Pharm Final Protypes & EAQ

Montelukast (Singulair)

leukotriene receptor antagonist to prevent asthma Take at least 2 hrs prior to exercise Takes 3-7 days to reach effectiveness Can cause hepatoxicity

Vitamin D

Enables the body to properly absorb and use calcium Needed for proper bone development and maintenance Fat soluable

Guaifenesin (Mucinex)

Expectorant that decreases viscosity of secretions Use for productive coughs Stay hydrated: 2-3 L/day Increased drowsiness in large doses

Docusate sodium (Colace)

Facilitates movement of water and fats into stool to improve regularity Prevents constipation with opioid use BM in 12-72 hrs

Fluticasone

For asthma attack prevention Not used to treat acute asthma attacks Can mask signs of infection and raise blood glucose levels Rinse mouth after use

epinephrine

For severe allergic reactions, cardiac resuscitation, hypotension in shock, and control of local bleeding Phentolamine used for IV filtration Don't use in fingers, toes, ears, or nose Epi pens effects only last 15-20 min

Prednisone (Deltasone)

Glucocorticoid used for antiinflammatory and immunosuppression Increases risk for osteoporosis and growth suppression in children Increases blood glucose and masks signs of infection Don't stop abruptly

Famotidine (Pepcid)

H2 receptor antagonist Decreases symptoms of GERD Take 15-60 min prior to eating or drinking Report signs of bleeding ulcers or increased pain

Calcium

Herbal used to improve bone density Take with Vitamin D for better absorption Improves bone density Monitor RR

Levothyroxine (Synthroid)

Hypothyroidism Take 30-60 min prior to breakfast Administer 4 hours after antacid, iron, or calcium Increases hyperglycemia in diabetics Hypersensitivity reactions

Phytonadione (Vitamin K)

Increases risk of blood clots Reversal of warfarin Change in taste Store in dry place

Metronidazole

Inhibits protozoan folic acid synthesis Contraindicated in pregnancy Metallic taste Avoid alcohol to prevent disulfiram- like reactions

NPH

Intermediate acting insulin White, cloudy suspension Can be mixed with rapid or short acting insulin Administer 1-2 times daily Peak 6 hours

Toujeo & Glargine (Lantus)

Long acting insulin Used in addition to rapid or short acting insulin Administer once daily at night No peak

Pantoprazole (Protonix)

PPI used to treat GERD Take 30 min prior to first meal Avoid alcohol, NSAIDs, or foods that cause irritation

Clopidogrel (Plavix)

Platelet Aggregation Inhibitor Decreases risk of MI or stroke OD is irreversible Effect lasts 7-10 days

Amiodarone (Cordarone)

Potassium channel blocker that treats ventricular arrhythmias Monitor BP and HR Can cause neurological impairments, GI disturbances, vision changes, and photosensitivity

Lispro (Humalog)

Rapid-acting insulin 1-3 hr peak, 30 min onset Administer 15 min prior to meals Can be mixed with NPH

Morphine

Reversal agent is Narcan Monitor RR and BP Can cause respiratory depression, hypotension, and sedation

Canagliflozin (Invokana)

SGLT2 inhibitor Improves glycemic control in Type 2 Give before first meal Can cause hyperkalemia Increased risk of lower limb amputation

Ibuprofen

Safe for infants 6 mo and older Can cause GI bleed, constipation, Steven-Johnson syndrome, and renal failure Stay well hydrated to prevent renal failure

Humulin R, Novolin R

Short insulin Dose based on carb intake Can be given IV Peak 3 hours Administer 30 min prior to meals

Ketorolac

Short term management of moderate to severe pain Ibuprofen is contraindicated Reduce dose for over 65 years old Can cause abnormal taste

Acetylsalicylic acid

reduces risk of heart attack/stroke Not for children or teenagers d/t Reye's syndrome Report GI bleed or tinnitus Used for analgesia, reduce inflammation, reduce fever, and decrease platelet aggregation

Methylphenidate

used for ADHD monitor growth and weight in children increased HR and BP avoid alcohol and caffeine

lithium

used for manic episodes and bipolar disorder can cause hyponatremia toxic level is 1.5 mEq/L may take 1-3 wks to improve

haloperidol

used for schizophrenia and Tourette's disorder contraindicated in Parkinson's disease and dementia with Lewy Bodies can cause involuntary motor symptoms takes several weeks for effects

lorazepan

used for sedation, antianxiety, and anticonvulsant effects CNS depression Benzodiazepine

Cyclobenzaprine

used to reduce muscle spasms administer at meal time to prevent GI upset use caution with pts who take antidepressants and other CNS depressants Serotonin syndrome

Metoprolol

Beta 1 blocker Check apical pulse and BP before dose Sit on side of bed to prevent orthostatic hypotension Don't stop abruptly to prevent rebound HTN

Metformin (Glucophage)

Biguanide Don't give with contrast dye Contraindicated in renal disease Can cause N/V/D, abdominal discomfort Doesn't cause hypoglycemia

Phentolamine (Regitine)

-alpha blocker that reduces peripheral vascular resistance and is also used to treat HTN. -Most often used to treat the extravasation of vasoconstriction drugs such as norepinephrine, epi, and dopamine, which when given IV can leak out of the vein esp if the IV tube is not correctly positioned. Monitor BP during administration Can cause hypotension and bradycardia

A client who is on metformin therapy is scheduled to undergo renal computed tomography (CT) with contrast dye. Which instruction from the primary health care provider would the nurse anticipate reinforcing with the client? 1. Discontinue metformin 1 day before procedure 2. Discontinue metformin 1 week before procedure 3. Discontinue metformin 3 days after the procedure 4. Discontinue metformin 7 days after the procedure

1. Discontinue metformin 1 day before the procedure Metformin can react with the iodinated contrast dye that is given for a renal CT and cause lactic acidosis. The nurse anticipates the instruction that the client discontinue the metformin 1 day before the procedure. The client is advised to discontinue the metformin for at least 48 hours after the procedure.

A child is prescribed insulin glargine before breakfast. Which instruction is most appropriate for the nurse to give the parents regarding bedtime snack? 1. Offer a snack to prevent hypoglycemia during the night 2. Give the child a snack if signs of hyperglycemia are present 3. Avoid a snack because the child is being treated with long acting insulin 4. Keep a snack at the bedside in case the child gets hungry during the night

1. Offer a snack to prevent hypoglycemia during the night Insulin glargine is released continuously throughout the 24 hour period; a bedtime snack will prevent hypoglycemia during the night

A client has been taking levothyroxine for hypothyroidism for 3 months. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply 1. Tremors 2. Brady cardia 3. Somnolence 4. Heat intolerance 5. Decreased blood pressure

1. Tremors 4. Heat intolerance Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia

Diphenhydramine (Benadryl)

1st generation antihistamine Can cause anticholinergic (ACh) effects, CNS depression, or CNS stimulation Paradoxical (opposite) effect in children Avoid alcohol or CNS depressants d/t sedation

A health care provider prescribes psyllium 3.5 g twice a day for constipation. Which statement is important for the nurse to teach this client? 1. Urine may be discolored 2. Each dose should be taken with a full glass of water 3. Use only when necessary because it can cause dependence 4. Daily use may inhibit the absorption of some fat soluble vitamins

2. Each dose should be taken with a full glass of water. Because this medication has a strong affinity for fluids, it will swell in the intestine. The large bulk stimulates peristalsis. A full glass of fluid taken at the same time will help minimize the risk of esophageal obstruction or fecal impaction

A child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7:00 AM each day. What time would the nurse anticipate a hypoglycemic reaction from the NPH insulin? 1. Before noon 2. In the afternoon 3. Within 30 minutes 4. During the evening

2. In the afternoon NPH insulin is an intermediate acting insulin that peaks approximately 6-8 hours after administration. It was administered at 7:00 AM, so between 1:00 PM and 3:00 PM is when the nurse would anticipate that a hypoglycemic reaction would occur.

When a client with chronic obstructive pulmonary disease has a new prescription for daily low dose prednisone, which information will the nurse include when teaching the client? 1. Take the medication an hour before eating 2. Report any dark stools to the health care provider 3. Weight loss is a common side effect of the medication 4. Take the medication as soon as you experience dyspnea

2. Report any dark stools to the health care provider Because corticosteroids can cause peptic ulcers and gastrointestinal bleeding, the client will be instructed to call the health care provider for any symptoms of ulcer such as gastric pain or dark stools.

Digoxin

2nd line treatment for heart failure or A. fib Toxic level is 2ng/mL Toxicity signs are bradycardia, N/V, vision changes, arrhythmias Avoid high fiber diets to ensure absorptions

A client reports frequently taking calcium carbonate. The nurse advises the client that this can have which effect? 1. Diarrhea 2. Water retention 3. Rebound hyperacidity 4. Bone demineralization

3. Rebound hyperacidity

The nurse recognizes that a client who receives regular insulin daily at 8:00 AM would have the greatest risk of hypoglycemia during which period of time? 1. 8:30 AM to 9:30 AM 2. 8:00 PM to 12:00 AM 3. 1:00 PM to 8:00 Pm 4. 10:00 AM to 1:00 PM

4. 10:00 AM to 1:00 PM Regular insulin peaks in 2-5 hours

A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. Which intervention is appropriate? 1. Administer insulin to the client 2. Give the client lunch immediately 3. Encourage the client to drink fluids 4. Assess the client's blood glucose level

4. Assess the client's blood glucose level The client needs glucose, not just fluids. The presence of hypoglycemia should be determined before initiating therapy; Humulin R insulin given in the morning peaks within 4 hours or just before lunchtime. After hypoglycemia is verified, the client should be given an immediate source of glucose. Administering insulin is contraindicated; the client is experiencing adaptations of hypoglycemia, and administering insulin will decrease further and already low blood glucose level. Giving the client lunch may be done after hypoglycemia is determined.

A health care provider prescribes famotidine for a client with dyspepsia. Which statement is important to include in a teaching session about famotidine? 1. Lowers the stress level 2. Neutralizes gastric acidity 3. Reduces gastrointestinal peristalsis 4. Decreases secretions in the stomach

4. Decreases secretions in the stomach Famotidine inhibits histamine H2 receptor sites in the stomach, inhibiting gastric acid secretion.

Famotidine is prescribed for a client with peptic ulcer disease. Which mechanism of action is a characteristic of this medication? 1. Increases gastric motility 2. Neutralizes gastric acidity 3. Facilitates histamine release 4. Inhibits gastric acid secretion

4. Inhibits gastric acid secretion

A health care provider prescribes daily docusate sodium for a client. The nurse explains to the client that this medication has which action? 1. Lubricates the feces 2. Creates an osmotic effect 3. Stimulates motor activity 4. Softens the feces

4. Softens the feces Docusate sodium promotes the drawing of fluid into the stool, which softens the feces.

A health care provider prescribes bisacodyl for a client with constipation. The nurse explains to the client that this medication acts by which mechanism? 1. Producing bulk 2. Softening feces 3. Lubricating feces 4. Stimulating peristalsis

4. Stimulating peristalsis Bisacodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowl movement.

Acetaminophen

Acetylcysteine is antidote Don't take more than 10 days Don't exceed 4,000 mg/day

Which action by a client taking alendronate requires correction? Select all that apply. 1. Taking medication twice a week 2. Taking medication before rising 3. Taking medication with breakfast 4.Taking medication before bedtime 5.Taking medication with apple juice

All of them need correction Bisphosphonates such as alendronate have specific dosing instructions. The medication is given once a week. Clients must remain in an upright position for 30 minutes after taking the medication. Clients should refrain from eating right before they are given the medication and should take it with a full glass of water because of the risk of esophagitis. Alendronate must be administered in the morning. Clients should take the medication with water.

Clonidine (Catapres)

Alpha 2 Agonist used for hypertension and ADHD Monitor BP and pulse Dose adjusted to pt's BP Avoid alcohol, and other CNS depressants

Calcium Carbonate (Tums)

Antacid that neutralizes gastric acid & increases pH of stomach Use cautiously with renal disease Rebound hyperacidity when D/C'd Take 3-4 times daily

Atropine Sulfate

Anticholinergic Can be used to diminish secretions and increase HR Reversal agent for cholinergic drug OD Causes dry mouth Large doses decrease GI motility

Scopolamine

Anticholinergic used for prophylaxis of motion sickness Patch is applied for 3 days Monitor for anticholinergic effects Reduces secretions

Heparin Sodium

Anticoagulant used for DVT and PE Monitor PTT Protamine sulfate is the reversal agent Avoid aspirin and NSAIDs

Warfarin

Anticoagulant used to prevent/treat DVT, PE, and thromboembolic complications Vit K is the reversal Monitor INR Can take 3 days to reach full effect

Gabapentin (Neurontin)

Anticonvulsant used for seizures or neuropathic pain Don't take within 2 hours of antacid use Increase risk of suicidal thoughts or behaviors Take at night to decrease dizziness and drowsiness

Prochlorperazine (Compazine)

Antiemetic that calms CNS Controls N/V associated with surgery Can cause pink to reddish brown urine Avoid alcohol & other CNS depressants d/t drowsiness

Atorvastatin (Lipitor)

Antihyperlipidemic Take the same time each day with or without food Avoid grapefruit juice Notify provider of muscle pain, tenderness, or weakness

Benzonatate (Tessalon Perles)

Antitussive for dry, hacking, non-productive coughs Don't use for productive coughs Avoid irritants that stimulate coughs Can cause dizziness, headaches, and nasal congestion

Tetracycline

Avoid use in children under 8 due to permanent teeth discoloration Photosensitivity Take at least 1 hour before bed to prevent esophageal irritation Impaired absorption with dairy products

Albuterol

Bronchodilator used to prevent/treat asthma and exercise induced bronchospasm Rescue inhaler Wait 2 min between inhalations Can cause CNS stimulation and tachycardia

psyllium mucilloid (Metamucil)

Bulk forming laxatives Mix with 8 oz water and take quickly after mixing Can cause bloating or cramping BM in 12-72 hrs

Glipizide (Glucotrol)

Controls hyperglycemia Take with meals Peak 1-3 hrs Can cause hypoglycemia

Penicillins

Cross sensitivities with cephalosporins Can cause black hairy tongue Monitor for superinfections Take with a full glass of water

Cephalosporins

Cross sensitivities with penicillins Drug interaction to anticoagulants Adjust dosage with renal impairment Monitor for superinfections

Propranolol (Inderal)

Nonselective beta blocker Used for high BP or migraine prevention Contraindicated in pts with COPD or asthma Can cause bronchoconstriction

Sitagliptin (Januvia)

DPP-4 inhibitor Reduces fasting blood sugar Give with or without food Dose based on GFR

polyethylene glycol (Miralax)

Osmotic laxative Causes water to be retained in stool Dissolve in 4-8 oz of liquid Produces BM in 1-3 days Can cause watery, loose stool

Aluminum/magnesium (Maalox)

Take after meals or bedtime Take with a full glass of water Long term use causes constipation Avoid food or beverages that increase acidity

Levofloxacin

Take with water 2 hours before or after meals Can cause tendonitis/tendon rupture Can cause neuropathy and CNS effects Avoid use of antacids

Levodopa/Carbidopa (Sinemet)

Used for Parkinson's and restless leg syndrome Take with meals to help with use of utensils Can discolor body fluids Avoid diets high in protein d/t decreased absorption

Sulfamethoxazole

Used for UTIs or Otitis Media Increased risk of crystaluria D/C if rash is noted Drink at least 2 L of fluid daily

Nirtoglycerin

Used for angina d/t coronary artery disease Take 1 tab every 15 min, up to 3 doses Don't take with sildenafil Can cause hypotension, palpitations, headache, and weakness

Erythromycin

Used for respiratory infections or otitis media Take with or without food Significant impact on liver function May prolong QT interval

Vancomycin

Used to treat c. Diff Monitor peak and trough levels Redman Syndrome nephrotoxicity and ototoxicity

Oseltamivir

Used to treat influenza Needs to be taken within 48 hours of symptoms Neuropsychiatric symptoms

Donepezil (Aricept)

acetylcholinesterase inhibitor Reduces Alzheimer's symptoms Administer before bed Monitor for GI bleeding

Ipratropium (Atrovent)

anticholinergic bronchodilator Used for maintenance of asthma, chronic bronchitis, and emphysema Can cause cough and drying of nasal mucosa

Alendronate (Fosamax)

bisphosphonate for osteoporosis Take 30 min before food Sit or stand for 30 min after taking May need to take calcium and vitamin D suppliment

Pseudoephedrine (Sudafed)

decongestant (alpha-1 adrenergic agonist) Contraindicated with MAOIs Don't administer within 2 hrs of bedtime Monitor for elevated BP, urinary retention, nervousness, or trouble sleeping