Pharmacology

Examples of Intermediate-Acting Insulin

NPH (Humulin N, Novolin N)

Nurse should respond to DM patient on insulin therapy with these symptoms?

Profused sweating and difficult to arouse.

What is the first line of cholesterol medications?

"statins" or HMG-CoA Reductase

What should you instruct the Patient to avoid while taking Flagyl?

*Alcohol* *educate patient that even some mouthwashes contain alcohol and should be avoided as well.

What is the vancomycin tough level?

10-20

What is the vancomycin peak level?

25-50

When is the best time to take Sulfonureas?

30 mins to 1 hour before meals

How long do you let a patient try to lower cholesterol with diet and exercise before starting a medication?

6 months

How long should you wait to check Lipid levels again, after stating patient on cholesterol medication?

6 to 8 weeks

What lifestyle factors contribute to hyperlipidemia? Select all that apply. A. The patient is 50 pounds overweight B. The patient admits to consuming alcohol C. Intake of small amounts of dietary fiber D. The patient is a life-long smoker E. Dietary saturated fats are restricted

A, C, D. Smoking, being overweight, and not having enough dietary fiber all contribute to elevated lipid and cholesterol levels.

Corticosteroids should not be given with what drugs to avoid interactions? Select all that apply. A. Warfarin B. ACE inhibitors C. Diuretics D. Oral hypoglycemic agents or insulin E. Antibiotics

A, C, and D. Corticosteroids shouldn't be used with warfarin due to the corticosteroids may enhance or decrease the anticoagulant effects of warfarin. Avoid Diuretics because the corticosteroids may enhance the loss of potassium. And avoid oral hypoglycemic agents or insulin because diabetic or prediabetic patients must be monitored for hyperglycemia. ACE Inhibitors and antibiotics do not interact with Corticosteroids and may be used.

What is the first line drug therapy for hypercholesterolemia? A. HMG-CoA Reductase "STATINS" B. Bile Acid Binding Resins C. Niacin D. Omega 3 fatty acids

A. HMG-CoA Reductase PowerPoint 23 states that HMG-CoA Reductases are the first line of therapy for hypocholesteremia. These drugs are -statins.

A patient reports to their health care provider after just starting antimicrobial therapy and complains of a sore throat, fatigue, bruises, fever, and skin hemorrhages. The HCP knows this could be a result of ? a. Blood dyscrasia b. Strep throat c. Hepatotoxicity d. Nephrotoxicity

A. The signs and symptoms to monitor for in blood dyscrasias are sore throat, bruising, skin hemorrhage, and elevated temperature.

A patient with an infection is undergoing an antibiotic regimen for treatment. Her chart calls for a dose of 3mg Zosyn at 1130. The nurse notes that her chart also has an allergy to penicillin listed. What is the nurse's next step? A. Hold the medication and notify the HCP of the mistake on the order. B. Administer the medication as ordered. C. Decrease the dosage to 1.5mg and administer the medication. D. Administer tazobactam 3mg at 1200.

A. Zosyn is a penicillin, and a patient with an allergy to penicillins should not receive penicillins. The nurse should hold the Zosyn and notify the HCP of the error.

Delay the absorption of carbohydrates in the small intestine, which decreases the expected rise in post prandial glucose after a meal

Alpha-Glucosidase Inhibitors

Second Generation Cephalosporins are the best for what type of bacteria?

Anaerobic bacteria. Examples: Cefaclor (Ceclor), Cefprozil (Cefzil), Cefoxitin (Metfoxin), Cefuroxime (Zinacef), Cefotatan (Cefotan)

Regarding Hyperlipidemia, what action does "statins" do in the body? A. Help promote the conversion of food into waste. B. Help soften the arteries to prevent CAD. C. Help convert the "bad" cholesterol to the "good" cholesterol. D.Interrupt the production of the "bad" cholesterol in the liver.

Answer: D. Interrupt the production of the "bad" cholesterol in the liver Rationale: Statin drugs block the liver's production of the "bad" cholesterol, which helps lower the overall cholesterol levels.

Stimulate release of insulin from beta cells of pancreas

Meglitinides

A 64-year-old woman presents to the ER with lower back pain, and dysuria. You ask the patient to use the restroom in order to obtain a urine sample. The urine sample confirms the patient has a UTI. You send the sample off for culture and sensitivity. When would you start the patient on an antibiotic for the conformed UTI? A. As soon as you get the culture and sensitivity back from the lab which shows what antibiotic would work best for that culture. B. As soon as it is confirmed that the patient has a UTI. C. Before you obtain a urine. D.After the patient subjectively tells the nurse that she has lower back pain and dysuria.

B. As soon as it is confirmed that the patient has a UTI. Rationale: You want to start the patient on an antibiotic as soon as a UTI is confirmed for a UA, even if the culture is not sensitivity to that antibiotic. When the C and S comes back from the lab, then you can change the antibiotic if need be. The reason to start the patient on an antibiotic before the C and S is results is because the antibiotic that is started could treat the patient, so the UTI will not worsen and lead to a more severe UTI.

How long should a patient on HMG-CoA Reductase Inhibitors (Statins) expect to wait before the lipid levels may be lowered to their maximum extent? A. 4-6 weeks B. 6-8 weeks C. 6-12 weeks D. 1-2 weeks.

B. Patients on Statins should be prepared to wait 6-8 weeks before their lipid levels may be lowered to their maximum extent. Waiting 7-12 weeks is too long. 1-2 weeks and 4-6 is too short of a time period for Statins to prove effective.

The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what? A. Resistant infection B. Superinfection C. Nosocomial infection D. Allergic reaction

B. Superinfection Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.

What drug causes tooth discoloration in children younger than 8 years old? A. Sulfonamides B. Tetracyclines C. Penicillins D. Fluoroquinolone

B. Tetracyclines. Tetracyclines cause discoloration in children younger than 8 due to the drug binding to the calcium in the teeth. They should also be avoided in pregnant or lactating women cause it can transfer to the infants.

A patient is taking insulin glargine, and wants to know when the drug is most effective How should the nurse respond? a.) The insulin will peak in 1-2 hours b.) The insulin has no peak c.) The insulin will peak in 6-8 hours d.) The insulin will peak in 20-24 hours

B. The insulin has no peak. With long acting insulin, there is no peak.

What is Rhabdomyolysis?

Breakdown of muscle protein

Low levels of HDL and high levels of LDL are risks for which of the following? Select all that apply. a.) Alopecia b.) Atherosclerosis c.) Jaundice d.) Coronary Heart Disease e.) Severe weight loss

B.) Atherosclerosis, C.) Coronary Heart Disease. Low levels of HDL and high levels of LDL put someone at risk for atherosclerosis, and coronary heart disease, not any of the other options.

Slowing the production of glucose by the liver. It may also slow the intestinal absorption of glucose and improve insulin receptor sensitivity.

Biguanides

NPO patient 4 test which dose of insulin should be given if ordered even if not eating?

Blood Glucose- 190 regular insulin 4 unit per sliding scale coverage

A patient in her third trimester of pregnancy has been diagnosed with a urinary tract infection. If the health care provider prescribes sulfonamides, what would the child be at risk for? A. Staining of the teeth B. No issue C. Jaundice D. Low birth weight

C is correct. Sulfonamides are capable of causing jaundice in the child if taken during the last couple of weeks of pregnancy. B is incorrect because sulfonamides are prone to causing jaundice in a newborn. A is true for tetracyclines, not sulfonamides. D is true for fetal alcohol syndrome.

In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A) That therapy typically lasts about 6 months. B) That weekly laboratory tests for T4 levels will be required. C) To report weight loss, anxiety, insomnia, and palpitations. D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations. Weight loss, anxiety, insomnia and palpitations are signs of hyperthyroidism. An adjustment in dose would need to be obtained in order to reach a therapeutic level of levothyroxine (Synthroid) in the patient with hypothyroidism.

How long should non drug means of controlling cholesterol be tried before switching to drug therapy? A. 3 months B. 12 months C. 6 months D. 9 months

C. 6 months. You should use non drug means of controlling cholesterol like changing your diet and exercising regularly before getting on a drug to lower your cholesterol.

A patient on heparin came into the hospital and was diagnosed with pneumonia. The physician should avoid prescribing what antibiotic for this patient due to it not being compatible with heparin? A. Neomycin B. Cefazolin C. Gentamicin D.Vancomycin

C. Gentamicin Heparin is incompatible and should not be mixed with Gentamicin. If needed, the nurse should provide a separate IV line for gentamicin.

A patient comes into the ED complaining of pain in his chest, shortness of breath, and fatigue. The patient is diagnosed with atherosclerosis. The nurse treating the patient knows that she should assess the patient for which of the following? A. High blood pressure B. Signs of infection C. Abnormal elevation of cholesterol D. Breakdown of muscle protein

C. Hyperlipidemia, which is the abnormal elevation of cholesterol and triglycerides, is the major cause of atherosclerosis

While rounding on her patients the nurse realizes that she gave Mrs. Harris her Lispro, but she is NPO for her surgery later that afternoon. The nurse realizes that this insulin is fast acting and could cause? A. Hyperglycemia B. Complications for the surgery C. Hypoglycemia D. Mrs. Harris pulse rate to increase

C. Lispro is a fast acting insulin given before meals to lower blood sugar when the patient eats. This should not be given if the patient isn't going to eat to counteract the insulin. Without food to raise the blood sugar, lowering it could cause the blood sugar to drop too low causing hypoglycemia.

While doing rounds, the nurse notices that she has a patient that is taking Levothyroxine, what is the best time to take this medication? A. Before bed. B. After lunch. C. On an empty stomach. D.With food.

C. On an empty stomach Rationale: Levothyroxine is taken on an empty stomach, normally at least 30 minutes before breakfast, to enhance the absorption of the medication.

A patient comes into the Emergency Department complaining of angina, pain in her arm and shortness of breath. Her lab work showed that there was an abnormal elevation of cholesterol and triglycerides in her blood. What does this patient suffer from? a. Myocardial infarction b. Atherosclerosis c. Hypertension d. Hypocholesterolemia

C. Signs and symptoms of atherosclerosis is angina, pain in extremities, and shortness of breath. Atherosclerosis is defined as an abnormal elevation of cholesterol and triglycerides in the blood.

A patient diagnosed with type 1 diabetes has a decreased number of beta cells due to their immune system attacking and destroying them as if they were invaders of the body. Which drug should be questioned by the nurse if seen on the MAR to give the patient? a. Insulin glulisine b. Metformin c. Sulfonylureas d. Pramlintide

C. Sulfonylureas are only prescribed for type 2 diabetes. A patient must have beta cell function for this drug class to work properly, and in type 1 diabetes beta cells are destroyed or diminished.

A patient is taking Humulin NPH insulin every morning. What time is a hypoglycemic episode most likely? A. 18-24 hours after administration B. 2-4 hours after administration C. 4-12 hours after administration D. 16-18 hours after administration

C. The peak time of NPH insulin is 4-12 hours after administration. Hypoglycemic reactions are most likely to happen during peak time.

The nurse is caring for an adult male patient with atherosclerosis. The patient tells the nurse, "My doctor said I have low HDL levels and high LDL levels. She said I should try to raise my HDL levels and lower my LDL levels." Which statement by the patient indicates effective teaching? A. "I should stop drinking alcohol completely and begin a daily exercise regimen." B. "It's okay for me to smoke some, but only one a day. It's more important to start eating greens and low-fat meals." C. "I should start exercising about 5 times a week and eat foods rich in fiber. I need to stop eating foods high in saturated fats, but it's okay for me to have a drink every night." D. "It is okay for me to keep eating the way I'm currently eating; the most important thing for me to do is exercise 5 times a week for about 30 min day."

C. To raise HDL levels, it is important to begin an exercise regime. The recommended time is 5 times a week for 30 min or 20 min of vigorous aerobic exercise 3 times a week. It is important to lower intake of saturated fats. Alcohol in moderation (roughly one drink a day) will not raise your LDL levels.

Rifampin can cause which of the following? a.) Hair loss b.) Weight loss c.) Orange tinted urine d.) Depression

C.) Orange tinted urine. Rifampin can cause red/orange tinted urine It does not cause weight loss, hair loss, or depression

Patient with DKA, Doctor writes orders insulin Lispro 0.1/kg/hr IV. What should you as the nurse do?

Consult the doctor/prescriber STAT.

What assessment change from yesterday morning would concern nurse if the patient is taking piglitazone (Actos)?

Crackles throughout lung fields, and 2.5 lb weight gain

What is the use of Pyrazinamide (Tebrazid)? A. Treat bone, joint, skin, and soft tissue infections B. Treat UTIs and URI's C. Treat acute bacterial skin and skin structure infections D. Treat tuberculosis

D. Pyrazinamide is an antitubercular agent that lowers the pH of the environment. This drug, in combination with other antitubercular agents, is used to treat tuberculosis.

What is the most common toxic effect of vancomycin therapy? A. Ototoxicity B. Cardiac toxicity C. Hepatotoxicity D. Renal toxicity

D. The liver and heart are not affected by vancomycin. Ototoxicity is extremely rare. Renal toxicity is the most common.

A patient was recently diagnosed with hypothyroidism and is preparing for therapy with thyroid replacement hormone levothyroxine (Synthroid). The patient also takes Coumadin daily. What does the nurse anticipate regarding the patient's medication(s)? A. An increase in Coumadin and decrease in levothyroxine. B. An increase in Synthroid and no change in Coumadin. C. A decrease of Coumadin and decrease of Synthroid. D. An increase in Coumadin and no change in Synthroid.

D. Thyroid replacement hormones like levothyroxine decrease the effectiveness of anticoagulants like warfarin (Coumadin); therefore, the nurse should anticipate an increase in Coumadin with the inclusion of Synthroid into the medication regimen.

Enhance the actions of incretin hormones, stimulating the release of insulin and suppressing the release of glucagon after eating, keeping blood glucose from elevating after meals

DPP-4 Inhibitor

What medications is a one time use to treat a yeast infection?

Diflucan

New vial NPH comes out of fridge partially frozen. What should the nurse do?

Discard vial and obtain a new one from the Pharmacy.

Novolog 5 units and Levimir 25 units to be administered at 0800. What should the nurse do?

Draw up 2 different syringes.

Hyperglycemia Symptoms

Dry Mouth, Increased Thirst, Weakness, Headache, Blurred Vision, and Frequent Urination

Type 2 Diabetes Mellitus

Either the body does not produce enough insulin or the body does not react to insulin

Clear insulin is always short acting? True or False

False

You should shake insulin? True or False

False

Patient gets glipizide and miglitol (Glyset) Blood Glucose now 43, what is quickly effective?

Glucose Tablet

First generation cephalosporins have good what?

Good Gram- positive Coverage. Examples: Cefadroxil (Duricef or Ultacef), Cephradine (Velosef), Cafazolin (Ancef), Cephalexin (Keflex)

What is the best time to take STATIN drugs?

In the evening, more cholesterol is being broke down in even time/ bedtime *REST AND DIGEST

What is a risk factor when taking Warfarin and statin drugs together?

Increased risk of Bleeding. Increases blood thinner levels

Increases serum insulin and reduces glucose concentrations, delays gastric emptying, reduces appetite

Incretin Mimetics

Onset 3-4hrs Peak 6-12hrs Duration 18-28hrs

Intermediate acting Insulin

Who should not be prescribed Tetracyclines?

Lactating or Pregnant women, or children under the age of 8 years or younger because of the risk of yellowing of teeth.

Biggest side effect from taking metformin

Lactic Acidosis

What is the most reliable test in the diagnosis of Rhabdomyolysis?

Level of Creatine Phosphokinase (CPK)

Never switch back and fourth to which Thyroid medication?

Levothyroxine/ Synthroid

Examples of Rapid-Acting Insulin

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra)

What lab levels should be checked when taking Isoniazid (INH)?

Liver enzymes

What labs are frequently checked when taking cholesterol medication?

Liver enzymes

Onset 3-4hrs Peak "Peakless" Duration 24hrs

Long acting Insulin

What are signs and symptoms of rhabdomyolysis?

Muscle aches, cramps and soreness, Weakness

What is the "Big Three" of antibiotics?

Nausea, Vomiting, and Diarrhea

What is the biggest side effect of Isoniazid (INH)?

Neuropathy

Biggest side effect of ahminoglycosides?

Ototoxicity

What would warrant RN not to give repaglinide (prandin) and consult a doctor?

Patient is NPO for a colonoscopy

What drug class of diabetic agents should you avoid use in patients who have congestive heart failure? A.Meglitinide B. Sulfonylurea C. Thiazolidinedione D. Alpha-Glucosidase Inhibitor Agents

Patients who have CHF should avoid the use of Thiazolidinedione as it causes fluid retention.

The best thing to treat Gram Positive Bacteria what is what Medication?

Penicillin

Onset 0.5hr Peak 1-3hrs Duration 3-5hrs

Rapid Acting Insulin

Vancomycin should be infused over one hour to help prevent what?

Red-man/Red-neck syndrome

Patient with DM2 on metformin brought to the clinic after drinking last night, what symptom is concern?

Respirations 32/min and deep

Which TB medication can change the color of urine?

Rifamipin can change the urine to an amber color.

Which insulin id given via IV?

Short-Acting Insulin only

When taking Quinolone's, what is the greatest risk?

Tendon rupture or tendon tear

Works by stimulating the pancreas to secrete more insulin and make the tissues more responsive to insulin

Sulfonylureas

What is a superinfection?

Superinfection is a disease caused by an organism that is often an opportunist or one that was present in low numbers. Superinfection is a sequel to removal of the normal flora by antibiotic treatment.

Blood Glucose- 37, Patient diaphoretic and confused, What priority assessment before giving orange juice?

Swallowing Reflex

Hypoglycemia symptoms

Sweating, Pallor, Irritability, Hunger, Lack of Coordination, and Sleepiness

A patient arrives at the ED thinking they are having an allergic reaction to antibiotics. Which symptoms is an actual allergic reaction to antibiotics? A. Diarrhea B. Nausea C. Pruritus D. Vomiting

The answer is C pruritus. The other are all adverse effects of antibiotics.

Type 1 Diabetes Mellitus

The body does not produce insulin

The time is 0830 and one of your patients with type 2 diabetes has just awoken from a good night's rest. What would be the best option for lowering the patient's blood glucose directly before eating breakfast? A. Regular insulin (Humulin R) B. Insulin lispro (Humalog) C. Insulin detemir (Levemir) D. Insulin glargine

The correct answer is B because insulin lispro is a rapid acting insulin. Regular insulin would still be a good choice, but it acts a little slower than insulin lispro. Levemir is an long acting and insulin glargine is a intermediate insulin.

When should the nurse adminster rapid acting insulin to a patient? 30 mins before they start eating As they are taking the first bite 2 hours before their meal Right after they eat

The correct answer is B. You should give them the insulin as the are taking their first bite.

A patient you are designated to is diagnosed with hyperlipidemia. What are the contraindications that would come along with the health care provider prescribing fibrates? A. Hypersensitivity B. Hepatic dysfunction C. Primary biliary cirrhosis D. Phenylketonuria (PKU) E. Bowel obstruction

The correct answers are A, B, and C. Answers D and E are contraindications for bile-acid sequestrants.

Which patient education points should you tell your patient with hyperlipidemia? A. Drink lots of water B. Eat high in fat foods C. Stop smoking D. Exercise daily E. Avoid vitamin K rich foods

The correct answers are A,C,D. You should avoid high in fat foods and eat foods rich in vitamin K.

What medication should patients with CHF avoid?

Thiazolidine

Decrease insulin resistance at the tissue level and may also decrease glucose production

Thiazolidonediones

Which generation cephalosporins are most potent against gram-negative bacteria?

Third Generation Cephalosporins. Examples: Cefdinir (Omnicef), Ceftraxone (Rocephin)

What is Isoniazid (INH) used for?

To treat and prevent TB

Giving insulin and sulfonylureas and not eating can cause serious effects from BG going to low? True or False

True

What is the main use of Sulfonamide's?

Urinary Tract Infections (UTI) but can be used for MRSA

What patient education should be provided when taking any antibiotic with Birth Control?

Use a back up method until next menstrual cycle. *May have to education on back up method, pulling out is not a back up method.

Examples of Long-Acting Insulin

glargine (Lantus) detemir (Levemir)

When a diabetic patient that is taking Metformin is having a scan done, the patient should do what after the scan?

hold the Medication for 2 to 3 days after the scan to reduce risk of nephrotoxicity. Because the Metformin and Radioactive Iodine used in scans are both excreted in the Kidneys.

Examples of Short-Acting Insulin

regular (Novolin R) regular (Humulin R)