Pharmacology Test 2

Anitcholinergic drugs

1. ipratroppium (IH) 2. Tiotropium (IH)

interventions of methylxanthine drugs

1. monitor plasma drug levels 2. discontinue if toxicity levels high 3. giver activated charcoal to decrease absorption 4. prepare to initate anticonvulsant therapy and institure seizure precautions 5. monitor HR and rhytm 6. give antidysrhytmics to restore rhythm

What are the contraindications of psyllium?

Esophageal or GI obstruction Narrowing of intestinal lumen fecal impaction dysphagia nausea/vomiting abdominal pain appendicitis

What is the adverse drug reaction for psyllium?

Esophageal or intestinal obstruction *this can occur when taking too little fluid with psyllium*

What is the prototype for Expectorants?

Guaifenesin (mucinex)

What are the therapeutic uses for Lubiprostone?

IBS with constipation in women over 18 Chronic idiopathic constipation in men and women

What is the prototype for proton pump inhibitors?

Omeprazole (Prilosec) *end in prazole*

What is the prototype for serotonin antagonists?

Ondansetron (Zofran) *Drugs end in -setron*

What are the contraindications for Lubiprostone?

Severe diarrhea, diverticulitis, crohn's disease, ulcerative colitis, GI obstruction

client education for beta 2 adrenergic agonists

1. take as prescribess, avoid overuse of rescue inhalers 2. avoid caffeine 3. report chest pain and heart palpitations 4. notify provider if tremors interfere with ADLs

what are some characteristic of second generation H1 receptor agonists

1.Do not readily enter the brain from the blood 2. Fexofenadine and other drugs in this class bind preferentially to peripheral rather than central H1 receptors 3. Supplanting the first-generation H1 receptor antagonists in the symptomatic treatment of allergic rhinitis and in the relief of pruritus in urticaria 4/ Have a mild beneficial effect in chronic asthma

What are the common uses of histamine h2 antagonists?

1.Gastric and duodenal ulcers 2. Heartburn and dyspepsia 3. Erosive esophagitis 4. GERD 5. Aspiration pneumonitis 6. hypersecretory disorders (Zollinger-Ellison syndrome, systemic mastocytosis)

•Found in CNS •Discharged from mast cells and basophils in response to particular stimuli •Binds with histamine receptors on target organs •Producing reactions specific to the muscle groups involved

histamine

action of second generation antihistamines

mainly block histaminic receptors and do not pass the blood-brain barrier.

-phylline drugs

methylxanthine drugs

•Inflammation of paranasal sinuses •Fluid and microbe movement via cilia impeded because of nasal swelling. •Impairment of movement results in infection. •Rhinitis most common cause of sinusitis

sinusitis

__________ causes a chemical reaction to occur in the stomach, creating a gel that coats the ulcers and creates a barrier between the stomach and gastric secretions.

sucralfate

antitussive drugs

· Codeine (Opioid) · Hydrocodone (Opioid) · Dextromethorphan Bezonatate

interactions or first generation antihistamines

Alcohol and other CNS depressants increase depressant effects of antihistamines.

Contraindications and precautions for Guaifenesin?

Allergy Diabetes Concurrent use with disulfiram Phenylketonuria Cough lasting more than a week

Administration of acetylcysteine?

Expect a sulfur-like (rotten egg) odor Give via nebulizer that does not contain metal or rubber parts Clear the airway before aerosol administration Assess the client's ability to cough BEFORE administration Have suction available

__________ reduces the surface tension of secretions, thins thick mucus making it easier to cough out of the lungs and drain out of the nose and sinuses.

Expectorants

True/ False It is okay to take omeprazole with ripirivine and or with pregnancy

False

What is a GI tract disorder that is associated with asthma

GERD

Administration considerations for proton pump inhibitors

Give once daily before the first meal (food can decrease absorption) Do NOT crush, chew, or break delayed release capsules of omeprazole

leukotriene modifiers (anti inflammatory) drugs

1. montelukast (PO) 2. zileutron (PO) 3. Zafirlukast (PO)

_________ block 5-HT3 serotonin receptors located in the brain and the nerves that innervate the stomach and small intestine. This minimizes nausea and vomiting.

Serotonin antagonists

T/F Antacids that contain magnesium will worsen the diarrhea if taken with prostaglandin E analogs

T

T/F Taking azathioprine with allopurinol increases levels.

T

you are about to administer diphenoxylate plus atrophine to a client to reduce diarrhea. which drugs should you have available to treat an overdose of this drug combination a. acetylcysteine b. flumazenil c. naloxone d. diphenhydramine

c. naloxone

•Many contain antihistamine, nasal decongestant, and analgesic •Some contain antitussives, expectorants, etc. •Many are over-the-counter (OTC) medications •Antivirals

cold remedies

action of anticholinergic drugs

counteract the cholinergic activity in brain

-dine drugs

second generation antihistamines

therapuetic effects off antitussives

suppression of chronic nonproductive cough

When does COPD usually develop

usually develops with long standing exposure to airway irritants (cigarrete smoke)

What are the possible adverse drug reactions for stool softeners?

diarrhea, mild abdominal cramps, throat irritation and rash

therapuetic use of methylxanthine drugs

long term manaagement of chronic asthma

•Liquefy mucus in respiratory tract; administered by inhalation •Effective immediately after direct instillation

mucolytics

what is the most frequent adverse effect of albuterol

muscle tremor

•Relieve nasal obstruction and discharge •Most often used to relieve rhinitis •Contraindicated: severe HTN, CAD, narrow-angle glaucoma, antidepressants •Used with caution in cardiac dysrhythmias, hyperthyroidism, DM, prostatic hypertrophy, glaucoma

nasal decongestants

interactions of mast cell stabilizers

none known

•Response to nonseasonal allergens •Dust mites, molds •Animal dander

perennial disease allergic rhinitis

action of mast cell stabilizers

prevents release of histamine

What is the prototype for bulk-forming laxatives (fiber supplements)?

psyllium

What does the nurse need to teach the client about proton pump inhibitors?

1.Perform weight bearing activities daily 2. consume adequate calcium and vitamin D 3. Report vomiting or diarrhea 4. Drink lots of water 5. take magnesium supplements as needed

When treating chemotherapy-induced nausea and vomiting, give Ondansetron or other drug IV slowly (over 15 min) starting __________ min before chemo administration, and then _________ and __________ hours later.

30 min, 4 and 8 hours later

Nursing interventions for acetylcysteine?

Monitor respiratory status, administer bronchodilators as needed Have suction available Give client tissues to encourage expectorate of secretions Administer antiemetics as needed

_______ work by breaking the disulfide linkages of proteins in mucus, decreasing the viscosity of mucus. This allows clients to more easily expectorate the mucus.

Mucolytics

What are the main therapeutic uses for Ondansetron?

Nausea Vomiting from chemo and post-op recovery

What are the main adverse drug reactions for Lubiprostone?

Nausea, vomiting, diarrhea, flatulence, HA

Should you administer Lubiprostone if the client is experiencing diarrhea?

No

_______ decrease intestinal peristalsis and allows for increased absorption of water from the feces, resulting in smaller harder feces and fewer bowel movements.

Opioids

_______ stimulate the intestinal motility of the colon and act on intestinal walls causing increased secretions of water and electrolytes from it.

Stimulant laxatives

Administration for Guaifenesin?

Use only when needed Notify provider if cough worsens or high fever develops Do NOT chew or crush extended release tablets Do NOT take in combination with products for cold that also contain Guaifenesin

a nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects a. reduces inflammation b. reduces gastric acid c. prevents diarrhea d. prevents straining

d. prevents straining

you are instructing a client about using cromolyn via inhalation to treat exercise induced bronchospasm. You advise the client to take the drug a. 15 minutes before exercising b. if needed to stop bronchospasm c. after strenuos activity d. once in the evening at bedtime

a. 15 minutes before exercising rationale: cromolyn may prevent exercise induced asthma if used 15 minutes before exercising and be used by nebulizer up to 4 times per day

a female client of childbearing potential is starting therapy with misoprostol to prevent gastric ulcers. Which of the following instructions should you include when teaching this client (select all that aply) a. mid cycle spotting can occur b. take a pregnancy test prior to therapy c. report excessive menstrual pain d. use effective contraception e. avoid taking the drug at bedtime

a,b,c,d

a client is starting therapy with psyllium. You explain to the client that psyllium will have which of the following therapuetic effects. select all that apply a. relieve constipation b. increase gastric ph c. reduce diarrhea d. decrease gastric acid secretion e. alleviate nausea

a,c

A nurse is planning care for a client who is receiving chemotherapy and has a new persciption for ondansetron. Which of the following actions should the nurse plan to take. Select all that apply a. infuse the drug 30 min prior to chemotherapy b. administer the drug when the client reports nausea c. infuse the drug slowly over 15 minutes d. administer the drug immediately following chemotherapy e. repeat the dose 4 hours after chemo

a,c,e

The health care professional is providing instructions to the client on taking aluminum hydroxide. Which of information should be included? select all that apply a. check labels for sodium and phosphate content b. decrease activity and exercise c. increase fluid and fiber intact d. report whitish colored stools e. monitor for signs of constipation

a,c,e

a nurse is teaching a client about the adverse effects of pseudoephedrine. Which of the following should the nurse include (select all that apply) a. restlessness b. bradycardia c. insomnia d. muscle pain e. anxiety

a,c,e

a nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include a. "avoid driving or activities requiring alertness" b. "if you miss a dose, double the next dose" c. "Rinsing the mouth with alcohol based mouth wash can reduce dryness" d. "Having one glass of wine each night can improve medication effectiviness"

a. "avoid driving or activities requiring alertness"

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make a. "use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn" b. "the medication can stain your contact lenses green" c. "the medication can color your urine dark brown" d. "Take an iron supplement when you take sulfasalazine to prevent anemia"

a. "use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn" photo sensitivity is a possible adverse effect of sulfasalazine that makes the skin sensitive to light. The nurse should instruct the client to wear sunscreen and protective clothing when outdoors to prevent burning

what are characteristics of anti tussives

1. Suppress dry, hacking, nonproductive cough 2. Centrally acting include 3. Narcotics and nonnarcotics 4. Locally acting include 5. Throat lozenges, cough drops

therapuetic use of leukotriene modifiers

• Adjunctive therapy in the treatment of allergic rhinitis, asthma, and exercise induced bronchospasm

Proton Pump inhibitors are used for?

1. Gastric and duodenal ulcers 2. prolonged dyspepsia 3. GERD 4. Erosive esophagitis 5. Hypersecretory disorders

What are the adverse effects of histamine h2 antagonists?

1. Impotence 2. reduced libido with cimetidine (not ranitidine) 3. confusion 4. arrhythmia 5. aplastic anemia 6. agranulocytosis 7. Increased susceptibility to pneumonia

contraindications and precautions for second generation antihistamines

1. Infants under 6 mo 2. Breastfeeding women 3. Allergy to H1-receptor antihistamines or hydroxyzine 4. Impaired kidney or liver function

a nurse is caring for an older adult client who has renal impairement and a new prescription for cimetidine. The nurse should instruct the client to report which of the following manifestions a. lethargy b. cellulitis c. dry mouth d. myalgia

a. lethargy

you should instruct a client using phenylephrine spray for nasal congestion to do which of the following to avoid rebound congestion a. limits the drugs use to 3-5 days b. add an intranasal glucocorticoid c. taper the dose before discontinution d. restrict the drugs use to one nostril at a time

a. limits the drugs use to 3-5 days rationale: short term use to prevent rebound congestion.

a nurse is caring for a client who is takin lubiprostone. The nurse should tell the client that lubiproston can cause which of the following adverse drug reactions a. nausea b. constipation c. urinary retention d. sore throat

a. nausea

a nurse is teaching a client about albuterol. The nurse should instruct the client to monitor for and report which of the following as an adverse effect of this drug? a. fever b. bruising c. polyuria d. palpitations

d. palpitations

adverse drug reactions of leukotriene modifiers

1. Leukotriene modifiers zileuton and zafirlukast can cause liver damage. Does not occur with montelukast. • 2. Neuropsychiatric effects such as suicidal ideations

contraindications and precautions of leukotriene modifiers

1. Liver dysfunction (zileuton and zafirlukast), not montelukast • 2. Acute asthma exacerbations • 3. Status asthmaticus 4. Severe asthma

interactions for sympathomimetics

1. MAOI antidepressants potentiate the effects; do not use within 3 weeks of each other. 2. Beta2-adrenergic agonists and other stimulants potentiate hypertensive effects of drug.

interventions of antitussives

1. Monitor clients when changing positions or ambulating. 2. Administer drug with food or milk. 3. Encourage diet high in fluids and fiber. 4. Administer stool softener such as docusate sodium (Colace) and stimulant laxatives such as bisacodyl (Dulcolax). 5. Monitor respirations. 6. For respiratory rates below 12/min, stimulate breathing. 7. Administer an opioid antagonist such as naloxone (Narcan) to restore respiratory rate. 8. Give drug only when needed.

therapuetic use of mast cell stabilzers

1. long term treatment of allergy relateed asthma 2. prophylaxis for exercise induced bronchospassm 3. prophylaxis for seasonal allergy symptoms 4. management of allergic rhinitis (NA)

What are the nursing interventions for antacids?

1. monitor bowel functions and administer stool softener 2. monitor for severe diarrhea 3. monitor magnesium and phosphorus levels

adverse drug reactions of methylxanthines

1. rare at therapeutic levels 2. when therapuetic levels are exceeded= restlessness, insomnia 3. n/v/d 4. when reaches toxic levels= seizures 5. dysrhytmia

client instructions of anticholinergic drugs

1. suck on hard candy 2. si[ water frequently 3. have regular eye exams for glaucoma 4. report any changes in urinary elimination

a nurse is caring for a client who has a new prescription for alostron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse effects of the drug a. headache b. drowsiness c. abdominal pain d. sore throat

c. abdominal pain

a client is going to take ranitidine in the form of effervescent tablets. Which administration instructions for this drug formulation should be included a. swallow the tablets whole b. chew the tablets before swallowing c. dissolve the tablets in water before drinking d. place the tablets under the tongues

c. dissolve the tablets in water before drinking

client instructions for methylxanthines

1. reduce or eliminate caffine 2. havae periodic lab testing of drug levels 3. stop taking the drug and notofy provider if experiencing seizures 4. stop taking the drug and notify the provider if experiencing dysrhytmias

What should the client know before taking Alosetron?

1.Signs required treatment agreement and meets the criteria for the drug 2. report constipation and bleeding 3. stop using after 8 weeks if diarrhea persists

a nurse is reviewing the medical record of a client who has a new prescription for ranitidine. The nurses should recognizes that which of the following drugs interacts with ranitidine? a. phenobarbital sodium b. ketoconazole c. lisinopril d. hydrochlorothiaziade

b. ketoconazole

action of first generation antihistmines

block both histaminic and muscarinic receptors as well as passing the blood-brain barrier.

a nurse is caring for a client who has a presciption for alosetron. The nurse should recognize that alosteron therapy is effective when the client reports which of the following a. one formed stool per day b. urination without burning c. cessation of nausea or vomiting d. reduced GI reflux effects

a. one formed stool per day

a nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions a. a seizure disorder b. rheumatoid arthritis c. a positive pregnancy test d. heart failure

c. a positive pregnancy test

a nurse is teaching a client about montelukast, which of the following instructions should the nurse include? a. use a spacer to improve inhalation b. take the drug at the onset of brochospasm c. rinse mouth to prevent an oral fungal infection d. take the drug once a day in the evening

d. take the drug once a day in the evening

therapeutic use of beta 2 adrengeric agonists

1. long term management of asthma 2. prevention of exercise induced bronchospams 3. treatment of ongoing asthma excerabations

therapuetic use for glucocorticoids

1. long term management of chronic asthma 2. short term managment of post exacerbation symptoms (oral)

Nursing interventions for metaclopramide?

1. monitor client while ambulation 2. Monitor for adverse drug reactions 3. recommend the lowest dose for shortest duration 4. Monitor for muscle rigidity, hyperthermia, tachycardia, diaphoresis, and altered consciousness

symptoms of allergic rhinitis

1. nasal congestion 2, itching, sneezing 3. watery drainage 4. itching of throat, eyes, ears common

client instructions of leukotriene modifiers

• Report abdominal tenderness, nausea, or anorexia. • Report behavioral changes such as agitation, insomnia, anxiety or irritability.

What are the adverse drug reactions for glucocorticoids?

inhaled- thrush (oral candidiasis) oral- suppression of adrenal function, bone demineralization, muscle wasting, hyperglycemia, peptic ulcer disease, infection, fluid and electrolyte imbalances nasal-headache, dry mucous membranes, epistaxis, sore throat

What are the drug interactions for sulfasalazine?

iron and antibiotics effect absorption decreases the absorption of digoxin

Why is metaclopramide used for nausea and vomiting?

it increases the threshold of the chemoreceptor trigger zone in the brain.

methylxanthine drugs

1. Theophylline (PO/IV) 2. Aminophylline (IV)

Contraindications of antihistamines?

1. newborns or premature infants 2. pregnancy 3. angle-closure glaucoma 4. hypersensitivity

What are the three antiemetics that treat nausea?

1. Serotonin antagonists 2. antihistamines 3. dopamine antagonists

_____________ prevent vertigo, nausea, and vomiting by blocking the release of histamine H1 receptors in the inner ears.

Antihistamines

1st generation antihistamines

1. Diphenhydramine 2. dimehydrinate 3. promethazine

_________ inhibit production of B and T lymphocytes which decreases the immune response in the body.

Immunosuppressants

Action of Methylxanthine drugs

Relaxation of bronchial smooth muscle, resulting in bronchodilation

-buterol drugs

beta 2 adrenergic agonists

What is the prototype for antihistamines?

dimehydrinate

NS antihistamine drugs

1. azelastine 2. olopatadine

Give stool softeners with _________ oz of water at least.

8 oz

Interactions with acetylcysteine?

Activated charcoal

mast cell stabilizer drug

Cromolyn (IH)

therapuetic use of anticholinergic drugs

1. relief of bronchoconstriction in clients who have COPD 2. decreases secretions in clients with COPD

antihistamine indications for use

1. relieve symptoms but dont relieve hypersensitivity •Allergic rhinitis •Anaphylaxis •Allergic conjunctivitis •Drug allergies, pseudoallergies •Blood/blood product transfusion •Dermatologic conditions, etc.

bronchorestrictive disorder characterisitcs

1. inflammation 2. mucousal edema 3. excessive mucous production (asthma, bronchitis, emphysema)

adverse reactions of glucocorticoids

1. inhaled= oral candidiasis 2. oral= suppression of adrenal function 3. bone demineralization, muscle wasting 4. hyperglycemia 5. peptic ulcer disease 6. infection 7. fluid and electrolyte imbalances 8. nasal (dry mucous membraes , epitaxis, sore throat) 9. headache

who should be cautious when taking beta 2 adrenergic agonists

1. diabetics 2. hyperthyroidism 3. CV disease 4. HTN 5. angina 6. tachydysrhythmias 7. tachycardia due to digitalis toxicity

adverse reactions of anticholinergic drugs

1. dry mouth 2. irritation of pharynx 3. increased intraocular pressure 4. urinary retention

symptoms of asthma

1. dyspnea 2. cough 3. wheezing 4. chest tightness 5. sputum production

What is the prototype for mucolytics?

acetylcysteine

-tropium drugs

anticholinergic

adverse reactions of beta 2 adrenergic agonists

1. chest pain, palpitations 2. nervousness, restlessness, tremors

When treating anesthesia-induced nausea and vomiting, give Ondansetron or other drug ________ hours before anesthesia administration.

1 hour

upper respiratory tract disorders

1, allergies 2. allergic rhinitis 3. cough 4. cold 5. flu 6. mild reactions 7. uticaria

What are the administration consideration for aluminum hydroxide?

1. Administer orally up to 4x a day, chew tablets thoroughly and follow w 8 oz of fluids 2. Do NOT give within 1-2 hours of drugs that react with antacids

interactions with beta 2 adrenergic agonists

1. Beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists. 2. Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risk of hypertension, tachycardia, and angina. 3. Hypoglycemic (antidiabetic) drugs require increased dosing because of hyperglycemic effects.

possible interactions with dimenhydrinate?

1. CNS depressants increase sedative effects 2. MAO inhibitor antidepressants increase anticholinergic effects

adverse drug reactions of antitussives

1. CNS depression (drowsiness, sedation common with opioid antitussives; only occurs in non-opioid antitussives if you give large doses or other CNS-depressant drugs concurrently) 2. Dizziness, lightheadedness (more common with opioid antitussives) 3. Gastrointestinal distress (nausea, vomiting) 4. Constipation (opioids only) 5. Respiratory depression (opioids only) 6. Potential for abuse

adverse reactions of sympathomimetics

1. CNS stimulation with oral agents (agitation, anxiety, insomnia) 2. Increased blood pressure 3. Tachycardia/palpitations 4. Overdosage or systemic absorption: hypertension, tachycardia, and heart palpitations 5. Rebound congestion with prolonged use of topical agents

contraindications and precautions of methylxanthines

1. clients with impaired metabolism 2. tobacco or marijuana use 3. caffine 4. heart disease 5. liver dysfunction 6. acute pulmonary edema

contraindications and precautions for sympathomimetics

1. Chronic rhinitis Narrow angle glaucoma • 2. Uncontrolled heart disease, dysrhythmia, or hypertension 3. Coronary artery disease 4. Hypertension 5. Older adults

client instructions for sympathomimetics

1. Notify provider of excessive symptoms of CNS stimulation. 2. Consult provider regarding alternative therapy or withdrawal of drug. 3. Report prolonged tachycardia or heart palpitations. 4. Have blood pressure checked while on medication if previously diagnosed with hypertension. 5. Do not use for more than 3 to 5 days. 6. Taper and discontinue the drug using one nostril at a time.

What are the two uses for antacids?

1. Peptic ulcer disease 2. GERD (gastrointestinal reflux disease)

What are characteristics of first generation H1 receptor antagonist

1. Prevent/reduce most physiologic effects that histamine produces at receptor sites 2. Inhibit smooth muscle constriction in blood vessels, respiratory, GI tract 3. Decrease capillary permeability 4. Decrease salivation and tear formation

_________ blocks serotonin receptors which decrease visceral pain, slow peristalsis, increases absorption of water and sodium through intestinal wall, and reduces the secretion of water and electrolytes.

Alosetron

What is the prototype for immunosuppressants and what are they used for?

Azathioprine Treatment of inflammatory bowel syndrome

What are important things to teach the client taking antihistamines?

Do not take prior to driving, sit or lie down if feeling drowsy and change positions slowly. Increase activity, fluids, and fiber intake, suck on candy urinate every 4hr

What is the prototype for stool softeners/ surfactant laxatives?

Docusate sodium

What is the prototype for stimulant laxatives?

Bisacodyl Senna is another one

What are the adverse effects of proton pump inhibitors?

Bone loss in long term use, HA, abdominal pain, N/V/D, hypomagnesemia

What are the adverse drug reactions of acetylcysteine?

Bronchospasms GI distress due to rotten-egg smell of drug and ingestion of secretions (nausea, vomiting)

interactions of leukotriene modifiers

Concurrent use with phenobarbital (Luminal), rifampin (Rifadin) and phenytoin (Dilantin) may necessitate higher dosages.

What is the main adverse drug reaction of sucralfate?

Constipation

What are the adverse drug reactions for Alosetron?

Constipation and ischemic Colitis

What is the therapeutic uses for bisacodyl?

Constipation from opioid use Colon evacuation prior to elective procedures

Therapeutic uses for Guaifenesin?

Cough related to viral upper respiratory infection

Therapeutic uses for acetylcysteine?

Decrease viscosity of mucus secretions reverse acetaminophen overdose

What are the adverse drug reactions for misoprostol?

Diarrhea, abdominal pain Women: dysmenorrhea, uterine cramping, spotting, miscarriage

what are the possible adverse effects of bisacodyl?

Diarrhea, mild abdominal pain burning sensation laxative abuse proctitis

Adverse drug reactions for Guaifenesin?

Dizziness, drowsiness, headache, GI distress (nausea, diarrhea), and allergic reaction (rash)

Client instructions for Guaifenesin?

Do not take before driving Sit or lie down if feeling lightheaded Change positions slowly Take the drug with food or 8 oz of water Stop the drug and seek medical attention if experiencing allergic reaction

Important administration considerations for histamine h2 antagonists

Given orally, IM, or IV ORALLY: -Give with or without food (given with food or immediately after meals or at bedtime prolongs effects) -make sure clients dissolve tablets in water!! Do not chew, swallow whole, or let dissolve on tongue -Do NOT give antacids within 1 HOUR of administration IV: -Administer slowly to prevent bradycardia

Adverse drug reactions of Ondansetron?

HA, dizziness, diarrhea, constipation Serotonin syndrome, torsade de pointes, stevens johnson syndrome

What are the adverse drug reactions of Sulfasalazine?

HA, pneumonitis, anorexia, N/V/D, infertility, orange discoloration of the urine, angioedema, fever *a lot more on the table*

___________ blocks histamine receptors in the stomach that are responsible for the secretion of stomach acid. They block the receptors located on the parietal cells on the stomach, which decreases the amount of stomach acid secreted, increasing the pH of the stomach.

Histamine H2 Antagonists

Antacids can ___________ absorption of histamine h2 receptors but has little effect on ranitidine

reduce

What are the different prototypes for glucocorticoids? Inhaled, oral, and nasal

Inhaled- beclomethasone dipropionate oral-prednisone nasal-fluticasone

Why should you not take Ondansetron with apomorphine?

It results in severe hypotension

_________ decreases visceral pain, increases peristalsis, increases the secretion of water and electrolytes from the intestinal wall. It also activates the chloride channels in the intestinal walls, which increases the secretion of sodium and water.

Lubiprostone

therapuetic use of first generation antihistamines

Management of: 1. Mild allergic reactions (seasonal allergic rhinitis, cough, urticaria, mild transfusion reaction) 2. Anaphylaxis (hypotension, acute laryngeal edema, bronchospasm) 3. Motion sickness 4. Insomnia. Short-term use: no longer than 2 consecutive weeks (firstgeneration H1 antagonists)

What is the prototype for Prokinetic/ dopamine antagonists?

Metaclopramide

What is the prototype for prostaglandin E analog?

Misoprostol

_________ is an endogenous prostaglandin. it decreases gastric acid secretion, increases the secretion of bicarbonate, increases secretion of mucus and increases vasodilation of blood flow in the gastric wall.

Misoprostol

___________ are erosive lesions that occur in the stomach and duodenum. They are typically caused by an infection of H. pylori.

Peptic Ulcers

Patients taking histamine h2 antagonists have an increased risk of developing ___________ due to elevated gastric pH, allowing bacteria to colonize in the stomach.

Pneumonia

Interactions of glucocorticoids

Potassium-depleting diuretics (furosemide-lasix) increase risk of hypokalemia NSAIDs increase risk of GI bleed Effects of insulin and oral hypoglycemics are decreased

Action of Leukotriene Modifiers

Prevent effects of leukotriene resulting in decreased inflammation, bronchoconstriction, airway edema, and mucus production

action of glucocorticoids

Prevent inflammatory response by suppression of airway mucus production, immune responses, and adrenal function

Action of Beta-2 Adrenergic Agonists

Promote bronchodilation by activating beta-2 receptors in bronchial smooth muscle

_________________ inhibit the the hydrogen potassium ATPase enzyme system in the parietal cells of the stomach. This suppressed gastric acid production (both the basal rate the stomach constantly produces and the extra it produces secondary to ingestion of food).

Proton Pump inhibitors

What is the prototype for Histamine H2 antagonists? What are some other drugs in this category?

Ranitidine (Zantac)- prototype cimetidine (Tagamet) famotidine (Pepcid) *Drugs end in -tidine*

Contraindications and precautions of glucocorticoids

Recent live virus vaccine systemic fungal infection oral candidiasis Peptic ulcer disease Diabetes mellitus HTN Renal dysfunction Use of NSAIDS

2 types of allergic rhinitis

seasonal and perennial

What should you teach your patient about Ondansetron?

Report HA, dizziness (lie down and change positions slowly if dizzy), report diarrhea, and drink plenty of fluids

Client instruction for acetylcysteine?

Report difficulty breathing and worsening cough Expectorate secretions Take antiemetics as needed Consume 2000-3000ml of water daily

What are the adverse drug reactions for Azathioprine?

Retinopathy Progressive multifocal Leukoencephalopathy pulmonary edema N/V/D, hepatotoxicity, alopecia, rash anemia malignancy

Client instructions when taking glucocorticoids

Rinse mouth after inhaled glucocorticoids to prevent thrush Never stop drug abruptly Take the drug on alternate days Use a spacer Take the drug with food or water Avoid NSAIDs Use a humidifier during sleep Consume adequate calcium and vitamin D Perform weight bearing activities daily Increase fluid intake Suck on hard candy REPORT ANY OF THESE IMMEDIATELY: Weakness, wt gain, edema Bloody vomit or black tarry stool Painful mucous membranes with white patches Signs of infection Polyphagia, Polydipsia, Polyuria

T/F The main therapeutic use for sucralfate is the treatment of acute duodenal ulcers.

True

True/False Misoprostol is used to prevent gastric ulcers from long-term NSAID use

True

True/False Nurses want to emphasize the important of taking at least 8 oz of fluid with each dose of psyllium.

True

True/False Pregnancy is a contraindication of misoprostol

True

True/False The prototype for Mucosal protectants is sucralfate.

True

interactions with antitussives

With opioids, alcohol, and other CNS depressants, increase CNS depression . • Nonopioid antitussives increase the analgesic effects of opioids. • St. John's wort may increase sedation.

•AKA, hay fever) •Response to airborne pollens

seasonal disease allergic rhinitis

you should advise a client who is taking beclomethasone to watch for which of the following possible interactions of an adverse effect of this drug a. white coating in the mouth b. abdominal pain c. muscle twitching d. palpitations

a. white coating in the mouth rationale: beclomethasone, an inhaled glucocorticoid may cause oropharyngeal candidiasis.

antitussive action

act on the cough control center in the medulla to suppress the cough reflex

action of sympathomimetics

activate alpha 1 adrenergic receptors in nose

What are the contraindications for azathioprine?

active infection or immunization with live virus pancreatitis anuria

interventions of mast cell stabilizer

administer epi or antihistamines to reverse anaphylaxsis

adverse reactions of mast cell stabillizer

allergic reactions in clients with known allergy to cromolyn

•Suppress dry, hacking, nonproductive cough •Centrally acting include •Narcotics and nonnarcotics •Locally acting include •Throat lozenges, cough drops

anti tussives

•Block the action of acetylcholine in bronchial smooth muscle Reduces bronchoconstrictive substance release

anticholinergics (beta blockers)

an immunosuppressant that reduces the inflammation of inflammatory bowel disease (unlabeled use)

azathioprine

a nurse is teaching a client about ipratropium. The nurse should include that this drug has which of the following adverse effects? Select all that apply a. muscle tremors b. urinary retention c. dry mouth d. insomnia e. tachycardia

b,c

a nurse is teaching a client about the use of a mucolytic to treat a cough. The nurse should include that a mucolytic has which of the following therapeutic effects? a. suppresses the cough stimulus b. reduces inflammation c, thins and loosens mucous d. dries secretions

c, thins and loosens mucous

A nurse is providing teaching to a client who has a new persciption for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include. Select all that apply a. sit upright for 30 minutes after taking the drug b. avoid antacids c. take the drug 30-60 minutes before activities that trigger nausea d. avoid activities that require alertness e. increase fluid and fiber intake

c,d,e

a client is about to start taking omeprazole to treat a duodenal ulcers. Which of the following instructions should you include when talking with the client about taking this drug a. take it with food b. avoid using aluminum based antacids c. consume adequate amounts of fluid d. do not drink grapefruit juice

c. consume adequate amounts of fluid

a nurse is teaching a client about the use of beclomethasone to treat asthma. The nurse should explain that the drug has which of the following therapeutic effects? a. thins mucous b. relaxes bronchial smooth muscle c. decrease inflammation d. increases the cough threshold

c. decrease inflammation

a nurse is teaching a client about the use of antihistamines to treat allergic rhinitis. The nurse should explain that these drugs are effective because they perform which of the following actions a. decrease viscosity of nasal secretion's b. block H2 receptors c. prevent histamine from binding to receptors d. reduce nasal congestion

c. prevent histamine from binding to receptors

a nurse is caring for a client who is taking codeine. The nurse should identify that which of the following assessments is priority to make? a, blood pressure b. apical heart rate c. respirations d. level of conciousness

c. respirations

•Viral infection •2 to 4 occurrences/year typical in adults; up to 10 occurrences/year for schoolchildren •Viruses invade via mucous membranes. •Can survive several hours on skin, hard surfaces

common cold

What are the therapeutic uses for stool softeners?

constipation and prevention of fecal impaction, straining and painful elimination of hard stools

What are the adverse reactions of aluminum hydroxide?

constipation, diarrhea, hypophosphatemia

What are the uses for psyllium?

constipation, diverticulitis, IBS, and stool regulation with diarrhea

anti inflammatory agent drugs

corticosteroids leukotriene modifier drugs

•Treat acute and chronic asthma, other bronchoconstrictive disorders •Resulting in •decrease mucus secretion •decrease airway mucosa edema •Repaired epithelium damage •Reduced airway reactivity

corticosteroids (antiinflammatory agents) mast cell stabilizers

you are instructing a client who has a new prescription for cetrizine. Which of the following information should you be sure to include a. restrict fluids to minimize the drugs adverse effects b. take the drug in the morning to reduce adverse effects c. take the drug on an empty stomach to increase absorption d. administer the drug prophylactically during allergy seasons

d. administer the drug prophylactically during allergy seasons rationale: cetrizine is a second generation antihistamine used primarily to relieve symptoms associated with seasonal allergic rhinitis.

which of the following drugs has protocols that require clients to meet specific risk management criteria and sign a treatment agreement before the nurse can administer the drug a. lubiprostone b. azathioprine c. sulfasalazine d. alosetron

d. alosetron

a nurse is caring for a client who has a new prescription for ranitidine to treat GERD. The nurse should instruct the client to wait at least one hour between ranitidine and which of the following over the counter drugs a. ginkgo biloba b. antidiarrheals c. st johns worts d. antacids

d. antacids

What is the prototype for opioids and what is it used for?

diphenoxylate/atropine and loperamide Treatment of diarrhea

stool softener

docusate sodium

•Liquefy respiratory secretions, allowing for easier removal

expectorants

•Do not readily enter the brain from the blood •Fexofenadine and other drugs in this class bind preferentially to peripheral rather than central H1 receptors •Supplanting the first-generation H1 receptor antagonists in the symptomatic treatment of allergic rhinitis and in the relief of pruritus in urticaria Have a mild beneficial effect in chronic asthma

second generation H1 receptor antagonists

What are the adverse drug effects of dimehydrinate?

sedation, and anticholinergic effects (dry mouth, constipation, urinary retention)

client instructions for mast cell stabilizers

seek medical care immediately after sudden rash, swelling of the mouth or throat or wheezing after use

true or false Histamine is the first chemical mediator released during inflammatory response

true Histamine is the first chemical mediator released during immune and inflammatory response. It is synthesized and stored in most body tissues.

•Is the following statement True or False? Sympathomimetic drugs are used to relieve nasal obstruction and discharge

true •Rationale: Sympathomimetic drugs are used to relieve nasal obstruction and discharge. Adrenergic drugs are used most often. They relieve nasal congestion and swelling by arteriole constriction (which reduces blood flow to nasal mucosa).

What is the therapeutic use for Alosetron?

women with severe IBS w diarrhea that has lasted 6 mo or more

What is the main interaction of bisacodyl?

If taken with antacids and milk they dissolve the enteric coating and cause abdominal cramping. *it is important to take oral forms 1 hour after drinking milk or taking antacid*

Nursing interventions for histamine h2 antagonists

For clients who develop impotence, reduced libido, or CNS effects, recommend switching to ranitidine Monitor for confusion in older clients

What are the contraindications for metaclopramide?

GI obstruction, hemorrhage, perforation, uncontrolled seizure disorders, breast cancer, pheochromocytoma.

What are the contraindications for stool softeners?

GI obstruction, perforation use of mineral oils fecal impaction nausea/ vomiting abdominal pain

What are the administration considerations for dimehydrinate?

Give it orally, IM, IV Give the initial dose 30-60 min before the activity that triggers nausea Give doses before meals and at bedtime Make sure the client dose not swallow chewable tablets whole

What are the adverse drug reactions for metaclopramide?

Sedation, restlessness, diarrhea Neuroleptic malignant syndrome Extrapyramidal symptoms

___________ change the surface tension of the stool. This increases absorption of water into the stool. They also act on the intestinal walls, which increases the secretion of water and electrolytes from the intestine instead of absorption.

Stool softener/ surfactant laxatives

What is the prototype for 5-Aminosalicylates and what do they do?

Sulfasalazine Treatment of inflammatory bowel disease

Nurses should instruct the client that is taking histamine h2 antagonists...

Take all medications as prescribed, avoid smoking, avoid anything that irritates the GI, report signs of GI bleeding such as coffee-ground emesis

A nurse is caring for a male client who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. Which of the following information should the nurse provide the client about alosetron? a. the drug is prescribed to female clients who have IBS-D lasting longer than 6 months b. this drug is prescribed to clients who have chronic diarrhea lasting more than 12 months c. the drug is the most beneficial for male clients who have inflammatory bowel disease d. the drug is most beenficial in treating clients who have constipation

a. the drug is prescribed to female clients who have IBS-D lasting longer than 6 months

for which of the following reasons should a client attach a spacer to a metered dose inhaler a. to increase the amount of the drug delivered to the lungs b. to increases the same amount of drug delivered to the oropharynx c. to increase the amount of drug delivered on exhalation d. to increase the speed of drug delivery into the mouth

a. to increase the amount of the drug delivered to the lungs

you are obtaining a heath history from a client who is to start using a new ipratropium inhaler. Which of the following information from the client's history alerts you to take further action. Select all that apply a. seizure disorder b. peanut allergy c. depression treated with a monoamine oxidase inhibitor (MAOI) d. hypothyroidism treated with synthetic thyroid hormone e. glaucoma

b, e rationale: clients who are allergic to peanuts or do not take ipratropium, an anticholinergic drug, because the medication preparation may contain peanut oil and soy.

a client is about to start taking aluminum hydroxide tablets to reduce gastric acid. Which instructions should you include when talking with the client about taking this drug. Select all that apply a. take the drug with large meals b. chew the tablets thoroughly c. drink a galss of water after taking it d. increase fluid and fiber intake e. take it once daily

b,c,d

A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction? Select all that apply a. level of consciousness b. skin integrity c. temperature d. urine output e. CBC

b,c,e

knowing the adverse drug reactions of ranitidine, the primary care providers assistant should instruct a client to watch for and report which of the following a. hyperactivity b. CNS depression c. hypertension d. bone pain

b. CNS depression

a nurse should identify that dextromethorphan can have which of the following effects when combined with morphine a. reduced antitussive effect of dextromethorphan b. potentiation of depression of CNS actions c. increased renal reabsorption of the dextromethorphan d. delayed analgesic effect of the opiod

b. potentiation of depression of CNS actions

A nurse is teaching a client about the use of an expectorant to treat a cough. The nurse should include that an expectorant has which of the following therapeutic effects? a. suppresses the cough stimulus b. reduces surface tension c. reduces inflammation d. dries mucous membranes

b. reduces surface tension

a nurse is providing teaching to a client who has a new presciption for omeprazole to treat a duodenal ulcer. Which of the following instructions should the nurse include a. take the drugs with food b. swallow the capsule whole c. dissolve the tablets in water d. take the drug at bedtime

b. swallow the capsule whole

a nurse is teaching a client about ipratropium. Which of the following instructions should the nurse include? a. do not drink anything for 30 minutes after using the drug b. wait 5 minutes between using the drug and another inhaled drug c. this drug is used to thin respiratory secretions d. check pulse rate after inhaling the drug

b. wait 5 minutes between using the drug and another inhaled drug

stimulant laxative that reduces constipation by increasing peristalsis and increasing the amount of intestinal fluid; for constipation

bisacodyl

the most effective and treatment of choice to relieve acute asthma

bronchodilators

You should not administer docusate sodium within 2 hours of any other laxative, especially _______________!!

mineral oils

Symptoms of COPD are described as..

more constant, less reversible

a histamine h2 antagonist, inhibits gastric acid secretion. It treats gastric and duodenal ulcers relieves heartburn and dyspepsia and helps minimize symptoms of GERD

ranitidine

a nurse is teaching a client about using intranasal glucocorticoids. Which of the following instructions should the nurse give. a. start at a low dose and gradually increase it b. take the drug as needed for nasal congestion c. allow at least 2 weeks for the full therapeutic effect d. use the drug prior to exercise

c. allow at least 2 weeks for the full therapeutic effect

a nurse is providing teaching to a client who has a new presciption for loperamide. Which of the following instructions should the nurse include? a. dissolve the powder thoroughly in 8 oz (237 ml) of water b. take with diphenhydramine to prevent extrapyramidal effects c. avoid activities that require alertness d. take 30 minutes before activities that trigger nausea

c. avoid activities that require alertness

What are the uses for Metaclopramide?

1. GERD 2. diabetic gastroparesis 3. Nausea and vomiting

a nurse should recognize that sulfasalazine is contraindicated for clients which of the following conditions? a. pancreatitis b. aspirin sensitivity c. bronchitis d. GERD

b. aspirin sensitivity

Administration consideration fro metaclopramide?

1. Give 30 min before meals and bedtime 2. When treating chemo-induced nausea give IV slowly over 15-30 min starting 30 min before chemo.

Nursing interventions for proton pump inhibitors

Monitor for adverse drug reactions, limit drug therapy to the lowest dose and shortest duration possible

What are the adverse drugs reactions for opioids?

drowsiness, constipation, allergic reactions, cardiac issues and dry mouth

therapuetic use of sympathomimetics

• Allergic rhinitis, sinusitis, and the common cold

What are the contraindications of Ondansetron?

1. pregnancy 2. congenital long QT syndrome 3. Phenylketonuria 4. concurrent use with apomorphine

interventions of anticholinergic drugs

1. provide water and hard candy 2. schedule routine testing for glaucoma 3. monitor urinary elimination patterns

-sone drugs

glucocorticoids

second generation antihistamine drugs

1. cetirizine 2. loratadine 3. fexofefnadine 4. desloratadine

adverse effects of anticholinergics

1. cough 2. nervousness 3. nausea 4. GI upset 5. headahce 6. dizziness 7. vary depending on medication used

Why is Metaclopramide used for GERD?

it increases the tone of the lower esophageal sphincter

•Long-term treatment of asthma •Prevent acute asthma attacks induced by •Allergens, exercise, cold air, hyperventilation, irritants, NSAIDs •Not effective in relieving acute attacks

leukotriene modifer drugs (anti inflammatory agents)

What are the different uses for glucocorticoids?

long-term management of chronic asthma short-term management of post-exacerbation symptoms (oral)

therapeutic use of second generation antihistamines

management of 1. allergic rhinitis 2. chronic idiopathic uticaria

•Prevent release of bronchoconstrictive and inflammatory substances •In response to allergens, other stimuli •Used in prophylaxis of acute asthma in mild, persistent asthma •Not effective in acute bronchospasm or status asthmaticus

mast cell stabilizers (anti inflammatory agents)

glucocorticoid medications

1. beclomethasone (IH) 2. prednisone (PO) 3. flutisone (NS) 4. budesonide/ formoterol (IH) 5. fluticasone/salmeterol (IH) 6. momtasone/formoterol (IH) 7. hydrocortisone (IV) 8. methylprednisone (IV)

characteristics of asthma

1. bronchoconstriction 2. inflammation 3. hyperactivity to stimuli

beta 2 adrenergic agonists

1. albuterol (SA) 2. formoterol (LA) 3. levalbuterol (SA) 4. salmeterol (LA) 5. Terburtaline (LA)

contraindications of beta 2 adrenergic agonists

1. allergy to albuterol or levalbuterol

Clients who test positive for H. pylori bacteria should take what antibiotics?

1. amoxicillin 2. metronidazole 3. tetracycline

drugs to reduce histamine response/ allergic reactions

1. antihistaminese

lower respiratory tract disorders

1. asthma 2. COPD 3. chronic bronchitis 4. emphysema

What should the nurse teach the client who is taking sucralfate?

Increase fiber intake, fluids, activity, and exercise. Drink plenty of fluids Teach the client to report any signs of GI bleeding, such as coffee-ground emesis

Administration of glucocorticoids

Inhaled:use on reg schedule rather than prn Do not use these for acute attack Use beta2 adrenergic agonist first to dilate the airway and then glucocorticoids oral:twice daily for 5-10 days for long term (10 days or more) take once daily or every other day Establish the lowest does possible to control symptoms Nasal:use a nasal metered-dose spray device Use full dose initially then taper to lowest effective dose Full therapeutic effect may take 2-3 wks Use a nasal decongestant first if nares are completely blocked

Nurses should monitor what with a patient taking sucralfate?

Monitor bowel functions If patient is constipated administer stool softeners as needed

What should the nurse monitor in patients taking dimehydrinate?

Monitor clients when ambulating, anticholinergic effects, bowel elimination patterns, and VS for signs of anaphylaxis.

Nursing interventions for Guaifenesin?

Monitor clients when changing positions or ambulating Give the drug with food or 8 oz of water Stop drug and recommend alternative therapy Encourage fluid intake of 1500 to 2000ml daily

What are the nursing interventions for a client taking Ondansetron?

Monitor for HA, dizziness, diarrhea, dehydration, and administer analgesics for pain relief

Nursing interventions for azathioprine?

Monitor for adverse drug reactions Monitor CBC before and after therapy If WBC count decreases stop therapy and institute neutropenic precautions

What are the nursing interventions for misoprostol?

Monitor for severe diarrhea, and abdominal pain Monitor for excessive menstrual pain or mid-cycle bleeding

Nursing interventions for glucocorticoids (there's A LOT)

Provide a spacer Initiate anti fungal therapy as needed observe for suppression of adrenal glands monitor plasma drug levels recommend alternate-day dosing monitor for bone demineralization and muscle wasting recommend lowest dose and shortest duration Monitor blood glucose for pt with diabetes mellitus!! Observe for GI bleed (bloody vomit, black stool) Monitor for wt gain or edema (hypernatremia) Monitor for generalized weakness (hypokalemia) Provide humidified air for epistaxis and sore throat

contraindications and precautions of acetylcysteine?

Risk of or actual GI bleeding Anaphylactic reaction when giving it IV Asthma, history of bronchospasm, severe respiratory insufficiency

you should instruct a client zileuton to report which of the following possible indications of a serious adverse effect of this drug? a. abdominal pain b. dysphagia c. blurred vision d. bradycardia

a. abdominal pain rationale: Zileuton may cause liver damage and hepatitis. Clients should report signs of hepatic, such as abdominal pain or jaundice.

A nurse is teaching a client who has a prescription for albuterol via inhaler and fluticasone via inhaler for asthma management. For which of the following reasons should the nurse instruct the client to use the albuterol inhaler before using the fluticasone inhaler a. albuterol will increase the absorption of fluticasone b. albuterol will decrease inflammation c. albuterol will reduce nasal secretions d. fluticasone will reduce the adverse effects of albuterol

a. albuterol will increase the absorption of fluticasone

a nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider? a. allopurinol delays the conversion of azathioprine b. azathioprine increase the effectiveness of allopurinol c. allopurinol increases the metabolism of azathioprine and can require an increased dosage d. azathioprine decreases the effectiveness of allopurinol

a. allopurinol delays the conversion of azathioprine

____________ are alkaline compounds that neutralize gastric acid

antacids

a nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the clients phosphorus levels when administering which of the following drugs a. omeprazole b. aluminum hydroxide c. sucralfate d. ranitidine

b. aluminum hydroxide

you are about to administer ondansetron to a client to prevent anesthesia induced nausea and vomiting. You prepare to monitor the client for which of the following adverse effects of this drug a. bronchospasm b. dizziness c. hypertension d. anxiety

b. dizziness

a nurse is teaching an adult client about diphenhydramine. The nurse should inform the client to expect which of the following adverse effects while taking this drug? a. muscle tremors b. drowsiness c. excitation d. insomnia

b. drowsiness

Legal restrictions apply to the purchase of pseudoephedrine (Sudafed) because of which of the following risks? a. respiratory depression b. drug abuse c. drug tolerance d. rebound congestion

b. drug abuse

_________ are non-digestible and absorb water from the intestine to form a glutinous mass that adds bulk to the stool. This stretches the intestinal wall stimulating peristalsis while softening and enlarging the stool.

bulk-forming laxatives (fiber supplements)

A nurse is caring for a client who is having difficulty mobilizing thick respiratory secretions. Which of the following drugs should the nurse expect to administer to the client a. Ipratropium b. Beclomethasone c. Acetylcysteine d. Azelastine

c. Acetylcysteine

client instructionss for antitussives

1. Change positions gradually and sit or lie down if feeling lightheaded. 2. Avoid alcohol and other CNS depressants when taking opioid antitussives. 3. Do not take opioid antitussive before driving or activities requiring mental alertness. 4. Take the drug with food or milk. 5. Lie down when feeling nauseated. 6. Increase fluid and dietary fiber intake. 7. Take the drug only when needed and on a short-term basis. 8. Remove triggers that precipitate coughing from environment.

interactions of methylxanthines

1. Cimetidine (Tagamet), some fluoroquinolones, and caffeine increase the risk of toxicity. • 2. Phenobarbital, phenytoin (Dilantin), and nicotine increase metabolism of theophylline

adverse reactions of second generation antihistamines

1. Drowsiness and fatigue (normally in dosages higher than 10mg/day) • 2. Anticholinergic effects: dry mouth, nose, and throat (less than firstgeneration sedating antihistamines, but still a possible effect)

adverse drug reactions of first generation antihistamines

1. Drowsiness, dizziness 2. Anticholinergic effects (dry mouth, constipation)

What are the six categories of drugs to treat Peptic ulcers?

1. Histamine H2 Antagonists 2. Proton Pump inhibitors 3. Mucosal prostaglandins 4. antacids 5. Prostaglandin E analogs 6. Antibiotics

general measures to prevent respiratory disease and promote an adequate airway

1. Use mechanical measures for removing excessive respiratory tract secretions and preventing their retention. Effective measures include coughing, deep breathing, percussion, and postural drainage. 2. Help the patient identify and avoid exposure to conditions that precipitate bronchoconstriction. 3. Assist patients with asthma to identify early signs of difficulty, including increased need for beta-adrenergic agonists, activity, etc. 4. Monitor the PEFR when indicated. 5. Assist patients with moderate to severe asthma in obtaining meters and learning to measure PEFR. Patients with a decreased PEFR may need treatment to prevent acute, severe respiratory distress. 6. Assist patients and at least one family member in developing an action plan to identify the correct action to manage acute attacks of bronchoconstriction, including when to seek emergency care. 7. •Try to prevent or reduce anxiety, which may aggravate bronchospasm. 8. With any patients who smoke cigarettes, encourage cessation of smoking and provide information, resources, and assistance in doing so.

Administration considerations of prostaglandin E analogs

1. administer 4x a day with meals and at bedtime 2. confirm pt is not pregnant 3. educate about contraceptions while taking this drug

When treating radiation-induced nausea and vomiting give the drug 1 to 2 hours before therapy, and every ______ hours as needed.

8 hours prn.

a nurse is teaching a client who is taking prednisone for an acute asthma exacerbation. Which of the following instructions should the nurse include a. avoid taking nonsteroidal anti-inflammatory drugs b. rinse your mouth after taking the medication to prevent a yeast infection c. stop taking the medication if you become nauseous d. change position slowly when standing up

a. avoid taking nonsteroidal anti-inflammatory drugs

The health care profession instructs a client about the therapeutic actions of sucralfate. She explains that this drug promotes ulcer healing by which actions a. creates a protective barrier b. increase gastric pH c. inhibits the proton pump d. neutralizes gastric acid

a. creates a protective barrier

a nurse is assessing a client who was administered ondansetron IV 1 hour ago. Which of the following findings should the nurse recognize as an adverse effect of this drug a. dizziness b. bradycardia c. tardive dyskinesia d. dyspepsia

a. dizziness

you should recognize that which of the following is a contraindication for taking codeine a. emphysema b. cataracts c. hyperthyroidism d. nonproductive cough

a. emphysema rationale: codine is unsafe for clients who have decreased respiratory reserve, such as with empysema or asthma

a nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor the manifestation of which of the following conditions. a. gout b. constipation c. insomnia d. hirsutism

a. gout

Inflammation of nasal mucosa caused by type I reaction to inhaled allergens

allergic rhinits

a nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include. Select all that apply a. expect results in 6-12 hours b. urinarte every 4 hours c. take the drug with at least 8 oz (237 ml) of fluid d. avoid activities that require alertness e. increase the fluid and fiber intact

c,e

a nurse should recognize that using pseudoephedrine to treat allergic rhinitis requires cautions use with clients who have which of the following conditions a. peptic ulcer disease b. a seizure disorder c. anemia d. coronary artery disease

d. coronary artery disease

you should monitor a client taking dextromethorphan because of the potential for which of the following a. tachycardia b. fluid retention c. blurred vision d. drug abuse

d. drug abuse rationale: dextromethorphan can cause euphoria and hallucinations at high doses.

which of the following instructions should the health care professional give a client about taking sucralfate to treat an acute duodenal peptic ulcer a. take it with a prescribed antacid b. reduce potassium intake c. take it with food d. increase fluid and fiber intake

d. increase fluid and fiber intake

a nurse is teaching a client about the use of cromolyn sodium to prevent bronchospasm. The nurse should explain that the drug has which of the following therapeutic effects? a. increases leukocyte activity b. blocks muscarinic receptors c. causes bronchodilation d. reduced inflammation

d. reduced inflammation

interventions of leukotriene modifiers

1. Monitor liver function with periodic testing. 2. Observe for behavioral changes

interventions of second generation antihistamines

1. Monitor the client when ambulating. 2. Provide water and encourage frequent sips. 3. Encourage intake of 1,500 to 2,000 mL daily 4. Provide hard candy to suck on.

two general types of inhaled beta2 adrenergic agonists that are used for asthma management

1. rescure ihalant medications (quick relief, short acting)= used for periods of acute symptoms and exacerbations 2. maintaince inhalant medications (long term control drugs used to achieve and maintain prophylactic control of persistent asthma

What should the nurse teach clients taking antacids?

1. Increase fluids and fiber, activity and exercise 2. Report abdominal pain and severe diarrhea 3. monitor phosphate and sodium intake 4. report any signs of GI bleeding 5. Do NOT take aluminum hydroxide within 1-2 hours of other medications

contraindications and precautions of antitussives

1. Known sensitivity to the drug 2. MAO inhibitors or SSRIs 3. Prostatic hypertrophy 4. Reduced respiratory reserve (emphysema, chronic asthma) 5. History of substance abuse 6. ucautiously in children and older adults. 7Known sensitivity to the drug 8.MAO inhibitors or SSRIs 9.Prostatic hypertrophy 10reduced respiratory reserve (emphysema, chronic asthma) 11.History of substance abuse 12Use cautiously in children and older adults.

interventions of first generation antihistamines

1. Monitor the client when ambulating. • 2. Advise against driving or operating machinery requiring mental alertness. 3. Recommend switching client to a nonsedating antihistamine if sedation is excessive. 4. Encourage sips of water or sucking on hard candy. 5. Give with food. 6. Encourage high intake of fluids. 7. Recommend selecting high fiber foods on menu and provide fiber supplement or laxative as needed. 8. Monitor for urinary retention.

contraindications and precautions of first generation antihistamines

1. Newborns and children under 2 yr 2. Breastfeeding women 3. Narrow-angle glaucoma 4. Prostatic hypertrophy • 5. Acute asthma exacerbation 6. children 7. older adults 8. history of asthma 9. urinary retention 10. open angle glaucoma 11. impaired kidney function or liver function

Nurse should teach the client that is taking prostaglandin E analogs

1. Report adverse drug effects 2. drink plenty of fluids 3. take with food to minimize GI effects 4. do not take with alcohol

A nurse should recognize that diphenoxylate/ atrophine should be used with caution for a client who has which of the following conditions? a. inflammatory bowel disease b. thrombophlebitis c. agranulocytosis d. immunization with a live virus vaccine within the last 6 weeks

a. inflammatory bowel disease

For which of the following reasons should a nurse instruct a client to avoid taking guaifenesin with combination over the counter cold products a. over the counter cold products can also contain guaifenesin b. blood glucose levels are increased c. rebound congestion is likely d. drug tolerance

a. over the counter cold products can also contain guaifenesin

a nurse is monitoring plasma drug levels in a client who is taking theophylline. Which of the following findings should the nurse expect to see if the client's drug level indicates toxicity a. seizures b. constipation c. normal sinus rhythm d. somnolence

a. seizures

•stimulate beta2-adrenergic receptors in the smooth muscle of bronchi and bronchioles. •The receptors, in turn, stimulate the enzyme adenyl cyclase to increase production of cyclic AMP. •The increased cyclic AMP produces bronchodilation.

albuterol

•Immune response to ingestion of a protein •Shellfish, fish, corn, seeds, bananas, egg, milk, soy, peanut, tree nuts •Higher risk of triggering anaphylaxis •Children allergic to milk, eggs, wheat, soy •May outgrow their allergy No known preventative

allergic food reactions

What is the prototype for antacids?

aluminum hydroxide (Amphojel) Magnesium hydroxide (milk of magnesia)

A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least 2 hr apart for which of the following reasons? a. phenytoin increases the metabolism of sucralfate b. phenytoin reduces the effectiveness of sucralfate c. sucralfate increases the risk for phenytoin toxicity d. sucralfate interferes with the absorption of phenytoin

d. sucralfate interferes with the absorption of phenytoin

which of the following information indicates that a client who is taking theophylline needs further instruction a. the client drive a school bus everyday b. the client drinks 8oz of wine with dinner c. the client exercises 1 hour each day d. the client drinks two cups of coffee each morning

d. the client drinks two cups of coffee each morning rationale: caffeine may increase CNS stimulation, causing nervousness, insomnia, and tremors. It may also increase stimulation and cause tachycardia. Instruct clients taking methylxanthines to avoid caffeine intake

•Is the following statement True or False? The common cold is caused by many types of bacteria

false The common cold is caused by many types of viruses. Adults usually have 2 to 4 colds per year; schoolchildren may have as many as 10 annually.

True or false Asthma only occurs in children

false rationale: Asthma may occur at any age but is especially common in children. Children who are exposed to allergens and airway irritants (tobacco smoke, etc.) during infancy are at high risk for developing asthma.

sympathomimetics (decongestants) drugs

1. phenylephrine 2. psuedoephedrine 3. ephedrine 4. naphazoline 5. oxymetazoline

There are several administration considerations for sucralfate

1. administer orally on an empty stomach 2. give 4x a day, 1 hr before the usual meal times and once before bed 3. do NOT give antacids within 30 min of administration (antacids reduce therapeutic effects) 4. do NOT give within 2 hours of: fluoroquinolone antibiotics, warfarin, phenytoin, theophylline, digoxin, tetracycline, or diazepam.

major adverse effects of albuterol

1. excessive cardiac and CNS stimulation 2. angina 3. tachycardia, palpitations 4. agitation 5. anxiety 6. insomnia 7. seizures 8. tremors 9. cardiac dysrhythmias 10. cardiac arrest

contraditions and precautions of anticholinergic drugs

1. hypersensitivity to ipratropium, atropine, belladonna alkaloids or bromide 2. history or allergies to soy or peanuts 3. glaucoma 4. protastic hypertrophy 5. bladder neck obstruction

•Prevent/reduce most physiologic effects that histamine produces at receptor sites •Inhibit smooth muscle constriction in blood vessels, respiratory, GI tract •Decrease capillary permeability •Decrease salivation and tear formation

first generations H1 receptor antagonisys (antihistamines)

Administration of loperamide

give orally initial dose of 4mg; follow each loose stool with 2mg DO NOT exceed 16 mg/day stop if diarrhea persists after 48 hours Does not cause opioid effects or dependance at high doses

Administration of diphenoxylate/atropine

give orally, Give 20mg/day in 5mg doses Excessive doses can cause CNS effects continue for 24-36 hours

what are some characteristics of nasal decongestants

1. Relieve nasal obstruction and discharge 2. Most often used to relieve rhinitis 3. Contraindicated: severe HTN, CAD, narrow-angle glaucoma, antidepressants 4. Used with caution in cardiac dysrhythmias, hyperthyroidism, DM, prostatic hypertrophy, glaucoma

client instructions for second generation antihistamines

1. Take once-daily dose at time desired. 2. Avoid driving and activities that require mental alertness until the drug's effects are known. 3. Take frequent sips of water. • 4. Suck on hard candy.

a nurse is preparing to administer phenylephrine to a client. The nurse should identify that which of the following manifestations is an adverse effect of this drug? a. headache b. sleepiness c. hypotension d. constipation

a. headache

•First chemical mediator in immune and inflammatory response •Synthesized and stored in most body tissues •Concentrated in environmentally exposed tissues: eyes, nose, lungs, GI tract

histamine

Why is metaclopramide used for diabetic gastroparesis?

increases peristalsis in both the stomach and the intestines

Pathophysiology of asthma

•Bronchoconstriction narrows airways •Sphincter action can completely occlude airway. •Aggravated by inflammation, mucosal edema, excessive mucus •Mast cells release substances in response to causative stimuli which leads to bronchoconstriction and inflammation

client instructions for first generation antihistamines

1. Take the drug before or at bedtime. 2. Avoid driving and activities that require mental alertness. 3. Suck on hard candy. 4. Take the drug with food. 5. Increase fluid and fiber intake. 6. Take laxative as needed 7. Report difficulty urinating

interactions with second generations antihistamines

1. Theophylline (Theo-24) can reduce clearance and lead to toxicity. 2. Concurrent use with sedative/hypnotics, opioid analgesics, or alcohol can potentiate CNS depression.

T/F Psyllium increases the absorption of orally ingested medicine?

False It decreases the absorption

A nurse is teaching a client who has a prescription for zileuton. Which of the following instructions should the nurse include? a. check apical pulse before taking the drug b. take the drug only as needed before exercising c. rinse mouth after using the drug d. have lab tests performed at regular intervals

d. have lab tests performed at regular intervals

a nurse is teaching a client who is beginning fluticason propionate/ salmetrol therapy. Which of the following instructions should the nurse include a. take the drug as needed for acute asthma b. follow a low sodium diet c. use an alternate day dosing schedule d. increase weight bearing activity

d. increase weight bearing activity

True or false In acute, severe asthma, a topical corticosteroid (in relatively high doses) is indicated for a patient whose respiratory distress is not relieved by an inhaled beta2-agonist.

false •Rationale: In acute, severe asthma, a systemic corticosteroid (in relatively high doses) is indicated for a patient whose respiratory distress is not relieved by an inhaled beta2-agonist. A topical corticosteroid will not be effective against airway inflammation.

which of the following information should you include when teaching a client about the use of an albuterol inhaler for asthma management a. use it every 12 hours b. use it periodically to prevent exercise induced asthma c. store the drug canister in the fridge d. watch for an oral yeast infection

b. use it periodically to prevent exercise induced asthma rationale: albuterol is a shorta acting betas2 agonist that clients should use only as needed to stop an acute asthma exacerbation or 30 minutes before exercising to prevent exercise induced brochospasm

interacations with anticholinergic drugs

beta 2 adgrenergic agonists enhance bronchodilation