Exam 4 Pharmacology

A patient has been receiving intramuscular injections of hydroxocobalamin as treatment for pernicious anemia. Which statement by the patient indicates that he understands the therapy?

"I will need these injections monthly for the rest of my life."

ACE inhibitors

"prils"

untreated hypertension

"silent killer" vision loss, CAD, renal failure

normal HCT levels

- Male: 37-49% - Female: 33-45%

Beta blockers

-olol

RAAS order

1. decreased perfusion stimulates secretion of renin 2.liver produces angiotensinogen 3.activation of angiotensin I to II occurs by a converting enzyme 4. angiotensin II 5. angiotensin II becomes III which releases aldosterone 6. aldosterone increases sodium and water reabsorption resulting in increased blood volume

erythrocytes live

120days

For which client would Procrit NOT be indicated?

A client with a hemoglobin of 12, with shortness of breath.

Assessment for of locally active antiviral agents

Assess for history of allergy Perform a physical assessment for baseline data to evaluating effectiveness and adverse effects Assess the infected area, including location, size, and character of lesions Evaluate for signs of inflammation at the site of infection to ensure safe use of the drug.

which drug should not be administered after anaphylactic reaction to penicillin G due to potential cross-sensitivity?

Cefadroxil

Which drug would be classified as third generation cephalosporin?

Ceftazidime

Fluoroquinolone used for anthrax

Ciprofloxacin

A client is experiencing iron toxicity. Which agent would the nurse expect to be given?

Deferoxamine

A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer?

Epoetin alfa

The nurse knows that malnutrition can cause which type of anemia?

Folic acid deficiency anemia occurs because of a dietary lack of folic acid, a component necessary in the formation of red blood cells.

aminoglycosides names

Gentamicin, Neomycin, Amikacin, Tobramycin, Streptomycin

A client comes to the clinic for epoetin alfa therapy. The nurse monitoring the client knows that blood will be drawn before the treatment begins, in order to evaluate which level?

HCT

Pneumonia and influenza vaccines in adults/routes

IM/ should receive annual influenza shot and every 10 tdap booster, and pnuemoccal after age 65

initial phase of treatment for TB

INH, rifampin, pyrazinamide, ethambutol

The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?

Increased RBC count

The nurse teaches the client about which action of oral iron administration?

Iron acts by elevating the serum iron concentration to replenish hemoglobin to treat anemia.

Normal hemoglobin levels

Male: 13-18 g/100mL Female: 12-16 g/100mL

Adverse effect of ACE inhibitor

Persistent cough

acquiring resistance

Producing an enzyme that deactivates the antimicrobial drug, Altering binding sites on the membranes or ribosomes, Changing cellular permeability, Producing a chemical that acts as an antagonist,

A client taking epoetin alfa requests changing the medication from the sub-Q to the PO route. How should the nurse respond?

This medication is destroyed in the stomach and can only be given by injection.

What do calcium channel blockers do?

Vasodilation of arteries and decrease heart rate

When administering iron injections, which method would the nurse use?

Z-track intramuscular

Selective toxicity

a drug harms microbes without harming human cells

A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery?

an iron supplement

Iron drug food interactions

antacids, eggs, milk, coffee, or tea.

Iron drug drug interactions

antacids, tetracyclines, or cimetidine, ciprofloxacin, chloramphenicol;

Polymoxin B

antiinfective used only for acute situations due to nerve damage

Acyclovir

antiviral agent- orally/buccally, parenterally, topically, peak within 1 hour, half-life of 2.5 to 5 hours. It is excreted unchanged in the urine. crosses into breast milk, exposes neonate to high levels of drug.

The component of the red blood cell that is not recycled is

bilirubin

Spread of Heb B

blood or blood products, sexual contact, or contaminated needles

What assessment is most important for a nurse to complete for a patient self administering epoetin?

blood pressure

1st gen cephalosporins

cefadroxil, cephalexin

Conditions caused by the herpes virus

cold sores, encephalitis, shingles, and genital infections

Adverse effects of thiazides

decreased effect of antidiabetic agents, risk of digoxin toxicity increases, risk of lithium toxicity, decreased absorption if used with cholestyramine or colestipol

Drug good interactions calcium channel blockers

diltiazem, grapefruit juice

ESA agents

epoetin alfa (Epogen, Procrit), darbepoetin alfa (Aranesp), and methoxy polyethylene glycol-epoetin beta (Mircera)

Names of antimycobacterials

ethambutol, isoniazid, pyrazinamide, rifampin, streptomycin, rifapentine,

hyperaldosteronism

excessive output of aldosterone from the adrenal gland, leading to increased sodium and water retention and loss of potassium

Loop diuretic names

eythecrinic acid (edecrin), bumetanide, furosemide (lasix), torsemide (Demadex)

Drugs for iron deficiency anemia

ferous drugs

Nonnucleoside Reverse Transcriptase Inhibitors adverse effects

for HIV- GI related—dry mouth, constipation or diarrhea, nausea, abdominal pain, and dyspepsia. Dizziness, blurred vision, and headache, flu-like symptoms

Nevirapine drug-drug interactions

for HIV- warfarin, Didanosine, Lamivudine and zalcitabine

megablastic anemia

from insufficient amounts of folic acid or vitamin B12

Compared with penicillins, cephalosporins more appropriate for treating infection by what type of microorganism?

gram-negative bacteria

A client is receiving an aminoglycoside antibiotic for an infection, the nurse should monitor closely for

hearing loss

drugs used for sickle cell anemia

hydroxyurea

Adverse effects of loop diuretics

hypokalemia, alkalosis, loss of calcium, hyperglycemia, ototoxicity

Contraindications and cautions of vaccines

immune deficiency, pregnancy, allergies to ingredients in vaccine, received blood to blood products in last 3months

Contraindications and cautions of ACE inhibitors

impaired renal function, heart failure, use contraceptives avoid pregnancy dont use if breastfeeding

What would be the priority nursing diagnosis for a patient who is prescribed epoetin alfa?

impaired tissue oxygenation related to anemia

the renin-angiotensin system is associated with?

intense vasoconstriction and BP elevation

anti-infective therapeutic actions

interference with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells

Action of Fluoroquinolones

interfering with DNA synthesis in the bacterial cell

A patient comes to the clinic reporting fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with:

iron deficiency anemia

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa?

iron supplementation

Family memebers will be treated prophylactically with which drug when a person is diagnosed with TB?

isoniazid

What necessitates discontinuing of isoniazide?

jaundice

Ways to decrease adverse effects in clients taking aminoglycosides

keeping client well hydrated

Which would they correctly identify as the formed elements of blood?

leukocytes, platelets, erythrocytes

Antibody titers

measures amount of a specific type of antibody present in the patients plasma

Iron deficiency anemia targets what group

menstrating women, pregnant/lactating women, rapidly growing adolescents, persons with GI bleeding

Superinfections

occur when opportunistic pathogens that were kept in check by the "normal" flora bacteria have the opportunity to invade tissues (ex. yeast infection, sores in mouth)

Pernicious anemia

occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed.

Pt teaching for antiinfectives

only for prescribed infection, drug must be taken exactly as prescribed

Adverse effects of aminoglycosides

ototoxicity, renal toxicity, GI disturbances, bone marrow depression, and superinfections

Patient teaching for antimycobacterials

plenty of fluids and good nutrition, use barrier contraceptives, expect orange stained body fluid, report difficulty breathing, hallucinations, or worsening of condition

aminoglycosides

powerful antibiotics used to treat serious infections caused by Gram-negative aerobic bacilli

high-ceiling diuretics

powerful diuretics that work in the loop of Henle to inhibit the reabsorption of sodium and chloride, leading to a sodium-rich diuresis

Botulism

produced by Clostridium botulinum, can be aerosolized or used to contaminate food. The toxin it produces causes cranial nerve palsies that can result in muscle paralysis and respiratory failure

cephalosporins are contraindicated for

pt allergic to penicillins

A patient is receiving hydroxyurea. The nurse understands that this drug is used to treat:

sickle cell anemia

After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia?

sickle cell anemia

antitoxins and antivenins

snake bites, black widow bites, scorpion stings, botulism

All hematopoietic and immune blood cells are derived from which cells in the bone marrow?

stem cells

Vaccines do what?

stimulate active immunity, vaccines provide lifelong immunity

Non black/diabetic patients with hypertension

thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB

Black/diabetic patients with hypertension

thiazide or calcium channel blocker first choice of treatment

Antiinfective therapy adverse effects

toxic effects on the kidney, GI tract, and nervous system

Antimycobacterials

used to fight leprosy and TB

Immune Sera

used to refer to sera that contain antibodies to specific bacteria or viruses

Why are viruses harder to treat than bacteria

viruses are contained inside human cells so its hard to make a drug that destroys the virus while leaving the human cell alone

The nurse knows that teaching has been effective when a student identifies which vitamin as necessary for the formation of the myelin sheath in the CNS?

vitamin B12

Which statement is true about the cause of anemia?

• "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."

A client diagnosed with iron deficiency anemia is learning about her prescribed iron supplement. Which additional information would the nurse include in the client's teaching plan?

• "If constipation or diarrhea become severe, call your primary care provider."

What inability of the kidneys causes anemia in chronic renal failure?

• Produce erythropoietin