ATI Pharmacology Retake 2

ATI Pharmacology Retake 2 Therapeutic outcome raloxifene (Evista) Ans- decreases bone reabsorption; slows down bone loss and preserves mineral density in postmenopausal osteoporosis Also used to protect again breast cancer Penicillin adverse effects: Ans- Allergies/anaphylaxis , renal impairment Macrolide Prototype Drug Ans- erythromycin (e-mycin) Airflow Disorders: Teaching About Theophylline Ans- If dysrhythmias or seizure occur, stop medication. Periodic blood levels are needed. Report nausea, diarrhea, or restlessness. Avoid consuming caffeinated beverages. digoxin toxicity symptoms Ans- fatigue, weakness, vision changes, GI effects digoxin level Ans- 0.5 to 2.0 ng/mL How to give digoxin Ans- infuse over at least 5 min, and monitor client for dysrhythmias. Management of digoxin toxicity Ans- Digoxin and potassium-sparing medication should be stopped immediately. Monitor K+ levels. For levels less than 3.5 mEq/L, administer potassium IV or by mouth. Do not give any further K+ if the level is greater than 5.0 mEq/L. Treat dysrhythmias with phenytoin (Dilantin) or lidocaine. Treat bradycardia with atropine. For excessive overdose, activated charcoal, cholestyramine, or Digibind can be used to bind digoxin and prevent absorption How to Treat dysrhythmias for digoxin toxicity patients Ans- Phenytoin Lidocaine Cyclophosphamide Alkylating agent (nitrogen mustard) Adverse effects: Ans- Bone marrow suppression Gi discomfort (N/V) Acute hemorrhagic cystitis monitor for hematuria, mesna can be given Alopecia Cyclophosphamide interactions Ans- Succinylcholine increased neuromuscular blockade Tricyclic Antidepressants Adverse Reactions Ans- -Orthostatic hypotension -Anticholinergic effects -Sedation -Toxicity -Decrease seizure threshold -Excessive sweating controlled substances Ans- Each level has a decreasing risk of abuse & dependence. For example, morphine (Duramorph) is a schedule II medication that has greater risk of abuse & dependence than phenobarbital (Luminal), which is a Schedule IV medication -Us Food & Drug Administration Pregnancy Risk Category (A, B, C, D, X) classifies medication in terms of their potential harm during pregnancy, with Category A being safest & Category X the most dangerous. Teratogenesis is most likely to occur during 1st trimester. Before giving any medication to a woman who is pregnant or could be pregnant, determine whether or not it is safe for administration during pregnancy Tricyclic Antidepressants (TCAs) Ans- Imipramine (Tofranil) Doxepin (Sinequan) Nortriptyline (Aventyl) Amoxapine (Asendin) Trimipramine (Surmontil) Anticholinergic effects Sx Ans- Dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia Anticholinergic effects Interventions: Ans- -Chew sugarless gum, sip water, wear sunglasses, eat high fiber foods, regular exercise, drink 2-3 L a day, void just before taking medication What medications should be avoided while taking TCAs? Ans- MAOIs, St. John's wort What interaction do TCAs and antihistamines have? Ans- Additive anticholinergic effects What happens when TCAs are taken with alcohol, benzos, opioids, or antihistamines? Ans- CNS depression Factors Effecting Medication Dosages and responses Ans- 1) Body Weight: individuals with more body tissue will require higher doses 2) Age: young children with immature liver/kidney function and older adults with decreased liver/kidney function may require lower doses 3) Gender: females may respond differently due to hormones 4) Genetics: missing enzymes can alter metabolism of certain drugs Medication and Pregnancy Ans- any medication ingested by a woman who is pregnant will be distributed to the fetus as well Live virus vaccines and pregnancy Ans- vaccines such as measles, mumps, polio, rubella, yellow fever are contraindicated due to possible teratogenic effects. A nurse is providing teaching to an older adult client to promote adherence with medication administration. Which of the following instructions should the nurse include? (Select all that apply.) AnsPlace pills in daily pill holders. Provide liquid forms if the client has difficulty swallowing pills. Ask a relative to assist periodically. Nursing interventions for lithium Ans- monitor plasma lithium levels while undergoing treatment monitor levels every 2-3 days and every 1-3 months Lithium blood levels should be obtained in the morning, usually 12 hrs after the last dose Advise clients that effects begin within 7-14 days A nurse is caring for a client who is taking ritonavir, a protease inhibitor, to treat HIV infection. The nurse should monitor for which of the following adverse effects of this medication? Ans- Hyperlipidemia with increased cholesterol and triglyceride levels can occur as an adverse effect of ritonavir. Action for clients who report persistent pain Ans- -Closely monitor patient‑controlled analgesia (PCA) pump settings (dose, lockout interval, 4‑hr limit). Reassure clients regarding safety measures that safeguard against self‑administration of excessive doses. Encourage clients to use PCA prophylactically prior to activities likely to augment pain levels -When switching clients from PCA to oral doses of opioids, make sure the client receives adequate PCA dosing until the onset of oral medication takes place -The first administration of a transdermal fentanyl patch will take several hours to achieve the desired therapeutic effect. Administer short‑acting opioids prior to onset of therapeutic effects and for breakthrough pain thyroid hormonesside/adverse effects: Ans- "overmedication" can result in signs of hyperthyroidism: anxiety, tachycardia, altered appetite, abd cramping, heat intolerance, fever, diaphoresis, weight loss, menstrual irregularities -instruct client to report these signs of overmedication Infiltration or Extravasation -- Nursing Interventions Ans- -Stop Infusion - Discontinue IV infusion if no vesicant drug -If Vesicant drug, disconnect IV tubing and aspirate drug from catheter. Agency policy and procedures may require delivery of antidote through catheter before removal. -Elevate Extremity -Contact health care provider if solution contained KCl, a vasoconstrictor, or other potential vesicant. -Apply warm moist compress or cold compress according to procedure for type of solution infiltrated. -Start new IV line in other extremity. Medications Affecting Cardiac Rhythm: Ventricular Dysrhythmia Ans- 1. Procainamide 2. Lidocaine 3. Propafenone 4. Miodarone 5. Norpace client teaching prior to allergy testing Ans- stop taking antihistammines ten days prior to testing Ergotamine adverse effects: Ans- -GI discomfort like Nausea and Vomitin -Ergotism-Muscle pain Paresthesias in fingers and toes: cold pale extremities -physical dependence -fetal abortion* Dantrolene Ans- Treatment of malignant hyperthermia Client teaching about infliximab/etanercept (RA) Ans- -function -how long does it take to work -what will happen after administration -they slow joint degeneration and progression of rheumatoid arthritis -can take 3-6 weeks to work -SubQ injection site swelling. Nurse will stop if irritation continues A charge nurse is leading a peer group discussion about factors affecting medication dosages and responses. Which of the following statements by a fellow nurse indicates the need for further teaching? Ans- "Client tolerance to medication is a result of decreased metabolism." A nurse is preparing medications for a preschool-age client. Which of the following factors should the nurse recognize as altering how children are affected by a medication? (Select all that apply.) Ans- Lower blood pressure Higher body water content Increased absorption of topical medications A nurse is providing medication teaching for a client who is lactating. Which of the following is appropriate to include to minimize secretion in breast milk? Ans- Take each prescribed dose right after breastfeeding. Preterm Labor medications Ans- -Terbutaline (Brethine) -Magnesium Sulfate -Indomethacin (Indocin) -Betamethasone (Celestone) Magnesium sulfate considerations Ans- -Monitor the client closely. Tocolytic therapy should be discontinued immediately if the client exhibits signs and symptoms of pulmonary edema, which includes chest pain, shortness of breath, respiratory distress, audible wheezing and crackles, and/or a productive cough containing blood-tinged sputum. Magnesium Sulfate Adverse Reactions Ans- loss of deep tendon reflexes, urinary output less than 30 mL/hr, respiratory depression less than 12/min, pulmonary edema, chest pain. Magnesium sulfate antidote Ans- calcium gluconate Dinoprostone Ans- a prostaglandin used to promote cervical ripening and stimulate uterine contractions Dinoprostone complications Ans- -Uterine tachysystole Dinoprostone (Cervidil) Contraindications Ans- C-sectio