Pharm Exam B, Pharm 2019 A, Pharmacology ATI Proctored NEW, ATI Pharmacology Test 1

Meglitinides

Repaglinide Used for type two diabetes Increases release of insulin from pancreas Side effects: hypoglycemia, angina Take three times a day, eat within thirty minutes of dose

A nurse is administering diazepam to a client who is having a colonoscopy. Which of the following actions should the nurse take?

Ensure flumazenil is available to administer for toxicity management.

A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescriptions for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication?

" I have tendonitis, so I haven't been able to exercise"

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching?

" Rinse your mouth after inhaling the beclomethasone"

A nurse is teaching a client about warfarin. The client asks if she can take aspirin while taking the warfarin. Which of the following responses should the nurse make?

"Aspirin will increase risk of bleeding"

A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an adverse effect of the medication?

Blurred vision

A nurse is caring for a client who is refusing to take their scheduled morning furosemide. Which of the following statements should the nurse make?

"By not taking your furosemide, you might retain fluid and develop swelling."

A nurse is planning discharge teaching for a client who has a prescription for furosemide. The nurse should plan to include which of the following statements in the teaching?

"Drink a glass of milk with each dose of medication."

A nurse is providing teaching to a client who has depression and a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching?

"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication."

Irritable Bowel Syndrome with Constipation

Lubiprostone Increases fluid secretion in intestine and increase intestinal motility Side effects: diarrhea or nausea

A nurse is providing teaching to a client about the use of ethinyl estradiol/norelgestromin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

"I will fold the sticky sides of the old patch together before disposing it."

A nurse is teaching about self-administration of transdermal medication with a male client who has a new prescription for nitroglycerin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

"I will remove the patch after 14 hours."

A nurse is teaching about a new prescription for ciprofloxacin to a client who has a urinary tract infection. The nurse should identify which of the following statements as an indication that the client understands the teaching?

"I will report any signs of tendon pain or swelling."

A nurse is providing discharge instructions to a client who is to self-administer insulin at home. Which of the following client statements should indicate to the nurse that the teaching is effective?

"I will store my unopened bottles of insulin in the refrigerator."

A nurse is teaching about zolpidem to a client who has insomnia. The nurse should identify that which of the following client statements indicates and understanding of the teaching?

"I will use this medication for a short period of time."

Trick to remember difference between Benzodiazepine and buspirone

"Pam" has anxiety, so she goes on a "benzo" and takes it for a long time but realizes that it is not healthy. So she takes a "bus" to a "pier" to sit "alone" and decides to treat her anxiety long term with "buspirone"

TB medications

(R.I.P.E.) Rifampine: orange colored secretions "ripe orange" Can decrease effectiveness of oral contraceptives Isoniazid: neuropathy, do not drink alcohol Pyrazinamide Ethambutol: Result in changes in patients vision. E for Eye Treatment will be six months to a year All of these are very harsh on the liver, best not to drink alcohol Monitor for s/s of liver damage Test family members Sputum cultures will be needed every 2-4 weeks and will no longer be infectious after 3 negative sputum samples. Will have to wear N-95 out in public

A nurse is preparing to administer 0.9% sodium chloride 1500 mL to infuse over 8 hr to a client who is postoperative. The nurse should set the IV pump to deliver how many mL/hr? (Round to the nearest whole number)

188

A nurse is caring for a client who received 0.9% NaCl 1 L over 4 hrs. instead of over 8 hrs. as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident?

0.9% NaCl 1 liter infused over 4 hr, vitals stable, provider notified

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report?

0830

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

100 gtt/min-------------- 400ml/60 min *15gtt/1ml = 100gtt/min

Antihistamines

1st gen: diphenhydramine 2nd gen: Loratadine Used for nasal congestion, mild allergic reactions, and motion sickness Blocks histamine release which helps reduce mucous secretion With 2nd gen - less side effects Side effects with 1st gen: anticholinergic effects and sedation

A nurse is caring for the mother of a newborn. The mother asks the nurse when her newborn should receive his first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the mother that her newborn should receive the immunization at which of the following ages?

2 months

A nurse is preparing to administer Ciprofloxacin 15mg/kg PO every 12 hr to a child who weighs 44lbs. how many mg should the nurse administer per dose?

300 mg

A nurse is preparing to administer 0.9% sodium chloride 1000 mL IV over 8 hr to a client. The drop factor of the manual IV tubing is 15 gtt/min. The nurse should set up the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number.)

31

D

A child with cerebral palsy is prescribed Baclofen (Lioresal). Which of the following therapeutic effects should the nurse monitor? A. Increased urine output B. Increased energy C. Decreased anxiety D. Decreased spacity

D

A client has a new prescription for oral nitroglycerin sustained-release capsules once a day. During the nursing history the client reveals his usual medications. Which of the following medications should the nurse question at this time? A. Diazepam(Valium) B. Lansoprazole(Prevacid) C. Gemfibrozil(Lopid) D. Sildenafil(Viagra)

A

A client has an IV infusion of nitroprusside (Nitropress) at 2 mcg/kg/min. The order reads to titrate the nitroprusside by 0.5 mcg/kg/min to maintain mean arterial pressure (MAP) to 70 to 110 mm HG. The client has a MAP of 120 mm Hg. The nurse should next titrate the nitroprusside to which of the following dosages? (Round to the nearest tenth.) A. 2.5 mcg B. 4.3 mcg C. 4.2 mcg D. 5.5 mcg

A

A nurse administered meperidine (Demerol) intramuscularly to a client with an ankle fracture. Which of the following actions should the nurse take next? A. Assess the clients respiratory status B. Document on the clients medication record C. Reassess the client's pain level D. Check the client's blood pressure

B

A nurse is administering verapamil (Calan) to a client via IV bolus. The nurse should monitor for which outcome? A. A rapid increase in a PTT. B. A sudden increase in heartrate. C. A sudden decrease in heartrate. D. A rapid decrease of a PTT.

A

A nurse is admitting a client to a long-term care facility. While reconciling the medication prescribed at home with those prescribed in the facility, the nurse discovers a discrepancy in the dosages. Which action should the nurse take? A. Clarify the medication dosages with the provider. B. Change the prescribed medication dosages to reconcile the discrepancy C. Contact the pharmacist regarding the dosage discrepancies D. Ask a family member to verify the medication dosages

A

A nurse is assessing a client who is receiving Chloramphenicol (Chloromycetin). Which of the following findings is an adverse effect of this medication? A. Ecchymosis B. Ototoxicy C. Hyertension D. Anxiety

A

A nurse is caring for a client who has a systemic infection. During the infusion of vancomycin (Vancocin) the client develops a rash and becomes flushed. Which of the following is an appropriate action for the nurse to take? A. Document a Penicillin allergy in the client's chart. B. Decrease the rate of administration. C. Obtain a prescription for oral vancomycin. D. Administer naloxone (Narcan) 1mgIV.

A

A nurse is caring for a client who has an order for clozapine (Clozaril) 350 mg PO daily. The nurse should recognize that which of the following findings is a side effect of this medication? A. WBC 8,000mm3 B. Serum sodium 136mg/dL C. Fasting blood glucose of 220mg/dL D. Weight loss of 2.26 kg (5 lb) in 2weeks

A

A nurse is caring for a client who has been taking ferrous sulfate for the past 2 months. Which of the following findings is expected? A. Increased energy B. Reduced frequency of coughing C. Increased vision D. Decreased inflammation

C

A nurse is caring for a client who is to receive 1,500 mL of 0.9% sodium chlorideIV over 8 hours. The nurse plans to use IV tubing with a drop factor of 10 gtt/mL.How many gtt/min of IV fluid should the client receive? (Round your answer tothe nearest whole number). A. 20gtt/min B. 70gtt/min C. 31gtt/min D. 40gtt/min

B

A nurse is caring for a client who is to receive a series of allergy tests. The nurse should instruct the client to avoid which medications for up to 4 weeks before the procedure? A. Acetemetaphen (Tylenol) B. Diphenhyramine (Benadryl) C. Albuterol(Accuneb) D. Psuedoephedrine hydrochloride(Sudafed)

D

A nurse is caring for a client with PCA Morphine Sulfate. Which of the following statements is not true? A. "I will not receive any pain medications during the lock out period" B. "I should push the button when the pain becomes severe" C. "I will be asked to rate my pain occasionally" D. "I don't have to worry about getting an overdose of the medication"

D

A nurse is caring for a client with a urinary tract infection. Her past history reveals an allergy to thiazide diuretics. Which of the following medications is contraindicated? A. Nitrofurantoin (Macrodantin) B. Ciprofloxacin(Cipro) C. Amoxicillin/ clavulanate(Augmentin) D. Trimethoprim/ sulfamethoxazole(Bactrim)

B

A nurse is providing care to a client who has heart failure. While verifying the orders with the medication administration record the nurse notes that the prescription for digoxin was transcribed incorrectly. As a result, the client received an extra does of the medication. Which of the following actions should the nurse take first? A. Complete an incident report B. Notify the charge nurse C. Obtain a set of vital signs D. Withhold the next dose

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (Select all that apply)

Blood glucose will be monitored, avoid infections, no grapefruit juice

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take?

Administer the medication outside the 5cm (2in) radius of the umbilicus

A nurse is completing an incident report for a medication error. Which of the following information should the nurse include in the report?

Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication.

A nurse is precepting a newly licensed nurse who is caring for four clients. The nurse should complete an incident report for which of the following actions by the newly licensed nurse?

Administers isosorbide mononitrate to a client who has BP 82/60 mmHg

A nurse is caring for a client who is receiving haloperidol. The nurse should identify which of the following findings as an adverse effect of the medication?

Akathisia

Beta2-adrenergic agonist

Albuterol and salmeterol Bronchodilation Treats COPD and asthma Side effects: Tachycardia, angina, tremors Albuterol - short acting; salmeterol - long acting If using with a glucocorticoid, use beta2-adrenergic agonist first to dilate the bronchioles

Bisphosphonates

Alendronate Used for post-menopausal osteoporosis, Paget's disease by preventing bone reabsorption by inhibiting osteoclasts activity Side effects: *esophagitis* GI upset, muscle pain, visual disturbances Need to take on empty stomach in the morning with at least 8 ounces of water and you need to sit upright for 30 minutes or more. Encourage intake of calcium and vit D Increase weight bearing exercises Monitor bone density via scans

Direct Renin Inhibitors

Aliskiren

Thrombolytic medications

Alteplase (tPA) "-ase" "If you're trying to break up clots you've come to the right "plase" Break us clots by converting plasminogen to plasmin which breaks up fibrinogen Used with MI, Stroke, PE, clogged PICC lines Side effects: BLEEDING Do not give with patients with internal bleeding, hemorrhagic stroke, recent trauma or surgery, or severe HTN Given within three hours of onset of symptoms of MI or stroke (ischemic only!) Closely monitor labs and vitals Limit venipunctures and IM injections

Antidysrhythmic Medications Class Three

Amiodarone Used for A-fib, A-Flutter, Ventricular fibrillation, Ventricular tachycardia Potassium channel blocker. Very serious med with serious side effects Side effects: hypotension, bradycardia, pulmonary toxicity, visual disturbances, liver toxicity, GI upset, thyroid dysfunction

Centrally Acting muscle relaxants

Baclofen (diazepam, baclofen, cyclobenzaprine, tizanidine) Used for muscle spasticity related to spinal injury cerebral palsy, multiple sclerosis, as well as malignant hyperthermia Enhances effect of GABA Drowsiness, GI upset, constipation (increase fiber and fluid)

Inhaled Glucocorticoids

Beclomethasone Used for asthma; can be used alone or with beta 2 agonist Decrease inflammation locally Side effects: hoarseness and candidiasis Rinse mouth out after the medication is used

Medications to support withdrawal from alcohol

Benzodiazepines: Chlordiazepoxide, lorazepam, diazepam First line treatment of alcohol withdrawal Keeps vitals within expected limits, decreases risk of seizures Clonidine and Propranolol depress autonomic response and decrease vitals Carbamazepine Further decreases risk of seizure

A nurse is planning care for a clienct who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects?

Bibasilar crackles

Withdrawal/abstinence from nicotine

Bupropion Nicotie gum, patch, or nasal spray Varenicline: a nicotine receptor agonist. Reduces cravings as well as withdrawal effects. Depression and suicidal effects can occur.

Atypical Antidepressants

Bupropion, Trazodone - more important Others: Vilazodone, mirtazapine, reboxetine Treats depression and aid for smoking cessation Side effects: headache, GI distress, insomnia, nausea, weight loss, seizures

Atypical anxiolytic

Buspirone Can take 2-6 weeks to work, but can be long term! Treats panic disorder, anxiety, OCD, and PTSD Side effects: dizziness, nausea (take w/ food to relieve), headache (sedation and dependency is not seen like in benzo)

A nurse is caring for a client who has a magnesium level of 3.1 mEq/L. The nurse should expect to administer which of the following medications?

Calcium gluconate

Magnesium

Can increase Mg levels IV - stops preterm labor or anticonvulsant during labor and delivery Watch for increased Mg: muscle weakness, paralysis, respiratory depression Calcium Gluconate

Angiotensin - converting enzyme inhibitors

Captopril "-pril"s Blocks conversion on angiotensin one into angiotensin two, which vasodilates Treats HTN, HF, MI, diabetic retinopathy Side effects: Angioedema, Cough, Elevated potassium (A.C.E.), rash, hypotension Closely monitor blood pressure Change position slowly

Mood - stabilizing antiepileptic

Carbamazepine, valproic acid Treats Bipolar disorder and seizure disorder Carbamazepine side effects: blood dyscrasias, hypo-osmolality Valproic acid side effects: *hepatotoxicity,* pancreatitis, thrombocytopenia

Cephalosporins

Cephalexin, cefazolin, and ceftriaxone Work by weakening the bacterial cell wall which leads to cell death Side effect: allergies, GI upset, superinfection Don't give in allergic reaction Should not consume any alcohol Take with food

A nurse adminsters a dose of metformin to a client instead of the prescribed dose of metaclopramide. Which of the actions should the nurse take first?

Check the clients blood glucose

A nurse is providing teaching to a client who is to start taking sumatriptan. Which of the following adverse effects should the nurse instruct the client to monitor for and report to the provider?

Chest pressure

A nurse is caring for a client who has hypocalcemia and is receiving calcium citrate. The nurse should identify that which of the following findings indicates a therapeutic response to the medication?

Client report of decreased paresthesia

D

Clinical findings of a client who has a prescription for lithium carbonate (Lithobid) .For which reasons should the nurse withhold the medication and notify the provider? A. Lithium level 1.0mEq/L B. Potassium at 3.7mEq/L C. Sodium at 143mEq/L D. Lithium level 2.5mEq/L

Centrally Acting Alpha2 agonist

Clonidine (do not confuse with clonzapine) Activate Alpha II receptors which cause decrease in heart rate and blood pressure Treats HTN Side effects: drowsiness and dry mouth

Antitussives: Opioid

Codeine (hydrocodone) Used for non-productive cough Decreases cough reflex Side effects: sedation, respiratory depression, GI upset, possible dependency Change positions slowly, increase fluid and fiber, and avoid alcohol

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to instruct the client to use prior to physical activity?

Cromolyn

A nurse is reviewing the medication administration record of a client who has hypecalcemia and a new prescription for IV calcium gluconate. the nurse should identify that which of the following medication can interact with calcium gluconate

Dioxin

B-12

Cyanocobalamin Treats Megaloblastic anemia if they are lacking intrinsic factor

Alkylating Agents

Cyclophosphamide Used for tumors/cancers Inhibits protein synthesis by interfering which DNA and RNA synthesis Side effects: bone marrow suppression, GI upset, hemorrhagic cystitis, alopecia Increase fluid intake, monitor blood in patient's urine, monitor CBC, give antiemetic

A nurse is reviewing laboratory results for a client who is to receive a dose of ceftazidime via intermittent IV bolus. Which of the following laboratory findings is the priority for the nurse to report to the provider before administering the medication?

Creatinine 2.6 mg/dL

A nurse is caring for a client who is taking atorvastatin for hyperlipidemia. Which of the following client laboratory values should the nurse monitor?

Creatinine kinase

Disulfiram

Daily oral medication to sustain abstinence of alcohol; type of aversion therapy Causes nausea, vomiting, sweating, palpitations, and hypotension if alcohol is consumed

Peripherally acting muscle relaxants

Dantrolene Treats: spasticity related to cerebral palsy, spinal cord injury, and multiple sclerosis Inhibits muscle contraction by preventing release of calcium in skeletal muscles. Side effects: drowsiness, muscle weakness, hepatic toxicity

A nurse is administering baclofen for a client who has a spinal cord injury. Which of the following findings should the nurse document as a therapeutic outcome?

Decrease in flexor and extensor spasticity.

Acamprosate

Decreases unpleasant effects resulting from abstinence like dysphoria, anxiety, restlessness

A nurse is administering cefotetan via intermittent IV bolus to a client who suddenly develops dyspnea and widespread hives. Which of the following actions should the nurse take first?

Discontinue the medication IV infusion.

A nurse is caring for a client who has developed hypomagnesemia due to long-term therapy with lansoprazole. The nurse should monitor the client for which of the following manifestations?

Disorientation

A nurse is preparing to administer medication to a client who tells the nurse, " I don't want to take my fluid pill until I get home today." Which of the following action should the nurse take?

Document the refusal and inform the client's provider.

A nurse is teaching a client who has a new prescription for docusate sodium about the medication's mechanism of action. Which of the following information should the nurse include in the teaching?

Docusate sodium reduces the surface tension of the stools to change their consistency.

Antitumor Antibodies

Doxorubicin Treats solid tumors. Binds to DNA and inhibits DNA and RNA synthesis. Kills rapidly growing cells Side effects: Cardiac toxicity, GI upset, alopecia, bone marrow suppression, red discoloration of urine, sweat and tears Monitor for infection or BMS Administer antiemetics, monitor cardiac function, monitor CBC

A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she has not told her provider yet. The nurse should identify that pregnancy is a contraindication for receiving which of the following medications?

Doxycycline

Tetracycline

Doxycycline Treats bacterial infection, acne, lyme disease, rocky mountain spotted fever. Prevent proteein synthesis which inhibits bacterial growth. "Static" Side effects: GI upset, tooth discoloration in children and fetuses, hepatotoxicity, photosensitivity, and superinfections Never give to pregnant women or children under 8. Tell patient to wear sunscreen Take on empty stomach with full glass of water Can decrease effectiveness of oral contraceptives Do not take with milk or antacids because it decreases aborption

A nurse is providing teaching to a client who has a prescription for trimethoprim/sulfamethoxazole. Which of the following instructions should the nurse include in the teaching?

Drink 8 to 10 glasses of water daily.

A nurse is assessing a client who is taking amitriptyline for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Dry mouth

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?

Dry mouth Blurred vision Dry eyes

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first?

Epinephrine

Ergot Alkaloids

Ergotamine Used for vascular headaches - migraine and cluster Vasoconstriction of intercranial blood vessles Side effects: GI upset, muscle pain, HTN, numbness, tingling Advise patient to lay down in dark quiet place. Avoid tyramine rich foods and alcohol

Loop diuretics

Furosemide Blocks re-absorption of sodium and water at ascending loop of henle causing rapid diuresis. Used for pulmonary edema, heart failure, and hypertension Side effects: hypotension, hyponatremia, and hypokalemia, ototoxicity, dehydration and hypergllycemia Administered in the morning or during day, not at night Infuse IV at 20 mg/min Weigh daily Monitor I&Os Watch electrolyte labs Encourage high potassium foods

Fibrates

Gemfibrozil Lowers cholesterol by decreasing triglyceride production and transport and increases HDL Side effects: GI upset, Gallstones, hepatotoxicity, and muscle pain Give 30 minutes before breakfast and dinner Monitor liver function and CK levels

Aminoglycosides

Gentamicin Used for serious bacterial infections. Destroys bacteria by inhibiting protein synthesis Side effects: ototoxicity, nephrotoxicity, vertigo, and ataxia Monitor for hearing loss Monitor kidney function Give IV or IM and monitor peak and though levels Narrow therapeutic range

Potassium

Given for hypokalemia who are on diuretics, have prolonged vomiting or diarrhea Watch for hyperkalemia Never want to give a rapid infusion as it can cause fatal hyperkalemia

A nurse is caring for a client who has sickle cell anemia and is taking hydroxyurea. Which of the following findings should the nurse report to the provider? (Select all that apply)

Hemoglobin, platelets, potassium

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching?

Hot flashes

Thiazide Diuretics

Hydroclorothiazide Blocks re-absorption of water and sodium at distal convoluted tubule. Used for Hypertension, edema side effects: dehydration, hypokalemia, hyperglycemia Admin during day, \ Monitor I&Os Watch electrolyte labs Encourage high potassium foods

Adrenal hormone replacement

Hydrocortisone Steroid Used for adrenal cortical insufficiency in Addison's disease by mimicking naturally occurring cortisol which maintains blood pressure, regulate metabolism Side effects: **Bone loss, peptic ulcer, infection, GI upset, weight gain, adrenal suppression, and skin fragility** Monitor for signs of peptic ulcer (coffee ground emesis or tarry stools) Never stop suddenly! Taper slowly Increase patients dose during times of stress Monitor for s/s of infection May need calcium and vit D supplement Avoid NSAIDs and alcohol during use

A nurse is caring for a client who has heart failure and a prescription for enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?

Hyperkalemia

Levothyroxine

Hypothyroidism Acts as a synthetic form of T3, T4 Side effects: r/t too high of a dose. GI upset, anxiety, heat intolerance, weight loss, sweating While patient is on therapy, monitor levels of TSH and T4 Should be taken on an empty stomach with a full glass of water in the morning Life long terapy

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching?

I should sit up for 30 minutes after taking the risedronate

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching?

I should tell my provider if I develop a sore throat

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective?

I will taper off the medication before discontinuing

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications?

Ibuprofen

Carbapenems

Imipenem-cilastatin, meropenem Treats serious bacterial infections. Destroys bacterial cell wall causing cell death Side effects: GI upset, rash, superinfection If allergic to penicillin or cephalosporin may also have a response to carbapenems

Benzodiazepines

Includes "Pams" Alprazolam, diazepam, lorazepam, oxazepam, clonazepam, chlordiazepoxide, chlorazepate Enhances GABA: increased GABA means decreased neuron activity Treats anxiety, PTSD, seizures, alcohol withdrawal, muscle spasm, induction of anesthesia Usually short term; if long term do NOT stop abruptly Antidote is flumazenil Side effects: CNS depression - sedation and respiratory depression, amnesia, dependency, and withdrawal effects

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves disease. Which of the following findings should the nurse identify as as an indication of the medication has been effective?

Increase in ability to focus

A nurse is providing discharge teaching to a client who has a new prescription for furosemide twice daily. The nurse should include which of the following instructions in the teaching? (Select all that apply)

Increase potassium, monitor for muscle weakness, dangle your legs

A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?

Increased blood pressure

A nurse is caring for a client who is receiving filgrastim. Which of the following finds should the nurse document to indicate the effectiveness of the therapy?

Increased neutrophil count

Medications that end in -mab

Infliximab, adalimumab Immune suppressants for cancer or autoimmune Infections are a huge risk

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. which of the following finding should the nurse identify as an adverse effect of the medication?

Insomia

Long acting insulin

Insulin Glargine or Lantus Onset: 1 hour No peak Duration is 24 hours

Inhaled anticholinergics

Ipratropium Used for asthma or COPD; blocks acetylcholine to bronchodilate Side effects: anticholinergic - dry mouth and hoarseness Increase fluid intake and suck on sugarfree candy.

Osmotic Diuretics

Mannitol Treats Edema, increased ICP, increased IOP Contraindicated in intracranial hemorrhage "Oh man I had a bad headache because of increased cranial pressure, but man it all went away when I took mannitol" Reduces ICP and IOP by increasing serum osmolality Side effects: Heart failure, pulmonary edema, renal failure, dehydration, electrolyte imbalances Use filter needle and tubing when admintering Monitor weight, I&Os, and electrolytes

Biguanides

Metformin Used for type two diabetes, controls BS levels Decreases glucose production in the liver and increases glucose uptake Side effects: GI upset, B-12 deficiency, lactic acidosis, metallic taste Take with a meal Do not drink alcohol If B-12 issue, you may need supplement and discontinue use of metformin if it requires NPO or contrast dye Monitor for signs of lactic acidosis (diarrhea, dizziness, hypotension, bradycardia, weakness)

A nurse is caring for a client who is to receive treatment for opioid use disorder. Which of the following medications should the nurse expect to administer?

Methadone

A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)?

Morphine 5mg subcut every 4 hr PRN sever pain

Hypertensive Crisis

Nitroprusside Directly vasodialates arteries and veins which rapidly decreases blood pressure by acting on preload and afterload Side effects: hypotension, cyanide poisoning, thiocyanate toxicity

A nurse is caring for a client who reports lethargy and myalgia after taking clozapine for 6 months. Which of the following actions should the nurse plan to take?

Obtain WBC with absolute neutrophil count.

A nurse is preparing to administer hydrochlorothiazide (HCTZ) to a client. Which of the following actions should the nurse take prior to administering the medication?

Obtain the client's blood pressure

Birth control

Often estrogen and progesterone therapy Side effects: same as estrogen and progesterone If used properly it will prevent ovulation, thicken cervical mucous, and alter endometrial lining to reduce chance of fertilization

Proton Pump Inhibitors

Omeprazole and Pantoprazole Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric juices) by inhibiting enzyme needed for gastric acid secretion Side effects: GI upset, osteoporosis with long term use

Antiemetics

Ondansetron - Used for nausea and vomiting for those receiving chemo, radiation, and post-op by blocking serotonin receptors in the CTZ. Side effects: headache, dizziness, GI upset. If giving to patient receiving chemotherapy give prior to chemo treatment

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. the nurse should include that the spacer deceases the risk for which of the following adverse effect of the medication?

Oral candidiasis

A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. The nurse should instruct the client to take the medication with which of the following to promote absorption?

Orange juice

A nurse is monitoring for adverse effects of hydrochlorothiazide after administering the medication to an older adult client who has heart failure. Which of the following findings should the nurse identify as an adverse effect of the medication?

Orthostatic hypotension

Muscarinic antagonist

Oxybutynin (darifenacin, solifenacin, tolterodine, fesoterodine, trospium) Used for overactive bladder symptoms: frequency, urgency, nocturia Inihibts muscarinic receptors Side effects: Anticholinergic!

Oxytocics

Oxytocin (Pitocin) Used to induce or enhance labor, deliver placenta, or stop postpartum hemorrhaging Side effects: Painful contractions, uterine rupture Closely monitor contractions: less than 60 seconds and every 2-3 minutes Monitor maternal and fetal blood pressure and pulse Magnesium can be used to relax the uterus.

Intravenous anesthetics

Pentobarbital: Barbiturate Medazolam: Benzo Propofol Initiate or maintain anesthesia, conscious sedation, intubation Depresses CNS, promote loss of consciousness Side effects: respiratory/cardiac depression. Propofol: pain at IV site, high risk of infection. Use within six hours For all: have rescue equipment available and constantly monitor EKG and vitals.

A nurse is caring for a client who has diabetes mellitus and is taking glyburide. The client reports feeling confused and anxious. Which of the following actions should the nurse take first?

Perform a capillary blood glucose test.

Monoamine oxidase inhibitors

Phenelzine (Prototype), Isocarboxazid, tranylcypromine, selegiline Side effects: CNS stimulation, Orthostatic hypotension, hypertensive crisis (especially with phenelzine). Tyramine rich foods can lead to hypertensive crisis

Decongestants

Phenylephrine (pseudoephedrine, ephedrine, naphazoline) Used for rhinitis Causes vasoconstriction and decreases mucous in nose Side effects: agitation, nervousness, palpitations, increased heart rate, rebound congestion

A circulating nurse is planning care for a client who is scheduled for surgery and has a latex allergy. Which of the following actions should the nurse include in the plan of care?

Place monitoring cords and tubes in a stockinet.

A nurse is caring for a 20 year old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgarism. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required?

Pregnancy Test

A nurse is reviewing the ECG of a client who is receiving IV furosemide for HF. The nurse should identify which of the following as an indication of hypokalemia?

Presence of U waves

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide?

Prevent Delirium Tremens

Antidysrhythmic medications Class One

Procainamide, Lidocaine Used for Supraventricular tachycardia (SVT), ventricular tachycardia, atrial flutter, atrial fibrillation. "If you were 'ProMcCain' when he was running for President, you might have gotten really upset and developed 'tachycardia' when he lost. Then you would need to take 'Procainamide' Sodium channel blocker Side effects: hypotension, lupus, leukopenia, thrombocytopenia, and arrhythmias

Antipsychotics: second and third generation (atypical)

Risperidone and Clozapine - most important Often first line in treating schizophrenia Treats negative and positive symptoms Side effects: diabetes mellitus, weight gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects Do not take with alcohol. IM every two weeks available for those who are not compliant

A nurse is caring for a client who is receiving end-of-life care and has a prescription for fentanyl patches. Which of the following information regarding the adverse effects of fentanyl should the nurse plan to give to the client and family?

Take a stool softener on a daily basis

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in her instructions?

Take one tablet at onset of migraine

Alpha1- adrenergic antagonists

Tamsulosin (Flomax) "-osin" Used for BPH. Antagonises alpha1-adrenergic receptors in prostate and veins. Relax smooth muscle of bladder neck and prostate Adverse effects: hypotension (relaxes veins), dizziness, nasal congestion, sleepiness, faintness, ejaculation failure Take 30 minutes after meals or same time every day Monitor blood pressure

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following to the provider as a manifestation of neuroleptic malignant syndrome (NMS)?

Temperature of 39.7 (103.5)

A nurse is assessing a client 1 hours after administering morphine for pain. The nurse should identify which of the following findings as best indication that them morphine has been effective?

The client rates pain as 3 on a scale of 0/10

A nurse is assessing a client who is postoperative following an outpatient endoscopy using midazoam. A nurse should monitor for which of the following findings as an indication that the client is ready for discharge ?

The client's capnography has returned to baseline.

B

The nurse is caring for a client who has tuberculosis and is being treated with combination medication therapy. To test the effectiveness of the treatment, the nurse should periodically monitor which of the following laboratory results. A. PTT B. ESD rate C. Sputum culture D. INR

A nurse in a clinic is caring for a client who is taking aspirin for the treatment of arthritis. The nurse should identify which of the following findings as an indication that the client is beginning to exhibit salicylism?

Tinnitus

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication?

Tinnitus

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first?

Turn the client to a side lying position .

Filgrastim

Used with neutropenia to increase production of neutrophils and decreases risk of infection. Usually for those on chemo Stimulates bone marrow to increase production of neutrophils Side effects: bone pain, leukocytosis, enlarged spleen Do not agitate vial Monitor CBC twice a week

Selective Serotonin Reuptake Inhibitors (SSRIs)

Usually end in "ine": paroxetine, sertraline, citalopram, escitalopram, fluoxetine, fluvoxamine Inhibits serotonin reuptake" increases serotonin Treats anxiety, OCD, PTSD, and depression Side effects: nausea, fatigue, sexual dysfunction, weight gain, insomnia (paroxetine), serotonin syndrome (agitation, hallucinations, tremors, fever, diaphoresis) Takes about four weeks after treatment begins to take full effect.

Antidiuretic Hormone

Vasopressin Desmopressin Treats diabetes insipidus (peeing out too much urine) Mimics ADH to reaborption water in the kidneys which decreases urine output and increase urine osmolality Side effects: over hydration, headache Decrease fluid intake during therapy Monitor I&Os carefully and urine specific gravity Make sure urine output is between 1.5-2.0 L in 25 hour period "Will help to 'suppress' all that urine"

A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that they are allergic to penicillin. Which of the following actions should the nurse take first?

Withhold the medication

A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following adverse effects should the nurse instruct the client to monitor and report to the provider?

Yellow-tinged vision

Irritable Bowel Syndrome with Diarrhea

You can have IBS with or without diarrhea Alosetron: Blocks 5-HT3 receptors which increases firmness of stool and decreases urgency Side effects: Constipation

Nonbenzodiazepines for insomnia

Zolpidem Enhances GABA Can cause day time sleepiness and dizziness. Ensure they have eight hours of sleep.

Foods that contain tyramine

aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching?

decreased respiration might occur.

Anticholinergic efffects

dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first?

obtain the clients blood pressure

Ciprofloxacin

prevents bacterial DNA replication Side effects: GI upset, photosensitivity, superinfections, Achilles tendon rupture

A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report?

tingling of fingers

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor?

Sedation

Vancomycin

Serious infections and C-Diff Destroys bacterial cell wall causing cell death Side effects: ototoxicity and renal toxicity, infusion reactions, and phlebitis If long term, central line is given *Monitor Vanc. though and peak levels. Dose may need to be adjusted due to creatnine levels. "Some is in a Van and the music is way too loud that it hurts their ears, and they have no air and aren't drinking water, so they hurt their kidneys"

A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Sexual Dysfunction

C

A nurse is admitting a client who has chest pain to the emergency department. What medication should the nurse anticipate administering to reduce cardiac demand? A. Heparin B. Pentazocine(Talwin) C. Morphine D. Butorphanol(Stadol)

D

A nurse is planning teaching for a client who has leukemia and is receiving chemotherapy. The client is taking Alopurinol (Zyloprim). The nurse should instruct the client that this medication will? A. Decrease blood glucose levels B. Prevent cardiac toxicity. C. Prevent urinary tract infections. D. Decrease uric acid levels.

B D E

A nurse is preparing to administer infliximab (Remicade) to a client who has rheumatoid arthritis. The nurse should watch the patient for which of the following adverse effects? (Select all that apply.) A. Bradycardia B. Jaundice C. Polyuria D. Urtipenia E. Fever

Penicillins

Amoxicillin, Penicillin G, Pipercillin tazobactum Work by weakening bacterial cell wall which leads to cell death Side effects: possible **allergic reaction, GI upset, renal toxicity Check for history of reaction to penicillins or cephalosporin

Urinary Tract Stimulant

Bethanechol (Cevimeline, pilocarpine, acetycholine) "Beth has is shy and has a shy bladder" Used for nonobstructed urinary retention. Stimulates the cholinergic receptors in GU tract. Side effects: r/t cholinergic effects like flushing, sweating, urinary urgency, bradycardia, hypotension One hour before or two hours after meal, not at meal time

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider?

Blood in urine

Benztropine

Decreases Acetylcholine Used for Parkinson's, helps with muscle rigidity and tremors Side effects relate to too little acetylcholine which means we will have anticholinergic side effects Teach to chew gum, wear sun glasses, increase fiber and fluids

A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during surgery. Which of the following actions should the nurse take?

Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent.

Insulin: Short acting

Regular or Humulin R Lin is just a regular short person Onset: 30 mins - 1 hour Peak: 2-3 hours Duration: 5-7 hours (7 letters in regular) Give about thirty minutes prior to meal

A nurse is preparing to administer PO sodium polystyrene sulfonate to a client client who has hyperkalemia. Which of the following action should the nurse plan to take?

Monitor for constipation

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medication?

Acetylcysteine

Naltrexone

Suppresses the craving and pleasurable effects of alcohol. Can have monthly IM injection

A nurse is providing teaching to a client who has peptic ulcer disease and is starting a new prescription for sucralfate. Which of the following actions of sulcralfate should the nurse inclide in the teaching

Forms a protective barrier over ulcers

Thiazolidinediones

Pioglitizone Used for type two diabetes Decreases insulin resistance, increases glucose uptake, decreases glucose production Side effects: fluid retention, increased LDL, hepatotoxicity Contraindicated in heart failure Take once a day with or without food

A nurse is teaching a client who is to start taking ranitidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understanding of the teaching?

"I know smoking makes ranitidine less effective."

A nurse is teaching a client who is starting to take diltiazem. Which of the following statements should the nurse identify as an indication that the client understands the teaching?

"I will check my heart rate before I take the medication."

HMG-CoA Reductase Inhibitors

(Statins) Atorvastatin Lowers cholesterol and decreases risk of MI by increasing HDL and decreasing LDL. Side effects: Hepatotoxicity, Muscle pain, GI upset, Rhabdomyolysis Administer in the evening with a meal because cholesterol is synthesized at night Monitor liver function and CK labs Patient should avoid alcohol

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methlypredinisolone. which of the following instructions should the nurse include?

* Blood glucose Avoid contact with people *Grapefruit juice

Oral glucocorticoids

*Prednisone* Used for asthma, autoimmune disorders and a variety of inflammatory disorders Suppresses inflammation and immune response Side effects: weight gain, bone loss, immune suppression, fluid retention, hyperglycemia, hypocalcemia, infection, muscle weakness, peptic ulcer disease, and adrenal gland suppresion Periods of stress may require a higher dose NEVER stop this medication abruptly, it will need to be tapered Monitor for signs and symptoms of infection Avoid NSAIDs

B

A nurse is caring for a client who has been taking furosemide (Lasix) for 3 days to treat heart failure. Which of the following findings indicate that the medication is effective? A. Reduced levels of HDL B. Potassium within the expected reference range C. Clear lung sounds C. Increased level of consciousness

Tricyclic antidepressants

Amitriptyline Treats depression, neuropathic pain, fibromyalgia, anxiety disorders, insomnia Side effects: Anticholinergic effects, Sedation, Seizures, Sweating (SSS) "Amy tripped over a tricycle in the desert." Amitriptyline is a tricyclic antidepressant and causes effects that make you feel like you're in the desert.

A nurse in the emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?

Atropine

Interferon alfa 2b

Biologic response modifier. Used for cancers and viral infections like hepatitis. Interferons are like proteins that increase immune response to tumors or viruses and decrease tumor cell production Side effects: flu like symptoms, bone marrow suppression, cardiotoxicity, neurotoxicity, alopecia, GI upset, psychiatric disorders Interferon interferes with tumor cell production, but it also interferes with you life

Herbal Supplements

Black Cohosh: estrogen substitute, tx symptoms of menopause Echinacea: Used to help stimulate immune system ***Garlic, Ginger, and Ginkgo Biloba: All start with G and increase bleeding. Antiplatelet qualities*** Glucosamine: Stimulates cells to make cartilage and synovial fluid. Can help patients with osteoarthritis St. John's Wort: Mild depression Saw Palmetto: Helps prostate symptoms Valerian: increases GABA, helps anxiety

A nurse is caring for a client who is recovering from deep-vein thrombosis and is to start taking warfarin. For which of the following findings should the nurse monitor as an adverse effect of warfarin?

Bleeding gums

a nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives?

Carbamazepine

Antipsychotics: First-generation (conventional)

Chlorpromazine, Haloperidol TONS of side effects-will only list important ones Extrapyramidal side effects: Acute dystonia- spasms of tongue, neck, face, or back; Parkinsonism- rigidity, shuffling gait, drooling, tremors; akathisia- unable to sit or stand still; tardive dyskinesia - involuntary movement of tongue and face EPS effects may be able to be treated with anticholinergic medication if the patient does not have anticholinergic side effects. Neuroleptic Malignant Syndrome: sudden high grade fever, dysrhythmias, muscle rigidity There is a long lasting injection for non-compliant patients.

Medications used to treat gout

Colchicine: decreases inflammation and pain in acute gout attack. Side effects: GI upset and thrombocytopenia "Cool chicken - pecks your toe that has gout" Probenecid: inhibits uric acid resorption and treats hyperuricemia r/t chronic gout Side effects: GI upset and kidney stones "Probenecid will 'benefit' you with your gout." Allopurinol: inhibits uric acid resorption and treats hyperuricemia r/t chronic gout Side effects: GI upset, rash, hepatotoxicity, nephrotoxicity "Allolpurinol will get rid of 'all' your uric acid production

Bile-acid Sequestrants

Colesevelam, Colestipol Used to lower cholesterol by binding bile acids in intestine which causes more cholesterol to be pulled from the blood stream to be used for new bile Side effects: constipation! Take with food and full glass of water Can interfere with absorption of fat soluble vitamins (DEKA) and oral contraceptives

Estrogens

Conjugated equine estrogens and estradiol Used for contraception in combination with progesterone or PMS symptoms, post menopausal osteoporosis, dysmenorrhea, and prostate cancer Side effects: increased risk of embolic effects: DVT, PE, MI, Stroke; risk for HTN, edema, weight gain, and estrogen dependent cancer Contraindicated patients who smoke***, HTN, and high risk for embolic effects or estrogen dependent cancer

A nurse is caring for a client who has cancer and is taking morphine and docusate sodium. The nurse should instruct the client that taking the dosusate sodium daily can minimize which of the following adverse effects of morphine?

Constipation

A nurse is assessing a client who is taking tamoxifen to treat breast cancer. Which of the following findings is the priority for the nurse to report to the provider?

Leg tenderness

A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering?

Flumazenil

Leuprolide

For Prostate cancers Works by decreasing the amount of testosterone produced Side effects: hot flashes, gynecomastia, decreased libido, bone loss Increase calcium and vitamin D Monitor PSA and testosterone levels "Leuprolide makes libido luke warm"

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. which of the following interventions should the nurse include in the plan of care?

Determine apical pulse prior to administration

Cardiac glycocides

Digoxin Used for heart failure and A-fib Positive inotropic effect: increase in force and efficiency of heart contractions Negative chronotropic effect: decreases heart rate Side effects: dysrhythmias, bradycardia Toxicity: GI upset, vision changes, and fatigue/weakness Always check apical pulse for full minute before giving and hold if under 60 Monitor serum levels: should be between 0.5 - 2.0 Hypokalemia increases risk for digoxin toxicity Treat bradycardia with atropine and overdose with activated charcoal, cholestyramine, or digoxin immune Fab (digibind)

Calcium Channel Blockers

Diltiazem, Nifedipine, Verapamil Used for HTN and angina; block calcium channels in the blood vessels and heart cause vasodilation and decreased heart rate Side effects: hypotension, bradycardia, dysrhythmias, constipation, edema Patient should NOT consume grapefruit juice Monitor blood pressure and heart rate regularly

Macrolides

Erythro'mycin' Used for bacterial infections Inhibits protein synthesis which slows bacterial growth Side effects: GI upset, dysrythmias, ototoxicity Administer on empty stomach with full glass of water.

Administration of Blood Products

Get baseline lab values. Get signed consent. Assess for risk of fluid overload like HF. Get baseline vitals right before administration and Q15min for first hour and every hour until infusion is complete. Use 20g or larger catheter. Use 0.9% NS. Always confirm with two nurses. Document type of blood, blood bank number, total volume infused, time started, time finished, any reactions, and vital signs. If whole blood or packed RBC: given in 2-4 hour period. Platelets are 15-30 minutes per unit. Fresh frozen plasma is 30-60 minutes.

Folic Acid

Given in pregnancy to prevent neural tube defects. Can also be given to alcoholics to treat poor dietary intake. Used for megaloblastic anemia when issue is too little folic acid. Never give to someone who is lacking in B-12

Levodopa/Carbidopa

Giving together to increase dopamine Used for parkinson's Decreases tremors and muscle rigidity Levodopa is converted to dopamine in the CNS and carbidopa prevents the breakdown of levodopa Side effects: quite a few: nausea, vomiting, drowsiness, dyskinesia, orthostatic hypotension, darkening of urine and sweat, possible psychosis High protein meals decreases effectiveness.

Lactulose

Laxative used for hepatic encephalopathy by decreasing ammonia levels and improve the mental status. Lowers pH in colon to promote ammonia excretion. Side effects: GI upset, electrolyte imbalances, hyperglycemia. Treats encephalopathy and decreases ammonia levels!!!

Treatment of H.pylori

Leading cause of peptic ulcer disease Antibiotics: (Two - three different types to increase effectiveness and prevent resistance) Amoxicillin, Clarithromycin, metronidazole H2 receptor Antagonist Proton Pump Inhibitor Mucous Protectant Antacid

Insulin: Rapid Acting

Lispro or Humalog Onset: less that 15 minutes Peak: 30 min - 1 hour Duration: 3 hours (three letters in log) Make sure patients food is right in front of them

Antidiarrheal agents

Loperamide and diphenoxylate/atropine Stimulate opioid receptors in the intestines cause a decrease in motility and increased absorption of water and sodium Side effects: Constipation, drowsiness, Diphen/atropine at high doses causes opioid and anticholinergic effects. (Put the two together to decrease abuse potential)

Leukotriene modifiers

Montelukast (Zafirlukast, Zileuton) Treats exercise induced asthma "Lukast will decrease the effect of Leukotrienes" Reduces airway inflammation and bronchoconstriction by decreasing leukotrienes Side effects: increased liver enzymes with Zafirlukast Take in the evening or two hours before exercise

Opioid agonists

Morphine, Fentanyl, and oxycodone Used for moderate to severe pain and promotion of sedation by binding to opioid receptors in the CNS Side effects: Sedation, respiratory depression, constipation, GI upset, hypotension, urinary retention Naloxone is the antidote for opioid analgesics Monitor pain level, vital signs, and respiratory status Administer slowly Administer around the clock for cancer pain Increase fluid and fiber

Intermediate Acting Insulin

NPH Humulin N NPH Neal Patrick Harris he is of intermediate height and is a hard working actor. So if you call him, he will come onset in 1-2 hours and will stay for 18-24 hours! Onset: 1-2 hours Peak: 4-12 hours Duration: 18-24 hours

Antiepileptics

Phenytoin, Carbmazepine, Valproic acid, lamotrigine Phenytoin: Side effects: gingival hyperplasia!, diplopia, stigmas, rash, ataxia, hypotension Closely monitor plasma levels! Narrow range! Range is 10-20 mcg/mL Decreases effectiveness of oral contraceptives.

A nurse is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings?

Platelets 96000/mm3

A nurse is reviewing the lab results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider?

Potassium levle 2.8 meq/L

Alpha adrenergic blockers

Prazosin

Phosphodiesterase type 5 inhibitors

Sildenafil (-afil) "A fills up the penis" Enhances the effects of nitric oxide released during sexual stimulation resulting in increased blood flow in corpus Side effects: prolonged erection, increase risk of MI Do NOT take with of nitrates! and use cautiously in men with cardiovascular disease.

Potassium sparing diuretics (Aldosterone Antagonist)

Spironolactone Blocks aldosterone promoting excretion of sodium and water ONLY Used for heart failure, hypertension Contraindication in severe kidney failure Side effects: hyperkalemia, issues with menstruation, gynecomastia or impotence in men Monitor potassium closely and avoid salt substitutes

A nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. Which of the following laboratory tests should the nurse review before administering the medication?

Total cholesterol

Methotrexate

Used for rheumatoid arthritis, psoriasis, and some cancers Inhibits folic acid production which inhibits cell reproduction which causes effects of rapidly replicating cells and has immunosuppressive properties Side effect: INFECTION, hepatotoxicity, bone marrow suppression and GI upset Do not give them fresh fruits or veggies, use protective precautions Notify the provider immediately if they have signs of infection Monitor liver labs and CBC

Epoetin alfa (Epogen)

Used in anemias to help increase production of RBCs in patients with chronic kidney disease, chemotherapy, or HIV by stimulating bone marrow Side effects: HTN (due to increased hematocrit), risk of DVT, stroke, or MI Do not agitate vial Monitor blood pressure for HTN Monitor Hgb and Hct twice a week Ensure the patient has sufficient iron levels or med will not work

Calcium Citrate

Used in hypocalcemia Ensure that patient has sufficient vitamin D - needed for absorption Look for hypercalcemia: abdominal pain, fatigue, constipation, muscle weakness

Types of Blood Products

Whole blood: Includes everything: RBCs, WBCs, Platelets, Plasma. Given to those with blood loss due to trauma or surgery, dehydration, shock. Helps to bring overall blood volume up Packed Red Blood Cells: Administered to those with anemia who need the extra RBCs, not the extra blood volume Platelets: For thrombocytopenia or low platelets Fresh Frozen Plasma: For missing clotting factors

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. which of the following instructions should the nurse include?

Report yellowing of the skin

Nicotinic Acid

Niacin Used to lower cholesterol by decreasing lipoprotein and triglyceride synthesis which lowers LDL and triglycerides Side effects: flushing, hepatotoxicity, GI distress, hyperglycemia Monitor liver function and blood glucose

NSAIDs and prednisone can treat....

Rheumatoid arthritis NSAIDs: help with pain Prednisone: suppresses immune response

D

A nurse is assessing a client who is taking naproxen (Naprosyn). Which of the following is an expected outcome for this client? A. Increased appetite B. Reduced bleeding C. Improved breathing D. Reduced pain

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understating of the teaching?

"I will take the patch off right after my evening meal"

B

A client is questioning the nurse about why she is receiving frequent doses of IV antibiotics. Which of the following responses by the nurse is appropriate? A. It helps to maintain a steady drug level B. It helps to prevent the emergence of drug-resistant bacteria C. It decreases the risk of an allergic reaction D. It decreases the length of necessary treatment

A

A client is receiving extended-release morphine sulfate (Avinza) 30mg PO every 12hr. Three hours after the last dose, the client requests pain medication. Which of the following assessment finding is the best indicator of the patient's need for more pain medication? A. Facial grimacing B. Elevated blood pressure C. Flushed skin D. Self report

B

A client who has been taking atenolol (Tenormin) receives a new prescription for nifedipine (Procardia). For which of the following interactions should the nurse monitor? A. Tachycardia B. Hypotension C. Bleeding D. Angina

C

A client who has supraventricular tachycardia (SVT) is receiving procainamide. The nurse recognizes that the primary pharmacological action of this medication is to: A. Decrease cardiac preload B. Promote systemic vasoconstriction C. Decrease sinoatrial node conduction. D. Control the rate of cardiac contraction.

C

A client with diabetes mellitus is admitted to the medical unit. The client has routine before breakfast prescription for 8 units of regular insulin and 18 units of NPH. The primary care provider adds an additional dose of Regular insulin based on the following: Blood Glucose Regular Insulin Dose 121 to 150 2 units 151 to 180 4 units 180 to 200 6 units 201 to 250 8 units > 250 Call provider The client's pre-breakfast glucose is 192 mg/dl. Which dosage of insulin should the nurse administer? A. 8 units of Regular, 18 units of NPH B. 8 units of Regular, 24 units of NPH C. 14 units of Regular, 18 units of NPH D. 14 units of Regular, 24 units of NPH

A

A female adult client is scheduled to start a prescription for azathioprine (Imuran) for active Rheumatoid Arthritis. The nurse should inform the client about the need for which of the following diagnostic tests prior medication? A. Erythro sedimentation rate B. Bone density scan C. Electrocardiogram D. PregnancyTest

B

A nurse is assessing a client who has been taking anti-tuberculosis medications for the past3 months. The nurse should instruct the client to notify the provider if which of the following occurs? A. Weight gain B. Jaundice C. Alopecia D. Polyuria

B

A nurse is assessing a client who is taking enalapril (Vasotec) for congestive heart failure. Which of the following indicates an expected finding? A. Activity tolerance B. Orthostatic hypotension C. Loss of strength D. Increase in blood pressure

D

A nurse is assessing a client who takes diphenoxylate with atropine (Lomotil)for inflammatory bowel disease. For which of the following should the nurse monitor? A. Hearing loss B. Increased oral secretions C. Bradycardia D. Urinary retention

A

A nurse is assessing a school age client who is experiencing seizure activity and is prescribed diazepam (Valium) IV. The nurse should should clarify the order if the client is receiving a continuous infusion of which of the following IV: A. Lactated Ringers solution B. 0.9% Sodium chloride with 100 units of regular insulin C. 0.9% sodium chloride D. 0.9% Sodium chloride with 20 mEq of potassium chloride

C

A nurse is caring for a 4 year old client, who is taking amoxicillin (Amoxil) 50 mg/kg/day PO in three divided doses. Which of the following resources should the nurse consult to verify that the dose is safe for the client? A. Medication administration record B. The client's health history C. Physician's desk reference D. The client's BMI record

C

A nurse is caring for a client who has a new prescription for bupropion (Wellbutrin). What should the nurse recognize as a contraindication for the use of this medication? A. Xerostomia B. GERD C. Seizure D. Bradycardia

C

A nurse is caring for a client who has a new prescription for estrogen-progestin combination (Ortho-Novum). Which of the following medications may interact with this medication and require the use of additional non-hormonal birth control? A. Thiamine ( Vitamin B1) B. Dilantin (Phenytoin) C. Amlodipine (Norvasc) D. Docusate sodium (Colace)

D

A nurse is caring for a client who has a new prescription for sucralfate (Carafate). The client also takes several other medications and herbal supplements. Which of the following requires that the nurse provide additional teaching for this client? A. Phenytoin (Dilantin) B. Bupropion(Wellbutrin) C. Gingko biloba D. Valerian root

A

A nurse is caring for a client who has a new prescription of zolpidem (Ambien) 10 mg by mouth. Which comments by the client indicates understanding regarding this medication? A. "I will take my medication at bedtime." B. "I will take this medication with food." C. "I will stop taking this medication in 1 week, so I don't get addicted." D. "I will take vitamin C to increase the effectiveness of this medication."

A

A nurse is caring for a client who has a prescription for Metformin (Glucophage) twice daily. Which of the following lab results projects the expected outcome? A. Hemoglobin A1C6.4% B. Pre-meal plasma glucose135mg/dl C. Bedtime blood glucose 150mg/dl D. Systolic blood pressure 146 mmHg

A

A nurse is caring for a client who has a prescription for levodopa carbidopa(Sinemet-CR). Which of the following should the nurse recognize as an adverse effect of this medication? A. Constipation B. Weight gain C. Hirsutism D. Dyskinesia

D

A nurse is caring for a client who has acute angina and has a prescription for nitroglycerin. Which of the following is an appropriate intervention for the nurse to take when administering this medication? A. Massage the nitroglycerin ointment completely into the skin. B. Replace the nitroglycerin transdermal patch every 4 hours. C. Administer a sustained nitroglycerin tablet orally. D. Administer a nitroglycerin tablet sublingually every 5minutes.

D

A nurse is caring for a client who has been prescribed Ceftriaxone (Rocephin). The nurse notes that the client's chart lists a penicillin allergy. Which of the following actions should the nurse take first? A. Notify the provider that the client is allergic to the medication. B. Teach the client about signs of allergic response. C. Question the client about previous allergic reactions D. Administer the medication and monitor the client for allergic response.

D

A nurse is caring for a client who has open angle glaucoma and was prescribed pilocarpine (Pilocar) 1 gtt of 3% solution. The nurse should recognize that which of the following findings indicates the client is developing systemic cholinergic toxicity? A. Stinging and burning sensation in her eye B. Hypertension C. Tachycardia D. Salivation and sweating

A

A nurse is caring for a client who has received acetaminophen (Tylenol) 650 mg and Hydrocodone (Vicodin) 5 mg every 4 hr for the past 24 hr. Which of the following is an appropriate action for the nurse to take? A. Complete an incident report B. Stagger the medications every 2hr C. Suggest a time with the pharmacy. D. Decrease acetaminophen to 325 mg every 4hr.

A

A nurse is caring for a client who has rheumatoid arthritis. The client is prescribed methotrexate (Rheumatrex). Which of the following should the nurse instruct the client to monitor and report to the provider? A. Sore throat B. Urinary retention C. Constipation D. Insomnia

A

A nurse is caring for a client who is receiving Haldol. The nurse should document which of the following findings are dystonia? A. Neck spasms B. Lip smaking C. Tremors D. Pacing

C

A nurse is caring for a client who is receiving a fentanyl transdermal system(Duragesic). What is important to document in the client's record? A. fluid intake B. Skin integrity C. Respiratory rate D. Pulse rate

B

A nurse is caring for a client who is receiving anticoagulant therapy with Warfarin (Coumadin). The client is prescribed Cefotetan (Cefotan) by intermittent IV bolus for pneumonia. The nurse should monitor the client for which of the following? A. Hemorrhage B. Hypoglycemia C. Hyperkalemia D. Paresthesia

A

A nurse is caring for a client who is receiving penicillin by intermittent IV bolus. The client develops cyanosis and tachycardia. A nurse should administer which of the following medications first? A. Epinephrine(Adrenalin) B. Prednisone(Deltasone) C. Hydrocortisone sodium succinateb(Solu-Cortef) D. Isoproterenol(Isuprel)

B

A nurse is caring for a client who is receiving therapy with the clonidine (Catapress) transdermal patch. The client reports light-headedness and drowsiness. Which of the following actions should the nurse take? A. Administer a prescribed antiemetic B. Remove the Patch C. Elevate the head of the bed D. Measure Blood pressure

B

A nurse is caring for a client who is taking amoxicillin (Amoxil) and is experiencing adverse effects. Which of the following instructions should the nurse give to this client? A. "Stand up slowly after taking this medication." B. "Monitor for increased urine output." C. "Take this medication with a snack." D. "Administer the medication at bedtime."

B

A nurse is caring for a client with Parkinson's disease. The client is taking carbidopa levodopa (Sinemet) and reports nausea. Which of the following instructions should the nurse include to reduce nausea? A. Give medication 1 hr before meals B. Give medication with meals C. Give medication 1 hr after meals D. Give medication with high-protein snacks

C

A nurse is caring for a postoperative client with PCA containing IV morphine. A nurse should recognize which is the following priority assessment? A. Hypotension B. Bradypnea C. Drowsiness D. Urticaria

B

A nurse is caring for a school age child who has been prescribed diphenhydramine (Benadryl). Which of the following adverse effects has highest priority? A. Sedation B. Dry mucous membranes C. Ataxia D. Diarrhea

B

A nurse is caring for an older adult client who is receiving gentamicin (Garamycin)following abdominal surgery Which of the following physiological changes is most important for the nurse to consider when administering this medication? A. Decreased serum albumin B. Decreased renal blood flow C. Increased gastric pH D. Increased bodyfat

A

A nurse is caring for four older adult clients who are taking digoxin (Lanoxin). Which of the following clients is at greatest risk for developing digoxin toxicity? A. A client taking furosemide (Lasix) for edema B. A client taking allopurinol (Zyloprim) for gout C. client taking fluoxetine (Prozac) for depression D. A client taking pramipexole (Mirapex) for Parkinson's disease

B

A nurse is completing discharge teaching for a client who has HTN. The client has a new prescription for spironolactone. Which of the following statements by the client indicates an understanding of the teaching? A. I'll increase my dietary fiber, because this medication causes constipation B. I'm aware that this medication can cause heart palpitations C. I'll take aspirin every day. Because it makes this medication more effective D. I realize that I should use sugar substitutes when taking this medication

B

A nurse is monitoring a client who is taking fosinopril (Monopril). The nurse should understand that this has a beneficial effect on which of the body systems? A. Gastrointestinal B. Cardiovascular C. Pulmonary D. Reproductive

B

A nurse is planning discharge teaching for a client who is to start therapy with repaglinide (Prandin). Which of the following should the nurse include in the teaching? A. "Take the medication 1 hour before meal time." B. "Hold the medication if your blood glucose is less than 120mg/dL." C. "Monitor for irritability and diaphoresis." D. "Increase your protein intake."

A

A nurse is preparing to administer insulin to a client with DM. The client is to receive insulin aspart (Novolog) 5 units and NPH 15 units SQ in the morning. Which of the following actions should the nurse take first? A. Inject 5 units of air into the insulin aspart vial B. Inject 15 units of air into the NPH vial C. Draw up 5 units of insulin aspart from the vial D. Draw up 15 units of NPH from the vial

B

A nurse is providing instruction to four clients regarding medication self-administration. Which of the following actions by a client indicates a need for further teaching? A. Client rolls insulin suspension between his palms B. Client takes iron supplements at bedtime C. Client uses cotton swab to apply antibiotic ointment D. Client allows 1 min between puffs when he uses a metered-dose inhaler.

A

A nurse is providing teaching to a client who had a total gastrectomy. The client has anew prescription for Cyanocobalamin (Vitamin B12). Which of the following client statements indicates understanding of the teaching? A. "I will have to take this medication for the rest of my life." B. "After I receive injections for a week, I will be able to switch to a pill." C. "I need to have my vitamin B12 levels measured once a month." D. "Increasing my intake of green, leafy vegetables will increase my vitamin B12 levels."

C

A nurse is providing teaching to a client who just started taking lithium (Eskalith). Which of the following statements indicates that the client understands the teaching? A. I should inject this medication subcutaneously.‟ B. "I should expect to feel better in just a few days." C. "I should call my doctor if I develop hand tremors." D. "I should take this medication on an empty stomach."

A B E

A nurse is providing teaching to a client who was recently diagnosed as HIV positive. The client is beginning medication therapy with zidovudine (Retrovir). Which of the following statements should the nurse include in the teaching. (Select all that apply.) A. Must be taken with other retroviral medicines. B. Has few adverse effects C. Cures an HIV infection D. Prevents you from transmitting the HIV infection E. Increases CD4+ cell count

A D E

A nurse is providing teaching to a school-age child and his parents. The child has a new prescription for methylphenidate (Concerta). For which of the following adverse effects should the nurse monitor? (Select all that apply.) A. Nose bleed B. Oliguria C. Weight loss D. Palpitations E. Insomnia

A

A nurse is reviewing the laboratory tests for a client who had an acute myocardial infarction. The client is prescribed warfarin (Coumadin) 10mg PO. The nurse notes an INR of 2.6. Which of the following actions should the nurse take? A. Give the dose as prescribed. B. Hold the next dose. C. Increase the dose by 2.5mg D. Decrease the dose by 5mg

A

A nurse is reviewing the medication administration record for a client who has metastatic cancer and a fentanyl (Duragesic) transdermal patch for pain. The client reports a pain level of 10 on a scale of 0 to 10. Which of the following medications should the nurse anticipate administering? A. Hydromorphone(Dilaudid) B. Butorphanol (Stadol) C. Alprazolam(Xanax) D. Carbamazepine (Tegretol)

C

A nurse is teaching a client who has decided to quit smoking about using a nicotine transdermal system (Nicotrol). Which of the following instructions should the nurse include? A. Cleanse the skin with alcohol before applying the patch. B. Moisten the patch and hold it against the skin until it adheres. C. Apply the patch first thing in the morning and remove it at bedtime. D. Place the patch in the same skin area for the duration of the treatment.

B

A nurse is teaching about IV betamethasone (Celestine Sol span) with a client who is at31 weeks of gestation and is in premature labor. Which of the following information should the nurse include in the teaching? A. Prevents contractions of the uterus to avoid premature birth B. Promotes the production of surfactant in the fetal lung C. Decreases inflammation associated with an allergic reaction D. Suppresses the immune system to prevent fetal respiratory distress.

B

A nurse receives a phone call from a client who has heart failure and reports a dry cough for the last week. After reviewing the client's medical record, the nurse asks the client to come to the provider's office. The nurse should then instruct the client to stop taking which of the following daily medications until he sees his provider? A. Isosorbide(Imdur) B. Hydrochlorothiazide (Hydrodiuril) C. Nifedipine(Procardia) D. Lisinopril(Zestril)

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? increased platelet

A transition in care requires the nurse to conduct medication reconciliation.

Alpha-glucosidase inhibitors

Acarbose Used for type two diabetes Inhibits glucose absorption in GI tract Side effects: GI upset, anemia, hepatotoxicity Contraindicated for GI disorders Taken three times a day, with meals, with the first bite of food

Mucolytics

Acetylcysteine Used for pulmonary disorders where there are thick mucous secretions such as in cystic fibrosis; improves flow of secretions Also used for acetaminophen toxicity Side effects: bronchospasm, rash, nausea, vomiting Use cautiously in patients with asthma

Antivirals

Acyclovir "-vir" Acyclovir: used for symptoms of herpes and varicella Ganciclovir: cytomegalovirus Both work by preventing viral DNA synthesis Side effects: phlebitis, GI upset and nephrotoxicity, bone marrow suppression in ganciclovir These medications do not cure the conditions! For ganciclovir, monitor CBC and infection

Antifungals

Amphotericin B, Ketoconazole Used for systemic fungal infections "Amphoterrible" Side effects: hepatotoxicity, GI upset, nephrotoxicity, bone marrow suppression, phlebitis Often test dose is administered Monitor closely for any liver or renal dysfunction Ketoconaole: Not as bad, but still has liver toxicity and GI upset

Antiplatelets

Aspirin, Abciximab, Clopidogrel Inhibit platelet aggregation to prevent MI, strokes Side effects: GI upset, BLEEDING, and with aspirin tinnitus Do not give aspirin to children with fever do to risk of Reye's Syndrome Do not give in patients with bleeding disorders

Nonsteroidal anti-inflammatory drugs

Aspirin, ibuprofen, naproxen, indomethacin Used for mild-moderate pain, fever, inflammation Inhibits prostaglandin synthesis and aspirin inhibits platelet aggregration Side effects: GI upset, GI bleeding, renal toxicity, rash, tinnitus (aspirin) Never give aspirin to child with fever Do not give in peptic ulcer disease or bleeding disorders Avoid alcohol Monitor for salicylism: sweating, dizziness, headache, tinnitus, respiratory alkalosis

A nurse is reviewing the medical record of a client who has hypertension. The nurse should identify which of the following findings as a contraindication for receiving propranolol?

Asthma

A nurse is preparing to teach a client who is to start a new prescription for extended release verapamil . Which of the following instructions should the nurse plan to include?

Change positions slowly

Direct inhibitor of factor Xa

Rivaroxaban (Xarelto) "Make your blood flow like a river" Prevention of DVT, PE, and stroke by selectively inhibiting factor Xa which blocks coagulation Side effects: BLEEDING, elevated liver enzymes Monitor liver enzymes, hemoglobin, and hematocrit levels

A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching?

Drink 2 L of water daily.

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately?

Dyspnea

Adrenergic agonist

Epinephrine, dopamine, and dobutamine (PT: Catecholamines) Epinephrine: Stimulates Alpha-1, Beta-1, and Beta-2 receptors. Used for cardiac arrest or asthma. Bronchodilates, vasoconstriction, increased cardiac output, and increases heart rate Dopamine: Used for shock and heart failure. Increases renal blood flow at low to moderate doses. Increase heart rate and cardiac output. Dobutamine: Primarily stimulates Beta-1 receptors and acts on heart. Used for heart failure. Increases cardiac output. Less effect on blood pressure and heart rate Side effects: hypertensive crisis, dysrythmias, angina

Cholesterol Absorption Inhibitors

Ezetimibe Lowers cholesterol by inhibiting absorption in small intestine "eZetimibe causes cholesterol to Zip on through" Side effects: hepatotoxicity and muscle pain Monitor liver function and CK levels

Opioid analgesics (for pregnancy)

Fentanyl, Butorphanol, nalbuphine Used for severe pain during labor by decreasing pain without causing significant respiratory depression in mom or baby Side effects: dry mouth, GI upset, sedation, hypotension, decrease fetal heartrate Labor should be well established: cervix should be 4cm With respiratory depression, administer naloxone

Iron Preparations

Ferrous Sulfate (Oral), Iron Dextran (IV or IM) Used for iron deficiency anemia Side effects: Oral: GI upset, constipation, teeth staining (use straw), dark green or black stool (harmless). IV: Staining at IV site, hypotension, flushing Vitamin C increases absorption. Take on empty stomach one hour before meals. Increase fluid and fiber intake If IM, use z-trac method Keep out of reach of children Increase intake of iron rich foods

5-Alpha reductase inhibitors

Finasteride (Proscar) Dutasteride (Avodart) "Proscar looks like 'pro-car' and that guy has a 'fine ride' ... but he does have BPH. Used to treat BPH or baldness Prevents conversion of 5-alpha reductase which prevents conversion of testosterone Side effects: erectile dysfunction and gynecomastia Pregnant women and women of child bearing age should not come into contact with this medication

Reactions to Blood Products

First STOP the infusion immediately. Disconnect existing tubing hook them up to normal saline. Call provider. Send blood and tubing back to blood bank for analysis. Obtain Urine specimen. Acute hemolytic reaction: fever, low back pain, tachycardia, hypotension, tachypnea. Ensure you have checked ABO type and Rh factors with extra nurse. Febrile nonhemolytic reaction: Most common. Fever, chills, possible headache, fever will increase greater than 1 degree of baseline. Anaphylactic Reaction: Wheezing, shock, cardiac arrest. Do normal Rx protocol as well as initiate code, give epi, intiate CPR Mild allergic reaction: Have flushing, itching, urticaria. Can give antihistamine prior to transfussion if hx of this reaction. May need to stop, notify provider, and continue infusion slowly after antihistamine is given. Circulatory overload: especially with CHF. Crackles, cough, SOB, HTN, tachycardia, distended neck veins. Infuse slowly. Wait two hours before infusion of additional units. Sit patient upright with feet down. Administer diuretics and oxygen as appropriate

Sulfonylureas

Glipizide and glyburide Used for type two diabetes to bring blood sugar down by increased insulin release from pancreas Side effects: hypoglycemia, photosensitivity, GI upset Take med 30 minutes before meal Do not drink alcohol Use sunscreen "Glipizide, Glyburide, riding and sliding down slides. Blood sugars are going down. Outside in the sun"

Hyperglycemic Agent

Glucagon Used for severe hypoglycemia when patient cannot take oral glucose (unconscious, swallowing issues) Stimulates breakdown of glycogen into glucose Side effects: GI upset Administer SQ or IM Provide food as soon as they can swallow "When all the glucose is gone, you take glucagon"

Expectorants

Guaifenesin "Guaif sounds like cough" Used for non-productive cough associated with respiratory infections; thins secretions to enable patient to cough up mucous Side effects: GI upset, possible rash, drowsiness Want patient to drink more fluids to help liquefy secretions

A nurse contacts a client's provider on the telephone to obtain a prescription for pain medication. Which of the following actions should the nurse take?

Have the provider spell out the unfamiliar medication names.

A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The clients BP is 144/86, heart Rate is 55 and RR is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings

Heart Rate

Parenteral Anticoagulation

Heparin, enoxaparin Used for stroke, PE, DVT Prevents new clots from forming but does not break up clots that are already formed Side effects: BLEEDING, heparin induced thrombocytopenia (HIT), hypersensitivity HIT- decreased platelets and formation of clots in the body Monitor aPtt levels: Normally 30-40 seconds but therapeutic levels will be 1.5-2 times the baseline. Max should be 80. If higher than 80, blood is way too thin Antidote is protamine Monitor for signs of bleeding like black tarry stools or coffee ground emesis Use soft toothbrush and electric razor

A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse notify the provider immediately?

Hyperventilation

A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicates that the medication is effective?

Increased cardiac output

Mood stabilizer

Lithium Carbonate Treats bipolar disorder Side effects: GI distress, fine hand tremors, polyuria, weight gain, renal toxicity, renal toxicity, hypothyroidism, electrolyte imbalance Lithium toxicity: occurs with levels over 1.5; presents with COARSE (not fine) hand tremors, confusion, tinnitus, seizures, hypotension, coma, possibly death. Do not give with diuretics, NSAIDs, or anticholinergics Need a balance of sodium and water.

Lidocaine

Local anesthetic that can be used topically or parenteraly Topically: decrease pain that involve puncture of skin Parenteraly: decrease pain in minor surgical procedure, epidurals, or biopsies Blocks conduction of pain impulses within certain radias Side effects: hypotension, bradycardia, prolonged labor, spinal headaches, allergic reactions If using cream: apply one hour before procedure and cover with occlusive dressing

Angiotensin II Receptor Blockers

Losartan "Sartans" Blocking action of angiotensin II; results in vasodilation Heart failure, HTN, MI, diabetic retinopathy Side effects: angioedema, GI upset, hypotension

Antacids

Magnesium Hydroxide, Sodium Bicarbonate, Aluminum Hydroxide, Calcium Carbonate *Know All* Used for peptic ulcer disease and GERD by neutralizing stomach acid Side effects: Vary depending. Aluminum or Calcium can cause constipation. Mg based causes diarrhea. One hour before and three hours after meals and at bedtime. Leave one hour before or after any medications.

Medications to support withdrawal/abstinence from opiods

Methadone Substitution Slow weening process Methadone substitution is an oral opioid agonist that replaces the opioid to which the client has a physical dependence It prevents abstinence syndrome and removes the need for the client to obtain illegal substances. Used for withdrawal and long term maintenance.

Central Nervous system stimulants

Methylphenidate and Amphetamine mixture Treats ADHD and Conduct disorder Can cause insomnia, decreased appetite, weight loss, and growth suppression Do not give at night. Give immediately before or after a meal. Monitor weight.

Prokinetic Agents

Metoclopramide (Reglan) Used for nausea and vomiting as well as GERD and gastroparesis by accelerating gastric emptying and blocks dopamine and serotonin receptor in CTZ Side effects: Drowsiness, extrapyramidal symptoms

Beta Blockers

Metoprolol "lol" HTN, angina, heart failure, MI; blocks beta 1 receptors in heart which decreases heart rate and blood pressure Side effects: hypotension, bradycardia, decrease output, fatigue, erectile dysfunction Teach to take pulse and change position slowly. If beta blocker is non-selective: it will cause bronchospasm and should not be used in asthma. These include Propranolol and Nadoll

Antiprotozoals

Metronidazole Effective against protozoal infections. Effective in anaerobic bacteria. Side effects: GI upset, metalic taste, dark urine, dizziness, headache Patient should not drink alcohol "Car broke down, so she has to take the metro, gets a metallic taste in her mouth. She starts getting sick on the metro so she has to find the restroom on the metro and sees that her urine is dark. And she is like 'oh this is great, I can't even have a drink when I get home.'"

A nurse is assessing a client who has myasthenia graves and is taking neostigmine. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect?

Miosis

Prostaglandins

Misoprostol Used to prevent gastric ulcers in patients taken NSAIDs long term and to induce labor by ripening cervix. Decreases stomach acid production, increases protective mucous and bicarbonate. Side effects: dysmenorrhea, miscarriage or GI upset. DO NOT give in pregnancy or it causes miscarriage. Run pregnancy test first.

Nasal glucocorticoids

Mometasone (fluticasone, triamcinolone, budesonide) Used for rhinitis; decreases inflammation in nasal passages Side effects: burning, headache, sore throat

A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer?

Naloxone

Opioid antagonist

Naloxone Used for opioid overdose by competitively blocking opioid receptors in the CNS Side effects: HTN, angina, agitation, GI upset (everything is cranked back up) Monitor respiratory status Monitor pain (reverses analgesia)

Cholinesterase inhibitors

Neostigmine, Physostigmine, Edrophonium (dx MG) Prevents the enzyme cholinesterase from inactivating acetylcholine thereby increasing the amount of ACh available. Treats myasthenia gravis and parkinson's Reversal for neuromuscular blocking agents Excessive muscarinic stimulation: increased GI motility, diaphoresis, increased salivation, bradycardia, and urinary urgency (too moist) Cholinergic crisis: give atropine! Atropine reverses this!

Organic Nitrates

Nitroglycerin (NTG) Used for angina by vasodilating to decrease preload and myocardial oxygen demand Side effects: headache, orthostatic hypotension, reflex tachycardia If someone is having chest pain you have them stop and sit down. You put one sublingual tablet under tongue and rest for five minutes. If they are still have chest pain they should call an ambulance and take a second. Five minutes later they can take a third but NO more! If patch: place on hairless area and rotate sites. Remove old patch and clean with soap and water and dry well before applying new patch. Wear gloves when applying!

Progesterone

Norethindrone Used in birth control pills, to maintain pregnancy, and counters some adverse effects of estrogen Side effects: increased risk of embolic events, menstrual changes, edema, increase risk of breast cancer Patients should delay conception for three months after progesterone therapy Contraindicated in patient who have a high risk of embolic events

A nurse administered digoxin immune Fab to a client who received the incorrect dose of digoxin over a period of 3 days. The nurse should identify that which of the following findings indicates the antidote was effective?

Normal sinus rhythm

Antidysrhythmic Medications Class Two

Propranolol Non-selective beta blocker A-fib, A-flutter, paroxysmal SVt, HTN, angina Impact Beta-1 and Beta-2 receptors in both heart and lungs. Which means it can cause bronchspasm and cannot be used in asthma Side effects: hypotension, bronchospasm, fatigue, weakness

Laxatives

Psyllium: Bulk forming, helps to soften stool and increase bulk Docusate Sodium: Surfactant laxative, softens stool by increasing the water content Bisacodyl: Stimulant laxative. Stimulates peristalsis. A little harsher than the rest. Magnesium hydroxide: Osmotic laxative, draws water into the intestine and promotes peristalsis. Check for Mg toxicity and dehydration Key points: Constipation r/t bowel obstruction. Increase fiber, fluid, and exercise.

Selective estrogen receptor modulators

Raloxafene Used for postmenopausal osteoporosis and reduces risk of breast cancer by binding to estrogen receptors and decreases bone reabsorption (keeps calcium inside the bone) Side effects: increase risk of embolic events: PE, DVT, stroke, hot flashes, leg cramps Encourage patient to increase calcium and vitamin D intake Engage in weight bearing exercise Monitor bone density through scans "Raloxafene: I can 'relax' now that I am taking raloxafene for osteoporosis

Histamine 2 Receptor Antagonists

Ranitidine and Famotidine "If you take this medication, you will feel better when you 'dine'" Used for duodenal and gastric ulcers as well as GERD and Zollinger-Ellison syndrome (increased gastric juices) by blocking H2 receptors in the stomach which reduces gastric acid secretion Side effects: increases risk of bacterial colonization in stomach because of reduced pH. Advis patient not to over eat, reduce stress, stop smoking, avoid aspirin and NSAIDs

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include int he teaching plan? (select all that apply)

Report muscle pain to the provider Avoid taking the medication with grapefruit juice Expect therapy with this medication to be lifelong

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry flavored lozenges on a stick. Which of the following information should the nurse include in the teaching?

Store unused medication sticks in a storage container

Neuromuscular Blocking Agent

Succinycholine and Pancuronium Blocks acetylcholine at the neuromuscular junction resulting in muscle relaxation and hypotension. They do not cross the blood brain barrier, so complete paralysis is achieved without loss of consciousness or decreased pain sensation. Used in anesthesia. Side effects: respiratory depression, prolonged apnea, muscle pain, and malignant hyperthermia (MH) MH: muscle rigidity with increased temperature. Need to give oxygen at 100%, initiate cooling measures and administer dantrolene.

Mucosal Protectant

Sucralfate (Carafate) Used for duodenal ulcers. Reacts with stomach acid to form paste that cover ulcers Side effects: Constipation Want to give one hour before meals and at bedtime

Sulfonamides and trimethoprim

Sulfamethoxazole-trimethoprim Inhibits bacteria folic acid synthesis Side effects: hypersensitivity, GI upset, blood dyscrasias, cyrstaluria Advise patients to increase fluid intake!

5-aminosalicylates

Sulfasalazine Used for IBS, Crohn's disease, and ulcerative colitis Inhibits prostaglandin synthesis which decreases colon inflammation Side effects: Blood dyscrasia, GI upset, rash, headache

Triptans

Sumatripan "-tripan_ Used for acute attacks of vascular headaches. Works by vasoconstriction of intracranial arteries. Side effects: warm tingling sensation, dizziness, angina, injection site discomfort Advise patient to lay down in dark quiet place. Avoid tyramine rich foods and alcohol

Tocolytic medications

Terbutaline Used for preterm labor Delays but does not prevent labor. Also used for COPD and asthma because to activates beta 2 adrenergic receptors in uterus and lungs. Side effects: angina, tachycardia, restlessness, tremor Contraindicated in gestation of 34 weeks or greater (Risk outweighs benefits) and cervical dilation greater than 6 cm.

Androgens

Testosterone Used in boys with delayed puberty, hypogonadism, post-menopausal breast cancer Side effects: acne, increased cholesterol, edema, liver dysfunction, polycythemia, premature epiphyseal closure, deepening of voice and abnormal hair growth in women Contraindicated in prostate cancer High abuse potential

A nurse administers ceftazidime to a client who has a severe penicillin allergy. The nurse should identify which of the following client findings as an indication that she should complete an incident report?

The client reports shortness of breath.

C

The nurse is caring for a client who is receiving muromonab-CD3 (orthoclode OKT3) and is experiencing fever and 3+ pitting edema in the lower extremities. Which of the following actions should the nurse take for the client? A. Administer corticosteroids as prescribed B. Obtain a prescription for a WBC count C. Auscultate the clients lungs for adventitious sounds D. Maintain strict fluid intake and output measurements

MethylXanthines

Theophylline "Theo means God and if you use this, you may be seeing God sooner than you intended due to side effects." Can be used long term for asthma or COPD Side effects: GI upset, fatal dysrhythmia, and seizures Narrow therapeutic range: frequent blood draws: 5-15 mcg/mL

Somatropin

Treats growth hormone deficiencies in Peds and Adult Acts by mimicing naturally occurring growth hormones. Helps stimulate growth and protein synthesis Side effects: hyperglycemia Want to administer via IM or SQ and rotate sites *Stop treatment prior to epiphyseal closure* Closely monitor patient's growth rate in order to know when to stop medication

Adjunct pain medications

Tricyclic Antidepressants: Amitriptyline can be used for neuropathic pain Anticonvulsants: carbamazepine can also be used for neuropathic pain

Cyclosporine

Ulcerative colitis and rheumatoid arthritis, psoriasis, prevention of graft-versus-host disease in transplant patients (transplant rejection) inhibits normal immune response by blocking interleukon-2 Side effects: infection, hepatotoxicity, nephrotoxicity, unusual hair growth Notify provider of signs of infection, monitor renal and liver function labs.

A nurse is teaching a client who is starting to take amitriptyline. Which of the following findings should the nurse include in the teaching as an adverse effect of the medication?

Urinary retention

Phenazopyridine

Urinary tract analgesia Helps with burning, pain, etc. of UTI Acts as a local anesthetic Side effects: orange discoloration of urine - can stain clothes

Nitrofurantoin

Urinary tract antiseptic Works by damaging bacterial DNA Side effects: GI upset, hypersensitivity, blood dyscrasias, peripheral neuropathy, brown discoloration (expected)

Tamoxifen

Used for breast cancer: competes with estrogen for binding sites within the breast stopping growth of dependent cancers Side effects: hot flashes, GI upset, hypercalcemia, increased risk of endometrial cancer, increased risk of pulmonary cancer

Propylthiouracil

Used for graves disease (hyperthyroidism) or preparation of thyroidectomy Blocks synthesis of thyroid hormone Side effects: agranulocytosis, GI upset, rash, hepatotoxicity, if too high: hypothyroidism signs like cold intolerance, lethargy, weight gain, depression Make take 1-2 weeks to work Important to monitor CBC and liver function PTU: Prevents Thyroid from being Up

Strong Iodine Solution

Used for hyperthyoidism and in preparation for thyroidectomy Inhibits thyroid production and release due to high levels of iodine Side effects: GI upset, iodism: metallic taste, stomatitis, sore throat/gums; hypersensitivity Have patient increase fluid intake Mix solution with juice to improve taste Avoid foods high in iodine such as seafood

Radioactive Iodine

Used for hyperthyroidism and thyroid cancer Absorbed by thyroid and destroys its cells Side effects: radiation sickness, bone marrow suppression and hypothyroidism Increase fluid intake and void frequency Limit contact with other, maintain safe distance, do not share dishware, flush twice

Hydroxychloroquine

Used for malaria Side effect: retinal damage Advise patient to have eye exams every six months

Acetaminophen

Used for mild - moderate pain, fever by inhibiting prostaglandin synthesis Side effects: hepatotoxicity! in high doses Limit patient's intake of Tylenol to less than 4 grams a day including certain combos of medications. Be aware of all medications and ingredients Many OTC drugs contain acetaminophen Acetylcysteine is the antidote to acetaminophen overdose

Calcitonin

Used for post-menopausal osteoporosis and hypercalcemia Preventing bone reabsorption by inhibiting osteoclasts activity Side effects: GI upset, nasal irritation Encourage intake of calcium and vit D Increase weight bearing exercises Monitor bone density via scans Monitor for hypocalcemia: (keeping calcium in the bone, may not have enough in the blood) positive Trousseau's sign and Chvostek's sign

Antidysrhythmic Medications Class Four

Verapamil, Diltiazem Calcium channel blockers Used for hypertension, A-fib, A-flutter, SVT, angina Side effects: Hypotension, bradycardia, GI upset

Antimitotic

Vincristine Used for tumors and cancers. Stops cell division during mitosis. M phase specific. Side effects: peripheral neuropathy, phlebitis, GI upset, balding Administer antiemetics, monitor for signs of neuropathy, use central line Does not cause bone marrow suppression! "If you drink too much Vino, you can't feel your arms and legs"

A nurse is reviewing the laboratory results of a client who is taking carbamazepine for a seizure disorder. Which of the following findings should the nurse report to the provider?

WBC 3500

Oral anticoagulants

Warfarin (Coumadin) Used for Venous thrombosis, A-fib with thrombosis, prevention of TIA, PE, MI, and DVT Antagonist of vitamin K which prevents the formation of several clotting factors Side effects: BLEEDING, GI upset, hepititis Monitor PT: 11-13 but 18-24 for therapy and INR: 2-3 It takes 3-5 days for therapeutic level to be achieved. This means that they will be on Warfarin and heparin at the same time until warfarin can catch up. Antidote: vitamin K Maintain consistent intake of vitamin K Monitor for signs of bleeding, use soft toothbrush, etc.

Overall notes about insulin

We can give insulin to type one or type two diabetics Type one: will always get insulin Type two: can sometimes be managed with oral medications Side effects: hypoglycemia (tachycardia, diaphoresis, shakiness, weakness, headache) lipohyperthrophy (if injected into same spot over and over again. Patients dose may need to increase in times of illnesses For hypoglycemia in a fully conscious patient, give 15 grams of glucose (4 oz of orange juice). If unconscious give IM glucagone When mixing draw short acting before long acting. Clear before cloudy. Inject air into long acting vial, inject air into faster acting insulin, draw up faster acting insulin, then draw up long acting insulin Never mix insulin glargine with anything else For suspension, gently rotate (For NPH) If short acting looks cloudy, discard