Pharm review

Benzodiazepines drugs

-Lorazepram (Ativan) treats anxiety, seizures -Diazepam (Valium) treats anxiety, muscle relaxer -Alprazolam (Xanax) treats anxiety, insomnia

A nurse is caring for the parent of a newborn. The parent asks the nurse when their newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the parent that their newborn should receive the immunization at which of the following ages?

2 months (1st dose)

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (Select all that apply.) a. "Blood glucose levels will need to be monitored during therapy." b. "Avoid contact with persons who have known infections." c. "Take the medication 1 hour before a meal." d. "Decrease intake of foods containing potassium." e. "Grapefruit juice can increase the blood levels of the medication."

A,B,E Grapefruit juice can increase the blood levels of the medication" is correct. The nurse should instruct the client that grapefruit juice increases the absorption of the medication, which can lead to toxicity and adrenal suppression

Acute Salicylate Poisoning

ASA Poisoning; respiratory alkalosis in the early stages (Hyperventilation)

Bupropion (Wellbutrin)-fyi

Atypical antidepressant -MOA: Inhibits synaptic reuptake of DA -Use: Antidepressant, smoking cessation, cocaine and amphetamine dependence -Has mild stimulant activity ("psychic energizer") -Toxicity: Lowers seizure threshold

Zopidem (Ambien)

Nonbarbiturate Hypnotic

Flumazenil (Romazicon)

Benzodiazepine antagonist

Tamoxifen (Nolvadex)-fyi

Breast cancer medication Hormonal agent Stops growth of estrogen-dependent breast cancer cells Can cause endometrial cancer, hypercalcemia, N/V, PE, hot flushes, vaginal discharge or bleeding Increase Ca and vit D intake

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurses should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives?

Carbamazepine (cause accelerated inactivation of oral contraceptive by action on hepatic medication metabolizing enzymes)

A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate?

Digoxin (increased toxicity)

DSS

Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching?

I should tell my provider if I develop a sore throat (neutropenia)

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. Which of the following findings should the nurse identify as an adverse effect of the medication?

Insomnia (by atypical antidepressant of bupropion)

Neuroleptic Malignant Syndrome (NMS)

Life-threatening muscle rigidity, high fever, and rhabdomyolysis.

Chlordiazepoxide and Diazepam

Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs

Acetazolamide (Diamox)

Oral CAI. Given w/ liquid for acute angle closure. Last resort for controlling POAG. SEs: metalic taste, tingling in hands, metabolic acidosis, aplastic anemia (all oral CAIs), bone marrow suppression.

ethinyl estradiol/norelgestromin

Patch contraceptive

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide?

Prevent delirium tremens

Budesonide-FYI

Pulmicort

Clozapine (Clozaril)

The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2 weeks up to 1 year.

A nurse is assessing a client who is postoperative following an outpatient endoscopy procedure using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge?

The client's capnography has returned to baseline (gas exchange is adequate)

A nurse is caring for a client who is taking acetazolamide fr chronic open angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report?

Tingling of fingers

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to instruct the client to use prior to physical activity? a. cromolynb. beclomethasonec. budesonided. tiotropium

a. cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching?

hot flashes (due to estrogen receptor blocking action of tamoxifen)

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor?

sedation

Fluoxetine (Prozac)

suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.

Midazolam (Versed)-FYI

*class*: Benzodiazepine *Indication*: sedation, conscious sedation, anesthesia, status epilepticus *Action*: Acts to produce CNS depression, may be mediated by GABA. *Nursing Considerations*: - assess level of sedation during and for 2-6 hours following - monitor blood pressure, pulse, respirations during IV administration - The antidote for overdose is flumazenil

Metoclopramide (Reglan)fyi

*class*: antiemetic *Indication*: prevention of nausea, vomiting, hiccups, migraines, gastric stasis *Action*: accelerates gastric emptying by stimulating motility *Nursing Considerations*: - don't use with GI obstruction - may cause extrapyramidal reaction, neurolyptic malignant syndrome, tardive dyskinesia, arrhythmias, blood pressure alterations, hematologic alterations, facial movements, sedation - can decrease effects of levodopa - assess nausea/vomiting - monitor liver function tests

dantrolene-FYI

-Mechanism: prevents release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle. -Use: malignant hyperthermia and neuroleptic malignant syndrome (a toxicity of antipsychotic drugs). -Muscle Relaxant

Carbamazepine (Tegretol) fyi

5-12 mcg/mL, anticonvulsant

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective?

I will taper off the medication before discontinuing it (prevent abstinence syndrome or rebound insomnia)

Patch contraceptive use

The birth control patch is a type of contraception that contains the hormones estrogen and progestin. You wear the patch to avoid becoming pregnant. Once a week for three weeks, The first patch on the first day menstrual cycle

Graves disease

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos

A nurse is teaching about zolpidem to a client who has insomnia. The nurse should identify that which of the following client statements indicates an understanding of the teaching? a. "I will need to get laboratory testing prior to a refill of this medication." b. "I will use this medication for a short period of time." c. "I will need to take this medication for 1 week before results are seen." d. "I will need to change the medications to prevent building up a tolerance."

b. "I will use this medication for a short period of time." Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription. Because the drug has the potential to cause dependence, it should not be prescribed for long periods, and the team should coordinate monitoring for dependency concerns.

A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. The nurse should instruct the client to take the medication with which of the following to promote absorption? a. vitamin Eb. orange juicec. milkd. antacids

b. orange juice The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice.

Sumatriptan

is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.

A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during surgery. Which of the following actions should the nurse take? a. administer the reconstituted medication slowly over 5 min b. store the reconstituted medication in the refrigerator c. use the reconstituted medication within 12 hours d. reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent

d. reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly.

A nurse is caring for a client who is receiving end-of-life care and has a prescription for fentanyl patches. Which of the following information regarding the adverse effects of fentanyl should the nurse plan to give to the client and family? a. the provider will prescribe naloxone at home for respiratory depression b. remove the patch to reverse the adverse effects immediately c. expect an increase in urinary output d. take a stool softened on a daily basis

d. take a stool softener on a daily basis Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.

A nurse is providing teaching to a client who is begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching?

dry mouth & dry eyes (anticholinergic) blurred vision (increase intraocular pressure)