Pharm exam 1

patient education on when to take stigmine meds

Take before meals to help with chewing take at exact time everyday monitor muscle contractibilty after administering

therapeutic prothrombin time

18-24 seconds

hydroxyzine

1st generation antihistamine (like diphenhydramine) causes drowsiness and confusion in elderly

imipramine used to treat

bedwetting urinary retention is an emergency

Therapeutic INR

20-30

Diphenhydramine in elderly (antihistamines in general)

causes confusion

adverse affects of sartans

hyperkalemia

adverse effects of the ides

tinnitus if infused too fast, hypokalemia--> be sure to eat foods high in potassium

benzos suffix

zepam, zelam

Antidote for Cholinergics

Atropine

The nurse is providing information to a client about propranolol. Which statement by the client indicates the teaching has been effective? A. "I should expect to feel nervousness during the first few weeks." B. "I can have a heart attack if I stop this medication suddenly." C. "I could have an increase in my heart rate for a few weeks." D. "I may experience seizures if I stop the medication abruptly."

B. "I can have a heart attack if I stop this medication suddenly."

The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately? A. Headache, hypertension, and blurred vision. B. Wheezing, hypotension, and AV block. C. Vomiting, dilated pupils, and papilledema. D. Tinnitus, muscle weakness, and tachypnea.

B. Wheezing, hypotension, and AV block. Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.

1st gen. antihistamines contraindications

BPH

stigmine side effects

Increased sweating, incontinence, weakness, NVD, abdominal pain, bradycardia, excessive drooling

ketorolac is a

NSAID (tordal)

what medication is contraindicated with ace inhibitors?

NSAIDs

Therapeutic PTT for Heparin

1.5-2.5x normal (times 16-40 seconds). Over 100 is life threatening bleeding risk

A client has been taking rosuvastatin for six weeks as part of a treatment plan to reduce hyperlipidemia. The clinic nurse is reviewing and reinforcing information about the medication with the client. Which statements by the client indicates an understanding about the medication? Select all that apply. A. "I will need to call my doctor if I have any muscle weakness or pain, especially in my legs." B. "I will need to come back to have my liver and kidney labs checked." C. "I need to be careful when I get up because this medication can make my blood pressure drop." D. "I add some nuts and fresh fruit to my oatmeal in the morning and I can't remember when I last ate a steak." E. "This medication has to be taken first thing in the morning, before I eat breakfast."

A. "I will need to call my doctor if I have any muscle weakness or pain, especially in my legs." B. "I will need to come back to have my liver and kidney labs checked." D. "I add some nuts and fresh fruit to my oatmeal in the morning and I can't remember when I last ate a steak."

Hydrochlorothiazide (HCTZ) has been prescribed for a client with hypertension. The client reports hearing that furosemide is more effective and requests a prescription change. How will the nurse respond? A. 'HCTZ has fewer side effects.' B. 'HCTZ does not cause dizziness.' C. 'HCTZ is only taken when needed.' D. 'HCTZ does not cause dehydration.'

A. 'HCTZ has fewer side effects.'

The nurse provides instruction when the beta-blocker (BB) atenolol is prescribed for a client with moderate hypertension. Which client statement indicates to the nurse that further teaching is needed? A. 'I must take the medication before going to bed.' B. 'This medication will make me feel drowsy.' C. 'I need to count my pulse before taking the medication.' D. 'I will move slowly when changing positions from sitting to standing.'

A. 'I must take the medication before going to bed.' This medication should be taken early in the morning to maximize its therapeutic effect. Orthostatic hypotension is a side effect of BBs, and the client should change positions slowly from sitting to standing to prevent dizziness and falls. Drowsiness is a side effect of BBs, and the client should be taught precautions to prevent injury. The pulse rate should be taken before administration because ventricular dysrhythmias and heart block may occur with BBs.

A client with hypertension is prescribed an angiotensin II receptor blocker (ARB). Which instructions will the nurse provide about this medication? Select all that apply. One, some, or all responses may be correct. A. 'Monitor the blood pressure daily.' B. 'Stop treatment if a cough develops.' C. 'Stop the medication if swelling of the mouth, lips, or face develops.' D. 'Have blood drawn for potassium levels 2 weeks after starting the medication.'

A. 'Monitor the blood pressure daily.' C. 'Stop the medication if swelling of the mouth, lips, or face develops.' D. 'Have blood drawn for potassium levels 2 weeks after starting the medication.'

Propranolol is prescribed for a client with coronary artery disease (CAD). The nurse should consult with the health care provider (HCP) before giving this medication when the client reports a history of which condition? A. Asthma B. Deep vein thrombosis C. Myocardial infarction D. Peptic ulcer disease

A. Asthma Rationale: Non-cardioselective beta-blockers such as propranolol block b1- and b2-adrenergic receptors and can cause bronchospasm, especially in clients with a history of asthma. Beta-blockers will have no effect on the client's peptic ulcer disease or risk for DVT. Beta-blocker therapy is recommended after an MI.

A nurse is providing dietary instructions to a client who is taking prescribed amiloride. Which information will the nurse include in the teaching? A. Avoid eating foods that are rich in potassium such as bananas B. It is important to control high-sodium foods such as canned soups C. Eat plenty of foods that contain calcium such as milk D. Choose foods that are high in iron content such as shellfish

A. Avoid eating foods that are rich in potassium such as bananas Rationale: Amiloride is a potassium-sparing diuretic used in the treatment of edema, hypertension, and potassium loss caused by other diuretic medications. Amiloride may cause hyperkalemia, so the client should be informed to limit their potassium intake. Sodium, calcium, and iron are not affected by the use of amiloride.

A client who has type 1 diabetes and chronic bronchitis is prescribed atenolol for the management of angina pectoris. Which clinical manifestation will alert the nurse to the fact that the client may be developing a life-threatening response to the medication? A. Paroxysmal nocturnal dyspnea B. Supraventricular tachycardia C. Malignant hypertension D. Hyperglycemia

A. Paroxysmal nocturnal dyspnea Rationale Atenolol is associated with the adverse reactions of bradycardia, heart failure, and pulmonary edema; these are the most serious responses to atenolol and are often manifested by episodes of paroxysmal nocturnal dyspnea and orthopnea. A decreased, not increased, pulse rate is associated with atenolol so supraventricular tachycardia is not a response. Atenolol decreases, not increases, blood pressure so malignant hypertension is not a response. It also will not cause an increase in blood glucose. It may increase the hypoglycemic response to insulin, causing hypoglycemia. In addition, the medication may mask the clinical manifestations of hypoglycemia.

A nurse is reviewing a client's medical history. The client has been newly diagnosed with hypertension and has been prescribed oral losartan as treatment. The nurse will clarify the use of losartan if which comorbidity is noted in the client's medical record? A. Renal stenosis B. Hyperlipidemia C. Atrial fibrillation D. Diabetes

A. Renal stenosis

Which instruction will the nurse include in a teaching plan for a client taking a calcium channel blocker such as nifedipine? Select all that apply. One, some, or all responses may be correct. Reduce calcium intake. A. Report peripheral edema. B. Expect temporary hair loss. C. Avoid drinking grapefruit juice. D. Change to a standing position slowly.

A. Report peripheral edema. C. Avoid drinking grapefruit juice. D. Change to a standing position slowly.

Clopidogrel

Antiplatelet

The nurse is preparing to administer diltiazem to a client with heart disease. Which action should the nurse take first? A. Assess the client's lung sounds and monitor for wheezing B. Assess the client's blood pressure and apical pulse C. Assess the client's urine output and potassium level D. Auscultate the abdomen for bowel sounds

B. Assess the client's blood pressure and apical pulse

Which instructions will the nurse include in the teaching plan for a client who will be taking simvastatin? Select all that apply. One, some, or all responses may be correct. A. Increase dietary intake of potassium. B. Avoid prolonged exposure to the sun. C. Schedule regular ophthalmic examinations. D. Take the medication at least half an hour before meals. E. Contact your health care provider if skin becomes gray-bronze.

B. Avoid prolonged exposure to the sun. C. Schedule regular ophthalmic examinations. E. Contact your health care provider if skin becomes gray-bronze.

The nurse is administering 40 mg of furosemide intravenously. Which sensation reported by the client would the nurse consider when determining that it is being administered too quickly? A. Full bladder B. Buzzing ears C. Fast heartbeat D. Numb arms and legs

B. Buzzing ears

Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply. One, some, or all responses may be correct. A. Alcohol B. Grapefruit juice C. Cheddar cheese D. Summer sausage E. Dark green vegetables

B. Grapefruit juice

A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A. Do not add salt to foods during preparation. B. Refrain for eating foods high in potassium. C. Restrict fluid intake to 1000 ml per day. D. Increase intake of milk and milk products.

B. Refrain for eating foods high in potassium.

The nurse is providing discharge education to a client who will be starting daily atenolol for the treatment of hypertension. Which side effect is most important for the client to notify their health care provider about? A. Decreased libido B. Slow, irregular heart rate C. Dizziness in the morning D. Decreased exercise tolerance

B. Slow, irregular heart rate

A 42-year-old male client diagnosed with hypertension tells the nurse he no longer wants to take the prescribed propranolol. Which client statement best explains the reason why he does not want to take this medication? A. "I have difficulty falling asleep." B. "I'm having problems with my stomach." C. "I'm experiencing decreased sex drive." D. "I feel so tired all the time."

C. "I'm experiencing decreased sex drive." Rationale: Propranolol is a beta-blocker used to treat many conditions, such as essential tremors, angina, hypertension and heart rhythm disorders. Common side effects of this drug include nausea, diarrhea, constipation, stomach cramps, rash, tiredness, dizziness, sleep problems and vision changes. Additionally, propranolol may cause decreased sex drive, impotence or difficulty having an orgasm in men. The clients can be switched to an alternative antihypertensive, such as an angiotensin-converting enzyme (ACE) inhibitor or a calcium channel blocker.

The nurse is talking with a client who was admitted with an acute myocardial infarction due to coronary artery disease. The clients asks what the purpose for the prescribed carvedilol is. How should the nurse respond? A. "A beta blocker will prevent postural hypotension." B. "Most people develop hypertension after a heart attack." C. "This drug will decrease the workload on your heart." D. "Beta blockers will help to increase your heart rate."

C. "This drug will decrease the workload on your heart."

A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.

C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect.

The nurse is caring for a client who is being treated for heart failure. After completing the medication reconciliation process, the nurse notes that the prescriber has added lisinopril 5mg orally bid. Which medication from the list below should the nurse question due to possible drug-to-drug interaction with lisinopril? A. Metoprolol B. Glipizide C. Naproxen D. Enoxaparin

C. Naproxen

A nurse is providing care to a client with diabetes insipidus. The client is on a prescribed vasopressin infusion with orders to titrate as needed. The nurse decreases the dose of vasopressin based on which clinical finding? A. Increased blood pressure B. Decreased urine osmolarity C. Reduced volume of urine output D. Elevated heart rate

C. Reduced volume of urine output Vasopressin decreases urine output by allowing the reabsorption of water in the kidneys. A reduction in the volume of urine output indicates the medication is delivering the intended effect, and the dose can be decreased.

A client has primary open-angle glaucoma. Which ophthalmic preparation is indicated to manage this condition? A. Tetracaine B. Fluorescein C. Timolol maleate D. Atropine sulfate

C. Timolol maleate

A health care provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which advice is important for the nurse to teach when the client initially takes the medication? A. Take the medication with breakfast. B. Have liver function tests every 6 months. C. Wear sunscreen to prevent photosensitivity reactions. D. Inform the health care provider if you wish to become pregnant.

D. Inform the health care provider if you wish to become pregnant.

which drink to not drink with calcium channel blockers?

Grapefruit juice

which drink can potentiate the effect of warfarin

Green tea (increases bleeding) and cranberry

critical patient education for steroid use

Must be tapered off

Indomethacin is a

NSAID

what med is avoided with spirinolactone?

ace inhibitors (ace inhibitors increase potassium volume also)

epinephrine and norepinephrine are used to treat

anaphylaxis, V tach and V fib

-trop suffix drugs uses contraindications

atropine, benztropine, tiotropium urinary incontinence bronchodilator increase heart rate *go to treatment for symptomatic bradycardia contraindicated in glaucoma

aminophylline and theophylline side effects and when to take

bronchodilators used to treat asthma take at the exact same time as prescribed do not take before bed because side effects are restlessness, tachycardia and palpitations

calcium channel blockers suffixes

dipine, pamil, tiazem

patient education for ace inhibitors

dizziness stand up slowly avoid using salt substitutes and foods high in potassium (hyperkalemia can occur with ace inhibitors)

Anticholinergic drugs

epinephrine and norepinephrine atropine, benztropine, tiotropium amphetamines scopolamine amitryptiline, nortriptyline pramine (i dont pee pramine)

adverse effects of calcium channel blockers

facial flushing, pulmonary edema, peripheral edema, hypotension

-ides meds and purpose

furosemide, hydrochlorothiazide, bumetanide

anticholinergics are contraindicated in what?

glaucoma

steroid therapy for nephrotic syndrome

helps stimulate the kidneys and promote diuresis

adverse effect and monitor with use of steroids

hyperglycemia -->monitor for polyuria and increased thirst increased risk for infection cuts up GI tract--> take with food monitor for bloody stool mood changes

which comorbidity is contraindicated with sartans?

kidney disease (works in the kidneys)

therapeutic effect of sartans (ARB)

lower bp

-lukast drug and contraindication

montelukast decreases WBC count (plateletes) so do not take with NSAIDs

edrophonium test for

myasthenia gravis

stigmine drugs ( treatment for neostigmine, pyridostigmine)

myasthenia gravis

vitamin k synthesizes _____ in the liver

prothrombin

overuse of phenylephrine and oxymetazoline may cause

rebound congestion

2 cholinergic drugs

stigmine and edrophonium

triptyline drugs name purpose

tricyclics --> amitriptyline, nortriptyline treats depression and migraines less cholinergic effects causes drowsiness and hypotension and anticholinergic (dry mouth, urinary retention, constipation)

A client with chronic liver disease that has bleeding gums and hemorrhagic lesions will take...

vitamin K because vitamin K synthesizes prothrombin from the liver