Pharmacology II Exam 1

Wellbutrin

(Bupropion) Antidepressant Secondary effect, smoking cessation

Distribution

- 2nd of 4 part of pharmacokinetics - Process by which the drug becomes available to body fluids and body tissues Protein binding - Protein-bound drugs are not FREE to be active - Two highly-protein bound drugs compete for sites...toxicity - Free drugs - Volume of drug distribution Blood-brain barrier protection - Only lipid-soluble drugs (vs. water soluble) able to pass - Makes treatment challenging! - Form of protection, challenging to treat/distribute medication!

Q: What time will the trough blood level need to be drawn is the nurse plans to administer the next intravenous medication dose at 6:00AM?

- 530 AM. In general trough blood levels are drawn just before the dose is to be administered - RN need to make sure levels have been drawn before administering the next dose, check values, hold if high, report findings.

Risk of Overdosing! Pediatrics

- Acetaminophen and Ibuprofen in OTC cold/cough remedies cold/cough remedies not recommended in children under 2y d/t accidental overdosing - Multiple caregivers unknowingly repeating doses - Caregivers unaware of ingredients in OTC products - American Academy of Pediatrics Clinical Report Fever and Antipyretic Use Alternating ibuprofen and acetaminophen is no longer recommended - "There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combines treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices

Adverse Reactions

- Adverse reactions: more severe than side effects - They are a range of untoward effects (unintended and occurring at normal doses) of drugs that cause mild to severe side effects, including anaphylaxis - Adverse reactions are always undesirable - Adverse effects must always be reported and documented because they represent variances from planned therapy

Receptor theory

- Agonists and antagonists - know the difference - The two drug agonists attach to the receptor site. The drug agonist that has an exact fit is a strong agonist and is more biologically active than the weak agonist. - Keep this simple, do NOT have to know ligand-biding, G protein-coupled receptors, etc - Agonists = drugs that produce a response - Antagonists = drugs that block a response

Q: During LM's postoperative period, when might the nurse expect signs of withdrawal to occur? What are some signs and symptoms of withdrawal?

- Alcohol withdrawal symptoms can begin within a few hours of discontinuation of drinking and may continue for 5 days or more - Withdrawal symptoms may be severe and include visual and auditory hallucinations and tonic-clonics seizures.

From Research to Practice

- As the drug hits the market, a much larger subject pool is available - Problems not seen in research trials, may occur. - Problems seen in research, may becomes more prevalent If a significant problem with a drug occurs... - 1/15,000pts - 10/150,000pts - 100/1,500,000pts - MedWatch FDA

Pediatric SAFE medication administration

- Atraumatic Care - Maintaining safety with minimal restraint - Eutectic mixture of local anesthetics (EMLA) - LET (lidocaine, epinephrine, and tetracaine) - Distractions and other nonpharmacologic methods of pain and anxiety control Intramuscular: IM drugs are absorbed faster in muscles that have more blood vessels, such as the deltoid - However! Ventrogluteal or the vastus lateralis are preferred site for pediatric IM injections because the deltoid is underdeveloped - Absorption and poor muscle development of pediatric deltoid muscle, NOT the preferred site for pediatric IM (vs adult) - Subcutaneous: Child may prefer subQ injections in the leg or upper arm rather than in the abdomen. SubQ injections absorption is slow and sustained. Intravenous sites - Fluid overload and/or toxicity occurs quickly in children

Sedative-hypnotics

- Barbiturates, benzodiazepines, and barbiturate-like drugs - Therapeutic effects: sleep agents, anti-anxiety meds, anti-seizure meds - short -acting barbiturates frequently abused - Side effects/adverse reactions: Respiratory Distress! CNS depression Tolerance develops quickly - Need for higher doses for same effect - NO TOLERANCE develops for resp, depression - Tolerance encourages higher doses..respiratory distress! NO TOLERANCE develops for resp distress!! - Sedative-hypnotics, cont. Withdrawal - Anxiety, agitation, delirium, seizures, cardiac & respiratory arrest - Life-threatening! Treatment of OD is emergency - Gastric lavage - Flumazenil (Romazicon) - benzodiazepine antagonist

Absorption

- Bioavailability - what % of the dose reaches systemic circulation - Affected by: drug form, route of administration, GI mucosa and motility, food and other drugs, and changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow - Absorption is reduced if there are fewer villi in the small intestine r/t disease, surgery, etc - Need to know your patient's health history!

Drug Names

- Chemical names - Generic names - Brand/trade names

Q: Polypharmacy What is it? Why is polypharmacy common in the elderly What are some ways to manage polypharmacy?

- Confusion, use of herbs and OTCs multiple providers - Elderly tend to keep d/c meds, even share with neighbors and friends - Patients who take multiple medications should be advised to bring medications to each clinic visit - Ask specifically about OTC meds. Many patients don't consider these "medications"

Q: Discuss creatinine clearance. What is it used to measure? Why is it important for pharmacology?

- Creatinine clearance is used to measure glomerular filtration rate (GFR) It is important to pharmacology because - The creatinine clearance tests helps provide information about how well the kidneys are working. The test compares the creatinine level in urine with the creatinine level in blood. Creatinine is a breakdown product of creatine Decreased GFR - drug excretion is slowed or impaired. Drug accumulation with possible severe adverse drug reactions can result

Q: What are some common lab tests to determine renal function?

- Creatinine levels - BUN - Creatinine clearance

Cardiac glycosides: Geriatric

- Digoxin (lanoxin) - Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 bpm - Narrow therapeutic range (0.5-2ng/mL)

Pharmaceutic

- Disintegration & dissolution - Drug becomes a solution so it can cross the biologic membrane - Rate limiting as the time it takes the drug to disintegrate & dissolve to become available for the body to absorb it - The two pharmaceutical phases are disintegration and dissolution - Pharmaceutic phase (dissolution) when the drug becomes a solution so that it can cross the biologic membrane - Disintegration and dissolution Necessary for PO medications - Drugs administered via parenteral route (SQ, IV, or IM) do NOT go this phase

Q: How does disulfiram (Antabuse) work? What patient education will you provide?

- Disulfiram (Antabuse) prevents drinking, reduced desire for alcohol, unpleasant reaction when using ETOH (n/v, palpitations, H/A, sweating, chest pain, hypotension) as acetaldehyde accumulates - Reactions can be severe, deadly, and all patients must understand the need to avoid all forms of alcohol while taking this medication, even topical. - Effects can occur up to 2 weeks after last dose

Genetic Factors Influencing Medication Effects

- Drug metabolizing enzymes - Drug transporters - Drug targets - Influence dose requirements and/or adverse effects - Effects receptor sites so that 2 drugs that work exactly the same, one is tolerated, the other is not; or one works the other does not - Lack of certain hepatic enzyme means drugs cannot be broken down and excreted ... side effects

Enteral Feedings and Drugs

- Enteral route used when the patient just isn't getting better - Many antibiotics are severely weakened by enteral feeding and TPNs/Lipids High protein, calcium, magnesium level cause chelation effect - Bind to drug, making low bioavailability - Especially true for antibiotics given via feeding tube - If a patient with pneumonia is on ABX via central line, isn't getting better; are they on TPNs and lipids too?

Q: Your patient has difficulty swallowing medication. His family asks that you crush his 0900 medication. The order reads: 81 mg ASA ec PO q morning. What will you tell the family and patient regarding this medication

- Enteric-coated drugs are designed to resist disintegration in the low pH of the stomach - Instead, they will disintegrate in the small intestine which has a higher pH - This allows optimal timing of absorption of the drug

Q: What are some potential problems related to excipients?

- Examples of inactive ingredients that have been reported to cause reactions in some patients include: Sulfites, benzoates, aspartame, saccharin, oleic acid, benzyl alcohol, lactose, soya lecithin, propylene glycol, and sorbitan trioleate - Another example of a problem with excipients is excessive sodium Ex. Sodium fluoride - Patients who have allergic or adverse reactions to certain inactive ingredients may be able to use products that are color - or preservative free

Cocaine Treatment

- First-line tx: Cognitive-behavioral therapy Drugs used in addition to cognitive-behavioral therapies - Disulfiram (Antabuse) - Anticocaine vaccine - antibodies bind with cocaine; research trials continue Off label medications used for treatment: - Modafinil (Provigil)

How can fluid overload be prevented? What assessments will you perform?

- Fluid overload - monitor for cough, SOB, edema. Monitor IV pump, note kidney function Differentiate fluid overload from pneumothorax/hemothorax - Decrease lung sounds vs. crackles (fluid overload)

Q: Why are some drugs administered with food & others on an empty stomach?

- Food in GI may interfere with the dissolution & absorption of certain drugs of enhance absorption of other drugs - Some drugs irritate the gastric mucosa. So fluids or food may be necessary to dilute drug concentration and to act as protectants - Example: Iron supplement taken with other meds: binding effect - Example: Synthroid taken with other meds: less bioavailability

Drug-food interactions

- Food is known to increase, decrease, or delay drug absorption - Food can bind with drugs, causing less or slower drug absorption Specific food groups may need to be avoided - MAOI (antidepressent)+ tyramine >>> Hypertensive crisis - Grapefruit juice CCBs (calcium channel blocker) for HTN >>> inhibits metabolism leading to toxicity

Accelerated Development & Review

- For serious, life threatening disease - The Abigail Alliance Developed for HIV - Group started by family of Abigail Burroughs, a 21 yo with head and neck cancer who died while trying to get a number of oncology drugs that were in phase 2 trials

Cultural Considerations

- Health/illness definitions and beliefs - OTC, herbs, supplements - Diet - Compliance

Gastrointestinal drugs: Geriatric

- Histamine (H2) blockers, ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid) used to treat peptic ulcer disease *** Cimetidine (Tagamet) - Cimetidine is not suggested for the older adult because of its side effects and drug interactions, including confusion Laxatives - potential for abuse among elderly, electrolyte imbalance, interference with absorption of other medications

M.M is to have his TPNs discontinued. What complications can occur at this time? How will it be prevented? What will you assess/monitor?

- Hypoglycemia - occurs when fluid stopped abruptly or when TPNs d/c and dextrose solution was not administered - S/Sx Shaky, H/A, cold/clammy - Patient should receive an isotonic dextrose solution for 12-24 hours after TPN is discontinued to prevent this reaction

Toxic Effects or Toxicity

- Identified by monitoring the plasma (serum) therapeutic range of the drug - Wide therapeutic index - (aminoglycoside antibiotics and anticonvulsants) therapeutic ranges are closely monitored - Drug level exceeds the therapeutic range - toxic effects are likely to occur from overdosing or drug accumulation

Q: Your pediatric patient is a new-onset diabetic. He has extreme anxiety and fear of needles. His mother asks why you won't mix his regular insulin with his juice. What explanation can you give?

- Insulin and many other protein-based drugs are quickly destroyed by digestive enzymes in the small intestine - Protease is a digestive enzyme that metabolizes protein from the pancreas

Pharmacodynamics: Geriatrics

- Lack of affinity to receptor sites - Age-related changes in the central nervous system (CNS) - Changes in the number of drug receptors - Changes in the affinity of receptors to drugs Compensatory response to physiologic changes is decreased - End result is that patients may be more or less sensitive to various medications

Q: Why are Lidocaine and some nitroglycerines not administered orally?

- Lidocaine and some nitroglycerines have extensive first-pass metabolism; therefore, most of the dose would be destroyed if they were administered orally First-pass effect - passes through the liver BEFORE systemic circulation (most oral and rectal medication) - Less availability if drug is metabolized by the liver before it moves to tissue - Other examples of drugs with first-pass metabolism: warfarin (Coumadin) and morphine

Pediatric Pharmacology

- Limited research - Research risk - Informed consent

Q: Your patient has low protein levels. How might this affect drug distribution?

- Low protein level means fewer binding sites for drug binding, which results in more free drug. These patients are at risk for possible drug toxicity. To avoid possible drug toxicity, checking the protein binding percentage of all drugs administered to a patient is important - Know your patients albumin and plasma protein levels - Geriatric patients tend to have lower protein levels Low serum protein mean fewer protein-binding sites...toxicity - Examples: Liver or kidney disease, advanced age, or malnourishment leads to low serum albumin levels

Q: What are some important nursing implications and actions related to peaks and troughs?

- Medication must be administered on time - Optimal lab draw times must be noted for each medication - Monitor closely for s&sx of toxicity and for therapeutic effect - Communicate abnormal lab values to treating prescriber immediately - RN needs to make sure levels have been drawn before administering the next dose, check values, hold is high, report findings.

Nicotine

- Most rapidly addicting of the drugs of abuse Side effects/adverse reactions: - Cardiovascular stimulation - Increased myocardial oxygen consumption - General CNS stimulation Tremors - Increased alertness and arousal - Promotion of relaxation and relief of anxiety Nicotine is frequently used as self treatment for anxiety and even symptoms of ADHD Physical and psychological dependency - Withdrawal symptoms occur within the first few hours after stopping smoking, peak in 24 to 48 hours, and last from a few weeks to several months - After withdrawal subsides, cue-induced craving nat cause relapse - Treatment: nicotine replacement therapy (NRT) or other smoking cessation agents are recommended for all tobacco users in addition to behavioral and support therapies - Best success with NRT + drug to help with cue-induced craving + cognitive behavioral therapy - Physical dependency and psychological (cue-induced) - Best success is with both a nicotine replacement (ex. patch) and Bupropion (Zyban); or Varenicline (Chantix)

Alcohol

- Most widely consumed substance of abuse in the United States Hospitalized patient - get history - "When was your last drink" Side effects/adverse reactions - Wernicke's encephalopathy - can be life threatening - Alcohol withdrawal: delirium tremens (DTs) chlordiazepoxide (Librium) or lorazepam (Ativan)

Caffeine

- Most widely used psychoactive substance in the world - Safe in most people "Energy" drinks - Long-term effects on kidneys!!! - Side effects/adverse twitching, confusion, chest pain, tachycardia, dysrhythmias Treatment for Over Dose! - Emergency treatment: reduce hypertension, dysrhythmias, other side effects - Addiction: reduction over time

Opioids

- Natural and synthetic - Effects: analgesia, drowsiness, slurred speech, and detachment from the environment - Signs of overdose of opiods: pinpoint pupils, clammy skin, depressed respiration, coma, and death not treated - Examples: codeine (Tylenol 3), hydrocodone (Vicodin, Norco), percocet, oxycodone

Cautions with Use of OTC Medications

- OTC drugs may cause delay in professional diagnosis and treatment - Symptoms may be masked - Inactive ingredients may cause adverse reactions - Be aware of potential for overdose - ASK your patient specifically about OTC medications

Q: Give an example of a medication in which it is extremely important to know the onset, peak, and duration of action. What factors might affect onset of action?

- Opioids - Insulin Factors affecting the onset of action - Route - Food in stomach - pH of GI tract - Other medications being taken

Drug-laboratory interactions

- Patients may need instructions regarding stopping medication for certain tests Example: metformin & contrast medium - Clearance by kidneys reduced - Leads to lactic acidosis - Other medications may alter the results of some tests

Antibacterials: Geriatric

- Penicillins, cephalosporins, tetracyclines, and sulfonamides *** Aminoglycosides, fluoroquinolones (quinolones), and vancomycin: Not frequently prescribed for patients older than 75 years - Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years

Side Effects

- Physiologic effects not related to desired drug effects - All drugs have desirable or undesirable side effects - Difference between the terms: side effects and adverse reactions

Nicotine Replacement Agents (NRT)

- Provide small doses of nicotine without the toxins or carcinogens - Gum - no food/drink 15 minutes before and during use; while chewing gum, there should be periods of holding the gum between cheek and teeth - Lozenges - must allow to dissolve slowly, not to be chewed - Patch - monitor for skin irritation; may cause insomnia; not to smoke while using - Nasal spray - monitor for irritation of mucosa - Inhaler - looks & feels like a cigarette - different from e-cigarettes!

Other Treatments for Alcoholism

- Rehabilitation and sustained abstinence Acamprosate (Campral) - helps alleviate unpleasant feelings during initial abstinence - Used with comprehensive treatment and rehab

Cocaine

- Schedule II drug - Side effects/adverse reactions: At usual doses, cocaine produces euphoria and increased energy and alertness as well as peripheral adrenaline-like actions Chronic use: Impairment of concentration and memory, irritability and mood swings, paranoia, and depression "Crack" - cheaper, cocaine base, crystal

Pharmacogenetics

- Scientific discipline studying how the effect of a drug action varies from a predicted drug response because of genetic factors or hereditary influence - Example: African Americans do not respond as well as Caucasians to some classes of antihypertensive medications, such as ACE inhibitors

Pharmacodynamics

- Study of the way drugs affect the body - Primary effect is desirable Secondary effect may be desirable or undesirable... - Wellbutrin (patients using as an antidepressant were noted to stop smoking; repackage for smoking cessation) - Minoxidil (vasodilator used as antihypertensive, side effect - hair growth...Rogaine) - Off-Label use of medications - Dose response - Response to a dose may vary between patients! Maximal efficacy - giving/taking more of a drug does not change its maximal effect; ex. Giving a higher dose of Ultram will not make it as effective for pain relief as morphine - Peak therapeutic value vs increased risk of side effects - MORE IS NOT BETTER - There is a point at which medication does not provide anymore therapeutic value, despite being taken at a larger dose. Higher doses also increase the chance of experiencing side effects

Amphetamines/Methamphetamines

- Synthetic drugs - Schedule II drug Often used as a cheaper alternative to cocaine - Can be made with OTC ingredients Examples - Crank - Crystal meth - Bath salts - Side effects/adverse reactions: Initial effects of increased alertness, improved performance, relief of fatigue, anorexia, and increased heart rate and blood pressure Long-term use: irritability, anxiety, paranoia, and hostile and violent behaviors - Yet, withdrawal symptoms are more difficult to tolerate...very difficult addiction to treat - Treatment - similar to cocaine, cognitive behavioral treatment is the mainstay Off label medications used for treatment - Bupropion (Zyban) - Modafinil (Provigil)

Therapeutic Index

- The Therapeutic Index. It measures the margin of safety of the drug. It is a ratio that measures the effective therapeutic dose and the lethal dose - A low Therapeutic Index drug has a narrow margin of safety. The drug effect should be closely monitored. A high therapeutic index drug has a wide margin of safety and carries less risk of drug toxicity. - Margin of safety!

Pediatric Pharmacodynamics

- The half-life of a medication may be different in children than in adults Pediatric variables such as organ function, developmental factors and administration issues affect drug pharmacodynamics - In other words, the variables of pharmacokinetics all affect the parameters of pharmacodynamics - Therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of any adverse reaction.

Antidepressants: Geriatric

- The normal dose of antidepressants in the older adult is 30% to 50% of the dose for young and middle-aged adults - Tricyclic antidepressants: Side effects include dry mouth, tachycardia, constipation, and urinary retention. Tricyclic antidepressants can contribute to narrow-angle glaucoma - SSRIs increase risk of fall, SSRIs with shorter half-life are better choice - Bicyclic antidepressant: Fluoxetine (Prozac) are a better choice for elderlty

Q: Why is the dose of an oral medication more than the dose of the same medication administered via the intravenous route?

- The percentage of bioavailability for the oral route is always less than 100% (d/t the high first-pass hepatic metabolism of oral drugs), but for the IV route it is usually 100% - Bioavailability - what % of the dose reaches systemic circulation Factors that alter bioavailability - Drug form - Route of administration - GI mucosa and motility - Food and other drugs - Changes in liver metabolism

Q: Discuss the role of chlordiazepoxide (Librium) and lorazepam (Ativan) in alcohol withdrawal

- These long-acting benzodiazepine help prevent seizures and delirium (delirium tremens), reduce anxiety, stabilize vital signs Other meds used adjunct to benzodiazepines for treatment of withdrawal" - Carbamazepine - seizure med - Clonidine - reduced symptoms of autonomic nervous system - Propranolol - reduce symptoms, Help control vital signs

Loading Dose

- Used when immediate drug response is desired - Large initial dose, known as the loading dose, of drug is given to achieve a rapid minimum effective concentration in the plasma - After a large initial dose, a prescribed dosage per day is ordered - Digoxin (Digitek, Lanoxicaps, Lanoxin): Digitalization

Pharmacogenetics

- Variations of the predicted response to a drug due to genetic factors - The FUTURE of treatment in healthcare

Anticoagulants: Geriatric

- Warfarin (coumadin) - Decreased serum albumin - Risk for falls drug/food interactions - Patients who take anticoagulants have an increased risk of hemorrhage - Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall risk protocol is important - What will be assessed/monitored? PT/INR, signs of bleeding!

Q: What is Wenicke's encephalopathy and what medications are used to prevent it?

- Wernicke's Encephalopathy - inflammatory, hemorrhagic condition of the brain - Thiamine (vit B1) and multiple vitamins should be administered routinely to patients in alcohol withdrawal..poor diet - Intravenous fluid therapy for rehydration may be necessary, but thiamine must be administered before glucose infusion to prevent Wernicke's encephalopathy

Q: Why are geriatric patients more likely to have an adverse reaction to vasodilator drugs?

- When a geriatric patient receives a vasodilator drug, the sympathetic feedback does not occur quickly, possibly resulting in orthostatic hypotension. SAFETY issue - Compensation does not occur as quickly as in a younger person...SAFETY issue, decreased blood pressure - More difficult for the body to maintain homeostasis

Overview of Addictive States

- Withdrawal syndrome: group of signs and symptoms that occurs in physically dependent persons when drug use is stopped. The symptoms are often opposite the effects the drug - Cessation and maintaining abstinence: treatment with other drugs may be used to decrease craving and prevent withdrawal syndrome (ex. Dopamine, Methadone) - Methadone is an opioid, successfully used to treat addiction

Q: Does the age of a patient have any impact on the pharmaceutic phase and, if so, why?

- Yes age has an effect Generally drugs are disintegrated and absorbed faster in acidic fluids - With a pH of 1 to 2 rather than alkaline fluids - Both very young children and older adults have less gastric acidity; therefore, drug absorption is generally slower for these drugs absorbed primarily in the stomach for individuals in these age groups

Nonselective drug effect

- act on many different types of receptors Four Categories of drug action - Stimulation or depression (narcotics, amphetamines, amaryl) - Replacement (synthroid, insulin, pancreatic enzymes) - Inhibition or killing or organisms (ABX) - Irritation (laxative) - Epinephrine affects three different receptors, alpha1, beta1, and beta2 - Drugs that may act at different receptors - Drugs that affects various nonselective drugs or have properties of non selectivity - Another example: Albuterol, relatively selective beta2-adrenergic, dilates bronchioles, also causes tachycardia

How can infection be prevented? What assessments will you perform?

- aseptic technique! Dressing changes require gloves, mask for everyone in the room (including patient, unless he/she can turn head away) - Change tubing and solution per protocols (usually every 24hrs)

glyburide/metformin

- highly protein bound - for diabetes

Warfarin (Coumadin)

- large first pass effect, avoid oral/rectal - highly protein bound

Q: The physician writes an order for Rocephin 50mg/kg IM. The client weighs 25 kg. The medication is supplied 350mg/mL. How many mL would you administer? Q: Is this a same amount to administer IM?

1. 50x25 2. = 1250 3. 1250/350 4. = 3.57mL A: Children max IM volume - 2mL - Rocephin often has to be given i 2 syringe, get help and give both at the same time; mixed with lidocaine to ease pain but still hurts

A patient is given an intravenous drug. What is the bioavailability of the drug in this patient? 1: 50% 2: 60% 3: 100% 4: 110%

100% Bioavailability is the quantity of a drug available in the body after it is administered either orally or via other routes. Bioavailability of 100% is recorded when drugs are administered intravenously directly into the bloodstream. The bioavailability of atropine is 100% because it is administered intravenously. Many drugs administered by mouth go through first-pass metabolism in the liver before beginning systemic circulation. Therefore the bioavailability of drugs taken orally is less than 100%. A drug cannot have more than 100% bioavailability.

The nurse administers 650 mg of aspirin at 7 PM. The drug has a half-life of 3 hours. The nurse should interpret this information to mean that 325 mg of the medication will have been eliminated from the patient's system by what time? 1: 7 AM 2: 1 AM 3: 10 AM 4: 10 PM

10PM The half-life (T ½) of a drug is the time it takes for one-half of the drug to be eliminated. If 650 mg of aspirin is administered at 7 PM, half of the amount (325 mg) will be eliminated in 3 hours, which would be 10 PM.

The healthcare provider has ordered nicotine gum for a patient who is admitted to the inpatient facility and withdrawing from nicotine. The order reads, "Nicotine chewable gum 2 mg PO every hour PRN not to exceed 30 pieces per 24-hour period." If the patient requests and receives one piece of nicotine gum every 3 hours, how many milligrams of nicotine will the patient receive in 24 hours? 1: 2 mg 2: 16 mg 3: 24 mg 4: 30 mg

16 If a patient gets a 2-mg piece of nicotine gum every 3 hours, he or she would get 8 doses within 24 hours; 8 multiplied by 2 mg equals 16 mg of nicotine in 24 hours.

The nurse is teaching a patient about the use of disulfiram. Which statement by the patient indicates that the teaching has been effective? 1: "I need to avoid all forms of alcohol including cough syrups and aftershave." 2: "I have to have regular blood testing while taking this medication." 3: "I can drink only one alcoholic beverage per day on this medication." 4: "I will get an upset stomach if I have alcohol, but it won't be serious."

1: "I need to avoid all forms of alcohol including cough syrups and aftershave." Disulfiram helps alcoholics avoid drinking by causing unpleasant effects if alcohol is ingested. This reaction, which may last from 30 minutes to several hours, can be brought on by consuming as little as 7 mL of alcohol. Patients must be made aware that consuming any alcohol while taking disulfiram may produce a severe, potentially fatal, reaction. Patients must be warned to avoid all forms of alcohol, including alcohol found in sauces and cough syrups, and alcohol applied to the skin in aftershave lotions, cologne, and liniments.

A patient asks the nurse why he feels so calm after smoking if this habit is so harmful and addictive. What is the nurse's best response? 1: "Nicotine acts on the pleasure system in the brain, which lessens feelings of aggression." 2: "Nicotine depresses the nervous system, which causes you to feel calm and relaxed." 3: "Nicotine decreases tone and motility in the digestive system, which helps you relax." 4: "Nicotine acts on special nerve receptors in the body and slows down your heart rate."

1: "Nicotine acts on the pleasure system in the brain, which lessens feelings of aggression." Nicotine has multiple psychologic effects. The drug increases alertness, facilitates memory, improves cognition, reduces aggression, and suppresses appetite. In addition, by promoting the release of dopamine, nicotine activates the brain's pleasure system, located in the mesolimbic area. Norepinephrine and epinephrine act on the cardiovascular system to constrict blood vessels, accelerate the heart, and increase the force of ventricular contraction. The net result is elevation of blood pressure and increased cardiac work. Nicotine influences gastrointestinal (GI) function primarily by activating nicotinic receptors in parasympathetic ganglia, thereby increasing the secretion of gastric acid and augmenting the tone and motility of GI smooth muscle. In addition, nicotine can promote vomiting. Nicotine is a central nervous system (CNS) stimulant. The drug stimulates respiration and produces an arousal pattern on the electroencephalogram. Moderate doses can cause tremors, and high doses can cause convulsions.

The nurse is explaining nicotine tolerance to the nursing student. Which statement by the student indicates that the teaching has been effective? 1: "Smokers develop tolerance to nausea and dizziness." 2: "All of the side effects from nicotine will go away after time." 3: "The heart of a smoker does not work as hard as the heart of a nonsmoker." 4: "Smokers eventually have the same blood pressure as nonsmokers."

1: "Smokers develop tolerance to nausea and dizziness." Users develop tolerance to some effects of nicotine but not to others. Tolerance does develop to nausea and dizziness, which are common in the unseasoned smoker. In contrast, very little tolerance develops to the cardiovascular effects. Veteran smokers continue to experience increased blood pressure and increased cardiac work whenever they smoke.

Which of the following statements about acamprosate are true? Select all that apply. 1: Acamprosate reduces the unpleasant feeling brought on by abstinence. 2: Acamprosate causes physical illness when alcohol is ingested. 3: Acamprosate should not be used in patients with severe renal impairment. 4: Acamprosate reduces the pleasant feelings that alcohol can cause. 5: Acamprosate has been shown to be more effective than a placebo.

1: Acamprosate reduces the unpleasant feeling brought on by abstinence. 3: Acamprosate should not be used in patients with severe renal impairment. 5: Acamprosate has been shown to be more effective than a placebo. Acamprosate works by reducing unpleasant feelings (eg, tension, dysphoria, and anxiety) brought on by abstinence. This effect contrasts with the effects of disulfiram (which makes drinking unpleasant) and naltrexone (which blocks the pleasant feelings that alcohol can cause). Compared with patients taking a placebo, those taking acamprosate abstained from their first drink longer, had greater rates of complete abstinence, and were abstinent for more total days. If the patient has severe renal impairment, acamprosate should not be used.

A patient has quit smoking. Which symptoms will the nurse assess if the patient experiences abstinence syndrome? Select all that apply. 1: Cravings 2: Irritability 3. Nervousness 4: Decreased appetite 5: Increased concentration

1: Cravings 2: Irritability 3. Nervousness Individuals who discontinue smoking will experience an abstinence syndrome. Prominent symptoms are cravings, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration, increased appetite, and weight gain.

The nurse is responsible for dispensing medications to a child younger than 1 year old. What characteristics of children this age have a significant impact on dosage of drugs? Select all that apply. 1: Decreased acid in stomach 2: Risk of excessive hydration 3: Limited protein-binding capacity 4: Immature liver and kidney function 5: Thin skin with reduced permeability

1: Decreased acid in stomach 3: Limited protein-binding capacity 4: Immature liver and kidney function Pediatric patients lack acid production in the stomach and therefore have a decreased ability to kill intestinal bacteria. In addition, some drugs may not be adequately dissolved in the stomach. Very young patients have limited capacity for protein binding, which affects distribution. They also have an immature liver and kidneys, which impairs drug metabolism and excretion. Pediatric patients are at risk of dehydration because of a larger surface area. They have thin skin, which is more permeable, and topical drugs may be absorbed readily.

Which factors alter the metabolism of drugs among older adults? Select all that apply. 1: Decreased hepatic mass 2: Decreased renal blood flow 3: Decreased hepatic blood flow 4: Decreased glomerular filtration rate 5: Decreased activity of hepatic enzymes

1: Decreased hepatic mass 3: Decreased hepatic blood flow 5: Decreased activity of hepatic enzymes Decreased hepatic mass and blood flow, as well as decreased activity of hepatic enzymes, affect the metabolism of medication. Decreased renal blood flow and glomerular filtration rate do not affect the metabolism of drugs; rather, these factors alter the excretion of drugs.

The nurse is explaining the changes in the distribution process of drugs occurring in elderly patients. Which pharmacokinetic changes occur in patients older than 60 years? Select all that apply. 1: Decreased serum albumin 2: Increase in lean body mass 3: Relative increase in body fat 4: Reduction in body fat content 5: Increase in protein-binding sites

1: Decreased serum albumin 3: Relative increase in body fat Four major factors can alter drug distribution in older adults: (1) decreased concentration of serum albumin, (2) increased percent body fat, (3) decreased percent lean body mass, and (4) decreased total body water. The increase in body fat seen in older adults provides a storage depot for lipid-soluble drugs (eg, pentobarbital). As a result, plasma levels of these drugs are reduced, causing a reduction in responses. Because of the decline in lean body mass and total body water, water-soluble drugs (eg, ethanol) become distributed in a smaller volume than in younger adults. As a result, the concentration of these drugs is increased, causing effects to be more intense. Although albumin levels are only slightly reduced in healthy older adults, these levels can be significantly reduced in older adults who are malnourished. Because of reduced albumin levels, sites for protein binding of drugs decrease, causing levels of free drug to rise. As a result, drug effects may be more intense.

Which factors affect the placental transfer of medications between the mother and the fetus? Select all that apply. 1: Degree of protein binding 2: Metabolic activity of the placenta 3: Molecular weight of the substance 4: Liver metabolism of medication in the fetus 5: Degree of ionization of the medication molecule

1: Degree of protein binding 2: Metabolic activity of the placenta 3: Molecular weight of the substance 5: Degree of ionization of the medication molecule The degree of protein binding affects the placental transfer of medications between the mother and the fetus. Medications that have a high degree of protein binding transfer very slowly compared to low-protein-bound medications. Medications that have a low molecular weight cross the placenta more readily than high-molecular-weight substances. Placental transfer of medications is also slower if the molecule is less ionized. The metabolic activity of the placenta biotransforms the molecules into active metabolites. The liver metabolism of medication in the fetus occurs after the medication crosses the placenta and reaches the fetus.

The nurse is reviewing a patient's drug prescription. Which elements of the medication prescription will the nurse specifically check for? Select all that apply. 1: Drug name on the prescription 2: Name of the patient on the prescription 3: Signature of the prescriber on the prescription 4: Expiration date of the drug in the prescription 5: Drug allergy of the drug specified on the prescription

1: Drug name on the prescription 2: Name of the patient on the prescription 3: Signature of the prescriber on the prescription Once detailed drug assessment is completed, the nurse checks six elements of the medication prescription: name of the patient, date the prescription was written, drug names, drug dosage, route of administration, and prescriber's signature. Information about allergies that are due to drug reaction should be requested during the initial assessments. The expiration date of the drug is not included on the prescription.

Which factors may contribute to unintentional nonadherence? Select all that apply. 1: Forgetfulness 2: Unpleasant side effects 3: Inability to pay for medications 4: Belief that the drug is not needed 5: Failure to comprehend instructions

1: Forgetfulness 3: Inability to pay for medications 5: Failure to comprehend instructions Forgetfulness, failure to comprehend instructions (because of intellectual, visual, or auditory impairment), and inability to pay for medications can contribute to unintentional nonadherence. Unpleasant side effects and the belief that the drug is not needed are factors that contribute to intentional nonadherence.

What should the nurse do when administering medications to a pregnant patient who has asthma? 1: Give the asthma medications because they improve fetal outcomes. 2: Hold the medications because drugs for asthma are not safe during pregnancy. 3: Give the medications as ordered because most drugs do not cross the placenta. 4: Assess the creatinine level because renal blood flow decreases during pregnancy

1: Give the asthma medications because they improve fetal outcomes. Uncontrolled maternal asthma is more dangerous to the fetus than the drugs used to treat it. Essentially all drugs can cross the placenta. Renal blood flow increases during pregnancy, which increases the clearance of some drugs, such as lithium. Lack of proof of teratogenicity does not mean that a drug is safe; it only means that the available data are insufficient to make a definitive judgment.

A nurse is evaluating the effectiveness of a drug addiction treatment program. Which treatment programs address the complex nature of drug addiction treatment? 1: In the comprehensive program, therapy addresses emotional problems, and medications treat drug use. 2: In the pharmacologic approach program, the director prescribes pharmacologic agents to modify the effects of abused drugs. 3: In the aversion program, threats of incarceration and loss of family support are used to discourage addiction. 4: In the compassionate care program, treatment focuses on group and individual therapy with a goal of becoming whole.

1: In the comprehensive program, therapy addresses emotional problems, and medications treat drug use. Because addiction is a complex illness that affects all aspects of life, the treatment program must be comprehensive and multifaceted. Techniques with proven success include group and individual therapy directed at resolving emotional problems that underlie drug use; threats and external pressure to discourage drug use; and use of pharmacologic agents to modify the effects of abused drugs. The most effective treatment programs incorporate two or more of these methods. A program with a single focus is ineffective.

According the Food and Drug Administration (FDA) Pregnancy and Lactation Labeling Rule, which content is considered part of the clinical considerations subsection? Select all that apply. 1: Labor or delivery 2: Maternal adverse reactions 3: Fetal or neonatal adverse reactions 4: Special considerations for multiple births 5: Disease-associated maternal and/or embryo or fetal risk 6: Dose adjustments during pregnancy and the postpartum period

1: Labor or delivery 2: Maternal adverse reactions 3: Fetal or neonatal adverse reactions 5: Disease-associated maternal and/or embryo or fetal risk 6: Dose adjustments during pregnancy and the postpartum period Information in the clinical considerations category of the FDA Pregnancy and Lactation Labeling Rule is provided for labor or delivery; maternal adverse reactions; fetal or neonatal adverse reactions; disease-associated maternal and/or embryo or fetal risk; and dose adjustments during pregnancy and the postpartum period. Special considerations for multiple birth is not part of the clinical considerations subsection of drug labels.

The nurse is providing medication teaching and notes that the patient is having difficulty understanding the instructions because of a language barrier. Which action by the nurse will best help the patient? 1: Obtain a translator to assist with teaching. 2: Instruct the patient to read the black box warnings. 3; Advise the patient to call the provider for more information. 4: Demonstrate how to administer the medication and provide written information.

1: Obtain a translator to assist with teaching. The nurse should arrange a translator while interacting with the patient who has a language barrier. It helps the patient to effectively understand all teaching regarding precautions and the frequency of drug administration. The nurse should clearly explain the instructions before asking the patient to read the black box warning because patients might not understand some of the instructions. The nurse should arrange for a translator rather than asking the patient to call the healthcare provider. The healthcare provider may not be able to properly convey the instructions given by the nurse. The nurse's teaching techniques, such as how to provide a self-injection of insulin therapy, will not help the patient understand the complete drug information. The nurse should demonstrate the technique in the presence of a translator, so the patient can follow the instructions of the nurse.

A nurse is reviewing the chart of a patient taking bupropion SR. Which information will cause the nurse to intervene? 1: Phenelzine 2: Nicotine patch 3: Wants to lose weight 4: History of appendectomy

1: Phenelzine Bupropion SR should not be given to patients taking monoamine oxidase inhibitors such as phenelzine. Combining a nicotine patch with bupropion SR is somewhat more effective than either treatment alone. Bupropion will cause weight loss because it suppresses appetite. A history of appendectomy does not affect treatment with bupropion SR.

How can healthcare providers promote medication adherence for children? Select all that apply. 1: Providing a calibrated medicine spoon for measuring liquid medications 2: Recommending that medication be stopped once the child begins to feel better 3: Taking extra time with parents to help ensure conscientious and skilled participation 4: Mixing oral drugs with small amounts of food or juice (when allowed) to improve palatability 5: Selecting the most convenient dosage form and dosing schedule when using over-the-counter drugs

1: Providing a calibrated medicine spoon for measuring liquid medications 3: Taking extra time with parents to help ensure conscientious and skilled participation 4: Mixing oral drugs with small amounts of food or juice (when allowed) to improve palatability 5: Selecting the most convenient dosage form and dosing schedule when using over-the-counter drugs Healthcare providers can promote adherence to medication dosing for children by selecting the most convenient dosage form and dosing schedule, mixing oral drugs with food or juice (when allowed) to improve palatability, providing a calibrated medicine spoon or syringe for measuring liquid formulations, and taking extra time with parents to help ensure conscientious and skilled participation. Suggesting stopping the medication when the child feels better (taking a partial course of medication) is not a way to promote adherence. The caregiver/parent should continue to administer the medication, even if the child feels better before the medication is completed.

Which statement is appropriate regarding the reporting of medical errors? 1: Reporting medical errors can prevent future errors. 2: Reporting medical errors should be done by a nurse. 3: Discussing medical errors with the patient should be avoided. 4: Reporting medical errors is limited to patients being cared for in hospitals.

1: Reporting medical errors can prevent future errors. Medical errors can be prevented by reporting the mistake as soon as possible. Medical error reports serve as a reference for healthcare professionals to take appropriate measures to avoid future errors. All healthcare professionals play an important part in reporting medical errors. Medical errors must be discussed with patients and should be reported when caring for patients in all types of institutions.

A nurse is preparing a teaching session about factors that contribute to drug abuse. Which information should the nurse include? Select all that apply. 1: Social factors 2: Drug availability 3: High tolerance for frustration 4: Vulnerability of the individual 5: Difficult procurement of drugs 6: Reinforcing properties of drugs

1: Social factors 2: Drug availability 4: Vulnerability of the individual 6: Reinforcing properties of drugs By making people feel "good," drugs reinforce the reasons for their use. Social factors can play an important role in the development of abuse. Drug availability is clearly a factor in the development and maintenance of abuse. Abuse can flourish only in environments where drugs can be readily obtained. In contrast, where procurement is difficult, abuse is minimal. Some individuals are more prone to becoming drug abusers than others. A low tolerance for frustration contributes to drug abuse, not high tolerance.

When preparing a teaching session for residents at an assisted living facility, what should the nurse include? 1: The importance of taking the full prescribed dose 2: The importance of taking double amounts of missed doses 3: The importance of reducing protein intake while taking prescription medications 4: The importance of using multiple pharmacies for cost-effective savings on prescription drugs

1: The importance of taking the full prescribed dose Underdosing, with resulting therapeutic failure, is much more common (90%) than overdosing among the elderly. In most cases (75%), the nonadherence is intentional because of the patient's conviction that the drug is simply not needed or because of unpleasant side effects. Using multiple pharmacies should be avoided, as should doubling missed doses. Doubling a dose could result in intentional overdosing. Reducing protein intake can result in decreased drug binding to albumin; consequently, the amount of free drug is increased, which could result in drug toxicity.

A nurse cares for a patient with gastrointestinal bleeding who was admitted to a medical unit 3 days ago. Today, the patient is irritable and nauseated with an increased heart rate. The patient says to the nurse, "There are roaches everywhere in this hospital, and they've been crawling on me. I'm so scared of bugs." The nursing admission assessment shows that the patient drinks socially. How does the nurse analyze this situation? 1: The patient may have minimized use of alcohol and may be experiencing withdrawal. 2: Caring behaviors by the nursing staff have most likely been inadequate, and the patient is lonely. 3: The facility's infection control nurse should be consulted about the insect infestation. 4: The patient probably has dementia, which was inadequately assessed at the time of admission.

1: The patient may have minimized use of alcohol and may be experiencing withdrawal. Chronic use of alcohol produces physical dependence, and abrupt withdrawal produces an abstinence syndrome. The patient is exhibiting withdrawal manifestations. Initial withdrawal symptoms appear 12 to 72 hours after the last drink. It is highly improbable that a pest infestation has happened in the sanitized environment of the hospital. It is not dementia that is causing the hallucination but alcohol withdrawal symptoms. Negligence is not a cause for hallucinations either.

When administering a medication known to be metabolized by the liver, the nurse should closely monitor for adverse drug reactions in which patient? 1:A 3-month-old infant 2:A 12-month-old infant 3:An 18-month-old toddler 4: A 13-year-old adolescent

1:A 3-month-old infant Neonates are especially sensitive to drugs that are eliminated primarily by hepatic metabolism. When these drugs are used, dosages must be reduced. The capacity of the liver to metabolize many drugs increases rapidly about 1 month after birth and approaches adult levels a few months later. The liver has matured completely by 1 year of age.

The nurse is teaching young parents about medication administration in their child. Which statements are appropriate to include in the teaching plan? Select all that apply. 1: "Do not mix your child's medication with food or drink." 2: "This calibrated spoon will help your child get an accurate dose." 3: "If your child spits some medication out, give another full dose at that time." 4: "Guard against spills and spitting to ensure that your child gets an accurate dose." 5: "Keep a medication record to make sure you do not give more than one dose at a time."

2: "This calibrated spoon will help your child get an accurate dose." 4: "Guard against spills and spitting to ensure that your child gets an accurate dose." 5: "Keep a medication record to make sure you do not give more than one dose at a time." Spills and spitting are common causes of inaccurate dosing in children. It is often helpful to mix medication with food or juice to mask the taste when allowed. Calibrated spoons and medication records can improve accuracy. To prevent overdosing, parents should estimate the amount a child spits out and replace only that amount.

Which statement is true regarding pharmacokinetics in children 1 year and older? 1: Children older than 1 year metabolize drugs much slower than adults. 2: By age 1 year, most pharmacokinetic parameters in children are similar to those in adults. 3: Drug sensitivity in children older than 1 year is more like that of infants than that of adults. 4: Drug-metabolizing capacity is markedly decreased until age 2 years and then gradually increases.

2: By age 1 year, most pharmacokinetic parameters in children are similar to those in adults. By age 1 year, most pharmacokinetic parameters in children are similar to those in adults. Children older than 1 year metabolize drugs much faster, not slower, than adults. Drug-metabolizing capacity is markedly increased, not decreased, until age 2 years, then gradually declines, not increases. Drug sensitivity in children older than 1 year is more like that of adults, not infants.

Which actions should the nurse perform to ensure that the medication dose for a pediatric patient is correct? Select all that apply. 1: Use the patient's weight in pounds. 2: Compare the drug dosage prescribed with the calculated safe range. 3: Use a current drug reference to determine usual dosage per 24 hours. 4: Determine the total amount of the drug to administer per dose and per day. 5: If the drug dosage prescribed varies from recommended reference range, notify the provider. 6: Determine the dose parameters by multiplying the weight by the minimum and maximum daily doses of the drug to determine the safe range.

2: Compare the drug dosage prescribed with the calculated safe range. 3: Use a current drug reference to determine usual dosage per 24 hours. 4: Determine the total amount of the drug to administer per dose and per day. 5: If the drug dosage prescribed varies from recommended reference range, notify the provider. 6: Determine the dose parameters by multiplying the weight by the minimum and maximum daily doses of the drug to determine the safe range. The patient's weight needs to be in kilograms, not pounds. All other information listed is correct and must be followed by the nurse to ensure the correct pediatric dosage.

A pregnant woman has taken a medication that is a known teratogen. What steps should the nurse take to identify risks for malformation? Select all that apply. 1: Determine who prescribed the medication. 2: Determine exactly when the pregnancy began. 3: Determine exactly when the medication was taken. 4: Determine why the woman was taking the medication. 5: Determine the frequency of when the medication was taken.

2: Determine exactly when the pregnancy began. 3: Determine exactly when the medication was taken. 5: Determine the frequency of when the medication was taken. When a pregnant woman has been exposed to a known teratogen, the first step is to determine exactly when the medication was taken, how often it was taken, and exactly when the pregnancy began. The other information is helpful but not necessary.

Which of the following statements about disulfiram are true? Select all that apply. 1: Disulfiram reduces the high from drinking alcohol. 2: Disulfiram has no applications outside the treatment of alcoholism. 3: Acetaldehyde syndrome symptoms can last 2 weeks after ingesting alcohol. 4: In the absence of alcohol, disulfiram rarely causes significant effects. 5: Acetaldehyde syndrome may occur from drinking less than an ounce of alcohol.

2: Disulfiram has no applications outside the treatment of alcoholism. 3: Acetaldehyde syndrome symptoms can last 2 weeks after ingesting alcohol. 4: In the absence of alcohol, disulfiram rarely causes significant effects. 5: Acetaldehyde syndrome may occur from drinking less than an ounce of alcohol. Disulfiram helps alcoholics avoid drinking by causing unpleasant effects if alcohol is ingested. Disulfiram has no applications outside the treatment of alcoholism. This reaction, which may last from 30 minutes to several hours, can be brought on by consuming as little as 7 mL of alcohol. In the absence of alcohol, disulfiram rarely causes significant effects. Patients should be made aware that the effects of disulfiram will persist for about 2 weeks after the last dose, and thus continued abstinence is necessary. Naltrexone reduces the high from drinking alcohol.

The nurse is working on a unit in which patients regularly receive controlled substances. Which principles guide the appropriate care of patients receiving these drugs? Select all that apply. 1: When federal and state laws differ, federal laws always take precedence. 2: Drugs are categorized into schedules based on their potential for abuse and dependence. 3: Drugs that are categorized in Schedule V have the highest potential for abuse. 4: A transfer must be documented every time a controlled substance is purchased or dispensed. 5: Prescriptions for Schedule I drugs must be written for no more than a 90-day supply.

2: Drugs are categorized into schedules based on their potential for abuse and dependence. 4: A transfer must be documented every time a controlled substance is purchased or dispensed. Drugs considered controlled substances are categorized according to their potential for abuse and dependence. Each time a controlled substance is purchased or dispensed, that transfer must be recorded. Drugs in Schedule I have the highest potential for abuse. The more stringent law, whether state or federal, always takes precedence. Schedule I drugs have no approved medical uses in the United States and therefore cannot be prescribed legally.

How can the nurse enhance effective medication use in an older adult? Select all that apply. 1: Provide oral rather than written instruction. 2: Explain the purpose and importance of each drug. 3: Educate the patient about the side effects of each drug. 4: Develop a chart that includes the time to take each drug. 5: Encourage family members to monitor the patient's drug regimen

2: Explain the purpose and importance of each drug. 3: Educate the patient about the side effects of each drug. 4: Develop a chart that includes the time to take each drug. 5: Encourage family members to monitor the patient's drug regimen The nurse should develop a chart that includes the time to take each drug, so the older adult is not confused; explain the purpose and importance of each drug to the patient to prevent confusion; encourage family members to monitor the patient's drug regimen, so the patient does not skip any doses; and educate the patient about the side effects of each drug, so the patient reports any discomfort immediately to the primary healthcare provider. The older adult may forget some instructions related to drug use. Therefore, the nurse should provide written instructions to the patient to reinforce teaching.

Older adult patients are at high risk for adverse drug reactions (ADRs). Which measures can reduce the incidence of ADRs? Select all that apply. 1: Using additional drugs to manage drug side effects 2: Helping patients avoid prescriptions for drugs on the Beers list 3: Regularly monitoring patients for drug-drug and drug-nutrient interactions 4: Taking a thorough drug history, including over-the-counter (OTC) medications 5: Monitoring clinical response and laboratory results to help determine proper dosage

2: Helping patients avoid prescriptions for drugs on the Beers list 3: Regularly monitoring patients for drug-drug and drug-nutrient interactions 4: Taking a thorough drug history, including over-the-counter (OTC) medications 5: Monitoring clinical response and laboratory results to help determine proper dosage A thorough drug history and careful monitoring can help reduce ADRs. Nurses should help patients use the simplest regimen possible to reduce the risk of ADRs. Monitoring patients for interactions reduces ADRs. The Beers list identifies drugs with a high likelihood of causing adverse effects in the elderly. Adding additional drugs promotes polypharmacy; the better solution is to substitute drugs that have fewer side effects.

Which of the following statements about nicotine are correct? Select all that apply. 1: Nicotine reduces memory. 2: Nicotine improves cognition. 3: Nicotine reduces aggression. 4: Nicotine suppresses appetite. 5: Nicotine is a central nervous system depressant.

2: Nicotine improves cognition. 3: Nicotine reduces aggression. 4: Nicotine suppresses appetite. Nicotine is a central nervous system stimulant. The drug stimulates respiration and produces an arousal pattern on an electroencephalograph (EEG). Moderate doses can cause tremors, and high doses can cause convulsions. Nicotine has multiple psychologic effects. The drug increases alertness, facilitates memory, improves cognition, reduces aggression, and suppresses appetite.

Which statement regarding adverse reactions during pregnancy is false? 1: Drugs taken during pregnancy can adversely affect the patient as well as the fetus. 2: One in five children is born with a malformation related to drug use during pregnancy. 3: The drug effect of greatest concern is teratogenesis. This is the production of birth defects in the fetus. 4: Pregnant women are not only subject to the same adverse effects as everyone else, but they may also suffer effects unique to pregnancy.

2: One in five children is born with a malformation related to drug use during pregnancy. Fewer than 1% of all birth defects are caused by drugs. All of the other statements are true.

A patient has refused to take his or her prescribed medication and is adamant that the tablet is worsening the patient's condition. What does the nurse do? 1: Mix the medication in the patient's food or drink. 2: Respect the patient's right to refuse and notify the provider. 3: Try to give the medication to the patient again after a few hours. 4: Return the unwrapped medication to the container for safe future use.

2: Respect the patient's right to refuse and notify the provider. The patient has the right to refuse a medication, and this right must be respected. The nurse should determine the cause of refusal, notify the provider, and make appropriate revisions in the nursing care plan. It is not safe to skip the dose and try to give it again after a few hours. Unwrapped medicine should never be returned to the container; agency policy usually requires it to be discarded. Forcing the patient to take a medicine is unethical and does not protect the patient's right to refuse.

The nurse reads that the half-life of the medication being administered is 12 hours. Which interpretation should guide the nurse's care of this patient? 1: The medication will not work for the first 12 hours. 2; This medication will be 50% eliminated in 12 hours. 3; The patient will require two doses of the medication before there is an effect. 4: The medication will be administered every 6 hours to maintain consistent blood levels.

2: This medication will be 50% eliminated in 12 hours. The half-life (T ½) of a drug is the time needed for one-half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of a drug. For example, with liver or kidney dysfunction, the half-life of the drug is prolonged; thus less of the drug is metabolized and eliminated. When a drug is taken continually, drug accumulation may occur. The medication will begin to exert effects before the 12-hour mark with one dose. To maintain consistent blood levels of the drug with a half-life of 12 hours, the medication will likely be administered every 12 or 24 hours, not every 6 hours.

Which statements accurately describe results of drug research in children? Select all that apply. 1: About three quarters of drugs have now been tested in children. 2: Traditionally, the pediatric population is subdivided into six groups: premature infants, full-term infants, neonates, infants, children, and adolescents. 3: Drug dosages for children can easily be extrapolated from dosages used in adults. 4: About 30% of drugs cause unanticipated side effects, some of them potentially lethal, in the pediatric population. 5: If a drug is effective in adults, it will definitely be effective in children.

2: Traditionally, the pediatric population is subdivided into six groups: premature infants, full-term infants, neonates, infants, children, and adolescents. 4: About 30% of drugs cause unanticipated side effects, some of them potentially lethal, in the pediatric population. It is true that about 30% of drugs cause unanticipated side effects, some of them potentially lethal, in the pediatric population. Traditionally, the pediatric population is subdivided into six groups: premature infants, full-term infants, neonates, infants, children, and adolescents. As pediatric patients grow older, they become more like adults physiologically and more like adults with regard to drug therapy. Only one-third of drugs have been tested in children. It is not true that a drug will definitely be effective in children if it is effective in adults; about 20% of drugs have been found to be ineffective in children even though they were effective in adults. It is not accurate that drug dosages for children can easily be extrapolated from dosages used in adults; about 20% of drugs studies required dosages different from those that had been extrapolated from dosages used in adults.

The nurse prepares a teaching session about cigarette smoking. What will the nurse include when discussing signs and symptoms of nicotine use? Select all that apply. 1: Sleepiness 2: Weight loss 3:Elevated mood 4: Increased alertness 5: Increased aggressiveness

2: Weight loss 3:Elevated mood 4: Increased alertness Nicotine increases alertness, facilitates memory, improves cognition, reduces aggression, and suppresses appetite. In addition, by promoting release of dopamine, nicotine activates the brain's "pleasure system" located in the mesolimbic area. The effects of nicotine on the pleasure system are identical to those of other highly addictive drugs, including cocaine, amphetamines, and opioids. Nicotine does not cause sleepiness or increase aggressiveness.

Which statement by a patient about the use of aspirin during pregnancy indicates a need for further learning? 1: "Aspirin can cause antepartum hemorrhage." 2: "Aspirin can affect hemostasis in the newborn." 3: "Aspirin can be used to relieve pain during pregnancy." 4: "Aspirin is most harmful when used late in pregnancy

3: "Aspirin can be used to relieve pain during pregnancy." Aspirin should not be used to relieve pain during pregnancy because it can affect uterine contractility. This may inhibit the initiation of labor and prolong labor. Aspirin is harmful when used late in pregnancy because it may increase maternal blood loss at the time of delivery. Aspirin can also affect hemostasis in the newborn if the mother uses aspirin during the last 2 months of pregnancy. Aspirin used late in pregnancy can cause antepartum hemorrhage.

Which statement best indicates that the nurse understands the meaning of pharmacokinetics? 1: "It explains the adverse reactions to drugs." 2: "It explains interactions among various drugs." 3: "It explains how drugs are absorbed and distributed." 4: "It involves the study of physiologic interactions of drugs."

3: "It explains how drugs are absorbed and distributed." Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion. It does not involve the study of interactions of drugs nor does it explain other interactions or adverse reactions.

The teaching plan for a patient taking bupropion SR should include which statement? 1: "Weight gain is common." 2: "Increased salivation is common." 3: "Take a second dose as early in the day as possible." 4: "Take the drug at least 1 hour before a monoamine oxidase inhibitor."

3: "Take a second dose as early in the day as possible." Adverse effects of bupropion SR are generally mild and include dry mouth, insomnia, seizure risk, appetite reduction, and weight loss. Bupropion SR should not be taken with monoamine oxidase inhibitors. To minimize sleep interference, the second dose should be taken as early in the day as possible but at least 8 hours after the morning dose.

Which statement about intramuscular (IM) administration is incorrect? 1: Drug absorption after IM injection in the neonate is slow and erratic. 2: Absorption of IM drugs becomes more rapid in infancy than in neonates. 3: Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. 4: Neonates experience low blood flow through muscle during the first days of postnatal life.

3: Absorption of IM drugs becomes slower and more erratic in infancy than in neonates. Drug absorption after IM injection in the neonate is slow and erratic . Delayed absorption is due in part to low blood flow through muscle during the first days of postnatal life. By early infancy, absorption of IM drugs becomes more rapid than in neonates and adults.

How does the nurse best describe the schedule class of heroin according to the Controlled Substances Act? 1: Able to be dispensed without a prescription 2: Able to be refilled only up to 6 months from the date of the original prescription 3: Having a high potential for abuse and not being approved for medical use in the United States 4: Approved for medical use but having abuse potential and potential for causing physical or psychologic dependence

3: Having a high potential for abuse and not being approved for medical use in the United States Heroin is a Schedule I opioid with a high abuse potential and no approved medical use. Schedule II drugs have a high abuse potential but are approved for medical use. Schedule III drugs can be refilled up to five times within 6 months of the original prescription. Schedule V drugs can be dispensed without a prescription.

Why would the nurse consult the Beers list when administering drugs? 1: It identifies drugs that have been known to cause liver toxicity. 2: It includes safer alternatives for patients who have drug allergies. 3: It lists drugs with a high likelihood of causing adverse effects in older adults. 4: It details which drugs can cause disulfiram-like reactions when taken with alcohol.

3: It lists drugs with a high likelihood of causing adverse effects in older adults. The Beers list identifies drugs with a high likelihood of causing adverse effects in older adults. It does not identify drugs with regard to liver toxicity, drug allergies, or disulfiram-like reactions.

The nurse encourages a patient with cardiovascular disease to quit smoking. The nurse makes this decision based on which cardiovascular effects of nicotine? Select all that apply. 1: Nicotine causes hypotension. 2: Nicotine dilates blood vessels. 3: Nicotine accelerates the heart. 4: Nicotine decreases cardiac work. 5: Nicotine increases force of ventricular contraction.

3: Nicotine accelerates the heart. 5: Nicotine increases force of ventricular contraction. The cardiovascular effects of nicotine result primarily from activating nicotinic receptors in sympathetic ganglia and the adrenal medulla. Activation of these receptors promotes release of norepinephrine from the sympathetic nerves and release of epinephrine (and some norepinephrine) from the adrenals. Norepinephrine and epinephrine act on the cardiovascular system to constrict blood vessels, accelerate the heart, and increase the force of ventricular contraction. The net result is elevation of blood pressure and increased cardiac work. Very little tolerance develops to the cardiovascular effects.

A patient is ordered a Schedule III drug. The patient asks the nurse what the schedule designation means. How are schedule drugs classified? 1: Risk for toxicity 2: Adverse effects 3: Potential for abuse 4: Pain relief provided

3: Potential for abuse Assignment to Schedules II through V is based on abuse potential and potential for causing physical or psychologic dependence. The designation does not provide information about the risk for toxicity, adverse effects, or pain relief provided.

Which action will the nurse take when administering disulfiram? 1: Prepare the syringe and needle. 2: Give the drug within 12 hours of last drink. 3: Remove aftershave lotions/colognes from the room. 4: Emphasize to the patient not to crush or mix with liquids.

3: Remove aftershave lotions/colognes from the room. Inform patients about the potential hazards of treatment and warn them to avoid all forms of alcohol, including alcohol in vinegar, sauces, and cough syrups, in addition to the alcohol applied to the skin in aftershave lotions, colognes, and liniments. The medication comes only in oral form. Inform patients that tablets may be crushed or mixed with liquid. Instruct the patient not to administer the first dose until at least 12 hours after his or her last drink.

The nurse is caring for a group of older adult patients who are all receiving multiple medications. Which statement represents a physiologic change that can alter pharmacodynamics in these patients? 1: The percentage of drug absorbed often is decreased in older adults. 2: Most older adults have decreased body fat and increased lean mass. 3: Renal function declines with age, leading to decreased drug excretion. 4: Hepatic metabolism tends to increase in older adults, resulting in decreased drug levels.

3: Renal function declines with age, leading to decreased drug excretion. Renal function declines in older adults, leading to decreased excretion and potential drug accumulation. Although absorption may be delayed in older adults, the percentage absorbed does not change. Most older adult patients have increased body fat and decreased lean mass. Hepatic metabolism tends to decline with age.

The breast-feeding patient with epilepsy takes anticonvulsant therapy. What guideline should the nurse follow to minimize risk to the baby? 1: Encourage the patient to increase fluid intake. 2: Administer the medication just before breast-feeding. 3: Request an order for drugs that have a shorter half-life. 4: Discontinue anticonvulsants until the patient has stopped breast-feeding.

3: Request an order for drugs that have a shorter half-life. The nurse should request an order for drugs that have a shorter half-life. Dosing immediately after breast-feeding minimizes the drug concentration in milk. Drugs with a shorter half-life are excreted by the mother more quickly. If possible, drugs should be avoided during breast-feeding; however, patients with chronic illnesses, such as epilepsy, may require medication for their own health. The maternal fluid intake is not related to medication safety during breast-feeding.

A patient is scheduled to start taking varenicline. The nurse should teach the patient to observe for which adverse effects? 1: Weight loss, nausea, and mood changes 2: Mood changes, erratic behavior, and diarrhea 3: Sleep disturbances, mood changes, and nausea 4: Severe physical dependence, anorexia, and euphoria

3: Sleep disturbances, mood changes, and nausea Adverse effects of varenicline include nausea (most common); psychologic changes such as mood changes, erratic behavior, and suicidality; sleep disturbance; headaches; abnormal dreams; constipation; dry mouth; flatulence; vomiting; and altered sense of taste. Mild physical dependence develops. Varenicline does not reduce weight gain that occurs with smoking cessation.

The nurse is providing education about the correct use of herbal medications and over-the-counter (OTC) medications to a patient who developed depression as a side effect of taking multiple herbal and OTC medications concurrently. Which action by the patient indicates effective teaching? 1: The patient limits water intake to six glasses per day while using herbal medications. 2: The patient declines to discuss the adverse effects of the medications with the nurse. 3: The patient decreases use of OTC drugs for pain and uses ice packs for acute pain relief. 4: The patient refuses to speak with the pharmacist and chooses medications by reading the label.

3: The patient decreases use of OTC drugs for pain and uses ice packs for acute pain relief. The nurse should educate the patient to reduce concurrent use of both herbal and over-the-counter drugs to treat pain. The nurse should teach nonpharmacologic techniques such as the use of hot packs and relaxation techniques to get relief from pain and stress. Before using any medications (herbal and/or OTC), the patient should consult a pharmacist or the primary healthcare provider to obtain information on contraindications for the drugs. The patient should drink at least six to eight glasses of water each day. It helps to avoid renal impairment and promotes effective elimination of most drug and herbal supplement metabolites. The nurse should encourage the patient to discuss the adverse effects of the medications and to promptly report them to the primary healthcare provider.

During which gestational period is drug transfer to the fetus more likely to happen? 1: First trimester 2: Third trimester 3: Second trimester 4: Perinatal period

3rd The drug transfer to the fetus is more likely during the last (third) trimester because of enhanced blood flow, increased fetal surface area, and increased amount of free drug in maternal circulation. The first trimester and second trimester of the gestational period are associated with less drug transfer to the fetus. The perinatal period is not a part of the gestational period.

A patient with symptoms of nicotine withdrawal has been prescribed 21 mg of nicotine patch to be taken every 24 hours. How long will the nurse instruct the patient to take this dose? 1: 1 to 3 weeks 2: 4 to 6 weeks 3: 8 to 10 weeks 4: 12 to 14 weeks

4-6 weeks The nicotine patch is used to treat symptoms of nicotine withdrawal. For effective treatment, 21 mg of the nicotine patch can be administered for 4 to 6 weeks once per day. After the first 4-6 weeks, the dosage will be reduced; the total duration of use for the nicotine patch will be 8-10 weeks, but the dosage will not remain 21 mg every 24 hours for the entire 8-10 weeks. Nicotine is not typically given for 1 to 3 weeks or 12 to 14 weeks.

The patient tells the nurse, "I have brought along the tea that I drink every day. My family has been drinking this kind of tea for generations because it promotes good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response? 1: "You should avoid the use of any kind of traditional remedy while you are taking this new medication." 2: "If you have been drinking this tea every day, then you should continue drinking it to maintain your health." 3: "Traditional remedies have no health benefits. You should stop drinking the tea; it's a waste of time and money." 4: "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications."

4: "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications." The nurse should be concerned about what is in the tea because it may interact with the medication. Patients may derive both psychologic and physical benefits from taking traditional remedies, but it is essential to ensure that the traditional remedies do not interfere with the action of the conventional medications the patient has been prescribed. Because patients may achieve health benefits or psychologic comfort from their traditional remedies, they should not be told that the remedies are forbidden or useless; however, they should be instructed not to continue the remedies until it has been determined that the remedies will not affect the action of the patient's conventional medications.

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breast-feeding. What is the appropriate response for this patient? 1: "I will leave the doctor a message to return your call." 2: "You should not take any medication while breast-feeding." 3: "Only certain medications pass to infants while breast-feeding." 4: "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

4: "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking." The nurse is aware that medications can pass in breast milk, but each medication is different. Women who take medication while breast-feeding should be assessed on a case-by-case basis, including assessment of the medication the patient is taking. The actual medication the patient is taking will need to be determined before providing information to the doctor.

Which statement best indicates that the nurse understands the meaning of pharmacokinetics? 1: "It explains the adverse reactions to drugs." 2: "It explains interactions among various drugs." 3: "It explains the movement of drugs through the body." 4: "It involves the study of physiologic interactions of drugs.

4: "It involves the study of physiologic interactions of drugs. Pharmacokinetics involves the study of the way drugs move through the body, including absorption, distribution, metabolism, and excretion. It does not involve the study of drug interactions, nor does it explain interactions or adverse reactions.

While undergoing experimental trials, the patient asks the nurse, "What does a placebo effect mean?" Which response by the nurse is accurate? 1: "It means tolerance resulting from accelerated drug metabolism." 2: "It means a reduction in drug responsiveness brought on by repeated dosing over a short time." 3: It means the amount of active drug that reaches the systemic circulation from its site of administration." 4: "It means any response that a patient may have based solely on his/her psychologic reaction to the idea of taking a medication."

4: "It means any response that a patient may have based solely on his/her psychologic reaction to the idea of taking a medication. Any response that a patient may have based solely on his/her psychologic reaction to the idea of taking a medication and not to any direct physiologic or biochemical action of the placebo itself is a placebo effect. A reduction in drug responsiveness brought on by repeated dosing over a short time is tachyphylaxis. The amount of active drug that reaches the systemic circulation from its site of administration is bioavailability. Tolerance resulting from accelerated drug metabolism is metabolic tolerance.

A 3-year-old child has been started on a new medication to be given as needed. What is the most important information to convey to the parents? 1: "Make sure the child likes the taste of the medication." 2: "Mix the medication with the child's favorite food or beverage." 3: "Make sure you give the medication at the same time every day." 4: "Observe the child for potential adverse effects of the medication."

4: "Observe the child for potential adverse effects of the medication." Adverse effects of medications can be dangerous as well as difficult to discern in young children, especially effects such as ringing in the ears, because the child might not be able to communicate this symptom. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects. Drugs that are ordered to be given as needed should not be given routinely on a schedule. Not all medications can be made palatable. The nurse can work with parents to help with successful medication administration even with medications that do not taste good.

Which statements by a student nurse about the effect of pregnancy on medication action indicate effective learning? Select all that apply. 1: "There is increased gastrointestinal motility during pregnancy." 2: "The liver decreases metabolism of medications during pregnancy." 3: "The maternal circulating blood volume concentrates the medications." 4: "There is a more rapid renal excretion of medications during pregnancy." 5: "The serum and tissue concentrations of the medications decrease during pregnancy."

4: "There is a more rapid renal excretion of medications during pregnancy." 5: "The serum and tissue concentrations of the medications decrease during pregnancy." The serum and tissue concentrations of medications decrease during pregnancy because of an alteration in the clearance of the medications. There is also a more rapid excretion of medications during pregnancy because of an increased glomerular filtration rate and an increase in renal perfusion. The expanded maternal circulating blood volume during pregnancy results in the dilution of medications. There is reduced gastrointestinal motility as a result of the hormonal changes during pregnancy. For some drugs, hepatic metabolism increases during pregnancy.

The nurse anticipates that which medication is likely to be prescribed to reduce the symptoms of alcohol withdrawal? 1: Disulfiram 2: Morphine 3: Carbamazepine 4: Chlordiazepoxide

4: Chlordiazepoxide Benzodiazepines, such as chlordiazepoxide, are the most effective agents for reducing alcohol withdrawal symptoms. They are safe and can stabilize vital signs, reduce symptom intensity, and reduce the risk of seizures. Carbamazepine also may be used in alcohol withdrawal to reduce the risk of seizures. Morphine is an opioid with a high abuse potential and is not likely to be used during alcohol withdrawal. Disulfiram causes unpleasant effects if alcohol is ingested and may be used to maintain alcohol withdrawal.

Which factors alter drug distribution in older adults? Select all that apply. 1: Decreased bone density 2: Increased total body water 3: Decreased percentage of body fat 4: Decreased percentage of lean body mass 5: Reduced concentration of serum albumin

4: Decreased percentage of lean body mass 5: Reduced concentration of serum albumin Both decreased percentage of lean body mass and reduced concentration of serum albumin play a role in the altered drug distribution in older adults. Decreased bone density has no effect on drug distribution. Total body water is not increased in older adults; it is decreased. Body fat is not decreased in older adults; it is increased.

Which concept guides the nurse's care of infants receiving a variety of medications? 1: The blood-brain barrier protects the infant's brain from toxic drugs. 2: Gastric emptying time is shorter in infants than in children and adults. 3: Drugs given intravenously (IV) leave the body more quickly in infants than in adults. 4: Drugs given subcutaneously (subQ) remain in the body longer in infants than in adults.

4: Drugs given subcutaneously (subQ) remain in the body longer in infants than in adults. The very young are at risk for drug effects that are more intense and prolonged than those seen in adults. Drugs given subQ reach higher levels and remain in the system longer than in adults. Drugs given IV leave the body more slowly in infants than in adults. Gastric emptying time is prolonged in infants. The blood-brain barrier is not fully developed in infants, increasing the risks of absorption and toxicity within the central nervous system.

A patient verbalizes an intense need for psychoactive drugs. The nurse recognizes this behavior as what? 1: Addiction 2: Drug tolerance 3: Physical dependence 4: Psychologic dependence

4: Psychologic dependence Psychologic dependence is defined as an intense subjective need for a drug. Physical dependence is a state in which withdrawal symptoms occur when use of the drug is discontinued. Tolerance is the state in which higher and higher doses are needed to produce the same effect. Addiction is a disease process characterized by continued use of a substance despite the risk for physical, psychologic, or social harm.

Which statement is accurate when discussing how to minimize adverse drug-drug interactions? 1: Increase the number of drugs a patient receives. 2: Obtain a list of prescribed drugs the patient has taken over the past 2 weeks. 3: Have a family member tell you what drugs he or she thinks the patient takes at home. 4: Take a thorough patient drug history and minimize the number of drugs the patient receives.

4: Take a thorough patient drug history and minimize the number of drugs the patient receives. The only true and accurate statement regarding minimizing adverse drug-drug interactions is to avoid detrimental interactions by taking a thorough drug history from the patient and to minimize the number of drugs the patient receives. The most obvious way to minimize adverse drug-drug interactions is to decrease, not increase, the number of drugs a patient receives. A great way to minimize adverse drug-drug interactions is to have the patient, rather than a family member, tell you what drugs the patient takes at home. An important way to avoid adverse drug-drug interactions is to get a thorough drug history, not just the prescription drugs the patient has taken over the past 2 weeks.

Which statement about the percentage of oral drug absorption is true? 1: The percentage absorbed increases with age. 2: The percentage absorbed decreases with age. 3: The percentage absorbed severely declines with age. 4: The percentage absorbed does not usually change with age.

4: The percentage absorbed does not usually change with age. As a rule, the percentage of an oral dose that becomes absorbed does not usually change with age.

The nurse identifies which appropriate principle of drug addiction treatment based on the guidelines from the National Institute on Drug Abuse (1999)? 1: Medical detoxification is the most important stage of addiction treatment. 2: The 12-step program is the best single treatment for drug abuse. 3: Treatment should focus on drug use, not on other, extraneous life situations. 4: The treatment plan must be reassessed continually and modified as indicated.

4: The treatment plan must be reassessed continually and modified as indicated. Effective treatment takes time, usually about 3 months or longer; therefore, individual needs will change. The treatment plan should be reassessed and modified regularly. No single treatment is appropriate for all individuals. Treatment must attend to the medical, psychologic, social, vocational, legal, and other problems the patient is experiencing, not just to drug use. Medical detoxification is only the first stage of addiction treatment; by itself, it does little to bring long-term change.

The nurse knows that which neurologic condition can be caused by the direct actions of alcohol or the nutritional deficiencies often seen in people with chronic alcoholism? 1: Panic disorder 2: Bipolar disorder 3: Paranoid schizophrenia 4: Wernicke's encephalopathy

4: Wernicke's encephalopathy Wernicke's encephalopathy is caused by thiamine deficiency, which results from alcohol-induced suppression of thiamine absorption. It is characterized by confusion, nystagmus, and abnormal ocular movements. Panic disorder, bipolar disorder, and paranoid schizophrenia are not caused by the nutritional deficiencies seen in patients with chronic alcoholism.

When does gastric emptying time reach adult values in infants? 1: At birth 2: At 3-4 months 3: At 6-8 months 4: At 18-24 months

6-8 months Gastric emptying time reaches adult values by 6-8 months. Gastric emptying time is both prolonged and irregular in early infancy. It will not have reached adult values at birth or 3-4 months, but it will reach adult values before 18-24 months.

When administering a central nervous system depressant, the nurse should closely observe for drug toxicity in which patient? 1: A 12-year-old boy 2: A 3-week-old neonate 3: A 25-year-old woman 4: A 15-month-old infant

A 3 week old neonate The blood-brain barrier is not fully developed at birth. It is fully developed by 1 year of age. As a result, newborns are much more sensitive than older children or adults to medicines that act on the brain.

Q: Pharmacogenetic research has found that some African Americans A. Are less responsive to beta blockers than are European Americans B. Are more responsive to beta blockers than are European Americans C. Experience fewer toxic side effects with psychotropic medications than do european americans D. Experience fewer toxic side effects with antidepressant medications than do European Americans

A. Are less responsive to beta blockers than are European Americans Rationale: African americans respond poorly to several classes of antihypertensive agents (beta blockers and angiotensin-converting enzyme inhibitors)

Q: An older adults comes to the emergency department after taking cimetidine (Tagamet) is it most important for the nurse to monitor the patient for which effect? A. Confusion B. Hypoglycemia C. Tachycardia D. Akinesia

A. Confusion Rationale: confusion and other neuropsychiatric changes with use of cimetidine (Tagamet) in older adults is one of the main drawbacks to use of this drug. Also increased toxicity of many common drugs

Q: A patient has liver and kidney disease. He is given a medication with a half life of 30 hours. As compared to a healthy person, the nurse expects the duration of the half-life of this medication to ___ in this patient A. Increase B. Decrease C. Remain unchanged D. Dissipate

A. Increase Rationale: metabolism and elimination affect the half-life of a drug. With liver or kidney dysfunction, the half life of the drug is prolonged, and less drug is metabolized and eliminated

Q: A nurse cares for a patient with gastrointestinal bleeding who was admitted to a medical unit 3 days ago. Today the patient is very irritable restless and says to the nurse. "These are roaches everywhere in this hospital, and they've been crawling on me. I'm so scared of bugs" The nursing admission assessment shows that the patient drinks socially. How does the nurse analyse this situation? A. The patient may have minimized his/her use of alcohol and may be experiencing withdrawal B. The facilities infection control nurse should be consulted about the insect infestation C. The patient probably has dementia with was inadequately assessed at the time of admission D. Caring behaviors by the nursing staff have most likely been inadequate and the patient is lonely

A. The patient may have minimized his/her use of alcohol and may be experiencing withdrawal Rationale; denial is the most commonly used defense mechanism for persons ith substance abuse and dependence. Denial may take the form of minimization.

Q: Although adolescents have physical appearance and organ structure and function similar to that of adults, the nurse understands that their bodies continue to grow, requiring the nurse to follow increased vigilance in monitoring what? A. Therapeutic and toxic drug levels B. Side effects of medications C. Route of medication administration D. Frequency of medication administration

A. Therapeutic and toxic drug levels Rationale: Although the physical appearance and organ structure and function of adolescence resemble those of adults, adolescents' bodies continue to grow and change, requiring increased vigilance in monitoring therapeutic and toxic drug levels.

A patient with alcohol withdrawal is given carbamazepine. Which finding indicates a therapeutic effect? 1: Absence of seizures 2: Absence of cravings 3: Absence of respiratory depression 4: Absence of damage to the myocardium

Absence of seizures Carbamazepine is an antiepileptic and is used to decrease withdrawal symptoms and prevent seizures. Atenolol and propranolol can help decrease cravings during withdrawal. Carbamezepine does not affect respiratory depression or damage to the myocardium; cessation of alcohol will help these effects.

Drug Interactions: Examples of Each?

Absorption - Changes in gastric emptying time (laxatives) Changes in pH (antacids, ASA) - Forming of drug complexes (colestipol & Tegretol (less effective)(Dairy products prevent absorption of ciprofloxacin) Distribution - Competition for protein binding sites (Warfarin and glyburide - both highly protein bound) Metabolism - Inhibition or induction of liver enzymes (Tagamet inhibits metabolism of theophylline (toxicity! can cause arrhythmias and seizures) Excretion - Changes in the rate of excretion (Lasix (decreases K+ levels) & digoxin (toxicity! with hypokalemia)

Four Stages of Pharmacokinetics

Absorption - the movement of drug particles from the GI tract to body fluids Distribution - drug becomes available to body fluids & tissue Metabolism - body inactivates (biotransforms) drugs Excretion - how the body gets rid of the drug

A nurse gives the patient with alcoholism a drug that will ease unpleasant feelings brought on by abstinence from alcohol. Which drug is the nurse administering? 1: Disulfiram 2: Naltrexone 3: Acamprosate 4: Chlordiazepoxide

Acamprosate reduces some of the unpleasant feelings (eg, tension, dysphoria, and anxiety) brought on by alcohol abstinence following detoxification. Naltrexone is a pure opioid antagonist that reduces the craving for alcohol and blocks its pleasurable effects. Disulfiram is used to prevent alcohol consumption by making drinking unpleasant, even deadly. Chlordiazepoxide is used to facilitate alcohol withdrawal.

To help prevent liver failure in a patient who drinks alcohol frequently, the nurse will instruct the patient to avoid which drug? 1: Opioids 2: Acetaminophen 3: Any antihypertensive agent 4: Nonsteroidal antiinflammatory drugs

Acetaminophen The combination of acetaminophen with alcohol poses a risk of potentially fatal liver injury. Accordingly, some authorities recommend that people who drink take no more than 2 gm of acetaminophen a day (ie, half the normal dosage). Antihypertensive drugs reduce blood pressure. Because alcohol raises blood pressure, it tends to counteract the effects of antihypertensive medications, leading to hypertension, not liver failure. Like alcohol, aspirin, ibuprofen, and other nonsteroidal antiinflammatory drugs (NSAIDs) can injure the gastrointestinal mucosa. The combined effects of alcohol and NSAIDs can result in significant gastric bleeding but not liver failure.

The healthcare provider has ordered a 15 mg nicotine patch to be applied every day for 16 hours and then removed for 8 hours. The patch was applied by the previous nurse at 10:00 a.m. The nurse anticipates the patch should be removed at what time? 1: 1:00 a.m. 2: 2:00 a.m. 3: 4:00 a.m. 4: 11:00 p.m.

Add 16 hours to 10:00 a.m. to equal 2 a.m. the next day. This is the correct removal time.

Which statement about renal excretion in infants is true? 1: Renal blood flow is high during infancy. 2: Adult levels of renal function are achieved by 1 year. 3: Renal drug excretion is significantly increased at birth. 4: Drugs that are eliminated primarily by renal excretion must be given in higher doses.

Adult levels of renal function are achieved by 1 year. Renal drug excretion is significantly reduced at birth. Renal blood flow, glomerular filtration, and active tubular secretion are low during infancy. Drugs that are eliminated primarily by renal excretion must be given in reduced dosage and/or at longer dosing intervals.

Drug interactions

Altered or modified action or effect of a drug as a result of interaction with one or multiple drugs

The nurse prepares to give a drug that will prevent receptor activation. Which term would describe this drug? 1: Potent 2: Agonist 3: Selective 4: Antagonist

An antagonist is a drug that prevents receptor activation. A selective drug has only the desired response but may not activate receptors. An agonist is a molecule that activates receptors. A potent drug requires a lower dose to achieve its effect.

Which drug reaction occurs as the result of an immunologic response? 1: Prediction reaction 2: Intolerance reaction 3: Idiosyncratic reaction 4: Anaphylactic reaction

Anaphylactic reaction An anaphylactic reaction in a patient as a result of a drug is considered an immunologic response. Intolerance, idiosyncratic, and predictable reactions are all considered nonimmunologic types of drug reactions.

When changing the bag of TPN, the nurse asks M.M to take a deep breath and hold it. What is the rationale for this maneuver?

Answer: Air embolism is a complication associated with changing TPN bags. Performing the Valsalva maneuver, which involves the patient taking a deep breathe, holding it, and bearing down, prevents air from being sucked into the IV tubing. In addition, clamps should be closed when tubing or bag change is done.

M.M's wife calls for the nurse because he complains of nausea and headache. On assessment you note he is also weak and c/o thirst despite having emptied his water cup. What complication is he presenting? Discuss.

Answer: Hyperglycemia r/t either too much nutrition or insufficient insulin coverage Monitor blood glucose, administer insulin per orders, contact provider if blood glucose cannot be normalized.

Pneumothorax and hemothorax are also risks for M.M. what symptoms should you monitor?

Answer: Pneumothorax & hemothorax r/t insertion of central line s/sx. SOB, increased HR, chest pain,and decreased lung sounds. THIS IS AN EMERGENCY!

M.M is a male patient who had abdominal surgery 6 days ago. After placement of a nasogastric tube, gastrointestinal distress became problematic, and a bowel obstruction was diagnosed. Due to a decrease in the serum albumin levels, the decision was made to begin total parenteral nutrition. M.M's wife asks why M.M needs to have a central line started for the TPN. How will the nurse respond?

Answer: The nurse will tell the patient's wife that the high level of glucose and other nutrients in the TPN solution is very irritating to the veins Rationale: The high glucose concentration (25%) in the TPN makes the solution acidic

Q: The health care provider has advised F.W's son that his mother needs to have digoxin levels checked soon. What are some reasons for this recommendation?

Answer: the effect of digoxin on F.W can change as she ages Rationale: digoxin has a narrow therapeutic index and the decreased renal excretion in older adults can be problematic as well.

Q: F.W is a 68 year old female who was brought to urgent care for a change in level of consciousness. She lives with her son and daughter-in-law and their children. She has a significant medical history of type 2 diabetes mellitus and atrial fibrillation, which is controlled by digoxin./ F.W's son reports that she was having a hard time sleeping, so she took half of one tablet of his diazepam. F.W's son notes that this morning F.W would not wake up and was very drowsy. Why would half of a tablet of diazepam be too much for F.W?

Answer: the half life of the medication is longer for F.W as compared to her son Rationale: as F/W ages, her liver is less efficient at metabolizing the diazepam. So the half-life can increase by half, greatly increasing the potency of the medication

The nurse is caring for a patient who is prescribed a drug to block the histamine receptors to prevent excessive gastric secretion. To which category of drugs does this medication belong? 1: Agonist 2: Antagonist 3: Nonspecific 4: Nonselective

Antagonist An antagonist drug is one that blocks the histamine receptors to prevent excessive gastric secretion. Drugs that produce a response are called agonists. For example, epinephrine is an agonist that stimulates beta 1 and beta 2 receptors. Nonspecific drugs affect various sites in the body. Bethanechol is a nonspecific cholinergic drug that affects cholinergic receptors located in the eye, heart, blood vessels, stomach, bronchus, and bladder. Nonselective drugs affect various receptors. Chlorpromazine acts on the norepinephrine, dopamine, acetylcholine, and histamine receptors, and a variety of responses result from action at these receptor sites.

The patient received an overdose of morphine. Naloxone is given to block the narcotic response. Which is the effect achieved when naloxone is administered? 1: Additive 2: Negative 3: Synergistic 4: Antagonistic

Antagonistic When the patient is known to have a morphine overdose, naloxone is known to have an antagonistic effect because each drug will cancel the effect of the other. A synergistic effect is said to be present when the effect of two drugs administered together is greater than the sum of each drug taken separately; there is nothing in the question to indicate that this has occurred. Incompatibility occurs in situations in which two parenteral drugs mixed together result in the chemical deterioration of one or both of the drugs or form a precipitate. An antagonistic effect occurs when the effect of two drugs given together is lower than the sum of each drug taken separately.

Pediatric Pharmacokinetics Excretion

Areas of occurrence - Kidneys Infants have decreased - Renal blood flow - Glomerular filtration rate - Renal tubular function - Intestines, salivary glands - Lungs - Sweat glands, mammary glands

The nurse is educating a group of high school students about the effects of alcohol abuse. As part of the teaching, the nurse explains that the more a person drinks, the higher his or her blood alcohol percent gets, and with a steady increase, different parts of the brain become affected. In which order does the nurse tell the students the areas of the brain are affected as a person continues drinking? 1. Medulla 2. Cerebellum 3. Frontal lobe 4. Parietal lobe 5. Occipital lobe 6. Diencephalon

As a person continues to drink, his or her blood alcohol level rises and begins to affect more parts of the brain. The lowest levels of blood alcohol first affect the frontal lobe, altering judgment and decreasing inhibitions. The parietal lobe is affected next, changing motor skills and slurring speech. As blood alcohol rises, the occipital lobe is affected, altering a person's perception, followed by the cerebellum, compromising the person's balance. When the diencephalon is affected, a person will fall into a stupor, and finally, once the medulla is affected, the person is at risk for respiratory depression and peripheral collapse. 1. frontal 2. parietal 3. occipital 4. cerebellum 5. diencephalon 6. medulla

To demonstrate the concept of drug selection based on efficacy, the nurse administers which PRN drug for a headache that the patient describes as a "mild dullness" with a pain level of 2 on a 1-to-10 scale? 1: Aspirin 2: Meperidine 3: Pentazocine 4: Morphine sulfate

Aspirin Maximal efficacy illustrates the fact that all drugs have a maximal effect, and dosages beyond this do not increase the effect. The goal is to match the intensity of the response to the patient's needs; therefore, a drug with high maximal efficacy is not always most desirable. Meperidine, pentazocine, and morphine sulfate all have a higher maximal efficacy than aspirin; therefore aspirin is the most desirable drug for a headache rated as "mild."

The nurse reviews all the patient's prescriptions. Which prescribed medications may cause a detrimental potentiative drug interaction? 1: Aspirin and warfarin 2: Isoniazid and rifampin 3: Propranolol and albuterol 4: Sulbactam and ampicillin

Aspirin and warfarin both suppress clotting. As a result, if aspirin and warfarin are taken concurrently, the risk of bleeding is significantly increased. Isoniazid and rifampin are antibiotics and are used together to treat tuberculosis, so there is not a detrimental potentiative drug interaction. Oral propranolol decreases the effects of albuterol sulfate by opposing drug effects, so there is an interaction, but it is not potentiative. Sulbactam and ampicillin are combined and commonly used as the brand Unasyn in the intravenous form. The two medications potentiate each other in a desired, not detrimental, manner.

The nurse has made a medication error. Which is the nurse's initial action? 1: Notify the shift supervisor. 2: Notify the healthcare provider. 3: Assess the patient's condition. 4: Verify the drug that should have been given.

Assess the patients condition The primary concern in any situation is patient safety. The nurse should first assess the patient's condition to ensure that no harm has come to the patient. Once the patient is assessed, the nurse should notify the healthcare provider. The supervisor should also be notified. The verification of the right drug to be given is one of the first steps in the drug administration process.

Nursing Process: Individual Variances

Assessment - Assess cultural and racial background - Consider communication styles social organization, environmental controls Planning - Collaborate with patient to reduce high-risk health behaviors Nursing interventions - Incorporate non-harmful traditional practices with biomedical prescriptions Patient Teaching - Provide information in more than one form - Include family, members of social group, as appropriate Evaluation - Patient correctly demonstrates understanding of prescriptive therapies and treatments

Nursing Process: Nicotine

Assessment - Pack year history - History of attempted quits - never quit quitting! - Readiness to quit - key to success Planning - Appropriate medication for patient? - "Quit plan" - Address both physical and psychological addiction - Patient teaching Evaluation - Again! NEVER QUIT QUITTING - 2ppd x 20 years - 40 pack year history

The nurse is teaching a patient prescribed felodipine for the treatment of hypertension. Which statement is the most appropriate for the nurse to include in the teaching session? 1: "This drug is free of dangerous drug interactions." 2: "Avoid foods high in tyramine such as aged cheese." 3: "Herbal agents can help this drug work more effectively." 4: "Avoid grapefruit juice while you are taking this medication."

Avoid grapefruit juice Grapefruit juice can raise levels of felodipine by as much as 406% because of the effect grapefruit juice has on the CYP3A4 isoenzyme. Serious drug-drug interactions are documented with felodipine, so medication reconciliation must always be undertaken. Any herbal supplement should be approved for use by the prescriber when a patient is taking other prescription medications because there can be significant interactions. There is no interaction between felodipine and tyramine-containing foods.

Q: Drug calculations for children are based on which factors? A. Sex B. Age C. Weight D. Height

B. Age C. Weight D. Height Rationale: Drug calculations are based on age, weight, and height for children

Q: The nurse performing an assessment on a patient identifies the manifestations of cocaine use, which include. A. Fatigue and hallucinations B. Agitation and cardiac dysrhythmias C. Shock and hypotension D. Shallow respirations and pallor

B. Agitation and cardiac dysrhythmias Rationale: cocaine increases norepinephrine at postsynaptic receptor sites, producing intense vasoconstriction and cardiovascular stimulation. Common manifestations of cocaine use include increased temperature, pulse, respiratory rate, and blood pressure; cardiac dysrhythmias: myocardial infarction; hallucinations; seizures; and possible death

Q: Which situation regarding controlled substances requires the supervising RN to intervene? A. The staff keeps a separate controlled-substances record for all required information B. Controlled substances are locked away from patients, and all staff members have keys for necessary access C. Opioids are kept under double lock limit access to them D. All discarded or wasted controlled substances are countersigned

B. Controlled substances are locked away from patients, and all staff members have keys for necessary access Rationale: all staff should not have keys to the controlled substances; only authorized persons should have keys. All other statements indicate preferred procedures for controlled substances

Q: A patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. The nurse would anticipate that this will interfere most with which phase of pharmacokinetics A. Absorption B. Distribution C.Metabolism D. Excretion

B. Distribution Rationale: distribution is the process by which the drug becomes available to body fluids and body tissues. Drug distribution is influenced by blood flow, the drug's affinity to tissue, and the protein-binding effect. This distribution can be affected by the effects of edema in the fluid overload phase.

Q: The patient's culture may influence the patient's attentiveness to time. This may be of special concern to nurses when they teach patients about A. The route of medication administration B. The schedule of medication dosing C. The anticipated side effects D. The anticipated therapeutic effects

B. The schedule of medication dosing Rationale: Patients should be taught that it is important that the schedule of medication administration must remain constant for appropriate therapeutic action of the medication to occur.

Phenobarbital (Luminal)

Barbiturate/Anticonvulsant Has a large lipid profile, in older adults levels are reduced because of decrease in body fat

Chlordiazepoxide (Librium)

Benzodiazepine, used for alcohol withdrawal help prevent seizures, delirium, reduce anxiety, stabilize vital signs

Lorezepam (Ativan)

Benzodiazepine, used for alcohol withdrawal help prevent seizures, delirium, reduce anxiety, stabilize vital signs

Q: What are some examples of excipients?

Binding materials, dyes, preservatives, and flavoring agents. Additional examples include potassium and sodium

Response to Medication

Biologic Variations - Pharmacogenomics - Certain classifications of medications have different effects in individuals whose genetic markers are predominantly characteristic of a certain biologic group Examples: - Persons of Asian descent may have a decreased response to some drugs because they are more likely to have higher levels of CYP2D6 enzymes - African Americans respond poorly to several classes of antihypertensive agents

When caring for an older adult, which physiologic cardiac changes should the nurse assess to evaluate for impact of the drug action? Select all that apply. 1: Blood flow 2: Blood group 3: Cardiac output 4: Blood viscosity 5: Blood cell count

Blood flow, cardiac output Aging is associated with many physiologic changes that may affect the therapeutic dosage of a drug. Reduced blood flow and decreased cardiac output in elderly patients are associated with decreased absorption and distribution of drugs. Blood group, blood viscosity, and blood cell count do not have an impact on drug action as they do not affect the drug metabolism.

For medications that do not have established pediatric doses, the most common method of extrapolating the appropriate dose is based on which measurement? 1: Age 2: Weight 3: Height/length 4: Body surface area

Body Surface Area Pediatric doses have been established for a few drugs but not for most. For drugs that do not have an established pediatric dose, dosage can be extrapolated from adult doses. The method of conversion employed most commonly is based on body surface area. Age, weight, and length are not the most common ways of evaluating drug dose.

Q: When assessing older adults and those with renal dysfunction, the nurse knows that creatinine clearance is usually A. Substantially increased B. Slightly increased C. Decreased D. In the normal range

C. Decreased Rationale: note the difference between creatinine clearance and serum creatinine levels - serum levels will be higher with kidney disease because of decreased creatinine clearance

Q: A patient who smoked 1 pack of cigarettes a day for 2 years abruptly stopped smoking 2 days ago. The nurse performing an assessment on the patient identifies manifestations of nicotine withdrawal as including A. Increased appetite and blood pressure B. Restlessness and increased blood pressure C. Depression and decreased blood pressure D. Nausea, confusion, and seizures

C. Depression and decreased blood pressure Rationale: nicotine withdrawal symptoms include nicotine craving, restlessness, depression, hyperirritability, headache, insomnia, decreased blood pressure, decreased heart rate, and increased appetite

Q: The nurse identifies the primary purpose of federal legislation in drug standards as A. Preventing overcharging for drugs B. Controlling efforts in drug research C. Ensuring public safety D. Moderating effective drug usage

C. Ensuring public safety Rationale: the primary purpose of federal legislation is to ensure public safety

Q: Most drugs are metabolized in the A. Kidney B. Small intestine C. Liver D. Brain

C. Liver Rationale: drugs can be metabolized in the GI tract; however the liver is the primary site of metabolism

Q: Older adults are at risk for taking many medications together, This is known as A. Tachyphylaxis B. Drug interaction C. Polypharmacy D. Tolerance

C. Polypharmacy Rationale: polypharmacy is taking many medications together

Q: A patient with a known opioid addiction is to have surgery. In planning the patient's postoperative pain management, the nurse will A. Withhold opioid medications B. Treat the addiction before managing pain C. Provide pain management as needed D. Anticipate that the patient will experience less pain

C. Provide pain management as needed Rationale: all patients have the right to receive pain management therapies. The patient's history of opioid addiction should have no bearing on this right. There is no evidence that providing opioid analgesia to patients addicted to these drugs will ain any way worsen their addictive disease.

Q: A toddler requires an oral medication. It is most appropriate for the nurse to administer the oral medication A. In a nipple B. Dipped in a pacifier C. Via an oral syringe D. Mixed with formula in a bottle

C. Via an oral syringe Rationale: most oral medications are administered to children using an oral syringe. Oral syringes ensure more exact dosing and are relatively easy to use. Syringes may be marked to ensure correct dosages. The syringe is inserted into either side of the mouth and pointed toward the buccal mucosa. Idans may suck medication from a bottle nipple into which the measured medication has been squirted from the oral syringe

A patient is preparing to start nicotine replacement therapy with nicotine chewing gum. Which instruction should the nurse provide to the patient? 1: Chew quickly 2: Chew constantly 3: Chew six pieces of gum a day 4: Chew 15 minutes after drinking

Chew 15 minutes after drinking Since foods and beverages can reduce nicotine absorption, patients should not eat or drink while chewing or for 15 minutes before chewing. Patients should be advised to chew the gum slowly and intermittently for about 30 minutes. Rapid chewing can release too much nicotine at one time. The average adult dosage is 9 to 12 pieces a day.

A patient with alcoholism has tremors and elevated blood pressure. The nurse observes that the patient is also agitated. Which drug does the nurse prepare to administer? 1: Naltrexone 2: Disulfiram 3: Acamprosate 4: Chlordiazepoxide

Chlordiazepoxide The patient is suffering from alcohol withdrawal. Benzodiazepines are the drugs of choice for alcohol withdrawal, and chlordiazepoxide is a benzodiazepine. Naltrexone is used to maintain abstinence by blocking the pleasurable effects of alcohol and decreasing cravings. Disulfiram is used for decreasing the alcohol consumption by the patient; it cannot be used as a treatment for alcohol withdrawal. Acamprosate reduces some of the unpleasant feelings brought on by alcohol abstinence, but it cannot be used for withdrawal.

The drug prescribed for an older adult patient is renally excreted. How should the nurse assess the patient's renal function to administer this drug safely? 1: Urine urea 2: Serum troponin 3: Urine creatinine 4: Creatinine clearance

Creatinine clearance The renal function of a patient is assessed by measuring the creatinine clearance by collecting urine samples for 24 hours. This parameter helps assess whether the drug would be excreted effectively from the kidneys. Blood urea is useful to assess renal function, not urine urea. Serum troponin and urine creatinine are not helpful in assessing renal function.

Q: A patient is prescribed tetracycline. The nurse should teach the patient to take the medication A. With breakfast B. With lunch C. With dinner D. 1 hour before or 2 hours after meals

D. 1 hour before or 2 hours after meals Rationale: Food is known to increase, decrease, or delay drug absorption. Food can bind with drugs, causing less or slower drug absorption. An example of food binding with a drug is the interaction of tetracycline and dairy products. The result is a decrease in the plasma concentration of tetracycline. Because of the binding effect, tetracycline should be taken 1 hour before or 2 hours after meals and should not be taken with fairy products Tetracycline should not be given to children or pregnant women. It interferes with tooth formation.

Q: A patient receives an opioid drug that depresses the patient's respiratory rate. The nurse adminsters an antidote. This is an example of what type of effect? A. Additive drug effect B. Synergistic drug effect C. Potentiating drug effect D. Antagonistic drug effect

D. Antagonistic drug effect Rationale: There are some situations in which the antagonistic (antidote) to block the narcotic response. This is a beneficial drug interaction of an antagonist.

Q: A patient taking MAO inhibitors should be taught about which dietary restriction associated with this medication? A. Avoid foods that contain salt B. Avoid foods that are high in calcium C. Avoid eggs D. Avoid yogurt

D. Avoid yogurt Rationale: the classic drug-food interaction occurs when an antidepressant of the monoamine oxidase inhibitor (MAOI) type (e.g., phenelzine (Nardil)) is taken with tyramine-rich foods such as cheese, wine, organ meats, beer, yogurt, sour cream, or bananas. These foods have sympathomimetic-like effects; more norepinephrine is released, and the result could be a hypertensive crisis. These foods must be avoided when taking MAOIs.

Q: A nurse is to administer a dose of furosemide (Lasix). The nurse is aware that Lasix the ___ name for the drug A. Generic name B. Chemical name C. Nonproprietary name D. Brand name

D. Brand name Rationale: the brand (trade) name, also known as the proprietary name, is chosen by the drug company and is usually a registered trademark owned by that specific company. In this care, Lasix is the brand name, and furosemide is the generic name.

Q: The nurse identifies the act that provides for the privacy of patient health information as the A. Drug Regulation Reform Act B. Drug Relations Act C. Food and Drug Administration Modernization Act D. Health Insurance Portability and Accountability Act

D. Health Insurance Portability and Accountability Act Rationale: HIPAA sets the standards for the privacy of individually identifiable health information. The Drug Regulation Reform Act shortened the time in which new drugs could be developed and marketed. The Drug Relations Act increased approval rate of drugs used to treat AIDS and cancer. The FDA Modernization Act controls new drug use and discontinued drugs

Q: When administering medications to the older adult population, the nurse is aware that the physiologic changes of aging that can affect drug activity include all of the following except A. Increased fat-to-water ratio B. Decreased liver enzyme production C. Loss of nephrons D. Increased gastrointestinal blood flow

D. Increased gastrointestinal blood flow Rationale: Older adults have decreased gastric acidity, reduced peristalsis, decreased body water, increased fat-to-water ratio, decreased numbers of functioning nephrons, and decreased liver enzyme production & function.

Q: Which is a physiologic change seen in the older adult that has an effect on drug administration? A. Increased acidic gastric secretions B. Increased first-pass effect through the liver C. Increased glomerular filtration rate D. Lower cardiac output

D. Lower cardiac output Rationale: Lower cardiac output is a physiological change associated with the older adult. The pH increases, not decreases, causing alkaline gastric secretions. The first-pass effect through the liver is decreased. The glomerular filtration rate is decreased.

Q: Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index? A. Monitoring a patient's urine output B. Assessing vital signs hourly C. Maintaining strict isolation precautions D. Monitoring serum peak and trough levels

D. Monitoring serum peak and trough levels

Q: A patient receiving oral contraceptives is placed on antibiotic therapy. The nurse should teach the patient to A. Discontinue the use of oral contraceptive while taking the antibiotic B. Refrain from using the oral contraceptive for 3 months after taking the antibiotic C. Expect to experience menstruation while on the antibiotic D. Use a barrier form of protection during sex when taking a course of antibiotics

D. Use a barrier form of protection during sex when taking a course of antibiotics Rationale: concurrent antibiotic administration with oral contraceptives may alter the intestinal bacteria that optimise the absorption and effectiveness of the oral contraceptive; therefore, a barrier form of contraception should be used

While assessing the renal function in an older adult patient, a nurse learns that the patient has reduced renal blood flow. What is the impact of this age-related change on drug action? 1: Decreased excretion 2: Decreased metabolism 3: Increased protein binding 4: Increased first-pass metabolism

Decreased Excretion The impact of reduced blood flow to the kidney because of increasing age results in decreased drug excretion. Therefore, the drug may remain in the blood for a relatively long time. As a result, the dosage would need to be adjusted. Reduced renal blood flow in older adult patients does not decrease metabolism of the drug, because it usually happens in the liver. The renal system has no role in protein binding or the first-pass metabolism of the drug.

Q: Define peaks and troughs. What is the importance of peak and trough measurement? List some common medications that require measurements.

Define peak and trough - Highest (peak) and lowest (trough) concentration of drug in system What is the importance of peak and trough measurements? - Used to adequately evaluate the appropriate dosage levels of many drugs; some drugs have a narrow therapeutic range List some common medications that require measurements - Gentamicin, Digoxin, Phenobarbital, Vancomycin

The nurse is explaining to an older adult patient about age-related gastrointestinal changes that have an impact on drug action. What changes should the nurse include in the teaching? 1: Altered metabolism 2: Reduced gastric pH 3: Increased peristalsis 4: Delayed gastric emptying

Delayed gastric emptying The age-related physiologic change of the older adult patient results in delayed gastric emptying because of a decrease in peristalsis. As a result, the drug may take more time to bring about the therapeutic action. With aging, the gastric pH tends to increase as a result of less acid secretion. This may lead to altered absorption of nutrients and drugs. Aging causes decreased peristalsis resulting in ineffective drug absorption. Metabolism is affected by liver function. Gastric pH does not decrease with age.

Bioavailability

Dependent on Route of Administration - IV - 100% - IM, SC - 75-100% - PO - 5% to nearly 100% Hepatic first-pass effect, incomplete absorption - Rectal - 30-100% - Inhalation - 5-100% - Transdermal - 80-100% (molecular weight must be small enough to permeate; no transdermal insulin as its molecular weight is too high)

The nurse should recognize which acute effects of alcohol on the brain? 1: Central nervous system stimulation and increased release of norepinephrine 2: Inhibition of dopamine and other neurotransmitters in the brain 3: Inhibition of the reward center and chemoreceptor trigger zone 4: Depression of the central nervous system and activation of the reward center

Depression of the central nervous system and activation of the reward center Alcohol interacts with receptors for gamma-aminobutyric acid and serotonin to promote the release of dopamine. This causes depression of the central nervous system and activation of the reward center.

The patient with an acute kidney injury (AKI) is prescribed a medication that is eliminated by the kidneys. The nurse recognizes that the patient is at risk for which drug response? 1: Increased drug excretion 2: Development of drug toxicity 3: Decreased drug levels in the blood 4: Increased tolerance to the medication

Development of drug toxicity AKI can reduce drug excretion causing drugs to accumulate in the body. If the dosage is not lowered, the drug may accumulate to toxic levels. AKI decreases, not increases, the excretion of drug metabolites from the body. Conversely, AKI will cause increased, not decreased, serum drug levels as a result of decreased drug excretion. Tolerance to the medication is not related to AKI.

Cough in a Child

Dextromethorphan vs honey vs placebo - Parents found honey to be most effective for relieving nighttime cough - Releases endogenous opioids, natural cough suppressants - Study used buckwheat honey - Results dependent on pollen honey beers are using - Not for children under 1 year of age d/t botulism - Chamomile tea with honey, soothing sweet drink

What should the nurse teach a patient who is prescribed enteric-coated tablets? 1: "Do not chew or crush the tablet." 2: "Place the tablet under the tongue." 3: "Dissolve the tablet in water or milk." 4: "Eat a high-fat meal before taking the medication."

Do not chew or crush the tablet Enteric-coated tablets disintegrate in the alkaline medium of the small intestine. Patients should be instructed not to chew or crush enteric-coated tablets because they will then be absorbed in the acidic medium of the stomach rather than in the small intestine. An enteric-coated tablet will not dissolve if it is placed under the tongue. The tablet must not be dissolved in water or milk to avoid alteration of the time and place of absorption. The patient should not eat a high-fat meal before taking the tablet because this will delay absorption.

What is the major neurotransmitter in the reward circuit of the brain that is related to addiction? 1: Serotonin 2: Dopamine 3: Epinephrine 4: Norepinephrine

Dopamine Molecular changes occur in the so-called reward circuit—a system that normally serves to reinforce behaviors essential for survival such as eating and reproductive activities. Their major transmitter is dopamine . Serotonin, epinephrine, and norepinephrine are not the major neurotransmitters involved in the reward circuit.

When calculating pediatric dosages, what should the nurse take into consideration? 1: Usage of drug reference recommendations based on milligram per kilogram of body weight is the preferred method. 2: Calculated doses based on body weight should be increased by 10% because of immature renal and hepatic function. 3: Dosage calculation according to body weight is the most accurate method because it takes into account differences in maturational development. 4: Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.

Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate. The body surface area takes into account not only the child's weight but also the relationship with height and is therefore both the most accurate and most preferred method. Immature renal and hepatic function would necessitate a decrease in dose, not an increase.

Opioid analgesics: Geriatrics

Dose-related adverse reactions - Hypotension - Respiratory depression - Constipation - Opioid analgesics can cause constipation. Stool softeners can help minimize this effect - Hypotension and respiratory depression may result from opioid use, so close monitoring is essential in the older patient

The process in which the brain decreases the amount of dopamine produced and the number of dopamine receptors is known as what? 1: Tolerance 2: Down-regulation 3: Drug availability 4: Cross-tolerance

Down-Regulation An important aspect of drug-induced remodeling is a phenomenon known as down-regulation, which serves to reduce the response to drugs. Because drugs release abnormally large amounts of dopamine, the reward circuit is put in a state of excessive activation. In response, the brain (1) produces less dopamine and (2) reduces the number of dopamine receptors. As a result, responses to drugs are reduced. Drug availability relates to the ready availability of drugs in hospitals and clinics as a major reason for the unusually high rate of addiction among pharmacists, nurses, and physicians. Tolerance is a state in which a particular drug dose elicits a smaller response than it formerly did. Cross-tolerance is a state in which tolerance to one drug confers tolerance to another drug.

The nurse working with elderly patients is concerned about the number of medications each patient is taking. Which should the nurse assess as the highest priority for the patients related to polypharmacy? 1: Drug interactions 2: Cost of medications 3: Schedule of medications 4: Nonadherence to drug regimen

Drug Interactions The highest priority for patients with multiple medications (polypharmacy) is the assessment for drug interactions. The more medications a patient takes, the higher is the risk of drug interactions. The cost, schedule, and degree of nonadherence are not priorities with regard to polypharmacy.

Pregnancy

Drug classifications: A, B, C, D, & X

The safety or potential harm of drug therapy during pregnancy relates to which factor? 1: Fetal sex 2: Drug properties 3: Diet of the mother 4: Maternal blood type

Drug properties Drug properties have a direct correlation to the safety or potential harm of drug therapy during pregnancy, and nurses working in prenatal settings need to be aware of information related to drug properties. Maternal blood type, fetal sex, and the mother's diet do not relate to the potential for drug harm.

Which statement about drug use among older adults is true? 1: Older adults require higher doses of most drugs. 2: Older adults experience fewer adverse drug reactions. 3: Drug use among older adults is disproportionately high. 4: Older patients are less sensitive to drugs than younger adults.

Drug use among older adults is disproportionately high. Older adults consume 33% of the nation's prescribed drugs. Older patients are more sensitive to drugs than are younger adults. Older adults experience more adverse drug reactions. Because of declining function of the organs that metabolize and excrete medications, older adults require lower doses of most drugs.

According to the U.S. Food and Drug Administration (FDA) Pregnancy Risk categories, which category represents the greatest risk for fetal harm? 1: A 2: B 3: C 4: D

Drugs in Category D are the most dangerous; these drugs are known to cause human fetal harm. Drugs in Categories B and C are progressively more dangerous than drugs in Category A and less dangerous than drugs in Category D.

Q: Water-soluble & lipid soluble drugs which are absorbed faster?

Drugs that are lipid soluble and nonionized are absorbed faster than water-soluble and ionized drugs d/t GI membrane being composed mostly of lipid

Synergistic drug effect or potentiation

Effects of the two drugs together are more than the combined individual drugs. 1+1 > 2

The nurse is caring for a 1-month-old infant with diarrhea who has been prescribed an antidiarrheal medication. Upon checking the composition of the medication, the nurse finds that the active ingredient is an alkaline and fat-soluble substance. Which pharmacokinetic variation would nurse expect to find in the child when compared to an adult? 1: Enhanced drug absorption 2: Enhanced drug elimination 3: Enhanced drug distribution 4: Enhanced drug metabolism

Enhanced drug absorption The gastrointestinal tract is not well developed in an infant; this greatly influences the absorption of the drug. Alkaline drugs are absorbed largely in alkaline pH, while acidic drugs are absorbed largely in acidic pH. An infant's gastric pH is alkaline when compared to that of adults. Therefore, infants will have increased drug absorption when compared to adults. The kidneys eliminate most of the drug from the body. A 1-month-old infant will not have enhanced elimination of the drug because of the absence of well-developed kidneys. The metabolism of the drug depends on hepatic functioning. Infants may have reduced metabolism of drugs because of the presence of a less-developed hepatic system. The distribution of the drug depends on the body composition. An infant has less fat; therefore, a fat-soluble drug will not be distributed effectively in an infant.

Drug-induced photosensitivityQ: What are normal creatinine clearance values? What patient education will you provide for a patient requiring a 24-hour urine sample? What factors affect creatinine clearance values? Normal values Male 97-137mL/min., Female: 88-128mL/min Requires 24 hour urine collection followed by blood draw, may have to stop some medications (ABX, antacids) Patient education for 24hr urine sample Find shit here What factors affect creatinine clearance values? Age and gender. Lower values are expected in patient with decreased muscle mass, such as older patients and some female patients Note the difference between creatinine clearance and serum creatinine levels - serum levels will be higher with kidney disease because of decreased creatinine clearance.

Example: sulfa antibiotics, Bactrim What patient education should be provided

When assessing for drug effects in the older adult, which phase of pharmacokinetics is the greatest concern? 1: Excretion 2: Absorption 3: Distribution 4: Metabolism

Excretion Although pharmacokinetic changes in older adults affect all phases of kinetics, drug accumulation secondary to reduced renal excretion is the most important cause of adverse drug reactions in the older adult.

A patient with kidney disease is admitted to the hospital with a complication and needs drug therapy. Which pharmacokinetic phase is affected by kidney disease? 1: Excretion 2: Absorption 3: Distribution 4: Metabolism

Excretion The kidneys are the primary organs responsible for excreting drugs from the body. Impaired kidneys often lead to compromised excretion and may result in increased toxic levels of drug in the bloodstream. Absorption occurs through various parts of the body apart from the kidneys. Kidneys are not responsible for metabolism and distribution of the drug in the body. Metabolism is generally through the liver, and distribution is via blood flow.

In which gestational period is drug therapy associated with a greater incidence of drug-induced developmental defects in the newborn? 1: First trimester 2: Second trimester 3: Third trimester 4: Perinatal period

First Trimester The first trimester of pregnancy is the period associated with the greatest risk of drug-induced developmental defects. This is because organogenesis occurs during this period. The second trimester, third trimester, and perinatal periods are associated with less risk of drug-induced developmental defects compared to the first trimester.

When teaching a pregnant patient about the effects of medication on the fetus, the nurse should recognize that the greatest harm from maternally ingested medications occurs during which time period? 1: First trimester 2: Third trimester 3: Second trimester 4: Birthing process

First trimester During the first trimester of pregnancy, the fetus is at greatest risk for drug-induced developmental defects. During this period, the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs, and visceral organs are developing at their most rapid rate. Risks are still present, but not greatest, during the second and third trimesters as well as during the birthing process.

Enteral Feedings

G-tube NG-tube

Histamine (H2) blockers

GI geriatric

Malfeasance

Giving correct drug via wrong route

Cimetidine (Tagamet)

H2 receptor antagonist NOT recommended for geriatric patients b/c of side effects, drug interactions (increases toxicity), and risk of confusion - Can inhibit the metabolism of theophylline causing toxicity...then arrhythmias and seizures

Health Teaching: Special Considerations

Help patient to have senses be as sharp as possible - Clean eyeglasses - Make sure functional hearing aids are in place - Speak in tones patient can hear - Face patient when speaking Treat patient with respect - Expect that the patient can learn - Use large print and bright colors in teaching aids - FYI promotes more effective learning and thus therapy - Review all medications at each visit - Encourage a simple dosing schedule - With onset of confusion or disorientation suspect recently prescribed medications - Encourage the patient to report if the new drug is not improving the condition for which is was prescribed

Acamprosate (Campral)

Helps client abstain from alcohol

An individual has a history of heroin abuse. The nurse recognizes that this drug is classified in which schedule? 1: Schedule I 2: Schedule II 3: Schedule III 4: Schedule IV

Heroin is classified as a Schedule I drug, with a high potential for drug abuse and no accepted medical use.

A patient is taking a drug with a low therapeutic index (TI). The nurse should be aware of which factors associated with this drug? 1: There is a high possibility that toxicity will occur. 2: There is a lower possibility of developing dependence. 3: The risk of side effects is low with this drug relative to other drugs. 4: Patients will be less likely to develop drug tolerance when compared to other drugs.

High possibility of toxicity A low TI indicates that the difference between the therapeutically active dose and the toxic dose of a drug is small. Therefore, a drug that has a low TI has a greater likelihood of toxicity relative to other drugs. There may be a high possibility of overdose with this drug. Tolerance and dependence are not related to the TI. Side effects are not related to therapeutic index, but more adverse effects may occur when drugs have a higher risk of toxicity.

famotidine (Pepcid)

Histamine H2 blocker GI geriatric peptic ulcer disease

nizatidine (Axid)

Histamine H2 blocker GI geriatric peptic ulcer disease

ranitidine (Zantac)

Histamine H2 blocker GI geriatric peptic ulcer disease

Onset, peak, and duration of action

How soon the medication takes effect, reaches maximum effect, and how long it sustains effect

Diuretics and antihypertensives: Geriatrics

Hydrochlorothiazide low dose (12.5 mg/day) - What lab should be monitored with this diuretic? - Older patients who take doses of hydrochlorothiazide between 25 to 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely - K+ & Kidney Function - Nonpharmacologic methods to reduce blood pressure - Calcium blockers, angiotensin-converting inhibitors, and beta-adrenergic blockers commonly used*** - Alpha 1 blocker or antagonists (prazosin, terazosin) and centrally acting alpha2 agonists (methyldopa, clonidine) are infrequently prescribed for older adults because of orthostatic hypotension

A nurse discusses the side effects of alcohol with a patient. Which patient statement indicates an understanding of the nurse's teaching? 1: "I will urinate more frequently." 2: "Alcohol will cause me to breathe faster." 3: "I can get acute hepatitis of the pancreas." 4: "Increased glucose levels can lead to diabetes."

I will urinate more frequently Alcohol is a diuretic. It promotes urine formation by inhibiting the release of antidiuretic hormone from the pituitary. Like all other central nervous system depressants, alcohol depresses respirations. Alcohol suppresses gluconeogenesis, blunts the postprandial rise in blood glucose, and lowers fasting levels of both glucose and insulin. Approximately 35% of cases of acute pancreatitis can be attributed to alcohol, making alcohol the second most common cause of the disorder. Alcohol-induced liver damage can progress from fatty liver to hepatitis to cirrhosis, depending on the amount consumed.

A patient is complaining of pain rated 10 on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Assuming there are no contraindications, which would be best for the nurse to administer at this time? 1: Transdermal patch 2: Tylenol suppository 3: Oral morphine sulfate 4: Intravenous morphine sulfate

IV Morphine When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation and will have an immediate effect to decrease pain. The other medications will not have an immediate effect. Pain medications that are administered by mouth, suppository, or a transdermal route take longer to have an effect and would not be the best options for 10/10 pain.

Why should the nurse follow safe medication administration for intravenous (IV) medications? 1: IV administration is irreversible. 2: The IV route results in a delayed onset of action. 3: Control over the levels of drug in the body is unpredictable. 4: The IV route can result in delayed absorption of the medication.

IV administration is irreversible The intravenous (IV) route allows precise control over levels of drug in the blood and results in rapid onset of action. Absorption of IV medication is instantaneous and complete. Once a drug has been injected, there is no turning back; the drug is in the body and cannot be retrieved. Instantaneous and complete absorption produces more predictable control over the levels of the drug in the body.

Q: How might LM's alcohol use affect his surgical experience?

If he is not alcohol dependent - Surgery would probably not be cancelled - Less anesthetic agent would probably be necessary If his pattern of use indicates alcohol dependency - BAC should be tested before surgery - If not intoxicated, but alcohol dependent, more anesthetic and other CNS depressants may be required

Pediatric Pharmacokinetics Distribution

Influencing factors - Body fluid composition - Neonates and infants are 70% water - Require HIGHER doses of water-soluble medications Body tissue composition - Neonates and infants have less body fat - Require LOWER doses of fat-soluble medications Protein-binding capability - Neonates and infants have less albumin and fewer protein receptor sites - Require LOWER doses of high protein-bound medications Effectiveness of barriers to drug transport - Skin - Blood-brain barrier - immature!

Pediatric Pharmacokinetics Absorption

Influencing factors - Child's age, health status, underlying disease, hydration, route of administration - Because the child's gastric pH is more alkaline than the adult's, less drug will be absorbed. Therefore, the dose should be increased Route of administration - Gastric acidity, emptying, motility, surface, enzyme levels, intestinal flora IM/subQ affected by - Peripheral perfusion - Effectiveness of circulation Topical - Children's skin is thin and porous

Pediatric Pharmacokinetics Metabolism

Influencing factors - Maturational level of child - First-pass effect High metabolic rate - May require higher, more frequent doses - Babies by age 3 months have adequate drug metabolizing enzymes, need adequate dosing vs. under dosing Patient SAFETY - Monitor for effectiveness of dose! - Monitor for toxicity - The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity

A drug administered by which route requires the most immediate evaluation of therapeutic effect? 1: Oral 2: Topical 3: Intravenous 4: Subcutaneous

Intravenous Intravenous drugs are absorbed more quickly than oral, subcutaneous, or topical drugs. The bioavailability of intravenous drugs is 100%, and these drugs require the most immediate evaluation of therapeutic effect.

Cytochrome P450 Isoenzymes

Isozymes responsible for the biotransformation of many drugs and other substances - Facilitates change from fat - to water soluble to allow for distribution and/or elimination or inactive compounds to active metabolites Substrated: inhibitors vs inducers Breastfeeding mom, supermetabolizer - She quickly converts codeine to its metabolite form: morphine - Baby dies; mom had baby in several times b/c lethargy; large amounts of morphine in frozen breast milk

A nurse teaches a patient to take acamprosate with meals. What is the rationale for the nurse's teaching? 1: It prevents diarrhea. 2: It decreases nausea. 3: It increases absorption. 4: It promotes compliance.

It promotes compliance The recommended dosage of acamprosate is two tablets (666 mg) 3 times a day taken with meals. The reason for administration with meals is to promote compliance—not to influence absorption or gastrointestinal effects.

Excretion (elimination)

Kidneys are the main route of elimination - Creatinine clearance - Beware renal dysfunction - Liver - Feces - Lungs - Saliva - Breast milk - Sweat - 4 phases of pharmacokinetics: Absorption, Distribution, Metabolism, Excretion - Decreased glomerular filtration rate (GFR) - impaired drug excretion (slowed) - Drug accumulation!

Q: Which drug has longer half life? Klonopin/Xanax

Klonopin - longer half life, less frequent dosing Xanax - shorter half life, more frequent dosing needed

phenelzine (Nardil)

MAOI Inhibitor (antidepressent) avoid foods that are tyramine-rich such as - cheese - wine - organ meats - beer - yogurt - sour cream - bananas these foods cause more norepinephrine to be release, causing a hypertensive crisis

The nurse asks a patient to provide a list of all medications the patient takes, including herbal and over-the-counter drugs. Which term best describes the nurse's action? 1: Error reporting 2: Patient notification 3: Quality improvement 4: Medication reconciliation

Medication reconciliation Medication reconciliation is a process in which the nurse asks the patient to provide a list of all medications, including herbal and over-the-counter drugs that the patient is currently taking. This knowledge prevents medication errors. Error reporting involves notifying the appropriate people about errors related to medication administration. Medication reconciliation helps in quality improvement. Notifying the patient is a process whereby the patient is informed about possible medication errors.

Neurobiology of Addiction

Mesolimbic system - "Pleasure center" or brain reward system - Ancient system that creates the sensation of pleasure for certain behaviors necessary for survival, such as eating and sexual behavior Dopamine - many addictive drugs allow higher levels by causing either: - Increased secretion of dopamine - Decreased absorption of dopamine Drugs of addiction increase availability of dopamine and other neurotransmitters

Which is an alternate name for biotransformation of a drug? 1: Dilution 2: Excretion 3: Absorption 4: Metabolism

Metabolism Metabolism involves a breakdown of a product. Biotransformation is a more accurate term because some drugs are actually changed into an active form in the liver rather than being broken down for excretion. Dilution, excretion, and absorption are not alternate names for biotransformation.

A lactating woman takes atenolol for blood pressure. Which drug would be a safer alternative for this breast-feeding patient? 1:Lithium 2:Metoprolol 3:Ergotamine 4:Bromocriptine

Metoprolol Drugs such as bromocriptine, ergotamine, and atenolol have the capacity to enter breast milk readily. Metoprolol, labetalol, and propranolol are the drugs of choice for breast-feeding women.Test-Taking

The nurse is preparing to administer morphine. The nurse recognizes that the medication is classified in which schedule? 1: Schedule I 2: Schedule II 3: Schedule III 4: Schedule IV

Morphine is classified as a Schedule II drug. Drugs in Schedules II through V all have approved applications.

Metabolism (biotransformation)

Most drugs metabolized via liver - Beware liver disease! - Half-life (t1/2) - time it takes for one-half of the drug concentration to be eliminated from the body - Longer half-life means less frequent dosing needed Liver disease means half life may be extended - Watch for signs of toxicity! - Drugs can be metabolized in both the GI tract and liver; however, the liver is the primary site of metabolism: Beware liver disease!

Opioid overdose

Naloxone

Q: How does naltrexone (ReVia) work for alcohol abuse and opioid abuse? What are the advantages and disadvantages of naltrexone (ReVia)?

Naltrexone (ReVia) is an opioid antagonist prescribed to block the pharmacologic effects of the "high" associated with opioids and alcohol Advantages and disadvantages of naltrexone (ReVia) Neg: - Patient must have stopped alcohol or opioid use - Side effect of suicidal thoughts and depression Pos: - May be used daily or IM once a month, naltrexone extended release (Vivitrol) - Prevents craving (?) conflicting evidence

The primary healthcare provider has prescribed a drug that will help reduce an individual's craving for alcohol. Which drug will the nurse prepare to administer? 1: Disulfiram 2: Naltrexone 3: Acamprosate 4: Chlordiazepoxide

Naltrexone is a pure opioid antagonist that reduces the craving for alcohol and blocks its pleasurable effects. Disulfiram is used to prevent alcohol consumption, acamprosate is used to maintain alcohol abstinence, and chlordiazepoxide is used to facilitate alcohol withdrawal.

Misfeasance

Negligence - wrong drug or wrong dose given

A patient who is a chronic smoker is being treated at a rehabilitation center. What will the nurse expect to administer to immediately stop cigarette craving in the patient? 1: Nicotine inhaler 2: Nicotine lozenges 3: Nicotine nasal spray 4: Nicotine chewing gum

Nicotine nasal spray With the nasal spray, blood levels of nicotine rise rapidly, much as they do with smoking, providing quick relief from withdrawal or from cigarette craving. With the gum, lozenges, patches, and inhaler, blood levels of nicotine rise slowly and remain relatively steady.

A hospitalized pregnant patient who reports smoking a pack of cigarettes per day requests that she be escorted outside to have a cigarette. What is the nurse's best response? 1: "Have you considered nicotine replacement therapy while you're pregnant?" 2: "The nicotine can increase your heart rate, which should improve blood flow to your baby." 3: "Nicotine is a central nervous system depressant and can help you relax, putting less stress on the fetus." 4: "Because you're underweight for the gestational age of the baby, it's best that you only smoke between mealtimes."

Nicotine replacement therapy can be reasonably considered during pregnancy to help a patient quit smoking when the patient smokes more than 5 cigarettes per day. Nicotine is a central nervous system stimulant, not a depressant. Smoking can actually harm the fetus and should not be advised by the nurse. Nicotine suppresses appetite; therefore, if poor nutrition is a risk in the pregnant patient, smoking is contraindicated. Nicotine does increase the heart rate. However, the increase can be weak and irregular, which can harm the fetus by leading to hypoxemia.

Q: What are normal creatinine clearance values? What patient education will you provide for a patient requiring a 24-hour urine sample? What factors affect creatinine clearance values?

Normal values - Male 97-137mL/min., Female: 88-128mL/min - Requires 24 hour urine collection followed by blood draw, may have to stop some medications (ABX, antacids) Patient education for 24hr urine sample Find shit here What factors affect creatinine clearance values? - Age and gender. Lower values are expected in patient with decreased muscle mass, such as older patients and some female patients - Note the difference between creatinine clearance and serum creatinine levels - serum levels will be higher with kidney disease because of decreased creatinine clearance.

Legislation

Nurse Practice Act Terms r/t medication deaths Misfeasance - Negligence - wrong drug or wrong dose given Nonfeasance - Omission - not giving a prescribed medication Malfeasance - Giving correct drug via wrong route

A pregnant woman smokes four cigarettes a day. What is a priority action for the nurse? 1: Offer varenicline 2: Offer psychosocial support 3: Offer nicotine replacement therapy 4: Offer a combination of bupropion and psychosocial support

Offer psychosocial support Pregnant patients who smoke no more than five cigarettes a day should be offered psychosocial support, but not nicotine replacement therapy (NRT). Conversely, pregnant patients who smoke more than five cigarettes per day should be offered NRT along with psychosocial support. One prominent voice, the American College of Obstetricians and Gynecologists (ACOG), says that bupropion may be considered when behavioral interventions have failed. However, another prominent voice, the Motherisk Program, says that bupropion should be avoided until we know more about its safety and efficacy. As for varenicline, we have no human data on safety in pregnancy, but we do have animal data showing fetal harm. Accordingly, varenicline should not be used.

Nonfeasance

Omission - not giving a prescribed medication

Opioids Treatment

Overdose - Naloxone (narcan) Withdrawal - Craving, GI, N/V, diarrhea - Not life threatening Treatment - may include use of opioids with low potential for abuse - Methadone (dolophine) - detox and maintenance - Buprenorphine (Buprenex) - detox and maintenance - Buprenex is an agonist-antagonist opioid that can be used for detoxification and maintenance therapy because it has a low potential for abuse - Clonidine (Catapres) - relieves GI symptoms during withdrawal Opioid antagonist - Naltrexone (oral ReVia, injectable Vivitrol) - blocks euphoria, as with ETOH treatment

Which enzyme system is responsible for metabolizing drugs in the liver? 1: Ptyalin 2: Gastric lipase 3: P450 enzymes 4: Pancreatic lipase

P450 Enzymes Multiple enzymes are required for the hepatic metabolism of drugs. P450 enzymes are a group of enzymes present in the liver. They are microsomal enzymes, which control a variety of reactions involved in the metabolism of medications. Pancreatic lipase, gastric lipase, and ptyalin are digestive enzymes involved in the digestion of food in the gastrointestinal tract.

Q: What is the fifth vital sign?

PAIN

Q: What cardiac dysrhythmias are aggravated by caffeine?

PVC's and PAC's Premature ventricular contractions are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat And they often interrupt the normal order of pumping. Resulting in less effective pumping of the blood throughout the body.

A nurse is reviewing treatment plans for addicted patients. Which patient behavior indicates that the ideal goal of addiction treatment has been met? 1: The patient relapses in the afternoon. 2: The patient totally abstains from alcohol. 3: The patient drinks alcohol in controlled moderation. 4: The patient decreases from compulsive to moderate drug use

Patient totally abstains from alcohol Ideally, the goal of treatment is complete cessation of drug use. While compulsive to moderate drug use is an improvement, it is not the ideal goal. The other answers are indications that the illness is chronic and includes relapses; therefore, these behaviors do not meet the ideal goal.

Nursing Implications: Pediatrics

Pediatric medication dosing and monitoring Monitoring for the therapeutic effects and adverse reactions - Allergies to medications Calculations - Often based on body weight, BSA (body surface area), height, and/or age Toxicity - Trust your assessment skills! - Even if the dosing is safe, if you see s/sx of toxicity, stop the med! - Antibiotics, especially penicillins, commonly cause allergic reactions in children. Intravenous antibiotics can cause rapid reactions, therefore, the pediatric patient's response to a medication should be assessed and monitored closely.

Geriatric Pharmacology

Pharmacokinetics Adverse reactions - Loss of protein-binding sites - Decline in hepatic first pass metabolism - Drugs with prolonged ½ life What labs might the RN want to review? - With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review: - Serum creatinine levels to monitor renal function - LFTs to monitor hepatic function - Physical changes in elderly result in more free drug. Un-metabolized drug, inefficient excretion...toxicity and adverse reactions - Prolonged half-life of the drug because of decreased liver and kidney function -> adverse reactions

The nurse prepares to administer phenobarbital. The nurse recognizes that the medication is classified in which schedule? 1: Schedule I 2: Schedule II 3: Schedule III 4: Schedule IV

Phenobarbital is classified as a Schedule IV drug. Prescriptions for drugs in Schedules III and IV may be oral, written, or electronic. If authorized by the prescriber, these prescriptions may be refilled up to five times. Refills must be made within 6 months of the original order. If additional medication is needed beyond the amount allowed in the original prescription, a new prescription must be written.

Which is not a reason for the decline in hepatic drug metabolism with age? 1: Poor diet 2: Reduced liver mass 3: Reduced hepatic blood flow 4: Decreased activity of some hepatic enzymes

Poor diet Rates of hepatic drug metabolism tend to decline with age. Diet is important but is not a principal reason for reduced hepatic drug metabolism. Principal reasons are reduced liver mass, reduced hepatic blood flow, and decreased activity of some hepatic enzymes. Diet is important but is not a principal reason for reduced hepatic drug metabolism.

LM, a 57 yo man is admitted to the surgical unit for back surgery. LM's wife tells the nurse she hopes the surgery will be successful. She confides that her husband has just been sitting around the house drinking more beer than usual, because he has not been able to work. LM appears relaxed and unconcerned about his surgery. He jokes with the nurse, telling her that he would be cured is a "cute young thing" like her "would only rub his back" What assessments of LM's alcohol use should the nurse make and communicate to the surgeon and anesthesiologist before he is further prepared for surgery?

Possible intoxication could cause anesthetic and other drug interactions. A pattern of use/abuse of ETOH may lead to withdrawal syndrome Assess - Time and amount of the last alcohol intake; may relate to anesthetic interactions and NPO status - Pattern of alcohol use, because it is related to the potential for withdrawal syndrome. - What effects have occurred with previous cessation of use, such as seizure or delirium tremens - Physical signs of alcohol intoxication such as lack of coordination and decreased blood pressure and respiratory rate - ASK about ETOH use - Patient may not have been honest about alcohol intake on admission

Placebo Effect

Psychological benefit from a compound that may not have the chemical structure of a drug effect Placebo is effective in approximately one third of persons who take a placebo compound

Which intervention should the nurse choose to minimize the risk for drug toxicity when giving protein-bound drugs to neonates and infants? 1: Reduce the amount of drug given. 2: Shorten the interval between doses. 3: Administer the medication intravenously. 4: Administer the medication before feedings

Reduce the amount of drug given The albumin in neonates and infants has a lower binding capacity for medication. A lower binding capacity leaves more of the free drug available for action; therefore, a lower dose is required to prevent toxicity. Shortening the time interval between doses will increase the risk of toxicity. Administering the medication intravenously or before feedings will not decrease the risk of toxicity.

The nurse is caring for an older adult patient. The laboratory reports reveal decreased liver function. How does this change affect the drug action? 1: Increased excretion 2: Reduced absorption 3: Reduced metabolism 4: Increased first-pass metabolism

Reduced metabolism Most drugs get metabolized in the liver. The decreased liver function will lead to reduced metabolism of drugs. As a result, drugs may not be available for therapeutic effect, or excretion may be reduced, causing drug toxicity. Reduced liver function does not cause increased drug excretion, because drug excretion takes place through the kidneys. Liver impairment does not affect absorption, because it is a function of the stomach and intestines. Impaired liver function may decrease first-pass metabolism.

The dosage of a certain drug is reduced when administered to a pregnant woman with liver impairment. Which other clinical situation requires reduction in the dosage of most drugs administered during pregnancy? 1: Epilepsy 2: Diabetes 3: Hypertension 4: Renal impairment

Renal Impairment Impaired renal function may result in increased drug levels. It may also prolong the drug exposure to the tissues and cause increased drug transfer to the fetus. Epilepsy, diabetes, and hypertension do not have a direct impact on drug metabolism and excretion. However, they have indirect impacts in late stages, when the liver and kidneys are involved secondarily.

A patient presents with nausea, salivation, confusion, faintness, and cold sweats. The nurse suspects nicotine poisoning. Which assessment is priority? 1: Pulse 2: Respirations 3: Temperature 4: Blood pressure

Respirations The patient is exhibiting nicotine poisoning. Respirations are the top priority. Death results from respiratory paralysis, which is caused by direct effects of nicotine on the muscles of respiration, as well as by effects in the central nervous system. Pulse, temperature, and blood pressure are important but not as important as respirations.

A nurse caring for a patient with a blood alcohol level of 0.45% monitors the patient closely for which priority assessment? 1: Oliguria 2: Respiratory depression 3: Decreased blood pressure 4: Vasoconstriction of cutaneous blood vessels

Respiratory Depression Excessive alcohol intake produces dose-dependent increases in blood pressure and respiratory depression. In general, alcohol acts as a diuretic and causes dilation of cutaneous blood vessels, which produces a feeling of warmth. Maintaining a patent airway and monitoring for respiratory depression are priority assessments after excessive alcohol intake (at or above 0.45% blood alcohol level).

A patient with alcoholism is prescribed a barbiturate. The nurse has advised the patient to stop drinking alcohol. Which risk is the nurse trying to prevent by giving this advice? 1: Delirium tremens 2: Trigeminal neuralgia 3: Korsakoff's syndrome 4: Respiratory depression

Respiratory Depression The central nervous system (CNS) effects of alcohol are additive with those of other CNS depressants (eg, barbiturates, benzodiazepines, and opioids). Consumption of alcohol with other CNS depressants intensifies the psychologic and physiologic manifestations of CNS depression and greatly increases the risk of death from respiratory depression. Delirium tremens is a severe form of alcohol withdrawal. Korsakoff's psychosis is a neuropsychiatric syndrome common in alcoholics and is caused by thiamine deficiency. Injection of alcohol is used to relieve pain from trigeminal neuralgia.

A teratogenic drug, such as methotrexate, is most likely to cause learning deficits during which phase of fetal development? 1: Weeks 3 to 8 2: First trimester 3: Conception through week 2 4: Second and third trimesters

Second and third trimester Exposure to teratogens during the second and third trimesters usually disrupts function rather than producing obvious anatomic abnormalities. Exposure to teratogens during the first 2 weeks of pregnancy usually causes an "all-or-nothing" response that may result in fetal death. Exposure during the remainder of the first trimester may result in anatomic malformations.

Ramelteon (Rozerem)

Sedative / Hypnotic Insomnia/anxiety this is the main one for geriatric patients

Carbamazepine

Seizure med, also used for alcohol withdrawal

Chemical Impairment in Health Professionals

Serious concern - 10% to 15% of nurses have substance abuse problem - 3% to 6% demonstrate impaired practice because of drugs

The nurse is caring for a patient with renal failure who is prescribed a protein-bound drug. Which parameter in the patient must the nurse assess before administering the medication? 1: Lipid profile 2: Hemoglobin level 3: Blood glucose level 4: Serum albumin levels

Serum albumin A patient with renal failure is likely to have low serum albumin levels, resulting in fewer protein-binding sites. This can lead to an excess of free drug, which in turn causes drug toxicity. The nurse need not assess the lipid profile, as it is used to determine the risk for cardiovascular disease. The hemoglobin level is used to detect anemia. Blood glucose level is used to determine whether the patient is diabetic or has a normal blood sugar level.

While teaching health promotion during a prenatal class, the nurse should list which modifiable risk factor as the most common, yet harmful, during pregnancy? 1: Smoking 2: Poor nutrition 3: Age during pregnancy 4: Overexertion while exercising

Smoking is the most serious modifiable risk factor for pregnancy-related morbidity and mortality. Smoking increases the risk of ectopic pregnancy, placenta previa, placental abruption, chorioamnionitis, stillbirth, preterm birth, and spontaneous abortion. In addition, fetal exposure increases the risk of low birth weight, perinatal mortality, sudden infant death syndrome (SIDS), and cognitive, behavioral, and emotional deficits in childhood.

The nurse is providing patient teaching about nicotine replacement therapy. The nurse knows the patient needs further teaching about available nicotine delivery systems if the patient says he wishes to take his nicotine in which form? 1: Patch 2: Lozenge 3: Nasal spray 4: Subcutaneous injection

SubQ injection The U.S. Food and Drug Administration (FDA) has approved five delivery systems for nicotine replacement therapy: chewing gum, lozenges, a transdermal patch, a nasal spray, and an inhaler. Subcutaneous injections are not available for nicotine replacement therapy.

Special needs of Drug Abusing Patients

Surgical patients Drug interactions - ETOH intoxication - less anaesthesia required - Chronic ETOH abuse, but not intoxicated - higher doses - Opioid addiction - may require higher doses Pain management: Addictive treatment is not a priority when patient is in pain; ie TREAT THE PAIN!

Which teaching point should the nurse provide when administering an enteric-coated oral tablet to a patient? 1L"Swallow the tablet whole." 2: "Chew the tablet before swallowing." 3: "Break the tablet in half before swallowing." 4: "Allow the tablet to be absorbed under the tongue."

Swallow the tablet whole Enteric-coated tablets are covered with a material designed to dissolve in the intestine instead of the stomach. They should not be chewed or broken before administration. Sublingual tablets are placed under the tongue for absorption and are not enteric coated.

The nurse knows that which government agency is responsible for carrying out the mandates of the Controlled Substances Act of 1970? 1: U.S. Public Health Service 2: U.S. Food and Drug Administration 3: U.S. Drug Enforcement Administration 4: U.S. Department of Health and Human Services

The U.S. Drug Enforcement Administration, an arm of the U.S. Department of Justice, is charged with enforcing the Controlled Substances Act.Test-Taking

Why are infants especially sensitive to drugs that affect central nervous system (CNS) function? 1: The blood-brain barrier is especially strong in infants. 2: The blood-brain barrier is not fully developed at birth. 3: The blood-brain barrier does not exist until 1 year of age. 4: The blood-brain barrier is weakened by the birth process.

The blood-brain barrier is not fully developed at birth. The other statements are not true.

Which term refers to the ratio between a drug's therapeutic effects and its toxic effects? 1: Affinity 2: Tolerance 3: Cumulative effect 4: Therapeutic index

Therapeutic Index The ratio of a drug's therapeutic benefits to its toxic effects is called the drug's therapeutic index. Tolerance is a decreased responsiveness to a drug as a result of repeated drug administration. Affinity refers to a drug's attraction to a binding site. Cumulative effect is a response generated by an accumulation of a drug in the body.

More on Genetic Variances

Time to Stable Warfarin Dose - Extensive (normal) metabolizer 4-5 days - Intermediate metabolizer 8-10 days - Poor metabolizer 12-15 days

Genetic Differences

Time to stable Warfarin dose - Extensive (normal) metabolizer 4-5 days - Intermediate metabolizer: 8-10 days - Poor metabolizer: 12-15 days

The nurse collects a patient's history of substance abuse on admission to inpatient rehabilitation. The patient reports increasing the drug dosage to get the same effect. What is the patient experiencing? 1: Tolerance 2: Addiction 3: Cross-dependence 4: Physiological dependence

Tolerance Tolerance results from regular drug use and can be defined as a state in which a particular dose elicits a smaller response than it did with initial use. As tolerance increases, larger and larger doses are needed to elicit desired effects. Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use despite harmful consequences. Physical dependence can be defined as a state in which an abstinence syndrome will occur if drug use is discontinued. Cross-dependence refers to the ability of one drug to support physical dependence on another drug.

Which of these is not an example of age-related adverse drug effects? 1: Toxicity 2: Kernicterus 3: Growth suppression 4: Discoloration of developing teeth

Toxicity Like adults, pediatric patients are subject to adverse reactions when drug levels rise too high. In addition, pediatric patients are vulnerable to unique adverse effects related to organ system immaturity and ongoing growth and development. Among these age-related effects are kernicterus (caused by sulfonamides), growth suppression (caused by glucocorticoids), and discoloration of developing teeth (caused by tetracyclines).

Digoxin

Toxicity more common if patient has hypokalemia

Q: Pharmacodynamics: True or False: The pharmacodynamics profile of a medication is unchanged over the lifespan of a patient

True - The way a drug works in a 2 month old, is the same as it is in a 102 year old Remember pharmacodynamics is not about how the body absorbs and metabolizes the medication. It is about the biochemical and physiological effects of the drug...What the drug does to the body and/or disease - Ex: How a drug mimics the actions of the body's own chemical messengers (beta-agonists, synthroid, insulin, etc.)

Q: Pharmacokinetics: True or False? Age and gender significantly impact a medication's pharmacokinetics

True! Pharmacokinetics - what your body does to the drug

True or False? Drugs given IM are absorbed faster when given in the deltoid muscle versus the gluteus.

True, drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when absorption needs to be slower and more sustained.

Smoking Cessation

Use with behavioral therapy - Bupropion (Zyban AKA Wellbutrin) - atypical (heterocyclic) antidepressant Varenicline (Chantix) - nicotinic receptor agonist - Black Box Warning - violent behavior - rescinded - Contraindicated with hx of seizures - Choose a "quit date", not continue to smoke as Bupropion builds in system, nay use for 12 weeks - Behavioral therapy should be included in all treatment plans - Caffeine and Tobacco - Ever notice tobacco users can consume large amounts of caffeine? Nicotine is a caffeine inhibitor As patient decreases nicotine intake, recommend decreasing caffeine, else caffeine side effects!

Hypnotics: Geriatric patients

Used to treat insomnia and anxiety - Ramelteon (Rozerem)** - Temazepam (Restoril) - Triazolam (Halcion) - Lorazepam (Ativan) If no other alternative is available, short term therapy with benzodiazepines that have short to intermediate half-life is best for geriatric patients

Lorazepam (Ativan)

Used to treat insomnia and anxiety - geriatric

Temazepam (Restoril)

Used to treat insomnia and anxiety - geriatric

Triazolam (Halcion)

Used to treat insomnia and anxiety - geriatric

Minoxidil

Vasodilator used as an antihypertensive, side effect is hair growth so Rogaine!

Q: What is an excipient? What is their purpose

What is an excipient - Inactive ingredients added during manufacturing. Inactive ingredients may also be referred to as inert ingredients or excipients, and generally have no pharmacological effect. What is their purpose? - Sometimes give the drug enough substance to form a tablet, sometimes make it chemically "compatible"

Pharmacokinetics (PK)

What the body does to the drug Includes - Absorption - Distribution - Biotransformation (metabolism) - Excretion of drugs

Antagonistic drug effect

When two or more drugs are administered together and causes opposite effects. (i.e. one drug can offset the effect of the other). 1+(-1)=0

How Drugs Reach the Market

Years 0-4 - Computer model to animal studies In vitro vs in vivo - MRSA - kill it with bleach in vitra, not practical in vivo Year 4 - healthy human volunteers - Often college students - Mostly male (no one wants a pregnant women to end up in these trials) Next phase is on patients with the target disease - Some drugs make it to market with a very small subject group b/c of rare disease - Double blind study in population Year 9 - hits market - Expanded to frail, elderly, liver/kidney issues, population with target disease - This is when other problems will come to surface...how safe are they? - When lots of options, HTN, no reason to rush to new drug (vs cancer) Patients usually 20 years - Extended with: new forms, goes generic, new delivery method (PO to mist Ambien to Zolpimist), new dosing formula (Zmac 2g extended release)

Nonspecific drug effect

act on multiple receptors (same type of receptor) throughout the body - Example: cholinergic effect on urecholine - Nonspecific drugs are drugs that affect various sites - Bethanechol (urecholine) - cholinergic agent, given for post-op urinary retention, yet affects all the cholinergic receptors

Fluorinoquinlones (category)

antibiotic do not give to geriatric patient > 75

Ciprofloxacin (Cipro)

antibiotic dairy inhibits absorption

Aminoglycosides

antibiotic do not give to geriatric patient < 75 excreted in the urine, geriatric has decreased renal function they do have a wide therapeutic index

Vancomycin

antibiotic not prescribed for geriatric patient > 75

Cephalosporins

antibiotic, ok for geriatrics

Penicillin

antibiotic, ok for geriatrics

Sulfonamides

antibiotic, ok for geriatrics

tetracycline

antibiotic, ok for geriatrics

Teratogens

are drugs that cause birth defects

Placebos

are drugs that have no pharmacologic activity

Metabolites

are the end product of metabolism

Flumazenil (Romazicon)

benzo overdose treatment

Propranolol (Inderal)

beta blocker used to control symptoms, and stabilize vital signs in alcohol withdrawal

Carcinogens

cause cancer

Drug incompatibility

chemical or physical reaction that occurs among two or more drugs

Lasix

decreases K+ levels

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. Which drug complication is this patient most likely experiencing? 1: An allergic reaction 2: Drug toxicity of the liver 3: Iatrogenic disease of the kidneys 4: An idiosyncratic drug effect on the bone marrow

drug toxicity of the liver Drug toxicity is an adverse drug reaction in which certain drugs are toxic to specific organs. Signs and symptoms of liver toxicity include jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, and loss of appetite. An allergic reaction to a medication most commonly manifests as a pruritic rash, hives, and possible respiratory complications, including bronchoconstriction, wheezing, coughing, dyspnea, or, more seriously, respiratory distress or arrest. Iatrogenic disease of the kidneys as a result of a drug complication manifests as fluid and electrolyte imbalances, nephritis, or renal failure. An idiosyncratic drug effect on the bone marrow will manifest as changes in blood counts and indices, known as blood dyscrasias.

Lidocaine

has an extensive first pass effect, do not give orally

Metformin

has to be stopped before having surgery with contrast dye leads to lactic acidosis

Anticonvulsants

have a wide therapeutic index

Synthroid

if taken with other meds it can cause less bioavailability

iron supplement

if taken with other meds it creates a binding effect

Morphine

large first pass effect, avoid oral/rectal

Buproprion (Zyban)

off label for meth/crack treatment also used for nicotine supression

Modafinil (Provigil)

off label use for cocaine

Clonadine (Catapres)

reduce symptoms of autonomic nervous system in alcohol withdrawal

Tolerance

refers to a decreased responsiveness over the course of therapy

Tachyphylaxis

refers to a rapid decrease in response to the drug. Drug categories that can cause tachyphylaxis include narcotics, barbiturates, laxatives, and psychotropic agents.

Additive drug effect

same class, increased effect, WORK TOGETHER 1+1=2

A patient who receives aversion therapy at an alcohol rehabilitation center has a flushed face and vomits copiously. How should the nurse interpret this finding? 1: The patient obtained alcohol. 2: The patient has erosive gastritis. 3: The patient is infectious with the flu. 4: The patient is experiencing delirium tremens.

the patient obtained alcohol A flushed face, nausea, and vomiting are signs of acetaldehyde syndrome, which is caused by disulfiram therapy when the patient combines disulfiram with alcohol. Erosive gastritis is an effect of alcohol, not an effect of aversion therapy. While the flu does cause vomiting, it is highly unlikely the flushed face and vomiting are from an infection since the patient is in a rehabilitation center receiving aversion therapy. Delirium tremens results from severe alcohol withdrawal and causes an increase in vital signs.

Ethanol

the type of alcohol in alcoholic beverages, because theyre water soluble and older adults have less water volume smaller amounts cause more of an effect

Absorption

type of drug interaction - Changes in gastric emptying time (laxatives) Changes in pH (antacids, ASA) - Forming of drug complexes (colestipol & Tegretol (less effective)(Dairy products prevent absorption of ciprofloxacin)

Distribution

type of drug interaction Competition for protein binding sites (Warfarin and glyburide - both highly protein bound)

Excretion

type of drug interaction Changes in the rate of excretion (Lasix (decreases K+ levels) & digoxin (toxicity! with hypokalemia)

Metabolism

type of drug interaction Inhibition or induction of liver enzymes (Tagamet inhibits metabolism of theophylline (toxicity! can cause arrhythmias and seizures)

Adverse drug reactions

undesirable drug effect that ranges from mild untoward effects to severe toxic effects, including hypersensitivity reaction and anaphylaxis

Bupropion (Zyban)cline (Chantix)

used for nicotine suppression