Pharm Test #1 EOC Questions + ATI Questions

A pt who has recently had a MI has started therapy with a beta blocker. The nurse explains the purpose of the beta blocker is to?

protect the heart from circulating catecholamines

The nurse is preparing to administer an injection to a preschool aged child. what is appropriate for this age group?

provide brief explanation, make use of magical thinking, provide comfort measures

What is moderate sedation?

pt does not lose total loss of consciousness and they can maintain their own airway

S&S of malignant hyperthermia?

rapid rise in temp over 104, tachycardia, tachypnea, muscular rigidity, cyanosis, diaphoresis *antidote is dantrolene

The nurse is reviewing the various forms of topical medications. What are considered topical medications?

rectal ointment, eye drops, inhaled medications

What is the contradiction of muscle relaxant?

renal impairment - kidney disease or injury

What should you teach pt's above adrenergic agonists?

report any respiratory problems, palpitations, HA blurred vision avoid OTC meds and herbal supplements

What bod systems would be important for a nurse to assess of someone who had been given an adrenergic agonist?

respiratory assessment blood pressure readings

A nurse in an ED is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following should the nurse expect?

respiratory depression

What are the major sites for cholinergic blocking receptors (anticholinergics)?

respiratory, GI, urinary, eye, sweat glands

A patient has a new prescription for a BP medication that may cause him to feel dizzy during the first few days of therapy. Which is the best nursing diagnosis for this situation?

risk for injury

A nurse reviewing a client's health record notes a new prescription for Lisinopril 10 mg PO once every day. The nurse should identify this as which of the following types of prescription? A. Single B. Stat C. Routine D. Standing

routine

What are the effects of anticholinergics?

same as adrenergic agonists!!! they inhibit the PSNS and mimic effects of SNS *mydriasis is pupil dilation

Common indications for Benzodiazepines

sedation, anxiety relief, sleep, muscle relaxation, acute seizure disorders

What is the main contradiction of using opioids?

sever asthma *caution is to be take in cases of increase cranial pressure, morbid obesity, sleep apnea, pregnancy

An opioid analgesic is prescribed for a pt, The nurse checks the patient's medical hx knowing this medication is contradicted by what disorder?

severe asthma

describe balanced anesthesia

smaller amounts of different types of anesthesia are better than a lot of one type

What are signs of a benzodiazepine overdose?

somnolence, confusion, coma, diminished reflexes - rarely results in respiratory depression and hypotension on its own *antidote is flumazenil

When teaching a client about spinal HA, which statement will the nurse include?

spinal HA can be prevented with bed rest after the epidural procedure

What should the nurse teach the client about memantine (drug used for Alzheimer's)?

squirt oral solution on the buccal area, Do not mix with any other liquids, does not cure

Why should AEDs not be stopped abruptly?

stopping quickly would cause rebound seizure

During a pt's recovery from a lengthy surgery the nurse monitors for signs of malignant hyperthermia. IN addition to a rapid rise in temp, what assessment would indicate possible presence of this condition?

tachypnea, tachycardia, muscle rigidity

What should the nurse teach the client about NSAIDs?

take with food or milk, do not give aspirin (salicylates) to children, effects may not bee seen for 3-4 weeks

What should a nurse teach a client about taking cholinergic agonists?

take with meals to prevent GI upset take at the same time don't crush chew or break

A client has a prescription for ketorolac. The nurse notes that the duration of the prescription is only 5 days. What is the reason for this short duration?

taking the drug longer will cause severe renal and GI effects

Which adrenergic blocking drug prototype is an alpha blocker?

tamsulosin

When administering beta blockers, the nurse will follow which guideline for administration and monitoring?

tapering off medication to prevent rebound hypertension

A nurse is teaching a client who has a new prescription for levodopa/carbidopa for parkinson's disease. Which of the following instructions should the nurse include?

take medication with food

A pt is receiving dobutamine for shock and is complaining of feeling "hearts skipping a beat." What should the nurse do?

assess vitals and cardiac rhythm

What is an important nursing implementation of someone just starting dopaminergic replacement drug therapy ( levodopa/carbidopa)?

assist with ambulating because ataxia is common

Before initiating therapy with a nonselective beta blocker, the nurse will assess for what condition?

asthma

The nurse knows that the AE of a nonselective beta blocker is likely to be the most immediately life threatening disorders?

asthma

Which response would a nurse expect to find in a pt with phenytoin level of 25 mcg/mL?

ataxia

What is a very well known AE of phenytoin?

gingival hyperplasia is a well known AE of long term oral phenytoin therapy so oral care if very important

define rem rebound

happens when a sedative is stopped and a pt has an abnormal amount of REM sleep resulting in vivid dreams

What patients must anesthesia be used very carefully in?

head injuries and glaucoma

A client is admitted to the ED with suspected salicylate toxicity. What finding correlates with salicylate toxicity?

hyperglycemia

What are alpha blockers typically given to treat?

hypertension and benign prostatic hyperplasia

A client with type 2 diabetes is taking a beta blocker as part of therapy. What will the nurse assess for?

hypoglycemia

drug interactions with garlic

hypoglycemic therapy and warfarin

When administering an alpha blocker for the first time, what is most important to assess for?

hypotension

What is the main complication of general anesthesia?

hypotension which can mean decreased perfusion

What should a nurse monitor for in adrenergic blocking drugs?

hypotension, heart rate, slow RR, look for if the patient has gained more than two pounds in 24 hours or 5 in a week

When giving IV cholinergic drugs, the nurse knows to look for what symptoms of a cholinergic crisis?

hypotension, syncope, dyspnea

What should you assess for pts on AED?

assess urinary output of at least 30 ml/hr

A pt has just received a prescription for an enteric coated stool softener. When teaching the pt, the nurse should include what statement?

"Be sure to take the tablet whole without swallowing it"

The nurse will include what information when providing teaching a client about antiparkinson drugs?

"Change positions slowly to prevent falling due to a drop in blood pressure."

A nurse is completing DC teaching for a client who has a new prescription for transdermal patch. What statement would indicate the teaching was successful?

"I will apply the patch to an area with no hair"

A 77 year old man who has been diagnosed with a URI tells the nurse he is allergic to penicillin. What is the best response by the nurse?

"What type of reaction do you have?"

The nurse is compiling a drug history for a pt. Which question from the nurse will obtain the most information from the pt?

"When you have pain what do you do to relieve it?"

What is normal creatine levels?

0.6-1.2 mg/Dl is normal creatine

What guidelines will the nurse follow when administering an antiepileptic drug? Select all that apply

1. monitor for drowsiness administer the 2. medication at the same time each day 3. notify the prescriber if unable to administer the medication *AEDs can cause drowsiness so really look for this, if the medication is not given at the same time each day the therapeutic levels could shift

therapeutic ranges for phenytoin

10-20 mcg/ml

Therapeutic ranges for phenobarbital

10-40 mcg/ml

A drug that delivers 300 mg has a half-life of 4 hours. How many mg of drug will remain in the body after half life?

150 mg

The nurse is preparing to give oral dose of acetaminophen to a child who weighs 12 kg. The dose is 15mg/kg. How many milligrams will the nurse administer?

180 mg

A nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy?

24 year old female with no health problems - women of child bearing age should take folic acid 55 yo female who has alcohol use disorder - alcohol can cause liver failure

What are the limit doses of acetaminophen per day?

3000 mg per day 2000 mg per day of people with liver disease

When is drug transfer most likely during pregnancy?

3rd trimester

therapeutic ranges for carbamazepine

4-12 mcg/ml

therapeutic ranges for valproic acid

50-100 mcg/ml

What are the major parameters to assess during anesthesia and after?

ABCs airway breathing circulation

What is normal BUN level?

BUN is 10x that 8-20 mg/dL, but 20 is on the high side, anything above could be kidney injury

What should you teach a pt about taking a centrally acting muscle relaxant?

Be aware that drowsiness and other CNS effects will decrease with time. Change position slowly if dizzy. Do not drive or use hazardous machinery if drowsy. Take oral doses with food or milk. Increase fiber and fluid intake and report constipation. Do not stop taking this drug abruptly; taper doses over 1 to 2 weeks.

The nurse will monitor the pt who is taking a muscle relaxant for what AE?

CNS depression

The nurse will monitor the pt who is taking a muscle relaxant for which AE?

CNS depression

What should a nurse assess for a pt taking barbiturates?

CNS depression and baseline vitals, seizure precautions in place

AE of opioids

CV: hypotension, flushing, bradycardia (caused by histamine) CNS: euphoria, sedation, disorientated GI: N/V, constipation GU: urinary retention integumentary: itching/rash (from histamine) resp: depression!!!

S&S of salcylism

CV: increased Hr CNS: tinnitus, hearing loss, HA, confusion GI: N/V Metabolic: sweating, thirst, hyperventilation, hypo or hyperglycemia

Effects of benzodiazepines withdraw?

Can cause paranoia, panic attacks, muscle twitching, hallucinations Gradually decrease use

What should a nurse implement in the care plan of a pt on cholinergic agonists?

Cardiac - look for decreased HR or pulse less than 60, decreased blood pressure

Valproic acid Class Indications Contradictions

Class: AED Indications: generalized seizure disorder, partial seizures, bipolar disorder Contradictions: liver impairment, urea cycle disorders AE: hepatotoxicity and pancreatitis, N/V *NOT a hepatic enzyme inducer like phenytoin is

Carbamazepine class indications contradictions

Class: AED - iminostibenes Indications: generalized tonic clonic seizures, partial seizures Contradictions: myoclonic or absence seizures, bone marrow depression *autoinduction of hepatic enzymes, this leads to lower than expected drug concentrations

Midazolam Class Indications Admin

Class: Benzodiazepines Indication: pre-op for moderate sedation and can cause amnesia, reduces anxiety and induces amnesia but pt can breath on their own and respond to verbal commands Admin: there is a liquid or oral dose for children, IV for adults

Celecoxib Class Indications Admin

Class: COX 2 inhibitor Indications: dysmenorrhea, acute pain Admin: only for oral use

Cyclobenzaprine Class Doses Indications

Class: Muscle relaxant Doses: 5mg, 10 mg, extended reales Indications: reduce spasms following musculoskeltal injury *very common to have marked sedation, most common

Atropine Class Indications Admin Contradictions

Class: anticholinergic antidote Indications: bradycardia or ventricular asystole Contradictions: hepatic or renal disease, glaucoma, GI obstruction

Tramadol Class indications

Class: centrally acting non opioid MOA: prevents the re-uptake of norepinephrine and serotonin indications: moderate to severe pain *not for people 75 and older

Baclofen Class

Class: muscle relaxant Admin: oral or injectable

Diphenhydramine Class

Class: muscle relaxants

Baclofen Class admin Indications

Class: muscle relaxants admin: oral and injectable indications: chronic spastic muscular conditions

Zolpidem Class Indications

Class: non benzodiazepine Indications: lower daytime sleepiness, induces sleep *sleep walking is a common AE

Carvedilol Class Indications

Class: nonselective beta and alpha blocker Indications: heart failure, hypertension, angina Given PO

Morphine Class Indications

Class: opioid agonist Indications: severe pain *not safe for patients with renal insufficiency!!!

Oxycodone Class Indications

Class: opioid agonist available in immediate release and long term release

Codeine Class Indications

Class: opioid agonist indications: suppress cough, *has a ceiling effect

Aspirin Class Indications Dose

Class: salicylates/NSAID Dose: tablets are 81 mg or 325 mg Indications: after an MI, to prevent thrombotic events, HA, myalgia, arthralgia *do not use in children!!!!

What are contradictions to cholinergic agonists?

GI obstruction, bradycardia, hyperthyroidism, epilepsy, hypotension, COPD

The nurse is teaching a patient about the possible AE of donepezil. What are possible AE?

GI upset, drowsiness, dizzy

What are cholinergic agonists drug primary used for?

GI, bladder and eye, urinary frequency, miosis , decreased HR Same as adrenergic blocking *at low doses they affect muscarinic receptors at high doses they impact nicotinic which is when there are undesirable outcomes

common AE of the AED valproic acid

Gastrointestinal upset Bruising, bleeding, prolonged bleeding time, decreased platelets Skin rash Liver toxicity (potentially fatal) Hyperammonemia

Common AE for benzodiazepines?

HA, drowsy, excited or nervous, lethargy and can create a fall hazard in older adults so they must receive a small dose, tolerance can develop over weeks overdose symptoms: somnolence, confusion, diminished reflexes and coma - overdose rarely has depression in RR or hypotension, the antidote is usually flumazenil

What should a nurse assess for when adminsitering cholinergic agonists?

Heart block, alertness, baseline vitals

A client is taking ibuprofen 800 mg three times a day. While obtaining a health history, the nurse finds out the client has "a few beers on weekends." For what interaction will the nurse monitor?

Increased chance for GI bleeding

Dopamine Indications Selective or not selective Route of admin

Indications: *lose dosages it is used dilate blood vessels in brain, heart and kidneys. This is important when someone is in shock, heart failure or acute kidney injury *moderate doses it is used for heart failure and shock but does not cause vasoconstriction *At higher rates it is used to improve cardiac contractility and causes vasoconstriction. Selective: beta1 and alpha 1 Route: IV

gabapentin Indications

Indications: adjunct given for seizures, neuropathic pain

Dobutamine Indications Selective or not selective Route of admin

Indications: heart failure Selective: beta1 selective Route: IV increases HR, CO, increased rate of conduction through AV node

Norepinephrine Indications Selective or not selective Admin

Indications: hypotension or shick Selective: alpha selective and some on heart, but none on the lungs (no beta2) Admin: IV

What questions should be asked when doing a health history of someone who may receive an adrenergic agonist?

Is there a history of asthma Is there a history of stroke Is there a history of renal disease

ibuprofen class

NSAID Indications: dysmenorrhea, dental pain, musculoskeletal disorders, pain

Naloxone MOA class indications

MOA: binds to opioid receptors class: opioid antagonist indications: reversal of opioid induced respiratory depression *can also be used in children

Acetaminophen MOA Indications contradictions AE

MOA: inhibits prostaglandin synthesis, does NOT have anti-inflammatory effects, does NOT cause the same GI issues as aspirin Indications: mild to moderate pain and fever, can be used in children contradictions: severe liver disease and G6PD AE: N/V, blood disorders, however liver toxicity is the most severe adverse reaction *alcoholics should avoid!!!

NSAIDS MOA Indications Contradictions AE

MOA:inhibition of leukotriene and prostaglandin pathways Indications: analgesic, anti-inflammatory, antipyretic, platelet inhibition, OA, RA, mild to moderate pain, fever, gout *good adjunctive pain relief Contradictions: Vit. K deficiency and peptic ulcer disease and women in the third trimester or nursing mothers AE: GI bleeding and acute renal injury especially if pt is dehydrated, MI, stroke, pulmonary edema

Metoprolol class indications

Most commonly used beta1 blocker Class: Beta1 blocker indications: post MI, stable heart failure Oral and injectable available

The nurse recognizes that manifestations of NSAID toxicity include

N/V

What is a cholinergic crisis? And what are the signs?

SLUDGE S-salivation L-lacrimation U- urinary incontinence D-diarrhea/cramps G-GI/cramps E-emesis *treat with atropine which is an anticholinergic

An older adult is taking ibuprofen 3200 mg divided in 3 doses daily for arthritic pain. To identify possible AE associated with this medication, what is the priority nursing assessment?

Serum creatinine and blood urea nitrogen

What are nursing implications of muscle relaxants?

Start with low dose, gradually increase Give oral dose with food. Encourage fluids, increased fiber Discontinuing drug

What should a nurse watch for with someone who is taking a benzodiazepines?

Weakness Slurred speech Ataxia Uncoordinated muscle movements Respiratory depression Monitor patients, especially older adults, for paradoxical reactions. Monitor patients for signs of dependence and tolerance. Taper benzodiazepines to prevent withdrawal *give 30 min before bedtime

The surgical nurse is reviewing operative cases scheduled for the day. Which of these patients is more prone to complications from general anesthesia? a) A 79-year-old woman who is about to have her gallbladder removed b) A 49-year-old male athlete who quit heavy smoking 12 years ago c) A 30-year-old woman who is in perfect health but has never had anesthesia d) A 50-year-old woman scheduled for outpatient laser surgery for vision correction

a

The nurse associates use of what OTC medication with development of hepatotoxcitiy?

acetaminophen

The nurse is reviewing the drugs currently taken by a pt who will be starting drug therapy with carbamazepine? Which drug interactions may arise?

acetaminophen

What is the most widely used non opioid analgesic?

acetaminophen

A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this client?

acetylcysteine

Conditions the predispose someone to toxic effects of Succinylcholine

acidosis, hypocalcemia, hypokalemia, myasthenia gravis

What are common contradictions of anticholingeric drugs?

acute asthma, cardiac instability, GI obstruction, BPH

A nurse is teaching a client who has anemia and a new prescription for a liquid iron supplement. Which of the following info should the nurse include in the teaching?

add foods that are high in fiber, rinse your mouth after medications, expect stools to be green or black in color, add red meat

A pt is receiving an opioid via a PCA pump as part of his post op pain management program. During rounds, the nurse finds him unresponsive, with respirations of 8 breathes/min and BP 102/58 mm Hg. After stopping the infusion what should the nurse do next?

administer an opiate antagonist per standing orders

The nurse is preparing to give medications. Which is the most appropriate nursing action IV phenytoin?

administer in normal saline solution

A patient has been admitted to the emergency department because of an overdose of an oral benzodiazepine. He is very drowsy but still responsive. The nurse will prepare for which immediate intervention?

administration of flumazenil

The nurse anesthetist is planning to use balanced anesthesia during a surgical procedure. A characteristic of this type of anesthesia is the:

administration of minimal doses of multiple anesthetics

A patient is recovering from general anesthesia. What is the nurses main concern during the immediate post op period?

airway

Succinylcholine is administered to a client who is being mechanically ventilated. What therapeutic response does the nurse expect?

alert but unable to move

What does a nonselective beta blocker do?

all of the same things as a selective beta blocker, but also blocks receptors on the smooth muscle of the bronchioles

Common contradictions for benzodiazepines?

allergy, narrow angle glaucoma, pregnancy

What medication will the nurse recognize as possibly causing the potentially life-threatening exfoliative dermatitis known as Stevens-Johnson syndrome or toxic epidermal necrolysis?

allopurinol

Adverse effects of adrenergic agonsits

alpha - HA, restlessness, excitement, insomnia, euphoria, chest pain, hypertension, palpitations, dysrhythmias, N/V beta- tremors, HA, nausea, dizzy

Which statement regarding the use of midazolam or propofol for moderate sedation is accurate?

amensia is a common effect of midazolam

Medications that relieve pain without losing consciousness are called what?

analgesics

What are common indications for beta blockers?

angina, MI, cardiac dysfunction, heart failure, hypertension, HA commonly given after an MI to protect the heart

Which condition will alert the nurse to a potential caution or contradiction regarding the use of dopaminergic drug for treatment of mild parkinson's?

angle closure glaucoma

When the nurse is reviewing a list of medications taken by an 88 year old patient, the pt says "I get dizzy when I stand up." She also states she has nearly fainted a few times. Her BP drop 15 points when she stand sup. What medication is responsible?

antihypertensives

For best results when treating severe pain associated with pathological spinal fractures related to metastatic bones cancer, the nurse should remember that the best type of dosage schedule is the administer the pain medication

around the clock, with additional doses as needed for breakthrough pain

An 82 yr old pt is admitted to the hospital after an episode of confusion at home. The nurse is assessing the current medications he is taking at home. Which method is the best way to asses his home medications?

ask pt wife to bring in medication containers

A nurse is preparing to administer eye drops. Which of the following actions should the nurse take?

ask the client to look up, drop medication into the center of the clients conjunctival sac, instruct client to close her eye gently after instillation

Identify the NSAIDS

aspirin ibuprofen ketorolac celecoxib

For a pt receiving vasoactive drug like IV dopamine, which action is most important?

assess the IV site hourly for possible infiltration

A client with Alzheimer's disease accidentally took 2 weeks supply of donepezil. Assessment on arrival to the ED reveals severe hypotension and vomiting. What drug will the nurse anticipate administering initially?

atropine

What is the cure for early stage cholinergic crisis?

atropine

What should a nurse teach a pt about adrenergic blocking drugs?

avoid caffeine, avoid alcohol. look for chest pain, palpitations, confusion or weight gain, move slowly while changing positions, constipation so increase fiber

The nurse is providing education about cholinergic blocking drug therapy to an older adult patient. What is important to emphasize?

avoid exposure to high temperatures

What are special conditions that pt's with chronic lung disease taking an adrenergic agonist need to take?

avoid situations that inflame respiratory tract (like infections, foods, allergens etc) increase fluid intake to 3000ml/day

Sodium thiopental

barbiturate general anesthetic

What is important for a nurse to assess of someone who is taking anti gout medications?

baseline serum uric acid levels and urinary output of at least 10-60 mL/hr or 0.5 mL/kg/hour

The nurse is preparing to administer a medication for sleep. Which intervention applies to the administration for a non benzadiazepine like zaleplom?

because of their rapid onset, these drugs need to be taken just before bedtime

How is spinal HA treated?

bedrest and analgesic medications

The nurse is giving a cholinergic blocking drug and will assess the patient for which contradictions to these drugs?

benign prostatic hyperplasia

Interactions with general anesthia

beta blockers and antihypertensives

Why could beta1 activation cause angina?

beta1 receptors increase the workload of the heart and increase demand for oxygen

If a pt has asthma or bronchitis, what adrenergic agonist would be helpful?

beta2

What are common signs of acetaminophen overdose?

bleeding, loss of energy, fever, sore throat, easy bruising

The nurse providing teaching for a patient who has a new prescription for beta1 blockers will keep in mind that these drugs may result in what effect?

bradycardia

What are the AE of cholinergic agonists?

bradycardia, bradypnea, dizzy, hypotension

What are common AE of beta blockers

bradycardia, depression, impotence, constipation, fatigue - avoid sudden withdraw should tapper off in 1-2 weeks

What would a stimulation in beta2 receptors cause?

bronchodilation and increase in glycogenolysis

What information will the nurse give to a client who is taking phenytoin?

call prescriber if you get sore throat or fever

drug interactions with saw palmetto

can change effects of birth control

drug interactions with gingko

can increase bleeding - anticoagulants and antiplatelets

drug interactions with hawthorn

can lead to toxic levels of cardiac glycosides

Why are beta blockers, specifically beta2 dangerous in diabetics?

can mask symptoms of hypoglycemia

drug interactions with ginger root

cardiac, anti diabetic or anticoagulant drugs

Identify the three anitparkinson's drugs

cardipoda/levodopa - dopamine replacement pramipexole - mimics effects of dopamine selegiline- inhibits monoamine oxidase

Define the term hypnotic

cause sleep and more potent on the CNS than sedatives

MOA of muscle relaxants

causes sedation and muscle relaxation by depressing the CNS

A client is receiving a dobutamine drip and starts to complain of a new feeling of tightness in his chest. What will the nurse do first?

check the vitals

A mother calls to ask what medication to give her 5 yo for a fever, the best response is?

children's doses of acetaminophen or ibprofen but NOT aspirin

Which ANS drug classification has the same response as adrenergic blocking?

cholinergic agonists

Which ANS drug classification has the same response as adrenergic agonists?

cholinergic blocking

Identify some conditions that oppose neuromuscular blocking drugs

cirrhosis, clostridial infections, hypercalcemia, hyperkalemia, neurapathies, thermal burns

Tamusolin Class Indications Contradictions

class: alpha blocker Indications: treatment for benign prostatic hyperplasia Contradictions: concurrent use of erectile dysfunction medication Only for oral use

Phenobarbital class infications

class: barbiturates - long acting Indications: generalized tonic clonic seizures and hyperbilirubinemia in neonates only in injectable and oral forms

Propofol class indications

class: general anestetics indications: sedation for mechanical ventilation, used for moderate sedation so pt may still be able to hear *if used for a long time serum lipids need to be monitored

Prednisone class

class: glucorticoids

methylprednisolone class

class: glucorticoids

Donepezil class indications

class: indirect acting cholinergic agonist, it increases the levels of ACh by inhibiting AChE Indications: mild to moderate Alzheimer's *not curative can take 6 weeks to work

lidocaine class

class: local anesthesia

Succinylcholine Class MOA Admin Contradiction AE

class: neuromuscular blocking drugs (NMBD) MOA: there is total muscle paralysis, since it is so quick acting it is used for endotracheal intubation this is because it is structurally similar to ACh - DOES NOT PRODUCE ANALGESIA OR REDUCE ANXIETY!!! Paralyzed but conscious. Indications: for controlled ventilation during surgery or induction of ET intubation Admin: only injectable form Contradictions: malignant hyperthermia, skeletal muscle myopathies AE: rhabdomyolysis and hyperkalemia!

Labetalol Class Indications

class: nonselective beta and alpha Indications: severe hypertension and hypertensive emergencies Oral and Injectable

Fentanyl Class Indications admin

class: opioid agonist Indications: patches (transdermal) can be used fro chronic pain. used to treat moderate to severe pain, more potent than morphine, high abuse potential admin: IV, transdermal, PO

Naltrexone class indications

class: opioid antagonist indications: used as an adjunct in opioid addicts, reversal of post op respiratory depression *dont use in pts with liver or renal dysfunction Admin: only oral

Allopurinol Class MOA AE Dose

class: uricourics MOA: inhibits uric acid production AE: agranulocytosis, aplastic anemia, skin falling off Dose: oral only and max of 800 mg/day *watch for stevens-johnson syndrome

Which opioid is most commonly used to suppress a cough?

codeine

A pt's chart includes an order that reads as follows: "Atentolol 25 mg once daily at 0900." Which action by the nurse is correct?

contact prescriber to clarify dosage

Each statement describes a phase of pharmacokinetics. Put the statements in order, with 1 indicating the phase that occurs first and 4 indicating the phase that occurs last. a) Enzymes in the liver transform the drug into an inactive metabolite. b) Drug metabolites are secreted through passive glomerular filtration into the renal tubules. c) A drug binds to the plasma protein albumin and circulates through the body. d) A drug moves from the intestinal lumen into the mesenteric blood system.

d, c, a, b

When a drug is said to have a negative chronotropic effect, the nurse knows to expect what?

decreased HR

drug interactions with cranberry

decreased elimination of many drugs

What effects does a cardioselective (beta1) blocker have?

decreased myocardial stimulation so things such as reduced HR, slows conduction through SA node and AV node, decreases demand for oxygen

While teaching a 76-year old pt about the adverse effects of his medications, the nurse encourages him to keep a journal of the AE he experiences. This is important for the older adult due to what alteration in pharmokinetics?

decreased perfusion (blood flow) to the liver, thus impaired metabolism

During a teaching session about antigout drugs, the nurse tell the pt that antigout drugs work by what mechanism?

decreasing serum uric acid levels

The nurse is giving medications to a pt in heart failure. The IV route is chosen instead of IM. What pt function does the nurse recognize as the most influential when deciding to use IV?

diminished circulation

A nurse is assessing a client with salicylism. Which of the following findings should the nurse have expected?

dizzy, tinnitus, HA

Identify the four prototype adrenergic agonists.

dobutamine dopamine epinephrine norepinephrine

If a patient is in shock, which adrenergic agonist is best?

dopamine because it does not cause vasoconstriction int he kidneys

A client with unstable epilepsy is being seen in the clinic. The prescriber increased the phenytoin dosage two weeks ago and today's drug level is 12 mcg/mL. Based on this drug level, which of the following will the nurse anticipate?

dose will not be changed, phenytoin is typically between 10-20 mcg/mL

When assessing the AE of a cholinergic blocking drug the nurse would expect eh pt complain of what?

dry mouth

What should a nurse educate a patient about when educating about NSAIDS?

dyspepsia, heart burn, GI bleeding, hearing loss, tinnitus, take with food or milk to limit GI distress

The nurse is assessing a client who has been taking donepezil for 3 days. The client has flushed skin, orthostatic blood pressure changes and is complaining of abdominal cramps, severe N/V. The nurse recognizes which of the following may occur?

early signs of cholinergic crisis

A client is taking OTC antacids for relief of indigestion and tells the nurse that he consumes at least one bottle a week and has done so for more than 1 month because "it works for me." What is the nurse's primary concern?

email her

OTC medications now account for about what percent of all medications used in the United States?

email her

Possible indications for adrenergic agonists

emergencies like shock or heart failure, reduce intraocular pressure, asthma or bronchitis

What is the cure for late stage cholinergic crisis?

epinephrine

What are the two nonselective adrenergic agonists?

epinephrine and norepinephrine

Order the first to last sensation of the neuromuscular blocking drug Succinylcholine.

first - muscle weakness second - small, rapid moving fingers and eyes third - limbs and trunk last - cessation of respiration and for recovery this order is reversed

what is the primary concern and AE of an alpha blocker?

first dose phenomenon - sever decrease in BP causing someone to faint or pass out. Orthostatic hypotension is common so pts must be taught to move slowly from supine position

During a patient teaching session about antiparkinson drugs the nurse should include what?

force fluids to prevent dehydration

A nurse is reviewing a new prescription for ondansteron 4 mg IV bolus prn for N/V. The nurse should clarify what?

frequency

An elderly woman took a prescription medicine to help her sleep; however she felt restless all night and did not sleep at all. The nurse recognizes that this woman has experienced which type of reaction or effect?

idiosyncratic reaction

Why is alcohol tolerance important to administration of anesthesia?

if someone is alcohol tolerant they may be tolerant to anesthesia

What should you teach a patient about acetaminophen?

if they have liver disease don't exceed 2000mg overdose is possible if also taking oxycodone or hydrocodone

The nurse is reviewing factors that influence pharmacokinetics in the neonatal pt. which factor puts the neonatal pt at risk with regard to drug therapy?

immature renal system - impaired excretion

Which nursing diagnosis is possible for a pt who is now recovering after having been under general anesthesia for 3/4 hours?

impaired gas exchange due to the CNS depressant effect of general anesthesia

What are therapeutic outcomes of adrenergic agnosists?

improved cardiac output, return to normal VS, improved skin color, normal RR

Define positive dromotropic effect

increase in conduction of cardiac electrical nerve impulses

Define positive inotropic effect

increase in force of contration of the heart

Define positive chronotropic effect

increase in heart rate

The nurse is responsible for pre-op teaching for a pt who is mildly anxious about receiving pain meds post op. The nurse knows this level of anxiety may...

increase pt's motivation to learn

drug interactions of valerian

increased CNS depression if sued with sedatives

The nurse caring for a patient who is receiving beta1 agonist drug therapy needs to be aware that these drugs cause which effect?

increased cardiac contractility

What would require an increase in dosage?

increased renal excretion, increased medication metabolizing enzymes, peripheral vascular disease

Drug interactions for chamomile

increased risk bleeding with anticoagulants

A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication?

increased urine output

A nurse is teaching a client about the new prescription for celebcoxib. Which of the following information should the nurse include in the teaching?

increases the risk for a myocardial infarction

Epinephrine Indications Selective or not selective Admin

indications: emergency situations. At low doses it stimulates beta1 receptors which increases HR and contractility. It can also be used for acute asthma, analyphaltic shock. At high doses it causes vasoconstriction thus an increase in BP, cardiac arrest, shock, AV block, asthma it can help control bleeding due to vasoconstrictive agents and increases BP *common med error!! It comes in two doses 1:1000 and 1:10,000 Asmin: subQ or IV nonselective: alpha and beta

Non-benzodiazepines MOA and indications

indications: temporary treatment of insomnia MOA: enhances effects of GABA *take on an empty stomach

A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following actions should the nurse take?

infuse medication through large-bore needle implement cardiac monitoring administer the infusion using IV pump

A client is recovering from a MI. The nurse notes a prescription for metoprolol and recalls the purpose of this drug is to:

inhibit catecholamines and myocardial stimulation

drugs interactions with evening primrose

interaction with antipsychotics

drug interactions with echinacea

interference with immunosuppressant drug and antivirals

What should a nurse teach a pt about donepezil (a drug used for Alzheimer's)

it can causing vomiting, GI bleed or ulcers, be cautious in pt's with asthma or COPD and to take before bedtime, can take with or without food, does not cure the disease

A nurse is caring for a client who requests information on the use of feverfew. What is the nurses best response?

it can decrease the frequency of migraine HA

Why is epinephrine administered with local anesthetics?

it is a vasoconstrictor and can help control blood loss

The nurse is developing a dc plan regarding a pt's medication. Which of these statement about dc plans is true?

it is individualized and based on the pt's cognitive level

A nurse is caring for a client who has increased liver enzymes and is taking herbal supplements, Which if the following herbal supplements should the nurse report to the provider?

kava - high doses could cause liver failure

What herbal supplements react with benzodiasapines

kava and valerian - be mindful of other CNS depressants

Which adrenergic blocking drug prototypes are beta and alpha blocking?

labetalol carvedilol

What should a nurse look at during the assessment phase of someone receiving opioids or non opioids analegics?

liver and kidney function, history of drugs or alcohol, respiratory status, presence of bowel sounds, cardiac status, if someone has asthma or head injury (with opioids)

What are two reasons to administer a medication at a dose lower than normal?

liver failure, concurrent use of medication the same pathway metabolizes

The nurse is caring for a client who has been taking phenytoin. Understanding the possible AE/SE associated with this drug, the nurse will be most concerned about which of the following?

low serum albumin

define REM interference

prolonged use of sedative-hypnotics can influence rem sleep this is rem interference

A client in a long-term care facility has a new order for carbamazepine. The nurse monitors for autoinduction, which will result in which of the following?

lower than expected drug levels

What is important for a nurse to teach about anticholinergics?

maintain good oral hygiene because dry mouth is expected, exercise must be done with caution, wear sunglasses due to sensitivity to light, constipation can be managed by increase of fiber intake

A nurse is preparing a client's medications. Which of the following actions should the nurse the nurse take to follow legal practice?

maintain skill competency, monitor for AE, safeguard medications

The nurse is assessing a client's medication list. Gabapentin is listed, but the client denies any history of seizures.. The nurse suspects that the client:

may be taking this drug for neuropathic pain.

drug interactions with kava

may increases effect of barbiturates and alcohol

drug interactions of st johns wort

may lead to serotonin syndrome

A client in the ICU will receive succinylcholine. What equipment is essential to have nearby before giving the drug?

mechanical ventilator

While caring for a pt with cirrhosis or hepatitis, the nurse knows that abnormalities in which phase of pharmacokinetics may occur?

metabolism

A pt with renal cancer needs an opiate for pain control. Which opioid medication would be the safest choice for this pt?

methadone

Which adrenergic blocking drug prototypes are only beta blocking? (cardioselective)

metoprolol

What is the benzdiapine prototypes? Non benzadiapine?

midazolam zolpidem

The nurse is monitoring a pt who is receiving an infusion of a beta-adrenergic agonist. Which AE may occur?

mild tremors, tachycardia, palpitations, nervousness

When a patient is taking a long term NSAID which drug may be given to prevent serious GI adverse effects?

misoprostol

What is the most appropriate nursing action when administering phenytoin IV? Select all that apply.

mix in normal saline stop if pt complains of palpitations

What are the main indications of opioids?

moderate to severe pain

What are nursing indications for adrenergic agonists?

monitor cardiac rhythm, look for chest pain or dysrhythmias, look at respiratory rate

The nurse is administering an AED and will follow which guidelines?

monitor for drowsiness, give medication at same time every day, notify prescriber if pt does not take it

A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches, The patient asks the nurse what benefits these patches shave. The nurse's best response includes which?

more constant drug levels

Identify all prototype opioid agonists

morphine (strong agonist) fentanyl (strong agonist) codeine (mild agonist) oxycodone (strong agonist) hydrocodone

Indications of muscle relaxants

muscle spasms, spasticity, MS, cerebral palsy

Identify the two opioid antagonists.

naloxone and naltrexone

IV morphine is prescribed fora patient who has had surgery the nurse informs the pt that which common AE can occur

nausea, pruritus

What must phenytoin must be diluted with

normal saline

When assessing a client who is receiving general anesthesia, what organ system change does the nurse expect?

nystagmus

A nurse reviewing a client's medical record notes a new prescription for verifying the trough. Which action should the nurse take?

obtain a blood specimen prior to administering the new medication

A provider prescribes phenobarbital for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day would the nurse administer the medication?

once - long half lives are once a day

Several pts have standard orders for acetaminophen as a needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the pts has a contraindication to acetaminophen. which pt would that be?

one admitted with severe hepatitis

What is a cholinergic receptor?

one that binds to ACh and mediates its actions Cholinergic refers to the PSNS instead of the SNS like adrenergic drugs do

Hydrocodone

opioid agonist only available in tablet form

A pt is taking an alpha blocker as treatment for benign prostatic hyperplasia. The nurse will monitor for which potential drug effect?

orthostatic hypotension, increased urine flow, HA

What are indications for opioid antagonists?

overdose

What suffix do Benzodiazepines usually end in?

pam

AN older adult has been given a benzodiazepine for sleep induction, but the night nurse noted that the pt was awake most of the night. The nurse documents that the pt has had which type of reaction?

paradoxical

What is the fastest way a drug can be absorbed?

parenteral route

What are common indications for anticholinergics?

parkinson's because they decrease muscle rigidity and tremors at low doses they slow the heart, but at high doses they increase heart rate

What is the main contradiction of giving an alpha blocker?

peripheral vascular disease, liver disease, renal disease, peptic ulcer

What would a stimulation in beta1 receptors cause?

positive inotropic effect, positive chronotropic effect and positive dromotropic effect

A 47 yo pt with diabetes is being dc to home and must take insulin injections bid. The nurse keep in mind which concepts when considering pt teaching.

teaching needs to begin at time of diagnosis or administration and is individualized to the pt's reading level

What is very important to assess for patients undergoing general anesthesia?

temperature - to make sure there is no malignant hyperthermia occurring

When is drug exposure most detrimental during pregnancy?

the 1st trimester

An 86 year old patient is being discharged to home on Digitalis therapy and has very little information regarding medication. Which statement best reflects a realistic outcome of patient teaching?

the daughter and pt will state proper ways to take the drug

Which considerations are important for the nurse to remember when administering a benzodiazepine as a sedative hypnotic drug.

the dose needs to be given about 1 hour before the pt's bedtime the pt needs to be evaluated for the drowsiness that may occur the morning after a benzodiazepine

A pt who has been taking carbidopa-levodopa for parkinson's for over 1 year wants to start a low carb/high protein diet. The nurse tells the pt that is diet may effect therapy how?

the high protein diet can slow or prevent absorption of the medication

Why do many people claim to be allergic to morphine?

the increase in histamine causes itching, but they are not actually allergic

Why are sublingual and buccal drugs absorbed quickly?

the tongue has a large blood vessel supply and they can bypass the liver

What should a nurse teach a client about post-op interventions?

there will be turning, coughing and deep breathing exercises

A pt is about to undergo cardioversion and the nurse is reviewing the procedure and explaining moderate sedation with propofol. The pt asks "I am afraid of feeling it when they shock me" What is the nurses best response?

these medications help ease any pain and most pts often report not having any recollection

What is the MOA of barbiturates

they act on the reticular formation to depress the CNS

What is important to know about phenytoin and Carbamazepine regarding birth control

they both decrease effectiveness of contraceptives and carbamazepine can indicate a false negative on a pregnancy test

Why would beta blockers be used to treat angina?

they decrease the oxygen demand from the heart, they are considered "cardioprotective" u

What are the AE of barbiturates?

they deprive people of sleep so it can result in agitation

What is the MOA of AED?

they increase the threshold making it harder for a nerve impulse to stimulate a response suppress transmission of nerve impulses decrease speed of nerve impulse *low levels of GABA are associated with seizures

One client has an order for aspirin 325 mg PO daily and another has an order for aspirin 650 mg PO 4-6 times per day. What is the indication for the prescription of aspirin 325 mg daily?

thromboprevention

A 49 yo pt has been admitted with possible salicylate intoxication. The nurse will assess for what?

tinnitus, HA, nausea

What is the difference between tolerance and dependence?

tolerance is a decreasing response to repeated drug doses and dependence is a physical need for a drug

During an assessment of a pt about to receive a cholinergic blocking drug, the nurse will determine whether the patient is taking any drugs that may potentially interact with anticholinergic like:

tricyclic antidepressants, such as amitriptyline

What are common non pharmaceutical interventions nurses may do with someone after anesthesia?

turn them, coughing and deep breathing exercises to prevent pneumonia and atelectasis, encourage ambulation

What are common contradictions for beta blockers?

uncompensated heart failure, shock, bradycardia, pregnancy, Raynauds

A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor?

urinary retention

A nurse is admitting a client and completing a pre assessment before administering medications. Which of the following data should the nurse include in the pre assessment?

use of herbal teas, current health status, food allergies

Which is the most appropriate example of a product formed by an indirect form of gene therapy?

vaccines

What action by the nurse is the best way to assess a pt's learning needs?

validate the pt's present level of knowledge

What is the primary alpha adrenergic response?

vasoconstriction and CNS stimulation

What SNS response would an adrenergic agonist cause?

vasoconstriction, GI muscle contraction, contraction of uterus and bladder, dilated pupils

Adrenergic blockade at the alpha receptors leads to what effects?

vasodilation, miosis, reduced BP

A nurse is completing an assessment of a clients current medications. The client states she also take gingko biloba. What medication is a contradiction with this medication?

warfarin

A nurse is taking a history for a client who reports that he is taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken by the pt is contradicted with aspirin?

warfarin

The physiological differences in the pediatric pt compared with the adult pt affect the amount of drug needed to produced a therapeutic effect. The nurse is aware that one of the main differences is that infants have...

water composition of approx 75%

What is important for a nurse to implement when administering an oral AED?

with oral dosing give with fluid and meals

A nurse is planning to administer morphine IV to a client who post-op. Which of the following actions should the nurse take?

withhold the medication until respiratory rate is greater than 12 breathes

A pregnant pt who is 32 weeks gestation asked about a pregnancy category A drug. Can she take it?

yes!!