Pharmacology Exam 4

Which are contraindications for taking sildenafil [Viagra]? (Select all that apply.) a. Patients who are taking nitroglycerin for angina pectoris b. Patients with nonarteritic ischemic optic neuropathy (NAION) in one eye c. Patients with BPH who are taking alpha1-adrenergic antagonists d. Patients with a blood pressure of 100/60 mm Hg e. Patients with a history of myocardial infarction (MI) in the past 6 months

A, B, C

Your 70 year old male patient comes to the office for a screening test for prostate cancer. What drug should you ask the patient if he is taking due to its ability to decrease serum PSA levels, resulting in a false-negative screening?

Finasteride

Your patient has gone to the cardiac cath lab for a percutaneous coronary intervention (PCI). Which drug class do you expect to be ordered for this patient?

Glycoprotein IIb/IIa inhibitors

You are caring for a client who is taking warfarin. When providing client education on warfarin you should include information about minimizing foods high in vitamin K. What are these foods?

Green leafy veggies

Your patient requires long-term therapy for chronic gout. He has been started on allopurinol (Zyloprim). What is the best statement that accurately describes the drug's mechanism of action?

It blocks the formation of uric acid by inhibiting xanthine oxidase

Which patient should not be prescribed sulfasalazine (Azulfidine)?

Keith who has a sulfa allergy

Your patient has recently begun therapy with hydroxychloroquine (Plaquenil) for her Rheumatoid Arthritis. She should be made aware that the most significant adverse effect of this drug is:

retinal damage

A patient with rheumatoid arthritis is taking leflunomide [Arava] and an oral contraceptive. She tells the nurse she would like to get pregnant. What will the nurse tell her?

to ask her provider about an 11-day course of cholestyramine

A patient about to begin therapy with etanercept has a positive tuberculin skin test. A chest radiograph is negative. The nurse will expect this patient to:

undergo tuberculosis treatment prior to beginning etanercept treatment

The preferred anticoagulant drug for use during pregnancy is

unfractionated heparin

The enzyme that degrades fibrin is called

Plasmin

What are the 2 mechanisms of hemostasis?

Platelet plug and coagulation

Rasburicase's primary use is for the treatment of

hyperuricemia secondary to chemotherapy

Main concern with cinacalcet

hypocalcemia

A patient will begin taking etanercept [Enbrel] for severe rheumatoid arthritis. The patient has been taking methotrexate [Rheumatrex]. The patient asks if the etanercept is stronger than the methotrexate. The nurse will tell the patient that etanercept

is better at delaying the progression of joint damage than methotrexate

Which statement is accurate regarding the difference between succinylcholine and tubocurarine? Succinylcholine:

is preceded by a transient period of contractions prior to the paralysis

Anti-factor Xa Assay

0.3-0.7 units/mL

What is important to monitor while the patient is taking methotrexate, a disease-modifying anti-rheumatic drug (DMARD)?

WBC and platelet counts

Which of the following medications can increase the risk of gout and decrease the effectiveness of uricosuric agents such as probenecid?

Acetylsalicylic acid (aspirin)

A nurse is discussing the administration of an intravenous infusion of rituximab (Rituxan) with a nursing student. Which statement by the student indicates a need for further education about the care of a patient receiving this drug?

"Angioedema and hypersensitivity may occur, but are usually self-limiting and mild."

A nursing student asks the nurse to discuss the differences between POAG and angle-closure glaucoma. Which statement by the nurse is correct?

"Early treatment with prostaglandin analogs can stop the progression of POAG"

A nurse is teaching a patient who will begin using a fixed-dose preparation of dorzolamide and timolol [Cosopt] for open-angle glaucoma. Which statement by the patient indicates a need for further teaching?

"I will need to instill 2 eyedrops 3x/day in each eye"

Nurse identifies deficient knowledge regarding warfarin when a pt states?

"I'm so glad I don't have to worry about my intake of spinach and salads"

A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct?

"The onset of warfarin is delayed"

A nurse in an ophthalmology clinic instills an anticholinergic agent into a patient's eyes. The nurse provides teaching when the patient asks the reason for the drops. Which statement by the patient indicates a need for further teaching?

"This medication anesthetizes my eyes so the exam won't be painful"

A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why she is taking both medications. What is the nurse's most accurate response?

"Warfarin takes 3-5 days to develop anticoagulant effects, so you still need the heparin"

A patient has had dilation of the eyes with an anticholinergic agent. What will the nurse say when preparing this patient to go home after the examination?

"You may need to wear dark glasses until this medication wears off"

A patient with ocular hypertension will begin using brimonidine [Alphagan] for long-term reduction of increased ocular pressure (IOP). The nurse teaches the patient about this medication. Which statement by the patient indicates understanding of the teaching?

"after using the drops, I should wait 15 minutes before putting in my contacts"

Your patient was recently diagnosed with osteoporosis and has started taking alendronate. What should you educate the patient on regarding its ADRs?

- Esophageal erosion -- take with 8oz of water and sit upright for at least 30 minutes after, and take in the AM before any food/liquids/meds

A patient with rheumatoid arthritis is starting methotrexate. She asks you when she can expect to see therapeutic effects of this medication and if there are special considerations related to this drug. The nurse would give which facts related to this medication? The drug will take:

3-6 weeks and you should take folate on daily basis

Which of the following drug/drug classifications irreversibly binds to and inactivates cyclooxygenase (COX) which is responsible for the formation of prostaglandins and thromboxane A2?

Acetylsalicylate acid

Class of drugs used to prevent arterial thrombosis?

Antiplatelet drugs

A patient begins using timolol [Timoptic] to treat primary open-angle glaucoma (POAG). The nurse gives a dose and notes that the patient develops shortness of breath. The nurse assesses the patient and auscultates wheezes in both lungs. The nurse will ask this patient about a history of which condition?

Asthma

The main ADR to be concerned about with anticoagulants is:

Bleeding

What drug was established for the treatment of postmenopausal osteoporosis?

Calcitonin-salmon

In end-stage renal disease, what calcium preparation can be used to treat dyspepsia and hyperphosphatemia?

Calcium carbonate

Which classes of medications are commonly used in Rheumatoid Arthritis?

DMARDs and TNF Inhibitors

What anticoagulant is a prodrug that binds to thrombin's active site and acts on both clot-bound and circulating thrombin?

Dabigatran

A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication?

Enoxaparin

A patient with severe allergic conjunctivitis who has been using cromolyn ophthalmic drops for 2 days calls the nurse to report persistence of the symptoms. When the nurse explains that it takes several weeks for maximum benefit to occur, the patient asks if there is something else to use in the meantime. The nurse will suggest that the patient discuss which drug with the provider?

H1RAs because they provide immediate relief

What drug for anticoagulation works by enhancing the activity of antithrombin?

Heparin

A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose, the patient begins vomiting. What will the nurse do?

Hold the medication and notify the prescriber

A nurse cares for a pt on warfarin therapy for atrial fibrillation. What lab value is the goal of this form of anticoagulation?

INR; 2-3x the control

Heparin suppresses coagulation by what mechanism?

Inactivates both thrombin and factor X

A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs, simvastatin, amoxicillin, and digoxin. What will the nurse do?

Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine

A patient who has erectile dysfunction asks a nurse whether sildenafil [Viagra] would be a good medication for him to take. Which aspect of this patient's history would be of most concern?

Occasional use of nitroglycerin

The effects of warfarin are monitored by what laboratory test?

PT and INR

A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which of the following drugs may be ordered?

Protamine sulfate

An overdose of heparin or lovanox can be treated with:

Protamine sulfate

Your patient is receiving a continuous heparin infusion. You note excessive bruising on the patient's arms and legs. You see the aPTT drawn an hour ago is 150 with a control of 30. You would anticipate administration of which of the following drugs?

Protamine sulfate

What classification of drugs help treat osteoporosis by preventing the activation of RANK receptors on the surface of osteoclasts?

RANKL inhibitor -- Denosumab

What drug for osteoporosis is structurally similar to estrogen and should not be taken concurrently with any estrogen-containing drugs such as birth control?

Raloxifene

A nurse administers timolol [Timoptic] ophthalmic drops to a patient who has glaucoma. The patient reports stinging of the eyes shortly after the drops were administered. What will the nurse do?

Reassure the patient that these are localized, reversible effects of the drug

A patient has been using latanoprost [Xalatan] ophthalmic drops. The patient tells the nurse, "My eyes used to be greenish-brown, but now they're brown." What will the nurse do?

Reassure the patient that this is a harmless side effect

The only drug available for the treatment of osteoporosis that both increases bone formation and decreases bone resorption is called

Teriparatide

For fibrinogen to bind to glycoprotein receptors in the formation of the platelet plug, the glycoproteins must first be activated by

Thrombin, thromboxane A2 and ADP

It is important to rule out which disease prior to starting etanercept (Enbrel), which is a TNF Inhibitor?

Tuberculosis

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?

Urate-lowering drugs

A client who has been treated with warfarin after open-heart surgery is involved in a car accident and has a laceration on her head. Which medication will be administered to assist in the development of clotting factors?

Vitamin K

Pt receiving enoxaparin. What factor is used to calculate the dose?

Weight

A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for:

a PT and INR

Correct statements related to warfarin therapy?

a. Garlic and ginsing are two supplements that can increase the effects of warfarin b. One should not take OTC multivitamin w/o consulting their physicians c. Major adverse effect is cholesterol microemboli (purple toe syndrome) d. Vitamin K 10 mg will be admin IV if pt is experiencing significant bleeding due to an elevated INR

Nurse order to admin heparin. Before admin, a priority nursing assessment will be the patient's?

aPTT

A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and:

administer the dose as ordered

Pt assigned to is having a thrombolytic admin for an acute MI. in addition to bleeding, you should monitor?

arrythmias

A nurse is teaching students about the use of Sildenafil for ED. Which statement by a student indicates a need for further teaching? a. the patient should wait at least 24 hours before taking a nitrate b. taking this medication can cause changes in vision such as a blue-tinge or blurry vision c. sildenafil can cause the patient to have an erection in the absence of sexual stimuli d. a patient should seek immediate medical attention for an erection lasting more than 4 hours

c. sildenafil can cause the patient to have an erection in the absence of sexual stimuli

aPTT

control: 40 seconds therapeutic: 60-80 seconds

A male patient tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as "annoying." The patient's provider examines him and notes that the prostate is moderately enlarged. The patient is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order:

doxazosin

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of:

having routine renal and hepatic function tests

A nurse is obtaining a history from a patient who will receive tadalafil [Cialis] for erectile dysfunction. The patient reports that he expects to have sexual activity three or four times a week. What should the nurse tell the patient?

he should talk to his provider about daily dosing of tadalafil

Fondaparinux differs from Heparin preparations d/t:

heparin causes inactivation of both thrombin and factor Xa, fondaparinux only produces inhibition of factor Xa

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____.

pulmonary embolism; heparin

Parenteral calcium salts such as calcium chloride and calcium gluconate are reserved for

severe, symptomatic hypocalcemia

A patient who has been diagnosed with rheumatoid arthritis (RA) for 1 month and has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate [Rheumatrex]. The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that:

starting methotrexate early can help heal joint degeneration

A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient?

that an eye exam is necessary at the beginning of therapy with this drug

A child who has juvenile idiopathic arthritis and who has been taking methotrexate [Rheumatrex] will begin a course of abatacept [Orencia]. What will the nurse include when teaching the child's family about this drug?

that signs of infection may warrant immediate discontinuation of abatacept