Pharmacology Exam 1
Muscle relaxant, makes people tired, & should not operate heavy machinery or drink alcohol
Cyclopenzaprine
If a person combines thyramine with their MAOI, what will happen?
Hypertensive crisis, die, or stroke
Explain what it means when a medication has an 8 hour half life?
In 4 hours, half of that medication will be gone
When a patient may need more than the initially prescribed dose to receive the desired effect
Tolerance
What class of drugs is most prominent for a patient experiencing extrapyramidal symptoms?
Traditional neuroleptics, haloperidol
Checking hepatic enzyme levels, notifying physicians, checking vitals, checking neuro status
Valproic Acid
Therapeutic: 50-125 ug/mL Toxic Levels: 150ug/mL
Valproic/ValproateAcid Levels
Can't see, can't spit, urine retention, no salivation's. Must order a Foley catheter for these patient's. Have patient increase fluids, chew sugar-free gum & mints. Must be sugar-free because the sugar is going to continue to dry things up.
Anti-cholinergics
What would you say to a patient that came in because they had a seizure & you find out they haven't been taking their antiepileptic medication?
Ask them why they have not been taking their medication
When should you administer benztropine? (Parkinson's)
At night for sedation effects
What do you do if a doctor writes an order you can't read?
Ask for clarification
Calms nerves by sustaining the GABA. Works on the central nervous system in the GABA receptors.
Benzodiazepines
AST: 10-40 units per liter ALT: 7-56 units per liter
Hepatic Enzyme Levels
What does oxycodone with APAP mean?
with Tylenol
Medication that works for seizures, can cross the placenta barrier and cause birth defects, a person can still get pregnant if using this drug and hormonal birth control at the same time, major side effect is gingival hyperplasia.
Phenation
How much Tylenol can you take in a 24 hour period?
3 grams/3,000mg
A charge nurse is supervising a newly licensed nurse provide care for a client who has a PCA pump. Which of the following statements made by the nurse requires further action by the charge nurse? A) "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it" B) "I noted that my client pushed the PCA button six times in the last hour, and the PCA lockout is set for 10 minutes" C) "I gave my client a bolus dose of morphine when I initiated the PCA pump" D) "I told the client's family that they must not push the PCA button for the client"
A) "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it" PSA pump is only used with narcotics
A nurse is providing teaching to a client who has schizophrenia and is receiving chlorpromazine. Which of the following client statements indicates a client understanding of the teaching? A) "I will contact my provider if I have difficulty urinating" B) "I am less likely to get an infection while taking this medication" C) "Weight loss is a sign that my medication dose is too high" D) "I may need to take this medication with an antacid due to stomach upset"
A) "I will contact my provider if I have difficulty urinating" Chlorpromazine has anticholinergic effects: urine retention
A nurse is caring for a patient who has just begun therapy with alprazolam to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication? A) Insomnia B) Bradycardia C) Hearing loss D) Hypertension
A) Insomnia Adverse effects of alprazolam is insomnia
What is the criteria NOT to give morphine?
Allergy, patient is already taking CNS medications, low blood pressure, respirations below 10, and an O2 saturation below 90%.
A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. Which of the following statements by the client indicates an understanding of the teaching? A) "If I get a rash from this medication, I will take my usual antihistamine" B) "I need to increase my fluid intake while taking this medication" C) "I should take this medication on an empty stomach" D) "If I get a fever while taking this medication, I will take some aspirin"
B) "I need to increase my fluid intake while taking this medication" When treating gout with allopurinol a buildup up of uric acid occurs. Uric acid begins to crystallize and need to be flushed out with urine.
A nurse is preparing to administer morphine IV to a client. Which of the following medications should the nurse plan to have available? A) Flumazenil B) Naloxone C) Protamine D) Neostigmine
B) Naloxone
Why are sympatholytics contraindicated in asthma care?
Betablockers make wheezing worse and work against the inhaler
Which atypical anxiolytic can be used on patients with COPD or respiratory problems?
Buspirone
A nurse is caring for a client who has a prescription for olanzapine. The nurse should monitor the client for which of the following manifestations as an expected response to this medication? A) A decrease in resting blood pressure B) Control of seizure activity C) Decreased auditory hallucinations D) Increased energy level and involvement in activities
C) Decreased auditory hallucinations
You have a patient taking MAOIs. What will you teach them?
Dietary restrictions, this is a last resort medication, can't have thyramine rich foods
Which type of medication will amplify tremors in a Parkinson's patient?
Haloperidol
What is the antidote to opioids?
Naloxone
Signs & symptoms are high fever, rigidity, arrhythmia, increased confusion, unstable blood pressure
Neuroleptic Syndrome
Long, half life medications with affects that overlap if two different types of these medications are given back to back. Wash out allows one drug to get completely out of the patients system to prevent overlapping effects
Psychotropic wash out period
What kind of medications cannot be crushed?
Sustained release tablet, enteric coated tablet (Aspirin), anything with an XL after it (depicote)
What would you do if a patient came in from an overdose of lorazepam?
Treat with flumazenil (Benzos end in pam/lam)
Does not work as a GABA sustainer. Can be used in COPD and respiratory patients. These patients cannot tolerate a suppressed respiration so they need this drug instead.
Atypical Benzos
A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates a understanding of the teaching? A) "I will report any loss of appetite" B) "Increased flatulence is an indication of toxicity" C) "Vomiting is an indication of toxicity" D) "I will call my provider if I experience any headaches"
C) "Vomiting is an indication of toxicity" Vomiting & diarrhea are early signs of lithium toxicity.
A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? A) "I should expect to feel better after 24 hours of taking this medication." B) "I should not take this medicine with grapefruit juice" C) "I'll take this medicine with food" D) "I'll take this medicine first thing in the morning"
D) "I'll take this medicine first thing in the morning" Fluoxetine will cause insomnia
Chemical produced internally that calms neurons.
GABA
What should a patient know about taking two high doses of aspirin for arthritis pain?
GI bleed, liver damage, nerve deafness, tinnitus
When you have a patient that is taking two neurolepitcs concurrently what are they at risk for?
Neuroleptic Syndrome
If you have a patient that is an epileptic and they are going home with a prescription for benzodiazepine taken 3 times daily, what should your discharge plan look like?
No alcohol, do not drive after taking this medication, no skipping doses, educate that they may require an increase in their dose due to tolerance
A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements? A) Sodium B) Potassium C) Vitamin K D) Vitamin C
A) Sodium Lithium is a salt
A nurse is preparing to administer the monthly injection of haloperidol decanoate to a client who has schizophrenia. Which of the following actions should the nurse plan to take? A) Have the client lie down for 30 minutes after the medication is injected B) Monitor the client for bradycardia following the injection C) Assess the client for a sudden relapse of manifestations D) Administer the medication using a tuberculin syringe
A) Have the client lie down for 30 minutes after the medication is injected The injection is used for severe agitation, eventually calming the client making them tired.
A nurse is a assessing a client who has schizophrenia and has been on long term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects? A) Tardive dyskinesia B) Parkinsonism C) Dystonia D) Akathisia
A) Tardive dyskinesia
If you had a patient come in that overdosed on phenobarbital, what is the antidote?
Activated Charcoal
What is the antidote to phenobarbitals?
Activated Charcoal (Very absorbent)
A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include? A) "Take this medication with food if nausea develops" B) "Monitor for muscle pain" C) "Expect to have increased bruising" D) "Increase your intake of grapefruit juice"
B) "Monitor for muscle pain"
A nurse is providing teaching for a client who has schizophrenia and a new prescription for fluphenazine. Which of the following information should the nurse provide? A) "This medication might turn your urine orange" B) "Sleepiness should subside within a week" C) "Stop the medication if hypotension occurs" D) "A low grade fever is expected with first doses"
B) "Sleepiness should subside within a week" Medications take up to 14 days before the patient gets a full effect from the medication
A nurse in a mental health clinic is caring for a client who has bipolar disorder and a prescription for an anti-psychotic medication. The provider and nursing staff suspect the client is not adhering to his medication therapy. Which of the following interventions should the staff use to encourage the client's adherence? (Select all that apply) A) Perform mouth checks following the administration of the medication B) Provide for once-daily dosing C) use sustained-release forms D) Engage the client in conversation following medication administration E) Rotate staff tat administer the medications
B) Provide for once-daily dosing C) Use sustained-release forms D) Engage the client in conversation following medication administration Sustained-release releases the medication throughout the day. Having a conversation with the patient allows the patient to have a chance to explain to the nurse why they are not taking their medication.
A nurse is caring for a client who is to start therapy with ibuprofen for his hip pain. Which of the following information should the nurse provide about ibuprofen? A) Take the medication with an aspirin to increase effectiveness B) Take the medication with food C) Taking the maximum dose will offer stroke prevention D) Sustained-release forms may be crushed for easier administration
B) Take the medication with food Ibuprofen can cause gastric issues
A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A) Glass of whole milk B) Celery sticks C) Bologna Sandwich D) Sliced apples
C) Bologna Sandwich No processed meat with an MAOI
A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity? A) Constipation B) Urinary Retention C) Muscle Weakness D) Hyperactivity
C) Muscle Weakness Muscle weakness is one of the side effects indicating toxicity levels from lithium.
A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching? A) Follow a low-sodium diet B) Limit daily fluid intake C) Obtain a daily weight D) Avoid foods that have a high tyramine content
C) Obtain a daily weight Lithium is a salt. If patient is holding salt, there will be weight gain
A nurse is assessing a client who has been taking setraline for two weeks. The nurse should identify which of the following findings as an indication that the medication is effective? A) The client's blood pressure is within the expected reference range B) The client reports a recent weight loss C) The client reports increase in mood D) The client's legs are not swollen
C) The client reports increase in mood After a two week period a patient should report a better mood
What are some signs and symptoms for an overdose of amitriptyline (tricyclic)?
Can lead to coma, low respirations, elevated heart rate, GI shut down, hard to arouse, sleepy
What do betablockers do?
Decrease heart rate, decrease blood pressure, wheezes more prominent
Adderall Taken PO Based off of height & weight C2 Drug Should be taken in the morning Suppresses appetite longer Stimulent; taken by ADHD patients, prescription is renewed every 3 months, should be controlled by the parents due to it being a street drug.
Dextroamphetamine
Given to Dementia patients Cholinergic Stimulates the bowel and bladder Increase in secretions, decrease in pulse
Donepezil
What is the antidote to benzodiazepines?
Flumazenil
If you have a patient in the manic phase & you notice they have elevated hepatic enzyme levels & the valproate level is normal but the valproic level is high, what would you do?
Hold the medication & notify the physician. Valproic acid is hepatatoxic.
What are some of the biggest side effects to penatoin?
Hyperplasia (swollen gums). To treat, increase oral care. Brushing and flossing after every meal. Have patient rinse their mouth.
Forcing a patient to take a med, wrong meds to wrong patient, wrong dose, not giving pain medications to a patient who is about to go into aggressive therapy and is complaining about pain all entail.......
Incident report
Therapeutic: 0.4-1.4 mEq/L Toxic Level: greater than 2.0 mEq/L
Lithium Levels
Vomiting & diarrhea, patient acting like they are intoxicated, dysrythmia, skipped heart beats (needs to be reported) This med is a SALT If taken with NSAIDS or diuretics, patient is at a higher risk for toxicity
Lithium Toxicity
What could happen if a patient receives more than 3 grams of tylenol?
Liver could shut down
Morphine sustained release medication that is given to the terminally ill for breakthrough pain. Cannot be crushed because it is a sustained release and must have a doctors order for a refill. C2 drug.
MS Contin
What do we use pregablin for?
Neuropathic pain Lyrica is used and is a controlled drug, has to be counted and kept in a locked box
Constipate patients, must increase fluid and fiber intake to prevent bowel blockage, slows bowel activity down
Opioids
Neuroleptic QUIET Given to schizophrenic patients to quiet imaginative delusions & hallucinations. Atypical Neuroleptic
Quetiapine
Why is diazepam the drug of choice to treat status epilepticus?
Resolves continual seizures immediately and does not require a loading dose
Atypical neuroleptic that does not engage for 2-3 weeks
Risperidone
Reduces the effects of certain chemicals in the body that may be unbalanced as a result of disease (such as Parkinson's). Used with other medications to treat the symptoms of Parkinson's (muscle spasms, stiffness, tremors, poor muscle control). Anti-cholinergic
Benztropine
This medication is a cholinergic Side effects are bradycardia, increased bowel & bladder contractility, wheezing, constricted pupils, secretions This medication relaxes everything
Bethanochol
How does activated charcoal work?
Binds medication in the gut & prevents absorption
How does a traditional neuroleptic work?
Block dopamine receptors
Can only be destroyed by the pharmacist, must have a new written prescription in order to get more of the drug, unused portions need to be destroyed, must be counted every shift by the ongoing and off going charge nurse, licensure is required for this task. (Morphine & Ativan)
C2 Drugs
Parkinson's medication, avoid a high protein diet, has to be equally divided 4 times a day at the same time (every 6 hours).
Carbidopa-levodopa
If you have an active psychotic patient that's violent and the doctor wants to start a neuroleptic, what type of neuroleptic will that doctor start?
Chlorpromazine & Haloperidol Fast acting traditional neuroleptics
Stimulates secretions (bowel & bladder) Drooling Decrease in pulse rate
Cholinergic
A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include? A) Bad breath B) Decreased alertness C) Breast enlargement D) Bleeding gums
D) Bleeding gums Gingko biloba is an herb & has a tendency to cause problems with human platelets
A nurse is assessing a client prior to the administration of morphine. The nurse should recognize that which of the following assessments is the priority? A) Pupil reaction B) Urine output C) Bowel sounds D) Respiratory rate
D) Respiratory rate
How do we treat an allergic reaction?
Epipen, steroid drug, diphenhydramine, neubulizer treatment
If a patient came in with a red rash, hives, & itching, what would you look for?
Make sure the patient can breathe, make sure the patient knows they are having an allergic response, make sure patient knows to no longer take that medication
If you have a patient with asthma taking an inhaler and it says it's a sympathomimetic medication, what does that mean?
Mimics sympathetic nervous system and triggers fight or flight (adrenaline). That response opens the airway so the patient can get more air into their lungs. Dilates bronchioles.
What are some of your biggest concerns for patients with dementia and older people on benzodiazepines?
Risk for falls
Anticholinergic used for motion sickness. Old patch is taken off before putting a new patch on. Gloves must be worn, area behind ears must be rotated. Old patch must be cleaned. New patch must be signed, dated, and initialed. Used on hospice patients, Parkinson's patients, patients with drooling tendencies, & for people going on flights.
Scopolamine Patch
What kind of medications can be crushed?
Scored tablets, antacids, uncoated tablets (Tylenol)
Agitation, confusion, rigidity, fever. Must call the doctor immediately!
Serotonin Syndrome
If you have patients that are switching antidepressant classifications rapidly, it can cause what?
Serotonin Syndrome