ATI Pharmacology

a nurse is preparing to administer nafcillin (Nallpen) IM to a client who has an infection. which of the following should the nurse plan to take ? SATA select a 25 gauge, 1/2 inch needle admin the medication deeply into the ventrogluteal muscle ask the client about previous allergy to penicillin before adminstering antiobiotic Monitor the client 30 mins following the injection Tell the client to expect a temporary rash following the injection

A 25 gauge needle is too small for an IM ijection. the nurse should plan to use a 19-22 gaugle 1 1/2 needle to reach muscle. the nurse would be sure to inject deeply into a large muscle mass to avoid damaging nerves. the nurse would also be sure to ask about previous reactions to penicillin and monitor the client 30 mins after injections for any adverse effects like itching, redness, or rash.

a nurse is reviewing a clients laboratory findings to identify which antibiotic the provider may prescribe to treat the clients UTI. which of the following tests would provide this information? Gram stain Culture Sensitivity Specific gravity

A sensitivity lab will provide information on which antibiotic would be most effective in treating a specific organism. a gram stain determines whether the organism is gram positive or negative a culture determines the type of organism that may be causing the infection. A specific gravity determines dilution of urine.

A nurse is monitoring serum electrolytes for four OA who take digoxin and furosemide. Which of the following electrolyte values put the client at risk for digoxin toxicity? Calcium 9.2 Calcium 10.3 Potassium 3.4 Potassium 4.8

A side effect of furosemide is hypotension which can increase digoxin toxicity causing dysrrhythmias. The other values are within Norma range.

Amylin Mimetics- Pramlintide (Symlin); mimics the action of amylin and reduce postprandial glucose levels by decreasing gastric emptying time and inhibits glucagon secretion Can be used for both type I and II DM

Adverse effects include Nausea, hypoglycemia, and reaction at injection site. Contraindicated for clients w/ RF and those on dialysis. Insulin increases risk of hypoglycemia, conccurent use with meds that slows gastric emptying like opioids or slow food absortion like acarbose will further delay gastric emptying. Admin SQ prior to meals in the thigh or abd. keep unopened vials in frig do not freeze and opened vials at room temp for 28 days not in direct sunlight. do not mix medication w insulin in the same syringe.

Insulins - Used by all type I Diabetics and some type II diabetics lowers the blood sugar by promoting cellular uptake of glucose, converts glucose into glycogen, and drives potassium into cells w/ glucose.

ADEVERSE EFFECTS include HYPOGLYCEMIA (too much insulin); w/ abrupt onset SNS: tachycardia, palpitations, diaphoresis, shakiness. W/ gradual onset PNS: HA, tremors,drowsiness,weakness. Administer glucose: for conscious clients, 15 g of carbs (4 oz OJ, 2 oz grape juice, 8 oz milk or glucose tab) for client not fully conscious- high risk for aspiration give IV glucose or 1 mg of glucagon IM. Encourage client to wear medic alert bracelet. LIPOHYPERTROPHY: rotate sites and allow 1 inch between injection sites. 2 in away from the umbilicus if in abd MEDICATIONS/FOOD INTERACTIONS- Sulfonylureas, meglitinides, beta blockers, and alcohol cause hypoglycemia. concurrent use of thiazide diuretics and glucocorticoids raise blood sugar levels and can cause hyperglycemia. Beta blockers can mask SNS response to hypoglycemia making it hard to identify hypoglycemia.

Oral Anti-diabetics- used for Type II diabetics only; Metformin can be used in polycystic ovary syndrome SULFONYLUREAS- glipizide (Glucotrol) glimepiride (Amaryl) tolazamide Chlorpropamide METGLITINIDES- repaglinide (Prandin) nateglinide (Starlix) BIGUANIDES- metformin (Glucophage) THIAZOLIDINEDIONES- pioglitazone (Actos) ALPHA GLUCOSIDASE INHIBITORS- acarbose (Precose) miglitol (Glyset) Gliptins- sitagliptin (Januvia)

ADVERSE EFFECTS: GLIPIZDE AND REPAGLINIDE (hypoglycemia) METFORMIN -GI effects; anorexia, N/V, weight loss; vit B12 and folic acid deficiency, and lactic acidosis (hyperventilation, myalgia, sluggishness, somnolence) PIOGLITAZONE- fluid retention, increased LDL and hepatotoxicity (monitor for edema, weight gain and indications of HF, monitorcholesterol, and LFTs report jaundice and dark urine ACARBOSE- intestinal effects (abd distension and cramping, hyperactive BS, diarrhea, excessive gas), anemia d/t decrease of iron absorption and hepatotoxicity w LT use (LFTs periodically, D/C if elevations occur, LFTs will return to normal after D/C) SITAGLIPTIN- generally well tolerated, rare occurrence of respiratory tract infection and panceratitis.

Incretin Mimetics- exenatide (Byetta) liraglutide (Victoza) mimics the effects of glucagon- like peptide-1 and promotes release of insulin, decreases release of glucagon, and slows gastric emptying. Fasting and postprandial blood glucose levels are lowered.

ADVERSE EFFECTS: GI effects (N/V/D) and pancreatitis (severe and intolerable abd pain) instruct client to withhold medication and notify provider. CONTRAINDICATIONS: Kidney Failure, Ulcerative Colitis, or Chrohn's disease. Use cautiously in clients w/ kidney impairment or thyroid disease. INTERACTIONS: Oral medication absorption is delayed, esp oral contraceptives, antibiotics, and acetaminophen (Adminster oral meds 1 hr before or 2 hrs after) Concurrent use of sulfonylurea increases risk of hypoglycemia. This medication comes in prefilled injector pens and should be admin in thigh abd or upper arm. Give within 60 mins before the morning and evening meals. NEVER ADMIN AFTER A MEAL. Instruct client to keep in the refrigerator and discard after 30 days. Effectiveness monitored by A1C less than 7% or preprandial glucose 90-130 postprandial less than 180

A nurse in an outpatient facility is caring for a client who has been taking acarbose (Precose) for type II DM. Which of the following laboratory tests should the nurse plan to monitor? WBC Serum potassium Platelet count Liver Function Test

Acarbose can cause liver toxicity when taken long term. LFT should be monitored periodically while the client is taking this medication.

Anterior Pituitary Hormone/ Growth Hormone- somatotropin (Genotropin, Nutropin); stimulate overall growthand production of protein, and decrease use of glucose. Used to treat growth deficiences, Turner's syn, Prader-willi syn

Adverse effects Hyperglycemia- observe for polyuria, polyphagia, and polydipsia Hypercalciuria and renal calculi- monitor for flank pain, fever, and dysuria, and report to provider Contraindicated in clients who had Prader-Willi syn and are severely obsese or have severe respiratory impairment (sleep apnea) bc higher risk of fatality. Used cautiously in clients w diabetes. TX SHOULD BE STOPPED PRIOR TO CLOSURE OF EPIPHYSEAL ENDS OF BONES. Concurrent use w/ glucocorticoids can counteract growth promoting effects. Reconstituted meds mix gently and do not shake prior to admin and rotate injection sites- abd and thighs preferred. Monitor growth patterns monthly and BL height and weight.

Antithyroid Medications strong iodine solution (Lugol's solution)- non radioactive iodine sodium iodine, potassium iodine creates high levels of iodine that will reduce iodine uptake (by thyroid gland), inhibit thyroid hormone production, and blocks release of thyroid hormones into bloodstream. Used for euthyroid state and reduction of thyroid gland size prior to thyroid removal surgery and emergency tx for thyrotoxocosis.

Adverse effects Iodism d/t corrosive properties (metallic, bitter taste, stomatitis, sore teeth and gums, frontal HA, skin rash) Early toxicity can progress to OD (severe GI distress and swelling of the glottis)- prepare to administer sodium thiosulfate to reverse findings and assist w/ gastric lavage as needed Contraindicated in pregnancy Concurrent intake of foods high in iodine (iodized salt and seafood) increases risk for iodism- monitor for brassy taste in mouth, burning sensation in mouth, sore teeth. Dilute strong iodine solution (Lugol's solution) w juice to improve taste, take at the same time each day to maintain therapeutic levels, and encourage client to increase fluid intake unless contraindicated Effectiveness can be evidenced by weight gain, decreased T4 levels, reduction in thyroid gland size, and client able to get adequate sleep, maintain B/P, and HR and free of complaints of hyperthyroidism.

a nurse is caring for a client who has an subacute bacterial endocarditis and is being treated w/ several antibiotics, including streptomycin IM. The nurse should monitor the client for which of the following adverse effects of streptomycin? Extremity paresthesia Urinary retention Severe constipation Complex partial seizures

Adverse effects of Streptomycin includes Neurologic disorder- paresthesia of hands/feet, peripheral neuritis, optic nerve dysfunction

Antithyroid medications propylthiouracil (PTU) safer if needed during pregnancy methimazole (Tapazole) blocks synthesis of thyroid hormone prevents oxidation of iodine blocks conversion of T4 and T3 TX for Graves disease, emergency treatment of thyrotoxicosis, provides euthroid state prior to thyroid removal surgery

Adverse effects Over medication can result in indications of hypothyroidism (drowsiness, depressions, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia) Agranulocytosis - monitor for early indications (sore throat, fever), blood counts, stop treatment and Neupogen may be given to reverse Liver injury, hepatits- monitor for jaundice, dark urine, light colored stools, and elevated LFTs Contraindications pregnancy and during lactation, used cautiously in bone marrow depression and/or immunocompromised and clients at risk for liver failure Medication/Food interaction Concurrent use w/ anticoagulants can increase anticoagulatin and increase glycoside levels (digoxin) Nursing admin/effectiveness therapeutic effects take 1-2 wks, take at consistent times each day w/ meals to maintain constant therapeutic levels and decrease GI upset. Monitor for indications of hyperthyroidism (indicating inadequate medication), may be given w a beta blocker to decrease tremors and tachycardia. Monitor for signs of overmedication (hypothyroidism) and Monitor CBC for leukopenia and thrombocytopenia

Thyroid hormone- levothyroxine (Synthroid, Levothroid) liothyronine (Cytomel) liotrix (Thyrolar) Increases metabolic rate, protein synthesis, CO, renal perfusion, oxygen use, body temperature, blood volume, and growth processes Used for tx for hypothyroidism and emergency tx for myxedema coma

Adverse effects Overmedication can lead to indications of hyperthyroidism- anxiety, tachycardia, palpitations, altered appetite, weight loss, abd cramping, heat intolerance, fever, diaphoresis, and menstrual irregularities)- report to MD Contraindiations Clients who have thyrotoxicosis and in clients following a MI Use cautiously in pregnancy and lactation, clients w/ cardiovascular problems (HTN, angina, ischemic heart disease) and older adults. Medications/Food Interactions Binding agents (cholestyramine, antacids, iron, and calcium supplements) and sucralfate (Carafate) reduce levothyroxine absorption w/ concurrent use - allow at least 4 hrs between medication admin Many antiseizure and antidepressants including carbamazepine (Tegretol), phenyotin (Dilantin), phenobarbital, and sertraline (Zoloft) increases levothyroxine metabolism- dosages of Synthroid may need to be increased Levothyroxine can increase anticoagulant effects of warfarin by breaking down vitamin K- monitor PT/INR levels, report signs of bleeding (bruising, petechia), decreased dosage of warfarin may be needed Nursing Admin/effectiveness BL VS, weight, and height. report signs of cardiac excitability, begine w low dosage that gradually increases, monitor T4 and TSH levels, TAKE DAILY ON EMPTY STOMACH BEFORE BREAKFAST, CHECK W PROVIDER BEFORE SWITCHING BRANDS OF LEVOTHYOXINE. SHOULD SEE DECREASED TSH LEVELS, T4 LEVELS W/T EXPECTED RANGE AND ABSENCE OF HYPOTHROIDISM MANIFESTATIONS (DEPRESSION, WEIGHT GAIN, BRADYCARDIA, ANOREXIA, COLD INTOLERANCE, DRY SKIN, MENORRHEA)

Antithyroid medications radioactive iodine (RAI) 131I radioactive iodine is absorbed by the thyroid and destroys some thyroid producing cells. At high doses, is used for hyperthyroidism and thyroid cancer and in low doses is helpful in the diagnosis of thyroid disorders

Adverse effects Radiation sickness (hematememis, epitaxis, severe nausea, and vomiting)- stop tx and notify doctor Bone marrow depression - monitor for anemia, leukopenia, and thrombocytopenia. Hypothyroidism (intolerance to cold, edema, weight gain, bradycardia, depression) Contraindications Pregnancy, clients of childbearing age/intent, and during lactation Medications/Food interactions concurrent use of other antithyroid medications reduce uptake of radioactive iodine- D/C use of other medications 1 week prior to radioactive iodine therapy Nursing Admin Instruct client to void frequently to avoid irradiation of gonads, limit contact w/ clients to 30 min/day/person. Increase fluids to 2-3 L/day, dispose of body wastes per protocol, and avoid coughing and expectorating (source of radioactive iodine)

antidiuretic hormone (ADH) vasopressin desmopressin (DDAVP, Stimate) ADH produced by posterior pituitary to promote reabsorption of water in the kidneys; used to treat diabetes insipidus (not enough adh) and sometimes used during CPR to temporarily decrease blood flow to the periphery and increase blood flow to the brain and heart

Adverse effects Reabsorption of too much water - monitor for indications of overhydration (sleepiness, pounding heart), should reduce fluid intake during therapy, and use the smallest effective dose of desmopressin Myocardial ischemia from excessive vasoconstriction (vasopressin)- monitor ECG and B/P notify provider of chest tightness, pain, or diaphoresis Contraindicated in clients who have CAD (high risk for angina, MI), peripheral circulation problems (risk for gangrene), or chronic nephritis. Medication/Food Interaction Carbamazepine and tricyclic depressants increase antidiuretic effects- use cautiously together Concurrent use w alcohol, heparin, lithium, and phenytoin can decrease antidiuretic effects- BL I/O weight and monitor frequently Monitor BUN, creatinine urine specific gravity and osmolality. Monitor B/P and HR, intranasal desmopressin starts at HS when nocturia controlled, twice daily. Monitor for HA, confusion, and other signs of water intoxication. should have 1.5-2 L UO/24 hr

Adrenal hormone replacement hydrocortisone (Solu-Cortef) prednisone, dexamethasone mineral corticoids: fludrocortisone hormone replacement for addisons disease (not enough cortisol), cancer, inflammation, and allergic reactions.

Adverse effects GLUCOCORTICOIDS Osteoprosis- take calcium/vit D supplements and/or biophosphonates (Etidronate) Adrenal suppression- observe for manifestations, taper dose do not dc abruptly Peptic ulcer, GI discomfort- observe for coffee ground emesis, bloody or tarry stools, abd pain; admin H2 receptor blockers Infection- avoid contact w ppl who have communicable diseases, monitor for fever or other signs of infection MINERALCORTICOIDS Retention of sodium and water can lead to HTN, edema, HF, and hypokalemia- monitor B/P, serum potassium, breath sounds and UO. Contraindicated in clients who have viral or bacterial infections not controlled by antibiotics. Used in caution w/ clients who have recent MI, gastric ulcer, HTN, kidney disorder, osteoporosis, DM, hypothyroidism, myasthenia gravis, glaucoma, or seizure disorder. Medication/Food Interactions GLUCOCORTICOIDS NSAIDs or alcohol increases gastric distress/ bleeding, decreases or increases anticoagulation, increase potassium loss when used w potassium depleting agents, and should not be used w vaccines and toxoids - can reduce antibody response MINERALCORTICOIDS Barbiturates and phenytoin can reduce fludrocortisone effects and antidiabetic effects of insulin and sulfonylureas decreases w concurrent use- monitor blood sugar closely in clients w DM Give w food to minimize GI upset, taper off dosage if D/C and notify provider of indications of acute adrenal insufficiency (fever muscle and joint pain weakness and fatigue).

A nurse is administering IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor which of the following lab values? SATA Blood glucose Serum amylase Serum potassium Hematocrit Serum creatinine

Adverse effects of amphotericin B includes hepatotoxicity, infusion site reactions, thrombophlebitis, hypokalemia, and bone marrow suppression. the nurse would be sure to monitor infusion site 1-3 hrs after initiation, BUN/ creatinine levels, Electrolytes esp potassium and CBC/hct

Antiretrovirals- Protease Inhibitors ritonavir (Norvir) saquinavir (Invirase) Indinavir (Crixivan) fosamprenavir (Lexiva) nelfinavir (Viracept) lopinavir/ ritonavir (Kaletra) Protease inhibitors acts against HIV 1 and HIV2 to alter and inactivate the virus by inhibiting enzymes needed for HIV replication

Adverse effects: Bone loss/ osteoporosis- eat diet high in calcium and vitamin D, severe bone loss treated w raloxifene and alendronate DM/ hyperglycemia- Monitor BG, adjust diet and monitor for increased thirst and polyuria Hypersensitivity reaction- monitor for rash and notify provider N/V- take med w food to minimize GI effects and increase absorption Elevated serum lipids- Monitor for hyperlipidemia, adjust diet Thrombocytopenia/leukopenia (monitor for CBC, indications for infection such as fever sore throat and bleeding in stools and bruising) Interactions- All protease inhibitors, except ritonavir, cause multiple meds to raise to toxic levels Ritonavir can increase med levels of sildenafil, tadatlafil, and verdenafil ritonavir decreases levels of ethynyl estradiol in oral contraceptives - need to use alternative form of BC Phenobarbital, phenytoin, carbamazepine, and St Johns wort significantly reduce the level of PIs- avoid concurrent use or adjust dosage Teach client to report all other medications inclusing OTC and herbal meds to provider All should be given w food except Indinavir (Crixivan)

Antiretrovirals- CCR5 antagonists maraviroc (Selzentry) Prevents HIV from entering lymphocytes by binding to CCR5 on cell membranes. Used to treat HIV infection in conjunction w/ other antiretroviral meds

Adverse effects: Cough and upper respiratory infections (report findings to provider) CNS effects (dizziness, paresthesias; move carefully from lying to sitting to standing and prevent injury c/b dizziness) Hepatotoxicity (jaundice RUQ pain, nausea often preceded by allergic reaction such as hives and rash; stop maraviroc and notify provider) Contraindicated as first medication to treat clients who are newly diagnosed w/ HIV infection and also w/ existing liver disease or during lactation Interactions: Most protease inhibitors raise maraviroc levels (Maraviroc dosage may need to be reduced) Rifampin, efavirenz, phenytoin, some other anticoagulants, and St. Johns wort decrease maraviroc levels (Maraviroc levels may need to be increased) Monitor LFTs, blood pressure, and CBC at BL and periodically.

Antiretrovirals- Fusion/entry inhibitors enfuvirtide (Fuzeon) subcutaneous; decreases and limits spread of HIV by blocking HIV from attaching to and entering the CD4 T cell

Adverse effects: Localized reaction at injection site (rotate injection sites, monitor for swelling and redness) Bacterial Pneumonia (auscultate BS prior to start of therapy and monitor for signs of pneumonia such as fever, cough, or SOB) Systemic reaction (fever, chills, rash, and hypotension; D/C and notify provider) Contraindicated in clients who have medication hypersensitivity.

Antiretrovirals- NNRTIs Delavirdine (Rescriptor) efavirnez (Sustiva) Nevirapine (Viramune) Etravirine (Intelence) NNRTIs work directly on reverse transcriptase to stop HIV replication used for primary hiv 1 infection and in combo w/ other antiretrovirals to prevent resistance

Adverse effects: Rash which can become serious and lead to Stevens- Johnson syndrome (treat w/ diphenhydramine; notify the provider of fever and blistering) Flulike symptoms (HA, fatigue, encouarge rest and adequate fluid intake) CNS manifestations (dizziness, drowsiness, insomnia, nightmares; esp w/ efavirenz; should drecrease after few wks of therapy and should not drive or operate machinery until effects are known) Contraindications- Contraindicated in clients w/ medication hypersensitivity and used w/ caution in clients w/ liver disease Interactions- Antacids can decrease absorption of delvirdine- allow 1 hr between meds NNRTIs can increase effects of benzodiapines, antihistamines, CCB, ergot alkaloids, quinidine, warfarin and other -monitor for med toxicity Rifampin and Phenytoin can decrease in levels of delavirdine - DO NOT USE TOGETHER Didanosine can reduce both meds absorption- allow 1 hr b/t meds NNRTIs increase in sildenafil levels- monitor for hypotension and visual changes; use together w caution Efavirens should be taken at HS on empty stomach to minimize adverse CNS effects

Antiretrovirals- NRTIs zidovudine (Retrovir) Didanosine (Videx) Stavudine (Zerit) Lamivudine (Epivir) Abacavir (Ziagen) Reduces HIV symptoms by inhibiting DNA synthesis and thus viral replication First line antiretrovirals to treat HIV infection****

Adverse effects: Zidovudine can cause bone marrow suppression resulting in anemia, agranulocytosis (neutropenia), and thrombocytopenia- monitor CBC and platelets and monitor for bledding, easy bruising, sore throat and fatigue. Lactic acidosis -monitor for hyperventilation, nausea, and abd pain. Pregnancy increases risk of lactic acidosis Hepatomegaly/fatty liver- monitor liver enzymes Contraindications: pregnancy increases risk of lactic acidosis, liver enlargement, and fatty liver Clients who have medication hypersensitivity and used w/ caution in clients who have liver disease and bone marrow suppression. Interactions: Probenecid, valproic acid andmethadone can increase zidovudine (Retrovir) -reduce dosage and monitor for toxicity Ganciclovir or meds that decrease bone marrown productioncan further suppress bone marrow- use together w caution Rifampin and Ritonavir can reduce zidovudine levels- adjust dosage if needed Phenytoin can alter both medication levels- monitor medication levels Anemia may be treated w/ epoetin alfa or transfusions Neutropenia may be treated w/ colony stimulating factors

adrenergic agonists catecholamines- epinephrine, dopamine, dobutamine, isoproterenol and noncatecholamine: terbutaline

Alpha 1- vasoconstriction Beta 1 (heart)- increased HR, myocardial contractility, and conduction rate through AV node. Receptors in kidneys release Renin. Beta 2 (lungs)- brochodilation(for asthma), uterine smooth muscles relaxed, glycogenolysis in liver, and muscle contraction in skeletal muscles. Dopamine- kidney causes renal vessels to dilate; good for when in shock or HF Dobutamine- Increased HR, myocardial contractility, and conduction through AV node

A health care professional is caring for a client who is to begin taking propranolol to treat tachydysrhythmias. The HCP should caution the pt about taking which of the following types of OTC drugs? Antihistamines Potassium supplements NSAIDs Antacids

Antacids and vitamin C can decrease the absorption of propranolol. The pt should avoid taking these OTC preparations and discuss appropriate alternatives.

A nurse is caring for a client who has a new prescription for baclofen for multiple sclerosis. Which of the following findings indicates to the nurse that the client is having a therapeutic effect? Decrease muscle spasticity Increased UO Increase mental alertness Decrease HR

Baclofen is an antispasmodic that decreases muscle spasticity in clients w multiple sclerosis. It can cause urinary retention, drowsiness, and hypotension.

A nurse is caring for a client who is taking enfurvitide (Fuzeon) to treat HIV infection. For which of the following adverse effects should the nurse monitor? Stools or emesis for blood Breath sounds for pneumonia LOC for cerebral edema Injection site for erythema B/P for hypersensitivity reaction

Bacterial pneumonia w fever, cough, and difficulty breathing. Enfurvitide is injected SQ, monitor for pain, itching, redness, and bruising A systemic allergy reaction can occur w/ enfurvitide- manifestations of hypersensitivity include rash, hypotension, fever, and chills

Beta Blockers ends with LOL Metoprolol Lopressor Atenolol Tenormin Esmolol brevibloc (cardioselective) Propranolol Inderal Nadolol Corgard (Nonselective) Carvedilol Coreg Labetalol Trandate (Alpha and beta blockers- vasodilation)

Beta adrenergic Blockers blocks the SNS symptoms causing decreased HR, myocardial contraction and rate of conduction through AV node. Can be used for primary HTN HF Angina tachydysrhtmias pheochromocytoma glaucoma and migraines. Hold if AP <60 can mask TACHHCARDIA ( an early sign of decreased BG) DECREASED CO (start doses very low esp HF pt) watch for worsening HF- sob edema fatigue Can cause AV BLOCK ORTHOSTATIC HYPOTENSION BETA 2 BLOCKADE- BRONCHOCONSTRICTION - avoid in asthmatic pts and INHIBITED GLYCOGENOLYSIS - decreased HR masks manifestations of impending decreased BG causing fat breakdown.

A nurse is caring for a client who is taking Bethanechol. For which of the following adverse effects should the nurse monitor? Decreases urination Increased GI motility Dry mouth Hypertension

Bethanechol is a muscarinic agonist that increases GI motility leading to abd cramps and diarrhea. It's stimulates voiding, increases salivation and hypotension.

Direct Renin Inhibitors- aliskiren (Tekturnia)

Binds w renin to inhibit Ang I thus decreasing Ang II and Aldosterone High fat meal decreases absorption (decreases BP increases UO) Adverse effects Allergic reaction, Hyoerkalemia, Diarrhea (dt dose) May decrease furosemide levels and affect other antihypertensive meds Atorvastatin and Ketconazole increases aliskiren levels. Take at same time daily and avoid high fat meals

Calcium Channel Blockers -end in Pine Nifedipine Procardia, Adalat Verapamil Calen Diltiazem Cardizem Amlodipine Norvasc Felodipine Plendil nicardipine Cardene Cleviprex

Blocks calcium channels to dilate peripheral and heart arteries and arterioles. It decrease the strength of heart contractions and slow the Hr allowing the ventricles to fill and slows conduction rate through AV node. Nifedipine- cause reflex tachycardia ( a beta blocker can be added) peripheral edema (diuretic and elevate legs) acute toxicity and have equipment ready for cardioversion and cardiac pacer. Verapamil, Diltiazem- orthostatic hypotension w/ peripheral edema Constipation Dysrrhythmias (prolonged QT QRS widened) Cardiac function suppression. GINGIVAL HYPERPLASIA growth of gum disease bleeding gums massage gum

Loop diuretics: furosemide (Lasix), ethacrynic acid (Edecrin), bumetanide (Bumex), torsemide (demadex)

Blocks reabsorption of sodium, chloride, and water even in severe renal impairment. Watch for ototoxicity (tinnitus, hearing loss) avoid other ototoxic drugs like gentamicin. Causes hypokalemia (digoxin toxicity risk) and hyponatremia (lithium carbonate -Lithobid) increases toxicity. NSAIDS decrease blood flow to kidneys - decreasing diuretic effect. Manifestations of hypokalemia and hypovolemia- significant weight loss, lightheadedness, dizziness, GI distress or general weakness.

Potassium sparing diuretics- spironolactone (Aldactone), triameterene (Dyrenium), amiloride (Midamor)

Blocks the action of aldosterone which reabsorps water and sodium. Promotes retention of potassium and excretion of sodium and water. Can cause hyperkalemia may need insulin to drive Kt into cells. Contraindicated in pts w/ hyperkalemia, severe kidney failure and anuria. Concurrent use with ACE-I increases hyperkalemia. Monitor cardiac function.

Angiotensin Converting Enzyme (ACE) inhibitors- end in PRIL Captopril Capoten Enalapril Vasotec Fosinopril Monopril Ramipril Altace Moexipril Univasc

Blocks the conversion of Ang I into Ang II causing vasodilation and excretion of sodium and water and retention of Kt. Can cause ORTHOSTATIC HYPOTENSION- diuretic stopped 2-3 days before ACEI monitor BP 2 hrs after initiation of TX change positions slowly COUGH*- notify immediately D/C HYPERKALEMIA, RASH, DYSGEUSIA, ANGIOEDEMA- needs SQ epinephrine *NEUTROPENIA- monitor WBC notify MD at first sign of infection (sore throats fever) AVOID NSAIDS CAPTOPRIL AND MOEXIPRIL W FOOD OTHER ACEI W/O *notify provider of cough rash dysgeusia or indication of infection.

a nurse is caring for a client who is starting captopril (Capoten) for HTN. for which of the following adverse effects should the nurse monitor the client? hypokalemia hypernatremia neutropenia anemia

Captopril (Capoten) is an ACE- inhibitor that blocks conversion of Angiontensin II causing vasodilation (low B/P), sodium excretion, and urinary retention of potassium. Can cause cough (should be D/C), orthostatic hypotension, hyperkalemia, rash, dysgeusia (altered taste), angioedema (SQ epinephrine), and neutropenia (monitor WBC and notify provider of first indications of infection-fever sore throat)* Use of NSAIDs decreases antiHTN effects.

a nurse is planning to administer a first dose of Captopril (Capoten) to a hospitalized client w/ HTN. which of the following medications can intensify early adverse effects of captopril? Select ATA simvastatin (zocor) Hydroclorothiazide (Microzide) Phentoin (dilantin) clonidine (Catapres) Aliskiren (Tekturna)

Captopril is an ACE I that blocks the conversion of Angiontensin I into Angiotensin II causing vasodilation, excretion of sodium, and retention of potassium. the nurse should monitor for hypotension when used in combination w/ other antihypertensive drugs such as HCTZ, clonidine, and aliskiren. simvastatin (Zocor) lowers cholesterol and phentoin (dilantin) is an antiseizure med.

A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain. The nurse should recognize which of the following is a contraindication to receiving celecoxib? Hyperglycemia Allergy to penicillin history of MI Peptic ulcer disease

Celecoxib is a NSAID used to treat pain and can be used for joint pain. It should be used w caution to clients w peptic ulcer disease. It is contraindicated in clients w history of MI or heart disease dt increased vasoconstriction and unimpeded platelet aggregation. It can cause a hypersensitivity reaction in clients allergic to sulfonamides or salicylates.

a nurse is caring for a client admitted w/ CSF infection c/b a highly resistant negative gram bacteria. Which of the following IV cephalosporin antibiotics should the nurse expect to be effective in treating this infection? Cefaclor Cefazolin (Kefzol) Cefepime (Maxipime) Cephalexin (Keflex)

Cepholasporin is grouped into four generations and each subsequent generations is more likely to reach CSF, less likely to be destroyed by beta lactamase, and more effective against gram negative organisms and anaerobes. Cefepime is a 4th generation cephalosporin so that would be most effective in treating the CSF infection.

a nurse is planning to administer ciprofloxacin (Cipro) IV to a client who has cystitis. which of the following is an appropriate action by the nurse? Admin a concentrated solution infuse medication over 60 min Piggyback the solution onto existing IV med tubing Choose a small peripheral vein for admin

Ciprofloxacin should be admin in diluted solution, into a large vein, slowly over 60 minutes to minimize irritation of vein and phlebitis. It should not be administered w/ other medications and should start a new IV site as needed.

Nursing administration of Insulin

Clients may need an increase in dosage in response to increase calorie intake, infection, stress, growth spurts, and in second/third trimester. A decrease in response to exercise or first trimester of pregnancy. Do not inject short acting insulin if it appears cloudy or discolored Insulin glargine and detemir are both clear, should not be admin IV, and avoid mixed w other insulins Unopened vials can be store in the refrigerator until expiration Vials of premixed insulin may be stored up to 3 mo Insulin premixed in syringes may be kept 1-2 weeks in refrigerator. Keep them in a vertical position w needles pointing up. Keep vials in use at room temperature avoiding proximity to sunlight and intense heat. Discard after 1 mo.

A nurse is reinforcing teaching with a client who is taking digoxin (Lanoxin) and has a new prescription for colesevelam (Welchol). Which of the following instructions should the nurse include in the teaching? Take digoxin with your morning dose of colesevelam Sodium and potassium levels will be monitored Watch for bleeding or bruising Take colesevelam with food and at least one glass of water

Colesevelam should be taken wit food and 8 oz of water and not concurrently with other drugs. Other medications should be taken 4 hours colesevelam to prevent decrease absorption of other meds. LDL, HDL, TGs blossom glucose and HbA1C are monitored.

Hypertensive Crisis medications- nitroprusside (Nitropress) Centrally acting vasodilator NTG nitrostat IV Nicardipine Cardene Clevidipine Cleviprex Enalaprilat Vasotec IV Esmolol Brevibloc

Direct vasodilation of arteries and veins to decrease cardiac preload and afterload. Adverse effects : excessive hypotension -admin slowly keep supine Cyanide poisoning- DC if occurs nitroprusside only Thiocyanate toxicity- delirium psychosis accumulates when nitroprusside given over several days avoid prolonged use monitor if > 3 days should be <10 should not be Admin in same infusion as other meds. Add diligent for IV infusion- should be light brown color discard if any other color.

Immunizations Adverse Effects

DTaP- local reaction at injection site, FEVER and IRRITABILITY (w/t 48 hrs), INCONSOLABLE CRYING lasting up to 3 hrs, SEIZURES (w/t 3 days), RARE: ACUTE ENCEPHALOPATHY (w/t 7 days) Hib- mild local reactions, LOW GRADE FEVERS, VOMITING, crying CONTRAINDICATED IN CHILDREN < 6 WEEKS Rotavirus- IRRITABILITY, MILD AND TEMPORARY N/V; CONTRAINDICATED IN INFANTS W/ SEVERE COMBINED IMMUNODEFICIENCY (SCID) IPV- local reaction at injection site, RARE: VACCINE ASSOCIATED PARALYTIC POLIOMYELITIS (CONTRAINDICATED IN PREGNANCY UNLESS THE WOMAN IS AT HIGH RISK FOR CONTRACTING POLIO AND ALLERGY TO STREPTOMYCIN, NEOMYCIN, AND POLYMYXIN B) MMR- local reaction at site, RASH, FEVER, SWOLLEN GLANDS, POSSIBLE JOINT PAIN, AND RISK FOR ANAPHYLAXIS AND THROMBOCYTOPENIA. CONTRAINDICATED IN PREGNANCY OR WOMEN BECOMING PREGNANT W/T 4 WKS, IMMUNOCOMPROMISED, RECENT BLOOD TRANSFUSION, HISTORY OF THROMBOCYTOPENIA, IF TB SKIN TEST AND MMR BOTH NEEDED SHOULD NOT BE ADMIN ON THE SAME DAY; DELAY TSR FOR 4-6 WKS AFTER MMR Varicella-VARICELLA- LIKE RASH, LOCAL OR GENERALIZED SUCH AS VESICLES ON THE BODY. CONTRAINDICATED IN PREGNANCY AND PREGNANCY W/T 4 WKS, AVOID CLOSE PROXIMITY TO CHILDREN RECENTLY VACCINATED, CANCERS OF THE BLOOD AND LYMPHATIC SYSTEM, ALLERGY TO NEOMYCIN AND GELATIN, IMMUNOCOMPROMISED, OR RECENT BLOOD TRANSFUSION PCV/PPV- MILD LOCAL REACTIONS, FEVER HEP A AND B- LOCAL REACTION AT SITE, MILD FEVER, ANAPHYLAXIS, ALLERGY TO BAKERS YEAST. SEASONAL INFLUENZA- INACTIVATED (MILD LOCAL REACTION, FEVER) LIVE ATTENUATED (HA, COUGH, FEVER) RISK FOR GUILLAN BARRE SYN (ASCENDING PARALYSIS BEGINNING IN LE AND PROGRESSING TO DYSPNEA) MCV4- MILD LOCAL REACTION RISK FOR ALLERGIC RESPONSE HPV2/4- MILD LOCAL REACTION AND FEVER, FAINTING SHORTLY AFTER VACCINATION; ALLERGY TO BAKERS YEAST HERPES ZOSTER- MILD LOCAL REACTION CONTRAINDICATED IN CLIENTS IMMUNOCOMPROMISED

Aldosterone antagonists- eplerenone (Inspra) spironolactone (Aldactone) ends in ONE

Decreases blood volume by blocking aldosterone receptors in the kidneys promoting excretion of water and sodium. Adverse effect hyperkalemia, flu like manifestations (fatigue, headache, mild GI manifestations) dizziness and hyponatremia. Contraindications hyperkalemia, kidney impairment, type II DM w Albuminuria VERAPAMIL, ACEI, ARBs, ERYTHROMYCIN AND KETOCONAZOLE INCREASES LITHIUM TOXICITY Admin w or wo food Do not admin w potassium products

Scopolamine patch for motion sickness

Decreases bronchial and nasal secretions- anticholingeric. The client should replace the patch q 3 days Constipation is an adverse effect of anticholingerics And should be placed behind the ear

Immunizations- Childhood vaccinations

Diphtheria and tetanus toxoids and acellular pertussis (DTaP) 2,4,6 MO; 15-18 mo 4-6 yrs Tetanus and diphtheria toxoids and pertussis (TDap) -one dose 11-12 years Tetanus and diphtheria (Td) booster- Q 10 years following first DTaP Haemophilus influenza Type B (Hib)- 2,4,6 mo and 12-15 mo Rotavirus (RV) oral vaccine- the first dose should not be initiated for infants 15 wks or older than 8 months. RV-5 vaccine (RotaTeq) administered as three dose at 2,4,6 mo. RV1 vaccine (Rotarix) is admin as two doses at 2 and 4 mo. Inactivated Poliovirus vaccine (IVP)- 2,4,6-18 mo and 4-6 yrs Measles, mumps, rubella (MMR)- 12-15 mo and 4-6 years Varicella vaccine - one dose 12-15 mo and 4-6 years OR two doses 4 wks apart if admin after 13 YO Pneumococcal conjugate vaccine (PCV) 2,4,6 and 12-15 mo Hepatitis A- two doses admin after 12 mo. Second dose 6-18 mom after the first dose Hepatitis B- admin w/t 12 hours of birth and 1-2 mo and 6-18 mo Seasonal influenza vaccine- trivalent inactivated influenza vaccine (TIV) annually beginning at 6mo Starting at 2 yo, the live, attenuated influenza vaccine (LAIV) nasal spray may be given -LAIV contraindicated in children w asthma, children 2-4 yrs w/ wheezing in the past year, or children w a medical condition that puts them at risk for influenza complications. Should be given bt october and november (Dec. is acceptable) Meningococcal vaccine (MCV4)- one dose at 11-12 years, earlier if risk factors present Human Papilliomavirus (HPV 2 or HPV4) three doses over 6 mo period for males (HPV4 Gardisil) and females (HPV2 Cervarix) 9-12 years old

Osmotic diuretics- mannitol (Osmitrol)

Diuretic used to decrease ICP and IOP by increasing serum osmolality by drawing fluids back into the vascular and extravascular space. Helps prevent kidney failure (hypovolemic shock and severe hypotension) Adverse effects HF, pulmonary edema ( dyspnea, weakness, fatigue, Distended neck veins, weight gain) kidney failure (increased BUN and creatinine and UO less than 30 ml/hr.

HPV 2 vaccine

Divided into three doses over 6 months. Clients can receive up to the age 26 An egg allergy isn't a contraindication And missed periods aren't a side effect of this immunization

A nurse is assisting with the monitoring of a client who is receiving a dopamine infusion at moderate dose for the Tx of severe HF. What is the expected finding? Lowered HR Increased myocardial contractility Decreases conduction through AV node Vasoconstriction of renal BV

Dopamine is a catecholamine that causes vasodilation of the renal BV, increased HR, increased myocardial contractility, and increased conduction through AV node ant moderate doses. At low doses -renal dilation High doses- vasodilation renal BV, increased HR, increased heart strength, increased AV node conduction and vasoconstriction of alpha 1 receptors (decrease BP, slow general anesthesia absorption rate, manages superficial bleeding,decreases nasal congestion

A nurse is monitoring a client who has IICP and is receiving mannitol Osmitrol. What should the nurse report? BG 150 UO 40/hr Dyspnea Headache

Dyspnea can indicate HF ( headache is a manifestation of ICP)

Antibiotics affecting bacterial cell wall: Cephalosporins- 1st Generation cephalexin (Keflex) and cefazolin (Zefzol), 2nd Generation cefaclor, cefotetan (bleeding risk), 3rd Generation ceftriaxone (Rocephrin) bleeding risk and cefotaxime (Claforan), 4th Generation cefapime (Maxipime)

Each subsequent generation of cephalosporins: more likely to reach CSF, less likely to be destroyed by beta-lactamase, and more effective against gram negative organisms and anaerobes. they are broad spectrum bactericides that treat UTI, postoperative infections, pelvic infections, and meningitis. adverse effects include possible cross sensitivity to penicillin (stop immediately if urticaria, rash, hypotension, and/or dyspnea appears. Question past history of allergy to penicillin or other cephalosporins), Bleeding tendencies (ceftoten and ceftriaxone; avoid in clients w/ bleeding disorders or taking anticoagulants, monitor PT and INR D/C id abn admin Vitamin K), Thrombophlebitis w/ IV infusion (rotate injection sites, admin diluted slowly over 3-5 min in bolus), Pain w/ IM injection - admin deep in large muscle mass, and Antibiotic associated psuedomembranous colitis- observe for diarrhea and D/C. use cautiously in clients w/ renal impairment and bleeding tendencies. Disulfiram reaction (intolerance to alcohol) occurs w/ combined use cefotetan, cefazolin, cefoperazone, and alcohol. Probenecid prolongs action and delays renal excretion. Complete the full course of treatment even if symptoms not present, take w/ food, and store cephalosporin suspension in refrigerator.

A nurse is caring for a client who has a new prescription for eplerenone to treat hypertension. For which of the following adverse effects should the nurse monitor? Hematuria Hypernatremia Hyperkalemia Constipation

Eplerenone can cause vaginal bleeding not blood in the urine. It cause hyponatremia and diarrhea. The client would be at risk for increased potassium levels bc eplerenone cause potassium retention.

When talking w a pt about taking eplerenone (Inspra) to treat HTN, the health care professional should include which of the following instructions? Avoid grapefruit juice Use sunscreen and protective cloths Avoid the use of salt substitutes Stop taking the drug of dizziness occur

Eplerenone is an aldosterone antagonist much like position sparing diuretics causes hyperkalemia. The client should avoid the use of salt substitutes because they contain potassium

Nursing administration for immunizations

FOR INFANTS/CHILDREN Obtain parental consent Note the date, route, site of injection Admin IM vaccinations in the Vastus Laterlis muslce for infant and children and Deltoid muscle for older children and adolescent Admin SQ in the outer aspect of the upper arm or anterolateral thigh Use strategies to minimize discomforts; cuddling and pacifiers during procedure, acetaminophen for 2-6 mo before procedure and 24 hrs after and ibuprofen after 6 mo (aspirin should be avoided bc the risk of Reye's syndrome) Provide praise afterwards Apply colorful bandage. admin oral meds before injections (injections are painful) Do not allow the child to delay the procedure FOR ADULTS Have emergency medications (epinephrine) in case of allergic response reconstituted meds given w/t 30 mins Document date, route, and site of vaccination. Type, manufacturer, lot number, expiration, name, address, and signature.

A nurse is caring for a client who takes several antiretrovial medications including NRTI zidovudine (Retrovir) to treat HIV. for which of the following adverse effects of zidovudine should the nurse monitor? SATA Fatigue Visual disturbances Ataxia Hyperventilation Vomiting

Fatigue is a manifestation of anemia that can occur in clients taking zidovudine. Neutropenia can also occur causing a high risk for infection. Hyperventilation is a finding that can occur if the client develops lactic acidosis, a serious adverse effect of zidovudine. Vomiting and other GI effects can occur in a client that takes zidovudine

A nurse is reinforcing teaching to a client who has a new prescription for digoxin. Which of the following can indicate digoxin toxicity and reported to the provider? Fatigue Constipation Anorexia Rash Diplopia

Fatigue, anorexia, and diplopia. N/V/D are common effects of dig toxicity and any GI disturbances.

MEDICATION/FOOD INTERACTIONS W/ ORAL ANTI DIABETICS

GLIPIZIDE- Use of alcohol can result in disulfiram- like reaction like N/V, flushing and palpitations.Alcohol NSAIDs sulfonamide antibiotics ranitidine (Zantac) and cemetidine (Tagamet) have additive hypotensive effect. beta blockers can mask sns response in hypoglycemia REPAGLINIDE AND PIOGLITAZONE- concurrent use w/ gemibrozil (Lopid) can lead to hypoglycemia. METFORMIN- alcohol increase the risk for lactic acidosis and concurrent use of iodine contrast media can result in ARF- d/c metformin 48 hrs before and after procedure ACARBOSE- concurrent use w/ sulfonlureas or insulin cause hypoglycemia and concurrent use of metformin causes additive GI effects and hypoglycemia.

Principles of Antimicrobal Therapy

Gram stain- determines whether the organism is gram negative or gram positive Culture- determines the type of organism that might be causing infection (should be obtained before starting antibiotic therapy) Sensitivity of microorganism to antimicrobial- identifies antibiotic most effective for a specific organism Infants/Elderly have increased risk for antibiotic toxicity b/c infants have underdeveloped liver/kidneys and elderly have decreased UO to excrete antibiotics. Certain infection sites are difficult for antibiotics to reach; meningitis (CSF), endocarditis (heart), and foreign objects (pacemaker, joint prosthesis, heart grafts, valves, and mesh) Antibiotics can harm a baby (Gentamicin= ototoxic and nephrotoxic) Tetracyclines (stains teeth, crosses placenta) avoided in breast feeding moms.

A nurse is monitoring a client receiving HCTZ for recurring episodes of HF. Which of the following findings should the nurse recognize as an adverse effect of this medication? Hypokalemia Hyperchloremia Hypernatremia Hypocalcemia

HCTZ is a thiazides diuretic that causes the excretion of sodium and water ( hyponatremia), hypochloremia, and hypercalcemia. Hypokalemia is also an adverse effect.

Thiazides diuretics: HCTZ (microzide), chlorothiazide (Diuril), methyclothiazide (Enduron) Thiazide type meds- Indapmide (Lozide, Lozol), chlorthadilone (Hygroton), metolazone (Zaroxolyn)

HCTZ usually first choice for essential HTN. Avoid during pregnancy. Drug interactions same as loop diuretics (digoxin, lithium carbonate,antihypertensive drugs) Monitor potassium levels Should take first thing in the AM to avoid nocturia. Can take with food if GI upset. Increase potassium intake and fluids. No risk of hearing loss so can be combined w/ ototoxic meds. Effectiveness AEB decrease BP, decrease edema, increase UO

A nurse is planning to administer a first dose of captopril to a hospitalized client who has hypertension. Which of the following medications can intensify early adverse effects of capoten? Select ATA Simvastatin hCTZ Phenytoin (Dilantin) Clonidine (Catapres) Aliskiren (tekturna)

HCTZ, Clonidine, and Aliskiren all intensifies the effects of ace inhibitor, captopril by causing hypotension and reduce fluid in the circulation.

HIV/AIDS

HIV is a retrovirus that must attach to a host cell in order to replicate. RNA is changed into DNA using the enzyme reverse transcriptase. Antiretroviral agents are used to treat HIV infections, it does not cure HIV or decrease the risk of passing the HIV infection to others. Antiretroviral agents may act by preventing the virus from entering the cells (fusion/entry inhibitors and CCr5 antagonists). Others act by inhibiting enzymes needed for HIV replication (nuceloside reverse transcriptase inhibitors; NRTIs, non nucleoside reverse transcriptase inhibitors NNRTIs, protease inhibitors, and integrase inhbitor. Highly active antiretroviral therapy (HAART) involves 3-4 HIV meds in combo w/ other antiretroviral meds to reduce med resistance, adverse effects, and dosages. HAART is an aggressive tx method using 3 or more different medications to reduce the amt of virus and increase CD4 counts. Also treat or prevent secondary infections such as pneumocystis pnemonia. Skipping doses or taking decreased dosages cause medication resistance and possible treatment failure.

A nurse is caring for a client who is starting niacin (Niaspan) to reduce cholesterol. The nurse should monitor the client for which of the following adverse effects? Select ATA Muscle aches Hyperglycemia Hearing loss Flushing of the skin Jaundice

Hyperglycemia, flushing of the skin, and jaundice. Myopathy ( muscle aches pain tenderness) occurs with statins and other antilipemic meds. Flushing of the skin along with tingling of the extremities occurs soon after taking niacin. Niacin may cause liver disorders so monitor for jaundice, abd pain and anorexia

A nurse is reviewing a medical history of client taking digoxin Lanoxin and NSAIDs. The client had a new medication, torsemide Demadex. The nurse plan to monitor what interactions? Decrease in digoxin level Hypokalemia Hypotension Low UO Ventricular dysrrhythmias

Hypokalemia (loop diuretic) Hypotension Low UO (nsaids reduce blood flow to kidneys) Ventricular dysrrhythmias (There will be an increase in digoxin level)

A nurse is reinforcing teaching w a client who has active tuberculosis about his treatment regimen. The client asks why he must take four different medications. Which of the following replies by the nurse is appropriate? "Taking multiple antituberculosis medications...." decrease chances of severe allergic reaction reduces the chances that TB bacteria will be resistant to meds minimizes the chance of adverse effects by any of the meds lessens the chance that you will have a positive TB test infinitively

If the client took only one medication to treat active TB, resistance to the medication will quickly occur. taking three to four different medications decreases the possibility of resistance.

a nurse is taking a medication history for a client who is to receive imipenem- cilistatin (Primaxin) IV. Which of the following medications taken by the client places the client at risk for medication interaction? Regular insulin (Humulin R) Furosemide (Lasix) Valporic acid (Depakote) Ferrous sulfate (Feosol)

Imipenem- cilistatin decreases the blood levels of valproic acid (antiseizure medication) putting the client at risk for increased seizure activity. Combination of these two medications should be avoided.

Organic Nitrates- NTG; Nitrodur, IV, NitroTime, Nitrostat (SL), Nitrolingual pump spray, isosorbide dinitrate (Isordil) and isosorbide mononitrate (Monoket)

In chronic stable angina, NTG is given to dilate venous and decrease venous return (preload) which decreases CO. in variant angina it prevents or reduces coronary artery spasm thus increasing oxygen supply to ischemic areas of the heart. NTG can cause headache - use aspirin or acetaminophen, orthostatic hypotension, reflex tachycardia- admin b blocker, and tolerance- use lowest dose needed to achieve effect and should have a medication free period daily to reduce tolerance risk. NTG is contraindicated in clients w/ traumatic head injury b/c it increases ICP. Avoid alcohol use and PDE5 inhibitors like sildenafil (Viagra), tadalafil (Cialis), and verdenafil (Levitra) can cause life threatening hypotension. Use cautiously in client taking CCB, b blockers, and diuretics. Should not stop taking NTG abruptly.

A nurse is reinforcing teaching with a client who is starting Verapamil (Calan) to control HTN. Which of the following should the nurse include in the instructions? Increase fiber in diet Drink grapefruit juice to increase Vit C Decrease calcium in diet Withhold food for 1 hr after medication is taken

Increase fiber to prevent constipation. Avoid grapefruit juice with CCB No restrictions on calcium Can take CCB with food to decrease GI upset

Hyperglycemic agent- Glucagon

Increases BG by increasing the breakdown of glycogen into glucose. Used in emergency hypoglycemic reactions like insulin OD or to decrease GI motility in clients undergoing radiological procedure of the stomach and intestines. Cause GI distress like N/V- turn client on left side to avoid aspiration. Admin SQ, IM, or IV, provide food as soon as the client regains full consciousness and is able to swallow. BG levels should rise above 50 mg/dL

a nurse is caring for a group of clients who are receiving antimicrobial therapy. which of the following clients is the priority for the nurse to monitor for manifestations of antibiotic toxicity? Adolescent child w/ sinus infection Older adult who has prostatitis new mother who has mastitis middle adult client w/ UTI

Infants and older adults are high risk for antibiotic therapy b/c infants have underdeveloped liver/ kidneys and older adults have decreased UO and drug metabolism. The new mother would not receive antibiotics for mastitis b/c its a infection of the breast not milk ducts and antibiotics crosses placenta

Prophylatic Use of antibiotics/ Preventive measures

Infections in clients undergoing surgery of GI, cardiac or vascular surgery, orthopedic surgery, and some gynecologic surgeries Influenza w/oseltamivir (Tamiflu) STIs following sexual exposure Limit Use: prosthetic heart valves prior to dental work or other procedures b/c of danger of bacterial endocarditis Recurring UTIs Invasive procedures increases risks, use hand hygiene before and after client contact, must take full course of antibiotic therapy, up to date immunizations, monitor for improvement (decreased fever, improved breath sounds)

A client is to begin taking isoniazid for tuberculosis. Which of the following should the nurse do? Determine clients alcohol intake Tell the client to expect red orange urine Reinforce teaching on low cal diet Instruct the client to have yearly tuberculin skin test

Isoniazid can cause liver damage therefore it's important to determine the clients daily alcohol intake because it increases the risk.

a nurse is administering IV acyclovir (Zovirax) to a client who has vericella and immunocompromised. Which of the following nursing actions is appropriate? Administer a test dose of 0.1 mg before starting regular infusion Decrease fluid intake during and for 2 hrs following infusion to prevent FVO Admin acyclovir infusion over 1 hr Monitor for severe infusion reactions w/t 15 mins of infusion start

It is important to increase, rather than decrease, fluid intake during and 2 hrs after therapy and it should be administered slowly over at least an hour

A health care professional should question the use of dobutamine for a patient who is receiving which of the following types of drugs? SATA ACE Inhibitors Monoamine oxidase inhibitor General anesthetic Tricyclics antidepressant Beta blocker

MOIAs, general anesthetic and tricyclic depressants, can cause tachydysrhythmias. Beta blockers can decrease the effects of dobtuamine

A client asks a nurse why she is taking propranolol (Inderal) along w her therapy for hyperthyroidism. Which of the following replies by the nurse is appropriate? Propranolol increase blood flow to thyroid gland It is used to prevent excess glucose in the blood It will decrease your tremors and tachycardia It will promote conversion of T4 to T3 in your body

Manifestations of hyperthyroidism includes restlessness, weight loss, tachycardia, altered appetite, palpitations, anxiety, abd cramping, fever, diaphoresis and heat intolerance. A beta blocker can be used to decrease the HR and tremors,

A nurse is caring for a client who has aprescription for Metformin (Glucophage). The nurse should monitor the client for which of the following adverse effects? Lactic Acidosis Hypoglycemia Hyperlipidemia Respiratory alkalosis

Metformin slows the production of glucose in the liver so it would not cause hypoglycemia on its own. Adverse effects of Metformin include GI effects, lactic acidosis (extreme drowsiness, hyperventilation, and muscle pain) and vitamin B12 and floic acid deficiency.

a nurse id caring for a client who is being prepared for extensive colorectal surgery. Which of the following oral antibiotics should the nurse expect to be prescribed for this client in order to supress normal flora in the GI tract? Amikacin Gentamicin Neomycin Erythromycin

Neomycin is used prior to GI tract surgery to suppress normal flora and also can be used to treat skin, eye, and ear infections.

A HCP is assessing a patient following the administration of nifedipine (Procardia). Recognizing the adverse effects of nifedipine, the HCP should be prepared to administerwhich of the following drugs? Prazosin (Minipress) Doxazosin (Cardura) Propranolol (Indera) Enalapril (Vasotec)

Nifedipine is a CCB that can cause reflex tachycardia, an adverse effects that causes an increase in oxygen demand. The nurse should be prepared to administer Propranolol, a beta blocker that will minimize this adverse effect.

A nurse is reinforcing teaching w a client who is to start therapy w nifedipine. The nurse should instruct the client that the medication decrease which of the following? Blood pressure Heart rate Nasal congestion Bladder spasma

Nifedipine is a CCB that decrease blood pressure by causing vasodilation. It cause the heart rate to increase and an adverse effect of nifedipine is nasal congestion.

A nurse in a acute care facility is assisting with the infusion of IV nitroprusside for a client in hypertensive crisis. For which of the following adverse reactions should the nurse monitor this client? Intestinal ileum Neutropenia Delirium Hyperthermia

Nitroprusside is a centrally acting drug and the nurse would monitor for delirium and other mental changes that can occur with thiocyanate toxicity when IV nitroprusside is infused at a high dosage in clients who have kidney dysfunction. Thiocyanate level should remain below 10 mg/dL

A nurse is caring for a client who has diabetes mellitus and pulmonary tuberculosis and has a new prescription for isoniazid (Laniazid). Which of the following supplements should the nurse expect to administer to prevent an adverse effect of isonazid? Ascorbic acid Pyridoxine Folic acid Cyanoclobalamin

One adverse effect of isoniazid use is peripheral neuropathy (tingling, numbness, burning, and pain r/t pyridoxine deficiency, Vitamin B6) the client should receive 50-200 mg of vitamin B6 daily. other adverse effects to monitor for is hepatoxicity and hyperglycemia. Cyanoclobalamin is vitamin B12

A nurse is monitoring a client who is receiving IV amphotericin B. Which of the following findings indicates an adverse reaction to this medication? Potassium level 5.6 Hematocrit 55% Polyuria Vertifo

Ototoxicity is an adverse effect of Amphotericin B. W manifestations including vertigo, tinnitus and healing loss. Impaired kidney function and oliguria are adverse effects. And also a decreased hematocrit and potassium level.

a nurse is administering gentamicin by IV infusion at 0900. the Gentamicin will take 1 hr to infuse. when should the nurse plan for a peak serum levelof gentamicin to be drawn? 1000 1030 1100 1130

Peak levels occur 30 minutes after infusion/administration. It will take 1 hr to infuse after infusion begins at 0900. peak serum levels should occur at 1030

Antibiotics Affecting the Bacterial Cell Wall: Penicillin, amoxicillin- clavulanate, ampicillin, Nafcillin (Nallpen), Ticarcillin-clavulanate (Timentin), Pipercillin- tazobactum (Zosyn)

Penicillin is the choice medication for gram positive cocci (pneumonia, meningitis, infectious endocarditis, pharyngitis), meningitis c/b gram negative cocci (Neisseria meningitides), syphilis, and prophylaxis against bacterial endocarditis for at risk clients prior to dental work. can cause allergic reactions (client should wear allergy id bracelet, and monitor for 30 mins following admin), renal impairment (monitor kidney function and I/O), hyperkalemia/dysrhthmias (high doses penicillin G potassium) and hypernatremia (IV ticarcillin). Do not mix penicillin and aminoglysides in the same IV solution-penicillin inactivates aminoglycosides. Probenecid (Probalan) delays penicillin excretion prolonging penicillin action.

A nurse is monitoring a client receiving spironolactone. Which of the following findings should the nurse report to the provider? Sodium 148 UO 120 ml / 4 hr Potassium 5.2 BP 140/90

Potassium 3.5-5.0

A nurse is reviewing the health record of a client who is starting propranolol (Inderal) to treat HTN. Which of the following conditions is a contraindication for this medication? Asthma Diabetes Angina Tachycardia

Propranolol is a non selective beta blocker that affects the heart and lungs so asthma would be a contradiction because it'll cause bronchoconstriction. Beta blockers mask signs of hypoglycemia so it should be used cautiously in diabetics Beta blockers are prescribed to help treat angina and tachydysrhythmias. It would be contraindicated for bradycardia and heart block.

a nurse is caring for a client who is taking propylthiouracil (PTU). Which of the following adverse effects of this medication should the nurse monitor? Bradycardia Insomnia Heat Intolerance Weight loss

Propylthiouracil (PTU) is an antithyroid medication used for hyperthyroidism. The nurse should monitor for signs of overmedication whic will be signs of hypothyroids such as bradycardia, weight gain, edema, intolerance to cold, and drowsiness.

A nurse administers an oral dose of ampicillin to a client and then monitors for the next 30 minutes. Which of the following findings indicate the client is havin an allergic reaction to the med? SATA Elevated BP Pruritis Flushing Wheezing Tinnitus

Pruritis, flushing, wheezing and tinnitus are adverse signs of ampicillin that can indicate an allergic reaction.

A nurse is collecting medication history data from a client who has angina and is to begin taking ranolazine (Ranexa). The nurse should report which of the following medications in the clients history that can interact with ranolazine. Select ATA: digoxin, simvastatin, verapamil, amlodipine, NIrtodur

Ranolazine increases digoxin levels so digoxin toxicity may occur. Ranolazine increases simvastatin levels so liver toxicity may occur. Verapamil is an inhibitor of CYP3A4 which can increase ranolazine levels leading to dysrrhythmias and torsades de pointes Amlodipine is a CCB used for HTN and stable angina may be prescribed along with ranozaline to treat angina Nitrodur (NTG) may be prescribed along with ranolazine to treat angina. Sotalol (betapace) and quinidine are also contraindicated.

A nurse is reinforcing teaching w clients in an outpatient facility about the use of insulin to treat type I DM. For which of the following types of insulin should the nurse tell the client to expect a peak effect 1-5 hrs after administration? Insulin glargine (Lantus) NPH insulin (Humulin N) Regular insulin (Humulin R) Insulin lispro (Humalog)

Regular insulin onset 1/2-1 hr, peak1-5 hr Lantus is a basal insulin duration is 24 hrs and no peak NPH is an intermediate insulin used for post meals peak in glucose- onset is 1-2 hr, peak 6-14 hr insulin lispro Humalog- onset 15-30 min and peak 1/2 -2.5 hr

A nurse is reinforcing teaching for a client who is prescribed NTG ( nitrodur) transdermal patch for angina pectoris. Which of the following instructions should the nurse give the client? Remove the patch each evening and replace it with a new patch in the morning Cut each patch in half of angina attacks are under control Take off NTG patch temporarily for 30 mins of headache occurs Change the patch every 48 hr after the first meal of the day

Remove the patch every evening to reduce risk of developing tolerance to NTG. Be medication free 10-12 hrs/day before applying a new one in the morning. To ensure appropriate dose patches should not be cut. A headache is a common adverse effect of NTG because it dilate all arteries even in the brain.

a nurse is preparing to administer cefotaxime (Cleforan) IV to a client who has a severe infection and has been receiving cefotaxime for the past week. Which of the following findings indicates a potentially serious adverse reaction to this medication and should be reported to the provider? Diaphoresis Epitaxis Diarrhea Alopecia

Severe diarrhea can be an indication that the client has developed antibiotic associated pseudo membranous colitis which can be life threatening.

a nurse is reinforcing teaching w a client about preventing medication resistance while taking HAART for HIV infection. Which of the following instructions should the nurse include about resistance? taking low dosage of antiretroviral medication minimizes resistance taking one antiretroviral med at a time minimizes resistance Taking meds at the same time daily w/o skipping doses minimizes resistance Changing the med regimen when adverse effects occur minimizes resistance

Skipping even a few doses of antiretroviral medications can promote medication resistance, which can cause treatment failure. The nurse should emphasize the importance of taking each dose of medications exactly as prescribed.

Nursing Administration of Types of NTG

Sublingual- used to treat ACUTE anginal attack it has a rapid onset and should be place SL because vascular under tongue and directly into bloodstream. Take one tab wait five minutes if still experiencing pain call 911 take 2nd tab wait another 5 minutes and take 3rd- do not exceed three tabs. should use prior to activity that is known to cause chest pain. should be kept in dark, cool place in original glass amber bottles. SR oral caps- slow onset and long duration used for long term prophylaxis against anginal attacks. swallow whole w/o crushing and chewing take on empty stomach w/ 8oz water Transdermal- slow onset, long term prophylaxis do not cut pacthes, place on dry hairless skin like back and chest or abd, remove old patch wash and dry and apply new patch, remove at night to reducerisk of tolerance and she med free for 10-12 hrs/day Topical Ointment- remove old dose prior to new dose applied, measure specific dose with paper application, cover w/ clear plastic, avoid touching w/ bare hands- cause headache.

A nurse is reinforcing teaching for a client who has angina pectoris and is learning to treat acute angina attacks. The clients asks, "what is my next step if I take one tablet, wait five minutes, but still have anginal pain?" What is an appropriate reply? Take 2 tabs at a time and call 911 Call 911 and take a second SL tab Take a SR NTG capsule rather than a SL tab and wait 5 more minutes before calling 911 Wait another 5 mins before taking a second SL tab

Take one tab wait 5 minutes, if still experiencing anginal pain call 911 and take a second tablet. Wait another 5 minutes and take the 3rd tablet You should take one tablet at a time then wait five minutes before taking the next tablet. Should not exceed 3 tablets and should be taken SL because it's quicker and directly absorbed in the bloodstream.

A nurse is reinforcing teaching w/ a client who has a new prescription for hydrochlorothiazide Microzide. Which of the following info should the nurse include? Take w/ food Plan to take HS Expect increased swelling in ankles Limit fluid intake in the morning

Take with meals to avoid GI upset (avoid taking a night to reduce nocturia, decreased edema expected, maintain normal intake to avoid dehydration)

Immunizations- Adult Vaccinations; for adults age 19 and older

Td booster- Admin at least one dose of Tdap and then Td booster Q 10 years MMR 1 or two doses 19-49 YO Varicella vaccine- Two doses should be admin to adults who do not have evidence of previous infection. A second dose should be admin for clients who had only one dose previously. Pregnant women needing protection should wait until postpartum period for vaccination Pneumococcal polysaccharide vaccine (PPV) vaccinate clients who are immunocompromised, have a chronic disease, smoke cigarettes, or live in a LTC facility. If client is not previously vaccinated or has no evidence of disease then one dose should be give at age 65 Hep A admin two doses 6-12 mo apart for high risk individuals Hep B admin three doses for high risk individuals. There must be at least 4 wks bt one and two doses and 8 wks bt two and three doses. Seasonal influenza - one dose annually for all adults (Note that LAIV nasal spray is for adults under 50 who are not pregnant or immunocompromised)** MCV4- students entering college and living in dormitories if not previosuly immunized. Recommended for adults older than 56 yo. Reactivation may be recommended after 5years for adults at high risk for infection HPV2 or HPV4 three doses recommended for women up to 26 yo who were not vaccinated at 9-12 yo. If not vaccinated, HPV4 given to males 19-21 and 22-26 who are high risk for HPV Herpes zoster vaccine- one time dose for all adults oer age 60

a nurse is reinforcing teaching w a client prescribed tetracycline to treat GI infection c/b H. Pylori. which of the following client statements indicates understanding of the treatment? I will take this medication w/ a glass of milk I will let my doctor know if i start to have diarrhea I can stop taking this medication when i start to feel better i can take this medication just before bedtime

Tetracycline can be taken on an empty stomach w/ a glass of water. taking it with milk products, calcium, or magnesium can cause unabsorbable chelates to form decreasing its absorption. Diarrhea indicate the client is developing a suprainfection and should notify the doctor. The client should finish the prescribed treatment even if symptoms are absent to prevent resistance to antibiotic. tetracycline should be avoided before bedtime and lying down to avoid esophagus ulceration.

Antibiotics affecting protein synthesis: Tetracyclines, doxycycline (Vibramycin), and minocycline (Minocin)- both can be used in clients w/ renal disease and increase risk of digoxin toxicity. demeclocycline

Tetracyclines are broad spectrum antibiotics that inhibit mirobes growth by preventing protein synthesis (bacteriostatic). Used as first line medication for Rickettsial infections, infections of the urethra or cervix c/b Chlamydia trachomatis, Lyme disease, Anthrax, GI infections c/b H. Pylori, and pneumonia. Adverse effects include GI discomfort (cramping, N/V/D, and esophagus ulceration- Doxycycline and minocycline can be taken w/ meals, avoid at bedtime to avoid esophagus ulcerations), Yellow/ Brown discoloration and/or hypoplasia of tooth enamel (avoid in pregnant women and children younger than 8), Hepatotoxicity (letherygy and jaundice avoid high admin doses IV), Photosensitivity- exaggerated sunburn (Wear protective clothing and use sunscreen), Suprainfection, and dizziness and lightheadness w/ minocycline. Interactions w/ milk products, calcium or iron supplements, laxatives containing magnesium hydroxide (MOM), and antacids causes nonabsorbable chelates- reducing absorption of tetracycline (tetracycline should be taken on empty stomach w/ glass of water and 1 hr before or 4 hrs after magnesium or calcium products) tetracycline reduces oral contraceptives effectiveness.

A nurse is caring for several clients who came to the clinic for seasonal influenza vaccination. which of the following clients could receive the vaccine via nasal spray rather than an injection? 1 yo w/ no health problems 17 yo w/ a hypersensitivity to penicillin 25 yo who is pregnant 52 yo who take multivitamin supplement

The 17 yo w/ a hypersensitivity to penicillin can receive the seasonal influenza vaccine via nasal spray rather than an injection. The Live, attenuated influenza vaccine nasal spray is contraindicated in children younger than 2, pregnant women and clients over 50 yo.

A nurse is caring for a client who has a new diagnose of HIV infection and is beginning combination oral NRTIs (abacavir, lamivudine, zidovudine {Trizivir}). The client asks how medications work to treat HIV. Which of the following responses by the nurse is appropriate? These meds block HIV entry into cells These meds weaken the cell wall of HIV The meds inhibit ezymes to prevent HIV replication These meds prevent protein synthesis within the HIV cells

The NRTIs antiretroviral meds work by inhibiting enzymes reverse transcriptase and preventing HIV replication The fusion/entry inhibitor and CCR5 antagonist work byblocing HIV entry into cells

A nurse is reinforcing teaching to a group of parents about immunizations. which of the following vaccines should the nurse tell the parent is administered to children younger than 1 and not to older children and adults? Pneumococcal vaccine Meningococcal vaccine Varicella vaccine Rotavirus vaccine

The Rotavirus is given only to infants less than 8 months. It is given at 2 and 4 months or 2,4, and 6 months.

a nurse is reinforcing teaching w/ a client who has a new prescription for nitrofurantoin (Furadantin). which of the following information should the nurse include in the teaching? SATA observe for bruising on the skin take the medications w/ meals or milk expect brownish urine discoloration crush the med if difficult to swallow expect HA and drowsiness

The client should be taught to observe for bruising or epitaxis that may indicate blood dyscrasias, take the med w/ meals or milk to decrease GI discomfort- N/V/D and anorexia, and would expect urine to be brownish. the client should avoid crushing the tablet- stains teeth and should report to the provider if experiencing HA, drowsiness, dizziness and peripheral neuropathy (tingling of hands/feet, numbness, and muscle weakness)

A nurse is reinforcing teaching w a client who has type II DM and a new prescription for metformin. The nurse should instruct the client to monitor for which of the following adverse effects? SATA Muscle pain Agitation Weight gain Constipation Metallic taste

The client should monitor for pain as it could indicate lactic acidosis, agitation indicates a CNS adverse effect, and metallic taste bc metformin cause GI manifestations such as bitter or metallic taste.

a nurse is assisting w/ discharge planning for a female client who has a new prescription for sulfamethoxazole-trimethoprim (Septra). which of the following information should the nurse include in the teaching? may take if pregnant drink 1 L of water/ day take medication on an empty stomach D/C med whe symptoms subside

The client should not take Septra while pregnant - it can cause birth defects and kernicertus. The client is encouraged to drink 2-3 L of fluids/ day to prevent crystalluria resulting in kidney damage. The client should take on an empty stomach w/ water to maximize absorption. and you should finish the prescribed medication to avoid rebound infection.

A nurse is reinforcing teaching w/ a client who has a prescription for pramlintide (Symlin) for type I DM. which of the following should the nurse reinforce in teaching? SATA Take oral meds 1 hr before injection Upper arms are preferred injection site Mix pramlintide w breakfast dose of insulin Inject pramlintide just before a meal Discard open vials after 28 days

The client should take oral meds 1 hr before or 2 hrs after pramlintide. The thighs and abd are preferred sites and should not be mixed with other insulin in same syringe It should be injected prior to meals and discard open vials after 28 days

a nurse is caring for a client who has a prescription for somatotropin (Genotropin) to stimulate growth. The nurse should plan to monitor the clients urine for which of the following? Bilirubin Protein Potassium Calcium

The client will be at high risk for hypercalciuria and renal calculi so the nurse should expect to monitor for calcium in the urine

A nurse is monitoring the digoxin level for a client who has been taking a daily dose of dig for one month. The dig level is 0.25 ng/ml. The nurse notify the provider and anticipate which of the following? An increase in the clients dig level A decrease in dig level No change Discontinuation of dig prescription.

The normal digoxin level is 0.5-2.0. The nurse will suspect an increase in digoxin levels because 0.25 is below normal.

a nurse is reviewing a plan of care for a client who has an infected arm wound. which of the following actions should the nurse perform first? administer antibiotic medication Obtain culture of the wound instruct the client on purposes of antibiotics apply a dressing to the clients wound

The nurse first priority is to obtain a culture of the wound to determine the type of organism. Starting antibiotics before obtaining a culture would cause inaccurate results.

A nurse is infusing IV Amphotericin B for a client who has a severe fungal infection. The nurse starts the infusion at 0800. When should the nurse begin to monitor the client for indications of an infusion reaction? 0805 0830 0900 1200

The nurse should begin to monitor for infusion reactions 1-3 hours after initiation of treatment. If the infusion started at 0800 the nurse would monitor for reactions between 9- 11.

A nurse is reviewing the history or a client who is about to start taking cefotetan to treat a bacterial infection. Which of the following information from the clients medical history should the nurse report to the provider before the client begins this medication? Hearing impairment Milk protein allergy Tendon pain Penicillin allergy

The nurse should report the clients penicillin allergy bc cefotetan is a cephalosporin which is structurally similar to penicillin and may have a cross reaction to cefotetan. Aminoglucosides are ototoxic drugs and tendon pain is an adverse effect of fluoroquinolone antibiotics.

A nurse is administering RV, DTaP, Hib, PCV, and IPV to a 4 month old infant in an outpatient facility. Which of the following actions should the nurse plan to take? SATA administer any oral vaccine before injectable vaccines adminster SQ injections in the anteriolateral thigh Admin IM injections in the deltoid muscle Administer infant a pacifier during vaccine injections Instruct parents to administer aspirin prior to vaccination to prevent inflammation

The nurse should to plan to administer any oral vaccines before injectable ones to ensure the full dose is given, administer SQ injections in the outer aspect of the upper arm or anteriolateral thigh and The nurse should administer a pacifier during the procedure to distract the infant. The nurse will avoid using the deltoid muscle in infants and instead use the Vastus Lateralis and also avoid giving the infant aspirn (risk for Reye's syndrome) and instead give acetaminophen (2-6 mo) and Ibuprofen starting at 6 mo.

A nurse is performing the third check before administering hydromorphone to a client. After opening the unit dose packet, the client declines taking the medication. Which of the following actions should the nurse take? Complete an unusual occurrence report Encourage the client to take the med Leave the med at the clients bedside Dispose of the med w a second nurse as witness

The nurse would dispose of the medication w another nurse as witness when disposing a controlled substance. The nurse would document the disposal and it should not be left at the bedside. The nurse should respect the clients right to refusal.

a nurse is reviewing a client's medication history and notes allergy to sulfonamides. which of the following medications are contraindicated d/t this allergy? SATA HCTZ (Microzide) Metoprolol (Lopressor) Acetaminophen (Tylenol) Tolbutamide Furosemide (Lasix)

Thiazide and Loop diuretics are contraindicated w/ sulfonamide use and sulfonamide like oral hypoglycemic meds like tolbutamide are also contraindicated. metoprolol and tylenol are not.

a nurse is caring for an OA client who has a new prescription for digoxin (lanoxin) and takes multiple other medications. concurrent use of which of the following places the client at risk for digoxin toxicity? phenytoin (dilantin) verapamil (calan) Warfarin (coumadin) aluminum hydroxide (Amphojel)

Thiazide and loop diuretics can lead to hypokalemia - dig toxity. verapamil and quinidine can increase digoxin plasma levels which both can lead to dig toxicity. ACE I and ARBs increase potassium levels and decrease digoxin therapeutic effects. antacids (aluminum hydroxide) decreases digoxin absorption and effectiveness. phenytoin is an antiseizure/ antidysrrhytmic that can be given in the event of digoxin toxicity.

A nurse is contributing to the POC for a client recieving furosemide Lasix IV for peripheral edema. What should the nurse include in the plan? Select ATA Check for tinnitus Report UO of 50ml/hr Monitor serum potassium level Elevate HOB slowly before ambulating Recommend eating a banana

Tinnitus, minitor potassium levels, elevate HOB, eat banana (a urine output of 50 is good. You would report an urine output less than 30)

Manifestations of magnesium toxicity

UO < 30 ml/ day Hyporeflexia Respirations <12 Bradycardia

A nurse is reinforcing teaching w a client who is beginning a course of metronidazole (Flagyl) to treat an infection. The nurse should instruct the client to stop taking metronidazole and notify the provider if which of the following adverse effects occurs? Metallic taste Nausea Ataxia Dark colored urine

Use of metronidazole (Flagyl) causes GI discomfort like N/V, dry mouth, and metallic taste; darkening of the urine which is a harmless effect, and CNS manifestations including numbess of extremities, ataxia, and seizures which the client shoould stop use and notify the provider if it occurs.

Lithium

Used to treat bipolar disorder should take w meals or milk to decrease GI upset. Hypothyroidism may occur monitor for manifestations. Polyuria can occur. And client should maintain a consistent level of sodium because decreased sodium levels causes lithium excretion to decline leading to toxicity.

A nurse is caring for a group of clients who are not protected against varicella. Which of the following clients should receive a varicella vaccination at this time? a 24 yo woman in the third trimester 3 yo who has Wilm's tumor and receiving chemotherapy 2 month infant who has no health problems 32 yo man who has essential HTN

Varicella is a live vaccine so it should be avoided in pregnancy or possibility of pregnancy w/t 4 weeks of varicella, immunocompromised clients, and infants younger than 12 months. The client w/ essential HTN may receive the varicella vaccine.

A nurse is caring for a client who takes vasopressin for diabetes insipidus. For which of the following adverse effects should the nurse monitor for? Hypovolemia Hypercalcemia Hypoglycemia Hypertension

Vasopressin is an antidiuretic hormone that promotes the reabsorption of water. The nurse should monitor for Hypervolemia and edema rather than hypovolemia and cardiac effects such as HTN and agina pectoris. The nurse should also monitor for signs of water intoxication or FVO

A nurse is caring for an older adult client who has a new prescription for digoxin and is taking multiple medications. Concurrent use of which of the following put client at risk for dig toxicity? Phenytoin ( Dilantin) Verapamil (Calan) Warfarin (Coumadin) Aluminum hydroxide (Amphojel)

Verapamil can increase digoxin levels; digoxin may need to be decreased. Phenytoin is an anti seizure/ antidysrhthmic medication that can be given to treat digoxin toxicity. Antacids such as aluminum hydroxide decreases absorption of digoxin and decreases dig levels and effectiveness

a nurse is reinforcing teaching w/ a client who is starting Verapamil (Calan) to control HTN. which of the following should the nurse include in the instructions? Increase dietary fiber drink grapefruit juice daily to increase Vit C decrease amt of calcium in diet Withhold food for 1 hr after medication is taken

Verapamil is a calcium channel blocker that blocks calcium channels in the BV leading to vasodilation of peripheral and heart arteries and arterioles. can decrease force of contraction, decrease HR, and slow rate of conduction through AV node. it is used to treat angina, HTN, and Cardiac dysrrhytmias. some adverse effects include orthostatic hypotension/peripheral edema, constipation (increase fiber intake), bradycardia and HF, dysrrhythmias, and hyperplasia gingivitis. Consuming grapefruit juice causes toxicity (tachycardia, hypotension, and flushing) and should be avoided. can take w/ food if GI upset occurs.

A 12 month old child just received her first mumps, measles, and rubella (MMR) vaccine. For which of the following possible reactions should the nurse teach the parents to monitor for? SATA Rash Redness and discomfort at site Bruising on multiple areas of body Fainting Inconsolable crying

W/ a MMR vaccine, the parents should monitor for redness, rash and discomfort at injection site and bruising d/t risk of thrombocytopenia. Fainting is seen in the HPV2/4 vaccine and inconsolable crying in the DTap vaccine.

A nurse is caring for a client who is starting captopril (Capoten) for HTN. For which of the following adverse effects should the nurse monitor the client? Hypokalemia Hypernatremia Neutropenia Anemia

While taking captopril an ace inhibitor, the nurse should monitor for neutropenia ( decreased WBCs; notify MD at first sign of infection such as fever and sore throat). The client will most likely experience hyperkalemia and hyponatremia d/t increased sodium and water excretion.

a nurse is assisting w admitting a client to an acute care facility for a total hip arthroplasty. the client takes hydrocortisone for addison's disease. Which of the following is the nurse's priority action? Administering a supplemental dose of hydrocortisone Instructing the client to cough and deep breathe Collect additional info from the clients addisons disease history Inserting an indwelling catheter

With addison's disease, the client may receive additional dosing of glucocorticoids in stressful situations including surgery or illness.

Angiotensin II receptor blockers (ARBs) ends in SARTAN; losartan (Cozaar) valsartan (Diovan) irbesartan (Avapro) candesartan (Atacand)

Works much like ACE I but blocks action of Ang II causing vasodilation and excretion of sodium and water. Biggest difference bt ACEI and ARBs - *ARBs doesn't cause hyperkalemia or cough* Adverse effects ANGIOEDEMA, FETAL INJURY contraindications RENAL STENOSIS BILATERALLY OR SINGLE KIDNEY

a nurse is reviewing the records of several clients. which of the following should the nurse expect to be prescribed prophylactic antimicrobial therapy? SATA a client who suspects exposure to STI a client who is having orthopedic surgery a client who has prosthetic heart valve and schedule for dental work a client w/ recurrent UTI a client w/ upper respiratory infection

a client who suspects STI, having orthopedic surgery, has a prosthetic heart valve and dental work scheduled, a client w/ recurrent UTIs. The upper respiratory infection can be viral- antibiotics not used

Antivirals- Acyclovir (Zovirax) Ganciclovir (Cytovene) Lamiduvine (Epivir) (Hep B & C) Osletamivir (Tamiflu) (Influenza A & B) Amantadine Telaprevir (Incivek) Hepatitis C Virus Ribavirin (Rebetol) Respiratory Syntical Virus & influenza Boceprevir (Victrelis) Hepatitis C Virus

act by altering viral reproduction. are only effective during viral replication and ineffective when the virus is dormant. Acyclovir treats herpes implex and varicella-zoster viruses. Ganciclovir treats and prevent cytomegalovirus (prevention for clients who have HIV/AIDS, organ transplant, and other immunosuppressed states) Acyclovir- Phlebitis/inflammation at site of infusion (rotate iv sites), Nephrotoxicity (admin slowly over 1 hr, ensure adequate hydration during and 2 hr after infusion to minimize nephrotoxicity), Mild discomfort w/ oral therapy (Nausea, HA, diarrhea; notify provider). Acyclovir should be used cautiously in clients who have renal impairment, dehydration, or taking other nephrotoxic meds. Probenecid can decrease excretion of acyclovir- monitor for toxicity and concurrent use w/ zidovudine may cause drowsiness. For topical administration wear gloves to avoid transfer of virus to other body parts, wash affected area 3-4 x/day w/ soap and water and keep lesions dry after washing, refrain from sex while lesions are open, can still give virus even if lesions are healed. Ganciclovir- Supressed bone marrow (leukocytes and thrombocytes; monitor CBC and platelet count, admin granulocyte colony stimulating factors, monitor WBC, neutrophil, and platelet count) Report fever, HA, nausea, diarrhea, and can have teratogenic and embryotoxic effects (warn women to prevent pregnancy and men about possible sterility) Contraindicated in pregnancy and clients who have a neutrophil count <500 or platelet count <25,000. Used cautiously in infants younger than 3 mo, older adults, and clients who have dehydration, renal insufficiency, or malignant disorders. admin oral med w food and encourage extra fluid intake during therapy avoid getting on skin infuse slowly over 1 hr.

Medications for UTIs: phenazopyridine (Pyridiate, Pyridium, Urogesic)

azo dye that functions as a local anesthetic on the mucosa of the urinary tract. relieves manifestations of burning on urination, pain, frequency, and urgency. Contraindicated in clients who have acute kidney injury or chronic kidney disease. medication changes urine to an orange/red color and might stain clothes. Admin w/ or after meals to prevent mild GI discomfort.

Antibiotics affecting protein synthesis: Aminoglycosides- Gentamicin (ototoxic/ nephrotoxic) Amikacin Tobramycin Neomycin (suppresses normal flora and eye, ear, skin infections) Streptomycin (Active TB)- monitor for neurologic disorder (peripheral neuritis, optic nerve dysfunction, paresthesias of hands/feet) Paromomycin (oral) tapework infection/ Intestinal amebiasis

bactericidal antibiotics that disrupt protein synthesis. Adverse effects inlcude Ototoxicity (hearing loss, balance loss, tinnitus, HA, Nausea, dizziness, and vertigo), Nephrotoxicity (proteinuria, protein casts, dilute urine, elevated BUN and creatinine levels- report hematuria and cloudy urine), Intensified neuromuscular blockade (respiratory depression and muscle weakness; monitor closely in myasthenia gravis, taking skeletal muscle relaxants, or general anesthesia), Hypersensitivity (rash, pruritis, paresthesias of hands/feet, and urticaria). used cautiously in clients w/ renal impairment, preexisting hearing loss, or myasthenia gravis, taking other ototoxic drugs (loop diuretics, vancomycin, cephalosporin, amphotericin B and neuromuscular blockades (tubocurarine). should not be taken w/ penicillin. Peaks 30 mins after admin of aminoglycosides IM or IV trough levels right before next dose.

a nurse is reviewing information w/ a newly licensed nurse on client conditions that decreases the effectiveness of antimicrobial therapy. which of the following client conditions should the nurse include in the information? SATA a client who has meningitis a client who has a pacemaker a client who has endocarditis a client who has pneumonia a client who has pyelonephritis

certain sites are difficult for antibiotics to reach; infections where the blood-brain barrier must be crossed (meningitis), bacterial infiltration of the heart (endocarditis), and foreign objects (pacemaker, joint prosthesis, vascular grafts, heart valves, and surgical mesh) purulent abscess cause poor blood supply.

Medications for UTIs: Fluoroquinolones- ciprofloxacin (Cipro), ofloxacin, moxifloxacin (Avelox), levofloxacin (Levaquin), norfloxacin (Noroxin)

bactericidal as result of inhibition of the enzyme necessary for DNA replication; Adverse effects- GI discomfort (N/V/D), Achilles tendon rupture (pain, swelling, and redness at achilles tendon site; D/C and don't exercise until inflammation subsides), Suprainfection (thrush, vaginal yeast infection; monitor for cottage cheese/curd like leasions on the mouth or genital area), and Photosensitivity (severe sunburn; avoid sun exposure, wear protective clothing, and sunscreen at all times, D/C immediately) Contraindications- should not be administered in children younger than 18- risk of achilles tendon rupture, clients w/ myasthenia gravis, increased risk of C Diff, can effect the CNS (dizziness, HA, restlessness, discomfort) Interactions- cationic compounds (aluminum-magnesium antacids, iron slats, sucralfate, milk/dairy products; admin cationic products 6 hr before or 2hr after ciprofloxacin), plasma levels of theophylline and warfarin increases w/ ciprofloxacin (monitor PT/INR and adjust warfarin) D/C other IV infusions or use another IV site when admin IV ciprofloxacin, decrease doses in clients w/ renal dysfunction, IV ciprofloxacin should be admin slowly over 60 minutes in large vein to reduce risk of phlebitis. for inhalation anthrax infection- ciprofloxacin admin q 12 hrs for 60 days.

Antiobiotics affecting the bacterial cell wall: Carbapenems- imipenem- cilistatin (Primaxin) and meropenem (merrem IV)

beta lactam antibiotics that destroy bacteria by altering its cell wall. its effective for serious infection such as pneumonia, peritonitis, UTI c/b gram positive cocci, gram negative cocci, and anaerobic bacteria. Resistance can occur when imipenem is used alone to treat psuedomonas aeruginosa- combination of antipseudomonal medications should be used. Adverse effects include allergy or cross sensitivity to penicillin and or cephalosporins, GI symptoms (N/V/D), and suprainfection (monitor for indications of colitis; diarrhea oral thrush or vaginal yeast infection) Imipenem- cilistatin can reduce blood levels of valproic acid (Depakote) increasing risk of seizure activity. use cautiously in clients w/ renal impairment.

Medications for UTIs: Urinary Tract Antiseptics-nitrofurantoin (Furadantin), nitrofurantoin macrocrystals (Macrodantin, Macrobid), and methenamine (Hiprex, Urex)

broad spectrum antiseptic w/ bactericidal and bacteriostatic actions by damaging DNA. treat acute UTI and prophylaxis for recurrent lower UTIs. Adverse effects- GI discomfort (anorexia, N/V/D; take w/ meals or milk, reduce dosage and use macrocrystalline tab to reduce discomfort), Hypersensitivity w/ pulmonary manifestations (dyspnea, cough, chest pain, fever chills, and alveolar infiltrations; stop medications, manifestations should subside several days after D/C, do not take again), Blood dyscrasias (agranulocytosis, leukopenia, thrombocytopenia, megalobalastic anemia, and hepatotoxicity; BL CBC and LFT, monitor easy brusing and epitaxis), peripheral neuropathy (numbness, paresthesias of hands/feet, muscle weakness; avoid chronic use and not recommended for clients w/ RF) and HA drowsiness and dizziness. Nitrofurantoin is contraindicated in clients w/ renal dysfunction and creatinine clearance <40 ml/min- increase risk of medication toxicity r/t inability to excrete med. Clients will have brownish urine, admin w/ food if GI upset, avoid crushing/chewing- tooth staining, prevent use in pregnant women

Antibiotics affecting protein synthesis: Macrolides- erythromycin and azithromycin (Zithromax)

can be bacteriostatic and bactericidal if given in high enough doses. Used to treat infections in clients w/ penicillin allergy, Legionnaire's disease, whooping cough (pertussis), and acute diptheria (eliminates carrier state), chlamydia, and respiratory tract infections. prophylaxis against rheumatic fever and bacterial endocarditis. Adverse effects include GI discomfort (N/V epigastric pain; admin erythromycin w/ meals), Prolonged QT interval (dysrrhythmias; avoid use clients taking meds that affect hepatic drug metabolizing enzymes), and ototoxicity (hearing loss, tinnitus, vertigo). Erythromycin inhibits metabolism of antihistamines, theophylline, carbamazepine, warfarin, and digoxin- can lead to toxicity. Verapamil, diltiazem, HIV protease inhibitors, antifungal meds, and nefazodone inhibit hepatic drug metabolism increasing risk for erythromycin toxicity- tachydysrrhytmias and cardiac arrest- concurrent use not recommended. taken 1 hr before meals or 2 hrs after w/ water unless gi upset, PT/ INR monitor w/ clients taking warfarin an erythromycin, and monitor LFT if therapy more than 1-2 wks

Antifungals- Amphotericin B (Amphotec)- a polyene and Ketoconazole- an azole Nystatin (Nystop) Miconazole (Monistat) Terbinafine (Lamisil) Fluconazole (Diflucan) *Amphotericin B is highly toxic and should be reserved for severe life threatening fungal infections and infused slowly over 2-4 hrs IV b/c oral route poorly absorbed in GI tract; discard if precipitation present*

can be fungistatic or fungicidal treatment choice for systemic fungal infection, tinea pedis (athletes foot), tinea cruris (jock itch), candida infections of skin/ mucous membranes, fungus of nails (onychromycosis) Adverse effects (Amphotericin B): infusion reactions -fever, chills, rigors and HA 1-3 hr after infusion (pretreat w/ diphenhydramine and acetaminophen. Meperidine (Demerol) or dantrolene given for rigors). Thrombophlebitis (admin in large vein and heparin before Amp B monitor site for erythema, swelling and pain) Nephrotoxicity (Infuse 1L saline on day of Amp B infusion, BL kidney function: BUN Creatinine) Hypokalemia and Bone marrow suppression. Adverse effects: Ketoconazole Hepatotoxicity (anorexia, N/V, dark urine, clay colored stools) Gynecomastia in males, decreased libido, ED, and irregular menstrual flow. Aminoglycosides (Gentamicin, streptomycin, cyclosporine-additive nephrotoxic risk- avoid use) can reduce dosage of Amp B when used w/ flucytosine Monitor for toxicity of digoxin, warfarin, and sulfonylurea antidiabetic meds.

a nurse in an acute care facility is assisting w/ the infusion of IV nitroprusside for a client in Hypertensive Crisis. For which of the following adverse reactions should the nurse monitor this client? intestinal ileus neutropenia delirium hyperthermia

complications of Hypertensive Crisis is excessive hypotension, Cyanide poisoning (HA, drowsiness- may lead to cardiac arrest- give thiosulfate concurrently) and Thiocyanate toxicity (CNS findings such as delirium and psychosis) accumulates when nitroprusside given over several days)

HMG-CoA Reductase Inhibitors- Statins- lowers cholesterol levels

decreases LDL, VLDL (TGs), and increases HDL (good cholesterol) other benefits include vasodilatio, decrease in plaque site inflammation, and decreased risk for thromboembolism. Adverse effects include Hepatotoxicity (increased liver enzymes, jaundice, anorexia, N/V, avoid alcohol, D/C if abn LFT) Myopathy AEB muscle aches, pain and tenderness- may progress to myolitis or rhabdomyolysis (BL CK level; report muscle aches, tenderness, pain) Peripheral Neuropathy AEB weakness, numbness, tingling of hands and feet Contraindicated w/ pts w/ hepatitis induced by viral infections or alcohol Rouvastatin avoided in asian descent clients or smaller doses. Grapefruit juice, ketoconazole, and eryhtromycin increases statin levels and fibrates and ezetimibe increases risk of myopathy (BL CK)

cardiac glycosides- digoxin (lanoxin)

digoxin is used to treat HF and cardiac dysrhythmias like A fib by decreasing HR (gives time for ventricles to fill) Increasing force and efficiency of myocardial contraction, and slowing the rate of conduction through AV nodes. therapeutic ranges are 0.5-2.0. digoxin toxicity is bought on by hypokalemia (general weakness, N/V) and manifestations include: fatigue, weakness, vision changes (diplopia, blurriness, yellow-green or white halos around objects) phenytoin (dilantin) and lidocaine should be given in event of dig toxicity and dysrrhythmias and atropine for bradycardia. for excessive OD- activated charcoal, Digibind, and cholestyramine to bind digoxin and prevent absorption.

A HCP is caring for a pt who is to begin taking gemibrozil (Lopid) to treat hypercholesterolemia. Which of the following instructions should the HCP include when teaching the pt about the drugs? SATA Take w food Report any new intolerances to fried foods Report muscle tenderness Expect periodic LFTs Take the drug once a day

gemibrozil (Lopid) is a fibrate used to treat hypercholesterolemia. the client should report any new intolerance to fried food, bloating, or upper abd discomfort- this can indicate gallstones. The client should also report muscle tenderness, pain or joint pain because fibrates can cause myopathy that may lead to rhabdomyolysis. And expect periodic LFTs because fibrates can increase risk for liver toxicity. Avoid taking w food- should be taken 30 AC and it is taken twice a day

antimycobacterial (antituberculosis) rifampin (Rifadin) SHOULD NOT BE GIVEN W FOOD bactericidal- inhibition of protein synthesis

given in combo w at least one other antituberculosis medication to help prevent antibiotic resistance. Adverse effects: Discoloration of body fluids (expect orange color of urine, saliva, tears, and sweat), Hepatotoxicity (jaundice, anorexia, fatigue, malaise; monitor liver function and avoid alcohol), Mild GI discomfort (anorexia, nausea, and abd discomfort-usually doesn't require intervention). Interactions: Rifampin accelerate metabolism warfarin, oral contraceptives, protease inhibitors, and NNRTIs- meds for HIV-results in diminished effects (increase dosage of HIV meds, monitor PT/INR, may need to use alternative form of BC) Concurrent use w/ isoniazid and pyrazinamide increases risk of hepatotoxicity (avoid alcohol use and monitor LF). Admin 1 hr before or 2 hr after meals- food decreases absorption

Antimycobacterial (Antituberculosis): isoniazid (Laniazid) Pyrazinamide Ethambutol (Myambutol) Rifapentine (Priftin)

highly specific for mycobacteria; inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall. Indicated for active and latent tuberculosis. isoniazid is contraindicated in liver disease and Rifapentine in children under 12, HIV patients, and pregnant women. Adverse effects include: Peripheral Neuropathy (tingling numbness burning and pain r/t deficiency of pyridoxine, Vit B6-admin 50-200 mg of B6), Hepatotoxicity (anorexia, malaise, fatigue, nausea, and jaundice of skin and eyes-avoid alcohol, d/c if LFT abnormal), Hyperglycemia and decrease glucose control in clients w/ DM (monitor BG may require antidiabetic meds) Interactions: Isoniazid inhibits phenytoin metabolism leading to buildup/toxicity (Ataxia and impaired coordination) Avoid concurrent use of alcohol, rifampin, and pyrazinamide- increases risk of hepatotoxicity. when give IM make sure crystal free and deeply into the muscle. take isoniazid 1 hr before meals or 2 hrs after- take w meals if gi upset.

Cholesterol Absorption Inhibitor - ezetimibe (Zetia)

inhibits absorption of cholesterol secreted in bile and from food. used as an adjunct for clients w/ TLC to lower cholesterol. can be used alone or w/other statins. Can cause hepatitis and myopathy and contraindicated in clients w/ active moderate- severe liver disorders. Bile acid sequestrants interferes w/ absorption (eztimibe 1 hr before 4 hr after BAS), statins can increase risk for liver dysfunction, concurrent use of fibrates increase risk of cholelithiasis (gallstones) and myopathy, and cyclosporine increases ezetimibe levels- monitor for liver damage and myopathy. report muscle aches and pains, follow low fat low cholesterol diet w/ regular exercise

Medications for UTI- Sulfonamides and Trimethoprim; sulfamethoxazole- trimethoprim (SMZ-TMP, Bactrim, Septra), Sulfadiazine, trimethoprim

inhibits bacterial growth by preventing synthesis of folic acid, which is essential to production of DNA, RNA, and protein. Adverse effects can include Hypersensitivity including Stevens- Johnson syndrome (do not admin SMZ-TMP to clients allergic to sulfa drugs, Thiazide & loop diuretics, and sulfonylurea type oral hypoglycemics like tolbutamide), Blood dyscrasias (hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia; observe for bleedign episodes, sore throat, or pallor- BL CBC levels), Crystalluria (crystalline aggregates in the kidneys, ureters, and bladder leading to irritation and obstruction; maintain adequate oral fluid intake 2-3 L/day and UO at least 1200 ml/day), Kernicterus (jaundice, hyperbilirubenemia; avoid use in pregnant women and infants younger than 2 mo), Photo-sensitivity (avoid prolonged exposure to sunlight, use sunscreen, wear protective wear). Sulfonamides increases the effects of Warfarin, Phenytoin, sulfonylurea oral hypoglycemics and tolbutamide- monitor PT/INR and BG levels. Contraindicated in clients w/ folate acid deficiency- increases risk for megaloblastic anemia. used cautiously in clients who have renal dysfunction and clients > 65 yo taking ACE-I and ARBs - risk of hyperkalemia. Take n empty stomach w/ glass of water and complete prescribed therapy.

a nurse is monitoring a client who is receiving a dopamine infusion at a moderate dose for the treatment of severe heart failure? which of the following is the expected effect? lowered heart rate increased myocardial contractility decreased conduction through AV node Vasoconstriction of renal BV

moderate dose dopamine causes vasodilation of renal BV, increased HR, increased myocardial contractility, and increased rate of conduction through AV node. Low dose dopamine- vasodilation renal BV High dose dopamine- renal BV dilation, Increased HR, force of contraction, and rate of conduction through av node with vasoconstriction causing increased B/P

a nurse is monitoring serum electrolytes for four OA clients who take digoxin (lanoxin) and furosemide (Lasix). which of the following electrolyte values put the client at risk for digoxin toxicity? calcium 9.2 calcium 10.3 potassium 3.4 potassium 4.8

potassium levels below norm can cause fatal dysrrhythmias and puts the client at risk for dig toxicity. the client may need potassium supplements and/ or potassium sparing diuretics. the calcium levels are WNL and potassium of 4.8 is WNL.

Antiprotozoals- metronidazole (Flagyl) bactericidal against anaerobic microorganisms

prophylaxis for clients who will have surgical procedures and are high risk for anaerobic infections (vaginal abd colorectally) and tx of H. Pylori in combo w/ tetracycline and bismuth salicylate (pepto bismol) in clients w/ peptic ulcer disease. Adverse effects: GI discomfort (N/V, dry motuh, and metallic taste- notify provider) Darkening of urine (harmless effect), CNS manifestations (numbness of extremities, ataxia, and sz-stop meds and notify provider) Contraindication: active CNS disorders, blood dyscrasias, and during lactation and first trimester of pregnancy w clients w/ trichomoniasis. Alcohol causes a disulfiram-like reaction-avoid alcohol Metronidazole inhibits inactivation of wafarin- monitor PT/INR and adjust warfarin accordingly. complete full course of antimicrobial therapy even if symptoms resolve before finished.

A nurse is reviewing the health record of a client who is starting propranolol (Inderal) to treat HTN. Which of the following conditions is a contraindication for taking propranolol? Asthma Diabetes Angina Tachycardia

propranolol (inderal) is a beta 1 and beta 2 blockers that affects the heart and the lungs causing decreased HR, myocardial contractions, and conduction rate through AV node. It causes bronchoconstriction in asthma clients and should be avoided. W/ diabetes pts beta blockers are used cautiously b/c it mask hypoglycemic S/S. It can be prescribed too treat angina pectoris and tachydysrrhytmias . It would be contraindicated for AP <60 bpm and AV block

A nurse is reinforcing teaching w a client who has type II DM and is starting repaglinide (Prandin). Which of the following statements made bt the client indicates understanding of the administration of this medication? Ill take this with my meals Ill take this 30 mins before i eat Ill take this just before i go to bed Ill take this as soon as i wake in the AM

repaglinide is a postprandial medication given TID 30 minutes AC and should eat within 30 mins after receiving it. Must ensure the client is going to eat their meals because it can cause hypotension.

a nurse is reinforcing teaching about ciprofloxacin (Cipro) w/ a female client who has a severe UTI. which of the following information about adverse reactions should the nurse include in teaching? SATA Observe for pain/swelling of Achilles tendon Monitor for vaginal yeast infection Check for excessive nighttime diaphoresis Inspect the mouth for cottage cheese like lesions take medication w/ a dairy product

the client should observe for pain/swelling of achilles tendon and monitor for vaginal yeast infections- curd/cottage cheese like lesion in mouth or vagina can indicate suprainfection. Diaphoresis is not an adverse effect of Cipro and should not be taken w/ dairy or milk products- milk products should be taken 6 hr prior to or 2 hrs after ciprofloxacin medications- decreases absorption of ciprofloxacin

a nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for one month. the digoxin level is 0.25 ng/mL. the nurse should anticipate which of the following? an increase in digoxin levels a decrease in clients dig levels no change in digoxin level discontinuation of digoxin prescription

the digoxin level of 0.25 is below the therapeutic range of 0.5 -2.0 ng/ mL. the nurse should anticipate an increase in the digoxin

a nurse is reinforcing teaching to a client who has a new prescription for digoxin (lanoxin). which of the following can indicate digoxin toxicity and should be reported to the provider? select ATA fatigue constipation anorexia rash diplopia

the nurse should monitor for fatigue, GI effects such as N/V/D and anorexia, and visual changes such as blurriness, diplopia, yellow-green or white halos around objects.

A nurse is caring for a client who is taking ritonavir (Norvir), a protease inhibitor, to treat HIV infection. For which of the following abnormalities in laboratory values should the nurse monitor? Increased TSH and T4 levels Decreased AST and ALT Hypoglycemia Hyperlipidemia

the nurse should monitor for hyperlipidemia, hyperglycemia, and increased liver enzymes AST and ALT.

a nurse is caring for a client who is starting a course of gentamicin IV for a serious respiratory infection. for which of the following adverse effects should the nurse monitor? SATA Drowsiness Hematuria Muscle weakness Difficulty swallowing Vertigo

the nurse would monitor adverse effects of gentamicin including ototoxicity (tinnitus, hearing/balance loss, vertigo, HA, nausea, ataxia), Nephrotoxicity (hematuria, cloudy urine, proteinuria, casts, diluted urine, elevated BUN and creatinine), Neuromuscular blockade (muscle weakness and RD), and hypersensitvity (rash, pruritis, urticaria, paresthesia of hands/feet) Dysphagia and drowsiness arent adverse signs of Gentamicin

A nurse is caring for an older adult client in a LTC facility who has hypothyroidism and is beginning levothyroxine (Synthroid). Which of the following dosage schedules should the nurse expect for this client? The client will start a high dose then taper down PRN The client will remain on the initial dose during the course of tx The clients dosage will be adjusted daily based on blood levels The client will start a low dose and will be gradually increased

to prevent toxicity, the elderly client will start on the lowest dosage possible and gradually increased to received the lowest therapeutic dosage possible.

Bile Acid Sequestrants colesevelam HCL (Welchol) colestipol (Colestid)

used as an adjunct w/ HMG CoA Reductase Inhibitors (Statins) and dietary measures to lower LDL cholesterol. Adverse effect- Constipation Contraindicated- pancreatitis r/t high TGs and in bowel obstruction. take other medicatons 4 hr before take BAS: Synthroid, 2nd gen sulfonylureas, phenytoin, Fat soluble Vits, and oral contraceptives. Should be taken w/ food and water (Welchol) taken 30 mins before meals; not crushed/chewed (Colestid)

Nicotonic Acid, Niacin (Niacor, Niaspan- raise HDL)

used for clients at risk for pancreatitis and elevated TGs; works by decreasing LDL and TGs levels Can cause GI distress and may be take w food, facial flushing, feeling of warmth, tingling of hands/feet, hyperglycemia, hepatotoxicity and hyperuricemia (monitor kidney function, BUN, creatinine, I/O, encouage 2-3 L fluids, admin allopurinol if uric acid elevated) Standard admin is TID w/ or after meals. dosage much larger when taken as vitamin supplement.

Fibrates gemifibrozil (Lopid) fenofibrate (Tricor)

used for clients who cannot lower TGs w/ TLC or other antilipemic meds); decrease in TGs levels and increase in HDLs Adverse effects- GI distress, gallstones (RUQ pain, fat intolerance, bloating), myopathy, and hepatotoxicity. Contraindicated in clients w/ liver disorders, severe renal impairment, and gallbladder disease. avoid concurrent use w/ statins- increase risk of myopathy and concurrent use of warfarin increase risk of bleeding (monitor PT and INR and report indications of bleeding)

Antibiotics affecting bacterial cell wall Vancomycin (Vancocin) Aztreonam (Azactam)- monobactum Fosfomycin (Monurol)

used for serious infections c/b methicillin- resistant Staphylococcus aureus, E. Coli, or Staphylococcus epidermidis and antibiotic associated pseudo membranous colitis c/b C Diff. Can cause hearing loss and increased risk when used w/ other ototoxic drugs (loop diuretics and aminoglycosides), infusion reactions (red man syndrome; rashes flushing tachycardia and hypotension) IV infusion site thrombophlebitis- redness swelling inflammation, and Renal toxicity- monitor I/O and renal function tests. contraindicated in those w/ corn or corn product allergy or previous reaction to vancomycin. IV dose may be adjusted according to creatinine clearance levels if renal insufficiency is present.

Antianginal Agent- ranolazone (Ranexa)

used in chronic stable angina in combo w/ amlodipine, b blocker, or organic nitrate; lowers cardiac oxygen demand thus improving activity tolerance and decreases pain. Adverse effects- QT prolongation and elevated B/P. Should avoid concurrent use w/ CYP3A4 inhibitors (grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungals, and verapamil), Quinidine, and sotalol (Betapace). it can increase digoxin levels and simvastatin levels - monitor dig level and report muscle weakness. Admin 2X/day w/ or w/o food.