Pharm 2 Exam - Questions
What does the first-pass effect mean?
Portion of the medication is absorbed by the liver before being absorped by the GI system. It means the medication will be in lesser effect due to this hepatic absorption.
What are contraindications of opioids?
Pregnant women Patient with respiratory depression Very altered LOC
The nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy?
Prolonged bleeding time
Which antidepressant has a fatal interaction with MAOIs?
Venlafaxine
What is the prototype for SNRI? What class?
Venlafaxine Antidepressant
What do you need to assess before giving an opioid?
Vital signs, especially respiratory status Ensure patient is not pregnant Check for allergies Ensure patient does not have any pre-existing/current respiratory depression Assess LOC
You are instructing your patient on therapeutic response. When should a patient expect a therapeutic response when taking an antidepressant?
Week 4 Rationale: Initial response takes 1-4 weeks, but I would like to set a realistic expectation/do not want to raise expectations too high.
A client with depression was prescribed fluoxetine and reports restlessness, confusion, an elevated body temperature, and poor concentration. Which intervention would the nurse anticipate preparing for in the treatment of these signs and symptoms?
Withdrawing the medication Rationale: Restlessness, confusion, poor concentration, and fever are symptoms of serotonin syndrome. The only treatment for serotonin syndrome is discontinuation of the medication.
What is malignant hyperthermia?
Adverse effect of general anesthesia Failure of calcium reuptake into the muscles
What are the side effects of opioid medication?
CNS depression Respiratory depression Pupil constriction Orthostatic hypotension Constipation Nausea Vomiting Facial flushing Urinary retention
Why is levodopa combined with another medication?
Combined with carbidopa to help with the nausea caused by levodopa
A client receiving high-dosage risperidone exhibits hand tremors. Which would be the nurse's FIRST intervention?
Contacting the primary health care provider Rationale: This is not a severe enough finding to warrant withholding the medication. It is a reaction to the risperidone and is not transitory.
What will happen if a patient on MAOIs consumes food with tyramine?
Hypertensive crisis
What is the action of lidocaine?
Local anesthetic Induces absent sensation in a specific body part Creates local insensitivity to pain
What factors affect IM and SQ absorption?
Local pH Vascularity Heat/cold
What does a small/narrow TI mean?
More risky Requires close monitoring or testing
A patient asks their nurse about drug interactions with over-the-counter prescriptions, what should be the nurse's best response?
"Read the labels carefully and ask your health care provider"
A client with urinary incontinence is prescribed amitriptyline. Which specific instruction would the nurse provide to the client?
"You should rise slowly when getting up from a sitting or lying position." Rationale: Amitriptyline is an antidepressant used to treat incontinence. This medication causes dizziness, orthostatic hypotension, and increases the risk of falls. The nurses should encourage the client to rise slowly because rising too quickly results in orthostatic hypotension.
The nurse is explaining drug action to a nursing student, which statement made by the nurse is correct?
"A drug not bound to a protein is an active drug." "If they're off the bus, they're at work!"
A patient has just received a prescription for an enteric-coated stool softener. When teaching the patient, the nurse should include which statement?
"Be sure to swallow the tablet whole without chewing it."
The nurse is teaching an older client about proper medication use. Which statement made by the clients indicates the need for further education?
"I will use over-the-counter medicines along with prescribed medications."
Aspirin is prescribed for a client with rheumatoid arthritis. Which clinical indicators of aspirin toxicity will the nurse teach the client to report?
Blood in stool Ringing in the ears
What is an example of "negative" schizophrenia?
Blunted affect Apathy Emotional withdrawal Poor rapport
An adolescent with a major depressive disorder is prescribed venlafaxine. Which s/s related to the medication will the nurse communicate immediately to the prescribing provider?
Blurred vision Suicidal ideation Difficult urination Rationale: Abnormal vision is a s/e of venlafaxine. CNS effects such as vertigo, anxiety, insomnia, and suicidal ideation are s/e of venlafaxine. Difficult or painful urination is a serious s/e of venlafaxine.
A client with osteoarthritis (OA) reports experiencing painful back muscle spasms. Which medication would the nurse administer?
Cyclobenzaprine hydrochloride
What is agranulocytosis and what drug is it associated with?
Dangerous low levels of WBC Antipsychotics Haloperidol Risperidone
A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given?
Depresses the central nervous system (CNS)
What would you teach a patient who was recently prescribed a barbiturate (i.e. phenobarbital)?
If used for seizures, keep a seizure journal Avoid alcohol, other CNS depressants, including antihistamines and opioid analgesics Use alternative for birth control Don't double dose Avoid driving and heavy machinery Don't stop abruptly Narrow TI causes fatal overdoses Report any difficulty breathing
Does tobacco increase or decrease drug metabolism?
Increase
How do atypical antipsychotics affect glucose levels?
Increase blood glucose
If a drug has extensive first pass effect, what are 2 options?
Increase dose Change route
A patient has been hospitalized due to being severely depressed and expressing suicidal thoughts. She was started on antidepressant medication 6 days ago. She now appears more energized and communicative. Which of the following would be most important for the nurse to do?
Increase vigilance with the patient's suicidal precautions Initial response to antidepressants is 1-4 weeks (6 days is not enough time to determine effect)
What are examples of pharmacodynamics?
Onset, peak, duration Therapeutic index Agonist, synergist, antagonist Side effects, toxicity
In report, you hear that your patient has a PCA pump with morphine. When you go in to assess the patient, he is difficult to arouse and has a respiratory rate of 8 breaths/min and an O2 sat of 84% on RA. What do you think is the cause?
These are symptoms of a possible morphine overdose Increased sedation, respiratory depression, and decrease O2 sat
What is the prototype for MAOIs? What class?
Tranylcypromine Antidepressant
When does malignant hyperthermia typically occur in patients under general anesthesia?
Within 30 minutes of induction
Can an overdose of TCAs (amitriptyline) be lethal?
Yes Anticholinergic and cardiac effects
In general, is absorption faster with IM and SQ routes compared to Oral?
Faster
What is the risk with MAOIs?
Fatal interaction with many foods including tyramine Hypertensive crisis Orthostatic hypotension Anticholinergic effects
In report, you hear that your patient has a PCA pump with morphine. When you go in to assess the patient, he is difficult to arouse and has a respiratory rate of 8 breaths/min and an O2 sat of 84% on RA. What should the nurse's initial action be?
First - Stop the infusion/pump
What NSAID can be used to prevent an MI?
Acetylsalicylic acid
What NSAID can cause tinnitus?
Acetylsalicylic acid
What is an example of "positive" schizophrenia?
Agitation Combativeness Hyperactivity
What is the MOA for lithium (Lithobid)?
Lithium ions substitute Na+ ions causing decreased neurotransmitter release (serotonin, dopamine, norepinephrine) Causes mood stabilization
Where are sites of drug metabolism?
Liver Kidneys Intestinal mucosa Lungs Blood plasma Placenta
Why would Naloxone seem to only work temporarily on a patient who overdosed on morphinie?
Naloxone has a short half-life of 60-100 minutes May require multiple doses
What is a normal WBC range?
4,500 to 11,000
What is the difference between drug agonists and antagonists?
Agonist drugs bind tightly to a receptor to produce a desired effect Antagonist drugs compete with other molecules and block specific responses at a receptor site
Lithium (Lithobid) has a narrow TI. What is an acceptable lab range for lithium (Lithobid)?
0.6-1.2
What are normal lab values for Lithium?
0.6-1.2
When the client taking haloperidol has a sudden change in health status, the nurse reviews the client's medical record and performs a physical assessment. Which medical emergency would the nurse conclude that the client is experiencing?
105 degree temp, Tachycardia, Tachypnea, Unstable BP, Diaphoresis, Severe muscle rigidity, Decreasing LOC, Metabolic acidosis, Increased creatinine phosphokinase (CPK) Neuroleptic Malignant Syndrome Rationale: Medication should be discontinued and supportive care provided.
A client takes acetaminophen routinely. The nurse will advise the client to avoid which substance?
Alcohol Rationale: Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage.
What are nursing assessments needed for patients on anti-parkinsonian drugs?
Assess parkinsonian s/s (tremor, muscle rigidity, bradykinesia, postural instability) Assess BP (specifically orthostatic hypotension) Assess PR Monitor RFTs and LFTs Assess for s/s toxicity
What is speed of drug onset and why is it important for an RN to know and understand?
How long it will take the drug to begin working Monitor patient's reponse Communicate to patient expecations When they should expect patient to find relief
What is the primary difference between Acetaminophen (Tylenol) and Ibuprofen (Motrin) in regards to inflammation?
Acetaminophen has little to no anti-inflammatory effects unlike Ibuprofen
Describe drug management for acetaminophen overdose.
Acetylcysteine (mucomyst) antidote Large doses exceeding 4000mg/day can cause hepatotoxicity Long-term use of large doses can lead to nephropathy/kidney disease
What phase of pharmacokinetics does the first-pass effect take place?
Absorption
For a client with difficulty swallowing, the nurse will crush which of the following medications: Metoprolol extended release, Felodipine sustained release, Acetaminophen extra strength, Potassium chloride extended release
Acetaminophen extra strength
What is the prototype for Tricyclic? What class?
Amitriptyline Antidepressant
What is the difference between phenobarbital and phenytoin?
Phenobarbital is non-selective in treating seizure activity as it effects the entire CNS and has many more uses Phenytoin selectively suppresses seizure activity
Which anticonvulsant can cause gingival hyperplasia?
Phenytoin
Which of the following drug forms is most rapidly absorbed from the GI tract? Tablet, Enteric coated tablet, Suspension, or Extended Release Capsule
Suspension
Which oral medication would be absorbed faster, Asprin 81 mg tablet or Asprin 325 mg enteric coated tablet? Why?
Aspirin 81 mg tablet because Aspirin 325 mg has an enteric coating making it an extended release medication Oral medication with an enteric coating are the slowest absorbed medications
What main classification of drugs is used to treat bipolar disease and name a prototype.
Anti-mania agent Lithium
What is neuroleptic malignant syndrome (NMS) and what drugs are the connected to?
Antipsychotics Haloperidol Risperidone Muscle rigidity Tremors Changes in LOC Tachycardia High fever
A patient presents with the following subjective s/s: flight of thoughts, difficulty concentrating, SOB, and feeling faint. The nurse knows that these are potentially indicative of which disorder?
Anxiety
How do you decrease IM or SQ absorption?
Apply cold
How do you increase IM or SQ absorption?
Apply heat
What are 3-5 topics you will need to teach a patient/family regarding taking a stimulant?
Avoid caffeine and other stimulants Take as directed at same time daily Recommend taking in the morning to avoid sleep disruption Eat regularly, even when not hungry School policies Do not share Contraindicated in children under age 6, ensure safely stored
What are implications of self-administered psychoactive drugs?
Because of the many side effects and restrictions of antipsychotics, patients may have difficult time being med compliant Follow up labs Take as directed Do not skip or double dose EPS and NMS
What is the difference between depression and bipolar disease?
Bipolar requires life-long therapy and depression may not
In report, you hear that your patient has a PCA pump with morphine. When you go in to assess the patient, he is difficult to arouse and has a respiratory rate of 8 breaths/min and an O2 sat of 84% on RA. After stopping the infusion/pump, what will the RN's subsequent actions be?
Call the provider and stay with the patient Provider may order Naloxone to reverse these effects
What patient teaching could you give a patient you are discharging in order for him to avoid stomach upset with NSAIDs?
Can be taken with food Report any bleeding to the provider
Two weeks after starting pheobarbital sodium, the client develops new symptoms. Which symptom is probably caused by the medication?
Cognitive impairment Rationale: Phenobarbital can cause significant lethargy, depression, and cognitive impairment. Depression is also a common adverse effect for this medication.
A 58-year-old patient with a history of recent MI has been started on atenolol (Tenormin) and warfarin (Coumadin) approximately 1 month ago. The patient also has a history of arthritis, and last week during a flare up began taking aspirin because that has helped his arthritis pain in the past. What teaching or recommendation would you as the nurse have for this patient?
Combining acetylsalicylic acid (Tylenol) with warfarin, an anticoagulant, will place the patient at higher risk for bleeding Patient dosages should be reviewed closely
What would you need to teach a patient who has been prescribed lithium?
Comply with lab draws Do not take NSAIDs Toxicity s/s Take as directed even if you are feeling well Maintain sodium uptake
What is an example of "cognitive" schizophrenia?
Concrete thinking Word salad Slowed thought processing Inability to change cognitive set
What will you teach your patient who has been prescribed an MAOI?
Contain many drug and food interactions, especially ones containing tyramine Avoid cheeses, smoked/pickled meats, aged/fermented meats, yeast, sauerkraut, beer/chianti wines It takes up to 4 weeks to take effect Orthostatic hypotension - change positions slowly Hypertensive s/s (tachy, palpitations, headache, sweating, increased BP) Be alert to suicidal tendencies Take as directed at same time daily Do not double dose Do not combine with other CNS depressants, antidepressants, or alcohol Avoid OTCs
A patient's mother calls your clinic and asks if she should give her daughter St. Joseph's Acetylsalicylic (Aspirin) for her illness. What questions should you ask before answering her question?
How old her daughter is What are her symptoms Acetylsalicylic is contraindicated in children under age 12
What is the fastest route for drug absorption and why?
IV due to circulatory system
What is the fastest overall absorbed medication route?
IV/Injections Parenteral
Which NSAID can cause photosensitivity?
Ibuprofen
How do atypical antipsychotics affect the liver and lipid profile?
Elevates cholesterol levels Throws of the lipid balance in your body
What is the role of P-45O in the liver?
Enzymes that help break down and clear out medications
A patient was prescribed a neuroleptic medication and is experiencing an oculogyric crisis, which medical emergency would the nurse conclude that the client is experiencing?
Extrapyramidal symptom Should be treated quickly with an antiparkinsonian agent
What is EPS?
Extrapyramidal symptoms Dystonia (involuntary muscle contractions) Akathesia (restlessness) Parkinsonism (tremor, slow movement) Tardive dyskinesia (repetitive, involuntary movements)
A patient experiences muscle contractions, dysrhythmia, a temperature of 103.6, and hyperkalemia 20 minutes after sedation for surgery. The nurse anticipates that an order for which of the following will be initiated?
Dantrolene
What medication is used to manage the muscle contractions exhibited by malignant hyperthermia by stimulating reuptake of Ca+ ions?
Dantrolene
Mrs. Smith, a 66-year-old client with cirrhosis of the liver, exhibits decreased metabolic activity. This will require what possible change in her drug regimen?
Decrease dose, speak with the pharmacist Change the route if there is a more safe, alternative route
Why would an aging adult have increased amounts of "free" circulating drug concentrations?
Decreased first-pass effect
Why do newborns have a decreased ability to metabolize medications?
Decreased number of enzymes in the developing liver (P-45O enzymes help to break down and metabolize drugs)
A client reports to the nurse, "I've been using St. John's Wort to try and feel more like myself again. I'm not sure whether it's going to work." Which symptom would the nurse further assess?
Depression Rationale: St. John's Wort is an herb marketed as a natural way to improve mood and ease feelings of depression.
Why is it important to determine if the patient has depression or bipolar disease?
Different medications and therapies to help
The nurse is giving medications to a patient in cardiogenic shock. The intravenous route is chosen instead of the intramuscular route. The nurse knows that the factor that most influences the decision about which route to use is the patient's:
Diminished circulation Cardiogenic shock is related to the heart = circulation. IM needs to be vascularized/have blood supply to it to distribute medication.
Which instruction would the nurse provide to a client who has anxiety and depression and is prescribed venlafaxine ER tablets?
Do not crush the tablets Report any suicidal thoughts The medication takes 3 to 4 weeks to work Do not suddenly stop taking the medication Taper your dose up to the required dose
What is the difference between drug absorption and drug metabolism?
Drug absorption occurs when the drug enters the body and travels into circulation Durg metabolism is the actual breakdown of the drug molecule
What is the difference between drug potency and drug efficacy?
Drug potency is the amount of drug it takes to have an effect Efficacy is having the actual therapeutic effect
Which antidepressant is highly protein bound so displacement of other drugs is common?
Fluoxetine
What is the prototype for SSRI? What class?
Fluoxetine Antidepressant
What are 3 disadvantages for patient therapy associated with Lithium?
Frequent lab monitoring Lifelong treatment Narrow TI Tremors, weight gain, thirst, nausea, dry mouth Med compliance is difficult due to lab draws and lifelong treatment
What can alter drug metabolism?
Genetics (rapid acetylator and slow acetylator) Age Social habits P-450 System Extent of protein binding Disease processes
Is Ibuprofen 200 mg or Aspirin 325 mg more potent? Why?
Ibuprofen would be more potent because it requires a lower dose to produce the same effect Both drugs have the same efficacy
What impact does grapefruit juice have on certain medications? Inhibits metabolism
Increases risk for drug toxicity
What does grapefruit do to drugs after they are administered?
Inhibits drug metabolism
A medication's therapeutic dose is 30 mg. The same medication's toxic dose is 120 mg. The nurse understands that this means what related to the medication's safety?
It has a wide TI
A patient reports having taken phenobarbital (Lithium) in the past. The patient asks the nurse why they have now been prescribed lorazepam (Ativan) for anxiety. The nurse knows that the new prescription is better because:
It has a wider TI (less risk for toxicity)
The nurse knows that less drug is available to the patient when it has which of the following properties?
It is highly protein bound
The nurse knows that a prescription for phenytoin (Dilantin) is a benefit for the patient because:
It is the only medication to suppress seizures without suppressing whole CNS
How would you describe "balanced anesthesia?"
It is the use of 2 or more smaller doses of agents to help prevent side effects/achieve desired effect without having to use on large dose of a single agent Considered more safe when compared to general anesthesia
What would be important to teach a patient prescribed an antidepressant?
It may take up to 4 weeks to work Watch for orthostatic hypotension Change position slowly Anticholinergic effects Med compliance Take as directed at same time daily Be alert to suicidal tendencies Do not combine with alcohol or other CNS depressants
A patient has orders for pain medication. The nurse assesses the patient and determines that patient's pain level is 8 out of 10. Which of the following medications would the nurse anticipate giving with this pain rating?
Ketorolac
What is the difference between pharmacokinetics and pharmacodynamics?
Kinetics is the process of drug movement throughout the body (absorption, distribution, metabolism, excretion). Dynamics is the study of the affects of the drugs in the body. Think "kinetics" as "movement" and "dynamics" as "dynamic effects."
How would you know if your antidepressant is working?
Less sadness/fear Increased amount of interest/pleasure (less anhedonia) Improved appetite Increased amount of sleep More energy/less fatigued Less feelings of guilt, nervousness, helplessness Increased ability to concentrate
A patient has been instructed to have lab draws weekly. The draws should also be completed in the morning before any medication has been taken. The nurse knows that the result should be 0.6-1.2 mEq/L. The patient is likely taking which medication?
Lithium Requires regular lab draws to determine appropriate lithium levels
The nurse is caring for an adolescent admitted to the hosptial after taking an acetaminophone overdose. Which result is MOTS important for the nurse to monitor at this time? Blood gas level, Liver function tests, complete blood count, or glycosylated hemoglobin?
Liver function tests Rationale: Acetaminophen is metabolized by the liver, and an excess may result in increased aspartate aminotransferase and bilirubin levels and prothrombin time. Liver damage may be permanent.
What can affect drug excretion?
Liver, kidney, and lung function Pregnancy Age Half-life
What is trough?
Lowest blood dose collected 30-60 minute before readministration
What is the last choice for medication of depression?
MAOIs
What are our post-medication assessments associated with anesthetics?
Maintain patient safety Monitor vital signs, especially respiratory status Assess LOC Monitor recovery from anesthesia/procedure Evaluate for N/V Assess for shivering Assess pain level Document post-op pain level Monitor for systemic effects
What is the nurses' roles with anesthetic drugs?
Maintain patient safety, always
What assessments are necessary for the RN to do when caring for a patient immediately after surgery who has had a general anesthetic?
Maintain safety Monitor vital signs, especially respiratory status Evaluate LOC Monitor recovery from anesthesia and procedure Evaluate for N/V Assess for shivering Evaluate pain
What does Dantrolene do?
Manages the muscle contractions exhibited in malignant hyperthermia by stimulating reuptake of Ca+ ions
What is peak?
Medication is at its highest concentration in the blood
While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur?
Metabolism
While caring for a patient with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur?
Metabolism Cirrhosis and hepatitis impact the liver. Metabolism occurs in the liver.
In what ways may rate of absorption be changed?
Modifying gastric emptying time Changing gastric pH Forming drug complexes Rationale: PO medications' absorption time is altered by the amount of time they have to be absorbed in the GI tract, the site of absorption for this type of administration. Gastric pH can affect the absorption and the amount of the drug that is altered to an absorbable form. Drug complexes may alter the degree to which certain drugs in that complex can be absorbed.
What will you monitor when assessing a patient that is taking a CNS stimulant?
Monitor growth and weight Assess therapeutic response Assess sleep patterns Ensure patient is not consuming caffeine or other CNS stimulants Obtain baseline vitals and perform periodic checks
What are our pre-medication assessments associated with anesthetics?
Monitor vitals, especially respiratory status (RR, depth, quality, and SpO2) Assess LOC Assess pain level
What are MAOIs used for?
Monoamine oxidase enzymes remove serotonin, dopamine, and norepinephrine MAOIs inhibit monoamine oxidase enzymes so serotonin, dopamine, and norepinephrine remain active longer It is used to treat atypical depression
What does a short half life mean?
More frequent administrations
How can you determine the elapsed time until next administration?
Multiply the half like by 5
A client takes an antipsychotic medication. When assessing the client for signs and symptoms of pseudoparkinsonism, the nurse will be alert for which complication?
Muscle tremors Rationale: drug-induced pseudoparkinsonism presents with the classic triad of adaptations associated with Parkinson disease: rigidity, slowed movement (bradykinesia), and tremors. Antipsychotic medications have an anticholinergic effect.
If a drug is classified as highly protein bound, do you think it is going to be easily distributed throughout the body?
No It will be "on the bus" and not easily distributed
Can lidocaine and epinephrine be used for a right hand injury? Why or why not?
No Lidocaine with epi acts as a vasoconstrictor in addition to eliminating pain sensation Contraindicated for periphery parts as it will cut off the circulation to those areas and cause tissue death
Can an overdose of SSRIs (fluoxetine) be lethal?
No, rare Fewer anticholinergic and cardiac effects than TCAs
Can grapefruit effect administered IV medications?
No. It can only effect oral medications and some rectal medications.
The nurse must identify which patients are potentially at the highest risk for drug interactions, which groups of patients might the nurse identify?
Older patients Patients with chronic health conditions Patients taking three or more drugs
What do you think could be a barrier to a patient staying on their medication and what could the nurse do to help?
One large barrier is often cost Another barrier is dulling of the patient's personality (their perception) Side effects Required consistency in taking Nurse could educate patient on risks for not taking the medication
The patient is prescribed a new medication. The nurse provides education about the medication. The patient questions when s/he might begin feeling the effect of the medication. The nurse would define which of the following to answer the questions appropriately?
Onset of action (time when medication effects will first begin)
Which analgesic would an RN advise a patient not to consume grapefruit with?
Oxycodone and acetaminophen
A patient who has advanced cancer is receiving opioid medications around the clock to "keep him comfortable" as he nears the end of his life. Which term best describes this type of therapy?
Palliative
Methylphenidate is prescribed to treat a child's attention-deficit/hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of ADHD in children because it has which effect?
Paradoxical Rationale: Methylphenidate is a stimulant that has an opposite or paradoxical effect on hyperactive children. It does have an hypotensive effect, but not why it would be given to hyperactive children.
What are patient contraindications to NSAID therapy?
Patient already taking an NSAID Bleeding disorders or ulcers already there Perform medication history to assess for potential drug interactions: alcohol, heparin, phenytoin, oral anticoagulants, steroids, sulfonamides
Why is it important to ask about a patient's family surgical history before the administration of general anesthesia?
Patients undergoing general anesthesia are at a risk for malignant hyperthermia This condition can be genetic and a good indicator of the risk factor associated for the patient
Which components of pharmacokinetics does a nurse need to understand before administering a drug?
Patients with kidney disease may have fewer protein binding sites and are at a risk for drug toxicity When the drug metabolism rate is decreased, excess drug accumulation can occur and therefore cause toxicity
The nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sufate, a monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective?
Pepperoni pizza Bologna sandwich Rationale: Cheese and processed meats contain tyramine, which is contraindicated when MAOIs are taken. Can lead to a sharp increase in norepinephrine and a potentially fatal hypertensive crisis. Delicatessen meats, meat extracts, and liver are high in tyramine.
What are ways to improve patient compliance with psychotropic drugs?
Provide thorough education Assess patients' readiness to receive teaching and understanding of medication Explain importance of regular lab draws, connecting safety precautions as to why lab draws are needed Explain effects of not taking doses on a regular schedule Explain effects of double dosing Explain overall risks for not being compliant
Which assessment will assist the nurse in determining whether a client is experiencing adverse effects of risperidone?
Question if dizziness is experienced Rationale: Hypotension and dizziness are a/e of risperidone. The medication may cause constipation, not diarrhea. It does not affect the neuromuscular or cardiovascular function of the legs; numbness and coldness of the lower extremities do not occur. Risperidone does not cause wheezing or SOB.
What is tardive dyskinesia and what is it associated with?
Repetitive, involuntary movements Grimacing, eye blinking, lip smacking Effect of antipsychotics
What is the first choice for medication of depression?
SSRIs
What are the differences between SSRIs and TCAs?
SSRIs selectively inhibit reuptake of serotonin, making it safer TCAs inhibit reuptake of serotonin, dopamine, and norepinephrine SSRI do have a risk of causing serotonin syndrome SSRIs have fewer anticholinergic and cardiac effects than TCAs
What is the risk with the SSRIs (fluoxetine)?
Serotonin syndrome Highly protein bound so displacement with other drugs common - increase risk for toxicity
After 4 weeks, Allison continues to have signs of depression despite the implementation of non-pharmacologic interventions including therapy, and she is started on 10 mg of Fluoxetine (Prozac). She has less depression at subsequent appointments. After taking Prozac for 6 weeks, Allison comes in for a follow-up appointment complaining of restlessness, a fast heartbeat, a temperature of 101, stomach pain and diarrhea. She reveals to you she has been taking St. John's Wort for the past six months. St Johns Wort is an OTC supplement that is often used for treating mild depression.
She is likely experiencing serotonin syndrome due to the combination of St. John's Wort and SSRI
What are 2 examples of factors affecting drug metabolism?
Social habits Age
What are the factors affecting oral (enteral) absorption?
Solubility Food or fluid Vascularity Stomach pH GI motility Surface area First pass effect
What is meant by rapid acetylator?
Someone who metabolizes drugs quickly Typically Asian or Inuit decent
What is meant by slow acetylator?
Someone who metabolizes drugs slowly Typically European or African decent
A patient tells you that their pain is 8/10. What medication would you think about administering?
Strong opioids with or without non-opioid and adjuvant medications Morphine sulfate or oxycodone-acetaminophen
What factors affect topical absorption?
Surface area Vascularity Skin integrity Skin thickness
Naloxone effectively reverses a client's respiratory depression from an overdose of heroin. Why will the nurse continue to closely monitor this client's status?
Symptoms of the heroin overdose may return after the naloxone is metabolized Rationale: The duration of action of naloxone is shorter than that of heroin. After naloxone is metabolize and its effects are diminished, the respiratory distress caused by the heroin overdose will return, necessitating readministration of naloxone.
What are s/s of malignant hyperthermia?
Tachycardia Arrhythmias Prolonged muscle contractions due to lack of calcium in the muscles Elevated temp Flushing Cyanotic skin Hyperkalemia Cardiovascular collapse Respiratory collapse
What are s/s of hypertensive crisis?
Tachycardia Palpitations Headache Sweating Increased BP greater than 180/120
What would be important for the nurse to teach a patient about antipsychotics?
Take medications as ordered Do not skip or double dose May take up to 6 weeks to achieve full effect Avoid alcohol Do not stop abruptly Follow up lab draws
A health care provider prescribes lithium carbonate for a client with bipolar disorder, depressive episode. Which instructions will the nurse include when teaching the client about lithium?
Take the medication with food It may take several weeks for beneficial results to occur Restriction of sodium intake is unnecessary Rationale: Lithium should be taken with food to prevent GI irritation. It will take 1-3 weeks before beneficial results occur. Lithium decreases sodium resorption by the renal tubules. If sodium intake is decreased, sodium depletion may occur. In addition, lithium retention is increased when sodium intake is decreased; restricted sodium intake can lead to lithium toxicity.
A patient is being switched from an MAOI to an SSRI. The nurse knows that an essential teaching point for the patient would include:
Taper off tranylcypromine and begin fluoxetine in 2-5 weeks Antidepressants should not be stopped abruptly and there must be a 2-5 week wash out between the two medications
What is the MOA of haloperidol?
Targets dopamine and serotonin receptors
Gary, a 77-year-old patient, is preparing to be discharged from the hospital. The nurse is going over his discharge medications and Gary says, "I usually take all my medications in the morning with grapefruit or orange juice, is that ok?" What is the nurse's best response?
The RN should review Gary's medications and speak with the pharmacist Not all medications are affected by grapefruit juice The medications that are impacted have their metabolism inhibited and give patient increase risk for toxicity If medications are found to be contraindicated with grapefruit/juice, the RN will educate the patient as to why they need to avoid consuming grapefruit
Fluoxetine is prescribed for a client with depression. Which precaution will the nurse consider when initiating treatment with this medication?
The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. Rationale: Fluoxetine does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Weekly blood level checks are not necessary with fluoxetine.
A nurse is monitoring the therapeutic drug level of a patient on vancomycin (vancocin) and notes that the peak level is in the therapeutic range. What does this indicate to the nurse?
The drug level is appropriate to demonstrate therapeutic effects The nurse will continue to monitor because each patient response to a drug is unique
The nurse is describing to their young adult patient that their prescription is a caffeine synergist, what does this mean?
The effects of one drug amplifies the effect of the other, and a greater effect is achieved when the drugs are administered together.
The protein binding capacity of drugs in infants is low. The nurse understands which is an impliaction of this physiological process?
The free levels of a medication will increase
How does protein binding affect drug metabolism?
The higher the protein levels the more seats on the bus and the less medication circulating out because they are sitting on the bus
The nurse should question the prescriber if the drug with the half life of more than 24 hours is ordered to be administered more than how often?
Twice weekly Rationale: the medication should exponentially decrease its concentration in the blood by 50% each day, meaning that by day 5, the medication should no longer be active, no more than 2 doses in any given week may be administered for this medication.
A client receiving morphine is being monitored by the nurse for adverse effects of the medication. Which clinical findings warrant an immediate follow up by the nurse?
Unconsciousness Bradycardia Bradypnea (Morphine does not increase urine output or dilated pupils. Morphine causes constriction of pupils)
Which would the nurse include when teaching a client with Parkinson disease about carbidopa-levodopa?
The medication should be taken with meals Rationale: Carbidopa-levodopa should be taken with meals to reduce the N/V that commonly are caused by this medication. Multivitamins are contraindicated; may contain pyridoxine (vitamin B6), which diminishes the effects of levodopa. A high-protein diet is contraindicated.
A nurse is teaching a 16-year-old female patient about a newly prescribed medication. The patient is bilingual in Spanish and English. Which behavior best indicates the patient's understanding of the instructions?
The patient repeats the nurse's instructions to her parents
The nurse will be administering a pain medication with a half life of 4 hours. The nurse knows that this means which of the following in regard to therapeutic effect?
The patient will need to be reassessed for pain in 4 hours The patient will receive 50% of the medication in 4 hours
Which reason explains why so many psychiatric clients are given benztropine or trihexyphenidyl in conjunction with phenothiazine-derivative neuroleptic medications?
They combat the extrapyramidal side effects of the neuroleptic medication Rationale: Benztropine and trihexyphenidyl control the EPS manifestations associated with the neuroleptics and are classified as antiparkinsonian medications.
What does onset mean?
Time it takes for the drug to reach maximum effective concentration in the blood
Lithium toxicity can occur in patients taking lithium. What are 3 symptoms of lithium toxicity?
Tremors Weight gain Thirst
How long can the grapefruit effect last?
Up to 3 days if consumed on a daily basis
An older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. Which intervention is appropriate?
Withholding the next dose of lithium and drawing blood for a lithium level Rationale: The client is displaying s/s of early lithium toxicity; older clients should be monitored carefully and given smaller doses of lithium because its excretion from the kidneys is slower than that in younger adults. There is no antidote to lithium. Coarse hand tremor is an indication of advanced lithium toxicity; the lithium should be withheld.
Is there an increased chance for toxicity if a drug is classified as highly protein bound?
Yes If patient receives additional medication, that medication may bump the drug off "the bus" causing potentially higher blood concentrations than intended
Your patient is almost 24 hours post-op for a right knee replacement. He has been experiencing swelling and pain and has been taking one Vicodin 5/500 every 4 to 6 hours. He also has Tylenol, Ibuprofen and Morphine ordered on his MAR for pain. When you make your first assessment, he rates the pain 8/10. You see on the MAR that he had one Vicodin tablet 2 hours ago. What can you do to alleviate his pain?
You could give the patient morphine Important the patient does not exceed 4000 mg/day of acetaminophen (Tylenol) Vicodin also needs to be spaced out every 4 hours (patient received Vicodin 2 hours ago)
