HESI Pharmacology Combined Study Guide with Practice Questions and Answers
HESI Pharmacology Combined Study Guide with Practice Questions and
... [Show More] Answers.
- Community: PARKINSON medication
• Assess for signs and symptoms of PD
Masklike expression
Speech problems
Dysphagia
Rigidity of arms, legs, and neck
• Main med is Sinemet: Levodopa/Carbidopa
• Levodopa converted to dopamine.
• Carbidopa increase its effectiveness and prevents or les sens levodopa side effects
• Levodopa side effects: nausea, vomiting, heart rhythm disturbance
• TEACHINGS: Take on empty stomach at least 30 minutes, or one hour before meals
o There are two forms of Sinemet, controlled-release or immediate-release Sinemet. Controlled-release (CR) Sinemet and immediate-release Sinemet are equally effective in treating the symptoms of Parkinson's disease, but some people prefer the controlled release version.
- Cardio vascular - Nitroglycerin- Decreases BP
• Nitroglycerin – Anti ANGINA Meds, chronic heart failure
Prototypical nitrate : POTENT VASODILATOR
Large first-pass effect with oral forms
Used for symptomatic treatment of ischemic heart conditions (angina)
IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies
Available form: Sublingual tablets, sprays and patches
• Nitroglycerin Teaching
Instruct patients in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain
Instruct patients never to chew or swallow the sublingual form
Instruct patients that a burning sensation felt with sublingual forms indicates that the drug is still potent
Instruct patients to keep a fresh supply of sublingual medication on hand; potency is lost in about 3 months after the bottle has been opened
To preserve potency, medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler
• If anginal pain occurs:
Stop activity and sit or lie down, and take a sublingual tablet
If no relief in 5 minutes, call 911/Emergency Services immediately and take a second sublingual tablet
If no relief in 5 minutes, take a third sublingual tablet
Do not try to drive to the hospital
- Med Administration
o Doses
o Secondary infusion (drip rates)
o Peak & Trough schedule
Peak level
˜Highest blood level
Trough level
˜Lowest blood level
o Tetracycline – is a form of ANTIBIOTICS
Bacteriostatic—inhibit bacterial growth
Inhibit protein synthesis
Stop many essential functions of the bacteria
Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines
Should not be used in children under age 8 or in pregnant/lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth
Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed; they should not stop taking the medication early when they feel better
Assess for signs and symptoms of superinfection: fever, perineal itching, cough, lethargy, or any unusual discharge
The most common adverse effects of antibiotics are nausea, vomiting, and diarrhea
All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water
Tetracyclines
• Avoid milk products, iron preparations, antacids, and other dairy products because of the chelation and drug-binding that occurs
• Take all medications with 6 to 8 ounces of fluid, preferably water
• Because of photosensitivity, avoid sunlight and tanning beds
o Transdermal Fentanyl (DURAGESIC) – OPIOID ANALGESIC Chapter 10
Fentanyl Transdermal System is indicated for the management of pain in opioid-tolerant patients, severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.
Patients considered opioid-tolerant are those who are taking, for one week or longer, at least 60 mg of morphine daily, or at least 30 mg of oral oxycodone daily, or at least 8 mg of oral hydromorphone daily, or an equianalgesic dose of another opioid.
- Nutrition
o Orlistat - ALLI (side effects : weight loss/poop)
- Med Administration
o Aldactone – heart failure meds: Aldosterone agonist chp 24.
Potassium-sparing diuretic
Also acts as an aldosterone antagonist, which has been shown to reduce the symptoms of heart failure
Treats high blood pressure. Also treats fluid retention and related conditions such as heart failure. Used to treat high levels of aldosterone and low potassium levels. This medicine is a potassium-sparing diuretic.
Diuretic drugs – take in the morning.
Primary hyperaldosteronism
o Long test: ALDACTONE is administered at a daily dosage of 400 mg for three to four weeks.
o Short test: ALDACTONE is administered at a daily dosage of 400 mg for four days.
o ALDACTONE may be administered in doses of 100 to 400 mg daily in preparation for surgery.
Edema in adults (congestive heart failure, hepatic cirrhosis, or nephrotic syndrome)
o An initial daily dosage of 100 mg of ALDACTONE administered in either single or divided doses is recommended, but may range from 25 to 200 mg daily.
Essential hypertension
o For adults, an initial daily dosage of 50 to 100 mg of ALDACTONE administered in either single or divided doses is recommended.
Hypokalemia
o ALDACTONE in a dosage ranging from 25 mg to 100 mg daily is useful in treating a diuretic-induced hypokalemia, when oral potassium supplements or other potassium-sparing regimens are considered inappropriate.
Severe heart failure (NYHA class III – IV)
- Treatment should be initiated with ALDACTONE 25 mg once daily if the patient's serum potassium is ≤ 5.0 mEq/L and the patient's serum creatinine is ≤ 2.5 mg/dL. Patients who tolerate 25 mg once daily may have their dosage increased to 50 mg once daily as clinically indicated. Patients who do not tolerate 25 mg once daily may have their dosage reduced to 25 mg every other day.
o Antihistamine: PRECAUTIONS
Interacts with OPIOID ANALGESICS
Interacts with barbiturates
Anticholinergic properties – blocks neurotransmitters
Sedative properties
Dries up most glands
Best tolerated when taken with meals—reduces GI upset
If dry mouth occurs, teach patient to perform frequent mouth care, chew gum, or suck on hard candy (preferably sugarless) to ease discomfort
o Boniva (side effects)
Used for osteoperosis
that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water.
Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects.
o Bulk forming laxative
Bulk-forming
• High fiber
• Absorb water to increase bulk
• Distend bowel to initiate reflex bowel activity
• Examples
o psyllium (Metamucil)
o methylcellulose (Citrucel)
Patients should take all laxative tablets with 6 to 8 oz of water
Patients should take bulk-forming laxatives as directed by the manufacturer with at least 240 mL (8 oz) of water
o Dilaudid (Hydromorphone) (side effects) – an opiod pain medication
commonly used in the hospital setting, mostly intravenously (IV) because its bioavailability orally, rectally, and intranasally is very low.
- NO st. john’s worts
o weak or shallow breathing
o pounding heartbeats or fluttering in your chest
o wheezing, chest tightness, trouble breathing
o seizure (convulsions)
o confusion, severe weakness or drowsiness; or
o feeling like you might pass out
o Steroids (taper off)
If you abruptly stop taking steroids or taper off too quickly, you might experience prednisone withdrawal symptoms:
•Severe fatigue
•Weakness
•Body aches
•Joint pain
A gradual reduction in dosage gives your adrenal glands time to resume their normal function.
o Antibiotic resistance
Don’t overuse antibiotics, takes the efficacy away
- Nutrition
o Vitamin D Overdose
Too much vitamin D can cause an abnormally high blood calcium level, which could result in nausea, constipation, confusion, abnormal heart rhythm, and even kidney stones.
- Teaching
o Baclofen (side effects)
Baclofen Overview - Patient Information: Side Effects. SIDE EFFECTS: Drowsiness, dizziness, weakness, tiredness, headache, trouble sleeping, nausea, or constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
- Neuro - Aricept nursing implication
Meds used for mild to moderate alzheimers diseases
Medications should be taken as ordered and not abruptly stopped
Doses should be spread evenly apart to optimize the effects of the medication
JULES
- Cardio Vascular
o Coumadin precautions
˜Bleeding
ØRisk increases with increased dosages
ØMay be localized or systemic
˜May also cause:
ØHeparin-induced thrombocytopenia (HIT)
ØNausea, vomiting, abdominal cramps, thrombocytopenia, others
Patient & Family Education
• Understand that bleeding can occur even though PT/INR are within therapeutic range. Stop drug and notify physician immediately if bleeding or signs of bleeding appear: Blood in urine, bright red or black tarry stools, vomiting of blood, bleeding with tooth brushing, blue or purple spots on skin or mucous membrane, round pinpoint purplish red spots (often occur in ankle areas), nosebleed, bloody sputum; chest pain; abdominal or lumbar pain or swelling, profuse menstrual bleeding, pelvic pain; severe or continuous headache, faintness or dizziness; prolonged oozing from any minor injury (e.g., nicks from shaving).
• Stop drug and report immediately any symptoms of hepatitis (dark urine, itchy skin, jaundice, abdominal pain, light stools) or hypersensitivity reaction (see Appendix F).
• Avoid brand interchange, take drug at same time each day, and do NOT alter dose.
• Notify physician if there is an unusual increase in menstrual bleeding (slightly increased or prolonged). Note: PT/INR are checked at least monthly in menstruating women.
• Risk of bleeding is increased for up to 1 mo after receiving the influenza vaccine.
• Fever, prolonged hot weather, malnutrition, and diarrhea lengthen PT/INR (enhanced anticoagulant effect).
• A high-fat diet, sudden increase in vitamin K–rich foods (cabbage, cauliflower, broccoli, asparagus, lettuce, turnip greens, onions, spinach, kale, fish, liver), coffee or green tea (caffeine), or by tube feedings with high vitamin K content shorten PT/INR.
• Maintain a well-balanced diet and avoid excess intake of alcohol.
• Inform dentist or any new physician about anticoagulant therapy and duration of treatment.
• Use a soft toothbrush and floss teeth gently with waxed floss.
• Use barrier contraceptive measures; if you become pregnant while on anticoagulant therapy the fetus is at great potential risk of congenital malformations.
• Do not take any other prescription or OTC drug unless specifically approved by physician or pharmacist. Carry medical identification at all times. It needs to indicate medical diagnosis, medication(s), physician's name, address, and telephone number.
Do not breast feed while taking this drug without consulting physician.
o Digoxin toxicity (signs and symptoms)
• Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm, when digoxin is prescribed for atrial fibrillation.
• Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances.
• Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.
• Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day.
• Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician.
• Continue with brand originally prescribed unless otherwise directed by physician.
Do not breast feed while taking this drug without consulting physician.
o Dopamine IV infiltration
DOPAMINE, after dilution, is administered intravenously through a suitable intravenous catheter or needle. An i.v. drip chamber or other suitable metering device is essential for controlling the rate of flow in drops/minute. Each patient must be individually titrated to the desired hemodynamic and/or renal response with DOPAMINE. In titrating to the desired increase in systolic blood pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the hemodynamic condition is stabilized.
Administration rates greater than 50 mcg/kg/minute have safely been used in advanced circulatory decompensation states. If unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution.
o Lasix & Cramps (loss of potassium)
One of LAsix side effects is cramps.
Assessment & Drug Effects
• Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported.
• Monitor for S&S of hypokalemia
• Monitor BP during periods of diuresis and through period of dosage adjustment.
• Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.
• Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter.
• Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.
• Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.
• Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents.
Patient & Family Education
• Consult physician regarding allowable salt and fluid intake.
• Ingest potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion.
• Learn S&S of hypokalemia (see Appendix F). Report muscle cramps or weakness to physician.
• Make position changes slowly because high doses of antihypertensive drugs taken concurrently may produce episodes of dizziness or imbalance.
• Avoid replacing fluid losses with large amounts of water.
• Avoid prolonged exposure to direct sun.
Do not breast feed while taking this drug.
o Labetalol & weight gain
Labetalol is a is a mixed alpha/beta adrenergic antagonist, which is used to treat high blood pressure.[1]
Inform patients to report the following to their physician: Weight gain of more than 2 pounds in 1 day or 5 pounds in 1 week
- Endocrine
o Byetta & hypoglycemia
Injectable Antidiabetic Drugs˜
• Incretin mimetics: exenatide (Byetta)
• Improves glycemic control in people with type 2 diabetes mellitus by mimicking the functions of incretin, a glucagon-like peptide-1 (GLP-1). Exenatide enhances glucose-dependent insulin secretion by pancreatic beta-cells, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying. These actions decrease glucagon stimulation of hepatic glucose output and decrease insulin demand.
Hypoglycemia
• ˜Abnormally low blood glucose level (below 50 mg/dL)
• ˜Mild cases can be treated with diet—higher intake of protein and lower intake of carbohydrates—to prevent rebound postprandial hypoglycemia
o Thyroid & overdose signs
Symptoms of thyroid overdose can include diarrhea, irregular heartbeat, headache, tremors, nervousness, stomach cramps, fever, chest pain, or difficulty sleeping. If you suspect an overdose, contact your local poison control center or emergency room immediately. There are two ways to overdose.
There are two ways to overdose. Accidental overdoses can happen in one of two ways: you may forget you've already taken your medication, or your pharmacist dispensed a higher dosage tablet than the one ordered by your physician.
The second way to overdose is iatrogenic: the doctor prescribes too high a dose. Since many of the symptoms of overdose are the same as untreated or under-treated hypothyroidism, you may end up needing to see an endocrinologist if your internist or other prescribing physician is not responsive to your report of continuing or new symptoms.
o Intranasal antidiuretic hormone
Intranasal steroids
˜Vasopressin and desmopressin
ØUsed in the treatment of diabetes insipidus
ØBecause of their vasoconstrictor properties, they are useful in the treatment of various types of bleeding, in particular gastrointestinal hemorrhage
ØDesmopressin is useful in the treatment of hemophilia A and type I von Willebrand’s disease because of its effects on various blood-clotting factors
ØDesmopressin and vasopressin should reduce severe thirst and decrease urinary output
Vasopressin is also a potent vasoconstrictor in larger doses and is therefore used in certain hypotensive emergencies, such as vasodilatory shock (septic shock). It is also used in the Advanced Cardiac Life Support (ACLS) guidelines for treatment of pulseless cardiac arrest. Desmopressin is useful in treating certain blood disorders. Cosyntropin is used in the diagnosis of adrenocortical insufficiency. Somatropin and somatrem are effective in stimulating skeletal growth in patients with an inadequate secretion of normal endogenous GH.
o Glucagon emergency kit
Glucagon Emergency Kit is small and portable, keeps all the items needed to administer Glucagon, and comes in a bright red case which is easy to recognize in an emergency. The Glucagon Kit is for family, friends, or caregivers to use in case of an emergency. You should talk to the people who need to be prepared to use Glucagon in case you have a severe low blood sugar event. They should become familiar with the kit before an emergency arises.
This medication is the same as your body's own glucagon, a natural substance that raises blood sugar by causing the body to release sugar stored in the liver. It is used to quickly increase blood sugar levels in diabetics with low blood sugar (hypoglycemia) who cannot take a quick source of sugar (e.g., fruit juices, table sugar, regular soda) by mouth.
Glucagon is also given before some X-ray procedures of the gut to slow down the movement of the stomach, intestines, and colon, thereby giving a better X-ray picture.
- GI
o Lactulose -monitor Labs
LAB TESTS, including blood electrolyte levels, may be performed while you use lactulose solution. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Lactulose helps to reduce blood ammonia levels by converting ammonia to ammonium, which can then be eliminated by the body.
o Prevacid (GERD)
Prevacid – PPI
˜Irreversibly bind to H+/K+ ATPase enzyme
˜This bond prevents the movement of hydrogen ions from the parietal cell into the stomach
˜Results in achlorhydria—ALL gastric acid secretion is temporarily blocked
ØTo return to normal acid secretion, the parietal cell must synthesize new H+/K+ ATPase
˜Assess for allergies and history of liver disease
˜Not all are available for parenteral administration
˜May increase serum levels of diazepam and phenytoin; may increase chance for bleeding with warfarin
Food may decrease absorption of the proton pump inhibitors, and it is recommended that they be taken on an empty stomach. They are taken on a daily basis, not as needed for heartburn.
o Tigan side effects
Tigan: tx of postop n/v and for nausea associated with gastroenteritis
o Stop using this medication and call your doctor at once if you have any of these serious side effects:
o jaundice (yellowing of the skin or eyes);
o seizure (convulsions);
o easy bruising or bleeding, unusual weakness;
o tremor (uncontrolled shaking); or.
o muscle cramps, severe muscle spasms.
o Ketorolac side effects
Less serious side effects may include:
upset stomach, mild nausea or vomiting, diarrhea, constipation.
mild heartburn, stomach pain, bloating, gas.
dizziness, headache, drowsiness.
sweating; or.
ringing in your ears.
o Tylenol overdose & lab values (liver)
The serum acetaminophen (APAP) concentration is the basis for diagnosis and treatment, even in the absence of symptoms, because of the delay in onset of clinical manifestations of toxicity. After a single ingestion, N -acetylcysteine (NAC) therapy is guided by the serum APAP concentration. An APAP level 4 hours post ingestion of greater than 150 mcg/mL (>993 µmol/L) reflects possible toxicity.
Obtain liver function tests (LFTs). Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels begin to rise within 24 hours after an acute ingestion and peak at about 72 hours. In severe overdose, transaminase elevation can be detected as early as 12-16 hours post-ingestion. Toxicity is defined as serum AST or ALT levels greater than 1000 IU/L. A rapid progression of transaminase values to 3000 IU/L or higher reflects worsening hepatotoxicity. Include bilirubin and alkaline phosphatase levels.
- Immune/Hematology
o Allergy assess
Blood tests are available that measure levels of immunoglobulin E (IgE) against specific allergens such as foods, inhalants, medications, latex, and venoms. These tests can confirm the diagnosis of an allergic disorder, supplementing a clinical history consistent with an immediate allergic reaction. They are particularly useful when skin testing cannot or should not be performed.
o Epivir HIV: Epivir = Lamivudine
What is lamivudine?
• Lamivudine is an HIV medication. It is in a category of HIV medications called nucleoside reverse transcriptase inhibitors (NRTIs). Lamivudine prevents HIV from altering the genetic material of healthy CD4 cells. This prevents the cells from producing new virus and decreases the amount of virus in the body.
• Lamivudine was approved for the treatment of HIV by the U.S. Food and Drug Administration (FDA) in 1995. Epivir, the brand name version of lamivudine, is sold in the U.S. by ViiV Healthcare. Generic lamivudine is sold in the U.S. by various manufacturers.
• Epivir and generic lamivudine are available in pharmacies as a single drug. Epivir is also available in combination tablets, notably Epzicom (Ziagen and Epivir) and Combivir (Retrovir [zidovudine] and Epivir). A generic combination tablet containing lamivudine plus zidovudine is also available.
• Lamivudine is also approved for the treatment of chronic hepatitis B infection (Epivir HBV). The lamivudine dose normally used to treat hepatitis B is one 100mg tablet once a day. The dose used to treat HIV is one 300mg tablet once a day, or one 150mg tablet every 12 hours. If you are infected with both HIV and hepatitis B, it is important that you take the dose used to treat HIV.
• Lamivudine must be used in combination with other HIV drugs.
o Lab/Lovalox = Lovenox
Lovenox anti coagulant, used for treatment of DVT
Periodic complete blood counts, including platelet count, and stool occult blood tests are recommended during the course of treatment with Lovenox. When administered at recommended prophylaxis doses, routine coagulation tests such as Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) are relatively insensitive measures of Lovenox activity and, therefore, unsuitable for monitoring. Anti-Factor Xa may be used to monitor the anticoagulant effect of Lovenox in patients with significant renal impairment. If during Lovenox therapy abnormal coagulation parameters or bleeding should occur, anti-Factor Xa levels may be used to monitor the anticoagulant effects of Lovenox
o Myasthenia gravis
o ˜Encourage patients with myasthenia gravis to take medication 30 minutes before eating to help improve chewing and swallowing
o
Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them.
There is no known cure for myasthenia gravis. Treatment may allow you to have periods without any symptoms (remission).
Lifestyle changes often help you continue your daily activities. The following may be recommended:
Resting throughout the day
Using an eye patch if double vision is bothersome
Avoiding stress and heat exposure, which can make symptoms worse
Medicines that may be prescribed include:
Neostigmine or pyridostigmine to improve the communication between the nerves and the muscles
Prednisone and other medications (such as azathioprine, cyclosporine, or mycophenolate mofetil) if to suppress the immune system response, if you have severe symptoms and other medicines have not worked well.
Crisis situations are attacks of weakness of the breathing muscles. These attacks can occur without warning when either too much or too little medicine is taken. These attacks usually last no longer than a few weeks. You may need to be admitted to the hospital where you may need breathing assistance with a ventilator.
If you have eye problems, your doctor may suggest lens prisms to improve vision. Surgery may also be recommended to treat your eye muscles.
Physical therapy can help maintain your muscle strength. This is especially important for the muscles that support breathing.
Some medicines can worsen symptoms and should be avoided. Before taking any medicine, check with your doctor whether it is okay for you to take.
- Neurological
o Dylantol - Dilantin
Long-term therapy with phenytoin (Dilantin) may cause gingival hyperplasia, acne, hirsutism, and Dilantin facies
o Mygranol – treats tension headaches
o Narcotics & PCA pump
˜PCA and “PCA by proxy”
˜Patient comfort vs. fear of drug addiction
˜Opioid tolerance
˜Use of placebos
˜Recognizing patients who are opioid tolerant
˜Breakthrough pain
˜Synergistic effect
- Oncology
o Androgen Block
Synthetic testesterone
Hormone Therapy for Prostate Cancer
˜Used to treat prostate cancer (GnRH Analog)
• ˜goserelin (Zoladex)
• ˜leuprolide (Lupron)
• ˜triptorelin (Trelstar)
- Renal
o Bacteren effect
o Muscarinic
- Respiratory
o Antitussive
Drugs used to stop or reduce coughing
Opioid and nonopioid
Used only for nonproductive coughs!
May be used in cases where coughing is harmful
Used to stop the cough reflex when the cough is nonproductive and/or harmful
benzonatate
• ØDizziness, headache, sedation, nausea, and others
dextromethorphan
• ØDizziness, drowsiness, nausea
Opioids
• ØSedation, nausea, vomiting, lightheadedness, constipation
o
o Rifampin (oral contraceptive)
Used to treat tuberculosis
Increases metabolism
Decrease effectiveness of oral contraceptive
Rifampin causes oral contraceptives to become ineffective; another form of birth control will be needed
Rifampin – side effects
• Hepatitis; discoloration of urine, stools, and other body fluids
• Perform liver functions
o Tetracycline (oral contraceptive)
When these two medicines are taken together, the tetracycline medicine may alter the way your body processes the birth control pill.
The effects of your birth control pills may decrease and cause breakthrough bleeding, spotting, or even an unintended pregnancy.
General consensus is that a backup method of birth control is not needed while taking this antibiotic.
o Theophylline
- The main therapeutic uses of theophylline are aimed at:
- chronic obstructive pulmonary disease (COPD)
- asthma
- infant apnea
- Blocks the action of adenosine, an inhibitor neurotransmitter that induces sleep, contracts the smooth muscles and relaxes the cardiac muscle.
- Sensory
o Garamycin : ANTIBIOTIC
Gentamicin may cause damage to the kidneys and/or nerves.
Kidney function and drug levels in the blood may be monitored with blood tests during treatment.
Tell your doctor if you experience hearing loss, dizziness, numbness, skin tingling, muscle twitching, or seizures which may be signs of nerve damage.
o Pilocarpine
Use of pilocarpine may result in a range of adverse effects, most of them related to its non-selective action as a muscarinic receptor agonist.
Pilocarpine has been known to cause excessive salivation, sweating, bronchial mucus secretion, bronchospasm, bradycardia, vasodilation, and diarrhea.
Eye drops can result in brow ache and chronic use in miosis.
Systemic injection of pilocarpine can compromise the blood brain barrier allowing pilocarpine to gain access to the brain which can lead to chronic epilepsy.
Epilepsy induced by injected pilocarpine has been used to develop animal models in rodents in order to study human epilepsy.
- Reproductive
o Anabolic side effects
o The long list if side effects from anabolic steroids include shrinking of testicles, breast enlargement (gynecomastia), low sperm count, increased hair growth, deeper voice and reduced breast size in women, high blood pressure, heart attack, stroke, high cholesterol, rage, violence and aggression.
- Psychosis
o Ambilify Atypical antipsychotic
ØInstruct patients to wear sunscreen because of photosensitivity
ØTell patients to avoid taking antacids or antidiarrheal preparations within 1 hour of a dose
ØInform patients to avoid alcohol or other CNS depressants with these medications
ØOral forms may be taken with meals to decrease GI upset
ØThese drugs may cause drowsiness, dizziness, or fainting; instruct patients to change positions slowly
o ˜Monitor for therapeutic effects (cont’d)
ØFor antipsychotics
•Improved mood and affect
•Alleviation of psychotic symptoms and episodes
•Decreased hallucinations, paranoia, delusions, garbled speech, and inability to cope
o Lithium
Mood Stabilizers – Lithium is the drug of choice for the treatment of mania
Ø It is thought to potentiate serotonergic neurotransmission
Ø Narrow therapeutic range: maintenance serum levels should range between 0.6 and 1.2 mEq/L
Assess sodium level before administration – make sure sodium level isn’t too low
- Abuse
o Lamisil
o Contraindication
˜Liver failure
˜Renal failure
˜Porphyria (griseofulvin)
˜Drug allergy
o
- Teaching
o Grief
o Psychotropic drugs
˜Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected
˜Advise patients to avoid abrupt withdrawal
˜Advise patients to change positions slowly to avoid postural hypotension and possible injury
˜The combination of drug therapy and psychotherapy is emphasized because patients need to learn and acquire more effective coping skills
˜Only small amounts of medications should be dispensed at a time to minimize the risk of suicide attempts
˜Simultaneous use of these drugs with alcohol or other CNS depressants can be fatal
o
Questions:
Chapter 15: Antiparkinson meds
**The “off-on phenomenon” that some patients with Parkinson’s disease (PD) experience is best explained as the
A.need to take a drug holiday to improve response to medications.
B.variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms.
C.alternating schedule of medications needed to control PD.
D.fluctuation of emotions that often occurs with PD.
Which drug used for the management of the patient with Parkinson’s disease is most likely to cause postural hypotension?
A.amantadine (Symmetrel)
B.selegiline (Eldepryl)
C.tolcapone (Tasmar)
D.entacapone (Comtan)
The beneficial role of the NDDRA ropinirole (Requip) is that it
A.appears to delay the start of levodopa therapy.
B.allows for levodopa therapy to begin earlier.
C.improves the patient’s tolerance of parkinsonian symptoms.
D.replaces dopamine in the brain.
When providing teaching to a patient receiving an anticholinergic for the treatment of Parkinson’s disease, the nurse will include which information?
A.Take the medication first thing in the morning.
B.Limit fluid intake when taking this drug.
C.The tremors you experience will be reduced within 24 hours of taking this drug.
D.Do not take this medication at the same time as other medications.
Chapter 23 – Anti Anginal DRUGS
A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be?
A.Take his nitroglycerin tablet
B.Stop mowing and sit or lie down
C.Go inside the house to cool off and get a drink of water
D.Call 911
A patient with extremely high blood pressure is in the emergency department. The physician will be ordering therapy with nitroglycerin to manage the patient’s blood pressure. Which form of nitroglycerin is most appropriate?
A.Sublingual spray
B.Transdermal patch
C.Oral capsule
IV infusion
A patient who was walking his dog developed chest pain and sat down. He continues to experience chest pain when sitting down. When should he call 911?
A.Immediately
B.If the pain becomes more severe
C.If one sublingual tablet does not relieve the pain after 5 minutes
If the pain is not relieved after three sublingual tablets, taken 5 minutes apart
A patient asks how to apply transdermal nitroglycerin. What is the nurse’s best response?
A.“Always apply the transdermal patch over the area of your chest where your heart is.”
B.“Keep the previous patch on for one full day so you always have 2 patches on at a time.”
C.“Apply the patch to hairless areas of the body.”
D.“First apply vaseline to your body, then apply the transdermal patch.”
FENTANYL – DURAGESIC CHAPTER 10
A patient who has metastasized bone cancer has been on transdermal fentanyl patches for pain management for 3 months. He has been hospitalized for tests and has told the nurse that his pain is becoming “unbearable.” The nurse is reluctant to give him the ordered pain medication because the nurse does not want the patient to get addicted to the medication. The nurse’s actions reflect
A. appropriate concern for the patient’s best welfare.
B. appropriate caution for a patient who is already on a long-term opioid.
C. an uncaring attitude toward the patient.
D. a failure to manage the patient’s pain properly.
A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed patient-controlled analgesia (PCA) with hydromorphone (Dilaudid). Which vital sign is of greatest concern?
A.Pulse
B.Blood pressure
C.Temperature
D.Respirations
Chapter 28: DIURETIC
The patient is ordered furosemide (Lasix). Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class?
A. Aminoglycosides
B. Sulfonamides
C. Macrolides
D. Penicillins
Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide (Lasix)?
A.Hypocalcemia
B.Hypophosphatemia
C.Hypokalemia
Hypomagnesemia
The patient is being discharged home with furosemide (Lasix). When providing discharge teaching, which instruction will the nurse include?
A.Avoid prolonged exposure to the sun.
B.Avoid foods high in potassium content.
C.Stop taking the medication if you feel dizzy.
Weigh yourself once a week and report a gain or loss of more than 1 pound.
Chapter 34: Women’s health
A 60-year-old woman is taking a bisphosphonate (BONIVA). She calls the clinic and tells the nurse that her stomach has been bothering her and wants to know what she should do. The nurse will instruct her to:
A.take this medication with milk.
B.take this medication with breakfast.
C.remain upright in a sitting position for at least 10 minutes after taking this medication.
D.stop the medication and to come in for an evaluation.
Rationale: Bisphosphonates (e.g., alendronate) are to be taken exactly as prescribed; that is, the drug is taken at least 30 minutes before the first morning beverage, food, or other medication and with at least 6 to 8 oz of water. Emphasize the importance of remaining upright for at least 30 minutes after taking the medication to prevent esophageal and GI adverse effects. Esophageal irritation, dysphagia, severe heartburn, and retrosternal pain must be reported to the prescriber immediately to help prevent severe reactions.
Chapter 51: Bowel Disorder Drugs
A patient is receiving lactulose four times a day but does not have a history of constipation. In fact, he has had bowel movements every day. What is the probable reason for the lactulose?
A.Cleansing the bowel before a procedure
B.Removal of helminths
C.Reduction of high ammonia levels associated with liver failure
D.Daily maintenance to prevent constipation
A 48-year-old patient has been admitted with abdominal pain, and states that she has not had a bowel movement for 4 days. Her abdomen is distended and slightly tender. Which laxative would be appropriate for this patient?
A.Milk of magnesia
B.A bulk-forming laxative
C.Mineral oil
D.No laxative should be given at this time
Chapter 14: Dilantin
A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use?
A.Administer the drug by rapid IV push
B.Infuse slowly, not exceeding 50 mg/min
C.Mix the medication with dextrose solution
D.Administer via continuous infusion [Show Less]