Upgrade to remove ads
Only $35.99/year

Pharm quiz 2

Terms in this set (20)

Common side effects of NSAIDs
-Gastric erosion and ulceration
-Distress, heart burn, nausea
-Bleeding tendencies
-Renal impairment
-Salicylism

ex ASA, ibprofen, naproxen, celebrex, diclofenac, indomethacin
Hypersensitivity reactions associated with aspirin
laryngeal edema, urticaria.

more likely in those with asthma, rhinitis and nasal polyps.

NOT an allergic response.

Response mediated by release of leukotriene triggered by inhibition of COX 1.

-Profuse watery rhinorrhea
-Bronchospasm
-Laryngeal edema
-Urticaria
-Shock

-Contraindicative to taking other aspirin-like drugs
4 exceptions- two cox-2 inhibitors and cox-1 inhibitors
Epinephrine is treatment of choice
patient education for ibuprofen
-All first-generation NSAIDs are associated with an increased risk of GI bleeding that can lead to hospitalization or death
-Take with glass of water/remain upright
-may cause drowsiness and dizziness
- avoid alcohol (GI bleed)
-consult health care provider if rash, itching, visual disturbances, tinnitis, weight gain, edema, epigastric pain, pregnancy planned or expected etc.
what labs would be monitored to determine if patient has hepatotoxicity?
ALT - aminotransferase
AST- asparate aminotansferase

When the liver is damaged or diseased, it releases ALT/AST into the bloodstream, which makes levels go up. The amount of AST/ALT in the blood is directly related to the extent of the tissue damage. After severe damage, levels rise in 6 to 10 hours and remain high for about 4 days.
Adverse effects in glucocorticoid use
- adrenal insufficency with prolonged administration (chronic fatigue, muscle weakness)
-osteoporosis
-infection (pneumocystis pneumonia
-glucose interolerance (glycosuria/hyperglycemia)
- myopathy (proximal muscles)
-fluid and electrolyte imbalances
-pyschologic disturbances(insomnia)
-cataracts/glaucoma
-peptic ulcer disease
Iatrogenic Cushing's syndrome
side effects and adverse effects of celecoxib (celebrex)
-Dyspepsia- indigestion
-Abdominal pain
-Renal impairment
-Sulfonamide allergy
-Cardiovascular impact (stroke, MI, and other serious events)
-Use in pregnancy- contraindicated 3rd trimester
Anemia
What technique with glucocorticoids may be done to minimize growth delays with pediatrics
alternate day therapy (large dose of glucocorticoid every other morning before 9AM - may cause flare ups)

-make periodic measurement of height and weight

-other benefits: reduced adrenal suppression and reduced overall toxicity
Patient teaching for fluid and electrolyte imbalance associated with taking glucocorticoids
-glucocorticoids can cause the retention of sodium and water which causes a loss of potassium

-Educate pt about signs and symptoms of fluid retention (weight gain, pedal edema) and hypokalemia (muscle weakness, irregular pulse, cramping), and to notify provider immediately if these occur.

-Use glucocorticoids that have low mineralocorticoid activity
Possible adverse effects of taking Entanercept (Enbrel) is severe allergic reactions such as Stevens-Johnson syndrome. What findings would suggest a reaction is taking place?
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis- characterized by painful rash, blistering of the skin and mucous membranes and detachment of the epidermis. Considered a medical emergency as it can result in death.
Entanercept (enbrel)
-neutralizes TNF (rheumatoid arthritis drug)

-biologic DMARD

Adverse effects:
-Serious infections (invasive fungal infections, TB, HBV)
-Severe allergic reactions (SJS, TEN, erythema multiforme),
-Heart failure (new develops or existing gets worse)
-Cancer (risk of lymphoma in children, adolescence and young adults)
-Hematologic disorders (neutropenia, thrombocytopenia, and aplastic anemia-fatal)
-Liver injury (liver failure, rare)
-Central nervous system (CNS) demyelinating disorders (MS, myelitis, and optic neuritis all rare)
A patient asks the nurse to explain how antibodies protect the body
against bacterial diseases. Which statement is an accurate response by
the nurse?

A. "Antibodies that destroy bacteria are part of the body's natural immunity. No prior exposure to the bacteria is needed for the body to respond."
B. "Antibodies attach to the antigens (or large molecules) on the bacteria surface, creating a way for white blood cells to attach and destroy the bacteria."
C. "Antibodies are large molecules present on the surface of bacteria. White blood cells are able to neutralize these antibodies and destroy the bacteria."
D. "Most antibodies that protect against bacteria are called immunoglobulin A. These antibodies are found on the surface of mature B cells."
Answer: B
Rationale: Opsonization is coating bacteria with antibodies. This process helps macrophages and neutrophils grab on to bacteria and facilitate phagocytosis. Most antibodies that act as opsonins are immunoglobulin G.
After receiving an allograft liver transplant, a patient is prescribed
cyclosporine [Sandimmune] oral solution. What is the most critical component of patient teaching that the nurse should stress?

A. The medication will help prevent transplant rejection.
B. The oral solution can be mixed with orange juice.
C. The medication will be taken every day for life.
D. The medication causes reversible increase of hair growth.
Answer: C
Rationale: Allograft recipients must take immunosuppressants for life to prevent transplant rejection. The other concepts are important to teach the patient but are not as high a priority.
A patient is prescribed Sirolimus [Rapamune] and Cyclosporine
[Sandimmune] after renal transplantation. It is most important for the nurse to closely monitor which value?

A.Serum creatinine
B. Aspartate aminotransferase
C. Serum potassium
D. Partial thromboplastin time
Answer: A
Rationale: Sirolimus combined with cyclosporine poses a significant risk of renal injury. Renal function (serum creatinine, serum blood urea nitrogen, and urinary creatinine clearance) should be monitored.
A patient is prescribed celecoxib [Celebrex] and warfarin
[Coumadin]. The nurse should monitor the patient for what?

A. Renal toxicity
B. Bleeding
C. Stroke symptoms
D. Dysrhythmias
Answer: B
Rationale: Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.
A patient drinks five to six alcoholic beverages per day and takes
acetaminophen [Tylenol] for pain relief. The nurse should
caution the patient to do what?

A. Limit intake of acetaminophen to less than 2000 mg/day
B. Avoid taking acetaminophen for pain
C. Take acetaminophen with food to reduce the risk of liver
damage
D. Avoid taking any pain reliever other than acetaminophen
Answer: A
Rationale: Patients who drink three or more alcoholic beverages per day should limit their acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.
Nonaspirin NSAIDs differ from aspirin in all but which way?

A. They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline.
B. They can suppress platelet aggregation, but they are not used to prevent MI and stroke.
C. They increase the risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest possible time.
D. They are safe to use in children with chickenpox or influenza.
Answer: D
Rationale: As with aspirin, these drugs should not be given to children with chickenpox or influenza, owing to the possibility of precipitating Reye's syndrome. All other statements are true.
A patient with systemic lupus erythematosus is prescribed
prednisone. It is most important for the nurse to monitor the patient for what?

A. Hypotension
B. Elevated potassium levels
C. Neck and back pain
D. Hypoglycemia
Answer: C
Rationale: Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy. Other possible adverse effects of prednisone include hypertension, hypokalemia, and hyperglycemia.
A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what?

Increase intake of dietary sodium.
Take antibiotics to prevent infection.
Never abruptly withdraw therapy.
Have an eye examination every year.
Answer: C
Rationale: Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis. Infection should be prevented, but the use of antibiotics without a known infection is inappropriate. Sodium intake should be restricted while the patient is taking glucocorticoids. Eye examinations are recommended every 6 months for patients on glucocorticoid therapy.
A patient with rheumatoid arthritis has been taking high-dose aspirin and complains of gastric upset and pain. What does the nurse anticipate will be prescribed for this patient?

A. Taking a lower dose of aspirin
B. Biweekly injections of methotrexate [Rheumatrex]
C. Obtaining a prescription for celecoxib [Celebrex]
D. Daily drug therapy with prednisone
Answer: C
Rationale: If aspirin causes gastrointestinal upset or pain, a cyclooxygenase-2 (COX-2) inhibitor (celecoxib) should be considered. Methotrexate is administered once a week. Daily prednisone therapy is not indicated; prednisone is usually administered for exacerbations and as short-term therapy.
A patient is prescribed allopurinol for chronic tophaceous gout. The patient develops a rash. What is the priority intervention by the nurse?

Stop the medication and assess the patient for liver and kidney failure.
Instruct the patient to avoid exposing the skin to sunlight.
Administer diphenhydramine (Benadryl) with the dose of allopurinol.
Monitor the patient for respiratory depression.
Answer: A
Rationale: A serious toxic reaction to allopurinol is hypersensitivity syndrome. The medication should be immediately discontinued; the patient should be observed for rash, fever, eosinophilia, and liver and kidney dysfunction.
Sets with similar terms