Chapter 5- Adverse Effects and Drug Interactions
1. Talwin given in combination with Vistaril diminishes the adverse effects of nausea caused by the
... [Show More] Talwin. This drug interaction affecting the pharmacodynamics of the Talwin is
A) an additive effect.
B) a synergistic effect.
C) a potentiated effect.
D) an antagonistic effect. Ans: D
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An antagonistic drug interaction results in a therapeutic effect that is less than the effect of either drug alone because the second drug either diminishes or cancels the effects of the first drug. An additive effect occurs when two or more “like” drugs are combined and the result is the sum of the drugs' effects. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. Potentiation is an interaction in which the effect of only one of the two drugs is increased.
2. On the 1 AM rounds, the nurse finds a patient awake and frustrated that she cannot go to sleep. The nurse administers an ordered hypnotic to help the patient sleep. Two hours later, the nurse finds the patient out of bed, full of energy and cleaning her room. The nurse evaluates the patient's response to the hypnotic as
A) an allergic reaction.
B) an idiosyncratic response.
C) a synergistic effect.
D) a teratogenic effect. Ans: B
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An idiosyncratic response is an unusual or opposite effect of what is intended. A response of this nature is related to a person's unique response to a drug rather than to the dose of a drug. An allergic reaction is an immune system response. A synergistic effect occurs when two or more “unlike” drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drug's activity alone. A teratogenic effect is a physical defect in the developing fetus caused by a drug or a vaccine that the mother took during pregnancy.
3. The nurse is caring for a patient receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which of the following will alert the nurse that the patient may be experiencing nephrotoxicity?
A) Visual disturbances
B) Yellowing of the skin
C) A decrease in urine output
D) Ringing noise in the ears Ans: C
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Decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid–base balance, and electrolyte imbalances can occur with nephrotoxicity. Ringing noise in the ears (tinnitus) is an indication of possible ototoxicity. Visual disturbances can suggest neurotoxicity, and yellowing of the skin (jaundice) is a sign of hepatotoxicity.
4. A nurse is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The nurse suspects that the change in the effectiveness of the drug is related to
A) the impact of the placebo effect on the patient's response.
B) the accumulative effect of the drug if it has been taken for many years.
C) the impact of the warmer climate on the patient's physical state.
D) problems with patient compliance with the drug regimen due to the move. Ans: C
Feedback:
Antihypertensive drugs work to decrease blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure decreases. If a patient is taking an antihypertensive drug and enters a warmer climate, there is a chance that the patient's blood pressure will drop too low, resulting in dizziness and a feeling of weakness. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. Most antihypertensives are metabolized and excreted and do not accumulate in the body. The patient has not given the nurse any information that would indicate that she has not been compliant with her drug regimen due to the move. [Show Less]