Pharm Exam 3

A patient who is receiving treatment for cancer asks why she is taking three different chemotherapy drugs. Which is the nurse's best response? "Your cancer is very advanced, therefore it requires more complicated treatment." "Each drug attacks the cancer cells in a different way, increasing the effectiveness of your treatment." "Several drugs are prescribed to find the right drug for your cancer." "One drug will cancel out the side effects of the other."

"Each drug attacks the cancer cells in a different way, increasing the effectiveness of your treatment."

The nurse realizes more medication teaching is necessary when the 30-year-old patient taking lorazepam (Ativan) makes which statement? Answers: "I must stop drinking alcoholic beverages." "I should not become pregnant while taking this drug." "I can stop this drug after 3 weeks if I feel better." "I must stop drinking coffee and colas."

"I can stop this drug after 3 weeks if I feel better."

antibiotic

A chemical that kills bacteria or slows their growth without harming body cells.

status epilepticus

A condition in which seizures recur every few minutes or last more than 30 minutes.

Erythropoietin

A hormone produced and released by the kidney that stimulates the production of red blood cells by the bone marrow.

Pseudoparkinsonism

A medication-induced temporary constellation of symptoms associated with Parkinson's disease, including tremor, reduced accessory movements, impaired gait, and stiffening of muscles.

Tolerance

A progressive decrease in a person's responsiveness to a drug.

Narcolepsy

A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times.

Herpes

A viral infection causing small painful blisters and inflammation, most commonly at the junction of skin and mucous membrane in the mouth or nose or in the genitals

A patient is receiving chemotherapy for the treatment of cancer. The nurse anticipates that the nadir will likely occur when? 2 days 8 days 15 days 30 days

8 days

The nurse is caring for a patient who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect? Answers:A. Increased gastrointestinal (GI) motility B. Mydriasis C. Urinary retention D. Vasoconstriction

A. Increased gastrointestinal (GI) motility

The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse? Answers:A. Weak peripheral pulses and decreased heart rate B. Increased peripheral pulses and increased heart rate C. Stable blood pressure and increased cardiac output D. Heart rate of 95 beats per minute and strong peripheral pulses

A. Weak peripheral pulses and decreased heart rate

Lorazepam (Ativan)

Action: •Enhances GABA neurotransmission by binding to specific benzodiazepine receptors. •GABA acts in the central nervous system to put the brakes on anxiety by slowing neurotransmission from the fear centers in the amygdala Use: •Anxiolytic, anticonvulsant, preoperative drug Side effects: •Drowsiness, dizziness, confusion •Blurred vision •Weakness, restlessness •Sleep disturbance, hallucinations •GI distress

Cytotoxic therapy

Acts by killing cells. This type of therapy will kill both normal and cancerous cells. Chemotherapy and radiation therapy are forms of this.

What is the most effective approach to managing the nausea and vomiting caused by many of the chemotherapies? Answers: Administer an IM antiemetic after the chemotherapy infusion is completed. Encourage additional fluids and bland foods like crackers prior to the administration of the medication. Administer an oral antiemetic when the patient complains of nausea. Administer an antiemetic prior the the antineoplastic medication.

Administer an antiemetic prior the the antineoplastic medication.

•Aripiprazole (Abilify)- prototype drug

Advantages: •Effective in treating both positive and negative •symptoms of schizophrenia •Positive sx are "in your face" hallucinations, illusions, bizarre behaviors and thoughts •Negative sx are "recessive" or "depressive" withdrawal, speech poverty, avolition •Less likely to cause EPS or tardive dyskinesia

•Clozapine (Clozaril)

Adverse effect •Agranulocytosis Nursing interventions •Monitor weekly WBC counts.

Cell cycle-nonspecific drugs

Alkylating agents Antitumor antibiotics Topoisomerase I inhibitors Platinum compounds

cross-sensitivity

Allergy to drugs that are chemically similar

A patient has been prescribed rivastigmine for moderate Alzheimer disease. What should the nurse teach the family member who is caring for this patient? Answers: Encourage the patient to rise slowly. Urine discoloration may be seen but is harmless. Administer the medication following the prescribed schedule. Remove obstacles that can cause injury. The medication may cause weight gain.

Answers: Encourage the patient to rise slowly. Administer the medication following the prescribed schedule. Remove obstacles that can cause injury.

Which actions can contribute to bacterial resistance to antibiotics? Select all that apply. Answers: Frequent use of antibiotics Giving large doses of antibiotics Skipping doses Taking a full course of antibiotics Treating viral infections with antibiotics

Answers: Frequent use of antibiotics Skipping doses Treating viral infections with antibiotics

cell cycle specific drugs

Antimetabolites Mitotic inhibitors Alkaloid topoisomerase II inhibitors Topoisomerase I inhibitors Antineoplastic enzymes

A patient will be receiving chemotherapy that will cause significant myelosuppression. Which priority nursing actions should the nurse plan? Select all that apply. Assess for a change in temperature Assess for an increase in diarrhea Assess for evidence of petechiae Assess for fatigue and shortness of breath Assess for taste changes

Assess for a change in temperature Assess for evidence of petechiae Assess for fatigue and shortness of breath

A client is preparing to receive cyclophosphamide as part of his cancer treatment. Which nursing intervention is a priority for the nurse? Assess for signs of hematuria or dysuria. Medicate the patient with an antiemetic if nausea occurs. Provide IV fluid hydration after the administration of cyclophosphamide. Decrease fluids to reduce the risk of renal calculi formation.

Assess for signs of hematuria or dysuria.

A patient has received atropine 30 minutes prior to a surgical procedure. The nurse knows that which is the purpose of the administration of preoperative atropine? Answers: A. To decrease heart rate B. To induce sedation C. To decrease salivary secretions D. To promote urination

C. To decrease salivary secretions

A child is receiving Vincristine (Oncovin) for the treatment of Wilms' tumor. Which finding is evidence of the main adverse effect of this medication? Numbness of the hands or feet Dysrhythmias Dyspnea Decreased urine output

Numbness of the hands or feet

Risperidone nursing interventions

Nursing Interventions •Monitor vital signs. •Monitor patient for "cheeking" medications. •Give oral drugs with food or milk. •Give IM by Z track into deep muscle using large-gauge needle. •Do not massage injection site. •Rotate injection sites. •Do not allow drug to remain in plastic syringe. •Administer drug within 15 minutes of preparation. •Monitor for EPS, NMS, WBCs. Nursing Interventions •May turn urine pink to red brown. •Warn patient that drug may take 3 to 6 weeks to achieve effectiveness. •Encourage smoking cessation. •Warn patient not to combine drug with alcohol, narcotics, or other CNS depressants. •Warn against sudden discontinuation of antipsychotics to avoid sudden recurrence of psychotic symptoms. •Monitor compliance

antipsychotic drugs

TYPICAL MEDS: (Dopamine Antagonists) Phenothiazines: - Fluphenazine (prototype drug) Nonphenothiazines: - Haloperidol ATYPICAL MEDS: •Clozapine (Clozaril) •Olanzapine (Zyprexa) •Quetiapine (Seroquel) •Asenapine (Saphris) •Risperidone (Risperdal) •Ziprasidone (Geodon)

seizure threshold

Term that refers to a person's susceptibility to seizures

A patient will be beginning therapy with fluoxetine for Major Depressive Disorder. Which is appropriate teaching related to this drug? Answers: The patient can stop taking them if they are not effective. The patient can increase the dose if the depressive symptoms become overwhelming. The full effect of the medication may take several weeks. The medication may cause unusual movement disorders.

The full effect of the medication may take several weeks.

Sedation

The reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Drugs which can be used for sedation include etomidate and midazolam

metastasis

The spread of cancer cells beyond their original site

capillary leak syndrome

__is when the number and size of the pores in the capillaries increases, causing leaking into tissue.

Pathogen

a bacterium, virus, or other microorganism that can cause disease.

Biologic Response Modifiers (BRMs)

a class of drugs that are used to treat cancer by altering or augmenting naturally occurring processes within the body.

Antipsychotics

a class of psychotropic medications used for the treatment of schizophrenia and other disorders that involve psychosis

monoclonal antibodies

a collection of identical antibodies that interact with a single antigen site

targeted therapy

a developing form of anticancer drug therapy that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells

ADHD (Attention-Deficit Hyperactivity Disorder)

a psychological disorder marked by extreme inattention and/or hyperactivity and impulsivity

Multikinase Inhibitors (MKIs)

a type of targeted therapy that inhibits the activity of specific kinase enzymes in cancer cells, preventing the activation of transcription factors

Herpes Medications

acyclovir (Zovirax) famciclovir (Famvir) valacyclovir (Valtrex) - NOT curative, but may reduce pain and shorten period of viral shedding

broad spectrum antibiotics

affect a broad range of gram-positive or gram-negative bacteria

Bacteriocidal

agent that kills bacteria

superinfection

an infection on top of another infection

Alkylating agents

anti-neoplastic- interferes with rapid DNA replication used: leukemia, multiple myeloma Csplatin, busulfan (Mylerin), cyclophosphamide (Cytoxin) adfx: very hepatotoxic, basic chemo adfx: bone marrow suppression, decreased WBC, platelets, RBCs, bleeding, GI s/s, alopecia, lost nails, infertility check hematopoesis, CBC

hormone agonist

any chemical that can bind to receptor proteins and mimic the effects of the hormone

Buspirone hydrochloride (BuSpar)

binds to serotonin and dopamine receptors; may not be effective until 1-2 weeks after continuous use; has fewer side effects of sedation and physical and psychological dependency associated with many benzodiazepines; good for use with compromised respiratory system; and grapefruit can lead to toxicity

CNS (central nervous system)

brain and spinal cord

A patient will begin receiving doxorubicin (Adriamycin) as a part of her chemotherapy protocol. Which assessment finding is the most important to assess prior to the administration of this chemotherapy agent? liver function respiratory function mental status cardiac function

cardiac function

Neurotransmitters

chemical messengers that cross the synaptic gaps between neurons

Antimetabolites

chemicals that prevent cell division by inhibiting formation of substances necessary to make DNA; used in cancer chemotherapy

palliative chemotherapy

chemotherapy that is given to relieve pain or other symptoms of cancer but not to cure it

A patient has been diagnosed with neuroleptic malignant syndrome. The nurse anticipates administration of which medication to treat this patient? Answers: tetrabenazine (Xenazine) propranolol (Inderal) lorazepam (Ativan) dantrolene (Dantrium)

dantrolene (Dantrium)

Virulence

degree of pathogenicity

hypnotic

drug that exerts a sleep-inducing effect

ototoxic

drug that is damaging to the ear/hearing

amphetamines

drugs that stimulate neural activity, causing speeded-up body functions and associated energy and mood changes

Anorexiants

drugs that suppress the activity of the brain's appetite center, causing reduced food intake

Influenza

flu

A patient with malignant melanoma is being treated with inferferon alfa. The nurse teaches the patient about the management what common side effect of biologic therapy. Increase in white blood cells flu-like syndrome alopecia constipation

flu-like syndrome

If a client were to ingest drugs or foods that interact with phenelzine, what reaction might the client experience? Answers: anaphylaxis orthostatic hypotension hallucinations hypertensive crisis

hypertensive crisis

Bacteriostatic

inhibits bacterial growth

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors

anesthesia

loss of feeling or sensation

antineoplastic drugs

medication that blocks the development, growth, or proliferation of malignant cells

extrapyramidal syndrome

movement disorders such as akathisia, dystonia, and parkinsonism caused by antipsychotic drug therapy

hospital acquired infection

nosocomial infection: E.g.- MRSA & VRE

gingival hyperplasia

overformation of gum tissue

Mitosis

part of eukaryotic cell division during which the cell nucleus divides

Antifungal drugs

polyenes and azoles, target plasma membrane of fungi

Apoptosis

programmed cell death

A patient being treated for cancer is receiving chemotherapy for palliation. The nurse understands that palliation therapy is used for what purpose?

relieve symptoms

Akathisia

restlessness

SSRIs

selective serotonin reuptake inhibitors; fluoxetine (Prozac) - *prototype drug sertraline (Zoloft) paroxetine (Paxil) citalopram (Celexa) escitalopram (Lexapro) fluvoxamine trazodone Action Block uptake of neurotransmitter serotonin Uses Major depression Anxiety disorders Obsessive-compulsive disorder Panic Phobias Prevention of migraine headaches Interactions Increased CNS effects with alcohol and other CNS depressants Side effects/adverse reactions Headache, nervousness, restlessness Insomnia, tremors, seizures GI distress Sexual dysfunction Suicidal ideation -BLACK BOX Side effects often decrease over 2 to 4 weeks.

bradykinesia

slow movement

colony stimulating factors

stimulate growth and differentiation of immature leukocytes in bone marrow

vesicant

substance that can broduce blistering on direct blistering on direct contact with skin or mucous membrane

What is the black box warning for children taking selective seratonin reuptake inhibitors ( SSRIs) ?

suicidal ideation

myelosuppression

suppression of the blood cell-producing function of the bone marrow

dependence

the condition that results when the brain develops a chemical need for a drug and cannot function normally without it

withdrawal

the discomfort and distress that follow discontinuing the use of an addictive drug

nadir

the lowest point of something

Viruses

tiny particles, smaller than bacteria and other pathogens, which must invade living cells in order to reproduce; when they invade, the cells are damaged or destroyed in the process releasing new particles to infect other cells

Gram-negative bacteria

type of bacteria that stain red with Gram stain and have a thin cell wall with an outer membrane

Tetracyclines

uExamples uTetracycline uDoxacycline *prototype drug uminocycline uSome of the broadest spectrum antibiotics uBacteriostatic uAntacids reduce absorption ( 2-3 hours apart) uTetracycline: uDon't take with dairy uStore tetracycline away from light and heat (decomposes in light) and drug can become toxic uFemale patients avoid during pregnancy Teratogenic uCaution with contraceptives uPhotosensitivity

Macrolides

uExamples: uAzithromycin *prototype drug uerythromycin uBacteriostatic uGram (+) & Gram (-) uBroad-spectrum uExamples: erythromycin, azithromycin uExamples of what these treat: C. diff., Legionnaire's, strep., Chlamydia, H. pylori

Fluoroquinolones

uExamples: uCiprofloxacin uLevofloxacin *prototype drug umoxifloxacin uBacteriocidal uGram (-) traditionally, although newer generations are effective against some gram (+). uWell absorbed via PO, although shouldn't be taken w/ vitamins or minerals uCan increase risk for tendonitis/tendon rupture Nursing Actions: uTake oral form 2 hours before or after meals uAntacids 2 hours after taking drug uCan increase Theophylline levels and Levofloxin can increase effects of oral hypoglycemics. uHypersensitivity may occur even after first dose, Stop Drug! uPhotosensitivity

Aminoglycosides

uExamples: uGentamicin *prototype drug uAmikacin uNeomycin uStreptomycin utobramycin uThese are toxic with serious Adverse Effects (ototoxicity, deafness) uBacteriocidal uAerobic, gram- (such as E. coli, Klebsiella, Pseudomonas) Poorly absorbed from GI tract Nursing Interventions: uMonitor patient for ototoxicity, nephrotoxicity thrombocytopenia and agranulocytosis uCheck hearing before and during treatment!!!! uCan increase action of oral anticoagulants uAdequate Fluid intake (minimize damage to tubules) uSometimes draw peak/trough levels uIf IM deep large muscle, If IV too rapid can cause neuromuscular issues (30 - 60 minutes infusion Adult)

yeast

unicellular fungi

combination chemotherapy

use of several chemotherapeutic agents together for the treatment of tumors

anxiolytic drugs

used to treat anxiety and anxiety disorders, insomnia, OCD, depression, posttraumatic stress disorder, and alcohol withdrawal Benzodiazepines: •Chlordiazepoxide (Librium) •Diazepam (Valium) •Clorazepate dipotassium (Tranxene) •Lorazepam (Ativan) •Alprazolam (Xanax)

Narcoleptic Malignant Syndrome

Sleep disorder. Drugs: methylphenidate (Ritalin) modafinil (Provigil) Uses ØIncreases wakefulness in narcolepsy

Which is the highest priority intervention for a patient admitted with glaucoma? Answers: A. Teach the patient to wear glasses at all times. B. Adminster pilocarpine. C. Keep lights very low. D. Teach the patient to stay out of sunlight.

B. Adminster pilocarpine.

The nurse knows that the following drug may be prescribed for symptoms of drug induced parkinsonism. Answers: A. atropine sulfate B. benztropine C. tolterodine tartrate D. scopalomine

B. benztropine

A patient treated with acyclovir for genital herpes should be instructed that Answers: breast cancer is more common in patients with a history of genital herpes antiviral medications provide a cure for genital herpes oral hygiene should be performed several times a day the medication must be taken on an empty stomach

Answer: oral hygiene should be performed several times a day

The patient asks what can be expected from carbidopa-levodopa , which has been prescribed for Parkinson's disease. What is the best response by the nurse? Answers: "A cure can be expected with consistent therapy for 6 months." "Symptoms can be reduced and your ability to perform daily tasks can improve." "Disease progression will be stopped with this drug." "This drug is given to help improve your memory."

"Symptoms can be reduced and your ability to perform daily tasks can improve."

hormone antagonists

-Binds to the hormone of the tumor --ONLY GIVE IF A HORMONAL LINK!

Influenza drugs

Amantadine Rimantadine Oseltamivir Zanamivir

EEG (electroencephalogram)

An amplified recording of the waves of electrical activity that sweep across the brain's surface. These waves are measured by electrodes placed on the scalp.

A patient is admitted to the hospital for treatment of pneumonia. The patient was not able to produce sputum for a culture. The nurse will expect the patient's provider to order which treatment? Answers: A broad -spectrum antibiotic A narrow-spectrum antibiotic Multiple antibiotics The pneumococcal vaccine

Answer: A broad -spectrum antibiotic

A nurse is teaching a nursing student about the antifungal medication amphotericin B. Which statement by the student indicates a need for further teaching? Answers: Amphotericin B can be given intravenously or by mouth. Patients who take the drug should have potassium levels monitored. This medication should not be given to patients with renal disease. This drug is used for severe systemic infections.

Answer: Amphotericin B can be given intravenously or by mouth.

While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? Answers: Aminoglycosides Cephalosporins Sulfonamides Tetracyclines

Answer: Cephalosporins

The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs? Answers: Drugs with a broad spectrum Drugs with a narrow spectrum Drugs with a broad therapeutic index Drugs with a narrow therapeutic index

Answer: Drugs with a narrow therapeutic index

A patient who has bipolar disorder has a lithium level of 2.0 mEq/L in the morning lab draw. Lithium carbonate (Lithobid) 600 mg po is ordered for 0900. What will the nurse do? Answers: Notify the mental health tech to take VS and report them to the nurse. Assess the patient for return of manic symptoms in morning rounds. Give the dose as ordered. Hold the Lithobid and notify the mental health provider STAT.

Answer: Hold the Lithobid and notify the mental health provider STAT.

A patient is taking choroquine to treat acute malaria. Which statement by the patient indicates understanding of the teaching? Answers: I should abstain from alcohol while taking this medication. I should report urine output of less than a liter per day. I should report vision changes immediately. I should take this drug on an empty stomach.

Answer: I should report vision changes immediately.

Which nursing intervention is the priority when a patient is receiving antiviral agents? Answers: Enhancing bowel function Increasing tidal volume Promoting circulation Promoting hydration

Answer: Promoting hydration

A client is receiving ampicillin sodium for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? Answers: Rash Nausea Headache Dizziness

Answer: Rash

A patient taking metronidazole reports a metallic taste in the mouth. Which action will the nurse take? Answers: Obtain an order for BUN and creatinine levels. Reassure the patient that this is a harmless effect of the drug. Request an order for a urinalysis. Test the urine for blood and protein.

Answer: Reassure the patient that this is a harmless effect of the drug.

The nurse is teaching a patient who is starting antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? Answers: Headache and neck pain Gynecomastia Reddish brown urine Numbness or tingling of extremeties

Answer: Reddish brown urine

The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patient's tongue and buccal mucosa. Which action will the nurse take? Answers: Hold the drug and notify the provider. Obtain an order to culture the oral lesions. Gather emergency equipment to prepare for anaphylaxis. Report a possible superinfection side effect of the cephalosporin.

Answer: Report a possible superinfection side effect of the cephalosporin.

A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse teach this patient? Answers: Coat the buccal mucosa with the drug and then rinse your mouth. Place the pill under your tongue and let it dissolve. Mix the suspension in 4 ounces of water and then drink it. Swish the liquid in your mouth and then swallow it after a few minutes.

Answer: Swish the liquid in your mouth and then swallow it after a few minutes.

Which is the most common site for helminthiasis? Answers: liver blood urinary tract intestines

Answer: intestines

Gram-positive bacteria

Bacteria that have a thick peptido glycan cell wall, and no outer membrane. They stain very darkly (purple) in Gram stain.

Antitumor antibiotics

Bleomycin Dactinomycin (actinomycin D) Doxorubicin, Daunorubicin

signal transduction inhibitors

Block specific enzymes and growth factor receptors that signal cancer cell proliferation

Analeptics

CNS stimulants that have effects on the brainstem and spinal cord, which produce an increase in responsiveness to external stimuli and stimulate respiration

Cytostatic therapy

Chemotherapy; slows or suppresses the growth of cells.

A patient is taking a tricyclic antidepressant in a psychiatric hospital. The nurse should perform which priority assessment due to potential adverse reactions? Answers: Urine output Mood and affect Social interactions with staff members and peers Daily recording of pulse and blood pressure

Daily recording of pulse and blood pressure

Acetylcholineesterase inhibitors

Donazpezil Rivastigmine (prototype drug)

The neurotransmitter that is deficient in Parkinson's disease is ________________?

Dopamine

mTOR kinase inhibitors

Everolimus (Zortress) Sirolimus (Rapamune)

Sulfonamides

Examples: Sulfadiazine Trimethoprim-Sulfamethoxazole (TMP-SMZ) *prototype drug Old class, around for >70 yrs., generally safe Bacteriostatic Broad-spectrum Nursing Actions: -Can increase anticoagulant effect of warfarin and hypoglycemic effect with oral antidiabetics -Photosensitivity -Utilized in some ophthalmic and topical preparations -If allergic to one allergic to all Sulfa products -Report bleeding -Adequate fluid

Serotonin Norepinephrine Reuptake Inhibitors (SNRI)

Examples: venlafaxine (Effexor) duloxetine (Cymbalta) desvenlafaxine (Pristiq) Action: Inhibit the reuptake of serotonin and norepinephrine, increasing these substances in nerve fibers Use: Major depression as well as generalized anxiety disorder and social anxiety disorder Interactions: concurrent interaction of venlafaxine and St. John's wort may increase the risk of serotonin syndrome and neuroleptic malignant syndrome Side effects of venlafaxine include drowsiness, dizziness, insomnia, headache, euphoria, amnesia, blurred vision, photosensitivity, and ejaculation dysfunction. Adverse effects of venlafaxine include tachycardia, hypertension, angioedema, seizures Life Threatening effects include suicidal ideation, and Stevens-Johnson syndrome.

A young woman is being treated for psychosis with fluphenazine (Prolixin). Which sign would indicate the need to add an anticholinergic to the patient's medication regimen? Answers: A decrease in pulse and respiratory rate Facial grimacing and tongue spasms An increase in hallucinations A decrease in the patient's level of orientation

Facial grimacing and tongue spasms

suppressor genes

Genes that deactivate the process of cell division

Carbapanems

MOA: Same as penicillins Uses: just in hospitals, IV

Penicillins

Group of antibiotics that are often used to treat infections by gram-positive bacteria. One of the safest classes Examples: Penicillin G Amoxicillin *Prototype drug Ampicillin Nafcillin Oxacillin Piparacillin-tazobactam (+beta-lactamase inhibitor) Bacteriocidal Broad-spectrum Allergies to PCNs are common

dopaminergic drugs

Group of medications to treat Parkinson's disease by either replacing the dopamine that is lacking or increasing the strength of the dopamine that is present. EG. Carbidopa/ Levodopa *prototype drug -Helps improve symptoms

Hepatitis

Hepatitis A (HAV): -Serious liver infection caused by the hepatitis A virus - Transmission: Fecal-oral route - Best treatment is prevention (HAV vaccine, antibodies) - Treatment for active infection is symptomatic; infection is self-limiting Hepatitis B (HBV): - Serious liver infection caused by the hepatitis B virus - Transmission: Needlestick, intimate sexual contact, or childbirth - HBV is found in all body fluids, including blood, semen, and vaginal fluid. - Signs and symptoms of HBV: Anorexia, vomiting, diarrhea, jaundice, malaise, and myalgia - RxAdefovirand Lamivudine Hep C: - HCV transmitted through exposure to infected body fluids - No vaccine for HCV; no immunoglobulin therapy - Treatment is typically combination interferons/antivirals - Rx Combination Peginterferon and Ribavirin - 6 genotypes and 50 subtypes genotyping can help identify treatment response.

Tyrosine Kinase Inhibitors

Imatinib (Gleevec)

Cephalosporins

Largest class of antibiotics & generally safe Bacteriocidal - Effective primarily against gram- Broad-spectrum 1st-5th generations: 1st gen. - gram+ (E. coli) cepfazolin 2nd & 3rd gen. - broad-spectrum gram + & - cefuroxime ceftriaxone *prototype drug 4th gen. - can enter CSF cefepime 5th gen. - effective against MRSA ceftaroline Nursing Actions: -Do not consume alcohol in any form within 72 hours of TX - If GI distress take with food - Note Bleeding times - Allergies (PCN) - Superinfections (yogurt)

Distonia

Muscle contractions (seconds - hours) producing repetitive twisting movements causing abnormal postures.

Plant Alkaloids (Taxanes)

Vincristine sulfate (oncovin), vinblastine sulfate (velban); indicated for ALL, Hodgkin, Wilms tumor, sarcoma, breast cancer, testicular cancer; adverse reactions: bone marrow suppression, neurotoxicity, weakness, paresthesia, jaw pain, constipation, stomatitis, alopecia, headaches, minimal NV; administer antiemetic, monitor for neurotoxicity

Seizure types

Partial: Simple and Complex Generalized: Absence, Myoclonic, Tonic-Clonic, Tonic, Atonic

Hydantoins

Phenytoin (Dilantin)

Hepatitis Drugs

Prevent with HAV and HBV vaccine Passive immunity with immunoglobins for 3 months if exposed Interferon to treat

A patient is taking a serotonin reuptake inhibitor. The nurse should caution the patient to avoid which over the counter therapy due to the risk of seratonin syntrome? Answers: Ma-huang Feverfew Gingko biloba St. John's wort

Selected Answer: St. John's wort

Before administration of the influenza vaccine to a patient, it is most important for the nurse to ask the patient if they are allergic to Answers: peanuts eggs penicillin lidocaine

Selected Answer: eggs

When providing dietary teaching for a patient taking monamine oxidase inhibitors (MAOIs), the nurse should teach the patient to avoid which food? Answers: Avocado Oranges Yogurt Potato chips

Selected Answer: Yogurt

A client with myasthenia gravis is taking neostigmine methylsulfate. Which assessment finding demonstrates that the medication is having the intended effect? Answers:A. increased muscle strength B. decreased pain C. increased heart rate D. decreased nausea

Selected Answer:A. increased muscle strength

A nurse is monitoring a patient receiving atropine. Which finding requires nursing action? Answers:A. Heart rate of 60 beats per minute B. Nasal congestion C. Blood pressure of 90/40 mm Hg D. Dilated pupils

Selected Answer:C. Blood pressure of 90/40 mm Hg

Which assessment most assists the nurse in determining if bethanechol has had a therapeutic effect? Answers:A. Neurologic assessment B. Muscular assessment C. Urinary assessment D. Gastric assessment

Selected Answer:C. Urinary assessment

The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action? Answers:A. Apply a cold pad to the site. B. Pull the IV immediately. C. Elevate the patient's extremity. D. Stop the infusion.

Selected Answer:D. Stop the infusion.

A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? Select all that apply. Answers: A. Angina pectoris B. Cardiogenic shock C. Chronic obstructive pulmonary disease (COPD) D. Congestive heart failure (CHF) E. Hypertension

Selected Answers: A. Angina pectoris D. Congestive heart failure (CHF) E. Hypertension

Patients taking antispychotic medication may develop Extrapyrimidal Syndrome (EPS). Which of the following are types of EPS effects? Answers: Shuffling gait Paralysis of the extremities Acute dystonia Dysrhythmias Akathisia

Shuffling gait Acute dystonia Akathisia

Olanzapine (Zyprexa)

Side effects/adverse effects: •Headaches, dizziness, agitation •Insomnia, somnolence Hyperglycemia, hyperlipidemia, weight gain

Fungi infections

These types of infections are caused by dermatophytes, yeasts, and molds. They may result from a low level of normal flora in or on the body.

A patient will begin receiving rituximab, a monoclonal antibody. Which is the best explanation by the nurse about how this therapy works. Answers: This therapy is cytotoxic, killing cancer cells. This therapy targets specific molecules on the cancer cells to inhibit further growth. This therapy assists the bone marrow to recover after chemotherapy. This therapy prevents cancer cells from using certain hormones.

This therapy targets specific molecules on the cancer cells to inhibit further growth.

Atypical antipsychotics effectively treat the negative symptoms of schizophrenia (poor self-care, poverty of speech, and social withdrawal) Answers: True False

True

Antitubercular Drugs

Two to four drugs are given for a period of months to prevent development of resistance B. Method of Administration 1. Usually given orally. 2. The mycins as discussed earlier are given I.M. C. Side effects / nursing care 1. Streptomycin: Given IM several times a week 2. Isoniazid (INH) a. Liver toxicity: Monitor liver function tests before and during drug therapy b. Peripheral neuritis. Give Vitamin B6 (pyridoxine) with INH to prevent. 3. Paraaminosalicylate sodium (PAS) a. GI disturbances. Give with meals. b. Liver toxicity c. Interferes with absorption of Rifampin. If Rifampin is being given in conjunction with PAS, the drugs should be given 8 to 12 hours apart. 4. Rifampin (Rimactane) a. Red - orange body secretions. b. Affects the actions of many drugs. Negates birth control pills. Decreases the action of steroids, anticoagulants and digitoxin. 4. Ethambutol a. Optic neuritis b. Red-green color blindness c. Elevated uric acid can cause gout 5. Streptomycin is given IM; PAS is given with food; other drugs on an empty stomach 3-4 drugs for 9-12 months

Risperidone (Risperdal)

Use •Manage symptoms of psychosis, schizophrenia Side effects/adverse reactions •Sedation, headaches, photosensitivity •EPS, seizures •Dry mouth, weight gain •Tachycardia, orthostatic hypotension •Urinary retention, sexual dysfunction Contraindications •Dysrhythmias, blood dyscrasias, liver damage Interactions •Increased effects of antihypertensives •Decreased risperidone levels with concurrent use of carbamazepine

Vinca Alkaloids

Vincristine Vinblastine Vinorelbine