Pharm Exam Four

What should you teach a patient about omeprazole?

not take aluminum hydroxide within an hour of taking it

The patient with GERD had minimal relief with cimetidine. Omeprazole was started instead. What should the nurse share?

Long term therapy may be needed

A patient is taking warfarin and PPI omeprazole concurrently. The nurse should anticipate what?

Warfarin effects to be increased, dt/INR will be elevated, and there is an increased risk of bleeding

A patient stops their omeprazole after 6 weeks due to a foul smelling diarrhea and weakness. What should the nurse tell the patient?

Contact your primary care provider to be tested for Clostridium difficile (C. diff)

What does sucralfate do?

treatment of peptic ulcer by acting as a barrier to gastric secretions

What are medication administrations of sucralfate?

give 1-2 hors before meals

What is the prepared route of administration for promethazine? What is it never given as?

oral preparation, never given as SQ

What drug family is the first line of treatment of post-op nausea and vomiting?

SETRON family

How does metoclopramide work?

accelerating gastric emptying

What can metoclopramide cause?

tardive dyskinesia with involuntary and abnormal facial movements

What are the two common side effects of ondansetron?

headache and dizziness

What type of laxative is psyllium?

bulk laxative

What is the action of psyllium?

bulks up mass and water content of stool

What is psyllium used for?

constipation

How should you administer psyllium?

with a full glass of water

What type of laxative is bisacodyl?

stimulant laxative

What can occur as a result from bisacodyl or other stimulant laxatives?

dependency, fluid and electrolyte imbalances, and incontinence

What two medications are used as a bowel prep for a procedure like a colonoscopy?

-Polyethylene glycol/Golytely

-Magnesium citrate

What should the patient be taught in terms of medication administration of bulk forming laxatives?

take each dose with a full glass of water

What laxative is most likely prescribed to decrease straining for a postpartum client with a laceration from childbirth?

stool softener

What type of laxative is Lactulose?

osmotic laxative

Lactulose is a laxative but it also can do what? Who is it used for?

-decrease ammonia levels and are used for hepatic encephalopathy

What antidiarrheal medication has few adverse effects? Why?

Loperamide because it does not cross the BBB

What is a bismuth subsalicylate commonly known as and what are two common adverse reactions of bismuth subsalicylate that should be taught to the patient?

pepto bismol that can turn your tongue and bowel movements black

What is alosetron used for?

diarrhea

What are serious adverse effects of alosetron?

ischemic colitis and bowel obstructions that cause hospitilization or death

What is bismuth subsalicylate used to treat?

diarrhea

What must be assessed before giving bismuth subsalicylate to a patient?

allergy to aspirin

What medication is known to cause a diabetic's blood sugar to rise?

Prednisone (Deltasone)

How should insulin be administered to a patient with type 1 DM for life?

Mix NPH and regular insulin in 1 syringe

What antidiabetic drug is a rapid acting drug?

repaglinide/Prandin

When should repaglinide/Prandin be given?

no more than 30 minutes before meals

What is metformin used for?

diabetes

What are contraindications of metformin/Glucophage?

older adults, IV contrast, and high serum lactate levels

How does pramlintide/Symlin decrease blood sugar levels and how should it be administered?

Administered SQ with a meal immediately after in order to slow gastric empyting

How does Acarbose work?

delays complex carb digestion

What symptoms does Acarbose cause?

gross GI symptoms

When should Acarbose be given?

with the first bite of a meal

If 15 grams of carb are given for hypoglycemia, what symptoms happen at the insulin's peak action?

clammy and shakey

What is monitored when a patient is taking rosiglitazone/Avandia?

weight gain, crackles, and edema

What is contraindicated for rosiglitazone/Avandia?

patients with CHF

What cardiac medications can mask symptoms of hypoglycemia?

beta blockers

What is a very important teaching point to a newly diagnosed type 1 diabetic receiving insulin injections?

rotate injection sites preventing complications and inadequate absorption

What type of drug is glyburide?

sulfonylureas

What should be avoided when taking sulfonylureas' like glyburide and why?

alcohol because a disulfiram like reaction can occur

When is glargine given and why?

once daily, at the same time every day to maintain insulin throughout the day

What type of insulin is Insulin R?

short acting

What is Insulin R given for?

extremely high glucose due to diabetic ketoacidosis

What can insulin R be mixed with?

insuline NPH (Humulin N)

What medication releases insulin evenly throughout the day?

glargine (Lantus)

What is route of administration for glargine (Lantus)? Why?

SQ injection because stomach acid would destroy the PO insulin

What is the correct way to mix intermediate acting insulin NPH with regular insulin?

push air into NPH vial, then push air into regular vial, then draw up regular insulin, then draw up NPH insulin

What type of sliding scale insulin is given for a high fasting glucose level?

Lispro

What is Levothyroxine? What is it commonly prescribed for? What type of patients is it given to?

Medication that is commonly used to treat hypothyroidism, and given to patients who have taken sodium iodine131 or had a thyroidectomy

What is a medication administration consideration for Levothyroxine?

do not take with food

What drug is used to destroy the thyroid gland?

Sodium iodine131 because it is radioactive

What medication is the best option for a pregnancy in the 1st trimester before a thyroidectomy?

Propylthiouracil

When should PO Propylthiouracil be given?

every 8 hours

When is levothyroxine given and why?

In the morning to prevent insomnia

What medication is given to a patient with Graves disease for radioactive sodium iodine131 post treatment?

Levothyroxine

What is Desmopressin used for?

diabetes insipidus

What can desmopressin cause? Why?

electrolyte imbalance, such as hyponatremia, due to decreasing urine output

What criterion must be met for a child prescribed somatotropin? Why?

the child must have not begun puberty because long bones are still open

What is the regulatory function of desmopressin/DDAVP?

water balance

What adverse effect from taking alendronate should be reported immediately?

difficulty swallowing

What does calcitonin help treat?

osteoporosis

What is the ROA for calcitonin? What type of patient usually takes it his way?

intranasally, usually postmenopausal women

What does calcium citrate help treat?

osteoporosis

What is the ROA for calcium citrate?

PO

What vitamin can help with osteoporosis?

vitamin D

Why should the nurse reinforce correct administration of alendronate?

reduces risk of esophageal bleeding

What is teriparatide used for? What is its ROA?

osteoporosis used in a Pen SQ

How long is each pen of teriparatide stable for?

28 days

What is unique about teriparatide in terms of osteoporosis medications?

only drug that increases new bone formation

What should be taught to patients taking bisphosphonates like the dronate family?

Take in the morning on an empty stomach with a full glass of water and sit upright for 30 mins after taking

What medication is used to treat myasthenia gravis? What does this medications family class do for patients with myasthenia gravis?

pyridostigmine/Mestinon increases skeletal muscle tone and strength

Why is a sustained release Stigmine family drug be taking at night?

allows the patient with myasthenia gravis to awaken with the ability to swallow

What crisis can pyridostigmine cause?

cholinergic crisis

What is given to a patient experiencing a cholinergic crisis/what is the antidote to pyridostigmine?

atropine

How is transdermal donepezil used?

Put the patch on for 7 days, take it off, clean and dry site and then do not use that site for 14 days

What should be avoided and taught to the patient about transdermal donepezil pathces?

do not place patch on reddened, irritated, or opened skin

What medication is used if donepezil is not as effective as it once was?

memantine

What does memantine do?

decreases glutamate

What serious adverse effect is related to memantine?

increase seizure acitivty

What is the first line drug for Alzheimer's?

Donepezil

How/when should donepezil be given?

once daily at bedtime

What two things interfere with the absorption of carbidopa levodopa?

high protein diets and iron supplements

How long does it take carbidopa levodopa to work?

3 weeks to decrease symptoms

What 2 things can carbidopa levodopa cause in a patient?

a drop in BP with position change and darkened bodily fluids

What drug cause orange urine, risky gambling, and sleep attacks?

ropinirole/Requip