Pharmacology Final

A patient is receiving carbamazepine to treat trigeminal neuralgia. Which assessment finding indicates a therapeutic response to the medication? A. Absence of facial pain B. Improved ability to ambulate C. Reduction in foot pain D. Resolution of dizziness

A. Absence of facial pain Rationale: Carbamazepine is indicated in the treatment of trigeminal neuralgia (a painful facial nerve condition). If the patient relates no facial pain, this is a therapeutic response to the medication. The medication is not used to assist a patient in walking or relieving foot pain or dizziness. It is also a first-line treatment for partial and generalized seizures.

The nurse is caring for a patient with a phenytoin level of 12 mcg/mL. Which action by the nurse is appropriate? A. Continue to monitor the patient on this medication. B. Assess liver function tests for clearance of the drug. C. Call the health care provider for a decrease in the daily dose. D. Call the health care provider for an increase in the daily dose.

A. Continue to monitor the patient on this medication. Rationale: A level of 12 mcg/mL is a therapeutic drug level. The nurse would continue to monitor the patient on this medication. There is no need to assess liver function or increase or decrease the dose if the dose is within the therapeutic range. The nurse would call if the dose or drug level was too high or too low and would assess liver function tests if there was a risk of toxicity with a high dose.

Which medication would the nurse anticipate the health care provider to prescribe for a patient who has developed status epilepticus? A. Diazepam B. Lamotrigine C. Gabapentin D. Carbamazepine

A. Diazepam Rationale: Diazepam is used to treat status epilepticus. Lamotrigine, gabapentin, and carbamazepine are used as primary and adjunct treatment of generalized seizures and will not be effective in stopping seizures during status epilepticus.

7. The most serious adverse effect associated with valproic acid is: A. Fatal hepatic failure B. Gingival hyperplasia C. Drowsiness D. Mood disorder E. Dementia

A. Fatal hepatic failure

The patient's serum phenytoin level is 31 mcg/mL. Which action by the nurse is appropriate? A. Hold the medication. B. Increase the medication dose. C. Administer the medication intravenously. D. Have the patient continue the current regimen.

A. Hold the medication. Rationale: A therapeutic drug level for phenytoin is 10 to 20 mcg/mL. The nurse would hold the medication then call the health care provider. Increasing the medication dose, administering the medication intravenously, and having the patient continue the current regimen are not safe options, as they will all lead to increased blood levels of the medication and further increase the risk of toxicity.

The nurse is administering intravenous diazepam. When will the nurse expect the onset of action to occur? A. Immediately B. Within 1 hour C. Within 5 minutes D. Within 15 minutes

A. Immediately

Which intervention is appropriate to include in discharge teaching for a patient prescribed phenytoin therapy? A. Perform good oral hygiene. B. See a physical therapist for tremors. C. Stop the medication when you are seizure free. D. Report drowsiness to your health care provider.

A. Perform good oral hygiene.

Which antiepileptic drug may cause gingival hyperplasia? A. Phenytoin B. Gabapentin C. Phenobarbital D. Levetiracetam

A. Phenytoin Rationale: The antiepileptic drug phenytoin may cause gingival hyperplasia. Gingival hyperplasia refers to an increase in the size of the gums. Gabapentin, which is an antiepileptic drug, may cause visual and speech changes, edema, and dizziness. The antiepileptic drug phenobarbital may cause apnea and hypotension. Levetiracetam, an antiepileptic drug, may cause hyperactivity and behavioral changes, such as anxiety, hostility, agitation, or suicidal ideation.

Which drug used for the management of the patient with PD is most likely to cause postural hypotension? A.amantadine (Symmetrel) B.selegiline (Eldepryl) C.tolcapone (Tasmar) D.entacapone (Comtan)

A.amantadine (Symmetrel) Rationale: Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause postural hypotension.

The patient diagnosed with PD has been started on dopaminergic replacement drug therapy with carbidopa-levodopa, it is most important for the nurse to A.assess the patient for dizziness and syncope when the patient is walking. B.administer the medication first thing in the morning. C.administer the medication on an empty stomach. D.omit protein from the patient's diet.

A.assess the patient for dizziness and syncope when the patient is walking. Rationale: The patient may need assistance when walking because of the dizziness and possible syncope caused by these drugs. Doses are given several hours before bedtime to decrease the incidence of insomnia, a known adverse effect of these drugs. Oral doses are given with food to help minimize GI upset. It is important to make sure that the patient and family or caregivers understand that while taking carbidopa-levodopa, the patient may continue to eat high-protein foods (e.g., meat, fish, poultry, and dairy products) but with the following special instructions: use portion control (meat portion about the size of a deck of cards) and take the drug dose one-half hour before eating a protein-containing meal or one hour after.

The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. Which statement would the nurse include? A. "You will only need to be on therapy for a few months." B. "Your medication is chosen based on your type of seizure." C. "You will be started on several drugs to control your seizures." D. "Medication therapy is not essential in treating seizure disorders."

B. "Your medication is chosen based on your type of seizure."

Which assessment indicates the patient is having a therapeutic response to valproic acid? A. Nystagmus B. Absence of seizures C. Normal liver enzymes D. Decrease in headaches

B. Absence of seizures

A patient has been diagnosed with PD. Medication therapy is started for this patient. The nurse should teaching the patient and care giver that pharmacologic therapy of PD? A. The medication should be stopped when the patient's symptoms improve. B. Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. C. A common side effect of anticholinergics is drooling. D. Improvements in symptoms are expected within 5 days of medication therapy.

B. Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. Rationale: Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber. Emphasize the importance of taking the medication as prescribed and not quitting the medication. It is important for the patient and family or caregiver to understand that medication(s) must be taken at the dosage and time prescribed. Inability to adhere to or remain compliant may lead to exacerbation of symptoms and development of complications. Missing a dose by even 30 minutes may lead to an "off" period and last hours. With anticholinergics, warn the patient about the adverse effect of dry mouth. Use of artificial saliva drops or gum, frequent mouth care, fluids, and sucking on sugarless gum or hard candy may be helpful. The patient and family must understand that some antiparkinson drugs are often titrated to the patient's response and that it may take 3 to 4 weeks for a therapeutic response to become evident. ●

Which information would the nurse provide about how antiepileptics work? A. Suppress brain activity. B. Alter the movement of electrolytes. C. Enhance the nerve transmission impulses. D. Increase the spread of electrical impulses.

B. Alter the movement of electrolytes.

The nurse is caring for a patient who has been taking phenytoin for the past week and has developed a rash. Which action would the nurse take first? A. Monitor the area. B. Assess the patient. C. Apply a topical steroid cream. D. Notify the health care provider.

B. Assess the patient. Rationale: Development of a rash is evidence of a reaction to the drug. The nurse would first assess the patient to make certain no other side or adverse effects are noted. After assessment, the nurse would notify the health care provider. Finally, a topical cream may be applied with additional monitoring of the area.

The nurse instructs a patient receiving phenytoin to visit the dentist regularly and perform frequent oral hygiene. Which side effect will these interventions assist in preventing? A. Oral candidiasis B. Gingival hyperplasia C. Dental abscesses D. Dental caries

B. Gingival hyperplasia

All are side effects of phenytoin, except: A. Ataxia B. Hypoglycemia C. Hirsuitism D. Gum hypertrophy

B. Hypoglycemia

Which action would the nurse include in the plan of care to prevent drug toxicities for a patient receiving antiepileptic drugs? A. Examine oral cavity. B. Monitor blood levels. C. Administer with food. D. Assess for seizure activity.

B. Monitor blood levels. Rationale: The nurse would monitor blood levels of the antiepileptic medication to ensure levels stay in the therapeutic range to prevent toxicities. The oral cavity should be assessed due to the side effect of gingival hyperplasia when administering phenytoin. Taking antiepileptic drugs on an empty stomach can cause gastrointestinal upset, but not toxicities. Seizure activity may indicate less than therapeutic levels.

A patient with unstable epilepsy is receiving IV doses of phenytoin (Dilantin). The latest drug level is 12 mcg/mL. Which administration technique will the nurse use? A.Administer the drug by rapid IV push. B.Infuse slowly, not exceeding 50 mg/min. C.Mix the medication with dextrose solution. D.Administer via continuous infusion.

B.Infuse slowly, not exceeding 50 mg/min. Rationale: Phenytoin should be mixed only with normal saline, and it should be given by slow IV infusion (but not as a continuous infusion).

Before a patient is to receive phenytoin (Dilantin), the nurse practitioner orders lab work. Which lab result is of greatest concern? A.High white blood cell count B.Low serum albumin levels C.Low platelet levels High hemoglobin levels

B.Low serum albumin levels Rationale: Phenytoin is highly bound to plasma proteins. If serum albumin levels are low, more free drug will be available to exert an effect, and toxicity may occur.

A patient in a long-term care facility has a new order for carbamazepine (Tegretol) for seizure management. The nurse monitors for autoinduction, which will result in: A.toxic levels of carbamazepine (Tegretol). B.lower than expected drug levels. C.gingival hyperplasia. D.cessation of seizure activity.

B.lower than expected drug levels. Rationale: Carbamazepine (Tegretol) is associated with autoinduction of hepatic enzymes. Autoinduction is a process in which, over time, a drug stimulates the production of enzymes that enhance its own metabolism, which leads to lower than expected drug concentrations.

The "off-on phenomenon" that some patients with PD experience is best explained as the A.need to take a drug holiday to improve response to medications. B.variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms. C.alternating schedule of medications needed to control PD. D.fluctuation of emotions that often occurs with PD.

B.variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms. Rationale: Some patients who take levodopa on a long-term basis experience times when their PD symptoms are under control and other times when symptoms are not well controlled.

Which information would the nurse provide a patient beginning treatment with levetiracetam? A. "Take the medication with milk." B. "Obtain annual eye examinations." C. "Report hostility or suicidal ideations." D. "Increase activity to prevent weight gain."

C. "Report hostility or suicidal ideations." Rationale: Levetiracetam can cause behavioral changes including anxiety, hostility, agitation, and suicidal ideations. Therefore the nurse would instruct the patient to report if these symptoms occur. The medication does not need to be consumed with milk, as this may decrease medication absorption. Annual eye examinations are required for lamotrigine. Weight gain can occur with valproic acid.

Which information would the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? A. "Do not take the medication if you have a fever." B. "Lie in bed for at least an hour after taking your medication." C. "Wait to see how you react to the medication before driving." D. "Take the antiepileptic agent with milk or juice to prevent stomach upset."

C. "Wait to see how you react to the medication before driving."

Which alteration represents the reason for many potential drug interactions with antiepileptic drug therapy? A. Urinary output B. Electrolyte balances C. CYP450 enzyme metabolism D. Renal function

C. CYP450 enzyme metabolism Rationale: The mechanism for many drug interactions with antiepileptic therapy is the alteration of the CYP450 enzyme. The majority of antiepileptic drugs are metabolized through the CYP450 pathway rather than kidney metabolism; thus alterations in blood urea nitrogen and creatinine levels or urinary output are not a factor in drug interactions. Altered electrolyte balance does not necessarily interfere with antiepileptic drugs.

Which food would the nurse instruct a patient to eliminate from the diet when taking carbamazepine? A. Aged cheeses B. Milk products C. Grapefruit juice D. Carbonated beverages

C. Grapefruit juice

Which antiepileptic drug would the nurse anticipate being prescribed for a patient with a diagnosis of generalized seizures related to Lennox-Gastaut syndrome? A. Pregabalin B. Phenytoin C. Lamotrigine D. Gabapentin

C. Lamotrigine Rationale: Lamotrigine is used to treat generalized seizures related to Lennox-Gastaut syndrome. Pregabalin is used to treat partial seizures. Phenytoin is used to treat generalized seizures not associated with Lennox-Gastaut syndrome. Gabapentin is used to treat partial seizures.

Which information would the nurse provide the patient who is taking an antiepileptic drug with a narrow therapeutic index? A. Take the medication every other day. B. Keep the medication with you at all times. C. Make certain the drug is taken at the same time daily. D. Crush the drug for better absorption.

C. Make certain the drug is taken at the same time daily.

What is the goal of antiepileptic therapy? A. Reducing seizure occurrence to once per week B. Maximizing drug dosages to control seizure activity C. Maximally reducing seizure activity while minimizing side effects of medication therapy D. Eradicating all seizure activity and then weaning off medication once the patient is seizure-free for 3 months

C. Maximally reducing seizure activity while minimizing side effects of medication therapy

Which assessment is a priority for the patient starting on gabapentin therapy for a seizure disorder? A. Cardiac assessment B. Urologic assessment C. Neurologic assessment D. Respiratory assessment

C. Neurologic assessment Rationale: Gabapentin requires a thorough neurologic assessment, including baseline energy levels, vision level, sensory and motor functioning, and any changes in speech, as gabapentin has many neurologic side and adverse effects. Cardiac, urologic, and respiratory assessment are not the priority for the patient starting on gabapentin therapy for a seizure disorder.

Which information will the nurse provide to the patient who is receiving antiepileptic drug therapy? A.If you feel sleepy when taking the drug, decrease the dose by half. B.Take the drug on an empty stomach. C.Call your health care provider if you experience a sore throat or fever. Patients with epilepsy are not able to hold a job and work, so you should apply for benefits.

C.Call your health care provider if you experience a sore throat or fever. Rationale: To prevent complications, patients should be taught to call the health care provider if they experience fever, sore throat, excessive bleeding or bruising, and new onset of nosebleeds. Drowsiness is a common side effect of these drugs; the dose should never be altered without consulting the prescriber. These medications should be taken with food to decrease GI upset. Most patients with seizure disorders are able towork and are protected by the Americans with Disabilities Act.

The nurse is assessing the current medication list of a newly admitted patient. The drug gabapentin (Neurontin) is listed, but the patient states that he does not have any problems with seizures. The nurse suspects that the patient A.is unaware of his own disease history. B.has been taking his wife's medication by mistake. C.may be taking this drug for neuropathic pain. D.is reluctant to admit to having a seizure disorder.

C.may be taking this drug for neuropathic pain. Rationale: Gabapentin is commonly used to treat neuropathic pain.

Which drug would the nurse expect to administer to a patient as the first line of treatment for generalized tonic-clonic seizures? A. Pregabalin B. Topiramate C. Valproic acid D. Carbamazepine

D. Carbamazepine

Which information is important to teach the patient taking valproic acid for seizure management? A. Do not take the medication with meals. B. Take the medication every other day only. C. Take the medication an hour before or after other medications. D. Do not take the medication with milk or carbonated beverages.

D. Do not take the medication with milk or carbonated beverages. Rationale: Oral forms of valproic acid are not to be given with milk, because this may cause the drug to dissolve early and irritate the mucosa. Carbonated beverages must also be avoided during the time of drug administration. The medication can be taken with meals. The medication is taken daily to maintain blood levels and can be given with other medications.

Which intervention will help maintain therapeutic levels of an antiepileptic drug? A. Give the medication every 8 hours. B. Administer the medication intravenously. C. Administer the medication only during the day. D. Establish a drug regimen based on the half-life of the medication.

D. Establish a drug regimen based on the half-life of the medication.

The patient taking carbamazepine should be instructed to avoid taking the medication with which beverage? A. Grape juice B. Apple juice C. Orange juice D. Grapefruit juice

D. Grapefruit juice Rationale: The patient who is taking carbamazepine should avoid drinking grapefruit juice because it may lead to toxicity of the medication. There are no contraindications for grape, apple, or orange juice.

Adverse effects of carbamazepine include, all EXCEPT A. Skin rashes B. Drowsiness C. Diplopia D. Hair loss

D. Hair loss

Sodium valproate is contraindicated in: A. Tonic-clonic seizures B. Partial sezures C. Bipolar affective disorders D. Hepatic dysfunction

D. Hepatic dysfunction

Which assessment is essential before a patient starts therapy with lamotrigine? A. Platelet count B. White blood cell count C. Patient weight D. Risk for Stevens-Johnson syndrome

D. Risk for Stevens-Johnson syndrome Rationale There are relatively few risks of side effects of lamotrigine therapy. However, there is a risk of a serious adverse effect, Stevens-Johnson syndrome. Patients of Asian descent should consider genetic testing for this condition. Patients with an HLA-B 1502 gene have an increased risk for Stevens-Johnson syndrome if they take this drug. The nurse would assess the patient for development of a rash if taking this medication. There is no need to assess platelet count, weight, or white blood cell count, as lamotrigine does not alter these patient characteristics.

The nurse is administering intravenous phenytoin. When will the nurse expect the drug to take affect? A. Immediately B. Within 5 minutes C. Within 15 minutes D. Within 1 to 2 hours

D. Within 1 to 2 hours Rationale: When phenytoin is given intravenously, the nurse would expect onset of the drug to occur within 1 to 2 hours.

The patient has now been ordered an oral disintegrating form of the MAO-B inhibitor drugselegiline. When administering the drug, the nurse should A. tell the patient to take the medication with liquids. B. tell the patient to take the medication with a meal. C. assess the patient for hypertension, a common side effect of this medication. D. tell the patient to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted.

D. tell the patient to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted. Rationale: The oral disintegrating dose should be placed on the tongue and should not be swallowed until it is completely melted. This dosage form is to be taken without liquids and given in the morning before breakfast. Foods and fluids are not to be consumed for 5 minutes before or after the drug is taken. Postural hypotension may be a transient problem, so the patient needs to move and change positions slowly and purposely.

When providing teaching to a patient receiving an anticholinergic for the treatment of PD, the nurse will include which information? A.Take the medication first thing in the morning. B.Limit fluid intake when taking this drug. C.The tremors you experience will be reduced within 24 hours of taking this drug. D.Do not take this medication at the same time as other medications.

D.Do not take this medication at the same time as other medications. Rationale: When anticholinergics are used for the treatment of PD, these medications should not be taken at the same time as other mediations. The medications should be administered at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects of the medication to become evident.

Clinically used in treating grand mal seizures: A. phenobarbital B. carbamazepine C. phenytoin D. A & C E. A,B & C

E. A,B & C

Effective in treating absence seizures: A. ethosuximide B. valproate C. clonazepam D. trimethadione E. all the above

E. all the above