PPRA 3315 Test 4
Valerian Root ADE and precautions
-headache, dizziness, GI upset, tiredness in the morning -don't use in combination with other GABAergic drugs -dont use for more than 4-6 weeks
Safety precautions for Acetaminophen
-very few risks at normal doses (higher than 4 grams daily causes problems) -hepatotoxic in overdose or pt with liver failure -early symptoms of overdose = N/V/D, sweating, abdominal pain -tx for overdose = acetylcysteine
Timolol ADE
-heart block -bradycardia -bronchospasm -local effects: transient ocular stinging, conjunctivitis, blurred vision, photophobia, dry eyes
A patient asks a nurse what a sun protection factor (SPF) of 15 indicates. The nurse will tell the patient that an SPF of 15 indicates:
A 93% block of UVB radiation.
A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching?
"Cephalosporins have increased activity against gram-negative bacteria with each generation." -With each progression from first-generation agents to fifth-generation agents, the cephalosporins show increased activity against gram-negative organisms, increased resistance to destruction by beta-lactamases, and increased ability to reach the CSF.
A nurse is providing education about tetracycline [Sumycin]. Which statement by the patient best demonstrates understanding of the administration of this medication?
"I should not take this medication with milk or other dairy products." -The patient should avoid taking the medication with dairy products to help prevent chelation. An acne-like reaction would indicate an allergic response. Taking the medication with calcium-containing antacids or supplements should be avoided, because this also leads to chelation.
A nurse is discussing methicillin-resistant S. aureus (MRSA) with a group of nursing students. Which statement by a student correctly identifies the basis for MRSA resistance?
"MRSA bacteria have developed PBPs with a low affinity for penicillins." -MRSA strains have a unique mechanism of resistance, which is the production of PBPs with a low affinity for penicillins and all other beta-lactam antibiotics.
A pregnant adolescent patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct?
"Tetracycline can be harmful to the baby's teeth and should be avoided. -Tetracyclines can cause discoloration of deciduous teeth of infants if taken by the mother after the fourth month of gestation. Tetracyclines should not be given to pregnant women. Tooth discoloration can be prevented if the drugs are not taken by pregnant women or by children under 8 years of age. Tetracycline is not appropriate for a pregnant patient.
A nurse in an ophthalmology clinic instills an anticholinergic agent into a patient's eyes. The nurse provides teaching when the patient asks the reason for the drops. Which statement by the patient indicates a need for further teaching?
"This medication anesthetizes my eyes so that the exam won't be painful." -Anticholinergic agents are used to provide mydriasis and cycloplegia. They do not affect the sensation of pain and do not provide anesthesia.
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
"You should take oral antihistamines daily during each allergy season to get maximum effects." -Antihistamines are most effective when they are taken prophylactically, and they should be administered on a regular basis throughout the allergy season, even when symptoms are not present. They are less helpful when taken after symptoms appear.
most common ADE for fluticasone and triamcinolone (ICS)
-generally safe -oropharyngeal candidiasis (minimized by rinsing mouth out after each dose) -dysphonia -can slow growth in children but will not affect final height -small risk of bone loss, use lowest dose
Medications used for the treatment of chemo-induced nausea and vomiting (CINV)
-5-ht 2 antagonists ^ondansetron, granisetron, dolasetron, palonosetron -Aprepitant (substance P/neurkinin1 antagonist)
Vitamin E
-Main function: antioxidant properties -toxicity: increase risk of bleeding and hemorrhagic stroke -uses: antioxidant, neuroprotectant
Vitamin D
-Main function: regulates calcium and phosphorus -deficiency: riskets, osteomalacia, osteoporosis -most calcium supplements include this vitamin
Vitamin K
-Main function: required for blood cloting -deficiency: increased bleeding -ADE: hyperbilirubinemia in parental administration to newborns -used to control hemorrhage caused by excessive warfarin
Echinacea
-Prevention and treatment of the common cold or other upper resp infections -300mg taken 3x daily for 7-10 days -increases phagocytosis -
Which information on the product label of an herbal supplement would comply with the regulations established by the Dietary Supplement Health and Education Act (DSHEA)?
-Supports the immune system -The DSHEA restricts the wording of labels on product packaging. A label cannot claim to diagnose, treat, cure, or prevent disease. However, the label is allowed to state the product's ability to favorably influence body function or structure.
ADEs of PPIs
-headache -constipation or diarrhea and dizziness -long term = osteoporosis, vitamin deficiencies, and upper resp infections -best if taken 1 hour before a large meal, make take a few days to see full effect -only take as long as necessary because of long term effects
Ondansetron (Zofran) ADE
-headache -dizziness -constipation
Long-term ADE of systemic corticosteroid therapy
-adrenal suppression -osteoporosis -peptic ulcer disease -immunosupression -hyperglycemia (mostly short term) -needs to be discontinued slowly to avoid adrenal effects
inhaled bronchodilators used for asthma
-albuterol -levalbuterol
Penicillin pt education and precautions
-allergy to penicillin, cephalosporins, and imipenem -report signs of superinfection, or allergy -notify if signs of fever and diarrhea -if on BC, make sure to use a second non hormonal form of contraceptive until next period after stoping medication -take entire regimen
Benzoyl peroxide MOA and use
-antibiotic that suppresses the bacteria that causes acne -reduces inflammation - first line agent to treat mild to moderate acne
Penicillin monitoring parameters
-assess for signs of infection at beginning and during treatment -observe for signs of allergic reaction -obtain culture and sensitivity before initiating therapy
Penicillin MOA
-bactericidal -binds to bacterial cell wall and destroys its integrity -impacts mainly gram positive
Penicillin ADE
-big cause of allergic reactions -stomach upset
MOA of Proton Pump Inhibitors (PPIs)
-block final action of gastric acid production -98% reduction in secretion
Safety precautions for second gen NSAIDs (Celecoxib)
-can impair renal function and hypertension, and edema -increased risk for MI and stroke -lower risk for GI side effects -should not be used if they have a Sulfa allergy -can cause dyspepsia
benzoyl peroxide ADE
-can produce drying and peeling of skin, this is normal, treatment should not be discontinued because of this -if severe local irritation the frequency of application should be reduced -can produce a serious hypersensitivity reaction in patients especially those with asthma
ADE for H2 receptor antagonists
-cimetidine is a CYP inhibitor -headache, constipation or diarrhea, dizziness -monitor for black or tarry stools -heart burn can be confused with a heart attack, seek help if pt has heavy feeling on chest
General treatment for PUD and GERD
-combination of antibiotics, mucosal protectants, antacids and acid reducing drugs -symptomatic treatment = antacids, H2 receptor antagonists and PPIs
What is the difference between dietary supplements and pharmaceuticals?
-dietary supplements cannot claim to diagnose, prevent, treat or cure a disease -labeling must include directions name and quantity of each ingredient and serving size -part of plant used must be listed -all fillers must be listed -must be labeled as a dietary supplement -supplements do not require safety and efficacy testing to be sold
Homatropine ADE
-do not use if you have glaucoma -stinging, burning, dry mouth, increased thirst, photosensitivity -can cause eye swelling or redness, crusting or drainage, red or puffy eyelids, confusion, agitation or unusual thoughts or behaviors
Safety precautions for first gen NSAIDs (aspirin and ibuprofen)
-dont give to anyone who is allergic -not recommended for anyone with kidney disease, heart failure, or cirrhosis -ASA should not be combined wither other anticoagulants, glucocorticoids, alcohol, ibuprofen, ACE or ARBs -dont give to pregnant patients -can cause reye syndrome in children (presents as flu like) -can cause increased risk of GI bleeding -Ib has little risk except GI bleeding
Proper use of MDI (metered dose inhaler)
-exhale fully -place inhaler in mouth or use spacer -spray while inhaling and hold for a few seconds -can only repeat once (2x total)
Garlic
-hyperlipidemia and hypertension -prevention of CV events and cancer -acts like a weak statin -ADE: breath and body odor, burning sensation in mouth, heart burn, nausea, GI upset, antiplatelet
Short Term Beta 2 Agonists
-immediate onset, lasts 3-5 hours -as needed for attacks and prophylaxis for exercise -albuterol and levalbuterol -well tolerated can cause tachycardia, tremor, angina -can overdose, use no more that 2x
Lantanoprost MOA and uses
-increases aqueous humor outflow -used to treat open angle glaucoma and ocular hypertension -lowers IOP
inhaled anti-inflammatory agents
-inhaled corticosteroids -beclomethasone -budesonide -ciclesonide -fluisolide -fluticasone -mometasone -triamcinolone
benefits of ICS therapy
-limited systematic effect -most important agent for long term control of Asthma
Hydrocortisone ADE
-local infection -irritation -atrophy of dermis/epidermis (thinning, striae, purpura, telangiectasia -acne and hypertrichosis when used long term
Vitamin B12 (cobalamin)
-main function: essential in synthesis of DNA -deficiency: megaloblastic anemia, and neurologic damage
Vitamin A (retinol)
-main function: eyes -deficiency: night blindness, keratomalacia -toxicity: teratogenic, birth defects, liver harm -uses: skin conditions (accutane)
Vitamin B6 (pyridoxine)
-main function: metabolism of amino acids and proteins -sources: fortified breakfast cereals, meat, fish, poultry, white potatoes, non citrus fruits, starchy vegetables -may be combined with antihistamine to treat pregnancy related nausea
Vitamin C
-main function: required for collagen production -part of synthesis of adrenal steroids -helps in absorption of iron -deficiency: scurvy -sources: citrus, tomatoes, potatoes, strawberries, melons, spinach, broccoli
Vitamin B1 (thiamine)
-main function: used for carb metabolism -slight increase in requirement durin pregnancy and breastfeeding -deficiency: beriberi, Wernicke-Korsakoff syndrome (CNS disorder) -alcoholism is the biggest cause of deficiency
Homatropine MOA and use
-muscarinic antagonist -dialates pupils for an extended period of time -can also lower IOC -used to treat uveitis
Echinacea ADE and precautions
-nausea, abdominal pain diarrhea, allergic reactions -dont use if allergic to ragweed or daisy family -caution in patients with autoimmune conditions or those taking immunosuppresants
Timolol MOA and use
-non-selective beta blocker -use for treatment of open angle glaucoma by lowering intraoccular pressure -decreases aqueous humor formation
Isotretinoin ADE
-nosebleeds, inflammation of lips, eyes, dryness or itching of the skin nose and mouth -pain tenderness or stiffness in muscles, bones, and joints, -sensitivity to UV light -can increase triglyceride levels -extremely teratogenic
St johns Wort ADE
-photosensitivity when taken with retinoids, quinolones, sulfas, tetracyclines and tacrolimus -serotonin syndrome when combined with SSRIs, Triptans, tramadol -GI upset, insomnia, dry mouth, anxiety, sexual dysfunction -may decrease effects of BC, cyclosporin, antiseizure drugs, antiretroviral drugs used to treat HIV, warfarin -precaution when incorrectly diagnosed
Cranberry
-prevention of UTI -inhibits adhesion of bacteria to bladder wall -nausea and diarrhea possible with high doses -consumption of more than 1L per day can lead to kidney stones -prevents UTI, not treats a UTI
Hydrocortisone MOA and use
-relieves inflammation and itching associated with insect bites, dermatitis, psoriasis, eczema -lowest concentration available
ADEs for antacids
-sodium bicarb can cause belching -magnesium hydro can have a laxative effect -aluminum hydro and calcium are constipating -all antacids may affect absorption of drugs taken at the same time (take 1 hour before of 2 hours after)
Cephalexin ADE
-stomach upset. -allergic reactions -caution in renal impairment
What class of antibiotic is associated with kernicterus?
-sulfonamides
Lantanoprost ADE
-systemic reactions are rare -heightened brown pigmentation of the iris, harmless -blurred vision, , burning, stinging, conjunctival hyperemia, punctate keratopathy -can cause migraine rarely
Isotretinoin MOA and use
-taken orally for severe acne that has not responded to other treatments -accutane -decreases sebum production, sebaceous gland size, inflammation and keratinization
Ginger
-treats vertigo, nausea and vomiting associated with motion sickness, sea sickness, chemo, and anesthesia -anti-inflammatory for those with arthritis and other chronic inflammatory -can increase bleeding risk -can lower BS, caution in diabetics
Soy
-used for menopausal symptoms, bone health, improving memory, high BP, and high cholesterol levels -lowers LDL levels -reduces instances of hot flashes -can cause GI upset
How to use inhaled glucocorticoids?
-used usually once daily on a regular schedule -administered in an inhaler -should NOT be used PRN -may be using in combination with SABA for acute attacks
St. John's Wort
-uses: depression, anxiety, mood disorders -dosage: 300mg 3x daily
Valerian Root
-uses: insomnia, anxiety -dosage: 150mg a day in 3 doses, for 4 weeks or 400-600 mg taken 1 hour before bedtime -works as a GABA agonist (CNS depression)
What are the current recommendations and contraindications for the flu vaccine?
-vaccine is recommended every year for everyone 6 months and older -pregnant people and those with chronic health conditions should not receive some versions of the flu vaccine -people with allergies to gelatin, antibiotics, or eggs should not get the flu vaccine -children younger than 6 months should not receive -those with a hypersensitivity to the vaccine itself should not receive it
What is the significance of solubility in vitamins?
-water soluble vitamins are not stored in the body like fat solubles are, so it is easier to have an unbalance in water soluble vitamins
Long Acting Beta Agonists (LABA)
1) Formoterol, Salmeterol, Arformoterol, indacterol, olodaterol 2) Onset 20 minutes so NOT for ACUTE attacks 3) Lasts up to 12 hours 4) *Never used alone in ASTHMA, always with inhaled corticosteroids* different with COPD. This is bc smart study showed that LABA alone for asthma can cause death. 5) first line agent for COPD -daily prophylaxis with fixed doses -generally well tolerated can cause tachycardia
A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist -LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in COPD, it is no longer recommended. It is used only if beta2 agonists are not available.
Which vitamins are fat soluble?
A, D, E, K
The nurse identifies which medication as the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus?
Acyclovir -Acyclovir is the drug of choice for most infections caused by herpes simplex viruses and varicella-zoster virus. Ganciclovir is the drug of choice for prophylaxis and treatment of CMV infection in immunocompromised patients, including those with AIDS. Amantadine and oseltamivir are drugs of choice for the treatment and prophylaxis of influenza.
A patient who has peptic ulcer disease and is receiving magnesium hydroxide (milk of magnesia) is experiencing an increased number of bowel movements. Which is the nurse's priority action?
Administer the drug with an aluminum hydroxide antacid. -Magnesium hydroxide is a rapid-acting antacid with a prominent adverse effect of diarrhea. To compensate, it usually is administered in combination with aluminum hydroxide, which promotes constipation. A reduction in dose might be necessary if the diarrhea is severe, but this is not the priority action.
A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do?
Ask whether the patient is rinsing the mouth after each dose. -The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration.
Which vitamins are water soluble?
B and C
MOA of H2 receptor antagonists
Block the ability of histamine to induce secretion of gastric fluid w/ a high hydrogen ion concentration (increase gastric fluid pH)
Ondansetron (Zofran) MOA
Blocks serotonin receptors in the chemoreceptor trigger zone
Which factor in a patient's history is most likely related to the development of thiamine (vitamin B1) deficiency?
Chronic alcohol abuse -Thiamine deficiency is common in individuals who abuse alcohol. Thiamine requirements are related to caloric intake, and principal dietary sources are enriched, fortified, or whole-grain products, such as breads and cereals.
Prototype H2 receptor antagonist
Cimetidine, but famotidine is more clinically used
What is Kernicterus and how does it present?
Complication of unconjugated hyperbilirubinaemia resulting in irreversible bilirubin deposition in basal ganglia, pons and cerebellum. Lethargy Poor feeding High-pitched cry Hypertonicity Seizures -will present similar to jaundice
A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do?
Contact the provider and prepare to administer epinephrine. -This patient is showing signs of an immediate penicillin allergy, that is, one that occurs within 2 to 30 minutes after administration of the drug. The patient is showing signs of anaphylaxis, which include laryngeal edema, bronchoconstriction, and hypotension; these must be treated with epinephrine. This is an emergency, and the provider must be notified immediately, not when other symptoms develop.
Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug?
Diarrhea -CDAD is a serious, sometimes fatal suprainfection associated with clindamycin. Patients with diarrhea should notify their prescriber immediately and discontinue the drug until this condition has been ruled out
Which antifungal agent is used as a one-time oral dose to treat vaginal yeast infections?
Fluconazole [Diflucan] -Fluconazole [Diflucan] has almost 100% bioavailability and therefore is often sufficient as a single dose to treat vaginal yeast infections. Caspofungin [Cancidas] cannot be administered orally. It is used in patients unresponsive to amphotericin B. Nystatin [Mycostatin] is administered as an oral or topical application for candidiasis. Voriconazole [Vfend] is used in the treatment of aspergillosis.
A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy?
Folic acid -Folic acid deficiency during early pregnancy can cause neural tube defects [spina bifida].
A patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement?
Ginger root (Zingiber officinale) -Ginger root is used to suppress nausea and vomiting caused by motion sickness and morning sickness and also for postoperative nausea and vomiting.
Most common causes of peptic ulcer disease
H. pylori NSAIDs + acid hypersecretion
In assessing a patient with a vitamin A deficiency, the nurse should determine whether the patient has which manifestation?
Impaired night vision -Vitamin A plays an important role in adaptation to dim light and night blindness, which often are the first indicators of deficiency.
The nurse prepares to administer a bisacodyl suppository to a patient who has not had a bowel movement in several days. When should the nurse administer the PRN medication?
In the morning, after breakfast -Bisacodyl suppositories act rapidly (in 15 to 60 minutes). They can be given at any time, but for patient convenience, they should not be given at bedtime to avoid disrupting sleep. For convenience and patient ease, a fast-acting laxative should not be given before a meal, which could cause the urge to have a bowel movement during the meal.
prototype PPI
Omeprazole (Prilosec) -all others in class end in -prazole
A patient will begin treatment for severe acne that is resistant to other treatments. Which regimen will the nurse expect the provider to order?
Isotretinoin [Accutane] -Isotretinoin is used for severe acne that has not responded to other treatments.
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist (LABA) medication. What will the nurse tell this patient?
LABAs should be combined with an inhaled glucocorticoid. -LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.
Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death?
Ma huang (Ephedra) -Sales of ma huang have been banned in the United States since 2004, making it the first time that a dietary supplement has been ordered off the market. It has been associated with stroke, myocardial infarction, and death.
A patient who has gastroesophageal reflux disease (GERD) is taking magnesium hydroxide (milk of magnesia). Which outcome should a nurse expect if the medication is achieving the desired therapeutic effect?
Neutralized gastric acid -Antacids work by neutralizing, absorbing, or buffering gastric acid, which raises the gastric pH above 5. For patients with GERD, antacids can produce symptomatic relief.
A patient is taking bismuth subsalicylate [Pepto-Bismol] to prevent diarrhea. The nurse performing an assessment notes that the patient's tongue is black. What will the nurse do?
Reassure the patient that this is an expected side effect of this drug. -Bismuth subsalicylate can cause blackening of the tongue and stools, an expected side effect. This finding does not indicate GI bleeding, hepatotoxicity, or drug overdose.
An adolescent has begun using benzoyl peroxide lotion twice daily to treat acne. The patient reports experiencing drying and burning of the skin. What will the nurse suggest?
Reducing the frequency to one application a day. -Benzoyl peroxide may cause drying and peeling of the skin. If signs of severe local irritation occur, such as burning or blistering, then the frequency of application should be reduced.
Aprepitant moa? Clinical use?
Substance P antagonist. Blocks NK1 (neurokinin-1) receptors in brain Antiemetic for chemotherapy induced nausea and vomiting -generally well tolerated
The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush?
Superinfection
A pregnant patient who is taking ondansetron [Zofran] for morning sickness tells the nurse she is experiencing headache and dizziness. What will the nurse tell her?
These are common side effects of ondansetron. -The most common side effects of ondansetron are headache, diarrhea, and dizziness. Ondansetron is used for off-label treatment of morning sickness. These side effects do not indicate a need to stop taking the drug or to report the side effects to the provider.
The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats/min, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with:
red man syndrome. -Rapid infusion of vancomycin can cause flushing, rash, pruritus, urticaria, tachycardia, and hypotension, a collection of symptoms known as red man syndrome.
prototype of antacids
sodium bicarbonate
Cephalexin (Keflex) MOA
inhibits bacterial cell wall synthesis/disrupts integrity of cell wall -bactericidal -most commonly used class of antibiotics -1st generation -works best on gram positive bacteria -used for prophylaxis in surgery patients
A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that:
the patient should wait 1 minute between puffs. -When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Sudden inhalation can cause bronchospasm. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.
MOA of antacids
weak bases that neutralize stomach acid (react w/ protons) and might also stimulate protective function of gastric mucosa. -does not decrease acid production
