's going to be less vasoconstriction, more natriuresis and diuresis, sodium and water are going out to the kidneys, these actions decrease afterload and preload, less cardiac remodeling will occur and there is going to be decreased sympathetic tone. Now we add to that the neprilysin inhibitor Sacubitril - neprilysin normally breaks down the natriuretic peptides so if you're inhibiting that you're going to have more natriuretic peptides which we want, so there will be more natriuretic peptides circulating which causes vasodilation, diuresis, natriuresis, less cardiac remodeling, and fibrosis changes. there is also less breakdown of bradykinin, so one of the reasons you can't combine these drugs with an ACE inhibitor is because they both cause more circulating bradykinin and you can increase the risk for angioedema. Neprilysin inhibitor must be used with eh angiotensins receptor blocker because angiotensin 2 is also not broken down as much by the neprilysin and then the AT2 would increase, so the ARB is needed to block the angiotensin 2. What patient teaching will you provide when prescribing amiodarone? - correct answers one of the adverse effects is either hyper or hypothyroidism. Hypothyroidism is the more common one that might occur, so patients should understand why they need periodic thyroid function tests. So get one at baseline and then every 6 months. If they experience any signs or symptoms then you would test earlier. They should understand the signs and symptoms of both conditions. Check HR, tachycardia if you're hyperthyroidism sweating, diarrhea. why they are taking this med - what their underlying disease is, how long to take it, to take it on a regular basis, don't miss doses, with or without food, not a very well tolerated drug. corneal