Pharm. Exam 2
The nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy? -Urinary calculi -Atrophy of the liver -Prolonged bleeding time -Premature erythrocyte destruction
Prolonged bleeding time
What is the prototype for general anesthesia?
Propofol (Diprivan)
A client with depression was prescribed fluoxetine and reports restlessness, confusion, an elevated body temperature, and poor concentration. Which intervention would the nurse anticipate preparing for in the treatment of these signs and symptoms? -Withdrawing the medication -Administering isocarboxazid -Reducing the dose of the medication -informing the client that these are expected side effects
Withdrawing the medication
A client receiving high-dosage risperidone exhibits hand tremors. Which would be the nurse's *FIRST* intervention? -Withholding the medication -Telling the client it is transitory -Giving the client finger exercises -Contacting the primary health care provider
Contacting the primary health care provider
Which antidepressant causes hypertensive crisis when combined with foods containing tyramine?
MOA inhibitors
What are 2 side effects of morphine sulfate?
Respiratory depression, hypotension
What is the prototype for the sub class drug Propionic acid derivatives?
Ibuprofen (Motrin)
What is the daily adult limit for Acetaminophen?
4000 mg/day
What is the MOA of Naloxone?
Completely blocks the effects of opioids
What is the prototype for skeletal muscle relaxants?
Cyclobenzaprine (Flexeril)
Which antiparkinsonian drug treats Parkinson tremors?
Dopaminergic
What is the MOA of Benzodiazepine?
Increases GABA, CNS depression in select areas of the brain
What is the MOA of Barbiturates?
Increases GABA, non-selective CNS depression
Which NSAID drug CANNOT be taken with another anti-inflammatory drug?
Ketorolac
What is the prototype for local anesthetics?
Lidocaine (Xylocaine)
Anti-mania agents CANNOT be taken with what kind of drugs?
NSAIDs
What are the 4 stages of pharmacokinetics?
absorption, distribution, metabolism, excretion
List the side effects (4 D's) of ketorolac:
drowsiness, dizziness, dyspnea, dry mouth
Serotonin syndrome is a high risk with which prototypes?
fluoxetine and venlafaxine
What is the MOA of opioid agonists?
stimulate opioid receptors to alter pain perception
What is the prototype for MOA inhibitors?
tranylcypromine (Parnate)
What is the prototype for SNRIs?
venlafaxine (Effexor XR)
Which NSAID drug cannot be given to children because it causes "Reye syndrome"?
Acetylsalicylic Acid (Aspirin)
What is the prototype for the sub class drug salicylates?
Acetylsalicylic acid (Aspirin)
The term that means "How the drugs affect the body"
Pharmacodynamics
The study of how people's genes affect their response to medicines:
Pharmacogenetics
The term that means "How the body acts on the drugs"
Pharmacokinetics
What is the prototype for the sub class drug barbiturates?
Phenobarbital (Luminol)
Normal levels of lithium:
0.6 to 1.2 meq/L (Toxic is > 2.0)
What is Methylphenidate used to treat?
ADD/ADHd
Which analgesic can cause liver damage with large doses?
Acetaminophen
Which medication is safer to take for pain in the week before a surgical procedure? -Naproxen -Aspirin -Ketorolac -Acetaminaphen
Acetaminophen
What is the prototype for the sub class drug Non-opioid?
Acetaminophen (Tylenol)
For a client with difficulty swallowing, the nurse will crush which medication? -Metoprolol extended release -Felodipine sustained release -Acetaminophen extra strength -Potassium chloride extended release
Acetaminophen extra strength
What can Barbiturates be used to treat?
Anxiety and seizures
What should the nurse assess while a patient is under general anesthesia?
BP, pulse, respiratory rate, LOC
Name the 2 sub classes of CNS depressants:
Barbiturates and Benzodiazepines
List 2 side effects of Naloxone:
Cardiac dysrhythmias, hypertension
A client is treated with lorazepam for status epilepticus. Which effect of lorazepam is the reason it is given? -Decreases anxiety associated with seizures -Promotes rest after the seizure episode -Depresses the CNS -Provides amnesia for the convulsive episode
Depresses the CNS
A client reports to the nurse "I've been using St. John's wort to try and feel more like myself again. I'm not sure whether it's going to work." Which symptom would the nurse further assess? -Depression -Sleep disturbance -Diminished cognitive ability -Sensory-perceptual disturbance
Depression
What is the prototype for SSRIs?
Fluoxetine (Prozac)
List the 3 side effects for Ibuprofen:
GI irritation, Rash, Photosensitivity
What is the MOA for acetylsalicylic acid and Ibuprofen?
Inhibits COX 1 and 2
What is the MOA for ketorolac (Toradol)?
Inhibits prostaglandin synthesis
Side effects of methylphenidate:
Insomnia, tachycardia, anorexia, growth suppression in children
Prototype for anti-mania agents:
Lithium (Lithobid)
What is the prototype for the sub class drug Benzodiazepines?
Lorazepam (Ativan)
Contraindications for cyclobenzaprine:
MANY drug interactions (including other CNS depressants)
What is the prototype for a CNS stimulant?
Methylphenidate (Ritalin)
NSAIDs treat what level of pain?
Mild to moderate pain
What is the antidote for an Acetaminophen Overdose?
Mucomyst
A client take an antipsychotic medication. When assessing the client for signs and symptoms of pseudoparkinsonism, the nurse will be alert for which complication? -Drooling -Blurred vision -Muscle tremors -photosensitivity
Muscle tremors
What is the prototype for Narcotic Antagonists?
Naloxone (Narcan)
What are NSAIDs?
Non-steroidal anti-inflammatory drugs
List the 3 sub classes of Analgesics:
Opioid Agonists, Opioid w/ non-opioid, Non- opioid
Which assessment will assist the nurse in determining whether a client is experiencing adverse effects of risperidone? -Monitor for episodes of diarrhea -Test sensation of lower extremities -Question if dizziness is experienced -Auscultate breath sounds to detect wheezing
Question if dizziness is experienced
Which antidepressant inhibits serotonin and norepinephrine reuptake?
SNRIs
There must be a two week gap in between taking these two medications to avoid a fatal interact:
SNRIs and MOAIs
Which antidepressant inhibits the reuptake of serotonin?
SSRIs
SSRIs and SNRIs should not be taken with what?
St. John's Wort
What is the biggest side affect of the anticonvulsant drug gabapentin (Neurontin)?
Suicidal thoughts
Naloxone effectively reverses a client's respiratory depression from an overdose of heroin. Why will the nurse continue to closely monitor this client's status? -The medication may cause peripheral neuropathy -Naloxone and heroin can cause cardiac depression when combined -Symptoms of the heroin overdose may return after the naloxone metabolizes -Hyperexcitability and amnesia may cause the client to thrash about and become injured.
Symptoms of the heroin overdose may return after the naloxone metabolizes
Fluoxetine is prescribed for a client with depression. Which precaution will the nurse consider when initiating treatment with this medication? -It must be given with milk and crackers to prevent hyperacidity and discomfort -Eating chees or pickled herring or drinking wine may cause a hypertensive crisis. -The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks -The blood level should be checked weekly for 3 months to make sure it is appropriate
The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks
Which reason explains why so many psychiatric clients are given benztropine or trihexyphenidyl in conjunction with phenothiazine-derivative neuroleptic medications? -They reduce postural hypotension -They potentiate the effects of the neuroleptic medication - They combat the extrapyramidal side effects of the neuroleptic medication -They ameliorate the depression that may accompany schizophrenia
The combat the extrapyramidal side effects of the neuroleptic medication
The protein binding capacity of drugs in infants is low. The nurse understands which is an implication of this physiological process? -The free levels of a medication will increase -The free levels of a medication will decease -The free levels of a medication will remain constant -The free levels of a medication will disappear once administered
The free levels of a medication will increase
Which would the nurse include when teaching a client with Parkinson disease about Carbidopa-levodopa? -Multivitamins should be taken daily -A high-protein diet should be followed -The medication should be taken with meals -Alcohol consumption should be in moderation
The medication should be taken with meals
Which antidepressant blocks the reuptake of serotonin, dopamine and norepinephrine?
Tricyclic
An older adult living in a long-term care facility has been receiving 600 mg of lithium twice a day for 3 weeks to ease manic behavior. The client is experiencing nausea and vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. Which intervention is appropriate? -Withholding the next dose of lithium and drawing blood for a lithium level -Obtaining a prescription for the antidote to lithium and administering it immediately -Suggesting that the health care provider replace the lithium for an antiepileptic that will control the mania -Assessing the client for coarse hand tremor and, if it is present, giving the daily dose of lithium with a bit of water
Withholding the next dose of lithium and drawing blood for a lithium level
A client with urinary incontinence is prescribed amitriptyline. Which specific instruction would the nurse provide to the client? -You should avoid dehydration -You should monitor your urine output -You should rise slowly when getting up from a sitting or lying position -You should periodically check your blood pressure when starting the medication
You should rise slowly when getting up from a sitting or lying position
What is the prototype for the sub class drug Tricyclic?
amitriptyline (Elavil)
What are Benzodiazepines used for?
anxiety and preoperative sedation
Two weeks after starting phenobarbital sodium, the client develops new symptoms. Which symptom is probably caused by the medication? -Cognitive impairment -Frequent urination -Abdominal pain -Mania
cognitive impairment
Drug that causes high risk for Neuroleptic Malignant syndrome and EPS?
haloperidol (Haldol)
What are ADVERSE effects of oxycodone w/ acetaminophen?
hypotension, respiratory depression, apnea
What is the MOA of Non-opioids?
inhibits prostaglandin synthesis
What is the prototype for the sub class drug Acetic acid derivatives?
ketorolac (Toradol)
What is the prototype for the sub class drug opioid agonists?
morphine sulfate
Symptoms of Neuroleptic Malignant Syndrome:
muscle rigidity, tremor, changes in LOC, tachycardia, high fever
What is the biggest side effect with Dopaminergic drugs?
orthostatic hypotension
What is the prototype for the sub class drug opioid w/ non-opioid?
oxycodone & acetaminophen (Percocet)
What does the nurse have to monitor after a patient takes morphine sulfate?
pain scale, respirations, BP
Methylphenidate is prescribed to treat a child's ADHD. The nurse understands that methylphenidate is used in treatment of ADHD in children because it has which effect? -Diuretic -Synergistic -Paradoxical -Hypotensive
paradoxical
DO NOT use lidocaine w/ epinephrine where?
peripheral areas
Which anticonvulsant drug causes gingival hyperplasia?
phenytoin (Dilantin)
Define "half-life"
rate at which 50% of a drug is eliminated from the plasma
What does cyclobenzaprine treat?
relieve muscle spasms