Pharmacology Exam 2
Identify 2-3 factors that affect drug excretion
- Age (neonates have immature kidneys and geriatric patients have decreased kidney function) - Kidney disease (cirrhosis, renal failure) - A drug's half-life
Identify 2 or 3 disadvantages for patient therapy associated with lithium.
- Lithium toxicity is a real danger - Can cause cardiac arrhythmias - Requires strict compliance
lithium therapeutic index
0.8-1.2 mEq/L
A high therapeutic index is an __________ _____________ risk. A. Low, safety B. High, fall C. High, safety D. Low, fall
A
A patient has been newly diagnosed with Schizophrenia. What medication order does the nurse anticipate? A. Haloperidol B. Phenobarbital C. Tranyclpromine D. Effexor ER
A
It is important to encourage what with ibuprofen? A. Fluids to prevent renal failure B. Rising slowly to prevent falls C. High protein diet
A
Regarding, PHARMACOKINETICS, what special considerations should the nurse have while providing care for a geriatric patient. For example, the nurse should monitor the patient's pain if they administered a pain medicine to a patient at risk for decreased drug effectiveness. A. Accurate patient assessment and drug monitoring B. Accurate patient assessment and lab values C. Drug monitoring and lab values D. Patient assessment and PQRSTU
A
The SNRI prototype is A. Venlafaxine B. Amitriptyline C. Fluoxetine D. Tranylcypromine
A
The medication that the nurse should take precaution in pediatric and geriatric patients is? A. Lorazepam B. Phenobarbital C. Lithium D. Acetaminophen
A
The nurse knows that phenytoin(Dilantin) is indicated for preventing and treating seizures. How does phenytoin work on the body? A. Interferes with sodium channels in the brain B. Unknown but is similar to GABA C. Binds to specific GABA receptors to potentiate effects of GABA D. Blocks reuptake of norepinephrine and dopamine
A
What is the primary site of metabolism? A. Liver B. Lungs C. Kidney's D. Blood plasma
A
What route(s) are effected by the first pass effect? A. Oral B. IV C. IM D. Suppository
A
Which medication has a therapeutic index that increases risk of a toxic response. A. Lithium B. Oxycodone with Percocet C. Aspirin D. Phenobarbital
A
What is benztropine meant too treat? (More than one may be correct) A. Parkinson's disease B. Insomnia C. Drug induced EPS disorders D. Restless leg syndrome
A, c
What nursing considerations does a nurse need when administering phenytoin(Dilantin)? A. Monitor for safety B. Oral hygiene encouragement C. Monitor for S/S of infection D. Agranulocytosis E. Delirium
A, c, d
A patient received oxycodone with Percocet and is now experiencing some drowsiness. What other things should the nurse be monitoring? A. Bowel function B. CNS depression symptoms C. Respirations and BP D. GI bleeding E. Renal failure
A,b,c
GI bleeding is an adverse effect with what medication(s)? A. Ketorolac B. Ibuprofen C. Acetylsalicylic acid D. Phenobarbital E. Lorazepam
A,b,c
A patient is being prescribed gabapentin. What patient education should the nurse include? A. Avoid driving B. Don't stop abruptly C. Don't take within 2 hours of an antacid D. Monitor for increased SI E. Can cause high BP
A,b,c,d
Haldol adverse effects Select all that apply A. NMS B. EPS C. Tardive dyskinesia D. Agranulocytosis E. Cardiac Arrythmias F. Orthostatic hypertension
A,b,c,d,e
Levodopa/carbidopa nursing considerations select all that apply A. Administer on a routine schedule B. Low protein diet C. Contraindicated with MAOI's D. Be aware of hypertension E. Have patient rise slowly
A,b,c,e
Serotonin syndrome symptoms: Select all that apply A. Confusion B. Hallucinations C. Hepatoxicity D. Tachycardia E. Insomnia
A,b,d
Which tasks are part of the nurses role with anesthetic drugs? A. Safety precautions B. Monitor LOC C. Administer anesthetic D. Understand the different between lidocaine and lidocaine with epinephrine
A,b,d
Which medication(s) cause orthostatic hypotension? A. Amitriptyline B. Fluoxetine C. TRanylcypromine
A,c
A patient started on oxycodone with Percocet should be monitored for what? Select all that apply. A. CNS depression B. Nephrotoxicity C. Hepatoxicity D. Low BP E. Acetaminophen overdose
A,c,d,e
When looking at the MAR you notice that ketorolac is ordered any the patient will be having surgery in the morning. What nursing consideration(s) are most important? A. Do not administer ketorolac before surgery B. Assess pain prior and after administration C. Do not administer to a patient allergic to Anticonvulsants D. Order liver labs for the afternoon
A,d
Match the class to the MOI: A. Barbiturates B. Non-opioids C. Acetic acid derivites 1. Alters cerebella function and depresses the actions of the brain and sensory cortex. 2. Inhibits prostaglandin synthesis 3. Inhibits prostaglandin synthesis by inhibiting COX
A2, B1, 3C
Identify the four processes of pharmacokinetics and explain what happens in each. _________________ - Once the medication enters the body by any of the various routes the medication travels form the site of administration to the body's circulation to be distributed. _________________ - This is the process where the medication is dispersed throughout the body by the bloodstream to the interstitial and intercellular fluids to get to the target cells. ____________________ - This is the process of breaking down the drug molecule which is mostly done by the liver. ___________________- All remaining drug and metabolites in the blood stream are filtered by the kidneys and sent on there way to be eliminated by the body by the means of urine, tears, sweat, etc.
Absorption, distribution, metabolism, excretion
What is the primary difference between acetaminophen and ibuprofen regarding inflammation?
Acetaminophen is an analgesic which treats mild pain not an anti-inflammatory, ibuprofen is an anti-inflammatory.
Give two examples that affect drug metabolism
Age - neonate and geriatric patients have decreased metabolisms Tobacco and caffeine use
lithium MOI
Alters sodium transport ions in nerve and muscle cells
Benztropine has what significant side effect?
Anticholinergic effects (dry mouth, constipation, urinary retention, nausea)
What main classification of drugs is used to treat bipolar disease?
Antimania
A client is put on risperidone (Risperidal) and the client explains that he has been experiencing dizziness when going from sitting to standing and seizures. What is the correct response by the nurse? A. These are normal side effects and give instructions to help the effects. B. These are adverse effects and alert the provider C. These are allergic reactions to the medication and the medication should be stopped. It should also be documented in the chart.
B
A patient comes into the clinic and is complaining of muscle spasms in his back. What medication order would be most appropriate? A. Acetaminophen B. Ketorolac C. Ibuprofen D. Phenobarbital
B
Acetaminophen antidote A. Naloxone B. acetylcysteine C. Carbadova/Lepodova D. Oxycode
B
Loading doses are what? (Choose best answer) A. Subsequent smaller doses given to maintain relatively constant effect B. Initial temporary large dose given to elevate blood levels rapidly C. Initial dose given to increase blood serum levels
B
NSAIDS have several effects on the body. Which NSAIDS is an anti-inflammatory? A. Acetaminophen B. Ibuprofen C. Morphine sulfate
B
SNRI's inhibit the reputake of......... A. Serotonin B. Serotonin and epinephrine C. Serotonin, epinephrine, and dopamine
B
What enzyme is involved with metabolism in the liver? A. CZP450 B. CYP450 C. YCP400 D. CYP400
B
What goal(s) are appropriate for antipsychotic drugs? A. Increase hallucinations B. Decreased delusions C. Increased symptom's of psychosis D. No involuntary motor symptoms
B
What is the mechanism of action of benztropine? A. Unknown but is structurally similar to GABA B. Unknown but may block cholinergic receptors C. Suppresses the activity of sensory nerves D. Inhibits prostaglandin synthesis
B
What mediation inhibits the production of prostaglandins and decreases platelet aggregation. A. Morphine sulfate B. Acetylsalicylic acid C. Oxycodone with Percocet D. Acetaminophen
B
Which potential side effect can occur when on TCA antidepressants? A. Insomnia B. Dry mouth C. Hypertension D. Significant weight gain
B
A nurse just received an order to give her patient phenobarbital (luminol). What considerations should they put into effect for this patient? A. Ensure they aren't pregnant B. Monitor for CNS depression C. Keep rescue equipment nearby D. Increase fall risk prevention E. Administer with a full glass of water G. Monitor for SI
B,c,d,g
The nurse is providing education to patient who has been prescribed fluoxetine. The nurse knows to educate the patient about? Select all that apply A. This medication may cause orthostatic hypotension B. This medication can decrease your appetite C. Monitor for s/s of serotonin syndrome D. Avoid foods containing tyramnine E. The medication may take 4-12 weeks to feel affects
B,c,e
Which medications are NSAIDS? A. Morphine sulfate B. Acetylsalicylate acid C.acetaminophen D. Ketorolac E. Ibuprofen
B,d,e
A patient needs to have cardiac surgery in 7 days. What medication(s) need to be stopped? A. Ibuprofen B. Acetylsalicylic acid C. Oxycodone with Percocet D. Morphine sulfate E. Ketolorac
B,e
A patient calls the nurse help line and has explained that she has had some painful muscle spasms in her legs and some distressful motor restlessness. What does the nurse think is happening? A. Acute dystopia B. Akathisia C. EPS D. NMS
C
A patient comes into the emergency room after being on acetylsalicylic acid for 8 days. What sign would indicate the medication should be stop? A. GI upset B. Fever C. Ringing in ears D. Rash
C
A patient is taking fluoxetine (Prozac) and one of their other medications begins to not work. Why is this happening A. SSRI's damage the liver's ability to metabolize other drugs B. SSRI's alter sodium ions C. SSRI's are highly protein bound so displacement of other drugs is common.
C
Benztropine can aggravate which disease? A. EPS B. Parkinson's C. Tardive dyskinesia D. NMS
C
SNRI's can increase risk of ____________ A. Falls B. Hypertension C. Bleeding D. Tremors
C
The nurse understands that methylphenidate(Ritalin) works on the body in what way? A. Selectivity blocks reuptake of serotonin B. Binds to specific GABA receptors to potential effects of GABA C. Blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron D. Produces sedation by altering cerebella to function and depressing actions of the brain and sensory cortex.
C
What disease may cause increased risk for liver toxicity? A. COPD B. GI ulcers C. Cirrhosis D. Pancreatitis
C
Which statement best represents the diagnosis phase of the nursing process when applied to analgesic administration? A. Administering an oxycodone with Percocet. B. Assessing the patient's pain on a scale of 1-10 C. Validating and believing their pain D. Involving them in their plan of care
C
amitriptyline (Evail) can anticholinergic effects. What are symptoms of this? A. Edema B. Drowsiness C. Dry mouth D. Orthostatic hypotension E. Constipation
C,e
Low dose 81 mg aspirin is meant for
Cardiac
A patient comes into the clinic and is prescribed a new medication. He states he usually takes his medications with grapefruit juice and the nurse responds with "would you consider using a different juice? Grapefruit juice inhibits an enzyme that _____________________________." A. Damages the kidneys B. Affects the GI tract C. Alters metabolism D. Slows metabolism
D
A patient has been prescribed leviodopa/carbidopa which diet would the nurse order? A. High protein B. Heart healthy C. Low sodium C. Low protein
D
It is important to monitor an acetaminophen dose over _________ period. A. 2 day B. 12 hour C. 6 hour D. 24 hour
D
Lithium is ___% excreted by the kidneys A. 50% B. 75% C. 90% D. 95%
D
Medications made up of protein that are swallowed/absorbed in the GI tract. If the drug does get into the blood from the intestines part of it will be broken down by liver enzymes known as__________ ____________. A. Absorption B. Metabolism C. Distribution D. First pass effect
D
Phenytoin (Dilantin) therapeutic level is _______________ A. 20-30 mcg/ml B. 21-31 mcg/ml C. 15-25 mcg/ml D. 10-20 mcg/ml
D
The nurse is discharging a patient who will be taking morphine sulfate. Which statement by the patients means he understands the education? A. I can return to work and operate a crane. B. I should monitor my intake and output C. I can not have alcohol in the morning. D. I may experience dizziness and low bp.
D
The nurse understands that lorazepam works on the body in what way? A. Selectivity blocks reuptake of serotonin B. Binds to specific GABA receptors to potential effects of GABA C. Blocks the reuptake of norepinephrine and dopamine into the presynaptic neuron D. Produces sedation by altering cerebella to function and depressing actions of the brain and sensory cortex.
D
What method of administration are metabolized? A. Sallowed B. Inhaled C. Skin absorption (topical) D. Injected E. All methods F. A,B,D
E
True or false Duration is the time it takes for one half of the drug concentration to be eliminated.
False
True or false levodopa/carbidopa has a long half life and is only given once per day.
False
Drug for diabetic neuropathy?
Gabapentin (neurotontin)
Priority teaching for Dilantin?
Good oral hygiene
Your client is a 66-year-old client with cirrhosis of the liver, because of this the client will exhibit decreased metabolic activity. Because of the decreased metabolic activity, what potential drug regimen changes may be expected?
I would expect to see a decrease in the dosage of medications to avoid toxicity and other adverse effects since damage to the liver affects both metabolism and excretion.
Your client is preparing to be discharged from the hospital. The nurse is reviewing his discharge medications and the client states, "I usually take all my medications in the morning with grapefruit or orange juice, is that ok?" What is the nurse's best response?
I would recommend a different kind of juice if you're willing. Grapefruit juice has known to inhibit metabolism and can affect your medications.
Morphine sulfate is indicated for what type of pain and why is the MOI important?
It can take a while to kick in so giving it enough time to work is important?
Antimania prototype
Lithium (Lithobid)
MAOI's nursing considerations
Monitor for hypertensive crisis, orthostatic hypotension, monitor LFT's, monitor SI, assess compliance with diet
MAOI's Diet considerations
NO food or drink with tyramine. i. Cheeses, alcohol, yeast, salted fish, canned meats, sauerkraut, caffeine
Aspirin indication
Platelet aggregation
Prior to administering an opioid analgesic what should the nurse assess?
Respirations and pain
Ritalin priority considerations (3)?
Talk in morning, no caffeine, appetite suppressant (take with meal), monitor height and weight
Which oral medication would be absorbed faster, Aspirin 81mg tablet or Aspirin 325mg enteric coated tablet? Why?
The Aspirin 81mg tablet because the enteric coated tablet is one of the slowest forms of oral medications to be broken down.
Explain the impact of the CYP450 enzymes on drug metabolism and effect
The CYP450 is an enzyme in the liver and performs most drug metabolism. It can influence a person's response to a drug. Some people have genetic variances which is why some people can react differently to drugs.
identify the fastest route for drug absorption and provide rationale.
The fastest route for drug absorption is IV because it is directly administered to the blood stream. There is no delay like there is with capsules where they must be broken down first.
Explain the concept of enterohepatic recirculation (also known as the "first pass effect")
The first pass effect mainly effects orally ingested medications. These medications are absorbed in the GI tract and quickly deactivated by enzymes when they pass through the stomach and duodenum. If the drug enters the bloodstream through the intestines, then part of the drug with be broken down by liver enzymes.
A client is post op day 1 and received ketorolac 15 mg IV push at 0800 because they were not tolerating orals. It's now 1200 and the client has tolerated a full liquid breakfast, can the client receive ibuprofen now? Provide rationale for your answer.
The patient should not receive ibuprofen yet. NSAID's should not be administered until 6 hours after receiving ketorolac.
Common non-therapeutic intvertions?
Thermal therapy, massage, acupuncture
True or false Risperidone blocks dopamine 2 and serotonin 2 receptors
True
True or false ketorolac has the same adverse effects as ibuprofen.
True
Can an overdose of TCA's be lethal? Provide rationale.
Yes, it can be. TCA's can cause cardiac dysrhythmias with can cause death.
A client with Parkinson disease is admitted to the hospital. Which medication is prescribed to improve the physical manifestations of Parkinson disease? a. carbidopa-levodopa b. dopamine c. pyridoxine (vitamin b6) d. isocarboxazid
a
The client with a seizure disorder receives IV phenytoin. The nurse will monitor closely for what? a. cardiac dysrhythmias b. hypoglycemia c. paradoxical excitation d. cns depression
a
The nurse administers carbidopa-levodopa to a client with Parkinson's disease. Which activity describes the MOI? a. Replacement of a neurotransmitter in the brain b. increase in acetycholine producation c. regeneration of injured thalamic cells d. improvement in the myelination of neurons
a
Which adverse effect of morphine indicates the need for naloxone administration? a. respiratory depression b. blurred vision c. urinary retention d. mental confusion
a
Which medication is safest to take for pain in the week before a surgical procedure? a. acetaminophen b. ketorolac c, naproxen d. aspirin
a
Which would the nurse include in the client's medication teaching on the administration of aspirin 650 mg Q6 hours as needed for arthritic pain? Select all that apply. a. Report persistent abdominal pain b. Do not chew enteric-coated tablets c. Take the aspirin with meals/snack d. See a dentist if bleeding gums develop Switch to acetaminophen is tinnitus occurs
a,b,c
A client's guardian calls your clinic and asks if they should give their child acetylsalicylic acid (Aspirin) for a fever. What questions should you ask before answering their question? A. What is the age of the child? B. Current medications? C. Any GI ulcers? D. Any bleeding disorders? E. Do you have Reye's syndrome? F. Any history of SES or NMS?
a,b,c,d
Identify factors that affect drug absorption A. Food or fluid taken with the medication B. GI mobility C. Stomach pH D. Vascularity
a,b,c,d
SNRIs Pertinent teaching select all that apply A. Monitor weight B. Report S/S of SES C. Report S/S of hyponatremia D. Talk about increased risk of bleeding E. May take 8 weeks to feel therapeutic effects F. Don't stop abruptly G. Talk about dizziness, drowsiness, and sedation I. Take on an empty stomach
a,b,c,d,e,f
MAOIs Pertinent teaching select all that apply A. Food restrictions B. Monitor bp C. Know S/S of hypertensive crisis D. Implement safety precautions E. May take 4-6 weeks to feel therapeutic effects F. Monitor weight G. Don't stop abruptly H. No alcohol I. Report GI bleeding
a,b,c,d,f,g,h
Which information would the nurse include when teaching a client with coronary artery disease (CAD) about aspirin therapy? Select all that apply. a. Avoid OTC pain medications that contain aspirin b. do not mix aspirin with medications for erectile dysfunction c. monitor and report excessive bleeding and bruising d. report ringing in the ears e. take with food
a,c,d,e
What do you need to teach a patient about lithium? A. S/S of lithium toxicity B. Decreased sodium diet C. Importance of compliance D. Take on empty stomach E. Frequent lab monitoring F. Consult provider about all OTC meds G. S/S of hyponatremia H. S/S of NMS
a,c,e,f,g
A client takes oxycodone 3 hours for pain after surgery. Which actions would the nurse take before administering each dose? Select all that apply. a. count the clients respiratory rate b. examine for petechiae c. observe the client for movement disorders d. ask the client to rate their pain level e. assess the clients LOC
a,d,e
Scenario: It's 0730, and you are receiving handoff report that your assigned client received morphine sulfate 4 mg IV push at 0705. When you go in to assess the client, you note they are difficult to arouse and have a respiratory rate of 8 breaths/min and an oxygen saturation of 84% on room air. a. What do you think is the cause? b. What should the nurse's initial action be? c. What do you think the nurse's subsequent actions should be? d. What medication would anticipate using to treat the client? e. The medication only seems to work temporarily, why is that?
a. It is possible the morphine sulfate was given in conjunction with a CNS depressant increasing the risk for respiratory depression, difficulty breathing, and possibly death. b. The patient oxygen is at 84% so that needs to be treated first. (Apply oxygen, get rescue equipment) c. Double check what was given, and then administer the antidote if applicable(naloxone). Monitor the patient's vitals closely (1-2 minutes after admin) and give more naloxone if needed as it has a short half-life, and more doses could be required. The nurse should be monitoring for any more adverse reactions and continue monitoring the patient's vitals for at least a couple hours afterwards. d. Naloxone (Narcan) e. It has a short half life.
Your client cut their right hand with a piece of steel today while at work. The client comes to the emergency room (ED) for evaluation. The provider determines the laceration will require sutures to the right middle finger and palm. The laceration will be anesthetized with a local agent prior to suturing. a. What is the action of lidocaine? b. What should the nurse include in client education? c. Would lidocaine with epinephrine be appropriate? Provide rationale
a. Suppress the activity of sensory nerves. b. Be sure to protect the anesthetized area from injury. c. No, lidocaine with epinephrine should not be used on fingers or hands as it decreases blood flow to the area.
A client who receives morephine by patient controlled analgesia has a resp rate of 6 breaths per min. What intervention is need? a. Cardiopulmonary resuscitation b. Naloxone administration c. Mechanical ventilation d. Nontracheal suction
b
Which life-threatening complication may occur in clients taking high dose or long term ibuprofen? a. anaphylaxis b. GI bleeding c. cardiac dysrhythmia d. disulfiram reaction
b
A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant immediate follow up by the nurse? Select all that apply. a. Polyuria b. Unconsciousness c. Bradycardia d. Bradypnea e. Dilated pupils
b,c,d
TCA's Pertinent teaching select all that apply A. Double up doses B. Be mindful of activity due to hypotension C. Contraindicated with MAOI's D. Educate on how to manage anticholinergic effects E. May take 3-4 weeks to feel therapeutic
b,c,d,e
Select all the factors that effect drug excreation? A. Adolescent age B. Neonates age C. Geriatric age D. Kidney disease E. Liver disease F. Glomerulonephritis G. Drug's half life
b,c,d,e,g
SSRI's Nursing Considerations select all that apply A. Contraindicated with TCA's B. Use caution with liver dysfunction patients C. Assess for NMS D. Takes up to 6 weeks to be effective E. Short half life F. Highly protein bound and stays in the blood for a long time G. Assess for serotonin syndrome
b,c,f,g
SSRIs: Pertinent teaching select all that apply A. Monitor for hypertensive crisis B. May experience sexual dysfunction C. Avoid cranberry juice D. Can cause bleeding when taken with analgesics E. Avoid alcohol and CNS depressants F. Don't stop abruptly G. Monitor for drowsiness and confusion
b,e,f,g
A client takes morphine sulfate. The nurse will assess the client for which adverse effect? a. diarrhea b. addiction c. respiratory depression d. diuresis
c
A client with arthritis takes large doses of aspirin. Which symptoms would the nurse include when teaching the client about aspirin toxicity? a. Metallic taste in mouth b. intermittent constipation c. disturbances in hearing d. feeling drowsy
c
Naloxone effectively reverses a clients respiratory depression from an overdose of morphine. Why will the nurse continue to closely monitor this client's status? a. the medication may cause neuropathy b. naloxone and morphine can cause tachycardia c. symptoms of the morphine overdose may return after the naloxone is metabolized d. hyperexcitability and amnesia may cause the client to thrash about and become injured.
c
The nurse is teaching the parents of a child with ADHD. Which medication would the nurse include as the frequently prescribed medication for this disorder? a. lorazepam b. haloperidol c. methylphenidate d. methocarbamol
c
What are 3 symptoms of lithium toxicity? A. slurred speech, tremors, GI bleeding B. tachycardia, N/V/D, bruising C. drowsiness, slurred speech, coma
c
What does it mean if a drug is considered highly protein-bound? This means that the drug must specifically bind to a protein. This means when it enters the body it will circulate in the blood ___________and take __________ to reach its receptor site. This puts the patient at greater risk for adverse effects and toxicity. A. longer, shorter B. shorter, longer C. longer, longer D. shorter, shorter
c
A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given? a. decreases anxiety associated with seizures b. promotes rest after the seizure episode c. provides amnesia for the convulsive episode d. depresses the cns system
d
Before beginning administration of morphine via patient-controlled analgesia, which assessment would the nurse perform first? a. temperature b. blood pressure c. urinary output d. respirations
d
The nurse teaches the parents of a child perscribed long term phenytoin therapy about care. Which statement indicates the teaching has been effective? a. 'We can give the medication between meals' b. 'We'll call the clinic if her urine turns pink' c. 'She's eating high calorie foods, and we encourage fluids too' d. 'We'll have her massage her gums and floss her teeth frequently'
d
Which instruction will the nurse include when teaching a patient about carbidopa-levodopa? a. take this medication between meals b. blood levels of the medication should be monitored weekly c. it can cause happy feelings followed by feelings of depression d. you may experience dizziness when moving from sitting to standing
d