Pharmacology Week 4 Lesson Assessment

Question 13 of 14 Which statements made about salmeterol by a patient with asthma would alert the nurse that further intervention is warranted? Select all that apply. "I should use this when I feel an asthma attack is coming on." "I will make sure to also use my steroid inhaler and will never use salmeterol by itself." "I should only take the amount of salmeterol the health care provider prescribed." "I will follow up with my health care provider to have my liver tested after starting salmeterol." "I should rinse my mouth after I inhale salmeterol because I might develop a yeast infection."

"I should use this when I feel an asthma attack is coming on." "I will follow up with my health care provider to have my liver tested after starting salmeterol." "I should rinse my mouth after I inhale salmeterol because I might develop a yeast infection." - - - - - - - - - - - - - "I should use this when I feel an asthma attack is coming on." Salmeterol is a long-acting beta2-adrenergic agonist that is used in the maintenance of asthma control. It should not be used during an acute attack of asthma. "I will follow up with my health care provider to have my liver tested after starting salmeterol." Although follow-up is important for a patient receiving salmeterol, liver function tests are not warranted for patients receiving this drug. Liver function should be monitored for patients receiving leukotriene modifiers. Patients receiving salmeterol would have forced expiratory volume, peak expiratory flow, nighttime awakenings, symptom frequency and severity, and short-acting beta2-adrenergic agonist use assessed. "I should rinse my mouth after I inhale salmeterol because I might develop a yeast infection." Rinsing the mouth with water after inhalation of glucocorticoids, not LABAs such as salmeterol, is important to prevent oropharyngeal candidiasis.

A patient asks a nurse when he or she should expect to start experiencing the effects of pseudoephedrine. Which time frame would the nurse share? 5 to 10 minutes 15 to 30 minutes 3 to 4 hours 5 to 6 hours

15 to 30 minutes A patient would likely begin to experience the effects of pseudoephedrine (i.e., onset of action) between 15 to 30 minutes after administration.

In which time frame would the nurse expect to see an improvement in a patient's allergic symptoms after the administration of diphenhydramine? 5 to 10 minutes 15 to 30 minutes 30 to 60 minutes 60 to 120 minutes

15 to 30 minutes Diphenhydramine's onset of action is 15 to 30 minutes. This is when a patient would likely notice some improvement in allergic symptoms.

Which patients receiving theophylline would a nurse monitor more closely? Select all that apply. A patient with phenylketonuria A patient who is a social smoker A patient with acute narrow-angle glaucoma A patient who excessively consumes energy drinks A patient receiving ciprofloxacin for a urinary tract infection

A patient who is a social smoker A patient who excessively consumes energy drinks A patient receiving ciprofloxacin for a urinary tract infection - - - - - - - - - - - - - - - A patient who is a social smoker Smoking increases the clearance of theophylline. Therefore sporadic smoking can render the theophylline ineffective. A patient who excessively consumes energy drinksEnergy drinks contain excessive amounts of caffeine and other stimulants. Caffeine competes with theophylline for drug-metabolizing enzymes, causing theophylline levels to increase and subsequently the risk for toxicity. A patient receiving ciprofloxacin for a urinary tract infection Ciprofloxacin can increase theophylline levels through inhibition of metabolism, necessitating a decrease in the theophylline dosage when giving these drugs concomitantly.

Which patients would a nurse determine can safely receive inhaled acetylcysteine? Select all that apply. A patient with diabetes A patient with asthma An older adult with a history of drug abuse A patient with benign prostatic hyperplasia An older adult with uncontrolled hypertension

A patient with diabetes An older adult with a history of drug abuse A patient with benign prostatic hyperplasia An older adult with uncontrolled hypertension - - - - - - - - - - - - - A patient with diabetes There is no concern with administering acetylcysteine to a patient with diabetes. It is not expected to affect blood glucose levels. An older adult with a history of drug abuse There is no concern with administering acetylcysteine to an older patient with a history of drug abuse because there is no abuse potential. A patient with benign prostatic hyperplasia There is no concern with administering acetylcysteine to a patient with benign prostatic hyperplasia. It is not expected to affect voiding abilities like decongestants and antitussives do. An older adult with uncontrolled hypertension There is no concern with administering acetylcysteine to a patient with uncontrolled hypertension because it is not expected to increase blood pressure levels.

Which drugs are anticholinergics? Select all that apply. Zileuton Aclidinium Tiotropium Budesonide Theophylline Arformoterol

Aclidinium Tiotropium - - - - - - - - - - - - - - - Aclidinium Aclidinium is an anticholinergic. Tiotropium Tiotropium is a longer acting anticholinergic.

A patient with chronic obstructive pulmonary disease (COPD) has been prescribed ipratropium. The patient also takes diphenhydramine for allergic rhinitis and cimetidine for gastroesophageal reflux disease. Which effect caused by which drug does the nurse anticipate will occur when administered with ipratropium? Increased levels and toxicity of ipratropium caused by cimetidine Decreased levels and loss of effects of ipratropium caused by cimetidine Additive anticholinergic effects caused by diphenhydramine Reduced efficacy of ipratropium caused by diphenhydramine

Additive anticholinergic effects caused by diphenhydramine The anticipated drug interaction is between diphenhydramine and ipratropium. Both are anticholinergic drugs; therefore when these drugs are given together, the effect can be additive anticholinergic effects.

Which patient parameters would a nurse assess to help a health care provider determine an accurate dose for and monitor theophylline in a patient with asthma? Select all that apply. Age Height Weight Smoking status Presence of liver disease Presence of heart disease

Age Weight Smoking status Presence of liver disease Presence of heart disease - - - - - - - - - - - - - - Age Theophylline dosage ranges are generally based on age (i.e., pediatric patients), so it is important to determine the patient's age for accurate dose determination and monitoring. Weight The dosage of theophylline is typically dependent on weight; therefore the patient's weight would be important. Smoking status Smoking increases the clearance of theophylline; smoking status should be assessed for the patient taking theophylline for accurate dose determination and monitoring. If a patient decides to stop smoking or increases the quantity of cigarettes smoked, this would affect theophylline levels. Presence of liver disease Patients with liver disease will likely require a lower dosage of theophylline. Therefore the presence of liver disease would be important to ascertain for dosage determination and monitoring. Presence of heart disease Because patients with heart disease will likely require a lower dosage of theophylline, this information would be important to ascertain for accurate dosage determination and monitoring.

Which drug has a quick onset of action and is recommended for use during an acute asthma attack or chronic obstructive pulmonary disease (COPD) exacerbation? Albuterol Fluticasone propionate Salmeterol Zafirlukast

Albuterol Albuterol has a quick onset of action of 10 to 25 minutes and is considered a "rescue" drug used in patients suffering from an acute asthma attack or COPD exacerbation.

A patient with asthma has been prescribed salmeterol. The patient also takes aspirin, atenolol, furosemide, and phenobarbital. Which drug would be expected to decrease bronchodilation when given with salmeterol? Aspirin Atenolol Furosemide Phenobarbital

Atenolol Atenolol is a beta blocker. When a beta blocker is given with a beta agonist, there may be a reduction in bronchodilation.

Which counseling points would a nurse provide a patient who has been prescribed an antitussive containing codeine? Select all that apply. Avoid alcohol while receiving the codeine-containing antitussive. Potential side effects include sedation, dizziness, nausea, vomiting, and constipation. Increase water intake to help loosen secretions for them to be coughed up. Report any changes in sputum or mucus color, chest tightness, or difficulty breathing to a health care provider. Avoid driving or other activities that require mental alertness in the event dizziness and sedation occur.

Avoid alcohol while receiving the codeine-containing antitussive. Potential side effects include sedation, dizziness, nausea, vomiting, and constipation. Report any changes in sputum or mucus color, chest tightness, or difficulty breathing to a health care provider. Avoid driving or other activities that require mental alertness in the event dizziness and sedation occur. - - - - - - - - - - - - - - - - Avoid alcohol while receiving the codeine-containing antitussive.Patients who are taking codeine-containing antitussives should not consume alcohol because of the risk for central nervous system (CNS) depression/significant sedation. Potential side effects include sedation, dizziness, nausea, vomiting, and constipation. Sedation, dizziness, nausea, vomiting, and constipation are all potential side effects associated with codeine-containing antitussives. A patient should be educated to report any changes in the color of the sputum or mucus, chest tightness, or difficulty breathing to a health care provider because this may signify the possibility of a more serious condition that warrants further evaluation and treatment. Because opioid-containing antitussives may cause significant dizziness and drowsiness, patients should be advised against driving or completing other activities requiring mental alertness in the event these side effects occur.

Match the drug class to its mechanism of action. Decrease production/release of leukotrienes, histamine, & prostaglandins Inhibit muscarinic receptors in the lungs to improve lung function Relax bronchial smooth muscle to cause bronchodilation Stimulate adrenergic receptors in the sympathetic nervous system Glucocorticoids Leukotriene Modifiers Theophylline Anticholinergics Beta-2 Adrenergic Agonists

Decrease production/release of leukotrienes, histamine, & prostaglandins ANTICHOLINERGICS- Inhibit muscarinic receptors in the lungs to improve lung function Relax bronchial smooth muscle to cause bronchodilation Stimulate adrenergic receptors in the sympathetic nervous system

Which antihistamines are associated with minimal to no sedation? Select all that apply. Brompheniramine Desloratadine Diphenhydramine Hydroxyzine Levocetirizine

Desloratadine Levocetirizine - - - - - - - - - Desloratadine Desloratadine is considered a second-generation antihistamine that is associated with minimal to no sedation. Levocetirizine Levocetirizine is considered a second-generation antihistamine that is associated with minimal to no sedation.

Which drug causes a nurse to carefully consider the patient's drug list for potential drug-drug interactions due to its metabolism through CYP450 2D6? Acetylcysteine Dextromethorphan Guaifenesin Pseudoephedrine

Dextromethorphan Dextromethorphan is metabolized by CYP450 2D6 and should be carefully considered with other drugs the patient may be taking such as paroxetine and fluoxetine.

Which side effects would the nurse monitor for in a patient receiving an initial dose of diphenhydramine? Select all that apply. Dizziness Dry mouth Restlessness Sedation Tremors Visual changes

Dizziness Dry mouth Sedation Visual changes - - - - - - - - - - Dizziness Dizziness is a common side effect associated with first-generation antihistamines like diphenhydramine. Dry mouth Dry mouth is an anticholinergic side effect associated with first-generation antihistamines like diphenhydramine. Sedation Sedation or drowsiness is a common side effect associated with first-generation antihistamines like diphenhydramine. Visual changes Visual changes are an anticholinergic side effect associated with first-generation antihistamines like diphenhydramine.

Which clinical manifestation alerts a nurse to a possible drug interaction in a patient who is receiving both diazepam and diphenhydramine? Edema/weight gain Excessive drowsiness/lethargy Excessive sweating/heat intolerance Palpitations/overstimulation

Excessive drowsiness/lethargy Diazepam is a benzodiazepine that causes central nervous system (CNS) depression. Because first-generation antihistamines can also cause significant CNS depression, the combination of these drugs can cause additive CNS depression resulting in excessive drowsiness and lethargy. The dosage of the diazepam may need to be decreased while the patient is receiving diphenhydramine. Alternatively, the benzodiazepine or diphenhydramine may be altered to another drug that does not cause significant sedation.

Which clinical manifestation alerts a nurse to a possible drug-drug interaction in a patient with Parkinson disease who developed the common cold and is receiving selegiline and pseudoephedrine? Hepatotoxicity Hypertension Muscle aches and cramps Renal dysfunction

Hypertension Selegiline is an MAOI-B used in the management of Parkinson disease. When administering an MAOI in combination with pseudoephedrine, there is a significant risk for hypertension.

A patient has been prescribed fluticasone propionate for asthma management. The patient also has type 2 diabetes mellitus and dyslipidemia, which are medically managed. Which effect and action does the nurse anticipate may occur when fluticasone propionate is started for this patient? Increased lipids; adjustment of cholesterol medications Decreased lipids; discontinuation of cholesterol medications Increased blood glucose; adjustment of diabetes medications Decreased blood glucose; discontinuation of diabetes medications

Increased blood glucose; adjustment of diabetes medications Glucocorticoids such as fluticasone can increase blood glucose levels, even in patients without diagnosed diabetes mellitus. Therefore a dosage increase in diabetes medications may be warranted.

Which effect will a nurse anticipate for a patient who is receiving both zafirlukast and warfarin? Increased warfarin levels, thereby decreasing the risk for bleeding Increased warfarin levels, thereby increasing the risk for bleeding Reduced warfarin levels, thereby decreasing the risk for bleeding Reduced warfarin levels, thereby increasing the risk for bleeding

Increased warfarin levels, thereby increasing the risk for bleeding The drug interaction between zafirlukast and warfarin results in decreased clearance of warfarin, which increases warfarin levels. As a result, the patient's risk of bleeding also increases.

Which teaching points should be included for a patient prescribed montelukast? Select all that apply. Insomnia may occur when receiving this medication. You can anticipate experiencing dry mouth with montelukast. You may experience a racing heart or chest pain with this medication. Report suicidal thoughts to your provider immediately. You should not stop taking this medication abruptly because it may cause adrenal suppression.

Insomnia may occur when receiving this medication. Report suicidal thoughts to your provider immediately. - - - - - - - - - - - - Insomnia may occur when receiving this medication. Insomnia is a potential side effect associated with leukotriene modifiers. Report suicidal thoughts to your provider immediately. Suicidal ideations are a potential adverse effect associated with leukotriene modifiers and should be reported.

A patient with chronic obstructive pulmonary disease (COPD) complains of dry mouth, blurry vision, cough, and difficulty urinating but cannot recall the name of the inhaler that was recently prescribed. Which drug does the nurse determine the patient is likely receiving based on the symptoms? Albuterol Fluticasone Ipratropium Theophylline

Ipratropium The patient's symptoms of dry mouth, blurry vision, and urinary retention are suggestive of anticholinergic effects. In addition, patients receiving anticholinergic drugs such as ipratropium may experience cough.

Which statements describe the pharmacokinetics of guaifenesin? Select all that apply. It is readily absorbed in the gastrointestinal tract. It is largely protein bound. The drug undergoes hydrolysis. Its metabolism extensively involves the cytochrome P450 system. Guaifenesin is excreted in urine.

It is readily absorbed in the gastrointestinal tract. The drug undergoes hydrolysis. Guaifenesin is excreted in urine. - - - - - - - - - - - - - - - It is readily absorbed in the gastrointestinal tract. Guaifenesin is readily absorbed in the gastrointestinal tract. The drug undergoes hydrolysis. Guaifenesin is metabolized through hydrolysis. Guaifenesin is excreted in urine. The major route of elimination for guaifenesin is the urine.

Which statements describe the pharmacokinetics of diphenhydramine? Select all that apply. Oral administration is associated with good absorption in the gastrointestinal tract. When used topically, there is minimal systemic absorption of diphenhydramine. The drug is 80% to 85% protein bound. Diphenhydramine undergoes hepatic metabolism. The drug is excreted in the feces.

Oral administration is associated with good absorption in the gastrointestinal tract. When used topically, there is minimal systemic absorption of diphenhydramine. The drug is 80% to 85% protein bound. Diphenhydramine undergoes hepatic metabolism. - - - - - - - - - - - - - - Oral administration is associated with good absorption in the gastrointestinal tract. Diphenhydramine is well absorbed in the gastrointestinal tract after oral administration. When used topically, there is minimal systemic absorption of diphenhydramine. Topical administration of diphenhydramine is not expected to be systemically absorbed to any significant degree. The drug is 80% to 85% protein bound. Diphenhydramine is 80% to 85% protein bound. Diphenhydramine undergoes hepatic metabolism. The drug is metabolized by the liver.

Which counseling points would a nurse provide in patient teaching regarding the use of an inhaled glucocorticoid for asthma? Select all that apply. Palpitations and tremors are expected side effects associated with inhaled glucocorticoid therapy. Rinse the mouth and gargle with water after using an inhaled corticosteroid to minimize the risk for an oral fungal infection. Glucocorticoids are indicated for the acute treatment of symptoms and should be used on an "as-needed" basis for symptoms. Drug levels should be routinely assessed to ensure the patient is not receiving too much or too little of the inhaled glucocorticoid. Because long-term use of inhaled glucocorticoids may cause potential bone loss, adequate vitamin D and calcium intake, along with weight-bearing exercises, is recommended.

Rinse the mouth and gargle with water after using an inhaled corticosteroid to minimize the risk for an oral fungal infection. Because long-term use of inhaled glucocorticoids may cause potential bone loss, adequate vitamin D and calcium intake, along with weight-bearing exercises, is recommended. - - - - - - - - - - - - - - - Rinse the mouth and gargle with water after using an inhaled corticosteroid to minimize the risk for an oral fungal infection. Patients receiving an inhaled glucocorticoid should rinse and gargle with water after administration of the drug to prevent the development of an oral fungal infection (oropharyngeal candidiasis). The use of a spacer (if using a metered-dose inhaler) can also help to reduce the risk of an oral fungal infection. Because long-term use of inhaled glucocorticoids may cause potential bone loss, adequate vitamin D and calcium intake, along with weight-bearing exercises, is recommended. Although minimal systemic absorption is expected with inhaled glucocorticoids, chronic use can lead to bone loss. Therefore ensuring the patient receives adequate calcium and vitamin D, along with weight-bearing exercises, is important to prevent osteoporosis.

Which instructions would the nurse include when teaching a patient about the use of a first-generation antihistamine? Select all that apply. Take prophylactically to ensure efficacy. Administer on an empty stomach to enhance absorption. Avoid alcohol while taking the antihistamine because of the risk for central nervous system (CNS) depression. Sugarless candy and frequent sipping of liquids can help with dry mouth from the antihistamine. Avoid tasks requiring mental alertness, such as driving, until the patient determines the drug is not affecting motor skills or responses.

Take prophylactically to ensure efficacy. Avoid alcohol while taking the antihistamine because of the risk for central nervous system (CNS) depression. Sugarless candy and frequent sipping of liquids can help with dry mouth from the antihistamine. Avoid tasks requiring mental alertness, such as driving, until the patient determines the drug is not affecting motor skills or responses. - - - - - - - - - - - - - Take prophylactically to ensure efficacy. Antihistamines are best taken prophylactically and are less effective in the presence of acute symptoms. Avoid alcohol while taking the antihistamine because of the risk for central nervous system (CNS) depression. Alcohol and other CNS depressants should be avoided in patients receiving first-generation antihistamines because of the risk for additive CNS depression. Sugarless candy and frequent sipping of liquids can help with dry mouth from the antihistamine. Sugarless candies and frequent sipping of liquids can help combat dry mouth that is associated with first-generation antihistamines. Avoid tasks requiring mental alertness, such as driving, until the patient determines the drug is not affecting motor skills or responses. Patients should avoid tasks requiring mental alertness, such as driving, until the patient is able to determine the drug has not significantly affected his or her motor skills or responses or until tolerance develops.

Which counseling point regarding the pharmacokinetics and pharmacodynamics of dextromethorphan would a nurse include in patient teaching? Dextromethorphan's effects last for about 12 hours. Because it is an opioid drug, it may cause analgesia and excessive drowsiness. The drug is an antitussive that works through suppressing the cough reflex within the cough center. The drug is well absorbed in the lungs when inhaled deeply through a nebulizer.

The drug is an antitussive that works through suppressing the cough reflex within the cough center.The drug is an antitussive that activates sigma opioid receptors in the cough center to suppress the cough reflex. It is a derivative of the opioid levorphanol but is not an opioid itself, which is why it activates opioid receptors.

Which statement regarding the pharmacokinetics of loratadine is accurate? Loratadine is slowly absorbed after administration. The drug is minimally protein bound. Loratadine's metabolism predominantly occurs through CYP1A2. The drug is largely and equally excreted in urine and feces.

The drug is largely and equally excreted in urine and feces. It is true that approximately 80% of loratadine is excreted equally in urine and feces.

Which drug should be administered at least 1 hour before meals or 2 hours after meals? Albuterol Montelukast Zafirlukast Zileuton

Zafirlukast The absorption of zafirlukast is reduced by 40% in the presence of food; therefore the drug should be administered at least 1 hour before meals or 2 hours after meals.