pharm exam #4 quizlet (quiz questions included!!)

substance abuse: what drug am i? •Alcohol detox •Decreases alcohol cravings •Avoid if asthma •Treats essential tremors •Treats tachycardia •Ends in olol

propranolol

For which of the following side effects should a patient taking furosemide for hypertension be assessed? a. restlessness b. visual disturbance c. hear loss or tinnitus d. tremors

c, hear loss or tinnitus

The nurse should teach a patient who will be taking nitroglycerin about which common adverse effect of this drug? a. weakness b. dizziness c. blurred vision d. headache

d, headache

ace inhibitors mechanism of action

//

[early symptoms of hypokalemia] Lethargy Hypotension Muscle weakness Nausea Anorexia Mental confusion

[late symptoms of hypokalemia] dysrhythmias neuropathy paralytic ileus alkalosis

what do ace inhibitors end in?

pril

how many occasions of elevated BP do you need to be a diagnosis for htn?

2 separate occasions

diuretic case study: Dr. G., a 62-year-old university professor, has been diagnosed with primary hypertension and will be taking 50 mg of hydrochlorothiazide (HCTZ) daily. There is no evidence of renal insufficiency or cardiac damage at this time, nor is there evidence of retinopathy or other S & S of end-organ disease. She is anxious because the fall semester is starting and she has a heavy teaching load but is willing to take the steps needed to better her health.

At her 1-month follow-up appt., Dr. G. complains of "feeling tired" and asks whether the medication causes sleepiness. When questioned, she says that she takes the HCTZ at dinnertime because she is afraid it will "interfere with her classes."

angina case study: A patient with type II diabetes has been taking a beta-blocker for a month and notices that his blood glucose levels have been higher than usual. What is the problem?

Beta-blockers may cause hyperglycemia or hypoglycemia. In addition, because they cause a decrease in heart rate, beta blockers may mask the tachycardia that is associated with hypoglycemia

diuretic case study: During the follow-up appt., you ask Dr. G. if she is eating food high in potassium. She looks embarrassed and answers, "I lost the pamphlet about foods with K+, but I try to drink orange juice everyday." •What foods should she eat for K+?

Foods high in K+ include: Bananas, oranges, dates, raisins, plums, fresh vegetables, potatoes (white or sweet), meat, fish, apricots, whole grain cereals, and legumes.

what do ace inhibitors cause?

HYPERkalemia

diuretic case study: The report on Dr. G."s K+ level comes back from the lab, and the results are 3.4 mEq/L. She asks, "Am I going to be put on a K+ pill too?" •What is your answer?

Hydrochlorothiazide (HCTZ) diuretics may cause hypokalemia, so it is very important to monitor the patient's serum K+ levels regularly. (In general, K+ supplements are not started until the serum K+ levels decrease to 3mEq/L.)

diuretic case study: What do you suspect is happening with Dr. G., and what would you recommend?

If she is taking the diuretic in the evening, its action may be interfering with her sleep by causing her to wake up to urinate. In addition, there are also safety concerns because she may experience dizziness along with orthostatic changes while getting out of bed increasing her risk of falling and injury. (the nurse should recommend taking the diuretic in the morning, after her first block of classes.)

angina case study: A 73-year-old man begins to experience chest pain while golfing on a warm day. He reaches for the bottle of sublingual nitroglycerin he keeps in his pants pocket, and takes one tablet. He notices that the tablet does not burn under his tongue, and that the chest pain is not relieved. What should happen next?

If the sublingual medication does not burn or sting when placed under the tongue, then the medication has lost its potency. The prescription will need to be refilled. However, if he is still experiencing chest pain, then emergency services will need to be called.

angina case study: After a month, M.S. is switched from the extended release capsules to a transdermal nitro patch. He says that he is glad he does not have to remember to "take those pills" tid. However, 2 months later he calls and says, "I don't think this patch is working. I'm having more episodes of chest pain when I jog." What could be the explanation for this and what can be done?

M.S. should see his PCP for evaluation to make sure the frequency of the angina attacks are not caused by a worsening cardiac condition. (However, the most likely cause is tolerance. To prevent this, a regular nitrate-free period for 8 hours at night then replace the patch in the morning.)

diuretic case study: A patient taking a loop diuretic c/o weakness and leg cramps. •What is your nursing action?

Notify the PCP and check the patient's K+ level.....these are possible signs of hypokalemia.

diuretic case study: Why is it dangerous to administer both a potassium supplement and drugs like spironolactone?

Spironolactone is a potassium-sparing diuretic. If it is given with a potassium supplement, the patient could develop hyperkalemia, which could cause cardiac irregularities, and, if potassium levels are severely high, cardiac arrest could occur.

angina case study: Mr. M.S., a 68-year-old accountant, has been diagnosed with coronary artery disease (CAD) after experiencing chest pain at times when he jogs. After undergoing a thorough physical exam, including cardiac cath, he is given a prescription for extended release nitro capsules 6mg tid. He also has a prescription for 0.4mg sublingual nitro tablets to take prn for chest pain. M.S. wants to know why he has 2 prescriptions for the same med?

The extended release oral form is given to prevent angina attacks. The sublingual tablet is a rapid acting form of nitro that acts to stop the chest pain during an angina attack.

angina case study: Two days after he begins the nitro, M.S. calls the office complaining of "awful headaches". What is wrong? What is the best explanation, and what can he do about the headaches?

The most common undesirable effect is headache, which generally diminishes soon after the start of therapy. Acetaminophen may be given for drug-related headaches

diuretic case study: A 45-year-old woman is taking a loop diuretic. She is used to being physically active and complains that she gets "very dizzy" when she stands up suddenly. •What is your nursing action?

The patient is experiencing orthostatic (postural) hypotension and should be taught to change positions slowly to prevent this effect and to prevent injury from falling.

diuretic case study: A patient on diuretic therapy calls the office because he has had a "terrible gastrointestinal flu" for 2 days. He has not been able to eat or drink, has had vomiting and diarrhea, and feel very weak and lethargic.• (What is your nursing action?)

The patient needs to be evaluated for possible hypovolemia and may need to receive IV fluid replacement if he is unable to take fluids po. He should not take his diuretic at this time.

angina case study: A patient has been taking transdermal nitroglycerin for a week. On a follow-up visit, the nurse notices that the area around the patch is reddened. When asked, the patient states, "I don't know why my skin is so red. I put the patch on the same spot each day." What should the nurse say to the patient?

The patient needs to be instructed about rotation of application sites! The old patch should be removed, and the new patch applied to a new, non-hairy area of skin. The old site site should be cleaned carefully to remove medication residue.

diuretic case study: A patient taking spironolactone tells the nurse that she eats three bananas a day and drinks "plenty of orange juice" because she knows that she needs to take potassium while on this medication. •What is your nursing action?

This patient does NOT need to increase her K+ intake—she is on a K+ sparing diuretic! She may have some servings of K+ rich foods each day, but does not need to eat extra servings. (Her serum K+ level should be monitored while on this drug)

diuretic case study: 6 months later, Dr. G. is diagnosed with type 2 diabetes mellitus and is started on oral hypoglycemic therapy. •What should she be taught about managing her diabetes while taking the HCTZ?

When a patient with diabetes also has HTN, it is especially important to monitor both conditions carefully for control of both conditions. Prevention of end-organ damage (microvasculature of the eyes, kidneys, brain, and coronary vessels) is essential. (However, the HCTZ may cause hyperglycemia. Blood sugars should be monitored and hypoglycemic drugs may need altered to control diabetes.)

which assessing a patient who is taking a beta-blocker for angina, the nurse knows to monitor for which adverse effect? a. bradycardia b. dry cough c. hyperkalemia d. nervousness

a, bradycardia

a patient is to receive propranolol. The nurse would know that the client likely has which problem? a. hypertension, migraine headaches b. cushing's syndrome, parkinson's disease c. hypothyroidism, hypoglycemia d. acute bronchitis, asthma

a, hypertension/migraine headaches

what drug am i? •Antihypertensive •This med can increase lithium levels •This med can cause neutropenia, so monitor WBCs every 2 weeks for 3 months...watch for signs of infection: fever or sore throat •Adverse side effect: angioedema •Drug of choice for diabetics- Renal protective for diabetics •Monitor for elevated K levels (norm 3.5-5), so... •Avoid salt substitutes •Can cause a dry persistent cough •Ends in pril •Ex. Lisinopril

ace inhibitor

what drug am i? •Antihypertensive •Allows angiotensin I to be converted to angiotensin II, but blocks the receptors that receive angiotensin II •Given to replace ACE Inhibitor if patient gets an ACE cough •Ends in sartan •Ex. Losartan (Cozaar)

angiotensin II receptor blocker or ARB

the nurse is providing teaching to a patient who is recently prescribed nitroglycerin SL for acute angina attacks. The nurse should instruct the patient that they may repeat the nitroglycerin in __ minutes, if no relief in chest pain after taking the first nitroglycerin dose. a. 3 b. 5 c. 2 d. 1

b, 5

A patient with CHF is taking bumetanide. What would indicate that this medication is effective? a. occasional expiratory wheeze auscultated b. lungs are clear to auscultation bilaterally c. rales auscultated only in bases of lung fields d. weight has increased three pounds this week

b, lungs are clear to auscultation bilaterally

A patient is admitted to the hospital with hypotension. He is taking omeprazole, glucophage, nitroglycerin, amlodipine, propranolol, and sildenafil. Which medications would you question taking together? a. omeprazole and amlodipine b. nitroglycerin and sildenafil c. glucophage and propranolol d. propranolol and sildenafil

b, nitroglycerin and sildenafil

What action is recommended to help reduce the tolerance to transdermal nitroglycerin therapy that commonly develops? a. cut the patch in half for a week until the tolerance subsides. b. remove the patch at bedtime, then apply a new one in the morning. c. leave the patch on for 2 days at a time. d. omit a dose once a week.

b, remove the patch at bedtime, then apply a new one in the morning

The nurse should monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of the following diuretics? a. hydrochlorothiazide b. spironolactone c. furosemide d. metolazone

b, spironolactone

a nurse is providing information to a client who has a new prescription for hydrochlorothiazide. Which of the follow information should the nurse include? a. expect increase swelling of the ankles b. take the med with food to avoid GI upset c. plan to take the mediation at bedtime to avoid insomnia d. fluid should be limited in the morning

b, take the med with food to avoid GI upset

substance abuse: what drug am i? •Detox Alcohol treatment •Administer around the clock •Get baseline vs and maintains vs within normal limits •Decreases risk of seizures but still need seizure precautions •Decreases withdrawal symptoms •zolam or zepam last name, but cholordiazepoxide is still a family member •Chloradiazepoxide only given if able to tolerate po fluids •Diazepam, lorazepam

benzodiazepines

(angina/diuretic) what drug am i? •Used to treat HTN, angina, given after MI, migraines, essential tremors, stage fright, glaucoma, and tachydysrhythmias •Will increase or decrease blood sugars- Requires monitoring •Bradycardia •Change positions slowly •Avoid the Beta 2s such as propranolol (Inderol) if asthma •Ends in olol •Ex. metoprolol

beta blocker

what drug am i? - Used to treat HTN, angina, given after MI, migraines, essential tremors, stage fright, glaucoma, and tachydysrhythias -Will increase or decrease blood sugars- Requires monitoring -Bradycardia -Change positions slowly -Avoid the Beta 2s such as propranolol (Inderol) if asthma -Ends in olol -Ex. metoprolol

beta blocker

substance abuse: what drug am i? •Medication to support withdrawal/abstinence from nicotine •Given po •Avoid caffeine and other CNS stimulants to control insomnia •Chew sugarless gum or suck on hard candy to treat dry mouth •Decreases nicotine craving

bupropion

what is the normal range for serum potassium? a. 35-45 mg/dL b. 1.0-3.0 mEq/L c. 3.5-5.0 mEq/L d. 135-145 mg/dL

c, 3.5-5.0 mEq/L

What statement represents a good understanding of dietary teaching on spironolactone? a. "i will use salt substitutes" b." i will decrease my Vitamin K foods" c. "I will not use salt substitutes" d. "I will increase my Vitamin K foods"

c, i will NOT use salt substitutes

Which of the following diuretics is not indicated for peripheral edema, but it is used to reduce intraocular pressure, reduce intracranial pressure, and used for oliguria phase of acute kidney disease? a. metolazone b. triamterene c. mannitol d. hydrochlorothiazide

c, mannitol

A nurse is caring for a patient who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? a. ranolazine b. furosemide c. metoprolol d. captopril

c, metroprolol

which medication is the drug of choice for a hypertensive crisis? a. nitroglycerine b. fluoxetine c. nitroprusside d. levothyroxine

c, nitroprusside

a common side effect of lisinopril is? a. bradycardia b. tachycardia c. nonproductive dry cough d. hypokalemia

c, nonproductive dry cough

a 46 year-old man has been taking clonidine for 5 months. For the last 2 months, his blood pressure has been normal. During this office visit, he tells the nurse that he would like to stop taking the drug. What is the nurse's best response? a. It's likely that you can stop the drug if you exercise and avoid salty foods." b. I'm sure the doctor will stop it---your blood pressure is normal now." c. "This drug should not be stopped suddenly; let's talk to your doctor." d. "Your doctor will probably have you stop taking the drug for a month, and then we'll see how you do."

c, this drug should not be stopped suddenly; let's talk to your doctor

what drug am i? •Antihypertensive medication •May be used to treat migraines •May cause peripheral edema and constipation •Avoid grapefruit juice •Also a very nice drug...Verapamil, Nifedipine, and diltiazem •Ends in dipine •Ex. amlodipine

calcium channel blocker

what drug am i? •Antihypertensive •May cause drowsiness and sedation •Additive CNS depression if taken with alcohol •May cause dry mouth •May cause rebound hypertension if stopped abruptly- taper off over 2-4 days •Clonidine (Catapres)

centrally acting alpha2 agonist

substance abuse: what drug am i? •Medication to support withdrawal/abstinence from opioids •Obtain baseline vs •Avoid activities in patients who require mental alertness •Assists with the withdrawal effects related to diarrhea, nausea, and vomiting..but does not reduce cravings for opioids •Causes dry mouth, so chew sugarless gum or suck on hard candy to treat dry mouth

clonidine

a nurse is caring for a patient who has heart failure and is prescribed spironolactone and enalapril. what side effects should plan to monitor? a. hypokalemia b. hypercalcemia c. hypocalcemia d. hyperkalemia

d, hyperkalemia

bumetanide is prescribed for heart failure. When should this medication be given? a. before bed b. in the evening c. in the afternoon d. in the morning

d, in the morning

The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which is a potential nursing diagnosis for the patient taking antihypertensive medications? a. diarrhea b. impaired memory c. stress urinary incontinence d. sexual dysfunction

d, sexual dysfunction

substance abuse: what drug am i? •Oral medication used for alcohol abstinence maintenance that is an aversion behavioral tx •Wear a med alert bracelet •Check ALT and AST •Encourage participation in 12 step program •Advise patients that medication effects persist for 2 weeks following discontinuation •So... avoid any products containing alcohol •Use of alcohol concurrently with this medication can lead to acetaldehyde syndrome causing N/V, weakness, palpitations, and hypotension. If it progresses, it can lead to respiratory depression, CV depression, seizures, and death

disulfiram

"an ACE will give you a cough in your face" what kind of cough?

dry, unproductive cough

(angina/diuretic) what drug am i? •Diuretic used to treat pulmonary edema and HTN. May be used to treat hypercalcemia due to kidney stone formation •Change positions slowly-watch for signs of postural hypotension •Watch for tinnitus-indicates ototoxicity •Monitor for hypokalemia (K+ < 3.5 mEq/L) •Sign of hypokalemia-leg cramps •Monitor K+ levels closely if taking digoxin •furosemide (Lasix)

loop diuretic others: bumetanide, torsemide, and ethacrynic

substance abuse: what drug am i? Medication to support withdrawal/abstinence from opioids •Used for withdrawal and long-term maintenance •Encourage a 12 step program •This medication should be tapered slowly to produce detoxification •It is an oral opioid agonist that replaces the illegal opioid •Dependence is transferred from the illegal opioid to?

methadone

substance abuse: what drug am i? •Alcohol abstinence treatment •Opioid antagonist that suppresses the cravings and pleasurable effects of alcohol •Accurate history and urine triage to verify no opioid use, due to risk of opioid overdose •Take with food to decrease GI upset •Monthly injections if patient noncompliant

naltrexone

substance abuse: what drug am i? •Medication to support withdrawal/abstinence from nicotine •Not recommended for longer than 6 months •Avoid eating or drinking 15 minutes before and while using this medication •Chew slowly and intermittently over 30 minutes

nicotine gum

substance abuse: what drug am i? •Medication to support withdrawal/abstinence from nicotine •Avoid using nicotine products while using this medication •Apply to clean, dry skin each day •Remove prior to MRI and replace after MRI

nicotine patch

(angina/diruetic) what drug am i? •avoid sildenafil •Intravenous, topical, oral, sublingual, and translingual routes •May repeat dose every 5 minutes for a total of 3 doses •May cause headache •May cause orthostatic hypotension •Caution in patients with traumatic head injury (Increased intracranial pressure) or patients with decreased renal and liver function •Sublingual should burn if med is still potent-replace bottle 3 months after opening •nitroglycerin

nitrate

what drug am i? •Should not be administered in the same infusion as any other medication •Keep supine while administering, monitor EKG and blood pressure continuously •Titrate dosage •Medication needs to be given IV at a rate of 5 mcg/kg/min or less to prevent cyanide poisoning •May cause thiocyanate toxicity (delirium, psychosis) if this med is given over days and maintain levels < 10 mg/dL •Given for hypertensive crisis

nitroprusside (nitropress) other meds for hypertensive crisis are: nitroglycerin, nicardipine, clevidipine, enalapriat, esmolol

•Diuretic •Used to reduce intracranial pressure •Treatment for cerebral edema •Used to decrease intraocular pressure •NOT indicated for peripheral edema •May be used for oliguria phase of acute kidney injury •Adverse effects are heart failure, pulmonary edema, and kidney failure •Depending of the therapeutic intent, med is effective if: (Decreased intracranial pressure, decreased intraocular pressure, or normal kidney function urine output 30ml/hr, serum creatinine 0.6-1.2 mg/dl for men and 0.5-1.1 mg/dl for women and BUN levels 10-20mg/dl) •Ex. mannitol (Osmitrol)

osmotic diuretic

what drug am i? •Results in decreased blood pressure •Patient should lay down with initial dose due to first dose hypotensive effect •Ex. Doxazosin (Cardura)

peripheral alpha1 blocker/antagonist

(angina/diuretics) what drug am i? •May cause impotence in males or menstrual irregularities in females •Watch for lithium toxicity if taken concurrently •Monitor for hyperkalemia (K+ > 5.0 mEq/L) •Caution is recommended if taking an ACE Inhibitor-increased risk of hyperkalemia •If hyperkalemia develops, IV glucose and insulin injections will drive the K+ back into the cell •Spironolactone (Aldactone)

potassium sparing diuretics other meds: triamterene, amiloride

when taking bp

sitting 10 minutes arm at heart level

(angina/diuretics) what drug am i? •Initial drug therapy for most patients with hypertension without comorbidities •Take with food or after eating to prevent GI upset •Report urine output <30 mL/hr •Can cause hypokalemia •Can cause hyperglycemia •Ends in thiazide •Ex. Hydrochlorothiazide

thiazide diuretic

what drug am i? •Initial drug therapy for most patients with hypertension without comorbidities •Take with food or after eating to prevent GI upset •Report urine output <30 mL/hr •Can cause hyponatremia •Can cause hypokalemia •Can cause hyperglycemia •Ends in thiazide •Ex. Hydrochlorothiazide

thiazide diuretic

substance abuse: what drug am i? •Medication to support withdrawal/abstinence from nicotine •Take med after a meal •Monitor B/P •Reduces cravings •Reduces cravings by blocking the desired effects of nicotine •Titrate to minimize adverse effects •Contraindicated with chronic depression, mental illness or suicidal ideations •Notify provider if N/V, insomnia, new onset depression or suicidal ideations

varenicline