Exam (elaborations) PHARM 180(Pharm 180 Notes for Quizzes) (PHARM 180(Pharm 180 Notes for Quizzes))

Pharmacology notes Week 1: quiz1 1. Describe physical dependence to medication? - The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. - When the body adapts to a drug that now requires a larger dose to achieve a certain effect (tolerance). For example tobacco, alcohol, prescription drugs. 2. Medication administration and safety? - An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. - Prevent error due to misinterpretation - Oral assessment - 3 checks of medication before administering it: Checking the drug with the MAR , Checking the drug when preparing it, checking the drug bed side before administering it to the patient. - The 5 rights - Questions in regard to medication 3. What to do when wrong medication ordered for NG tube? - Enteric coated Tabs should never be crushed. Contact MD if you have a patient on NG tube with orders for enteric coated tab - Call the provider - Clarify with the provider - Waste the medication with a witness (another nurse) 4. How many mLs are in 2 tsps? - 10mL 5. Five Rights of medication administration: - Right patient - Right medication - Right dose - Right route of administration - Right time of delivery 6. Describe clinical investigation? - Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. - Takes place in three different stages termed clinical phase trails. - Longest part of approval process. - Evaluates human benefits - Tests on healthy humans first, then on those with the target ailment. 7. Define controlled substance? - Drugs that have a high potential for addiction are considered controlled substances. - The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. - Restricted by the controlled substances Act of 1970. - Frequently abused. - Have a high potential for addiction or dependence. - Have restricted use. - Are places into one of five schedules. - Medications are controlled because of overdose. 8. What are scheduled drugs? - Drugs that have a significant potential for abuse are placed into five categories called schedules. - Schedule I drugs have the highest abuse potential, schedule V the lowest. 9. What are schedule I drugs? - Heroin, Marijuana, LSD and Extasi is a Schedule I drug and has the highest potential for abuse - Drugs with the highest potential for addiction. - Restricted to situations of medical necessity. - Little or no therapeutic value - Heroin, LSD, marijuana, ecstasy. 10. What are schedule II drugs? - Schedule II drugs cannot be refilled by phone order. Patient needs to go see their Physician - Disabused only in cases where therapeutic value has been determined. - Drugs that have a high potential for abuse but should only be used if medically needed. - Dilaudid, methadone, meperidine, morphine, fentanyl, cocaine, Ritalin. - Fentnyl is mostly given for cancer pain. - These drugs need a special order to obtain. 11. What are preclinical investigation for medication testing? - Involves laboratory research on nonhuman subjects. - Involves laboratory research. - Ranges between 1-3 years - Tests done on cells and animals - Determines drug-dose range - Examines adverse effects - Results considered inconclusive 12. What organ is responsible for biotransformation of a drug? (Biotranformation is the process by which a substance changes from one chemical to another by a chemical reaction within the body). Also known as metabolism of medication. - Liver 13. What action occurs with the initial transformation of a drug? - Four components of pharmacokinestic- Absorption, Distribution, Metabolism, Excretion. - Drug is absorbed in the stomach and small intestines. - Drug enters blood stream and enters hepatic circulation, goes to liver. - Drug is metabolized to inactive form. - Drug conjugates and leave liver. - Drug is distributed to general circulation 14. Describe the pharmacological classification of a drug? - Explains the drug for how the drug works. - Drugs may elicit different responses dependent on individual client factor. 15. Physician has prescribed a brand name drug for the client. Client tells RN that Rx is too much. What is the best plan by the RN? - Ask the MD to prescribe the GENERIC medication. It is cheaper. 16. Define pharmacotherapeutics? - The application of drugs with the purpose of treating disease is referred to Pharmacotherapeutics - The treatment and prevention of pathological condition through the use of drugs. 17. List examples of complementary therapy? - Natural plant extracts, herbs, vitamins, minerals, dietary supplements. Acupuncture, hypnosis, biofeedback, massage. - Complementary alternative therapies are used as a nonconventional treatment. Things like therapeutic touch, guided imagery, meditation are all examples 18. The RN is teaching a class about over the counter drugs (OTC) meds. How does the RN determine that education has been effective? - I will read the label/dosage. I will know how much and how often to take the meds. And call doctor if unclear or have any questions. - When patients are receiving education about OTC medications it is important that the nurse explain to the patient that he/she must read all directions on the label/insert and contact physician if there is something they do not understand 19. Describe the term therapeutic? - Measure the drugs safety margin - Higher the value, safer the drug - Therapeutical drug classification is the classification based on the drug’s usefulness to treat a certain disease 20. Describe the prototype drug approach? - Lead agent and drug class family. - Prototype drug is the most known drug of a certain drug type. Morphine is prototype opiates, Heparin for anticoagulants 21. Mechanism of action. - Mechanism of Action describes how the drugs work, like binding with receptors and causing a response or blocking the action altogether - Absorption - Distribution - Metabolism - Excretion 22. Examples of trade names. - Advil, Motrin Nuprin are all trade names for Ibuprophen - Lopressor metoprolol- Antihypertensive - Lipitor-hyperlipidemia 23. How does laboratory become FDA? - Any pharmaceutical laboratory in America must have approval from the Food and Drug Administration (FDA) before marketing a drug." 
 - Phase 1: Preclinical - Phase 2: Clinical investigation - Phase 3: NDA review - Phase 4: post marketing studies. 25.What are the effects of medication on patients that are malnourished? - Toxicity. - A drug that is highly protein bound is given to a patient with Hypoalbuminemia. Patient will be at risk of toxic levels. Extra Notes: • Variables such as age, sex, body mass may elicit different responses in different patients even if they are using the same drug and the same dosage • Generic Drugs are usually less expensive then trade name drugs. Please keep in mind that if a patient cannot afford trade name, nurse should question physician for generic • 1 Teaspoon = 5 ml, 1 Tablespoon = 15 ml • The lower the therapeutic index, the more dangerous the drug can be. MLD50/ MED50 = Therapeutic Index/ You will be required to calculate • Kidney and Liver functions should always be assessed for an older patient • If a medication error does occur, assess the patient; notify physician and complete an incident report. • Remember conversions: How many mls are in a teaspoon or tablespoon. • Distribution of drugs are affected by the blood flow to the desired tissue • Review all 3 phases of clinical trials Week 2: Notes and questions – quiz 2 Pharmacology Review Quiz 2 1. The nurse has completed education about peptic ulcer disease (PUD) with the client. How does nurse evaluate patient teaching? - Patients with PUD should decrease modifiable risk factors such as Caffeine and tobacco. 2. List the potential complication of long-term therapy of PPIS? - Long-term use of PPIs, like Omeprazole, Pantoprazole, increases risk of: o osteopenia o osteoporosis o increased risk of gastric cancer Proton Pump Inhibitors (PPI) • Prototype drug: omeprazole (Prilosec) • Mechanism of action: Reduces acid secretion in stomach by binding irreversibly to enzyme H1, K1-ATPase • Primary use: for short-term, 4- to 8-week therapy for peptic ulcers and GERD • Adverse effects: headache, nausea, diarrhea, rash, abdominal pain • Long-term use associated with increased risk of gastric cancer • Take 30 minutes prior to eating, usually before breakfast • May be administered at same time as antacids • Often administered in combination with clarithromycin (Biaxin) 3. The physician has ordered combination therapy for the client with peptic ulcer disease (PUD) who tested positive for H. pylori. What will the best education plan by the nurse? - Combination therapy with PPI and antibiotics are commonly prescribed for patients with H pylori + PUD. Most common combinations will add Amoxicillin, clarithromycin and metronidazole (Flagyl). Antibiotics • Administered to treat H. pylori infections of gastrointestinal tract • Two or more antibiotics given concurrently – Increase effectiveness – Lower potential for resistance • The regimen often includes: – Proton pump inhibitor – Bismuth compounds  Inhibit bacterial growth  Prevent H. pylori from adhering to gastric mucosa 4. The nurse is planning medication administration instruction for a client receiving antacids should include what information? - Antacids should be administered at least 2 hours before other oral medication. Antacids • Prototype drug: aluminum hydroxide (Amphojel) • Mechanism of action: Neutralizes stomach acid by raising pH of stomach contents • Primary use: in combination with other antiulcer agents for relief of heartburn due to PUD or GERD • Adverse effects: minor; constipation • Obtain medical history, including use of OTC and prescription drugs • Assess patient for signs of renal insufficiency – Hypermagnesemia may occur—kidneys unable to excrete excess magnesium 5. The nurse completes medication education for the client receiving sucralfate (Carafate should include what information? - Sulcrafate works by dissolving into a gel and sticks to the ulcer almost like a bandaid. Should be taken 1 hour before meals and at bedtime. - Sucralfate (Carafate) o Coats ulcer and protects it from further erosion (Take 1 hour before meals and at bed time/ do not take with anatacids) 6. The nursing instructor is teaching student nurses about lower gastrointestinal (GI) functioning and the large intestine. The nursing evaluates that learning has occurred when? - The Large Intestines is responsible for the absorption of water along with the elimination of fecal matter Lower Digestive Tract - Consists of the small and large intestines - The first 10 inches of the small intestine is the duodenum - Small intestine is location for most nutrient and drug absorption - Peristalsis is controlled by autonomic nervous system - Peptic ulcer most common disorder Large intestine responsible for: o Reabsorption of water o Excretion of fecal matter 7. An elderly client has constipation and wants to know what caused this? What is the best response by the nurse? - Constipation can be connected to the low ingestion of fiber containing foods. When that happens the stool stays in the intestines for a long time and they get hard. Common condition caused by: - Lack of exercise - Insufficient dietary fiber - Diminished fluid intake - Slow motility of waste material through large intestine - Certain foods, medications, diseases 8. The client takes diphenoxylate with atropine (Lomotil) for diarrhea. The client asks the nurse why he does not experience pain relief since the drug is an opioid? - Lomotil is a combination of diphenoxilate and atropine. Analgesia is not noted because the opiate diphenoxilate does not have analgesic properties. Antidiarrheals, Opioids • Prototype drug: diphenoxylate with atropine (Lomotil) • Mechanism of action: Slows peristalsis • Primary use: for moderate to severe diarrhea • Adverse effects: dizziness and drowsiness 9. The client has been consuming very high amounts of vitamin A. He asks the nurse will this be a problem? - Any fat soluble vitamin if ingested in excess can be toxic. - Vitamin A: precursor of retinol needed for normal vision o Obtained from foods containing carotenes. 10. The client is receiving total parenteral nutrition (TPN). What is the best plan to prevent complications from the total parenteral nutrition? - Whenever patient is receiving TPN, the nurse must remind physicians to order for blood sugar checks due to the high glucose content in the TPN. 11. The client has been diagnosed with type 1 diabetes mellitus. He asks the nurse what this means? - Patients with Diabetes type 1 are at risk for DKA, Endocrine function from the pancreas is not working, thus the pancreas are not producing insulin. Type I Diabetes Mellitus • Caused by absolute lack of insulin secretion – Due to autoimmune destruction of pancreatic islet cells • If untreated, results in serious, chronic conditions – Cardiovascular damage • Nervous system damage Treatment – Dietary restrictions – Exercise – Insulin therapy Insulin Varies in: Onset of action; Time to peak effect; and duration 12. A client with diabetes mellitus type 1. Which nursing action is a priority? - If patient with Diabetes becomes unresponsive, the nurse must first assess ABC the assess and treat for Hypoglycemia 13. The client has type I Diabetes mellitus and receives insulin. He asks the nurse why he can’t just take pills instead? - Amylase will inactivate insulin. Insulin must be injected because it is destroyed in stomach acid if taken orally. 14. The client has type II diabetes mellitus. The nurse has taught the client about the illness and evaluates learning has occurred when? - With type 2 diabetes mellitus, the pancreas produces insulin, but the cells cannot use it. - When the client demonstrates understanding that type II DM is caused by insulin resistance and if its left untreated. It can cause chronic conditions such as cardiovascular and nervous system disease. - Causes o Lack of sensitivity of insulin receptors at target cells (insulin resistance) o Deficiency in insulin secretion - If untreated, results in same chronic conditions as type 1 DM - Treatment o Controlled through lifestyle changes o Treated with oral hypoglycemic drugs  All oral hypoglycemics lower blood glucose levels 15. The nurse makes a home visist to a client with diabetes mellitus. During the visit, the nurse notes that the clients 3 month supply of insulin vials that were delivered a week ago are not refrigerated? - Unopened vials should be refrigerated until needed and should be stored away from direct sunlight or direct heat. - Unopened vials should be refrigerated not frozen, can be used until expiration date if kept refrigerated. After opening, can be kept up to 1 month with out significant loss of activity, keep out of direct sunlight. 16. The client receives metformin, what are the nursing considerations? - Metformin (Glucophage), a medication used for Diabetes type II, decreases sugar production (gluconeogenesis) in the liver and reduces insulin resistance. - To avoid lactic acidosis, avoid using in patients with renal problems, store in tight container in cool place, take with food or take it with slow release tablets. This must be taken daily and not discontinued abruptly. 17. The physician orders intravenous (IV) insulin for the client with a blood sugar of 563. The nurse administers IV insulin. What is the only insulin that can be administered IV? - Regular insulin is the only insulin that can be given intravenously (IV). 18. The client has diabetes insipidus. Which medication would the nurse expect to be included in the medication management of this disorder? - Vasopressin is the synthetic form for ADH, used in the treatment of Diabetes Insipidus 19. The nurse is teaching the patient who is scheduled to receive radioactive Iodine I131 on its therapeutic uses. Which of the following is the correct information to teach the client? - Iodine 131 is utilized in the treatment of hyperthyroidism. 20. A client diagnosed with hypothyroidism had blood tests drawn. Which lab test would the nurse anticipate? - If T3 and T4 production by the thyroid is low, through the negative feedback system, patient may produce high TSH levels. 21. List the risk factors for peptic ulcer disease? - Increased Risk Factors for PUD include: Intake of Caffeine and tobacco, Type O blood and excess stress. Diabetes has nothing to do with PUD Risk Factors for PUD: - Family history, type O blood - Tobacco use and caffeine - Glucocorticoids and NSAIDs - Psychological stress 22. A client with GERD is prescribed a prokinetic agent to increase GI Motility. What name of the medication do you expect the HCP to order? - Reglan is a prokinetic agent because it speeds up peristalsis and can be prescribed in the treatment of GERD. 23. The client has an order for sucralfate (Carafate) 1g by mouth four times daily. The nurse writes in the medication do you expect the HCP to order? Breakfast, Lunch, Dinner, Before bedtime 24. Erythromycin 200mg po Q6H Available 50mg tablets. How many tablets do you give for the entire day? - 16 tablets for the entire day. 25. Demerol 50 mg IVP now. Supply: Demerol 200 mg/2ml. What is the quantity to administer for 1 dose. - 50/200 x 2ml = 0.5 ml Demerol Additional notes: - Levothyroxine has higher affinity to the protein in the blood. It also accelerates the degradation of vitamin K dependent clotting factors, which enhances the effects of warfarin. Patients taking warfarin who start taking levothyroxine may need to have their warfarin dose reduced. - Misoprostol (Cytotec) inhibits gastric secretion and stimulates the production of protective mucus. Sucralfate (Carafate) dissolves into a gel and adheres to the ulcer site. Bismuth (Pepto-Bismol) inhibits bacterial growth. Antacids neutralize stomach acid. - Review signs of Hypothyroidism like low heart rate, low temperature, pale skin, feeling cold and tired. Quiz 3- Pharm 1. Nonpharmacological techniques maybe used in place of drugs or as an adjunct to pharmacotherapy to help reduce the use of? (slide 6) - opioids/ narcotics. - "Nonpharmacological techniques are a good adjunct to pharmacotherapy." - "Nonpharmacological techniques may be used in place of drugs." 2. What is the mode of action about skeletal muscle relaxants? - Inhibits upper motor neuron activity, causes CNS depression; alters spinal reflexes. - All centrally acting agents like Flexeril (a centrally acting muscle relaxer) have the potential to cause sedation/drowsiness. The exact mechanism by which skeletal muscle relaxants work is not fully understood. It is believed that they inhibit upper motor neuron activity, causing CNS depression 3. The nurse keeps naloxone (Narcan) in the patient’s room as per protocol. What does the nurse recognize as the justification for this protocol? - Naxalone may be used to reverse respiratory depression and other acute symptoms. - Naloxone (Narcan) is an opioid antagonist and will reverse the effects of the narcotic if an overdose occurs. 4. What is priority assessment question to ask a postsurgical patient prior to administration of an opioid analgesic? (slide 14) - Would you please rate your pain on a scale of 1-10. 5. The patient comes to the ER with a head injury, broken ribs, and internal bleeding. What class of meds are contraindicated for this patient? (Slide 17 & 14). -Cox 11 and opioids inhibitors. - Opioids can mask changes in the patients LOC. - Opioids analgesics like morphine are contraindicated for patients that are positive for brain hemorrhage. The risk for increased intracranial pressure needs to be closely monitored by monitoring LOC. Analgesic Opiates will decrease LOC thus disrupting appropriate assessment. - Remember that Opioids are central nervous system (CNS) depressants and can mask the patient's level of consciousness; this is dangerous when the patient has a head injury. 6. List the common adverse effects of cyclobenzaprine (flexeril)? - CNS depression, hepatic toxicity, physical dependence, anticholinergic effects. 7. The client receives a nonsteroidal anti-inflammatory drug (NSAID) for treatment of pain. What patient teaching is important for the nurse to include when doing medication education? - GI bleeds, distress, renal impairment, Reyes syndrome hypersensitivity, salicylism-tinnitus, dizziness, headache, excessive perspiration. - Nonsteroidal anti-inflammatory drugs (NSAIDs) are nephrotoxic; keeping the client well hydrated will help prevent kidney damage and taking the medication with food will help prevent GI Irritation. 
 8. The mother asks the nurse if she can use liquid acetaminophen that is used for her 10-year-old child. What is the best response by the nurse? - Read label, directions, and dose. Call your doctor if you are unsure about the proper dose. - Tylenol Infant drops should be used for babies; they have a different concentration of medication than the liquid preparations which can be given to children (no switching)
 9. List the most common side effects of aspirin that the nurse will teach the client to report? - High doses may cause GI bleeding, renal impairment may increase actions of oral hypoglycemic agents. (slide 19). - Tinnitus, or ringing in the ears, is a common early sign of aspirin toxicity (salicylism). - If a patient who is taking aspirin starts to display salicylism (High levels of ASA= aspirin) remember that the one of the first interventions that the nurse must educate the patient on is to stop the use of aspirin. Review the signs of salicylism. Toxicity occurs at a salicylate level of 400 mcg/mL or higher. 10. Descried forms of complementary therapy. (Slide 6). -Therapeutic Touch, Acupuncture, massages are all complementary alternative therapies. These types of therapy can be used instead of the main treatment or in conjunction as an adjuvant therapy, Complementary alternative therapies can be used as adjuvants because they help decrease side effects as well as allowing lower doses. - Acupuncture, massage therapeutic or physical touch. -Biofeedback- hot or cold- relaxation- meditation or prayer. 11. The nurse teaches the patient relaxation techinques and guided imagery as an assistant to? - Evoke relaxation response, reducing stress, calming physical effects to manage pain. Guided imagery allows PN to reduce dosage of pain medication. 12. Client ordered an IV pain med and the patient wants to change the medication to oral? Which response by the nurse is best? - Consult with pharmacy or call HCP. - Pills have less side effects than IV medications…thus we must take that into consideration as we explain to patients why one route vs. another. 13. What client would be having opioid analgesics be a contradiction? - Acute bronchial asthma - Head injury - Grand mal seizures - Alcoholics - Opioids analgesics like morphine are contraindicated for patients that are positive for brain hemorrhage. The risk for increased intracranial pressure needs to be closely monitored by monitoring LOC. Analgesic Opiates will decrease LOC thus disrupting appropriate assessment. 14. Which comment by the client does the nurse recognize as a side effect of morphine? - Adverse effect is something we do not expect while side effect is expected. - Common side effects include- constipation, nausea, and vomiting. - “I feel dizzy and I may throw up.” - “I haven’t had a BM for two days.” 15. Which is an adverse effect associated with morphine? - Respiratory depression, sedation, nausea, vomiting, constipation. - One of the findings associated with morphine administration is respiratory depression and that is a priority as far as nursing intervention. Remember ABC. 16. What is the best patient teaching for older patients as it relates to side effects of NSAIDS? - Make sure they understand that adverse effects such as nausea, heartburn, epigastric pain, dizziness, upset GI, and acute renal failure. (slide 21 and 34). - Older adults are at risk for increased bleeding with nonsteroidal anti-inflammatory drug (NSAID) therapy. Nurse must educate patient to report any unusual bleeding 17. The client receives prednisone as treatment for his inflammatory disease. What is the best response by the nurse? - Long term use may result in Cushing syndrome - Taper off and can mask infection, peptic ulcer, and mood change. 18. What patient would the nurse assess acetaminophen to be contraindicated? - Patients with liver disease. - Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin). 19. Histamine release produces what response? - Inflammatory response. (slide 31) - Histamine dilates blood vessels causing capillaries to become more permeable. Thus, helping with the inflammatory process 20. The physician orders acetaminophen. The nurse would clarify the order with the physician what patient. - Use caution with patients who consume large amounts of alcohol or have liver disease. 21. Describe the role opioid receptors have on pain relief? - Mu and kappa - Opioid agonists will activate mu and kappa receptors, producing analgesia. - agonist drugs stimulate receptors. - Opioid agonists stimulate mu and kappa receptors, resulting in a variety of effects, including analgesia. 22. Order 25 mg Demerol. Available 75 mg/2ml. What is the amount to be given? 23. Aspirin gr. V is ordered. Available aspirin 325 mg. How many tablets do you give? 24. You have an order to infuse ancef 250 mg in 50 mL of Normal saline to be completed in 60 mins. How would you set up the pump in mL/hr, so that the infusion can end within the 15 mins specified by the physician? 25. A nurse is caring for a client with heart failure and pres. for digoxin 75 mcg PO daily. Available is digoxin PO 0.5 mg/ tablet. How many tablets should the nurse administer per dose? (round to the nearest tenth). Pharm Week 5- Quiz 4 1. What is the role of the nurse in educating about antihistamines? - When patients take antihistamines such as Benadryl, due to its effect on the CNS, patient should avoid any alcoholic drinks and operating heavy machinery. 2. What information does the nurse need to ask the patient who states that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion? - Oxymetazoline (Afrin) can cause rebound congestion if used for too long, so length of treatment is the best assessment question. - “How long have you been using the medication.” 3. What education tips does the nurse need to educate the patient about the use of a metered-dose inhaler (MDI) Spiriva? - When patients are using MDI inhalers they should not hear a whistling sound. That denotes that patient may not know how to appropriately use the inhaler. Teaching will be required. Also make sure to educate patient to hold their breath for at least 10 seconds to allow the medication to deposit in the lungs. 4. which information should the nurse teach the client regarding the medication hydrocodone? - If patients have severe cough and MD prescribes opiates such as Hydrocodone, the nurse must advise patient to monitor bowel movements for constipation. 5. Which assessment findings would the nurse anticipate for the patient taking pseudoephedrine (Sudafed)? - Sudafed, which is a combination drug can lead to increase in heart rate, Blood pressure and can also lead to dysrhythmias 6. Which discharge instructions should the nurse provide regrading the clients prednisone, a glucocorticoid? - Whenever glucocorticoids are prescribed the patient should be notified to never stop the medication abruptly. The medication should be tapered down instead. 7. The nurse in preparing to administer medication on a pulmonary unit. Which medication classes should the nurse anticipate administering? - A patient in a pulmonary unit, should have as one of the nurse’s first intervention administration of O2 if their O2 Sats are dropping 8. The client receiving theophylline (Theodur). What in the normal lab range for this medication? - Theophyline (Theodur) belongs to the class of drugs known as methylxanthines. This class has a very narrow range of safety that varies from 5-20 mg/dl. So Nurse should question administration of medication if the levels are higher than 20. That can lead the patient to develop adverse effects such as seizures. Keep in mind that Theophylline can increase cardiac stimulation and cause tachycardia. 9. What in the MOA for a non- narcotic antitussive medication? - Non-narcotics antitussive work by suppressing the cough reflex in the medulla in the brain. 10. The client with an acute exacerbation of asthma is being treated. Which assessment data indicates the medication is effective? - If your patient is receiving asthma medications, you will know that the medication is working if you hear the patient’s lung sounds and they are clear. 11. The nurse is teaching community education about the major functions of the upper respiratory tract. What would the nurse include in the teaching? (select all that apply) know slide 2 - Nursing education about the upper respiratory tract involve: The nose warms the air before it reaches the lungs. The nasal mucosa is the first line of immunological defense. Activation of the sympathetic nervous system constricts arterioles in the nose. 12. What education should the nurse include for the patient and the MOA of beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. - Intranasal glucocorticoids produce almost no serious adverse effects 13. The physician prescribes fluticasone (Flonase) for a patient that is pregnant. Why should the nurse hold the drug and contact physician? (select all that apply)-slide 2 - Fluticasone (Flonase) is a class C drug so effects on pregnancy are not known. Patients that are pregnant should avoid taking this medication 14. Is the MOA for Albuterol (Proventil) via inhaler faster acting than the oral dose of the same medication? - Albuterol (Proventil is a beta 2 adrenergic agonist used as a rescue inhaler during asthma attack. 15. The nurse teaches a medication class on the MOA of bronchodilators for clients with Asthma. What information should the nurse include in the teaching plan? - When nurses are educating patients about the use of bronchodilators like Albuterol, a good explanation as far as the mechanism of action is as follows: The inhalers will widen the airway due to activation of the flight or fight response, or the B2 adrenergic receptors of the sympathetic nervous system. This activation causes smooth muscle to relax and bronchodilation to occur. 16. The nurse teaches a medication treatment for clients with asthma. What information should the nurse include? - Inhalers used for continued treatment and prophylaxis of asthma are effective if used for long term as it assists with decreasing the inflammatory response. Thus, patients will need to continue taking medication as long as ordered as prophylaxis for asthma. 17. Bronchoconstriction in the airways is stimulated by? - Keep in mind that the parasympathetic nervous system will cause bronchoconstriction. 18. Which instructions does the nurse need to teach the patient regarding dry powder inhalers (DPI)? - DPIs or dry powder inhalers are activated during inhalation 19. Leukotriene modifiers MOAs? - Leukotriene modifiers are used primarily for prophylaxis in the treatment of asthma. This medication works by reducing inflammation. 20. Define asthma - Asthma is one of the conditions known as chronic Obstructive Pulmonary Disorder. This condition has both an obstructive component and an inflammatory component. 21. Side effect regarding antihistamines? - it effects CNS (Drowsiness) - pt. should avoid alcoholic drinks and operating heavy machinery. 22. The patient is diagnosed with restrictive airway disease, asthma. What is the MOA for the use of a rescue MDI? - Reduce inflammatory response - Broncho dilates 23. Dr. A orders your patient to receive 25 ml of D5W an hour for the next 8 hours. The nursing unit uses an IV tubing with a drip factor of 15. What is the drip rate per min? 24. Dr. B orders a liter of D5W to run this 12 hr shift. The drop factor of the IV tubing is 10. What is the drip rate per min? 25. A trauma patient post MVA arrives into your ED. Physician asks you to run a normal saline bag 1 L over 4 hours. There are no pumps available. You use a 60 drop per ml tubing. How many drops per min do you infuse the normal saline? Round to the nearest whole number. Extra Notes: • Intranasal glucocorticoids produce almost no serious adverse effects. • The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances. Thus, delivering respiratory medications via inhaler is the best route of administration. • Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication- Oropharyngeal candidiasis. • If your patient is receiving asthma medications, you will know that the medication is working if you hear the patient’s lung sounds and they are clear. • Nursing education about the upper respiratory tract involve: The nose warms the air before it reaches the lungs. The nasal mucosa is the first like of immunological defense. Activation of the sympathetic nervous system constricts arterioles in the nose. • Intranasal glucocorticoids, such as fluticasone propionate, are the most effective drugs for prevention and treatment of both seasonal and perennial allergic rhinitis, because they prevent or suppress all the major symptoms of allergic rhinitis (congestion, rhinorrhea, sneezing, nasal itching, and erythema). • Ipratropium bromide is an anticholinergic that is indicated for allergic rhinitis, asthma, and the common cold. The drug reduces rhinorrhea. Ipratropium bromide is an anticholinergic. In addition to asthma, ipratropium bromide can be used for allergic rhinitis and the common cold. Ipratropium bromide can be used for allergic rhinitis. • Guaifenesin is an expectorant. It stimulates the flow of respiratory tract secretions to improve cough productivity. • Benylin (dextromethorphan) is a non-opioid cough suppressant. • Albuterol (Proventil) is a Beta 2 adrenergic agonist used as a rescue inhaler during an asthma attack • • Med Math: o Vm (ml)/ Time (min) X Drop Factor (gtts/ml) = _______Gtts/min o Vm (ml)/ T (Hours) = ______ml/Hr Pharmacology Quiz 5 Review 1. Which assessment data would the nurse question administering beta blocker medications? If a Nurse is giving a patient a Beta Adrenergic Blocker, such as metoprolol, the nurse must make sure to check patients heart rate and blood pressure as this medication is a negative chronotropic and negative inotropic medication. If Vital Signs are low, nurse should hold medication and notify physician. Beta Blockers are contraindicated for Asthma Patients. 2. Which data is most important for the nurse to assess to determine the effectiveness of a loop diuretic medication? The best way to monitor if the diuretic therapy is working is by checking patient’s daily weight. If daily weight is unavailable Intake and Output is the next best way to monitor 3. The nurse is preparing to administer the following medications. Which medication should the nurse question administering? Digoxin (lanoxin), a cardiac glycoside has a very narrow safety range thus digoxin levels are monitored while patient is taking the therapy. Digoxin levels of greater than 1.8 ng/dl denotes that it is too high and digi toxicity can occur. This is a very serious concern as this medication is a negative chronotropic medication. In other words, this medication decreases the pulse rate and increases the myocardial contractility of the heart making the heart a more effective pump. 
Signs of Digoxin Toxicity include: nausea, anorexia, visual disturbances (seeing halos), fatigue and vomiting. When patient is taking digoxin, an apical pulse should be checked for one full minute prior to administering digoxin. If the heart rate is low (generally 60 bpm), the medication should be held, and the ordering practitioner informed. Digoxin can suppress electrical activity within the heart and lower heart rate. The drug Digibind can be used to treat toxic levels. 4. The health care provider prescribed an ACE inhibitor for the client diagnosed with arterial hypertension. What is the MOA for administering this medication? ACE Inhibitors prevents angiotensin I from turning into angiotensin II which is a potent vasoconstrictor to decreases blood pressure. ACE inhibitors are number one choice of therapy for Heart Failure, it can be used for Hypertension, decrease progression of diabetic neuropathy and post MI to improve outcomes. 5. Which intervention should the nurse administering a combination medication thiazide and beta blockers? If a combination drug (Thiazide diuretic and a beta blocker) like Tenoretic is prescribed, the nurse needs to remind patient that they may feel dizzy and that they should sit on the side of the bed before getting out of bed to avoid falls. 6. Which lab result would the nurse recognize as most significant for the patient receiving? Keep in mind that Hypokalemia can increase the likelihood of Digoxin toxicity. Thus if Potassium levels are less than 3.5 for a patient taking Digoxin the nurse would have to immediately notify MD and intervene accordingly. 7. The nurse is discharging a client prescribed isosorbide mononitrate (Isoradial), an organic nitrate what information does the nurse need to include related to the safety of this medication? Isordil (a nitrate) should not be used in conjunction with Viagra. This would lead to significant hypotension 8. What assessment data is most important for the nurse to evaluate when evaluating that the cardiac glycoside, digoxin (Lanoxin), is effective for the client diagnosed with congestive heart failure? We can measure that digoxin is working for a heart failure patient, if patient is able to perform ADL’s and walk better than without the medication. 9. What statement by the client warrants the nurse notifying the health care provider regrading client. 10. The client is receiving the medication, warfarin (Coumadin), for the client diagnosed with DVT. Which lab would be scheduled by the? Black Tarry stools is an abnormal finding for patients taking Coumadin. This may be indicative of bleeding. If patient is taking Coumadin, they should have PT and INR drawn to measure levels and be able to adjust Coumadin dose. 11. What intervention should the nurse include with administering NTG to a patient administer to prevent headache? - Transdermal Nitroglycerin can build tolerance. For that reason, the nurse should remove the patch for at least 6-8 hours to avoid tolerance to build up. Keep in mind that headache is a common side effect for a patient using Nitrates. Tylenol PRN can be suggested for that. 12. What intervention should the nurse implement first administering a transdermal nitroglycerin patch to a patient? - Transdermal Nitroglycerin can build tolerance. For that reason, the nurse should remove the patch for at least 6-8 hours to avoid tolerance to build up. Keep in mind that headache is a common side effect for a patient using Nitrates. Tylenol PRN can be suggested for that. 13. What is the scientific rational for administering digoxin for a patient with CHF? 14. A patient is taking a calcium-channel blocker. What information should the nurse indicate in the teaching plan? - Keep in mind that if patient is taking a calcium channel blocker, that they should not take grapefruit juice. 15. What assessment data indicated that the loop diuretic education is effective? - The best way to monitor if the diuretic therapy is working is by checking patient’s daily weight. If daily weight is unavailable Intake and Output is the next best way to monitor. 16. What symptoms is the assessment of the patient with CHF taking digoxin would trigger an immediate visit to the client ? - Keep in mind that Hypokalemia can increase the likelihood of Digoxin toxicity. Thus if Potassium levels are less than 3.5 for a patient taking Digoxin the nurse would have to immediately notify MD and intervene accordingly. 17. List the side effects for the medication furosemide (Lasix). - Some of the possible adverse effects/side effects of taking Lasix are as follow: Hypokalemia, Hypotension, Hyperuricemia, Hyperglycemia and Ototoxicity if the medication is IV pushed too fast. 18. What assessment data would the nurse report for the patient taking a statin drug. - If a patient is taking Statins for the treatment of Hypercholesterolemia, The nurse must assess for complaints of muscle pain, tenderness, and weakness as this could indicate a type of myopathy known as rhabdomyolysis. 19. What is the MOA for ACE inhibitors? - ACE Inhibitors prevents angiotensin I from turning into angiotensin II which is a potent vasoconstrictor to decreases blood pressure. ACE inhibitors are number one choice of therapy for Heart Failure, it can be used for Hypertension, decrease progression of diabetic neuropathy and post MI to improve outcomes. 20. Beta Blockers are contraindicated for what patient co-morbitity’s? - If a Nurse is giving a patient a Beta Adrenergic Blocker, such as metoprolol, the nurse must make sure to check patients heart rate and blood pressure as this medication is a negative chronotropic and negative inotropic medication. If Vital Signs are low, nurse should hold medication and notify physician. Beta Blockers are contraindicated for Asthma Patients. 21. You receive an order to infuse 1 liter of normal saline over. 8 hours using a 15 gtt tubing. 22. Your patient has an order to start Heparin drip at 5000 units per hour. The pharmacy brings a bag that is labeled 25,000 units in 100 ml Dextrose. At what rate will you set the pump to run in at ml/hr? 23. You receive an order to infuse Dopamine at 2mcg/kg/min. Patient weighs 220 pounds. The pharmacy delivers a bag labeled, Dopamine 200mg in 100ml Normal Saline. At what rate will you program the pump in ml/hr. 24. What vital sign is utmost apprehension to the nurse prior to administrating digoxin (Lanoxin)? 25. Discuss how to educate a patient whose blood pressure is 160/95 mmHg on ways to lower blood pressure and avoid hypertension. Which lifestyle choices ,any eliminate the need for pharmacotherapy in the patient? In doing education for hypertensive patient, the nurse should know that: o Restricting sodium intake is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Increased activity, especially aerobic activity, is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Eliminating tobacco products is a positive lifestyle change associated with the nonpharmacologic treatment of hypertension. Extra notes: • Patients that have diabetes and that develops hypertension will most likely be ordered Ace Inhibitors. Ace inhibitors slow the progression of kidney injury in diabetic patients along with decreasing the progression of diabetic neuropathy • Patients taking Ace Inhibitor medications must be monitored for Hyperkalemia. Hyperkalemia occurs in these patients because this medication decreases the release of Aldosterone • When patients start taking spironolactone as a diuretic added to the therapy for hypertension and or heart failure, the nurse must educate the patient to stay away of High potassium containing foods and potassium supplementation. Pharm Quiz 6 Review 1. Which assessment data would make the nurse questioned to do further teaching about antibiotics? • If patient believes they can discontinue medications • Remember that as we educate patients on antibiotics, keep in mind to educate patients that they need to take the entire medication as prescribed to avoid that the bacteria develop resistance. 2. Which data is most important for the nurse to assess to determine the effectiveness of a antibiotic medication? • Culture and sensitivity is the examination that will test for a specific organism and can determine the correct, most specific medication. 
 3. The nurse is preparing to administer the following A/B medications. Which intervention should the nurse question recommend? • In order to prevent that antibiotics, accumulate in the kidneys, nurses should encourage patients that are under antibiotic therapy to increase fluid intake. • Ask if patient has any allergies • Also make sure patient is not taking any cations due to decreased absorption 4. The health care provider prescribed an ACE-inhibitor for the client diagnosed with arterial hypertension. What is the MOA for administering this medication? • Ace inhibitors prevent angiotensin I from turning into angiotensin II, which is a vasoconstrictor, to decrease blood pressure 5. Which intervention should the nurse implement administering Gentamicin IV? • Dilute, infuse slowly over 30 mins • Check hearing impairment, assess patient, nutritional status, store in fridge 6. Which lab results would the nurse recognize as most significant for the patient receiving Gentamycin? • Monitor levels of peak in through (touff) • Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. Trough should be taken immediately before the next dose 7. Side effects of aminoglycoside? • Patients taking aminoglycosides like gentamycin should monitor their hearing as this medication can lead to hearing loss. Patients should also monitor their kidney function. • Medication is both auto-toxic and nephrotoxic 8. Patient with TB currently taking Rifampin. What side effects? • If a patient is taking rifampin the nurse must educate the patient that all body fluid will be turning orange while the patient is on this medication. This will include saliva, urine, tears…Because of bodily fluid discoloration, the nurse should suggest against the use of contact lenses during the therapy with rifampin. • Hepatoxicity, common with alcoholics/liver disease 9. Which statement by the client warrants the nurse notifying the health care provider regarding client taking A/Bs (antibiotics)? • Upper body rash and decreased urine output are most likely symptoms of vancomycin (Vancocin) toxicity, so the medication should be held and the physician notified. • In order to prevent that antibiotics, accumulate in the kidneys, nurses should encourage patients that are under antibiotic therapy to increase fluid intake 10. The client is receiving the medication gentamycin, which lab actions would be scheduled by the nurse? • Hearing – audiometry, Tympanometry; pure, tone testing • Kidney function-gfr • ECOG & ABR • Peak & trof 11. What intervention should the nurse implement first administering tetracycline to a patient? • It is important to educate the patient that tetracycline is better absorbed if taken on an empty stomach. Another important education is that Tetracycline effectiveness can be decreased by using milk products (avoid milk products). Another important point about Tetracyclines is the fact that it should not be used in children under the age of 8 or in pregnant woman due to the damage of the tooth enamel that is caused by this medication. 12. What is the scientific rationale for administering A/B prophylactically? • Prophylaxis antibiotic treatment is used with the intent to prevent infections in certain instances like surgeries, dental procedures, animal bites. 13. A patient is taking medications for TB. What information should the nurse indicate in the teaching plan? • Tuberculosis bacilli are likely to develop resistance to one drug, so multiple drugs must be used in the treatment of TB. 
 14. What lab data indicates that the patient’s immunity is improving? • WBC count must be decreased (Culture and sensitivity) • Lymphocytes are the primary cell of the specific immune response 15. What symptoms in the assessment of the patient with TB taking Rifampin would the nurse educate the patient about? (repeat question) Discoloration of body fluids • If a patient is taking rifampin the nurse must educate the patient that all body fluid will be turning orange while the patient is on this medication. This will include saliva, urine, tears…Because of that the nurse should suggest against the use of contact lenses during the therapy with rifampin. 16. What education should the nurse include with administering immunosuppressants to a patient going to a concert? • If a patient is taking immunosuppressive medications the nurse should educate the patient to avoid crowds as it is important to avoid exposure to infection. • Healthy patients are very resistant to fungal infection with exception of immunosuppressed patients. Clients who are immunosuppressed, such as HIV or organ transplant clients, are very non-resistant to serious infections. 17.&18. List the side effects for the medication Tetracycline? • Take on an empty stomach; w/no milk products • Side effects include: nausea, vomiting, diarrhea • S/E in children or pregnant woman: teeth discoloration; damage of the tooth enamel; defects to fetal bone growth 19. What assessment data would the nurse report for the patient is taking A/B drug. • Culture and sensitivity is the examination that will test for a specific organism and can determine the correct, most specific medication. 
 • WBC; Temperature; Heart rate 20. What methods can the nurse educate the patient taking Nystatin oral suspension? • Nystatin oral suspension should be stored at room temperature. • Oral Nystatin can be ordered with instructions to swish and spit or swish and swallow. If the patient cannot tolerate swallowing the medication, the nurse can suggest to the patient to just swish and spit and then the nurse notify the physician. 21. Low erythropoietin production causes a decrease in what lab value? • Regulation of hematopoiesis occurs through messages from hormones such as erythropoietin. 
 • Red Blood Cells 22. A nurse is preparing to administer 1000 ml of lactated Ringer’s IV over 4 hr. The drop factor of the manual IV tubing is 60 gtt/ml. The nurse should set the manual IV infusion to deliver how many gtt/min? V(ml)/T(min) x Drop Factor (gtts/ml)___gtts/min 1000mL x 60gtt/min=250 gtt/min 240 min 23. A nurse is preparing to administer 250 mg of an antibiotic IM. Available is 2g/5ml how many ml should the nurse administer per dose? D/H x Q 0.25g x 5mL = 0.625 = 0.6 2g 24. A nurse is caring for client who has sepsis and a prescription for vancomycin 1g in 250ml dextrose 5% (D5W) over 4 hr by IV intermittent bolus. The nurse should set the IV pump to deliver how many ml/hr? *Set an IV on a pump V(ml)/T(hour)____ml/hr 250mL = 62.5 mL/hr or 63 mL/hr 4hr 25. Order: Amoxicillin 75mg PO QID. Available: 400mg/5ml. How many ml do you give? __ ml? *Set an IV on a pump V(ml)/T(hour)____ml/hr 75mg x 5 mL = 0.9mL or 1 mL 400mg 26. What is humoral immunity? • “Humoral immunity uses cells produced by B lymphocytes in the immune response.” Humoral immunity refers to immunity mediated by antibodies, which are produced by B lymphocytes. 27. What is cell-mediated immunity • Immunity independent of antibody but dependent on the recognition of antigen by T cells and their subsequent destruction of cells bearing the antigen or on the secretion by T cells of lymphokines that enhance the ability of phagocytes to eliminate the antigen 28. Know what Red Man Syndrome is (vancomycin slide) • Vancomycin if infused too fast can cause a hypersensitive reaction known as red man syndrome. • The organisms that cause nosocomial infections have most likely been treated with antibiotics and are the most likely organisms to develop resistance to antibiotics 29. Mode of action of penicillin • The mechanism of action of Penicillin is by the disruption of the bacterial cell wall which can lead to cell death. Extra Notes: • One of the ways that microorganisms develop resistance to the anti-infective drugs is by altering the binding sites on their membrane or ribosomes, thus not allowing the antibiotics to enter the microorganisms