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96 terms

Pharm Final Exam

STUDY
PLAY
A patient receiving valproic acid (Depakote) should be monitored for which side effects?
drowsiness; nausea, vomiting, and other gastrointestinal disturbances; tremor; weight gain; and transient hair loss. The most serious side are hepatotoxicity and pancreatitis.
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?
"Fosphenytoin is a prodrug of phenytoin—it is converted to phenytoin once it is in your bloodstream. Since you are NPO, fosphenytoin is easier on your veins than phenytoin.
When administering intravenous phenytoin (Dilantin), which action will the nurse perform?
Flush the line with 10 mL normal saline to prevent precipitation.
Infusing phenytoin at rates >__ mg/min can cause severe hypotension.
50
Therapy for acute seizure activity is typically _______.
Valium
While completing discharge activity for a patient prescribed an antiepileptic drug, the nurse instructs the patient that abruptly stopping this drug could cause:
Rebound seizure activity
Antiepileptic drugs work by:
Decreasing nerve conduction
What is the goal of pharmacologic therapy for a seizure disorder?
Maximally reducing seizure activity while minimizing side effects of medication therapy.
While 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?
Absence seizures.
What is the therapeutic drug level for dilantin?
10-20 mcg.mL
The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene based on the knowledge that a common side effect of this drug is:
Gingival hyperplasia.
The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. What phenomenon does this describe?
ON-OFF and the med regimine will need to be changed
When teaching a patient about carbidopa-levodopa (Sinemet), the nurse responds based on knowledge that
carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.
Which 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?
selegiline
What is the goal of pharmacologic therapy in treating Parkinson's disease?
Balance cholinergic and dopaminergic activity in the brain.
The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's response is based on knowledge that
ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa.
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 brownish-orange urine. The nurse's response is based on the knowledge that
This is a normal occurence
When reviewing a patient's medication regimen before discharge, the patient asks why he is taking pyridoxine when he is already taking isoniazid to treat tuberculosis. What is the nurse's best response?
"Pyridoxine will help prevent numbness and tingling that can occur secondary to the isoniazid.
What is a nonharmful side effect of rifampin?
red-orange discoloration of urine, sweat, and tears.
While reviewing a TB pt's medication list that has just recently been put on rifampin is taking an oral contraceptive, what would be nursing implication?
pt should be switched to another form of contraceptive, they become ineffective when taken with rifampin
What lab tests should be monitored in a patient taking medications for treatment of TB?
LFT, CBC
Epinephrine, as an adrenergic (sympathomimetic) drug, produces which therapeutic effects?
Increased heart rate and contractility
What is the major therapeutic effects of dobutamine?
Increased CO
A hypertensive crisis may occur if adrenergic (sympathomimetic) drugs are given along with
MAO inhibitors
Nonselective beta-blockers may be used to treat hypertension and
Supraventricular arrythmias
When teaching a patient about beta-blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important to inform the patient that abrupt med. withdrawal can lead to what?
a rebound HTN crisis
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?
phentolamine (Regitine)
When assessing for cardiovascular effects of a beta-blocker, the nurse understands that these drugs produce
a negative inotropic, negative chronotropic, and negative dromotropic effect.
Beta-blockers are used to treat which disorders?
Card. dysrhythmias, angina, HTN
Cholinergic (parasympathomimetic) drugs have which therapeutic effect?
Increased GI motility
Cholinergic effects mimic the parasympathetic nervous system (rest and digest
Cholinergic (parasympathomimetic) drugs are indicated for which situation?
Lowering intraocular pressure in patients with glaucoma
During postoperative teaching, the nurse explains that the patient is receiving bethanechol (Urecholine) to treat
Urinary atony
The nurse administering donepezil (Aricept) to a patient understands that the expected therapeutic action of this drug is to
increase levels of acetylcholine in the brain by blocking its breakdown.
When providing teaching to a patient diagnosed with myasthenia gravis, which instruction regarding the administration of physostigmine (Antilirium) is most appropriate?
Take the medication 30 minutes before meals for therapeutic action (being able to swallow)
Which would be the most appropriate application time for a patient prescribed a scopolamine patch for motion sickness?
4 to 5 hours before travel
Which is an expected outcome associated with the administration of digoxin?
Decreased HR
What is the therapeutic level of digoxin?
0.5-2
Which are therapeutic effects of digoxin?
Positive inotropic, negative chronotropic, and negative dromotropic
Which effect(s) would alert the nurse to suspect early digitalis toxicity?
N/V
Phosphodiesterase inhibitors have an added advantage in treating heart failure because they cause a positive inotropic effect and
Vasodilation
The nurse reviews a patient's laboratory values and finds a digoxin level of 10 and a serum potassium level of 6.2. The nurse would notify the health care provider and anticipate administering
digoxin immune FAB.
Which is an indication for use of the antidysrhythmic drug lidocaine?
Ventricular arrythmias
When giving adenosine, it is important to remember to
Fast IV push
Adenosine is used to treat which condition?
Paroxysmal supraventricular tachycardia (PSVT)
Before administering a dose of an antiarrhythmic drug to an assigned patient, which assessments would be of highest priority?
Apical pulse and BP
Which classification of drugs is used to treat both hypertension and dysrhythmias?
CCB's
Calcium channel blockers have which pharmacodynamic effect?
coronary vasodilation
Amiodarone toxicity is evidenced in which body system?
Pulm
Nitrates relieve angina pain by reducing preload, which is
BV within the heart
Calcium channel blockers reduce myocardial oxygen demand by reducing afterload, which is
pressure against which the heart must pump.
Before administering isosorbide mononitrate (Imdur), a priority assessment would include
BP
During patient teaching, the nurse explains that nitroglycerin relieves chest pain primarily by which action?
decreases the WL of the heart
It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)?
(Viagra)
When caring for a patient with angina, the nurse would question an order for a noncardioselective beta-blocker in a patient with coexisting
asthma, copd, hypotension
An annoying side effect of ACE inhibitors that may be minimized by switching to an angiotensin receptor blocking drug includes
a dry, nonproductive cough.
ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by
Preventing aldosterone secretion
Which laboratory value might indicate an adverse response to hydrochlorothiazide (HydroDIURIL)?
Glucose
Which laboratory value depicts a known side effect of furosemide (Lasix)?
Hypokalemia
A patient is admitted to the hospital with pneumonia and has a history of chronic renal insufficiency. The physician orders furosemide (Lasix) 40 mg twice a day because it
is effective in treating patients with renal insufficiency.
What is the drug of choice for status epilepticus?
Vallium
A patient asks about taking potassium supplements while taking spironolactone (Aldactone). What is the nurse's best response?
"You are on a diuretic that is potassium-sparing, so there is no need for extra potassium."
The nurse would expect to administer which diuretic to treat a patient diagnosed with primary hyperaldosteronism?
spironolactone (Aldactone)
BC Spironolactone is the direct antagonist for aldosterone.
When assessing for therapeutic effects of mannitol, the nurse would expect to see
decreased intracranial pressure.
Thiazide diuretics can cause hyperuricemia, which would exacerbate
gout.
The nurse would assess which laboratory value to determine the effectiveness of intravenous heparin?
APTT
A patient who has been anticoagulated with warfarin (Coumadin) is admitted with gastrointestinal bleeding. The nurse will anticipate administering which substance?
vitamin K
What is the therapeutic range of INR?
2-3
Plavix is what type of drug?
antiplatelet for thrombus prevention associated with strokes and MI's
What three natural herbs alter blood coag and may increase the risk of bleeding when given with oral anticoags?
Garlic, Ginkgo, Ginseng
HMG-CoA reductase inhibitors (statins) are generally administered at which time?
in the evening
Which test will the nurse use to assess for adverse reactions to HMG-CoA reductase inhibitors?
LFT's
The nurse would question an order for simvastatin (Zocor) in a patient with which condition?
Hepatic disease
The nurse will assess a patient receiving gemfibrozil (Lopid) and warfarin (Coumadin) for which adverse effect?
Increased risk of bleeding
Which statement, made by the patient, indicates an understanding of discharge teaching regarding alendronate (Fosamax)?
"I will take the medication first thing in the morning with 8 ounces of water and remain upright for 30 minutes."
When monitoring for the most common side effect of traditional antihistamines, the nurse will assess the patient's
neuro status
Most common SE: sedation
A patient complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray for several days. The nurse's response is based on knowledge that
sustained use of nasal decongestants over several days may result in rebound congestion.
Which is a common side effect of antitussive medications?
Drowsiness and dizziness
Patient teaching regarding expectorants should instruct the patient to perform which action?
Increase fluid intake in order to decrease viscosity of secretions.
Corticosteroids are useful in the treatment of acute respiratory disorders secondary to their ability to
decrease inflammation
Parasympathomimetic ophthalmic drugs such as pilocarpine (Pilocar) reduce intraocular pressure in the treatment of glaucoma by which mechanism of action?
Miosis
The nurse is educating a patient who was administered atropine sulfate solution for an eye exam. The nurse includes which information in the education?
Use of sunglasses is encouraged to decrease sunlight sensitivity.
When administering ear drops what should you ensure prior?
the eardrops are at room temp
A 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?
carbamide peroxide
If the eye drop is being used for glaucoma it does what?
Decreases intraoccular pressure
Applying an eye ointment is what to what?
inner canthis to outter canthis
Xalantan is great for use with glaucoma but what is a main s/e that should be told to the pt's prior to use?
change of eye color
Inderal is used for what?
BP
Atropine is used to reverse _______ effects of a drug?
cholinergic
Your pt is DX with myasthenia gravis and is given mestanon to take at home, what pt education will you give that is important?
take med 30 minutes prior to eating
Ditropan:
antisoasmotic
Increases bladded tone
used for a post pt that is nto voiding
A pt is admitted with cerebral edema you will prepare to give what medication and why?
mannitol
bc it decreases ICP
What is the goal of an antianginal med?
decrease pain but decreasing the demand for 02 and increasing the blood flow.
Dilantin is used for what?
seizures
What is TPA and what is it used for?
dissolves clots and is used for CVA's
A pt that is DX with gout is prescribed Xylopran what is the MOA?
decreases uric acid production
When teaching a parkinson's pt about epdryl you will teach them to avoid what foods?
high tyramine foods bc it can cause spike in BP