Pharm test 2

Adrenergic Receptors

- SNS -adrenaline and noradrenaline -alpha and beta receptors

A nurse is preparing to administer enfuvirtide to a client. Which of the following actions should the nurse should plan to perform? (Select all that apply.) -Administer the drug subcutaneously -discard the unused portion -Roll the vial gently to reconstitute the solution -Inject the solution at room temperature - Expect a cloudy solution

-Administer the drug subcutaneously -Roll the vial gently to reconstitute the solution -Inject the solution at room temperature

A nurse is preparing to administer paclitaxel IV to a client who has ovarian cancer. Which of the following actions should the nurse take? (Select all that apply.) -Give the client an antihistamine -Infuse the drug over 1 hour -Administer the drug through non PVC tubing -Use an in-line filter - Add heparin to the paclitaxel solution

-Give the client an antihistamine -Administer the drug through non PVC tubing -Use an in-line filter

Cholinergic Receptors

-PNS - acetylcholine - Nicotinic and muscarinic receptors

A nurse is caring for a client who has a new prescription for maraviroc therapy. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) -Parasthesia -Cough - Tinnitus -Jaundice -Fever

-Parasthesia -Cough -Jaundice -Fever

A nurse is teaching a client who has a new prescription for mercaptopurine to treat leukemia. Which of the following instructions should the nurse include? (Select all that apply.) -Use contraception if pregnancy is a risk. -Perform oral hygiene frequently. - Avoid activities that require mental alertness -Perform hand hygiene frequently. -Avoid activities that can cause injury.

-Use contraception if pregnancy is a risk. -Perform oral hygiene frequently. -Perform hand hygiene frequently. -Avoid activities that can cause injury.

A nurse is assessing a client following a trastuzumab infusion to treat metastatic breast cancer. Which of the following findings should the nurse recognize as an indication that the client is experiencing an adverse reaction to the drug? (Select all that apply.) -Wheezing -Dysrhythmias -Hypotension -Fever - Ascites

-Wheezing -Dysrhythmias -Hypotension -Fever

A nurse is teaching a client who has a new prescription for imatinib to treat chronic myeloid leukemia. Which of the following instructions should the nurse include? (Select all that apply.) -clean fruits and vegetables thoroughly -Increase calcium intake -Weigh yourself daily -Perform hand hygiene frequently -Avoid grapefruit and grapefruit juice

-clean fruits and vegetables thoroughly -Weigh yourself daily -Perform hand hygiene frequently -Avoid grapefruit and grapefruit juice

A nurse is caring for a client who is receiving vincristine to treat lung cancer. The nurse should monitor the client and recognize which of the following manifestations as an indication that the client is experiencing an adverse effect of the drug. A) A weak hand grasp B) Constricted pupils C) Bradycardia D) Crackles

A) A weak hand grasp

Amphetamine-Like Drugs

ADHD Methylphenidate (Ritalin) Methamphetamine (Desoxyn)

Methylphenidate (Ritalin)/ actions/uses/interactions

Action Acts on cerebral cortex, reticular activity system Uses: ADHD, fatigue, narcolepsy Interactions }Caffeine may increase effects }Decreased effects of decongestants, antihypertensives, barbiturates May alter insulin effects

Amphetamines action/ uses

Action They stimulate release of norepinephrine and dopamine. Uses They increase wakefulness in narcolepsy. They increase attention span, cognition. They decrease hyperactivity, impulsiveness, restlessness of ADHD.

Epinephrine

Action •Inotropic •Vasoconstrictor •Bronchodilator Uses •Anaphylaxis, anaphylactic shock •Bronchospasms •, cardiac arrest Side effects/adverse reactions •Cardiac dysrhythmias •Hypotension, flushing, reflex tachycardia •Decrease renal perfusion Drug interaction •Beta-blockers •Decreases epinephrine action •Digoxin •Causes cardiac dysrhythmias •Caffeine and ephedra increase BP and HR •Overdose give alpha and beta blockers

Cholinergic- Muscarinic

Affects smooth muscle

Methylphenidate (Concerta, Ritalin, Others) adverse effects

All patients are at risk for irregular heartbeat, high blood pressure, and liver toxicity. Because methylphenidate is a schedule 2 drug it has the potential for causing dependence Periodic drug-free "holidays" are recommended to reduce drug dependence and to assess the patient's condition

CNS stimulants

Amphetamine

Psycomotor stimulants

Amphetamine Dextroamphetamine Methylphenidate Caffine Methylxanthines Nicotine Cocaine

Amphetamines

Amphetamine (Adderall) Dextroamphetamine (Dexedrine)

CNS Stimulants

Amphetamines Analeptics, caffeine Anorexiants

A nurse is caring for a client who has a new prescription for pramipexole to treat Parkinson's disease. The nurse should recognize that which of the following laboratory tests require monitoring? A) C-reactive protein B) Creatinine clearance C) Thyroid function D) CBC

B) Creatinine clearance

A nurse is teaching a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the following adverse effects A) Hirsutism B) Drowsiness C) Headache D) Ataxia E) Rash

B) Drowsiness C) Headache E) Rash

A nurse is administering fentanyl to a client to reduce pain. Which of the following drugs should the nurse have available to reverse the effects of fentanyl? A) Neostigmine B) Succinylcholine C) Naloxone D) Dantrolene

C) Naloxone

Amphetamine and Dextroamphetamine (Adderall)

Classification ADHD agent CNS stimulant, anorexiant, sympathomimetic Action Actions due to release of norepinephrine and dopamine Indications ADHD, Narcolepsy Precautions Bipolar disorder

Cholinergic agonist

Constricts pupil Constricts lungs Decreases heart rate Dilates BV Contracts bladder Increases salivation

Methylphenidate (Ritalin) Administration Alerts

Controlled substance: Schedule I I drug. Pregnancy category C.

A nurse is teaching a client who received a prescription for interferon beta-1a for the treatment of multiple sclerosis. Which of the following information should the nurse include? a) Have kidney function tests done every month for a year B) take an extra dose if muscle aches occur C) store the drug at room temp after mixing it D) Administer the drug in your thigh or upper arm

D) Administer the drug in your thigh or upper arm

A nurse is caring for a client who has a new prescription for intrathecal cytarabine therapy to treat meningeal leukemia. The nurse should inform the client that they will also receive which of the following drugs to reduce the risk of neurotoxicity? A) Diphenhydramine B) Leucovorin C) Folic Acid D) Dexamethasone

D) Dexamethasone

A nurse is caring for a client who is taking interferon beta-1b. The nurse should identify that which of the following findings indicates a potential serious adverse effect of this drug? A) Tinnitus B) Twitching eyelids C) Blue-green skin discoloration D) Fatigue

D) Fatigue

A nurse is caring for a client who has been taking selegiline to treat Parkinson's disease. The provider is considering the use of analgesics for the client but should be aware that a drug interaction between selegiline and meperidine can result in which of the following? a) Frequent urination (me) B) Jaundice C) Cellulitis D) Muscle rigidity

D) Muscle rigidity

Atropine side effects

DDDD Dry mouth Dry stools Dilated pupils Dilated bladder

Cholinergic OD side effects

DUMB BELS Diarrhea Urination Miosis/muscle weaknes Bronchorrea Bradycardia Emesis Lacrimation Salivation/sweating

•Which drug should the nurse realize may interact with propranolol (Inderal)?

Drug that interact with metoprolol include phenytoin, isoproterenol, NSAIDs, barbiturates, caffeine, and theophylline, which decrease propranolol's effects

Adrenergic Agent

Epinephrine, albuterol Phenyleprine

Adrenergic blockers

Feed breed pee poo

Contraindications Atropine

Glaucoma

Adrenergic Blocker

Monitor urinary hesitancy, incomplete bladder emptying, interrupted urinary stream Monitor vital signs, level of consciousness, and mood Monitor for dizziness, drowsiness, or light-headedness Observe for side effects Monitor cardiac output

Adrenergic Drugs (Sympathomimetics)

Monitor vital signs, urinary and cardiac output as appropriate Monitor breathing patterns Observe patient's responsiveness to light Monitor for rhinorrhea and epistaxis

Parasympathetic nervous system

Nonstressful -Rest and digest -Digestive process, heart rate and BP

Attention Deficit/Hyperactivity Disorder

Pathophysiology -Disregulation of transmitters -Serotonin, norepinephrine, dopamine Epidemiology Usually occurs in children before age 7 More common in boys

Cholinergics

SLUDGE Salivation Lacrimation Urination Diarrhea GI distress Emesis

A nurse is teaching a guardian of a child about the recommended age range to receive the human papillomavirus (HPV) vaccine. Which of the following age ranges should the nurse include? a) 11 to 12 years old B) 7 to 9 years old C) 13 to 15 years old D) 15 to 17 years old

a) 11 to 12 years old

Direct acting cholinergics

act on receptors to activate a tissue response -Pilocarpine (pilocar) constricts pupils

sympathetic nervous system

activate under stress Fight or flight

Cholinergic receptors- nicotinic

affects skeletal mucle

A depressant is a drug who

slows brain and body reactions

A stimulant is a drug that

speeds up activities of CNS

Phenylephrine is used for

the temporary relief of stuffy nose, sinus, and ear symptoms caused by the common cold, flu, allergies, or other breathing illnesses. This medication works by decreasing swelling in the nose and ears, thereby lessening discomfort and making it easier to breathe.

Atropine

•Prototype drug: atropine (Atropair, Atropisol) •Mechanism of action: to inhibit the parasympathetic nervous system •Primary use: peptic ulcers, irritable bowel syndrome, mydriasis and cycloplegia during eye examination, bradycardia, preanesthetic, asthma •Adverse effects: tachycardia, C N S stimulation, dry mouth, constipation, urinary retention, dry eyes, decreased sweating, photophobia

Albuterol (Proventil)

•Selective •Acts on beta2-adrenergic receptors •Promotes bronchodilation •Uses •Treats bronchospasm, asthma, bronchitis, COPD •Caution •Severe cardiac disease •Hypertension, hyperthyroidism •Diabetes mellitus, pregnancy

Albuterol Side effects

•Side effects/adverse reactions •Tremors, nervousness, restlessness •Dizziness, reflex tachycardia •Hallucinations •Cardiac dysrhythmias

A nurse is caring for a client who has a new prescription for cisplatin to treat testicular cancer. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) -Paresthesia -Sore throat -Flank pain -Tinnitus -conjunctivitis

-Paresthesia -Sore throat -Flank pain -Tinnitus

A nurse is instructing a client how to self-administer enfuvirtide. Which of the following instructions should the nurse include? A) Allow the vial to sit until the solution is completely clear and without particulates B) After reconstituting sterile water, vigorous shake the vial to mix the solution C) Use the medication immediately upon removing the refrigerator D) Use the same location for five injections before rotating to a new site

A) Allow the vial to sit until the solution is completely clear and without particulates

A nurse is teaching a client who has a prescription for baclofen. Which of the following instructions should the nurse include? A) Avoid driving until the drug's effects are evident. B) Stop taking the drug immediately if headache occurs C) Take the drug as needed for spasticity D) Take the drug with antacids to reduce gastric effects

A) Avoid driving until the drug's effects are evident.

A nurse is teaching a client who has a new diagnosis of breast cancer about the drug tamoxifen. The nurse should tell the client that which of the following conditions is a contraindication for taking tamoxifen? A) Deep-vein thrombosis B) COPD C) Diabetes millitus D) Alcohol use disorder

A) Deep-vein thrombosis

A nurse is caring for a client who has a new prescription for topotecan therapy to treat resistant, small-cell lung cancer. The nurse should advise the client against taking which of the following types of over-the-counter drugs while receiving the therapy? A) Folic acid B) St. John wort C) Obuprofen D) Aluminum hydroxide

A) Folic acid

A nurse is teaching the guardian of a 4-month-old infant about recommended immunizations for the infant. Which of the following immunizations should the nurse include? A) Haemophilus influenzae type B vaccine (Hib) B) Varicella vaccine C) Meningococcal conjugate vaccine (MCV4) D) Tdap vaccine

A) Haemophilus influenzae type B vaccine (Hib)

A nurse is caring for a client who is prescribed zidovudine. Which of the following laboratory values should the nurse report to the provider? A) Hemoglobin 7/1 g/dL B) RBC count 5.2/mm C) Neutrophil 57% D)Triglycerides 125 mg/dL

A) Hemoglobin 7/1 g/dL

A nurse is teaching a client about recommended immunizations. Which of the following immunizations should the nurse recommend the client receive starting at 50 years of age? A) Herpes zoster vaccine B) HPV vaccine C) Pneumococcal vaccine D) HIB vaccine

A) Herpes zoster vaccine

A nurse is teaching a client about maraviroc. Which of the following instructions should the nurse include? A) It is important to report any noticeable rash immediately as it might indicate an issue with your liver. B) Make sure you take this medication without any other medications first thing in the morning C) You might experience flu-like symptoms for which you can take any over-the-counter medication D) The side effects of this medication are minimal, so you can continue to work and drive as normal

A) It is important to report any noticeable rash immediately as it might indicate an issue with your liver.

A nurse is teaching a client about interferon beta-1a. Which of the following instructions should the nurse give to help the client avoid the adverse effects of this drug? A) Premedicate with acetaminophen B) Take the drug with food C) Increase your fluid intake D) Take the drug in the morning

A) Premedicate with acetaminophen

A nurse is caring for a client who has a new prescription for delavirdine therapy to treat HIV-1. The nurse should instruct the client to report which of the following adverse reactions to the drug? A) Rash B) Insomnia C) Rhinitis D) Alopecia

A) Rash

A nurse is caring for a client who has been taking amphetamine/dextroamphetamine sulfate for the treatment of ADHD for 2 weeks. The nurse should report which of the following findings to the provider? A) Weight loss of 2.3 kg (5 lb) B) BP 110/70 mm hg C) Apical pulse 80/min D) Respiratory rate 16/min

A) Weight loss of 2.3 kg (5 lb)

A nurse is teaching a client about immunizations. Which of the following information should the nurse include in the teaching? A) You should receive a tetanus booster every 10 years B) You should not receive the influenza immunization if you have a common cold C) You do not have to receive the shingles vaccine if you have received two doses of the varicella virus vaccine D) As long as you don't have risk factors, you will start receiving the pneumococcal vaccine when you are 50 years old

A) You should receive a tetanus booster every 10 years

A nurse is teaching a client who has a prescription for carbamazepine. Which of the following instructions should the nurse include to help the client avoid adverse effects of this drug? A) begin taking the drug at a low dosage B) Discontinue the drug immediately if diarrhea occurs C) Have serum glucose levels checked regularly D) Take on empty stomach

A) begin taking the drug at a low dosage

A nurse is teaching a client who is about to begin sumatriptan therapy to treat migraine headaches. The nurse should instruct the client to monitor for which of the following adverse effects? A) chest pain B) polyuria C) joint pain D) insomnia

A) chest pain

A nurse is teaching a client who has a prescription for modafinil to treat narcolepsy. Which of the following instructions should the nurse include? A) take the drug in the morning B) Take the drug 30 min before bedtime C)Anticipate daytime drowsiness D) Expect urinary frequency

A) take the drug in the morning

A nurse is considering drug therapy options for a client who has metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2). Which of the following drugs should the nurse expect the provider to prescribe? A) trastuzumab B) Imatinib C) Leuprolide D) Flutamide

A) trastuzumab

A nurse is reviewing the medical record of a client who has a newly diagnosed seizure disorder and a new prescription for valproic acid and phenytoin. The nurse should identify that which of the following can occur as a result of an interaction between these drugs? A) Hyperammonemia B) Phenytoin toxicity C) Hypertension D) Peptic ulcer disease

B) Phenytoin toxicity

A nurse is caring for a client who is receiving methohexital sodium. The nurse should monitor the client for which of the following adverse effects? A) Cardiac excitability B) Respiratory depression C) Hyperthermia D) Hypertension

B) Respiratory depression

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should identify that which of the following laboratory tests requires monitoring? A) Serum potassium B)Liver function C) Serum sodium D) Thyroid function

B)Liver function

The nurse is teaching a client who is taking metoprolol (Lopressor). Which should the nurse consider the highest priority in teaching side effects/adverse effects? A. Report any complaints of stuffy nose. B. Instruct the client how to take a pulse. C. Check urine output and bladder distention. D. Warn of possible impotence and decreased libido.

B. Instruct the client how to take a pulse

Which action should the nurse consider appropriate for the client who is taking atropine? A. Give the drug with meals. B. Monitor the client's vital signs. C. Auscultate breath sounds for rales. D. Observe for orthostatic hypotension.

B. Monitor the client's vital signs.

A nurse is preparing to administer memantine to a client who has Alzheimer's disease. Which of the following findings in the client's medical history indicates a need to withhold the drug and notify the provider? A) Pancreatic cancer B) Hypotension C) Cirrhosis D) Osteoporosis

C) Cirrhosis

A nurse is caring for a client who has a new prescription for dantrolene to treat skeletal muscle spasms. The nurse should instruct the client to report which of the following adverse effects? A) Slow heart rate B) Cough C) Diarrhea D) Hearing loss

C) Diarrhea

A nurse is providing teaching for a client who has a new prescription for valproic acid to treat a seizure disorder. The nurse should instruct the client to monitor for which of the adverse effects? A) Hirsutism B) Depression C) Jaundice D) Gum irritation

C) Jaundice

A nurse is caring for a client who is taking donepezil to treat Alzheimer's disease. For which of the following adverse effects should the nurse monitor? A) Confusion B) Dry mouth C) Nausea D) Double vision

C) Nausea

A nurse is caring for a client who has a new prescription for amphetamine sulfate. The nurse should monitor the client for which of the following adverse effects? A) Hypotension B) Tinnitus C) Tachycardia D) Bronchospasm

C) Tachycardia

A nurse should recognize that enfuvirtide can be prescribed to clients who have which of the following conditions? A) advanced prostate cancer B) primary brain tumor C) advanced HIV D) Metastatic ovarian cancer

C) advanced HIV

A nurse is caring for a client who has had atropine. Which problem would the nurse rate as the highest priority for this client? A. Anxiety B. Constipation C. Urinary retention D. Impaired oral mucous membrane

C. Urinary retention

Anticholinergics

Cant pee, see, spit or shit •Drugs that inhibit parasympathetic impulses •Suppression of parasympathetic division induces fight-or-flight symptoms

A nurse should recognize that maraviroc is used in the treatment of which of the following conditions? a) Diabetes mellitus B) Meningeal infection C) Pancreatitis D) Chemokine receptor 5(ccR5)-tropic-HIV-1

D) Chemokine receptor 5(ccR5)-tropic-HIV-1

A nurse is teaching a client who has a new diagnosis of Parkinson's disease about how levodopa/carbidopa can control symptoms. The nurse should identify that the drug has which of the following pharmacologic effects? a) Increases available acetylcholine in the brain b) Inhibits norepinephrine metabolism in the brain c) Inhibits serotonin metabolism in the brain D) Increases available dopamine in the brain

D) Increases available dopamine in the brain

A nurse should recognize that raltegravir is used to treat clients who have which of the following conditions? A) hairy cell leukemia B) Thyroid cancer C) Kaposi's sarcoma D) Resistant HIV

D) Resistant HIV

A nurse is caring for a client who has a new prescription for ritonavir and zidovudine therapy to treat HIV-1. The nurse should inform the client that zidovudine is prescribed with ritonavir for which of the following reasons? A) To prevent an infusion reaction B) To increase platelet production C) To protect healthy cells from the toxic effects ritonavir D) To prevent drug resistance

D) To prevent drug resistance

A nurse is teaching a client who has Alzheimer's disease and their caregiver about memantine. Which of the following instructions should the nurse include? A) increase fluid intake improve renal excretion B) Report memory loss or confusion C) Water for signs of liver impairment, such as jaundice and abdominal pain D) avoid taking over the counter antacids

D) avoid taking over the counter antacids

Adrenergic

Fight or flight

Medically approved uses of CNS stimulants

Medically approved uses Attention deficit/hyperactivity disorder (ADHD) Narcolepsy Reversal of respiratory distress Migraine Headaches

When reviewing the indications for various antidepressants, nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? Seasonal affective disorder Nicotine addiction Depression

Seasonal affective disorder Nicotine addiction Depression

Amphetamines Side effects/adverse reactions

Tachycardia, palpitations, dysrhythmias, hypertension }Sleeplessness, restlessness }Irritability }Anorexia, dry mouth, weight loss, diarrhea, constipation }Impotence

Interactions-Atropine

antihistamines, T C A s, quinidine, and procainamide. Atropine decreases effects of levodopa. •Herbal/Food: aloe, Serona repens (saw palmetto), buckthorn •Treatment of Overdose: Overdose may cause C N S stimulation or depression. A short-acting barbiturate or diazepam (Valium) may be administered to control convulsions.

A nurse is preparing to administer sumatriptan to a client for the first time. The nurse should instruct the client that sumatriptan is indicated for which of the following conditions? A) Tonic- clonic seizure B) Presence of migraine headache C) Exacerbation of MS D) alzheimers

b) Presence of a migraine headache

A nurse is teaching the family of a client who has a new diagnosis of Alzheimer's disease about donepezil. Which of the following information should the nurse include? A) Monitor for constipation B) the dosage will be increased weekly to provide optimum therapeutic effects C) Administering the drug first in the morning promotes effectiveness D) Avoid the use of NSAIDs for pain

d) Avoid the use of NSAIDs for pain

Pilocarpine Indications

open-angle glaucoma, angle-closure glaucoma and inductin of miosis Administered: topically or orally. Excreted •Stimulates the receptor producing miosis •Secretory gland effect: Increase in salivary flow •Hypersensitivity, retinal detachment airway disease •Adverse effects Ocular: stinging and burning, tearing and ciliary spasm •Oral: hepertension, tachycardia, bronchiolar spasm, pulmonary edema, salivation and sweating and nausea and vomiting •Drug Interactions No known important drug interactions •Antidote (Reversal agent): Atropine •

Amphetamine and Dextroamphetamine (Adderall) contraindications/ drug interactions

}Contraindications }Hypersensitivity to sympathomimetic amines }History of drug abuse, Diabetes, Hyperthyroidism }Hypertension, Cardiac disorders, Tourette's syndrome }Drug interactions }Decreased elimination }Alkalytic drugs: Acetazolamide, sodium bicarbonate }Increased elimination }Acidic drugs: ammonium chloride, ascorbic acid }Increased blood pressure effects }Furazolidone

Attention-Deficit/Hyperactivity Disorder (A D H D)

•Behavioral disorder •Developmentally inappropriate behaviors involving: •Easy distractibility •Failure to receive or follow instructions •Inability to focus on one task at a time •Difficulty remembering •Frequent loss or misplacement of personal items •Excessive talking; interrupting •Inability to sit still •Impulsiveness •Sleep disturbance

Albuterol Drug interaction

•Drug interaction •May increase effect with other sympathomimetics, MAO inhibitors, and tricyclic antidepressants •Antagonize effect with beta blockers

Effects of anticholinergics

•Effects of anticholinergics •Heart: large doses increase P; small doses decrease P •Lungs: bronchodilation, decrease secretions •GI: relax smooth muscle tone, decrease motility and peristalsis, decrease secretions •GU: relax detrusor muscle, increase sphincter constriction •Eye: dilate pupils, decrease accommodation •Glands: decrease salivation and perspiration •CNS: decrease tremors and rigidity

Epinephrine nursing interventions

•Monitor BP, P, urine output. •Report tachycardia, palpitations, tremors, dizziness, hypertension. •Monitor IV site for infiltration. •Antidote: phentolamine mesylate (Regitine) •Avoid cold medicines and diet pills if hypertensive, diabetic, CAD, or dysrhythmic. •Avoid adrenergics when breastfeeding. •Avoid continuous use of adrenergic nasal sprays.

Nursing interventions Atropine

•Monitor vital signs, urine output, bowel sounds. •Monitor safety: bedside rails, driving motor vehicles. •Provide mouth care and eye drops. •Avoid hot environments. •Avoid alcohol, cigarettes, caffeine, and aspirin at bedtime. •Wear sunglasses in bright light.