PHARM CH 15 (2)

A patient taking tolterodine (Detrol) reports decreased urination, ankle swelling, and a weight gain of 5 lb over the past 2 days. What should you do next? a. Hold the dose and notifies the prescriber. b. Check the patient's blood pressure and heart rate. c. Give the next dose as prescribed. d. Document the finding as the only action.

ANS: A Adverse effects of drugs for overactive bladder include chest pain, fast or irregular heart rate, shortness of breath, swelling (edema) and rapid weight gain, confusion, and hallucinations. Additionally, these drugs may cause decreased urination or no urine output, and painful or difficult urination. The dose should be held and the prescriber notified.

A hospitalized patient has received furosemide (Lasix), 40 mg orally, 30 minutes ago. To prevent injury to the patient, what should you do? a. Assist the patient to the bathroom b. Keep the patient on bed rest c. Place all four side rails in the elevated position d. Provide the patient with a bedpan or urinal

ANS: A An expected action of diuretic drugs is loss of excess fluid. This can lead to hypovolemia with signs of decreased volume including dizziness and light-headedness. To provide a safe environment for the patient, you should ensure that the patient has assistance when getting out of bed.

Why would a child be prescribed oxybutynin (Ditropan)? a. To reduce bed-wetting b. To prevent urinary retention c. To increase elimination of urea d. To decrease the risk for urinary tract infection

ANS: A Bed-wetting is a form of urinary incontinence that occurs at night. The major indication for the use of oxybutynin is to control incontinence.

You are to administer 20 mg of furosemide (Lasix) to a patient by the intravenous (IV) route. Which action is most important for you to take? a. Give the drug slowly over at least 2 minutes. b. Check the patient carefully for symptoms of low blood glucose levels. c. Mix the drug with potassium chloride to prevent a rapid drop in serum potassium levels. d. Monitor the IV site after giving the drug because furosemide causes severe tissue damage if infiltration occurs.

ANS: A Furosemide is ototoxic (can reduce hearing). This effect is more likely to occur when the drug is administered intravenously at a rapid rate (faster than 10 mg/min).

A patient is prescribed spironolactone (Aldactone). Why should you advise the patient to avoid the use of salt substitutes? a. They increase a patient's risk for a high potassium level. b. They can increase the patient's risk for hypertension. c. They may lead to hypokalemia. d. They can cause water retention.

ANS: A Most salt substitutes are made by replacing sodium with potassium. Use of salt substitutes at the same time as potassium-sparing diuretics such as spironolactone increases the patient's risk of a high potassium level (hyperkalemia).

A patient prescribed a drug for overactive bladder (OAB) tells you that he or she regularly exercises throughout the year. What would you be sure to teach him or her about exercising during summer heat? a. "When the weather is hot, you are at increased risk for heat stroke." b. "During summer always exercise early in the day or after the sun goes down." c. "Exercise will help you lose weight which will help decrease your OAB symptoms." d. "Be sure to wear disposable pads to absorb any urine that leaks from your bladder while exercising."

ANS: A Remind patients to avoid becoming overheated or dehydrated during exercise or hot weather. Patients may be at increased risk for heatstroke during exercise or hot weather because these drugs decrease perspiration (sweating).

What must you teach any patient who is taking a diuretic drug? a. Avoid foods that are rich in potassium such as bananas and broccoli. b. Sit on the side of the bed for 1 to 2 minutes before getting out of bed. c. Notify the prescriber if the heart rate is less than 70 beats/min. d. Keep a record of dietary intake for a few weeks.

ANS: B A common side effect of diuretics is hypotension and patients should be advised to change positions slowly. Patients should also be taught the signs of hypotension such as dizziness and light-headedness.

A patient is prescribed a diuretic drug twice a day. When should you advise him or her to take the last dose each day? a. Around noon with lunch b. Before 6:00 p.m. c. At 9:00 p.m. or bedtime d. Twelve hours after the first dose

ANS: B If a patient is taking more than one dose of a diuretic per day, the last dose should be taken no later than 6:00 p.m. to avoid frequent nighttime urination and disruption of sleep and rest.

A patient who has diabetes is now prescribed the thiazide diuretic metolazone (Zaroxolyn). In addition to the usual precautions, what else should you teach this patient about the new drug therapy? a. Always carry a simple sugar with you. b. Check your blood glucose level more frequently. c. Be sure to restrict your fluid intake after 6:00 p.m. d. Tell your dentist you are taking this drug before any dental work is performed.

ANS: B Metolazone can cause impaired glucose tolerance, glucosuria, and hyperglycemia in patients who have diabetes. This makes the disease harder to control.

A patient with overactive bladder has been prescribed tolterodine (Detrol). While assessing the patient, you discover the presence of the following health problems. For which problem should you contact the prescriber and question the drug order? a. Asthma b. Glaucoma c. Hypotension d. Diabetes mellitus

ANS: B Tolterodine (Detrol) is an anticholinergic drug that can close the angle of the iris of the eye and decrease the outflow of aqueous fluid in the eye. For people who have closed angle glaucoma, the intraocular pressure can become even higher and the risk for blindness increases.

Which are intended responses of antispasmodic drugs used to treat overactive bladder? (Select all that apply.) a. Urine leakage is contained in adult diapers. b. Frequency of urination is decreased. c. Perspiration (sweating) is increased. d. Incontinence of urine is decreased. e. Detrusor muscle spasm is strengthened. f. Sense if urinary urgency is decreased.

ANS: B, D, F Intended responses of urinary antispasmodic drugs include: urinary frequency is decreased, urinary urgency is decreased, and urinary incontinence is decreased.

A patient who has been prescribed amiloride (Midamor) for the past 3 months reports that she must shave her legs more frequently. What is your best action? a. Hold the next dose and notify the prescriber immediately. b. Instruct the patient to stop taking oral contraceptives while she is taking this drug. c. Document the response and reassure the patient that this is an expected side effect. d. Ask the patient whether she has noticed any changes in the thickness of her scalp hair.

ANS: C A common and nonharmful side effect of amiloride and other potassium-sparing diuretics is an increase in body hair (hirsutism) in women. It is not necessary to stop taking this drug.

Which class of drugs can increase the blood potassium level when taken with triamterene (Dyrenium)? a. High-ceiling "loop" diuretics b. Metabolism inhibiting antibacterials c. Angiotensin-converting enzyme inhibitors d. Nonnucleoside analogue reverse transcriptase inhibitors

ANS: C Drugs from the angiotensin-converting enzyme (ACE) inhibitor class promote potassium retention. When taken along with a potassium-sparing diuretic like triamterene, blood potassium levels can become too high. Drugs from the other classes on this list do not have the potassium retention action or effect.

A patient is prescribed an extended-release drug for overactive bladder. Which precaution is most important for you to teach the patient? a. "Avoid taking this drug at bedtime." b. "Drink at least 3 L of fluid daily." c. "Swallow the tablet or capsule whole." d. "Perform a home pregnancy test monthly."

ANS: C Extended-release tablets or capsules are meant to release a drug at a relatively even dose throughout the day. Chewing or crushing the drug ruins the timed-release feature and allows most of the drug dose to be absorbed at once. This can cause more side effects and limits how long the drug will be effective.

During medication reconciliation, the patient tells you that he takes Luvox daily as a "water pill." You note that this drug is not on his current list of ordered drugs. How should you proceed? a. Ask him what strength or dose of Luvox he takes. b. Request that the prescriber add Luvox to the patient's orders. c. Ask the patient to have all his drugs brought from home to the hospital. d. Check with the pharmacist to determine whether Luvox interacts with his ordered drugs.

ANS: C Luvox and Lasix are sound alike drugs and can easily be confused. Although this patient may indeed be prescribed to take Luvox (an antidepressant), the fact that he said he takes it as a "water pill" is a red flag. You must investigate this discrepancy further and not just make assumptions.

You prepare to give a second dose of furosemide (Lasix) to a patient by intravenous (IV) push. Before the injection is started, the patient reports having chest pain since the last dose of the drug. What is your best action? a. Assist the patient to lay flat and encourage him or her to take slow, deep breaths. b. Document the report as the only action for this expected side effect. c. Slow the IV drip rate and examine the infusion site for infiltration. d. Hold the dose and notify the prescriber immediately.

ANS: D Chest pain is a serious side effect or adverse reaction to furosemide and can indicate that the patient is having a heart attack. Another dose could cause a more severe response. The prescriber should be notified about this response immediately for preventive action.

A patient who is prescribed hydrochlorothiazide (HCTZ) informs you that she plans to become pregnant. What should you teach the patient about this drug? a. This drug is safe for use during pregnancy and breastfeeding. b. The prescriber will most likely decrease your dose while you are pregnant. c. You may take this drug during pregnancy, but should not use it if you plan to breastfeed. d. This drug should be avoided both during pregnancy and the time when you are breastfeeding.

ANS: D Thiazide diuretics should be avoided during pregnancy because they may cause side effects in the newborn, including jaundice and low potassium levels. Thiazide diuretics should also be avoided during breastfeeding because they pass into breast milk. The action of these drugs may decrease the flow of breast milk.

A patient is prescribed a urinary antispasmodic drug for overactive bladder. Which instruction should you provide to prevent a serious complication? a. "Be sure to let your prescriber know if your symptoms do not improve." b. "When using the patch, press it firmly to make sure it stays in place." c. "Use alcohol in moderation while taking this drug." d. "Avoid becoming overheated or dehydrated."

ANS: D Urinary antispasmodic drugs decrease the sweating response, increasing the risk for heat stroke. Patients can reduce this risk by ensuring that they keep themselves well hydrated during exercise or when in hot environments.

For which diuretic should you teach a patient to wear long sleeves, a hat, and sunscreen when going outdoors? a. Furosemide (Lasix) b. Ethacrynic acid (Edecrin) c. Torsemide (Demadex) d. Spironolactone (Aldactone)

ANS: A A side effect of furosemide is increased sensitivity of skin to sunlight (photosensitivity), possibly with skin rash, itching, redness, or severe sunburn. Teach patients prescribed furosemide to stay out of direct sunlight, wear protective clothing, and use sun block products with a skin protection factor (SPF) of at least 15. Remind them not to use sunlamps or tanning beds.