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Fogle Exam 2: Need to Know Drugs
Terms in this set (93)
Which organ is responsible for regulating blood glucose levels?
Hormones secreted by pancreas that relate to diabetes
insulin and glucagon
omeprazole (trade name)
antiulcer drug; proton pump inhibitor
First PPI to be approved for PUD
Action of omeprazole (Prilosec)
reduces stomach acid by irreversibly binding to the enzyme H+
Onset, Peak, and Duration
Onset: Up to 2 hours
Peak: 2 hours
Duration: 72 hours
Administration alerts for omeprazole (Prilosec):
1. Administer AC on an empty stomach
2. Can be administered with antacids
3. Capsules and tablets should not be chewed, divided, or crushed
4. Category C
Adverse effects: omeprazole (Prilosec):
Generally minor and include:
headache, nausea, diarrhea, rash, and abdominal pain.
blood disorders, unusual fatigue and weakness r/t blood disorders, therapy is limited to 2 months, atrophic gastritis and hypomagnesia have been reported with prolonged treatment with PPIs
What adverse effects have been reported with prolonged use r/t PPIs?
Atrophic gastritis and hypomagnesia
Contraindications of omeprazole (Prilosec)
OTC use is not approved for patients <18 years
Drug-Drug interactions with omeprazole (Prilosec)
concurrent use with diazepam, phenytoin, and CNS depressants may cause increased blood levels of these drugs.
Concurrent use with warfarin may increase likelihood of bleeding.
Alcohol can aggravate stomach mucosa and decrease effectiveness of omeprazole.
If used with omeprazole, which drug levels may increase in the blood?
diazepam, phenytoin, and CNS depressants
ranitidine (trade name)
Action of ranitidine (Zantac):
decreases acid production by blocking H2 receptors in the stomach
How long will an ulcer take to heal if treated with Zantac?
4-8 weeks, although those at high risk for PUD may continue on drug maintenance for prolonged periods to prevent recurrence
*Gastric ulcers require longer therapy for healing to occur
Which forms of Zantac are available for acute, stress induced bleeding ulcers?
IV and IM
Administration alerts for Zantac (ranitidine):
1. Administer PC and monitor liver and renal functions
2. Pregnancy Category B
Adverse effects of Zantac (ranitidine):
Rare: severe reductions in the number of red and white blood cells and platelets are possible; therefore, periodic blood counts should be performed.
What adverse effect should be made aware by the nurse to a male client receiving high doses of ranitidine (Zantac)?
high doses may result in impotence or loss of libido in men
Contraindications of ranitidine (Zantac):
hypersensitivity to H2 receptor antagonists, acute porphyria, OTC administration in children <12 years
Drug-Drug interactions for ranitidine (Zantac):
May reduce absorption of cefpoxodine, ketoconazole, itraconazole.
A patient has an order for ranitidine and antacids.
How should the nurse administer these two drugs?
antacids should not be given within 1 hour of Zantac because the effectiveness may be decreased due to reduced absorption.
Therefore, administer 1 hour apart.
Herbal/ food considerations for Zantac (ranitidine):
Vitamin B12 depends on acidic environment, deficiency may occur.
aluminum hydroxide trade name
aluminum hydroxide (AlternaGel) class
antiheartburn agent; antacid
Action of aluminum hydroxide (AlternaGel):
can be used alone or in combination with other antacids; neutralizes stomach acid by raising pH level of stomach contents
*Do not reduce acid secretion
How should aluminum hydroxide (AlternaGel) be administered with other drugs?
at least 2 hour before or after other drugs
A patient has been taking AlternaGel regularly and in high doses, what should the nurse teach about possible adverse effects?
constipation, phosphate depletion,
A patient with a suspected bowel obstruction has heartburn. Which antiheartburn agent, if prescribed, should the nurse phone the physician about before administering?
aluminum hydroxide (AlternaGel)
Drug- Drug interactions: Prilosec
should not be taken at the same time as other medications as it may interfere with absorption
Drugs to treat PUD
omeprazole (Prilosec), ranitidine (Zantac), aluminum hydroxide (AlternaGel)
Metamucil action and use
laxative; when taken with a sufficient amount of water, Metamucil swells and increases the size of fecal mass which promotes passage of stool
How should you administer Metamucil?
mix with at least 8oz of water, fruit juice, or milk and administer immediately.
Follow each dose with an additional 8oz of liquid, observe older adults for possible aspiration, Pregnancy Category C
Adverse effects for Metamucil:
Contraindications for Metamucil:
should not be administered to patients with undiagnosed abdominal pain, intestinal obstruction, or fecal impaction
diphenoxylate with atropine (Lomotil) action and class
Slows peristalsis, allowing time for additional water reabsorption from the colon and more solid stools.
Effective for moderate to severe diarrhea.
Adverse effects of Lomotil
dizziness or drowsiness (not common)
Contraindications of Lomotil
severe liver disease, obstructive jaundice, severe dehydration, narrow angle glaucoma,
Treatment of overdose for Lomotil
May be serious
narcotic antagonists such as naloxone may be administered parenterally to reveerse respiratory depression within minutes
sulfasalazine (Azulfidine) action and class:
inflammatory bowel disease, sulfonamide;
PO drug used to terat mild to moderate symptoms of ulcerative colitis, used off label for Crohn's disease, and rheumatoid arthritis
Administration alerts for sulfasalazine (Azulfidine):
1. DO NOT administer to patients allergic to sulfonamide and Lasix
2. Not approved for children <2 years
3. Do not crush or chew er tablets
4. Pregnancy Cat B
Adverse effects of sulfasalazine (Azulfidine):
nausea, vomiting, diarrhea, dypsepsia, abdominal pain, headache, blood dycrasias, skin rashes, may impair male fertility, can cause photo-sensitivity
Contraindications of Azulfidine:
patients with sulfonamide or aspirin hypersensitivity; use drug with caution if preexisting anemia, folate disorders, or hematologic disorders are present; caution with hepatic impairments; patients with urinary obstruction or dehydration; diabetes or hypoglycemia
Signs of overdose of Azulfidine:
abdominal pain, anuria, drowsiness, gastric distress, nausea, seizures, and vomiting
Prochlorperazine (Compazine) actions, classes, and administration alerts:
Actions: usually for psychoses; nausea and vomiting
Classes: antiemetic; phenothiazine antipsychotic
Administration alerts: 2 hours before or after antacids or antidiarrheals; Pregnancy Cat C
Adverse effects of Compazine:
dry mouth, sedation, constipation, orthostatic hypotension, and tachycardia
You are ordered to administer Compazine to an elderly patient with early signs of dementia, severe nausea, and fatigue.
What do you do first?
Call the MD
Blackbox warning for Compazine: Elderly patients with dementia who are treated are at an increased risk of death compared to placebo
Contraindications for Compazine:
not with comatose patients; or in the presence of CNS depression; children <2 years or weighing <20 lbs
Drug Interactions of Compazine:
interacts with alcohol and CNS depressants to cause additive sedation; antacids and antidiarrheals inhibit absoprtion;
Treatment of overdose:
antiparkinson drugs and possibly a CNS stimulant such as dextroamphetamine
lorazepam (Ativan) class and action
Class: Sedative-hypnotic; anesthetic adjunct
Action: Treats chemotherapy induced nausea and vomiting; preanesthetic medication to provide sedation; and benzodiazepines (<< Dont know what that means?LOOK IT UP)
Administration alerts for lorazepam (Ativan):
When administering IV, monitor respirations every 5 to 15 minutes. Have airway and resuscitative equipment accessible.
Pregnancy Category D.
Adverse effects for lorazepam:
Most common: drowsiness and sedation
More severe effects are observed when administered IV: amnesia, weakness, disorientation, ataxia, sleep disturbance, blood pressure changes, blurred vision, double vision, nausea, and vomiting.
A patient has been admitted to your unit who is undergoing chemotherapy. The patient is 42, has been experiencing severe uncontrolled pain for 24 hours, severe nausea, and has a stage 2 pressure ulcer located on their left antecubital region.
The doctor has ordered lorazepam, 3mg PO daily.
Which of the mentioned symptoms would prompt you to call the physician before administering the medication?
severe uncontrolled pain
(See prototype drug box "Contraindications" on page 164 of our pharm textbook)
Drug Interactions for lorazepam (Ativan):
Concurrent use with CNS depressants (including alcohol), potentiates sedative effects and increases the risk of respiratory depression and death.
Lorezapam may decrease antiparkinson effects of levodopa and increase phenytoin levels.
A patient has overdosed on Ativan.
What is the treatment?
flumazenil (Romazicon), can be administered to reverse CNS depressant effects
Tums classifications and actions:
Class: fluid and electrolytic balance agent; replacement solution; antacid
Actions: rapid acting antacid that decreases gastric acidity increases lower esophageal sphincter tone.
Administration alerts for Tums:
•Give 1 h after meals and at When used as calcium supplement, give 1-1 ½ h after meals, unless otherwise directed by physician.
•Chewable tablet should be chewed well before swallowing or allowed to dissolve completely in mouth, followed with water. Powder form may be mixed with water.
•Ensure that sustained-release form of drug is not chewed or crushed. It must be swallowed whole
Contraindications for administering Tums:
Hypercalcemia and hypercalciuria (e.g., hyperparathyroidism, vitamin D overdosage, decalcifying tumors, bone metastases), calcium loss due to immobilization, severe renal disease, renal calculi, GI hemorrhage or obstruction, dehydration, hypochloremic alkalosis, ventricular fibrillation, cardiac disease, pregnancy (category C).
Adverse effects of Tums:
could cause one GI extreme or the other (constipation or diarrhea...yeah, weird); nausea, flatulence, vomiting, Metabolic: Hypercalcemia with alkalosis, hypercalciuria, hypomagnesemia, CNS: Mood and mental changes. Urogenital: Polyuria, renal calculi
A patient is prescribed cipro, tums, and Coumadin.
Which of these combinations are contraindicated?
Cipro and tums.
Tums decreases the absorption fluroquinolones and tetracyclines.
What is Maalox used to treat?
Classification and actions of Maalox:
Class: gastrointestinal; antidiarrheal
Actions: dams up the brown river
Administration alerts for Maalox:
Never give prn dose to a child with acute diarrhea
Adverse effects of Maalox:
Body as a Whole: Hypersensitivity (skin rash); fever. CNS: Drowsiness, fatigue, dizziness, CNS depression (overdosage).
GI: Abdominal discomfort or pain, abdominal distention, bloating, constipation, nausea, vomiting, anorexia, dry mouth; toxic megacolon (patients with ulcerative colitis).
Contraindications for taking Maalox:
Conditions in which constipation should be avoided, severe colitis, acute diarrhea caused by broad-spectrum antibiotics (pseudomembranous colitis) or associated with microorganisms that penetrate intestinal mucosa
Actions and classifications of Colace:
Administration alerts for Colace:
•Give with a full glass of water if allowed.
•Store syrup formulations in tight, light-resistant containers at 15°-30° C (59°-86° F) unless directed otherwise.
•Microenema: Insert full length of nozzle (half length for children) into the rectum. Squeeze entire contents of tube and remove completely before releasing grip on tube.
•Store in tightly covered containers.
Adverse effects of Colace:
GI: Occasional mild abdominal cramps, diarrhea, nausea, bitter taste. Other: Throat irritation (liquid preparation), rash.
Contraindications of Colace:
fecal impaction, structural anomalies of colon and rectum, intestinal obstruction or perforation; use of docusate sodium in patients on sodium restriction; use of docusate potassium in patients with renal dysfunction; concomitant use of mineral oil; pregnancy (category C).
What should the nurse take into consideration when administering Colace and mineral oil concurrently?
Colace increases the absorption of mineral oil
Which of the following health care practitioners is most likely to prescribe Decadron?
b. Orthopedic Surgeon
d. Primary Care Physician
b. Orthopedic Surgeon
Decadron is most commonly used for postsurgical nausea and vomiting.
Which antiemitc should never be administered to an elderly patient with dimentia?
BLACK BOX WARNING (for all phothiazines):
Elderly patients with dimentia who are treated with phenothiazines are at an increased risk of death compared to placebo.
Which of the following should not be administered Azulfidine (inflammatory bowel disease)?
Select all that apply.
a. Contraindicated in pregnant women in 3rd trimester
b. Patients with allergies to sulfonamide antibiotics
c. Children <2
d. Patients with Crohn's disease
B & C
A. Incorrect. Azulfidine is Category B.
B. Correct, patients with allergies to sulfonamides should not receive this drug.
C. Correct. This drug is not approved for children <2.
D. Incorrect. This drug is used off-label to treat Crohn's disease.
Lomotil is used to treat...
c. chemotherapy induced nausea
Trick for remembering how diphenoxylate with Atropine (Lomotil) is used to treat diarrhea:
Think "Slowmotil"; the diphenoxylate in Lomotil slows peristalsis, allowing time for additional water reabsoprtion from the colon and more solid stools.
Which of the following drugs' absorption may be decreased if taken concurrently with Metamucil (bulk-type laxative)?
Select All That Apply.
d. tricyclic antidepressants
YAY IT'S ALL OF THEM! That's easy to remember, right?...
AlternaGEL is an antacid that should be administered 2 hours before or after other drugs.
Absorption could be affected if other drugs are taken with this antacid.
When taken regularly or in high doses, AlternaGEL can cause which of the following?
c. muscle spasms
When taken regularly or in high doses, aluminum antacids cause constipation.
Administration alerts for Zantac.
Select All That Apply.
a. do not administer to patients with PUD
b. Pregnancy Category B
c. administer after meals
d. monitor hepatic and renal function
B,C, & D
A. Incorrect because Zantac is used to treat PUD.
Silly nursing student ;)
Why should Prilosec (and all PPIs) be administered before breakfast on an empty stomach?
The proton pump is activated by food intake; therefore, PPIs should be taken 20-30 minutes before the first major meal of the day.
All PPIs (Prilosec, Protonix, Nexium) have similar adverse effects.
What are they (most frequently reported)?
Most frequently reported:
headache, abdominal pain, diarrhea, nausea, and vomiting.
Your patient is wearing a Transderm-Scop patch.
What are they being treated for (by this drug specifically)?
scopolamine (Transderm-Scop) is used to treat motion sickness.
a post-surgical drug to help ease nausea & vomiting
Which drug should be mixed with 8oz of milk, water, or liquid before administration and followed with 8oz of liquid after administration?
c. Metamucil (bulk-type laxative)
Which of the following are antacids?
Select All That Apply.
A & B
C. Senna- OTC used for self-treatment of constipation
D. Colace- stool softener
A patient is being treated for an ulcer that hurts most 1-3 hours after meals.
Which type of ulcer do they have?
Gastric ulcer pain worsens once the digestive process is over, 1-3 hours after eating.
Hey! Guess what?
You're studying right now. That's awesome!
So... take a deep breath and remember that you are going to rock this exam!
sucralfate (Carafate) action
treats ulcers and other stomach problems
prevents ulcers caused by NSAIDs
Treats gastric esophageal reflux disease (GERD). Also treats nausea, vomiting, and heartburn caused by a stomach problem called gastroparesis in patients with diabetes
corticosteroid used to prevent nausea r/t surgery
THIS SET IS OFTEN IN FOLDERS WITH...
Pharmacology Modules A&C
Anti-fungals, antivirals, antibacterials
Fogle Exam 2: PUD, GI, Diabetes, Anticoags
Pharmacology Ch. 13
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