Pharmacology III Final Exam Study Set

Diazepam

*Controlled Substance Schedule IV* *Func. Class:* Anti-anxiety, anticonvulsant, skeletal muscle relaxant, central acting. *Chem. Class:* Benzodiazepine, long-acting *Action:* Potentiated the actions of GABA, especially in the limbic system, reticular formation; enhances parasympathetic inhibition, inhibits spinal polysynaptic afferent paths *Uses:* Anxiety, acute alcohol withdrawal, adjunct for seizure disorders; preoperatively as a relaxant for skeletal muscle relaxation; rectally for acute repetitive seizures *Contraindications:* Pregnancy, hypersensitivity to benzodiazepines, closed-angle glaucoma, coma, myasthenia graves, ethanol intoxication, hepatic disease, sleep apnea *Black Box Warning:* Coadministration with other CNA depressants, respiratory depression *Common Side Effects:* Dizziness, drowsiness, blurred vision *Life Threatening Side Effects:* Respiratory depression *Nursing Considerations:* Seizure control and type, duration, intensity of seizures, IV site for thrombosis or phlebitis which may occur rapidly, Pregnancy and breastfeeding (Use in pregnancy not recommended; do not breastfeed, excretion in breast milk) *Black Box Warning:* Monitor for respiratory depression, respirations q5-15min if given IV *Teaching:* Not to discontinue medication abruptly after long-term use, to gradually taper; To notify prescriber if pregnancy is planned or suspected; to avoid breastfeeding *Treatment of Overdose:* Lavage, VS, supportive care, flumazenil

Sodium Bicarbonate

*Func. Class:* Alkalinizer *Chem. Class:* NaHCO3 *Action:* Orally neutralizes gastric acid, which forms water; NaCL, CO2; increases plasma bicarbonate, which buffers H+ ion concentration; reverses acidosis IV *Uses:* metabolic acidosis, cardiac arrest, alkalization (systemic/urinary), antacid, salicylate poisoning *Unlabeled Uses:* Contrast media nephrotoxicity prevention *Contraindications:* Metabolic/respiratory alkalosis, hypochloremia, hypocalcemia *Common Side Effects:* Twitching, hyperreflexia, belching, distention, metabolic alkalosis *Life-threatening Side Effects:* Tetany, seizures, cardiac arrest *Nursing Considerations:* Assess fluid balance (I&O, DW, edema); Milk-alkali syndrome (Confusion, headache, n/v, anorexia, urinary stones, hypercalcemia); Pregnancy/breastfeeding (Use as an antacid is considered unsafe; may breastfeed) *Teaching:* To notify prescriber if indigestion accompanies by chest pain; trouble breathing; diarrhea; dark, tarry stools; vomit that looks like coffee grounds; swelling of feet/ankles

Epoetin

*Func. Class:* Antianemic *Chem. Class:* Amino acid polypeptide *Action:* Erythropoietin is a factor controlling the rate of red cell production; product is developed by recombinant DNA technology *Uses:* Anemia caused by reduced endogenous erythropoietin production, primarily end-stage renal disease; to correct hemostatic defect in uremia; anemia due to AZT treatment in patients with HIV or those receiving chemotherapy; reduction of allogenic blood transfusion in surgery patients *Unlabeled Uses:* Anemia in premature preterm infants, anemia due to ribavirin and interferon-alfa therapy in hepatitis C *Contraindications:* Hyper sensitivity to mammalian-cell-derived products, human albumin; uncontrolled hypertension *Common Side Effects:* Hypertension *Life Threatening Side Effects:* Seizures, hypertensive encephalopathy, HF, DVT, MI, stroke *Nursing Considerations:* Pure cell aplasia (PRCA) (In absence of other causes; evaluate by testing sera for recombinant erythropoietin antibodies; any loss of response to epoetin should be evaluated); Seizures (Place patient on seizure precautions if increase of 1 Hct in any 2-wk period, increased BP; more communion chronic renal failure during the first 90 days of treatment); Pregnancy/Breastfeeding (Product should be used during pregnancy only when benefits outweigh fetal risk. Multi-dose vials are contraindicated due to the use of benzyl alcohol as a preservative; it is not known whether epoetin alfa is distributed to breast milk *Black Box Warning:* Blood Studies (Ferritin, transferrin, serum iron monthly; transferrin sat > or equal to 20%, ferritin > or equal to 100; Hct 2x/wk until stabilized in target range (30-36%) then at regular intervals; those with endogenous erythropoietin levels of <500 respond to product; monitor Hct 2x/wk with chronic renal failure; patients treated with zidovudine or patients with cancer should be monitored weekly, then periodically after stabilization; death may occur with Hgb >12; monitor for blood clots

Heparin

*Func. Class:* Anticoagulant *Action:* Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III *Uses:* Prevention treatment of DVT, PE, MI, open heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with embolization, as an anticoagulant in transfusion and dialysis procedures to maintain patency of indwelling venipuncture devices; diagnosis, treatment of DIC *Contraindications:* Bleeding, hypersensitivity to this product, corn, porcine protein (pork product) *Common Side Effects:* Fever, rash *Life Threatening Side Effects:* Hematuria, hemorrhage, thrombocytopenia (HIT), anaphylaxis *Nursing Considerations:* Assess bleeding, hemorrhage (gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, BP; HIT may occur after product discontinuation; check periodically for sign of decreasing clots), thrombosis (monitor for increases thrombosis daily, in affected areas), Heparin-induced thrombocytopenia [HIT](Platelet count q2-3days; thrombocytopenia may occur on 4th day of treatment and resolves even during continued treatment; HIT may occur on the 5th-10th day of treatment, with platelets to 5000 mm3; this may lead to HITT (venous/arterial thrombosis) even after discontinued therapy) *Teaching:* Report to the prescriber any signs of bleeding (gums, under skin, urine, stools) *Treatment of Overdose:* Withdraw product; administer 1 mg protamine/100 units heparin

Warfarin

*Func. Class:* Anticoagulant *Chem. Class:* Coumarin derivative *Action:* Interferes with blood clotting by indirect means; depresses hepatic synthesis of vitamin k dependent coagulation factors (II, VII, IX, X) *Uses:* Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, DVT; MI prophylaxis, after HI, stroke prophylaxis, PE *Contraindications:* Pregnancy, breastfeeding, hypersensitivity, hemophilia, leukemia with bleeding, peptic ulcer disease (Severe), malignant hypertension, subacute bacterial endocarditis, acute nephritis, blood dyscrasias, eclampsia, preeclampsia, hemorrhage tendencies; surgery of CNS, eye; traumatic surgery with large open surface, bleeding tendencies of GI/GU/respiratory tract, stroke, aneurysms, pericardial effusion, spinal puncture, major regional/lumbar block anesthesia *Black Box Warning:* Bleeding *Common Side Effects:* Rash *Life Threatening Side Effects:* Hematuria, Hemorrhage, agranulocytosis, leukopenia, eosinophilia, anaphylaxis, exfoliative dermatitis, purple toe syndrome *Nursing Considerations:* Assess fever, skin rash, urticaria; Pregnancy/breastfeeding (do not use in pregnancy,; use effective contraception during and for 1 month after final dose; cautious use in breastfeeding *Black Box Warning:* Blood studies (Hct, PT, platelets, occult blood in stools) q3months; INR, in hospital daily after 2nd or 3rd dose; when in therapeutic range (2-3) for 2 consecutive days, monitor 2-3x wk for 1-2 wk, then less frequently, depending on stability of INR results; Outpatient: monitor every few days until stable dose, then periodically thereafter, depending on stability of INR results, usually at least monthly) *Black Box Warning:* Bleeding (Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria, occult bleeding (cerebral, intraabdominal; fatal hemorrhage can occur; do not use in uncontrolled bleeding) *Teaching:* *Black Box Warning:* Bleeding (To Report any signs of bleeding: gums, nosebleed, under skin, urine, stools; to use a soft-bristle toothbrush to avoid bleeding gums; to use an electric razor *Treatment of Overdose:* Administer vitamin K, fresh frozen plasma, prothrombin complex concentrate

Dabigatran

*Func. Class:* Anticoagulant *Chem. Class:* Thrombin inhibitor *Action:* Direct thrombin inhibitor that inhibits both free and clot-bound thrombin; prevents thrombin-induced platelet aggregation and thrombus formation by preventing conversion of fibrinogen to fibrin *Uses:* Stroke/systemic embolism prophylaxis with nonvalvular partial fibrillation, DVT, PE in hip replacement *Contraindications:* Hypersensitivity, active bleeding, prosthetic heart valves *Life Threatening Side Effects:* Bleeding (any site), anaphylaxis (rare), angioedema *Nursing Considerations:* Bleeding (blood in urine or emesis, dark tarry stools, lower back pain; caution with arterial/venous punctures, catheters, NG tubes; monitor vital signs frequently; elderly patients more prone to serious bleeding, monitor aPTT, ocarina clotting time baseline beginning and during treatment); Postthrombotic syndrome (Pain, heaviness, itching/tingling, swelling, varicose veins, brownish/reddish skin discoloration, ulcers; use of ambulation, compression stockings, adequate anticoagulation can prevent this syndrome); Surgery (Discontinue 24-48hr before surgery in those with CCr> or equal to 50, 72-96hr in those with CCr < or equal to 50; longer times may be needed in major surgery; restart after surgery, spinal epidural catheter); Pregnancy/breastfeeding (No well controlled studies; bleeding may occur if used during pregnancy; discontinue breastfeeding or product, unknown if excreted in breast milk) *Black Box Warning:* Premature discontinuation: Risk of thrombosis/MI/emboli (Swelling, pain, redness, difficulty breathing, chest pain, tachypnea, cough, coughing up blood, cyanosis) *Black Box Warning:* Epidural/spinal anesthesia, Lumbar puncture (Risk of hematoma that may cause permanent paralysis; indwelling epidural catheters and products that cause coagulation changes (NSAIDs and anticoagulants) may increase risk of paralysis) *Black Box Warning:* Do not discontinue abruptly *Teaching:* Bleeding (To report any bleeding or bruising, including blood in stool, emesis, urine; nosebleeds *Black Box Warning:* Neurological changes (To notify prescriber immediately of bowel or bladder changes, numbness in lower extremities, midline back pain

Enoxaparin

*Func. Class:* Anticoagulant, antithrombotic *Chem. Class:* Low-molecular-weight heparin (LMWH) *Action:* Binds to antithrombin III inactivation factors Xa/IIa, thereby resulting in a higher ratio of antifactor Xa to IIa *Uses:* Prevention of DVT (inpatient or outpatient), PE (inpatient) in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina, acute MI, coronary artery thrombosis *Unlabeled Uses:* Antiphospholipid antibody syndrome, arterial thromboembolism prophylaxis, cerebral thromboembolism, percutaneous coronary intervention *Contraindications:* Hypersensitivity to this product, heparin, pork; active major bleeding, hemophilia, leukemia with bleeding, thrombocytopenia *Black Box Warning:* Lumbar puncture, aneurysm, coagulopathy, epidural anesthesia, spinal anesthesia *Life Threatening Side Effects:* Hemorrhage from any site, hypochromic anemia, thrombocytopenia, bleeding, angioedema, anaphylaxis *Nursing Considerations:* Assess: Monitor anti-factor Xa activity in chronic therapy (renal disease); Bleeding (Gums, petechiae, ecchymosis, black tarry stools, hematuria; notify prescriber); Anaphylaxis (Monitor for rash, swelling of face, lips, tongue, dyspnea; stop product, initiate emergency procedures; Pregnancy/breastfeeding (Do not use in multidose vials, benzyl alcohol is present; do not breastfeed *Black Box Warning:* Neurologic Symptoms in patients who have received spinal anesthesia, may develop spinal hematoma; those who have had trauma, spinal surgery are at greater risk *Teaching:* To report any signs of bleeding: gums, under skin, urine, stools; do not rub injection site, easy bruising; To report dizziness, rash, breathing changes

Penobarbital

*Func. Class:* Anticonvulsant *Chem. Class:* Long-acting barbiturate *Action:* Enhances Activity of GABA (inhibitory neurotransmitter) *Uses:* Tonic-clonic, partial, myoclonic seizures, and status epilepticus; sedation *Side Effects:* Dizziness, drowsiness, headache, weakness, ataxia, hypotension, bradycardia, N/V, constipation *Nursing Considerations:* Gradual discontinuation of therapy, take with food to minimize GI upset, monitor for respiratory depression, avoid pregnancy *Therapeutic Range:* 15-40 mcg/ml

Ethosuximide

*Func. Class:* Anticonvulsant *Chem. Class:* Succinimide *Action:* Decreases calcium influx through the t-type calcium channels *Uses:* Absence seizures *Side Effects:* Dizziness, drowsiness, headache, impaired cognition, ataxia, nightmares, gingival hyperplasia, N/V/dyspepsia *Nursing Considerations:* Assess for adverse reactions (Blood dyscrasia, psychosis, suicidal ideation, systemic lupus erythematous (SLE)) *Therapeutic Range:* 40-100 mcg/ml

Valproic Acid

*Func. Class:* Anticonvulsant, vascular headache suppressant *Chem. Class:* Carboxylic acid derivative *Action:* Increases levels of aminobutyric acid in the brain, which decreases seizure activity *Uses:* Simple (petit mal), complex (petit mal), absence, mixed seizures; manic episodes associated with bipolar disorder, prophylaxis of migraine, adjunct for schizophrenia, tar dive dyskinesia, aggression in children with ADHD, organic brain syndrome, mania, migraines; tonic-clonic (grand mal), myoclonic seizures *Contraindications:* Hypersensitivity, urea cycle disorders, mitochondrial disease, hepatic disease *Common Side Effects:* Sedation, nausea, vomiting, constipation, diarrhea, dyspepsia *Life Threatening Side Effects:* Coma, suicidal ideation, hypothermia, pancreatitis, hepatotoxicity, thrombocytopenia, leukopenia, DRESS, hyperammonemia *Nursing Considerations:* Mental Status (Bipolar disorder; mood, activity, sleeping/eating, behavior; suicidal thoughts/behaviors); DRESS (Eosinophilia, changes in lab work, fever, rash, lymphadenopathy if present and condition confirmed, discontinue immediately, do not restart); Suicidal thoughts/behaviors (Usually occurs during beginning of therapy, limit amount of product that is given to patient); Hyperammonemic encephalopathy (Can be fatal in those with urea cycle disorders (UCD); lethargy, confusion, coma, CV, respiratory changes; discontinue) *Black Box Warning:* Hepatotoxicity (AST, ALT, bilirubin, ammonia baseline and periodically during 6 months or more, discontinue if hyperammonemia occurs; hepatic failure has occurred; monitor for fever, anorexia, vomiting, lethargy, jaundice of skin, eyes that may occur during treatment; those with organic brain disorders, mental retardation, children <2ys are at greater risk) *Black Box Warning:* Pancreatitis (May be fatal; report immediately nausea, vomiting, anorexia, abdominal pain; may occur anytime during treatment or for several months/years after discontinuing treatment *Black Box Warning:* Pregnancy/Breastfeeding (Do not use in pregnancy (migraine prophylaxis), use only in pregnancy (epilepsy, manic episodes) if other alternatives are unavailable; major malformations may occur; enroll pregnant patients in the North American Antiepileptic Drug Pregnancy Registry, 888-233-2334; cautious use in breastfeeding, excreted in milk) *Teaching:* Not to discontinue medication quickly after long-term use because seizures may result, to take as directed, not to skip, double doses; DRESS (to report fever, swelling of lymph glands, rash); Hepatotoxicity (To report immediately anorexia, nausea, vomiting, abdominal pain, fever); Overdose symptoms (Heart block, coma); To report immediately suicidal thoughts/behaviors *Black Box Warning:* To report visual disturbances, rash, diarrhea, abdominal pain, light-colored stools, jaundice, protracted vomiting, weakness to prescriber *Black Box Warning:* Pancreatitis (To report immediately; may be fatal) *Black Box Warning:* Pregnancy/breastfeeding (To use contraception while taking this product; to notify prescriber if pregnancy is planned or suspected *Therapeutic Range:* 50-100 mcg/ml

Phenytoin

*Func. Class:* Anticonvulsant; antidysrhythmic *Chem. Class:* Hydantoin *Action:* Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction *Uses:* Generalized tonic-clonic seizures; status epilepticus; non epileptic seizures associated with Reye's syndrome or after head trauma; complex partial seizures *Contraindications:* Pregnancy, hypersensitivity, bradycardia, SA and AV block, Stokes-Adams syndrome *Life Threatening Side Effects:* Suicidal tendencies, ventricular fibrillation, bradycardia, cardiac arrest, hepatitis, nephritis, agranulocytosis, leukopenia, aplastic anemia, thrombocytopenia, megaloblastic anemia, lupus erythematosus, S-J, toxic epidermal necrolysis, purple glove syndrome (IV), DRESS, anaphylaxis *Nursing Considerations:* Phenytoin Hypersensitivity Syndrome (3-12wk after start of treatment: Rash, temperature, lymphadenopathy; may cause hepatotoxicity, renal failure, rhabdo); Serious skin disorders (For beginning rash that may lead to S-J syndrome or toxic epidermal necrolysis; phenytoin should not be used again; may occur more often amount asian patients); Purple glove syndrome with IV use; Phenytoin level (Toxic level is 30-50; Therapeutic level is 7.5-20); Seizures (Duration, type, intensity, precipitating factor; obtain EEG periodically, monitor therapeutic level); Mental status (Mood, sensorium, affect, memory, suicidal thoughts/behaviors); Blood Dyscrasias (Fever, sore throat, bruising, rash, jaundice); Pregnancy/breastfeeding (Pregnant women should enroll in the Antielieptic Drug Pregnancy Registry, 1-888-233-2334, may cause fetal malformations; use other options when possible; breastfeeding is not recommended) *Teaching:* Not to discontinue product abruptly because seizures may occur; To notify prescriber of unusual bleeding, bruising, petechiae (bleeding), clay colored stools, abdominal pain, dark urine, yellowing of skin or eyes (hepatotoxicity); slurred speech, headache, drowsiness; To report suicidal thoughts/behaviors immediately; To use non-hormonal contraception; to notify prescriber if pregnancy is planned or suspected *Therapeutic Range: 10-20 mcg/ml

Mannitol

*Func. Class:* Diuretic, Osmotic *Chem. Class:* Hexahydric alcohol *Action:* Acts by increasing osmolarity of glomerular filtrate, which inhibits reabsorption of water and electrolytes and increases urinary output *Uses:* Edema; promotion of systemic diuresis in cerebral edema; decrease in intraocular/intracranial pressure; improved renal function in acute renal failure; chemical poisoning, urinary bladder irrigation, kidney transplant *Unlabeled Uses:* Traumatic brain injury *Contraindications:* Active intracranial bleeding, hypersensitivity, anuria, severe pulmonary congestion, edema, severe dehydration, progressive heart/renal failure, acute MI, aneurysm, stroke *Common Side Effects:* Dizziness, headache, nausea, vomiting *Life Threatening Side Effects:* Tachycardia, HF, circulatory overload *Nursing Considerations:* *Black Box Warning:* Bronchospasm/asthma (inhalation test kit): Test for bronchial hyper-responsiveness should not be performed in any person with asthma or baseline pulmonary function test FEV1 <1-1.5 or <70% of predicted values *Treatment of Overdose:* Discontinue infusion; correct fluid, electrolyte imbalances; hemodialysis; monitor hydration, CV status, renal function

Ferrous Sulfate

*Func. Class:* Hematinic *Chem. Class:* Iron preparation *Action:* Replaces iron stores needed for red blood cell development as well as energy and oxygen transport and use *Uses:* Iron-deficiency anemia, prophylaxis for iron deficiency in pregnancy, nutritional supplementation *Contraindications:* Sideroblastic anemia, thalassemia, hemosiderosis/hemochromatosis *Common Side Effects:* Nausea, constipation, epigastric pain, black and red tarry stools *Nursing Considerations:* Toxicity (Nausea, vomiting, diarrhea (Green then tarry stools), hematemesis, pallor, cyanosis, shock, coma) *Teaching:* Accidental exposure (To keep out of reach of children or pets; iron poisoning may occur if increased beyond recommended level); Not to substitute 1 iron salt for another, that elemental iron content differs; To avoid reclining position for 15-30 minutes after taking product to avoid esophageal corrosion *Treatment of Overdose:* Induce vomiting; give eggs, milk until lavage can be done

Aspirin

*Func. Class:* Nonopioid analgesic, nonsteroidal antiinflammatory, antipyretic, antiplatelet *Chem. Class:* Salicylate *Action:* Blocks pain impulses by blocking COX-1 in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation *Uses:* Mild to moderate pain or fever, including rheumatoid arthritis (RA), osteoarthritis, thromboembolic disorders; TIAs, rheumatic fever, post-MI, prophylaxis of MI, ischemic stroke, angina, acute MI, Kawasaki Disease *Unlabeled Uses:* Colorectal cancer prophylaxis *Contraindications:* Pregnancy, breastfeeding, children <12yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine, GI bleeding, bleeding disorders, vitamin K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure, intracranial bleeding, nasal polyps, urticaria *Common Side Effects:* Nausea, vomiting, rash *Life Threatening Side Effects:* Seizures, intracranial hemorrhage, dysrhythmias, GI bleeding, pancreatitis, hepatotoxicity, thrombocytopenia, leukopenia, DIC, Reye's syndrome (children), anaphylaxis, laryngeal edema, angioedema *Nursing Considerations:* Hepatotoxicity (Dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy; Pregnancy/Breastfeeding (Do not use in 1st trimester; may cause fetal harm; use only if benefits outweigh fetal risks (2nd/3rd trimester); avoid breastfeeding) *Teaching:* To report any symptoms of hepatotoxicity, renal toxicity, visual changes, ototoxicity, allergic reactions, bleeding (long term therapy); To avoid if allergic to tartrazine; Not to Exceed recommended dosage; acute poisoning may result *Treatment of Overdose:* Lavage, monitor electrolytes, VS

Clopidogrel

*Func. Class:* Platelet aggregation inhibitor *Chem Class:* Thienopyridine derivative *Action:* Inhibits ADP-induced platelet aggregation *Uses:* Reducing the risk or stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina *Unable Uses:* Cardiac surgery (infant and child), Kawasaki disease *Life Threatening Side Effects:* Bleeding (major/minor from any site), neutropenia, aplastic anemia, agranulocytosis, thrombotic thrombocytopenic purpura, anaphylaxis, intracranial hemorrhage, toxic epidermal necrolysis, S-J, bronchospasm *Nursing Considerations:* Assess: Thrombotic/thrombocytic purpura (Fever, thrombocytopenia, hemolytic anemia, neurologic changes, treat immediately); Hypersensitivity (Rash, angioedema) *Teaching:* To report any unusual bruising, bleeding to prescriber; that it may take longer to stop bleeding; Pregnancy/breastfeeding (To notify provider if pregnancy is planned or suspected or if breastfeeding; do not breastfeed, use cautiously in pregnancy)

Altepase

*Func. Class:* Thrombolytic enzyme *Chem. Class:* Tissue plasminogen activator (TPA) *Action:* Produces fibrin conversion of plasminogen to plasmin; able to bind to fibrin, convert plasminogen into thrombus to plasmin, which leads to local fibrinolysis, limited systemic proteolysis *Uses:* Lysis of obstructing thrombi associated with acute MI, ischemic conditions that require thrombolysis (i.e., PE, unclotting arteriovenous shunts, acute ischemic CVA), central venous catheter occlusion (Cathflo) *Unlabeled uses:* Arterial thromboembolism, deep vein thrombosis (DVT), occlusion prophylaxis, percutaneous coronary intervention (PCI) *Contraindications:* Active internal bleeding, history of CVA, severe uncontrolled hypertension, intracranial/intraspinal surgery/trauma (within 3 mo), aneurysm, brain tumor, platelets <100,000 mm3, bleeding diathesis including INR>1.7 or PR>15 sec, arteriovenous malformation, subarachnoid hemorrhage, intracranial hemorrhage, uncontrolled hypertension, seizure at onset of stoke *Life Threatening Side Effects:* GI, GU, intracranial, retroperitonal bleeding, anaphylaxis *Nursing Considerations:* Assess: For bleeding (During first hour of treatment and 24 hr after procedure: hematuria, hematemesis, bleeding from mucous memebranes, epistaxis, ecchymossis; guaiac all body fluids, stools; do not use 150mg or more total dose because intrcranial bleeding may occur; do not use in severe uncontrolled hypertension, aneurysm, head trauma, for MI, PE; obtain noncontrast GI of brain or MRI to take out intracranial hemorrhage prior to systemic use); Hypersensitity (Fever, rash, itching, chills, facial swelling, dyspnea, notify prescriber immediately; stop product, keep resuscitative equipment nearby; mild reaction may be treated with antihistamines); Blood studies (Hct, platelets, PTT, PT, TT, APTT; Before starting therapy; PT or APTT must be less than 2x control before starting therapy; TT or PT q3-4hr during treatment); MI (ECG continuously, cardiac enzymes, radionuclide myocardial scanning/coronary angiography; chest pain intensity, character; monitor those with major early infarct signs on CT scan with substantial edema, mass effect, midline shift; PE (pulse, BP, ABG, rate/rhythm of respirations); Occlusion (Have patient exhale then hold breath when connecting/disconnecting syringe to prevent air embolism); Pregnancy/breastfeeding (Usually considered contraindicated in pregnancy except in serious conditions; use cautiously in breastfeeding)

Cyanocobalamin

*Func. Class:* Vitamin B12 Water-Soluble Vitamin *Action:* Needed for adequate nerve functioning, protein and carbohydrate metabolism, normal growth, RBC development, cell production *Uses:* Vitamin B12 deficiency, pernicious anemia, vitamin B12 malabsorption syndrome, Schilling test, increased requirements with pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, renal/hepatic disease, nutritional supplementation *Contraindications:* Hypersensitivity to this product, coralt, benzyl alcohol, optic nerve atrophy *Life Threatening Side Effects:* HF, pulmonary edema, anaphylactic shock *Nursing Considerations:* For pulmonary edema, worsening of HF in cardiac patients *Treatment of Overdose:* Discontinue product

One week after being hospitalized for an acute myocardial infarction, a client reports nausea and loss of appetite. Which of the client's prescribed medications would be withheld and the health care provider notified? 1. Digoxin 2. Propranolol 3. Furosemide 4. Spironolactone

1. Digoxin Toxic levels of digoxin stimulate the medullary chemoreceptor trigger zone, resulting in anorexia, nausea, and vomiting. Although anorexia, nausea, and vomiting may be side effects of furosemide, propranolol, and spironolactone, they do not indicate toxicity.

Intravenous (IV) potassium is prescribed for a client with a diagnosis of hypokalemia. Which statement about administration of IV potassium is accurate? 1. Oliguria is an indication for withholding IV potassium. 2. Rapid infusion of potassium prevents burning at the IV site. 3. Clients with severe deficits should be given IV push potassium. 4. Average IV dosage of potassium should not exceed 60 mEq in 1 hour.

1. Oliguria is an indication for withholding IV potassium. Potassium chloride should not be given unless renal flow is adequate; otherwise, the potassium chloride will accumulate in the body, causing hyperkalemia. Rapid infusion may cause severe pain at the infusion site and precipitate cardiac arrest. Potassium chloride must be well diluted or it will precipitate cardiac arrest. A dose of 60 mEq per hour of potassium chloride is too high.

How would the nurse prepare an intravenous piggyback (IVPB) medication for administration to a client who has an established IV infusion? Select all that apply. One, some, or all responses may be correct. 1. Wear clean gloves to assess the IV site. 2. Flush the IV insertion site with 2 mL saline. 3. Place the IVPB at a lower level than the existing IV. 4. Use a sterile technique when preparing the medication. 5. Establish the flow rate for infusion.

1. Wear clean gloves to assess the IV site. 4. Use a sterile technique when preparing the medication. 5. Establish the flow rate for infusion. Clean gloves should be worn to check the IV site because there is a risk of coming into contact with the client's blood. Because IV solutions enter the body's internal environment, all solutions and medications using this route must be sterile to prevent the introduction of microbes, and sterile technique should be used to avoid introducing microbes into the infusion system. It is important to establish the flow rate so that medications do not infuse too rapidly or too slowly. The insertion site does not have to be flushed with an infusing IV. The IVPB should be hung higher, not lower, than the existing bag.

A client with arthritis states that the prescribed aspirin causes stomach irritation. How would the nurse instruct the client to take the aspirin? 1. An hour before a meal 2. With food and a full glass of water 3. With sodium bicarbonate 4. At the same time as the other medications

2. With food an a full glass of water A full glass of water helps decrease gastric irritation by diluting the acidic substances in the stomach. If aspirin is taken on an empty stomach, gastric irritation is increased. Although taking the medicine with sodium bicarbonate will limit gastric irritation, it will also decrease the effect of aspirin by increasing its renal excretion. Aspirin has a gastric-irritating and ulcerogenic effect, which may be potentiated by other medications.

The health care provider prescribes a client 1 liter of intravenous (IV) fluid to infuse over 4 hours. The tubing drop factor is 10 drops/mL. At which rate would the nurse infuse the medications? 1. 20 drops/minute 2. 34 drops/minute 3. 42 drops/minute 4. 60 drops/minute

3. 42 drops/minute

When administering albumin intravenously, which fluid shift would the nurse anticipate? Incorrect1. Interstitial compartment to the intracellular compartment 2. Intravascular compartment to the interstitial compartment 3. Interstitial compartment to the intravascular compartment 4. Extracellular compartment to the intracellular compartment

3. Interstitial compartment to the intravascular compartment Intravenous albumin increases colloid osmotic pressure, resulting in a pull of fluid from the interstitial compartment to the intravascular compartment. Intravascular compartment to the interstitial compartment and extracellular compartment to the intracellular compartment are opposite to the actual shift of fluids when albumin is administered.

A client with insomnia takes a new medication to promote sleep. Two hours later, the client is wide awake and feeling more energized than before the medication was taken. Which type of response is the client demonstrating? 1. Allergic 2. Synergistic 3. Paradoxical 4. Idiosyncratic

3. Paradoxical A paradoxical response to a medication is directly opposite to the desired therapeutic response. An allergic response is an antigen-antibody reaction. A synergistic response involves medication combinations that enhance each other. Idiosyncratic responses to a medication are unpredictable and unrelated to the medication purpose. They are commonly attributed to immune responses or genetic factors.

While receiving a blood transfusion, a client develops acute dyspnea, generalized urticaria, a heart rate of 128 beats/minute, and a blood pressure of 70/38 mm Hg. Which type of reaction would the nurse conclude that the client probably is experiencing? 1. Panic 2. Pyrogenic 3. Hemolytic 4. Anaphylactic

4. Anaphylactic Anaphylactic reactions result from hypersensitivity to a product in the blood. Signs and symptoms are due to bronchospasm, systemic vasodilation, and compensatory tachycardia. The client may go into life-threatening shock without prompt treatment. Panic reactions (also known as panic attacks) involve high levels of anxiety and may be coupled with autonomic symptoms such as tachycardia. Bacterial pyrogens are present in contaminated blood and can cause a febrile transfusion reaction; signs include fever and chills. Hemolytic reaction results from the incompatibility of a recipient's antibodies with transfused red blood cells (RBCs); the reactions result from RBC hemolysis, agglutination, and capillary plugging.

A client is receiving dexamethasone to treat acute exacerbation of asthma. For which side effect would the nurse monitor the client? 1. Hyperkalemia 2. Liver dysfunction 3. Orthostatic hypotension 4. Increased blood glucose

4. Increased blood glucose Dexamethasone increases gluconeogenesis, which may cause hyperglycemia. Hypokalemia, not hyperkalemia, is a side effect. Liver dysfunction is not a side effect. Hypertension, not hypotension, is a side effect.

A client is scheduled to receive phenytoin extended release 100 mg orally at 6:00 PM but is having difficulty swallowing capsules. The unit has phenytoin suspension, suppositories, and injectable solution in stock. Which action will the nurse take? 1. Crush the capsule and mix into a soft food. 2. Insert a rectal suppository containing 100 mg of phenytoin. 3. Administer 4 mL of phenytoin suspension containing 125 mg/5 mL. 4. Request a prescription for phenytoin suspension.

4. Request a prescription for phenytoin suspension. A palatable suspension is preferable, but a prescription is necessary because suspensions are immediate-release formulations that cannot be substituted for extended-release medications without a prescription. Extended-release capsules and tablets should not be crushed. The route of administration cannot be altered without the health care provider's approval.