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ATI Pharmacology Review-Good One!! Questions and answers 100% correct
Cephalosporin -broad spectrum -ceph/cefs -Similar to PCN/ don't give if PCN allergy -can cause bleeding w/ other bleeding meds monitor bleeding time (t... [Show More] onsil story) - Disulfiram reaction (puke & puke & puke) just like Flagyl, the protozoal drug - Store in fridge & take with food ALL antibiotics have these side effects - allergy, hypersensitivity - suprainfection - organ (kidney & ear) toxicity - lowers OC effectiveness Vancomyocin - serious infections like MRSA - colitis by c-diff - ototoxicity: get hearing test, tell dr. if hearing getting worse -given over 60 minutes Tetracyclines - Sumycin, Doxycycline (Vibramycin) - broad, rocky mtn fever, lyme disease, acne, GI infections by H. Pylori - bad GI discomfort - Don't give to kids ≤8; teeth permanently yellow - Bad photosensitivity- wear sunscreen! - Can't take with milk, iron, or antacids - Take on empty stomach with a full glass of water When is Arythromycin given? What class of drugs is it? worse adverse effect? When pt allergic to PCN and needs abx. Bacteriostatic inhibitor bad GI issues Aminoglycosides ototoxicity, Renal toxicity, Can't take with PCN at all! - gentamicin, neomycin, streptomycin TMP-SMZ -Contains Sulfa - use for UTI - Blood problems; get CBC baseline -photosensitivity wear sunscreen and glasses! - empty stomach with a full glass of water Isoniazid (INH) -antiTB - take daily for 6-12 months and most likely with other meds too -worked if 3 neg. sputum cultures, no temp. - Liver toxicity (hepato) check liver fxn - Don't take with alcohol (liver fxn remember?) - Take on empty stomach Antiviral: Acyclovir, Ganciclovir Teratogenic preg. X; put on rubber gloves if topical! remember my purple glove experience -thrombocytopenia, lowers WBC What class of drugs if Flagyl? What is the weird effect it has? protozoal. works on C. diff & H. Pylori PUD. Antibuse effect if taken with alcohol Amphotericin B anti-fungal. HIGHLY TOXIC - infusin rxns (fever and chills) - nephrotoxicity - hypokalemia - hepatoxicity - gynecomasita - C/I with aminoglycosides (just like PCN) -azole Fungal ______ causes malignant hyperthermia. Use ____ to stop it succinylcholine, Dantrium/Dantrolene. Morphine adverse effects -Constipation -Resp depression -urinary retention -Sedation - Orthostatic HOTN - Cough suppression Morphine drug-drug interactions (think of what morphine does to the body) - MAOIs -anticholinergics -CNS depressants -hypotensive drugs -opiod antagonists (narcan) - antihistamines Morphine patient education re how to take Take with food for N/V, lie still will help Opiod withdrawl (stop abruptly is taking ≥6weeks). Is it life-threatening? Will it subside? sweating, restless, agitated, dilated pupils, tremors, tachycardia, increased BP, N/V, cramps, muscle spasms with kicking movements. NO, subside in 7-10 days. Migraine medicine & can you take them right after each other? vasoconstriction, ergot's and triptans. NO, space out ergot and triptan by at least 24 hours. What pain meds reduces fever? ibuprofen, tylenol What pain med reduces platelet aggregation? NSAIDS (aspirin), reduce thrombus but will bleed easier, too What pain med reduces fever but has NO anti-inflammatory effect and NO platelet effect? tylenol What can give child Reye's syndrome if they have viral illness? Aspirin NSAIDS education w/ how to take med. NSAIDS= with food, milk, or full glass of water to reduce gastric discomfort. Ibuprofen, Celebrex, Naproxen, Aspirin acetaminophen max dose/day? 4 grams When to withhold morphine/opiates RR <12/min & notify Dr Triptans & pregnancy Triptan= Teratogenic. Pregnancy X Rheumatoid Arthritis Drugs name potent toxic drug DMARDs, 1st choice: methotrexate. Bone Marrow Suppression and Fetal Death Methotrexate: most concerned about... bone marrow suppression; Baseline CBC and platelet counts, What are the s/s of circulatory overload? Seen if giving too much fluids flush, SOB, cough, heart palpitations What type of diuretic is not effective in renal failure? Thiazide - HCTZ Bumex is ___x more potent than lasix 40 Thiazide diuretics are good for the ___ and perfect for the eldery __ with HTN bones, woman Lasix drug-drug interaction: for manic depressive ppl it'll get to toxic levels in the body Lithium will become toxic Signs of hypokalemia weakness, dysrhymias, increased cardiac sensitivity of digoxin, ileus, Flat T wave Aspirin toxicity symptoms Tinnitus, HA Glucocorticoids adverse effects potent; suppress adrenal glad fxn, hyperglycemia, osteoporosis, if taken with NSAIDS, increase risk of GI ulcer, mask infection and suppress immune system Reo Pro (-mab) what is it for & adverse effects. What other use does Reo Pro have? Immunosuppressant for RA, Lupus. toxic to bone marrow, acute pulm edema, infection risk, neoplasia risk. Antiplatelet action. Classic CNS depressant drug classes and what they're used for Benzodiazepines, Barbituates. Anxiety. -lam & -pam are the endings for ________ Benzodiazepines Benzodiazepine Lorazepam (ativan) increases the possibility of ______. seizures Benzodiazepine antidote? Romazicon 1/2 life of 1 hour Other anxiolytics: and what they're for -Valproic Acid: anti-seizure, bi-polar - Phenergan: NV, anxiety, extrapyramidal effects Amitriptiyline (Elavil) drug drug interactions and how to take med Anticholinergics b/c TCA already have anticholinergic effects - void prior to dosing & take at bedtime to sleep through fatigue side effect MAOI's ___ line of choice for depression b/c of the adverse effects with _____. If eat _____ will cause an _____ ______ 2nd or 3rd, tyramine. Tyramine, hypertensive crisis MAOI adverse effects are related to stimulation of the _____ and include: SNS, CNS stimulation, CV-hypertensive crisis, palpitations, Liver toxicity 1st drugs of choice for depression and are equally as effective as _ _ _ but don't see _____ & ____ SSRI, TCA, hypotension and sedation SSRI drug examples: prototype and 2 popular drugs Prozac, Celexa, Zoloft Atypical antidepressant _______ better use in elderly Wellbutrin SSRI uses depresssion OCD bulimia PTSD Panic attacks Social phobias PMDD What time of day to give SSRI Give in the AM for optimal effects Lithium is used for Bipolar Disorder Valproic Acid is used for Anti-seizure Lithium and Diuretics toxicity if taking diuretics Anti-depressants have ___________ effects anticholinergic: dry mouth, constipation, lack of sweat, lack of voiding Antidepressants and anti-anxiety meds may take _ to __ weeks to take effect 1-3 weeks all anti-depressants have _____ ______ effect and pt must have their __ monitored orthostatic hypotension. BP If patient taking an antihypertensive and just got ordered MAOI, Nardil, Marplan, or Parnate, then... monitor their BP and call the Dr if theres a significant drop and may need to reduce the anti-htn dosage Lithium and Triptans? Safe in pregnancy? NO both lithium and triptans are teratogenic Therapeutic Levels of Lithium 0.4-1.0 mEq/L. Take 2-3 times a day. Chemotherapy Agents, name as much as you can! neosar (cyclophosphamide), methotrexate, doxorubicin, tamoxifen Cyclosporine is an _________ immunosuppressive drug PTT lab value should stay at >_________ for what medication? What is the therapeutic PTT level? 2 times the baseline, Heparin. 60-80 seconds To prevent HIT, stop heparin at platelet count of <________ 100,000 How to inject heparin, starting from drawing up draw up with 22-25 ga needle from vial, then use 25 or 26 ga to put into abdomen 2in from umbilicus. Drug to help with heparin overdose Protamine Sulfate [Show Less]
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Pharmaco Ch. 2: Basic Concepts of Pharmacology questions and answers
Absorption Process by which a drug enters the circulatory system (blood). Intravenous (IV) & Intra-Arterial Administration/Dosage routs that do no... [Show More] t require absorption. Absorption, Distribution, Metabolism, & Elimination... The Pharmacokinetic Process ADME Addiction Dependence characterized by a perceived need to take a drug to attain the psychological & physical effects of mood altering substances. Affinity Natural attraction - the strength by which a particular chemical messenger binds to its receptor site on a cell Agonist Drug that mimics the action of a neurotransmitter when it binds to a particular receptor site - i.e. & triggers the cell's response in a manner similar to the action of the body's own chemical messenger. Allergen Substance of a usually harmless nature that produces an abnormal hypersensitive reaction. Allergic Response A hypersensitive reaction to any usually harmless substance that does not normally cause a reaction. Anaphylactic Reaction Severe allergic response resulting in immediate life-threatening respiratory distress, usually followed by vascular collapse & shock accompanied w/ hives. Angioedema Abnormal accumulation of fluid in tissue. Antagonist Drug that neutralizes or counteracts the effects of a neurotransmitter or another drug when it binds to a particular receptor site. Antigen Foreign substance that is recognized by the immune system & induces the immune system to produce antibodies to defend against the foreign substance. These substances can gain access through any opening in the body such as cuts/scrapes, the digestive, circulatory, urinary, or reproductive systems. Bioavailability Degree to which a drug or other substance becomes available to the target tissue after administration. Blood-Brain Barrier Fortified area that prevents many substances from entering the cerebro-spinal fluid from the blood. This area is formed by glial cells that envelope capillaries in the fcentral nervous system. This creates a shield that blocks many water-soluble compounds, but is permeable to lipid-soluble substances. Ceiling Effect Point @ which no clinical response occurs w/ increased dosage of a drug. Clearance Rate @ which a drug is eliminated from a specific volume of blood per unit of time. Contraindication Any disease, condition, or symptom for which a drug will not be beneficial & may be harmful. Dependence State in which a person's body has adapted physiologically & psychologically to a drug & cannot function w/o it. Distribution Process by which a drug moves from the blood into other body fluids & tissues & ultimately to its site(s) of action. Dose Quantity of a drug administered at one time. Drug Abuse Use of a drug for purposes other than those prescribed &/or in amounts that were not directed. This is often linked to addiction. Drug Interaction When a drug is affected in some way by another drug, foods, or other substances, such as when enzymes that metabolize the drug are induced or inhibited. Drug Interaction Relationship: Addition The combined effect of 2 drugs is equal to the sum of the effects of each drug taken alone. Drug Interaction Relationship: Antagonism The action of 1 drug negates the action of a 2nd drug. Drug Interaction Relationship: Potentiation 1 drug increases or prolongs the action of another drug, & the total effect is greater than the sum of the effects of each drug used alone - drug potency is increased. Drug Interaction Relationship: Synergism The combined effect of 2 drugs is more intense or longer in duration than the sum of their individual effects. Drugs that work in combination like this are usually prescribed together. Enzymes, Nucleic Acids, Receptors, & Transport Proteins Types of specific body molecules that drugs can combine w/. Duration Of Action Length of time a drug gives the desired response/remains at the therapeutic level. Elimination Removal of a drug or the drugs metabolites from the body by excretion. First-Order Drugs for which the rate of elimination is concentration dependent (as opposed to ____ _ _____). First-Pass Effect Extent to which a drug is metabolized by the liver before reaching full body circulation. This can substantially decrease bioavailability of certain drugs when administered orally, in which case administration by injection is required. Half-Life Time necessary for the body to eliminate half of the drug in the body @ any 1 time (written as T 1/2). Homeostasis Maintenance of stability in the internal environment of the body. Induction Process by which a drug increases the concentration of certain enzymes that affect the pharmacologic response to other drugs. Inhibition Process by which a drug blocks enzyme activity & impairs the metabolism of another drug. Interaction Change in the action of a drug caused by another drug, food, or another substance, such as alcohol or nicotine. Lipid Fatty molecule - An important constituent of cell membranes; they generally repel water. Local Effect Action of a drug that is confined to a specific part of the body. Loading Dose Amt of a drug that will bring the blood concentration rapidly to a therapeutic level. Maintenance Dose Amt of a drug administered at regular intervals to keep the blood concentration @ a therapeutic level. An important factor in determining this, is a drug's clearance rate. Metabolic Pathway Sequence of chemical steps that convert a drug tinto a metabolite. Metabolism Process by which drugs are chemically converted to other compounds. Metabolite Substance into which a drug is chemically converted in the body. Peak Top or upper limit of a drug's concentration in the blood. Pharmacokinetic Modeling Method of describing the process of absorption, distribution, metabolism, & elimination (ADME) of drug w/i the body mathematically. Pharmacokinetics Activity of a drug w/i the body over a period of time; includes absorption, distribution, metabolism, & elimination (ADME). Prophylaxis Effect of a drug in preventing infection or disease. Pruritus Itching Sensation. Receptor Protein molecule on the surface of or w/i a cell that recognizes & binds w/ specific molecules, thereby producing some effect w/i the cell. Classified as protein melecules, Different types for different cells, Located on the surface or inside cells, Must have complementary chemical structure to bind w/ a messenger, Play an important role in body functions such as blood clotting, smooth muscle contraction, & protection against injury & infection, & Specificity Characteristics Of Receptors Side Effect Secondary response to a drug other than the primary therapeutic effect for which the drug was inteneded. Solubility Ability of a drug to dissolve in body fluids. Specificity Property of a cell receptor that enables it to bind only w/ a specific chemical messenger; in order to bind w/ the receptor, the messenger must ahve a chemical structure that is complementary to the structure of the receptor. [Show Less]
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HESI Pharmacology Exam Practice questions and answers | latest updated
1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse p... [Show More] repare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate 3. Calcitonin (Miacalcin) 4. Large doses of vitamin D 3. Calcitonin (Miacalcin) Rationale: The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia. Calcium gluconate and calcium chloride are medications used for the treatment of tetany, which occurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to be avoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration. 2.) Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item? 1. Milk 2. Water 3. Apple juice 4. Orange juice 4. Orange juice Rationale: Vitamin C increases the absorption of iron by the body. The mother should be instructed to administer the medication with a citrus fruit or a juice that is high in vitamin C. Milk may affect absorption of the iron. Water will not assist in absorption. Orange juice contains a greater amount of vitamin C than apple juice. 3.) Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which of the following would indicate the presence of systemic toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations 1. Tinnitus Rationale: Salicylic acid is absorbed readily through the skin, and systemic toxicity (salicylism) can result. Symptoms include tinnitus, dizziness, hyperpnea, and psychological disturbances. Constipation and diarrhea are not associated with salicylism. 4.) The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied: 1. Immediately before swimming 2. 15 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun 4. At least 30 minutes before exposure to the sun Rationale: Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating. 5.) Mafenide acetate (Sulfamylon) is prescribed for the client with a burn injury. When applying the medication, the client complains of local discomfort and burning. Which of the following is the most appropriate nursing action? 1. Notifying the registered nurse 2. Discontinuing the medication 3. Informing the client that this is normal 4. Applying a thinner film than prescribed to the burn site 3. Informing the client that this is normal Rationale: Mafenide acetate is bacteriostatic for gram-negative and gram-positive organisms and is used to treat burns to reduce bacteria present in avascular tissues. The client should be informed that the medication will cause local discomfort and burning and that this is a normal reaction; therefore options 1, 2, and 4 are incorrect 6.) The burn client is receiving treatments of topical mafenide acetate (Sulfamylon) to the site of injury. The nurse monitors the client, knowing that which of the following indicates that a systemic effect has occurred? 1.Hyperventilation 2.Elevated blood pressure 3.Local pain at the burn site 4.Local rash at the burn site 1.Hyperventilation Rationale: Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication should be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury. 7.) Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed? 1. Platelet count 2. Triglyceride level 3. Complete blood count 4. White blood cell count 2. Triglyceride level Rationale: Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. Options 1, 3, and 4 do not need to be monitored specifically during this treatment. 8.) A client with severe acne is seen in the clinic and the health care provider (HCP) prescribes isotretinoin. The nurse reviews the client's medication record and would contact the (HCP) if the client is taking which medication? 1. Vitamin A 2. Digoxin (Lanoxin) 3. Furosemide (Lasix) 4. Phenytoin (Dilantin) 1. Vitamin A Rationale: Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. Options 2, 3, and 4 are not contraindicated with the use of isotretinoin. 9.) The nurse is applying a topical corticosteroid to a client with eczema. The nurse would monitor for the potential for increased systemic absorption of the medication if the medication were being applied to which of the following body areas? 1. Back 2. Axilla 3. Soles of the feet 4. Palms of the hands 2. Axilla Rationale: Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions in which permeability is poor (back, palms, soles). 10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that the client is taking azelaic acid (Azelex). Because of the medication prescription, the nurse would suspect that the client is being treated for: 1. Acne 2. Eczema 3. Hair loss 4. Herpes simplex 1. Acne Rationale: Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears to work by suppressing the growth of Propionibacterium acnes and decreasing the proliferation of keratinocytes. Options 2, 3, and 4 are incorrect. 11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with a partial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse is reinforcing information to the client about the medication. Which statement made by the client indicates a lack of understanding about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication will permanently stain my skin." 4. "The medication should be applied directly to the wound." 3. "The medication will permanently stain my skin." Rationale: Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not stain the skin. 12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. During an inspection of the site, the nurse notes redness and swelling and that the rate of infusion of the medication has slowed. The nurse should take which appropriate action? 1. Notify the registered nurse. 2. Administer pain medication to reduce the discomfort. 3. Apply ice and maintain the infusion rate, as prescribed. 4. Elevate the extremity of the IV site, and slow the infusion. 1. Notify the registered nurse. Rationale: When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great care must be taken to prevent the medication from escaping into the tissues surrounding the injection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signs of extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. If extravasation occurs, the registered nurse needs to be notified; he or she will then contact the health care provider. 13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? 1. Echocardiography 2. Electrocardiography 3. Cervical radiography 4. Pulmonary function studies 4. Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication. 14.) The client with acute myelocytic leukemia is being treated with busulfan (Myleran). Which laboratory value would the nurse specifically monitor during treatment with this medication? 1. Clotting time 2. Uric acid level 3. Potassium level 4. Blood glucose level 2. Uric acid level Rationale: Busulfan (Myleran) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute renal failure. Options 1, 3, and 4 are not specifically related to this medication. 15.) The client with small cell lung cancer is being treated with etoposide (VePesid). The nurse who is assisting in caring for the client during its administration understands that which side effect is specifically associated with this medication? 1. Alopecia 2. Chest pain 3. Pulmonary fibrosis 4. Orthostatic hypotension 4. Orthostatic hypotension Rationale: A side effect specific to etoposide is orthostatic hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication. [Show Less]
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Nursing Pharmacology (Drugs) questions and answers rated
albuterol (SABA) short acting beta 2 receptor agonist, used for bronchospasm, acute symptoms of asthma acetaminophen centrally acting cox inhibito... [Show More] r; analgesic and antipyretic properties; no antiinflammatory,antirheumatic properties acyclovir Antimetabolite for Treating Herpes Simplex Virus & Varicella-Zoster Virus Infections; MOAs: Purine necleoside analog: DNA polymerase inhibitor, suppresses synthesis of viral DNA, resistance. amiodarone Class 3 Potassium channel blocker Only approved for life-threatening dysrhythmias. Delays repolarization and extends action potential of heart muscle cells. SE: Profound hypotension." amoxicillin Broad-spectrum penicillin active against H. influenzae, E. coli, and N. Gonorrhoeae. It is inactivated by beta-lactamases, so not helpful for Staphylococcus. atropine muscinarinic receptor antagonist/anticholinergic drug; used for mydriases (eye exams), to raise HR, lower GI motility, and as antidote to muscarinic poisoning (rx, shrooms) amphotericin B broad spectrum antifungal, which is the agent of choice for systemic mycoses, despite being highly toxic. Its uses are limited to treating progressive and potentially fatal infections. Adverse effects include infusion reactions, nephrotoxicity, and hypokalemia. aspirin A drug that decrease platelet aggregation and is used to prevent arterial thrombosis, stroke, or MI. Major SEs include risk of major GI bleeding. This drug is an NSAID that works by inhibiting platelet COX, COX-1, and COX-2. beclomethasone inhaled corticosteroid used to treat airway inflammation in asthma bethanechol muscarinic agnonist, used primarily for urinary retention buproprion (DA and NE). Weight loss, seizure, insomnia, headache, serotonin syndrome (see laundry list above), withdrawal, Neonatal Abstinence Syndrome captopril ACE inhibitor - shown to have efficacious effects in treating a patient with heart failure. Blocks production of angiotensin II, dilates arterioles and veins, and decreases release of aldosterone. It may show the adverse effects of hypotension, hyperkalemia, or persistant cough, CARDIAC REMODELING carbenicillin "Extended spectrum (antipseudomonal penicillins), which has the same spectrum of activity as broad-spectrum penicillins, plus treatment of Pseudomonas aeruginosa cefotaxime "Third generation cephalosporin with activity against meningitis and nosocomial infections resistant to others (restricted use). It has greater activity against Gram negative bacteria, increased resistance to beta-lactamases, and better ability to reach CSF. cephalexin "First generation cephalosporin poor activity against Gram negative bacteria, sensitive to to most beta-lactamases, unable to reach CSF. Used for Staphylococcus if mild penicillin allergy. celecoxib 2nd Generation Nonsteroidal Antiinflammatory Drug (COX-2 Selective NSAID); AE: risk of CV events, warfarin may be more effective with celecoxib cholestyramine Inhibits bile reabsorption in intenstine, increases LDL receptors in liver, accelerates bile excretion. Many of the adverse effects result from the drug not being absorbed from GI, including constipation and a decreased absorption of fat-soluble vitamins (A, D, E, & K). ciprofloxacin fluoroquinolone broad -cidal. PO tetracycline and cipro should NOT BE GIVEN WITH ANTACIDS. ALSO KNOW IT CAN RUPTURE TENDONS AND CAUSE CANDIDA. " codeine antitussive, AE: respiratory depression also weak mu opioid agonist clozapine atypical antipsychotic; 2nd Gen. Treats negative symptoms. Greater efficacy than 1st gen. Fewer EPS/tardive dyskinesia side effects. SE: Agranulocytosis and Metabolic effects (Weight gain, diabetes, hyperlipidemia) clonidine alpha 2 agonist, HTN drug -> vasodilation clavulanic acid A penicillinase inhibitor that is combined with a broad spectrum penicillin to increase is bactericidal activity. clopidogrel decreases platelet aggregation and is used to prevent arterial thrombosis or stroke. Major SEs include risk of major GI bleeding. This drug is not an NSAID and does not inhibit COX chlorpromazine FGA, low potency, treats positive symptoms. SE: Sedation, orthostatic hypotension, anticholinergic effects. NOTE: it may take up to 6 weeks to see effects cromolyn mast cell stabilizer, inhaled, for asthma or allergies diphenhydramine 1st Generation H1 Competitive Antagonist; antihistamine (benadryl), sedation effects digoxin "Medication prescribed for treating heart failure and some dysrhythmias. It is an ionotropic agent with narrow therapeutic index. Increases myocardial contractility and cardiac output. Improves symptoms but not shown to increase life expectancy. Significant cardiotoxicity requires monitoring of drug levels and K+ levels epinephrine Mixed Alpha/Beta Adrenergic Receptor Agonists (Nonselective) dabigatrine direct thrombin inhibitor, (PO) dextromethorphan non opioid antitussive enoxaparin low molecular weight heparin; indirect inhibitor, a shorter form of heparin, can be given using a fixed dose with no aPTT monitoring. Inactivates ONLY Xa. subQ only. Can be used at home. exenatide incretin mimetic; Activates receptors for GLP-1. Increases insulin secretion; slows GI absorption of glucose and gastric emptying. [-ide, acts similar to tolbutamide] fexofenadine 2nd gen antihistamine, H1 competitive antagonist (allegra), lesser sedative effects dopamine "Inotropic agent that requires constant BP/EKG monitoring. Activates beta1 AR in heart and increases contractility and HR (risk of tachycardia). Dilates renal blood vessels and increases urine output via receptor activation in the kidney erythromycin Macrolid; Static, narrow (G+), inhibits protein synthesis SEs: GI; DDIs with 3A4 inhibitors (cardiotoxic) and antidysrythmics" furosemide Loop diuretic. Site of action in the nephron is the Loop of Henley. Can cause hypokalemia. Diuretics increase the risk of dysrhythmias in a patient taking digoxin by promoting potassium loss. Used for HTN and HF. Works with low GFR. gemfibrozil fibroacid derivative, lowers triglycerides gentamicin Cidal, narrow (G-)--> ONLY ONE. Lethal inhibition of protien synthesis (ONLY ONE THAT DOES THIS). SE: Ototoxic (High pitch tinnitus and headache), Kidney problems (nephrotoxicity). Hypersensitivity, Neuro-mm'r blockade=resp. depression. KNOW THESE GENTAMICIN SEs." glucagon treats hypoglycemia; carbohydrate; opposite effects of insulin glyburide 2nd generation sulfonylurea; stimulates insulin release in pancreas; Same as Tolbutamide, but more potent. [-ide]; haloperidol FGA, high potency; treats positive symptoms. SE: EPS (Acute-dystonia, parkinsons-like, akathesia and Late- Tardive Dyskinesia) and NMS. Immediate effects. Only used in emergent situation, b/c of SE heparin "Rapid-acting anticoagulant that enhances activity of antithrombin and inactivates clotting factors. It is used in treating pulmonary embolism, evolving stroke, and prevention of vein thrombosis. Its adverse effects include hemorrhage, drug-induced thrombocytopenia, and hypersensitivity reactions. hydralazine a vasodilator that directly dilates arterioles. It may produce SEs including systemic lupus erythematosus-like syndrome, reflex tachycardia, and increased blood volume; BB can prevent tachycardia hydrocodone/acetaminophen opioid and non opioid combined for analgesia hydrochlorothiazide Thiazide diuretic. Site of action in the nephron is the Distal Convoluted Tubule. First line of treatment for patients without compelling indications. Can cause hypokalemia. Does not work with low GFR. Also used for HF. indinavir "Protease inhibitor. Side effects include hyperglycemia/diabetes, fat redistribution, hyperlipidemia, reduced bone density, hepatotoxicity, and increased bleeding in hemophiliacs. insulin glargine "Long duration insulin that includes less risk of hypoglycemia than shorter acting insulins. It is produced by making an amino acid switch from natural insulin. NOT mixed with other insulins. imipramine (prototype) tricyclic antidepressant and anxiolytic; block reuptake of norepinephrine (NE) and 5-hydroxytryptamine (5-HT) ipratropium Respiratory Muscarinic Acetylcholine Receptor Antagonist (bronchodilator) iodine (131I) Radioactive isotope that produces clinical remission of hyperthyroidism by destruction of thyroid gland. ketoconazole Alternative antifungal drug for systemic mycoses and is also suitable for superficial mycoses. Fewer SEs and only slightly less effective fungistatic activity. AE: hepatotoxicity, effects on sex hormones, nausea & vomiting, headache, and abdominal pain. levothyroxine "Common treatment for all forms of hypothyroidism. It is highly protein bound with a half-life of 7 days. SEs include tachycardia, angina, and tremors. lidocaine "Class IB Antidysrhythmic Drug that accelerates repolarization with little or no effect on ECG. Is also used as a local anesthetic. Adverse effects include mental confusion and paresthesias. linezolid static, inhibits protein synthesis ;cross-resistance unlikely. Activity against multidrug-resistant gram-positive pathogens, including vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). It is NOT active against Gram negative bacteria. Its use is highly reserved in order to limit development of resistance. losartin Blocks the effects of Angiotensin II on receptor organs: counters RAAS & blocks release of aldosterone. Tx: HTN. SE: Angioedema. lispro insulin Short-duration/rapid acting insulin often taken with longer acting insulin. It is produced by making an amino acid switch from natural insulin. lithium BPD; drug of choice for euphoric mania.Na+ depletion can lead to Lithium toxicity (diuretics, dehydration) When the body is low on sodium, it holds onto lithium, voiding increased lovastatin "Inhibitor of HMG-CoA reductase leading to increases in the number of LDL receptors. Beneficial actions include lowering LDL levels, raising HDL levels and increasing plaque stability. SEs include headache, myalgia, and rash. Category X drug. metformin "Biguanide that acts by decreasing glucose production. Major SEs include hypoglycemia and lactic acidosis. It is a preferred treatment for obese pts with insulin resistant diabetes, and possibly for NIDDM prevention. metoprolol "Cardiac-specific beta blocker - shown to have efficacious effects in treating a patient with heart failure. minoxidil "Vasodilator with the unusal SE of hypertrichosis; used for treating HTN unresponsive to other drugs. [Show Less]
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Pharmacology Exam #2 Practice Questions and answers
A patient is taking two prescription medications that both cause bradycardia. The nurse should monitor the patient for which type of effect? A. An incre... [Show More] ased therapeutic effect B. An increased adverse effect C. A reduced therapeutic effect D. A reduced adverse effect B. An increased adverse effect Which individual is at the highest risk for a drug-drug interaction? A. A toddler who is prescribed two antibiotics for a serious infection B. An adolescent who takes over-the-counter medications for menstrual cramping C. An adult who takes eight prescription medications for a chronic condition D. An older adult who takes two prescription medications and a dietary supplement for anxiety C. An adult who takes eight prescription medications for a chronic condition The nurse cares for a patient who is taking a calcium channel blocker for hypertension. The nurse should be most concerned if the patient makes which statement? A. "I take my medication with a glass of water." B. "I eat foods high in fiber to prevent constipation." C. "I drink a glass of grapefruit juice each evening." D. "I avoid foods such as broccoli and cabbage." C. "I drink a glass of grapefruit juice each evening." A patient is prescribed a medication to be taken on an empty stomach. Which statement should the nurse include when providing patient teaching? A. "Take the medication 1 hour before eating." B. "Take the medication with a small glass of water." C. "Take the medication before going to bed at night." D. "Take the medication 1 hour after a meal." A. "Take the medication 1 hour before eating." Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction? A. A 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine B. A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic C. A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what? A. Blood urea nitrogen and serum creatinine B. Aspartate aminotransferase and alanine aminotransferase C. Prolonged QT interval on the electrocardiogram D. Serum potassium, serum sodium, and serum magnesium B. Aspartate aminotransferase and alanine aminotransferase The healthcare provider writes a medication order that the nurse cannot read. What should the nurse do? A. Consult with the charge nurse to verify the order. B. Discuss the order with the pharmacist. C. Check with the patient to determine the correct medication. D. Contact the prescriber to clarify the order. D. Contact the prescriber to clarify the order. The nurse reviews a patient's admission orders written by the healthcare provider. Which medication order should the nurse question? A. Cyanocobalamin 100 mcg intramuscularly every month B. Mso4 2.0 mg IV every 2 to 4 hours as needed for pain C. Levothyroxine 75 mcg orally every morning D. Enoxaparin 40 mg subq. every day for 7 days B. Mso4 2.0 mg IV every 2 to 4 hours as needed for pain A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse? A. "Increasing the dose of morphine will make you so sleepy that you will not be able to function." B. "This means that you have developed a psychological addiction to morphine." C. "You have developed a tolerance to morphine and will need a higher dose." D. "It is recommended that we wait to increase the morphine until the pain is more severe." C. "You have developed a tolerance to morphine and will need a higher dose." The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient has altered CYP2D6 genes. It is most important for the nurse to do which of the following? A. Check for signs of a transient ischemic attack. B. Monitor for ST segment elevation or depression. C. Observe the patient's legs for symptoms of a blood clot. D. Examine the patient's stools for the presence D. Examine the patient's stools for the presence A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask? A. "Do you think you have another bladder infection?" B. "Have you taken all of the antibiotics as directed?" C. "How much water have you been drinking each day?" D. "What antibiotic do you usually take to treat an infection B. "Have you taken all of the antibiotics as directed?" The nurse is assessing an infant delivered by a patient who is suspected of regularly using alcohol and cocaine during her pregnancy. It is most important for the nurse to observe the infant for what? A. Lethargy, hypothermia, and weight gain B. High-pitched cry, vomiting, and jitteriness C. Depressed reflexes, jaundice, and dysphagia D. Hypotonia, absent sucking reflex, and epistaxis B. High-pitched cry, vomiting, and jitteriness A patient is taking a Category A drug during pregnancy. Which statement by the nurse is accurate? A. "The risk of harm to the fetus is remote." B. "The drug is safe to take during pregnancy." C. "This drug has caused congenital birth defects." D. "No controlled studies of this drug have been done in humans." A. "The risk of harm to the fetus is remote." A patient is 2 months pregnant and complains of gastric distress. It is most appropriate for the nurse to do what? A. Consult with the healthcare provider about a prescription for misoprostol (Cytotec). B. Instruct the patient to avoid acidic foods such as orange juice and tomatoes. C. Suggest an over-the-counter medication such as bismuth subsalicylate (Pepto-Bismol). D. Use an alternative therapy such as valerian as a dietary supplement. B. Instruct the patient to avoid acidic foods such as orange juice and tomatoes. A patient who is breast-feeding her newborn infant is prescribed an antibiotic to take after discharge. Which statement should the nurse include when providing discharge instructions? A. "Drink plenty of fluids to dilute the drug in your breast milk." B. "Take the drug at night with a full glass of water." C. "Pump your breasts, and then discard all of the milk." D. "Take the antibiotic immediately after breast-feeding." D. "Take the antibiotic immediately after breast-feeding." The nurse provides teaching for the caregiver of a 2-month-old infant and a 3-year-old child. Both children will be taking oral ampicillin (an acid-labile drug) to treat a bacterial infection. The nurse determines that teaching is successful if the caregiver makes which of the following statements? A. "The dose will not be different, but the baby will take the drug for 7 days instead of 10 days." B. "The dose will be higher for the baby, because the infection is more serious." C. "The dose will be the same, because my children have the same infection." D. "The dose will be smaller for the baby, because the drug will be absorbed better in the stomach." D. "The dose will be smaller for the baby, because the drug will be absorbed better in the stomach." A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child's age, the nurse would expect to make which adjustment? A. The drug may need to be administered more frequently. B. The dosage of the drug may need to be decreased. C. The route should be changed from oral to intramuscular. D. The drug should be administered on an empty stomach A. The drug may need to be administered more frequently. A 15-month-old patient develops chemotherapy-induced nausea and vomiting. Which medication, if ordered by the healthcare provider, should the nurse question? A. Ondansetron [Zofran] B. Dexamethasone [Decadron] C. Promethazine [Phenergan] D. Metoclopramide [Reglan] C. Promethazine [Phenergan] A toddler has been prescribed a medication that does not have an established pediatric dose. To calculate the appropriate dose for the child, the nurse should consider what information? A. The child's weight is 26 pounds. B. The child's height is 32 inches. C. The child's body surface area is 0.52 kg/m2. D. The child's age is 24 months. C. The child's body surface area is 0.52 kg/m2. The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal this patient's function? A. Serum creatinine B. Blood urea nitrogen C. Urinalysis D. Creatinine clearance D. Creatinine clearance An older adult patient is taking a new prescription medication. After reviewing the patient's medical record, the nurse is most concerned about an adverse drug reaction if what is documented? A. The patient is currently taking eight prescription medications. B. The patient's urinary creatinine clearance is 70 mL/min/1.73 m2. C. The patient regularly takes herbal and dietary supplements. D. The patient takes a medication with a high therapeutic index. B. The patient's urinary creatinine clearance is 70 mL/min/1.73 m2. [Show Less]
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Pharmacology Final Exam Questions and answers 100% correct
Phenothiazines, like chlorpromazine, are used to treat___________. Psychosis A1 Blockers have __________ as an adverse effect. Hypotension (They w... [Show More] ork too well) Which drug works on the hypothalamus to reduce fevers? acetaminophen (Tylenol) Which drugs work to reduce symptoms of BPH? A1 Blockers such as tamsulosin (Flomax) and 5-Alpha Reductase Inhibitors such as Proscar. Benzos and Antihistamines work to reduce__________. Anxiety What are the signs and symptoms of a cholinergic crisis? Circulatory collapse Hypotension Bloody Diarrhea Bronchoconstriction Shock Cardiac Arrest Clients with asthma or COPD should not receive __________________________. Non-selective Beta Blockers Hydroxzine hydrochloride (Atarax), Hydroxine pamoate (Vistaril) and diphenhydramine (Benadryl) are all ______________________ and are used to treat ______________. Antihistamines Anxiety Three catchecolamines are : Epinephrine Norepinephrine Dopamine B1 Beta Adrenergic Receptors are located in________. The Heart--When it comes to Beta Receptors remember: You have ONE heart and TWO lungs. Beta1 works in the heart and Beta2 works in the lungs. Cholinergic drugs mimic the ________ response which is __________ or __________ . Parasympathetic rest digest Beta blocker drugs all end in what three letters? LOL Propranololol, atenolol, carvedilol Non-Benzos like Ambien can have ___________ as an adverse effect. somnabulation (Sleep walking) The dopaminergic drug for Parkinson's disease is _____________' carbida-levodopa (Sinemet) Diazepam (Valium), Alaprazolam (Xanax) and Lorazepam (Ativan) are all _________ to treat ____________. Benzos Anxiety Pam is crazy and drives a Benz! Migraine headaches and glaucoma can be treated with B1 Blockers because they ___________________. decrease pressure The Adrenergic drugs mimic the _______________ response which is _______ or ____________. Sympathetic Fight Flight Cholinergic drug effects are: Lower HR Lower BP (through vasodilation) Bronchial Constriction Increased GI secretions and motility Increased urinary frequency Increased Salivation Increased sweating (diphoresis) Pupils Constric (Miosis) Bethanechol (Urecholine) is used for ___________. Urinary Retention (URE=urine) What conditions would cholinergic drugs be useful to treat? Glaucoma Xerostomia (dry mouth) GI Motility Lowering HR Vasodilation Indirectly: Alzheimers What are B1 Blockers used to treat? Angina, MI cardiac dysrhythmias, hypertension and heart failure. (B1 Blockers work on the heart so all of these are cardiac issues) What are the adverse effects of cholinergic drugs? (Think that they suppress the parasympathetic nervous system too much.) Syncope Hypotension Urinary frequency Breathing difficulties Tylenol overdose drug: acetylcysteine Dobutamine, Dopamine, Norepinephrine, Phenylphrine, epinephring and midodrine are all ____________. Adrenergics Tricyclic Antidepressants are not used as often. What are some of the names to be aware of? Elavil, Sinequan, Tofranil Patients using MAO Inhibitors should avoid__________. Foods with tyramine (Aged cheese, wine, etc) What are the limits of acetaminophen? 4g/day (may be lowered to 3g/day) 2g/day for liver problems or advanced age What is the tylenol overdose drug? acetylcysteine For ACE inhibitors, what would be a sign that the patient isn't tolerating the drug very well? Dry, persistent cough What are the nursing activities for administering Ace Inhibitors? 1) Monitor BP and Serum K 2) Monitor for 1st Dose Hypotensive Effect and instruct patient to change positions slowly 3)Monitor cough What are the nursing activities for ARB's? 1)Monitor BP and Serum K (Watching for hyperkalemia) 2) Manage symptoms of hypotension What population do CCB's work best for? African Americans (in combination with diuretics) What are the nursing activities for CCB patients? 1)Monitor BP and HR 2)Assess for hypotension and instruct patient to change positions slowly What are the general nursing activies for all antihypertensive drug patients? 1) Administered as ordered 2) Maintain safety (because of the risk of postural hypotension) 3)Assess sexual dysfunction 4) Know when to hold the drug and seek clarification What factors effect absorption or drugs? First-pass effect (how much drug is metabolized by liver) Food Milk Antacids Grapefruit juice Route of administration Coatings What are the seven "rights"? Right Dose Right Documentation Right Drug Right Patient Right Route Right Time Right of Refusal What are the fastest to slowest routes of administration? IV, SL, IM, SubQ, Oral, Topical When we think of excretion, we think of __________. Kidneys If there is impaired excretion, it could lead to______. Toxicity Explain a schedule C-1 Drug Most addictive, high potential for abuse, no medical use With Warfarin, the patient should avoid________. Why? Leafy Greens Due to the decreased anticoagulant effect Tetracycline and Quinolones patients should avoid______________. Dairy Products due to the decreased treatment effect due to absorption Statin, Antidsyrhythmics and CCB patients should avoid____________________. Grapefruit Juice MAO inhibitor patients and Linezolid patients should avoid_________________. Foods with tyramine due to the raised blood pressure and a possible hypertensive crisis. Why is the enzyme cytochrome P450 important? It is involved with a lot of drug to drug reactions because the drugs all bind to the same substrate. Either the drug has a lowered treatment effect or the drug becomes toxic because of the amount of free drug in the body. How is hypertension treated in African Americans? With CCB's and diuretics in combination therapy What do you need to be aware of with the Asian and Hispanic populations? They can be slow acetylators. Antipsychotics and antianxiety drugs take longer to metabolize. Therefore, a lower dosage may be needed. Rapid Acetylators have higher levels of _______ and need ___________ doses of some drugs because otherwise the treatment will be ______. Cytochrome P-450 Higher (They metabolize the drug too fast) Sub-Therapeutic Slow Acetylators have lower levels of _____________ and need___________ doses of some drugs because otherwise the treatment will be __________. Cytochrome P-450 Lower (They metabolize drugs slower) Toxic _____________ dilate all blood vessels and relax smooth muscle. Nitrates For angina (chest pain), whether prophylactically or to treat an attack, ______________ will be used. Nitrates What are the four antidiarrheals? Adsorbents (Pepto-Bismol) Anticholinergics (Bella Donna Alkyloid) Opiate Derivatives (Immodium, Lomotil) Probiotics How do bulk forming laxatives work? Absorbs fluids Stimulates GI peristalsis How do Hyperosmotic and Saline Laxatives work? Increase of Fecal Water Content How do Emollient/Softening laxatives, like Colace, work? By mixing stool, fat and water content What do stimulant laxatives stimulate? The nerves for peristalsis What needs to be ASSESSED when administering adrenergic agonists such as epinephrine? 1) Photosensitivity 2) Nausea and Constipation 3) Urinary Output What needs to be MONITORED when administering adrenergic agonists? 1) Vital Signs 2) Breath Sounds 3) Watch for IV infiltration What needs to be MONITORED when administering anticholinergic drugs such as Atropine, Bentyl, Robinul, Vesicare, or Oxybutynin? 1) Bowel Sounds (can slow or stop GI motility) 2) Urinary Output (can be made difficult to urinate) 3)Oral Care (Secretions can dry up) 4) Heart Rate (can be increased) 5) Patient Safety must be ensured 6) Do not give to glaucoma patients (increases intraocular pressure) Crazy Pam Drives a Benz means what? Benzodiazepams are used to treat psychosis and anxiety. What nursing activities are important to remember when adminstering Benzo's? 1) Taper off gradually 2) Evaluate level of anxiety 3) AVOID ETOH AND OTHER CNS DEPRESSANTS 4) Patient safety must be ensured. What nursing activities are important to remember when administering MAO Inhibitors? 1) Avoid foods with tyramine 2) Monitor mood/suicidal thoughts 3) Inform about "lag time" 4) Avoid antihistamines 5)Avoid St. John's Wort What is the therapeutic level of antiseizure meds? 10-20 mcg/mL Dilantin mixed with dextrose will create a ___________. Precipitate. Mix with NS only With oral antiseizure meds and Lithium, _________can occur so teach to maintain ______________. Gingival Hyperplasia Oral Hygiene With head injury patients, would opioids be advisable to use? NO! Avoid head injury or patients with increased intercranial pressure What should be monitored when administering Opioid painkillers? Respiratory Rate (can slow) Intensity of pain (should go down) Blood Pressure (can lower) Nausea (administer with food or antiemetic if needed) Bowel Pattern (motility can slow or stop) Signs of dependence What should the patient be educated on when giving opioid painkillers? Disposing for patches properly (Fold and Flush) Avoid activities requiring mental awareness Increase fiber and water in diet What does the nurse need to be aware of when administering opioid painkillers? The antidote for overdose is NARCAN. (Have on hand if respiratory depression occurs.) There are multiple routes for adminstration. Use the equianalgesic chart when using different routes/drugs/doses to find the right dose. Know immediate release versus extended release forms. Why is methadone good for detox? It has a long half life that lasts longer than the action How to administer bronchodilators: Give bronchodilator before inhaled steroid. Wait 2-5 minutes between medications. Wait 1-2 minutes between puffs. After using an inhaled steroid, what should the patient do? Rinse their mouth with water to prevent fungal infection. What is the route of administration of thrombolytic drugs? IV-it is always given as an IV to quickly break up clots that cause stroke but has risky side effects because ALL clots in the body break up and the patient could bleed out. With Heparin the _________ should be monitored and kept in the _________________ range. aPTT Norm=25-35 seconds Therapeutic range =45-70 seconds With Heparin injections, what are the nursing activities? What is the overdose antidote? Do not rub Rotate Sites Do not aspirate SubQ injections IV infusion with a pump Protamine Sulfate What ranges are we looking at when administering warfarin (Coumadin) and what are the therapeutic levels? What is the overdose antidote? INR=2-3.5 PT=18 Seconds (norm=11-13 seconds) Vitamin K All antiplatelet, antifibrinolytic, thrombolytic and anticoagulants have the same adverse effect that the nurse should monitor for. What is it and what should be done? Bleeding Implement bleeding precautions such as use of an electric razor, minimize dangers, etc. Diuretics, like the Loop Diuretic furosemide (Lasix), should be administered ___________. Early in the day If the serum potassium level is low what should you do when administering the next dose of diuretics? HOLD it until the potassium level increases or hypokalemia can occur Potasssium supplements and eating potassium rich foods would all be advised for patients taking ___________. Diuretics With potassium-sparing diuretics, like spironolactone, they can keep too much potassium in the body which is a condition called_________. Hyperkalemia With all diuretics, what should be monitored? Urine output Weight Edema Blood Pressure (can go too low) Potassium levels Loop Diuretics, like furosemide, can have a cross-sensitivity allergic reaction in patients allergic to _______ drugs. Sulfa Any stimulating growth factor, like Filgrastim (Neupogen), should not be administered within 24 hours of __________________. Antineoplastics (Chemotherapy) Filgrastim (Neupogen) stimulates the productions of _____________________. WBC's When do you discontinue use of Filgrastim (Neupogen)? When the Absolute Neutrophil Count (ANC) is greater than 1000/mm3 for 3 or more consecutive days. When monitoring Epoetin Alfa (Epogen), use the _____________ because it changes faster. Hemoglobin level Epoetin Alfa (Epogen) will not create RBC's without ___________________________ in the body. Adequate stores of iron If Epoetin Alfa (Epogen) is working, the patient will feel less ______________. Fatigue (Oxygen levels will increase) What should patients taking insulin be educated about? Types and Routes of administration Site Rotation Types of Insulin Prevention and Treatment of hypoglycemia What are the causes of hypoglycemia in diabetes patients? Excessive Exercise Insufficient Food Excessive Insulin Metformin should be discontinued __________ before any radiologic test with contrast and ____________. If not, what condition is the patient at risk for? 48 Hours The day of the procedure Lactic Acidosis Metformin can commonly cause: Metformin can infrequently cause: GI Distress Metallic Taste, Hypoglycemia When teaching a patient about the legalities regarding a prescription for methylphenidate (Ritalin), which statement is most accurate? a.Methylphenidate (Ritalin) is a C-I narcotic that can only be prescribed according to an approved protocol. b.Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription. c.Methylphenidate (Ritalin) is a C-III narcotic for which a prescription will expire in 6 months. d. Methylphenidate (Ritalin) is a C-IV narcotic that is only allowed to be refilled five times per prescription. b.Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription. Methylphenidate (Ritalin) is classified as a C-II narcotic. C-II narcotics can only be dispensed with a written prescription and cannot be refilled. The nurse is assessing a patient's culture and race on admission to the hospital. Which concept is important for the nurse to understand regarding drug therapy as it relates to different races of individuals? a.Polypharmacy b. Polymorphism c.Pharmacokinetics d. Pharmacodynamics b. Polymorphism Drug polymorphism refers to the effect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. The race of an individual may influence drug therapy decisions for the individual. During the implementation phase of the nursing process, which action will the nurse perform when administering medications? a.Switch the route of administration based on drug availability. b. Call the patient by name when entering the room to verify the drug is for the right person. c.Check the patient's armband before administering the medication. d.Prepare medications for all patients first, then administer by room to manage time appropriately. c.Check the patient's armband before administering the medication. Checking the patient's armband is the most accurate method of determining identity. All the other answers leave room for error. The nursing process is important as a well-established, research-supported framework for professional nursing practice. Which is the correct order for the steps of the nursing process? a.Evaluation, Planning, Diagnoses, Assessment, Implementation b.Planning, Assessment, Diagnoses, Implementation, Evaluation c. Diagnoses, Assessment, Planning, Evaluation, Implementation d.Assessment, Diagnoses, Planning, Implementation, Evaluation d.Assessment, Diagnoses, Planning, Implementation, Evaluation The typical organization for the nurse process is assessment, nursing diagnoses, planning, implementation, and evaluation. The nurse should check a medication how many times before administration of a medication under the "right drug" part of the Six Rights? a.One time b. Three times c.Five times d.Depends on the drug being administered b. Three times The nurse should check the medication three times and confirm each time that the medication is the right drug before to administration of the medication. [Show Less]
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Unit 1: Basic Concepts of Pharmacology questions and answers
Phases of the Nursing Process 1. Assessment 2. Diagnosis 3. Outcome Id & planning 4. implementation 5. Evaluation Nursing process phase #1: Ass... [Show More] essment Data is collected, reviewed, and analyzed from patient, family, group, and/or community sources. Objective Data any information gathered through the senses or that which is: ♥ seen ♥ heard ♥ felt ♥ or smelled Objective Data may also be obtained from: ♥ Nursing Physical Assessment ♥ Nursing History ♥ Past and Present Medical History ♥ Results of Laboratory Tests, ♥ Diagnostic Studies or Procedures ♥ Measurement of Vital Signs ♥ Weight and Height ♥ Medication Profile Subjective Data includes information shared through the spoken word by any reliable source such as the ♥ Patient ♥ Spouse ♥ family member ♥ significant other ♥ or caregiver Components of a prescription/medication Order: Seven Elements: 1. Patient's name 2. Date the drug order was written 3. Name of drug(s) 4. Drug dosage amount 5. Drug dosage frequency 6. Route of administration 7. Prescriber's signature (example in powerpoint) Assessment about the specific drug involves the collection of specific information about prescribed, OTC, and herbal/complementary/alternative therapeutic drug use, with attention to the: ♥ drug's action ♥ signs symptoms of allergic reaction ♥ adverse effects ♥ dosages and routes of administration ♥ contraindications ♥ drug incompatibilities ♥ drug-drug interactions ♥ drug-food interactions ♥ drug-laboratory test interactions ♥ toxicities ♥ available antidotes WHATS'S WRONG? WHAT WOULD YOU DO? Date of order: 9/13/15 Patient: John Doe Physician: Dr. A. Jackson, M.D. Order: Acetaminophen (Tylenol), 2 Tablets PO, every 4 hours as needed for fever ♥ Missing the dose ♥ Clarify temperature ♥ Call and get it clarified ♥ NEVER assume Nursing process phase #2: Diagnoses are the result of clinical judgement about a human response to health conditions and/or life processes, critical thinking, creativity, and accurate collection of data regarding the patient as well as the drug. ♥ Describes symptoms (notes) Diagnoses-Problems pertaining to Drug Therapy: ♥ Knowledge deficit ♥ Risk for injury ♥ Noncompliance - disturbances - deficits - excesses - impairments of bodily functions Formulation of nursing diagnoses: Part one of statement The human response of the patient to illness, injury, or significant change. May be: ♥ actual problem ♥ increased risk of developing problem ♥ opportunity to improve the human response by the patient, family, group, or community Formulation of nursing diagnoses: Part two of statement Defining characteristics and identifies the factor(s) related to the response, with more than one factor often named. ♥ connection between factor(s) and response ♥ (not necessarily cause-and-effect) Formulation of nursing diagnoses: Part three of statement Contains a listing of clues, cues, evidence, signs, symptoms, or other data that support the nurse's claim that this diagnosis is accurate Assessment-Data Collection: ♥ Drug data ♥ Patient data ♥ Prescription/Medication order Nursing diagnosis does not equal Medical diagnosis Shortness of breath does not mean someone has COPD Nursing process phase #3: Planning Includes identification of outcomes The major purpose of the Planning phase: ♥ Prioritize the nursing diagnoses ♥ Specify outcomes including the time frame for their achievement Patient outcomes are _______ based. and may be categorized into... behavior based ♥ Physiologic ♥ Psychological ♥ Spiritual ♥ Sexual ♥ Cognitive ♥ Motor ♥ and/or other domains Outcomes are... ♥ Objective ♥ measurable ♥ realistic with an established time frame for the patient's achievement Define Outcome the changes you expect to see after you intervene (opposite of the diagnosis/problem) Nursing Process Phase #4: Implementation Doing/active/intervening phase Nine Rights of Medication Administration 1. Right drug 2. Right dose 3. Right time 4. Right route and form 5. Right patient 6. Right documentation 7. Right reason 8. Right response 9. patient Right to refuse To check if you are giving medication to the right patient you must have them.... repeat their name and date of birth Intervention define: any treatment based on clinical judgement and knowledge and performed by a nurse to enhance outcomes To ensure the right drug is given, the specific medication order must be checked against the medication label or profile.... three times before giving the medication. Always confirm that the dosage amount is appropriate for the patient's... age and size For routine medication orders, the standard of care is to give the medications no more than 1/2 hour before or after the actual time specified in the prescriber's order. Prescriber define: Any health care professional licensed by the appropriate regulatory board to prescribe medication. Outcomes define: Descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of behaviors related to each nursing diagnoses. These statements are specific while framed in behavioral terms and are measureable. Nursing process define: An organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for the patient. Compliance define: Implementation or fulfillment of a prescriber's or caregiver's prescribed course of treatment or therapeutic plan by a patient. Medication error define: Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or my not cause the patient harm. Noncompliance define: An informal decision on the part of the patient not to adhere to or follow a therapeutic plan or suggestion. Do not record completion of an incident report in the... medical chart. Right reason: Confirm the rationale for use of medication through... ♥ researching the patient's history while also ♥ asking the patient the reason he or she is taking the drug (Rights of Med administration) Right response: Drug and its desired response Nursing Process Phase #5: Evaluation Occurs after the nursing care plan has been implemented but also needs to occur at each phase of the nursing process. Nursing Process Evaluation includes: ♥ Monitoring the fulfillment of outcomes ♥ Monitoring the patients therapeutic response to the drug ♥ Monitoring the patients adverse effects response to the drug ♥ Monitoring the patients toxic effects response to the drug ♥ DOCUMENTATION Nursing Process Evaluation Monitoring Effectiveness: Example: Diuretic ♥ Were outcomes met? ♥ Is the patient responding to the drug(s)? ♥ See if drug is working, Patient should be peeing The nursing process, as it relates to drug therapy involves: the way in which a nurse ♥ gathers ♥ analyzes ♥ organizes ♥ provides and acts upon data about the patient within the context of prudent nursing care and standards of care. Drug: Any chemical that affects the physiological process of a living organism. Pharmacology: The broadest term for the study or science of drugs. Chemical name: Complex terminology of chemical structure. Generic name: Universally accepted, less complicated terminology, most commonly used. (lower case) Trade name: Assigned by the company marketing the drug. Drug classification Grouped together based on properties (NSAIDS) and therapeutic use (analgesics, antipyretics). Pharmaceutics: The study of how various dosage forms influence the way in which the drug affects the body. Pharmacokinetics: Involves the processes of... The study of what the body does to the drug. ♥ absorption ♥ distribution ♥ metabolism ♥ excretion Pharmacodynamics: Involves... The study of what the drug does to the body. ♥ drug-receptor relationships Pharmacotherapeutics: Focuses on the clinical use of drugs to prevent and treat diseases. drug actions: The processes involved in the interaction between a drug and body cells (like the action of a drug on a receptor protein); a.k.a. mechanism of action. toxicology: The study of the adverse effects of drugs and other chemicals on living systems. Toxic: The quality of being poisonous (injurious to health or dangerous to life). Pharmacognosy: The study of drugs that are obtained from natural plant and animal sources. Pharmacoeconomics: The study of economic factors impacting the cost of drug therapy. Three Phases of Drug Activity: (Pharmacology Principles) Dose of formulated drug ♥Administration 1st Pharmaceutical Phase: Disintegration of dosage form; dissolution of drug in body. ♥Drug available for absorption 2nd Pharmacokinetic Phase: Absorption, distribution, metabolism, excretion. ♥Drug available for action 3rd Pharmacodynamic Phase: Drug receptor interaction. Effect Pharmaceutics Drug form impacts how quickly the onset of action occurs Drug Absorption of Various Oral Preparations: FASTEST--------------> SLOWEST FASTEST ♥ Oral disintegration, buccal tablets, and oral soluble wafers ♥ Liquids, elixers, and syrups ♥ Suspension solutions ♥ Powders ♥ Capsules ♥ Tablets ♥ Coated tablets ♥ Enteric-coated tablets SLOWEST *liquids absorb quicker *food impacts drug absorption Enteric Coated Tablets ♥ are not meant to break down in the stomach ♥ could be toxic if broken down in the stomach or... ♥ could possibly not work at all if broken down in the stomach Pharmacokinetics ABSORPTION: Movement of drug from the administration into the blood stream. Pharmacokinetics ABSORPTION ROUTE SLOWEST-------------> FASTEST SLOWEST ♥ Enteral: absorbed through GI tract (oral, SL, buccal, rectal) • tablets, capsules, elixirs, syrups, suppositories, etc. • First pass effect: liver breaks down drug before it reaches blood steam ♥ Topical: application/absorption through skin, eyes, ears, nose, lungs, vagina, rectum • aerosols, ointments, creams, pastes, inhalers, suppositories ♥ Parenteral: Injections (IV, IM, Subcutaneous) • solutions, suspensions, emulsions, powder for reconstituting FASTEST Will absorption take longer with a Pill or IV? A PILL Pill: has to go through liver Injection: does not go through liver Stomach-----> Liver METABOLIZED 30 mg of oral morphine equals how many mg of IV morphine? 10 mg of IV morphine *10 mg of oral morphine does not equal 10 mg of IV morphine Pharmacokinetics DISTRIBUTION: The transport of a drug by the bloodstream to its site of action. Heat and Ice v.s. Blood Vessels Heat: Dialates Blood Vessels Ice: Constricts Blood Vessels Distribution cont.: ♥ Protein-binding ♥ Water vs. fat affinity ♥ Blood supply -rapid distribution to * heart * liver * kidneys * brain (major organs) -slow distribution to *muscle *skin *fat More Albumin binding to drug means... less dosage of drug for destination organ Less Albumin binding to drug means... more dosage of drug for destination organ Drug attaches to Albumin and what's left over... goes to the destination organ Pharmacokinetics METABOLISM: biochemical alternation of a drug into a inactive metabolite, or a more/less potent active metabolite. Metabolism Organs: ♥ Liver (primary) ♥ kidneys ♥ muscle ♥ lungs ♥ Intestines ***Cytochrome P-450 Enzymes: aid in liver metabolism of fat-soluble drugs Enzyme inhibitors: drugs that delay metabolism Enzyme inducers: drugs that stimulate metabolism Substrates: Drugs that are specifically targeted by enzymes Factors that decrease metabolism: ♥ Cardiovascular dysfunction ♥ Renal insufficiency ♥ Starvation ♥ Obstructive jaundice ♥ Genetics (Slow acetylator) ♥ P-450 enzyme inhibitors ♥ Drugs Factors that increase metabolism: ♥ Genetics (Fast acetylator) ♥ Drugs (Barbiturate therapy) ♥ P-450 enzyme inducer Pharmacokinetics EXCRETION: The elimination of drugs from the body. Organs involved in excretion: ♥ Kidneys (major organ) ♥ Liver- Bile ♥ Bowel Half-Life: Time it takes for one half of the drug to be removed from the body. *5 half-lives for removal Example: What is the half-life of the following? 100 mg @ 0800 50 mg @ 1200 What time and mg would the next two half-lives be? 4 hours 25 mg @ 1600 12.5 mg @2000 Narrow Therapeutic Window: Small range from being therapeutic to being toxic. Wide Therapeutic Window: Would have to take a lot to be toxic. Therapeutic Range ONSET: The time it takes for the drug to elicit a therapeutic response. Therapeutic Range PEAK: The time it takes for a drug to reach its maximum therapeutic response. Therapeutic Range DURATION: The time a drug concentration is sufficient to elicit a therapeutic response. Therapeutic Drug Monitoring PEAK LEVEL: Highest concentration of drug in blood Therapeutic Drug Monitoring TROUGH LEVEL: Lowest concentration of drug in blood PHARMACODYNAMICS Mechanisms of drug action in tissues Natural chemical + Receptor site = Normal response Agonist drug + Receptor site = Mimicked response Natural chemical + Antagonist drug + Receptor site = Blocked response Example: Heart & Adrenalin If body is low on natural drug... 1. Agonist would: 2. Antagonist would: 1. (drug that takes place of enzyme) Make heart beat faster 2. Blocks receptor site (blocks bodies natural response from occurring) *EX: beta blocker makes heart slow Pharmacotherapeutics: Clinical use of drugs to prevent or treat disease/illness Pharmacotherapeutics types ACUTE THERAPY: Treatment for quick onset of illness Pharmacotherapeutics types MAINTENANCE THERAPY: Prevents chronic progression of illness Pharmacotherapeutics types SUPPLEMENTAL/REPLACEMENT THERAPY: Supplies substance to body to maintain function Pharmacotherapeutics types PALLIATIVE THERAPY Comfort from symptoms Pharmacotherapeutics types SUPPORTIVE THERAPY: Maintains body function during illness Pharmacotherapeutics types PROPHYLACTIC THERAPY: Prevents illness/outcome of planned event [Show Less]
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Pharmacology Exam 1 Practice Questions and answers rated A+
A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours. What is the expected duration of this medication? A.increas... [Show More] e. B.decrease. C.remain unchanged. D.dissipate. A A nurse is to administer a dose of furosemide (Lasix). The nurse is aware that Lasix is the ________ for the drug. • A.generic name B.chemical name C.nonproprietary name D.brand name D When assessing older adults and those with renal dysfunction, the nurse would expect the creatinine clearance to be which of the following? A. substantially increased. B. slightly increased. C. decreased. D. in the normal range. C A patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. The nurse would anticipate that this will interfere most with which phase of pharmacodynamics? • A. Absorption B. Distribution C. Metabolism Excretion B Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index? A.Monitoring a patient's urine output B.Assessing vital signs hourly C.Maintaining strict isolation precautions D.Monitoring serum peak and trough levels D What is the primary site of metabolism for most drugs? A. kidney. B. small intestine. C. liver. D. brain. C Children have higher metabolic rates than adults. The nurse realizes that this affects administration of medication for pain in children in all of the following ways except A.higher requirement for medication. B.increased dosage. C.decreased frequency. D.increased frequency. D A toddler requires an oral medication. It is most appropriate for the nurse to administer the oral medication A.in a nipple. B.dipped in a pacifier. C.via an oral syringe. D.mixed with formula in a bottle. C Older adults are at risk for taking many medications together. This is known as • A.tachyphylaxis. B.drug interaction. C.polypharmacy. tolerance. C Which is a physiologic change seen in the older adult that has an effect on drug administration? • A.Lower (acidic) gastric secretions B.Increased first-pass effect through the liver C.Increased glomerular filtration rate D.Lower cardiac output D When assessing older adults' renal function, which laboratory value will the nurse monitor? • A.Liver enzymes B.Serum electrolytes C.Complete blood count D.Blood urea nitrogen and creatinine D The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply) A. Dilated pupils B. Increased heart rate C. Increase gastrointestinal motility D. Vasodilation E. Bronchospasm F. Relaxed uterine muscles A, B, F Stimulation of which adrenergic receptor results in dilation of vessels and decrease in blood pressure? • A.Alpha1 B.Alpha2 C.Beta1 D.Beta2 B The nurse is teaching the patient about the side effects of atenolol. These include • A.pupillary constriction. B.blood vessel dilation. C.bronchospasm. D.tachycardia. B A nurse has just administered atropine to a patient. It is most important for the nurse to assess the patient for the development of which effect? A.Nausea B.Tachycardia C.Rales D.Hypotension B A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? • A.Asthma B.Hypertension C.Diabetes mellitus D.Chronic allergies A A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition? ● A.Diabetes mellitus B.Glaucoma C.Allergy to penicillin D.Gastric ulcer B •A patient has an allergy to sulfa drugs but she receives sulfamethoxazole accidentally. She becomes flushed and short of breath. Her heart rate is normal but her blood pressure is dropping. You first administer: • A.Epinephrine B.Diphenhydramine C.Albuterol D.Atropine A •The patient who has nasal congestion asks the nurse to recommend a decongestant medication. • Which drug the nurse can recommend to patients? •The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension. Which of the over-the-counter products below would be most appropriate to recommend? -Adrenergic Agonist- Alpha 1 - Nasal spray antihistamine (do not increase HR & BP) •An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has: • A. overused the albuterol. B. not been using albuterol. C. taken a beta-adrenergic blocker. D. taken a monoamine oxidase (MAO) inhibitor. A •The nurse is caring a patient who is experiencing urinary retention. Which type of drug to treat this condition? A.Anticholinergic B.Cholinergic agonist •The nurse is preparing to administer Bethanechol (Urecholine). The nurse notes that the patient has blood pressure of 90/60 mm Hg. What action the nurse will perform ? •Why? -B - Hold med and contact physician - Side effect of cholinergic agonist is hypotension A patient is ordered to receive bethanechol chloride for urinary retention. Which health condition would serve as a contraindication for this medication? • A.Asthma B.Hypertension C.Diabetes mellitus D.Chronic allergies A A patient is prescribed scopolamine. It is most important for the nurse to assess the patient for a history of which condition? ● A.Diabetes mellitus B.Glaucoma C.Allergy to penicillin D.Gastric ulcer B •Outside of hypnotics, we can see respiratory depression can be seen in the following______________________. 1. 2. 3. 4. Alcohol use Opioid use chronic aspiration CO2 retention •What if you wake up before your hypnotic is eliminated? 1. 2. 3. mentation impaired motor skills impaired Benzodiazepine antidote? Flumazenil (Romazicon) •A 65 year old patient is being discharged on temazepam (Restoril). This is a brand new medication for him. Provide at least 5 counseling points before you send him home..... 1. 2. 3. 4. 5. 1. don't consume with alcohol 2. don't drive 3. take right before bed 4. Monitor Blood pressure & resp rate 5. Avoid other CNS depressants •Inhaled anesthetics are easy to identify and used commonly during OR procedures. What is the most concerning adverse effect with these agents? How is this managed? -Malignant Hyperthermia -Treated with Dantrolene (muscle relaxer) Which anorexiant is not mediated through the CNS? Orlistat- Lipase inhibitor Why is Myasthenia gravis bad? •Ocular muscles, bulbar muscles, limb muscles and respiratory muscles are all involved What neurotransmitter do we need to increase in Myasthenia Gravis? Acetylcholine recptors What are the adverse effects of increasing acetylcholine? Salivation Lactation Urination Deification Bradycardia What would indicate to the nurse that the child taking methylphenidate requires more teaching? A.The child is seen drinking a cola product. B.The child checks his weight twice a week. C.The child takes the drug 45 minutes before a meal. D.The child takes the drug before breakfast and lunch. A What would indicate to the nurse that a patient taking a sedative-hypnotic requires more teaching? A.The patient wants to listen to music on the radio. B.The patient has saved her urine to be measured. C.The patient says she has taken 1800 mL of fluid today. D.The patient requests a cup of kava kava tea to help her get to sleep faster. D An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue? A."Take Benadryl pills each evening before bedtime." B."Drink warm milk or chamomile tea before bedtime." C."Develop an exercise regimen for the evening hours." D."Take naps during the day whenever you feel drowsy." B A patient is experiencing status epilepticus. The nurse anticipates immediate administration of which drug? • A.Phenobarbital B.Phenytoin C.Valproic acid D.Diazepam D Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? A.Dysphagia B.Increased libido C.Agranulocytosis D.Urinary retention C Before administering benztropine (Cogentin) for the treatment of Parkinson's disease, it is most important for the nurse to assess the patient for a history of • A.pulmonary disease. B.diabetes mellitus. C.allergy to penicillin. D.glaucoma. D A patient with Parkinson's disease is being treated with carbidopa-levodopa. The daughter asks the nurse why he needs both agents. The nurse responds, • A."The two medicines together are doubly effective." B."This combination has fewer side effects." C."You'll tolerate this better than a single-agent medication." D."The carbidopa helps the levodopa reach the brain." D A patient with myasthenia gravis comes to the emergency department in respiratory distress. He has been diagnosed with myasthenic crisis. The nurse anticipates administration of which drug? A.Diazepam B.Baclofen C.Edrophonium D.Neostigmine D The patient is admitted to the emergency department with cholinergic crisis. The nurse anticipates administration of A.atropine. B.baclofen. C.edrophonium. D.neostigmine. A A child with cerebral palsy is ordered to receive baclofen. The nurse is aware that this medication is prescribed to A.induce sleep and rest. B.increase appetite. C.reduce muscle spasticity. D.increase bowel function. C A patient has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include? (Select all that apply.) A.Avoid taking aspirin with ibuprofen. B.Take with food to reduce GI upset. C.Monitor for bleeding gums, nosebleeds, black tarry stools. D.Take herbs, ginkgo and garlic, with ibuprofen. E.Take NSAIDs 2 days before menstruation to decrease discomfort. A, B, C An older adult patient takes tolmetin for arthritis pain. Which statement made by the patient is of most concern to the nurse? A."I feel like I am coming down with a cold." B."My stomach aches and burns." C."I have a bad headache." D."I feel dizzy when I get up fast." B The nurse is caring for a client who is taking naproxen, a nonsteroidal anti-inflammatory (NSAID) drug for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client serum laboratory value is most important for the nurse to review? A.Glucose B.Total protein C.Sodium D.Hemoglobin D A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with • A.allopurinol. B.colchicine. C.adalimumab. D.infliximab. A A 35-year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab. The nurse identifies infliximab as which type of medication? A.Immunosuppressive B.Immunomodulator C.Antimalarial D.Steroid B The nurse identifies Infliximab as useful in the treatment of rheumatoid arthritis as well as A.Crohn disease. B.asthma. C.peptic ulcer disease. D.multiple sclerosis. A The patient asks the nurse how the infliximab will be administered. The nurse should respond that this medication is administered A.orally. B.subcutaneously. C.intramuscularly. D.intravenously. D The next day, the patient's pain medication is changed from morphine sulfate to hydromorphone. Which statement regarding hydromorphone does the nurse identify as being true? A.Hydromorphone must be administered intravenously. B.Hypertension is a common side effect. C.Physical dependence does not occur with hydromorphone therapy. D.Hydromorphone is more potent than morphine. D The nurse assesses a patient receiving morphine via a PCA pump. The patient has a respiratory rate of 6 breaths/min. The nurse anticipates administration of which of the following drugs? A.Naloxone B.Sumatriptan C.Nalbuphine D.Hydromorphone A [Show Less]
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Pharmacology First Exam, questions and answers
Pharmacology Scientific study of the origin, nature, chemisty, effects and use of drugs Pharmacodynamics What the medication does to the body ... [Show More] Pharmacokinetics What the body does to the medication Pharmacotherapeutics How the medication helps with the pathophysiology Nonprescription/ OTC med examples Herbal meds, vitamins, tylenol. ASK PATIENTS SPECIFICALLY IF THEY TAKE THESE Generic name most cases derived from chemical name but shorter (offical name). have to adhere to naming "rules" Trade name brand name selected by the company What should you check on the MEDS before giving them? The expiration date. Check date on cardex and computer also. What should you do if the meds are expired? Get them reordered What needs to be listed when meds are ordered? Route, name, how often, time Can you take verbal orders? NO Is "daily" an acceptable time? NO Absorption, distribution, metabolism, excretion are apart of what? Pharmacokinetics Factors affecting absorption body surface area Blood flow Pain and stress (negatively) Drug soluability (ph of stomach and GI motility) Enteral mouth or rectal small intestines (absorption depends on when peak and concentration levels are reached) Parental Injection (rapid absorption) vein, arteries, muscle (intermediate absorption) Topical skin and mucous membranes (absorption is slow) What is the fastest route of absorption? Parental What can cause physiological changes that affect drug metabolism? Diseases What is the ability to change a drug biologically from original to water soluable form Drug metabolism Why would you get a 24 hour urine? To look at by products serum drug levels (too high-toxicity) (too low-not therapeutic) How can drugs be eliminated? Through the lungs, exocrine glands, kidneys, liver, skin, and GI tract. What is a half-life? Time the total amount is dimished by 1/2 It helps determine the drug frequency Onset time when the drug is sufficiently absorbed to reach an effective blood level and distributed to elicit a therapeutic response Peak when the body absorbs more drug, blood concentration rises, more drug reaches the site of action, therapeutic response increases. (BS is low) Duration Length of time a drug concentration is sufficient in the blood to produce a therapeutic response Bioavailability Refers to the extent to which a drugs active ingredient is absorbed and transported to its site of action Why are blood concentration levels measured? To help determine whether the dosing has achieved therapeutic goals What is drug ACTION?? Interaction at the cellular level between a drug and cellular components. What is drug EFFECT?? The response resulting from drug action which may affect total body function What is the PRIMARY job of the nurse? SAFETY. After that is monitor for adverse and therapeutic effects AND documenting the findings! Drug interactions may occur between drugs, between drugs and herbs, or between..... drugs and food The more drugs a patient recieves, the greater risk for... drug interaction What happens if you drip an antibiotic in too fast? TOXICITY What happens if you give the medication at the wrong time? CONFLICT What happens in you push a med too fast? INFILTRATION What happens if you forget to give a med? LEVELS DROP. Report this! What happens if you give an antibiotic late? BACTERIA GROWS Nursing responsibilites for meds Check dose Ordered correctly? Clients weight correct? Monitor before giving drug (BP, HR) Monitor AFTER giving drug (BP, HR) Teach about drug (DONT ASSUME; ask why they are taking it) If you give a med as ordered and it wasnt right, are you liable? YES If you give a med as ordered and the order was for too much, are you liable? YES How much of the population is older adults? What percentage are on meds? 13% 30% prescribed meds 40% OTC meds 90% take atleast 1 prescribed med 12% use ten or more per week Who takes the most meds? Women, multiple health conditions, frail elderly, nursing home residents Meds used most commonly in the community analgesics, diuretics, CV, sedative-hypnotics Meds used most commonly in nursing homes antipsychotics, sedative hypnotics, dieurtetics, antihypertensives, analgesics, CV, antiboitics What question do you have to ask when giving a patient meds? Do the potential benefits outweigh the potential risks for this patient Example of drug-drug interaction Aspirin and coumadin Aspirin is an antiplatelet, but will cause more bleeding if combined with coumadin. It interferes with clotting cascade and slows clotting down. What else can interfere with drugs? Food, a physical condition, alcohol How do drug interactions occur? Drug may affect the amount of a substance in the body which then affects the way another drug is processed Drug interactions can also occur from an increase or decrease is what? Absorption, distribution, metabolism, elimination If total body water decreases, Increases serum concentration of water-soluable drugs Patient will have a prolonged half life if they have... more body fat If you have slow circulation, it may delay drugs getting to liver and kidneys (which affects the time it takes for these meds to break down and leave body) Issues with med use and older adults Mutiple medical conditions, multiple physicians, multiple pharmacies, underuse, cost, noncompliance, lack of research (we just dont know) Drug effects appear to be unpredictable which may be asummed as.... another health problem or just "old age". DONT ASSUME It is harder for the elderly to.. process and metabolize medications Side effect An action of a drug other than the one for which it is being used Adverse drug event (ADE) injury resulting from the medical use of a drug Preventable ADE those that result from a med error in prescribing, dispensing, administering, or monitoring Nonpreventable ADE an injury resulting from the medical use of a drug where NO error is involved Anaphylactic reaction A severe allergic reaction that can be life-threatening (small dose first and MONITOR) Primary thing to assess with Anaphylactic reaction AIRWAY Penicillin related antibiotics are the number 1 most common. These allergies kill 400 people in the US every year Symptoms of ADE confusion, nausea, decreased balance, change in bowel pattern. sedation, ortho hypotension (measure BP lying, sitting, standing) Significant ADE Falls w/o fractures, oversedation, rashes, hemorrhages not requiring transfusion or hospitalization without hypotension Serious ADE Delirium, falls WITH fractures, hemmorhages REQUIRING transfusions or hospitalizations WITHOUT hypotension Life-threatening ADE Hemorrhage with associated hypotension, liver failure, hypoglycemia (low BS) encephalopathy (brain disorder) Most at risk for ADE's new residents, 80+, multiple conditions, multiple meds, psychoactive meds, opioids, anti-infective drugs What errors lead to ADEs? Prescribing. monitoring, patient adherance OTC pain relievers Analgesics, antipyretics, NSAIDS, acetaminophen (toxic in high doses) What should you review on any drug being considered ACTIVE INGREDIENTS MAIN POINT The important question to ask yourself as the nurse before giving meds Do the potential benefits outweigh the potential risks for this patient If you miss a dose, can you double up on the next dose? NO Can you bring medicine into the hospital when you are admitted? YES Are OTC meds always safe to take? NO Do herbal products interact with prescription or OTC meds? YES Medication Reconciliation Process of identifying the most accurate list of all meds a patient is taking including name, dose, frequency, and route. Comparing the patients current list of meds against the physicians admission, transfer, and/or discharge orders. What causes 50% of all med errors and 20% of ADE? LACK OF COMMUNICATION (everytime a pt moves facilities, HCP should reconcile) Pharmacogenomics Genetic polymorphisms Personalized medicine Medication Administration Record Legal documentation that the nurse uses to sign off meds that are given. First-pass effect The metabolism of a drug before its systemically available, and it reduces the bioavailability (becomes available to the target tissue) of the drug High alert meds can cause significant patient harm. What do you need to do for high alert meds before giving? Check with a second RN (these meds may be on a different med cart) [Show Less]
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Pharm made easy 4.0: Introduction to Pharmacology, questions and answers
A nurse is providing teaching for a client who has a new prescription for a drug with a high potential for toxicity. Which of the following information sho... [Show More] uld the nurse include? (select all that apply) [] periodic laboratory tests are essential to measure serum drug levels [] monitoring for indications of toxicity is important [] taking the drug with an inducing agent will increase the possibility of toxicity [] taking the smallest effective dose is crucial [] increasing fluid intake is recommended to avoid toxicity Periodic laboratory tests are essential for measuring serum drug levels is correct. *Clients who are taking drugs that have a high potential for toxicity should undergo regular monitoring of serum drug levels to be certain the drug level stays within the therapeutic range. Monitoring for indications of toxicity is important is correct. *Drugs that have a high potential for toxicity can quickly build up to toxic levels in the blood, resulting in effects that can be irreversible or life-threatening. Therefore, the nurse should monitor for manifestations of toxicity particular to the drug the client is taking. Taking the smallest effective dose is crucial is correct. *It is optimal to use the lowest effective dose of a drug to achieve therapeutic effects because doing so helps minimize the risk for toxicity. A nurse is teaching a client about the adverse effects of digoxin. which of the following statements should the nurse include in the teaching? [] "adverse effects are the intended effects of the medication." [] "adverse effects indicate a severe allergy to the medication." [] "decrease your medication dose if adverse effects occur." [] "contact your provider if adverse effects occur." "contact your provider if adverse effects occur." A nurse is caring for a client who has a history of renal insufficiency and is taking lithium. The nurse should monitor the client for which of the following? [] tolerance to the drug [] drug interaction [] drug toxicity [] dependence on the drug Drug toxicity Drug toxicity develops when the amount of a drug that is taken is greater than its rate of excretion, and it results in the drug accumulating in the body. A client who has renal insufficiency might have delayed or impaired excretion of the drug. The drug dosage should be reduced if toxicity occurs. A nurse is teaching a client about naproxen enteric-coated tablets. Which of the following statements should the nurse include in the teaching? [] "drug absorption occurs in the stomach." [] "you should expect immediate absorption of the drug." [] "you should allow the tablet to dissolve in your mouth." [] "do not crush or chew the tablet." "do not crush or chew the tablet." Drugs that irritate the stomach are often covered with an enteric coating that does not dissolve until the drug enters the alkaline environment of the small intestine. Clients should not crush or chew enteric-coated drugs because this will damage the enteric coating. A nurse is caring for a client who is newly admitted to the facility for chest pain. At which of the following times should the nurse begin teaching about drugs and discharge planning? [] after the client has a definitive diagnosis [] on the day of discharge [] when the client's family members are present [] as soon as possible As soon as possible A nurse is caring for a client who was prescribed an antidepressant based on its ability to prevent the reuptake of neurotransmitters. The nurse should identify that which of the following terms describes why this drug was prescribed for the client? [] pharmacologic action [] chemical stability [] route [] adverse effects Pharmacologic action is Correct The nurse should identify that the mechanism of action of a drug on the body to achieve the desired effect is referred to as pharmacologic action. Chemical stability The nurse should identify that knowledge of how a drug should be stored and handled to maintain maximum effectiveness is referred to as chemical stability. Route The nurse should identify that route refers to the method of administering the drug, such as oral, topical, or parenterally. Adverse effects The nurse should identify that adverse effects refer to the unintended and undesired effects that drugs have on the body, which can range from annoying to life-threatening. A nurse is reviewing a drug handbook prior to administering a drug to a client who has kidney disease. The handbook states that the drug can be administered but identifies certain risks. Which of the following terms describes these risks? [] contraindications [] precautions [] paradoxical effects [] adverse effects Precautions A precaution includes disease states, such as kidney disease, or clinical situations in which use of a drug involves particular risks or dosage modification might be necessary. When reviewing a list of drugs in a drug handbook, a nurse can identify the generic name for a drug in which of the following ways? [] it begins with a lower-case letter [] it is listed in parentheses along with the trade name [] there are both letters and numbers in the name [] the chemical name is listed in parentheses before the generic name [] it begins with a lower-case letter A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the client can receive the drug? [] adverse effects [] contraindications [] implementation [] black box warning Contraindications The nurse should review the contraindications section in the drug handbook to determine if a client can receive the drug. This section lists pre-existing diseases or clinical situations that could make it unsafe to administer a drug. A nurse is caring for a client who has a new prescription for a drug. After receiving the first dose of the drug, the client experiences anaphylaxis. The nurse should identify that anaphylaxis represents which of the following results of the drug? [] adverse effect [] paradoxical effect [] therapeutic effect [] toxicity Adverse effect is correct Adverse effects are the unintended and unexpected effects of a drug, which can range from mildly annoying to life-threatening, such as an anaphylactic reaction. Paradoxical effect Paradoxical effects are the opposite of the intended or desired effect of a drug, such as a drug intended to aid with sedation causing increased excitability in certain clients. Therapeutic effect A therapeutic effect is the intended benefit of the drug for the client. Toxicity Toxicity occurs when the client receives a drug in excessive dosages. Manifestations of toxicity differ between drugs. A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the drug has more than one use? [] Adverse effects [] indications [] pharmacokinetics [] nursing implications Indications is Correct The indications section provides information on conditions and diseases for which the drug is used. Adverse effects This section categorizes the adverse effects of a drug. Pharmacokinetics The pharmacokinetics section outlines how the drug is processed in the body through absorption, distribution, metabolism, and excretion, but it does not address the disease or conditions that the drug is used to treat. Nursing implications The nursing implications section explains how the nurse will apply the nursing process to the use of the drug. A nurse is caring for a client who is postpartum and breastfeeding. The client asks the nurse about the effects that taking over-the-counter drugs will have on her newborn. Which of the following should the nurse consider when recommending a drug for the client? (select all that apply) [] the newborn's weight [] how much breast milk the newborn consumes each day [] whether or not the benefits to the client outweigh the risks to the newborn [] the properties of the drug [] the route of administration of the drug The newborn's weight is correct. *The nurse should consider the weight of the newborn when recommending a drug for a client who is breastfeeding. The lower the newborn's weight, the greater the effects of the drug absorbed via breastmilk will be to the newborn. How much breast milk the newborn consumes each day is correct. *The nurse should consider the amount of breast milk the newborn consumes per day when recommending a drug for a client who is breastfeeding. The more breast milk the newborn consumes, the more of the drug is likely to be absorbed into the newborn's circulation. Whether or not the benefits to the client outweigh the risks to the newborn is correct. *The nurse should weigh the benefits against the risks when recommending a drug for a client who is breastfeeding. If the benefits will be minimal, it is generally not worth the risk to the newborn. The properties of the drug is correct. *The nurse should consider the properties of the drug when recommending a drug for a client who is breastfeeding. Certain drugs can transfer more easily into breast milk, depending on properties like fat solubility. A nurse is caring for a client who is having difficulty remembering to take their prescribed drug three times each day. The nurse should identify that which of the following alternate forms of the drug can help to promote adherence to the prescribed dosage? [] liquid suspension [] immediate-release capsule [] extended-release tablet [] powder form Extended-release tablet Extended-release tablets release the drug over an extended period of time. Clients can take them less frequently. A nurse is preparing to teach a client how to take care of a newly created colostomy. The nurse should identify that which of the following factors can decrease the client's ability to learn? (select all that apply) [] impaired cognitive level [] language barrier [] discomfort [] repetition of teaching [] unreadiness to learn [] impaired cognitive level [] language barrier [] discomfort [] unreadiness to learn A nurse is speaking to a client who is taking sertraline and reports drinking grapefruit juice. The nurse explains that grapefruit juice inhibits an enzyme in the liver that is used to metabolize sertraline. The nurse should recognize the client's risk for which of the following? [] reduced drug absorption [] drug dependence [] altered drug distribution [] drug toxicity Drug toxicity Grapefruit juice can cause increased levels of certain drugs, such as sertraline, which can lead to drug toxicity. Clients should avoid drinking grapefruit juice while taking these drugs. A nurse is caring for a client who is receiving nitroglycerin IV and is switching to the oral form of the drug. The nurse should identify that the oral dose will be higher than the IV dose for which of the following reasons? [] the IV form crosses the blood-brain barrier [] the oral form has a decreased half-life [] the oral form has decreased bioavailability because of the first-pass effect [] the oral form has an increased rate of excretion The oral form has decreased bioavailability because of the first-pass effect Oral doses are often larger than IV doses of the same drug because of the first-pass effect by the liver, which reduces the bioavailability of the drug. Enzymes in the liver metabolize drugs, making less of the drug available for use by the body. A nurse is obtaining a client's health history. The client reports no allergies but has experienced mild itching while taking amoxicillin in the past. Which of the following responses should the nurse make? [] "itching is an expected adverse effect of amoxicillin." [] "itching can indicate amoxicillin toxicity." [] "itching can indicate a hypersensitivity to amoxicillin." [] "itching can result from dry skin, which is often caused by amoxicillin." "itching can indicate hypersensitivity to amoxicillin. Itching can be an indication of drug hypersensitivity, and a more severe allergic reaction can develop with future exposures. The client might be allergic to amoxicillin and other penicillins. A nurse is caring for a client who is taking diphenhydramine for insomnia and reports drowsiness. The nurse should identify that drowsiness indicates which of the following? [] therapeutic effect [] adverse reaction [] contraindication [] precaution Therapeutic effect Drowsiness is a therapeutic effect of diphenhydramine for a client who is taking the drug to treat insomnia. A nurse is preparing to teach a client about a newly prescribed drug. Prior to providing teaching, the nurse should review the precautions section of a drug handbook for which of the following reasons? [] to determine drug-food interactions [] to determine if dosage modification is indicated [] to determine how the drug is absorbed [] to determine availability To determine if dosage modification is indicated The precautions section includes diseases or clinical situations in which drug use involves particular risks or dosage modification might be necessary, such as the presence of a client condition or restrictions due to the client's age. A nurse is providing teaching to a pregnant client who is taking captopril, an ACE inhibitor, to treat hypertension. The nurse informs the client that captopril is a teratogenic drug. The nurse should explain that teratogenic drugs can cause which of the following? [] maternal bleeding [] maternal blood clots [] gestational diabetes mellitus [] fetal malformation fetal malformation Teratogenic drugs can cause birth defects. Clients who are pregnant should not take these drugs. A nurse is caring for a client who is taking acetaminophen and codeine for pain relief. These analgesic drugs interact with one another to cause an additive effect. The nurse should identify that which of the following are characteristics of additive drug interactions? (select all that apply) [] clients can achieve desired effects with the use of lower dosages [] taking the two drugs together can reduce the effects of one or both drugs [] taking the two drugs together can potentiate the effects of one or both drugs [] the two drugs can produce an action neither would have produced alone [] both drugs have similar actions Clients can achieve desired effects with the use of lower dosages is correct. *When two or more drugs are given at the same time and have similar actions, an additive effect will occur. Clients can take some drugs together for their additive effects, so they can take lower doses of each drug. Both drugs have similar actions is correct. *Additive effects occur when two or more drugs with similar actions are taken at the same time. [Show Less]
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