ATI Pharmacology Across the Lifespan

A nurse is reviewing the medical history of a female client who has a new prescription for phenytoin for seizure activity. Which of the following findings should the nurse report to the provider? a. The client has a history of alcohol use disorder. b. The client uses a diaphragm for contraception. c. The client is taking allopurinol for gout. d. The client has a heart rate of 90/min.

ANS: A. The client has a history of alcohol use disorder. --> Rationale: The nurse should notify the provider of the client's history of alcohol use disorder because she might have impaired liver function, which can affect medication metabolism. Alcohol intake can lead to increased plasma levels of phenytoin and toxicity by reducing the rate at which the medication is metabolized. X The client uses a diaphragm for contraception. --> Phenytoin can decrease the effects of hormonal contraceptives. A client who uses a diaphragm, which is a nonhormonal contraceptive, is using the preferred method of birth control when taking this medication. X The client is taking allopurinol for gout. --> Allopurinol is not known to increase or decrease the effects of phenytoin. X The client has a heart rate of 90/min. --> This finding is within the expected reference range. Also, an adverse effect of phenytoin is bradycardia and not tachycardia.

A nurse is preparing to administer sublingual nitroglycerin to a client who has chest pain. The client asks the nurse, " Why am I placing the medication under my tongue instead of swallowing it with some water?" Which off the following responses should the nurse make? a. "There are no oral forms of nitroglycerin for you to swallow." b. "The sublingual form of the medication will not be effective if you swallow it." c. "The sublingual form of the medication will last longer in your system than the oral form." d. "There are no adverse effects with the sublingual form of the medication."

ANS: B. "The sublingual form of the medication will not be effective if you swallow it." --> Rationale: When nitroglycerin is administered orally, the majority of the dose is destroyed on the first pass through the liver. The sublingual form is absorbed directly through the oral mucosa and can enter the bloodstream rapidly. It is ineffective if swallowed. X "There are no oral forms of nitroglycerin for you to swallow." --> The nurse should inform the client that nitroglycerin comes in various forms including oral capsules. However, these forms of the medication are sustained release and will not relieve the client's chest pain as rapidly as the sublingual medication will. X "The sublingual form of the medication will last longer in your system than the oral form." --> The nurse should inform the client that sublingual tablets have a brief duration of 30 to 60 min whereas oral capsules, which are sustained release, have a longer duration of 3 to 8 hr. This allows the client to take subsequent doses of sublingual nitroglycerin to achieve relief of chest pain. X "There are no adverse effects with the sublingual form of the medication." --> The nurse should inform the client that sublingual nitroglycerin can produce adverse effects such as headache, orthostatic hypotension, and reflex tachycardia.

A nurse is admitting an older adult client who is scheduled for surgery and is completing medication reconciliation process for which of the following situations? a. The provider obtains informed consent from the client for surgery. b. The client returns to the unit from the surgical suite. c. The pharmacy delivers the client's medications to the unit. d. The nurse is preparing to provide change-of-shift report.

ANS: B. The client returns to the unit from the surgical suite. --> Rationale: It is important for the nurse to ensure that medication reconciliation is completed when a client is transferred from one level of care to another, even within the same facility. This process addresses omissions, interactions, and duplications that can lead to complications from polypharmacy in the older adult client. X The provider obtains informed consent from the client for surgery. --> Medication reconciliation is a process for comparing medications that a client is taking with any newly prescribed medications. The nurse does not need to perform medication reconciliation during the consent process. X The pharmacy delivers the client's medications to the unit. --> Medication reconciliation is the process of creating a complete and accurate list of a client's medications. The nurse does not need to repeat this process when the client's medications are delivered by the pharmacy. X The nurse is preparing to provide change-of-shift report. --> The nurse should include any new medications that were prescribed during that shift in the change-of-shift report. However, the nurse does not need to complete medication reconciliation at this time.

A nurse at an obstetric clinic is caring for a client who has just had a positive pregnancy test. The client tells the nurse that she has epilepsy and is taking phenobarbital to control seizure activity. Which of the following information should the nurse provide to the client? a. "You will not be able to take phenobarbital while you are pregnant." b. "You should avoid taking folic acid during your pregnancy because you have epilepsy." c. "You will need to come to the clinic so the provider can monitor your blood levels to adjust your dosage." d. "You will not be able to breastfeed your child while taking phenobarbital."

ANS: C. "You will need to come to the clinic so the provider can monitor your blood levels to adjust your dosage." --> Rationale: During pregnancy, there is an increase in plasma volume levels and this can affect medication metabolism and distribution. Therefore, the nurse should inform the client that blood levels of her anticonvulsant medication will be drawn frequently and the medication dosage will be adjusted as needed. X "You will not be able to take phenobarbital while you are pregnant." --> The nurse should inform the client that it is important to prevent seizures during pregnancy even though there is an increased risk of fetal malformation if a client is taking phenobarbital during pregnancy. The client and obstetrician will determine the best course of therapy for this client. X"You should avoid taking folic acid during your pregnancy because you have epilepsy." --> The nurse should inform the client that she should take a folic acid supplement daily during pregnancy, which can decrease the incidence of neural tube defects. X "You will not be able to breastfeed your child while taking phenobarbital." --> The nurse should inform the client that, although anticonvulsant medications are found in breast milk, the use of these medications is not a contraindication to breastfeeding.

A nurse is reviewing the medication list of an older adult client upon admission and notes that he is taking fluoxetine for depression. The nurse should identify that fluoxetine can increase the effects of which of the following medications that is also on the client's list? a. Levothyroxine b. Gabapentin c. Warfarin d. Nadolol

ANS: C. Warfarin --> Rationale: Older adult clients often take an increased number of medications, referred to as polypharmacy, due to multiple health conditions. To prevent complications from polypharmacy, the nurse should review the client's medications and identify potential interactions. The nurse should recognize that this client's antidepressant medication, fluoxetine, can increase the effects of his anticoagulant medication, warfarin, which could lead to a potential toxicity. X Levothyroxine --> Fluoxetine does not increase the effects of levothyroxine. X Gabapentin --> Fluoxetine does not increase the effects of gabapentin. X Nadolol --> Fluoxetine can decrease the effects of antihypertensive medications, such as nadolol.

A nurse is providing discharge teaching to an older adult client who is taking multiple medications. Which of the following information should the nurse include in the teaching? a. "You should keep a medication list that includes only your prescribed medications." b. "You should compare your medication dose with others taking the same medications." c. "You should not experience adverse effects unless you begin taking a new medication." d. "You should consult your provider before taking an herbal supplement."

ANS: D. "You should consult your provider before taking an herbal supplement." --> Rationale: The nurse should instruct the client to discuss taking any new medications, including herbal supplements, with the provider. This is especially true for the older adult client who is taking multiple medications due to the potential for adverse reactions and medication interactions. X "You should keep a medication list that includes only your prescribed medications." --> The nurse should instruct the client to maintain a home medication list that includes prescription medications, over-the-counter medications, vitamins, nutritional supplements, and herbal supplements. "You should compare your medication dose with others taking the same medications." --> The nurse should instruct the client that dosage information is individualized and is often different from other clients who are taking the same medication. "You should not experience adverse effects unless you begin taking a new medication." --> The nurse should instruct the client that she can experience adverse effects to medications even if she has been taking them for an extended period of time. The client should discuss any new manifestations with her provider.

A nurse is teaching a client who has postherpetic neuralgia and a new prescription for gabapentin. Which off the following information should the nurse include in the teaching? a. "You should take this medication on an empty stomach." b. "You should expect to experience swelling of your lower legs while taking this medication." c. "You should avoid taking this medication with fruit juice." d. "You should not take this medication within 2 hours of taking an antacid."

ANS: D. "You should not take this medication within 2 hours of taking an antacid." --> Rationale: Antacids can decrease the absorption pattern of the medication and decrease the levels of gabapentin in the bloodstream. Therefore, the nurse should instruct the client not to take this medication within 2 hr of taking an antacid. X "You should take this medication on an empty stomach." --> The nurse should instruct the client that gabapentin can be taken without regard to meals. X "You should expect to experience swelling of your lower legs while taking this medication." --> The nurse should instruct the client that peripheral edema is an adverse effect of the medication and is not an expected finding while taking gabapentin. X "You should avoid taking this medication with fruit juice." --> The nurse should instruct the client that the medication can be taken with juice. The capsules can be opened and the contents can be dissolved in juice if the client has difficulty swallowing the medication.

A nurse is reviewing the laboratory results of an older adult client who is taking multiple medications. Which of the following findings could impact the client's ability to distribute medication throughout his system? a. potassium 3.7 b. Total cholesterol 188 c. Hgb 15 d. albumin 3.0

ANS: D. Albumin 3.0 g/dL --> The rest are within the expected reference range. When a client is taking multiple medications, especially medications that are protein-bound, an albumin level that is below the expected reference range impacts the client's ability to distribute medications throughout his system. The poor distribution decreases the effectiveness of the medication and leads to low serum drug levels. Drug toxicity can be the end result of a medication dosage adjustment based on a low serum drug level.

A nurse is preparing to administer medications to an older adult client. The nurse should identify that which of the following physiologic changes can affect the DISTRIBUTION of medications in the older adult client? a. Decreased renal blood flow b. Increased gastric pH c. Decreased hepatic mass d. Increased body fat

ANS: D. Increased body fat --> Rationale: The nurse should identify that the older adult client experiences an increase in body fat. This physiologic change affects the DISTRIBUTION of medications. X Decreased renal blood flow --> Although the older adult client does experience a decrease in renal blood flow, this physiologic change affects the EXCRETION of medications, not their distribution. X Increased gastric pH --> Although the older adult client does experience an increase in gastric pH, this physiologic change affects the ABSORPTION of medications, not their distribution. X Decreased hepatic mass --> Although the older adult client does experience a decrease in hepatic mass, this physiologic change affects the METABOLISM of medications, not their distribution.

A nurse is reviewing the medication list of an older adult client and notes the client is taking simvastatin for hypercholesterolemia as well as multiple herbal supplements. Which of the following supplements indicated on the client's medication list can decrease this medication? a. Garlic b. Ginkgo biloba c. Glucosamine d. St. John's wort

ANS: D. St. John's wort --> Rationale: Polypharmacy occurs when a client is taking multiple medications, including herbal supplements and over-the-counter medications. The nurse should be aware of the interactions between medications and herbal supplements. St. John's wort can decrease the effect of simvastatin. Therefore, the nurse should notify the provider that the client is taking this medication and herbal supplement combination.

When considering the physiologic changes that affect pharmacokinetics in the elderly, the nurse recognizes that which factors occur? Select all that apply. A. Decreased gastric pH B. Increased gastric pH C. Decreased body fat D. Increased body fat E. Decreased hepatic mass F. Increased hepatic mass

B. Increased gastric pH D. Increased body fat E. Decreased hepatic mass Several physiologic changes affect the absorption, distribution, metabolism, and excretion of drugs in the elderly. The correct answers in this list—increased body fat, increased gastric pH, and decreased hepatic mass—are just a few examples.

Which factors contribute to intentional noncompliance in the elderly? Select all that apply. A. Taking several drugs throughout the day B. Unpleasant side effects C. Problems with manual dexterity D. Forgetfulness E. Failure to understand instructions F. Believing that the prescribed dose is not needed

B. Unpleasant side effects F. Believing that the prescribed dose is not needed Unpleasant side effects and believing that the prescribed dose is not needed are two factors that contribute to intentional noncompliance. The other factors listed may contribute to unintentional noncompliance.

When evaluating renal function in the elderly, the nurse knows that the best indicator of renal function is: A. blood urea nitrogen (BUN). B. serum creatinine. C. creatinine clearance. D. uric acid.

C. creatinine clearance. Creatinine clearance is the proper indicator of renal function in an elderly person; the serum creatinine level does not reflect kidney function in the elderly because the source of creatinine, lean muscle mass, is reduced in parallel with the decline of kidney function. Therefore, the creatinine level may appear to be "normal" even when renal function is reduced.

While assessing the medications taken by an elderly woman, you determine that she is experiencing polypharmacy. This indicates that she: A. takes only prescription medications for her illnesses. B. takes medications for a single illness several times a day. C. takes multiple medications for several different illnesses. D. risks problems only if she also takes over-the-counter medications.

C. takes multiple medications for several different illnesses. Polypharmacy is defined as treatment with multiple drugs and is often a factor in drug therapy in the elderly

When considering the effect of renal function on drug excretion, the nurse recalls that adult levels of renal function are achieved by what age? A. 1 month of age B. 3 months of age C. 6 months of age D. 12 months of age

D. 12 months of age Adult levels of renal function are achieved by 1 year of age.

An older adult patient will often experience a reduction in the stomach's ability to produce gastric acid. The nurse knows that this change: A. causes delayed gastric emptying. B. results in an increase in gastric acidity. C. causes decreased intestinal absorption of medications. D. may alter absorption of drugs that require acidity to dissolve.

D. may alter absorption of drugs that require acidity to dissolve. Gastric acidity is reduced in the elderly and may alter the absorption of drugs that require high acidity to dissolve.

Pregnancy and Hepatic metabolism pharmacokinetics

Increases for some drugs and an increased dosage may be needed to time schedule compressed (give dose more frequently)

Pregnancy and GI system pharmacokinetics

Tone and motility are decreased (may have problems with constipation), takes longer for contents to pass...leads to more time available for drugs to absorb and to go through enterohepatic recirculation. May have prolonged drug effects and there may be a need to reduce dosage

Breast feeding and medication

Use the lowest effective dose for the shortest time, lipid soluble drugs are the ones to worry most about, avoid drugs with long half lives, and dose immediately after feeding

metabolism and older adults

decreased hepatic metabolism r/t blood flow, less liver mass, and decreased activity of hepatic enzymes. This leads to an increased half life of drugs.

Drug distribution in infants

protein binding is limited in infants bc of low albumin levels and competition for binding site so the result is that there are high free drug levels which intensifies the effects...dosages must be reduced

Pregnancy and Renal pharmocokinetics

renal blood flow doubles, GFR increased by 3rd trimester and this will accelerate drug clearance, so there needs to be an increase in dosage

Geriatric prescribing principles

secure a thorough drug history, choose the simplest regimen and only make one change at a time! Promote adherence to regimen

excretion and older adults

there is a reduction in renal excretion, leads to decreased ability to conserve sodium and concentrate urine

Pharmacokinetics and infants

there is an increased sensitivity related to five immature processes in infants (drug absorption, renal excretion, hepatic metabolism, protein binding, blood-brain barrier).

When considering the age-related changes in the kidney of the older adult, the nurse recalls that which drug response is possible? A. Drug half-life is lengthened. B. Drug half-life is shortened. C. Drug excretion is accelerated. D. Drug effect is diminished.

A. Drug half-life is lengthened. Decreased renal excretion causes drug accumulation and is the most important cause of adverse drug reactions in the elderly.

Placental drug transfer

Assume that all drugs cross the placenta! This is more prevalent with lipid soluble drugs but is more difficult with ionized, highly polar protein bound drugs.

When considering drug dosages for the older adult, the nurse recognizes that which is an age-related change that may affect pharmacokinetics? A. Decreased body fat B. Decreased GI motility C. Increased hepatic blood flow D. Increased serum albumin

B. Decreased GI motility Age-related changes include decreased GI motility, increased body fat, decreased hepatic blood flow, and decreased serum albumin.

Distribution in older adults

there is an increased percentage of body fat which increases storage for lipid soluble drugs so their half lives increase, there is a decreased total body water so water soluble drugs in smaller volume will lead to more intense effect and there is a reduction in albumin so drugs have less binding sites and there will be more drug in plasma

Teratogensis

Produces birth defects; physical defects occur between 1-8 weeks gestation, effect of a teratogen is highly dependent on when the drug/substance was given during the pregnancy

Absorption and older adults

There is decreased acidity, surface area, and GI motility, gastric emptying is delayed but % of oral dose absorbed does not change

promoting adherence in older adults

encourage use of pill boxes, family support, written schedule, keep in visible place where routine is consistent, journaling, putting drugs into simple terms, literacy problems that may need to be addressed