pharm final exam

Phenothiazines, like chlorpromazine, are used to treat\___________.

Psychosis

A1 Blockers have \__________ as an adverse effect.

Hypotension (They work too well)

Which drug works on the hypothalamus to reduce fevers?

acetaminophen (Tylenol)

Which drugs work to reduce symptoms of BPH?

A1 Blockers such as tamsulosin (Flomax) and 5-Alpha Reductase Inhibitors such as Proscar.

Benzos and Antihistamines work to reduce\__________.

Anxiety

What are the signs and symptoms of a cholinergic crisis?

Circulatory collapse
Hypotension
Bloody Diarrhea
Bronchoconstriction
Shock
Cardiac Arrest

Clients with asthma or COPD should not receive \__________________________.

Non-selective Beta Blockers

Hydroxzine hydrochloride (Atarax), Hydroxine pamoate (Vistaril) and diphenhydramine (Benadryl) are all \______________________ and are used to treat \______________.

Antihistamines
Anxiety

Three catchecolamines are :

Epinephrine
Norepinephrine
Dopamine

B1 Beta Adrenergic Receptors are located in\________.

The Heart--When it comes to Beta Receptors remember: You have ONE heart and TWO lungs. Beta1 works in the heart and Beta2 works in the lungs.

Cholinergic drugs mimic the \________ response which is \__________ or \__________ .

Parasympathetic
rest
digest

Beta blocker drugs all end in what three letters?

LOL
Propranololol, atenolol, carvedilol

Non-Benzos like Ambien can have \___________ as an adverse effect.

somnabulation (Sleep walking)

The dopaminergic drug for Parkinson's disease is \_____________'

carbida-levodopa (Sinemet)

Diazepam (Valium), Alaprazolam (Xanax) and Lorazepam (Ativan) are all \_________ to treat \____________.

Benzos
Anxiety

Pam is crazy and drives a Benz!

Migraine headaches and glaucoma can be treated with B1 Blockers because they \___________________.

decrease pressure

The Adrenergic drugs mimic the \_______________ response which is \_______ or \____________.

Sympathetic
Fight
Flight

Cholinergic drug effects are:

Lower HR
Lower BP (through vasodilation)
Bronchial Constriction
Increased GI secretions and motility
Increased urinary frequency
Increased Salivation
Increased sweating (diphoresis)
Pupils Constric (Miosis)

Bethanechol (Urecholine) is used for \___________.

Urinary Retention (URE\=urine)

What conditions would cholinergic drugs be useful to treat?

Glaucoma
Xerostomia (dry mouth)
GI Motility
Lowering HR
Vasodilation
Indirectly: Alzheimers

What are B1 Blockers used to treat?

Angina, MI cardiac dysrhythmias, hypertension and heart failure. (B1 Blockers work on the heart so all of these are cardiac issues)

What are the adverse effects of cholinergic drugs?

(Think that they suppress the parasympathetic nervous system too much.)

Syncope
Hypotension
Urinary frequency
Breathing difficulties

Tylenol overdose drug:

acetylcysteine

Dobutamine, Dopamine, Norepinephrine, Phenylphrine, epinephring and midodrine are all \____________.

Adrenergics

Tricyclic Antidepressants are not used as often. What are some of the names to be aware of?

Elavil, Sinequan, Tofranil

Patients using MAO Inhibitors should avoid\__________.

Foods with tyramine (Aged cheese, wine, etc)

What are the limits of acetaminophen?

4g/day (may be lowered to 3g/day)
2g/day for liver problems or advanced age

What is the tylenol overdose drug?

acetylcysteine

For ACE inhibitors, what would be a sign that the patient isn't tolerating the drug very well?

Dry, persistent cough

What are the nursing activities for administering Ace Inhibitors?

1) Monitor BP and Serum K
2) Monitor for 1st Dose Hypotensive Effect and instruct patient to change positions slowly
3)Monitor cough

What are the nursing activities for ARB's?

1)Monitor BP and Serum K (Watching for hyperkalemia)
2) Manage symptoms of hypotension

What population do CCB's work best for?

African Americans (in combination with diuretics)

What are the nursing activities for CCB patients?

1)Monitor BP and HR
2)Assess for hypotension and instruct patient to change positions slowly

What are the general nursing activies for all antihypertensive drug patients?

1) Administered as ordered
2) Maintain safety (because of the risk of postural hypotension)
3)Assess sexual dysfunction
4) Know when to hold the drug and seek clarification

What factors effect absorption or drugs?

First-pass effect (how much drug is metabolized by liver)
Food
Milk
Antacids
Grapefruit juice
Route of administration
Coatings

What are the seven "rights"?

Right Dose
Right Documentation
Right Drug
Right Patient
Right Route
Right Time

Right of Refusal

What are the fastest to slowest routes of administration?

IV, SL, IM, SubQ, Oral, Topical

When we think of excretion, we think of \__________.

Kidneys

If there is impaired excretion, it could lead to\______.

Toxicity

Explain a schedule C-1 Drug

Most addictive, high potential for abuse, no medical use

With Warfarin, the patient should avoid\________. Why?

Leafy Greens
Due to the decreased anticoagulant effect

Tetracycline and Quinolones patients should avoid\______________.

Dairy Products due to the decreased treatment effect due to absorption

Statin, Antidsyrhythmics and CCB patients should avoid\____________________.

Grapefruit Juice

MAO inhibitor patients and Linezolid patients should avoid\_________________.

Foods with tyramine due to the raised blood pressure and a possible hypertensive crisis.

Why is the enzyme cytochrome P450 important?

It is involved with a lot of drug to drug reactions because the drugs all bind to the same substrate. Either the drug has a lowered treatment effect or the drug becomes toxic because of the amount of free drug in the body.

How is hypertension treated in African Americans?

With CCB's and diuretics in combination therapy

What do you need to be aware of with the Asian and Hispanic populations?

They can be slow acetylators. Antipsychotics and antianxiety drugs take longer to metabolize. Therefore, a lower dosage may be needed.

Rapid Acetylators have higher levels of \_______ and need \___________ doses of some drugs because otherwise the treatment will be \______.

Cytochrome P-450
Higher (They metabolize the drug too fast)
Sub-Therapeutic

Slow Acetylators have lower levels of \_____________ and need\___________ doses of some drugs because otherwise the treatment will be \__________.

Cytochrome P-450
Lower (They metabolize drugs slower)
Toxic

\_____________ dilate all blood vessels and relax smooth muscle.

Nitrates

For angina (chest pain), whether prophylactically or to treat an attack, \______________ will be used.

Nitrates

What are the four antidiarrheals?

Adsorbents (Pepto-Bismol)
Anticholinergics (Bella Donna Alkyloid)
Opiate Derivatives (Immodium, Lomotil)
Probiotics

How do bulk forming laxatives work?

Absorbs fluids
Stimulates GI peristalsis

How do Hyperosmotic and Saline Laxatives work?

Increase of Fecal Water Content

How do Emollient/Softening laxatives, like Colace, work?

By mixing stool, fat and water content

What do stimulant laxatives stimulate?

The nerves for peristalsis

What needs to be ASSESSED when administering adrenergic agonists such as epinephrine?

1) Photosensitivity
2) Nausea and Constipation
3) Urinary Output

What needs to be MONITORED when administering adrenergic agonists?

1) Vital Signs
2) Breath Sounds
3) Watch for IV infiltration

What needs to be MONITORED when administering anticholinergic drugs such as Atropine, Bentyl, Robinul, Vesicare, or Oxybutynin?

1) Bowel Sounds (can slow or stop GI motility)
2) Urinary Output (can be made difficult to urinate)
3)Oral Care (Secretions can dry up)
4) Heart Rate (can be increased)
5) Patient Safety must be ensured
6) Do not give to glaucoma patients (increases intraocular pressure)

Crazy Pam Drives a Benz means what?

Benzodiazepams are used to treat psychosis and anxiety.

What nursing activities are important to remember when adminstering Benzo's?

1) Taper off gradually
2) Evaluate level of anxiety
3) AVOID ETOH AND OTHER CNS DEPRESSANTS
4) Patient safety must be ensured.

What nursing activities are important to remember when administering MAO Inhibitors?

1) Avoid foods with tyramine
2) Monitor mood/suicidal thoughts
3) Inform about "lag time"
4) Avoid antihistamines
5)Avoid St. John's Wort

What is the therapeutic level of antiseizure meds?

10-20 mcg/mL

Dilantin mixed with dextrose will create a \___________.

Precipitate. Mix with NS only

With oral antiseizure meds and Lithium, \_________can occur so teach to maintain \______________.

Gingival Hyperplasia
Oral Hygiene

With head injury patients, would opioids be advisable to use?

NO! Avoid head injury or patients with increased intercranial pressure

What should be monitored when administering Opioid painkillers?

Respiratory Rate (can slow)
Intensity of pain (should go down)
Blood Pressure (can lower)
Nausea (administer with food or antiemetic if needed)
Bowel Pattern (motility can slow or stop)
Signs of dependence

What should the patient be educated on when giving opioid painkillers?

Disposing for patches properly (Fold and Flush)
Avoid activities requiring mental awareness
Increase fiber and water in diet

What does the nurse need to be aware of when administering opioid painkillers?

The antidote for overdose is NARCAN. (Have on hand if respiratory depression occurs.)
There are multiple routes for adminstration.
Use the equianalgesic chart when using different routes/drugs/doses to find the right dose.
Know immediate release versus extended release forms.

Why is methadone good for detox?

It has a long half life that lasts longer than the action

How to administer bronchodilators:

Give bronchodilator before inhaled steroid. Wait 2-5 minutes between medications. Wait 1-2 minutes between puffs.

After using an inhaled steroid, what should the patient do?

Rinse their mouth with water to prevent fungal infection.

What is the route of administration of thrombolytic drugs?

IV-it is always given as an IV to quickly break up clots that cause stroke but has risky side effects because ALL clots in the body break up and the patient could bleed out.

With Heparin the \_________ should be monitored and kept in the \_________________ range.

aPTT
Norm\=25-35 seconds
Therapeutic range \=45-70 seconds

With Heparin injections, what are the nursing activities?
What is the overdose antidote?

Do not rub
Rotate Sites
Do not aspirate
SubQ injections
IV infusion with a pump
Protamine Sulfate

What ranges are we looking at when administering warfarin (Coumadin) and what are the therapeutic levels?
What is the overdose antidote?

INR\=2-3.5
PT\=18 Seconds (norm\=11-13 seconds)
Vitamin K

All antiplatelet, antifibrinolytic, thrombolytic and anticoagulants have the same adverse effect that the nurse should monitor for. What is it and what should be done?

Bleeding
Implement bleeding precautions such as use of an electric razor, minimize dangers, etc.

Diuretics, like the Loop Diuretic furosemide (Lasix), should be administered \___________.

Early in the day

If the serum potassium level is low what should you do when administering the next dose of diuretics?

HOLD it until the potassium level increases or hypokalemia can occur

Potasssium supplements and eating potassium rich foods would all be advised for patients taking \___________.

Diuretics

With potassium-sparing diuretics, like spironolactone, they can keep too much potassium in the body which is a condition called\_________.

Hyperkalemia

With all diuretics, what should be monitored?

Urine output
Weight
Edema
Blood Pressure (can go too low)
Potassium levels

Loop Diuretics, like furosemide, can have a cross-sensitivity allergic reaction in patients allergic to \_______ drugs.

Sulfa

Any stimulating growth factor, like Filgrastim (Neupogen), should not be administered within 24 hours of \__________________.

Antineoplastics (Chemotherapy)

Filgrastim (Neupogen) stimulates the productions of \_____________________.

WBC's

When do you discontinue use of Filgrastim (Neupogen)?

When the Absolute Neutrophil Count (ANC) is greater than 1000/mm3 for 3 or more consecutive days.

When monitoring Epoetin Alfa (Epogen), use the \_____________ because it changes faster.

Hemoglobin level

Epoetin Alfa (Epogen) will not create RBC's without \___________________________ in the body.

Adequate stores of iron

If Epoetin Alfa (Epogen) is working, the patient will feel less \______________.

Fatigue (Oxygen levels will increase)

What should patients taking insulin be educated about?

Types and Routes of administration
Site Rotation
Types of Insulin
Prevention and Treatment of hypoglycemia

What are the causes of hypoglycemia in diabetes patients?

Excessive Exercise
Insufficient Food
Excessive Insulin

Metformin should be discontinued \__________ before any radiologic test with contrast and \____________.
If not, what condition is the patient at risk for?

48 Hours
The day of the procedure
Lactic Acidosis

Metformin can commonly cause:
Metformin can infrequently cause:

GI Distress
Metallic Taste, Hypoglycemia

When teaching a patient about the legalities regarding a prescription for methylphenidate (Ritalin), which statement is most accurate?
a.Methylphenidate (Ritalin) is a C-I narcotic that can only be prescribed according to an approved protocol.
b.Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription.
c.Methylphenidate (Ritalin) is a C-III narcotic for which a prescription will expire in 6 months.
d. Methylphenidate (Ritalin) is a C-IV narcotic that is only allowed to be refilled five times per prescription.

b.Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription.

Methylphenidate (Ritalin) is classified as a C-II narcotic.
C-II narcotics can only be dispensed with a written prescription and cannot be refilled.

The nurse is assessing a patient's culture and race on admission to the hospital. Which concept is important for the nurse to understand regarding drug therapy as it relates to different races of individuals?
a.Polypharmacy
b. Polymorphism
c.Pharmacokinetics
d. Pharmacodynamics

b. Polymorphism

Drug polymorphism refers to the effect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. The race of an individual may influence drug therapy decisions for the individual.

During the implementation phase of the nursing process, which action will the nurse perform when administering medications?
a.Switch the route of administration based on drug availability.
b. Call the patient by name when entering the room to verify the drug is for the right person.
c.Check the patient's armband before administering the medication.
d.Prepare medications for all patients first, then administer by room to manage time appropriately.

c.Check the patient's armband before administering the medication.

Checking the patient's armband is the most accurate method of determining identity. All the other answers leave room for error.

The nursing process is important as a well-established, research-supported framework for professional nursing practice. Which is the correct order for the steps of the nursing process?
a.Evaluation, Planning, Diagnoses, Assessment, Implementation
b.Planning, Assessment, Diagnoses, Implementation, Evaluation
c. Diagnoses, Assessment, Planning, Evaluation, Implementation
d.Assessment, Diagnoses, Planning, Implementation, Evaluation

d.Assessment, Diagnoses, Planning, Implementation, Evaluation

The typical organization for the nurse process is assessment, nursing diagnoses, planning, implementation, and evaluation.

The nurse should check a medication how many times before administration of a medication under the "right drug" part of the Six Rights?
a.One time
b. Three times
c.Five times
d.Depends on the drug being administered

b. Three times

The nurse should check the medication three times and confirm each time that the medication is the right drug before to administration of the medication.

Pharmacokinetics involves the study of
a. physiologic interactions of drugs.
b.distribution rates among various body compartments.
c.interactions between various drugs.
d. adverse reactions to medications.

b.distribution rates among various body compartments.

Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.

Highly protein-bound drugs
a. increase the risk of drug-drug interactions.
b. typically provide a short duration of action.
c.must be administered with 8 ounces of water.
d. have a decreased effect in patients with a low albumin level.

a. increase the risk of drug-drug interactions.

When administering two medications that are highly protein bound, the medications can compete for binding sites on plasma proteins. This competition results in either less of both or less of one of the drugs binding to the proteins, thus increasing the risk of toxicity.