Pharm midterm SG
modulators
Drugs that have agonist effects at receptors in some tissues, but antagonistic effects in other tissues
antagonists
A drug that blocks the action of the endogenous molecule - Binds and competes with and blocks the activity of the endogenous molecule - stabilizes the receptor in its inactive state - may sometimes be overcome by increasing dose of the agonist
agonists
A drug that mimics the activity of the endogenous molecule. - Binds with and activates a receptor which brings about the physiologic effect (directly or indirectly) - Does what the hormone/NT "would have done"
List the clinical manifestations of serotonin syndrome and the drug combinations that may precipitate it
-Clinical manifestations: altered mental status, agitation, confusion, disorientation, anxiety, hallucinations, poor concentration -Drug combos: increased risk by use of MAOI and other serotonergic drugs
A patient is prescribed a drug that causes the selective stimulation of beta2 receptors. The nurse should assess the patient for what? A. Hypoglycemia B. Improved breathing C. Tachycardia D. Decreased pain
B
For anesthetics, recognize the difference between local and general anesthetics; list examples of ester and amide anesthetics and the significance of this; What is the role of epinephrine in local anesthesia? Differentiate inhaled vs. IV general anesthetics; what is meant by the term "balanced anesthesia?" Point out the special features or education points for cocaine, midazolam, nitrous oxide, and propofol
-Local anesthetics: stop pain in limited area and do not reduce consciousness -General anesthetics: drugs that produce unconsciousness and lack of responsiveness to all painful stimuli -Esters (local anesthetics): cocaine, benzocaine, tetracaine -Amides (local anesthetics): rare side/adverse effects; bupivacaine, lidocaine, ropivacaine, mepivacaine -Role of Epinephrine: decreases local blood flow, delays systemic absorption of the anesthetic, prolong anesthesia, and reduces risks of toxicity -Inhaled general anesthetics: gas and volatile liquids (-ide or -ane); molecular mechanism of action -IV general anesthetics: barbiturates, dissociative, opioids, benzodiazepines -Balanced anesthesia: technique used to compensate for lack of an ideal anesthetic; combination of drugs to ensure that induction is smooth and rapid and that analgesia and muscle relaxation are adequate -Cocaine education points: pronounced effects of sympathetic and CNS (illegal) -Midazolam education points: benzodiazepam -Nitrous oxide: laughing gas Propofol: sedative-hypnotic for the induction and maintenance of analgesia
mechanism of action (MOA), main indications, and class side effects for: NSAIDs
-MOA: COX-1 and COX-2 inhibition (reduction in prostaglandins involved in inflammation) -Main indications: used for pain associated with acute/chronic inflammation; headache, rheumatoid arthritis, osteoarthritis, gout, musculoskeletal pain, inflammation associated with tissue injury or surgical procedures -Side effects: abdominal pain, nausea, vomiting, ulcers, GI bleeding, renal insufficiency/failure, tinnitus, dizziness, fluid retention, hypertension, abnormal liver function tests
mechanism of action (MOA), main indications, and class side effects for: opioids
-MOA: bind to specific opioid receptors in CNS or GI tract -Main indications: analgesia, cough suppression (antitussive), slow guy motility (antidiarrheal) -Side Effects: euphoria, sedation, respiratory depression, nausea/vomiting, constipation, biliary colic, itching, intracranial pressure; tolerance develops to most except constipation
mechanism of action (MOA), main indications, and class side effects for: benzodiazepines
-MOA: bind with GABA receptors to enhance GABA-ergic activity -Main indications: Anxiolytics and hypnotics (situational/short term management of anxiety); can also be used in anesthesia, muscle relaxants, treat epilepsy/other seizure disorders -Side effects: drowsiness, light-headedness, confusion, unsteadiness, dizziness, slurred speech, muscle weakness, memory problems, constipation, nausea, dry mouth, blurred vision
mechanism of action (MOA), main indications, and class side effects for: barbiturates
-MOA: binds to GABA receptor (chloride channel complex) -Main indications: seizures, insomnia, anesthesia; include ultrashort, short-intermediate, and long acting classifications -Side effects: drowsiness, headache, dyspnea, confusion, fainting, bradycardia, nausea, muscle weakness, low body temp
mechanism of action (MOA), main indications, and class side effects for: SSRIs
-MOA: produce selective inhibition of serotonin reuptake -Main indications: most commonly prescribed for depression, can be used for bipolar disorder, anxiety disorders, PTSD, and paired with cognitive therapies -Side effects : headache, nausea, tremor, diarrhea, insomnia, weight gain, agitation, sexual dysfunction
mechanism of action (MOA), main indications, and class side effects for: local anesthetics
-MOA: suppress pain by blocking sodium channels and by blocking impulse conduction along axons -Main indications: suppress pain without generalized depression of nervous system; used for dental procedures (infiltration), labor & delivery, nerve block, intravenous regional -Side effects: hypersensitivity, arteriolar dilation, hypotension, methemoglobinemia; for epidural/spinal anesthesia - autonomic blockade causing incontinence, "spinal headache"
Difference between nociceptive pain and neuropathic pain in terms of how patients describe it and how it is treated pharmacologically
-Nociceptive pain: pain caused by damage to the tissues; nervous system is functioning properly -Pt description: aching, throbbing, caused by injury, surgery, or procedure -Nociceptive pain: NSAIDs -Neuropathic pain: caused damage or injury to nerves that transfer info between CNS and other parts of body; nervous system is not functioning properly -Pt description: burning, tingling, shooting pain -Neuropathic pain Tx: responds best to agents that specifically target certain neurotransmitters
List opioid adverse effects for which a patient does not develop a tolerance and how toxicity and adverse effects are managed; know the important differences between morphine, oxycodone, fentanyl, meperidine (therapeutic indication, dosage form, duration of therapy)
-Pt will not develop tolerance to constipation(might need bowel regimen for long term Tx) and miosis -Management of adverse effects: bowel regimens, antihistamines, monitoring RR, do not take with food -Management of toxicity: Naloxone is used to stop lethal effects of opioid overdose -Morphine: for moderate to severe pain, IV, SQ, IM, epidural, oral, and rectal -Oxycodone: for severe pain, oral -Fentanyl: severe pain or pain after surgery, IV, IM, patches, IN, IT -Meperidine: moderate to severe pain, injection
What is significant about buspirone, how is it different from other sedative-hypnotics in terms of indications and monitoring
-Reduces anxiety without causing marked sedation or euphoria - Not a CNS depressant; has no abuse potential or tolerance or dependence
• For the stimulant drugs, remember the general MOA, therapeutic indications, patient education points, monitoring, and toxicities. Pay particular attention to these agents: methylphenidate, dextroamphetamine, and caffeine
-Stimulant Drug MOA: increases availability of neurotransmitters, individuals with ADHD are able to focus and concentrate more effectively -Therapeutic indications: ADHD in children -Pt education/monitoring: should not be given if history/diagnosis of severe depression, anorexic disorders, suicidal tendencies, psychotic symptoms, severe mood disorders, mania, schizophrenia; will monitor height, weight, vitals; look for signs of misuse/abuse
Know the 5 different classes of antidepressants and the prototype agent(s) in each (except MAOIs, for MAOIs you should recognize the drug-food interactions that are significant)
-Tricyclic antidepressants (TCA): block neuronal reuptake of norepinephrine and serotonin -SSRI (selective serotonin reuptake inhibitors): produce selective inhibition of serotonin reuptake -SSRI prototype drug: Fluoxetine -SNRI (serotonin norepinephrine reuptake inhibitors): blocks norepinephrine and serotonin uptake -SNRI prototype drug: Duloxetine -Atypical antidepressants: acts as stimulant and suppresses appetite Atypical antidepressants prototype drug: Bupropion -Monoamine Oxidate Inhibitors (MAOI): convert monoamine neurotransmitters into inactive products MAOI food-drug interaction: tyramine (aged cheese and meats, draft beer)
For antipsychotics, remember the difference between typical and typical agents, the positive and negative symptoms of schizophrenia, and understand each of the following potential adverse effects of antipsychotics: EPS, tardive dyskinesia, akathisia, metabolic effects
-Typical/first generation antipsychotics: block receptors for dopamine in CNS; cause serious extrapyramidal symptoms -Atypical/second generation antipsychotics: produce only moderate blockade of dopamine receptors and have stronger blockade for serotonin; fewer extrapyramidal symptoms -Positive Schizophrenia side effects: hallucinations, delusions, agitation, tension, paranoia -Negative Schizophrenia symptoms: loss of normal function, lack of motivation, poverty of speech, blunted affect, poor self care, social withdrawal -Extrapyramidal symptoms: inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements -Tardive dyskinesia: movements of the tongue and face; lip smacking; tongue flicks in and out, slow worm-like movements of the tongue and some involuntary movements of the limbs, toes, fingers, and trunk -metabolic effects: increased BP, BG, excess body fat around waist and abnormal cholesterol or triglyceride levels
narrow therapeutic index drug vs a wide therapeutic index drug (in terms of safety)
-Wider the therapeutic index (TI) = safer the drug and less risk for toxicity -narrower the therapeutic index = small differences in doses and blood concentration may lead to serious therapeutic failures
what are the essential points to remember about medication use and lactation
-all drugs can enter breast milk to some extent -choose drugs least likely to enter milk/effect infant -avoid most hazardous drugs -lowest dose, shortest duration -dose immediately after breastfeeding -pump and discard if needed for short-term
A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child's age, the nurse would expect to make which adjustment? A. The drug may need to be administered more frequently. B. The dosage of the drug may need to be decreased. C. The route should be changed from oral to intramuscular. D. The drug should be administered on an empty stomach.
A
A patient is prescribed a medication to be taken on an empty stomach. Which statement should the nurse include when providing patient teaching? A. "Take the medication 1 hour before eating." B. "Take the medication with a small glass of water." C. "Take the medication before going to bed at night." D. "Take the medication 1 hour after a meal."
A
A patient receives a medication that results in the activation of the acetylcholine receptors of the heart. The nurse should assess the patient for which intended effect? A. Decreased heart rate B. Dysrhythmia suppression C. Increased heart rate D. Improved contractility
A
The nurse administers a medication to a patient that stimulates the sympathetic nervous system. The nurse should assess the patient for which intended effect? A. Increased heart rate B. Blood pressure reduction C. Bronchial constriction D. Decreased blood glucose level
A
The nurse cares for a patient who is receiving mitoxantrone [Novantrone]. It is most important for the nurse to assess the patient for what? A. Elevated temperature B. Increased fatigue C. Decreased blood sugar D. Enlarged thyroid gland
A
The nurse cares for a patient with myasthenia gravis. Before administering pyridostigmine [Mestinon], it is most important for the nurse to take which action? A. Assess the patient's ability to swallow a sip of water. B. Cleanse the patient's skin before applying the transdermal patch. C. Ask whether the patient has an allergy to aspirin. D. Give the patient food or milk to prevent stomach upset.
A
The nurse instructs an 82-year-old patient about over-the-counter medications that are generally safe for older adults. The nurse should intervene if the patient makes which of the following statements? A. "I can take chlorpheniramine [Chlor-Trimeton] for a cold." B. "If I have a headache, I should take acetaminophen [Tylenol]." C. "Cetirizine [Zyrtec] would be safe to take for my allergies." D. "I should avoid taking diphenhydramine [Benadryl] for hives."
A
The nurse is caring for a patient who is taking phenytoin [Dilantin]. Which medication, if ordered by the physician, should the nurse question? A. Cimetidine [Tagamet] B. Captopril [Capoten] C. Pantoprazole [Protonix] D. Ondansetron [Zofran]
A
absorption, distribution, metabolism, and elimination (ADME)
Absorption: The process of the drug entering the body - Absorption into the bloodstream is the goal for systemic effectas - How well it accomplishes this depends on route Distribution: Follows absorption into systemic circulation, distributed throughout body. - affecting: tissue permeability, blood flow and plasma protein binding Metabolism: "Biotransformation" bodys attempt to prepare an ingested substance for elimination. - Transform lipophillic to hydrophillic - Formation of pharmacologically active and/or inactive metabolites: Pro drugs - Phase 1 and phase 2 reaction: chemical reactions in liver to convert drug to more easily excreted compound Elimination: the ability of the body to remove a drug from circulation - Sweat, tears, exhaled, bile, urine
What are examples of two chemical names (or abbreviations)
Acetaminophen ATA Aspirin ASA
What is the role of acetylcholinesterase? What happens when it is inhibited and what therapeutic and adverse effects might be expected?
Acetylcholinesterase breaks down ACh into choline and acetate, when it is inhibited, the action is being blocked which increases the amount and duration of action of ACh. - so the therapeutic effects would be those of increasing the ACh, which would include contraction of the pupil, decrease in HR, decrease in heart strength, bronchoconstriction, increase in bronchial secretions, increased motility of GI and relaxed sphincters, Contraction of bladder and relaxation of sphincter. - Adverse effects would include diarrhea and stomach cramping, increased incontinence, increased salivation, bradycardia, dizziness and syncope, insomnia.
pharmacodynamics
Actions of a drug in the body, antagonists and antagonists
pharmacokinetics
Actions of the body on the drug, ADME
Subtypes of adrenergic neurotransmitter receptors
Alpha, beta, dopamine
A patient is prescribed a medication that is potentially hepatotoxic. Before administering the medication, it is most important for the nurse to assess what? A. Blood urea nitrogen and serum creatinine (BUN and SrCr) B. Aspartate aminotransferase and alanine aminotransferase (AST and ALT) C. Prolonged QT interval on the electrocardiogram D. Serum potassium, serum sodium, and serum magnesium (K, Na, and Mg)
B
A patient is prescribed metaxalone [Skelaxin]. Which sign or symptom should the nurse teach the patient to report immediately to the healthcare provider? A. Drowsiness B. Yellow skin color C. Dizziness D. Decreased pain
B
For Alzheimer's and Parkinson's disease, know: • Pathophysiology, neurotransmitters affected and the rationale for drug therapy • Recognize the different classes of drugs used to treat each • Acetylcholinesterase inhibitors (prototype drug), what makes memantine different? • Role of levodopa and how carbidopa helps; Recognize drugs in each of the following classes: dopamine agonists, MAOI-B, COMT inhibitors • Know the patient education points for rasagiline
Alzheimer's Disease -Pathophysiology: progressive neurologic disorder that causes the brain to shrink and brain cells to die; plaque and tangle formation, synaptic deterioration -Neurotransmitters affected: acetylcholine and glutamate -Rationale for drug therapy: slow progression of disease -Drugs for treatment: cholinesterase inhibitors -Memantine: not a cholinesterase inhibitors and better tolerated than cholinesterase inhibitor Parkinson's Disease -Pathophysiology: neurodegenerative disease of the extrapyramidal system; tremors, rigidity, dyskinesias, akinesia -Neurotransmitters affected: imbalance between dopamine and acetylcholine -Rationale for drug therapy: improve pts ability to carry out ADLs -Drugs for treatment: dopaminergic agents (increase dopamine levels) and anticholinergic agents (decrease ACh levels) -Acetylcholinesterase inhibitors prototype drug: Benztropine? -Role of levodopa: increases dopamine synthesis in striatum; converted into active form dopamine in brain; only given in combo with carbidopa -Role of carbiopa: prevents levodopa from being broken down before reaching brain -Dopamine agonists: derivatives or ergot (bromocriptone and cabergoline) and non-ergot derivatives (pramipexole, ropinrole, rotigotine, apomorphine) -MAOI-B: selegiline or rasagiline -COMT inhibitors: entacapone and tolcapone Rasagiline Pt teaching: avoid food containing high amounts of tyramine (aged cheeses)
A patient is concerned about developing AD. What should the nurse include in the teaching plan? A. Estrogen replacement therapy improves cognitive functioning. B. No solid evidence supports the use of drugs to prevent AD. C. Naproxen taken daily after the age of 50 years decreases the risk of AD. D. Daily doses of ginkgo biloba can prevent cognitive decline.
B
A patient is newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for the nurse to teach the patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit
B
A patient is receiving a drug that blocks alpha1- adrenergic receptors. Which adverse effect, if experienced by the patient, is of most concern to the nurse? A. Nasal congestion B. Orthostatic hypotension C. Inhibition of ejaculation D. Reflex tachycardia
B
A patient is scheduled for a dose of interferon beta [Betaseron]. Which nursing action would be most effective to decrease pain at the injection site? A. Use a topical hydrocortisone cream. B. Apply ice packs for 2 to 3 minutes. C. Administer oral diphenhydramine [Benadryl]. D. Perform passive range-of-motion exercises.
B
A patient is taking two prescription medications that both cause bradycardia. The nurse should monitor the patient for which type of effect? A. An increased therapeutic effect B. An increased adverse effect C. A reduced therapeutic effect D. A reduced adverse effect
B
A patient taking levodopa/carbidopa [Sinemet] for Parkinson disease experiences frequent "on-off" episodes (i.e., the abrupt loss of effect). Which action by the nurse is best? A. Administer the medication when the patient has an empty stomach. B. Instruct the patient to avoid high-protein foods. C. Have the patient increase the intake of vitamin B6. D. Discontinue the drug for 10 days (for a "drug holiday").
B
A patient was discharged from the hospital with instructions to take an antibiotic for 7 days to treat a bladder infection. Twelve days later, a home care nurse visits the patient and finds that the symptoms have not resolved. What is the most important question for the nurse to ask? A. "Do you think you have another bladder infection?" B. "Have you taken all of the antibiotics as directed?" C. "How much water have you been drinking each day?" D. "What antibiotic have you taken in the past to treat an infection?"
B
A patient who takes oxybutynin [Ditropan] for an overactive bladder takes an over-the-counter antihistamine for hay fever symptoms. What symptoms should the nurse watch for that would indicate toxicity? A. Cool and moist skin, confusion, and bradycardia B. Dry mouth, increased temperature, and blurred vision C. Hallucinations, increased salivation, and diaphoresis D. Hypothermia, increased respiratory rate, and pupil constriction
B
A patient with multiple sclerosis is prescribed baclofen [Lioresal, Gablofen]. Which assessment by the nurse indicates that the medication is exerting its desired therapeutic effect? A. Decreased strength B. Suppression of spasticity C. Improved muscle tone D. Increased muscle resistance
B
A patient with type 2 diabetes mellitus is diagnosed with stable angina. Which beta blocker, if prescribed by the physician, would the nurse question? A. Metoprolol[Lopressor] B. Propranolol[Inderal] C. Bisoprolol [Zebeta] D. Atenolol [Tenormin]
B
After an intramuscular injection of penicillin, a patient develops severe difficulty breathing and a swollen tongue. Which medication should the nurse prepare to administer? A. Dopamine[Inotropin] B. Epinephrine[Adrenalin] C. Norepinephrine [Levophed] D. Pseudoephedrine [Sudafed]
B
An older adult patient is taking a new prescription medication. After reviewing the patient's medical record, the nurse is most concerned about an adverse drug reaction if what is documented? A. The patient is currently taking eight prescription medications. B. The patient's urinary creatinine clearance is 50 mL/min/1.73 m2. C. The patient regularly takes herbal and dietary supplements. D. The patient takes a medication with a wide therapeutic index.
B
The nurse administers a medication to a patient that stimulates the function of the parasympathetic nervous system. Which of the following physiologic effects should be expected? A. Reduced esophageal motility B. Improved bladder emptying C. Dilation of the pupils D. Decreased gastric secretions
B
The nurse cares for a patient with asthma who uses an albuterol (Ventolin) metered-dose inhaler. The nurse is most concerned if the patient makes which of the following statements? A. "The medicine in the inhaler helps me to breathe." B. "I can use the inhaler as often as needed." C. "My hand starts to shake after I use the inhaler." D. "If the inhaler doesn't work, I should dial 911."
B
The nurse cares for a patient with depression who has been prescribed an antidepressant. When would the nurse expect the medication to reach its full therapeutic effect? A. In 7 to 10 days B. In 2 to 4 weeks C. In 2 to 4 months D. In 5 to 6 months
B
The nurse prepares to administer a cholinesterase inhibitor to a patient with AD. Which medication, if ordered by the healthcare provider, should the nurse question? A. Famotidine [Pepcid] B. Amitriptyline [Elavil] C. Memantine [Namenda] D. Levothyroxine [Synthroid]
B
The nurse prepares to administer memantine [Namenda] to a patient with severe AD. The nurse should assess what before administering of the medication? A. Hemoglobin and hematocrit B. Blood urea nitrogen and serum creatinine C. Aspartate aminotransferase and alanine aminotransferase D. Erythrocyte sedimentation rate and neutrophil count
B
how do the concepts of bioavailability, protein binding, cytochrome P450 system, first-pass effect, half-life, clearance, and blood-brain-barrier fit into each one (absorption, distribution, metabolism, elimination)
Bioavailability: The extent of the drug being absorbed. The fraction of unchanged drug reaching systemic circulation following administration. - IV is 100% - Oral <100% d/t incomplete absorption and/or first pass metabolism Protein binding: Part of distribution process -drugs bind with protein plasma -portion bound to protein is considered inactive so it can inhibit pharmacological effects -portion remaining free is considered an active drug so it can inhibit pharmacological effects -factors affecting protein binding include competing for protein binding sites and low plasma protein levels which decreases availability in binding sites Cytochrome P450: Extensive system of microsomal enzymes for metabolizing xenobiotics -Requires enzyme, reducing agents, molecular oxygen - CYP3A4 isoform alone is responsible for >50% of the prescription drugs metabolized in liver -Some drugs are metabolized by more than one isoform - Some frugs can be an inducer of CYP450 isoforms and result in accelerated substrate metabolism - Some drugs can be an inhibitor of CYP450 and result in decreased substrate metabolism Clearance: The body's ability to eliminate a drug. Closely related to principles of renal physiology. - Creatinine clearance is calculated to dose drugs and monitor toxicity, some drugs require dose adjustments depending on function First-pass: after oral administration, drugs are absorbed into the portal venous system. Before entering general circulation, drugs will under go first pass which could put their bioavailability to close to zero. Half life: The time required to decrease the concentration of the drug by half. Some drugs follow multi-compartment kinetics, so half life may be different from standard equation. Since many factors influence clearance and dosing, need to consider more than just half life. Blood brain barrier: vessels in brain have special endothelial lining where cells are pressed tightly together -part of distribution process -protects brain from foreign substances -lipid soluble drugs cross BBB
A 15-month-old patient develops chemotherapy-induced nausea and vomiting. Which medication, if ordered by the healthcare provider, should the nurse question? A. Ondansetron [Zofran] B. Dexamethasone [Decadron] C. Promethazine [Phenergan] D. Metoclopramide [Reglan]
C
A nurse administers a medication that activates dopamine receptors. The nurse should assess the patient for which intended effect? A. Uterine muscle relaxation B. Contraction of skeletal muscle C. Improved renal perfusion D. Decreased piloerection
C
A patient is brought to the emergency department with hallucinations related to a tricyclic antidepressant (TCA) overdose. The patient has hot, flushed skin and an oral temperature of 103.8°F (39.9°C). Which medication should the nurse prepare to administer as an antidote? A. Pyridostigmine [Mestinon] B. Epinephrine [EpiPen] C. Physostigmine [Antilirium] D. Atropine [AtroPen]
C
A patient is scheduled for a procedure that requires axon conduction blockade. The nurse anticipates that which medication will be used? A. A receptor agonist B. A receptor antagonist C. A local anesthetic D. A beta2 blocker
C
A patient with MS is prescribed interferon beta [Betaseron]. What is a priority for teaching at this time? A. Provide information about myelosuppression. B. Teach symptoms of hepatotoxicity. C. Educate about self-injection technique. D. Forewarn about blue tint to urine and skin.
C
A patient with cancer is receiving morphine for pain control. The patient calls the nurse to report that the morphine is no longer controlling his pain. What is the most appropriate response by the nurse? A. "Increasing the dose of morphine will make you so sleepy that you will not be able to function." B. "This means that you have developed a psychologic addiction to morphine." C. "You have developed a tolerance to morphine and will need a higher dose." D. "It is recommended that we wait to increase the morphine until the pain is more severe."
C
A toddler has been prescribed a medication that does not have an established pediatric dose. To calculate the appropriate dose for the child, the nurse should consider what information? A. The child's weight is 26 pounds. B. The child's height is 32 inches. C. The child's body surface area is 0.52 kg/m2. D. The child's age is 24 months.
C
An older adult patient frequently forgets to take an oral medication that has been prescribed to be taken 3 times a day. Which action by the nurse is best? A. Assess the patient's ability to swallow the medication. B. Arrange for a neighbor to call the patient 3 times a day. C. Call the prescriber for a sustained-release form of the drug. D. Give the patient verbal and written instructions about the drug.
C
An older patient with skin cancer and hypertension is prescribed levodopa/carbidopa [Sinemet] to treat Parkinson disease. Which action by the nurse is best? A. Give the medication if the patient's blood pressure is normal. B. Administer the medication as prescribed. C. Ask the patient about the type of skin cancer. D. Hold the medication if the patient is more than 65 years old.
C
The nurse cares for a patient who is taking a calcium channel blocker for hypertension. The nurse should be most concerned if the patient makes which statement? A. "I take my medication with a glass of water." B. "I eat foods high in fiber to prevent constipation." C. "I drink a glass of grapefruit juice each evening." D. "I avoid foods such as broccoli and cabbage."
C
The nurse cares for a patient with Alzheimer's disease who has been prescribed donepezil [Aricept]. Which of the following is the most common adverse effect of donepezil [Aricept]? A. Hallucinations B. Decreased sweating C. GI upset/diarrhea D. Dry mouth
C
The nurse instructs a patient about doxazosin [Cardura]. Which statement by the patient to the nurse indicates an understanding of the instructions? A. "It is common to have nightmares and insomnia." B. "I need to take the medication on an empty stomach." C. "The medication should be taken tonight before I go to bed." D. "I should stop taking the medication if I feel lightheaded."
C
The nurse instructs a patient about taking cyclobenzaprine [Flexeril]. The nurse determines that teaching is successful if the patient makes which statement? A. "It is common to experience insomnia when taking this drug." B. "Prescription muscle relaxants do not cause dependence." C. "I should avoid drinking alcohol while taking this medication." D. "This medication may cause increased salivation and diarrhea."
C
The nurse receives a phone call from a patient who has been taking a CNS drug (like morphine) for 3 days. The patient tells the nurse that the medication causes nausea. Which response by the nurse is best? A. "Nausea is not a common side effect of this drug." B. "You should stop taking the medication immediately." C. "The nausea will most likely decrease over time." D. "Try taking the medication on an empty stomach."
C
The nurse teaches a student nurse about the action of an antagonist medication. The nurse determines that the teaching is successful if the student makes which statement? A. "Antagonists enhance the effects of natural transmitters." B. "Antagonists bind directly to nervous system receptors." C. "Antagonist medications prevent receptor activation." D. "Drugs that activate receptors are called antagonists."
C
Which individual is at the highest risk for a drug-drug interaction? A. A toddler who is prescribed two antibiotics for a serious infection B. An adolescent who takes over-the-counter medications for menstrual cramping C. An adult who takes six prescription medications for two chronic conditions D. An older adult who takes two prescription medications and a dietary supplement for anxiety
C
drug-drug interaction
Can occur wherever a patient takes more than one drug. - Intensification effects: Increases therapeutic effects, increased adverse effects - Reduction of effects (Inhibition): Reduce therapeutic effects, reduced adverse - Unique response: Alcohol with disulfiram - these interactions could be direct chemical/physical (dont mix drugs in same container without establishing compatibility, Most common is IV sol, Dont administer if precipitated form), pharmacokinetic interaction (Altered ADME, metabolism is most important and complex pt which drugs interact), pharmacodynamic interaction (2 drugs at same receptor), combined toxicity (overlapping toxicities should not be used together).
difference between chemical, generic, and brand names which is the best name to be familiar with and why?
Chemical name refers to the specific structure of the drug, it is lengthy and it is rarely used in clinical practice. Generic name is the "official" name that is derived from the chemical name but is shorter and more usable, this is the best name to be familiar with, these are manufactured by other companies. Brand name is the pharmaceutical company that developed the drug has exclusive rights to market it for a limited time (20yr patents), FDA regulates and verifies. Generics are less expensive
A patient has been taking a medication for 2 months. Which statement, if made by the patient, would indicate that drug tolerance to the therapeutic effect is occurring? A. "The medication seems to be working even better now than it did at first." B. "I feel really sick if I do not take the medication every day." C. "The side effects are not bothering me anymore." D. "The medication does not seem to be working as well."
D
A patient is prescribed bethanechol [Urecholine] for urinary retention. If the patient exhibits signs of an overdose, such as increased salivation and sweating, bradycardia, or hypotension, which medication should be administered? A. Acetylcholine [Miochol-E] B. Cevimeline [Evoxac] c. Oxybutynin [Ditropan] D. Atropine [AtroPen]
D
A patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A. Teach the patient to adjust the dose according to the presence of symptoms. B. Tell the patient to take the medication with meals. C. Inform the patient about the prevention of gingival hyperplasia. D. Teach the patient to avoid the abrupt cessation of treatment.
D
A patient is prescribed the dopamine agonist pramipexole [Mirapex]. Which statement made by the patient indicates a need for further teaching? A. "The drug should be taken with food to prevent nausea." B. "I may experience hallucinations while taking this drug." C. "I should rise slowly to prevent dizziness and fainting." D. "This drug will stop the progression of Parkinson disease."
D
A patient is receiving dopamine [Inotropin] for the treatment of shock. What would indicate to the nurse that the medication is effective? A. Decreased mean arterial pressure B. Gain of 2kg in 24hours C. Increased heart rate D. Increased urine output
D
A patient with mild symptoms of AD is prescribed donepezil [Aricept]. Which statement made by the patient indicates the need for further teaching? A. "The drug will improve transmission by neurons in my brain." B. "I may experience an upset stomach while taking this drug." C. "I will take the drug every night at bedtime with a snack." D. "The drug will stop damage to the neurons in my brain."
D
The healthcare provider writes a medication order that the nurse cannot read. What should the nurse do? A. Consult with the charge nurse to verify the order. b. Discuss the order with the pharmacist. c. Check with the patient to determine the correct medication. D. Contact the prescriber to clarify the order.
D
The nurse is assessing an 82-year-old patient before the administration of medications. Which laboratory result would provide the best index of renal this patient's function? A. Serum creatinine B. Blood urea nitrogen C. Urinalysis D. Creatinine clearance
D
The nurse is educating a patient on genetic testing. Which barrier does the nurse realize prevents many patients from receiving genetic testing? A. Lack of research on genetic testing B. Conflicting information regarding genetic testing C. The topic of genetic testing is often not discussed in the healthcare arena D. Insurance plans often do not cover costs associated with genetic testing
D
The nurse is preparing to administer warfarin [Coumadin] to a patient. The nurse notes that the patient's pharmacogenomic profile indicates altered CYP2D6 genes. It is most important for the nurse to do which of the following? A. Check for signs of a transient ischemic attack. B. Monitor for ST-segment elevation or depression. C. Observe the patient's legs for symptoms of a blood clot. D. Examine the patient's stools for the presence of blood.
D
The nurse prepares to administer dantrolene [Dantrium] to a patient. Before the administration of the drug, it is most important for the nurse to assess which laboratory value? A. Serum amylase B. Creatinine clearance C. Blood glucose D. Aminotransferases
D
The nurse prepares to administer metoprolol [Lopressor] to a patient with chronic stable angina. What is a priority assessment to make before the administration of this medication? A. Temperature B. Urinary function C. Respiratory rate D. Heart rate
D
Which patient does the nurse identify as being at highest risk for the development of an adverse drug reaction? A. 1-month-old patient whose mother has allergies to penicillin, aspirin, and codeine B. A 16-year-old patient with multiple traumatic injuries who is taking morphine and an antibiotic C. A 54-year-old patient with multiple sclerosis who has been enrolled in a clinical trial of a new drug D. An 84-year-old patient with diabetes, heart failure, and hypertension who takes seven prescription medications each day
D
Which statement is NOT accurate regarding pharmacogenomics? A. "Pharmacogenomics is used to predict disease." B. "Pharmacogenomics is used to modify DNA." C. "Pharmacogenomics is not reliable." D. "Pharmacogenomics can determine reaction to drug treatment."
D
For epilepsy, recognize the basic difference between absence and tonic-clonic seizures; what is a reasonable goal of anti-epileptic (AED) drug therapy? Be able to educate a patient and monitor the therapy of phenytoin and carbamazepine
Epilepsy -Absence seizures: seizures makig the persion stare into space "zoned out" -Tonic-clonic seizures: seizures involving stiffening of the muscles, muscle spasms and LOC -Goal of AED: prevent seizures through suppressing sodium influx, suppressing calcium influx, or increasing GABA action -Phenytoin pt teaching: don't abruptly stop meds, urine discoloration, avoid alcohol, report sore throat, fever, bruising, nosebleeds -Phenytoin therapy: monitor therapeutic serum levels -Carbamazepine Pt teaching: signs of blood, liver, or skin disorders, report fever, sore throat, rash, mouth ulcers, bruising, bleeding
Know the basic pathophysiology of multiple sclerosis and the rationale for drug therapy; be able to educate a patient on the main points associated with interferon beta therapy and natalizumab
MS is an autoimmune condition with myelin destruction in the CNS. Demyelination, inflammation may injure underlying axons and damage cells, damaged tissue is replaced by the astrocyte-derived filaments that form scleroses (scars). MS can happen in episodes. Symptoms: paresthesias, muscle or motor problems, visual impairment, bladder and bowel symptoms, sexual dysfunction, etc. - Drug therapy slows progression, decreases the frequency and intensity of relapses, delays permanent neurologic loss. - Interferon Beta therapy: Pts need to learn the proper injection technique and use ice before and after to improve comfort, oral diphenhydramine or topical hydrocortisone can be used for itching and redness at site. - Natalizumab: Prevents circulating leukocytes from migrating to sited where they can do harm. Generally well treated: common adverse would be headache and fatigue, abdominal discomfort, arthralgia, depression, etc. Most serious effects are progressive multifocal leukoencephalopathy, liver injury, and hypersensitivity
what are the receptor subtypes for acetylcholine?
Muscarinic and nicotinic
Differentiate spasticity from muscle spasms and list drugs for each indication; know what makes each of the following agents distinct (in terms of indication or side effects): baclofen, dantrolene, cyclobenzaprine, and carisoprodol
Muscle spasms: involuntary contraction of muscle or muscle group. Cyclobenzaprine and Carisoprodol (could have anticholinergic effects, hepatotoxicity, and physical dependency) Spasticity: Movement disorders of CNA origin, often related to damage or lesions to the spinal cord or brain. Could be caused by MS and CP. Baclofen (suppress hyperactive reflexes, mimic GABA on spinal cord neurons, not used with stroke, could cause CNS depression or GI symptoms or urinary retentions, my be delivered directly into the subarachnoid space at different levels of spinal cord), Dantrolene (Directly on muscle cells, suppresses release of calcium, could cause drowsiness or muscle weakness or hepatic toxicity or diarrhea or acne-like rash)
basic considerations when drugs are used in pediatric vs. geriatric patients
Pediatric: younger than 16yr. More sensitive, greater individual variation, sensitivity d/t organ immaturity, increased risk for adverse rxns, they are not small adults. Geriatric: More adverse drug reactions and drug drug interactions than younger pts. Altered pharmacokinetics, more sensitive, multiple and severe illnesses, multiple drug therapy, poor adherence.
describe the physiologic effects expected from: pro-adrenergic drugs and antiadrenergic drugs. provide a prototype example
Pro-adrenergic: CV, Resp, topicals, nasal decongestants, anti-anaphylactic. They activate adrenergic receptors - Alpha 1 activation: mucosal vasoconstriction for nasal decongestion, delays absorption of local anesthetic, elevated BP - Beta 1 agonist: in heart, maintains blood flow to organs and increases HR and BP when in shock, also a positive inotropic effect in heart failure -Beta 2 activation: in lungs, promote bronchodilation to help with asthma attacks, also delay preterm labor, but could result in hyperglycemia and tremor - Dopamine activation: dilate renal vessels to reduce risk of failure, activates beta 1 receptors in heart to increase cardiac performance - epinephrine: Delays absorption of local anesthetic, controls superficial bleeding, raises BP, overcomes AV block, restores heart function, bronchodilation for asthma, anaphylactic shock treatment but could cause hypertensive crisis and dysrthmias and angina Anti-adrenergic: Alpha blockers and beta blockers. Lower blood pressure - alpha blockade: BPH reduced contraction of smooth muscle in prostatic capsule and in bladder neck. may cause orthostatic hypotension, reflex tachycardia, inhibiting ejaculation, nasal congestion. Tamsulosin (flomax): Only approved for BPH - beta blockers: decrease the cardiac workload and reduce oxygen demand by bringing it back into balance for angina pectoris. Not used for hypertension much anymore. Decrease in rate of sinus nodal discharge and suppress conduction through the AV node which helps with dysrhythmias. Reduces size, pain, mortality and risk of reinfarction with an MI. Standart therapy with heart failure. Also can be used for hyperthyroidism, migraine prophylaxis, stage fright, pheochromocytoma, glaucoma. Can cause bradycardia, reduced cardiac output, AV block, precipitation of heart failure, rebound cardiac excitation. Propranolol: Beta 1 blocker
describe the physiologic effects expected from: procholinergic drugs vs. anticholinergic drugs. provide a prototype example
Procholinergic: Bethanechol (prototype) Mimic the effects of ACh directly (agonizing cholinergic receptors) or indirectly (inhibiting acetylcholinesterase). - Contract pupils, decrease HR, bronchoconstriction, increase in broncho secretions, increase and relax GI motility, Urinary contraction and relaxation of sphincter. - Used for Glaucoma (cause contraction on ciliary body and facilitate outflow of aqueous humor), Myasthenia gravis (increase activity of ACh at neuromuscular junction to help functioning of muscles), Alzheimers (Memantine is a NMDA receptor antagonist- blocks excitotoxicity induced by glutamate). Anticholinergic: Block effects of ACh via antagonistic action at muscarinic receptor. Decrease ACh - For Parkinsons (Bring down the ACh activity), Asthma and COPD (Blocking muscarinic receptors and cause bronchodilation), GI (decreases motility, relax stomach walls), GU ( relaxing detrusor muscle and increases bladder capacity), Motion sickness. - Atropine (prototype): antimuscarinic drug. Dilation of eye, increase HR via vagus nerve, bronchodilation, decreased broncho secretion, decreased salivation, decreased in GI transit, slows voiding, confusion.
legend (or Rx) vs. over-the-counter (OTC) drugs
Rx must be ordered by authorized practitioner, bottles will carry a federal legend ("Rx only, federal law prohibits dispensing without prescription") OTC May be purchased directly by consumers, considered safe for use without medical supervision
For sedative-hypnotics, recognize the difference in toxicity (level of CNS depressant effects) and recognize agents from different classes: alprazolam and lorazepam from the benzodiazepines, phenobarbital from the barbiturates, zolpidem and eszopiclone for the BZlike drugs, and ramelteon as the melatonin agonists; role of flumazenil
TOXICITY LEVELS? Benzodiazepines: bind with GABA receptors to enhance GABA-ergic activity; acute toxicity via IV or oral dose -Alprazolam and Lorazepam Barbiturates: bind to GABA receptor (chloride channel complex); toxicity includes respiratory depression, coma, pinpoint pupils -phenobarbital Benzodiazepine-like drugs: bind to GABA A receptors at different sites than BZ -zolpidem: sedative hypnotic -eszopiclone insomnia Tx Ramelteon: agonist at MT1 and MT2 (melatonin receptors), no direct effects on GABA -Role of Flumazenil: reverses sedative effects of BZ but may not reverse respiratory depression
Differentiate various types of headaches and how they are treated; what are common migraine headache triggers; what are some special precautions with the use of triptan drugs
Types of headaches -Migraine: throbbing head pain of moderate to severe intensity -Migraine Tx: aborting vs preventing migraines -Migraine triggers: emotions, certain foods (tyramine, nitrates, glutamate), alcohol, analgesics, caffeine, estrogen, weather changes -Cluster: severe, throbbing, unilateral pain near 1 eye -Cluster Tx: prophylaxis or oxygen therapy (acute Tx) -Tension: moderate, non-throbbing pain located in headband distribution -Tension Tx: Tylenol, NSAIDs, analgesics sedative combo, Pt teaching -Triptan drug precautions: transient "heavy arms" or "chest pressure", teratogenesis, coronary vasospasm
adverse drug effect
any noxious, unintended, and undesired effect that occurs at normal drug doses. - Mildly annoying: drowsiness, nausea, itching, rash Severe: Resp depression, neutropenia, hepatocellular injury, anaphylaxis, hemorrhage. - Most common in older adults and young children
5 essential education points when talking to a patient about a newly prescribed medication
indication, expected duration of treatment, possible side effects and how to monitor, storage instructions, and what to do in the case of a missed dose
