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Terms in this set (1945)
The client says to the nurse "My wife and I take the same drug, but we have different side effects. "Are we doing something wrong?" What is the best response by the nurse?
a. "I'll have to check. What is the name of the drug you were using?"
b. "Possibly. This could happen if one uses generic or brand name drugs."
c. "No. Differences such as your sex can result in different side effects."
d. "I'm not sure. Maybe the drug is not the same; you should check it."
a. "I'll have to check. What is the name of the drug you were using?"
b. "Possibly. This could happen if one uses generic or brand name drugs."
c. "No. Differences such as your sex can result in different side effects."
d. "I'm not sure. Maybe the drug is not the same; you should check it."
The student nurse is preparing for the first pharmacology exam. In planning for this exam, what is most important for the student nurse to remember about the Food, Drug, and Cosmetic Act?
a. It prevented the sale of drugs that had not been thoroughly tested before marketing.
b. It prohibited the sale of drugs labeled with false therapeutic claims that could defraud the public.
c. It gave the government the power to control the labeling content of medications.
d. It helped standardize the quality of drugs and cosmetics.
a. It prevented the sale of drugs that had not been thoroughly tested before marketing.
b. It prohibited the sale of drugs labeled with false therapeutic claims that could defraud the public.
c. It gave the government the power to control the labeling content of medications.
d. It helped standardize the quality of drugs and cosmetics.
The nursing mother asks the nurse if it is all right to take St. John's wort for mild depression. What is the best response by the nurse?
a. "No, it will affect the taste of your milk, and your baby might reject nursing."
b. "No, it will probably cause your baby to have more allergies."
c. "No, it could be excreted in your milk and affect the baby."
d. "No, because it might decrease the amount of milk you produce."
a. "No, it will affect the taste of your milk, and your baby might reject nursing."
b. "No, it will probably cause your baby to have more allergies."
c. "No, it could be excreted in your milk and affect the baby."
d. "No, because it might decrease the amount of milk you produce."
Which of the following would most accurately indicate that a therapeutic range for a medication had been reached?
a. The medication was effective, but the patient experienced a lethal dysrhythmia.
b. A pre-specified amount (in milligrams) was administered
c. No serious adverse effects are experienced following administration.
d. The indication for administration was achieved without serious side effects.
a. The medication was effective, but the patient experienced a lethal dysrhythmia.
b. A pre-specified amount (in milligrams) was administered
c. No serious adverse effects are experienced following administration.
d. The indication for administration was achieved without serious side effects.
When administering an oral medication to a client, the nurse should:
a. Administer the medication with grapefruit juice
b. Assess the patient's ability to swallow
c. Crush enteric coated medications if the patient has difficulty swallowing them whole
d. Avoid giving the medication to a patient with a nasogastric tube
a. Administer the medication with grapefruit juice
b. Assess the patient's ability to swallow
c. Crush enteric coated medications if the patient has difficulty swallowing them whole
d. Avoid giving the medication to a patient with a nasogastric tube
A client with a urinary tract infection is to take nitrofurantoin (Macrodantin) four times a day. The client asks the nurse, "What should I do if I forget a dose?" What should the nurse tell the client?
a. "Double the amount prescribed with your next dose."
b. "Take a lot of water with a double amount of your prescribed dose."
c. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose."
d. "You can wait and take the next dose when it is due."
a. "Double the amount prescribed with your next dose."
b. "Take a lot of water with a double amount of your prescribed dose."
c. "Take the prescribed dose as soon as you remember it, and if it is very close to the time for the next dose, delay that next dose."
d. "You can wait and take the next dose when it is due."
The client with inflammatory bowel diease is prescribed sulfasalazine (Azulfidine), a sulfonamide antibiotic. Which intervention should the nurse implement when administering this medication?
a. Administer the medication once a day with breakfast
b. Ensure the client drinks at least 2000 mL of water daily
c. Assess the client's stool for steatorrhea and mucus.
d. Explain that the medication may cause slight bruising
a. Administer the medication once a day with breakfast
b. Ensure the client drinks at least 2000 mL of water daily
c. Assess the client's stool for steatorrhea and mucus.
d. Explain that the medication may cause slight bruising
c. Determine if the client has any known allergiesThe 72-year-old client is admitted to the medical unit diagnosed with an acute exacerbation of diverticulosis. The health-care provider has prescribed the intravaneous antibiotic ceftriaxone (Rocephin). Which intervention should the nurse implement first?
a. Assesss the client's most recent vital signs
b. Send a stool specimen to the laboratory
c. Determine if the client has any known allergies
d. Monitor the client's white blood cell countd. Tell the woman to get the hepatitis B immune globulin (HBIG)The public health nurse notified a young woman that one of her sexual contacts was positive for hepatitis B. The woman denied ever having hepatitis B or having received the hepatitis B vaccinations. Which information is most important for the nurse to discuss with the woman?
a. Instruct the woman not tho unprotected intercourse
b. Advise the woman not to drink any type of alcoholic beverage
c. Encourage the client to get the hepatitis B vaccination
d. Tell the woman to get the hepatitis B immune globulin (HBIG)d. Recommend taking acetaminophen (Tylenol) before the injectionThe client with hepatitis is being treated with interferon alfa (Remeron), a biological response modifier. Which information should the clinic nurse discuss with the client?
a. Tell the client that the skin will become yellow while taking this medication
b. Discuss that the client may experience som abnormal bruising and bleeding
c. Explain that if flulike symptoms occur, the client should stop taking the medication
d. Recommend taking acetaminophen (Tylenol) before the injectionb. Cephalexin (Keflex), a cephalosporing, to a client who is allergic to penicillinThe nurse is administering medications to clients on a urology floor. Which medication should the nurse question?
a. Trimethoprim sulfa (Bactrim), a sulfa antibiotic, to a client post-prostate surgery
b. Cephalexin (Keflex), a cephalosporing, to a client who is allergic to penicillin
c. Nitrofurantoin (Macrodantin), a sulfa antibiotic, to a client with urinary stasis
d. Ceftriaxone (Rocephin), a third-generation cephalosporin, to a client who is pregnantc. Benzathine penicillin G, an antibiotuc, IM one time onlyWhich is the preferred treatment for the diagnosis of syphilis in a teenage client?
a. Nitrofurantoin, a macrolide, PO BID for 1 month
b. Doxycycline, a tetracycline, po every 4 hours for 10 days
c. Benzathine penicillin G, an antibiotuc, IM one time only
d. Miconazole, and antifungal, topical for one weekb. The client should avoid crowdsThe client receives infliximab (Remicade), an immunosuppressant medication. What is important for the nurse to teach the client about this medication?
a. The client should drink plenty of fluids
b. The client should avoid crowds
c. The client should get adequate exercise
d. The client should eat plenty of fresh fruits and vegetables.a. Do not drink alcohol with this medicationThe client receives metronidizole (Flagyl) for treatment of a vaginal infection. What does the best medication education by the nurse include?
a. Do not drink alcohol with this medication
b. Eat at least two cups of yogurt daily while on this medication.
c. Do not take this medication with milk or milk products.
d. Drink at least 2,000 mL of fluid with this medicationc. "I may have cramping and expel worms for a few days after I finish the medication."The client is being treated for pinworms with mebendazole (Vermox). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement?
a. "I must avoid aspirin while I am on this medication."
b. "I need high-fiber foods to help with passage of the worms."
c. "I may have cramping and expel worms for a few days after I finish the medication."
d. "I need to have three negative stool cultures before I am cured."d. Fever and chillsA client is receiving amphotericin B, a systemic antifungal. The nurse will reinforce teaching by telling the client that he should watch for:
a. Constipation
b. Heartburn
c. Headache
d. Fever and chillsa. CD4 countWhich of the following laboratory tests best evaluates HIV disease?
a. CD4 count
b. Liver function studies
c. Platelets
d. Complete blood countb. Vancomycin (Vancocin)Which of the following is an antibiotic responsible for causing red-man syndrome as an adverse effect?
a. Erythromycin (E-mycin)
b. Vancomycin (Vancocin)
c. Tetracycline (Sumycin)
d. Cefotaxime (Claforan)b. Dissolve the oral tablet in your mouth and then swallow it.The client receives nystatin (Nilstat) for a fungal infection in the mouth. The nurse plans to do medication education prior to discharge. What will the best plan of the nurse include?
a. Swallow the oral tablet whole without chewing or crushing it.
b. Dissolve the oral tablet in your mouth and then swallow it.
c. Take the oral suspension with a straw to prevent tooth discoloration.
d. Crush the oral tablet, mix it with orange juice, and then swallow itb. They will kill the bacteria.What is the action of bactericidal drugs?
a. They have a high potency.
b. They will kill the bacteria.
c. They disrupt normal cell function.
d. They will slow the slow growth of the bacteria.c, e, fA client is receiving monthly doses of chemotherapy for treatment of stage III colon cancer. The nurse should report which of the following laboratory results to the oncologist before the next dose of chemotherapy? SATA
a. Hemoglobin of 14.5 g/dL
b. Blood Urea Nitrogen (BUN) level of 12 mg/dL
c. Temperature of 101.2 F
d. Urine specific gravity of 1.020
e. White Blood Cell Count of 2,300/mm
f. Platelet count of 40,000/mmb, c, eA client who has been diagnosed with tuberculosis has been placed on drug therapy. The medication regimen includes rifampin (Rifadin). Which of the following instructions should the nurse include in the client's teaching plan related to the potential adverse effects of rifampin? Select all that apply.
a. Having eye examinations every 6 months
b. Maintaining follow-up monitoring of liver enzymes
c. Avoiding alcohol intake
d. Decreasing protein intake in the diet
e. The urine may have an orange colora, c, dThe nurse is administering didanosine (Videx) to a client with HIV. Before administering this medication, the nurse should check which lab test results? Select all that apply.
a. Elevated aspartate aminotransferase (AST)
b. Elevated blood urea nitrogen (BUN)
c. Elevated alanine aminotransferase (ALT)
d. Elevated serum amylase
e. Elevated serum creatininea. The medication must be tapered off when discontinued.The client with chronic low back pain has been taking baclofen (Lioresal), a muscle relaxant. Which instruction should the nurse review with the client?
a. The medication must be tapered off when discontinued.
b. The client may consume no more than one glass of wine per day.
c. The client should not take the medication before bedtime.
d. The medication can cause gastric ulcer formation.a. "I take aspirin daily to help prevent heart disease."The client with osteoarthritis is prescribed the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID). Which statement by the client warrants intervention by the nurse?
a. "I take aspirin daily to help prevent heart disease."
b. "I know I am overweight and need to lose 50 pounds."
c. "I walk 30 minutes at least three times a week.)
d. "I am allergic to penicillin and aminoglycosides."a. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin).The nurse is preparing to administer the following medications. Which medication should the nurse question administering?
a. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin).
b. Ibuprofen (Motrin), an NSAID, to a client receiving furosemide (Lasix).
c. Nabumetone (Relafen), a COX-2 inhibitor, to a client receiving digoxin (Lanoxin).
d. Ketorolac (Toradol), and NSAID, intramuscularly to a client on a morphine PCA.d. Tell the client to not take any more of the Celebrex.The client with osteoarthritis who is taking the COX-2 inhibitor celecoxib (Celebrex), a non-steroidal anti-inflammatory drug (NSAID), calls the clinic and reports having black, tarry stools. Which intervention should the clinic nurse implement?
a. Ask if the client is taking any kind of iron prepartation.
b. Instruct the client to bring a stool specimen to the clinic.
c. Explain that this is a side effect of the medication.
d. Tell the client to not take any more of the Celebrex.c. "I will take my vitamins while I am on this drug."After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching?
a. "I will continue taking my birth control pills."
b. "I must not drink any alcohol while I am on this drug."
c. "I will take my vitamins while I am on this drug."
d. "I should brush my teeth after every meal."b. The client's subcutaneous site for redness following injection.A nurse is caring for a client who is beginning a new prescription for etanercept (Enbrel) for rheumatoid arthritis. Based on the route of administration of etanercept, which of the following should the nurse plan to monitor?
a. The client's skin for irritation following removal of transdermal patch.
b. The client's subcutaneous site for redness following injection.
c. The client's vein for thrombophlebitis during IV administration.
d. The client's oral mucosa for ulceration after oral administration.d. "I've been buying Tagamet to help with the indigestion I've had."A nurse is caring for a client who is taking naproxen (Naprosyn) following an exacerbation of rheumatoid arthritis. Which of the following comments by the client requires further discussion by the nurse?
a. "I signed up for a swimming class."
b. "The Naprosyn goes down easier when I crush it and put it in applesauce."
c. "I've lost 2 pounds since my appointment 2 weeks ago."
d. "I've been buying Tagamet to help with the indigestion I've had."a. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.Which statement describes the primary difference between centrally acting muscle relaxants and direct-acting antispasmodics?
a. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents work at the level of the neuromuscular junction and skeletal muscles.
b. Centrally acting agents stimulate neurons of the central nervous system, while direct-acting agents stimulate neurons of the peripheral nervous system.
c. Centrally acting agents stimulate the central nervous system, while direct-acting agents inhibit neuronal conduction of the central nervous system.
d. Centrally acting agents inhibit neurons of the central nervous system, while direct-acting agents stimulate neurons of central nervous systemc. Beef liver & onionsThe nurse is assisting the patient with gout to mark his menu. Which of the following would the nurse recommend he avoid?
a. Cheese pizza
b. Tossed salad with cucumbers
c. Beef liver & onions
d. Egg salad sandwicha. "I drink at least eight ounces of water a day."The client with renal calculi was prescribed allopurinol (Zyloprim) for uric acid stones. Which statement indicates the client understands the teaching?
a. "I drink at least eight ounces of water a day."
b. "I really enjoy a glass of wine with my evening meal."
c. "i should have at least 8 ounces of milk with my pill."
d. "My joints ache so I take a couple of aspirin."a. Hyperventilation and drowsinessA mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children?
a. Hyperventilation and drowsiness
b. Acute gastrointestinal bleeding
c. Photosensitivity and nervousness
d. Tinnitus and hearing lossd. prevent thrombus formation.A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The nurse is aware that the purpose of this dose of aspirin is to
a. reduce anxiety.
b. relieve pain.
c. reduce inflammation.
d. prevent thrombus formation.d. Risk for falls related to decreased sensoriumA patient is recovering from a minor automobile accident that occurred 1 week ago. He is taking cyclobenzaprine (Flexeril) for muscular pain and goes to physical therapy three times a week. Which nursing diagnosis would be appropriate for him?
a. Risk for addiction related to psychological dependency
b. Decreased fluid volume related to potential adverse effects
c. Disturbed sleep pattern related to the drug's interference with REM sleep
d. Risk for falls related to decreased sensoriumb. Rheumatoid arthritisA patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug?
a. Osteoporosis
b. Rheumatoid arthritis
c. Thrombocytopenia
d. Severe anemiab. Chronic obstructive pulmonary diseaseAbatacept (Orencia) is prescribed for a patient with severe rheumatoid arthritis. The nurse checks the patient's medical history, knowing that this medication would need to be used cautiously if which condition is present?
a. Hypertension
b. Chronic obstructive pulmonary disease
c. Diabetes mellitus
d. Coronary artery diseaseb. maintenance of muscle strenghtA 62-year-old client is receiving treatment for myasthenia gravis with an acetylcholinesterase inhibitor. The nurse is assessing the client. What clinical manifestations would be noted to determine if the medication is working?
a. increased salivation
b. maintenance of muscle strenght
c. miosis
d. experiencing the side effect of GI upseta, bThe client is diagnosed with low back pain and is prescribed the muscle relaxant cyclobenzaprine (Flexeril). Which instructions should the clinic nurse teach the client? Select all that apply.
a. The medication can cause drowsiness that will make driving unsafe.
b. Suck on hard candy if the client experiences dry mouth.
c. Divide the dose of medication between early morning and bedtime.
d. Drink a full glass of water with each dose of medication.
e. Take the medication just before leaving home for work each day.a, c, d, eThe client is taking acetylsalicyclic acid (ASA), four to five times a day for severe osteoarthritic pain. Which teaching interventions should the nurse discuss with the client? Select all that apply.
a. Maintain a serum salicylate level of between 15 and 30 mg/dL.
b. Explain that ringing in the ears is a common side effect.
c. Do not drink any type of alcoholic beverages.
d. Inform the dentist about taking high soses of ASA.
e. Keep the ASA bottle out of the reach of children.a, b, dA nurse is providing teaching to a client who is to start colchicine (Colgout) for acute gouty arthritis. The nurse should advise the client to do which of the following? Select all that apply.
a. Avoid aspirin or products containing salicylates.
b. Avoid alcohol use.
c. Decrease fluid intake.
d. Notify the provider of bleeding, bruising, or sore throat.
e. Take the medication on an empty stomach to increase absorption.c. BradycardiaWhen monitoring a patient who is taking a cholinergic drug, the nurse will watch for which cardiovascular effect?
a. Vasoconstriction
b. Palpitations
c. Bradycardia
d. Tachycardiad. Stimulation of salivationA patient who has been diagnosed with Sjögren's syndrome will be given cevimeline for the treatment of xerostomia. The nurse will monitor for what therapeutic effect?
a. Reduction of salivation
b. Improvement of fine-motor control
c. Reduction of gastrointestinal peristalsis
d. Stimulation of salivationa. NicotinicThe nurse is reviewing the mechanism of action of cholinergic drugs. The undesired effects of cholinergic drugs come from the stimulation of which receptors?
a. Nicotinic
b. Ganglionic
c. Muscarinic
d. Cholinergicd. Uncontrolled angle-closure glaucomaA patient has a prescription for oxybutynin (Ditropan), an anticholinergic drug. When reviewing the patient's medical history, which condition, if present, would be considered a contraindication to therapy with this drug?
a. Diarrhea
b. Hypertension
c. Neurogenic bladder
d. Uncontrolled angle-closure glaucomad. Parasympathetic nervous systemThe nurse is reviewing the use of anticholinergic drugs. Anticholinergic drugs block the effects of which nervous system?
a. Sympathetic nervous system
b. Central nervous system
c. Somatic nervous system
d. Parasympathetic nervous systemc. He will need to take measures to reduce the occurrence of heat stroke during his activities.A 72-year-old man has a new prescription for an anticholinergic drug. He is an active man and enjoys outdoor activities, such as golfing and doing his own yard work. What will the nurse emphasize to him during the teaching session about his drug therapy?
a. Increased salivation may occur during exercise and outside activities.
b. Fluid volume deficits may occur as a result of an increased incidence of diarrhea.
c. He will need to take measures to reduce the occurrence of heat stroke during his activities.
d. Drowsiness may interfere with his outdoor activities.a. Dry mouthThe nurse will monitor for which adverse effect when administering an anticholinergic drug?
a. Dry mouth
b. Pupillary constriction
c. Diaphoresis
d. Excessive urinationc. Urge incontinenceThe nurse is reviewing a patient's medication history and notes that the patient is taking the cholinergic blocker tolterodine (Detrol). Which is an indication for this medication?
a. Irritable bowel disease
b. Reduction of secretions preoperatively
c. Urge incontinence
d. Induction of mydriasisa. The incidence of dry mouth is much lower with darifenacin.A patient has been taking tolterodine (Detrol), but today her prescriber changed her to a newer drug, darifenacin (Enablex). What advantage does darifenacin have over the tolterodine?
a. The incidence of dry mouth is much lower with darifenacin.
b. It helps reduce urinary retention.
c. It can be used in patients with narrow-angle glaucoma.
d. The newer cholinergic-blocker drugs are more effective.a. Elevated blood glucoseWhen monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect?
a. Elevated blood glucose
b. Mental alertness
c. Hyperkalemia
d. Metabolic alkalosisc. Intravenously, through a filterMannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure?
a. By mouth in a single morning dose
b. Through a gravity intravenous drip with standard tubing
c. Intravenously, through a filter
d. By rapid intravenous bolusa. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct?
a. "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."
b. "Take this medication in the evening."
c. "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit."
d. "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates."d. DigitalisWhen monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic?
a. Penicillin
b. Aspirin
c. Potassium supplements
d. Digitalisc. Intake, output, and daily weightWhen a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status?
a. Measurements of abdominal girth and calf circumference
b. Blood pressure and pulse
c. Intake, output, and daily weight
d. Serum potassium and sodium levelsa. Thiazide diureticsA patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially?
a. Thiazide diuretics
b. Potassium-sparing diuretics
c. Osmotic diuretics
d. Loop diureticsc. Osmotic diureticsA patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure?
a. Vasodilators
b. Loop diuretics
c. Osmotic diuretics
d. Thiazide diureticsb. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient?
a. He should take the diuretic with his evening meal.
b. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.
c. He should skip the diuretic dose if he plans to leave the house.
d. If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead.d. "Please come into the clinic for an evaluation to make sure there are no complications."A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct?
a. "You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician."
b. "It's important to try to stay on your prescribed medication. Try to take it with sips of water."
c. "Stop taking the diuretic for a few days, and then restart it when you feel better."
d. "Please come into the clinic for an evaluation to make sure there are no complications."a, b, d, fA cholinergic drug is prescribed for a patient. The nurse checks the patient's medical history, knowing that this drug is contraindicated in which disorders? (Select all that apply.)
a. Bradycardia
b. Chronic obstructive pulmonary disease
c. Bladder atony
d. Gastrointestinal obstruction
e. Alzheimer's disease
f. Hypotensionb, c, eWhen assessing a patient who is receiving a loop diuretic, the nurse looks for the manifestations of potassium deficiency, which would include what symptoms? (Select all that apply.)
a. Dyspnea
b. Muscle weakness
c. Lethargy
d. Tinnitus
e. Anorexia
f. Constipationa. ConstipationA patient is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect?
a. Constipation
b. Abdominal cramping
c. Nausea
d. Diarrheac. ketoconazole (Nizoral)The nurse is reviewing the medication orders for a patient who will be taking an H2 antagonist. Which drug may have an interaction if taken along with the H2 antagonist?
a. tetracycline (Doryx)
b. ranitidine (Zantac)
c. ketoconazole (Nizoral)
d. ibuprofen (Motrin)b. He smokes two packs of cigarettes a day.A patient who has been taking cimetidine (Tagamet) for hyperacidity calls the clinic to say that the medication has not been effective. The nurse reviews his history and notes that which factor may be influencing the effectiveness of this drug?
a. He drinks a glass of water with each dose.
b. He smokes two packs of cigarettes a day.
c. He takes an antacid 3 hours after the cimetidine dose.
d. He takes the cimetidine with meals.c. Give the medications at 0900, and then the antacid at 1000.At 0900, the nurse is about to give morning medications, and the patient has asked for a dose of antacid for severe heartburn. Which schedule for the antacid and medications is correct?
a. Give both the antacid and medications at 0900.
b. Give the medications at 0900, and then the antacid at 0915.
c. Give the medications at 0900, and then the antacid at 1000.
d. Give the antacid at 0900, and then the medications at 0930.d. Long-term use of these drugs may contribute to osteoporosis.The nurse is teaching a patient who will be taking a proton pump inhibitor as long-term therapy about potential adverse effects. Which statement is correct?
a. Proton pump inhibitors can cause diarrhea.
b. These drugs can cause nausea and anorexia.
c. Proton pump inhibitors cause drowsiness.
d. Long-term use of these drugs may contribute to osteoporosis.d. "Take the tablets with water, not milk or juice."The nurse is providing teaching to a patient who will be taking the laxative bisacodyl (Dulcolax). Which statement by the nurse is appropriate during this teaching session?
a. "This laxative is not known to cause dependence."
b. "In a normal bowel pattern, a bowel movement occurs daily."
c. "You can crush the laxative tablets for improved action."
d. "Take the tablets with water, not milk or juice."c. Oral hypoglycemic drugsA patient will be taking bismuth subsalicylate (Pepto-Bismol) to control diarrhea. When reviewing the patient's other ordered medications, the nurse recognizes that which medication or medication class will interact significantly with the Pepto-Bismol?
a. Antidepressants
b. acetaminophen (Tylenol)
c. Oral hypoglycemic drugs
d. Antibioticsb. polyethylene glycol (GoLYTELY)A patient is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel?
a. docusate sodium (Colace)
b. polyethylene glycol (GoLYTELY)
c. magnesium hydroxide (milk of magnesia)
d. mineral oild. Fat-soluble vitaminsWhen administering mineral oil, the nurse recognizes that it can interfere with the absorption of which substance?
a. Electrolytes
b. Minerals
c. Water-soluble vitamins
d. Fat-soluble vitaminsa. A terminally ill patient who has opioid-induced constipationThe nurse is preparing to administer methylnaltrexone (Relistor), a peripherally acting opioid antagonist. This drug is appropriate for which patient?
a. A terminally ill patient who has opioid-induced constipation
b. A patient with diarrhea
c. A patient who will be having colon surgery in the morning
d. A patient who is scheduled for a colonoscopyc. Prokinetic drugs, such as metoclopramide (Reglan)A patient is receiving a tube feeding through a gastrostomy. The nurse expects that which type of drug will be used to promote gastric emptying for this patient?
a. Neuroleptic drugs, such as chlorpromazine (Thorazine)
b. Serotonin blockers, such as ondansetron (Zofran)
c. Prokinetic drugs, such as metoclopramide (Reglan)
d. Anticholinergic drugs, such as scopolamine (Scopace)b. dronabinol (Marinol), a tetrahydrocannabinoidA patient who has AIDS has lost weight and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to stimulate his appetite?
a. metoclopramide (Reglan), a prokinetic drug
b. dronabinol (Marinol), a tetrahydrocannabinoid
c. ondansetron (Zofran), a serotonin blocker
d. aprepitant (Emend), a substance P/NK1 receptor antagonistb. "I will change the patch every 3 days."A patient with motion sickness is planning a cross-country car trip and has a new prescription for a scopolamine transdermal patch mc013-1.jpgThe nurse provides teaching for the use of this patch medication. The patient shows a correct understanding of the teaching with which statement?
a. "I will change the patch every other day."
b. "I will change the patch every 3 days."
c. "I will remove the patch only if it stops working."
d. "I will change the patch every day."c. Call the prescriber to question the route that is ordered.The nurse is reviewing new postoperative orders and notes that the order reads, "Give hydroxyzine (Vistaril) 50 mg IV prn nausea or vomiting." The patient is complaining of slight nausea. Which action by the nurse is correct at this time?
a. Give the dose orally instead of intravenously.
b. Hold the dose until the patient complains of severe nausea.
c. Call the prescriber to question the route that is ordered.
d. Give the patient the IV dose of hydroxyzine as ordered.a, b, cThe nurse is providing patient teaching about antacids. Which statements about antacids are accurate? (Select all that apply.)
a. Rebound hyperacidity may occur with calcium-based antacids.
b. Antacids neutralize acid in the stomach.
c. Magnesium-based antacids cause diarrhea.
d. Antacids reduce the production of acid in the stomach.
e. Aluminum-based antacids cause diarrhea.a, c, d, eThe nurse is reviewing the uses of oral laxatives. Which conditions are general contraindications to or cautions about the use of oral laxatives? (Select all that apply.)
a. Fecal impaction
b. Ingestion of toxic substances
c. Abdominal pain of unknown origin
d. Acute abdominal pain
e. Nausea and vomiting
f. Irritable bowel syndromeb, d, fA patient is on a chemotherapy regimen in an outpatient clinic and is receiving a chemotherapy drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? (Select all that apply.)
a. Observing carefully for the adverse effects of restlessness and anxiety
b. Instructing the patient that the antinausea drugs may cause extreme drowsiness
c. Giving antinausea drugs at the beginning of the chemotherapy infusion
d. Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension
e. For best therapeutic effects, medicating for nausea once the symptoms begin
f. Administering antinausea drugs 30 to 60 minutes before chemotherapy is startedb. Diabetes insipidusThe nurse notes in a patient's medication history that the patient has been taking desmopressin (DDAVP). Based on this finding, the nurse interprets that the patient has which disorder?
a. Diabetes mellitus
b. Diabetes insipidus
c. Adrenocortical insufficiency
d. Carcinoid tumora. The somatropin dosage may be adjusted.A 16-year-old boy who is taking somatropin comes into the office because he had an asthma attack during a race at school. Because of this new development, the nurse expects which intervention to occur next?
a. The somatropin dosage may be adjusted.
b. His growth will be documented and monitored for changes.
c. He will need to stop participating in school physical education classes.
d. The somatropin must be discontinued immediately.c. "I am looking forward to a cure for my condition with this hormone replacement."A pituitary drug is prescribed for a patient with a hormone deficiency, and the nurse provides instructions about the medication. Which statement by the patient indicates a need for further instruction?
a. "I will have to stop drinking my nightly glass of wine."
b. "I will call my doctor if I have a fever or sore throat."
c. "I am looking forward to a cure for my condition with this hormone replacement."
d. "I will not stop the drug unless my doctor tells me to stop it."c. Adrenocortical insufficiencyA patient's medication order indicates that he is to receive a dose of cosyntropin (Cortrosyn). The nurse is aware that this drug is used to diagnose which condition?
a. Diabetes insipidus
b. Pituitary dwarfism
c. Adrenocortical insufficiency
d. Myasthenia gravisd. It slows down the formation of thyroid hormone.A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate?
a. It destroys overactive cells in the thyroid gland.
b. It blocks the action of thyroid hormone.
c. It inactivates already existing thyroid hormone in the bloodstream.
d. It slows down the formation of thyroid hormone.b. "The full therapeutic effects may not occur for 3 to 4 weeks."A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct?
a. "Is it possible that you did not take your medication as instructed?"
b. "The full therapeutic effects may not occur for 3 to 4 weeks."
c. "It will probably require surgery for a cure to happen."
d. "Let's review your diet; it may be causing absorption problems."c. Decreased white blood cell countWhen reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect?
a. Decreased glucose levels
b. Increased platelet count
c. Decreased white blood cell count
d. Increased red blood cell countc. To decrease insulin resistanceA patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these?
a. To increase the pancreatic secretion of insulin
b. To decrease the pancreatic secretion of insulin
c. To decrease insulin resistance
d. To increase blood glucose levelsa. insulinThe nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class?
a. insulin
b. glitazone
c. sulfonylurea
d. metformin (Glucophage)b. "Basal dosing delivers a constant dose of insulin."The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct?
a. "With basal dosing, you can eat what you want and then give yourself a dose of insulin."
b. "Basal dosing delivers a constant dose of insulin."
c. "Basal-bolus dosing is the traditional method of managing blood glucose levels."
d. "Glargine insulin is given as a bolus with meals."c, e, fA patient is about to receive a dose of octreotide (Sandostatin). The nurse will assess for which contraindications or cautions? (Select all that apply.)
a. Diarrhea
b. Carcinoid crisis
c. Gallbladder disease
d. Esophageal varices
e. Chronic renal failure
f. Type 1 diabetes mellitusb, e, fLevothyroxine (Synthroid) has been prescribed for a patient with hypothyroidism. The nurse provides information to the patient about the medication and tells the patient to contact the prescriber if which potential adverse effect occurs? (Select all that apply.)
a. Constipation
b. Chest pains
c. Drowsiness
d. Fatigue
e. Rapid heart rate
f. Palpitationsa, d, eA patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.)
a. Weight gain
b. Peripheral edema
c. Diarrhea
d. Nausea
e. Hypoglycemiab, c, d, aThe nurse is reviewing the various types of insulins. For each insulin listed below, place in order from shortest duration (1) to longest duration (4).
a. Glargine insulin
b. Aspart insulin
c. Regular insulin
d. NPH insulinc. "Your baby's gut is sterile, and this will help the blood to clot."The mother of a newborn African American infant asks the nursery nurse, "Why did you give my baby a vitamin K injection?" Which statement is the nurse's best response?
a. "Vitamin K will help your infant's ability to fight off infection."
b. "It will help protect your baby from getting sickle cell anemia."
c. "Your baby's gut is sterile, and this will help the blood to clot."
d. " This will help prevent your baby from becoming jaundiced."d. Monitor the client's serum potassium level.The client diagnosed with pernicious anemia is prescribed cyanocobalamin (Cyanabin), Vitamin B12. Which intervention should the nurse implement?
a. Administer the subcutaneous injection into the lower outer aspect of the abdomen.
b. Double-check the dose with another registered nurse.
c. Instruct the client to sip the medication through a straw.
d. Monitor the client's serum potassium level.b. "This should not hurt you because vitamin deficiencies do not occur for some time."The female client having her annual physical exam tells the clinic nurse, "I take vitamins daily but I have not had the money to buy any for the past week." Which response is most appropriate for the nurse?
a. "As long as you eat a balanced diet, you do not need to take vitamins."
b. "This should not hurt you because vitamin deficiencies do not occur for some time."
c. "Daily vitamins are necessary, so please get them as soon as possible."
d. "I will have the physician give you a prescription for some vitamins."a. Diminished deep tendon reflexesYou are caring for a patient admitted with a diagnosis of renal failure. When you review your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess?
a. Diminished deep tendon reflexes
b. Tachycardia
c. Cool, clammy skin
d. Increased serum magnesiumb. Osmosis and osmolalityA nurse in the medical ICU has orders to infuse a hypertonic solution into her patient with low blood pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. Which term or terms is/are associated with this process?
a. Hydrostatic pressure
b. Osmosis and osmolality
c. Diffusion
d. Active transportb. HypocalcemiaYou are the nurse caring for a 65-year-old female patient who is in renal failure. During your shift assessment, the patient complains of tingling in her lips and fingers whenever anyone takes her blood pressure. She tells you that she gets a spasm in her wrist and hand and that it is very painful. What would you suspect?
a. Hypophosphatemia
b. Hypocalcemia
c. Hypermagnesemia
d. Hyperkalemiab. Dilute urineThe nurse caring for a patient post colon resection is assessing the patient on the first postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL per hour. The patient reports pain at the incision site rated at a three on a zero-to-ten rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs). You suspect the patient has hypokalemia. What other signs or symptoms would you expect this patient to exhibit?
a. Increased bowel motility
b. Dilute urine
c. Increased muscle strength
d. Excessive thirsta. Never, it rapidly enters red blood cells, causing them to rupture.Isotonic IV fluids are fluids with a total osmolality close to that of the ECF. Most IV fluids contain either dextrose or electrolytes in water. When would you infuse electrolyte-free water intravenously?
a. Never, it rapidly enters red blood cells, causing them to rupture.
b. When the patient is severely dehydrated
c. When the patient is in an excess of an electrolyte, i.e. hypercalcemia
d. When the patient is in a deficit of an electrolyte, i.e. hypocalcemiac. HyperchloremiaYou are called to your patient's room by a family member who voices concern about the patient's status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance would you suspect?
a. Hypercalcemia
b. Hyponatremia
c. Hyperchloremia
d. Hypophosphatemiab. Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a poor historian. The patient appears malnourished and TPN has been started. Why would you know to start the TPN slowly?
a. Patients receiving TPN are at risk for hypercalcemia if calories are started too rapidly.
b. Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively.
c. Malnourished patients who receive fluids too rapidly are at risk for hypernatremia.
d. Patients receiving TPN are at risk for hypochloremia if fluids are introduced too rapidly.d. Shallow respirationsYou are caring for a patient with a secondary diagnosis of hypermagnesemia. What would you assess this patient for?
a. Hypertension
b. Kussmaul respirations
c. Increased DTRs
d. Shallow respirationsd. HypocalcemiaThe nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance does a positive Chvostek's sign indicate?
a. Hypermagnesemia
b. Hypercalcemia
c. Hyperkalemia
d. Hypocalcemiab. Lactated Ringer'sYou are caring for a patient in liver failure who is exhibiting signs and symptoms of hypovolemic shock. You anticipate that the physician will order the administration of a crystalloid for the management of this patient. Which crystalloid fluid is most commonly used to treat hypovolemic shock?
a. Albumin
b. Lactated Ringer's
c. 3% NaCl
d. Dextrana. HypothermiaYou are precepting a new graduate nurse in the ICU. The two of you are caring for a patient who is receiving large volumes of crystalloid fluid as a result of shock. What would you teach the new nurse to monitor the patient for symptoms of?
a. Hypothermia
b. Bradycardia
c. Coffee ground emesis
d. Painc. Whatever fluid that is most readily available in the ICU, due to the nature of the emergencyYou are working in the ICU and have just been notified that you are receiving a patient from the Obstetrics unit who is in hypovolemic shock due to massive blood loss during delivery. You know that the best choice for fluid replacement for this patient is what?
a. 5% Albumin because it is inexpensive and is always readily available
b. Dextran because it increases intravascular volume and counteracts coagulopathy
c. Whatever fluid that is most readily available in the ICU, due to the nature of the emergency
d. Lactated Ringer's solution because it increases volume, buffers acidosis, and is the best choice for patients with liver failureb. HyperglycemiaThe nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. What is a major complication of TPN?
a. Extreme hunger
b. Hyperglycemia
c. Hypotension
d. Hypoglycemiaa. Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN.The nurse is caring for a patient who has an order to discontinue the administration of parenteral nutrition. What will the nurse do to prevent the occurrence of rebound hypoglycemia in the patient?
a. Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN.
b. Administer a hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN.
c. Administer 3 ampules of dextrose 50% immediately prior to discontinuing the PN.
d. Administer 3 ampules of dextrose 50% 1 hour after discontinuing the PN.a. Risk for infection related to the presence of a subclavian catheterYou are caring for a patient with a subclavian catheter who is receiving parenteral nutrition (PN). In preparing a care plan for this patient, what nursing diagnosis will you give highest priority to?
a. Risk for infection related to the presence of a subclavian catheter
b. Risk for caregiver role strain related to the care of a subclavian catheter
c. Risk for activity intolerance related to the presence of a subclavian catheter
d. Risk for loneliness related to need for isolation related to the presence of a subclavian catheterb, d, eThe nurse is discussing vitamins with a group of women at a community center. The nurse is discussing water-soluble vitamins and fat-soluble vitamins. Which vitamins are fat-soluble vitamins? Select all that apply.
a. Vitamin C
b. Vitamin D
c. Folic Acid
d. Vitamin A
e. Vitamin Ea, b, eYou are doing discharge teaching with a patient who is going home with a diagnosis of hypophosphatemia. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? (Mark all that apply.)
a. Poultry
b. Liver
c. Green vegetables
d. Beef
e. Milkd. Having direct action on the cough centerWhen giving dextromethorphan, the nurse understands that this drug suppresses the cough reflex by which mechanism of action?
a. Decreasing the viscosity of the bronchial secretions
b. Causing depression of the central nervous system
c. Anesthetizing the stretch receptors
d. Having direct action on the cough centerb. Force fluids to help loosen and liquefy secretions.A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching?
a. Report clear-colored sputum to the prescriber.
b. Force fluids to help loosen and liquefy secretions.
c. Avoid driving a car or operating heavy machinery because of the sedating effects.
d. Report symptoms that last longer than 2 days.a. "Limit use of this spray to 3 to 5 days."A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. The nurse will include which instruction?
a. "Limit use of this spray to 3 to 5 days."
b. "Avoid use of this spray if a fever develops."
c. "You won't see effects for at least 1 week."
d. "Continue the spray until nasal stuffiness has resolved."d. Increased ease of breathingA patient is taking intravenous aminophylline for a severe exacerbation of chronic obstructive pulmonary disease. The nurse will assess for which therapeutic response?
a. Increased sputum production
b. Increased respiratory rate
c. Increased heart rate
d. Increased ease of breathinga. A short-acting beta2 agonist such as albuterol (Proventil)A patient is in an urgent-care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment?
a. A short-acting beta2 agonist such as albuterol (Proventil)
b. A corticosteroid such as fluticasone (Flovent)
c. A long-acting beta2 agonist such as salmeterol (Serevent)
d. An anticholinergic such as ipratropium (Atrovent)d. It needs to be taken every day on a continuous schedule, even if symptoms improve.The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication?
a. The patient needs to keep it close by at all times to treat acute asthma attacks.
b. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.
c. The proper technique for inhalation must be followed.
d. It needs to be taken every day on a continuous schedule, even if symptoms improve.b. "This is an expected adverse effect. Let me take your pulse."After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response?
a. "We will hold the treatment for 24 hours."
b. "This is an expected adverse effect. Let me take your pulse."
c. "The next scheduled nebulizer treatment will be skipped."
d. "I will notify the physician about this adverse effect."d. "Take the bronchodilator inhaler first."A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?
a. "Take the corticosteroid inhaler first."
b. "It does not matter which inhaler you use first."
c. "Take these two drugs at least 2 hours apart."
d. "Take the bronchodilator inhaler first."a. at a therapeutic level.The nurse is monitoring drug levels for a patient who is receiving theophylline. The most recent theophylline level was 13 mcg/mL, and the nurse evaluates this level to be
a. at a therapeutic level.
b. below the therapeutic level.
c. above the therapeutic level.
d. at a toxic level.a. Obtain an order for a spacer device.When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time?
a. Obtain an order for a spacer device.
b. Notify the doctor that the patient is unable to use the MDI.
c. Obtain an order for a peak flow meter.
d. Ask the prescriber if the medication can be given orally.a, c, fWhen teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.)
a. "Drink extra fluids if possible."
b. "Take the medication on an empty stomach to maximize absorption of the drug."
c. "Take the medication with food to minimize gastrointestinal distress."
d. "Antihistamines are generally safe to take with over-the-counter medications."
e. "Antihistamines may cause restlessness and disturbed sleep."
f. "Avoid activities that require alertness until you know how adverse effects are tolerated."b, d, eA patient tells the nurse that she wants to start taking the herbal product goldenseal to improve her health. The nurse will assess for which potential cautions or contraindications to goldenseal? (Select all that apply.)
a. Sinus infections
b. Taking a proton-pump inhibitor
c. Nasal congestion
d. Pregnancy
e. Hypertension
f. Hypothyroidismb, d, eThe nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.)
a. fluticasone (Flovent) Rotadisk inhaler
b. aminophylline IV infusion
c. salmeterol (Serevent) inhaler
d. albuterol (Proventil) nebulizer solution
e. epinephrine
f. montelukast (Singulair)e, fThe nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.)
a. "I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling."
b. "I will continue to use this inhaler, even if I am feeling better."
c. "I will rinse my mouth with water after using the inhaler and then spit out the water."
d. "I will use a peak flow meter to measure my response to therapy."
e. "I will use this inhaler for asthma attacks."
f. "I will gargle after using the inhaler and then swallow."d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.A patient with severe liver disease is receiving the angiotensin converting enzyme (ACE) inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this patient is which characteristic?
a. Captopril is a prodrug and is metabolized by the liver before becoming active.
b. Captopril has little effect on electrolyte levels.
c. Captopril rarely causes first-dose hypotensive effects.
d. Captopril is not a prodrug and does not need to be metabolized by the liver before becoming active.a. "The provider is making sure the treatment is effective over the long-term."During a follow-up visit, the health care provider examines the fundus of the patient's eye. Afterward, the patient asks the nurse, "Why is he looking at my eyes when I have high blood pressure? It does not make sense to me!" What is the best response by the nurse?
a. "The provider is making sure the treatment is effective over the long-term."
b. "The provider is assessing for visual changes that may occur with drug therapy."
c. "We must watch for increased intraocular pressure."
d. "We need to monitor for drug toxicity."d. Calcium channel blockers with thiazide diureticsThe nurse is reviewing drug therapy for hypertension. According to the JNC 7 guidelines, antihypertensive drug therapy for a newly diagnosed stage 1 hypertensive African-American patient would most likely include which drug or drug classes?
a. Vasodilators alone
b. ACE inhibitors alone
c. Beta blockers with thiazide diuretics
d. Calcium channel blockers with thiazide diureticsb. HypotensionAn elderly patient will be taking a vasodilator for hypertension. Which adverse effect is of most concern for the older adult patient taking this class of drug?
a. Restlessness
b. Hypotension
c. Constipation
d. Dry moutha. Remove the old ointment before new ointment is applied.When the nurse is administering topical nitroglycerin ointment, which technique is correct?
a. Remove the old ointment before new ointment is applied.
b. Apply the ointment on the skin on the forearm.
c. Massage the ointment gently into the skin, and then cover the area with plastic wrap.
d. Apply the ointment only in the case of a mild angina episode.b. If the chest pain is not relieved after one tablet, call 911 immediately.A patient has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the patient how to use sublingual nitroglycerin, the nurse will include which instruction?
a. Take up to five doses at 15-minute intervals for an angina attack.
b. If the chest pain is not relieved after one tablet, call 911 immediately.
c. Wait 1 minute between doses of sublingual tablets, up to three doses.
d. If the tablet does not dissolve quickly, chew the tablet for maximal effect.b. Blood pressure of 88/62 mm HgA patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?
a. Apical pulse rate of 110 beats/min
b. Blood pressure of 88/62 mm Hg
c. History of a myocardial infarction 2 years ago
d. History of renal diseasec. Withhold the dose, and notify the prescriber.A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/minute. What will the nurse do next?
a. Administer the dose.
b. Check the radial pulse for 1 full minute.
c. Withhold the dose, and notify the prescriber.
d. Administer the dose, and notify the prescriber.b. "This drug is an antidote to digoxin and will help to lower the blood levels."A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity. The patient has been admitted to the telemetry unit, where the physician has ordered digoxin immune Fab (Digifab). The patient asks the nurse why the medication is ordered. What is the nurse's best response?
a. "It helps to convert the irregular heart rhythm to a more normal rhythm."
b. "This drug is an antidote to digoxin and will help to lower the blood levels."
c. "It will increase your heart rate."
d. "This drug helps to lower your potassium levels."a. Potassium level 2.8 mEq/LIn assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
a. Potassium level 2.8 mEq/L
b. Potassium level 4.9 mEq/L
c. Sodium level 140 mEq/L
d. Calcium level 10 mg/dLa. 0.5 mgWhen administering digoxin immune Fab (Digibind) to a patient with severe digoxin toxicity, the nurse knows that each vial can bind with how much digoxin?
a. 0.5 mg
b. 5.5 mg
c. 5 mg
d. 15 mga. Prolonging action potential durationThe nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone (Cordarone) is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action?
a. Prolonging action potential duration
b. Blocking slow calcium channels
c. Blocking sodium channels and affecting phase 0
d. Decreasing spontaneous depolarization and affecting phase 4c. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur.A patient will be discharged on quinidine sulfate (Quinidex) extended-release tablets for the treatment of ventricular ectopy. The nurse will include which information in the teaching plan?
a. If any tablet or capsule is visible in the stool, contact the prescriber immediately.
b. It is important to use sunscreen products when outside because of increased photosensitivity.
c. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur.
d. The medication should be stopped once the cardiac symptoms subside.b. amiodarone (Cordarone)A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia?
a. adenosine (Adenocard)
b. amiodarone (Cordarone)
c. verapamil (Calan)
d. diltiazem (Cardizem)c. ConvulsionsA patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect?
a. Dry mouth
b. Drowsiness
c. Convulsions
d. Nystagmusd. diltiazem (Cardizem)A patient is in the emergency department with a new onset of rapid-rate atrial fibrillation, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia?
a. atenolol (Tenormin)
b. lidocaine
c. adenosine (Adenocard)
d. diltiazem (Cardizem)b. Cells lack an adequate blood supply and are deprived of oxygen and nutrients.An understanding of the pathophysiologic rationale behind shock is something every nurse needs to have. Which of the following statements best describes the pathophysiology for shock?
a. Blood is shunted from vital organs to peripheral areas of the body.
b. Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
c. Circulating blood volume is decreased.
d. Hemorrhage occurs as a result of trauma.b. The drug dose should be weaned down prior to discontinuing.A patient is receiving dopamine, a vasoactive drug used for shock, to increase her stroke volume. What should the nurse be aware of when monitoring a vasoactive drug?
a. The drug should be discontinued immediately after blood pressure increases.
b. The drug dose should be weaned down prior to discontinuing.
c. The drug may cause respiratory alkalosis.
d. The drug reduces oxygen demands of the heart.d. IronA patient has come to the OB/GYN clinic with complaints of a heavy menstrual flow. The nurse knows that red blood cell production will be increased in the patient's body. Because of this, the nurse is aware that the patient may need to increase her daily intake of what?
a. Vitamin D
b. Vitamin C
c. Magnesium
d. Ironb. Stop the transfusion immediately.The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (RBCs) has begun, the patient is having difficulty breathing and chest tightness. What is the most appropriate initial action for the nurse to take?
a. Assess the patient's chest sounds and vital signs.
b. Stop the transfusion immediately.
c. Remove the patient's intravenous access.
d. Notify the patient's physician.a. Iron will cause the stools to darken in color.The nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What will the nurse include in her teaching?
a. Iron will cause the stools to darken in color.
b. Limit foods high in fiber due to the risk for diarrhea.
c. Take the iron with dairy products to enhance absorption.
d. Increase the intake of vitamin E to enhance absorption.d. PlasminWhen a human body receives an injury that causes blood loss, there are several processes involved in maintaining hemostasis. When a blood clot is no longer needed, what digests the fibrinogen and fibrin?
a. Thrombin
b. Plasminogen
c. Prothrombin
d. Plasminb. Fresh frozen plasmaA patient is admitted to the ICU with a diagnosis of bleeding esophageal varices. The patient has a comorbidity of cirrhosis. An attempt to stop the bleeding has been only partially successful. What would the critical care nurse expect to have ordered for this patient?
a. Vitamin K
b. Fresh frozen plasma
c. Heparin drip
d. Oral anticoagulantsc. Prothrombin time (PT) 1 1/2 to 2 times the controlThe nursing instructor is talking about anticoagulant therapy. The instructor explains that when administering warfarin (Coumadin) to a client with deep vein thrombophlebitis, the nurse monitors the PTT, PT , INR, and hematocrit. Which laboratory value would the instructor teach the class that indicate warfarin is at therapeutic levels?
a. International normalized ratio (INR) of 3 to 4
b. Hematocrit of 32%
c. Prothrombin time (PT) 1 1/2 to 2 times the control
d. Partial thromboplastin time (PTT) 1 1/2 to 2 times the controlb. Lower doses are required.You are caring for a patient who is on thrombolytic therapy. The patient has a comorbidity of renal insufficiency. What do you know about the amount of heparin required to treat this patient?
a. You do not need to use an infusion pump for this patient.
b. Lower doses are required.
c. You cannot use heparin to treat this patient.
d. Higher doses are required.a. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale?
a. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.
b. The oral and injection forms work synergistically.
c. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone.
d. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so.b. Take the medication with 6 to 8 ounces of water and food.A patient has been instructed to take one enteric-coated low-dose aspirin a day as part of therapy to prevent strokes. The nurse will provide which instruction when providing patient teaching about this medication?
a. Low-dose aspirin therapy rarely causes problems with bleeding.
b. Take the medication with 6 to 8 ounces of water and food.
c. Coated tablets may be crushed if necessary for easier swallowing.
d. Aspirin needs to be taken on an empty stomach to ensure maximal absorption.b. Take an aspirin tablet 30 minutes before taking the drug.A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects?
a. Take the drug with large amounts of fiber.
b. Take an aspirin tablet 30 minutes before taking the drug.
c. Take the drug on an empty stomach.
d. Take the medication every other day until the effects subside.a. DiarrheaA patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication?
a. Diarrhea
b. Constipation
c. Joint pain
d. Dry mouthc. High-density lipoproteins (HDLs)A patient with risk factors for coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids?
a. Triglycerides
b. Low-density lipoproteins (LDLs)
c. High-density lipoproteins (HDLs)
d. Very-low-density lipoproteins (VLDLs)a, b, cA nurse is admitting a patient with idiopathic thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that alter platelet function? (Mark all that apply.)
a. Aspirin-based drugs
b. Sulfa-containing medications
c. NSAIDs
d. Antihypertensives
e. Penicillinsa. Nonopioid analgesic, such as indomethacin (Indocin)An 18-year-old basketball player fell and twisted his ankle during a game. The nurse will expect to administer which type of analgesic?
a. Nonopioid analgesic, such as indomethacin (Indocin)
b. Opium alkaloid, such as morphine sulfate
c. Opioid antagonist, such as naloxone HCL (Narcan)
d. Synthetic opioid, such as meperidine (Demerol)a. How to prevent constipationA patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan?
a. How to prevent constipation
b. How to prevent dehydration due to diarrhea
c. Importance of taking the drug only when the pain becomes severe
d. Importance of taking the drug on an empty stomachb. Hepatic necrosisA 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken several pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition?
a. Tachycardia
b. Hepatic necrosis
c. Central nervous system depression
d. Nephropathyb. Infiltration of the puncture wound with lidocaineDuring a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure?
a. Topical benzocaine spray on the area
b. Infiltration of the puncture wound with lidocaine
c. Topical prilocaine (EMLA) cream around the site
d. No anesthesiac. Malignant hyperthermiaWhile monitoring a patient who had surgery under general anesthesia 2 hours ago, the nurse notes a sudden elevation in body temperature. This finding may be an indication of which problem?
a. Malignant hypertension
b. Tachyphylaxis
c. Malignant hyperthermia
d. Postoperative infectiona. Impaired gas exchange related to central nervous system depression produced by general anesthesiaA patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient?
a. Impaired gas exchange related to central nervous system depression produced by general anesthesia
b. Anxiety related to the use of an anesthetic
c. Decreased cardiac output related to systemic effects of local anesthesia
d. Risk for injury related to increased sensorium from general anesthesiac. diazepam (Valium)A patient who has received some traumatic news is panicking and asks for some medication to help settle down. The nurse anticipates giving which drug that is most appropriate for this situation?
a. zolpidem (Ambien)
b. phenobarbital
c. diazepam (Valium)
d. cyclobenzaprine (Flexeril)a. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.A patient has been taking phenobarbital for 2 weeks as part of his therapy for epilepsy. He tells the nurse that he feels tense and that "the least little thing" bothers him now. Which is the correct explanation for this problem?
a. This drug causes deprivation of REM sleep and may cause the inability to deal with normal stress.
b. This drug causes the rapid eye movement (REM) sleep period to increase, resulting in nightmares and restlessness.
c. The drug must be stopped immediately because of possible adverse effects.
d. These are adverse effects that usually subside after a few weeks.a. A history of peptic ulcersA patient is receiving instructions regarding the use of caffeine. The nurse shares that caffeine should be used with caution if which of these conditions is present?
a. A history of peptic ulcers
b. Asthma
c. Migraine headaches
d. A history of kidney stonesa. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.A patient who started taking orlistat (Xenical) 1 month ago calls the clinic to report some "embarrassing" adverse effects. She tells the nurse that she has had episodes of "not being able to control my bowel movements." Which statement is true about this situation?
a. The patient will need to restrict fat intake to less than 30% to help reduce these adverse effects.
b. These are expected adverse effects that will eventually diminish.
c. The patient will need to stop this drug immediately if these adverse effects are occurring.
d. The patient will need to increase her fat intake to prevent these adverse effects.b. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.A 6-year-old boy has been started on an extended-release form of methylphenidate hydrochloride (Ritalin) for the treatment of attention deficit hyperactivity disorder (ADHD). During a follow-up visit, his mother tells the nurse that she has been giving the medication at bedtime so that it will be "in his system" when he goes to school the next morning. What is the nurse's appropriate evaluation of the mother's actions?
a. The medication should be taken with meals for optimal absorption.
b. The medication should be given 4 to 6 hours before bedtime to diminish insomnia.
c. She is giving him the medication dosage appropriately.
d. The medication should not be taken until he is at school.a. phenobarbitalThe nurse is reviewing the dosage schedule for several different antiepileptic drugs (AEDs). Which antiepileptic drug allows for once-a-day dosing?
a. phenobarbital
b. valproic acid (Depakote)
c. gabapentin (Neurontin)
d. levetiracetam (Keppra)b. "I will need to take extra care of my teeth and gums while on this medication."The nurse has given medication instructions to a patient receiving phenytoin (Dilantin). Which statement by the patient indicates that the patient has an adequate understanding?
a. "I will be able to stop taking this drug once the seizures stop."
b. "I will need to take extra care of my teeth and gums while on this medication."
c. "I can skip doses if the side effects bother me."
d. "I can go out for a beer while on this medication."c. "Regular, consistent dosing is important for successful treatment."When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction?
a. "Driving is allowed after 2 weeks of therapy."
b. "If seizures recur, take a double dose of the medication."
c. "Regular, consistent dosing is important for successful treatment."
d. "Antacids can be taken with the AED to reduce gastrointestinal adverse effects."a. HypertensionA patient has been taking selegiline (Eldepryl), 20 mg per day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and "felt awful." What did the patient most likely experience?
a. Hypertension
b. Gastrointestinal upset
c. Hypotension
d. Urinary discomfortc. Carbidopa prevents the breakdown of levodopa in the periphery.A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson's disease. She asks the nurse, "Why are there two drugs in this pill?" The nurse's best response reflects which fact?
a. Carbidopa is the biologic precursor of dopamine and can penetrate into the CNS.
b. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy.
c. Carbidopa prevents the breakdown of levodopa in the periphery.
d. Carbidopa allows for larger doses of levodopa to be given.d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson's disease, the nurse should include which information in the teaching plan?
a. Discontinue the medication if adverse effects occur.
b. Minimize the amount of fluid taken while on this drug.
c. Take the medication on an empty stomach to enhance absorption.
d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.a. Anxiety disorderThe nurse reads in the patient's medication history that the patient is taking buspirone (BuSpar). The nurse interprets that the patient may have which disorder?
a. Anxiety disorder
b. Bipolar disorder
c. Schizophrenia
d. Depressionc. AnticoagulantsBefore beginning a patient's therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants, the nurse will assess for concurrent use of which medications or medication class?
a. Aspirin
b. Diuretics
c. Anticoagulants
d. Nonsteroidal antiinflammatory drugsa. Decreased paranoia and delusionsWhen a patient is receiving a second-generation antipsychotic drug, such as risperidone (Risperdal), the nurse will monitor for which therapeutic effect?
a. Decreased paranoia and delusions
b. Fewer panic attacks
c. Improved tardive dyskinesia
d. Decreased feeling of hopelessnessb. A woman with a history of thrombophlebitisThe nurse recognizes that use of estrogen drugs is contraindicated in which patient?
a. A patient who has atrophic vaginitis
b. A woman with a history of thrombophlebitis
c. A patient who has inoperable prostate cancer
d. A woman who has just given birth and wants to prevent postpartum lactationb. Pregnancy testA woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy?
a. Vaginal cultures
b. Pregnancy test
c. Serum potassium level
d. Complete blood countd. "The patch allows for better absorption of the medication."A patient is to receive testosterone therapy via a transdermal patch. He asks the nurse, "Why am I getting a patch? Can't I just take a pill?" Which response by the nurse is correct?
a. "You will only have to change the patch weekly."
b. "If you don't take the patch, you will have to have injections instead."
c. "The patch reduces the incidence of side effects."
d. "The patch allows for better absorption of the medication."d. It must not be handled by pregnant women.During the administration of finasteride (Proscar), the nurse must remember which important precaution?
a. The patient needs to be warned that alopecia is a common adverse effect.
b. It must be taken on an empty stomach.
c. It is given by deep intramuscular injection to avoid tissue irritation.
d. It must not be handled by pregnant women.d. Significant decrease in blood pressureA 73-year-old male patient is in the clinic for a yearly physical and is asking for a prescription for sildenafil (Viagra). He has listed on his health history that he is taking a nitrate for angina. The nurse is aware that which problem may occur if sildenafil is taken with a nitrate?
a. Reduced effectiveness of the sildenafil
b. Increased risk of bleeding
c. Significant increase in pulse rate
d. Significant decrease in blood pressurea. "This drug may cause increased redness of your skin."A teenage boy is taking tretinoin (Retin-A) for acne. Which statement will the nurse include in the teaching plan?
a. "This drug may cause increased redness of your skin."
b. "Avoid foods that are heavy in salt and oils."
c. "Being out in the sunlight will help your skin heal."
d. "Try using an abrasive cleanser to remove old skin layers."b. "You will have to use two contraceptive methods while on this drug."A female patient will be starting therapy with oral isotretinoin (Amnesteem) as part of treatment for severe acne, and the nurse is providing teaching. Which teaching point will the nurse include in her teaching plan about isotretinoin?
a. "You will have to avoid pregnancy for 2 weeks after taking this drug."
b. "You will have to use two contraceptive methods while on this drug."
c. "You must avoid sexual activity while on this drug."
d. "If you are taking an oral contraceptive, you may take this drug."d. mannitol (Osmitrol)The nurse will be giving ophthalmic drugs to a patient with glaucoma. Which drug is used to reduce intraocular pressure?
a. tobramycin (Tobrex)
b. bacitracin (AK-Tracin)
c. ketorolac (Acular)
d. mannitol (Osmitrol)a. Immunosuppression may make it more difficult to eliminate the eye infection.A patient has been taking the corticosteroid dexamethasone (Decadron) but has developed bacterial conjunctivitis and has a prescription for gentamicin (Garamycin) ointment. The nurse notes that which interaction is possible if the two drugs are used together?
a. Immunosuppression may make it more difficult to eliminate the eye infection.
b. The infection may become systemic.
c. The corticosteroid may cause overgrowth of nonsusceptible organisms.
d. The gentamicin effects may become more potent.a. "Apply the drops into the conjunctival sac instead of directly onto the eye."When teaching a patient about the proper application of timolol (Timoptic) eyedrops, the nurse will include which instruction?
a. "Apply the drops into the conjunctival sac instead of directly onto the eye."
b. "Tilt your head forward before applying the eyedrops."
c. "Apply the drops directly to the eyeball (cornea) for the best effect."
d. "Blot your eye with a tissue immediately after applying the drops."c. "Take the Restasis first, and then wait 15 minutes before taking the artificial tears."A patient is receiving ocular cyclosporine (Restasis) and also has an order for an artificial tears product. The nurse includes which instructions in the teaching plan for these medications?
a. "First take the artificial tears, and then take the Restasis after 5 minutes."
b. "These two eye drugs cannot be given together. Let's check with your prescriber."
c. "Take the Restasis first, and then wait 15 minutes before taking the artificial tears."
d. "You may take these two drugs together at the same time."b. Perforated eardrumThe nurse is preparing to administer a new order for eardrops. Which is a potential contraindication to the use of many otic preparations?
a. Ear canal itching
b. Perforated eardrum
c. Staphylococcus aureus otitis externa infection
d. Escherichia coli ear infectionc. The corticosteroid reduces the inflammation and itching associated with ear infections.The nurse is administering eardrops that contain a combination of an antibiotic and a corticosteroid. What is the rationale for combining these two drugs in eardrops?
a. The corticosteroid reduces pain associated with ear infections.
b. The combination works to help soften and eliminate cerumen.
c. The corticosteroid reduces the inflammation and itching associated with ear infections.
d. The drops help to eliminate fungal infections.b. Drainage from the ear canalThe nurse is preparing to give an earwax emulsifier to a patient and will assess the patient for which contraindication before administering the drops?
a. Partial deafness in the affected ear
b. Drainage from the ear canal
c. Allergy to penicillin
d. Excessive earwax in the outer ear canala. It is a local anesthetic that causes temporary relief of pain.The nurse is administering an otic preparation as part of treatment for a severe fungal ear infection. Why is pramoxine added to the otic medication?
a. It is a local anesthetic that causes temporary relief of pain.
b. It is a corticosteroid that reduces inflammation.
c. It is an emulsifying drug that works to soften the cerumen.
d. It works synergistically to enhance the effect of the antifungal drug.b. Take the drops out of the refrigerator 1 hour before the dose is due.The nurse is administrating eardrops that have been refrigerated. Which action by the nurse is correct before administering the drops?
a. Heat the chilled solution for 10 seconds in the microwave.
b. Take the drops out of the refrigerator 1 hour before the dose is due.
c. Leave the drops in the refrigerator until use.
d. Soak the bottle for 60 seconds in a container of very hot water.A. AllergiesWhich information is of highest priority when obtaining a pharmacologic history from a patient?
A. Allergies
B. Use of over-the-counter medications
C. Home remedy use
D. Alcohol intakec. Check the patient's armband before administering the medication.During the implementation phase of the nursing process, which action will the nurse perform when administering medications?
a. Switch the route of administration based on drug availability.
b. Call the patient by name when entering the room to verify the drug is for the right person.
c. Check the patient's armband before administering the medication.
d. Prepare medications for all patients first, then administer by room to manage time appropriately.c. Monitoring the patient continuously for therapeutic as well as adverse effectsFor which activity is the nurse responsible during the evaluation phase of drug administration?
a. Preparing and administering prescribed medications safely
b. Planning measurable outcomes for the patient related to drug therapy
c. Monitoring the patient continuously for therapeutic as well as adverse effects
d. Gathering data in a drug and dietary historyd. Therapeutic effect on patientThe nurse should include which information when evaluating the outcome after a patient's medication has been administered?
a. Dose of medication administered
b. Time medication administered
c. Patient allergies to medications
d. Therapeutic effect on patientb. Three timesThe nurse should check a medication how many times before administration of a medication under the "right drug" part of the Six Rights?
a. One time
b. Three times
c. Five times
d. Depends on the drug being administereda. 0800The nurse notes that a medication was scheduled to be administered at 0900. A medication error has occurred if the medication was administered at which time?
a. 0800
b. 0830
c. 0900
d. 0930a. HivesWhile the nurse is taking an admission history, the patient reports having a previous allergic reaction to penicillins. What will the nurse document as part of the patient's allergic reaction response to penicillins?
a. Hives
b. Dry eyes
c. Frequent urination
d. Constipationd. Assessment, Diagnoses, Planning, Implementation, EvaluationThe nursing process is important as a well-established, research-supported framework for professional nursing practice. Which is the correct order for the steps of the nursing process?
a. Evaluation, Planning, Diagnoses, Assessment, Implementation
b. Planning, Assessment, Diagnoses, Implementation, Evaluation
c. Diagnoses, Assessment, Planning, Evaluation, Implementation
d. Assessment, Diagnoses, Planning, Implementation, Evaluationa, d, e, fThe nurse has an order for administering a medication to the patient. Which providers have legal authority to prescribe medications for patients? (Select all that apply.)
a. Physician
b. Physical therapist
c. Pharmacist
d. Dentist
e. Physician assistant
f. Nurse practitionerc. PharmacodynamicsWhat is the study of the physiochemical properties of drugs and how they influence the body called?
a. Pharmacokinetics
b. Pharmacotherapeutics
c. Pharmacodynamics
d. Pharmacologyb. distribution rates among various body compartments.Pharmacokinetics involves the study of
a. physiologic interactions of drugs.
b. distribution rates among various body compartments.
c. interactions between various drugs.
d. adverse reactions to medications.d. MetabolismWhat is an alternate name for biotransformation of a drug?
a. Absorption
b. Dilution
c. Excretion
d. Metabolismc. OralA drug given by which route is altered by the first-pass effect?
a. Sublingual
b. Subcutaneous
c. Oral
d. Intravenousc. be eliminated by the body.Drug half-life is defined as the amount of time required for 50% of a drug to
a. be absorbed by the body.
b. exert a response.
c. be eliminated by the body.
d. reach a therapeutic level.d. Massaging the site after injectionWhich action, when performed by the nurse, will increase the absorption of a medication administered intramuscularly?
a. Applying cold packs to the injection site
b. Lowering the extremity below the level of the heart
c. Administering the medication via the Z-track method
d. Massaging the site after injectiona. increase the risk of drug-drug interactions.Highly protein-bound drugs
a. increase the risk of drug-drug interactions.
b. typically provide a short duration of action.
c. must be administered with 8 ounces of water.
d. have a decreased effect in patients with a low albumin level.b IntravenouslyTo achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route?
a Subcutaneously
b Intravenously
c Intramuscularly
d Intrathecallya excretionPatients with renal failure would most likely have problems with drug
a excretion.
b absorption.
c metabolism.
d distribution.c Therapeutic indexWhat is the ratio between a drug's therapeutic effects and toxic effects called?
a Tolerance
b Cumulative effect
c Therapeutic index
d Affinitya Medications given intravenously are not affected by the first-pass effect.When a patient asks the nurse why a lower dose of intravenous pain medication is being given than the previous oral dose, what knowledge will the nurse draw on to respond to the patient?
a Medications given intravenously are not affected by the first-pass effect.
b Medications given orally bypass the portal circulatory system.
c A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver.
d Drugs administered intravenously enter the portal system prior to systemic distribution.a, c, dThe nurse understands that drugs exert their actions on the body by (Select all that apply.)
a. interacting with receptors.
b. making the cell perform a new function.
c. inhibiting the action of a specific enzyme.
d. altering metabolic chemical processes.a, b, d, eThe nurse needs to be aware that which factors will affect the absorption of orally administered medications? (Select all that apply.)
a. Presence of food in the stomach
b. pH of the stomach
c. Patient position upon intake of medication
d. Form of drug preparation
e. Time of dayd Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.When calculating pediatric dosages, what will the nurse take into consideration?
a Utilization of drug reference recommendations based on mg/kg of body weight is the preferred method.
b Calculated doses based on body weight need to be increased by 10% due to immature renal and hepatic function.
c Dosage calculation according to body weight is the most accurate method because it takes into account differences in maturational development.
d Dosage calculation by body surface area is the most accurate method because it takes into account the difference in size of the child and/or neonate.a First trimesterWhen teaching a pregnant mother about the effects of medication on the fetus, the nurse recognizes that the greatest harm from maternally ingested medications occurs during which time period?
a First trimester
b Second trimester
c Third trimester
d Birthing processa Decrease the amount of drug givenKnowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse can expect the prescriber to perform which action to minimize the risk of toxicity?
a Decrease the amount of drug given
b Increase the amount of drug given
c Shorten the time interval between doses
d Administer the medication intravenouslyb Drug half-life is lengthened.The physiologic changes that normally occur in the older adult have which implication for drug response in this patient?
a Drug metabolism is faster.
b Drug half-life is lengthened.
c Drug elimination is faster.
d Protein binding is more efficient.c verapamil (Calan), a calcium channel-blocking drugThe nurse is admitting an 82-year-old patient for treatment of heart failure. During assessment of the patient's history, the nurse notes a subjective complaint of chronic constipation. Of the prescribed medications the patient was taking prior to admission, which would the nurse suspect might contribute to this gastrointestinal complaint?
a naproxen (Aleve), a nonsteroidal antiinflammatory drug
b warfarin sodium (Coumadin), an anticoagulant
c verapamil (Calan), a calcium channel-blocking drug
d spironolactone (Aldactone), a potassium-sparing diureticc Drug propertiesThe nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor?
a Maternal blood type
b Fetal sex
c Drug properties
d Diet of the motherd "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the appropriate response for this patient?
a "You should not take any medication while breastfeeding."
b "Only certain medications pass to infants while breastfeeding."
c "I will leave the doctor a message to return your call."
d "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."a. Drug interactionsA nurse working with elderly patients is concerned about the number of medications each patient is taking. Which will the nurse assess as the highest priority for the patients related to polypharmacy?
a. Drug interactions
b. Cost of medications
c. Schedule of medications
d. Nonadherence to drug regimenb, c, d, e, fWhich actions will the nurse perform to ensure the medication dose for a pediatric patient is correct? (Select all that apply.)
a. Use the patient's weight in pounds.
b. Use a current drug reference to determine usual dosage per 24 hours.
c. Determine the dose parameters by multiplying the weight by the minimum and maximum daily doses of the drug (the safe range).
d. Determine the total amount of the drug to administer per dose and per day.
e. Compare the drug dosage prescribed with the calculated safe range.
f. If the drug dosage prescribed varies from recommended reference range, notify the provider.a Monitoring for and reporting any adverse effects noted during Phase IV studiesWhat is the nurse's role in the development of new and investigational drugs?
a Monitoring for and reporting any adverse effects noted during Phase IV studies
b Selecting patients to participate in Phase I studies
c Identifying patients who are receiving placebo drugs during Phase III studies
d Informing patients of the specific drug they are receiving within a blinded investigational study during Phase IIId transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.Ethically, a nurse has the responsibility to
a employ beneficence, the duty to do no harm to a patient.
b withhold information from the patient as requested by the family.
c impose his or her own values upon the patient when doing so would help the patient.
d transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.a Administration of some drugs may elicit varied responses in specific racial-ethnic groups.Which statement best reflects the nurse's understanding of cultural influences on drug therapy and other health practices?
a Administration of some drugs may elicit varied responses in specific racial-ethnic groups.
b Regardless of one's cultural background, it is crucial to always adhere to recommended medical practices.
c Most cultures are fairly standard in reference to the use of medications during illness.
d Dietary habits and practices can be of little value to the care of an ill adult.b Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription.When teaching a patient about the legalities regarding a prescription for methylphenidate (Ritalin), which statement is most accurate?
a Methylphenidate (Ritalin) is a C-I narcotic that can only be prescribed according to an approved protocol.
b Methylphenidate (Ritalin) is a C-II narcotic that cannot be refilled and can only be filled with a written prescription.
c Methylphenidate (Ritalin) is a C-III narcotic for which a prescription will expire in 6 months.
d Methylphenidate (Ritalin) is a C-IV narcotic that is only allowed to be refilled five times per prescription.b PolymorphismThe nurse is assessing a patient's culture and race on admission to the hospital. Which concept is important for the nurse to understand regarding drug therapy as it relates to different races of individuals?
a Polypharmacy
b Polymorphism
c Pharmacokinetics
d Pharmacodynamicsc Use of herbs or over-the-counter medicationsThe emergency department nurse is documenting the history of a patient of Asian culture. The patient states that she does not take any medications, but the nurse notes a bottle of capsules in the patient's purse. What information will the nurse collect next?
a Vital signs
b Primary care provider name
c Use of herbs or over-the-counter medications
d Insurance informationc 10 to 12 years.New drugs must go through extensive research and testing before approval for use in humans. The nurse is providing education to a patient on a new medication and will inform the patient that the average length of time a medication is researched before being prescribed for humans is
a 2 to 4 years.
b 6 to 8 years.
c 10 to 12 years.
d 14 to 16 years.d Phase IVA pharmaceutical company is voluntarily conducting a postmarketing study to obtain further proof of the therapeutic effects of a new drug. What phase of drug study is this considered?
a Phase I
b Phase II
c Phase III
d Phase IVd Health Insurance Portability and Accountability ActWhat legislation, which was passed in 1996, ensures the privacy of patient information is protected?
a Federal Food, Drug, and Cosmetic Act
b Durham-Humphrey Amendment
c Medicare Prescription Drug, Improvement, and Modernization Act
d Health Insurance Portability and Accountability Acta, b, c, d, e, f, gThere are multiple factors that affect medication response. The nurse recognizes which factors as having a possible effect on medication response? (Select all that apply.)
a. Patient compliance with therapy
b. Genetic influences
c. Body composition
d. Use of alternative therapies
e. Diet and nutrition
f. Level of education
g. Socioeconomic factorsc the majority of medication errors result from weaknesses within the system rather than individual shortcomings.When planning interventions aimed at reducing medication errors, the nurse recognizes that
a only 10% of all preventable adverse drug reactions (ADRs) begin at the medication ordering (prescribing) stage.
b disciplinary action is necessary to increase the nurse's vigilance in preventing medication errors.
c the majority of medication errors result from weaknesses within the system rather than individual shortcomings.
d the use of trailing zeros (i.e., 1.0 mg) and omission of leading zeros (i.e., .25 mg) reduces transcription errors.a Completing a medication reconciliation between unitsWhen receiving a patient transferred from another unit, which action is most useful to prevent medication errors?
a Completing a medication reconciliation between units
b Participating in a verbal report from the transferring nurse
c Asking the patient what medications were received upon transfer
d Asking the physician to rewrite all medication orders upon transferd Ask the patient and/or family to bring in all medications the patient was taking at home.When admitting an elderly patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors?
a Call the primary care physician to verify current medications.
b Ask the patient's family to verify medications the patient was taking at home.
c Ask the patient to provide you with a written list of all medications being taken at home.
d Ask the patient and/or family to bring in all medications the patient was taking at home.a Potential for patient harm is higher with these medications.Why are specific medications classified as "high-alert" medications?
a Potential for patient harm is higher with these medications.
b Medications always cause certain adverse effects.
c States require that these medications be on the high-alert list.
d Only RNs are allowed to administer these medications.d Notify the provider and document the error on an incident report.The nurse administers a medication to the wrong client. Which is the appropriate nursing action following this error?
a Assess the client for an adverse reaction and report if an adverse event occurs.
b Document the medication error. No further action is required.
c Report the error and document the medication on the patient chart.
d Notify the provider and document the error on an incident report.b Encourage the patient to question medications if the medications are different than he or she expects.Which action assists the nurse in prevention of a potential medication error?
a Ask the patient what disease the medication is for before administering.
b Encourage the patient to question medications if the medications are different than he or she expects.
c Allow the patient to take home medications when desired.
d Administer the patient's medications from his or her personal bottles while in the hospital.a U.S. Food and Drug Administration (FDA)What organization announced new regulations requiring bar codes for all prescription and over-the-counter medications?
a U.S. Food and Drug Administration (FDA)
b Drug Enforcement Agency (DEA)
c Federal Bureau of Investigation (FBI)
d Department of Health and Human Services (DHHS)a, b, c, eIn which step of the medication process can a medication error occur? (Select all that apply.)
a. Procurement
b. Prescribing
c. Transcribing
d. Verification
e. Administrationb, c, e,The nurse knows that the medication reconciliation process involves which three steps? (Select all that apply.)
a. Reporting
b. Reconciliation
c. Verification
d. Administration
e. Clarificationd Patient is unable to verbalize reason for taking the medication.Which assessment findings best support the nursing diagnosis of "Deficient knowledge related to medication therapy"?
a Patient is not taking medication as directed.
b Patient is not reporting side effects as directed.
c Patient is unwilling to comply with medication therapy.
d Patient is unable to verbalize reason for taking the medication.c Have the patient perform a return demonstration of the procedure.When planning care for an assigned patient, the nurse identifies the outcome of "Patient will be able to safely self-administer enoxaparin (Lovenox) subcutaneously upon discharge." Which method best evaluates the patient's achievement of this outcome?
a Have the patient verbalize the correct procedure step by step.
b Visually demonstrate the correct procedure to the patient.
c Have the patient perform a return demonstration of the procedure.
d Give the patient detailed written instructions illustrating the procedure.c Psychomotor domainThe nurse is educating a patient diagnosed with type 1 diabetes. When the nurse has the patient demonstrate how to perform self-injections of insulin, which domain of learning is the nurse assessing?
a Cognitive domain
b Affective domain
c Psychomotor domain
d Physical domaina AssessmentWhat phase of the nursing process would be a priority for the nurse when providing education on a new medication to a patient and family?
a Assessment
b Outcome planning
c Evaluation
d Goal identificationa Ask specific questions to evaluate understanding.When the nurse completes patient teaching on a new medication, which method will the nurse use to evaluate the patient's understanding of the information?
a Ask specific questions to evaluate understanding.
b Observe the patient taking the medication.
c Assess the patient for response to the medication.
d Document the education session in the patient chart.a upon the patient's admission to the health care setting.The nurse is aware that the most appropriate time to begin patient education and begin the teaching-learning process is
a upon the patient's admission to the health care setting.
b once the medical diagnosis is established.
c when there are written orders for teaching.
d at the time discharge planning is begun.a, b, d, eThe nurse is providing discharge teaching to an elderly patient with short-term memory problems. Which strategies will the nurse use in educating the patient? (Select all that apply.)
a. Repeat information frequently.
b. Provide written instructions for home use.
c. Instruct patient to take all medications in the morning.
d. Encourage use of daily medication containers with alarms.
e. Perform several short teaching-learning sessions.a, b, c, d, e, fThe nurse is providing medication education to a non-English-speaking patient. Who is qualified to act as a translator in this situation? (Select all that apply.)
a. A certified translator
b. A family member who does speak English
c. Another health care provider who speaks the language
d. Religious leader for the family
e. A layperson versed in the person's language
f. Translator system on computer/web-basedD) "Over-the-counter medications can, at times, be used in place of prescription drugs. It is important to discuss the use of these with your health care provider."Which statement is accurate when discussing self-treatment options with a patient?
A) "Over-the-counter medications are not as potent as prescription drugs."
B) "The use of over-the-counter medications is gradually decreasing with the increased availability of more effective prescription medications."
C) "Herbal remedies have not demonstrated any adverse effects with their use."
D) "Over-the-counter medications can, at times, be used in place of prescription drugs. It is important to discuss the use of these with your health care provider."D) HepatitisThe nurse would question the use of kava in a patient with a history of which condition?
A) Anxiety
B) Hypertension
C) Cardiovascular disease
D) Hepatitisb GinsengThe nurse obtains a medication history from a patient diagnosed with primary hypertension. A nursing diagnosis of "Deficient knowledge related to medication therapy" would be identified when the patient states that he or she takes which over-the-counter medication and/or supplement?
a Garlic
b Ginseng
c Valerian root
d St. John's wortc Complementary medicineA patient provides a list of her current medications to the nurse. The patient tells the nurse that she takes medications prescribed by her physician as well as herbs from the local health food store. Based on this information, the patient uses which type of medicine?
a Western medicine
b Eastern medicine
c Complementary medicine
d Traditional medicineb "Confirm with your health care provider that any herbs you take will not interact with prescribed medications."The nurse is providing education to a group of patients interested in complementary medicine. The nurse will include which teaching point as priority education for the group?
a "Understand the use of any herb before taking it."
b "Confirm with your health care provider that any herbs you take will not interact with prescribed medications."
c "Read the directions and labels of all herbs before taking."
d "Stop taking any herb if you note any adverse effects."c Uracil (U)Deoxyribonucleic acid (DNA), the primary molecule in the body that serves to transfer genes from parents to offspring, is composed of four different organic bases. Which is not one of the four organic bases of DNA?
a Adenine (A)
b Guanine (G)
c Uracil (U)
d Cytosine (C)c Obtain a family historyNurses working in the general population are required to have a basic understanding of the role of the nurse in genetics. Which is an appropriate role for a general nurse related to genetics?
a Provide genetic testing options
b Suggest genetic counseling
c Obtain a family history
d Develop a genetic testing policyb insert the needle at a 45- or 90-degree angle, depending on patient size, to penetrate subcutaneous tissue.When administering a medication subcutaneously, the nurse will
a use a 1- to 1½-inch, 25-gauge needle.
b insert the needle at a 45- or 90-degree angle, depending on patient size, to penetrate subcutaneous tissue.
c aspirate with heparin and insulin injections.
d use the landmark between the greater trochanter and superior iliac crest for the vastus lateralis site.c With medications that are known to be irritating, painful, and/or staining to tissuesThe nurse will use a Z-track technique when giving an intramuscular injection in which situation?
a When there is insufficient muscle mass in the landmarked area
b When massaging the area after medication administration is contraindicated
c With medications that are known to be irritating, painful, and/or staining to tissues
d With any injection that is given into the ventrogluteal musclec. The dorsogluteal region is no longer recommended for injection; select a different site.Which are the appropriate landmarks for an intramuscular injection into the dorsogluteal region?
a. A "V" formation between the anterior superior iliac spine and the greater trochanter
b. A handbreadth below the greater trochanter and the sacroiliac joint
c. The dorsogluteal region is no longer recommended for injection; select a different site.
d. Below the iliac spine and between the greater trochanter and the iliac crestb Wear gloves to place the tablet under the patient's tongue.When administering a sublingual medication, which action will the nurse perform?
a Ask the patient to chew the medication so that it will absorb faster.
b Wear gloves to place the tablet under the patient's tongue.
c Instruct the patient to drink room temperature water to enhance dissolution.
d Have the patient swallow several times while the tablet dissolves.c Crush and administer each medication separately.Which nursing intervention is most appropriate when crushing oral medications to administer to a patient with dysphagia?
a Only crush enteric-coated medication.
b Mix medications together for ease of administration.
c Crush and administer each medication separately.
d Open sustained-release capsules prior to crushing.c Fowler's positionIn which position is it most appropriate to place a patient when administering medications via a nasogastric tube?
a Left side
b Supine
c Fowler's position
d Trendelenburg positiond 3 to 4 finger widths below the antecubital space.When planning to administer an intradermal medication, the nurse recognizes that the preferred site of injection on the forearm is
a just above the wrist.
b just below the antecubital space.
c 2 to 4 finger widths above the wrist.
d 3 to 4 finger widths below the antecubital space.b Drop the prescribed number of drops into the conjunctival sac.When administering ophthalmic eyedrops, the nurse will perform which action?
a Place the eyedrops directly on the cornea.
b Drop the prescribed number of drops into the conjunctival sac.
c Hold the eyedropper 4 to 5 cm above the eye to avoid contamination.
d Document that a smaller dose was absorbed if the patient blinks during administration.c 0.2 mLThe nurse is preparing to administer an intramuscular medication using an airlock to prevent leakage of the medication into the subcutaneous space. Which amount of air should the nurse withdraw for the air lock?
a 0.05 mL
b 0.1 mL
c 0.2 mL
d 0.3 mLb TwoThe nurse will check how many patient identifiers, required by The Joint Commission's standards, prior to administering a medication to a patient?
a One
b Two
c Three
d Fourd morphineA patient needs to switch analgesic drugs secondary to an adverse reaction to the present regimen. The patient is concerned that he will not receive an effective dose of a new drug to control pain. The nurse responds based on knowledge that potencies of analgesics are determined using an equianalgesic table comparing doses of these drugs with what prototype?
a meperidine
b fentanyl
c codeine
d morphineb methadoneA patient is admitted to the psychiatric unit for treatment of narcotic addiction. The nurse would anticipate administration of which medication?
a morphine
b methadone
c meperidine
d naloxonec Acute hepatic necrosisA patient has been admitted after overdosing on acetaminophen (Tylenol), with a total ingested dose of 14 g over a period of 1 hour. The nurse plans to monitor this patient for development of which of the following signs and symptoms related to the overdose?
a Renal failure
b Kidney stones
c Acute hepatic necrosis
d Metabolic alkalosisb acetylcysteine (Mucomyst)While admitting a patient for treatment of an acetaminophen overdose, the nurse prepares to administer which medication to prevent toxicity?
a naloxone (Narcan)
b acetylcysteine (Mucomyst)
c methylprednisolone (Solu-Medrol)
d vitamin Kb massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.Massage therapy is ordered as adjunct treatment for a patient with musculoskeletal pain. The patient asks the nurse how "rubbing my muscles" will help the pain go away. The nurse responds based on the knowledge that
a massaging muscles decreases the inflammatory response that initiates the painful stimuli.
b massaging muscles activates large sensory nerve fibers that send signals to the spinal cord to close the gate, thus blocking painful stimuli from reaching the brain.
c massaging muscles activates small sensory nerve fibers that send signals to the spinal cord to open the gate and allow endorphins to reach the muscles and relieve the pain.
d massaging muscles helps relax the contracted fibers and decrease painful stimuli.a Respiratory rateWhen assessing for the most serious adverse reaction to a narcotic analgesic, what does the nurse monitor for in the patient?
a Respiratory rate
b Heart rate
c Blood pressure
d Mental statusa naloxone (Narcan)Which medication is used to treat a patient suffering from severe adverse effects of a narcotic analgesic?
a naloxone (Narcan)
b acetylcysteine (Mucomyst)
c methylprednisolone (Solu-Medrol)
d flumazenil (Romazicon)b Cough suppressantA patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also has what effect?
a Stimulation of the immune system
b Cough suppressant
c Expectorant
d Bronchodilationc the chemoreceptor trigger zone.In monitoring a patient for adverse effects related to morphine sulfate, the nurse assesses for stimulation of
a autonomic control over circulation.
b the cough reflex center.
c the chemoreceptor trigger zone.
d respiratory rate.b Notify the physician and delay drug administration.The nurse is preparing to administer an injection of morphine to a patient. Assessment notes a respiratory rate of 10 breaths/min. Which action will the nurse perform?
a Administer a smaller dose and record the findings.
b Notify the physician and delay drug administration.
c Administer the prescribed dose and notify the physician.
d Hold the drug, record the assessment, and recheck in 1 hour.d increasing fluid and fiber in the diet.A patient receiving narcotic analgesics for chronic pain can minimize the gastrointestinal (GI) side effects by
a taking Lomotil with each dose.
b eating foods high in lactobacilli.
c taking the medication on an empty stomach.
d increasing fluid and fiber in the diet.c Every 72 hoursThe nurse teaches a patient prescribed the fentanyl (Duragesic) transdermal delivery system to change the patch at what interval?
a When pain recurs
b Every 24 hours
c Every 72 hours
d Once a weekc pain relief is best obtained by administering analgesics around the clock.The nurse plans pharmacologic therapy for a patient with pain based on the knowledge that
a narcotic analgesics should not be used for more than 24 hours secondary to the risk of addiction.
b analgesics should be administered as needed (prn) to minimize side effects.
c pain relief is best obtained by administering analgesics around the clock.
d patients should request analgesics when the pain level reaches a "6" on a scale of 1 to 10.c Impaired gas exchange related to respiratory depressionIn developing a plan of care for a patient receiving morphine sulfate, which nursing diagnosis is a priority?
a Acute pain
b Risk for injury related to central nervous system side effects
c Impaired gas exchange related to respiratory depression
d Constipation related to gastrointestinal side effectsa, c, dWhen assessing a patient for adverse effects related to morphine sulfate, which effects would the nurse expect to find? (Select all that apply.)
a. Decreased peristalsis
b. Diarrhea
c. Delayed gastric emptying
d. Urinary retentiona produces deep muscle relaxation and loss of consciousness.While completing preoperative patient teaching, the nurse explains that general anesthesia
a produces deep muscle relaxation and loss of consciousness.
b results in moderate sedation in which the patient can follow commands but will not remember anything following the procedure.
c provides anesthesia to a specific region of the body and generalized sedation.
d typically is achieved using only one type of medication.c "Nausea and vomiting occur much less frequently than in the past related to the use of a balanced approach to anesthesia."A patient expresses fear of nausea and vomiting postoperatively from the anesthesia. Which is the nurse's best response?
a "I understand your concern; that is one of the pitfalls of surgery."
b "Don't worry, because you'll be heavily sedated if that occurs."
c "Nausea and vomiting occur much less frequently than in the past related to the use of a balanced approach to anesthesia."
d "You will need to speak to both the surgeon and the anesthesiologist in order to identify possible allergies to drugs that may be causing this side effect."c propofol (Diprivan)An intubated, mechanically ventilated patient in the intensive care unit is becoming increasingly restless and anxious. The nurse expects to administer which intravenous anesthetic drug?
a isoflurane (Forane)
b nitrous oxide
c propofol (Diprivan)
d halothane (Fluothane)b Turning, coughing, and deep breathing every 2 hoursWhich postoperative nursing action will help the patient recover from the effects of anesthesia?
a Ambulating once a day
b Turning, coughing, and deep breathing every 2 hours
c Forcing fluids to 400 mL per shift
d Administering loperamide (Imodium) as neededc Notify the physician.Immediate postoperative assessment of a patient reveals a body temperature of 102° F. Which action will the nurse perform?
a Administer acetaminophen as ordered and recheck in 1 hour.
b Apply a cooling blanket per protocol.
c Notify the physician.
d Assess for signs and symptoms of infection related to the surgical wound.c "Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site."A patient questions the use of epinephrine for repair of a laceration, stating, "I thought that was the drug they use in the emergency room for patients who are coding." Which is the nurse's best response?
a "Epinephrine is used with lidocaine to prevent side effects."
b "The systemic absorption of lidocaine is maximized by the epinephrine, and the anesthetic effect is reached more quickly."
c "Vasoconstriction caused by epinephrine enhances the duration of action for lidocaine and minimizes bleeding at the laceration site."
d "Epinephrine is metabolized more quickly than lidocaine so that the anesthetic effect wears off more quickly once the laceration is sutured."b patient's level of sedation is inadequate.A mechanically ventilated patient receiving a neuromuscular-blocking drug has tearing in the eyes and increased heart rate and blood pressure. The nurse interprets that the
a patient is having an adverse reaction to the medication.
b patient's level of sedation is inadequate.
c patient's dose of the neuromuscular-blocking drug is insufficient.
d patient's response to the drug is appropriate.c Anesthetic-induced complicationsWhile taking a patient's history prior to surgery for a cardiac problem, the patient informs the nurse he is addicted to cocaine. The nurse alerts the anesthesiologist of the finding because the nurse knows the use of cocaine can cause which effect when a patient is under anesthesia?
a Immediate withdrawal symptoms
b Blood-clotting problems
c Anesthetic-induced complications
d Complications during recoveryd flumazenil (Romazicon)A patient is admitted to the emergency department with a severe overdose of a benzodiazepine. The nurse immediately prepares to administer which antidote from the emergency drug cart?
a naloxone (Narcan)
b naltrexone (ReVia)
c nalmefene (Revex)
d flumazenil (Romazicon)b AtaxiaA nurse would monitor older adults who are prescribed a benzodiazepine for treatment of insomnia for which potential side effect?
a Hallucinations
b Ataxia
c Alertness
d Dyspneac Risk for injuryWhich nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic drug?
a Ineffective peripheral tissue perfusion
b Fluid volume excess
c Risk for injury
d Risk for infectionb activated charcoalA patient is admitted to the emergency department after taking an overdose of a barbiturate 15 minutes prior to arrival. The nurse can anticipate that which drug will be prescribed?
a naloxone (Narcan)
b activated charcoal
c flumazenil (Romazicon)
d ipecac syrupc "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses."During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement?
a "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time."
b "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis."
c "Most drugs produce sedation at low doses and sleep, the hypnotic effect, at higher doses."
d "There really is no difference; the terms are used interchangeably."b Malignant hyperthermiaThe patient's chart notes the administration of dantrolene (Dantrium) immediately postoperatively. What does the nurse expect the patient has experienced?
a Delirium tremens
b Malignant hyperthermia
c Tonic-clonic seizure
d Respiratory arrestb AmnesiaMidazolam (Versed) has been ordered for a patient to be administered by injection 30 minutes prior to a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is which effect?
a Decreased heart rate
b Amnesia
c Constipation
d Dry moutha, b, dA patient asks the nurse about a new drug advertised on television. The patient wants to know if Ambien would be better for her to use than her current medication, Restoril, for periodic insomnia. The nurse's response is based on knowledge that zolpidem (Ambien) (Select all that apply.)
a. is less likely to cause grogginess in the morning.
b. is a pregnancy category C medication.
c. is contraindicated with asthma.
d. should be limited to 7 to 10 days of treatment.A atomoxetine (Strattera)The mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system (CNS) stimulant?
A atomoxetine (Strattera)
B dextroamphetamine sulfate (Dexedrine)
C methylphenidate (Concerta)
D amphetamine aspartate (Adderall)B CNS stimulants increase release of and block reuptake of neurotransmitters.Which statement correctly identifies the pharmacodynamics of CNS stimulants?
A CNS stimulants decrease the production of excitatory neurotransmitters.
B CNS stimulants increase release of and block reuptake of neurotransmitters.
C CNS stimulants block the activity of inhibitory neurons.
D CNS stimulants enhance the effects of phosphodiesterase and subsequent breakdown of cyclic adenosine monophosphate (cAMP).A InsomniaWhen assessing for side effects expected in a patient taking analeptics, the nurse would monitor for which effect?
A Insomnia
B Bradycardia
C Hypotension
D Decreased mental alertnessB Cardiac dysrhythmiasThe nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug?
A Myelin degeneration
B Cardiac dysrhythmias
C Constipation
D Heart blockB Limit dietary intake of fat to <30% of total calories.To reduce the gastrointestinal side effects of orlistat (Xenical), what will the nurse encourage the patient to do?
A Take the medication with an antacid.
B Limit dietary intake of fat to <30% of total calories.
C Supplement diet with fat-soluble vitamins.
D Increase fluid and fiber in the diet.A vasoconstriction.Ergot alkaloids such as ergotamine tartrate (Ergostat) exert a therapeutic effect by causing
A vasoconstriction.
B vasodilation.
C blockade of the beta2 receptors.
D simulation of the alpha receptors.B Schedule IIA nurse working with patients who are diagnosed with ADHD is aware such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified?
A Schedule I
B Schedule II
C Schedule III
D Schedule IVa, b, cThe nurse is educating a patient who has been prescribed methylphenidate for narcolepsy about the drug's adverse effects. What potential adverse effects would the nurse include in the patient teaching? (Select all that apply.)
A Weight Loss
B Headache
C Insomnia
D Decreased blood pressure
E Increased appetiteA Gingival hyperplasiaThe nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What common side effect is the nurse educating the patient about for this medication?
A Gingival hyperplasia
B Oral candidiasis
C Increased risk of dental abscesses
D Increased incidence of dental cariesC 12 mcg/mLThe patient receiving phenytoin (Dilantin) has a serum drug level drawn. Which level will the nurse note as therapeutic?
A 8 mcg/mL
B 30 mcg/mL
C 12 mcg/mL
D 6 mcg/mLA Absence seizuresWhile obtaining a patient history, the nurse notes that the patient has been prescribed ethosuximide (Zarontin). Which condition will the nurse suspect that the patient experiences?
A Absence seizures
B Tonic-clonic seizures
C Panic attacks
D Partial seizuresC Maximally reducing seizure activity while minimizing side effects of medication therapy.While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication?
A Eradicating all seizure activity and then weaning off medication once the patient is seizure free for 3 months.
B Reducing seizure occurrence to one per week.
C Maximally reducing seizure activity while minimizing side effects of medication therapy.
D Maximizing drug dosages to control seizure activity.A Rebound seizure activityWhile completing discharge activity for a patient prescribed an antiepileptic drug, the nurse instructs the patient that what potential complication could occur if he or she abruptly stopped taking the antiepileptic drug?
A Rebound seizure activity
B Acute withdrawal syndrome
C Hypotension
D Confusion and deliriumB diazepam (Valium)A postoperative craniotomy patient is received in the intensive care unit. The nurse makes sure which prescribed drug is readily available to treat acute seizure activity?
A gabapentin (Neurontin)
B diazepam (Valium)
C ethosuximide (Zarontin)
D flumazenil (Romazicon)B Flush the line with normal saline before and after administration to prevent precipitation.When administering intravenous phenytoin (Dilantin), which action will the nurse perform?
A Always use an infusion pump.
B Flush the line with normal saline before and after administration to prevent precipitation.
C Administer through peripheral intravenous sites only.
D Monitor for hypertension.C "Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin."The patient asks the nurse why she is receiving a different drug than her usual phenytoin (Dilantin). The patient is NPO (nothing by mouth) secondary to illness and is receiving intravenous fosphenytoin (Cerebyx). Which is the nurse's most accurate response?
A "Your serum phenytoin levels were not therapeutic, so your health care provider has changed your medication to a more effective drug."
B "Phenytoin is not effective while you are NPO, so your health care provider has changed your medication to a more effective drug."
C "Fosphenytoin is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin."
D "Since you are NPO, you cannot take phenytoin orally. Phenytoin does not come in an intravenous form. You will be transferred back to phenytoin after you recover from this illness."a, b, cA patient receiving valproic acid (Depakote) should be monitored for which adverse effects? (Select all that apply.)
A Tremors
B Weight gain
C Hepatoxicity
D Hypoglycemia
E InsomniaC "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?
A "You have obviously developed resistance to your current medication and will have to be switched to another drug."
B "This is an atypical response. Unfortunately, there are no other options of drug therapy to give you."
C "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."
D "You just need to keep taking your medication and these effects will go away."A Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.When teaching a patient about carbidopa-levodopa (Sinemet), what information will the nurse include in the teaching?
A Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.
B Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain.
C Giving both drugs together minimizes side effects.
D Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.C selegilineWhich antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications?
A levodopa
B carbidopa
C selegiline
D diphenhydramineC To balance cholinergic and dopaminergic activity in the brainWhat is the goal of pharmacologic therapy in treating Parkinson's disease?
A To increase the amount of acetylcholine at the presynaptic neurons
B To decrease the amount of dopamine available in the substantia nigra
C To balance cholinergic and dopaminergic activity in the brain
D To block dopamine receptors in both presynaptic and postsynaptic neuronsA "Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa."The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). How will the nurse respond?
A "Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa."
B "Carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease."
C "Both drugs have the same pharmacodynamic and side effect profiles."
D "Carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine."D This is a normal occurrence related to entacapone (Comtan).The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide?
A The patient may be developing renal failure.
B The patient may be developing hepatic failure.
C Brown-orange urine signifies a lack of fluid intake.
D This is a normal occurrence related to entacapone (Comtan).B Wearing-off phenomenonA patient who has been taking antiparkinson medications for years begins to have increased symptoms on a constant basis. In documenting these symptoms, what term will the nurse use?
A On-off phenomenon
B Wearing-off phenomenon
C Chorea
D DystoniaC COMT inhibitorsThe nurse is providing care for a patient who has been diagnosed with Parkinson's disease. The patient is also in early stage liver failure. What class of medications, if prescribed, would the nurse question?
A Dopamine modulator
B Anticholinergics
C COMT inhibitors
D Ergot derivativeA Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease.A patient with Parkinson's disease is discussing a recent bout of insomnia with the nurse. The patient asks if he can take an old prescription he has to treat insomnia. What does the nurse know about the use of benzodiazepines in patients taking levodopa?
A Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease.
B Use of benzodiazepines increases the therapeutic effect of the levadopa and may result in a decrease in the symptoms of Parkinson's disease.
C Use of benzodiazepines decreases the therapeutic effect of the levadopa and may result in a decrease in the symptoms of Parkinson's disease.
D Use of benzodiazepines increase the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease.a, b, d, eA patient is prescribed selegiline, an MAO-B inhibitor, as adjunctive therapy in treatment of Parkinson's disease. What potential adverse effects would the nurse include in education for this patient? (Select all that apply.)
A Headache
B Insomnia
C Weight gain
D Depression
E Blood pressure changesC Bipolar disorderThe nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with?
A Obsessive-compulsive disorder
B Absence seizures
C Bipolar disorder
D Paranoid schizophreniaA Blocking the reuptake of neurotransmitters at nerve endingsSelective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism?
A Blocking the reuptake of neurotransmitters at nerve endings
B Increasing alertness levels in the brain
C Decreasing levels of epinephrine and serotonin at nerve endings
D Increasing the placebo effectD There is a risk of toxicity when this medication is taken with alcohol.A patient diagnosed with depression is started on a TCA after failure to improve symptoms on an SSRI. The nurse should include which teaching point when educating the patient about the new medication?
A There are no contraindications to this medication.
B The medication is safe; it has been used longer than many others.
C This class of medications has no other use and is only for depression.
D There is a risk of toxicity when this medication is taken with alcohol.B St. John's wortA patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance?
A ibuprofen
B St. John's wort
C vitamin E supplements
D glucosamine chondroitinB "I will not get as dizzy when I change positions after I switch medications."A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education?
A "I can just stop taking my Elavil and start taking the Celexa as ordered."
B "I will not get as dizzy when I change positions after I switch medications."
C "The doctor is switching me to this medication because it is less expensive but just as effective."
D "I will need to limit my intake of cheese when taking Celexa to prevent a rise in my blood pressure."C Eating aged cheeseWhich activity should the patient be cautioned to avoid while taking an MAO inhibitor?
A Participating in a bowling league
B Sunbathing at the pool
C Eating aged cheese
D Smoking a low-nicotine cigaretteB Smoking cessationWhat is another approved and indicated use for bupropion (Zyban), a second-generation antidepressant?
A Orthostatic hypotension
B Smoking cessation
C Anorexia in patients undergoing chemotherapy
D Nocturnal enuresis in childrenB buspirone (BuSpar)A patient diagnosed with an anxiety disorder has been using lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient?
A alprazolam (Xanax)
B buspirone (BuSpar)
C chlordiazepoxide (Librium)
D hydroxyzine hydrochloride salt (Vistaril)C "It is okay to take this drug with a small glass of wine to help relax me."Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy?
A "I need to change positions slowly to prevent dizziness."
B "I will need to wear sunscreen and protective clothing when outdoors."
C "It is okay to take this drug with a small glass of wine to help relax me."
D "I should call my doctor if I notice any uncontrollable movements of my tongue."B Complete blood countWhich laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)?
A Renal panel
B Complete blood count
C Liver function tests
D Immunoglobulin levelsA DystoniaThe nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What is the nurse assessing for in the patient?
A Dystonia
B Orthostatic hypotension
C Dry mouth and constipation
D Neuroleptic malignant syndromeD risperidone (Risperdal)What atypical antipsychotic medication would the nurse anticipate a provider prescribing for treatment of refractory schizophrenia?
A trazodone (Desyrel)
B phenelzine (Nardil)
C amoxapine (Asendin)
D risperidone (Risperdal)C Increased heart rate and contractilityEpinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effect?
A Urinary retention
B Bronchial constriction
C Increased heart rate and contractility
D Decreased intestinal motilityA fluid replacement.The physician has ordered dopamine to treat the patient's hypovolemic shock secondary to severe blood loss. For the medication to be effective, the physician must also order
A fluid replacement.
B beta-stimulating drugs.
C antibodies.
D fluid restriction.B 30 mL/hrYour patient is to receive dopamine 5 mcg/kg/min. He weighs 176 lb. You have dopamine 400 mg in 500 mL D5W. You will infuse this at which rate?
A 20 mL/hr
B 30 mL/hr
C 35 mL/hr
D 50 mL/hrA a positive inotropic, positive chronotropic, and positive dromotropic effect.When assessing for cardiovascular effects of an adrenergic (sympathomimetic) drug, the nurse understands that these drugs produce
A a positive inotropic, positive chronotropic, and positive dromotropic effect.
B a positive inotropic, negative chronotropic, and negative dromotropic effect.
C a negative inotropic, positive chronotropic, and positive dromotropic effect.
D a negative inotropic, negative chronotropic, and negative dromotropic effect.D monoamine oxidase (MAO) inhibitors.A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with
A beta blockers.
B diuretics.
C alpha1 blockers.
D monoamine oxidase (MAO) inhibitors.B phentolamine (Regitine)The nurse assesses the intravenous infusion site of a patient receiving dopamine and finds it is infiltrated. The nurse will prepare which medication to treat this infiltration?
A lidocaine (Xylocaine)
B phentolamine (Regitine)
C nitroprusside (Nipride)
D naloxone (Narcan)C the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray.A patient using Afrin nasal spray complains of worsening cold symptoms and tells the nurse, "I don't understand why this is not working. I am using it almost every 3 hours!" The nurse's response is based on knowledge that
A Afrin nasal spray is not an effective nasal decongestant.
B the medication needs to be used every 30 minutes for maximum effectiveness.
C the patient is suffering from rebound congestion related to excessive use of the Afrin nasal spray.
D adrenergic decongestants should only be used prophylactically, not to treat acute congestion.a, b, cYour patient is receiving dobutamine as a continuous infusion. Titration of this medication is based upon which factors? (Select all that apply.)
A Heart rate
B Blood pressure
C Urine output
D Liver enzymes
E Respiratory rateD supraventricular dysrhythmias.Nonselective beta blockers may be used to treat hypertension and
A chronic obstructive pulmonary disease (COPD).
B heart failure.
C heart block.
D supraventricular dysrhythmias.C atenolol (Tenormin).An example of a cardioselective beta blocker includes
A propranolol (Inderal).
B labetalol (Normodyne).
C atenolol (Tenormin).
D sotalol (Betapace).D abrupt medication withdrawal may lead to a rebound hypertensive crisis.When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that
A these medications may be taken with antacids to minimize gastrointestinal distress.
B hot baths and showers will help enhance the therapeutic effects and are encouraged.
C alcohol intake is encouraged for its vasodilating effects.
D abrupt medication withdrawal may lead to a rebound hypertensive crisis.B nonselective beta-adrenergic antagonist.Propranolol (Inderal) is an effective
A selective alpha-adrenergic antagonist.
B nonselective beta-adrenergic antagonist.
C beta1-adrenergic antagonist.
D beta2-adrenergic antagonist.B phentolamine (Regitine)During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. The nurse would expect to administer which medication?
A nadolol (Corgard)
B phentolamine (Regitine)
C dobutamine (Dobutrex)
D verapamil (Calan)D a negative inotropic, negative chronotropic, and negative dromotropic effect.When assessing for cardiovascular effects of a beta blocker, the nurse understands that these drugs produce
A a positive inotropic, positive chronotropic, and positive dromotropic effect.
B a positive inotropic, negative chronotropic, and negative dromotropic effect.
C a negative inotropic, positive chronotropic, and positive dromotropic effect.
D a negative inotropic, negative chronotropic, and negative dromotropic effect.A Risk for decreased cardiac tissue perfusion related to effects of medication.The priority nursing diagnosis for a patient taking metoprolol (Lopressor) would be
A Risk for decreased cardiac tissue perfusion related to effects of medication.
B Acute confusion related to adverse central nervous system effects of the drug.
C Deficient knowledge related to therapeutic regimen.
D Risk for injury related to possible side effects of the adrenergic blockers.A "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."Patient teaching for a patient being discharged on a beta blocker includes which statement?
A "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
B "If you become dizzy, do not take your medication for 2 days and then restart on the third day."
C "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem."
D "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."A carvedilol (Coreg)The nurse is admitting a patient with a history of angina and hypertension who is currently experiencing moderate heart failure. The patient's current medication regimen includes digoxin (Lanoxin), furosemide (Lasix), and quinapril (Accupril). Which medication would be most beneficial for the health care provider to add to this patient's treatment plan?
A carvedilol (Coreg)
B propranolol (Inderal)
C esmolol (Brevibloc)
D sotalol (Betapace)a, c, dBeta blockers are used to treat which disorders? (Select all that apply.)
A Hypertension
B COPD
C Angina pectoris
D Cardiac dysrhythmias
E Raynaud's diseaseB Increased gastrointestinal motilityCholinergic (parasympathomimetic) drugs have which therapeutic effect?
A Urinary retention
B Increased gastrointestinal motility
C Mydriasis
D VasoconstrictionB Lowering intraocular pressure in patients with glaucomaCholinergic (parasympathomimetic) drugs are indicated for which situation?
A Treating a postoperative patient who has bradycardia
B Lowering intraocular pressure in patients with glaucoma
C Inhibiting muscular activity in the bladder
D Preventing salivation and sweatingB urinary atony.During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat
A postoperative hypotension.
B urinary atony.
C respiratory atelectasis.
D postoperative ischemic colitis.D HeadacheWhich is an adverse effect of bethanechol (Urecholine)?
A Constipation
B Hypertension
C Tachycardia
D HeadacheB increase levels of acetylcholine in the brain by blocking its breakdown.The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to
A relieve anxiety and restless behavior of the patient.
B increase levels of acetylcholine in the brain by blocking its breakdown.
C block the effects of acetylcholine at the presynaptic neurons.
D help control associated urinary incontinence.B Take the medication 30 minutes before meals.When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate?
A Increase fluid and fiber in the diet to prevent constipation.
B Take the medication 30 minutes before meals.
C If a dose is missed, double the next dose to prevent withdrawal.
D Common side effects include tachycardia and hypertension.C Alzheimer's diseaseThe provider has ordered donepezil (Aricept) for the patient, and the patient states "I have no idea why I take this medication." What is the most common diagnosis associated with the administration of donepezil (Aricept)?
A Parkinson's disease
B Bladder retention
C Alzheimer's disease
D Urinary retentiona, c, dThe nurse is providing education to a patient on the primary uses of cholinergic drugs. Which uses would the nurse include in the teaching? (Select all that apply.)
A To stimulate peristalsis
B To elevate heart rate
C To decrease intraocular pressure
D To stimulate bladder emptying
E To dilate pulmonary airwaysB. 0.5 mgAn adult patient presents with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously?
A. 0.3 mg
B. 0.5 mg
C. 1.25 mg
D. 2 mgC. 2 mgAn adult patient presents to the emergency room with insecticide poisoning. The nurse prepares to administer which dose of atropine intravenously?
A. 0.3 mg
B. 0.5 mg
C. 2 mg
D. 4 mgB. Decrease in urinary frequency3. The nurse monitors a patient taking tolterodine (Detrol) for which therapeutic effect?
A. Decrease in gastrointestinal motility
B. Decrease in urinary frequency
C. Increase in heart rate
D. Increase in blood pressureA. Decrease in gastrointestinal motilityThe nurse monitors a patient prescribed dicyclomine (Bentyl) for which therapeutic effect?
A. Decrease in gastrointestinal motility
B. Decrease in urinary frequency
C. Increase in heart rate
D. Increase in blood pressureB. Impaired gas exchange related to thickened respiratory secretionsWhat would be a priority nursing diagnosis for a patient receiving anticholinergic (parasympatholytic) drugs?
A. Risk for injury related to excessive central nervous system stimulation
B. Impaired gas exchange related to thickened respiratory secretions
C. Urinary retention related to loss of bladder tone
D. Deficient knowledge related to pharmacologic regimenC. 4 to 5 hours before travelWhich would be the most appropriate application time for a patient prescribed a scopolamine patch for motion sickness?
A. At bedtime
B. Every 4 hours as needed
C. 4 to 5 hours before travel
D. At the first sign of motion sicknessB. Decreased urinary frequency7. After administering oxybutynin (Ditropan) to a patient with spina bifida, the nurse is assessing the patient for therapeutic effects. What is the nurse assessing for in the patient?
A. Decreased muscle twitches
B. Decreased urinary frequency
C. Increased bowel movements
D. Increased heart ratea, b, cSide effects to expect from anticholinergic (parasympatholytic) drugs, such as atropine, include (Select all that apply.)
A. dilated pupils.
B. urinary retention.
C. dry mouth.
D. diarrhea
E. increased sweating.A. "I will check my blood pressure every day and take my medication when it is over 140/90."Which statement, if made by your patient, signifies that additional patient teaching regarding antihypertensive treatment is required?
A. "I will check my blood pressure every day and take my medication when it is over 140/90."
B. "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause."
C. "I will change my position slowly to prevent feeling dizzy."
D. "I will not mow my lawn until I see how this medication makes me feel."B. Dry, nonproductive coughWhat side effect of angiotensin-converting enzyme (ACE) inhibitors most often results in the provider changing the treatment plan to an angiotensin receptor blocker?
A. Orthostatic hypotension
B. Dry, nonproductive cough
C. Fatigue
D. HypokalemiaD. potassiumWhich medication would the nurse question if prescribed concurrently with ACE inhibitors?
A. furosemide (Lasix)
B. morphine
C. Colace
D. potassiumA. Serum electrolytesWhich would be a priority assessment prior to administering eplerenone (Inspra)?
A. Serum electrolytes
B. Level of consciousness
C. Patient's knowledge level
D. Thiocyanate levelsC. nimodipine (Nimotop)The nurse would plan to administer which calcium channel blocker to a patient with cerebral artery spasms following a subarachnoid hemorrhage?
A. amlodipine (Norvasc)
B. diltiazem (Cardizem)
C. nimodipine (Nimotop)
D. verapamil (Calan)C. HypotensionThe nurse would question an order for a calcium channel blocker in a patient with which condition?
A. Angina pectoris
B. Increased intracranial pressure
C. Hypotension
D. DysrhythmiaB. "The patch should be applied to a nonhairy site, and abrupt withdrawal should be avoided."Which statement would be most appropriate during discharge teaching for a patient receiving transdermal clonidine (Catapres)?
A. "Your blood pressure should be checked by a physician at least once a year."
B. "The patch should be applied to a nonhairy site, and abrupt withdrawal should be avoided."
C. "Excessive exercise or prolonged standing is not a problem with clonidine as it can be with other antihypertensive drugs."
D. "If you are having difficulty with the common side effect of excessive drooling, notify your physician so your dosage can be adjusted."B. Diuretics and calcium channel blockersThe nurse is conducting a community education program. When explaining different medication regimens to treat hypertension, it would be accurate to state that African Americans probably respond best to which combination of medications?
A. ACE inhibitors and diuretics
B. Diuretics and calcium channel blockers
C. Diuretics and beta blockers
D. ACE inhibitors and beta blockersC. Dual-action alpha1 and beta receptor blocker.Carvedilol (Coreg) is classified as a
A. beta blocker.
B. alpha1 blocker.
C. Dual-action alpha1 and beta receptor blocker.
D. Calcium channel blocker.B. HypotensionWhen administering nitroprusside (Nipride) intravenously, the nurse would monitor for which sign of toxicity?
A. Fever
B. Hypotension
C. Extreme fatigue
D. HyperglycemiaB. Obstructive benign prostatic hyperplasiaA patient prescribed prazosin (Minipress) does not have a history of hypertension. The nurse would assess for what disorder for which this medication is also used?
A. Pulmonary emboli
B. Obstructive benign prostatic hyperplasia
C. Seizure disorder
D. Subarachnoid hemorrhageD. preventing aldosterone secretion.ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by
A. preventing the formation of angiotensin II.
B. enhancing sodium and water resorption.
C. increasing the breakdown of bradykinin.
D. preventing aldosterone secretion.A. Ineffective cerebral tissue perfusion related to disease process and/or medicationWhich is a priority nursing diagnosis for a patient taking an antihypertensive medication?
A. Ineffective cerebral tissue perfusion related to disease process and/or medication
B. Deficient knowledge related to medication regimen
C. Fatigue related to side effects of medication
D. Risk for injury to mucous membranes related to medication side effectsa, bWhen teaching a patient about carvedilol (Coreg), the nurse explains that this medication reduces blood pressure by which actions? (Select all that apply.)
A. Reducing heart rate
B. Vasodilation
C. Decreasing stress
D. Increasing urine outputA. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms."Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin patch?
A. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms."
B. "Apply the patch to the same site each day to maintain consistent drug absorption."
C. "If you get a headache, remove the patch for 4 hours and then reapply."
D. "If you get chest pain, apply a second patch right next to the first patch."A. It is the blood volume within the heart.Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient?
A. It is the blood volume within the heart.
B. It is the pressure within the superior vena cava.
C. It is the pressure against which the heart must pump.
D. It is the oxygen demand of the heart.D. "I can take up to four tablets at 5-minute intervals for chest pain."Which statement by the patient demonstrates a need for further education regarding nitroglycerin?
A. "If I get a headache, I should keep taking my nitroglycerin and use Tylenol for pain relief."
B. "I should keep my nitroglycerin in a cool, dry place."
C. "I should change positions slowly to avoid getting dizzy from the nitroglycerin's effect on my blood pressure."
D. "I can take up to four tablets at 5-minute intervals for chest pain."C. It is the pressure against which the heart must pump.Calcium channel blockers reduce myocardial oxygen demand by reducing afterload. How would the nurse explain afterload to the patient?
A. It is the blood volume within the heart.
B. It is the pressure within the heart.
C. It is the pressure against which the heart must pump.
D. It is the contractility of the heart muscle.D. Transdermal nitroglycerin patchWhich nitrate preparation or dosage form has the longest duration of action?
A. Sublingual nitroglycerin
B. Sublingual isosorbide dinitrate
C. Oral isosorbide dinitrate
D. Transdermal nitroglycerin patchC. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night.In order to prevent the development of tolerance, the nurse instructs the patient to perform which action?
A. Apply the nitroglycerin patch every other day.
B. Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg.
C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night.
D. Use the nitroglycerin patch for acute episodes of angina only.C. Blood pressureWhat is included in the priority assessment before administering isosorbide mononitrate (Imdur)?
A. Serum electrolytes
B. Blood urea nitrogen (BUN) and creatinine
C. Blood pressure
D. Level of consciousnessB. "It's best to keep it in its original container away from heat and light."The patient asks how nitroglycerin should be stored while traveling. What is the nurse's best response?
A. "You can protect it from heat by placing the bottle in an ice chest."
B. "It's best to keep it in its original container away from heat and light."
C. "You can put a few tablets in a resealable bag and carry in your pocket."
D. "It's best to lock them in the glove compartment of your car to keep them away from heat and light."D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."Patient teaching regarding sublingual nitroglycerin should include which statement?
A. "You can take up to five doses every 3 minutes for chest pain."
B. "Chew the tablet for the quickest effect."
C. "Keep the tablets locked in a safe place until you need them."
D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."B. "I will need to keep the nitroglycerin stored in the bottle it comes in."Which statement indicates that the patient understands discharge teaching about nitroglycerin?
A. "I will need to refill my prescription once a year in order to maintain potency."
B. "I will need to keep the nitroglycerin stored in the bottle it comes in."
C. "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone."
D. "I should take a nitroglycerin tablet 2 hours before I want to engage in activity that will cause chest pain."C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin."A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response?
A. "This is a normal response to your chest pain."
B. "Stop taking the nitroglycerin because you are probably allergic to it."
C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin."
D. "These symptoms are not related to your sublingual nitroglycerin. You should notify your doctor for diagnostic testing."B. Apply the ointment to a nonhairy part of the upper torso.When applying nitroglycerin ointment, the nurse should perform which action?
A. Use the fingers to spread the ointment evenly over a 3-inch area.
B. Apply the ointment to a nonhairy part of the upper torso.
C. Massage the ointment into the skin.
D. Apply two thick lines of ointment over the prescribed measured area on the nitroglycerin paper.B. Decrease the intravenous nitroglycerin by 10 mcg/min.A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action?
A. Assess the patient's lung sounds.
B. Decrease the intravenous nitroglycerin by 10 mcg/min.
C. Increase the intravenous nitroglycerin by 10 mcg/min.
D. Recheck the patient's vital signs in 1 hour.D. Erectile dysfunction medicationsIt is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)?
A. Antacids
B. Grapefruit juice
C. Thiazide diuretics
D. Erectile dysfunction medicationsC. Bronchial asthmaWhen caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis?
A. Hypertension
B. Atrial fibrillation
C. Bronchial asthma
D. Myocardial infarctionb, c, dWhich are common side effects of nitroglycerin? (Select all that apply.)
A. Blurred vision
B. Flushing
C. Headache
D. Hypotensiona, b, cWhen titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.)
A. Blood pressure
B. Heart rate
C. Chest pain
D. Respiratory rateB. Decreased heart rateWhich is an expected outcome associated with the administration of digoxin?
A. Increased heart rate
B. Decreased heart rate
C. Decreased urinary output
D. Increased blood pressureA. Below the therapeutic levelThe patient has a serum digoxin level drawn and it comes back 0.4 ng/mL. How does the nurse interpret this lab value result?
A. Below the therapeutic level
B. A therapeutic level
C. Above the therapeutic level
D. A toxic levelA. Evaluate the patient for other symptoms of digoxin toxicity.A patient is taking digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg. When the nurse enters the room, the patient states, "I think I need to take a nap. Everything is starting to look a little yellow." Which action will the nurse take?
A. Evaluate the patient for other symptoms of digoxin toxicity.
B. Withhold the furosemide.
C. Administer the medication as ordered.
D. Document the findings and reassess in 1 hour.A. 0.2 mgThe patient weighs 44 pounds and is to receive a loading dose of digoxin. The loading dose is to be 0.03 mg/kg in three divided doses. How much will the nurse administer per dose?
A. 0.2 mg
B. 0.3 mg
C. 0.4 mg
D. 0.6 mgA. Positive inotropic, negative chronotropic, and negative dromotropicWhich are therapeutic effects of digoxin?
A. Positive inotropic, negative chronotropic, and negative dromotropic
B. Positive inotropic, positive chronotropic, and negative dromotropic
C. Negative inotropic, negative chronotropic, and negative dromotropic
D. Positive inotropic, negative chronotropic, and positive dromotropicB. VasodilationPhosphodiesterase inhibitors have an added advantage in treating heart failure. The drugs cause a positive inotropic effect and what other effect?
A. Vasoconstriction
B. Vasodilation
C. Platelet inhibition
D. BronchodilationD. digoxin immune Fab.The nurse reviews a patient's laboratory values and finds a digoxin level of 10 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate administering
A. sodium polystyrene sulfonate.
B. atropine.
C. epinephrine.
D. digoxin immune Fab.B. Aortic regurgitationThe nurse would question the use of milrinone (Primacor) in a patient with which disorder?
A. Systolic heart failure
B. Aortic regurgitation
C. Acute renal failure
D. Mitral valve prolapseB. Wheat branWhen teaching a patient regarding the administration of digoxin, the nurse instructs the patient not to take this medication with which food?
A. Bananas
B. Wheat bran
C. French toast
D. Scrambled eggsa, b, c, dAssessment of a patient receiving a positive inotropic drug would include reviewing which values? (Select all that apply.)
A. Lung sounds
B. Daily weights
C. Apical pulse
D. Serum electrolytes
E. Complete blood countB. Ventricular arrhythmiasA patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order?
A. Bradycardia
B. Ventricular arrhythmias
C. Atrial arrhythmias
D. Heart blockA. Give it as a rapid intravenous push.The nurse is reviewing emergency protocols and administration of adenosine (Adenocard). What is a vitally important task to remember when administering adenosine?
A. Give it as a rapid intravenous push.
B. Give it at the highest port in the IV tubing.
C. Offer it with food or milk.
D. Prepare to set up for an intravenous drip infusion.C. Avoid drinking grapefruit juice.To prevent the occurrence of cinchonism in a patient prescribed quinidine, what does the nurse emphasize as important?
A. Wear sunscreen.
B. Change positions slowly.
C. Avoid drinking grapefruit juice.
D. Increase dietary intake of potassium.C. Paroxysmal supraventricular tachycardia (PSVT)Adenosine is used to treat which condition?
A. Atrial fibrillation
B. Atrial flutter
C. Paroxysmal supraventricular tachycardia (PSVT)
D. Second-degree atrioventricular blockA. Class ISodium channel blockers are considered which class of antidyshythmic drugs?
A. Class I
B. Class II
C. Class III
D. Class IVB. Conversion of recent-onset atrial fibrillation and flutterThe patient has been prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse is aware that this drug has been prescribed for which reason?
A. Treatment of PSVT
B. Conversion of recent-onset atrial fibrillation and flutter
C. Conversion of life-threatening ventricular arrhythmias
D. Treatment of dysrhythmias in patients with acute renal failureC. Apical pulse and blood pressureBefore administering a dose of an antidysrhythmic drug to an assigned patient, which assessments would be of highest priority?
A. Urine output and specific gravity
B. Temperature and pulse rate
C. Apical pulse and blood pressure
D. Peripheral pulses and level of consciousnessB. Calcium channel blockersWhich class of drugs is used to treat both hypertension and dysrhythmias?
A. Sodium channel blockers
B. Calcium channel blockers
C. Angiotensin-converting enzyme (ACE) inhibitors
D. Direct-acting vasodilatorsB. Coronary vasodilationCalcium channel blockers have which pharmacodynamic effect?
A. Positive inotropic effect
B. Coronary vasodilation
C. Positive chronotropic effect
D. Shortened refractory periodC. PulmonaryThe most severe adverse effects of amiodarone are evidenced in which body system?
A. Renal
B. Hepatic
C. Pulmonary
D. Hematologica, c, dFor which potential adverse effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.)
A. Bluish skin discoloration
B. Diarrhea
C. Hypothyroidism
D. Photosensitivity
E. HypertensionB. Activated partial thromboplastin time (aPTT)The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin?
A. Complete blood count (CBC)
B. Activated partial thromboplastin time (aPTT)
C. Prothrombin time (PT)
D. Blood urea nitrogen (BUN)B. vitamin KA patient who has been anticoagulated with warfarin (Coumadin) is admitted with gastrointestinal bleeding. The nurse will anticipate administering which substance?
A. vitamin E
B. vitamin K
C. protamine sulfate
D. calcium gluconateB. The patient's warfarin dose is therapeutic.The nurse interprets a patient's international normalized ratio (INR) value of 2.5. What is the meaning of this reported value?
A. The patient is not receiving enough warfarin for a therapeutic effect.
B. The patient's warfarin dose is therapeutic.
C. The patient is not receiving enough subcutaneous heparin for a therapeutic effect.
D. The patient is receiving a dangerously high amount of heparin.C. "I will increase the dark green leafy vegetables in my diet."Which statement when made by the patient indicates deficient knowledge regarding warfarin?
A. "I will avoid contact sports."
B. "I will take my medication in the early evening each day."
C. "I will increase the dark green leafy vegetables in my diet."
D. "I will contact my physician if I develop excessive bruising."A. clopidogrelWhich medication has antiplatelet properties?
A. clopidogrel
B. enoxaparin
C. heparin
D. alteplaseA. tirofiban (Aggrastat)While preparing a patient with acute chest pain for an emergency angioplasty, the nurse would anticipate administering which medication to prevent platelet aggregation?
A. tirofiban (Aggrastat)
B. protamine sulfate
C. warfarin (Coumadin)
D. aminocaproic acid (Amicar)A. Low-molecular-weight heparinEnoxaparin sodium (Lovenox) is an anticoagulant used to prevent and treat deep vein thrombosis and pulmonary embolism. This drug is in which drug group?
A. Low-molecular-weight heparin
B. Oral anticoagulant
C. Glycoprotein IIb/IIIa inhibitor
D. Thrombolytic drugB. "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect."The patient asks what the difference is between dalteparin (Fragmin) and heparin. What is the nurse's best response?
A. "There is really no difference, but dalteparin is preferred because it is less expensive."
B. "Dalteparin is a low-molecular-weight heparin that has a more predictable anticoagulant effect."
C. "I'm not really sure why some physicians choose dalteparin and some heparin, so you should ask your doctor."
D. "The only difference is that heparin dosing is based on the patient's weight."D. protamine sulfateBefore emergency surgery, the nurse would anticipate administering which medication to a patient receiving heparin?
A. vitamin K
B. vitamin E
C. phenytoin
D. protamine sulfateB. Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants.A patient who is taking an anticoagulant requests an aspirin for headache relief. What is the nurse's best action?
A. Administer 650 mg of acetylsalicylic acid (ASA), and reassess pain in 30 minutes.
B. Take advantage of a teachable moment to inform the patient of potential drug interactions with anticoagulants.
C. Explain to the patient that ASA is contraindicated, and administer ibuprofen as ordered.
D. Explain that the headache is an expected side effect and will subside shortly.B. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed."A patient is started on oral anticoagulant therapy while still receiving intravenous heparin. The patient is concerned about risk for bleeding. What is the nurse's best response?
A. "Your concern is valid in that you are at an increased risk for bleeding, so I will call the doctor to discontinue the heparin."
B. "It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin is continued to help prevent blood clots until the warfarin is working up to speed."
C. "Because of your valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone."
D. "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."D. "I should use a soft toothbrush for dental hygiene."The nurse evaluates and determines the patient has a good understanding of the discharge instructions regarding warfarin (Coumadin) when the patient responds with which statement?
A. "I will double my dose if I forget to take it the day before."
B. "I should keep taking ibuprofen for my arthritis."
C. "I should decrease the dose if I start bruising easily."
D. "I should use a soft toothbrush for dental hygiene."B. Massages the site after administration of the medicationWhile observing a patient self-administer enoxaparin (Lovenox), the nurse identifies the need for further teaching when the patient completes which action?
A. Does not aspirate prior to injecting the medication
B. Massages the site after administration of the medication
C. Administers the medication greater than 2 inches away from the umbilicus
D. Injects the medication and then waits 10 seconds before withdrawing the needlea, b, c, eThe nurse recognizes that patient teaching regarding warfarin (Coumadin) has been successful when the patient acknowledges an increased risk of bleeding with concurrent use of which herbal product? (Select all that apply.)
A. Garlic
B. Ginkgo
C. Dong quai
D. Glucosamine
E. St. John's worta, b, dNursing care for a patient receiving alteplase (Activase) would include which action? (Select all that apply.)
A. Record vital signs and report changes.
B. Observe for signs and symptoms of bleeding.
C. Monitor liver enzymes.
D. Assess for cardiac dysrhythmias.
E. Administer injections intramuscularly to prevent bleeding.B. "I will increase fiber in my diet."Which statement will indicate to the nurse that the patient understands the discharge instructions regarding cholestyramine (Questran)?
A. "I will take Questran 1 hour before my other medications."
B. "I will increase fiber in my diet."
C. "I will weigh myself weekly."
D. "I will have my blood pressure checked weekly."B. Administer aspirin 30 minutes before nicotinic acid.The nurse plans which intervention to decrease the flushing reaction of niacin?
A. Administer niacin with an antacid.
B. Administer aspirin 30 minutes before nicotinic acid.
C. Administer diphenhydramine hydrochloride (Benadryl) with the niacin.
D. Apply cold compresses to the head and neck.B. In the eveningHydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are generally administered at which time?
A. When the stomach is empty
B. In the evening
C. With breakfast
D. With an antacidD. "Continue your exercise program, and maintain a diet high in omega-3 fatty acids."What education and discharge information for a patient receiving an antilipemic medication would the nurse include for the patient?
A. "This medication will take over for other interventions you have been trying to decrease your cholesterol."
B. "It is important for you to double your dose if you miss one in order to maintain therapeutic blood levels."
C. "Stop taking the medication if it causes nausea and vomiting."
D. "Continue your exercise program, and maintain a diet high in omega-3 fatty acids."A. Inhibiting absorption of dietary and biliary cholesterol in the small intestineWhat is the mechanism of action of ezetimibe (Zetia)?
A. Inhibiting absorption of dietary and biliary cholesterol in the small intestine
B. Inhibiting the biosynthesis of cholesterol in the liver
C. Binding to bile in the intestinal tract, inhibiting its absorption and thus causing the liver to produce bile from cholesterol
D. Decreasing the adhesion of cholesterol on the arterial wallsB. It binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.How will the nurse explain to the patient the action of cholestyramine (Questran) and how it decreases lipid levels?
A. It inhibits absorption of dietary cholesterol in the small intestine.
B. It binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces.
C. It inhibits the biosynthesis of cholesterol in the liver.
D. It stimulates the biliary system to increase excretion of dietary cholesterol.D. "I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication."Which statement, made by the patient, demonstrates a knowledge deficit regarding colestipol (Colestid)?
A. "The medication may cause constipation, so I will increase fluid and fiber in my diet."
B. "I should take this medication 1 hour after or 4 hours before my other medications."
C. "I might need to take fat-soluble vitamins to supplement my diet."
D. "I should mix and stir the powder in as small an amount of fluid as possible in order to maintain potency of the medication."D. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liverBy which action does atorvastatin (Lipitor) decrease lipid levels?
A. Inhibiting absorption of dietary cholesterol in the small intestine
B. Binding to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces
C. Stimulating the biliary system to increase excretion of dietary cholesterol
D. Inhibiting HMG-CoA reductase, the enzyme responsible for the biosynthesis of cholesterol in the liverB. Liver function testsWhich test will the nurse use to assess for adverse reactions to HMG-CoA reductase inhibitors?
A. Serum cholesterol levels
B. Liver function tests
C. Serum electrolytes
D. Complete blood countA. Muscle painDischarge teaching for a patient receiving simvastatin (Zocor) would include the importance of reporting which symptoms that might indicate a serious adverse reaction to the medication?
A. Muscle pain
B. Headache
C. Weight loss
D. FatigueC. Hepatic diseaseThe nurse would question an order for simvastatin (Zocor) in a patient with which condition?
A. Leukemia
B. Diabetes
C. Hepatic disease
D. Chronic obstructive pulmonary disease (COPD)A. gemfibrozil (Lopid)A patient with elevated triglyceride levels unresponsive to HMG-CoA reductase inhibitors will most likely be prescribed which drug?
A. gemfibrozil (Lopid)
B. cholestyramine (Questran)
C. colestipol (Colestid)
D. simvastatin (Zocor)B. Complete bowel obstructionThe nurse would question an order for colesevelam (Welchol) in a patient with which condition?
A. Renal disease
B. Complete bowel obstruction
C. Glaucoma
D. Hepatic diseaseC. Increased risk of bleedingThe nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for which adverse effect?
A. Increased risk of clotting
B. Increased risk of vitamin K toxicity
C. Increased risk of bleeding
D. Deep vein thrombosisa, b, c, eWhich are common side effects of fenofibrate (Tricor), a fibric acid derivative? (Select all that apply.)
A. Nausea, vomiting, and abdominal pain
B. Increase in gallstone formation
C. Impotence
D. Constipation
E. RashB. Glucose levelsWhich laboratory value might indicate an adverse response to hydrochlorothiazide (HydroDIURIL)?
A. Sodium levels
B. Glucose levels
C. Calcium levels
D. Chloride levelsB. This combination promotes diuresis but decreases the risk of hypokalemia.The nurse is providing education to a patient on why spironolactone (Aldactone) and furosemide (Lasix) are prescribed together. What information does the nurse provide to the patient?
A. Moderate doses of two different types of diuretics are more effective than a large dose of one type.
B. This combination promotes diuresis but decreases the risk of hypokalemia.
C. This combination prevents dehydration and hypovolemia.
D. Using two drugs increases osmolality of plasma and the glomerular filtration rate.C. HypokalemiaWhich laboratory value depicts a known side effect of furosemide (Lasix)?
A. Hyperchloremia
B. Hypernatremia
C. Hypokalemia
D. HypophosphatemiaC. Furosemide is effective in treating patients with renal insufficiency.A patient is admitted to the hospital with pneumonia and has a history of chronic renal insufficiency. Why does the physician order furosemide (Lasix) 40 mg twice a day?
A. Furosemide will not cause potassium loss.
B. Furosemide is effective in treating patients with pulmonary congestion.
C. Furosemide is effective in treating patients with renal insufficiency.
D. Furosemide will increase PO2 levels.C. A 47-year-old patient with anuriaThe nurse would question the use of mannitol for which patient?
A. A 67-year-old patient who ingested a poisonous substance
B. A 21-year-old patient with a head injury
C. A 47-year-old patient with anuria
D. A 55-year-old patient who receives cisplatin to treat ovarian cancerB. 4 mg/minWhen preparing to administer furosemide (Lasix) intravenously to a patient with renal dysfunction, the nurse plans implementation based on knowledge that the medication should be administered no faster than which rate?
A. 2 mg/min
B. 4 mg/min
C. 6 mg/min
D. 8 mg/minD. "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response?
A. "You are correct about your concern. I will make sure that you get some right away."
B. "I will call your doctor and let him know of your concern."
C. "Potassium supplements are usually not necessary with this type of diuretic."
D. "You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."A. spironolactone (Aldactone)The nurse would expect to administer which diuretic to treat a patient diagnosed with primary hyperaldosteronism?
A. spironolactone (Aldactone)
B. hydrochlorothiazide (HydroDIURIL)
C. acetazolamide (Diamox)
D. furosemide (Lasix)D. furosemide (Lasix)The nurse prepares to administer which diuretic to treat a patient with acute pulmonary edema?
A. spironolactone (Aldactone)
B. amiloride (Midamor)
C. triamterene (Dyrenium)
D. furosemide (Lasix)A. Decreased intracranial pressureWhen evaluating for therapeutic effects of mannitol, what does the nurse anticipate?
A. Decreased intracranial pressure
B. Decreased excretion of therapeutic medications
C. Increased urine osmolality
D. Decreased serum osmolalityC. HyperkalemiaWhen assessing a patient taking triamterene (Dyrenium), the nurse would specifically monitor for which adverse effect?
A. Hypokalemia
B. Hypoglycemia
C. Hyperkalemia
D. HypernatremiaB. Leg crampsWhen teaching a patient about signs and symptoms of hypokalemia, the nurse will instruct the patient to notify the health care provider if which occurs?
A. Diaphoresis
B. Leg cramps
C. Constipation
D. Blurred visiona, c, dA patient taking spironolactone (Aldactone) requests assistance with dietary choices. The nurse would recommend which food choices? (Select all that apply.)
A. Lean meat
B. Bananas
C. Apples
D. Squasha, c, dAcetazolamide (Diamox) is used to treat which disorders? (Select all that apply.)
A. Edema associated with heart failure
B. Metabolic acidosis
C. High-altitude sickness
D. Open-angle glaucomaa, b, cPotassium-sparing diuretics may cause which adverse reactions? (Select all that apply.)
A. Hyperkalemia
B. Dizziness
C. Headache
D. Hypermagnesemia
E. Muscle crampsC. hetastarch (Hespan)A patient with severe trauma is admitted to the intensive care unit. The patient has received 5000 mL of normal saline, is exhibiting peripheral edema, and remains hypotensive. The nurse anticipates administering which substance to correct fluid balance?
A. Ringer's lactate
B. A 3% saline solution
C. hetastarch (Hespan)
D. D5WB. Maintain infusion rate at no greater than 20 mEq/hr.When caring for a patient with serum potassium of 2.8 mEq/L, which is a priority nursing intervention when administering intravenous replacement therapy?
A. Administer potassium as a bolus over 10 minutes.
B. Maintain infusion rate at no greater than 20 mEq/hr.
C. Apply ice packs to site of intravenous administration.
D. Teach the patient and family the signs and symptoms of hypokalemia.C. flushed skin and increased thirst.When planning administration of hypertonic saline solution to treat a patient with severe hyponatremia, the nurse monitors for signs and symptoms of overdose as manifested by
A. lethargy and hypotension.
B. vomiting and diarrhea.
C. flushed skin and increased thirst.
D. confusion and seizures.C. Discontinue the infusion of packed cells.A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. Following patient assessment, what is the nurse's initial action?
A. Reassure the patient that this is an expected reaction.
B. Notify the physician while a peer monitors the blood transfusion.
C. Discontinue the infusion of packed cells.
D. Decrease the infusion rate, and reassess the patient in 15 minutes.A. Fresh frozen plasmaThe nurse is caring for a patient with an acute renal insufficiency and thrombocytopenia. Along with platelet transfusions, the nurse would expect to administer which substance to increase deficient clotting factors in this patient?
A. Fresh frozen plasma
B. Albumin
C. Plasma protein factors
D. Whole bloodC. 5% albuminThe nurse is assessing a patient noted to have third spacing and edema of the hands and feet at +3, yet the patient is having signs and symptoms of intravascular dehydration. The patient's lab results report a total protein level of 4.6 g/dL. What fluid does the nurse anticipate the provider will order for this patient?
A. Normal saline
B. Lactated Ringer's
C. 5% albumin
D. Whole bloodC. Renal failureThe nurse is providing care to a patient newly admitted for trauma from a motor vehicle accident. The provider has ordered IV fluids with potassium. What information noted in the patient's history would alert the nurse to question the order for this IV fluid?
A. Hypertension
B. Cirrhosis of the liver
C. Renal failure
D. Multiple sclerosisB. Pulmonary edemaThe nurse is receiving shift report on her patients. One patient, per report, had a new IV bag of normal saline (NS) hung, which is to be infused at a rate of 100 mL per hour. The nurse discovers that the bag is almost empty and the pump was mistakenly set at 1000 mL per hour. What is the most immediate concern for any patient in this situation?
A. Edema of hands and feet
B. Pulmonary edema
C. Increased urination
D. PhlebitisB. AcromegalyThe nurse would question an order for somatrem (Protropin) in a patient with which condition?
A. Dwarfism
B. Acromegaly
C. Growth failure
D. HypopituitarismC. Excess fluid volumeWhich is a priority nursing diagnosis for a patient receiving desmopressin (DDAVP)?
A. Risk for injury
B. Acute pain
C. Excess fluid volume
D. Deficient knowledge regarding medicationA. Fluid balanceWhat would the nurse assess when monitoring for the therapeutic effectiveness of vasopressin?
A. Fluid balance
B. Patient's pain scale
C. Serum albumin levels
D. Adrenocorticotropic hormone (ACTH) levelsD. octreotide (Sandostatin)The nurse admitting a patient with acromegaly anticipates administering which medication?
A. desmopressin (DDAVP)
B. corticotropin (Acthar)
C. somatropin (Nutropin)
D. octreotide (Sandostatin)D. Serum glucose levelsAfter administering somatropin (Serostim), the nurse would assess for adverse effects by monitoring which parameters?
A. Serum potassium levels
B. Mental status
C. Respiratory rate
D. Serum glucose levelsA. desmopressin (DDAVP)The nurse is providing care to a patient following a non-accidental traumatic brain injury. The patient has developed diabetes insipidus due to the injury. What medication is most often used in the management of diabetes insipidus?
A. desmopressin (DDAVP)
B. corticotrophin (Acthar)
C. octreotide (Sandostatin)
D. somatropin (Humatrope)a, b, c,When teaching a patient regarding desmopressin (DDAVP), the nurse will inform the patient to monitor for which potential side effects? (Select all that apply.)
A. Headache
B. Weight gain
C. Nasal irritation
D. Hyperglycemia
E. HypotensionA. "I will take this medication in the morning so as not to interfere with sleep."Which statement by the patient demonstrates an understanding of discharge instructions on the use of levothyroxine (Synthroid)?
A. "I will take this medication in the morning so as not to interfere with sleep."
B. "I will double my dose if I gain more than 1 pound per day."
C. "I will stop the medication immediately if I lose more than 2 pounds in a week."
D. "I can expect to see relief of my symptoms within 1 week."D. IrritabilityThe nurse would suspect excessive thyroid replacement in a patient taking levothyroxine (Synthroid) when the patient is exhibiting which adverse effect?
A. Depression
B. Intolerance to cold
C. Weight gain
D. IrritabilityB. Increased risk of bleedingPatients taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently would be monitored for which adverse effect?
A. Cardiac arrhythmias
B. Increased risk of bleeding
C. Excessive weight loss
D. Increased risk of deep vein thrombosisB. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal."A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve his symptoms. What is the nurse's best response?
A. "Propylthiouracil inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism."
B. "Propylthiouracil inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal."
C. "Propylthiouracil helps your thyroid gland use iodine and synthesize hormones better."
D. "Propylthiouracil stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which inhibits the production of hormones by the thyroid gland."C. SeafoodThe nurse is teaching the patient taking an antithyroid medication to avoid foods high in iodine. Which food will the nurse advise the patient against?
A. Milk
B. Eggs
C. Seafood
D. ChickenB. "This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism."Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy?
A. "I will have to isolate myself from my family for 1 week so as not to expose them to radiation."
B. "This drug will be taken up by the thyroid gland and destroy the cells to reduce my hyperthyroidism."
C. "This drug will help decrease my cold intolerance and weight gain."
D. "I will need to take this drug on a daily basis for at least 1 year."A. CBCWhen assessing for potential toxicity to PTU, the nurse will monitor the patient for changes in which laboratory test?
A. CBC
B. BNP
C. Serum electrolytes
D. Renal function testsa, d, eThe nurse is reviewing adverse effects of antithyroid medications with a patient who has been taking PTU. What adverse effects does the nurse include in the teaching? (Select all that apply.)
A. Liver toxicity
B. Polyuria
C. Kidney damage
D. Bone marrow toxicity
E. Joint painB. insulin aspart (NovoLog)Which is a rapid-acting insulin with an onset of action of less than 15 minutes?
A. insulin glargine (Lantus)
B. insulin aspart (NovoLog)
C. regular insulin (Humulin R)
D. insulin detemir (Levemir)A. insulin glargine (Lantus)Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours?
A. insulin glargine (Lantus)
B. insulin glulisine (Apidra)
C. regular insulin (Humulin R)
D. NPH insulinC. regular insulin (Humulin R)Which insulin can be administered by continuous intravenous infusion?
A. insulin glargine (Lantus)
B. insulin aspart (Novolog)
C. regular insulin (Humulin R)
D. insulin detemir (Levemir)C. 5:00 PMAssuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia following an 8:00 AM dose of NPH insulin at what time?
A. 10:00 AM
B. 2:00 PM
C. 5:00 PM
D. 8:00 PMB. metformin (Glucophage)The nurse is caring for a patient scheduled to undergo a cardiac catheterization procedure utilizing iodine-based contrast material. The nurse would question an order for which medication to be given to this patient the day before the scheduled procedure?
A. acarbose (Precose)
B. metformin (Glucophage)
C. repaglinide (Prandin)
D. pioglitazone (Actos)C. repaglinide (Prandin)Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat?
A. acarbose (Precose)
B. metformin (Glucophage)
C. repaglinide (Prandin)
D. pioglitazone (Actos)A. Pramlintide slows gastric emptying.Pramlintide (Symlin) is added to the treatment plan for a patient with type 1 diabetes. What information about the action of this medication does the nurse include in the patient teaching?
A. Pramlintide slows gastric emptying.
B. Pramlintide increases glucagon excretion.
C. Pramlintide works to prevent side effects of insulin.
D. Pramlintide is an oral drug administered 15 minutes before meals.A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."The patient is prescribed 30 units regular insulin and 70 units NPH insulin subcutaneously every morning. The nurse will provide which instruction to the patient?
A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."
B. "Mixing insulins will help increase insulin production."
C. "Rotate sites at least once weekly."
D. "Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorption."D. "You cannot mix this insulin with regular insulin and thus will have to take two injections."The nurse would include which statement when teaching a patient about insulin glargine?
A. "You should inject this insulin just before meals because it is very fast acting."
B. "The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day."
C. "You can mix this insulin with NPH insulin to enhance its effects."
D. "You cannot mix this insulin with regular insulin and thus will have to take two injections."B. 30 minutes before a mealThe nurse is providing education to a patient about the time to take glipizide (Glucotrol). For maximum benefit, the nurse will tell the patient to administer glipizide at which time?
A. In the morning
B. 30 minutes before a meal
C. 15 minutes postprandial
D. At bedtimeB. glucagonThe nurse will advise the patient to treat hypoglycemia with which drug?
A. propranolol (Inderal)
B. glucagon
C. acarbose (Precose)
D. bumetanide (Bumex)B. glipizide (Glucotrol)When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug?
A. insulin glargine (Lantus)
B. glipizide (Glucotrol)
C. insulin glulisine (Apidra)
D. NPH insulina, b, dWhich information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.)
A. Limit your alcohol consumption.
B. Report symptoms of anorexia and fatigue.
C. Take your medication only as needed.
D. Notify your physician if blood glucose levels rise above the level set for you.a, c, dWhich actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.)
A. Stimulate insulin secretion from beta cells
B. Increase hepatic glucose production
C. Enhance action of insulin in various tissues
D. Inhibit breakdown of insulin by liverC. It should be administered with food to diminish the risk of gastric irritation.The nurse is discussing with a patient the time of day for taking prednisone. What information would the nurse include in the teaching based on knowledge of glucocorticoids?
A. It is usually administered early in the evening to coincide with the natural secretion pattern of the adrenal cortex.
B. It is usually administered on a strict, unchanging schedule in order to prevent adverse reactions.
C. It should be administered with food to diminish the risk of gastric irritation.
D. It should be administered with the patient's morning coffee to enhance its effects.A. They influence carbohydrate, fat, and protein metabolism.When discussing glucocorticoids, what statement is accurate in relation to the action of these medications?
A. They influence carbohydrate, fat, and protein metabolism.
B. They are produced in decreased amounts during times of stress.
C. They decrease serum sodium and glucose levels.
D. They stimulate defense mechanisms to produce immunity.A. Uncontrolled diabetes mellitusThe nurse would question an order for steroids in a patient with which condition?
A. Uncontrolled diabetes mellitus
B. Rheumatoid arthritis
C. Septic shock
D. Exacerbation of chronic obstructive pulmonary disease (COPD)C. HypokalemiaWhen assessing for potential side effects of fludrocortisone (Florinef), the nurse monitors for signs and symptoms of which adverse effect?
A. Hyponatremia
B. Hypercalcemia
C. Hypokalemia
D. HypovolemiaB. acetaminophenDischarge teaching for a patient receiving glucocorticoids would include the preferred use of which medication for pain management?
A. aspirin
B. acetaminophen
C. ibuprofen
D. naproxenD. Addison's diseaseThe nurse would question an order for aminoglutethimide in a patient with which condition?
A. Metastatic breast cancer
B. Cushing's syndrome
C. Adrenal malignancy
D. Addison's diseaseA. Rinse the mouth after each use.To prevent oral candidiasis, it is most important for the nurse to teach a patient using a steroid inhaler to perform which action?
A. Rinse the mouth after each use.
B. Minimize use of an inhaler to every other day.
C. Swish and swallow with mycostatin after each use.
D. Report any gingival irritation to the health care provider.B. AIDSThe nurse has an order for a patient to receive prednisone for contact dermatitis. What condition in the patient would alert the nurse to question the order?
A. Asthma
B. AIDS
C. COPD
D. Multiple sclerosisa, c, dWhich conditions is aminoglutethimide used to treat? (Select all that apply.)
A. Cushing's syndrome
B. Testicular cancer
C. Adrenal cancer
D. Metastatic breast cancer
E. Thyroid cancerC. "I will take the medication first thing in the morning with 8 ounces of water and remain upright for 30 minutes."Which statement, made by the patient, indicates an understanding of discharge teaching regarding alendronate (Fosamax)?
A. "I need to decrease my intake of dairy products so as to prevent hypercalcemia."
B. "I need to take this medication with food to prevent damage to my esophagus."
C. "I will take the medication first thing in the morning with 8 ounces of water and remain upright for 30 minutes."
D. "This medication will help relieve the bone pain I have from my osteoporosis."B. Endometrial cancerThe addition of continuous administration of progestin to an estrogen regimen reduces the risk of which cancer?
A. Ovarian cancer
B. Endometrial cancer
C. Breast cancer
D. Vaginal cancerA. Deep vein thrombosisThe nurse would question the order for estrogen replacement therapy in a patient with a history of which condition?
A. Deep vein thrombosis
B. Vaginal bleeding
C. Weight loss
D. DysmenorrheB. oxytocin (Pitocin)During a postpartum assessment, the nurse notes a boggy uterus and increased vaginal bleeding. Based upon this assessment and standing physician orders, the nurse prepares to administer which medication?
A. prostaglandin E
B. oxytocin (Pitocin)
C. terbutaline (Brethine)
D. clomiphene (Clomid)B. Liver function testsWhich laboratory test would the nurse expect to be ordered to monitor a patient for adverse effects related to progestin medications?
A. Cardiac enzymes
B. Liver function tests
C. BUN and creatinine
D. Complete blood countB. History of thromboembolic eventsA female patient arrives in the clinic for counseling on potential hormone replacement therapy. When taking the patient history, which finding would the nurse consider as a contraindication to use of hormone replacement therapy for the patient?
A. High cholesterol
B. History of thromboembolic events
C. Early menstrual onset
D. High number of pregnanciesC. "The different color pills are due to different amounts of hormones in each week."When educating a patient about the use of oral contraceptives, the nurse provides what explanation for the pills having different colors each week?
A. "They help you remember which week you are taking."
B. "There isn't a reason for the color, just the choice of the drug company."
C. "The different color pills are due to different amounts of hormones in each week."
D. "They are color coded for the weeks of the month."A. "Use an alternative method of birth control this month during antibiotic use."A patient taking oral contraceptives is being treated for a urinary tract infection with antibiotics. Which information should the nurse include as education related to the oral contraceptives?
A. "Use an alternative method of birth control this month during antibiotic use."
B. "The urinary tract infection can be passed to your partner, so he should be screened."
C. "Be sure to complete the full course of antibiotics."
D. "There is no interaction of oral contraceptives and antibiotics."B. Venous thromboembolismAn elderly woman being treated for osteoporosis with a selective estrogen receptor modulator (SERM) should be alerted to the potential for an increased risk of which condition?
A. Elevated blood pressure
B. Venous thromboembolism
C. Hypercalcemia
D. Skin color changesB. oxytocinWhich is the most common drug used for induction of labor in pregnant women and to promote ejection of milk during lactation?
A. clomiphene
B. oxytocin
C. misoprostol
D. mifepristoneB. Increased protein synthesisWhich is a pharmacodynamic effect of exogenous androgens?
A. Decreased erythropoiesis
B. Increased protein synthesis
C. Increased nitrogen excretion
D. Decreased sperm productionC. HyperkalemiaThe nurse would question the administration of testosterone to a patient with which condition?
A. Hypocalcemia
B. Hyponatremia
C. Hyperkalemia
D. HypovolemiaC. Ejaculatory dysfunctionWhat common side effect would the nurse include in the discharge teaching for a patient receiving finasteride (Proscar)?
A. Hair loss
B. Increased libido
C. Ejaculatory dysfunction
D. Muscle weaknessA. nitroglycerinPatients prescribed sildenafil (Viagra) should be instructed regarding the potential fatal drug interaction with which medication(s)?
A. nitroglycerin
B. aspirin
C. acetaminophen
D. AnticoagulantsC. Place the patch on clean, dry, shaved scrotal skin.When teaching a patient regarding proper application of a Testoderm transdermal patch, the nurse will instruct the patient to perform which action?
A. Replace the patch every 72 hours.
B. Replace the patch every 36 hours.
C. Place the patch on clean, dry, shaved scrotal skin.
D. Place the patch on the back, abdomen, upper arms, or thigh.C. It must not be touched or handled by his daughter due to teratogenic effects.The nurse is providing education to a patient and his caregiver—his pregnant daughter—about dutasteride (Avodart), which he will be taking for benign prostatic hyperplasia (BPH). What important teaching would the nurse provide to the patient and his daughter about the administration of this medication?
A. It should be taken with food containing dairy.
B. It may be placed in daily medication container with other medications.
C. It must not be touched or handled by his daughter due to teratogenic effects.
D. For best results, it needs to be taken at hour of sleep on empty stomach.a, b, eA nurse is providing education to a group of athletes on the topic of anabolic steroids. What side effects would the nurse include in the discussion with the group of athletes? (Select all that apply.)
A. Sterility
B. Liver cancer
C. Impotence
D. Stroke
E. Cardiovascular diseaseb, cThe nurse is educating a patient about medications used to treat erectile dysfunction. Which erectile dysfunction medications have the longest therapeutic effect when taken orally? (Select all that apply.)
A. sildenafil (Viagra)
B. vardenafil (Levitra)
C. tadalafil (Cialis)
D. alprostadil (Caverject)B. Neurologic statusWhat system assessment will the nurse monitor in a patient due to a known common side effect of traditional antihistamines?
A. Cardiac status
B. Neurologic status
C. Respiratory status
D. Gastrointestinal statusB. less sedative effect.Loratadine (Claritin) has an advantage over traditional antihistamines such as diphenhydramine (Benadryl) in that loratadine has
A. less risk of cardiac arrhythmias.
B. less sedative effect.
C. increased bronchodilating effects.
D. less gastrointestinal upset.B. sustained use of nasal decongestants over several days may result in rebound congestion.A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 to 4 hours for the past 5 days. The nurse's response is based on knowledge that
A. oxymetazoline is not an effective nasal decongestant.
B. sustained use of nasal decongestants over several days may result in rebound congestion.
C. oxymetazoline should be administered in an hourly regimen for severe congestion.
D. the patient is probably displaying an idiosyncratic reaction to oxymetazoline.B. "This medication will help prevent the inflammatory response of my allergies."Which statement by the patient demonstrates understanding of action or use of beclomethasone diproprionate (Beconase)?
A. "I will need to taper off the medication to prevent acute adrenal crisis."
B. "This medication will help prevent the inflammatory response of my allergies."
C. "I will need to monitor my blood sugar more closely because it may increase secondary to Beconase."
D. "I only need to take this medication when my symptoms get bad."A. Drowsiness and dizzinessThe nurse is discussing use of antitussive medications with a patient. What common side effect does the nurse include in the patient teaching?
A. Drowsiness and dizziness
B. Diarrhea and abdominal cramping
C. Tremors and anxiety
D. Bradycardia and increased lacrimationC. Increase fluid intake to decrease viscosity of secretions.Patient teaching regarding expectorants should instruct the patient to perform which action?
A. Restrict fluids to decrease mucus production.
B. Take the medication once a day only, usually at bedtime.
C. Increase fluid intake to decrease viscosity of secretions.
D. Increase fiber and fluid intake to prevent constipation.C. Atrial fibrillationThe nurse would question an order for pseudoephedrine in a patient with a history of which condition?
A. Pneumonia
B. Osteoporosis
C. Atrial fibrillation
D. Peptic ulcer diseaseB. Do not use in patients younger than 2 years of age, unless prescribed.When providing general education on use of over-the-counter medications for allergies, which is the highest priority for the nurse to include?
A. Discontinue use 4 days before allergy testing.
B. Do not use in patients younger than 2 years of age, unless prescribed.
C. It may cause dry mouth.
D. The medication treats the symptoms but is not a cure.A. AntihistaminesA patient is making an appointment for allergy testing. The nurse instructs the patient not take what class of medications at least 4 days before allergy testing?
A. Antihistamines
B. Decongestants
C. Bronchodilators
D. AntitussivesC. Intranasal steroidsThe nurse is providing education to a patient with a history of chronic nasal congestion secondary to allergic rhinitis. Which class of medications would the nurse anticipate the provider would recommend for the patient to use on a long-term basis?
A. Anititussives
B. Antihistamines
C. Intranasal steroids
D. Expectorantsa, b, c, dThe nurse is discussing management of symptoms of an upper respiratory tract infection. Which classes of medications are often used in treating the symptoms of upper respiratory tract infections? (Select all that apply.)
A. Antihistamines
B. Nasal decongestants
C. Antitussives
D. Expectorants
E. Antibioticsc, d, eThe nurse is discussing use of antihistamines for allergic rhinitis. Which medications would be included in the list of H1 antagonists used in the treatment of allergic rhinitis? (Select all that apply.)
A. ranitidine (Zantac)
B. nizatidine (Axid)
C. fexofenadine (Allegra)
D. loratadine (Claritin)
E. cetirizine (Zyrtec)B TherapeuticThe nurse receives lab values for a patient with a theophylline level of 14 mcg/mL. How does the nurse interpret this theophylline level?
A Subtherapeutic
B Therapeutic
C Toxic
D Life-threateningA. TachycardiaDischarge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect?
A. Tachycardia
B. Nonproductive cough
C. Hypoglycemia
D. SedationC. St. John's wortWhich over-the-counter/herbal product, when taken with theophylline, can decrease theophylline's serum drug levels?
A. Caffeine
B. Diphenhydramine
C. St. John's wort
D. EchinaceaA. Coronary artery diseaseThe nurse is providing care to a patient prescribed a nonselective adrenergic agonist bronchodilator. Which medical diagnosis on this patient's chart would alert the nurse to question this order?
A. Coronary artery disease
B. Chronic obstructive pulmonary disease (COPD)
C. Hyperkalemia
D. Premature laborD. Longer duration of actionA nurse is providing education to a patient taking two different medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil)?
A. Shorter onset of action
B. Better side effect profile
C. Quicker peak action
D. Longer duration of actionC. "This medication works by preventing the inflammation that causes your asthma attack."Patient teaching regarding the use of antileukotriene drugs such as zafirlukast (Accolate) would include which statement?
A. "Take the medication as soon as you begin wheezing."
B. "It will take about 3 weeks before you notice a therapeutic effect."
C. "This medication works by preventing the inflammation that causes your asthma attack."
D. "Increase fiber and fluid in your diet to prevent the common side effect of constipation."D. They decrease inflammation.What is the role of corticosteroids in the treatment of acute respiratory disorders?
A. They stimulate the immune system.
B. They directly dilate the bronchi.
C. They increase gas exchange in the alveoli.
D. They decrease inflammation.B. "I will rinse my mouth with water after each use."Which statement by a patient best demonstrates an understanding of the teaching on flunisolide (AeroBid)?
A. "I will take two puffs to treat an acute asthma attack."
B. "I will rinse my mouth with water after each use."
C. "I will immediately stop taking my oral prednisone as soon as I start using the AeroBid."
D. "I will not use my albuterol inhaler while I am taking AeroBid."C. AllergensMast cell stabilizers are most effective in treating bronchoconstriction associated with which condition?
A. Emphysema
B. Exposure to cold
C. Allergens
D. InfectionC. "Wait 1 to 2 minutes before you take a second puff of the same drug."Which statement would be included when teaching a patient about the proper use of metered-dose inhalers?
A. "After you inhale the medication once, repeat until you obtain relief."
B. "Make sure that you puff out air repeatedly after you inhale the medication."
C. "Wait 1 to 2 minutes before you take a second puff of the same drug."
D. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."D. "This inhaler is not to be used alone to treat an acute asthma attack."What statement by the patient, who is using the anticholinergic inhaler ipratropium bromide (Atrovent), indicates to the nurse that teaching has been successful?
A. "I will increase my intake of caffeine."
B. "I may gain weight as a result of taking this medication."
C. "Nausea and vomiting are common adverse effects of this medication, so I will always take it with meals."
D. "This inhaler is not to be used alone to treat an acute asthma attack."A. Liver enzymesWhich laboratory value would the nurse assess before administering zafirlukast (Accolate) to a patient?
A. Liver enzymes
B. Cardiac enzymes
C. Renal function tests
D. Complete blood counta, b, cBefore administering an antileukotriene medication, the nurse would assess the patient for allergies to which substance? (Select all that apply.)
A. Lactose
B. Povidone
C. Cellulose
D. Chlorhexedine3, 2, 1The physician orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Beclovent) inhalers for your patient. Put the drugs in the correct order in which they will be administered.
1. beclomethasone (Beclovent)
2. ipratropium bromide (Atrovent)
3. albuterol (Proventil)B. inhibiting prostaglandin production.Most nonsteroidal antiinflammatory drugs (NSAIDs) work by
A. enhancing pain perception.
B. inhibiting prostaglandin production.
C. increasing blood flow to painful areas.
D. increasing the supply of natural endorphins.B. Black tarry stoolsWhen teaching a patient about potential side effects of NSAID therapy, the nurse will teach the patient to promptly report which effect?
A. Mild indigestion
B. Black tarry stools
C. Nonproductive cough
D. NauseaD. prolong the effectiveness of penicillin therapy.The nurse is administering probenecid (Benemid) to a patient with recurrent strep throat. The nurse teaches the patient that the most likely reason for taking this medication is to
A. prevent the occurrence of gout.
B. increase uric acid excretion.
C. inhibit bacterial growth and replication.
D. prolong the effectiveness of penicillin therapy.C. do not decrease the cytoprotective lining of the stomach.The advantage of cyclooxygenase-2 (COX-2) inhibitors over other NSAIDs is that they
A. have a longer duration of action.
B. are less likely to cause hepatic toxicity.
C. do not decrease the cytoprotective lining of the stomach.
D. have a more rapid onset of action.D. "Glucosamine sulfate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain. Discuss this with your health care provider."The patient questions a nurse about herbal treatments for arthritic pain. What is the nurse's best response?
A. "Ginkgo biloba has shown tremendous benefit as an antiinflammatory drug."
B. "High doses of vitamins have been used for many years to help maintain joint health."
C. "There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications."
D. "Glucosamine sulfate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain. Discuss this with your health care provider."A. decreases mobility of leukocytes.The nurse assesses for therapeutic effects of colchicine based on knowledge that colchicine
A. decreases mobility of leukocytes.
B. increases process of phagocytosis.
C. increases uric acid metabolism.
D. increases production of lactic acid.D. Deficient fluid volume related to side effects of nausea, vomiting, and diarrheaAssessment of the patient taking colchicine should include consideration of which nursing diagnoses?
A. Constipation related to side effect of medication
B. Risk for infection related to medication-induced leukocytosis
C. Risk for injury related to side effect of seizures
D. Deficient fluid volume related to side effects of nausea, vomiting, and diarrheaA. "Increase your fluid intake to 3 L per day."Patient teaching for a patient receiving allopurinol (Zyloprim) should include which information?
A. "Increase your fluid intake to 3 L per day."
B. "Include salmon and organ meats in your diet on a weekly basis."
C. "Take the medication with an antacid to minimize gastrointestinal distress."
D. "This medication may cause your urine to turn orange."C. PregnancyThe nurse would question an order to administer misoprostol (Cytotec) to a patient with which condition?
A. Chronic obstructive pulmonary disease
B. Gastroesophageal reflux disease
C. Pregnancy
D. Peptic ulcerC. 14-year-old boy with a history of flulike symptomsThe nurse should question an order written to administer acetylsalicylic acid (aspirin) to which patient?
A. 45-year-old man with a history of heart attack
B. 28-year-old woman with a history of sports injury
C. 14-year-old boy with a history of flulike symptoms
D. 62-year-old woman with a history of strokeC. ketorolac (Toradol)Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain?
A. allopurinol (Zyloprim)
B. indomethacin (Indocin)
C. ketorolac (Toradol)
D. diclofenac (Cataflam)a, b, dThe acetic acid derivative indomethacin (Indocin) has which properties? (Select all that apply.)
A. Antiinflammatory
B. Antirheumatic
C. Antinausea
D. Antipyretic
E. AnticonvulsantA. oprelvekin (Neumega)A patient with low platelets is prescribed a drug to stimulate platelet production. Which drug would the nurse anticipate being prescribed?
A. oprelvekin (Neumega)
B. epoetin (Epogen)
C. aldesleukin (Proleukin)
D. interferon beta-1a (Avonex)A. T-cellsWhich cells are activated by aldesleukin (interleukin-2)?
A. T-cells
B. Red blood cells
C. Undifferentiated cells
D. NeutrophilsC. Bone painPatients receiving filgrastim (Neupogen) should be taught to expect which side effect?
A. Hypotension
B. Constipation
C. Bone pain
D. InsomniaB. Absolute neutrophil count (ANC) count of 12,000 cells/mm3Upon which patient finding would the nurse hold the ordered dose of filgrastim (Neupogen) and notify the provider?
A. Fever of 99.5° F
B. Absolute neutrophil count (ANC) count of 12,000 cells/mm3
C. White blood cell (WBC) count of 4.5/mm3
D. Blood pressure of 142/88 mm HgA. AIDSA patient has been prescribed monoclonal antibody therapy for the treatment of rheumatoid arthritis. What known disorder or disease is a contraindication and would alert the nurse to question the order for this class of drugs?
A. AIDS
B. Hypertensive crisis
C. Chronic obstructive pulmonary disease
D. Nephrotic syndromeA. B cellsWhat cells are the functional cells of the humoral immune system that mature into immunoglobulins?
A. B cells
B. Granulocytes
C. T cells
D. Red blood cellsb, c, dWhich are mechanisms of action of biologic response-modifying drugs? (Select all that apply.)
A. Interruption of the cell lifecycle at the genetic level to interfere with growth of the cancer cell
B. Direct toxic effect on tumor cells, causing them to rupture
C. Adverse modification of a tumor's biology, making it harder for the tumor cells to survive and reproduce
D. Enhancement or restoration of the host's immune system defenses against a tumorA. neutralize gastric acid.The nurse will teach patients that antacids are effective in treatment of hyperacidity because they
A. neutralize gastric acid.
B. decrease stomach motility.
C. decrease gastric pH.
D. decrease duodenal pH.B. ConstipationThe nurse will monitor for which adverse reaction to aluminum-containing antacids such as aluminum hydroxide (Amphojel)?
A. Diarrhea
B. Constipation
C. Gastrointestinal upset
D. Fluid retentionC. Magnesium-containing antacidsWhich type of antacids will the nurse most likely question in an order for a patient with chronic renal failure?
A. Aluminum-containing antacids
B. Calcium-containing antacids
C. Magnesium-containing antacids
D. Sodium-containing antacidsA. Metabolic alkalosisWhat condition will the nurse monitor for in a patient using sodium bicarbonate to treat gastric hyperacidity?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Hyperkalemia
D. HypercalcemiaB. Risk for injury related to thrombocytopeniaWhich nursing diagnosis is appropriate for a patient receiving famotidine (Pepcid)?
A. Risk for infection related to immunosuppression
B. Risk for injury related to thrombocytopenia
C. Impaired urinary elimination related to retention
D. Ineffective peripheral tissue perfusion related to hypertensionA. They compete with histamine for binding sites on the parietal cells.What is the action of histamine2-receptor antagonists?
A. They compete with histamine for binding sites on the parietal cells.
B. They irreversibly bind to H+/K+ ATPase.
C. They cause a decrease in stomach pH.
D. They decrease signs and symptoms of allergies related to histamine release.B. "Smoking decreases the effects of this medication, so I should look into cessation programs."Which statement demonstrates understanding of patient teaching regarding the use of histamine2-receptor antagonists?
A. "Since I am taking this medication, it is OK for me to eat spicy foods."
B. "Smoking decreases the effects of this medication, so I should look into cessation programs."
C. "I should take this medication 1 hour after each meal in order to maximally decrease gastric acidity."
D. "I should decrease bulk and fluids in my diet to prevent diarrhea."B. They irreversibly bind to H+/K+ATPase.How will the nurse describe the action of proton pump inhibitors?
A. They compete with histamine for binding sites on the parietal cells.
B. They irreversibly bind to H+/K+ATPase.
C. They cause a decrease in stomach pH.
D. They cannot be used to treat erosive esophagitis.C. AchlorhydriaProton pump inhibitors have the ability to almost totally inhibit gastric acid secretion. Due to this possibility, the use of the medication can lead to what problem?
A. Gastric ulcer formation
B. Gastroesophageal reflux disease (GERD)
C. Achlorhydria
D. DiverticulosisC. A 32-year-old pregnant woman with a urinary tract infectionThe nurse will question an order for misoprostol (Cytotec) in which patient?
A. A 21-year-old man with Zollinger-Ellison syndrome
B. A 64-year-old man with hypertension
C. A 32-year-old pregnant woman with a urinary tract infection
D. A 45-year-old woman with GERDC. Carbonated beveragesThe nurse would teach a patient prescribed simethicone (Gas-X) to avoid which substances?
A. Antacids
B. Dairy products
C. Carbonated beverages
D. Histamine2-receptor antagonistsC. By forming a protective barrier over the gastric mucosaHow does sucralfate (Carafate) achieve a therapeutic effect?
A. By neutralizing gastric acid
B. By enhancing gastric absorption
C. By forming a protective barrier over the gastric mucosa
D. By inhibiting gastric acid secretionC. 8To avoid fecal impaction, psyllium (Metamucil) should be administered with at least how many ounces of fluid?
A. 4
B. 6
C. 8
D. 10D. Binding to diarrhea-causing bacteria for excretionBismuth subsalicylate (Pepto-Bismol), as an adsorbent, has which mechanism of action?
A. Decreased gastrointestinal motility
B. Decreased gastric secretions
C. Increased fluid absorption
D. Binding to diarrhea-causing bacteria for excretionC. It decreases peristalsis in the intestinal wall.What is the mechanism of action of diphenoxylate (Lomotil)?
A. It increases intestinal excretion of water.
B. It increases intestinal motility.
C. It decreases peristalsis in the intestinal wall.
D. It decreases the reabsorption of water in the bowel.A. Increasing water absorption into the colonMilk of magnesia alleviates constipation by which action?
A. Increasing water absorption into the colon
B. Lubricating the passage of stool
C. Increasing bulk within the colon
D. Stimulating nerves that regulate defecationC. Reducing ammonia levelsWhat is an additional function of lactulose, a hyperosmotic laxative?
A. Decreasing peripheral edema
B. Correcting sodium imbalances
C. Reducing ammonia levels
D. Alleviating galactose intoleranceB. Increased bleedingThe nurse would question the prescription for use of bismuth subsalicylate as an antidiarrheal in a patient on aspirin daily for anticoagulation therapy due to what potential concern?
A. Nausea
B. Increased bleeding
C. Constipation
D. Urinary retentionC. Renal insufficiencyA patient is prescribed an over-the-counter laxative magnesium hydroxide (milk of magnesia). Which disorder in the patient's history would alert the nurse that there is a need to discuss this medication with the patient and the provider?
A. Hypertension
B. Liver dysfunction
C. Renal insufficiency
D. Chronic constipationb, c, d, eWhen diarrhea occurs in the pediatric patient, the nurse will advise the parents to seek emergency medical treatment for the patient if which symptoms occur? (Select all that apply.)
A. Urination every 3 to 4 hours
B. Malaise or lethargic
C. Severe abdominal pain
D. Firm or rigid abdomen
E. Bloody diarrheaD. promotes motility in the small intestine.The nurse recognizes that metoclopramide (Reglan) is useful in treating postoperative nausea and vomiting because it
A. decreases motility in the gastrointestinal tract.
B. decreases chemoreceptor stimulation.
C. improves the body's response to analgesia.
D. promotes motility in the small intestine.C. different vomiting pathways are blocked.When planning administration of antiemetic medications to a patient, the nurse is aware that combination therapy is preferred because
A. the risk of constipation is decreased.
B. lower doses of medication are cost-effective.
C. different vomiting pathways are blocked.
D. increased sedation is achieved by higher doses of medication.B. Deficient fluid volume related to nausea and vomitingIn developing a plan of care for a patient receiving an antihistamine antiemetic drug, which nursing diagnosis would be of highest priority?
A. Deficient knowledge regarding medication administration
B. Deficient fluid volume related to nausea and vomiting
C. Risk for injury related to side effects of medication
D. Anxiety related to nausea and vomitingC. Dry mouthA patient receiving an anticholinergic drug to treat nausea and vomiting should be taught to expect which side effect?
A. Diarrhea
B. Lacrimation
C. Dry mouth
D. BradycardiaD. ondansetron (Zofran)Which drug works by blocking serotonin in the gastrointestinal tract, vomiting center, and chemoreceptor trigger zone (CTZ)?
A. metoclopramide (Reglan)
B. meclizine (Antivert)
C. droperidol (Inapsine)
D. ondansetron (Zofran)A. GlaucomaBefore administering the anticholinergic drug scopolamine, the nurse would be careful to assess the patient for a history of which condition?
A. Glaucoma
B. Hyperthyroidism
C. Rheumatoid arthritis
D. GastroenteritisD. Undiluted over 2 minutesThe nurse plans to administer 50 mg diphenhydramine (Benadryl) intravenously. How will the nurse administer this medication?
A. Diluted in 50 mL normal saline over 30 minutes
B. Undiluted over 1 minute
C. Diluted in 100 mL D5W over 20 minutes
D. Undiluted over 2 minutesA. scopolamine (Transderm-Scōp)The nurse would expect to teach a patient about which antiemetic commonly used to prevent motion sickness?
A. scopolamine (Transderm-Scōp)
B. droperidol (Inapsine)
C. prochlorperazine (Compazine)
D. metoclopramide (Reglan)C. 30 minutes before meals and at bedtime.When planning to administer metoclopramide (Reglan), the nurse is aware that this drug must be given
A. with food to decrease gastrointestinal upset.
B. every 6 hours around the clock.
C. 30 minutes before meals and at bedtime.
D. with a full glass of water first thing in the morning.C. "I will apply the scopolamine patches to rotating sites on my arms."Which statement regarding antiemetic medications, if made by the patient, indicates the need for further patient teaching?
A. "I will not drive while I am taking these medications because they may cause drowsiness."
B. "I may take Tylenol to treat the headache caused by ondansetron."
C. "I will apply the scopolamine patches to rotating sites on my arms."
D. "I should take my prescribed antiemetic before receiving my chemotherapy dose."a, c, dAntidopaminergic drugs are useful to treat not only nausea and vomiting but which other conditions? (Select all that apply.)
A. Anxiety
B. Seizures
C. Intractable hiccups
D. Schizophrenia
E. Bone marrow suppressionA. Depressed deep tendon reflexesWhen administering intravenous magnesium sulfate, the nurse will monitor for which signs and symptoms of hypermagnesemia?
A. Depressed deep tendon reflexes
B. Hyperthermia
C. Diaphoresis
D. TachycardiaB. Pernicious anemiaCyanocobalamin (vitamin B12) is indicated for the treatment of which condition?
A. Acute lymphocytic leukemia
B. Pernicious anemia
C. Bone marrow suppression
D. Optic nerve atrophyD. Nausea and vomiting and abdominal crampingPatient teaching regarding the administration of vitamin C would include which indication(s) of toxicity?
A. Excessive bleeding tendencies
B. Constipation
C. Seizure activity
D. Nausea and vomiting and abdominal crampingB. altered coagulation studies.A patient receiving vitamin K most likely has demonstrated
A. diarrhea.
B. altered coagulation studies.
C. seizure activity.
D. confusion.C. HyperparathyroidismThe nurse would question a physician's prescription for vitamin D in a patient with which diagnosis?
A. Chronic renal failure
B. Hypothyroidism
C. Hyperparathyroidism
D. Graves' diseaseC. "Can you tell me what vitamins you take and how many and how often?"The nurse is educating an elderly patient on vitamin supplementation. The patient states that she takes "lots of vitamins every day" to stay healthy. Based on this information and knowledge of vitamins, what is the nurse's best response?
A. "That's great. You should be very healthy."
B. "You need to make certain that is okay with your health care provider."
C. "Can you tell me what vitamins you take and how many and how often?"
D. "You don't need vitamins if you eat well."C. Vitamin DWhat vitamin can be synthesized by the skin when exposed to sunlight but can also be supplemented as needed?
A. Vitamin C
B. Vitamin K
C. Vitamin D
D. Vitamin B complexa, d, eWhat vitamins are most likely to lead to toxic levels, hypervitaminosis, when administered in megadoses? (Select all that apply.)
A. Vitamin A
B. Vitamin B complex
C. Vitamin C
D. Vitamin D
E. Vitamin KA. DiarrheaWhen preparing an adult formula gastrostomy tube feeding for a patient, the nurse is aware that which is the most common adverse effect?
A. Diarrhea
B. Gastroesophageal reflux
C. Allergic reaction
D. FlatulenceC. PhlebitisThe most common and possibly devastating effect of peripheral total parenteral nutrition (PPN) is which condition?
A. Poor nutrition
B. Heart failure
C. Phlebitis
D. Electrolyte imbalanceB. Digestive intoleranceWhat is the most common adverse effect for infants receiving nutritional supplements?
A. Seizures
B. Digestive intolerance
C. Reflux
D. Poor weight gainA. phenytoinA patient prescribed a tube feeding has a history of a seizure disorder. The absorption of which antiepileptic medication is reduced when given with tube feedings?
A. phenytoin
B. levetiracetam
C. pregabalin
D. lamotriginea, c, dElemental formulations are used for patients with conditions that cause limited ability to digest nutrition. Which substances may be included in elemental formulations? (Select all that apply.)
A. Amino acids
B. Cow-based proteins
C. Dipeptides
D. Tripeptides
E. Fatsa, cWhich are nursing responsibilities associated with the care of a patient receiving total parenteral nutrition (TPN)? (Select all that apply.)
A. Monitoring capillary serum glucose every 6 hours
B. Protecting the solution from exposure to light at all times
C. Maintaining sterile asepsis when handling the site or solution
D. Accelerating the rate of infusion to keep the infusion on time as neededD. Orange juiceWhen administering ferrous sulfate (iron) to a patient, the nurse plans to give this medication with which fluid to increase absorption of the iron?
A. 8 ounces of water
B. 4 ounces of milk
C. Hot tea
D. Orange juiceB. Intramuscular injection using the Z-track methodThe nurse will plan to inject iron dextran by which technique?
A. Subcutaneous injection with a ½-inch, 25-gauge needle
B. Intramuscular injection using the Z-track method
C. Intradermal injection with a sunburst technique of administration
D. Intramuscular injection with a ½-inch, 18-gauge needleB. Dried beansThe nurse is educating a patient on diet. Which food will the nurse encourage the patient to include in a diet as a source of folate?
A. Cheese
B. Dried beans
C. Steak
D. ApplesB. ConstipationThe nurse knows a common expected adverse effect of iron supplementation is which effect?
A. Fatigue
B. Constipation
C. Heartburn
D. FlatusC. ErythropoietinThe formation of erythrocytes and maturation of the red blood cell (RBC) is driven by what hormone?
A. Progesterone
B. Testosterone
C. Erythropoietin
D. Free thyroxinD. Use for anemic patient with renal failureThe nurse is caring for a patient who is prescribed epoetin alfa (Epogen). What does the nurse expect as the reason for use of this medication in this patient?
A. To replace blood loss from surgery
B. To replace blood loss from a trauma
C. Treatment of pregnancy associated anemia
D. Use for anemic patient with renal failureD. DairyA patient informs the nurse she must take her iron with a meal to avoid stomach upset. To increase uptake of oral iron, which food group should the nurse instruct the patient to avoid?
A. Proteins
B. Fruits
C. Vegetables
D. DairyA. Uncontrolled hypertensionThe nurse would question the order for epoetin in a patient with which condition?
A. Uncontrolled hypertension
B. Anemia
C. Chronic renal failure
D. HIV/AIDSD. Change in level of consciousnessWhen developing a nursing care plan for a patient receiving epoetin alfa (Epogen), the nurse will include monitoring for which adverse effect?
A. Chronic diarrhea
B. Severe hypotension
C. Impaired liver function
D. Change in level of consciousnessa, b, c, eWhich are known contraindications for use of erythropoiesis stimulation agents in patients? (Select all that apply.)
A. Uncontrolled hypertension
B. Cancer of the neck
C. History of thrombosis
D. Renal failure
E. Hemoglobin level of 15 g/dLa, b, eWhich groups of individuals are at highest risk for development of iron deficiency anemia? (Select all that apply.)
A. Women aged 12 to 40
B. Children
C. Men aged 20 to 40 years
D. Men over age 50 years
E. Pregnant womenD. silver sulfadiazine (Sulfadine)When planning care for a burn patient, the nurse would anticipate applying which topical medication?
A. erythromycin (E-Mycin)
B. lindane
C. minoxidil (Rogaine)
D. silver sulfadiazine (Sulfadine)A. acne.Isotretinoin (Amnesteem) and tretinoin (Retin-A) are common dermatologic drugs used to treat
A. acne.
B. male pattern baldness.
C. keloid scarring.
D. fungal infections.A. mupirocin (Bactroban)The nurse will anticipate application of which medication to treat a patient diagnosed with impetigo?
A. mupirocin (Bactroban)
B. benzoyl peroxide
C. isotretinoin (Amnesteem)
D. retinoic acid (Renova)B. The patient must use at least two forms of contraception while taking this medication.A teenage female patient is going to be prescribed isotretinoin (Amnesteem) for acne. Which information is most important for the nurse to include in the education of the patient?
A. The drug is supplied in oral form.
B. The patient must use at least two forms of contraception while taking this medication.
C. The drug is used in treatment of severe acne.
D. Providers who prescribe this medication must be registered with the FDAA. CandidiasisA patient who is prescribed the drug miconazole (Monistat), a topical antifungal, has most likely been diagnosed with which condition?
A. Candidiasis
B. Pruritus
C. Eczema
D. FolliculitisB. Bacterial infectionA patient is prescribed bacitracin topical ointment. What does the nurse suspect as the possible diagnosis based on the medication prescribed?
A. Fungal infection
B. Bacterial infection
C. Parasitic infection
D. Viral infectionD. Tinea crurisA male patient has been ordered clotrimazole (Lotrimin, Mycelex-G) after a diagnosis of jock itch. What is the technical name the nurse would use to document the diagnosis on the chart and the reason the patient has been prescribed this medication?
A. Tinea corporis
B. Tinea capitis
C. Tinea pedis
D. Tinea crurisa, b, dA patient is being seen for acne issues. The nurse is discussing use of various topical drugs. Which drugs are used in the treatment of acne?(Select all that apply.)
A. benzoyl peroxide
B. clindamycin
C. isotretinoin
D. vitamin A acid
E. norethindrone and ethinyl estradiolB. MiosisParasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action?
A. Mydriasis
B. Miosis
C. Decrease in drainage of aqueous humor
D. Pupillary dilatationC. "I will rinse the eyedropper with tap water after each use."Which statement, made by a patient, indicates the need for further patient teaching regarding proper administration of eyedrops?
A. "I will put pressure on the inside corner of my eye after I administer the drops."
B. "I will be careful not to touch my eye with the dropper."
C. "I will rinse the eyedropper with tap water after each use."
D. "I will turn my head slightly toward the outside of the eye I am putting the drops in."A. Patient is allergic to sulfa drugs.The nurse is providing education to a patient who was diagnosed with bilateral conjunctivitis (pink eye). The patient is prescribed sulfacetamide (Bleph-10) for the diagnosis. What information in the patient history has the highest priority and should be reported immediately to the health care provider?
A. Patient is allergic to sulfa drugs.
B. Patient does not like eyedrops.
C. Patient reports never having pink eye before.
D. Patient wears contacts.B. Use of sunglasses is encouraged to decrease sunlight sensitivity.The nurse is educating a patient who was administered atropine sulfate solution for an eye exam. The nurse includes which information in the education?
A. The patient will have to wait 72 hours to wear contacts.
B. Use of sunglasses is encouraged to decrease sunlight sensitivity.
C. The patient may have small pupils for 12 hours after administration.
D. A common side effect is dry eyes.C. Competing at histamine receptor sitesThe patient has been prescribed an ocular antihistamine, olopatadine (Patanol), for treatment of allergic conjunctivitis. The nurse knows the medication works though which action?
A. Vasoconstriction of blood vessels to reduce edema
B. Isotonic action to lubricate and reduce symptoms
C. Competing at histamine receptor sites
D. Inhibiting release of mast cellsB. Congenital glaucomaA child born with increased intraocular pressure is likely to be diagnosed with which type of glaucoma?
A. Angle-closure glaucoma
B. Congenital glaucoma
C. Pigmentary glaucoma
D. Open-angle glaucomaA. "This is a typical adverse effect and may lessen over time. If this continues, we need to schedule an appointment with your provider."A patient is prescribed epinephrine eye drops for treatment of chronic open-angle glaucoma. The patient complains of burning with instillation of the drops. How would the nurse respond to the patient?
A. "This is a typical adverse effect and may lessen over time. If this continues, we need to schedule an appointment with your provider."
B. "That should not occur. Come to the office now."
C. "This only occurs if the drop is not placed in the correct area of the eye."
D. "This is normal and will continue as long as you use the drops."A. Thyroid hormonesSympathomimetic mydriatics have the potential to react with other drugs if sufficient topical absorption occurs. When given concurrently, drugs in which class may interact with the sympathomimetic mydriatics?
A. Thyroid hormones
B. Oral contraceptives
C. Nonsteroidal antiinflammatories
D. Calcium channel blockersC. Neisseria gonorrhoeaeAt the time of birth, infants are often treated with erythromycin eye ointment as prophylactic treatment against what possible organism?
A. Aspergillus fumigatus
B. Candida albicans
C. Neisseria gonorrhoeae
D. Malassezia furfura, c, dThe nurse is educating a patient newly diagnosed with open-angle glaucoma on the adverse effects of the indirect-acting miotic eye drops prescribed. What will the nurse include in the teaching as possible adverse effects? (Select all that apply.)
A. Blurred vision
B. Farsightedness
C. Stinging on instillation
D. Decreased nighttime vision
E. Paralysis of eyelidsB. warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction.The nurse bases the plan of care regarding administration of eardrops on knowledge that
A. proper administration includes holding the pinna up and out in an infant.
B. warming the eardrops to room temperature before administration helps reduce a vestibular-type reaction.
C. the pinna of an adult should be held down and back.
D. eardrops may be warmed in the microwave before administration.D. carbamide peroxideA patient is complaining of excessive earwax, leading to diminished hearing ability. The nurse will expect to teach the patient regarding administration of which medication to correct this problem?
A. hydrocortisone
B. pramoxine
C. acetic acid
D. carbamide peroxideC. "I will use the eardrops in the ear canal to treat this condition."The nurse is providing education to a patient diagnosed with otitis externa (OE). Which statement by the patient indicates an understanding of the OE treatment plan?
A. "I will finish taking all the pills for my ear infection."
B. "This is contagious, and I need to stay away from others for 24 hours."
C. "I will use the eardrops in the ear canal to treat this condition."
D. "The cold I had last week caused this to occur; it will go away on its own."A. Mother demonstrates accurate medication administration technique.The nurse is educating the mother of an infant on how to instill eardrops for otitis media with a perforated eardrum. Which is an appropriate nursing outcome criterion for this patient?
A. Mother demonstrates accurate medication administration technique.
B. Mother takes infant's temperature prior to administration of medication.
C. Patient lies still for administration of medication and 5 minutes after administration.
D. Patient stops using medication when the ear no longer has active drainage.B. Reduce inflammationThe health care provider has ordered ciprofloxacin/dexamethasone (Ciprodex) otic drops for a patient with OE. The nurse knows the combination medication has both antibacterial medication and topical steroid medication. What is the purpose of the steroid in this medication?
A. Relieve pain
B. Reduce inflammation
C. Treat infection
D. Decrease the amount of earwaxB. DebroxA mother of a young child asks what she can use to help keep her child's ears clean from wax. What over-the-counter medication will the nurse suggest?
A. Cortic
B. Debrox
C. Floxin
D. CiprodexA. "Hold the pinna down and back."The nurse is teaching the mother of a 1-year-old patient how to instill ear drops for OE. What instructions on instillation does the nurse provide to the mother?
A. "Hold the pinna down and back."
B. "Just put in as many drops as you can get into the ear."
C. "Put a cotton ball in to keep the medication in the ear."
D. "Keep the ear drops in cold place so they work better."B. Improved hearingThe nurse is evaluating the effectiveness of the otic medication used for OE. What will the nurse evaluate for to determine if the goals of therapy have been met?
A. Increased pain in ear
B. Improved hearing
C. Redness around ear
D. Discharge in canalB. Otic and oral antimicrobialsA 14-year-old patient is diagnosed with perforated tympanic membrane, OE, and otitis media. What does the nurse anticipate the provider will prescribe?
A. Otic antimicrobials only
B. Otic and oral antimicrobials
C. Oral antimicrobial only
D. Otic antimicrobial and otic antifungalD. silver sulfadiazine (Sulfadine)When planning care for a burn patient, the nurse would anticipate applying which topical medication?
A. erythromycin (E-Mycin)
B. lindane
C. minoxidil (Rogaine)
D. silver sulfadiazine (Sulfadine)What are the major functions of the alpha-1 receptor?Increase vascular smooth muscle contraction, increase pupillary dilator muscle contraction (mydriasis), increase intestinal and bladder sphincter muscle contractionWhat are the major functions of the αlpha-2 receptor?Decrease sympathetic outflow, decrease insulin release, decrease lipolysis, increase platelet aggregation, decrease aqueous humor productionWhat are the major functions of the βeta-1 receptor?Increase heart rate, increase contractility, increase renin release, increase lipolysisWhat are the major functions of the βeta-2 receptor?Vasodilation, bronchodilation, increase lipolysis, increase insulin release, decrease uterine tone (tocolysis), ciliary muscle relaxation, increase aqueous humor productionWhat are the major functions of the Histamine-1 receptor?Increase nasal and bronchial mucus production, increase vascular permeability, contraction of bronchioles, pruritis, painWhat are the major functions of the Histamine-2 receptor?Increase gastric acid secretionBethanechol-Direct cholinergic agonist
-Activates bowel and bladder smooth muscle
-Used in postoperative and neurogenic ileus
-Resistant to AChECarbachol-Direct cholinergic agonist
-Carbon copy of acetylcholine
-Constricts pupils and relieves intraocular pressure in glaucomaMethacholine-Direct cholinergic agonist
-Stimulates muscarinic receptors in airways when inhaled
-Used as a challenge test for diagnosis of asthmaPilocarpine-Direct cholinergic agonist
-Contracts ciliary muscle of eye (open angle glaucoma), contracts pupillary sphincter (closed angle glaucoma)
-Potent stimulator of sweat, tears and saliva
-AChE resistantDonepezil-Anticholinesterse - increases ACh
-Alzheimer diseaseGalantamine-Anticholinesterse - increases ACh
-Alzheimer diseaseRivastigmine-Anticholinesterse - increases ACh
-Alzheimer diseaseEdrophonium-Anticholinesterse - increases ACh
-Historically used to diagnose myasthenia gravis (MG is now diagnosed by anti-AChR Ab test.Neostigmine-Anticholinesterse - increases ACh
-Used in postoperative and neurogenic ileus and urinary retention, myasthenia gravis, and postoperative reversal of neuromuscular junction blockadePhysostigmine-Anticholinesterse - increases ACh
-Used in anticholinergic toxicity
-Crosses the blood-brain barrier (CNS)Pyridostigmine-Anticholinesterse - increases ACh
-Increases muscle strength
-Used in myasthenia gravis (long acting)
-Does not penetrate CNSAtropine-Muscarinic antagonist
-Used in bradycardia and for ophthalmic applications
-Also used as antidote for cholinesterase inhibitor poisoning
-Actions include increase pupil dilation, cycloplegia, decreased airway secretions, decreased acid secretions, decreased gut motility, decreased bladder urgency in cystitis
-Toxicity: increased body temp (due to decreased sweating), rapid pulse, dry mouth, dry and flushed skin, cycloplegia, constipation, disorientation;
-Can cause acute angle-closure glaucoma in elderly (due to mydriasis), urinary retention in men with prostatic hyperplasia, and hyperthermia in infants
-See also homatropine and tropicamideBenztropine-Muscarinic antagonist
-Works in CNS
-Used in Parkinson disease and acute dystoniaGlycopyrrolate-Muscarinic antagonist
-Parental use: preoperative use to reduce airway secretions
-Oral use: drooling, peptic ulcerHyoscyamine-Muscarinic antagonist
-Antispasmodics for IBSDicyclomide-Muscarinic antagonist
-Antispasmodics for IBSIpratropium-Muscarinic antagonist
-Used in COPD and asthmaTiotropium-Muscarinic antagonist
-Used in COPD and asthmaOxybutynin-Muscarinic antagonist
-Reduced bladder spasms and urge urinary incontinenceSolifenacin-Muscarinic antagonist
-Reduced bladder spasms and urge urinary incontinenceTolterodine-Muscarinic antagonist
-Reduced bladder spasms and urge urinary incontinenceScopalamine-Muscarinic antagonist
-Motion sicknessAlbuterol-β2 > β1 direct agonist
-Acute asthmaSalmterol-β2 > β1 direct agonist
-Long term asthma or COPD controlDobutamine-β1 > β2, α direct agonist
-Uses: heart failure (HF) (inotropic > chronotropic), cardiac stress testing.Dopamine-D1 = D2 > β > α direct agonist
-Uses: unstable bradycardia, HF, shock; inotropic and chronotropic α effects predominate at high doses.Epinephrine-β > α direct agonist
-Uses: anaphylaxis, asthma, open-angle glaucoma;
α effects predominate at high doses. Significantly stronger effect at β2-receptor than norepinephrine.Isoprterenol-β1 = β2 direct agonist
-Uses: electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemiaNorepinephrine-α1 > α2 > β1 direct agonist
-Hypotension (butrenal perfusion). Significantly weaker effect at β2-receptor than epinephrine.Phenylephrine-α1 > α2 direct agonist
-Uses: hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)Amphetamine-Indirect general sympathetic agonist
-reuptake inhibitor; also releases stored catecholamines
-Narcolepsy, obesity, ADHD.Cocaine-Indirect general sympathetic agonist
-Reuptake inhibitor
-Causes vasoconstriction and local anesthesia.
-Never give β-blockers if cocaine intoxication is
suspected (can lead to unopposed α1 activation and extreme hypertension).Ephedrine-Indirect general sympathetic agonist
-Releases stored catecholamines
-Nasal decongestion, urinary incontinence, hypotension.Clonidine-α2-agonist
-Uses: hypertensive urgency (limited situations); does not decrease renal blood flow; ADHD, Tourette syndrome
-Toxicity: CNS depression, bradycardia, hypotension, respiratory depression, miosisα-methyldopa-α2-agonist
-Used for hypertension in pregnancy
-Toxicity: Direct Coombs ⊕ hemolysis, SLE-like syndromePhenoxybenzamine-Nonselective α-blocker
-Irreversible
-Used preoperatively for pheochromocytoma to prevent catecholamine (hypertensive) crisis
-Toxicity: orthostatic hypotension, reflex tachycardiaPhentolamine-Nonselective α-blocker
-Give to patients on MAO inhibitors who eat tyramine containing foods
-Toxicity: orthostatic hypotension, reflex tachycardiaPrazosin-Selective α1-blocker
-Uses: urinary symptoms of BPH; PSTD
-Hypertension
-Toxicity: 1st-dose orthostatic hypotension, dizziness, headacheTerazosin-Selective α1-blocker
-Uses: urinary symptoms of BPH;
-Hypertension
-Toxicity: 1st-dose orthostatic hypotension, dizziness, headacheDoxazosin-Selective α1-blocker
-Uses: urinary symptoms of BPH;
-Hypertension
-Toxicity: 1st-dose orthostatic hypotension, dizziness, headacheTamsulosin-Selective α1-blocker
-Uses: urinary symptoms of BPH;
-Toxicity: 1st-dose orthostatic hypotension, dizziness, headacheMirtazapine-Selective α2-blocker
-Used in depression
-Toxicity: sedation, increased serum cholesterol, increased appetiteEffects of β-blockers-Angina pectoris—decrease heart rate and contractility, resulting in decrease O2 consumption
-MI—β-blockers (metoprolol, carvedilol, and bisoprolol) mortality
-SVT (metoprolol, esmolol)—decrease AV conduction velocity (class II antiarrhythmic)
-Hypertension—decrease cardiac output, decrease renin secretion (due to β1-receptor blockade on JGA cells)
-HF—decrease mortality in chronic HF
-Glaucoma (timolol)—decrease secretion of aqueous humorNonselective β-blockers-Nadolol, pindolol (partial agonist), propranolol, timolol
-Mostly go from N to Zβ1-selective antagonist-acebutolol (partial agonist), atenolol, betaxolol, esmolol, metoprolol
-Mostly go from A to MNonselective α- and β-antagonists-Carvedilol, labetalolToxicity of β-blockers-Impotence, cardiovascular adverse effects (bradycardia, AV block, HF), CNS adverse effects (seizures, sedation, sleep alterations), dyslipidemia (metoprolol), and asthma/COPD exacerbations
-Avoid in cocaine users due to risk of unopposed α-adrenergic receptor agonist activity
-Despite theoretical concern of masking hypoglycemia in diabetics, benefits likely outweigh risks; not contraindicatedAcetaminophen toxicity antidoteN-acetylcysteine (replenishes glutathione)Benzodiasepines toxicity antidoteFlumazenilβ-blocker toxicity antidoteGlucagonCarbon monoxide toxicity antidote100% O2, hyperbaric O2 PenicillamineDigitalis toxicity antidoteAnti-dig Fab fragmentsHeparine toxicity antidoteProtamine sulfateIron toxicity antidoteDeferoxamine, deferasiroxOpioids toxicity antidoteNaloxone, naltrexoneSalicylates toxicity antidoteNaHCO3 (alkalinize urine), dialysisWarfarin toxicity antidoteVitamin K (delayed effect), fresh frozen plasma (immediate)Drugs that cause coronary vasospasmCocaine, sumatriptan, ergot alkaloidsDrugs that cause cutaneous flushingVancomycin, Adenosine, Niacin, Ca2+ channel blockers (VANC)Drugs that cause Torsades de pointesClass III (e.g., sotalol) and class IA (e.g., quinidine) antiarrhythmics, macrolide antibiotics, antipsychotics, TCAsDrugs that cause adrenocortical insufficiencyHPA suppression 2° to glucocorticoid withdrawalDrugs that cause hot flashesTamoxifen, clomipheneDrugs that cause hyperglycemiaTacrolimus, Protease inhibitors, Niacin, HCTZ,
CorticosteroidsDrugs that cause hypothyroidismLithium, amiodarone, sulfonamidesDrugs that cause acute cholestatic hepatitis, jaundiceErythromycinDrugs that cause diarrheaMetformin, Erythromycin, Colchicine, Orlistat,
AcarboseDrugs that cause focal to massive hepatic necrosisHalothane, Amanita phalloides (death cap
mushroom), Valproic acid, AcetaminophenDrugs that cause hepatitisRifampin, isoniazid, pyrazinamide, statins, fibratesDrugs that cause pancreatitisDidanosine, Corticosteroids, Alcohol, Valproicacid,
Azathioprine, Diuretics (furosemide, HCTZ)Drugs that cause pseudomembranous colitisClindamycin, ampicillin, cephalosporinsDrugs that cause agranulocytosisGanciclovir, Clozapine, Carbamazepine, Colchicine, Methimazole, PropylthiouracilDrugs that cause aplastic anemiaCarbamazepine, Methimazole, NSAIDs, Benzene, Chloramphenicol, PropylthiouracilDrugs that cause direct Coombs- positive hemolytic anemiaMethyldopa, penicillinDrugs that cause thrombocytopeniaHeparinDrugs that cause thrombotic complicationsOCPs, hormone replacement therapyDrugs that cause gingival hyperplasiaPhenytoin, Ca2+ channel blockers, cyclosporineDrugs that cause goutPyrazinamide, Thiazides, Furosemide, Niacin, CyclosporineDrugs that cause myopathyFibrates, niacin, colchicine, hydroxychloroquine, interferon-α, penicillamine, statins, glucocorticoidsDrugs that cause osteoporosisCorticosteroids, heparinDrugs that cause photosensitivitySulfonamides, Amiodarone, Tetracyclines,
5-FUDrugs that cause Stevens-Johnson syndromeAnti-epileptic drugs (especially lamotrigine),
allopurinol, sulfa drugs, penicillinDrugs that cause teeth discolorationTetracyclines (TETra=bad TEeTh)Drugs that cause tendonitis, tendon rupture, and cartilage damageFluoroquinolonesDrugs that cause Parkinson-like syndromeAntipsychotics, Reserpine, MetoclopramideDrugs that cause seizuresIsoniazid (vitamin B6 deficiency), Bupropion, Imipenem/cilastatin, EnfluraneDrugs that cause tardive dyskinesiaAntipsychotics, metoclopramideDrugs that cause diabetes insipidusLithium, demeclocyclineDrugs that cause hemorrhagic cystitisCyclophosphamide, ifosfamideDrugs that cause interstitial nephritisMethicillin, NSAIDs, furosemideDrugs that cause SIADHCarbamazepine, Cyclophosphamide, SSRIsDrugs that cause dry coughACE inhibitorsDrugs that cause pulmonary fibrosisBleomycin, amiodarone, methotrexate, busulfanDrugs that cause nephrotoxicity/ototoxicityAminoglycosides, vancomycin, loop diuretics, cisplatin. Cisplatin toxicity may respond to amifostine.Sulfa drugsProbenecid, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonamide antibiotics, Sulfasalazine, Sulfonylureas.
Patients with sulfa allergies may develop
fever, urinary tract infection, Stevens-
Johnson syndrome, hemolytic anemia, thrombocytopenia, agranulocytosis, and urticaria (hives). Symptoms range from mild to life threatening.-cholCholinergic agonist-ololβ-blocker-stigmineAChE inhibitor-terolβ2-agonist-zosinα1-antagonist-prilACE inhibitor-sartanAngiotensin-II receptor blocker-statinHMG-CoA reductase inhibitor-dronateBisphosphonate-prazoleProton pump inhibitor-prostProstaglandin analog-tidineH2-antagonist-tropinPituitary hormonePenicillin G, V-Prototype β-lactam antibiotics
-G=IV or IM; V=Oral administration
-Bind penicillin-binding proteins (transpeptidases).
-Block transpeptidase cross-linking of peptidoglycan in cell wall. Activate autolytic enzymes.
-Mostly used for gram-positive organisms (S. pneumoniae, S. pyogenes, Actinomyces). Also used for gram-negative cocci (mainly N. meningitidis) and spirochetes (namely T. pallidum). Bactericidal for gram-positive cocci, gram-positive rods, gram-negative cocci, and spirochetes.
-Penicillinase in bacteria (a type of β-lactamase) cleaves β-lactam ring.
-Toxicity: hypersensitivity reactions, hemolytic anemiaAmoxicillin, ampicillin (aminopenicillins)-Penicillinase-sensitive penicillins
-Same mechanism as penicillin (inhibits peptidoglycan cross-linking) with wider spectrum;
-Penicillinase sensitive (ombine with clavulanic acid to protect against destruction by β-lactamase)
-Use: extended-spectrum penicillin—H. influenzae, H. pylori, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci.
-Toxicity: Hypersensitivity reactions; rash; pseudomembranous colitis.
-Resistance: penicillinase in bacteria (a type of β-lactamase) cleaves β-lactam ring.Dicloxacillin, nafcillin, oxacillin-Penicillinase-resistant penicillins
Same mechanism as penicillin (inhibits peptidoglycan cross-linking)
-Narrow spectrum;
-Penicillinase resistant because bulky R group blocks access of β-lactamase to β-lactam ring.
-Use with S. aureus (except MRSA; resistant because of altered penicillin-binding protein target site).
-Toxicity: Hypersensitivity reactions, interstitial nephritis.Mechanism of action of cephalosporins-β-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases. Bactericidal.
-Organisms typically not covered by cephalosporins are LAME: Listeria, Atypicals (Chlamydia, Mycoplasma), MRSA, and Enterococci. Exception: ceftaroline covers MRSA.1st generation cephalosporinsCefazolin, cephalexin
Use: Gram- positive cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae. Cefazolin used prior to surgery to prevent S. aureus wound infections2nd generation cephalosporins-Cefoxitin, cefaclor, cefuroxime
-Use: gram-positive cocci, Haemophilus influenzae, Enterobacter aerogenes, Neisseria spp., Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens.3rd generation cephalosporins-Ceftriaxone, cefotaxime, ceftazidime)
-Use: serious gram-negative infections resistant to other β-lactams. Ceftriaxone—meningitis, gonorrhea, disseminated lyme disease; ceftazidime—Pseudomonas4th generation cephalosporins-Cefepime
-Use: gram-negative organisms, with activity against Pseudomonas and gram-positive organisms.5th generation cephalosporins-Ceftaroline
-Use: broad gram-positive and gram-negative organism coverage, including MRSA; does not cover Pseudomonas.Cephalosporin toxicity-Hypersensitivity reactions, autoimmune hemolytic anemia, disulfiram-like reaction, vitamin K deficiency.
-Exhibit cross-reactivity with penicillins.
-Increased nephrotoxicity of aminoglycosides.Mechanism of resistance of cephalosporinsStructural change in penicillin-binding proteins (transpeptidases)Carbapenems-Imipenem, meropenem, ertapenem, doripenem
-Imipenem is a broad-spectrum, β-lactamase- resistant carbapenem. Always administered with cilastatin (inhibitor of renal dehydropeptidase I) to decrease inactivation of drug in renal tubules
-Use: gram-positive cocci, gram-negative rods, and anaerobes. Wide spectrum, but significant side effects limit use to life-threatening infections or after other drugs have failed. Meropenem has arisk of seizures and is stable to dehydropeptidase I
-Toxicity: GI distress, skin rash, and CNS toxicity (seizures) at high plasma levelsVancomycin-Inhibits cell wall peptidoglycan formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal. Not susceptible to β-lactamases.
-Gram-positive bugs only—serious, multidrug-resistant organisms, including MRSA, S. epidermidis, sensitive Enteroccocus species, and Clostridium difficile (oral dose for pseudomembranous colitis).
-Well tolerated in general—but NOT trouble free. Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing—red man syndrome (can largely prevent by pretreatment with antihistamines and slow infusion rate).
-Resistance occurs in bacteria via amino acid modification of D-ala D-ala to D-ala D-lac. "Pay back 2 D-alas (dollars) for vandalizing (vancomycin)."Aminoglycosides-Gentamicin, neomycin, amikacin, tobramycin, streptomycin
-Bactericidal; irreversible inhibition of initiation complex through binding of the 30S subunit. Can cause misreading of mRNA. Also block translocation. Require O2 for uptake; therefore ineffective against anaerobes.
-Severe gram-negative rod infections. Synergistic with β-lactam antibiotics.
-Neomycin for bowel surgery.
-Toxicity: Nephrotoxicity, Neuromuscular blockade, Ototoxicity (especially when used with loop diuretics). Teratogen.
-Resistance: Bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation.Tetracyclines-Tetracycline, doxycycline, minocycline
-Bacteriostatic; bind to 30S and prevent attachment of aminoacyl-tRNA; limited CNS penetration. Doxycycline is fecally eliminated and can be used in patients with renal failure. Do not take tetracyclines with milk (Ca2+), antacids (Ca2+ or Mg2+), or iron-containing preparations because divalent cations inhibit drugs' absorption in the gut.
-Clinical use: Borrelia burgdorferi, M. pneumoniae. Drugs' ability to accumulate intracellularly makes them very effective against Rickettsia and Chlamydia. Also used to treat acne.
-Toxicity: GI distress, discoloration of teeth and inhibition of bone growth in children, photosensitivity. Contraindicated in pregnancy.
-Resistance: decrease uptake or increased efflux out of bacterial cells by plasmid-encoded transport pumps.Chloramphenicol-Blocks peptidyltransferase at 50S ribosomal subunit.
-Bacteriostatic.
-Use: Meningitis (Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae) and Rocky Mountain spotted fever (Rickettsia rickettsii). Limited use owing to toxicities but often still used in developing countries because of low cost.
-Toxicity: anemia (dose dependent), aplastic anemia (dose independent), gray baby syndrome (in premature infants because they lack liver UDP-glucuronyl transferase).
-Resistance: plasmid-encoded acetyltransferase inactivates the drug.Clindamycin-Blocks peptide transfer (translocation) at 50S ribosomal subunit. Bacteriostatic.
-Anaerobic infections (e.g., Bacteroides spp., Clostridium perfringens) in aspiration pneumonia, lung abscesses, and oral infections. Also effective against invasive group A streptococcal infection.
-Treats anaerobic infections above the diaphragm vs. metronidazole (anaerobic infections below diaphragm)
-Toxicity: pseudomembranous colitis (C. difficile -overgrowth), fever, diarrheaMacrolides-Azithromycin, clarithromycin, erythromycin
-Inhibit protein synthesis by blocking translocation ("macroslides"); bind to the 23S rRNA of the 50S ribosomal subunit. Bacteriostatic.
-Atypical pneumonias (Mycoplasma, Chlamydia, Legionella), STIs (Chlamydia), gram-positive cocci (streptococcal infections in patients allergic to penicillin), and B. pertussis.
Toxicity: MACRO: Gastrointestinal Motility issues, Arrhythmia caused by prolonged QT interval, acute Cholestatic hepatitis, Rash, eOsinophilia. Increases serum concentration of theophyllines, oral anticoagulants. Clarithromycin and erythromycin inhibit cytochrome P-450.
Resistance: methylation of 23S rRNA-binding site prevents binding of drug.Trimethoprim-Inhibits bacterial dihydrofolate reductase. Bacteriostatic.
-Used in combination with sulfonamides (trimethoprim-sulfamethoxazole [TMP- SMX]), causing sequential block of folate synthesis. Combination used for UTIs, Shigella, Salmonella, Pneumocystis jirovecii pneumonia treatment and prophylaxis, toxoplasmosis prophylaxis.
-Toxicity: megaloblastic anemia, leukopenia, granulocytopenia. (May alleviate with supplemental folinic acid). TMP Treats Marrow Poorly.Sulfonamides-Sulfamethoxazole (SMX), sulfisoxazole, sulfadiazine
-Inhibit folate synthesis. Para-aminobenzoic acid (PABA) antimetabolites inhibit dihydropteroate synthase. Bacteriostatic (bactericidal when combined with trimethoprim). (Dapsone, used to treat lepromatous leprosy, is a closely related drug that also inhibits folate synthesis.)
-Gram-positives, gram-negatives, Nocardia, Chlamydia. Triple sulfas or SMX for simple UTI.
-Toxicity: Hypersensitivity reactions, hemolysis if G6PD deficient, nephrotoxicity (tubulointerstitial nephritis), photosensitivity, kernicterus in infants, displace other drugs from albumin (e.g., warfarin).
-Resistance: Altered enzyme (bacterial dihydropteroate synthase), decreased uptake, or increased PABA synthesis.Fluoroquinolones-Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin.
-Inhibit prokaryotic enzymes topoisomerase
II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids.
-Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms.
Toxicity: GI upset, superinfections, skin rashes, headache, dizziness. Less commonly, can cause leg cramps and myalgias.
-Contraindicated in pregnant women, nursing mothers, and children < 18 years old due to possible damage to cartilage. Some may prolong QT interval. May cause tendonitis or tendon rupture in people > 60 years old and in patients taking prednisone.
-Resistance: chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps.Metronidazole-Forms toxic free radical metabolites in the bacterial cell that damage DNA. Bactericidal, antiprotozoal.
-Treats Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes (Bacteroides, C. difficile). Used with a proton pump inhibitor and clarithromycin for "triple therapy" against H. Pylori.
-Treats anaerobic infection below the diaphragm vs. clindamycin (anaerobic infections above diaphragm).
Toxicity: Disulfiram-like reaction (severe flushing, tachycardia, hypotension) with alcohol; headache, metallic taste.What is the prophylaxis for M. tuberculosis?IsoniazidWhat is the treatment for M. tuberculosis?Rifampin, isoniazid, pyrazinamide, ethambutol (RIPE)Isoniazid-Decrease synthesis of mycolic acids. Bacterial catalase- peroxidase (encoded by KatG) needed to convert INH to active metabolite.
-Use in Mycobacterium tuberculosis. The only agent used as solo prophylaxis against TB.
-Toxicity: Neurotoxicity, hepatotoxicity. Pyridoxine (vitamin B6) can prevent neurotoxicity.
-Resistance: mutations leading to underexpression of KatG.Pyrazinamide-Mechanism uncertain. Pyrazinamide is a prodrug that is converted to the active compound pyrazinoic acid.
-Use: Mycobacterium tuberculosis.
-Toxicity: Hyperuricemia, hepatotoxicity.Ethambutol-Reduces carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase.
-Use: Mycobacterium tuberculosis.
-Toxicity: optic neuropathy (red-green color blindness).High risk for endocarditis and undergoing surgical or dental proceduresAmoxicillinExposure to gonorrheaCeftriaxoneHistory of recurrent UTIsTMP-SMXExposure to meningococcal infectionCeftriaxone, ciproflaxacin, or rifampinPregnant woman carrying group B strepPenicillin GPrevention of gonococcal conjunctivitis in newbornErythromycin ointmentPrevention of postsurgical infection due to
S. aureusCefazolinProphylaxis of strep pharyngitis in child with prior rheumatic feverBenzanthine penicillin G or or penicillin VExposure to syphiliBenzanthine penicillin GProphylaxis in HIV patientsTreatment of MRSAVancomycin, daptomycin, linezolid, tigecycline, ceftarolineTreatment of Vancomycin-resistant enterococci (VRE)Linezolid and streptogramins (quinupristin, dalfopristin).Antifungal therapy (general overview)Amphotericin B MoA-Binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes.
-Amphotericin "tears" holes in the fungal membrane by forming poresAmphotericin B clinical use-Serious, systemic mycoses. Cryptococcus (amphotericin B with/without flucytosine for cryptococcal meningitis), Blastomyces, Coccidioides, Histoplasma, Candida, Mucor.
-Intrathecally for fungal meningitis.
-Supplement K+ and Mg2+ because of altered renal tubule permeabilityAmphotericin B toxicityFever/chills ("shake and bake"), hypotension, nephrotoxicity, arrhythmias, anemia, IV phlebitis ("amphoterrible"). Hydration nephrotoxicity. Liposomal amphotericin toxicity.Nystatin MoASame as amphotericin B. Topical use only as too toxic for systemic use.Nystatin clinical use"Swish and swallow" for oral candidiasis (thrush); topical for diaper rash or vaginal candidiasis.Name the -azolesClotrimazole, fluconazole, itraconazole, ketoconazole, miconazole, voriconazole.Azoles MoAInhibit fungal sterol (ergosterol) synthesis by inhibiting the cytochrome P-450 enzyme that converts lanosterol to ergosterol.Azoles clinical useLocal and less serious systemic mycoses. Fluconazole for chronic suppression of cryptococcal meningitis in AIDS patients and candidal infections of all types. Itraconazole for Blastomyces, Coccidioides, Histoplasma. Clotrimazole and miconazole for topical fungal infections.Azoles toxicityTestosterone synthesis inhibition (gynecomastia, especially with ketoconazole), liver dysfunction (inhibits cytochrome P-450).Toxoplasmosis therapyPyrimethamineChloroquine MoABlocks detoxification of heme into hemozoin. Heme accumulates and is toxic to plasmodiaChloroquine clinical useTreatment of plasmodial species other than P. falciparum (frequency of resistance in P. falciparum
is too high). Resistance due to membrane pump that intracellular concentration of drug. Treat
P. falciparum with artemether/lumefantrine or atovaquone/proguanil. For life-threatening malaria, use quinidine in U.S. (quinine elsewhere) or artesunate.Choroquine toxictyRetinopathy; pruritus (especially in dark-skinned individuals).Antihelminthic therapy drug regimenMebendazole, pyrantel pamoate, ivermectin, diethylcarbamazine, praziquantel.Antiviral therapy generalOseltamivir, zanamivir clinical useTreatment and prevention of both influenza A and B.Acyclovir, famciclovir, valacyclovir MoAGuanosine analogs. Monophosphorylated by HSV/VZV thymidine kinase and not phosphorylated in uninfected cells few adverse effects. Triphosphate formed by cellular enzymes. Preferentially inhibit viral DNA polymerase by chain termination.Acyclovir, famciclovir, valacyclovir clinical use-HSV and VZV. Weak activity against EBV. No activity against CMV. Used for HSV- induced mucocutaneous and genital lesions as well as for encephalitis. Prophylaxis in immunocompromised patients. No effect on latent forms of HSV and VZV. Valacyclovir, a prodrug of acyclovir, has better oral bioavailability.
-For herpes zoster, use famciclovir.Acyclovir, famciclovir, valacyclovir toxicityObstructive crystalline nephropathy and acute renal failure if not adequately hydrated. Mutated viral thymidine kinase.Acyclovir, famciclovir, valacyclovir mechanism of resistanceMutated viral thymidine kinase.Ganciclovir MoA5′-monophosphate formed by a CMV viral kinase. Guanosine analog. Triphosphate formed by cellular kinases. Preferentially inhibits viral DNA polymerase. Preferentially inhibit viral DNA polymerase by chain termination.Ganciclovir clinical useCMV, especially in immunocompromised patients. Valganciclovir, a prodrug of ganciclovir, has better oral bioavailability.Ganciclovir toxicityLeukopenia, neutropenia, thrombocytopenia, renal toxicity. More toxic to host enzymes than acyclovir.Ganciclovir mechanism of resistanceMutated viral kinase.Foscarnet MoAViral DNA/RNA polymerase inhibitor and HIV reverse transcriptase inhibitor. Binds to pyrophosphate-binding site of enzyme. Does not require activation by viral kinase.
Foscarnet = pyrofosphate analog.Foscarnet clinical useCMV retinitis in immunocompromised patients when ganciclovir fails; acyclovir-resistant HSV.Foscarnet toxicityNephrotoxicity, electrolyte abnormalities (hypo- or hypercalcemia, hypo- or hyperphosphatemia, hypokalemia, hypomagnesemia) can lead to seizures.Foscarnet mechanism of resistanceMutated DNA polymerase.Cidofovir clinical useCMV retinitis in immunocompromised patients; acyclovir-resistant HSV.HIV therapy-Highly active antiretroviral therapy (HAART): often initiated at the time of HIV diagnosis.
-Strongest indication for patients presenting with AIDS-defining illness, low CD4+ cell counts (< 500 cells/mm3), or high viral load.
-Regimen consists of 3 drugs to prevent resistance: 2 NRTIs and 1 of the following: NNRTI or protease inhibitor or integrase inhibitor.List the protease inhibitorsAtazanavir Darunavir Fosamprenavir Indinavir Lopinavir Ritonavir SaquinavirProtease inhibitor mechanism-Assembly of virions depends on HIV-1 protease (pol gene), which cleaves the polypeptide products of HIV mRNA into their functional parts. Thus, protease inhibitors prevent maturation of new viruses.
-Ritonavir can "boost" other drug concentrations by inhibiting cytochrome P-450.
-All protease inhibitors end in -navir. Navir (never) tease a protease.Protease inhibitor toxicity-Hyperglycemia, GI intolerance (nausea, diarrhea), lipodystrophy.
-Nephropathy, hematuria (indinavir).
-Rifampin (a potent CYP/UGT inducer) contraindicated with protease inhibitors because it can decrease protease inhibitor concentration.Interferons clinical useIFN-α: chronic hepatitis B and C, Kaposi sarcoma, hairy cell leukemia, condyloma acuminatum, renal cell carcinoma, malignant melanoma.
IFN-β: multiple sclerosis.
IFN-γ: chronic granulomatous disease.Interferons toxicityNeutropenia, myopathy.Ribavirin MoAInhibits synthesis of guanine nucleotides by competitively inhibiting inosine monophosphate dehydrogenase.Ribavirin clinical useChronic HCV, also used in RSV (palivizumab preferred in children)Ribavirin toxicityHemolytic anemia; severe teratogen.Simeprevir MoAHCV protease inhibitor; prevents viral replicationSimeprevir clinical use-Chronic HCV in combination with ribavirin and peginterferon alfa.
-Do not use as monotherapy.Simeprevir toxicityPhotosensitivity reactions, rashAntibiotics to avoid during pregnancy-Sulfonamides
-Aminoglycosides
-Fluoroquinolones
-Clarithromycin
-Tetracyclines
-Ribavirin (antiviral)
-Griseofulvin (antifungal)
-Chloramphenicol
(SAFe Children Take Really Good Care)Adverse effect of sulfonamides during pregnancyKernicterusAdverse effect of aminoglycosides during pregnancyOtotoxicityAdverse effect of fluorquinolones during pregnancyCartilage damageAdverse effect of clarithromycin during pregnancyEmbryotoxicAdverse effect of tetracyclines during pregnancyDiscolored teeth, inhibition of bone growthAdverse effect of ribavirin during pregnancyTeratogenicAdverse effect of griseofulvin during pregnancyTeratogenicAdverse effect of chloramphenicol during pregnancyGray baby syndrome (vomiting, ashen gray color of the skin, limp body tone, hypotension, cyanosis of lips and skin, hypothermia, cardiovascular collapse, within 2-9 days of birth-especially premature)Cyclosporine MoACalcineurin inhibitor; binds cyclophilin. Blocks T-cell activation by preventing IL-2 transcription.Cyclosporine clinical useTransplant rejection prophylaxis, psoriasis, rheumatoid arthritisCyclosporine toxicityNephrotoxicity, hypertension, hyperlipidemia, neurotoxicity, gingival hyperplasia, hirsutism.Tacrolimus MoA-Calcineurin inhibitor; binds FK506 binding protein (FKBP).
-Blocks T-cell activation by preventing IL-2 transcription.Tacrolimus clinical useTransplant rejection prophylaxisTacrolimus toxicitySimilar to cyclosporine, risk of diabetes and neurotoxicity; no gingival hyperplasia or hirsutism.Sirolimus (Rapamycin) MoA-mTOR inhibitor; binds FKBP.
-Blocks T-cell activation and B-cell differentiation by preventing response to IL-2.Sirolimus (Rapamycin) clinical use-Kidney transplant rejection prophylaxis.
-Synergistic with cyclosporine.
-Also used in drug-
eluting stentsSirolimus (Rapamycin) toxicityAnemia, thrombocytopenia, leukopenia, insulin resistance, hyperlipidemia; not nephrotoxic (kidney "sir-vives")Daclizumab, basiliximab MoAMonoclonal antibodies; block IL-2R.Daclizumab, basiliximab clinical useKidney transplant rejection prophylaxisDaclizumab, basiliximab toxicityEdema, HTN, tremorAzathioprine MoAAntimetabolite precursor of 6-mercaptopurine.
Inhibits lymphocyte proliferation by blocking nucleotide synthesis.Azathioprine clinical useTransplant rejection prophylaxis, rheumatoid arthritis, Crohn disease, glomerulonephritis, other autoimmune conditions.Azathioprine toxicity-Leukopenia, anemia, thrombocytopenia.
-6-MP degraded by xanthine oxidase; toxicity by allopurinol.Glucocorticoids MoAInhibit NF-κB. Suppress both B- and T-cell function by transcription of many cytokines.Glucocorticoids clinical useTransplant rejection prophylaxis (immunosuppression), many autoimmune disorders, inflammationGlucocorticoids toxicity-Hyperglycemia, osteoporosis, central obesity, muscle breakdown, psychosis, acne, hypertension, cataracts, avascular necrosis.
-Can cause iatrogenic Cushing syndrome.Clinical use of aldesleukinRenal cell carcinoma, metastatic melanomaClinical use of epoetin alfa (erythropoietin)Anemias (especially in renal failure)Clinical use of interferon-αlphaChronic hepatitis B and C, Kaposi sarcoma, malignant melanomaBevacizumab clinical useColorectal cancer, renal cell carcinomaCetuximab clinical useStage IV colorectal cancer, head and neck cancerRituximab targetCD20Rituximab clinical useB-cell non-Hodgkin lymphoma, CLL, RA, ITPTrastuzumab clinical useBreast cancerAdalimumab, infliximab clinical useIBD, rheumatoid arthritis, ankylosing spondylitis, psoriasisEculizumab clinical useParoxysmal nocturnal hemoglobinuriaNatalizumab clinical useMultiple sclerosis, Crohn diseaseAbciximab clinical useAntiplatelet agent for prevention of ischemic complications in patients undergoing percutaneous coronary interventionDenosumab clinical useOsteoperosis; inhibits osteoclast maturation (mimics osteoprotegerin)Digoxin immune Fab clinical useAntidote for digoxin toxicityPrimary (essential) hypertension therapyThiazide diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), dihydropyridine Ca2+ channel blockers.Hypertension with heart failure therapy-Diuretics, ACE inhibitors/ARBs, β-blockers (compensated HF), aldosterone antagonists.
-β-blockers must be used cautiously in decompensated HF and are contraindicated in cardiogenic shock.Hypertension with diabetes mellitusACE inhibitors/ARBs, Ca2+ channel blockers, thiazide diuretics, β-blockers.
ACE inhibitors/ARBs are protective against diabetic nephropathy.Hypertension in pregnancyHydralazine, lebetalol, methyldopa, nifedipineList the dihydropyridine calcium channel blockersAmlodipine, clevidipine, nicardipine, nifedipine, nimodipine
-Act on vascular smooth muscleList the non-dihydropyridine calcium channel blockersdiltiazem, verapamil
-Act on the heartCalcium channel blockers mechanism-Block voltage-dependent L-type calcium channels of cardiac and smooth muscle to decrease muscle contractility.
-Vascular smooth muscle—amlodipine = nifedipine > diltiazem > verapamil.
-Heart—verapamil > diltiazem > amlodipine = nifedipine (verapamil = ventricle).Dihydropyridine calcium channel blockers clinical useHTN, angina (including Prinzmetal), Raynaud phenomenon.
**NOT nimodipine which is used for subarachnoid hemorrhage to prevent cerebral vasospasm)Nimodipine clinical useUsed in subarachnoid hemorrhage to prevent cerebral vasospasm)Clevidipine clinical useHTN urgency or emergencyNon-dihydropyridine calcium channel blockers clinical useHTN, angina, atrial fib/flutterCalcium channel blocker toxicityCardiac depression, AV block (non-dihydropyridines), peripheral edema, flushing, dizziness, hyperprolactinemia (verapamil), constipation, gingival hyperplasia.Hydralazine mechanismIncrease cGMP causing smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction.Hydralazine clinical use-Severe HTN (particularly acute), HF (with organic nitrate).
-Safe to use in pregnancy.
-Frequently coadministered with a β-blocker to prevent reflex tachycardia.Hydralazine toxicityCompensatory tachycardia (contraindicated in angina/CAD), fluid retention, headache, angina.
Lupus-like syndrome!!!!What drugs can be used in a hypertensive emergency?Clevidipine, fenoldopam, labetalol, nicardipine, nitroprussideNitroprussideShort acting; increase cGMP via direct release of NO. Can cause cyanide toxicity (releases cyanide)List the nitratesNitroglycerin, isosorbide dinitrate, isosorbide mononitrateNitrate mechanism of actionVasodilate by increasing NO in vascular smooth muscle thereby increasing cGMP and smooth muscle relaxation. Dilate veins >> arteries. Reduces preloadNitrate clinical useAngina, acute coronary syndrome, pulmonary edemaNitrate toxicityReflex tachycardia (treat with β-blockers), hypotension, flushing, headache, "Monday disease" in industrial exposure: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend - tachycardia, dizziness, headache upon reexposure.Goal of antianginal therapyGoal is reduction of myocardial O2 consumption (MVO2) by decreasing 1 or more of the determinants of MVO2: end-diastolic volume, BP, HR, contractility.What effect do nitrates have on EDV (end diastolic volume)?DecreasesWhat effect do nitrates have on BP?DecreasesWhat effect do nitrates have on HR?Increase (reflex response)What effect do nitrates have on ejection time?DecreaseWhat effect do nitrates have on MVO2?DecreasedWhat effect do β-blockers have on BP?DecreaseWhat effect do β-blockers have on contractility?DecreaseWhat effect do β-blockers have on HR?DecreaseWhat effect do β-blockers have on ejection time?IncreaseWhat effect do β-blockers have on MVO2 (myocardial volume oxygen concentration)?DecreaseWhat effect does nitrates + β-blockers have on BP?DecreaseAntianginal therapy summary tableLipid lowering agents summary tableLipid lowering agents summary schematicList the HMG-CoA reductase inhibitorsLovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatinHMG-CoA reductase effect on lipid levelsLDL Δ: big time triple decrease!!!
HDL Δ: increase
TG Δ: decreaseHMG-CoA reductase mechanism of actionInhibit conversion of HMG- CoA to mevalonate, a cholesterol precursor;
Decreased mortality in CAD patientsHMG-CoA reductase side effects/problemsHepatotoxicity ( LFTs), myopathy (esp. when used with fibrates or niacin)List the bile acid resinsCholestyramine, colestipol, colesevelamBile acid resin mechanismPrevents intestinal absorption of bile acids; liver must use cholesterol to make moreBile acid resin side effects/problemsGI upset, decrease absorption of other drugs and fat-soluble vitaminsWhat effect does ezetimibe have on lipid levels?LDL Δ: double decrease
HDL Δ: none
TG Δ: noneEzetimibe mechanism of actionPrevents cholesterol absorption at the small intestine brush borderEzetimibe side effects/problemsRare increase in LFTs, diarrheaList the fibratesgemfibrozil, clofibrate, bezafibrate, fenofibrateFibrate effect on lipid levelsLDL Δ: down
HDL Δ: up
TG Δ: TRIPLE DOWN!!!Fibrates mechanism of action-Upregulate LPL causing increase in TG clearance.
-Activates PPAR-α to induce HDL synthesisFibrates side effects/problemsMyopathy (increase risk with statins), cholesterol gallstonesNiacin effect on lipid levelsLDL Δ: double down
HDL Δ: double up
TG Δ: downNiacin mechanism-Inhibits lipolysis (hormone sensitive lipase) in adipose tissue;
-Reduces hepatic VLDL synthesisNiacin side effects/problemsRed, flushed face, which is decreased by NSAIDs or long term use; hyperglycemia, hyperuricemia (gout)Digoxin mechanismDirect inhibition of Na+/K+ ATPase causing indirect inhibition of Na+/Ca2+ exchanger. Increased [Ca2+]i creates positive inotropy. Stimulates vagus nerve to increase HR.Digoxin clinical useHF (increased contractility), atrial fibrillation (decrease conduction at AV node and depression of the SA node)Digoxin toxicity-Cholinergic—nausea, vomiting, diarrhea, blurry yellow vision (think van Gogh), arrhythmias, AV block.
-Can lead to hyperkalemia, which indicates poor prognosis.Factors predisposing to digoxin toxicityRenal failure (decreased excretion), hypokalemia (permissive for digoxin binding at K+-binding site on Na+/K+ ATPase), verapamil, amiodarone, quinidine (digoxin clearance; displaces digoxin from tissue-binding sites).Antidote for Digoxin toxicitySlowly normalize K+, cardiac pacer, anti-digoxin Fab, Mg2+General mechanism of sodium channel blockers (class I antiarrhythmic)-Slow or block conduction (especially in depolarized cells). -Decrease slope of phase 0 depolarization.
-Are state dependent - selectively depress tissue that is frequently depolarized (e.g., tachycardia)List the class IA sodium channel blockersQuinidine, procainamide, disopyramide,Class IA sodium channel blockers effect on action potential-Decreases slope of phase 0
-Increase action potential duration
-Increase effective refractory period
-Increased QT intervalClass IA sodium channel blocker mechanismIncrease action potential duration, increase effective refractory period in ventricular action potential, and increase QTClass IA sodium channel blocker clinical useBoth atrial and ventricular arrhythmias, especially re-entrant and ectopic SVT and VTClass IA sodium channel blocker toxicityCinchonism (headache, tinnitus with quinidine), reversible SLE like syndrome (procainamide), heart failure (disopyramide), thrombocytopenia, torsades de pointes due to increased QTProcainamide toxicitySLE like syndrome (reversible)Quinidine toxicityCinchonism (headache, tinnitus)Disopyramide toxicityHeart failureList the class IB sodium channel blockersLidocaine, mexiletine
Phenytoin can also fall into this categoryClass IB sodium channel blockers effect on action potential-Decreases AP duration
-Decreases slope of phase 0Class IB sodium channel blockers mechanismDecrease AP duration. Preferentially affect ischemic or depolarized Purkinje and ventricular tissue.Class IB sodium channel blockers clinical useAcute ventricular arrhythmias (especially post- MI), digitalis-induced arrhythmias.
(IB is Best post-MI)Class IB sodium channel blockers toxicityCNS stimulation/depression, CV depressionList the class IC sodium channel blockersFlecainide, propafenoneClass IC sodium channel blockers effect on action potential curve-Minimal effect on action potential duration
-Decreases slope of phase 0Class IC sodium channel blockers mechanism-Significantly prolongs ERP in AV node and accessory bypass tracts. No effect on ERP in Purkinje and ventricular tissue.
-Minimal effect on AP durationClass IC sodium channel blockers clinical useSVTs, including atrial fibrillation. Only as a last resort in refractory VT.Class IC sodium channel blockers toxicity-Proarrhythmic, especially post-MI (DO NOT USE POST MI!)
-Contraindicated in structural and ischemic heart diseaseList the key β-blockers (class II antiarrhythmics)Metoprolol, propranolol, esmolol, atenolol, timolol, carvedilolβ-blockers (class II antiarrhythmics) mechanism-Decrease SA and AV nodal activity by decreasing cAMP, and decreasing Ca2+ currents. Suppress abnormal pacemakers by decreasing slope of phase 4.
-AV node particularly sensitive - increase PR interval. Esmolol very short actingWhat is the shortest acting β-blockerEsmololβ-blockers (class II antiarrhythmics) clinical useSVT, ventricular rate control for atrial fibrillation and atrial flutterβ-blockers (class II antiarrhythmics) toxicityImpotence, exacerbation of COPD and asthma, cardiovascular effects (bradycardia, AV block, HF), CNS effects (sedation, sleep alterations). May mask the signs of hypoglycemia.
β-blockers cause unopposed α1-agonism if given alone for pheochromocytoma or cocaine toxicity.Metoprolol side effectsDyslipidemiaPropranolol side effectsMay exacerbate vasospasm in Prinzmetal anginaβ-blockers overdose treatmentSaline, atropine, glucagonList the potassium channel blockers (class III antiarhythmics)Amiodarone, ibutilide, dofetilide, sotalolPotassium channel blockers mechanismIncrease AP duration, increase ERP, increase QT intervalPotassium channel blockers clinical useAtrial fibrillation, atrial flutter; ventricular tachycardia (amiodarone, sotalol)Amiodarone toxicityPulmonary fibrosis, hepatotoxicity, hypothyroidism/hyperthyroidism, act as hapten (corneal deposits, blue/gray skin deposits resulting in photodermatitis), neurologic effects, constipation, CV effects (bradycardia, heart block, HF)Sotalol toxicityTorsades de pointes, excessive β blockade.List the calcium channel blockers (class IV antiarrhythmics)Verapamil, diltiazemCalcium channel blockers effect on the pacemaker cell action potential curve-Slow rise of AP (decrease conduction velocity)
-Increased ERP
-Increased PR interval
-Prolonged repolarization (at AV node)Calcium channel blockers (class IV antiarrhythmics) mechanism-Decrease conduction velocity
-Increase ERP and PR intervalCalcium channel blockers (class IV antiarrhythmics) clinical usePrevention of nodal arrhythmias (e.g. SVT), rate control in atrial fibrillationCalcium channel blockers (class IV antiarrhythmics) toxicityConstipation, flushing, edema, CV effects (HF, AV block, sinus node depression)Adenosine-Antiarrhythmic
-Increase K+ out of cells hyperpolarizing the cell and increasing intracellular Ca2+.
-Drug of choice in diagnosing/abolishing supraventricular tachycardia. Very short acting (~ 15 sec). Effects blunted by theophylline and caffeine (both are adenosine receptor antagonists).What are the adverse effects of adenosine?Adverse effects include flushing, hypotension, chest pain, sense of impending doom, bronchospasm.Mg hydroxideEffective in torsades de pointes and digoxin toxicityTreatment strategy with type 1 DMLow-carb diet and insulin replacementTreatment strategy with type 2 DMDietary modification and exercise for weight loss; oral agents, non-insulin injectables, insulin replacementTreatment strategy for gestational DMDietary modification, exercise, insulin replacement if lifestyle changes failName the rapid acting insulinsAspart, glulisine, lisproRapid acting insulin mechanism-Binds insulin receptor (tyrosine kinase activity)
-Liver: increase glucose stored as glycogen
-Muscle: increase glycogen, protein synthesis; increase K+ uptake
-Fat: increase TG storageRapid acting insulin clinical useType 1 DM, type 2 DM, GDM (postprandial glucose control)Rapid acting insulin toxicityHypoglycemia, rare hypersensitivity reactionShort acting insulin (regular) mechanism-Binds insulin receptor (tyrosine kinase activity)
-Liver: increase glucose stored as glycogen
-Muscle: increase glycogen, protein synthesis; increase K+ uptake
-Fat: increase TG storageShort acting insulin clinical useType 1 DM, type 2 DM, GDM, DKA (IV), hyperkalemia (+ glucose), stress hyperglycemia.Intermediate acting insulin (NPH) clinical useType 1 DM, type 2 DM, GDMName the long acting insulinsDetemir, GlargineLong acting insulin clinical useType 1 DM, type 2 DM, GDM (basal glucose control)Metformin mechanism-Exact mechanism unknown.
-Decrease gluconeogenesis, increase glycolysis, increase peripheral glucose uptake (increase insulin sensitivity).Metformin clinical use-Oral. First line therapy in type 2 DM, causes modest weight loss.
-Can be used in patients without islet functionName the SulfonylureasFirst generation: Chlorpropamide, Tolbutamide
Second generation: Glimepiride, Glipizide, GlyburideSulfonylureas mechanismClose K+ channel in β-cell membrane then cell depolarizes causing insulin release via increased Ca2+ influx.Sulfonylureas clinical useStimulate release of endogenous insulin in type 2 DM. Require some islet function, so useless in type 1 DM.Sulfonylureas toxicityRisk of hypoglycemia in renal failure.
First generation: disulfiram- like effects.
Second generation: hypoglycemia.Glitazones/ thiazolidinediones mechanismIncrease sensitivity in peripheral tissue. Binds to PPAR-γ nuclear transcription regulator.Glitazones/ thiazolidinediones clinical useUsed as monotherapy in type 2 DM or combined with other agentsGlitazones/ thiazolidinediones toxicityWeight gain, edema, hepatotoxicity, HF, increased risk if fracturesPramlintide action-Amylin analog
-Decrease gastric emptying
-Decrease glucagonPramlintide clinical useType 1 and type 2 DMPramlintide toxicityHypoglycemia, nausea, diarrhea.α-glucosidase inhibitorsAcarbose, miglitolα-glucosidase inhibitors action-Inhibit intestinal brush-border α-glucosidases.
-Delayed carbohydrate hydrolysis and glucose absorption leading to decreased postprandial hyperglycemia.α-glucosidase inhibitors clinical use-Used as monotherapy in type 2 diabetes or in combination with other agentsPropylthiouracil, methimazole mechanismBlock thyroid peroxidase, inhibiting the oxidation of iodide and the organification (coupling) of iodine -> inhibition of thyroid hormone synthesis. Propylthiouracil also blocks 5′-deiodinase -> decreased peripheral conversion of T4 to T3.Levothyroxine (T4), triiodothyronine (T3) mechanismHormone replacementLevothyroxine (T4), triiodothyronine (T3) clinical useHypothyroidism, myxedema. Off label use as weight loss supplementsLevothyroxine (T4), triiodothyronine (T3) toxicityTachycardia, heat intolerance, tremors, arrhythmiasOxytocin clinical useStimulates labor, uterine contractions, milk let-down; controls uterine hemorrhageSomatostatin (octeotride) clinical useAcromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varicesDemeclocycline (mechanism, use, and toxicity)-Mechanism: ADH antagonist (member of tetracycline family).
-Use: SIADH.
-Toxicity: Nephrogenic DI, photosensitivity, abnormalities of bone and teeth.Glucocorticoids (the ridiculist)Beclomethasone, dexamethasone, fludrocortisone (mineralocorticoid and glucocorticoid activity), hydrocortisone, methylprednisolone, prednisone, triamcinolone.
Basically anything ending in -sone/loneGlucocorticoids mechanismMetabolic, catabolic, anti-inflammatory, and immunosuppressive effects mediated by interactions with glucocorticoid response elements, inhibition of phospholipase A2, and inhibition of transcription factors such as NF-κB.Glucocorticoids clinical useAddison disease, inflammation, immunosuppression, asthmaGlucocorticoids toxicity-Iatrogenic Cushing syndrome (hypertension, weight gain, moon facies, truncal obesity, buffalo hump, thinning of skin, striae, osteoporosis, hyperglycemia, amenorrhea, immunosuppression), adrenocortical atrophy, peptic ulcers, steroid diabetes, steroid psychosis.
-Adrenal insufficiency when drug stopped abruptly after chronic use.Cinacalcet (mechanism, use, and toxicity)-Mechanism: Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ and thus decreases PTH.
-Use: Hypercalcemia due to 1° or 2° hyperparathyroidism.
-Toxicity: Hypocalcemia.Acid suppression therapy general overview imageList the H2 blockers-Cimetidine, ranitidine, famotidine, nizatidine.
-Take H2 blockers before you "dine". Think "table for 2" to remember H2.H2 blocker mechanismReversible block of histamine H2 receptors decreasing H+ secretion by parietal cellsH2 blocker clinical usePeptic ulcer, gastritis, mild esophageal refluxH2 blocker toxicity-Cimetidine is a potent inhibitor of cytochrome P-450 (multiple drug interactions); it also has antiandrogenic effects (prolactin release, gynecomastia, impotence, decreased libido in males); can cross blood-brain barrier (confusion, dizziness, headaches) and placenta.
-Both cimetidine and ranitidine increase renal excretion of creatinine. Other H2 blockers are relatively free of these effects.Name those proton pump inhibitorsOmeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole.Proton pump inhibitor mechanismIrreversibly inhibits H+/K+ ATPase in stomach parietal cellsPPI usePeptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndromePPI toxicity-Increased risk of C. difficile infection, pneumonia.
-Decreased serum Mg2+ with long term useBismuth, sucralfate mechanismBind to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucus layerBismuth, sucralfate useIncreased ulcer healing, travelers' diarrheaOveruse of aluminum hydroxideCauses constipation and hypophosphatemia; proximal muscle weakness, osteodystrophy, seizuresOveruse of calcium carbonate-Hypercalcemia, rebound acid increase
-Can chelate and decrease effectiveness of other drugsOveruse of magnesium hydroxideDiarrhea, hyporeflexia, HoTN, cardiac arrestOsmotic laxatives (drugs, mechanism, clinical use and toxicity)Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose.
-Mechanism: provide osmotic load to draw water into the GI lumen.
-Use: Constipation. Lactulose also treats hepatic encephalopathy since gut flora degrade it into metabolites (lactic acid and acetic acid) that promote nitrogen excretion as NH4+.
-Toxicity: Diarrhea, dehydration; may be abused by bulimics.Sulfasalazine (mechanism, clinical use and toxicity)-Mechanism: A combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory). Activated by colonic bacteria.
-Use: Ulcerative colitis, Crohn disease (colitis component).
-Toxicity: Malaise, nausea, sulfonamide toxicity, reversible oligospermia.Ondansetron (mechanism, clinical use and toxicity)-Mechanism: 5-HT3 antagonist; decrease vagal stimulation. Powerful central-acting antiemetic.
-Use: Control vomiting postoperatively and in patients undergoing cancer chemotherapy.
-Toxicity: Headache, constipation, QT interval prolongation.Metoclopramide (mechanism, clinical use and toxicity)-Mechanism: D2 receptor antagonist. Increase resting tone, contractility, LES tone, motility. Does not influence colon transport time.
-Use: Diabetic and postsurgery gastroparesis, antiemetic.
-Toxicity: Increased parkinsonian effects, tardive dyskinesia. Restlessness, drowsiness, fatigue, depression, diarrhea. Drug interaction with digoxin and diabetic agents. Contraindicated in patients with small bowel obstruction or Parkinson disease (due to D1-receptor blockade).Orlistat (mechanism, clinical use and toxicity)-Mechanism: Inhibits gastric and pancreatic lipase breakdown and absorption of dietary fats.
-Use: Weight loss.
-Toxicity: Steatorrhea, decreased absorption of fat-soluble vitamins.Heparin mechanismActivator of antithrombin; decrease thrombin and decrease factor Xa. Short half-life.Heparin useImmediate anticoagulation for pulmonary embolism (PE), acute coronary syndrome, MI, deep venous thrombosis (DVT). Used during pregnancy (does not cross placenta). Follow PTT.Heparin toxicityBleeding, thrombocytopenia (HIT), osteoporosis, drug-drug interactions. For rapid reversal (antidote), use protamine sulfate (positively charged molecule that binds negatively charged heparin).What is the heparin toxicity antidote, and how does it work?Protamine sulfate, positively charged molecule that binds negatively charged heparinLow molecular weight heparins (e.g., enoxaparin, dalteparin) and fondaparinuxAct more on factor Xa, have better bioavailability, and 2-4 times longer half-life; can be administered subcutaneously and without laboratory monitoring. Not easily reversibleHeparin-induced thrombocytopenia (HIT)Development of IgG antibodies against heparin- bound platelet factor 4 (PF4). Antibody-heparin-PF4 complex activates platelets leading to thrombosis and thrombocytopenia.Warfarin mechanism-Interferes with γ-carboxylation of vitamin K- dependent clotting factors II, VII, IX, and X, and proteins C and S. -Metabolism affected by polymorphisms in the gene for vitamin K epoxide reductase complex (VKORC1). In laboratory assay, has effect on EXtrinsic pathway and increase PT.
-Long half-life.Warfarin useChronic anticoagulation (e.g., venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation). Not used in pregnant women (because warfarin, unlike heparin, crosses placenta). Follow PT/INR.Warfarin toxicityBleeding, teratogenic, skin/tissue necrosis
A , drug-drug interactions. Proteins C and S
have shorter half-lives than clotting factors
II, VI, IX, and X, resulting in early transient hypercoagulability with warfarin use. Skin/tissue necrosis believed to be due to small vessel microthromboses.
-For reversal of warfarin, give vitamin K.
-For rapid reversal, give fresh frozen plasma.
-Heparin "bridging": heparin frequently used
when starting warfarin. Heparin's activation of antithrombin enables anticoagulation during initial, transient hypercoagulable state caused by warfarin. Initial heparin therapy reduces risk of recurrent venous thromboembolism and skin/tissue necrosis.Reversal of warfarin toxicityVitamin K; for rapid reversal give fresh frozen plasmaWhat coagulation pathway is affected by heparin?PTT (intrinsic pathway)What coagulation pathway is affected by warfarin?PT (extrinsic pathway)Direct factor Xa inhibitors (drugs, mechanism, use, toxicity)Apixaban, rivaroxaban
-Mechanism: bind to and directly inhibit factor Xa.
-Use: treatment and prophylaxis for DVT and PE (rivaroxaban); stroke prophylaxis in patients with atrial fibrillation. Oral agents do not usually require coagulation monitoring.
-Toxicity: bleeding (no reversal agent available).Thrombolytics (drugs, mechanism, use, toxicity)Alteplase (tPA), reteplase (rPA), streptokinase, tenecteplase (TNK-tPA)
-Mechanism: Directly or indirectly aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots. Increase PT, increase PTT, no change in platelet count.
-Use: Early MI, early ischemic stroke, direct thrombolysis of severe PE.
-Toxicity: Bleeding. Contraindicated in patients with active bleeding, history of intracranial bleeding, recent surgery, known bleeding diatheses, or severe hypertension. Treat toxicity with aminocaproic acid, an inhibitor of fibrinolysis. Fresh frozen plasma and cryoprecipitate can also be used to correct factor deficiencies.Aspirin mechanismIrreversibly inhibits cyclooxygenase (both COX-1 and COX-2) enzyme by covalent acetylation. Platelets cannot synthesize new enzyme, so effect lasts until new platelets are produced: increase bleeding time, decrease TXA2 and prostaglandins. No effect on PT or PTT.Aspirin useAntipyretic, analgesic, anti-inflammatory, antiplatelet (decreased aggregation).Aspirin toxicity-Gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding. Reye syndrome in children with viral infection.
-Overdose initially causes hyperventilation and respiratory alkalosis, but transitions to mixed metabolic acidosis-respiratory alkalosis.ADP receptor inhibitors (drugs, mechanism, use, toxicity)Clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine.
-Mechanism: inhibit platelet aggregation by irreversibly blocking ADP receptors. Prevent expression of glycoproteins IIb/IIIa on platelet surface.
-Use: acute coronary syndrome; coronary stenting. Decreased incidence or recurrence of thrombotic stroke
-Toxicity: neutropenia (ticlopidine). TTP may be seen.Cilostazol, dipyridamole (mechanism, use, toxicity)-Mechanism: phosphodiesterase III inhibitor; increase cAMP in platelets, resulting in inhibition of platelet aggregation; vasodilators.
-Use: intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (combined with aspirin), angina prophylaxis.
-Toxicity: nausea, headache, facial flushing, hypotension, abdominal pain.GP IIb/IIIa inhibitors (drugs, mechanism, use, toxicity)Abciximab, eptifibatide, tirofiban
-Mechanism: bind to the glycoprotein receptor IIb/IIIa on activated platelets, preventing aggregation. Abciximab is made from monoclonal antibody Fab fragments.
-Use: unstable angina, percutaneous transluminal coronary angioplasty.
-Toxicity: bleeding, thrombocytopenia.Cancer drugs - cell cycle-G1: alkylating agents (carmustine, cisplatin, lomustine)
-S: antimetabolites (azanthroprine, cladribine, cytarabine, 5-fluouracil, hydroxyurea, methotrexate, 6-MP, 6-thioguanine), also etoposide, teniposide
-G2: bleomycin, etoposide, teniposide
-M: microtubule inhibitors (paclitaxel), vinca alkaloids (vinblastine, vincristine)5-fluorouracil (5-FU) mechanism-Pyrimidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid.
-This complex inhibits thymidylate synthase decreasing dTMP and decreasing DNA synthesis.5-fluorouracil (5-FU) useColon cancer, pancreatic cancer, basal cell carcinoma (topical)5-fluorouracil (5-FU) toxicityMyelosuppression, which is not reversible with leucovorin (folinic acid)Methotrexate (MTX) mechanismFolic acid analog that competitively inhibits dihydrofolate reductase decreasing dTMP and decreasing DNA synthesis.Methotrexate (MTX) use-Cancers: leukemias (ALL), lymphomas, choriocarcinoma, sarcomas.
-Non-neoplastic: ectopic pregnancy, medical abortion (with misoprostol), rheumatoid arthritis, psoriasis, IBD, vasculitis.Methotrexate (MTX) toxicity-Myelosuppression, which is reversible with leucovorin "rescue."
-Hepatotoxicity.
-Mucositis (e.g., mouth ulcers).
-Pulmonary fibrosis.Bleomycin (mechanism, use, toxicity)-Mechanism: induces free radical formation causing breaks in DNA strands.
-Use: testicular cancer, Hodgkin lymphoma.
-Toxicity: Pulmonary fibrosis, skin hyperpigmentation, mucositis, minimal myelosuppression.Dactinomycin/actinomycin D (mechanism, use, toxicity)-Mechanism: intercalates in DNA.
-Use: Wilms tumor, Ewing sarcoma, rhabdomyosarcoma. **Used for childhood tumors ("children act out").
-Toxicity: myelosuppression.Doxorubicin, daunorubicin (mechanism, use, toxicity)-Mechanism: generate free radicals. Intercalate in DNA causing breaks in DNA decreasing replication.
-Use: solid tumors, leukemias, lymphomas.
-Toxicity: cardiotoxicity (dilated cardiomyopathy), myelosuppression, alopecia. Toxic to tissues following extravasation.
Dexrazoxane (iron chelating agent), used to prevent cardiotoxicity.Cyclophosphamide, ifosfamide (mechanism, use, toxicity)-Mechanism: cross-link DNA at guanine N-7. Require bioactivation by liver.
-Use: solid tumors, leukemia, lymphomas.
-Toxicity: myelosuppression; hemorrhagic cystitis, partially prevented with mesna (thiol group of mesna binds toxic metabolites).Nitrosoureas (drugs, mechanism, use, toxicity)Carmustine, lomustine, semustine, streptozocin
-Mechanism: require bioactivation. Cross blood-brain barrier into CNS. Cross-link DNA.
-Use: brain tumors (including glioblastoma multiforme).
-Toxicity: CNS toxicity (convulsions, dizziness, ataxia)Paclitaxel, other taxols (mechanism, use, toxicity)-Mechanism: hyperstabilize polymerized microtubules in M phase so that mitotic spindle cannot break down (anaphase cannot occur). "It is taxing to stay polymerized."
-Use: ovarian and breast carcinomas.
Toxicity: myelosuppression, alopecia, hypersensitivity.Vincristine, vinblastine (mechanism, use, toxicity)-Mechanism: vinca alkaloids that bind β-tubulin and inhibit its polymerization into microtubules preventing mitotic spindle formation (M-phase arrest).
-Use: Solid tumors, leukemias, Hodgkin (vinblastine) and non-Hodgkin (vincristine) lymphomas.
-Toxicity: vincristine: neurotoxicity (areflexia, peripheral neuritis), paralytic ileus. Vinblastine blasts bone marrow (suppression).Hydroxyurea (mechanism, use, toxicity)-Mechanism: inhibits ribonucleotide reductase decreasing DNA Synthesis (S-phase specific).
-Use: melanoma, CML, sickle cell disease ( HbF).
-Toxicity: severe myelosuppression, GI upset.Prednisone, prednisolone (mechanism, use, toxicity)-Mechanism: various; bind intracytoplasmic receptor; alter gene transcription.
-Use: most commonly used glucocorticoids in cancer chemotherapy. Used in CLL, non-Hodgkin lymphoma (part of combination chemotherapy regimen). Also used as immunosuppressants (e.g., in autoimmune diseases).
-Toxicity: Cushing-like symptoms; weight gain, central obesity, muscle breakdown, cataracts, acne, osteoporosis, hypertension, peptic ulcers, hyperglycemia, psychosis.Rituximab (mechanism, use, toxicity)-Mechanism: monoclonal antibody against CD20, which is found on most B-cell neoplasms.
-Use: non-Hodgkin lymphoma, CLL, IBD, rheumatoid arthritis.
Toxicity: increased risk of progressive multifocal leukoencephalopathy.Tamoxifen, raloxifene (mechanism, use, toxicity)-Mechanism: selective estrogen receptor modulators (SERMs)—receptor antagonists in breast and agonists in bone. Block the binding of estrogen to ER ⊕ cells.
-Use: breast cancer treatment (tamoxifen only) and prevention. Raloxifene also useful to prevent osteoporosis.
-Toxicity: tamoxifen—partial agonist in endometrium, which increases the risk of endometrial cancer; "hot flashes." Raloxifene—no increased in endometrial carcinoma because it is an estrogen receptor antagonist in
endometrial tissue.Difference between tamofixen and raloxifene?Tamoxifen has increased risk of endometrial carcinoma whereas raloxifene does not because it is an estrogen receptor antagonist in endometrial tissueAcetaminophen (mechanism, use, toxicity)-Mechanism: reversibly inhibits cyclooxygenase, mostly in CNS. Inactivated peripherally.
-Use: antipyretic, analgesic, but not anti-inflammatory. Used instead of aspirin to avoid Reye syndrome in children with viral infection.
-Toxicity: overdose produces hepatic necrosis; acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic tissue byproducts in liver. N-acetylcysteine is antidote—regenerates glutathione.Aspirin (mechanism, use, toxicity)-Mechanism: irreversibly inhibits cyclooxygenase (both COX-1 and COX-2) via acetylation, which synthesis of TXA2 and prostaglandins. bleeding time. No effect on PT, PTT. A type of NSAID.
-Use: low dose (< 300 mg/day): platelet aggregation. Intermediate dose (300-2400 mg/day): antipyretic and analgesic. High dose (2400-4000 mg/day): anti-inflammatory.
-Toxicity: gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis, GI bleeding. Risk of Reye syndrome in children treated with aspirin for viral infection. Causes respiratory alkalosis early, but transitions to mixed metabolic acidosis-respiratory alkalosis.Celecoxib (mechanism, use, toxicity)-Mechanism: reversibly inhibits specifically the cyclooxygenase (COX) isoform 2, which is found in inflammatory cells and vascular endothelium and mediates inflammation and pain; spares COX-1, which helps maintain gastric mucosa. Thus, does not have the corrosive effects of other NSAIDs on the GI lining. Spares platelet function as TXA2 production is dependent on COX-1.
-Use: rheumatoid arthritis, osteoarthritis.
-Toxicity: increased risk of thrombosis. Sulfa allergy.NSAIDs (drugs, mechanism, use, toxicity)Ibuprofen, naproxen, indomethacin, ketorolac, diclofenac.
-Mechanism: reversibly inhibit cyclooxygenase (both COX-1 and COX-2). Block prostaglandin synthesis.
-Use: antipyretic, analgesic, anti-inflammatory. Indomethacin is used to close a PDA.
-Toxicity: interstitial nephritis, gastric ulcer (prostaglandins protect gastric mucosa), renal ischemia (prostaglandins vasodilate afferent arteriole).Bisphosphonates (drugs, mechanism, use, toxicity)Alendronate, other -dronates.
-Mechanism: pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity.
-Use: osteoporosis, hypercalcemia, Paget disease of bone.
-Toxicity: corrosive esophagitis (patients are advised to take with water and remain upright for 30 minutes), osteonecrosis of jaw.Chronic gout drugsAllopurinol, febuxostat, pegloticase, probenecidAllopurinol-Gout
-Inhibits xanthine oxidase after being converted to alloxanthine, decrease conversion of xanthine to uric acid. Also used in lymphoma and leukemia to prevent tumor lysis-associated urate nephropathy. Increase concentrations of azathioprine and 6-MP (both normally metabolized by xanthine oxidase).Febuxostat-Gout
-Inhibits xanthine oxidasePegloticase-Gout
-Recombinant uricase that catalyze metabolism of uric acid into allantoin (a more water soluble product)ProbenecidInhibits reabsorption of uric acid in proximal convoluted tubule (also inhibits secretion of penicillin). Can precipitate uric acid calculi.Acute gout drugsNSAIDs (naproxen, indomethacin), glucocorticoids, colchicineColchicine-Acute gout
-Binds and stabilizes tubulin to inhibit microtubule polymerization, impairing neutrophil chemotaxis and degranulation.
-Acute and prophylactic value. GI side effects.Etanercept-Mechanism: fusion protein (receptor for TNF-α + IgG1 Fc), produced by recombinant DNA. Etanercept is a TNF decoy receptor.
-Use: rheumatoid arthritis, psoriasis, ankylosing spondylitisInfliximab, adalimumab-Mechanism: anti-TNF-α monoclonal antibody.
-Use: inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriasisGoal of glaucoma drugsDecrease IOP via reducing amount of aqueous humor (inhibit synthesis/secretion or increase drainage)Epinephrine (α1 agonist) as a glaucoma drug-Mechanism: decrease aqueous humor synthesis via vasoconstriction
-Side effects: mydriasis (α1); do not use in closed-angle glaucoma. Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritusBrimonidine (α2 agonist)Decrease aqueous humor synthesisβ-blockers as glaucoma drugs (drugs, mechanism, side-effects)Timolol, betaxolol, carteolol
-Mechanism: decreased aqueous humor synthesis
-Side effects: No pupillary or vision changesAcetazolamide as a glaucoma drug-Mechanism: diuretic; decrease aqueous humor synthesis via inhibition of carbonic anhydrase
-No pupillary or vision changesDirect cholinomimetics as glaucoma drugsPilocarpine, carbachol
-Mechansism: increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
-Use pilocarpine in emergencies—very effective at opening meshwork into canal of Schlemm
-Side effects: miosis and cyclospasm (contraction of ciliary muscle)Indirect cholinomimetics as glaucoma drugsPhysostigmine, echothiophate
-Mechanism: increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
-Side effects: miosis and cyclospasm (contraction of ciliary muscle)Latanoprost as a glaucoma drug-Decrease outflow of aqueous humor
-Side effect: darkens color of iris (browning)Morphine mechanismAct as agonists at opioid receptors (μ = full, κ = full, decreased potency) to modulate synaptic transmission—open K+ channels, close Ca2+ channels decreasing synaptic transmission.Morphine clinical useRelief of Moderate-Severe Acute & Chronic Pain associated with: Cancer, MI (vasodilating properties), Relief of Dyspnea (caused by acute LV failure & pulmonary edema), Preanesthetic MedicationAdverse effects of morphine-CSA Schedule 2 drug
-Behavioral restlessness, tremulousness, hyperactivity, respiratory depression, N/V, ↑intracranial pressure, postural HoTN accentuated by hypovolemia, constipation, urinary retention, itching around nose, urticaria
-CI: concomitant use of full w/ partial agonists (or antagonists), ↓pulmonary function, head injury, pregnancy, impaired hepatic or renal function, endocrine dysfunction
-Drug Interactions: sedative hypnotics, antipsychotics, MOAIsMethadone mechanismFull agonist at μ receptor; NMDA receptor antagonist and MAOIMethadone use-Opioid abuse
-Increasingly Recognized as a useful analgesic (can be used in opioid rotation)Methadone side effects-CSA Schedule 2 drug
-Same as morphine, plus prolonged QT interval, and cardiac arrhythmia.
-CI: ↓metabolism (by drug-drug interaction or impaired hepatic function) ↑risk of respiratory depression & cardiac adverse effects. Potential for drug-drug interaction w/ MAOIs & SSRIs (due to weak inhibition of serotonin reuptake)→ potential for Serotonin SyndromeMeperidine mechanismFull agonist at μ receptor with antimuscarinic effectsMeperidine useNo longer first line analgesic due to high adverse effect profileMeperidine adverse effects-CSA Schedule 2
-Drug-drug interactions w/ MAOIs & SSRIs (due to weak inhibition of serotonin reuptake and/or inhibition of hepatic CYP enzymes)→ Serotonin Syndrome, Coma, Death
-Use w/ MAOIs (or 2 weeks after) is CIFentanyl mechanismFull agonist at μ receptorFentanyl use-One of the Most Used Synthetic Opioids
-Relief of Moderate-Severe Pain
-Anesthetic Adjuvant (Preoperative Analgesia)
-Postoperative or Labor Analgesia (Epidural)
-Chronic Pain (Patch)
-Breakthrough in Cancer pain (Oral Lozenge)Fentanyl adverse effects-CSA Schedule 2
-As for morphine (except histamine release)
-Chest muscle rigidity if infused IV too fast
-CI: As for morphine
-Use w/ MAOIs (or 2 weeks afterwards)Codeine (mechanism, use, adverse effects)-Mechanism: partial agonist at μ receptor; biotransformed into a number of active metabolites: morphine (<10%)
-Use: relief of moderate pain; antitussive in selected patients (at doses much less than needed for analgesia)
-Adverse effects: same as morphineHydrocodone (mechanism, use, adverse effects)-Mechanism: partial agonist at μ receptor; partially biotransformed to hydromorphone
-Use: in combination w/ acetaminophen for relief of mild-moderate pain (MC prescribed generic drug); antitussive in selected patients (doses are ↓than needed for analgesia)→ in combination w/ Guaifenesin or other drugs
-Adverse effects: same as morphineNaloxone (mechanism, use, adverse effects)-Mechanism: antagonist at all opioid receptor sites
-Use: treatment of acute opioid overdose; low dose treatment for adverse effects of opioid agonist delivered IV or epidural
-Adverse effects: can precipitate withdrawal syndrome in individuals already receiving full agonists (particularly in dependent users)
-CI: pregnancy→ crosses placenta, can precipitate withdrawal in fetusNaltrexone (mechanism, use, adverse effects)-Mechanism: antagonist at all opioid receptors
-Use: alcohol dependence treatment; maintenance treatment to prevent relapse in opioid dependent patients.
-Adverse effects: multiple effects including CNS, hepatic & injection site effects; can precipitate withdrawal syndrome in individuals already receiving full agonists (particularly in dependent users)
-CI: narcotic dependence or current use of opioid analgesics; compromised liver functionTramadol (mechanism, use, adverse effects)-Mechanism: inhibition of serotonin & NE reuptake (main mechanism); μ receptors (partial agonist)→ analgesic effect only partially inhibited by naloxone
-Use: mild to moderate pain; chronic neuropathic pain (can be insensitive to opioids)
-Adverse effects: as for morphine except - ↓respiratory depression than equivalent doses of morphine, ↓constipation, precipitation of withdrawal on abrupt discontinuation (tapered withdrawal recommended)
CI: As for morphine; patients w/ Hx of opioid abuse/addiction (can reinitiate dependence). Avoid using w/ MAOIs & SSRIs (drug-drug interaction)→ Serotonin SyndromeButorphanol (mechanism, use, toxicity)-Mechanism: κ-opioid receptor agonist and μ-opioid receptor partial agonist; produces analgesia.
-Use: severe pain (e.g., migraine, labor). Causes less respiratory depression than full opioid agonists.
-Toxicity: can cause opioid withdrawal symptoms if patient is also taking full opioid agonist (competition for opioid receptors). Overdose not easily reversed with naloxone.Ethosuximide (mechanism, use, side effects)-Mechanism: blocks thalamic T-type Ca2+ channels
-Use: Absence seizures (Sux to have Silent (absence) Seizures)
-Side effects: *Stevens-Johnson syndrome*, GI, fatigue, headache, urticaria,Benzodiazepines as anti-epileptic (diazepam, lorazepam)(mechanism, use, side effects)-Mechanism: increase GABA-A action
-Use: first line for acute status epilepticus. Also for eclampsia seizures (1st line is MgSO4)
-Adverse effects: sedation, tolerance, dependence, respiratory depressionPhenytoin (mechanism, use, side effects)-Mechanism: Increase Na+ channel inactivation, zero order kinetics
-Use: all seizure types except for absence; first line tonic-clonic; first line prophylaxis for status epilepticus
-Adverse effects: gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome), SLE-like syndrome, induction of cytochrome P-450, lymphadenopathy, *Stevens- Johnson syndrome*, osteopeniaCarbamazepine (mechanism, use, side effects)-Mechanism: increase Na+ channel inactivation
-Use: first line for simple, complex, and tonic-clonic seizures. 1st line for trigeminal neuralgia
-Side effects: blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of cytochrome P-450, SIADH, *Stevens-Johnson syndrome*Valproic acid/valproate (mechanism, use, side effects)-Mechanism: increase Na+ channel inactivation, increase GABA concentration by inhibiting GABA transaminase; action at the T-type Ca2+ channels
-Use: all seizure types except for status epilepticus; first line for tonic-clonic; also used for myoclonic seizures; bipolar disorder
-Adverse effect: GI, distress, rare but fatal hepatotoxicity (measure LFTs), neural tube defects (e.g., spina bifida), tremor, weight gain, contraindicated in pregnancyGabapentin (mechanism, use, side effects)-Mechanism: primarily inhibits high- voltage-activated Ca2+ channels; designed as GABA analog
-Use: partial (focal) seizures - simple and complex. Also used for peripheral neuropathy, postherpetic neuralgia
-Adverse effects: sedation and ataxiaPhenobarbital (mechanism, use, side effects)-Mechanism: increased GABA-A receptor action (keeps receptor open longer)
-Use: simple, complex, and tonic-clonic seizures; 1st line in neonates
-Adverse effects: sedation, tolerance, dependence, induction of cytochrome P-450, cardiorespiratory depressionTopiramate (mechanism, use, side effects)-Mechanism: blocks Na+ channels, increases GABA action
-Use: simple, complex, and tonic-clonic seizures; also used for migraine prevention
-Adverse effects: sedation, mental dulling, kidney stones, weight lossWhat is Stevens-Johnson syndrome and which epilepsy drugs can cause it?-SJ syndrome is a prodrome of malaise and fever followed by a rapid onset of erythematous/purpuric macules (oral, ocular, genital). Skin lesions progress to epidermal necrosis and sloughing
-Drugs that can cause this horrific motha ****a: lamotragine, carbamazepine, phenytoin, ethosuximide (Stephen Johnson's LAMe CAR SUX PHENis)Drugs for simple seizure-Carbamazepine is 1st choice
-All other epilepsy drugs can be used except for ethosuxamide and the benzodiazepinesDrugs for complex seizure-Carbamazepine is 1st choice
-All other epilepsy drugs can be used except for ethosuxamide and the benzodiazepinesDrugs for tonic-clonic seizure-Carbamazepine, valproate, and phenytoin are 1st choice
-Phenobarbital, lamotragine, topiramate, and levetiracetam can all be used 2nd lineDrugs for absence seizures-Ethosuxamide is 1st line
-Lamotragine and valproate may also be usedDrugs for status epilepticus-Benzodiazepines (diazepam, lorazepam) are first line for acute
-Phenytoin is first line prophylaxisBarbiturates (drugs, mechanism, use, toxicity)Phenobarbital, pentobarbital, thiopental, secobarbital
-Mechanism: facilitate GABA-A action by increasing duration of Cl− channel opening, thus decreasing neuron firing (barbidurates increase duration). Contraindicated in porphyria.
-Use:sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental).
-Toxicity: respiratory and cardiovascular depression (can be fatal); CNS depression (can be exacerbated by EtOH use); dependence; drug interactions (induces cytochrome P-450). Overdose treatment is supportive (assist respiration and maintain BP).Benzodiazepines (drugs, mechanism, use, toxicity)Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam
-Mechanism: Facilitate GABA-A action by increasinf the frequency of Cl− channel opening. Decrease REM sleep. Most have long half-lives and active metabolites (exceptions: Alprazolam, Triazolam, Oxazepam, and Midazolam are short acting higher addictive potential)
-Use: anxiety, spasticity, status epilepticus (lorazepam and diazepam), detoxification (especially alcohol withdrawal-DTs), night terrors, sleepwalking, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia)
-Toxicity: dependence, additive CNS depression effects with alcohol. Less risk of respiratory depression and coma than with barbiturates. Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor)Nonbenzodiazepine hypnotics (drugs, mechanism, use, toxicity)Zolpidem, Zaleplon, esZopiclone. "All ZZZs put you to sleep."
-Mechanism: act at BZI subtype of the GABA receptor;
-Use: insomnia
-Toxicity: ataxia, headaches, confusion. Short duration because of rapid metabolism by liver enzymes. Unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnestic effects. Decreased dependence risk than benzodiazepines.Which benzos are used in the elderly?Lorazepam, oxazepam, temazepam
"The elderly like Benzos a LOT"Flumazenil (mechanism, use, toxicity)-Mechanism: : competitive BZ receptor antagonist that can block the effects of BZ and any drug that binds to the BZ site, including the Z drugs. Does not block effects of other sedative hypnotics: alcohol, barbiturates or buspirone
-Use: antidote to excessive BZ intake
-Toxicity: noneBuspirone (mechanism, use, toxicity)-Mechanism: partial agonist at 5-HT 1A, acts as agonist when 5-HT is low and an antagonist when 5-HT is high; onset of action takes 1-2 weeks; doesn't produce sedation, confusion, mental clouding; doesn't enhance alcohol or other CNS depressants
-Use: reduce cognitive aspects of worry and poor concentration; helps in depression with anxiety; useful with CBT; anxiety in ADHD; alleviates aches, cramps, fatigue, pain, and sexual dysfunction due to GAD
-Toxicity: no abuse liability
-CI: MAOIsZolpidem (mechanism, use, toxicity)-Mechanism: selective agonist at GABA-A α1-site; shortens sleep latency, prolongs sleep time; onset w/in 30 minutes; extended release available→ 7 hours of sleep; T ½: 2-4 hours; greater in hepatic insufficiency & the elderly
-Use: approved for bedtime use to sleep through the night, especially if one has lots of awakenings; can try to fall asleep & then use after not falling asleep for 30 min. (don't use in the middle of the night b/c you'll be drowsy if you don't get 7 hours); should taper off for 5 weeks
-Tolerance and dependance rareRamelteon (mechanism, use, toxicity)-Mechanism: melatonin agonist (MT1 & 2); shortens sleep latency
-Use: may be used in the elderly, ICU & those who travel
-No bad side effects, tolerance or dependencyDrugs with solubility in blood =Rapid induction and recovery times.Drugs with solubility in lipids =increased potency = 1 / MAC (minimal alveolar concentation) of inhaled anestheticMAC (minimal alveolar concentration)-Minimal Alveolar Concentration (of inhaled anesthetic) required to prevent 50% of subjects from moving in response to noxious stimulus (e.g., skin incision).
-Examples: nitrous oxide (N2O) has blood and lipid solubility, and thus fast induction and low potency. Halothane, in contrast, has lipid and blood solubility, and thus high potency and slow induction.Inhaled anesthetics (drugs, mechanism, use, toxicity)Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, N2O
-Mechanism: unknown.
-Use: myocardial depression, respiratory depression, nausea/emesis, cerebral blood flow ( cerebral metabolic demand).
-Toxicity: hepatotoxicity (halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), expansion of trapped gas in a body cavity (N2O). *Can cause malignant hyperthermia—rare, life-threatening hereditary condition in which inhaled anesthetics (except N2O) and succinylcholine induce fever and severe muscle contractions. Treatment: dantrolene.Most common drug used for endoscopy?Midazolam; used adjunctively with gaseous anesthetics and narcotics. May cause severe postoperative respiratory depression, BP (treat overdose with flumazenil), anterograde amnesia.Arylcyclohexylamines (Ketamine)PCP analogs that act as dissociative anesthetics. Block NMDA receptors. Cardiovascular stimulants. Cause disorientation, hallucination, bad dreams. cerebral blood flow.PropofolUsed for sedation in ICU, rapid anesthesia induction, short procedures. Less postoperative nausea than thiopental. Potentiates GABA-AEsters (local anesthetics)Procaine, cocaine, tetracaineAmides (local anesthetics)Lidocaine, mepIvacaIne, bupIvacaIne
(amIdes have 2 I's in name)Local anesthetics mechanismBlock Na+ channels by binding to specific receptors on inner portion of channel. Preferentially bind to activated Na+ channels, so most effective in rapidly firing neurons. 3° amine local anesthetics penetrate membrane in uncharged form, then bind to ion channels as charged formWhy give a local anesthetic with vasoconstrictors?Enhance local action - decrease bleeding, increase anesthesia by decreasing systemic concentrationOrder of loss with local anesthetic1. pain 2. temp 3. touch 4. pressureClinical use of local anestheticsMinor surgical procedures, spinal anesthesia. If allergic to esters, give amidesLocal anesthetic toxicityCNS excitation, severe cardiovascular toxicity (bupivacaine), hypertension, hypotension, arrhythmias (cocaine), methemoglobinemia (benzocaine).Neuromuscular blocking drugsMuscle paralysis in surgery or mechanical ventilation. Selective for motor (vs. autonomic) nicotinic receptor.Depolarizing neuromuscular blocking drugsSuccinylcholine—strong ACh receptor agonist; produces sustained depolarization and prevents muscle contractionComplications of depolarizing neuromuscular blocking drugsComplications include hypercalcemia, hyperkalemia, malignant hyperthermia.Nondepolarizing neuromuscular blocking drugsTubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium—competitive antagonists—compete with ACh for receptors.Nondepolarizing neuromuscular blocking drugs blockade reversalNeostigmine (must be given with atropine to prevent muscarinic effects such as bradycardia), edrophonium, and other cholinesterase inhibitors.Dantrolene-Mechanism: prevents release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle.
-Use: malignant hyperthermia and neuroleptic malignant syndrome (a toxicity of antipsychotic drugs).Baclofen-Mechanism: inhibits GABA-B receptors at spinal cord level, inducing skeletal muscle relaxation.
-Use: muscle spasms (e.g., acute low back pain).Cyclobenzaprine-Mechanism: centrally acting skeletal muscle relaxant. Structurally related to TCAs, similar anticholinergic side effects.
-Use: muscle spasmsDopamine agonistsErgot—Bromocriptine
Non-ergot (preferred)—pramipexole, ropiniroleAmantadine-Mechanism: increase dopamine release and decrease dopamine reuptake)
-Use: Parkinson disease; also used as an antiviral against influenza A and rubella
-Toxicity: ataxia, livedo reticularisLevodopa (L-dopa)/carbidopa-Mechanism: carbidopa blocks peripheral conversion of L-DOPA to dopamine by inhibiting DOPA decarboxylase. Also reduces side effects of peripheral L-dopa conversion into dopamine (e.g., nausea, vomiting).
-Use: Parkinson disease therapySelegiline-Mechanism: blocks conversion of dopamine
by selectively inhibiting MAO-B.
-Use: Parkinson disease therapyTolcapone-Mechanism: blocks conversion of dopamine to DOPAC by inhibiting central COMT
-Use: Parkinson disease therapyBenztropine-Mechanism: antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia
-Use: Parkinson disease therapyl-dopa (levodopa)/carbidopa-Mechanism: increase level of dopamine in brain. Unlike dopamine, l-dopa can cross blood-brain barrier and is converted by dopa decarboxylase in the CNS to dopamine. Carbidopa, a peripheral DOPA decarboxylase inhibitor, is given with l-dopa to the bioavailability of l-dopa in the brain and to limit peripheral side effects.
-Use: Parkinson disease.
-Toxicity: arrhythmias from peripheral formation of catecholamines. Long-term use can lead to dyskinesia following administration ("on-off" phenomenon), akinesia between doses.Memantine-Mechanism: NMDA receptor antagonist; helps prevent excitotoxicity (mediated by Ca2+).
-Use: Alzheimer disease
-Toxicity: dizziness, confusion, hallucinationsDonepezil, galantamine, rivastigmine-Mechanism: AChE inhibitors
-Use: Alzheimer disease
-Toxicity: nausea, dizziness, insomniaTreatment of Huntington disease-Neurotransmitter changes in Huntington disease: decrease GABA, decrease ACh, increase dopamine.
-Treatments: 1. tetrabenazine and reserpine—inhibit vesicular monoamine transporter (VMAT); limit dopamine vesicle packaging and release; 2. haloperidol—D2 receptor antagonist.Sumatriptan-Mechanism: Inhibit trigeminal nerve activation; prevent vasoactive peptide release; induce vasoconstriction.
-Use: acute migraine, cluster headache attack
-Toxicity: Coronary vasospasm (contraindicated in patients with CAD or Prinzmetal angina), mild paresthesia.Nonspecific depressant withdrawalAnxiety, tremor, seizures, insomniaAlcohol intoxicationEmotional lability, slurred speech, ataxia, coma, blackouts. Serum γ-glutamyltransferase (GGT)—sensitive indicator of alcohol use. AST value is twice ALT value.Alcohol withdrawalMild alcohol withdrawal: symptoms similar to other depressants. Severe alcohol withdrawal can cause autonomic hyperactivity and DTs (5-15% mortality rate). Treatment for DTs: benzodiazepines.Opioids (e.g., morphine, heroin, methadone) intoxicationEuphoria, respiratory and CNS depression,
gag reflex, pupillary constriction (pinpoint pupils), seizures (overdose).
Treatment: naloxone, naltrexone.Opioids (e.g., morphine, heroin, methadone) withdrawalSweating, dilated pupils, piloerection ("cold turkey"), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea ("flu-like" symptoms). Treatment: long-term support, methadone, buprenorphine.Barbiturates intoxicationLow safety margin, marked respiratory depression. Treatment: symptom management (e.g., assist respiration, BP).Barbiturates withdrawalDelirium, life-threatening cardiovascular collapse.Benzodiazepines intoxication-Greater safety margin that barbiturates; ataxia, minor respiratory depression.
-Treatment: flumazenil (benzodiazepine receptor antagonist, but rarely used as it can precipitate seizures).Benzodiazepines withdrawalSleep disturbance, depression, rebound anxiety, seizureNonspecific stimulant intoxicationMood elevation, psychomotor agitation, insomnia, cardiac arrhythmias, tachycardia, anxiety.Nonspecific stimulant withdrawalpost-use "crash," including depression, lethargy, weight gain, headacheAmphetamines intoxicationEuphoria, grandiosity, pupillary dilation, prolonged wakefulness and attention, hypertension, tachycardia, anorexia, paranoia, fever. Severe: cardiac arrest, seizureAmphetamines withdrawalAnhedonia, appetite, hypersomnolence, existential crisis.Cocaine intoxicationImpaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. Treatment: α-blockers, benzodiazepines. β-blockers not recommended.Cocaine withdrawalHypersomnolence, malaise, severe psychological craving, depression/suicidality.Caffeine intoxicationRestlessness, increase diuresis, muscle twitchingCaffeine withdrawalLack of concentration, headacheNicotine intoxicationRestlessnessNicotine withdrawalIrritability, anxiety, craving. Treatment: nicotine patch, gum, or lozenges; bupropion/ vareniclinePCP intoxicationBelligerence, impulsivity, fever, psychomotor agitation, analgesia, vertical and horizontal nystagmus, tachycardia, homicidality, psychosis, delirium, seizures. Treatment: benzodiazepines, rapid-acting antipsychoticPCP withdrawalDepression, anxiety, irritability, restlessness, anergia, disturbances of thought and sleep.Marijuana withdrawalIrritability, depression, insomnia, nausea, anorexia. Most symptoms peak in 48 hours and last for 5-7 days. Generally detectable in urine for up to 1 month.DOC for ADHDStimulants (e.g. methylphenidate)DOC for alcohol withdrawalLong-acting benzodiazepine (e.g. chlordiazepoxide, lorazepam, diazepam)DOC for bipolar disorderLithium, valproic acid, atypical antipsychoticsDOC for bulimiaSSRIsDOC for depressionSSRIsDOC for generalized anxiety disorderSSRIs, SNRIsDOC for OCDSSRIs, clomipramineDOC for panic disorderSSRIs, venlafaxine, benzodiazepinesDOC for PTSDSSRIs, venlafaxineDOC for schizophreniaAtypical antipsychoticsDOC for social phobiasSSRIs, β-blockersDOC for Tourette syndromeAntipsychotics(e.g. fluphenazine, pimozide), tetrabenazine, clonidineMethylphenidate-Mechanism: ↑dopamine & NE tone by blocking their reuptake & facilitating their release;
-Use: ADHD; narcolepsyAmphetamine-Mechanism: ↑dopamine & NE tone by blocking their reuptake & facilitating their release
-Use: ADHD; improves attention, concentration, execution, wakefulness, hyperactivityGuanfacine-Mechanism: works like clonidine→ CNS postsynaptic α-2A receptor agonist; ↑noradrenergic effects directly; phenobarbitol & phenytoin may ↓plasma levels
-Use: improves attention, concentration, execution, wakefulness, hyperactivity; often used when too activated or oppositional→ tics, emotional outbursts
-Toxicity: -Somnolence, headache, fatigue, upper abdominal pain, sedation, HoTN, dry mouth & constipation
-CI: don't use w/ other sedative drugs, caution w/ drug inducers & inhibitorsList the typical (neuroleptics) antipsychoticsHaloperidol, trifluoperazine, fluphenazine, thioridazine, chlorpromazine (haloperidol + "-azines")Typical antipsychotic mechanismAll typical antipsychotics block dopamine D2 receptors ( [cAMP])Typical antipsychotic useSchizophrenia (primarily positive symptoms), psychosis, acute mania, Tourette syndromeTypical antipsychotic toxicity-Highly lipid soluble and stored in body fat; thus, very slow to be removed from body.
-Extrapyramidal system side effects (e.g., dyskinesias). Treatment: benztropine or diphenhydramine.
-Endocrine side effects (e.g., dopamine receptor antagonism hyperprolactinemia galactorrhea).
-Side effects arising from blocking muscarinic (dry mouth, constipation), α1 (hypotension), and histamine (sedation) receptors.
-Can cause QT prolongation.High potency typical antipsychoticsTrifluoperazine, fluphenazine, haloperidol
"Try to Fly through the Halo"Side effects of high potency typical antipsychotics-Neurologic side effects (e.g. Huntington disease, delirium, EPS symptoms)Low potency typical antipsychoticsChlorpromazine, thioridazineSide effects of low potency typical antipsychoticsNon-neurologic side effects (anticholinergic, antihistamine, and α1-blockade effects).Side effect of chlorpromazineCorneal depositsSide effect of thioridazineReTinal depositsSide effect of haloperidolNMS, tardive dyskinesiaEvolution of EPS side effects-4 hr acute dystonia (muscle spasm, stiffness,
oculogyric crisis)
-4 day akathisia (restlessness)
-4 wk bradykinesia (parkinsonism)
-4 mo tardive dyskinesiaNeuroleptic malignant syndrome (NMS)Rigidity, myoglobinuria, autonomic instability, hyperpyrexia.
Treatment: dantrolene, D2 agonists (e.g., bromocriptine).For NMS, think FEVERFever
Encephalopathy
Vitals unstable
Enzymes up
Rigidity of musclesTardive dyskinesiastereotypic oral- facial movements as a result of long-term antipsychotic use.List the atypical antipsychoticsOlanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidoneAtypical antipsychotics mechanismNot completely understood. Varied effects on 5-HT2, dopamine, and α- and H1-receptorsAtypical antipsychotics useSchizophrenia—both positive and negative symptoms. Also used for bipolar disorder, OCD, anxiety disorder, depression, mania, Tourette syndrome.Atypical antipsychotic toxicity-Fewer extrapyramidal and anticholinergic side effects than traditional antipsychotics.
-Olanzapine/clozapine may cause significant weight gain. --Clozapine may cause agranulocytosis (requires weekly WBC monitoring) and seizure.
-Risperidone may increase prolactin (causing lactation and gynecomastia) decreasing GnRH, LH, and FSH (causing irregular menstruation and fertility issues).
-All may prolong QT interval.Lithium mechanism-Mechanism: not established; possibly related to inhibition of phosphoinositol cascade.Lithium useMood stabilizer for bipolar disorder; blocks relapse and acute manic events. Also SIADH.Lithium toxicity-Tremor, hypothyroidism, polyuria (causes nephrogenic diabetes insipidus), teratogenesis.
-Causes Ebstein anomaly in newborn if taken by pregnant mother.
-Narrow therapeutic window requires close monitoring of serum levels.
-Almost exclusively excreted by kidneys; most is reabsorbed at PCT with Na+. Thiazide use is implicated in lithium toxicity in bipolar patients.Buspirone-Mechanism: stimulates 5-HT1A receptors.
-Use: generalized anxiety disorder. Does not cause sedation, addiction, or tolerance. Takes 1-2 weeks to take effect. Does not interact with alcohol (vs. barbiturates, benzodiazepines).Antidepressants schematicSSRIsFluoxetine, paroxetine, sertraline, citalopram.SSRIs mechanism5-HT-specific reuptake inhibitors.SSRIs use-Depression, generalized anxiety disorder, panic disorder, OCD, bulimia, social phobias, PTSD.SSRIs toxicityFewer than TCAs. GI distress, SIADH, sexual dysfunction (anorgasmia, decreased libido).Serotonin syndromeWith any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).How long does it take for antidepressants to have an effect?It normally takes 4-8 weeks for antidepressants
to have an effectSNRIsVenlafaxine, duloxetineSNRIs mechanismInhibit 5-HT and norepinephrine reuptake.SNRIs useDepression. Venlafaxine is also used in generalized anxiety disorder, panic disorder, PTSD. Duloxetine is also indicated for diabetic peripheral neuropathySNRIs toxicityIncrease BP most common; also stimulant effects, sedation, nausea.Tricyclic antidepressantsAmitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine.Tricyclic antidepressants mechanism, use, and toxicity-Mechanism: block reuptake of norepinephrine and 5-HT.
-Use: major depression, OCD (clomipramine), peripheral neuropathy, chronic pain, migraine prophylaxis.
-Toxicity: sedation, α1-blocking effects including postural hypotension, and atropine-like (anticholinergic) side effects (tachycardia, urinary retention, dry mouth). 3° TCAs (amitriptyline) have more anticholinergic effects than 2° TCAs (nortriptyline). Can prolong QT interval.
-Tri-C's: Convulsions, Coma, Cardiotoxicity (arrhythmias); also respiratory depression, hyperpyrexia. Confusion and hallucinations in elderly due to anticholinergic side effects (use nortriptyline). Treatment: NaHCO3 to prevent arrhythmia.Monoamine oxidase (MAO) inhibitors (drugs, mechanism, use, toxicity)Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selective MAO-B inhibitor)
-Mechanism: nonselective MAO inhibition increases levels of amine neurotransmitters (norepinephrine, 5-HT, dopamine).
-Use: atypical depression, anxiety.
-Toxicity: hypertensive crisis (most notably with ingestion of tyramine, which is found in many foods such as wine and cheese); CNS stimulation.
-Contraindicated with SSRIs, TCAs, St. John's wort, meperidine, dextromethorphan (to prevent serotonin syndrome).Bupropion (use, mechanism, toxicity)-Use: Depression; also used for smoking cessation and ADHD.
-Mechanism: increase norepinephrine and dopamine via unknown mechanism.
-Toxicity: stimulant effects (tachycardia, insomnia), headache, seizures in anorexic/bulimic patients. No sexual side effects.Mirtazapine (use, mechanism, toxicity)-Use: depression
-Mechanism: α2-antagonist (increase release of norepinephrine and 5-HT) and potent 5-HT2 and 5-HT3 receptor antagonist.
-Toxicity: sedation (which may be desirable in depressed patients with insomnia), increase appetite, weight gain (which may be desirable in elderly or anorexic patients), dry mouth.Trazodone-Mechanism: primarily blocks 5-HT2 and α1-adrenergic receptors.
-Used primarily for insomnia, as high doses are needed for antidepressant effects.
-Toxicity: sedation, nausea, priapism, postural hypotension. Called trazobone due to male-specific side effects.Diuretics: sites of action schematicMannitol (mechanism, use, toxicity)-Mechanism: osmotic diuretic; increase tubular fluid osmolarity - increase urine flow, decreasing intracranial/intraocular pressure.
-Use: drug overdose, elevated intracranial/intraocular pressure.
-Toxicity: pulmonary edema, dehydration. Contraindicated in anuria, HF.Acetazolamide (mechanism, use, toxicity)-Mechanism: carbonic anhydrase inhibitor. Causes self- limited NaHCO3 diuresis and decreased total body HCO3− stores.
-Use: glaucoma, urinary alkalinization, metabolic alkalosis, altitude sickness, pseudotumor cerebri.
-Toxicity: hyperchloremic metabolic acidosis, paresthesias, NH3 toxicity, sulfa allergy.Loop diuretics (drugs, mechanism, use, toxicity)Furosemide, bumetanide, torsemide
-Mechanism: sulfonamide loop diuretics. Inhibit cotransport system (Na+/K+/2Cl−) of thick ascending limb of loop of Henle. Abolish hypertonicity of medulla, preventing concentration of urine. Stimulate PGE release (vasodilatory effect on afferent arteriole); inhibited by NSAIDs. Increase Ca2+ excretion. Loops Lose Ca2+.
-Use: edematous states (HF, cirrhosis, nephrotic syndrome, pulmonary edema), hypertension, hypercalcemia.
-Toxicity: ototoxicity, hypokalemia, dehydration, allergy (sulfa), nephritis (interstitial), gout.Ethacrynic acid (mechanism, use, toxicity)-Mechanism: phenoxyacetic acid derivative (not a sulfonamide). Essentially same action as furosemide.
-Use: diuresis in patients allergic to sulfa drugs.
-Toxicity: similar to furosemide; can cause hyperuricemia; never use to treat goutThiazide diuretics (drugs, mechanism, use, toxicity)Chlorthalidone, hydrochlorothiazide.
-Mechanism: inhibit NaCl reabsorption in early DCT decreasing diluting capacity of nephron. Decreased Ca2+ excretion.
-Use: hypertension, HF, idiopathic hypercalciuria, nephrogenic diabetes insipidus, osteoporosis.
-Toxicity: hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia. Sulfa allergy.K+-sparing diuretics (drugs, mechanism, use, toxicity)Spironolactone and eplerenone; Triamterene, and Amiloride.
-Mechanism: spironolactone and eplerenone are competitive aldosterone receptor antagonists in cortical collecting tubule. Triamterene and amiloride act at the same part of the tubule by blocking Na+ channels in the cortical collecting tubule.
-Use: hyperaldosteronism, K+ depletion, HF.
-Toxicity: hyperkalemia (can lead to arrhythmias), endocrine effects with spironolactone (e.g., gynecomastia, antiandrogen effects).Urine NaCl changes with diuretic therapyIncrease with all diuretics except acetazolamide. Serum NaCl may decrease as a resultUrine K+ changes with diuretic therapyIncrease with loop and thiazide diuretics. Serum K+ may decrease as a result.Diuretics that decrease blood pH (acidemia)Carbonic anhydrase inhibitors: decrease HCO3− reabsorption. K+ sparing: aldosterone blockade prevents K+ secretion and H+ secretion. Additionally, hyperkalemia leads to K+ entering all cells (via H+/K+ exchanger) in exchange for H+ exiting cells.Diuretics that increase blood pH (alkalemia)Loop diuretics and thiazides cause alkalemia through several mechanisms:
-Volume contraction increase AT II increasing Na+/H+ exchange in PCT increasing HCO3− reabsorption ("contraction alkalosis")
-K+ loss leads to K+ exiting all cells (via H+/K+ exchanger) in exchange for H+ entering cells
-In low K+ state, H+ (rather than K+) is exchanged for Na+ in cortical collecting tubule causing alkalosis and "paradoxical aciduria"Urine Ca2+ changes with diuretic therapy-Increase with loop diuretics: decrease paracellular Ca2+ reabsorption causing hypocalcemia
-Decreases with thiazides: enhanced Ca2+ reabsorption in DCTACE inhibitors (drugs, mechanism, use, toxicity)Captopril, enalapril, lisinopril, ramipril
-Mechanism: inhibit ACE -> decrease AT II -> decrease GFR by preventing constriction of efferent arterioles. Levels of renin increase as a result of loss of feedback inhibition. Inhibition of ACE also prevents inactivation of bradykinin, a potent vasodilator.
-Use: hypertension, HF, proteinuria, diabetic nephropathy. Prevent unfavorable heart remodeling as a result of chronic hypertension. In diabetic nephropathy, intraglomerular pressure, slowing GBM thickening
-Toxicity: cough, Angioedema (contraindicated in C1 esterase inhibitor deficiency), Teratogen (fetal renal malformations), increased Creatinine (decreased GFR), Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further decrease GFR causing renal failure.Angiotensin II receptor blockers (ARBs) (drugs, mechanism, use, toxicity)Losartan, candesartan, valsartan
-Mechanism: selectively block binding of angiotensin II to AT1 receptor. Effects similar to ACE inhibitors, but ARBs do not increase bradykinin.
-Use: hypertension, HF, proteinuria, or diabetic nephropathy with intolerance to ACE inhibitors (e.g., cough, angioedema).
-Toxicity: hyperkalemia, decreased renal function, hypotension; teratogen.Aliskiren (mechanism, use, toxicity)-Mechanism: direct renin inhibitor, blocks conversion of angiotensinogen to angiotensin I.
-Use: hypertension
-Toxicity: hyperkalemia, decreased renal function, hypotension.
-Contraindicated in diabetics taking ACE inhibitors or ARBs.Leuprolide (mechanism, use, toxicity)-Mechanism: GnRH analog with agonist properties
when used in pulsatile fashion; antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary causing decreased FSH/LH).
-Use: infertility (pulsatile), prostate cancer (continuous use following androgen receptor blockade with flutamide), uterine fibroids (continuous), precocious puberty (continuous).
-Toxicity: antiandrogen, nausea, vomiting.Estrogens (ethinyl estradiol, DES, mestranol) (mechanism, use, toxicity)-Mechanism: bind estrogen receptors.
-Use: hypogonadism or ovarian failure, menstrual abnormalities, hormone replacement therapy in postmenopausal women; use in men with androgen-dependent prostate cancer.
-Toxicity: increased risk of endometrial cancer, bleeding in postmenopausal women, clear cell adenocarcinoma of vagina in females exposed to DES in utero, increased risk of thrombi.
-Contraindications—ER ⊕ breast cancer, history of DVTsClomiphene (mechanism, use, toxicity)-Mechanism: antagonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and
release of LH and FSH from pituitary, which stimulates ovulation.
-Use: to treat infertility due to anovulation (e.g., PCOS). ----Toxicity: may cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances.Tamoxifen (mechanism, use, toxicity)-Mechanism: antagonist at breast; agonist at bone, uterus;
-Used to treat and prevent recurrence of ER/PR ⊕ breast cancer;
-Increased risk of thromboembolic events and endometrial cancer (as opposed to raloxifine)Raloxifene (mechanism, use, toxicity)-Mechanism: antagonist at breast, uterus; agonist at bone; -Use: primarily to treat osteoporosis
-Increased risk of thromboembolic events but no increased risk of endometrial cancer (vs. tamoxifen);Hormone replacement therapy-Used for relief or prevention of menopausal symptoms (e.g., hot flashes, vaginal atrophy), osteoporosis (increased estrogen, decreased osteoclast activity).
-Unopposed estrogen replacement therapy increases risk of endometrial cancer, so progesterone is added. Possible increased cardiovascular risk.Progestins (mechanism, use)-Mechanism: bind progesterone receptors, decrease growth and increase vascularization of the endometrium
-Used in oral contraceptives and to treat endometrial cancer, abnormal uterine bleeding.Oral contraception (synthetic progestins, estrogen)-Estrogen and progestins inhibit LH/FSH and thus prevent estrogen surge. No estrogen surge, then no LH surge then no ovulation.
-Progestins cause thickening of cervical mucus, thereby limiting access of sperm to uterus. Progestins also inhibit endometrial proliferation -> endometrium is less suitable to the implantation of an embryo.
-Contraindications: smokers > 35 years old (increased risk of cardiovascular events), patients with history of thromboembolism and stroke or history of estrogen-dependent tumor.Terbutaline, ritodrineβ2-agonists that relax the uterus; used to contraction frequency in women during labor.Danazol (mechanism, use, toxicity)-Mechanism: synthetic androgen that acts as partial agonist at androgen receptors.
-Use: endometriosis, hereditary angioedema.
-Toxicity: weight gain, edema, acne, hirsutism, masculinization, decreased HDL levels, hepatotoxicity.Testosterone, methyltestosterone (mechanism, use, toxicity)-Mechanism: agonists at androgen receptors.
-Use: treats hypogonadism and promotes development of 2° sex characteristics; stimulation of anabolism to promote recovery after burn or injury.
-Toxicity: causes masculinization in females; decreased intratesticular testosterone in males by inhibiting release of LH (via negative feedback) causing gonadal atrophy. Premature closure of epiphyseal plates. Increased LDL, decreased HDL.Finasteride-A 5α-reductase inhibitor ( conversion of testosterone to DHT).
-Useful in BPH and male-pattern baldnessFlutamide-A nonsteroidal competitive inhibitor at androgen receptors.
-Used for prostate carcinoma.KetoconazoleInhibits steroid synthesis (inhibits 17,20-desmolase)SpironolactoneInhibits steroid binding, 17α-hydroxylase, and 17,20-desmolase.Use and side effects of ketoconazole and spironolactoneKetoconazole and spironolactone are used to treat polycystic ovarian syndrome to reduce androgenic symptoms. Both have side effects of gynecomastia and amenorrheaTamsulosinα1-antagonist used to treat BPH by inhibiting smooth muscle contraction. Selective for α1A,D receptors (found on prostate) vs. vascular α1B receptorsSildenafil, vardenafil, tadalafil (mechanism, use, toxicity)-Mechanism: inhibit PDE-5 increasing cGMP, smooth muscle relaxation in corpus cavernosum, increase blood flow, penile erection. "Sildenafil, vardenafil, and tadalafil fill the penis"
-Use: erectile dysfunction.
-Toxicity: headache, flushing, dyspepsia, cyanopsia (blue-tinted vision). Risk of life-threatening hypotension in patients taking nitrate**Minoxidil-Mechanism: direct arteriolar vasodilator
-Use: androgenetic alopecia; severe refractory hypertension1st generation H1 blockersDiphenhydramine, dimenhydrinate, chlorpheniramine1st generation H1 blockers mechanism, use, and toxicity-Mechanism: reversible inhibitors of H1 histamine receptors.
-Use: allergy, motion sickness, sleep aid.
-Toxicity: sedation, antimuscarinic, anti-α-adrenergic.2nd generation H1 blockersLoratadine, fexofenadine, desloratadine, cetirizine2nd generation H1 blockers mechanism, use, and toxicity-Mechanism: reversible inhibitors of H1 histamine receptors.
-Use: Allergy.
-Toxicity: far less sedating than 1st generation because of decreased entry into CNS.GuaifenesinExpectorant—thins respiratory secretions; does not suppress cough reflex.N-acetylcysteineMucolytic—can loosen mucous plugs in CF patients by disrupting disulfide bonds. Also used as an antidote for acetaminophen overdose.Dextromethorphan-Antitussive (antagonizes NMDA glutamate receptors).
-Synthetic codeine analog. Has mild opioid effect when used in excess.
-Naloxone can be given for overdose. Mild abuse potential. -May cause serotonin syndrome if combined with other serotonergic agentsPseudoephedrine, phenylephrine (mechanism, use, toxicity)-Mechanism: α-adrenergic agonists, used as nasal decongestants.
-Use: reduce hyperemia, edema, nasal congestion; open obstructed eustachian tubes. Pseudoephedrine
also illicitly used to make methamphetamine.
-Toxicity: hypertension. Can also cause CNS stimulation/anxiety (pseudoephedrine).Endothelin receptor antagonists-Pulmonary hypertension therapy
-Include bosentan.
-Competitively antagonize endothelin-1 receptors decreasing pulmonary vascular resistance.
-Hepatotoxic (monitor LFTs)Bronchoconstriction is mediated by(1) inflammatory processes and (2) parasympathetic tone; therapy is directed at these 2 pathwaysAlbuterol-β2-agonists
-Relaxes bronchial smooth muscle (β2).
-Used during acute exacerbationSalmeterol, formoterol-β2-agonists
-Long-acting agents for prophylaxis.
-Adverse effects are tremor and arrhythmia.Fluticasone, budesonide-Corticosteroids
-Inhibit the synthesis of virtually all cytokines. Inactivate NF-κB, the transcription factor that induces production of TNF-α and other inflammatory agents. 1st-line therapy for chronic asthma.Ipratropium-Muscarinic antagonist
-Competitively blocks muscarinic receptors, preventing bronchoconstriction. Also used for COPD. Tiotropium is long acting.Montelukast, zafirlukast-Antileukotrienes
-Block leukotriene receptors (CysLT1).
-Especially good for aspirin-induced asthma.Theophylline-Methylxanthine
-Likely causes bronchodilation by inhibiting phosphodiesterase increasing cAMP levels due to decreased cAMP hydrolysis.
-Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrome P-450.
-Blocks actions of adenosine.Methacholine-Muscarinic receptor (M3) agonist.
-Used in bronchial challenge test to help diagnose asthma.Pathophysiology of ADHD-may be caused by a dysregulation of seratonin, norepinephrine, and dopamine.
-occurs primarily <age7.
-3 to 7 times more common in boysADHD S&S-inattentiveness
-inability to concentrate
-restlessness (fidgety)
-hyperactivity
-inability to complete tasks
-impulsivityS&S of Narcolepsy-falling asleep during normal waking hours
-sleep paralysis (muscle paralysis)
-unable to move
-collapseAmphetamine & -Like (MoA, use, adverse effects, contraindications, example)MoA-modulation of seratonergic pathways occurs by affecting changes in dopamine transport.
USE-hyperactivity caused by ADHD, increase attention-span, and control narcolepsy
AR-tachycardia, HTN, seizures, growth suppression, transient wt loss in children, blurred vision, irritability, tremors, dry mouth, euphoria, headache, n/v, dizziness.
CI-glaucoma, tourettes, anxiety, hyperthyroidism, psychosis, depression
INTERACTS-decrease anti-htn effects, barbituates, increase oral anti-coag effects, anti-convulsants, and TCA's, Increase hypertensive crisis with MAOI's, caffeine may increase effects
EX-Methylphenidate (Ritalin), Modafinil (Provigil)Amphetamine & -Like Nursing Process-assess for contraindications
-monitor for SE's;report abnormals
-
-take before meals
-avoid alcohol
-use sugarless gum to relieve dry mouth
-monitor wt q2w
-do not abruptly d/c drug
-read OTC drug labels
-report tachycardia/palpitations
-
-monitor children for tourettesAnorexiantsMoA-stimulant effect on hypothalamic and limbic region of the brain.
USE-suppress appetite, wt loss, obesity
AR-headache, dry mouth, hypokalemia, erectile dysfunction, dysgeusia, hypoglycemia, tremors, suicidal ideation, euphoria, dysphoria
CI-under age 12, heart failure, glaucoma, within 14days of MAOI therapy
-------caution in diabetes, psychosis, renal impairment
EX-NaltrexoneAnorexiants Nursing Process-emphasize nutritious diet, exercise, and behavior modification.
-don't rely on appetite suppressants.
-for short-term use
-Long term use frequently results in severe SE's nervousness, restlessness, irritability, insomnia, palpitations, HTN.Phenothiazines (typical anti-psychotic, anti-cholinergic)MoA-D2 dopamine antagonist
USE-schizophrenia, depression with psychotic features
AR-short term: extrapyramidal effect, dystonia, parkinsonion, resting tremor, akathisia
long term: tardive dyskinesia, agranulocytosis, neuroleptic syndrome
EX-chlorpromazine, perphenazine, thioridazine, fluphenazineAtypical Anti-Psychotics (Benzodiazepines)MoA-long acting, increase the action of the neurotransmitter GABA to GABA receptors
AR-bradycardia
EX-Lorazepam
TEACH
-avoid alcohol
-avoid smokingFDAWhich regulatory agency in the U. S. must approve a drug before it can be marketed, determines if a drug is safe and effective, and determines whether a drug should be OTC or require a prescription?DEAWhat branch of the Department of Justice requires all persons dealing with drugs to register annually to obtain a permit number in order to manufacture or prescribe controlled drugs that have a potential for abuse?FDAWhich regulatory agency has jurisdiction over the advertising of most drugs?Schedule IDrugs with the highest potential for abuse are found in which schedule?Schedule VDrugs with the lowest potential for abuse are found in which schedule?Heroin, LSD (Ecstacy)Give two examples of drugs found in Schedule I:Oxycodone, hydrocodone, morphine, methadoneGive four examples of drugs found in Schedule II:NONEHow many refills can a prescription for a Schedule II drug be given?Only in emergency situationsCan a prescription for a Schedule II drug be called in?FDAWhat regulatory agency regulates the labeling and advertising of prescription drugs?U.S. Adoptive Names CouncilWho determines the generic name for a drug?tramadol (Ultram), diazepam (Valium)Give two examples of a Schedule IV drug:ADAThe Council on Dental Therapeutics is part of what larger organization?SubscriptionOn a prescription, this is directions to the pharmacist:TranscriptionOn a prescription, this is directions to the patient:SignaOn a prescription, this is dosage information:2 yearsIf a dentist gives a patient a controlled substance, such as Percocet, how long must they maintain records of this?YesCan a prescription for a Schedule III drug be called in?6 months (5 months + prescription)How many refills can you write for a Schedule III drug?within 6 monthsHow long can you wait before you fill your prescription for a Schedule III drug?Vicodin, Lorcet, LortabName three Brand names for hydrocodone with acetaminophen:Opioid (narcotic), analgesic combinationWhat is the pharmacologic category for hydrocodone with acetaminophen?Relief of severe painWhat is hydrocodone commonly used for?Xerostomia, drowsiness, constipation, respiratory depressionName 4 common side effects of narcotic analgesics such as hydrocodone?Muscle pain, abdominal pain, joint pain, possible liver damageWhat are 4 major side effects of taking Lipitor?Prinivil, ZestrilWhat are the common Trade Names for lisinopril?ACE Inhibitor (Angiotensin-Converting Enzyme)What is the pharmacologic category for lisinopril?HypertensionWhat is the most common use of ACE Inhibitors such as lisinopril?atorvasatinWhat is the generic name for Lipitor?antilipemic agentWhat pharmacologic category is Lipitor?High cholesterolWhat is the major use for Lipitor?xerostomiaWhat is the major contraindication for the use of narcotic analgesics?Orthostatic hypotension, NSAID diminishes effectsWhat are 2 common side effects of ACE Inhibitors?TenorminWhat is the common Trade Name for the drug atenolol?Beta-1 selective blockerWhat is the pharmacologic category for atenolol?Treatment of hypertension, angina pectorisWhat are beta blockers most commonly used for?Bradycardia, hypotensionName two common side effects of beta blockers:levothyroxineWhat is the generic name for the drug Synthroid?Thyroid productWhat is the pharmacologic category for Synthroid?HypothyroidismWhat is Synthroid commonly used for?PharmacologyThe study of drugs and there effects on organisms.MedicineDrug used to diagnose, treat, or prevent disease.pharmacotherapeuticsUse of drug to treat different disease states.pharmacodynamicsWhat the drug does to the body and its function (Mechanism of Action)pharmacokineticsWhat the body does to the drug to break it down and get rid of it.toxicologyThe Study of the harmful effects of drugs.generic nameThe official name of a drug that will never change.LiverThe primary site of drug metabolism.Effective dose 50What is the dose that produces a desired response in 50% of the subjects?Time response curveWhat indicates the frequency that a drug should be taken?GreaterThe _____ the Therapeutic Index, the safer the drug.betterThe more lipid soluble a drug is, the ______ it is absorbed.PoorlyThe more ionized a drug is, the more _____poorly it is absorbed.Receptor sitesDrugs exert an effect by binding to ________ on a cell membrane or within a cell.Yes, but only one at a time.Can more than one drug fit into a receptor site?AgonistIf a drug binds to a receptor site and increases the function of the cell, it is called an _______.AntagonistIf a drug binds to a receptor site and decreases the function of the cell, it is called an ______.Active Transport and Passive TransportWhat are two ways drugs are transported into a cell?Hepatic Microsomal enzymes of the liverMost drugs are metabolized by the ______.Lethal Dose 50 divided by Effective Dose 50How is Therapeutic Index calculated?Lipid soluble, Non-Ionized, Neutral or slightly alkalineWhich of the following drugs generally are easily absorbed into cells?EfficacyWhat is the term which has to do with the "Effectiveness" of a drug, efficacy or potency?DoseThe ___ is the amount of a drug that is necessary to produce the desired response.The amount of a drug necessary to produce a desired effect in 50% of the people who take the drug.What is the Effective Dose 50 (ED50)?Dose response curveThe curve that allows us to determine how much of a drug is needed to reach the ceiling effect.Time response curveThe curve that allows us to determine how often a drug needs to be taken in order to maintain the ceiling effect.Ceiling effectThe point at which increasing the dose of a drug no longer increases the effect of the drug is referred to as _____.MorphineWhich of the following drugs has the greatest efficacy in relieving severe pain, aspirin or morphine?Therapeutic effectThe intended effect of a drug.Adverse effectsAffects that are caused by a drug, other than the intended effects.TeratogenicAdverse effects on the fetuspredictableAdverse/side effects are normally _____.Onset of a drugTime required for the drug to produce its therapeutic effectDuration of a drugLength of time a drug produces its therapeutic effectHalf-lifeTime required fir the concentration of a drug in the blood stream to be reduced by 50%.Five half-lives______ are normally required for a drug to be eliminated from the body.Active transport_______ requires and energy source and moves from an area of low concentration to high concentration.Passive transport____ requires no energy and moves from and area of high concentration to low concentration.PotencyDetermined by the amount of a drug that is required to produce the desired effect.PotentiationOne drug HELPS another drug produce its desired effect without producing the effect itself.Rate of excretion of a drugOn what is the duration of action dependent?Beta lactamWhat type of antibiotic is amoxicillin?thiazide diureticWhat pharmacologic category does hydrochlorothazide belong to?HypertensionWhat is the drug hydrochlorothiazide used for?macrolide antibioticWhat pharmacologic category does azithromycin belong to?Zithromax, Z-PakGive two common Trade names for Azithromycin:Moxatag, Amoxil, TrimoxWhat are three common Trade names for Amoxicillin:LasixWhat is the common Trade name for furosemide?Loop DiureticWhat pharmacologic category does the drug furosemide belong to?Calcium Channel BlockerWhat pharmacologic category does Norvasc belong to?amlodipineWhat is the generic name for Norvasc?hypertensionWhat are loop diuretics such as furosemide commonly used for?gingival hyperplasiaWhat is the most common side effect for taking Calcium Channel Blockers that effects the oral cavity?Hypertension and angina pectorisWhat is the most common usage for Calcium channel blockers?Sympathetic Nervous SystemSpeeds the heart, slow SLUDParasympathetic Nervous SystemSlows the heart, speeds SLUDSomatic Nervous systemThe ______ deals with skeletal muscles.Somatic Nervous systemWe can control our _______.AdrenergicSympatheticCholinergicParasympatheticGlycogenolysisconversion of glucogen to glucosemydriasisdilation of pupilsmyosisconstriction of pupilsepinephrineis equal to adrenalineA trade name is protected by a federal patent for how long?20 yearsHow long does it take for the patent of the original drug expires, and other companies can market the same compound under a generic name?17 yearsin 1984, congress passed the Drug Price Competition and Patent Term restoration act what did what?allows generic drugs to receive expedited approval. The FDA still requires that the active ingredient of the generic product enter the bloodstream at the same rate as the trade name product.True/false, you capitalize the generic name?False, the Trade name only.True/False, there are many generic brands of the same trade name?False, Many trade names only one generic name.True/false there are 6 schedules of controlled substances.False, 5.What would Heroin be schedule as?1, highest abuse potential. No accepted medical use; experimental use, only in research.what is schedule 2 handling procedures?written prescription with providers;signature only; no refills.what is schedule 3 handling procedures?abuse potential is moderate. Examples Codeine mixtures. Prescriptions may be telephoned; no more than five prescriptions in 6 months.what is schedule 4 handling procedures?less abuse potential. valium, darvon. prescriptions may be telephoned; no more than five in 6 months.what is schedule 5 handling procedures?least, some codeine-containing cough syrups. Can be bought OTC in some states.PRNas required , if needed.qeveryhhourbidtwice a daytidthree times a daysigwritetabtabletudas directed (think you direct)POby mouth.pcafter mealsacBefore mealsWhen the two formulations produce similar concentrations of the drug in blood and tissues, they are termedbiologically equivalent.When two formulations of a drug meet the chemical and physical standards established by the regulatory agenciesChemically equivalentWhen the two formulations prove to have an equal therapeutic effect in a clinical trial,therapeutically equivalent.Heading on a prescription pad requires?name, address, and telephone number of the prescribe. same of patient. date of prescription.the body of a prescription requires?the RX symbol. name and dose size or concentration of the drug. amount to be dispensed. directions to the patient.In the case of tablets and capsules, the word "dispense" is ofter replaced with #. however when writing prescriptions for opioids or other controlled substances what also should be written in parentheses next to the number?the written out form of the number to prevent people from adding 1's or 0's.The closing should include?prescribers's signatures. DEA number. and refill instructions.In order for a dentist to prescribe medicine two conditions must be met?1 patient of record. 2 Dental condition.where have people searched for active components in drugs?plants, animals, minerals, and soil. today organic synthetic chemistry researchers are responsible primarily for developing new drugs.The effect of a drug exerts on biologic systems can be related to-quantitatively to the dose of the drug given.Potency-a function of the amount of the drug required to produce an effect.Efficacyis the maximal intensity of effect or response that can be produced by a drug.administering more drug will _______ the efficacy.will not increase the efficacy. but can often increase the probability of an adverse reaction.Are the efficacy and the potency of a drug related?nopeDrugs elicit pharmacological effects after they have been distributed totheir sites of action.Drugs can not impart what to an organism?A new function. They either produce the same action as an endogenous agent, or lock the action of an endogenous agent.Usually a specific drug will bind with any receptor in a lock-and key fashion. true false?False. only one key for each lock.Drugs compete for the same receptor sites. The ones that win are considered what?The drug with the stronger affinity will win. they are also more potent than drugs with weaker affinity.and Agonist drug is?has affinity for the receptor, combines with the receptor and produces an effect.antagonist drug?counteracts the action of the agonist.phramacokinetics?the study of how a drug enters the body, circulates within the body, is changed by the body and leave the body.ADMEabsorption, distribution, metabolism, excretion.Membranes made of lipids are relatively impermeable to ions and polar molecules? T/Ftrue.The less ionized the molecule is the easier it is to transverse the membrane?true.The Ph of tissues at the site of administration and dissociation characteristics of the drug will determine?the amount of drug in the ionized and nonionized state.when the Ph at the site increases?the hydrogen ion concentration falls. This means the ionized form cannot easily penetrate tissues.when the PH at the site decreases?the hydrogen ion concentration will rise. this results in an increase in the un-ionized form, what can more easily penetrate tissues.weak acids are better absorbed when the Ph is _____ than the PkalessWeak bases are better absorbed when the ph is _____ than the pkaGreaterPKathe percent the drug is 50/50 nonionized to ionized.in the presence of Infection, the acidity of the tissue...increases (the ph decreases), and the effect of local anesthetics decreases.For a pill taken orally, there are four stages.Disruption: initial disruption of coating or shell.
disintegration; contents must break apart
dispersion; particles must spread
dissolution; drug must be dissolved in GI fluid.Drugs that are the least soluble will have the __________duration of action.longestDistribution is determined by what factors?size of the organ, blood flow to the organ, solubility of the drug. plasma protein-binding capacity. presence of barriers.When the half-life is short, the duration of action is?short.most drugs are metabolized in the?liverif redistribution occurs between specific sties and nonspecific sites, a drugs action will be terminated? true falseyeah true.What is a drug that is concentrated in the Gingival crevicular fluid?Tetracycline.onsetthe time required for the drug to begin to have its effect.duration;the length of a drugs effect.routes can be classified as Enteral or parenteral. define the two.drugs given by the enteral route are placed directly into the GI tract by oral or rectal administration. Paraenteral route bypasses the gi tract and includes injection routes, inhalation, and topical administration.What type of administration is considered safest, least expensive, and most convenient?suppository....kidding, oral administration.Advantage of parenteral route?injection results in fast absorption, which produces a rapid onset and more predictable response than oral administration.What route is the fastest drug response?intravenous route.What drug commonly uses subcutaneous route?insulinwhat test is commonly intradermal route?Tuberculin skin test.what is the most common type of excretion of drugs?renal excretionNo drug is free from producing what?Adverse effects.Toxic reaction-an extension of the phramacologic effect resulting from a drugs effect on the target organs. (the amount of the desired effect is excessive)Side effect-a dose related reaction that is not part of the desired therapeutic outcome. The drug acts on nontraget organs to produce an undesirable effectDrug allergy:an immunologic response to a drug resulting in a reaction such as a rash or anaphylaxis. SPECIAL NOTE THIS IS NEITHER PREDICTABLE NOR DOSE RELATED.How many pregnancy categories are there?they are A, B,C,D, and Xpenicillin erythromycin, acetaminophen and LA are considered safe? true/falsetrueTetracycline, non-steroidal anti inflammatory agents, benzodiazepines, and metronidazole are safe for pregnancy's?falseeffects of local reactions?irritation pain, and tissue necrosis at the site of injection.A person is having anaphylatic shock. this is a what type of reaction?Type 1. it is mediated by the immunoglobulin E (IGE) antibodies. binding to histamine, leukotrienes, and prostoglandin are released, producing vasodilation, edema and inflammation.A person is suffering Anemia due to penicillin. what type of reaction is this?Type 2.(cytotoxic/cytolytic) complement dependent reaction involving either immunoglobiulin G or M antibodies. The antigen-antibody complex is fixed to a circulating red blood cell, resulting in lysis.a person is suffering from a fever, arthritis, joint pain. the patient had started taking sulfonamides, this could be?type 3 (immune complex/arthus/serum sickness) Mediated by IgG antibodies. the drug antigen antibody complex fixes complement and deposits int he vascular endothelium.a person is wearing a cheap watch, their skin breaks out underneath the watch, this is called a what?Type 4 (delayed hypersensitivity) mediated by the sensitized T lymphocytes. when the cell contacts the antigen, an inflammatory reaction is produced by lymphokines, neutrophils, and macrophages. contact dermatitis is typical.idiosyncrasy.a reaction that is neither the drugs side effect nor an allergic reaction. caused by genetric abnormal reactions.what is a problem with Long term systematic administration of corticosteroids?its a example of a drug that can result in decreased resistance to infection with prolong use.What is the median lethal does? LD50the dose that kills 50% of experimental animals.The median effect dose?ED 50is the dose required to produce a specified intensity of effect in 50% of the animalsthe ratio LD50/ED50 isthe therapeutic index TI of a drug..If the value of the TI is small, then toxicity is _________ likelyMorea TI of greater than ___ is usually needed to produce a therapeutically useful drug.10The autonomic nervous system functions as an automatic modulating system. what are some examples it affects?regulation of blood pressure, heart rate, gastrointestinal tract motility, salivary gland secretions, and bronchial smooth muscle.the autonomic nervous system is divided in two called?SANS and PANS. each division has afferent (sensory) fibers, and efferent motor preganglionic and post ganglionic.the space between the preganglionic and the post ganglionic fibers is called the ?synapseCell bodies in CNS give rise to preganglionic fibers of the ___parasympathetic divisionThe parasympathetic division originates in the nuclei of cranial nerves?3,7,9 ,10 and sacral segments of the spinal cord.Pans. postganglionic fibers, originate in ganglia, they are usually _____ and ________ on the innervated tissueshort and TerminateSans. - cell bodies that give origin to the preganglionic fibers of the sans span from....the thoracic T1 to the lumber L2 portion of the spinal cordThe adrenal medulla is innervated by ?sympathetic preganglionic fibers. when the sans in stimulated, the adrenal medulla releases primarily epinephrine. and norepinephrine.Pans is concerned with:conservation of body processes. both digestion and intestinal tract motility are greatly influenced by the pansSans: is designed foremergencies, the fight or flight response.SANS does what to pupil size?increases. called mydriasisthe Pans does what to pupil size?constrict. called myosisacteylcholine is a neurotransmitter. nerves that release this are called?cholinergicbecause the postsynaptic tissue responds to muscarine, it is called?muscarinic found in poisonous mushrooms, and decaying fishSans: Ne is the transmitter released by the postganglionic nerves. this is called :adrenergicwhat are the four functions divided in the ANS drugs?1. a drug that stimulates the Pans is called P+ (cholinergic or parasympathomimetic)
2. a drug that blocks Pans is called P- ( anticholinegeric, parasympatholytic, or cholinergic blockers)
3. a drug that stimulates the Sans is called S+ (sympathomimetic or adrenergic)
a drug that blocks the SANS is called S- (adrenergic blockers, sympathetic blockers, or sympatholytic)What is the Principal mediator in the PANS?acetylcholinecholinergic agents are classified by two ways?direct acting (acts on receptor) or indirect acting (causes release of neurotransmitter)Direct acting Cholinergic agent includes?choline derivatives and pilocarpine.Indirect acting parasympathomimetic agents act by?inhibiting the enzyme cholinesterase.How does cholinergic drugs effect the cardiovascular?decrease in cardiac output. relaxation and vasodilation. the indirect effect is an increase in heart rate and cardiac output. because the effects are opposite, the effect will depend on concentration of drug. generally causes bradycardia and decrease BP and cardiac outputhow does Cholinergic effect the GI?excites the smooth muscle. increases activity.How do cholinergic effect the eyes?produces miosis (contraction) and cycloplegia (loss of accommodation) useful in the treatment of glaucoma.Define SLUDSalivation,lacrimation, urination, and defecation. seen in large dose toxic effects of Cholinergic drugs.Patients who should not recieve cholinergic drugs?people who are suffering from : peptic ulcer, myasthenia gravis, severe cardiac disease, gi obstruction, hyperthyroidism.What cholinergic drug is used to treat Xerostomia?pilocarpine (salagen).how are anticholinergic drugs used in dentistry?reduce the flow and volume of exocrine secretions to decrease salivation and create a dry field.anticholinergic effects on smooth muscle?they relax the muscles in respiratory and GI tracts. Think asthma medication for the trachea and spasmolytic agents are used to reduce GI motility.anticholinergic effects on the eye?causes dilation of pupil.anticholinergic drugs effect on cardiovascular?large doses causes vagal blockade, resulting in tachycardia. small does causes bradycardia.nonopioids-also called non narcotic, periheral, mild and antipyretic analgesicsopioids,narcotic, central, or strong analgesics.nonopioids primarily affect the-peripheral nerve endings . although their antipyretic effect is mediated centrally.what does old aspirin smell like?vinegar due to the acetic acid breakdown.aspirin's mechanism of action?analgesic (pain), antipyretic (fever reducer), antiinflammatory, and antiplatelet (anti aggregated) is due to its ability to inhibit prostaglandin synthesis.aspirin is a zero-order kinetics, which means?the rate of metabolism remains constant over time. the same amount of drug metabolized per unit of time regardless of does.which drug is Reye's syndrome associated with?aspirin.what are the drug pharmacologic effects for NSAIDS?analgesic, antipyretic and antiinflammatory.Which drug binds irreversibly to platelets, which drug binds reversibly?aspirin irreversibly, and NSAIDS reversibly.what is acetaminophen's pharmacological effects?analgesic and antipyretic. it is not a anti inflammatory. can be poisonous to the liver.ChlorthalidoneThiazide diuretic
- low K+, slight xerostomia, oral ulcerations
- NSAIDs potentially decrease diuretic effectivenessHydrochlorothiazideThiazide diuretic
- low K+, slight xerostomia, oral ulcerations
- NSAIDs potentially decrease diuretic effectivenessBumetanideLoop diuretic
-Dehydration, low K+, oral lesions, most significant xerostomia
- NSAIDs potentially decrease diuretic effectivenessFurosemideLoop diuretic
-Dehydration, low K+, oral lesions, most significant xerostomia
- NSAIDs potentially decrease diuretic effectivenessAmilorideK+ sparing diureticSpironolactoneK+ sparing diureticTriamtereneK+ sparing diureticBenazaprilACE inhibitor (-pril)
-HA, dizziness, hypotension, loss of taste, oral ulcers, cough, orofacial angioedema, scalded mouth syndrome
-NSAIDs potentially decrease effectiveness, caution with position change, watch for hyperkalemiaEnalaprilACE inhibitor (-pril)
-HA, dizziness, hypotension, loss of taste, oral ulcers, cough, orofacial angioedema, scalded mouth syndrome
-NSAIDs potentially decrease effectiveness, caution with position change, watch for hyperkalemiaLisinoprilACE inhibitor (-pril)
-HA, dizziness, hypotension, loss of taste, oral ulcers, cough, orofacial angioedema, scalded mouth syndrome
-NSAIDs potentially decrease effectiveness, caution with position change, watch for hyperkalemiaRamiprilACE inhibitor (-pril)
-HA, dizziness, hypotension, loss of taste, oral ulcers, cough, orofacial angioedema, scalded mouth syndrome
-NSAIDs potentially decrease effectiveness, caution with position change, watch for hyperkalemiaIrbesartanARB (-sartan)LosartanARB (-sartan)ValsartanARB (-sartan)amlodipineCCB
-gingival overgrowth, position change, drug intx including the potentially fatal intx with diltiazem/verapamil and macrolidesDiltiazemCCB
-gingival overgrowth, position change, drug intx including the potentially fatal intx with diltiazem/verapamil and macrolidesNifedipineCCB
-gingival overgrowth, position change, drug intx including the potentially fatal intx with diltiazem/verapamil and macrolidesVerapamilCCB
- gingival overgrowth, position change, drug intx including the potentially fatal intx with diltiazem/verapamil and macrolidesAtenololbeta-blocker (+, selective beta-1)
- Can use up to 0.2mg epic with + agents.
- NSAIDs may reduce effectiveness, may cause xerostomiaBisoprololbeta-blocker (+, selective beta-1)
- Can use up to 0.2mg epic with + agents.
- NSAIDs may reduce effectiveness, may cause xerostomiaCarvedilolbeta-blocker (+++ beta and alpha-1)
- +++ agents used for HF so disease limits epi to 0.04mg
- NSAIDs may reduce effectiveness, may cause xerostomiaMetoprololbeta-blocker (+, selective beta-1)
- Can use up to 0.2mg epic with + agents.
- NSAIDs may reduce effectiveness, may cause xerostomiaNadololbeta-blocker (++, non-selective beta-1 and beta-2
- Limit epi to 0.04mg with ++ agents
- NSAIDs may reduce effectiveness, may cause xerostomiaPropranololbeta-blocker (++, non-selective beta-1 and beta-2
- Limit epi to 0.04mg with ++ agents
- NSAIDs may reduce effectiveness, may cause xerostomiaDoxazosinAlpha blocker
- dizziness
- HA
- NSAIDs reduce effectiveness, caution with position changeTerazosinAlpha blocker
- dizziness
- HA
- NSAIDs reduce effectiveness, caution with position changeTamsulosinAlpha blocker
- dizziness
- HA
- NSAIDs reduce effectiveness, caution with position changeAmiodaroneAntiarrhythmic
- oral ulcers, neuraligic pain, pulmonary toxicity
- may increase lidocaine levelsDigoxinAntiarrhythmic
- anorexia, GI, HA, bradycardia
- levels increased by BSDP, erythromycin, tetracycline, ibuprofenFlecainideAntiarrhythmic
-bradycardia, dizziness, HA, GI, neutropeniaSotalolAntiarrhythmic
- QT prolongation, bradycardia, chest pain, fatigueEzetimibe (Zetia)Antihyperlipidemic
- cholesterol absorption inhibitors
- GI, HA, flatulence
- taste distrubance, gag reflex increasedGemfibrozilAntihyperlipidemic
- fibrate
- GI, abnormal tasteNicotinic Acid (Niacin, B3)Antihyperlipidemic
- flushing, itching, GIApixaban (Eliquis)Anticoagulation (DOAC), factor Xa
Major bleed 1.5-1.7%, easy bruising
NO NSAID
no antidote, prevents more strokes per year than Warfarin and leads to fewer bleeds and deathsAspirinAnti-platelet effect
- GI disturbances, GI bleeding, tinnitusClopidogrel (Plavix)Anti-platelet effect
- Dizziness, GI upset
- Levels increased by NSAIDsDabigatran (Pradaxa)DOAC, direct fibrin/thrombin inhibitor
- NO NSAID
- GI bleeding, monitor with ECT or PTT
- NO ANTIDOTE AND CANT MONITOR
- fewer food and drug intrx. compared to Warfarin
- Bleeding risk same as WarfarinEdoxaban (Savaysa)NEW, DOAC
- hypertension, nosebleed, major bleed 2.2%
- NO NSAIDPrasugrelAnti-platelet effect
- major bleed 2-5%, syncope, stroke riskRivaroxaban (Xarelto)DOAC
- selective/reversible direct inhibitor Xa
- only 1x/day
- Cant monitor, no antidote
- Perisurgical bleeding may be prolonged, pruritus, thrombocytopenia, increase liver enzymes
-Toxicity increased by 3A4 inhibitors such as macrocodes
- NO NSAIDTicagrelor (Brilinta)anti-platelet effect
-Toxicity increased by 3A4 inhibitors such as macrocodes
- discontinue 5d prior to major surgery but consult MDWarfarin (Coumadin)Anticoagulation effect
- monitor with INR
- II, VII, IX and Xa inhibitor (vitamin K dependent factors--vitamin K antagonist)
- many drug and food interactions
- antidote= Vitamin-K-1 and fresh frozen plasma
- Bridged with enoxaparin
- NO NSAID
- GI bleeding, INR 1.5-3.5 times normal can be managed without dose change, hemorrhage, hematuria, abdominal pain, skin necrosis, gangreneAmitriptylineTCA, +4 (worst for xerostomia)
- sedation, dry mouth, orthostatic hypotension, tachycardia
- greater than 100 mg per day can cause interaction with epic (limit 2.5 carpules)
- Additive CNS depression with opioids and anti-anxiety agentsDesipramineTCA, +1
- sedation, dry mouth, orthostatic hypotension, tachycardia
- greater than 100 mg per day can cause interaction with epic (limit 2.5 carpules)
- Additive CNS depression with opioids and anti-anxiety agentsDoxepinTCA, +2
- sedation, dry mouth, orthostatic hypotension, tachycardia
- greater than 100 mg per day can cause interaction with epic (limit 2.5 carpules)
- Additive CNS depression with opioids and anti-anxiety agentsImipramineTCA, +2
- sedation, dry mouth, orthostatic hypotension, tachycardia
- greater than 100 mg per day can cause interaction with epic (limit 2.5 carpules)
- Additive CNS depression with opioids and anti-anxiety agentsNortriptylineTCA, +1-2
- sedation, dry mouth, orthostatic hypotension, tachycardia
- greater than 50 mg per day can cause interaction with epic (limit 2.5 carpules)
- Additive CNS depression with opioids and anti-anxiety agentsTrazodoneMisc Antidepressant
- increase serotonin, used for insomnia
- increase CNS depression when combined with opioidsDuloxetine (Cymbalta)SNRI
- nausea, dry mouth (0-1+), constipation, fatigue
- additive CNS depressant effects with trazodone and opioids
- less dry mouth than TCA
- increase BP (increased NE activity)
- used for neuropathic or chronic pain (diabetic neuropathy)
- less BP increase compared to venlafaxineVenlafaxine (Effexor)SNRI
- dizziness, anxiety, tremor, BP increase
- additive CNS depressant effects with trazodone and opioids
- less dry mouth than TCA
- increase BP (increased NE activity)
- used for neuropathic or chronic pain
- Prolongation QT, sexual dysfunction, discontinuation syndromeCitalopram (Celexa)SSRI
- nausea, dry mouth, sedation, insomnia
- much less dry mouth than TCA
-BRUXISM (TX WITH buspirone or switch to mirtazapine)Escitalopram (Lexapro)SSRI
- reduced side effects, well tolerated
-BRUXISM (TX WITH buspirone or switch to mirtazapine)Fluoxetine (Prozac)SSRI
- HA, insomnia, irritability
-BRUXISM (TX WITH buspirone or switch to mirtazapine)Paroxetine (paxil)SSRI
- nausea, sedation, dry mouth, dizziness
-BRUXISM (TX WITH buspirone or switch to mirtazapine)Sertraline (Zoloft)SSRI
- decrease diazepam clearance
-BRUXISM (TX WITH buspirone or switch to mirtazapine)MirtazapineAlpha-2 receptor antagonist
- drowsiness, dizziness, weight gain
- NO BRUXISM
- minimal dry mouth, minimal SSRI type side effectsBupropionSNRI (aminoketone antidepressant) --> NRI and DRI
- seizures, agitation, insomnia, dry mouth
- can cause anxiety (stimulatory--increase dopamine), low risk for sexual dysfunction
- seizure risk above 300 mgLithium CarbonateBIOPOLAR
- tremor, GI, thirst, polyuria, edema, taste disturbance, abnormal facial movements
-hypothyroidism
- for pure maniaIsocarboxazidMAOI
- orthostatic hypotension, tachycardia, HA, restlessness, insomnia, dizziness, overstimulation including anxiety, agitation, and manic symptoms, dry mouth, paresthesias, diarrhea
- limit epi dose to .04mg and aspirate
- record baseline and post tx BP
- hypertensive crisis with tyramine rich foodsPhenelzineMAOI
- orthostatic hypotension, tachycardia, HA, restlessness, insomnia, dizziness, overstimulation including anxiety, agitation, and manic symptoms, dry mouth, paresthesias, diarrhea
- limit epi dose to .04mg and aspirate
- record baseline and post tx BP
- hypertensive crisis with tyramine rich foodsSelegiline transdermalMAOI
- for Parkinson's Disease
- orthostatic hypotension, tachycardia, HA, restlessness, insomnia, dizziness, overstimulation including anxiety, agitation, and manic symptoms, dry mouth, paresthesias, diarrhea
- limit epi dose to .04mg and aspirate
- record baseline and post tx BP
- hypertensive crisis with tyramine rich foodsTranylcypromineMAOI
- orthostatic hypotension, tachycardia, HA, restlessness, insomnia, dizziness, overstimulation including anxiety, agitation, and manic symptoms, dry mouth, paresthesias, diarrhea
- limit epi dose to .04mg and aspirate
- record baseline and post tx BP
- hypertensive crisis with tyramine rich foodsBuspironeanti-anxiety
-dizziness, nausea, headache, nervousness
- treatment of bruxism
- xerostomia, CNS depressants additiveDiphenhydramineAnti-anxiety
- xerostomia, CNS depressants additive
-dry mouth, sedation, tachycardia
- Atropine potentiates anticholinergic effects of antihistaminesEszopiclone (Lunesta)Anti-anxiety
- xerostomia, CNS depressants additive
-head ache, unpleasant taste, drowsiness
- Macrolides, azole antifungals and doxycycline increase Lunesta levelsRamelteonAnti-anxiety
- xerostomia, CNS depressants additive
-dizziness, headache, sonmolence (strong desire to sleep)ZaleplonAnti-anxiety
- Dizziness, blurred vision, fatigue
- xerostomia, CNS depressants additiveZolpidemAnti-anxiety
- headache, sedation, myalgia, nausea
- xerostomia, CNS depressants additiveHaloperidolAntipsychotic--Butyrophenone
- movement disorders, orthostatic hypotension, tradeoff dyskinesia
- little or no interaction with EPI, CNS depressants potentiate drug, xerstomia can be severeAripipazole (Abilify)Antipsychotic--second generation atypical
- headache, agitation, anxiety, insomnia, weight gainClozapineAntipsychotic--second generation atypical
- 3+ for xerostomia, drowsiness, dizziness, salivation, dry mouth, aplastic anemia
- most commonly usedOlanzepineAntipsychotic--second generation atypical
- weight gain, sedation, good for refractory
- most commonly usedQuetiapineAntipsychotic--second generation atypical
- HA, drowsiness, dizzinessRisperidoneAntipsychotic--second generation atypical
- HA, insomnia, agitation, weight gain, EPS
- most commonly usedZiprasidoneAntipsychotic--second generation atypical
- HA, drowsiness, dizziness, weight gainCarbamazepineAnticonvulsant
- drowsiness, ataxia, severe blood dycrasias
- increase APAP liver toxicity, decrease APAP effect
- low stress environment (consider BZDP), seizure control history oftenClonazepamAnticonvulsant
- Drowsiness, ataxia, behavior disorders
- low stress environment (consider BZDP), seizure control history oftenGabapentinAnticonvulsant
- dizziness, ataxia, fatigue, nystagmus
- low stress environment (consider BZDP), seizure control history oftenLamotrigineAnticonvulsant
- dizziness, ataxia, HA, diplopia, rash
- low stress environment (consider BZDP), seizure control history oftenLevetiracetamAnticonvulsant
- drowsiness, dizziness
- low stress environment (consider BZDP), seizure control history oftenOxcarbazepineAnticonvulsant
- drowsiness and ataxia
- low stress environment (consider BZDP), seizure control history oftenPregabalinAnticonvulsant
- drowsiness, dry mouth, peripheral edema
- low stress environment (consider BZDP), seizure control history oftenPhenytoinAnticonvulsant
- Gingival overgrowth, drowsiness, ataxia
- low stress environment (consider BZDP), seizure control history oftenSodium ValproateAnticonvulsant
- Possible bleeding, GI, HA, ataxia, drowsiness, tremor, thrombocytopenia
- low stress environment (consider BZDP), seizure control history oftenTopiramateAnticonvulsant
- low stress environment (consider BZDP), seizure control history often
- drowsiness, dizziness, fatigueCarbidopa/LevodopaAnti-parkinson's: Dopaminergic Agent
- movement disorders, GI, alliterated taste, excess salivation, bruxism
- can increase effects of EPIPramipexoleAnti-parkinson's: Dopaminergic Agent
- hallucinations, nausea, dizziness, sedation, sudden sleep attacksRopiniroleAnti-parkinson's: Dopaminergic Agent
- syncope, nausea, dizziness, sedationRasagilineMisc Parkinson's Disease
- arthralgias, depression, dyspepsia, falls
- MAOI (type B) inhibitor
- Limit EPI dose to .04 mgSelegilineMisc Parkinson's Disease
- nausea, dizziness, confusion, dry mouth
- MAOI--limit epi .04mgEntacaponeMisc Parkinson's Disease
- diarrhea, avoid sudden d/cAtomoxetineADD/ADHD
- GI, anorexia, dizziness, mood swings, no abuse
- may cause seizures, nervousness, insomnia, dizziness, HA, dyskinesia, tachycardia, anorexiaMethylphenidateADD/ADHD
- GI, anorexia, dizziness, mood swings, no abuse
- may cause seizures, nervousness, insomnia, dizziness, HA, dyskinesia, tachycardia, anorexiaDexmethylphenidateADD/ADHD
- GI, anorexia, dizziness, mood swings, no abuse
- may cause seizures, nervousness, insomnia, dizziness, HA, dyskinesia, tachycardia, anorexia
- dry mouth, disguise, no seizure increaseDextroamphetamineADD/ADHD
- GI, anorexia, dizziness, mood swings, no abuse
- may cause seizures, nervousness, insomnia, dizziness, HA, dyskinesia, tachycardia, anorexia
- dry mouth, disguise, no seizure increase
- less abuse potential but still schedule II CSLIsdexamfetamineADD/ADHD
- GI, anorexia, dizziness, mood swings, no abuse
- may cause seizures, nervousness, insomnia, dizziness, HA, dyskinesia, tachycardia, anorexiaAmphetamine mixturesADD/ADHD
- GI, anorexia, dizziness, mood swings, no abuse
- may cause seizures, nervousness, insomnia, dizziness, HA, dyskinesia, tachycardia, anorexia
- dry mouth, dyskinetic movements, increased BP, pulseChemical nameChemical structure of the drugGeneric name-Official name of drug
-Lower case
-Only one generic name
-Active ingredient must enter bloodstream at same rate as trade nameBiologically equivalentTwo formulations of drug produce similar concentrations in blood and tissuesTherapeutically equivalent-Two formulations of drug have equal therapeutic effect on the body
Ex: ibuprofenTrade name(Brand name)
o First letter capitalized
o May have multiple trade names
Ex: Motrin, AdvilPrescription required for scheduleII, III, and IV drugsSchedule IAbuse Potential highest
• No accepted medical use
heroin, LSD, marijuana - (Still cat.1)Schedule IIAbuse Potential high
• opioid narcotics (oxycodone, morphine, ADHD (Adderall, Ritalin, Concerta)Schedule IIIAbuse Potential Moderate
codeine mixtures (Tylenol 3)Schedule IVAbuse Potential less
antianxiety -Xanax
tramadolSchedule VAbuse Potential Least
codeine containing cough syrupsPotencyamount of drug needed to produce a therapeutic effect (wanted effect)
-log dose curve along x-axisEfficacymaximum intensity of effect produced by a drug
Shown by height (y) of log dose curveLess potent drugneed more to get an effectGiving more of a drug will not increase efficacy - increases risk for?toxicityPotency and efficacy areunrelated → drugs may have different potencies, but the same efficacyTherapeutic indexmeasurement of the safety of a drugSynergisminteraction of two or more drugs such that the total effect is greater than the sum of the individual effectsAntagonismoccurs when a combination of two agents produces less effect than either agent aloneAgonistDrug produces an effect and has affinity for a receptor on cell membrane
—gives actionAntagonistDrug counteracts the action of agonist
—blocks receptorPharmacokinetics ADMEAbsorption
Distribution
Metabolism
ExcretionPharmacokinetics AbsorptionFactors
-Lipid solubility
-Ionization- nonionic molecules cross membranes more readily
-Molecular size
-Site of absorption oral route - large amount absorbed from small intestine
-Solubility
-Infection more acidic tissue increased drug ionization - less penetration of membranes
-Blood flow at injection siteThe absorption phase is bypassed when a drug is administeredintravenously.
***No LA should be delivered into blood streamThe MOST important site for drug absorption of orally administered drugs is thesmall intestine.Distributiondrug distributed by blood plasma
Factors
-Organ size and blood flow
-Drug solubility
-Plasma protein binding power. -Free drug - exerts the effect of drug
-Barriers -blood brain barrier, placental barrierMetabolism(aka biotransformation)
-changing a drug so that it can be excreted
-Excreted product is metabolite - more ionized and less lipid soluble than a parent compound (cant absorb so excretes)
-Most common location is the liver
Metabolism mechanisms:
-Active drug to inactive metabolite - (most common )
-Inactive drug to active metabolite - inactive prodrug (valcyclovir )
-Active drug to active metabolite - long half life (valium)Metabolism Factors-Liver function- hepatitis, alcoholism
-First pass effect liver inactivates some drugs
-Other drugs
-Half-life First order kinetics :constant percentage of drug is removed
-Half-life Zero order kinetics :Constant amount of drug removed from body per unit time (alcohol and aspirin)Liver is the major site for drugmetabolism.Patients with liver disease or alcoholism may have decreased ability to metabolize drugs; leads toincreased levels of drug in the blood, which increases the risk for toxicity.Excretiondrug can be excreted unchanged or as a metabolite (modified)Kidney (renal) excretion ismost common.
Also, from lungs, saliva, breast milk, Gingival crevicular fluid.Lipid soluble drugs are not excreted inmust be metabolized by liver into water soluble form to be excreted in urine.Major route of fluoride excretion is inthe urine.Drug excretion elimination terminatesdrug effect.Enteral Routeo Drug placed directly in GI tract - :- orally or rectally
o Safe, cheap, convenient
o Large absorbing area
-Requires patient cooperation
-Orally delivered drugs must pass through hepatic portal circulation which can inactive some drugs - Called the first-pass effect.
P-450 enzymes in the liver are responsible. more drugs needed thenAmount of drug available to produce systemic effect is reduced bythe first-pass effect.Drugs with high first-pass effect require a larger oral dose as high percentagewill be deactivated.Parenteral RouteBypasses the GI tract
—Injection
•Intravenous most rapid
•Intramuscular
•Subcutaneous insulin
•Intradermal TB test
—Inhalation Inhalers for asthma
—Topical Systemic side effects are rare
•Steroids, Contraindicated if surface tissue is ulcerated,Therapeutic effectwanted effect desirable action of the drug
*Predictable
*Dose related
*Target organsSide effectundesirable (aka adverse reaction)
*Expected response - but unwanted
*Dose related
*Nontarget organsToxic reaction(aka overdose reaction)
*Expected response - exaggeration of the therapeutic effect
*Dose related
*Target organsAllergic reaction*NOT predictable
*NOT dose related
-Mild reactions treated with antihistamine and possibly steroids
-Life-threatening (anaphylaxis) treated with epinephrine injection
-4 typesType I:Immediate hypersensitivity- anaphylaxisType II:Cytotoxic/cytolytic - lysis of red blood cellsType III:Arthus - serum sicknessType IV:Delayed hypersensitivity- contact dermatitisTeratogenic effect-Cause congenital malformations during pregnancy - rapidly dividing cells most susceptive to the effects
-FDA defined categories A, B, C, D, X
A = least
X- most
-Dental drugs of concern:
Tetracycline,
NSAIDS,
Benzodiazepines,
MetronidazoleLocal effect-Oral drugs can cause GI symptoms nausea or dyspepsia
-Topical drugs can irritate the site
-Injectable drugs can irritate injection siteDrug interactions-More drugs a patient takes, higher the chance
- may cause - toxicity, lack of efficacy or increased efficacyIdiosyncratic reaction-Not a side effect or allergic reaction - just random reaction
-Sometimes genetic reactionInterference with natural defense mechanismsSome drugs decrease body's ability to fight infection
Ex: corticosteroids, immunosuppressive drugsLethal dosedose that kills 50% of animals in laboratory studiesEffective dosedose that produces effect in 50% of animalsTherapeutic index: lethal dose divided bythe effective dose (LD50 / ED50)Narrow therapeutic index (small TItoxicity more likelyWide therapeutic index (large TI) -toxicity less likely - safer drugTI of>10 needed foruseful drugDrugs known to have narrow TI (more dangerous drugs)carbamazepine, cyclosporine, DIGOXIN, levothyroxine, lithium, phenytoin, warfarinSympathetic Response (SANS)Fight or flight- STRESS
-Increased blood pressure (vasoconstriction)
-Increased heart rate
-Increased oxygen to muscles
-Decreased peristalsis
-Dilates bronchioles
-Dilates pupils (myDriasis)
-Decreased salivary flow
*Adrenergic agents /sympathomimeticsParasympathetic Response (PANS)Rest and digest - PEACE
-Lowered blood pressure
-Decreased heart rate
-Increased blood flow to GI system
-Increased peristalsis / GI motility
-Constricts bronchioles
-COnstricts pupils (miOsis)
-Increased salivary flow
*Cholinergic agents / parasympathomimetics (Chol. goes w/ 'C' of PEACE)Adrenergic Drugs(sympathomimetics MIMIC the SANS)
-a-receptors- vasoconstriction use Epinephrin
-B1 receptors - 1 HEART
Increased rate and strength of contraction of heart
-B2 receptors- 2 LUNGS
Relaxation of smooth muscles of bronchioles - bronchodilationadrenergic BronchodilatorsB2 receptors agonist
-terol
albuterol (Ventolin, ProAir, Proventil)
levalbuterol (Xopenex)
salmeterol (Serevent)adrenergic VasopressorsContract smooth muscle vasoconstriction
-nasal decongestants by constricting swollen vessels of the nasal mucous membranes
-epinephrine (used in local anesthetic to keep medication at area of administration)
-dopamine :shock and hypotension
-ephedrine :cold medications
-pseudoephedrine :cold medicationsadrenergic Cardiac stimulatorsUsed to stimulate and restore the heartbeat in emergency situations
-epinephrineOther Common Sympathomimetics / Adrenergic Agents-Ritalin / Adderall - used in treatment of ADHD
-cocaine :The only local anesthetic that is a vasoconstrictorAdrenergic Agents-Epinephrine is contraindicated incocaine or methamphetamine abuser.Adverse effects of adrenergic agents-CNS disturbances (anxiety, fear, tension, headache, tremor)
-Cardiac arrythmias
-Cerebral hemorrhage
-these should not be used in patients with angina, uncontrolled hypertension and uncontrolled hyperthyroidism ie. epinephrine•Adrenergic Blocking Drugs-olol drugs
-a-blocking drugs - increased blood flow Used to treat Raynaud's syndrome (poor circulation)
-B-blocking drugs - block the B-receptors Used mainly to treat cardiac conditions
-Some off-label uses
•Migraine headaches
•Generalized anxiety disorder
-propranolol (Inderal)
-metoprolol (Lopressor, Toprol) B1
-atenolol (Tenormin)Adverse Effects of B-blockersNon-specific B-blockers will block B2 receptors (lungs)- causing shortness of breath in asthmatics (Ex. propranolol) not for asthmaticsCholinergic Drugs(parasympathomimetics - MIMIC the PANS)
-Bradycardia,
-Increased motility
-Miosis - pupil constriction, decrease intraocular pressure
-Large doses produce SLUD (toxic effect - exaggerated therapeutic effect) **increase salivation**SLUD =Salivation, Lacrimation, Urination, DefecationCholinergic Drugs Uses:-pilocarpine (Salagen) - treat xerostomia
-nicotine found in tobacco products, nicotine patches, smoking cessation chewing gum
-treatment of glaucoma and Alzheimer's
*increase salivationAnticholinergic Drugs(act opposite of PANS - block acetylcholine receptors)
-Mydriasis - dilation
-Reduced secretions yerostomic affect
-Reduced GI motility
Uses: ****ATROPINE - used pre-operatively to decrease salivary flow for dental procedures****
- ipratropium for COPD - relaxes smooth muscle in respiratory system
-loperamide (Imodium) - used to treat diarrhea
-copolamine- used for motion sickness preventionmethamphetamine: sympathomimetic/ adrenergicrampant caries and burned mucosal surfaces
**Oral mucosal irritation is a result of the method of drug administration...not the drug itself.NONOPIOID ANALGESICS (NONNARCOTICS)For Pain
**Act at peripheral nerve endings, not in CNS, opiods work in CNS.
-Inhibit prostaglandin synthesis
-Prostaglandins:
•Sensitize pain receptors
•Lower pain threshold
•Cause inflammation and fever
•Edema
-Reduce fever through action on hypothalamusaspirin (ASA)NONOPIOID ANALGESICS
-Considered a nonsteroidal anti-inflammatory drug (NSAID)
4A'S
Analgesic
Antipyretic
Anti-inflammatory
AntiplateletAdverse reactions of aspirin:-GI irritation contraindicated with peptic ulcer
-Hypersensitivity - 15% of patients
-Can cause Reye syndrome in children contraindicated for children
-Contraindicated with warfarin (Coumadin) drug interaction & increased bleedingaspirin (ASA) Toxicity(salicylism)NONOPIOID ANALGESICS Pain ibuprofen (IBU), naproxenConsidered (NSAID)
**Most useful pain medication in dentistry
3A's (not antiplatelet)Adverse reactions of ibuprofen and naproxen:-GI irritation- contraindicated with peptic ulcer
-Increased bleeding contraindicated with warfarin
-XerostomiaExamples: ibuprofen(Advil, Motrin) drug of choice for dental painExamples: naproxen(Aleve) longer half-life - given on 8-12 hour scheduleibuprofen can decreasethe effects of many drugs:Taking NSAID with phenytoin (Dilantin) canincrease phenytoin levelsAspirin has how many 'A' effects?4IBU has how many 'A' effects?3, not antiplateletNonopiod analgesic: acetaminophen (APAP)-NO anti-inflammatory action -NOT considered an NSAID
-NO effect on clotting
-no GI irritation
Uses 2A'S
o Analgesic
o Antipyretic
-safe Use for pg womenacetaminophen (APAP) Side effectsrare
-Patients with liver disease should avoid
-Overdose can result in Hepatotoxicity (liver toxicity)acetaminophen is contraindicated incurrent or past alcoholicsacetaminophen is drug of choice for patients onanticoagulants (warfarin) or with peptic ulcersnatural opioid-like substances in the bodyEndorphinsOPIOID NARCOTIC ANALGESICSBind to receptors in the CNS
•Pharmacologic Effects:
-Analgesia
-Sedation/euphoria Larger doses euphoria
-Cough suppression
-GI Effects • Decreases GI motility/contractions Used to treat diarrheaOPIOID NARCOTIC ANALGESICS Adverse ReactionsRespiratory depression • Usually cause of death with overdoseOPIOID NARCOTIC ANALGESICS Drug Interactions AdditiveAdditive effects with other CNS depressants - causing respiratory depression
Alcohol, Antianxiety medicationsOPIOID NARCOTIC ANALGESICS Addiction PotentialStronger the opioid, more addiction potential
-Build tolerance to the Not to the myosis or constipation
-methadone (Dolophine) opioid agonist to treat opioid addicts
-naloxone (Narcan) parenteral opioid for treating overdosenaloxone (Narcan)parenteral opioid antagonist
-Drug of choice for treating opiod overdose
-Will reverse respiratory depression from OD
-Should be in emergency kitOpioid Agonistso morphine prototype
o oxycodone (Oxycontin, Percocet)
o hydrocodone (Vicodin, Norco)
•codeine (Tylenol #2, #3, #4 and cough syrup)
o meperidine (Demerol)
o hydromorphone (Dilaudid)
•fentanyl, sufentanil, alfentanilmost common opioid used in dentistryCodeine (Tylenol #3)Sign of overdose or addiction to opioidpinpoint pupilsAll opioids lead toconstipation... not diarrheaOpioids are NOT used forchronic pain (like TMJ)Antibiotics are affective against BACTERIAL INFECTIONS...notviral infections.Stage 1 - Initial stages of infectiono Gram-positive cocci
o Drug of choice Penicillin / amoxicillin
•Penicillin allergy→ erythromycin or clindamycinState 2 Mixed infectiongram-positive cocci and gram-negative anaerobic organisms
-Gram-positive cocci - same as stage 1 drugs
-Anaerobic organisms - metronidazole or clindamycin
**Clindamycin - treats both gram-positive cocci and gram-negative anaerobes.Stage 3 - advanced infectionPredominately anaerobic bacteria
(mean clean)
Metronidazole or clindamycinANTIBIOTICS: Penicillins (-cillin)-B-lactam ring
-Narrow spectrum (less side effects)
-bactericidal
-Many bacteria are resistant (staphylococci infections)
-Most common for allergic reaction
-Most common antibiotic used in dentistry
-Safe for pregnancypenicillin is most likely antibiotic to causeallergic reaction and anaphylaxispenicillin VK is preferred overpenicillin G (pen G is inactivated by Gastric acids)penicillin is NOT effective against penicillinase producing bacteria... BUTAugmentin IS effective - it prevents penicillinase from breaking down amoxicillin
o Augmentin = amoxicillin with clavulanic acidCephalosporinsB-lactam antibiotics (like penicillin)
- bactericidal
cephalexin (Keflex) ear infectionMacrolides(-mycin)
-Closely resemble penicillin
-Broad spectrum and very safe
•erythromycin
Increase effect of warfarin (increased bleeding) most common side effect is GI upset
•azithromycin & clarithromycincan be used for premedication if there is a penicillin allergyo azithromycin & clarithromycinTetracyclines (-cycline)bacteriostatic
*Don't take with milk / dairy
-Main use is to treat acne
*causes photosensitivityTetracyclines dentally Used to treatNUP/NUG and aggressive perio
-due to their excretion into the gingival crevicular fluid where they have an Anti-Collagenase effectTetracyclines are contraindicated inpregnant / nursing mothers and early childhood due to tooth discoloration
-**cross placental barrier and are excreted in breast milkTetracyclines Examples (oral administration):o tetracycline
o doxycycline atridox
o minocycline ArestinClindamycinMean Clean drug
-Bacteriostatic
-Can lead to suprainfection of Candida albicans (yeast infection/thrush)
-**Can lead to pseudomembranous colitis (C-diff → Clostridium difficile)
•Severe persistent diarrheaNitroimidazolesMean clean drug
-treat parasitic infections
-****If alcohol is ingested, will make you very sick - similar to disulfiram (Antabuse) with alcoholic - avoid Listerine (high alcohol content)
Examples o metronidazole (Flagyl)Anti-Tuberculosis AgentsTB is caused by Mycobacterium tuberculosis
-Treatment is difficult treat with multiple drugs at same time
(RIPE)
rifampin
isoniazid
pyrazinamide
ethambutol
(Ripe looking lungs)Anti-Tuberculosis drugsrifampin
isoniazid
pyrazinamide
ethambutolIf a patient indicates they are taking rifampin or isoniazid only...are likely taking it as a preventive agentCurrent guidelines for antibiotic premedication:-Prosthetic cardiac valves
-Prosthetic material used for cardiac valve repair
-History of infective endocarditis
-Cardiac transplant with valve regurgitation due to abnormal valve
-Congenital Heart Disorders (only very specific situations)Suggested pre-med regimen if needed: amoxicillin2000mg (2g)
(4)-500mg pills
30 minutes - 1 hour prior to dental appointmentpre-med regimen If allergic to penicillin cephalexin (Keflex)2000 mg one hour priorpre-med regimen If allergic to penicillin clindamycin600 mg one hour prior
C.diffpre-med regimen If allergic to penicillin azithromycin500 mg one hour priorpre-med regimen If allergic to penicillin clarithromycin500 mg one hour priorHerpes Simplex Virus (HSV)acyclovir (Zovirax)
penciclovir (Denavir)
valacyclovir (Valtrex)
-Prodrug inactive drug is metabolized to active drug (acyclovir)HIV / AIDSSeveral drugs are combined for an improved effect
—-- Highly Active Antiretroviral Therapy (HAART)
-Slows the replication rate of the virus
-Sometimes called a drug cocktail these are constantly changing
-usually take a combination of 3 drugs
•Nucleoside Reverse Transcriptase Inhibitors (NRTI)
•Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)
•Protease Inhibitors (PI)Anesthetic cartridges: Antioxidant PreservativeSodium bisulfite or sodium metabisulfite
-Contraindicated in patients with sulfite allergies or sensitivitiesAnesthetic cartridges o Alkalinizing agentSodium hydroxide
-raises the pH to between 6-7 (makes onset faster)Local Anesthetic Mechanism of Action:Block peripheral nerve conduction by decreasing permeability of ion channels to
-BOARD ALERT: Local anesthetic agents 'inhibit the influx of sodium ions'
-Affect the myelinated fibers only at the nodes of RanvierFunction is lost in this order1Autonomic
2temperature
3pain
4touch/pressure
5vibration and MOTOR (last thing to lose)
o Regain function in the reverse orderTwo groups of anesthetics →Esters and AmidesEsters-*Metabolized in the plasma / BLOOD
-High potential for allergic reactions
-BOARD ALERT - Benzocaine is an ester and available as a topical
-procaine (Novocain) - no longer used in dentistry
-propoxycaine (Ravocaine)
-tetracaine (Pontocaine)AmidesMetabolized in the LIVER
••lidocaine (Xylocaine)
-Safe in pregnancy (Category B) and during lactation
-Available in combination with epinephrine (not plain in US)
••mepivacaine (Carbocaine)
-Available with levonordefrin (neo-cobefrin)
••prilocaine (Citanest)
-Associated with methemoglobinemiaRelative contraindications of prilocaine-patients with methemoglobinemia - condition in which the iron in hemoglobin does not carry oxygen effectively
-Sickle cell and other anemias
-Patients taking acetaminophen raises methemoglobinbupivacaine (Marcaine)Amide
-Greatly prolonged duration of action
-Indicated for postoperative pain and lengthy dental procedures*articaine (Septocaine)Amide anesthetic with ester linkage in chemical structure (hybrid molecule)
-Partially metabolized in the liver (5-10%)
-partially in the blood (90-95%)
GOOD 4 peeps w/ Liver problems. Drug of choiceDuration of action of anesthetics (Shortest to longest)mepivacaine (shortest)
lidocaine
prilocaine
articaine
bupivacaine (longest)Duration of action of anesthetics (shortest)mepivacaineDuration of action of anesthetics (longest)bupivacainepKarelated to onset of action
-lower = better absorbedprotein binding capacityrelated to duration of action
-stronger binding = longer durationlipid solubilityrelated to potency
-more lipid soluble = more potentvasodilating propertiesaffect potency and duration of action
-less vasodilation (vasoconstrictor added) = more potent and longer durationVasoconstrictors - Epinephrine Added to anesthetic for:-Decreased systemic absorption - Lower risk of toxicity
-Decreased absorption
-Increased duration of action
-Decreased bleedingOnly true contraindication to vasoconstrictors issulfite allergy - due to the preservative that is presentRelative contraindications to vasoconstrictors: Tricyclic antidepressants (TCA)hypertension
amitriptyline (Elavil)Relative contraindications to vasoconstrictors: Nonselective B-blockershypertension
-propranolol (Inderal)vasoconstrictors: Two available in USEpinephrine
-1:100,000 → 0.018mg epi/cartridge
-1:200,000 (lowest conc.) → 0.009mg epi/cartridge
Levonordefrin
-1:20,000 || CartiAnesthetics available WITHOUT a vasoconstrictor (Plain solution)
(no sodium bisulfate)-lidocaine - not available in dentistry in the US
-mepivacaine
-prilocaine***articaine and bupivacaine will ALWAYS havea vasoconstrictor***Topical Anesthetics benzocainemost commonly used topical anestheticTopical Anesthetics Огаqixlidocaine and prilocaine (2.5% : 2.5%) gel
applied in periodontal pocketTopical Anesthetics CetacaineYellow-Smells like bananas
benzocaine 14%,
butamben 2.0%, tetracaine HCI 2.0%BOARD ALERTS Local anesthetic is a weak base and works poorly where there isinfection due to the very acidic environment- increased dose may be neededBest way to reduce systemic toxicity from local anesthetic is:Aspiration and inject slowly
fast: finds path off least resistance
ie: blood StreamANTIANXIETY DRUGS Benzodiazepines(-pam, -lam)
• Fast acting
(Benz fast car picknup Pam and Lam)
-NO analgesic effect- BOARD ALERT
-Additive with other CNS depressantsBenzodiazepines Examples:-diazepam (Valium)
-lorazepam (Ativan)
-alprazolam (Xanax)
-midazolam (Versed)
short half life: IV benzodiazepine used in dentistry
-triazolam (Halcion)
greatest amnesia producedANTIANXIETY Barbiturates-(-tal)
-(Bad BARBie is Tall and Bad.. will be in jail a Long time)
Long acting & narrow therapeutic index (narrow margin of safety)
-Replaced by benzodiazepines for anxiety
-for anticonvulsant
-Produce CNS depression
-NO analgesic effect BOARD ALERTANTIANXIETY Nitrous Oxide/Oxygen Sedation-Rapid onset & rapid recovery LOW solubility in blood
-Excreted by exhalation
o No biotransformation(metabolizing) inhaled and exhaled in same formNitrous Oxide Sedation BOARD ALERT- place patient on 100% oxygen for 5 minutes following sedation to preventdiffusion hypoxia (rapid outward flow of CO2- decreasing ventilation causing headache)Contraindications to nitrous oxide / oxygen sedation:-COPD
-Upper respiratory infections (stuffy nose)
-Emotional /behavioral instability
-Pregnancy
-Cystic fibrosis
-Language barrierNitrous oxide/oxygen sedation maintains patient in what Stage?awake, Can talk open, close
Stage I anesthesiaNitrous oxide/ oxygen sedation can reduce the orofacial muscle tone incerebral palsy patients during dental treatmentNitrous Oxide abuse can lead to:-Neurologic symptoms similar to Parkinson's disease and dementia
-Numbness and tingling in the extremitiesANTIDEPRESSANT DRUGS Used to treat symptoms ofmoderate to severe depression
**not a curewith all antidepressantsXerostomiaSelective Serotonin Reuptake Inhibitors (SSRIS)Most common antidepressant
-ine and -pram
fluoxetine (Prozac)
ocitalopram (Celexa)
oescitalopram (Lexapro)
sertraline (Zoloft)
paroxetine (Paxil)Serotonin Norepinephrine Reuptake Inhibitors (SNRIS)Similar to the SSRIS
venlafaxine (Effexor)
desvenlafaxine (Pristiq)
duloxetine (Cymbalta)Tricyclic Antidepressants (TCAS)-suicidal tendencies
-BOARD ALERT - Do not use epinephrine in patients taking TCAS- may lead to hypertensive crisis- relative contraindication - if must use, limit to cardiac dose
-amitriptyline (Elavil)Q: TCAS are cOntraindicated with What?A: epinephrine
Hypertensive crisisMonoamine Oxidase Inhibitors (MAOIS)Not used much anymore due to many interactions with foods, wines, other drugs
o Can cause hypertensive crisis and deathAntidepressant: bupropion (Wellbutrin)Can precipitate seizures
o Also used for smoking cessation**ANTICONVULSANT DRUGSMost have a narrow therapeutic index
-increase the metabolism of other drugs
-CNS depression
Examples:
-phenytoin (Dilantin)] - Gingival enlargement in 50% of chronic users - anterior facial gingiva
-carbamazepine (Tegretol)
-phenobarbital (Luminal)
-thosuximide (Zarontin)
-benzodiazepines diazepam (Valium)Drug of choice for status epilepticus which CAN be caused by local anesthetic overdosediazepam (Valium)ANTIHISTAMINE DRUGS-ine
-Block histamine release from H1 Receptors
-Main side effects: xerostomia and sedation
-diphenhydramine (Benadryl)
-fexofenadine (Allegra)
-cetirizine (Zyrtec)
-loratadine (Claritin)ANTIHYPERTENSIVE DRUGS Diuretics-ide
-Enhance the excretion of sodium and water - decreasing blood pressure
-Effectiveness reduced by NSAIDS Adverse Reactions
o xerostomia and orthostatic hypotension
Two major types:
Thiazide diuretics: hydrochlorothiazide (HCTZ)
Loop diuretics: furosemide (Lasix)ANTIHYPERTENSIVE DRUGS ACE Inhibitors-A-pril
-Prevent conversion of angiotensin I to angiotensin II → by blocking the ACE (Angiotensin Converting Enzyme)
o Angiotensin II causes vasoconstriction... so when blocked, the result is vasodilation, resulting in lowered blood pressure.
-Effectiveness reduced by NSAIDSAdverse Reactions ACE Inhibitors (-pril)Orthostatic hypotension
***Dry, hacking cough**Common examples of ACE Inhibitors (-pril)-lisinopril (Prinivil, Zestril)
-enalapril (Vasotec)ANTIHYPERTENSIVE
Angiotensin Receptor Blockers (ARBS)-attach to angiotensin II - block the effect of the angiotensin II
-More specific than ACE Inhibitors - so fewer adverse reactions
-Effectiveness reduced by NSAIDSCommon examples of ARBSs (-sartan)-valsartan (Diovan)
-losartan (Cozaar)
(Sartan says ARB!!)ANTIHYPERTENSIVE
Calcium Channel Blockers (CCBS)-some end in -dipine
-Effectiveness NOT reduced by NSAIDS (one of the few!!)
Adverse Reactions
-Orthostatic hypotension
-Xerostomia
-Gingival enlargement hyperplasiaCommon examples of CCBS (Always Very Nice Day - except with ging enlargement!)o (a)mlodipine (Norvasc)
o (v)erapamil (Isoptin, Calan)
o (n)ifedipine (Procardia, Adalat)-high probability of gingival enlargement!!
o (d)iltiazem (Cardizem, Dilacor)ANTIHYPERTENSIVE
Beta Blockers (B -Adrenergic Blocking Agents)- think letter blocks OLOL (baby-beta)
-Block stimulation of ß receptors decreasing cardiac output - lowering BP
-Effectiveness reduced by NSAIDS
-Adverse Reactions
Orthostatic hypotensionCommon examples of B-Blockers
(-olol)-metoprolol (Lopressor)
-cardio-selective more specific for Bi (heart) less side effects
-propranol (Inderal)
-affects B1(heart) and B2(lungs) meaning more side effectsBOARD ALERT: Epi should NOT be used on patients taking specific B-Blockers such as? (Q may be in testlet or case study)propranolol. can result in greatly increased vasopressor response causing HYPERTENSION. Avoid using epinephrine-containing product or use cardiac dose.ANTIHYPERTENSIVE
Alpha Blockers (a -Adrenergic Blocking Agents)-produce peripheral vasodilation - reducing vascular resistance - lowering BP
-Also used to benign prostatic hypertrophy used in men that have prostate problems and high blood pressure
-Effectiveness reduced by NSAIDS
Adverse Reactions
-Orthostatic hypotensionCommon examples of a -Blockersdoxazosin (Cardura)
terazosin (Hytrin)
A(lpha) to Z(osin)!Diuretics commonly end in-ideACE Inhibitors commonly end in-prilARBS commonly end in-SartanB-Blockers commonly end in-ololCONGESTIVE HEART FAILURE DRUGSPatients may be on the following drugs Diuretics ACE Inhibitors ARBS B-Blockers
-Digitalis glycosides are also used to treat CHF
-Not used much any longer due to narrow therapeutic index
-digoxin (Lanoxin) not safe If a patient is on this, most likely they have CHFANTIANGINAL DRUGSchest pain
-Nitroglycerin
-administered sublingual
Adverse Reactions
-Hypotension
-Dangerously low BP if given when patient has taken a PDE5 inhibitor (erectile dysfunction drug) in the last 24 hours (Viagra)ANTIHYPERLIPIDEMIC DRUGSlower level of cholesterol in the blood by reducing the production of cholesterol by the liver
- (they inhibit HMG-COA reductase the enzyme that aids in cholesterol synthesis)
-atorvastatin (Lipitor)
-lovastatin (Mevacor)
-rosuvastatin (Crestor)
-simvastatin (Zocor)
-Statins =cholesterolwarfarin (Coumadin) anticoagulantMost common
—-Drug interactions:
-Most serious is with aspirin - increased bleeding
-Antibiotics can increase the bleeding effects (due to effects on vitamin K)anticoagulant clopidogrel (Plavix) - BOARD ALERTUsed to prevent blood clots after recent heart attack or strokeanticoagulant heparin(Sounds like H-aspirin)
-One of most common used anticoagulant used in Hospitalized patients
-Given by injection onlyGastroesophageal reflux disease (GERD)Most common GI disease in US
Aka heartburnGastroesophageal reflux disease (GERD) Treatment:-Decrease acid in stomach
Histamine2 (H2) Blockers Proton pump inhibitors (PPIS)
-Constricting cardiac sphincter
GI stimulants
-Relief of symptoms
AntacidsUlcers Causes:-Helicobacter pylori (tx-antibiotic)
-Use of nonsteroidal anti-inflammatory drugs (NSAIDS)
Tx- antibiotic, H2 blocker, PPI
**not associated with GERD**Maximum recommended dose of epinephrine is based on the patient's health status —Healthy dose0.2mg epi per dental appt
ASA I or IIepinephrine dental "cardiac dose"0.04mg epi per dental appt
ASA III or IV
Pregnancy, diabetes, hypertension, etcPregnant patient receiving lido with 1:100,000 epi can receive2 cartridges of anesthetic
0.04mg/0.018mg = 2.22 = 2 cartridges1:200,000=4 cartridgesAntacidsOTC meds that help neutralize hydrochloric acid of the stomach
o Sodium bicarbonate
-Cardiovascular patients that are on sodium restriction should avoid these due to the sodium contentH2 Blockers-Block histamine-induced gastric acid secretion from the parietal cells of the gastric mucosa (lining of the stomach) -Used to treat GERD and ulcers
Examples: (-tidine)
cimetidine (Tagamet)
famotidine (Pepcid)
ranitidine (Zantac)Proton pump inhibitors (PPIS)-Potent inhibitors of gastric acid secretion
-Most powerful med for treating GERD Examples: (-prazole) (P=P)
omeprazole (Prilosec)
lansoprazole (Prevacid)
esomeprazole (Nexium)Patients on cimetidine (Tagamet) - likely being treated forBOARD ALERTS: gastric ulcersGastric ulcerations do NOT causegingival bleedingEnamel erosion on the lingual surfaces of the maxillary anterior teeth-common in pts with GERDADRENOCORTICOSTEROID DRUGS(-SONE, -LONE)
-palliative - NOT curative
-Prevent the release of substances in the body that cause inflammation.
-suppress the immune system
Useful in treating many conditions:
-Inflammation
-Allergic reactions
-Autoimmune disorders
-Addison's disease: take steroids
-Asthma
Examples: cortisone, hydrocortisone, prednisone, triamcinoloneSide Effects of corticosteroids:Delayed wound healing
HyperglycemiaBOARD ALERT - do not use these drugs with herpes- will suppress immune system and worsen the condition as Herpes is a virusADRENOCORTICOSTEROID DRUGSRESPIRATORY DRUGSAsthma is Reversible airway obstruction
-Need short acting B2-agonist produces bronchodilation
-albuterol (ProAir, Proventil)
-metaproterenol
inhaled corticosteroids: fluticasone (Flovent)Aspirin should be avoided in asthmatics becauseincreased risk of aspirin hypersensitivityalbuterol can causeinsomnia. all adrenergic drugs can
- fight or flight responseCorticosteroid inhalers can lead tooral candidiasis (thrush) - patient should rinse mouth after use.
Treat thrush with nystatinDIABETES DRUGS Type 1- Insulin Dependent Diabetes Mellitus (IDDM)-lack of insulin secretion
-Most common medication is insulin given by subcutaneous injection
-common side effect is
hypoglycemia*
insulin shock
confusion
weakness, slurred speech
Causes of insulin shock
-Too much insulin given
-Failure to eat with medication
-Increase exercise or STRESS - can lead to dental emergency
-Some dental drugs affect insulin demand - raise blood sugar - use with caution in diabetic patients
-epinephrine
-GlucocorticosteroidsDIABETES DRUGS Type 2 - Non-Insulin Dependent (NIDDM)Obesity is a major risk factor
BOARD ALERT - hyperglycemia can result from the cells becoming insulin resistantOral medications used to treat Type 2 Diabetes-glyburide
Classified as a sulfonylurea
-metformin (Glucophage)
Classified as a biguanideTHYROID DRUGS-Hypothyroidism
levothyroxine (Synthroid) Hashimoto's
-Hyperthyroidism
due to Grave's Disease goiterANTINEOPLASTIC DRUGS (CANCER DRUGS)treat initial stages aggressively
-Used at much lower doses, can treat Psoriasis, rheumatoid arthritis, lupusOSTEOPOROSIS DRUGSBisphosphonates are most common used
-alendronate (Fosamax)
-ibandronate (Boniva)
*Use of these drugs is associated with osteonecrosis of the mandible Specifically, with IV administrationBisphosphonates =osteonecrosis of the mandibleAnalgesics Contraindicated in pregnancyAspirin NSAIDSAnalgesics Safe for use:acetaminophen (Tylenol)PREGNANCY Local Anesthetics • Safe for use:Lidocaine and prilocaine-Anti-infective Agents Contraindicated in pregnancytetracyclines
metronidazoleAntianxiety Agents Contraindicated in pregnancybenzodiazepines
nitrous oxide-oxygenBOARD ALERT Common medications that cause gingival overgrowth (gingival hyperplasia):-phenytoin (Dilantin)
-Calcium Channel Blockers (Always Very Nice Day) - antihypertensives
-amlodipine (Norvasc)
-verapamil (Calan)
-nifedipine (Procardia)
-diltiazem (Cardizem)
-cyclosporine (immunosuppressant for organ transplant patients)Common medications that cause gingival bleeding:warfarin (Coumadin)
clopidogrel (Plavix)
aspirinCommon medications that cause xerostomia:diuretics anticholinergic agents antidepressants antihistamines adrenergic agents and many more!!acbefore mealsqdevery daybidtwice a daytidthree times a dayqidfour times a daydispdispensehsat bedtimepcafter mealsPOby mouthprnas neededq-everysiglabel, instructions for usestatimmediatelyudas directedBrand Name: NexiumGeneric Name: EsomeprazoleEsomeprazoleTreatment of PUD and GERD, hypersecretory conditions
Dental Considerations: XerostomiaBrand Name: Synthroid®Generic Name: LevothyroxineLevothyroxineHypothyroidism/ Pituitary TSH supression
No effects on dental treatment.Vicodin®Generic Name: Hydrocodone/ APAPHydrocodone/ APAPHypertension/Edema/ Congestive heart failure/ Cirrhosis of the liver with edema
No effects on dental treatment.Brand Name: AmoxilGeneric Name: AmoxicillinAmoxicillinOtitis media/ Sinusitis
Dental Considerations: Oral candidiasis w/prolonged useBrand Name: PrinivilGeneric Name: LisinoprilLisinoprilHypertension/ Heart failure/ Acute MI
Dental Considerations: Orthostatic hypotension, cough may interfere with longer proceduresBrand Name: LipitorGeneric Name: AtorvastatinAtorvastatinDyslipidemia/ Prevent CVD
Dental considerations:Muscle weakness/ MyopathyBrand Name: ZocorGeneric Name: SimvastatinSimvastatinHyperlipidemia/ Secondary prevention of CHD and CVD
Dental considerations:
Muscle weakeness/ MyopathyBrand Name: PlavixGeneric Name: ClopidogrelClopidogrelUnstable angina/ non ST-segment elevation MI, ST-segment elevation MI, recent MI/Stroke
Dental considerations: After stent implantation, any elective surgery should be postponed for a year after the implantationBrand Name: SingulairGeneric Name: MontelukastMontelukastAsthma, seasonal allergies, prevention of exercise-induced bronchoconstriction
Dental considerations: Dental pain, increased bleeding tendency/thrombocytopeniaBrand Name: CrestorGeneric Name: RosuvastatinRosuvastatinFamilial Hypercholesterolemia/ Hyperlipidemia/ Hypertriglyceridemia/ Prevention of CVD
Dental considerations: Muscle weakness/ MyopathyBrand Name: LopressorGeneric Name: MetoprololMetoprololAngina/ Heart failure/ Hypertension
Dental considerations:
Enhances response to epinephrineBrand Name: LexaproGeneric Name: EscitalopramEscitalopramMajor Depressive Disorder/ Generalized anxiety disorders
Dental considerations:
Xerostomia, toothache, possible bleeding complication, especially co-administered with other antiplatelet agentsBrand Name: ZithromaxGeneric Name: AzithromycinAzithromycinAcute otitis media
No effects on dental treatmentBrand Name: ProAir HFAGeneric Name: AlbuterolAlbuterolTreatment and prevention of bronchospasm
Dental considerations:
XerostomiaBrand Name: HCTZGeneric Name: HydrochlorothiazideHydrochlorothiazideEdema/ Hypertension/ Hepatic cirrhosis
Dental considerations: Orthostatic hypotension/ HypotensionBrand Name: GlucophageGeneric Name: MetforminMetforminDiabetes Mellitus Type 2
Dental considerations: Taste disorderBrand Name: ZoloftGeneric Name: SertralineSertralineMajor Depressive Disorder/ OCD/ Panic Disorder/ PTSD/ Premenstrual Dysphoric Disorder/ Social Anxiety Disorder
Dental considerations:
Xerostomia, possible prolonged bleeding timeBrand Name: AmbienGeneric Name: ZolpidemZolpidemInsomnia
Dental considerations:
Xerostomia
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