NSG 3153 Pharm Final Exam Review

Thyroid Stimulating Hormone (also called thyrotropin)

secreted by anterior pituitary, stimulates thyroid

Iodine

essential for thyroid hormone synthesis and must come from an external, dietary source

Hashimoto's Disease

an autoimmune disease in which the body's own antibodies attack and destroy the cells of the thyroid gland

Levothyroxine (Synthroid)

Synthetic T4 for treatment of hypothyroidism

Avoid grapefruit - reduces absorption

Levothyroxine adverse effects

Symptoms of hyperthyroidism due to overdose: hypertension, palpitations, tachycardia, anxiety, heat intolerance, diaphoresis, skin rash, goiter, weight loss, abdominal cramps, dypsnea

Grave's Disease

autoimmune disorder related to hyperthyroidism, characterized by goiter and/or exophthalmos

Methimazole

treatment of hyperthyroidism, oral medication

Radioactive iodine

Treats hyperthyroidism by destroying the gland

Iodine solution adverse effects

metallic taste, sore teeth and gums, stained teeth, GI upset

The client with hyperthyroidism who received radioactive iodine tells the nurse they don't think the medication is working because they don't feel any different. Which statement is the nurse's best response?

It may take up to several months to get the full benefits of the treatment.

A client with hyperthyroidism has been given methimazole. What nursing consideration is associated with this medication?

Administer with food. Instruct client to report side and adverse effects such as sore throat, fever, and headaches. Use special radioactive precautions when handling clients urine for first 24 hours after initial administration.

HIV pre-exposure prophylaxis for patient's partner, taken daily to minimize the risk of contracting HIV

PrEP

Chloroquine

Antiprotozoan, used prophylactically and for the treatment of malaria. Cannot be used by pregnant women.Adverse: hepatotoxicity and retinal damage/visual disturbances.

Prophylatic antiemetic

Give prior to chemotherapy administration to prevent severe nausea and vomiting

A client who travels extensively has been receiving chloroquine for malaria prophylaxis for an extended time. What should the nurse teach the client?

You should have your eyes examined regularly

Desmopressin

Antidiurectic hormone, treatment of diabetes insipidus, nasal route, monitor urine output

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

"saturated inside" elevated ADH, fluid retention, dilution of blood and electrolytes, concentrated urine

Diabetes Insipidus

"dry inside" decreased ADH, polydipsia, polyphagia, and dehydration, concentrated blood and electrolytes, diluted urine

Rapid-acting Insulin

lispro, aspart, glulisine onset 15 minutes, peak 1 hour, duration 2-4 hours

short-acting insulin

regular, humulin R onset 30 minutes, peak 2 hours, duration 6 hours

intermediate-acting insulin

insulin

NPH, humulin N onset 2 hours, peak 4-12 hours, duration 12-18 hours

long-acting insulin

Glargine/Lantis onset 0.8-4 hours, minimal peak, duration up to 24 hours

drug class estrogens

prototype estradiol, conjugated estrogen indication: menopause

estrogen adverse effects

increased blood clot risk

HbA1c levels

Average of blood sugar over 2-3 months.

NORMAL: 4-5.6%

RISK: 5.7-6.5%

DIABETES: >6.5%

Raloxifene

estrogen receptor modulator indication: post menopausal osteoporosis

Norethindrone acetate

Progesterone, contraceptive, treats amenorrhea, inhibits FSH, LH

An elderly woman is diagnosed with pelvic relaxation disorder secondary to age related changes. Which medication should the nurse expect to administer?

Estrogen (changes pelvic floor muscles and lining of the uterus)

A client is being treated for secondary amenorrhea. The nurse expects which drug to be used to treat this problem?

Medroxyprogesterone

Causes of hyperthyroidism

hyperpituitarism, thyroid tumor, thyroiditis, Grave's Disease

Hyperthyroidism manifestations

intolerance to heat, tremors, anxiety, weight loss, goiter, exophthalmos (build up of subcutaneous tissues pushes eyes out), tachycardia, diarrhea, localized edema

A nurse is preparing to administer a prescribed antibiotic and is aware that the medication is selectively toxic. What does the nurse understand about this medication?

It can kill foreign cells without causing significant harm to the client's own body cells

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction?

wheezing

dyspnea (SOB)

swelling of the tongue (also face or hands)

pruritus (itching)

The nurse is monitoring for therapeutic results of antibiotic therapy in a client with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy?

Decreased white blood cell count

Mebendazole

Antihelminthic

Adverse - abdominal pain/discomfort and diarrhea

Collect stools samples for ova and parasites

A newly admitted patient reports a penicillin allergy. The healthcare provider has prescribed a cephalosporin medication as part of the therapy. Which nursing action is most appropriate?

Notify the healthcare provider for clarification of the prescription (cross sensitivity is common).

penicillin

Prototype Amoxicillan

Broad spectrum

Allergy is common

Assess for tinnitus

Cross sensitivity to cephalosporins

cephalosporins

Prototype Cefaclor

Broad Spectrum

Complications nausea, vomiting, diarrhea, pseudomembranous colitis

Avoid alcohol - Disulfiram effect, 72 hours

enhances anticoagulant effect of warfarin

tetracycline

Prototype Doxycycline

Broad spectrum

Used to treat acne

Can cause tooth discoloration

Use back up birth control, not for children under 8

Interacts with calcium and iron supplements, avoid milk, can cause kidney stones

A client has been prescribed to take both a tetracycline and a sulfonamide drug. When providing client teaching, what priority information should the nurse give the client related to adverse drug effects?

Use protective measures when exposed to the sun

The female client diagnosed with acne is prescribed tetracycline. Which intervention should the nurse include in the medication teaching?

Tell the client to use sunscreen and protective clothing when outside (teeth discoloration in children under 8)

fluoroquinolones

Prototype Ciprofloxacin

Broad spectrum

Black box warning: tendinitis/Achilles tendon rupture

Client must avoid physical activity

Avoid sun, grapefruit may inhibit metabolism

aminoglycosides

Prototype Gentamicin

Narrow spectrum, IV, IM

Can cause nephrotoxicity and ototoxicity

Monitor peak and trough levels to avoid toxicity

superinfection

overgrowth of normal microbiota that is resistant to antibiotics, unrelated to first infection

A client is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this client in the past. Which could be a probable cause of the test result?

The client is taking a strong diuretic

The nurse is caring for a client admitted to the hospital who is receiving an aminoglycoside twice a day, intravenously, for an infection. The nurse is planning to obtain blood for a peak aminoglycoside level. When would the blood be drawn?

30 minutes after completing the infusion

When assessing a client for toxicities associated with aminoglycoside therapy, the nurse should include evaluation of which of the following?

Creatinine levels

Hearing acuity

The nurse has been caring for an increasing number of clients who have antibiotic resistance. What principles should the nurse and the other members of the care team follow to prevent antibiotic resistance?

Avoid broad spectrum agents when treating trivial or viral infections. Use narrow spectrum agents if the are likely to be effective. Teach clients not to save antibiotics for self medication in the future.

Causes of antibiotic resistance

widespread use of antimicrobials, treatment is interrupted or inadequate, microorganisms have ability to restrict access of drug to cell, microorganisms have the ability to change the antibiotic

A client is taking an anthelmintic that is absorbed systemically. The nurse should caution the client about what possible adverse effect?

headache and dizziness

Herbal remedy that interactions with many medications?

St. Johns Wort

A client is experiencing intense nausea while being treated with chemotherapeutics. What actions should the nurse perform?

Ensure that the client has had a dietitician consult. Administer antiemetics as prescribed. Provide the client with small frequent meals.

Colony Stimulating Factor

Prototype: Filgrastim

Used to increase production of WBCs for patients taking chemotherapy.

Given for neutropenia by injection.

Adverse: bone pain and generalized pain.

Antineoplastic agents

Chemotherapy drugs, do not have selective toxicity

Adverse: nausea, vomiting, diarrhea, superinfections, bone marrow depression, alopecia, renal/liver toxicity, malaise.

Test for bone marrowing functioning - WBC, RBC, and platelets.

Use PPE.

Methotrexate

Antineoplastic used for cancer and RA. Teratogenic

Tamoxifen

Antineoplastic, blocks hormone receptor sites in patients with estrogen linked cancers.

Adverse: artificial menopause

To which client would the nurse question the healthcare provider's prescription to administer a live virus?

The child who lives with a grandparent undergoing chemotherapy.

A client who is receiving a course of chemotherapy has neutropenia. Which symptom, if experienced, should be reported to the provider immediately?

Fever (fever is principal early sign of infection on those with low WBC count)

Sildenafil

PDE5 inhibitor used to treat erectile dysfunction, causes vasodilation, not for use with nitrate medications, lowers blood pressure, avoid grapefruit increases bioavailability

The nurse learn a client receiving a new prescription for oxandrolone takes a lipid lowering medication daily. What will the nurse tell the client about this drug interaction?

Lipid lowering drug becomes much less effective (anabolic steroids alter lipid metabolism)

A 21 year old male athlete admits to using androgenic steroids. The nurse tells him that what is a possible adverse effect of these drugs?

Liver failure due to formation of blood filled cavities in the liver.

Anabolic steroids adverse effects

cardiomyopathy, personality changes, inhibited testicular function, gynecomastia, testicular atrophy, "roid rage"

Oxandrolone

Anabolic steroid used to increase weight in debilitated patients or patients with severe anemia

Corticosteroids

produced in adrenal cortex androgens, glucocortoids, mineralcorticoids

Mineralcorticoids

affect electrolyte levels and homeostasis

Prednisone adverse effects

secondary infection, vertigo, headache, hypotension, bloating, increased appetite, weight gain

Pregnancy category B drug

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Pregnancy category X drug

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits. Teratogenic

Pregnancy category A drug

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Pregnancy category C drug

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Pregnancy category D drug

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Not prescribed unless the mother's life is in danger.

Do not vaccinate if

Patient is sick.

Patient has received blood products or immune globulin in the last 3 months.

MMR and Varicella

Not given during pregnancy because it is a live vaccine. Avoid becoming pregnant for 3 months after receiving the vaccine.

Tdap

Given every 10 years and with each pregnancy.

normal vaccine response

fever, rash, heat at site, chills, drowsiness, anorexia, local swelling

When are vaccines contraindicated?

When a patient has received a transfusion within the past three months

After the intramuscular administration of immune globulin, the nurse should provide which instructions to the client?

Apply ice pack to injection site if swelling occurs

Postpone receiving live vaccine for 3 months

Notify nurse if chills and fevers develop

The nurse at a well baby clinic is preparing to administer the scheduled recommended immunizations to a 2 month old. The nurse should prepare to administer which vaccines?

Rotavirus

Pneumococcal

Inactivated Polio

Haemophilus influenzae type b

DTaP

A client has a urinary tract infection. Which class of drugs is especially useful for such infections?

Sulfonamides

sulfonamides

Prototype cotrimoxazole (septra, bactrim)

Broad spectrum

Inhibits folic acid synthesis - teratogenic

Can cause neural tube defects

Sunlight sensitivity

Somatropin

growth hormone, affects anterior pituitary, for treatment of hypopituitarism in children, requires routine monitoring of growth and xrays

The nurse in an endocrinology clinic is working with a client who has been receiving somatropin on a regular basis for several months. What assessment should the nurse most likely prioritize when the client presents for follow-up?

Measure the client's height and weight

What assessment finding would indicate the need to stop somatropin administration in a child who has taken the drug for several years?

closure of the epiphyseal plate

A client is receiving their third IV dose of a penicillin drug. They report they are feeling anxious, and they are having trouble breathing. What should the nurse do first?

Stop the infusion (because a potential allergic reaction may be occurring)

A client with which integumentary disorder may benefit from a prescription for acyclovir?

Herpes simplex

The client is diagnosed with herpes simplex II infection and is prescribed valacyclovir. Which information should the nurse provide?

Even after lesions have gone, it is still possible to transmit the virus.

Acyclovir

Antiviral used to treat CMV and herpes

Which intervention is of the highest priority for the nurse working with a client who has herpes zoster and who recently began drug therapy with acyclovir?

Encourage fluid intake of 2500-3000mL daily if not contraindicated. (Nephrotoxic)

A client is receiving glargine in addition to aspart. When the nurse checks the blood glucose at the bedside, it is greater than 200 mg/dL. How should the nurse administer the insulins?

Put air into the glargine insulin vial and draw up the correct dose in an insulin syringe. Then with a different insulin syringe put air into the aspart vial and draw up correct dose (long acting insulin cannot be mixed with other insulin products).

The client with type 1 diabetes mellitus is taught to take Humulin N at 1700 each day. The client should be instructed that the greatest risk of hypoglycemia will occur at about what time?

0100, while sleeping because insulin peaks at 4-12 hours

The nurse in a medsurg department is preparing to administer Humalog to a client with type 1 diabetes. Which intervention should the nurse implement?

Make sure the client eats the food on the meal tray that is at bedside (rapid acting insulin).

The nurse is teaching a client with diabetes how to mix regular insulin and NPH insulin in the same syringe. Which action performed by the client indicates the need for further teaching?

Withdraws the NPH insulin first

What insulin can be administered IV

regular

Drug Class: NSAID

Prototype: Ibuprofen

antinflammatory, antipyretic, analgesic

Caution with cardiovascular dysfunction and hypertension.

Increases risk of GI bleed

Hard on kidneys

IV version is Ketorolac for short term moderate to severe pain

A client with low back pain has been self-medicating with ibuprofen around the clock. The client calls the clinic and tells the nurse they have been getting dizzy and lightheaded. Which action would be the nurse's BEST response?

Have the client come to the clinic for lab work immediately. (Concern for NSAID ulcer GI bleed)

Drug Class: Acetaminophen

Prototype: Acetaminophen

Analgesic, antipyretic

Caution with patients who have hepatic dysfunction or alcoholism.

Antidote is acetylcysteine

Can damage liver, often in combination OTC medications

An adolescent client has been admitted to the intensive care department for an overdose of acetaminophen. Which laboratory data should the nurse monitor for long-term complications from the affect?

liver function tests

Drug Class: Salicylates

Prototype: Aspirin

antinflammatory, antipyretic, analgesic, antiplatelet

Use in children can cause Reye's Syndrome

Can increase bleeding risk when used with other blood thinning agents.

Toxicity: bleeding and tinnitus

Regular dose 325mg, baby dose 81mg

hold/stop usage before surgery

hypothalamic-piuitary axis

negative feedback loop, stimulation of endocrine glands to release hormones shuts down production of releasing factors

Superinfection examples

Thrush, Yeast Infection, C diff