NMNC 1230 PHARM EXAM 2 QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026

NMNC 1230 PHARM EXAM 2 QUESTIONS WITH VERIFIED SOLUTIONS LATEST UPDATE 2026 Estrogen hormone replacemenEstrogen hormone replacement - Answers Indication(s) -Menstrual disorders, contraception, menopause, infertility, female hypogonadism, osteoporosis, failure/removal of ovaries, uterine bleeding from hormonal imbalance Common side effects -breast tenderness/swelling, headaches, stomach cramps, weight gain, nausea, vaginal bleeding, dizziness, amenorrhea, acne, oily skin Adverse effects *hypertension, pulmonary embolism* -anaphylaxis, malignancy (breast, endometrial, ovarian) Patient Teaching -Instruct patient to report signs of fluid retention -contraindicated in pregnancy *advise against use of tobacco* *for estrogen replacement in menopause* *always use lowest effective dose and reevaluate need for treatment every 3 - 6 months* Folic acid - Answers Drug Class (therapeutic or pharmacological): Therapeutic: Vitamins, Pharmacological: Water soluble vitamins. Indication(s): - Prevention and treatment of megaloblastic and macrocytic anemia. *Given during pregnancy for the promotion of normal fetal development and prevention of neural tube defects* Common side effects: Flushing, malaise, erythema, pruritus, skin rash, and, in rare cases, allergic bronchospasm, nausea, loss of appetite, abdominal pain. *Patients should be aware that folic acid supplementation may cause urine to turn more intensely yellow in color* Adverse effects: No life-threatening adverse effects. Patient Teaching: - Instruct patient to notify health care professionals if rash occurs, a possible indicator of hypersensitivity. - Instruct patient not to exceed RDA as the effectiveness of mega dosing for treatment of various medical conditions is unproven and may cause side effects. Nursing Interventions: -Provide education on importance of consuming foods high in folic acid including vegetables, fruits, and organ meats; heat may destroy folic acid in foods. Testosterone cypionate - Answers Drug Class (therapeutic or pharmacological): therapeutic: hormones, pharmacologic: androgens Indication(s): -delayed puberty, male hypogonadism Common side effects: -priapism, gynecomastia, BPH, virilization (muscle, hair), increased (or decreased) libido, mood changes baldness, hirsutism stunted growth (premature epiphyseal plate fusion) *hypercalcemia, increased (LDL) cholesterol, hypoglycemia* Adverse effects: -MI, stroke, thromboembolism, anaphylaxis Patient Teaching: -Takes 3-4 years for sexual development to occur -Male pts: report priapism, hard to pee, gynecomastia -Female pts: virilism (see interventions), hypercalcemia -Female pts: Report if you plan to become pregnant/are pregnant or breastfeeding -Report: edema, hepatitis (yellowing skin/eyes, abdominal pain), unusual bleeding or bruising -Diabetic pt: monitor blood glucose closely *Importance of regular X-rays, serum lipid lab tests, physical exams* Nursing Interventions: -Avoid in: pregnancy, hypercalcemia, pituitary/liver problems, BPH, prostate/breast cancer -Regular X-rays (monitor for pre-mature epiphyseal plate fusion for growing males) -Monitor intake/output -Drug interactions may occur with oral antidiabetic drugs -Male pts: monitor for precocious puberty (acne, darkening skin, male characteristics), increased urge to urinate, difficulty urinating (BPH maybe), gynecomastia -Female pts: assess for virilism (voice, hair changes, clit enlargement, acne, irregular menstruation) -Monitor liver, calcium, blood glucose, pituitary Tamsulosin - Answers Drug Class (therapeutic or pharmacological): Alpha-Adrenergic Blocking Agent Indication(s) *Decreases symptoms of benign prostatic hyperplasia* Common side effects: *Dizziness, headache, orthostatic hypotension* -decrease libido, priapism, Upper respiratory infection Adverse effects: No life-threatening side effects noted in Davis Drug Guide Patient Teaching: -Emphasize taking pill even if feeling well -Caution pt to change positions slowly to minimize orthostatic hypotension. -Advise pt not to drive to operate dangerous equipment. -Inform pt about the effects on libido and fertility. -Take forgotten dose as long as not close to next dose -Instruct pt to take doses daily and not to skip doses, double doses, or stop abruptly. Nursing Interventions: -Assess I & O -Assess urinary symptoms of BPH (signs of narrowing urethra - difficulty, urgency, dribble, etc) -Assess for syncope and orthostatic hypotension -Assist pt. With ambulation to avoid falls from orthostatic hypotension. Magnesium Sulfate - Answers Drug Class (therapeutic or pharmacological): Mineral electrolyte; Calcium antagonist and CNS depressant Indication(s) -Severe preeclampsia, prevention of eclampsia, pre-term labor, tocolytic Common side effects *flushing, feelings of increased warmth, perspiration, dizziness, nausea, headache, lethargy, slurred speech* -sluggishness, nasal congestion, heavy eyelids, blurred vision, decreased GI activity, tachycardia, hypotension Adverse effects -Depressed reflexes, confusion, magnesium toxicity. -In fetus: *decreased FHR, respiratory depression* slight hypotonia with diminished reflexes, lethargy. Patient Teaching -Left-lateral lying -understanding of preeclampsia -understanding of treatment regimen including indwelling catheter, infusion pump *fetal monitoring* *assessment of DTR and clonus* -visitor restrictions. Nursing Interventions -assess deep tendon reflexes and clonus -assess pain and uterine contractions -assess bowel sounds every 4 hrs. *report respirations less than 12 per minute* *monitor serum magnesium (4-7 mEq/L)* -monitor fetal status *have calcium gluconate available* Clomiphene citrate - Answers Drug Class (therapeutic or pharmacological): *Ovulation Stimulant* Indication(s) -stimulate ovarian follicle growth; stimulate release of stimulating-follicle hormone and luteinizing hormone Common side effects *fatigue, headache, breast discomfort, heavy menses, depression, anxiety, fluid retention* -increased appetite. Adverse effects -vision disturbances, abdominal pain, weight gain, hair loss, ectopic pregnancy Patient Teaching *advise patients on chance of multiple births with treatment* *advise female partner to take the drug at the same time every day to maintain steady blood levels* Nursing Interventions -advise patient on sexual techniques for fertilization -initiate drugs treatment regimens prescribed by the provider -provide psychological couple's counseling and support. Beractant - Answers Drug Class (therapeutic or pharmacological): Pharm: *pulmonary surfactants* / Therapeutic: anti-RDS agents Indication(s): *Indicated for prevention and treatment of RSD in premature neonates* Common side effects: -Oxygen desaturation, cyanosis, bradycardia and apnea as a result of the administration process. Hyperoxia (excessive oxygenation), Hypocarbia (decreased carbon dioxide) Adverse effects: No adverse reactions known; no drug-to-drug interactions known. Patient Teaching: -Explaining the purpose of the medication to parents Nursing Interventions: -Administration is a two-person procedure, at least one medical practitioner or neonatal nurse practitioner who administers the medication and one RN as the assistant. -Suctioning ET tube before administration. No suctioning of ET tube after dosing, unless obvious signs of airway obstruction. Oxytocin - Answers Drug Class (therapeutic or pharmacological): Uterotonic medication Indication(s): *Labor induction, post-partum hemorrhage* Common side effects: *uterine cramping* -nausea, vomiting, dizziness, hypertension with IV administration, sweating, tinnitus, chest pain, dyspnea, itching, and severe headaches. Adverse effects: -ergotism, pain in arms legs and lower back, numbness, cold hand and feet muscular weakness, diarrhea, hallucinations, seizures, blood hypercoagulability. Patient Teaching: -"This will cause increased uterine contractions." Nursing Interventions: *Have tocolytic drugs ready in case of complicated delivery* *Monitor maternal pulse and BP, uterine activity, and FHT* -Promote placental infusion by having patients sit up or lay on side -Monitor for signs of uterine rupture -Use IV pump. Sumatriptan - Answers Drug Class (therapeutic or pharmacological): Selective Serotonin Receptor Agonist: Antimigraine Indication(s): *To treat migraines and cluster headaches* Common side effects: *Dizziness, blurred vision* headache, paresthesia, fatigue, flushing, drowsiness, dysgeusia, myalgia, hyperhidrosis, nausea, vomiting, injection site reaction pruritis, skin irritation Adverse effects: *hypertensive crisis, dysrhythmias* -Hypotension, angina, bradycardia, tachycardia, thrombosis, seizure, hearing loss, ocular hemorrhage, GI bleed, renal failure, intracranial hemorrhage stroke, MI, cardiac arrest, suicidal ideation. Patient Teaching: *This med should only be used during a migraine attack not for prevention* -Take it as soon as symptoms begin but can be given at any time during the migraine -Lying down in a dark room can help symptoms -Overuse of this med can increase frequency of migraines and exacerbate headaches. Nursing Interventions: -Give initial subcut dose under observation to patients with potential for CAD -Monitor for serotonin syndrome Febuxostat - Answers Drug Class (therapeutic or pharmacological): xanthine oxidase enzyme inhibitor, Indication(s): *Chronic management of pt's c/ hyperuricemia c/ gout* that have an inadequate response, are intolerant of, or where allopurinol is not appropriate. Common side effects: -Dizziness, headache, blurred vision, anorexia, dry mouth, ABD pain, N/V/D, myalgia, weakness, edema, dehydration, rash, pruritis, erectile dysfunction Adverse effects: -Bradycardia, gout exacerbations, Guillain-Barre syndrome, chest pain, DM, hyperglycemia, hyperlipidemia, rhabdomyolysis. LIFE THREATENING: thrombocytopenia, neutropenia, angioedema, *hepatic/renal impairment*, dysrhythmias, Stevens-Johnson syndrome Patient Teaching: -Instruct to take as indicated -consult PCP if flare up, of gout, occurs -Advise pt to notify HCP if CP, SOB, dizziness, or stroke-like-symptoms occur -Teach pt's about follow up lab tests and frequency of the tests. Nursing Interventions: -Assess for joint pain, serum uric acid levels -monitor for signs of an MI/stroke -assess pts for s/sx of anaphylaxis/reactions throughout treatment *Contraindicated for hepatic/renal disease, cardiac disease, stroke* Pyridostigmine - Answers Drug Class (therapeutic or pharmacological): Acetylcholinesterase (AChE) inhibitors Indication(s): -Myasthenia gravis Common side effects: -Abdominal pain, confusion, depression, diarrhea, blurred vision, hyperesthesia, fecal and urinary incontinence, seizures Adverse effects: -Bradycardia, cardiac dysrhythmias, COPD, hypertension, and seizures Patient Teaching: -Inform patients to take the drug before meals for best absorption -If gastric irritation occurs, take the drug with food -Teach patients to take drugs as prescribed every day at the same time to avoid recurrence of symptoms -encourage patients to wear a medical identification bracelet or necklace that indicates health problems *Overdosing and underdosing of AChE inhibitors have similar symptoms: muscle weakness, dyspnea, and dysphagia* *Underdosing can result in myasthenia crisis, and overdosing can result in cholinergic crisis* Nursing Interventions: *Evaluate effectiveness of drug therapy to maintain muscle strength* *Determine the absence of respiratory distress* -Evaluate the correct use of the drug by the patient -Evaluate patient's feelings of safety, comfort, and security -Involve family members in teaching about prescriptive therapies and disease processes using simple and clear instructions -communicate respect for the patient's cultural beliefs -Assess the patient's understanding of adherence to the drug regimen -Instruct the patient to notify the HCP before taking any medications other than what the HCP has ordered. Diazepam - Answers Drug Class (therapeutic or pharmacological): Benzodiazepines Indication(s): *Anxiety, muscle spasms, alcohol withdrawal, seizures, status elipticus (drug of choice)* Common side effects: *Drowsiness, dizziness, weakness* -headache, confusion, depression, euphoria, amnesia, ataxia, blurred vision, restlessness, constipation, erectile dysfunction, injection site reaction Adverse effects: *hyper/hypotension, urinary retention, memory impairment, and respiratory depression* -bradycardia, tachycardia, hearing loss, tolerance, dependence, seizures, hyponatremia, heart failure Patient Teaching: -Advise patients not to operate a motor vehicle or dangerous equipment while taking Diazepam -Warn patients against alcohol consumption while taking diazepa -Inform patients that an effective response may take 1-2 weeks -Encourage patient to follow drug regimens and not to abruptly stop taking drug after prolonged use because withdrawal symptoms may occur. Nursing Interventions: *Monitor VS especially blood pressure and pulse* *observe patient for side effects, tolerance and physical/psychological dependence* -Encourage family to be supportive of patient. Haloperidol - Answers Drug Class (therapeutic or pharmacological): Antipsychotic: Neuroleptic *(non-phenothiazine)* Indication(s): *Used to treat acute psychosis, schizophrenia* -Tourettes syndrome Common side effects: *lethargy, weight gain/loss* -Drowsiness, edema, headache, blurred vision, depression, confusion, euphoria, cataracts, , tremor, dry mouth, constipation, restlessness, hyperhidrosis, erectile dysfunction, urinary retention Adverse effects: *EPS (extrapyramidal symptoms)* -Tachycardia, orthostatic hypotension, hyper/hypoglycemia, hyponatremia, seizures, retinopathy, osteopenia Life-threatening: Laryngeal edema, bronchospasm, dysrhythmias, eosinophilia, aplastic anemia, hemolytic anemia, agranulocytosis, leukopenia, neutropenia, thrombocytopenia, pancytopenia, hepatic failure, NMS, rhabdomyolysis Patient Teaching: -Caution patients not to consume alcohol on CNS depressants. -Inform patients that medication may take 6 weeks or longer to achieve full effect -Effects of haloperidol may be increased by amiodarone, kava kava, magnesium sulfate -Discontinuing drug use should be tapered off -May increase anticholinergic effects if taking. Nursing Interventions: *Obtain a health history including present drugs* -assess for EPS -assess for symptoms of neuroleptic malignant syndrome (NMS): increased fever, pulse, and blood pressure; muscle rigidity; increased creatine phosphokinase and white blood cell (WBC) count; altered mental status; acute renal failure; varying levels of consciousness; pallor; diaphoresis; tachycardia; and dysrhythmias *Evaluate effectiveness of the drug and whether the patient has acceptably reduced psychotic symptoms (hallucinations or delusions) at lowest dose possible* Beta Interferon - Answers Drug Class (therapeutic or pharmacological): Immunomodulator Indication(s): *Used to treat RRMS (relapsing remitting muscular sclerosis)* -immunomodulators are often first line of defense. Common side effects: *bruising, thrombocytopenia, autoimmune hepatitis, cystitis, neutropenia* -Depression, dizziness, fatigue, suicidal ideation, vision problems, dyspnea, chest pain, edema, abdominal pain, injection site reaction, myalgia, arthralgia, muscle spasm, anaphylaxis, flulike symptoms Adverse effects: *Increased myelosuppression may occur* with other myelosuppressives including antineoplastics; concurrent use of hepatotoxic agents may increase risk of hepatotoxicity. Avoid concomitant use with immunomodulating natural products such as astragalus, echinacea, and melatonin Nursing Interventions: -Monitor neurologic status and neuropsychiatric status during therapy Celecoxib - Answers Drug Class (therapeutic or pharmacological): Nonsteroidal anti-inflammatory: *COX-2 inhibitor* Indication(s): *Severe osteoarthritis, osteoarthritis, to relieve dysmenorrhea* -When you need a high does of an anti inflammatory but other NSAIDS would have too high of GI effects. Common side effects: Less GI upset than other NSAIDS that are COX 1 and Cox 2 inhibitors, but still some GI upset, headaches, and dizziness, drowsiness, pharyngitis Adverse effects: *Headache, dizziness, drowsiness* -GI upset (but not as much as other NSAIDS), GI bleeding, hypertension, angioedema, anaphylaxis, bronchospasm, renal/hepatic failure, agranulocytosis, thrombocytopenia, pancytopenia. Patient Teaching: *Take with food* Nursing Interventions: -Report adverse reactions, such as GI bleeding, peptic ulcer... Phenytoin - Answers Drug Class (therapeutic or pharmacological): Anticonvulsant: *Hydantoin* Indication(s): -Prevents tonic-clonic and partial seizures and status epilepticus Common side effects: *Headache, confusion, drowsiness* -insomnia mood changes, nystagmus (constant involuntary eye movement), slurred speech, nausea, vomiting, tremor, hyperreflexia, abdominal pain, constipation, dysgeusia, and paresthesia Adverse effects: *gingival hyperplasia* -Hypotension, bradycardia, hyperglycemia, depression, peripheral neuropathy, injection site reaction (purple glove syndrome; swollen, discolored, and painful extremities that may require amputation). LIFE THREATENING: Agranulocytosis leukopenia, thrombocytopenia, hepatic ventricular fibrillation, suicidal ideation. Patient Teaching: -Should not be taken during pregnancy -advise from driving or using heavy machinery -avoid alcohol -do not stop abruptly to prevent seizure rebound -patient with diabetes should monitor glucose levels closely (phenytoin inhibits insulin release). Nursing Interventions: *Monitor levels to determine therapeutic range (10 - 20 mcg/mL)* *encourage medication compliance* *Monitor CBC for blood dyscrasias* -use seizure precautions -adequate nutrition -female patients should take additional contraceptive methods. Rivastigmine - Answers Drug Class (therapeutic or pharmacological): Anticholinesterase Indication(s): Alzheimer disease Common side effects: *dizziness, headache, depression, confusion* -(anticholinergic SE) Anorexia, abdominal pain, GI distress, nausea, vomiting, diarrhea, constipation, weight loss, peripheral edema, dry mouth, dehydration, nystagmus Adverse effects: *orthostatic hypotension, cataracts* -Seizures, bradycardia, myocardial infarction, heart failure, hepatic toxicity Patient teaching: *Instruct pt to get up slowly as medication can cause dizziness and loss of balance* Nursing Interventions -observe behavioral changes, not improvement or decline in memory -monitor liver function tests -monitor for bradycardia, hypotension, bowel incontinence. Midazolam - Answers Drug Class (therapeutic or pharmacological): *anticonvulsant/benzodiazepine* Indication(s): *moderate sedation before short diagnostic or endoscopic procedures* -acute seizures Common side effects: -blurred vision, hiccups, nausea, vomiting, phlebitis at IV site, throat irritation, drowsiness Adverse effects: *drowsiness, respiratory depression* -cardiac arrest, erythema, rhinorrhea, apnea, suicidal thoughts Patient Teaching: -avoid grapefruit juice during therapy -avoid alcohol and other CNS depressants for 24 hours after administration *advise pt. to ask for assistance with ambulation and transferring* Nursing Interventions: -check insertions site for redness, swelling, pain -Assess level of consciousness for 2-6 hours following administration -Monitor BP, pulse, respiration *Benzodiazepine reversal: Flumazenil* Benztropine - Answers Drug Class (therapeutic or pharmacological): Anticholinergics Indication(s): *Antiparkinson Drug, Anticholinergic Agent* Common side effects: *dry mouth, constipation* -nausea, vomiting, anhidrosis, dizziness, headache, drowsiness, blurred vision, confusion, depression, hallucinations, weakness, hyperthermia, and paresthesia, mydriasis, urinary retention, photophobia Adverse effects: *ocular hypertension* -tachycardia LIFE-THREATENING: ileus, coma Patient Teaching: -Avoid alcohol, cigarettes, caffeine, and aspirin to decrease gastric acidity *encourage annual eye exams to evaluate for cataracts* Nursing Interventions: *Monitor vital signs, urine output, and bowel sounds.* Increased pulse rate, urinary retention, and constipation are side effects of anticholinergic drugs. -Observe and assess the patient for involuntary movements. -Assess personal beliefs of patients and family and modify communications to meet the patients' needs, use an interpreter and community nurse to follow up as needed. Carbidopa/Levodopa - Answers Drug Class (therapeutic or pharmacological): Anticholinergic (Dopaminergic) Indication(s): *Parkinson's Disease - decrease Parkinson's symptoms by inhibiting enzyme dopa decarboxylase to allow for more levadopa to be available* Common side effects: -Dry mouth, photophobia, urine retention Adverse effects: -Lightning Bolt Side Effect Contraindicated in patients with glaucoma Patient Teaching: *Avoid alcohol, cigarettes, caffeine, and aspirin to decrease gastric acidity* -Relieve dry mouth - use hard candy, ice chips, or sugarless chewing gum -Reduce photophobia - Avoid direct sunlight and use sunglasses -Reduce urinary retention - Void before taking it to decrease risk of urinary retention *Glaucoma - Get regular eye exams to prevent contraindication* Nursing Interventions: -Monitor vital signs, urine output and bowel sounds -Observe and assess for involuntary movements Nalbuphine - Answers Drug Class (therapeutic or pharmacological): Opioid Agonist-Antagonist Analgesic Indication(s): -Relieve moderate to severe pain Common side effects: *Dizziness, headache, constipation* -dysuria (painful/difficult urination), rash, or blurred vision. Adverse effects: *hypotension/hypertension, respiratory depression* -dyspnea, seizures, dependence Patient Teaching: *Do not use alcohol or CNS depressants (can cause respiratory depression)* -Suggest nonpharmacological methods (changing position and ambulation) Nursing Interventions: *Monitor vital signs and any changes in respirations need to be noted* *May be used to decrease substance abuse disorder with opioids* -Check bowel sounds/bowel movements to identify constipation -Check urine output (report if less than 30 mL/h or less than 600 mL/day) -Do not mix with barbiturates. Methylphenidate - Answers Drug Class (therapeutic or pharmacological): Amphetamine-like CNS Stimulant Indication(s): *To correct hyperactivity caused by ADHD, increase attention span, control narcolepsy* Common side effects: *weight loss* -Anorexia, dry mouth, nausea, vomiting, dizziness, insomnia, irritability, restlessness, anxiety, confusion, depression, euphoria, hyperhidrosis, tremors, blurred vision, headache, abdominal pain, constipation, diarrhea, paresthesia Adverse effects: *Tachycardia, hypertension, growth suppression* -bradycardia, palpitations, seizures, psychosis LIFE-THREATENING: Blood dyscrasias (any condition that affects the blood, bone marrow, or lymph tissue), hepatotoxicity, and ocular hypertension Patient Teaching: *Teach patient to take the drug before meals* -Advise alcohol consumption *Advise patients to avoid foods that contain caffeine* -Use sugarless gum to relieve dry mouth. -Advise patients to avoid driving and using hazardous equipment when experiencing tremors, nervousness, or increased heart rate *Do not stop abruptly; taper off to avoid withdrawal symptoms* -Report irregular heartbeat. -Record height, weight, and growth of children. Nursing Interventions: *Monitor BP* *Monitor and report height and weight changes to HCP (loss of appetite can be present)* -Give dose no later than 6 pm (can cause loss of sleep/ restlessness) Antidote: Alprazolam Magnesium sulfate - Answers Drug Class (therapeutic or pharmacological): (Calcium Antagonist) To treat preeclampsia and the prevention of eclampsia. Works on the CNS and can treat seizures due to preeclampsia. *Relaxes the smooth muscle of the uterus through calcium displacement* Indication(s): -Severe preeclampsia or for prevention of eclampsia *Helps stop uterine contractions* Common side effects: -Flushing, warmth, perspiration, slurred speech, Dizziness, headache, sluggishness, lethargy, Heavy eyelids, blurred vision, nasal congestion, Nausea, tachycardia, hypotension, confusion, Depressed reflexes, respiratory depression Respiratory and cardiac arrest Adverse effects: *hypotension, DTR, and decreased muscle tone* -Early signs of increased magnesium levels include lethargy, flushing, feelings of increased warmth, perspiration, thirst, sedation, heavy eyelids, slurred speech Patient Teaching: -Explain preeclampsia and its implications for the patient, fetus, and newborn. -Provide information about nonpharmacologic and pharmacologic treatment measures for preeclampsia -Advise avoiding exposure to the common cold, flu, and other infectious diseases Instruct the patient with diabetes to have their glucose level taken as ordered *Inform patient to watch for signs of magnesium toxicity - respiratory depression, respiratory arrest, circulatory collapse, and cardiac arrest* Nursing Interventions: - Perform maternal and fetal assessment and record daily weight -Monitor intake and output, breath/bowel sounds. *Assess deep tendon reflexes (DTR)* *Assess fetal heart rate continuously* -Assess pain and uterine contractions. *Monitor serum magnesium levels to watch for magnesium toxicity (therapeutic level is 4 to 7 mg/dL)* -Have calcium gluconate (1 g given IV over 3 min) available as an antidote. -Assess newborn for 24 to 48 h for magnesium Terbutaline - Answers Drug Class (therapeutic or pharmacological): Beta2-Sympathomimetic Indication(s): *Preterm labor; relaxes uterine smooth muscle to decrease contractions* Common side effects: -Tremors, dizziness, nausea, anxiety, tachycardia, hypotension, hyperglycemia, hypokalemia, nervousness, chest pain, palpitations, vomiting Adverse effects: -Ketoacidosis, pulmonary edema, anaphylactic shock., dysrhythmias Not for long-term use, may cause maternal cardiac problems and death. Patient Teaching: -Teach that anxiety may be a side effect *lay in left-lateral position* -void/drink fluids to increase placental perfusion. Nursing Interventions: *Monitor contractions and FHR* *monitor maternal vital signs, dysrhythmias* -auscultate breath sounds for pulmonary edema -maintain pt in left lateral position -monitor daily weight -report leakage of amniotic fluid, vaginal bleeding/discharge, -assess for presence of hyperglycemia/hypokalemia in mother and hypoglycemia in newborn Dinoprostone - Answers Drug Class (therapeutic or pharmacological): Prostaglandin Indication(s): -creates cervical effacement and softening for cervical dilation before labor induction begins (usually given before oxytocin) Common side effects: -uterine hyperstimulation, chills, fever, vomiting, diarrhea Adverse effects: -hypersensitivity reactions including anaphylaxis, GI distress, uterine contractions, back pain Patient Teaching: -teach patient to remain lying down for 30 min to 2 hours after administration -teach about common GI distress. Nursing Interventions: -assess cervical dilation and effacement -monitor FHR and uterine stimulation -remove insert if uterine hyperstimulation occurs -Fetal monitoring and resuscitation equipment required. -Blackbox warning. Phentermine hydrochloride (Anorexiants) - Answers Drug Class (therapeutic or pharmacological): Anorexiants; stimulant Indication(s): -Suppresses appetite. Common side effects: *Restlessness, hypertension* -euphoria, insomnia, seizures, erectile dysfunction. Adverse effects: -Chest pain, trouble breathing, irregular heartbeat. Patient Teaching: *Should not be given to children under 12* Nursing Interventions: *Avoid alcohol consumption* *avoid driving and using hazardous equipment* -Must be tapered off -Read labels for the OTC products. Selegilene (MAOI) - Answers Drug Class (therapeutic or pharmacological): MAOI B Indication(s): *treatment of depression* -parkinsonism Common side effects: -anticholinergic symptoms, dizziness, headaches, insomnia, dry mouth, abdominal pain, nausea, diarrhea, orthostatic hypotension, impulse control disorder, hallucinations, ED Adverse effects: *hypertensive crisis can occur with consumption of tyramine-containing foods (cheese, liver, sausage, wine)* Patient Teaching: -advise pt to rise slowly, orthostatic hypotension is common Nursing Interventions: -observe pt for signs of depression, mood changes, insomnia, apathy, or lack of interest in activities *Monitor VS. Observe for ANTICHOLINERGIC like symptoms (dry mouth, increase HR, urinary retention, constipation)* Monitor pt for SUICIDAL TENDENCIES *Monitor drug-drug and food-drug interactions, avoid TYRAMINE (may cause HTN crisis)* Zolpidem - Answers Drug Class (therapeutic or pharmacological): Sedative-hypnotic: Nonbenzodiazepine CSS IV Indication(s): -treat insomnia Common side effects: *Drowsiness, lethargy* -headache, hot flashes, hangover (residual sedation), irritability, dizziness, ataxia, visual impairment, anxiety, nausea and vomiting, edema, erectile dysfunction, anterograde amnesia, memory impairment, nightmares, binge eating Adverse effects: -Tolerance, psychological or physical dependence, withdrawal; sleep-related behaviors, hypotension, angioedema, dysrhythmias, depression, suicidal ideation LIFE-THREATENING: Pulmonary edema, renal failure Patient Teaching: *Teach patients to use nonpharmacologic methods to induce sleep (taking a warm bath, listening to music, drinking warm fluids such as milk, avoiding drinks with caffeine after dinner)* *Teach patients food decreases absorption, and should be taken at bedtime.* Nursing Interventions: -Monitor vital signs. Check for signs of respiratory depression (slow, irregular breathing patterns). -Use bed alarm for older adults or patients receiving nonbenzodiazepines for the first time. Confusion may occur, and injury may result. -Caution with patients with renal/liver dysfunction, *pregnancy, children, pulmonary disease* -Observe patient for side effects of nonbenzodiazepines such as hangover (residual sedation), lightheadedness, dizziness, or confusion. Fluoxetine - Answers Drug Class (therapeutic or pharmacological): antidepressants: SSRI Indication(s): -depression, bipolar disorder, bulimia disorder, OCD, panic disorder and premenstrual dysphoric disorder Common side effects: -dry mouth, insomnia, anorexia, diarrhea, headache, nausea, nervousness. Adverse effects: -seizures, angioedema, hypo/hyperkalemia, hyponatremia, hypocalcemia, dehydration, osteoporosis, orthostatic hypotension, STEVENS-JOHNSON SYNDROME, HEPATIC/ RENAL FAUILURE, SEROTONIN SYNDROME, SUICIAL IDEATION, STROKE Patient Teaching: -Avoid other CNS depressants and alcohol due to increased effects of CNS/ respiratory depression and hypotensive effect. -Increased prolonged bleeding can happen with aspirin, NSAIDS and anticoagulants -St. John wort increase risk for serotonin syndrome -Advise patients to change positions slowly -Education patient it may take a few months until they see improvement on symptoms Nursing Interventions: -monitor vs, signs of depression, mood changes, insomnia, lack of interest -S/S of serotonin syndrome (agitation, hallucinations, sweating, coma, tachycardia, hypertension, hyperthermia, and rigidity) Acetaminophen - Answers Drug Class (therapeutic or pharmacological): *Analgesic* (Para-aminophenol derivative) Indication(s): -Pain and Fever Common side effects: -Headache, insomnia, anxiety, fatigue, anorexia, nausea, vomiting, constipation, peripheral edema Adverse effects: *Oliguria, hearing loss* LIFE-THREATENING: *Hepatotoxicity*, renal failure, hypokalemia, rhabdomyolysis, anemia, hemolytic anemia, agranulocytosis, neutropenia, thrombocytopenia, pancytopenia. Patient Teaching: -Keep out of reach of children and call poison control if child takes large or unknown amount -do not self-medicate for more than 10 days in adults and 5 days in children *Check OTC drug labels for acetaminophen dosages and do not exceed recommended dosage (4000 mg per day)* -avoid alcohol while taking. Nursing Interventions: -Check hepatic enzymes (ALT, ALP, GGT, and bilirubin) for elevations in patients taking high doses Morphine sulfate - Answers Drug Class (therapeutic or pharmacological): Opioid Analgesic Indication(s): -To relieve moderate to severe pain Common side effects: *Drowsiness, constipation, urinary retention* -dizziness, blurred vision, miosis, GI distress, flatulence, dry mouth, confusion Adverse effects: *orthostatic hypotension, bradycardia, tachycardia, respiratory depression* -palpitations, seizures, ileus, psychological dependence, dyspnea, anemia, leukopenia, thrombocytopenia, pulmonary edema, GI obstruction, dysrhythmia Patient Teaching: -Advise to avoid alcohol -avoid St. John's Wort