Pharmacology Exam 1

nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include?

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discard NPH solution if it appears cloudy

shake the insulin vigorously before loading the syringes

expect the NPH insulin to peak in 6-14 hours

freeze unopened insulin vials

expect the NPH insulin to peak in 6-14 hours

nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. which of the following instructions should the nurse include in the teaching?

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keep the open vial of insulin at room temperature

inject the insulin into a large

aspirate the medication prior to administration

administer the insulin in two separate injections

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keep the open vial of insulin at room temperature

nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include?

discard the medication if its cloudy

briskly shake the medication before filling the syringe

take this medication 15 minutes before meals

eat a snack 8 hours after taking this medication

eat a snack 8 hours after taking this medication

nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following statements by the client indicates a need for further teaching?

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i will change my needle every 3 days

i should store all unused insulin in the refrigerator

if i skip lunch, i will skip my mealtime dose of insulin

i will use insulin glargine in my insulin pump

i will use insulin glargine in my insulin pump

pt who has diabetes and nurse plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. after checking the client’s morning glucose level, which of the following actions should the nurse take?

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give the insulin at 0700

give the insulin when the breakfast tray

give the insulin 30 min after breakfast with the client’s other routine medications

give the insulin at 0730

give the insulin at 0730, regular insulin has an onset 30 to 60 minutes and should be given at a specific time before meals

a nurse is assessing a client who is taking levothyroxine. nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?

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insomnia

constipation

drowsiness

hypoactive deep-tendon reflexes

insomnia

nurse is teaching a client who has diabetes mellitus and a new prescription for prednisone for a rash. which of the following statements by the client indicates the need for further teaching

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i might need to increase my regular insulin during this time

i will gradually stop the prednisone when my rash goes away

i should expect my stools to become very dark and sticky while on this medication

i might have a hard time falling asleep while taking prednisone

i will gradually stop the prednisone when my rash goes away

a nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instruction should the nurse include?

draw up the NPH insulin into the syringe first

inject air into the regular insulin first

shake the NPH insulin until it is well mixed

discard regular insulin that appears cloudy

discard regular insulin that appears cloudy

a nurse is providing teaching for a client who is newly diagnoses with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?

absorbs the excess carbohydrates in your system

glipizide stimulates your pancreas to release insulin

replaces insulin that is not being produced by your pancreas

prevents your liver from destroying your insulin

glipizide stimulates your pancreas to release insulin

new prescription for prednisone to treat rheumatoid arthritis. nurse should inform the client that which of the following is a therapeutic effect of this medication

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reduces risk of infection

decreases inflammation

improves peripheral blood flow

increases bone density

decreases inflammation

pharmaceutics

science of preparing dispensing drugs, including dosage form design

pharmacokinetics

how medications travel through the body and the biochemical processes they go through

pharmacodynamics

study of mechanism of drug action, initial consequence of drug-receptor interaction

drug efficacy

ability to produce desired effect

drug effect

specific physiological change

therapeutic index (TI)

ratio between min that can be harmful and minimum that gives desired effect

short half life

4-8 hours

more addictive, leave body faster

long half life

24+ hours

take longer to leave body so need less doses

agonists

medications that bind to or mimic the receptor activity that endogenous compounds regulate

antagonist

blocks usual receptor activity that endogenous compounds regulate or receptor activity of other medications

pharmacotherapeutics

treatment of pathologic conditions through the use of medication

acute

intensive drug treatment for acutely or critically ill

maintenance

prevents progression of disease, doesn’t eradicate initial problems

supplemental

supplies body with substance needed to maintain normal functions

palliative

makes the patient as comfortable as possible

supportive

maintains integrity of body functions while patient recovers

prophylactic

prevents illness or undesirable outcomes

4 phases of pharmokinetics

Absorption (site of administration into blood)

Distribution (one location to another)

Metabolism (change drugs into compounds)

Excretion/Elimination (removing drug from body)

protein bound drugs

bind to plasma proteins in bloodstream, therefore unavailable to use by the body

first pass effect (oral)

metabolism of drugs or chemicals in liver or intestine prior to reaching systemic circulation

ex. 80% first pass effect= only 20% used by body

chemical name

chemical composition and molecular structure

generic name

common name

brand/ trade name

registered trademark/ patent

controlled substance categories

I: not approved for medical use

V: written prescription requirements vary by state

categories based on risk to the fetus

A: no risk

B: no evidence of risk to animal fetus

C: adverse effects in animal fetuses

D: adverse effects shown in human fetuses

X: adverse effects on human and animal fetuses, contraindicated in pregnancy

high alert meds

==M==agnesium

==I==nsulin

==T==PA (tissue plasminogen activator)

==C==hemotherapy

==H==eparin

==T==PN (total parenteral nutrition

antibiotics which destroy the bacterial cell wall

penicillins

cephalosporins

carbapenems

vancomycin

penicillins common side effects

rash

itchy skin

cross sensitivity to cephalosporins

penicillins

penicillin

amoxicillin

ampicillin

cephalosporins

cefazolin

cephalexin

ceftriaxone

cefepime

cephalosporin complications

* allergy
* hypersensitivity
* cross sensitivity to penicillin
* severe diarrhea may indicate antibiotic associated colitis such as C diff

carbapenems

broadest antibacterial action of any antibiotic to date

what do cephalosporins treat

* UTIs
* post-op infections
* pelvic infections
* meningitis

what do carbapenems treat

* pneumonia
* peritonitis
* UTIs

carbapenems

meropenem (Merrem)

ertapenem (Invanz)

carbapenems complications

* gross sensitivity to PCN and cephalosporins
* nausea
* vomiting
* diarrhea
* superinfection

vancomycin treats

gram positive infections

MRSA

C. Difficile

vancomycin complications

\-ototoxicity

\-nephrotoxicity

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\-Red Man’s Syndrome

\-decreased BP

\-flushing of neck, face, and torso

Red Man’s Syndrome treatment

antihistamine

IV hydration

antibiotics which impair protein synthesis

\-tetracycline

\-macrolides

\-aminoglycosides

tetracyclines

\-doxycycline (vibramycin)

\-minocycline (minocin)

what are tetracyclines used for

* teenage acne
* chlamydia
* rocky mnt spotted fever
* H. pylori
* Lyme disease

tetracycline complications

* photosensitivity
* teeth discoloration in children younger than 8
* milk and antacids cause reduction in absorption

macrolides used to treat

* chlamydia
* pneumonia
* Legionnaire’s disease
* strep

macrolides complications

* GI discomfort
* abnormal EKG
* ototoxicity

macrolides

* azithromycin (Zithromax)
* clarithromycin (Biaxin)
* erythromycin (E-mycin)

aminoglycosides

* neomycin (po)
* gentamycin (IV)
* tobramycin (IV)

aminoglycosides used for

* E. coli
* Klebsiella
* pneumoniae
* pseudomonas
* intestinal ambiasis (parasite)
* tapeworm

aminoglycosides complications

nephrotoxicity

ototoxicity

pruritus

rash

urticaria

paresthesia of hands and feet

urinary tract infections treated by

sulfonamides and trimethoprim

fluoroquinolones

urinary tract antiseptics

urinary tract analgesics

sulfonamides treat

UTIs

otitis media

sulfonamides

trimethoprim-sulfamethoxazole (bactrim)

sulfadiazine

trimethoprim

sulfonamides adverse reactions

* crystaluria
* hypersensitivity
* photosensitivity
* some anemias

sulfonamides considerations

* lowers blood glucose, so be careful with oral hypoglycemics
* enhances effects of anticonvulsant phenytoin
* enhances effects of anticoagulant warfarin
* concurrent use of cyclosporin increases risk of nephrotoxicity
* may cross react with loop and thiazide diuretics

with sulfonamides avoid/use cautiously with

* kidney disease
* kidney stones
* pregnant/lactating

fluoroquinolones

* ciprofloxacin (cipro)
* levofloxacin (Levaquin)

fluoroquinolones complications

GI discomfort

Achilles tendon rupture

phototoxicity

avoid in children under

nitrofurantoin (macrobid)

urinary tract antiseptic

treats acute UTIs and recurrent UTIs

nitrofurantoin (macrobid) complications

GI discomfort

blood dyscrasias (abnormal RBC) (bruising on skin)

peripheral neuropathy

can stain teeth

phenazopyridine (pyridium)

urinary tract analgesic

functions as local anesthetic

relieves burning, pain, frequency

phenazopyridine (pyridium) side effect

turns urine funny orange color

antibiotics for tuberculosis

Rifampin

Isoniazid (INH)

Pyrazinamide

Ethambutol

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Streptomycin

anti-TB med side effects

* peripheral neuropathy (esp. diabetic patients)
* hepatotoxicity
* rifampin causes discoloration of bodily fluids, may decrease efficacy of birth control pills

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* interacts with HIV meds

antiprotozoal metronidazole treats

C. difficile

antiprotozoal metronidazole nursing considerations

* GI discomfort
* Darkening of urine

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* Interacts with alcohol

antifungals treat

candidiasis

aspergilosis

histoplasmos

ringworm

candida infection

antifungals

amphotericin B (IV)

nystatin (powder)

fluconazole (Diflucan)

viral infection, HIV, AIDS meds

acyclovir

gangiclovir

ribavirin

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oseltemivir (Tamiflu)

antivirals

depress the immune system

retrovirals

prevent HIV

MRSA

Methicillin-resistant Staphylococcus aureus

VRE

Vancomycin-resistant Enterococcus

ESBL

Extended Spectrum Beta Lactamase

KPC

Klebsiella Pneumoniae Carbapenemase

somatotropin

\-hormone used to treat hypopituitarism

\-growth hormone

\-used until epiphyseal plates stop growing

octreotide (sandostatin)

\-treats hyperpituitarism

\-giganstism in children, acromegaly in adults

what suppresses AntiDiuretic Hormone (Vasopressin)

alcohol

ADH treats

diabetic insipidus

ADH complication

overhydration

while taking ADH, clients should

reduce fluid intake

thyroid disorder medications

levothyroxine

methimazole

propylthiouracil (PTU)

radioactive iodine

levothyroxine

* hypothyroidism treatment
* IV used for myxedema coma
* complication for chronic over treatment: **bone loss**
* yearly blood levels of: TSH and T4

methimazole (Tapazole)

* hyperthyroidism treatment, used to treat Grave’s disease and goiter
* complication: hypothyroidism

propylthiouracil (PTU)

* used for emergency treatment of thyrotoxicosis
* hyperthyroidism treatment

radioactive iodine

* absorbed by thyroid and destroys cells
* hyperthyroidism
* thyroid cancer

radioactive iodine complications

* radiation sickness
* bone marrow depression
* hypothyroidism

rapid acting insulins

Aspart (Novelog)

Lispro (Humalog)

rapid acting insulin onset

15-30 min

rapid acting insulin peak

1-2h

rapid acting insulin duration

3-6 h