ATI Modules 9-12
A patient asks, "Why do I have to avoid grapefruit products while on tamsulosin?" How should the nurse respond?
"Grapefruit juice may increase the potential for low blood pressure."
Which patient statement about sildenafil is correct?
"I can take this without regard to meals."
Which instruction is most important for patients taking BPH medications?
"Take your medication at the same time each day."
A patient has been taking tamsulosin for benign prostatic hyperplasia (BPH) for 7 days. The patient calls the nurse and states, "This medication is not helping me." How should the nurse respond?
"The therapeutic benefits develop in 2-4 weeks."
Which statement should be included in patient teaching for tamsulosin?
"You may experience diminished or absent semen during ejaculation."
Mr. Hawkins states that if he experiences more side effects of tamsulosin, he will stop taking it. How should the nurse respond?
"You should not abruptly stop taking this medication"
What should be assessed with finasteride?
1. Obtain history of liver disease and altered urinary functioning 2. determine whether client has a female partner who is pregnant, is planning to become pregnant, or is breast feeding.
When is estradiol used and why does it help with that?
1. contraception; because it suprresses the release of FSH needed for conception at high levels 2. relief of moderate to severe postmenopausal manifestations such as hot flashes and mood changes bc it substitutes estrogen. 3. prevention of postmenopausal osteoporsis bc it blocks bone resorption 4. Treatment of uterin bleeeding bc it can promote blood coagulation
What are two precautions for finasteride when using it?
1. pregnant wife cannot handle crushed or broken medication due to it being category X 2. cannot donate blood while on finasteride. have to wait a month.
A client is prescribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the client's theophylline serum levels to maintain which therapeutic range? a. 1 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 40 mcg/mL
10 to 20 mcg/mL
Before prescribing dextromethorphan (Robitussin), the HCP should know that, when giving an opioid, the drug can result in which of the following? 1. Reduced antitussive effect of dextromethorphan 2. Potentiation of the analgesic effect of the opioid 3. Increased renal reabsorption of the dextromethorphan 4. delayed analgesic effect of the opioid
2 potentiation of the analgesic effect of opioid
2. A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia (BPH). The nurse should anticipate a prescription for which of the following medications? A. Oxybutynin (Ditropan) B. Diphenhydramine (Benadryl) C. Ipratropium (Atrovent) D. Tamsulosin (Flomax)
2. A. INCORRECT: Oxybutynin is an anticholinergic medication that is used to treat overactive bladder. Anticholinergic medications are contraindicated for a client who has BPH. Oxybutynin causes urinary retention. B. INCORRECT: Diphenhydramine is an antihistamine and is contraindicated for a client who has BPH. Diphenhydramine causes urinary retention. C. INCORRECT: Ipratropium is an anticholinergic used to treat asthma and other respiratory conditions. Anticholinergic medications are contraindicated for a client who has BPH. Ipratropium causes urinary retention. D. CORRECT: Tamsulosin is an alpha-adrenergic receptor antagonist that relaxes the bladder outlet and the prostate gland, which improves urinary flow.
Which of the following instructions would you include with patient education on intranasal glucocorticoids? 1. Start at a low dose and gradually increase it 2. Take the drug as needed for nasal congestion 3. Allow at least 2 weeks for the full therapeutic effect 4. Use the drug prior to exercise
3
How long should oral glucocorticoids be taken?
3 -10 days no more than 10
What time should tamsulosin be taken?
30 minutes after a meal at the same time
Which should a healthcare professional include when advising a patient about montelukast (Singulair)? 1. Use spacer to improve inhalation 2. Take the drug at the onset of bronchospasm 3. Rinse the mouth daily the prevent an oral fungal infection 4. Take the drug once a day in the evening
4
A patient must wait how long after the administration of bile-acid sequestrants before taking another medication?
4 hours
When advising a patient who is beginning Advair (fluticasone) therapy, which of these instructions should a HCP include? 1. Take as needed for acute asthma 2. Follow a low sodium diet 3. Use an alternate day dosing schedule 4. Increase weight bearing activity
4 increase weight bearing activity
What type of drugs are finasteride and dutasteride?
5 alpha reductase inhibitors
Which prostate therapy decreases need for prostate surgery?
5-alpha reductase inhibitors (decrease physical size of prostate)
5. A nurse is teaching a client who has a new prescription for finasteride (Proscar) about the medication. A. Therapeutic Uses: Identify the therapeutic use of this medication for this client. B. Client Education: Identify four instructions the nurse should include.
5. A. Finasteride inhibits 5-alpha reductase and enzyme, which converts testosterone to dihydrotesterone. Production of testosterone in the prostate gland is reduced, which in turn reduces the size of prostate tissue. B. Client Education ● The medication must be taken on a long-term basis. It may take as long as a year before the effects of the medication are evident. ● Impotence and a decreased libido are possible adverse effects. ● Report breast enlargement to the provider. ● Finasteride is teratogenic to the male fetus. The medication can be absorbed through the skin. Pregnant women should not be in contact with tablets. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administratio
What needs to be monitored with a statin? What symptoms should the client report?
AST getting a baseline, after 12 weeks, after 6 months; CK getting a baseline and checked periodically. anorexia, vomiting, nausea, jaundice, muscle aches pain and tenderness.
Which should be avoided in a patient diagnosed with benign prostatic hyperplasia?
Antihistamines
A patient on medication for BPH states, "I have an appointment with my ophthalmologist to schedule cataract surgery." What is the appropriate action by the nurse?
Ask if the patient has informed his ophthalmologist about the BPH medication.
A pregnant woman is helping her elderly father with taking his medications. He is taking dutasteride (Avodart). The nurse will instruct the daughter to do what? -Use a barrier contraceptive while helping her father prepare the drug. -Crush the tablets to help facilitate swallowing. -Avoid touching any crushed or broken tablets. -Avoid direct contact with her father while he is on the medication.
Avoid touching any crushed or broken tablets.
A client has been prescribed guaifenesin (Robitussin). The nurse realizes that the purpose of the drug is to accomplish what? a. To treat allergic rhinitis and prevent motion sickness b. To loosen bronchial secretions so they can be eliminated by coughing c. To compete with histamine for receptor sites, thus preventing a histamine response d. To stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa
B
Which clinical manifestation would indicate the need for further evaluation of the patient taking sildenafil?
Blurred vision
A client with a history of asthma is short of breath and says, "I feel like I'm having an asthmatic attack." What is the nurse's best action? a. Call a code. b. Ask the client to describe the symptoms. c. Administer a beta2 adrenergic agonist. d. Administer a long-acting glucocorticoid.
C
Which instruction will the nurse include when teaching a client about the proper use of metered-dose inhalers? a. "After you inhale the medication once, repeat until you obtain relief." b. "Make sure that you puff out air repeatedly after you inhale the medication." c. "Hold your breath for 10 seconds if you can after you inhale the medication." d. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
C
A patient that has hypothyroidism should not be on what lipid lowering drug?
Cholestyramine or colestipol
Which drug can cause tamsulosin toxicity when taken together?
Cimetidine
A client is prescribed the decongestant oxymetazoline (Afrin) nasal spray. What should the nurse teach the client? a. Take this drug at bedtime as a sleep aid. b. Directly spray away from the nasal septum and gently sniff. c. This drug may be used in maintenance treatment for asthma. d. Limit the drug to 5 days of use to prevent rebound nasal congestion.
D
Beclomethasone (Beconase) has been prescribed for a client with allergic rhinitis. The nurse teaches the client that which is the most common side effect from continuous use? a. Dizziness b. Rhinorrhea c. Hallucinations d. Dry nasal mucosa
D
The nurse instructs the client to avoid which over-the-counter products when taking theophylline (Theo-Dur)? a. acetaminophen (Tylenol) b. echinacea c. diphenhydramine (Benadryl) d. St. John's wort
D
The nurse is instructing a client about the advantages of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the difference in these two medications? a. Salmeterol has a shorter onset of action. b. Salmeterol does not have any side effects. c. Albuterol has a longer onset of action. d. Salmeterol has a longer duration of action.
D
What three lipid changes are expected with Niacin?
Decreased triglycerides, decreased LDLs, increased HDLs. Does NOT improve incidence of CV events
A patient of trimethoprim-sulfa is reporting sore throat and pallor, what should be the action of the nurse?
Discontinue the drug and monitor the CBC counts to detect the blood dyscrasias that are complications of T-S such as hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia
Why would one patient with BPH be prescribed doxazosin (or terazosin) and another pt be given tamsulosin?
Doxazosin would be given to a patient that has hypertension with BPH to treat both since it is nonselective and causes vasodilation to lower bp. Tamsulosin does not.
What is the brand name of tamsulosin?
Flomax
What type of drug is norfloxacin, levofloxacin, ciprofloxacin?
Fluoroquinolenes
What are the complications of the fibrates?
GI distress, gallstones, and myopathy, hepatoxicity
Fibrates can cause what gastrointestinal dysfunction?
Gallstones (increases biliary cholesterol), nausea, diarrhea, and abdominal pain
What are the four complications of fluoroquinolones?
Gi discomfort, achilless tendon rupture, suprainfection, phototoxicity
What are the five complications of nitrofurantoin or methenamine?
Gi discomfort, hypersensitivity, blood dyscrasias, peripheral neuropathy, (headache, drowsiness, dizziness)
What are the complications of niacin?
Gi distress, facial flushing and feeling of warmth, tingling of hands and feet, hyperglycemia, hepatotoxicity, hyperuricemia
What type of drugs are atorvastatin, simvastatin, and rosuvastatin?
HMG Coa reductase inhibitors
Do fibrates increase or decrease the effect of warfarin?
Increase by displacing warfarin from the albumin Monitor PT/INR
Why use a spacer for a metered dose inhaler?
It increases the amount of drug delivered to the lungs
When taking albuterol or salmeterol, what two types of drugs would you avoid to lessen the chance of onset of tachycardia?
MAOIs and tricyclic antidepressants
What lifestyle changes are needed to be an adunct to statins?
NO alcohol, avoid smoking, and dietary modifications
What test results can finasteride interfere with during therapy?
PSA test results
What is the most stingent complication to be mindful of when taking trimethoprim-sulfamethoxazole.
Steven JOhnson syndrome
Why is acute kidney injury a possibility with trimethoprim-sulfa and how can it be intervened?
T-S causes crystalluria where crystalline aggregates in the kidneys ureters and bladder causing obstruction; by pt taking 8 oz glasses of water per day, and to monitor urine output.
What patient teaching is required with calcium?
Take a calcium supplement at least 1 hr apart from glucocorticoids, tetracyclines, or thyroid hormone.
What types of drugs are tamsulosin, terazosin, and doxazosin and how do they differ?
Tamsulosin is a selective alpha 1 receptor antagonist Terazosin and Doxazosin are nonselective alpha 1 receptro antagonists
Which statement is correct in regard to men being treated with 5 alpha reductase inhibitors for BPH?
There is a potential increase in prostate cancer in men treated with 5 alpha reductase inhibitors.
Fibrates (or fibric acid derivatives) are the most effective drug for lowering what?
Triglycerides (VLDLs) MOA: Activate liver and brown fat receptors, which accelerate clearance of VLDLs (TG); increased HDL by increasing apolipoproteins A-I & A-II
Lovaza (omega-3 fatty acids) is used to decrease what lipid?
Trigylcerides
What deficiencies can be caused by bile-acid sequestrants?
Vitamin A, D, E, K
what does a client need to be aware of when taking corticosteroids with progesterone therapy or anticoagulants?
Vitamin D deficiency so must increase vitamin D and calcium
What medicines are used to premedicate patients prior to Niacin?
What medicines are used to premedicate patients prior to Niacin?
What can be given to improve the effects of theophylline and decrease a toxic serum level?
activated charcoal decreases absorption, and diazepam can be given for the seizures, and lidocaine is given for the dysrhythmias.
What can reduce the risk of endometrial or ovarian cancers with estradiol? and by doing so what do they increase the risk of occurring?
administering progestins along with estrogen; breast cancer
What is the difference between an albuterol and a salmeterol?
albuterol is used for asthma exacerbations while salmeterol is used for long acting care and is taken every 12 hours and with a glucocorticoid
Which beta agonists can be taken orally?
albuterol, levalbuterol, and terbutaline
MOA of this BPH class is the relaxation of bladder neck, prostate capsule and prostatic urethra
alpha blockers (no effect on prostate size - terazocin, doxazocin, tamsulosin, alfuzosin, silodosin)
What two classes of BPH meds should not be taken together?
alpha receptor antagonists, and phosphodiesteradse inhibitors
What type of schedule should be used when taking prednisone and why?
alternate day dosing schedule bc its taken only orally suppresses adrenal gland function
What drugs have their effects decreased with estrogen therapy?
anticoagulants, oral hypoglycemics, and thyroid meds
What should be taken 30 minutes before niacin if feeling flushing or warmth
aspirin
What time should doxazosin be taken?
at the same time each day
Which statin should be used for clients with impaired kidney function?
atorvastatin
What is the action of sildenafil?
augments the effects of nitric oxide released during sexual stimulation, resulting in enhanced blood flow to corpus cavernosum and penile erection
What is the action of phenazopyridine?
azo dye that functions as a local anesthetic on the mucosa of the urinary tract
A client is prescribed ipratropium and cromolyn sodium. What will the nurse teach the client? a. "Do not take these medications within 4 hours of each other." b. "Take the ipratropium at least 5 minutes before the cromolyn." c. "Administer both medications together in a metered-dose inhaler." d. "Take the ipratropium only in the mornings."
b
The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action? a. Question the order; three inhalers should not be given at one time. b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide, followed by the albuterol several minutes later.
b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later.
A client with COPD has an acute bronchospasm. The nurse knows that which is the best medication for this emergency situation? a. zafirlukast (Accolate) b. epinephrine (Adrenalin) c. dexamethasone (Decadron) d. oxtriphylline-theophyllinate (Choledyl)
b. epinephrine (Adrenalin)
What is the brand name of trimethoprim-sulfa?
bactrim
What needs to be assessed prior to administration of atorvastatin?
baseline of liver function tests, lipid studies, pregnancy test, obtain history of any OTC meds that affect the liver
Why must live virus vaccines need to be avoided with glucocorticoid use.?
bc glucocorticoids suppress immune function and the live virus can cause an infection with use of these drugs
Why do clients on sildenafil have to notify hcp if their erection lasts more than 4 hr?
bc priapism is a complication of sildenafil
Why is it not recommended to give estrogen to prepubescent girls?
bc the epiphyseal plate has not closed and can stunt their growth so monitor bone growth
Before what procedure must a alpha 1 receptor antagonist be held or discontinued and why?
before a cataract surgery bc it causes floppy iris syndrome
What type of drugs are albuterol, formoterol, levealbuterol, salmeterol, and terbutaline?
beta 2 adrenergic agonists
What kind of drug is cholestyramine?
bile acid sequestrant
What type of drug is alendronate?
bisphosphonates
What needs to be checked often with cholestyramine?
blood pressure
What needs to be monitored earnestly with doxazosin or terazosin use with a PDE5 inhibitor or nitroglycerin?
blood pressure bc causes sever hypotension together
What system needs to be monitored with cholestyramine?
bowel function and may need to increase fiber and fluids for constipation
what are some complications of progestin?
breast cancer, thromboembolic events such as pulmonary embolism, thrombophlebitis, stroke; breakthrough bleeding, amenorrhea, breast tenderness, edema, jaundice, migraine headaches, birth defects and spontaneous abortion
What is the action of nitrofurantoin?
broad spectrum urinary antiseptic with bacteriostatic and bacteriocidal action- damages bacterial DNA
What is the desired effect of a beta 2 agonist?
bronchodilation from activation of the beta 2 receptors in the bronchial smooth muscle
What would need to be monitored when taking warfarin with fibrates?
bruising, belleding gums, prothrombi time and INR
The nurse is caring for a client with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? a. Increase the IV drip rate. b. Monitor the client for toxicity. c. Continue to assess the client's oxygenation. d. Stop the IV for an hour then restart at lower rate.
c. Continue to assess the client's oxygenation.
The nurse reviews the client's medication history. Based on the client's prolonged use of glucocorticoids, what does the assessment include? (Select all that apply.) a. Obesity b. Thinning of the skin c. Erythematous lesions d. Purpura
c. Erythematous lesions d. Purpura
A client taking an oral theophylline preparation is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110. The client is irritable. What is the best action for the nurse to take? a. Continue to monitor the client. b. Call the health care provider. c. Hold the next dose of theophylline. d. Administer oxygen 2 lpm via nasal cannula.
c. Hold the next dose of theophylline.
A client is taking aminophylline-theophylline ethylenediamine (Somophyllin). For what should the nurse monitor the client? a. Drowsiness b. Hypoglycemia c. Increased heart rate d. Decreased white blood cell count
c. Increased heart rate
What is the most important thing for the nurse to teach the client with a history of diabetes and asthma who has started on albuterol PRN? a. Take Tylenol for headaches when taking albuterol. b. Monitor for orthostatic hypotension every 2 hours when taking albuterol. c. Monitor blood glucose levels every 4 hours when taking albuterol. d. An antianxiety agent may be prescribed to help with nervousness.
c. Monitor blood glucose levels every 4 hours when taking albuterol.
What needs to be avoided with several respiratory drugs and why?
caffeine bc it acts like a bronchodilator
What needed to be avoided with the use of theophylline? What two types of drugs have the same effect?
caffeine because it increases the theophylline levels and may go above the therapeutic range of 5-15 mcg/mL. cimetidine and fluoroquinolones.
What decreases the absorption of tetracyclines and thyroid hormone?
calcium citrate
Mixing calcium with digoxin can cause what?
can lead to severe bradycardia
Which drugs should a women be aware would reduce the contraceptive effects when given with progesterone?
carbamazepine, phenobarbital, phenytoin, rifampin
Why must one evaluate report of vision changes with atorvastatin?
causes photosensitivity so use sunglasses
What is a problem with tamsulosin that might make the patient noncompliant with medication?
causes problems with ejaculation
What lipid lowering drug forms insoluble complexes with thiazide diuretics digoxin or warfarin?
cholestyramine or colestipol
What clients should not take estrogen therapy?
client or family history of heart disease atypical vaginal bleeding that is undiagnosed breast or estrogen dependent cancer history or risk of thromboembolic disease
What type of clients should rosuvastatin be avoided or cautiously prescribed?
clients of Asian descent; a pregnant women, liver disease, kidney impairment or electrolyte imbalance
Which clients should not be using sildenafil and if using needs to be monitored very closely?
clients that have a QT prolongation on EKG
What drug if taken with ezetimibe can cuase ezetimibe toxicity?
cyclosporine
Beclomethasone (Beconase) has been prescribed for a client with allergic rhinitis. The nurse teaches the client that which is the most common side effect from continuous use? a. Dizziness b. Rhinorrhea c. Hallucinations d. Dry nasal mucosa
d. Dry nasal mucosa
What are the actions of gemfibrozil, and fenofibrate?
decrease triglyceride levels (VLDLs), and increase HDL levels
What are three main complications associated with finasteride?
decreased libido, decreased ejaculate volume, gynecomastia
What is the action of niacin?
decreases LDL cholesterol and triglyceride levels
What are the actions of an HMG Coa Reductase inhibitor?
decreases manufacture of LDL and VLDL, increases HDL, promotes vasodilation, decreases in plaque site inflammation, thromboembolism, risk of atrial fibrilllation.
How does tamsulosin or doxazosin treat BPH?
decreases mechanical obstruction of the urethra by relaxing smooth muscles of the bladder neck and prostate.
What is the action of bisphosphonates?
decreases the number and action of osteoclasts, and inhibit bone resorption.
How does finasteride help decrease prostate size?
decreases usable testosterone by inhibiting the converting enzyme.
Why would a patient need to be careful to rise slowly from sitting or lying position when on doxazosin versus tamsulosin? What else needs to be avoided by pt? What should be monitored prior to movement?
doxazosin cause hypotension, dizziness, nasal congestion, sleepiness, faintness due to nonselectivity causing widespread vasodilation; driving and operating machinery; bp
Why would a patient want to report complaints of painful urination, flank pain while on trimethoprim-sulfa and how to avoid it?
drug causes cahne in urine ph and increase risk of renal calculi and can be avoided with drinking 2.5-3 liters of fluid daily
A patient on norfloxacin that is older than 18 is complaining of swelling and redness above the ankle, what should be done? What other sign will lead to discontinuation?
drug needs to be discontinued bc it can cause achilles tendon rupture. photoxicity
A HCP is caring for a patient taking ipratropium (Atrovent). The HCP should explain which of the following adverse effects to the patient? Muscle tremors, urinary retention, dry mouth, insomnia, tachycardia
dry mouth, urinary retention
What are some of the complications of inhaled anticholinergics?
dry mouth, urinary retnetion, and hoarseness
What are some uses for progestins?
dysfunctional uterine bleeding due to hormonal imbalance amenorrhea due to hormonal imbalance endometriosis endometrial, breast, kidney cancers
What are some of the complications of estrogen or estradiol use?
endometrial and ovarian cancers, increases risk for estrogen dependent breast cancer, embolisms, MI, stroke,
What are the complications of alendronate?
esophagitis, esophageal ulceration, GI disturbances. musculoskeletal pain, visual disturbances, bisphosphonate related osteonecrosis of the jaw, kidney toxicity with IV infusion
What drug can increase the effects of corticosteroids?
estradiol or estrogen therapy
What drug is a cholesterol absorption inhibitor?
ezetimibe
What is the action of ezetimibe?
ezetimibe inhibits the absorption of cholesterol secreted in the bile and from food
What two lipid lowering drugs need to be separated in time when taking both?
ezetimibe, and cholestyramine; need to take ezetimibe 1 hr before of 4 hours after taking bile sequestrants
What lipid lowering drugs needs to be taken before meals?
fibrates at least 30 minutes prior to breakfast and dinner
Which lipid lowering drugs if taken together would increase the risk of myopathy?
fibrates, gemfibrozil and fenofibrate, ezetimibe and statins
Patient complains after a month that the finasteride is not working? What should the hcp inform the patient?
finasteride takes 6 months to take effect
A patient is going to take an inhaled form of a beta 2 agonist and a glucorticoid. Which one would he do first?
glucocorticoid
What reduces the absorption of calcium and needs to be taken an hr apart from the calcium supplement?
glucocorticoids; give at least 1 hr apart
What drugs or foods if taken together with atorvastatin and simvastatin will cause statin toxicity?
grapefruit juice, erythromycin, ketoconazole, amiodarone, cyclosporine
What are some of the complications of the statins or ezetimibe?
hepatotoxicity and myopathy
What are the five complications of Trimethoprim-sulfa?
hyperkalemia, kernicterus, crystalluria, SJS, blood dyscrasias-
A person on nitrofurantoin is having a fever, chills, dyspnea, cough, and chest pain, what is the problem and how to respond to it?
hypersensitivity rxn; stop taking the drug
When should a client discontinue the use of viagra?
if hearing loss is noticed
When does estrogen therapy need to be discontinued?
if planning to become pregnant before any knee of hip surgery that will cause immobilization if have swelling or redness of the legs or chest pain.
Why should grapefruit juice be avoided in a patient taking sildenafil? What drugs need to be avoided for the same reason?
increase plasma concentrations and its adverse effects; ketoconazole, erythromycin, cimetidine, ritonavir
What are some complications of raloxifene?
increased risk for pulmonary embolism and DVT, hot flashes
Why would you especially not give nitrofurantoin to a client with chronic kidney disease or with a creatinine clearance of less than 40mL/min?
increases risk of getting peripheral neuropathy
What can occur when taking gemfibrozil and ezetimibe together?
increases the risk of cholelithiasis and myopathy; not recommended to take together
What is the action of norethindrone?
induces favorable conditions for fetal growth and development and maintains pregnancy.
What is an effect to teach with nitrofurantoin use to avoid future stress of fear?
inform clients that it turns urine rust yellow to brown and can stain teeth
What is the difference in the schedules between inhalation and oral routes?
inhalation has to be on a fixed schedule; oral has to be an alternate day schedule
What is the action of trimethoprim and sulfonamide?
inhibit bacterial growth by preventing the synthesis of a folic acid derivative, tetrahydrofolate.
What do clients need to do when on estrogen therapy?
instruct clients to report persistent vaginal bleeding if they have an intact uterus, have an endometrial biopsy every 2 years, and a pelvic exam yearly, yearly breast exams and periodic mammograms
What needs to be instructed to the female sexual partner of a patient taking finasteride?
instruct female to avoid semen of man, avoid touching crushed tablets, use barrier contraceptive
After taking alendronate what do you need the client to do to avoid esophagitis?
instruct the client to sit upright or ambulate for 30 min?
What does a woman need to becareful about if taking cholestyramine or colestipol?
interference of absorption of oral contraceptives
A patient with BPH has asthma as well. What drug would you avoid using on this patient?
ipratropium
An asthma patient reports a peanut allergy. What drug cannot be given to this patient?
ipratropium, tiotropium
What needs to be monitored while taking niacin?
kidney function tests, BUN, creatinine, liver function tests, blood glucose levels,
When should the statins be taken? and which statin needs to be taken with food?
late evening; lovastatin
What type of drug is montelukast? What are the other two drugs in this class?
leukotrienemodifier or antagonist; zileuton, zafirlukast
What patient disorder should would prevent him from taking finasteride?
liver disease
Tamsulosin and doxazosin should be used with caution in what illness?
liver impairment for both; and renal impairment as well for tamsulosin.
What lipid lowering drugs need to be taken with food?
lovustatin, niacin
What are two therapeutic uses of finasteride?
male pattern baldness, and BPH
What things need to be avoided with in 2 hours of administration of a fluoroquinolone?
meds or food with calcium, iron, zinc like antacids, dairy products, sucralfate, or vitamin supplements
This type of drug was once the first line medication for asthma but is now used infrequently bc of safer and mroe effective drugs?
methylxanthines- theophylline
When does montelukast need to be taken? How does this differ from the other drugs in this class?
montelukast needs to be taken at bedtime or 2 hours before exercise. Zafirlukast can not be given with food ,a nd zileuton needs to be taken 1 hr before or after a meal.
A diabetic needs to be careful of what when on cholestyramine?
needs to worry if on a sulfonylurea bc it decreases absorption of that drug
Which lipid lowering drug would you not want to give to a patient with gout? What other illness would you avoid with this drug?
niacin; diabetes
What UTI drug needs to be taken with meals?
nitrofurantoin
What two drugs are urinary tract antiseptics?
nitrofurantoin, methenamine
What drug cannot be taken with sildenafil?
nitroglycerin or any drug in the nitrate family
What is a serious nursing diagnosis to be concerned as a nurse with a patient taking finasteride?
noncompliance due to side effects sexual dysfunction
What drug causes breakthrough bleeding, amenorrhea, and breast tenderness?
norethindrone
What needs to be assessed prior to administration of trimethoprim-sulfa?
obtain drug history and history of allergies assess intake and output
Where does one place an estrogen patch?
on the skin of the trunk avoiding the breasts and waistline.
What patient would you avoid using albuterol? and when would you use it cautiously?
patient with tachydysthmia; diabetes, hypertension, angina, and hyperthyroidism
What drug is an urinary tract analgesic?
phenazopyridine
What drug can inhibit the effects of montelukast?
phenytoin
Which drug decreases the effects of estrogen therapy?
phenytoin
What type of drug is sildenafil?
phosphodiesterase inhibitor
What are the therapeutic uses of raloxifene?
prevent and treat postmenopausal osteoporosis to prevent spinal fractures in female clients protect against breast cancer
What type of drug is norethindrone?
progesterone therapy
What needs to be monitored closely with a beta 2 agonist?
pulse;
What sign would indicate immediate discontinuation of trimethoprim-sulfa?
rash
A patient who has just inhaled ipratropium will want to do what next and why?
rinse the mouth to remove the bad taste
What lipid lowering statin has better prognosis with other lipid lowering drugs?
rosuvastatin
Which beta agonists are long acting?
salmeterol, formoterol, and terbutaline
When monitoring the plasma drug levels in a patient taking theophylline (Theo-24), which of the following adverse effects should the HCP see if the patients level is toxic? 1. Seizures 2. Constipation 3. Vomiting 4. Restlessness
seizures
What type of drug is raloxifene?
selective estrogen receptor modulator------
A client is being treated for benign prostatic hyperplasia (BPH). The nurse should explain to the client that he will experience relief of urinary symptoms because the drug will: -shrink the gland and/or relax the sphincter of the bladder. -increase testosterone levels, reducing the size of the gland. -locally increase blood pressure in prostate, reducing its size. -activate nitric acid, which will dilate blood vessels in the area to relieve pressure.
shrink the gland and/or relax the sphincter of the bladder
Which BPH med needs to be taken with food?
silodosin
A patient is taking ipratropium, what would you recommend this patient to do to help with the most common complication resulting from taking this drug?
sip fluids and suck on sugar candies to control dry mouth
What signs and symptoms need to reported by the client when on trimethoprim-sulfa?
skin rash, sore throat, fever, mouth sores, unusual bruising
What increases the risk of thrombophlebitis if done with estrogen or progesterone therapy?
smoking
Who can not take a fluoroquinolone?
someone under 18 yo
What foods decrease the absorption of calcium?
spinach, rhubarb, beets, bran, and whole grains
Allergies to which drug would indicate a high possibility of an allergic reaction to trimethoprim-sulfamethoxazole?
sulfonamides, thiazide diuretics, sulfonylurea type oral hypoglycemics, loop diuretics
What is the action of a leukotriene modifier?
suppress the effects of leukotriene thereby reducing inflammation, bronchoconstriction, airway edema, amd mucus production
The nurse is administering an initial dose of tamsulosin. Which assessment finding will need further evaluation?
syncope
Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize reporting which side effect? a. Hypoglycemia b. Nonproductive cough c. Sedation d. Tachycardia
tachycardia
What are the three main complications of a beta 2 agonist?
tachycardia and angina are possible bc the alpha receptors in the heart are activated, tremors bc it also activates beta receptors in skeletal muscle
What are four teaching lessons to give for trimethoprim-sulfa?
taken on empty stomach with 8 oz of water complete entire course need to use additional contraception avoid exposure to direct sunlight
Which BPH med cannot be taken with food?
tamsulosin
Which alpha blocker is okay to use with phosphodiesterase inhibitors (Viagra, cialis, levitra)?
tamsulosin
Which BPH treatments are associated with hypotension side effect?
terazocin and doxazocin (1st gen alpha blockers)
What does a female patient need to be taught with trimetoprim-sulfa?
that cannot be taken in the first trimester, breastfeeding, or near term, or infants younger than 2 months bc it can cause kernicterus which is increased bilirubin levels or jaundice
Patient is on a oral medication for her asthma. Two hours later she is feeling and looking restless and has n/v/d. What drug is she most likely on? Why?
theophylline bc it causes GI distress and restlessnes with dysrhythmias and possible seizures.
What two drugs can be increased with the use of ciprofloxacin?
theophylline, warfarin
A HCP is advising a patient about the use of a mucolytic to treat cough should explain this type of drug is effective because it performs which of the following actions? 1. Suppresses the cough stimulus 2. Reduces inflammation 3. Thins and loosens mucus 4. Dries secretions
thins and loosens mucus
Why would a client want to avoid crushing, chewing or openin capsules of nitrofurantoin?
to avoid tooth staining
Why must adequate intake of water be taken with niacin?
to lower the effects of hyperuricemia
Which route of estradiol reduces incidents of nausea and vomiting?
transdermal therapy
What UTI drug cannot be taken with food ?
trimethoprim-sulfamethoxazole
What needs to be taught with phenazopyridine?
turns urine to an orange red color and that the urine can stain clothes; can be taken with or after meals
what clients should not take progesterone therapy?
undiagnosed vaginal bleeding, history of breat or genital cancers, history of thromboembolic disease
What is theophylline used for?
used for long term care of chronic asthma or COPD
Which drugs are toxic when taken with Trimethoprim-sulfa?
warfarin, phenytoin, and sulfonylureas.
When should glucocorticoids be taken and what needs to be monitored with them?
with meals; blood glucose levels, calcium level, blood in the stools, potassium levels, signs of edema, signs of muscle weakness bc the complications of prednisone are myopathy, electolyte imbalance, edema, peptic ulcer disease, hyperglycemia, bone loss.