HESI for Pharmacology Drug Study List

Celecoxib Contraindications:

-Treatment of perioperative pain after Coronary artery bypass surgery -Patients with asthma -Patients with hives -Patients allergic to sulfonamides, aspirin, or other NSAIDs

Carbamazepine Adverse Effects:

-Worsening of seizures -Depression -Suicidal Ideation -Drowsiness -Confusion

Enoxaparin Indication:

treatment and prevention of DVT, ischemic complications of acute MI, post-thrombolysis

Dicyclomine Nursing Considerations:

Overdose may cause muscle relaxant-like effects, such as respiratory paralysis.

Carbidopa/levodopa Indication:

Parkinson disease (increases dopamine levels in brain)

Erythropoietin Alfa Nursing Considerations:

Patient should not receive epoetin if they have hypertension.

Clopidogrel Indication:

Prevent Stroke and MI in patients with peripheral arterial disease or angina

Donepezil Nursing Considerations:

-Increased risk of GI bleeding with NSAIDs

Donepezil Adverse Effects:

-Increased salivation -Involuntary defecation -Bradycardia -Hypotension -Heart block -Cardiac arrest

Aluminum Hydroxide Adverse Effects:

-Intestinal Obstruction -Hypophosphatemia -Constipation

Magnesium Hydroxide Contraindications:

-Intestinal obstruction -Rectal fissures -Fecal impaction

Cyclophosphamide (Cytoxan) Adverse Effects:

-Leukopenia -Thrombocytopenia -Anemia -Alopecia (hair loss) -Nausea/Vomiting -Hepatotoxicity

Bactrim (clotrimazole) Adverse Effects:

-MIld vaginal burning or irritation -Urine frequency -Erythema -Blistering -Pruritus (itching)

Sodium Bicarbonate Adverse Effects:

-Metabolic alkalosis (most severe) -Hypokalemia -Hypernatremia -Hyperosmolarity -ACID REBOUND

Diclofenac Indication:

-Migraines -Analgesia -Rheumatoid arthritis -Osteoarthritis -Ankylosing spondylitis (arthritis of the spine and large joints)

Cyclophosphamide (Cytoxan) Nursing Considerations:

-Monitor CBC and Renal Function tests and Liver Function results

Celecoxib Nursing Considerations:

-NSAIDs cause an increased risk of serious GI bleeding -NSAIDs may increase the risk of MI or stroke

Diclofenac Nursing Considerations:

-NSAIDs cause in increased risk of GI bleeding and ulcerations

Cyclosporine Adverse Effects:

-Nephrotoxicity -Anemia -Leukopenia -Thrombocytopenia -Hepatotoxicity -Hypertension

Ferrous sulfate Nursing Considerations:

-Patients stools may become dark, tarry, and green. -Have children drink with a straw to avoid staining teeth. -Administer IM in Z track method -Monitor hemoglobin and hematocrit

Sodium Bicarbonate Contraindications:

-Patients with metabolic or respiratory alkalosis. -Renal disease

Cyclosporine Indication:

-Prevent organ rejection

Diltiazem Indications:

-Prinzmetal angine -Hypertension -Atrial fibrillation -Supraventricular tachycardia

Cyclophosphamide (Cytoxan) Teaching:

-Report all signs and symptoms of Infection, bleeding, dyspnea, cough, edema, and dizziness

Diclofenac Teaching:

-Report signs of GI bleeding -Avoid drinking alcohol -Avoid taking aspirin during drug therapy

Celecoxib Teaching:

-Report signs of GI bleeding -Immediately report rash, unexplained weight gain, or swelling -Seek medical attention if chest pain or shortness of breath or slurred speech occurs.

Dicyclomine Adverse Effects:

-Severe Constipation -Bloating -Stomach pain -Worsening of Diarrhea -Feeling thirsty or hot -Urinary retention -Heavy sweating

Carbidopa/levodopa Adverse Effects:

-Suicidal tendencies -Psychotic episodes -Dizziness -Insomnia

Bactrim (clotrimazole) Indications:

-Superficial fungal infections (tinea) -Candidiasis (yeast infection) -UTI

Magnesium Hydroxide Adverse Effects:

-Fluid and electrolyte disturbances -Could develop dependency -Diarrhea

Diclofenac Adverse Effects:

-Abdominal distention -Heart failure -Edema -Fluid retention -Bleeding

Ferrous sulfate Adverse Effects:

-Anorexia -Constipation -CNS toxicity progressing to coma and death

Carbamazepine Contraidications:

-Antidepressants -History of bone marrow suppression -MAO Inhibitor -Pregnancy

Diltiazem Classification:

-Antihypertensive -Antiarrhythmic -Antianginal (Prinzmetal angina) -Calcium Channel Blocker

Diltiazem Adverse Effects:

-Bradycardia -Peripheral edema -Hypotension -AV block -Skin flushing -Dry hachy cough

Cyclophosphamide (Cytoxan) Indication:

-Breast or Ovarian cancer -Various Lymphomas (lymph cancer) -Leukemai

Acetylcysteine Adverse Effects:

-Bronchospasm -Anaphylactoid reaction

Diflucan Indication:

-Candidiasis -Cryptococcal meningitis (infection in brain or spinal column)

Sodium Bicarbonate Teaching:

-Do NOT take with MILK. -If acid indigestion, heartburn, upset stomach last longer than 2 weeks, call Dr.

Carbamazepine Nursing Considerations:

-Don't give with grapefruit juice -Monitor patients for changes in behavior or suicidal thoughts -Normal drug level is 4-12 mg/dL

Clopidogrel Adverse Effects:

-Fatal intracranial bleeding -Hemorrhage -Thrombocytopenia (low platelet count)

Erythropoietin Alfa Adverse Effects:

-Fatigue -Dizziness -Potential for serious seizures -Hypertension

A nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this client may have based on the use of this medication? 1. Dementia 2. Schizophrenia 3. Seizure disorder 4. Obsessive-compulsive disorder

1. Dementia Rationale: Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderate dementia of the Alzheimer type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer's disease. Options 2, 3, and 4 are incorrect.

A nurse prepares to reinforce instructions to a client who is taking allopurinol (Zyloprim). The nurse plans to include which of the following in the instructions? 1. Instruct the client to drink 3000 mL of fluid per day. 2. Instruct the client to take the medication on an empty stomach. 3. Inform the client that the effect of the medication will occur immediately. 4. Instruct the client that, if swelling of the lips occurs, this is a normal expected response

1. Instruct the client to drink 3000 mL of fluid per day. Rationale: Allopurinol (Zyloprim) is an antigout medication used to decrease uric acid levels. Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with or immediately following meals or milk to prevent gastrointestinal irritation. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the health care provider because this may indicate hypersensitivity.

Donepezil Inidcation:

Mild-moderate-severe Alzheimer's

The client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. Intestinal obstruction 2. Peptic ulcer with melena 3. Diverticulitis with perforation 4. Vomiting following cancer chemotherapy

4. Vomiting following cancer chemotherapy Rationale: Metoclopramide is a gastrointestinal (GI) stimulant and antiemetic. Because it is a GI stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of emesis after surgery, chemotherapy, and radiation.

Aluminum Hydroxide Class:

Antacid

Sodium Bicarbonate Classification:

Antacid

Donepezil Classification:

Anti-Alzheimer's

Erythropoietin Alfa Classification:

Anti-anemia

Enoxaparin Classification:

Anticoagulant (Low molecular weight heparin)

Carbamazepine Class:

Anticonvulsant

Diflucan Classification:

Antifungal

Bactrim (clotrimazole) Class:

Antifungals

Allopurinol Class:

Antihyperuricemic, antigout

Cyclophosphamide (Cytoxan) Classification:

Antineoplastic

Carbidopa/Levodopa Class:

Antiparkinsonians

Enoxaparin Adverse Effects:

Causes fewer systemic adverse effects than other anticoagulants

Diflucan Nursing Considerations:

Caution with hepatic/renal failure for possible liver toxicity -Check for any drug-to-drug interactions because many drugs interact. (digoxin, antihyperglycemics)

Allopurinol Indications:

Gout, Cancer therapy-induced hyperuricemia, calcium oxalate stones

Carbidopa/levodopa Nursing Considerations:

Hallucination may require reduction or withdrawal of drug.

Acetylcysteine Contraindications:

Hypersensitivity

Dicyclomine Teaching:

If signs and symptoms (fever, decreased sweating) occur, instruct patient to stop drug and contact prescriber.

Cyclosporine Classification:

Immunosuppressant

Ferrous sulfate Classification:

Iron Supplement

Magnesium hydroxide Class:

Laxative

Drugs that only affect COX-2 indications?

Osteoarthritis

Allopurinol Adverse Effects:

Rash (most common), Renal failure, Acute gout attack

Allopurinol Nursing Considerations:

Rash can be followed by more severe hypersensitivity reactions like Steven-Johnson syndrome or irreversible hypatotoxicity. (Discontinue at first sign of RASH)

A nurse reinforces instructions to a client who is taking levothyroxine (Synthroid). The nurse tells the client to take the medication: 1. With food 2. At lunchtime 3. On an empty stomach 4. At bedtime with a snack

Rationale: Oral doses of levothyroxine (Synthroid) should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast. *Note that options 1, 2, and 4 are comparable or alike in that these options address administering the medication with food.*

Celecoxib Adverse Effects:

Signs of GI bleed: -Blood or tarry stools -Coughing up blood -Coffee ground vomitus

A client taking carbamazepine (Tegretol) asks the nurse what to do if he misses one dose. The nurse responds that the carbamazepine should be: 1. Withheld until the next scheduled dose 2. Withheld and the health care provider is notified immediately 3. Taken as long as it is not immediately before the next dose 4. Withheld until the next scheduled dose, which should then be doubled

Taken as long as it is not immediately before the next dose Rationale: Carbamazepine is an anticonvulsant that should be taken around the clock, precisely as directed. If a dose is omitted, the client should take the dose as soon as it is remembered, as long as it is not immediately before the next dose. The medication should not be double dosed. If more than one dose is omitted, the client should call the health care provider.

Enoxaparin Teaching:

Teach patient to self administer shots in abdomen, and how to watch for signs of bleeding.

Carbamazepine Teaching:

Tell patient that drug may cause mild to moderate dizziness and drowsiness when first taken and to avoid hazardous activities until effects disappear.

Bactrim (clotrimazole) Teaching:

Tell patient to refrain from sexual intercourse during vaginal treatment.

Sodium Bicarbonate Nursing Considerations:

To avoid risk of alkalosis, obtain blood pH, partial pressure of arterial oxygen, partial pressure of arterial carbon dioxide, and electrolyte levels.

Aluminum Hydroxide Indication:

Treat Acid indigestion

Acetylcysteine Class:

mucolytic and antidote

Antacid Prototype:

sodium bicarbonate

Carbamazepine Indication:

-Tonic-clonic and complex partial seizures

Magnesium hydroxide Indication:

-Treat constipation -Evacuate bowel before surgery

Calcium phosphate Indication:

-Treat low calcium levels such as bone loss (Osteoporosis) -Weak bones (osteomalacia/rickets) -Muscle disease (latent tetany)

Acetylcysteine Indication:

-treat abnormal thickened mucous secretions -acetaminophen toxicity antidote

Celecoxib Indication:

-treat acute pain -primary dysmenorrhea (menstrual cramps) -relieve signs and symptoms of Osteoarthritis

Diclofenac Contraindications:

-treatment of perioperative pain after CABG -Patients with Asthma -Patients allergic to sulfonamides, aspirin, or other NSAIDs

Carbidopa/levodopa Contraindications:

-Hypersensitivity -Angle-closure glaucoma

Cyclosporine Nursing Consideration:

-Immunosuppressants increase the risk of opportunistic infections -Monitor Renal Function

Calcium phosphate Adverse Effects:

-Nausea/Vomiting -Unusual weight loss -Mental/mood changes -Bone/muscle pain -Increased thirst -Increased urination

Sodium Bicarbonate Indication:

-Symptomatic relief of upset stomach from hyperacidity -Prophylaxis for GI bleeding

Allopurinol Teaching:

-Take after meals and with fluids, avoid alcohol. -May cause drowsiness so don't operate machinery or drive. -Discontinue if RASH appears

Cyclosporine Teaching:

-Teach patient how to measure dosage and mask taste of oral solution. -Don't take with grapefruit juice -Avoid people with infections

Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures that which of the following medications is available on the nursing unit? 1. Protamine sulfate 2. Potassium chloride 3. Phytonadione (vitamin K ) 4. Aminocaproic acid (Amicar)

1. Protamine sulfate Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage occurs. Potassium chloride is administered for a potassium deficit. Vitamin K is an antidote for warfarin sodium. Aminocaproic acid is the antidote for thrombolytic therapy.

Which of the following precautions will the nurse specifically take during the administration of ribavirin (Virazole) to a child with respiratory syncytial virus (RSV)? 1. Wearing goggles 2. Wearing a gown 3. Wearing a gown and a mask 4. Handwashing before administration

1. Wearing goggles Rationale: Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A gown is not necessary. A mask may be worn. Handwashing is to be performed before and after any child contact.

The nurse is reinforcing medication instructions to a client with breast cancer who is receiving cyclophosphamide (Neosar). The nurse tells the client to: 1. Take the medication with food. 2. Increase fluid intake to 2000 to 3000 mL daily. 3. Decrease sodium intake while taking the medication. 4. Increase potassium intake while taking the medication.

2. Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is a toxic effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal (GI) upset occurs. Hyperkalemia can result from the use of the medication; therefore the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

Insulin glargine (Lantus) is prescribed for a client with diabetes mellitus. The nurse tells the client that it is best to take the insulin: 1. 1 hour after each meal 2. Once daily, at the same time each day 3. 15 minutes before breakfast, lunch, and dinner 4. Before each meal, on the basis of the blood glucose level

2. Once daily, at the same time each day Rationale: Insulin glargine is a long-acting recombinant DNA human insulin used to treat type 1 and type 2 diabetes mellitus. It has a 24-hour duration of action and is administered once a day, at the same time each day.

A nurse reinforces medication instructions to a client who is taking levothyroxine (Synthroid). The nurse instructs the client to notify the health care provider (HCP) if which of the following occurs? 1. Fatigue 2. Tremors 3. Cold intolerance 4. Excessively dry skin

2. Tremors Rationale: Excessive doses of levothyroxine (Synthroid) can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the HCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism.

Ribavirin (Virazole) is prescribed for the hospitalized child with respiratory syncytial virus (RSV). The nurse prepares to administer this medication via which of the following routes? 1. Orally 2. Via face mask 3. Intravenously 4. Intramuscularly

2. Via face mask Rationale: Ribavirin is an antiviral respiratory medication used mainly in hospitalized children with severe RSV and in high-risk children. Administration is via hood, face mask, or oxygen tent. The medication is most effective if administered within the first 3 days of the infection.

A client with portosystemic encephalopathy is receiving oral lactulose (Chronulac) daily. The nurse assesses which of the following to determine medication effectiveness? 1. Lung sounds 2. Blood pressure 3. Blood ammonia level 4. Serum potassium level

3. Blood ammonia level Rationale: Lactulose is a hyperosmotic laxative and ammonia detoxicant. It is used to prevent or treat portosystemic encephalopathy, including hepatic precoma and coma. It also is used to treat constipation. The medication retains ammonia in the colon (decreases the blood ammonia concentration), producing an osmotic effect. It promotes increased peristalsis and bowel evacuation, expelling ammonia from the colon.

After kidney transplantation, cyclosporine (Sand immune) is prescribed for a client. Which laboratory result would indicate an adverse effect from the use of this medication? 1. Decreased creatinine level 2. Decreased hemoglobin level 3. Elevated blood urea nitrogen level 4. Decreased white blood cell count

3. Elevated blood urea nitrogen level Rationale: Nephrotoxicity can occur from the use of cyclosporine (Sandimmune). Nephrotoxicity is evaluated by monitoring for elevated blood urea nitrogen (BUN) and serum creatinine levels. Cyclosporine is an immunosuppressant but does not depress the bone marrow.

A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol). Which laboratory result would indicate that the client is experiencing an adverse reaction to the medication? 1. Sodium level, 140 mEq/L 2. Uric acid level, 5.0 mg/dL 3. White blood cell count, 3000 cells/mm3 4. Blood urea nitrogen (BUN) level, 15 mg/dL

3. White blood cell count, 3000 cells/mm3 Rationale: Adverse effects of carbamazepine (Tegretol) appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, cardiovascular disturbances, thrombophlebitis, dysrhythmias, and dermatological effects. Options 1, 2, and 4 identify normal laboratory values.

The client with acquired immunodeficiency syndrome has begun therapy with zidovudine (Retrovir, Azidothymidine, AZT, ZDV). The nurse carefully monitors which of the following laboratory results during treatment with this medication? 1. Blood culture 2. Blood glucose level 3. Blood urea nitrogen 4. Complete blood count

4. Complete blood count Rationale: A common side effect of therapy with zidovudine is leukopenia and anemia. The nurse monitors the complete blood count results for these changes. Options 1, 2, and 3 are unrelated to the use of this medication.

A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitors the client for which common side effect associated with this medication? 1. Diarrhea 2. Weakness 3. Headache 4. Constipation

4. Constipation Rationale: Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortable side effect associated with the administration of oral iron supplements. Stool softeners are often prescribed to prevent constipation. *Focus on the name of the medication. Recalling that oral iron can cause constipation will easily direct you to the correct option.*

Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse reactions to the medication. Which of the following indicates that the client is experiencing an adverse reaction? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements

4. Impaired voluntary movements Rationale: Dyskinesia and impaired voluntary movement may occur with high levodopa dosages. Nausea, anorexia, dizziness, orthostatic hypotension, bradycardia, and akinesia (the temporary muscle weakness that lasts 1 minute to 1 hour, also known as the "on-off phenomenon") are frequent side effects of the medication.

A nurse is assisting in preparing to administer acetylcysteine (Mucomyst) to a client with an overdose of acetaminophen (Tylenol). The nurse prepares to administer the medication by: 1. Administering the medication subcutaneously in the deltoid muscle 2. Administering the medication by the intramuscular route in the gluteal muscle 3. Administering the medication by the intramuscular route, mixed in 10 mL of normal saline 4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw

4. Mixing the medication in a flavored ice drink and allowing the client to drink the medication through a straw Rationale: Because acetylcysteine has a pervasive odor of rotten eggs, it must be disguised in a flavored ice drink. It is consumed preferably through a straw to minimize contact with the mouth. It is not administered by the intramuscular or subcutaneous route. *Knowing that the medication is a solution that is also used for nebulization treatments will assist you to select the option that indicates an oral route*

Clopidogrel Classification:

Antiplatelet Agent

Dicyclomine Classification:

Antispasmodics

What lab do we need to monitor for Diclofenac?

CBC because it can interact with blood thinners adn antiplatelet drugs

Calcium Phosphate Class:

Calcium supplement

Magnesium Hydroxide Considerations:

Caution in patients with rectal bleeding

Carbidopa/levodopa Teaching:

Caution patient about possible dizziness when standing up quickly, especially at start of therapy.

Clopidogrel Nursing Considerations:

May decrease platelet count (thrombocytopenia)

Acetylcysteine Nursing Considerations:

Monitor for Bronchospasm especially pts with Asthma

Diclofenac Classification:

NSAID

Celecoxib Class:

NSAID, selective COX-2 inhibitor

Clopidogrel Teaching:

Notify prescriber if unusual bleeding or bruising occurs.

Aluminum Hydroxide Teaching:

Urge patient to notify prescriber about signs and symptoms of GI bleeding, such as tarry stools or coffee-ground vomitus.

Dicyclomine Indication:

Used for Irritable Bowel Syndrome (IBS)

Magnesium Hydroxide Teaching:

Warn patient that prolonged use may cause dependency.

Aluminum Hydroxide Nursing Considerations:

Watch for evidence of Hypophosphatemia (anorexia, malaise, muscle weakness) with prolonged use.

Bactrim (clotrimazole) Nursing Considerations:

Watch for irritation or sensitivity; stop if irritation occurs, and notify prescriber.