MIDTERM (ch. 6, 24, 25, 27, + 3, 18, 21, 22)

a nurse should advise a patient who is receiving lorazepam (Ativan) about the adverse effects of this medication, which include: a. tachypnea b. astigmatism c. ataxia d. euphoria

c

a patient is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. which statement made by the patient indicates to the nurse that patient education has been successful? a. "inhaled medications should only be taken in the morning" b. "doses for inhaled medication are larger than those taken orally" c. "medicines taken by inhalation produce a very rapid response" d. "inhaled drugs are often rendered inactive by hepatic metabolic reactions"

c

a patient who has migraines self-administered sumatriptan (Imitrex) for the first time yesterday. today, the patient informs the nurse that after taking the medication, the patient began to experience chest pain. the patient further states that the drug was effective in relieving the headache. the nurse should: a. encourage the patient to continue using the drug because it was effective b. advise the patient to tell the healthcare provider about the chest pain at the next visit c. instruct the patient to contact the healthcare provider to report the chest pain today and to not use the sumatriptan until the healthcare provider has been consulted d. encourage the patient to lie down in a quiet room and use cold packs during the next migraine

c

a patient who is taking methylphenidate (Concerta, Metadate, Ritalin) for attention-deficit/hyperactivity disorder reports having insomnia. which intervention will assist in the promotion of sleep? a. have a glass of wine with dinner b. eat a chocolate bar at bedtime c. take the drug before 4 pm d. switch to decaffeinated coffee

c

as the nurse enters the room to administer medication, the patient states, "I'm in the bathroom. please leave the medication on my bedside table, and I will take it when I come out." which would be the appropriate response by the nurse? a. "I will leave the medication and follow up with you in 30 mins" b. "you must take the medication now or refuse the dose" c. "let me know when you are ready, and I will then return with your medication" d. "I've given the drugs to your visitors. take it when you come out of the bathroom"

c

carbamazepine (Tegretol) has been prescribed for a 24-year-old patient for the control of partial seizures. the nurse will teach the patient to immediately report: a. blurred vision b. leg cramps c. blister-like rash d. lethargy

c

the nurse is caring for a patient receiving a sedative-hypnotic. which adverse effect associated with this drug therapy is the highest priority for the nurse? a. urinary incontinence b. activity intolerance c. fall risk d. poor nutritional intake

c

the nurse is counseling the caregivers of a patient with alzheimer's disease. which statement, if made by a caregiver, would indicate that the session had been effective? a. "I should give this medication as symptoms of Alzheimer's disease become noticeable" b. "if constipation occurs, I will notify the healthcare provider immediately" c. "the medication may improve symptoms but will not cure the disease" d. "I will take the patient's vital signs before every dose of the medication"

c

the patient is receiving multiple medications, including one drug specifically used to stimulate gastric peristalsis. the nurse knows that this drug could have what influence on additional oral medications? a. increase absorption b. reduced excretion c. decreased absorption d. enhanced distribution

c

when given a medication, the patient tells the nurse, "I've never seen this pill before. it's not like the others I take." which would be the most appropriate action for the nurse to take? a. instruct the patient that different brands are frequently used b. administer the medication in the existing form c. verify the order and double-check the drug label d. advise the patient to talk with the health care provider and give the drug

c

which of the following statements made by the patient recovering from substance use disorder would indicate high potential for relapse? a. "I need the help of a support system to stop using" b. "after I stop using, I will no longer have a desire to use drugs" c. "whom I hang out with doesn't make any difference in whether to not I use drugs" d. "talking with other recovering addicts will help me cope"

c

succinimides

epilepsy treatment suppresses influx of Ca+ absence seizures protodrug: ethosuximide (Zarontin) similar drugs: methsuximide

most frequent factors contributing to med errors

errors in pt assessment inaccurate prescribing errors in admin

patient safety event

event, incident, or condition that could have resulted or did result in harm to a patient

med errors may...

extend length of hospitalization, increase medical costs for the pt and agency, or create legal challenges

opium

extracted from unripe seeds of poppy plant, milky contains over 20 different chemicals 9-14% morphine .8-2.5% codeine activate mu and kappa receptors

absorption is ______ in larger surface areas

faster ex: small intestine, lungs

absorption and blood flow

faster where blood flow is higher diminished blood flow during heart failure or shock vasoconstrictors (epi) and ice slow absorption

amphetamines

for ADHD and narcolepsy promote release of NE through activation of alpha- and beta-adrenergic receptors increase dopamine, in high doses increase serotonin may cause vasoconstriction, HTN, and tachycardia protodrug: amphetamine and dextroamphetamine (Adderall) similar drugs: dexmethylphenidate (Focalin), lisdexamfetamine (Vyvanse), methylphenidate (Concerta, Metadate, Ritalin)

other miscellaneous drugs for epilepsy

gabapentin (Neurontin), valproic acid (Depacon, Depakene, Depakote) = protodrugs MANY OTHERS, may also be used for bipolar disorder

GABA

gamma-aminobutyric acid primary inhibitory transmitter in the CNS seizure and anxiety disorder significance

maintenance dose

given to keep plasma concentration ion therapeutic range after the loading dose

loading dose

higher amount of drug only given once or twice to "prime" the bloodstream with a level sufficient to quickly induce a therapeutic response

amygdala

key part of limbic system in temporal lobe involved in anxiety essential for the ability to feel certain emotions and to perceive them in other people

narcotic

law enforcement definition: broad range of abused illegal drugs such as hallucinogens, cocaine, amphetamines, and marijuana medical definition: morphine-like drug used to alleviate pain narcotic analgesic = opioid

plasma half life

length of time required for the plasma concentration of a drug to decrease by 1/2 after admin short = drug given more frequently long = drug given less frequently ~4 half lives until excretion (94%)

toxic concentration

level of drug that results in serious adverse effects

skin route

local effects or very slow systematic effects

amyotrophic lateral sclerosis (ALS)

lou gehrig's disease typically progresses rapidly to death in 2-3 years due to respiratory failure or pneumonia riluzole (Rilutek) - stated to prolong life for only 3 months edaravone (Radicava) - stated to slow progression for longer, approved in 2017

mucous route

may be rapid if membrane is thin with rich blood supply

hepatic microsomal enzyme system

metabolism in the liver CYP450 enzyme system some drugs inhibit CYP450 enzymes; other induce (increase)

MAOIs

monoamine oxidase inhibitors inhibits body getting rid of NE = increases NE rare due to adverse effects no FDA approved for anxiety disorders; some used off-label

GI tract environment

most absorption in small intestine (stomach = thicker, large = water) digestive motility differs in all patients presence of food in stomach slows absorption, especially fat

idiopathic PD

most common no known cause characterized by progressive destruction of neurons believed to have a genetic link

alzheimer's disease (AD)

most common form of dementia chronic, progressive loss of cognitive function genetics, environmental, and lifestyle factors

cholinesterase inhibitors

most widely prescribed drug class for treating AD protodrug: donepezil (Aricept) - similar to neostigmine with greater CNS activity similar drugs: galantamine (Razadyne), rivastigmine (Exelon)

distribution

movement of medications throughout the body after they are absorbed or injected parenterally more blood flow = easier distribution high affinity organs = high attraction (bone marrow, teeth, eyes, adipose tissue), stored lipid soluble = not limited by water soluble barriers = more completely distributed drug protein complexes (esp to albumin) can form and be too large to reach target cells competition of binding sites may lead to drug-drug or drug-food interactions blood-brain barriers makes it difficult for drugs to reach brain (only highly lipid soluble can cross, ex: anesthetics, sedatives, antianxiety, and anticonvulsant meds as well as alcohol, nicotine, and caffeine - water soluble such as penicillin have difficulty)

opiates

natural substances obtained from opium activate mu and kappa receptors protodrug: morphine similar drugs: codeine, hydrocodone (Hycodan), hydromorphine (Dilauded, Exalgo), levorphanol (Levo-Dromoran), methadone (Dolophine), oxycodone (Oxycontin), tapentadol (Nucynta), metadone (Dolophine) - may be used for withdrawal

prodrugs

need metabolism to produce therapeutic action

multiple sclerosis (MS)

neurodegenerative disease characterized by demyelination (destruction or removal of myelin sheath) autoimmune exacerbation and remission periods

institute for safe medication practices (ISMP)

nonprofit agency comprising 23 national healthcare organizations help standardize medication error reporting systems, examine interdisciplinary causes of med errors, and promote med safety

sublingual and buccal routes

not subject to stomach acid or first pass effect because of mouth's rich blood supply buccal route slower administer second to PO meds

physical dependence

occurs when the body adapts to repeated use of a substance by altering normal physiology

pharmacologic pain therapies

opioids and nonopioids

intradermal route

parenteral route below dermis contains more blood vessels more readily absorbed small volumes of meds (0.1 - 0.2 mL)

sub Q route

parenteral route deepest layers of skin insulin, heparin, vitamins, vaccines larger volume of meds (0.5 - 1 mL)

IV route

parenteral route directly into bloodstream fastest onset but also the most dangerous not absorbed

IM route

parenteral route rapid onset of action larger volume of meds (up to 3 mL in glutes and 0.5 - 1 mL in deltoid)

enteral route

passes through intestine and delivered to GI tract orally, sublingual or buccal, nasogastric or gastrostomy tubes liquids absorbed faster

parkinson's disease (PD)

peaks between 58-62 years old idiopathic and secondary caused by a lack of sufficient amounts of dopamine produced by the substantia nigra (dopamine inhibits impulses/muscle movement, Ach overpowers in PD) characterized by tremor, muscle rigidity, bradykinesia, and postural instability may cause depression (over 50%), anxiety, sleep disturbances, constipation, difficulty urinating, sexual dysfunction, dementia

non-restorative sleep

persistent sleepiness during the day, despite adequate sleep duration

barbiturates

powerful CNS depressants high potential for abuse, suicide, and OD protodrug: phenobarbital (Luminal) - only long acting other drugs: ultrashort acting - methohexital (Brevital) short acting - secobarbital (Seconal) intermediate acting - amobarbital (Amytal)

benzodiazepines for anxiety

primarily for GAD may be used for seizure disorders and anesthesia off label for insomnia do not produce respiratory depression when taken PO in therapeutic doses OD unlikely, but dependence common protodrug: lorazepam (Ativan) other drugs for anxiety: alprazolam (Xanax), chloridiazepoxide (Librium), clorazepate (Tranxene), diazepam (Valium), oxazepam for anxiety other drugs for insomnia: estazolam, flurazepam, quazepam (Doral), temazepam (Restoril), triazolam (Halcion)

renal excretion

primary site drugs may undergo reabsorption after filtration greatly influenced by pH of filtrate weak acids excreted more efficiently when filtrate is slightly alkaline weak bases excreted more efficiently when filtrate is slightly acidic dose reduction indicated in renal impairment

medication reconcilliation

process of comparing the meds a pt is taking with newly ordered meds keeping track of pt's meds

absorption

process of moving a drug from the site of admin to the bloodstream IV drugs = not absorbed heavily impacted by route administered

psychological dependence

produces no signs of physical discomfort after the agent is discontinued, but the user has an intense emotional desire to continue despite obvious negative economic, physical, or social consequences

neurodegenerative diseases

progressive and irreversible loss of neural function in the brain, spinal cord, or both ex: alzheimer's, parkinson's, Huntington's disease, multiple sclerosis, amyotrophic lateral sclerosis

drugs to treat substance abuse - opioids

protodrug: buprenorphine with naloxone (Suboxone) mixed agonist antagonist opioid work on kappa, weak at mu typically (euphoria) similar drugs: naltrexone (ReVia, Vivitrol) - blocks opiate receptors

4 classes of drugs for anxiety and sleep disorders:

1. benzodiazepines 2. nonbenzodiazepine anxiolytics 3. antidepressants 4. barbiturates

antidepressants used for anxiety

1. SSRIs 2. SNRIs 3. TCAs 4. MAOIs

serotonin

5-hydroxytryptamine (5-HT) 98% found outside of the CNS in platelets, mast cells, and other peripheral cells found in limbic system of the brain in close association with adrenergic synapses make melatonin antidepressant drug significance

dopamine replacement drug

protodrug: levodopa and carbidopa (Sinemet, Parcopa) carbidopa does not cross BBB; inhibits breakdown of levodopa low protein diet similar drugs: none

nonopiod analgesics

NSAIDs, acetaminophen protodrug for mixed opioid/nonopioid analgesic: tramadol (Ultram)

oral route

PO tablets and capsules

a nurse in the post-anesthesia recovery unit is caring for a client who received a nondepolarizing neuromuscular blocking agent and has muscle weakness. the nurse should anticipate a prescription for which of the following medications? a. neostigmine b. naloxone c. dantrolene d. vecuronium

a

a nurse is providing information to a client who has early Parkinson's disease and a new prescription for pramipexole. the nurse should instruct the client to monitor for which of the following adverse effects of this medication? a. hallucinations b. increased salvation c. diarrhea d. discoloration of urine

a

a nurse is teaching a client who has OCD and has a new prescription for paroxetine. which of the following instructions should the nurse include? a. "it can take several weeks before you feel like this medication is helping." b. "take the medication just before bedtime to promote sleep." c. "you should take the medication when needed for excessive urges." d. "monitor for weight gain while taking this medication."

a

a nurse reviewing a client's medical record notes a new prescription for verifying the trough level of the client's medication. which of the following actions should the nurse take? a. obtain a blood specimen immediately prior to administering the next dose of medication b. verify that the client has been taking the medication for 24 hr before obtaining a blood specimen c. ask the client to provide a urine specimen after the next dose of medication d. administer the medication, and obtain a blood specimen 30 min later

a

a patient who has overdosed on amphetamine sulfate and dextroamphetamine (Adderall XR) is admitted to the emergency department. the nurse would anticipate which medications to be administered to assist in counteracting the effects of the overdosage? a. chlorpromazine (Thorazine) b. phenytoin (Dilantin) c. propofol (Diprivan) d. dexamethasone (Decadron)

a

a provider prescribes phenobarbital for a client who has a seizure disorder. the medication has a long half-life of 4 days. how many times per day should the nurse expect to administer this medication? a. one b. two c. three d. four

a

the nurse cannot read the number of milligrams (mg) to be administered in a drug order written by the health care provider. it is questionable whether 125 mg, 1.25 mg, or 12.5 mg should be administered. what action would be the most appropriate to prevent a medication error? a. telephone the health care provider about the illegible medication order b. ask another nurse to read the questionable medication order c. contact the pharmacist about the medication order d. consult a drug handbook and administer the normal dose

a

the nurse is caring for several patients. which patient will the nurse anticipate is most likely to experience an alteration in drug metabolism? a. a 3 day old premature infant b. a 22 year old pregnant woman c. a 32 year old man with kidney stones d. a 50 year old executive with hypertension

a

the nurse knows an advantage to rivastigmine (Exelon) over other cholinesterase inhibitors is that it: a. has no significant drug interactions b. does not cause cholinergic adverse effects c. is absorbed best on an empty stomach d. does not alter glucose control in patients with diabetes

a

the nurse, who is monitoring a patient taking phenytoin (Dilantin), has noted symptoms of nystagmus, confusion, and ataxia. considering these findings, the nurse would suspect that the dose of the drug should be: a. reduced b. increased c. maintained d. discontinued

a

the patient returned from a major surgery 3 hours ago and requests medication for pain. in considering the best action for this patient, the nurse knows that: a. prescription drugs rarely cause addition when used according to accepted medical protocol b. all drugs should be withheld until the patient's past substance abuse history is evaluated c. it is best to wait until the patient can no longer tolerate the pain to avoid addiction problems d. patients often request analgesia when it is not really needed

a

the patient, who is receiving benzodiazepines, is a two-pack-per-day cigarette smoker. the nurse expects to administer a/an _____ dose of this medication a. larger b. smaller c. extra d. half

a

while administering medication to several patients, the nurse suddenly realizes that the wrong medication has been given to a patient. which would be the first priority action taken by the nurse? a. assess the patient in order to monitor for adverse effects b. cell the healthcare provider and report the error c. complete the hospital's drug error form d. report the medication error to the FDA

a

while teaching the patient about disulfiram (Antabuse), which of the following should the nurse instruct the patient to avoid? a. mouthwash, alcoholic beverages, and over-the-counter cold medications b. dairy products such as milk, cream, and yogurt c. foods high in iron such as green leafy vegetables d. driving or operating machinery while taking this medication

a

transdermal patches

a method of administering topical medication slowly and consistently specified amount of med rate of delivery can vary

inferon beta-1b (Betaseron) has been ordered for the patient with MS. the nurse will instruct the patient on possible adverse effects that may be managed symptomatically by the patient. these include (select all that apply): a. flulike symptoms b. insomnia c. depression d. rashes e. pain at the injection site and blackening of the surrounding skin

a, b, d

a nurse is reviewing a new prescription for oxcarbazepine with a female client who has partial seizures. which of the following instructions should the nurse include? (select all that apply) a. "use caution if given a prescription for a diuretic medication" b. "consider using an alternative form of contraception if you are using oral contraceptives" c. "chew gum to increase saliva production" d. "avoid driving until you see how the medication affects you" e. "notify your provider if you develop a skin rash"

a, b, d, e

the nurse knows that the use of donepezil (Aricept) to treat the symptoms of early Alzheimer's disease has which of the following advantages? (select all that apply) a. it is not associated with hepatotoxicity b. it is taken once per day c. it may be used safely in patients with peptic ulcer disease d. it may be used safely with patients with cardiac disease e. it may increase the time between diagnosis and when memory care is needed

a, b, e

a nurse is preparing a client's medications. which of the following actions should the nurse take in following legal practice guidelines? (select all that apply) a. maintain skill competency b. determine the dosage c. monitor for adverse effects d. safeguard medications e. identify the client's diagnosis

a, c, d

a nurse who is caring for a client who takes paroxetine to treat PTSD and reports that he grinds his teeth during the night. the nurse should identify which of the following interventions to manage bruxism? (select all that apply) a. concurrent admin of buspirone b. administration of a different SSRI c. use of a mouth guard d. changing to a different class of antidepressant medication e. increasing the dose of paroxetine

a, c, d

the nurse is monitoring the patient for adverse effects associated with morphine. which adverse effects would be expected? (select all that apply) a. respiratory depression b. hypertension c. urinary retention d. constipation e. nausea

a, c, d, e

a nurse is admitting a client and completing a preassessment before administering medications. which of the following data should the nurse include in the preassessment? (select all that apply) a. use of herbal tea b. daily fluid intake c. current health status d. previous surgical history e. food allergies

a, c, e

a nurse is teaching a patient who will begin varenicline (Chantix) for smoking cessation. which of the following instructions will the nurse give the patient? (select all that apply) a. doses will be increased over a week's period and the drug used for up to 6 months b. smoking may continue because the drug blocks the harmful effects of nicotine c. the drug is not known to cause any adverse effects and has an excellent safety profile d. any unusual rashes, skin reactions, or facial edema should be reported immediately e. any unusual changes in behavior including depression, hostility, or thoughts of suicide should be reported immediately

a, d, e

non pharmacologic pain therapies

acupressure and acupuncture, application of cold or heat, biofeedback therapy, distraction (art or music therapy, laughter), electrical nerve stimulation, hypnosis, massage, meditation, physical therapy, yoga

drug metabolism

aka biotransformation process used by body to chemically change a drug molecule primary site = liver also kidneys and intestinal tract lipid -> water soluble for excretion

miscellaneous dopaminergic drugs used as adjuncts to levodopa therapy

amantadine (Gocovri) catechol-o-methyltransferase inhibitors monoamine oxidase-B inhibitors

minimum effective concentration

amount of drug required to produce a therapeutic effect

strategies for reducing med errors

assessment: history, allergies, other meds planning: avoid abbreviations, verbal orders implementation: pt check, med checks, calculate dose correctly, open meds immediately prior to admin and record on MAR, focus on situation at hand, watch pt evaluation: assess pt for expected outcomes and adverse reactions to the drug

methylxanthines

associated with treating pts with COPD, asthma, and other restrictive lung diseases due to their ability to relax smooth muscle protodrug: caffeine similar drugs: theophylline

a 23-year-old patient has been taking gabapentin (Neurontin) for control of partial seizures. he is admitted to the emergency department with slurred speech, dyspnea, reports of double vision, and sedation. the admitting nurse suspects the patient has: a. not taken his drug for several days b. taken an overdose of the drug, either unintentionally or deliberately c. taken the drug with grapefruit or grapefruit juice d. continued to smoke despite prior patient education that smoking interacts with the drug

b

a nurse orienting a newly licensed nurse is reviewing the procedure for taking a telephone prescription. which of the following statements should the nurse identify as an indication that the newly licensed nurse understands the process? a. "a second nurse enters the prescription into the client's medical record." b. "another nurse should listen to the phone call." c. "the provider can clarify the prescription when he signs the health record." d. "I should omit the 'read back' if this is a one‑time prescription

b

a nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. which of the following actions is the nurse's priority? a. administer flumazenil b. identify the client's level of orientation c. infuse IV fluids d. prepare the client for gastric lavage

b

a patient with diabetes reports increasing pain and numbness in his legs. "it feels like pins and needles all of the time, especially at night." which drug would the nurse expect to be prescribed for this patient? a. ibuprofen (Motrin) b. gabapentin (Neurontin) c. naloxone (Narcan, Evzio) d. methadone

b

an office worker has made an appointment with a healthcare provider for heart palpitations, dysrhythmias, and facial tingling. the nurse is taking the patient's history. which of the following does the nurse note may explain the symptoms? a. the patient takes zolpidem (Ambien) for occasional insomnia b. the patient has been working late frequently and has relied on coffee to maintain alertness c. the patient is taking gabapentin (Neurontin) for pain associated with herpes zoster d. the patient has been under stress at work and has switched to using herbal teas

b

the emergency department nurse is caring for a patient with a migraine. which drug would the nurse anticipate administering to abort the patient's migraine? a. morphine b. dihydroergotamine (Migranal) c. propranolol (Inderal) d. ibuprofen (Motrin)

b

the nurse is counseling the patient on a medication taken daily. which strategy should the nurse include in this teaching session that might prevent a medication error? a, insist on trade-name drugs rather than generic drugs b. have all prescriptions filled at one pharmacy c. request all prescriptions be placed in easily opened containers d. consult the internet about possible adverse effects

b

the nurse is teaching the patient about a newly prescribed medication. which statement made by the patient would indicate the need for further medication education? a. "the liquid form of the drug will be absorbed faster than the tablets" b. "if I take more, I'll have a better response" c. "taking this drug with food will decrease how much drug gets into my system" d. "I can consult my healthcare provider if I experience unexpected adverse effects"

b

the nurse should question a healthcare provider's order of phenobarbital for the patient with which condition? a. seizure disorder b. panic disorder c. prior to a bronchoscopy d. prior to receiving a general anesthetic

b

the patient is receiving levodopa and carbidopa for Parkinsonism. which drug would the nurse expect to be added to the patient's drug regimen to help control tremors? a. amantadine (Gocovri) b. benztropine (Cogentin) c. haloperidol (Haldol) d. donepezil (Aricept)

b

which parameter is most critical when a nurse is assessing a patient with an overdose of sedatives? a. cardiac stimulation b. respiratory suppression c. hepatic dysfunction d. depression of consciousness

b

which therapeutic outcome would the nurse consider most significant in evaluating a patient who started atomoxetine (Strattera) 6 months ago? a. decrease in attention b. decrease in hyperactivity c. development of mydriasis d. elevated liver enzymes

b

the nurse is monitoring the therapeutic drug level for a patient on vancomycin (vancocin) and notes that the level is within the accepted range. what does this indicate to the nurse? (select all that apply) a. the drug should case no toxicities or adverse effects b. the drug level is appropriate to exert therapeutic effects c. the dose will not need to be changed for the duration of treatment d. the nurse will need to continue monitoring because each patient response to a drug is unique e. this drug will effectively treat the patient's condition

b, d

a nurse is preparing to administer eye drops to a client. which of the following actions should the nurse take? (select all that apply) a. have the client lie on her side b. ask the client to look up at the ceiling c. tell the client to blink when the drops enter her eye d. drop the medication into the center of the client's conjunctival sac e. instruct the client to close her eye gently after instillation

b, d, e

a nurse is preparing to administer a medication to a client who has absence seizures. the nurse should anticipate administering which of the following medications to the client? (select all that apply) a. phenytoin b. ethosuximide c. gabapentin d. carbamazepine e. valproic acid f. lamotrigine

b, e, f

tolerance

biological condition that occurs when the body adapts to a substance after repeated administration not an indication of drug abuse

anticholinergic drugs

block the excitatory actions of ACh for treatment of Parkinson's disease protodrug: benztropine (Cogentin) similar drugs: trihexyphenidyl (Artane)

drugs to treat substance abuse - nicotine

bupropion (Zyban) antidepressant, nicotine replacement therapy protodrug: varenicline (Chantix) - stimulates release of dopamine to increase the pleasurable effects associated with nicotine, banned for commercial drivers, air traffic controllers, or airline pilots similar drugs: none

a 10-year-old child has been evaluated for a learning disability and has been diagnosed with absence seizures. ethosuximide (Zarontin) has been ordered and the nurse is teaching the patient and family about the drug, because of the patient's age, it is important to include instructions to: a. curtail after-school sports activities because the drugs metabolism may be increased with physical activity b. increase intake of Ca+ rich foods and vitamin D to prevent bone loss c. monitor height and weight weekly to be sure GI side effects are not hindering nutrition and normal growth d. increase fluid intake to avoid dehydration caused by the drug

c

a high school student taking atomoxetine (Strattera) for attention-deficit hyperactivity disorder visits the school nurse's office and confides, "I am so depressed. the world would be better off without me." which action would the nurse take for this patient? a. tell the patient to stop taking atomoxetine immediately and not to take it until checking with the provider b. assure the patient that these are normal symptoms because the drug may take 3 or 4 weeks to work c. alert the family or caregiver that immediate attention and treatment are needed for these symptoms d. have the patient increase intake of caffeine by consuming cola products, coffee, or tea to counteract the depressive effect

c

a nurse is completing discharge teaching for a client who has a new prescription for transdermal patches. which of the following statements should the nurse identify as an indication that the client understands the instructions? a. "I will clean the site with an alcohol swab before I apply the patch" b. "I will rotate the application sites weekly" c. "I will apply the patch to an area of skin with no hair" d. "I will place the new patch on the site of the old patch"

c

a nurse is teaching a client who has a new prescription for escitalopram for treatment of GAD. which of the following statements by the client indicates understanding of the teaching? a. "I should take the medication on an empty stomach." b. "I will follow a low-sodium diet while taking this medication." c. "I need to discontinue this medication slowly." d. I should not crush this medication before swallowing."

c

a nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. which of the following instructions should the nurse include? a. increase intake of protein-rich foods b. expect muscle twitching to occur c. take this medication with food d. anticipate relief of manifestations in 24 hours

c

a nurse reviewing a client's health record notes a new prescription for lisinopril 10 mg PO once every day. the nurse should identify this as which of the following types of prescription? a. single a. stat c. routine d. standing

c

which of these statements, if made by a patient, would indicate that further instruction is needed about alprazolam (Xanax)? a. "I will stop smoking by undergoing hypnosis." b. "I will not drive immediately after I take this medication." c. "I will stop the medicine when I feel less anxious." d. "I will take my medication with food if my stomach feels upset."

c

which statement, if made by the patient, would alert the nurse that the antiparkinson medication is effective? a. "I'm sleeping a lot more, especially during the day" b. "my appetite has improved" c. "I'm able to shower by myself" d. "my skin doesn't itch anymore"

c

a staff educator is reviewing medication dosages and factors that influence medication metabolism with a group of nurses at an in-service presentation. Which of the following factors should the educator include as a reason to administer lower medication dosages? (select all that apply) a. increased renal excretion b. increased medication-metabolizing enzymes c. liver failure d. peripheral vascular disease e. concurrent use of medication the same pathway metabolizes

c, e

patient education

carry list of all meds use one pharmacy if possible ask questions consult pharmacist if medication looks unfamiliar

medication error index

categorizes medication errors by evaluating the extent of harm an error can cause A -> I

migraines

caused by blood vessel overactivity (dilation after constriction event) key factor: 5-HT treatment: Triptans/ergot alkaloids constrict vessels (triptans selective, ergot both veins and arteries) protodrug: sumatriptan (Imitrex, Onzetra) similar drugs: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), zolmitriptan (Zomig)

neuropathic pain

caused by injury or irritation to nerve tissue burning, shooting, or numbing analgesics are often unsuccessful or high doses are required responds well to adjuvant analgesics such as anti seizures drugs and antidepressants

secondary PD

caused by medical conditions such as head trauma, brain infections, brain exposures, and neurotoxins most frequent cause is antipsychotics (EPS); usually reversible

ADHD

characterized by impulsive behavior, distractibility, lack of attention, and hyperactivity pharmacotherapy involves stimulants (amphetamine and amphetamine-like drugs) and nonstimulants

narcolepsy

characterized by steep attacks, cataplexy (loss of muscle tone and emotion), sleep paralysis, hypnagogic hallucinations protodrug: modafinil (Provigil) similar drugs: armadafinil (Nuvigil), sodium oxybate (Xyrem)

dementia

chronic, degenerative disorder characterized by progressive memory loss, confusion, and inability to think or communicate effectively

addiction

continued use of a substance despite serious health and social consequences overwhelming compulsion to continue repeated drug use

a 22-year-old addict is exhibiting withdrawal symptoms. which symptom of withdrawal does the nurse expect? a. somnolence, lethargy, and fatigue b. dry skin, rash, and itching c. paranoia, hallucinations, and delusions d. chills, running nose, and muscle spasms

d

a nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. which of the following information should the nurse include? a. "take this medication on an empty stomach." b. "expect optimal therapeutic effects within 24 hr." c. "take this medication when needed for anxiety." d. "this medication has a low risk for dependency."

d

a nurse is reviewing a new prescription for ondansetron 4 mg PO PRN for nausea and vomiting for a client who has hyperemesis gravidarum. the nurse should clarify which of the following parts of the prescription with the provider? a. name b. dosage c. route d. frequency

d

an 80-year-old patient is prescribed carbamazepine (Tegretol) for a newly diagnosed seizure disorder. the nurse will implement safety measures because this patient is at an increased risk for which adverse effects with the administration of this drug? a. dementia and confusion b. insomnia and forgetfulness related to sleep deprivation c. stroke and decreased motor function d. sedation and falls

d

an elementary school nurse is providing education to the faculty on the use of central nervous system stimulants to treat attention-decific/hyperactivity disorder. of the following, which is the most important for the nurse to convey to the faculty? a. have the child bring the drug dose in a lunch bag and come to the office to take it to avoid being teased b. request that the parents leave an extra copy of the prescription at the school in case the dose runs out c. suggest that the parents have two prescriptions filled, one for home and one to keep at school d. keep the drugs in a locked drawer, clearly labeled with the student's name and only the number of doses allowed by school policy

d

it is 2:45 am and the nurse has telephoned the prescriber to report that the patient is experiencing an acute episode of postoperative pain. how can the nurse avoid medication errors when receiving a telephone order from a prescriber? a. decline to accept the telephone order b. refuse to call the prescriber but attempt to comfort the patient c. instruct the patient's family to call the prescriber d. repeat the order verbally to ensure accuracy

d

several days postoperative bowel surgery, the client is eating soft food, ambulating regularly, and using hydrocodone (Vicodin) for pain. what should the nursing care plan include? a. monitoring vital signs for respiratory depression b. inserting a urinary catheter for urinary retention c. weaning pain medication to prevent addiction d. increasing dietary fiber and fluids and administering a stool softener if needed

d

the nurse is caring for a 42-year-old patient who was recently diagnosed with partial seizures and has been prescribed oxcarbazepine (Trileptal). which lab study would the nurse expect to be ordered? a. CBC with differential b. serum albumin and glucose levels c. sedimentation rate and platelet count d. serum sodium and renal function studies

d

the nurse is caring for a patient with hepatitis and resulting hepatic impairment. the nurse would expect the duration of action for most medications to: a. decrease b. improve c. be unaffected d. increase

d

the nurse is caring for several patients who are receiving opioids for pain relief. which patient is at the highest risk of developing hypotension, respiratory depression, and mental confusion? a. a 23-year-old woman, postoperative ruptured appendix b. a 16-year-old adolescent, post-motorcycle injury with lacerations c. a 54-year=old woman, post-myocardial infarction d. an 86-year-old man, postoperative femur fracture

d

the patient with insomnia is being treated with temazepam (Restoril). the nurse monitors for therapeutic effectiveness by noticing which of the following? a. sleeping in 3-hour intervals, awakening for a short time, and then returning to sleep b. feeling less anxiety during activities of daily living c. having fewer episodes of panic attacks when stressed d. sleeping 7 hours without awakening

d

sleep-onset insomnia

difficulty falling asleep

sleep-maintenance insomnia

difficulty staying asleep

dopamine agonist

directly activate dopamine receptors not converted to potentially toxic metabolites low-protein diet not necessary, but may have more serious adverse effects ergot alkaloids and nonergot drugs protodrug: pramipexole (Mirapex) - nonergot similar drugs: apomorphine (Apokyn), bromocriptine (Parlodel), ropinirole (Requip), rotigotine (Neupro)

epilepsy

disruption in the activity of clusters of neurons in the brain that is characterized by two or more seizures (disturbance of brain's electrical activity)

extended release capsules

dissolves slowly for longer duration do not crush

nonstimulant ADHD meds

do not appear to have abuse potential not a controlled substance takes 2-4 weeks to work unlike stimulants protodrug: atomoxetine (Strattera) - SNRI similar drugs: clonidine (Kapvay) - can be used for opioid withdrawal, guanfacine (Intuniv) also TCAs: tofranil, norpramin, aventyl other antidepressants: Wellbutrin

oral cavity capsules

do not crush

first pass effect

drugs absorbed by stomach and small intestine may be inactivated by the liver before reaching target organs

pulmonary excretion

drugs delivered by gas or volatile liquids most excreted unmetabolized dependent on rr and blood flow to lungs

immunomodulars

drugs that affect body defenses (boost or suppress) protodrug: interferon beta-1b (Betaseron, Extavia) similar drugs: alemtuzumab (Lemtrada), daclizumab (Zinbryta), dimethyl fumarate (Tecfidera), fingolimod (Gilenya), glatiramer (Copaxone, Glatopa), IFN beta-1a (Avon, Rebif) and PEG IFN beta-1a (Plegridy), Mitoxantrone (Novantrone), natalizumab (Tysabri), orelizumab (Ocrevus), teriflunomide (Aubagio)

high alert meds

drugs that bear heightened risk of causing significant patient harm when used in error list should be posted on each unit

mixed agonist and antagonist opioids

drugs that occupy one receptor and block (or have no effect) on the other (mu/kappa) weak at mu typically (euphoria) ex: buprenorphine (Buprenex, Butrans, Suboxone), butorphanol (Stadol), nalbuphine (Nubain), pentazocine (Talwin)

fecal and biliary excretion

drugs travel through GI tract without being absorbed or secrete into bile and leave body in feces

nonbenzodiazepine anxiolytics

drugs used for anxiety and sleep disorders that are chemically unrelated to benzodiazepines protodrug: zolpidem (Ambien) other drugs: beta blockers such as propranolol (Inderal), antihistamines such as diphenhydramine (Benedryl), buspirone as an anxiolytic, eszopiclone (Lunesta)

sleep-offset insomnia

early morning awakenings

dibenzazepines

epilepsy treatment chemically related to TCAs affect Na+ channels, but also have analgesic, anticholinergic, antidysrhythmic, antidepressant, and sedative effects that are unexplained protodrug: carbamazepine (Carbatrol, Tegretol, others) similar drugs: eslicarbazepine (Aptiom), oxcarbazepine (Oxtellar XR, Trileptal)

hydantoins

epilepsy treatment delay influx of Na+ ions to prevent action potential (do not block - desensitize); high doses exert excitatory effects and can induce seizures protodrug: phenytoin (Dilantin, Phenytek) similar drugs: fosphenytoin (Cerebyx)

benzodiazepines for seizures

epilepsy treatment enhance inhibitory action of GABA protodrug (for status epilepticus): diazepam (Valium) similar drugs: clobazam (Onfi), clonazepam (Klonopin), clorazepate (Tranxene), lorazepam (Ativan)

barbituates

epilepsy treatment have largely been replaced by safer medications ex: phenobarbital, primidone (Myoline)

CNS stimulants

range from caffeine (no schedule) to ecstasy (schedule 1) raise general alertness of brain increase concentration mood elevation -> euphoria side effects: nervousness, dizziness, irritation, convulsions at higher doses, anorexia use: ADHD, narcolepsy, weight management, stimulation of respiration, migraines

therapeutic range

range where drug produces desired effect after peaking, drug plasma level falls due to excretion want to keep drug within this range at all times

tachyphylaxis

rapid development of tolerance after only a few doses more common in cocaine, LDS, and amphetamines, but also nitroglycerin beneficial when it comes to adverse effects

excretion

removal of drugs from the body rate of excretion determines drug blood level

enteric coated capsules

resists acidic stomach contents do not crush

therapeutic drug monitoring

results used by healthcare provider to predict half lives and keep drug dose within predetermined range

5 rights

right patient right drug rise dosage right route right time

sentinel event

risk to patient safety that is so significant that it may result in death, permanent harm, or severe temporary harm

parenteral route

routes other than enteral or topical intradermal, sub Q, IM, IV

glandular secretion

saliva, sweat, breast milk

SSRIs

selective serotonin reuptake inhibitors increase serotonin adverse effects: weight gain, sexual dysfunction OD: confusion, tremors, restlessness, lack of muscle control, fever paroxetine (Pazil), escitalopram (Lexapro), fluoxetine (Prozac), sertraline (Zoloft)

substance abuse

self-administration of a drug in a manner that does not conform to the norms within the individual's given culture or society craving for a specific substance even though it is lowering the patient's quality of life (physical dependence) failure to maintain normal work or home relationships because a substance is being used repeatedly repeated, unsuccessful attempts two discontinue substance use behavioral changes occur when substance is discontinued such as agitation, drowsiness, anxiety, or pain (withdrawal syndrome) increased time devoted to obtaining or using substance which reduces time available for work, home, or leisure activities

SNRIs

serotonin-norepinephrine reuptake inhibitors increase serotonin and NE adverse effects: insomnia, sweating, constipation, dry mouth, weight loss, decreased libido duloxetine (Cymbalta), venlafaxine (Effexor XR)

topical route

skin or mucous membranes (ophthalmic, otic, intranasal, vaginal, rectal)

nociceptor pain

somatic pain: sharp, localized sensations usually in muscles and joints visceral pain: generalized dull, throbbing, or aching pain usually in internal organs responds well to analgesics

enterohepatic recirculation

some substances in bile resorbed and circulated back to liver may participate in this process multiple times accounts for half life

pharmacokinetics

study of drug movement throughout the body pharmaco: medicine kinetics: motion absorption -> distribution -> metabolism -> excretion

withdrawal syndrome

substance abruptly discontinued in a patient physically dependent in general are opposite of drug effects (rebound effects) abstinence syndrome

antiepileptic drugs (AEDs)

suppress neuron discharges by 1. electrolyte movement (inhibition of Na+ or Ca+ into neurons, causing +++ activity) or 2. neurotransmitter balance (GABA receptor activation by Cl-; glutamate receptor blocking) barbituates, benzodiazepines, hydantoins, dibenzazepines, succinimides

opioids

synthetic drug with morphine-like activity ex: fentanyl

adherence

taking meds in the manner prescribed by the healthcare provider

pain pathway

transduction -> transmission -> perception -> modulation

TCAs

tricyclic antidepressants adverse effects: anticholinergic effects (dry mouth, urine retention, HTN, blurred vision) clomipramine (Anafranil), doxepin (Silenor)

adjuvant analgesics

used to enhance analgesia have other primary classifications ex: antidepressants, anti seizure medications, corticosteroids, local anesthetics, muscle relaxants, bone-specific meds, miscellaneous drugs

dopamine drugs

used to increase the levels of dopamine in the striatum for treatment of Parkinson's disease may be accomplished by: 1. directly replacing dopamine 2. decreasing the breakdown of dopamine 3. increasing the release of dopamine from neurons 4. activating dopamine receptors

nasogastric or gastrostomy tubes

usually liquid

drugs to treat substance abuse - ETOH

withdrawal symptoms are severe, proceeding to delirium tremens, a syndrome of intense agitation, confusion, terrifying hallucinations, uncontrollable tremors, panic attacks, and paranoid, and kill approximately 35% of those affected if not treated protodrug: disulfiram (Anabuse) - makes pt sick w/ alcohol use, aversive therapy similar drugs: naltrexone (ReVia, Vivitrol) - blocks opiate receptors, think euphoria

anxiety

worry, fear, or uneasiness over a perceived threat activates sympathetic nervous system may cause increased BP, heart palpations, respiratory changes (SOB), increased sweating, etc 5 types: GAD, panic disorder, social anxiety disorder, OCD, PTSD