NUR 326: medication quiz 1

what is metoprolol and what is it used for

beta blocker → treats hypertension, angina, decrease mortality after MI, cardiac dysrhythmias, and heart failure
(think meto → slows the motor = heart goes slow)

what is the mechanism of action for metoprolol

- blocks beta1 receptors in heart and kidneys
→ in heart: decrease heart rate and contractility resulting in decreased cardiac output and reflex tachycardia
→ in kidneys: decreased renin release results in vasodilation, urine excretion (Na + H2O), and retention of K
→ plus: decrease peripheral vascular resistance

what is the food and drug interaction for metoprolol

- other antihypertensive meds will increase effect
- antacids will decrease absorption
- digoxin has additive effect and may increase bradycardia
- may increase risk for hypoglycemia with oral hypoglycemics
- can increase effect of neuromuscular blockers

what are adverse effects for metoprolol

- bradycardia (can reduce CO)
- heart failure manifestations (SOB, edema, nigh cough)
- rebound excitation (angina, MI) with abrupt withdrawal

what are nursing interventions for metoprolol

- monitor HR and report <50
- monitor HF
- teach clients to never stop abruptly
- taper doses slowly over 1-2 weeks on discontinuation

what are contraindications and precautions for metoprolol

- contraindications: sinus bradycardia or 1st degree heart block, moderate to severe HF, cardiogenic shock, children <6 y.o.
- precautions: asthma, COPD, diabetes mellitus (can mask hypoglycemia), hyperthyroidism, major depression, renal/liver disorders

what is administration and client education for metoprolol

- administration: orally or IV
- for acute MI: IV initially and then oral
- medication absorption is enhanced with food
- take at consistent time daily
- check pulse before dosing and report <60
- report SOB, edema, night cough, and chest pain

what is enalapril and its therapeutic use

ACE inhibitor → treats hypertension, HF, prevention or treatment of diabetic nephropathy, left ventricular dysfunction after MI
(think: A: angioedema, C: cough, E: elevated K)

what is the mechanism of action for enalapril

blocks ACE → decreased conversion of angiotensin I → angiotensin II → less vasoconstriction and less aldosterone → decreased BP

what are adverse effects for enalapril

- first dose hypotension
- dry, nonproductive cough
- angioedema (swelling of face, tongue, throat, lip)
- hyperkalemia
- neutropenia

what are food/drug interactions for enalapril

- potassium-sparing diuretics or potassium supplements → hyperkalemia
- NSAIDs decrease antihypertensive effect and can increase renal risk
- can cause lithium toxicity
- addictive hypotension with other antihypertensives

what are nursing interventions for enalapril

- monitor BP closely after 1st dose
- monitor K levels
- monitor persistent dry cough
- treat angioedema with IV epinephrine and discontinue med
- monitor WBC with differential periodically

what are contraindications and precautions for enalapril

- contraindications: pregnancy (teratogenic), history of ACE-inhibitor-induced angioedema, bilateral renal artery stenosis
- precautions: renal impairment, older adult, less effective in African Americans

what is administration and client education for enalapril

- administration: oral tablet (slow onset but longer duration) 1-2 times, IV (only in hospitals) → can be taken without meals
- monitor BP and K levels
- avoid potassium supplements/salt substitutes
- report dry persistent cough
- swelling of face, lips, tongue, or difficulty breathing is emergency
- dont' take if pregnant or planning
- report signs of infection (sore throat, fever) due to neutropenia

what is nifedipine and therapeutic use

calcium channel blocker → treats mild to moderate hypertension, stable (exertional) and variant (vasospastic) angina
(think nifedipine = vessels relax → BP falls → heart may reflexively race)

what is the mechanism of action for nifedipine

blocks calcium entry primarily into vascular smooth muscle → arterial vasodilation → decreased BP and cardiac workload

what are adverse effects for nifedipine

- reflex tachycardia
- headache, lightheadedness, dizziness
- facial flushing, sensation of heat
- peripheral edema of feet/leg
- arrhythmias
- gingival hyperplasia (rare)

what are food and drug interactions for nifedipine

- beta blockers increase risk for heart failure but revent reflex tachycardia
- Rifampin, rifabutin, phenobarbital, phenytoin, and carbamazepine decrease efficacy
- St. John wort decrease blood level
- grapefruit juice potentiates effects

what are nursing interventions for nifedipine

- may give beta blocker to prevent reflex tachycardia
- monitor HR and BP
- withhold med for systolic <90
- monitor for and report edema
- advise regular dental care

what are contraindications and precautions for nifedipine

- contraindications: systolic BP <90, 2nd or 3rd degree AV block, sick sinus syndrome, concurrent grapefruit, rifampin or rifabutin or phenobarbital or phenytoin or carbamazepine or st. john wort, severe renal or hepatic impairment, history of HF, severe ventricular arrhythmias
- precautions: HF, GERD, older adults

what is administration and client education for nifedipine

- administration: oral capsules or sustained release tablets
- report rapid heartbeat or worsening angina
- avoid hazardous activities
- report swelling of feet/legs, dizziness, syncope
- report heart rate <50
- report bleeding gums, gum overgrowth, get regular dental care
- don’t increase dose on own

what is nitroglycerin and therapeutic use and what are the different forms for

nitrate → treats and prevents angina, rapid acting forms (SL) treat acute attacks, longer acting forms prevent attack, IV form for severe unstable angina or perioperative BP control or HF after acute MI
(think: nitro opens vessels → decrease BP → headache

what is the mechanism of action for nitroglycerin

produces nitric oxide → vascular smooth muscle relaxation, especially vasodilation → decreased preload and cardiac workload → decreased myocardial oxygen demand

what are the adverse effects of nitroglycerin

- headache (severe at first and then lessens with continued use)
- orthostatic hypotension
- tachycardia
- tolerance develops quickly to all forms

what are the food and drug interactions of nitroglycerin

- increased hypotension with other antihypertensives or alcohol
- PDE5 inhibitors cause severe/life threatening hypotension
- anticholinergics decrease absorption of SL nitroglycerin (rapid acting form)

what are the nursing interventions for nitroglycerin

- caregivers should avoid touching ointment
- monitor headache severity, mild analgesics PRN
- monitor baseline BP and pulse and then again at peak effect
- give beta blocker or CCB if prescribed to suppress reflex tachycardia
- use intermittent scheduling (transdermal or long acting) to reduced tolerance

what are contraindications and precautions for nitroglycerin

- contraindications: allergy/tolerance to nitrates, pregnancy, lactation, increased intracranial pressure, severe anemia, pericardial tamponade or constrictive pericarditis, uncorrected hypovolemia
- precautions: head trauma, glaucoma, cardiomyopathy, severe liver disease, conditions causing dry mouth, early MI, older adults

what is administration and client education for nitroglycerin

- administration: SL tablets under tongue at chest pain onset, SL spray no more than 3 doses/15 min, taper long acting forms when discontinuing
- take OTC analgesic for unrelieved headache, report dizziness, syncope, rise slowly from lying to sitting or standing, avoid hazardous activity if dizzy, take pulse, report tachycardia

what is furosemide and therapeutic effect

loop diuretic → treats pulmonary edema in HF, edema from renal, hepatic, or cardiac failure not responsive to other diuretics, and hypertension not controlled by other diuretics
(think: furosemide = fluid and K fly out)

what is the mechanism of action for furosemide

blocks sodium/chloride reabsorption in Loop of Henle → lots of Na and H2O excreted → decreased fluid volume and BP

what are the adverse drug reactions for furosemide

- electrolyte imbalance: hyponatremia, hypochloremia, dehydration, hypokalemia
- hypotension
- ototoxicity
- hyperglycemia
- hyperuricemia (gout)

what are the food/drug interactions for furosemide

+ high risk of digoxin toxicity with hypokalemia
+ other diuretics increase diuretic effect
+ NSAIDs decrease diuretic effect
+ prolonged effect of neuromuscular blockers
+ lithium toxicity risk
+ amphotericin B or corticosteroids increase hypokalemia
+ other ototoxic drugs like aminoglycosides increase ototoxicity risk

what are the nursing interventions for furosemide

+ monitor electrolytes periodically
+ monitor cardiac dysrhythmias if hypokalemia occurs
+ can combine with potassium-sparing diuretic if hypokalemia risk
+ monitor BP frequently
+ avoid concurrent ototoxic meds
+ monitor blood glucose and uric acid periodically

what are the contraindications and precautions for furosemide

+ contraindications: allergy, hepatic coma, electrolyte imbalance or dehydration, anuria
+ precautions: renal or hepatic disorders, diabetes mellitus, older adult, pregnancy, lactation

what is administration and client education for furosemide

+ administer oral, IV, IM with food, give second dose by early afternoon to prevent nocturia
+ eat potassium rich foods (citrus, potatoes, bananas), report confusion, muscle twitching, weakness, irregular pulse, nausea, monitor BP frequently, report dizziness, syncope, new hearing loss, tinnitus, or vertigo, diabetic clients need to monitor glucose closely, report gout manifestations

what is trimethoprim sulfamethoxazole (TMP-SMX) and its therapeutic effect

sulfonamide → treats urinary tract infections, pneumocystis pneumonia, shigella enteritis (traveler’s diarrhea), chronic bronchitis (acute phase), acute otitis media in children

what is the mechanism of action for trimethoprim sulfamethoxazole (TMP-SMX)

blocks 2 sequential steps of bacterial folic–acid synthesis → inhibits bacterial growth

what is the adverse drug reaction for trimethoprim sulfamethoxazole (TMP-SMX)

+ GI: nausea, vomiting, anorexia
+ allergic skin reactions
+ blood cell deficiencies (thrombocytopenia, leukopenia, anemia, agranulocytosis, aplastic anemia)
+ C diff associated diarrhea or candida superinfection
+ severe rash including stevens johnson syndrome
+ kernicterus

what are the food and drug interactions for trimethoprim sulfamethoxazole (TMP-SMX)

+ alcohol → disulfiram-type reaction
+ increases effects of warfarin, phenytoin, sulfonylureas
+ increased immunosuppression with methotrexate
+ reduced effectiveness of oral contraceptives

what are the nursing interventions for trimethoprim sulfamethoxazole (TMP-SMX)

+ monitor for manifestations of rash, hives, severe diarrhea
+ encourage fluids, monitor I&O
+ monitor CBC and urinalysis throughout treatment

what are the contraindications and precautions for trimethoprim sulfamethoxazole (TMP-SMX)

+ contraindications: pregnant, lactation, allergy to sulfonamides or trimethoprim or COX 2 inhibitors (celecoxib), megaloblastic anemia from folic acid deficiency, children <2 months, group A beta-hemolytic strep pharyngitis, hyperkalemia, severely impaired creatinine clearance
+ precautions: decreased kidney or liver function, sulfite hypersensitivity, suppressed bone marrow, risk for megaloblastic anemia (alcohol use disorder, pregnancy, debilitated clients)

what is the administration and client education for trimethoprim sulfamethoxazole (TMP-SMX)

+ administer fixed-dose combo: tablet, liquid, IV. Oral dose with 8oz water, IV slowly over 60-90 mins, drink 1,200 to 1,500 mL water/day during treatment
+ take with food to minimize GI effects, report rash, hives, fatigue, pallor, easy bruising, new infections, report watery or bloody diarrhea, report mouth pain, difficultly eating, vaginal burning or discharge, use alternate contraception as it decreases oral contraceptive effectiveness

what is cephalexin and its therapeutic effect

cephalosporin → first gen cephalosporin: treats infection caused by gram-positive cocci
+ later gens (2-5) more gram negative activity, more beta lactamase resistance, better CSF penetration (meningitis)
(think: cephalexin = cell wall)

what is the mechanism of action for cephalexin

beta-lactam antiobiotics → disrupts bacterial cell wall synthesis → bacterial death

what is the adverse effect for cephalexin

+ GI: diarrhea, nausea
+ C. difficile associated diarrhea (rare)
+ possible cross allergy with penicillin
+ thrombophlebitis (IV cephalosporins)

what are the food and drug interactions for cephalexin

+ probenecid prolongs effect of most cephalosporins
+ cefotetan + alcohol or anticoagulants → bleeding risk
+ IV calcium + ceftriaxone: avoid combination

what are the nursing interventions for cephalexin

+ monitor bloody stools or watery diarrhea
+ assess for cephalosporin and penicillin allergy before administer
+ prepare to treat rash or gives with antihistamines; anaphylaxis with epinephrine
+ monitor prothrombin or bleeding time, give vitamin K if bleeding occurs
+ monitor IV site for thrombophlebitis

what are the contraindications and precautions for cephalexin

+ contraindications: allergy to cephalosporins, penicillin
+ precautions: renal failure, GI disease

what is administration and client education for cephalexin

+ take with food to decrease GI effects
+ report watery or bloody diarrhea
+ stop med and notify provider for allergic reaction, call 911 with difficulty breathing
+ report unusual bruising or bleeding
+ report IV site burning, pain, swelling

what is vancomycin and its therapeutic effect

glycopeptide antibiotic → treats severe infections, MRSA infections, infections in clients with penicillin allergy, C. diff associated diarrhea (oral form)

what is the mechanism of action for vancomycin

inhibits bacterial cell wall synthesis

what are the adverse drug reactions for vancomycin

+ renal failure secondary to nephrotoxicity
+ hypotension, tachycardia, flushing (red man syndrome) with rapid IV infusion
+ rare, usually reversible ototoxicity
+ thrombophlebitis or tissue damage at IV site

what are food and drug interactions for vancomycin

+ other ototoxic or nephrotoxic meds increase risk
+ incompatible in solution with multiple IV meds

what are nursing interventions for vancomycin

+ administer >1hr by IV infusion with proper dilution
+ monitor vital signs during infusion
+ monitor vancomycin trough levels, BUN, creatinine
+ assess IV site for redness/swelling, ensure patency

what are contraindications and precautions for vancomycin

+ contraindications: allergy to vanco, hypersensitivity
+ precautions: renal insufficiency (reduce dosage), impaired hearing, colitis

what is administration and client education for vancomycin

+ report flushing or faintness during infusion
+ report tinnitus or perceived hearing loss
+ report change in urine output
+ report pain, swelling, redness at IV site immediately
+ report vertigo
+ oral = C diff
+ IV = systemic infections

what is levothyroxine and therapeutic use

thyroid hormone replacement → hypothyroidism (life long), myxedema coma (IV, emergency), TSH suppression in some thyroid cancers
(think: low thyroid = levo lifts metabolism)

what is the mechanism of action for levothyroxine

synthetic T4 → replaces deficient thyroid hormone → increases metabolic activity

what is the adverse drug reaction for levothyroxine

+ manifestations of hyperthyroidism if overdosed: tachycardia, palpitations, chest pain, insomnia, tremors, weight loss, heat intolerance
+ cardiac dysrhythmias or angina with excessive dosing, esp in clients with cardiac disease

what are the food and drug interactions for levothyroxine

+ increases anticoagulant effect of warfarin
+ antacids, calcium, and iron reduce absorption (separate administration)
+ increases effect of sympathomimetics

what are the nursing interventions for levothyroxine

+ monitor TSH/T3/T4 periodically
+ monitor manifestations of both overdose (hyperthyroid) and underdose (hypothyroid)
+ start at low dose and titrate slowly in older adults or clients with cardiac disease
+ monitor pulse and BP

what are the contraindications and precautions for levothyroxine

+ contraindications: thyrotoxicosis, recent uncorrected myocardial infarction, hypersensitivity
+ precautions: cardiovascular disease, older adults, untreated adrenal insufficiency (need to be corrected before starting levothyroxine)

what is administration and client education for levothyroxine

+ take on empty stomach in morning, same time daily
+ do not stop abruptly, life long
+ report chest pain, rapid heartbeat, excessive swelling, tremors
+ separate dosing from calcium, iron, and antacids by several hours (reduced absorption)

what is methotrexate and therapeutic effect

antimetabolic/DMARD → rheumatoid arthritis, psoriasis, inflammatory bowel disease (Crohn’s - unlabeled), certain cancers, ectopic pregnancy
(think: methotrexate is week + watch blood/liver/lungs)

what is mechanism of action for methotrexate

folate antagonists → inhibits DNA synthesis and rapidly dividing cells; at lower doses it suppresses inflammatory and immune activity

what are adverse drug reactions for methotrexate

+ bone marrow suppression: leukopenia, thrombocytopenia, anemia
+ hepatotoxicity
+ pulmonary toxicity and pneumonitis
+ GI ulceration, stomatitis, nausea
+ nephrotoxicity
+ teratogenic

what are food and drug interactions for methotrexate

+ NSAIDs and salicylates increase methotrexate toxicity
+ alcohol increases hepatotoxicity risk
+ live vaccines contraindicated during therapy
+ TMP-SMX increases bone marrow suppression risk

what are nursing interventions for methotrexate

+ monitor CBC, liver enzymes, and renal function periodically
+ monitor for signs of infection or bleeding
+ give folic acid supplements to reduce toxicity at RA/psoriasis doses
+ monitor pulmonary status (cough, dyspnea)

what are contraindications and precautions for methotrexate

+ contraindications: pregnancy, breastfeeding, alcohol use disorder or significant liver disease, severe renal impairment, blood dyscrasias
+ precautions: renal or hepatic impairment, active infection, bone marrow suppression

what are client education for methotrexate

+ confirm and follow WEEKLY dosing schedule for RA and psoriasis
+ report fever, sore throat, unusual bleeding or bruising
+ report yellowing of skin or eyes (jaundice)
+ report cough or SOB
+ avoid alcohol
+ use reliable contraception and avoid pregnancy during and for a period after therapy