Pharm Week 1

A client with recurrent urinary tract infections was prescribed sulfamethoxazole-trimethoprim and experienced an allergic reaction. The client states, "I don't understand. I had a two-day course of the same drug last year with no problems." What is the nurse's best response? "Allergic reactions are usually dose-dependent, so it could be that you were treated with a lower dose last year." "If you were more ill with an infection last time, it's possible you confused an allergic reaction with your UTI symptoms." "It's likely that you didn't have an allergic reaction last time because you had such a short course of treatment." "Allergic reactions happen after your body has been sensitized to a drug in the past."

"Allergic reactions happen after your body has been sensitized to a drug in the past."

The mother of a 14-month-old girl calls a nurse working in a pediatric clinic and reports that her daughter ingested an unknown number of sleeping pills about 4 hours ago and is now drowsy. The mother asks what she should do. The best response to give the mother is "Administer a dose of syrup of ipecac to ensure vomiting" "Call the Poison Control Center immediately" "Administer a strong laxative and observe for a response" "Call 911 to transport your daughter to the nearest emergency department"

"Call 911 to transport your daughter to the nearest emergency department"

While collecting a medication history, the client admits to doubling the recommended dosage of acetaminophen, saying "It's harmless or they would require a prescription." What is the nurse's best response? "Taking medications like that is careless and you could cause yourself serious harm if you keep doing it." "Sometimes you need to take more than the package directs to treat the symptoms. It's important not to do this frequently." "Did you notify your health care provider of the increased dosage you were taking?" "OTC drugs are serious medications and carry serious risks if not taken as directed."

"OTC drugs are serious medications and carry serious risks if not taken as directed."

A nurse demonstrates an understanding of the impact the National Institutes of Health (NIH) Revitalization Act has had on the policies currently guiding drug trials, when making which statement? "There is such a important information now available since both women and minorities are included in drug research studies." "The inclusion of a double-blind testing format adds credibility to the findings of human drug testing." Every drug research study must include the gathering of data on the medication's effect on men." "The safety of the participants has improved since animal testing must be completed prior to human drug testing."

"There is such a important information now available since both women and minorities are included in drug research studies."

The client is taking a 2-mg dose of ropinerol XR. The drug has a half-life of 12 hours. In how many hours will 0.25 mg of this drug remain in the client's system?

36 hr

Which client would a nurse expect to experience alterations in drug metabolism? 35-year-old woman with cervical cancer 62-year-old woman in acute renal failure 41-year-old man with kidney stones 50-year-old man with cirrhosis of the liver

50-year-old man with cirrhosis of the liver

The nurse is taking care of a man who is confused about the different medications he is prescribed. He notes that some of the drug names have changed over the course of time he has been taking them. When counseling him, it is most important to keep the following statement in mind: A drug can belong to only one group or classification. A prototype drug is the standard by which similar drugs are compared. Drug groups and prototypes change frequently, and knowledge about a prototype cannot guide knowledge about other drugs in the same class. The generic name of a drug changes among manufacturers.

A prototype drug is the standard by which similar drugs are compared.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine? Administer glargine via IV route. Administer insulin that has been refrigerated. Shake the vial vigorously before withdrawing insulin. Avoid mixing glargine with other insulin.

Avoid mixing glargine with other insulin.

Pregnancy Categories

Category A. Risk to the fetus in the first trimester (and in later trimesters) has not been demonstrated in well-controlled studies in pregnant women. Category B. Animal reproduction studies have not demonstrated risk to the fetus, and there are no well-controlled studies in pregnant women. Category C. Animal reproduction studies have not demonstrated risk to the fetus, and there are no well-controlled studies in pregnant women; however, potential benefits may outweigh potential risk in use of drug in pregnant women. Category D. Evidence of risk to the fetus has been demonstrated. However, the benefits may outweigh risk in pregnant women if the drug is needed in a life-threatening situation and other safer drugs cannot be used or are ineffective. Category X. Studies in humans or animals have demonstrated fetal abnormalities or evidence of fetal risk, and the risk clearly outweighs the benefit. The drug is contraindicated in women who are pregnant or in those who may become pregnant.

Prescription practices of primary health care providers for controlled substances are monitored by which agency? Drug Enforcement Agency (DEA) U.S. Pharmacopeia (USP) World Health Organization (WHO) Food and Drug Agency (FDA)

Drug Enforcement Agency (DEA)

Schedule IV

Drugs with an accepted medical use in the United States but with some potential for abuse: benzodiazepines (e.g., diazepam, lorazepam), other sedative-hypnotics (e.g., phenobarbital, chloral hydrate), and some prescription appetite suppressants (e.g., phentermine).

Schedule III

Drugs with less potential for abuse than those in Schedules I and II, but abuse of which may lead to psychological or physical dependence: androgens and anabolic steroids, some depressants

Pure Food and Drug Act

Established official standards and requirements for accurate labeling of drug products Established the forerunner of U.S. Food and Drug Administration (FDA)

Variables that effect drug actions

Ethnicity Sex Age Body Weight Psychological factors

Schedule 2

Has a high potential for abuse and may lead to physical or psychological dependence but also has a currently accepted medical use in the u.s. EX: Amphetamines,opium,cocaine, methadone

One of the phases of drug development is the post-marketing surveillance phase. Which activity is carried out during this phase? The drug is given to clients with the disease. Health care providers report adverse effects to FDA. In vitro tests are performed using human cells. Healthy volunteers are involved in the test.

Health care providers report adverse effects to FDA.

The nurse is explaining to the client what bioavailability is. What statement is true of bioavailability? It is the portion of a dose that reaches the systemic circulation and is available to act on body cells. It is the portion of a dose that causes toxicity. It is the portion of a dose that reaches the systemic circulation. It is the portion of a dose that is absorbed by the system to achieve a therapeutic drug level.

It is the portion of a dose that reaches the systemic circulation and is available to act on body cells.

Schedule V

Products containing moderate amounts of controlled substances. They may be dispensed by the pharmacist without a physician's prescription but with some restrictions regarding amount, record keeping, and other safeguards. Included are cough suppressants containing small amounts of codeine and antidiarrheal drugs, such as diphenoxylate and atropine (Lomotil).

Harrison Narcotic Act 1914

Restricted the importation, manufacture, sale, and use of opium, cocaine, marijuana, and other drugs that the Act defined as narcotics

Food, Drug, and Cosmetic Act

Revised and broadened FDA powers and responsibilities; gave the FDA control over drug safety Required proof of safety from the manufacturer before a new drug could be marketed Authorized factory inspections Established penalties for fraudulent claims and misleading labels

Six Rights of Medication Administration

Right patient Right medication Right dose Right route Right time Right documentation

The nurse is caring for a patient who admits to having taken anabolic steroids to enhance his cycling ability. What schedule medication was this patient abusing? Schedule II Schedule III Schedule IV Schedule I

Schedule III

A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man's most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man's serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings? The man may be experiencing nephrotoxic effects of aspirin The man may be experiencing a paradoxical effect of aspirin The man may be experiencing liver toxicity from the aspirin The man may be allergic to aspirin

The man may be experiencing nephrotoxic effects of aspirin

A drug was introduced to the market, where it was well received, and the nurse has learned that generic equivalents will soon be released. The nurse should understand what implication of this fact? The drug is facing increased competition from OTC drugs. The manufacturer's patent on the drug has recently expired. The drug was previously an orphan drug, with limited supply. The drug has recently completed phase 3 testing.

The manufacturer's patent on the drug has recently expired.

Pharmacokinetics

The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.

Pharmaeconomics

The study of economic factors impacting the cost of drug therapy.

Which of the following are ways that drugs are classified? Select all that apply. Dosage Therapeutic uses Effects on body systems Method of manufacture Chemical characteristics

Therapeutic uses Effects on body systems Chemical characteristics

A nurse is looking up information about the effects of a drug on different receptors. Characteristics of receptors include which of the following? They are carbohydrates located in cell membranes or inside cells. They are constantly synthesized and degraded in the body. They bind with molecules of any drug circulating in the bloodstream. They regulate the actions of all drugs

They regulate the actions of all drugs.

Schedule I

This type of drug has no accepted medical use in the United States.

What vitamin interacts with Warfin?

Vitamin K

Which of the following are examples of drugs with local effects? Select all that apply. Oral diabetes drugs Wart medicine Sunscreen Cold sore medicine Antihypertensive

Wart medicine Sunscreen Cold sore medicine

The nurse should consider teratogenic effects when caring for what clients? Select all that apply. a 37-year-old female client who is taking fertility drugs a 29-year-old client receiving prenatal care in her first trimester of pregnancy a 44-year-old female being treated in the intensive care unit for multiorgan dysfunction syndrome a 41-year-old male who is immunocompromised following bone marrow transplant an 81-year-old male with chronic heart failure and peripheral edema

a 37-year-old female client who is taking fertility drugs a 29-year-old client receiving prenatal care in her first trimester of pregnancy

Phase one of drug testing

a few doses are given to a certain number of healthy volunteers to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity

Phase two of drug testing

a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied, and responses are compared with those of healthy subjects.

A female client has a 12-year history of ETOH abuse. The client is injured in a motor vehicle accident and requires surgery with general anesthesia. What would the nurse expect for this client? no general anesthesia, because general anesthesia should not be given to a client with her history a smaller-than-normal dose of the general anesthetic the same dose of the general anesthetic as another female of her age and medical history a larger-than-normal dose of the general anesthetic

a larger-than-normal dose of the general anesthetic

Which of the following are nursing responsibilities connected to controlled substances? Select all that apply. a.) Administering controlled substances only to people for whom they are prescribed b.) Storing controlled substances in locked containers C.) Recording each dose given on agency narcotic sheets and on the patient's medication administration record d.) Supervising the inventory kept by nursing assistants and UAPs e.) Reporting discrepancies to the proper authorities

a.) Administering controlled substances only to people for whom they are prescribed b.) Storing controlled substances in locked containers c.) Recording each dose given on agency narcotic sheets and on the patient's medication administration record e.) Reporting discrepancies to the proper authorities

A patient with an overdose of an oral drug usually receives which of the following? specific antidote activated charcoal syrup of ipecac strong laxative

activated charcoal

The Universal Antidote

activated charcoal

Pharmacogenomics

the study of how one's genetic inheritance affects the body's response to drugs.

serum-half life

time required for the serum concentration of a drug to decrease by 50%; also called elimination half-life

The Joint Commission requires performance measures related to safety in drug administration. Some of these performance measures require specific precautions when administering which drug? antipsychotics anesthetics analgesics anticoagulants

analgesics

CYP enzymes

are complex proteins with binding sites for drug molecules (and endogenous substances). They catalyze the chemical reactions of oxidation, reduction, hydrolysis, and conjugation with endogenous substances, such as glucuronic acid or sulfate.

The nurse is preparing to administer the drug papaverine (Pavabid). What does the nurse identify the name Pavabid as? brand name chemical name chemical and generic name generic name

brand name

The Controlled Substances Act of 1970 regulates what actions in regards to drugs classified as controlled substances? (Select all that apply.) elimination distribution manufacturing formulation dispensing

distribution manufacturing dispensing

loading dose

dose larger than the regular prescribed daily dosage of a medication; used to attain a therapeutic blood level

A nurse is reading a research report about use of a medication that describes the pharmacokinetics of a particular medication that a patient is taking. Pharmacokinetics involves drug effects on human cells drug binding with receptors drug absorption, distribution, metabolism, and elimination drug stimulation of normal cell functions

drug absorption, distribution, metabolism, and elimination

antagonist

drug that inhibits cell function by occupying receptor sites

Agonist

drug that produces effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances

Nonreceptor Drug Actions

drugs that act by mechanism other than combination with receptor sites on cells. examples: antacids, osmotic diuretics, drugs that are structurally similar to nutrients required by body cells (purines, pyrimidines) several cancer drugs act this way, metal chelating agents

A man is very upset with a drug recall of a medication he has been taking for a long time. He states that he feels like he can no longer trust anyone to protect him. In response to his questions about the process of drug development, it is important to know that with a new drug, the U.S. Food and Drug Administration (FDA) is responsible for testing the drug with animals testing the drug with healthy people marketing the drug to health care providers evaluating the drug for safety and effectiveness

evaluating the drug for safety and effectiveness

What is included in FDA approval of a drug for OTC availability? studies involving the safe use of the medication by the consumer analysis of the cost of the drug to the consumer evaluation of evidence that the consumer can use the drug safely, using information on the product label analysis of the diagnoses for which the medication may be used by the consumer

evaluation of evidence that the consumer can use the drug safely, using information on the product label

Pro drugs

initially inactive drugs that exert no pharmacologic effects until they are metabolized

Phase 0 of drug testing

initially, drug testing occurs in animals and small groups of humans

Pharmacodynamics

involves drug actions on target cells and the resulting alterations in cellular biochemical reactions and functions (i.e., "what the drug does to the body").

The Quality and Safety Education for Nurses (QSEN) project

is committed to the continuous improvement in the quality and safety of health care systems by focusing on the needed knowledge, skills, and attitudes (KSA) required in the preparation of future nurses in six areas: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

serum drug level

laboratory measurement of the amount of a drug in the blood at a particular time. For most drugs, serum levels indicate the onset, peak, and duration of drug action.

Biotechnology

manipulating deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) and recombining genes into hybrid molecules that can be inserted into living organisms

A nurse is caring for a man who has worsening liver disease. In monitoring his medication, it is important to know that a patient with liver disease may have impaired drug absorption distribution metabolism excretion

metabolism

A nurse practitioner (NP) has just changed a patient's medication from an oral form to a patch formulation to avoid the first-pass effect. The NP has explained it to the patient, but the patient still has questions and asks the nurse to explain again what is meant by the first-pass effect. The nurse would be most correct in explaining that this has to do with how drugs initially bind to plasma proteins initial renal function is involved in drug excretion the way drugs first reach their target cells initial metabolism of an oral drug occurs before it reaches the systemic circulation

nitial metabolism of an oral drug occurs before it reaches the systemic circulation

systemic absorption

occurs from the mucosa of the oral cavity, nose, eye, vagina, and rectum. Drugs absorbed through mucous membranes pass directly into the bloodstream

A patient is asking what the difference is between a prescription for 800 mg of a medication that can be purchased on an OTC basis as a 200-mg tablet. To address this issue, it is important that the nurse knows that OTC drugs are considered safe for any consumer to use are not available for treatment of most commonly occurring symptoms often differ in indications for use and recommended dosages from their prescription versions are paid for by most insurance policies

often differ in indications for use and recommended dosages from their prescription versions

A drug has been approved by the Food and Drug Administration. What study phase would occur next? phase IV study phase II study phase III study phase I study

phase IV study

Bioavilability

portion of a drug dose that reaches the systemic circulation and is available to act on body cells

Error-reduction strategies during medication administration include (choose all that apply) quiet zone signs at entrance to the medication room protocols and checklist outlining medication administration wearing of a sash or vest to signal others to avoid interruptions of the nurse during medication administration carrying several patients' prescanned medications on a tray

quiet zone signs at entrance to the medication room protocols and checklist outlining medication administration wearing of a sash or vest to signal others to avoid interruptions of the nurse during medication administration

When considering the management of diabetic ketoacidosis (DKA), what type of insulin can be administered intravenously? lispro insulin glargine regular isophane insulin (NPH)

regular

The nurse is caring for a postoperative client whose diabetes has been well controlled on acarbose. The client is not allowed to take anything orally following complications of abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer intravenously to control the client's blood glucose level? regular insulin acarbose NPH insulin glyburide

regular insulin

Food and Drug Administration (FDA)

regulate the manufacture, distribution, advertising, and labeling of drugs

In understanding the use of controlled substances for patients, it is important that the nurse knows that controlled drugs are categorized according to prescription or nonprescription status regulated by state and local laws more than federal laws those that must demonstrate high standards of safety scheduled according to medical use and potential for abuse

scheduled according to medical use and potential for abuse

A client, prescribed a drug that has an exceptionally narrow margin of safety, should be educated about the need for what intervention? regular changes to the administration route half-life analysis serum drug level monitoring frequent administration of scheduled "drug holidays"

serum drug level monitoring

The nurse is caring for a woman who has strong beliefs about not putting anything unnatural into her body. It is most accurate to say that most modern medications are natural products derived from plants natural products derived from minerals synthetic products manufactured in laboratories synthetic modifications of natural products

synthetic products manufactured in laboratories

Phase 4

the FDA allows the drug to be marketed and requires manufacturers to continue postmarketing monitoring and electronic report submission of the drug's safety and effectiveness.

Drug distribution into the central nervous system (CNS) is limited because ___________________________ , which is composed of capillaries with tight walls, limits movement of drug molecules into brain tissue.

the blood-brain barrier

Phase 3 of drug testing

the drug is given to different populations and different dosages and by using the drug in combination with other drugs