173-244 pharmacology

Question 1

tetracyclines (eg, tetracycline, doxycycline, minocycline):

Answer 1

Take on an empty stomach
Avoid antacids or dairy products
Take with a full glass of water
Photosensitivity
additional contraceptive techniques

Question 2

Linezolid

an antibiotic with MOA–type properties

to treat vancomycin- and methicillin-resistant bacterial infections

Answer 2

XXX MOA + SSRI

SSRI’s are contraindicated during therapy due to the increased risk of serotonin syndrome.

Question 3

allergy to penicillin = cephalosporins

Answer 3

Clients with an allergy to penicillin antibiotics (eg, amoxicillin) can experience a cross-sensitivity reaction to cephalosporin antibiotics (eg, cefazolin) because the medication molecules are structurally similar

Question 4

vacomycin

Answer 4

A trough level should be obtained approximately 15-30 minutes before administration of the next IV dose

should be administered over a minimum of 60 minutes to prevent VIR. infusion reaction

flushing, erythema, pruritus, and/or maculopapular rash usually of the upper body (i.e. face, neck, trunk, and/or upper extremities).

Question 5

macrolide antibiotics
(azithromycin, erythromycin, clarithromycin)

Answer 5

can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes.

ECG should be monitored

can also cause hepatotoxicity when taken in high doses or in combination with other hepatotoxic medications such as acetaminophen, phenothiazines, and sulfonamides.

Question 6

The nurse should tell the parent to discontinue the use of bismuth subsalicylate (Pepto-Bismol) as it contains a salicylate (same class as aspirin)

Answer 6

bismuth subsalicylate (Pepto-Bismol
for kids

it contains a salicylate (same class as aspirin)

could possibly cause Reye syndrome

Question 7

Sulfonamides (eg, sulfamethoxazole, sulfadiazine)

Answer 7

take the medication with a full glass of water

protect the skin from the sun,

avoid the medication if pregnant or planning to become pregnant,

and finish the entire course of antibiotics.

Question 8

aminoglycosides (eg, gentamicin, tobramycin, amikacin)

Answer 8

ototoxicity and nephrotoxicity

assess for changes in the client’s hearing, balance, and urinary output

Question 9

Vancomycin
require close monitoring due to its narrow therapeutic window

Answer 9

Infusing over at least 60 minutes

Obtaining a vancomycin trough level prior to administration

signs of vancomycin infusion reaction,

upper body pruritus
erythema

peripheral venous access device (VAD) site frequently for pain, erythema, and swelling because vancomycin is a vesicant and may cause thrombophlebitis or extravasation

Question 10

Isoniazid

tx tuberculosis

Answer 10

Avoid intake of alcohol
pyridoxine (vitamin B6)

Avoid aluminum-containing antacids

Report changes in vision

Report signs/symptoms of severe adverse effects such as:
Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue)
Peripheral neuropathy (eg, numbness, tingling of extremities)

Question 11

Rifampin

tx tuberculosis

Answer 11

causes a red-orange discoloration of body fluids (ie, urine, sweat, saliva, tears)

prevent pregnancy with non-hormonal contraceptives

notify the health care provider of any signs or symptoms of hepatotoxicity (eg, jaundice, fatigue, weakness, nausea, anorexia

Question 12

Management of an acute asthma exacerbation

Answer 12

Inhaled short-acting beta agonist (eg, albuterol) and anticholinergic (eg, ipratropium) nebulizer treatments to produce bronchodilation

Systemic corticosteroids (eg, methylprednisolone)

Supplemental oxygen to maintain saturation >90%

Question 13

Inhaled short-acting beta-2 agonists (SABAs)

Answer 13

albuterol

levalbuterol

smooth muscle relaxation of the airways, which results in immediate bronchodilation. Bronchodilation decreases airway resistance, facilitates mucus drainage, decreases the work of breathing (eg, decreased accessory muscle use)

Anxiety and tachycardia are adverse effects of SABAs

These symptoms can be reduced with the use of a spacer device.

Question 14

Tamoxifen

Answer 14

a selective estrogen receptor modulator

to treat certain types of breast cancer and to prevent breast cancer recurrence

serious side effects, including:

Thromboembolic events (eg, deep venous thrombosis, pulmonary embolism, stroke)

Endometrial cancer (eg, abnormal vaginal bleeding)

Question 15

allopurinol

Answer 15

Tumor lysis syndrome prophylaxis

to dissolve and prevent urate crystal formation that contributes to AKI

Question 16

calcium decreases iron absorption

“liz doesnt like coffee Ca Fe”

Answer 16

Ca XXXX Fe

An acid-rich environment enhances iron absorption, so oral supplements should be taken 1 hour before or 2 hours after meals.

Fe + vit C

Taking an iron supplement with vitamin C (eg, orange juice) further enhances duodenal acidity and increases absorption

Question 17

Erythropoietin is administered IV or subcutaneously

Answer 17

for Anemia caused by chronic kidney disease
check the client’s blood pressure before administering erythropoietin.

Uncontrolled hypertension is a contraindication to recombinant human erythropoietin therapy

Iron in the form of iron sucrose or ferric gluconate is typically prescribed to promote an adequate response to erythropoietin.

Question 18

Hydroxychloroquine (Plaquenil)

tx lupus

eye exams

Answer 18

used to treat the skin and arthritic manifestations of SLE (Lupus)

Take with food can help alleviate gastrointestinal upset.

Serious adverse drug reactions include retinopathy and visual disturbances; = regular eye examination every 6-12 months

Question 19

sulfa drugs

Answer 19

Crystalluria causing kidney injury – client should drink 8 glasses of water daily to maintain adequate urine output (eg, 1200-1500 mL/day)

Photosensitivity

Folic acid deficiency (megaloblastic anemia and stomatitis) – client should eat folate-rich foods and take 1 mg/day folic acid supplement

Rarely life-threatening agranulocytosis (leukopenia) – client should be monitored for complete blood count at the start of therapy and report fever or sore throat immediately

Stevens-Johnson syndrome – client should stop the medicine if rash develops

Question 20

Duloxetine (Cymbalta)

SSRI that also treats pain

for fibromyalgia

Answer 20

is a serotonin-norepinephrine reuptake inhibitor that has both antidepressant and pain-relieving effects. It is used to relieve chronic pain that interferes with normal sleep patterns in clients with FibroMyalgia

Question 21

sodium polystyrene sulfonate

for mild to moderate hyperkalemia.

Answer 21

It works in the gastrointestinal tract to exchange sodium for potassium, thereby eliminating excess potassium through the stool

should have normal bowel function to avoid the risk of intestinal necrosis.

assess bowel sounds and recent bowel patterns (eg, constipation) before administering

Question 22

tardive dyskinesia

meds that can cause it: metoclopramide (antiemetic)

Answer 22

Lip movement (eg, smacking, sucking, puckering)
Tongue movement (eg, protrusion, curling)
Grimace
Brow furrow or twitch
Excess blinking

Foot tap
Hand wringing
Tremor or shake

Question 23

Bile acid sequestrants (eg, colestipol, colesevelam)

Answer 23

used to lower the serum LDL level

used concurrently with HMG-CoA reductase inhibitors (“statins”)

Question 24

Lipase inhibitors

for obesity

Answer 24

prevent the breakdown and absorption of fats

take lipase inhibitors with, or within 1 hour of, meals that contain fat

may experience fecal incontinence, flatulence, and oily stools because unabsorbed fat is eliminated through defecation.

Because lipase inhibitors block the absorption of fats, they also interfere with absorption of fat-soluble vitamins (ie, vitamins A, D, E, and K). To be most effective, clients should take fat-soluble vitamins 2 hours before or 2 hours after the lipase inhibitor

Question 25

Pancrelipase

for cystic fibrosis when pancreatic duct is blocked

Answer 25

If the client is not ready to consume a meal, the nurse should hold the dose until the client is ready to eat because pancrelipase should be taken immediately before every meal

Question 26

hyperthyroidism meds

methimazole

Answer 26

may cause agranulocytosis and immunosuppression.

s/s of infection (eg, sore throat) require immediate assessment and treatment.

Question 27

Beers criteria

Answer 27

inappropriate for older adult clients due to the risks outweighing the benefits

Sulfonylureas (eg, glyburide)
risk for severe and prolonged hypoglycemia in older adults

Anticholinergic

First-generation antihistamines
Gastrointestinal antispasmodic

Cardiovascular

Alpha-1 blockers (as antihypertensives)
Centrally acting alpha-2 agonists
Many antiarrhythmic

CNS

Tricyclic antidepressants
Antipsychotics
Barbiturates, benzodiazepines & other hypnotics

Endocrine

Long-acting sulfonylureas
Sliding-scale insulin

Pain

Nonselective NSAIDs
Skeletal muscle relaxants

Question 28

Regular insulin is the only insulin that can be administered via IV push

Answer 28

NPH insulin should never be administered via IV push.
SubQ only

Question 29

GH replacement therapy

Answer 29

daily subcutaneous injection

most effective when given at bedtime when the pituitary naturally releases GH

Treatment is discontinued when bone growth begins to cease or when the client, parents, and health care provider make the decision.

Question 30

Levothyroxine

Answer 30

should be taken first thing in the morning because it is best absorbed on an empty stomach (ie, 1 hr before a meal, 2 hr after a meal)

doses may need to be increased during pregnancy

report signs of excess TSH, such as heart palpitations (eg, fluttering), tachycardia, weight loss, and insomnia

Question 31

Licorice root XXXX hydrochlorothiazide (diuretic)

can augment potassium loss

Answer 31

When used in combination with hydrochlorothiazide

Licorice root is an herbal remedy used for gastrointestinal disorders such as stomach ulcers, heartburn, colitis, and chronic gastritis.

Question 32

Amiodarone

antiarrhythmic used to treat life-threatening arrhythmias.

Answer 32

Pulmonary toxicity is a life-threatening complication that may cause symptoms such as dry cough, pleuritic chest pain, and dyspnea.

Clients taking amiodarone with signs of pulmonary toxicity require immediate follow-up.

Question 33

Albumin effectiveness

Answer 33

indicated by a blood pressure and heart rate within normal limits.

Question 34

Holding digoxin

Answer 34

Infant/young child HR <90-110/min

older children: <70/min

<60 bpm in an adult

Question 35

Potassium-sparing diuretics +thiazide diuretics
<3

Answer 35

Potassium-sparing diuretics (eg, spironolactone, amiloride, triamterene eplerenone) are generally very weak diuretics and antihypertensives. However, they are useful when combined with thiazide diuretics to reduce potassium (K+) loss. Thiazide diuretics can cause hypokalemia when used as monotherapy.

Question 36

Statins

Answer 36

Potential adverse effects include hepatic dysfunction and muscle injury.

Question 37

Warfarin therapy takes several days (eg, 2-5 days) to achieve a therapeutic anticoagulation (ie, INR) level

Answer 37

Therefore, heparin and warfarin are administered concurrently until a therapeutic INR level (ie, 2.0-3.0 for DVT) is achieved

Question 38

All beta blockers (eg, metoprolol, timolol, atenolol), including eye drops that can be absorbed systemically, can decrease the HR and should be held until the prescriptions can be clarified by the HCP.

Question 39

Levofloxacin (Levaquin) is a quinolone antibiotic

XXX with supplements

Answer 39

For this class of antibiotics, 2 hours should pass between drug ingestion and consumption of aluminum/magnesium antacids, iron supplements, multivitamins with zinc, or sucralfate.

These substances can bind up to 98% of the drug and make it ineffective.

Question 40

Sucralfate (Carafate, Sulcrate)

for gastric ulcers,

Answer 40

before meals to coat the mucosa and prevent irritation of the ulcer during meals.

given at least 2 hours before or after other medications to prevent interactions that reduce drug efficacy.

Question 41

Ethambutol (Myambutol)

to treat tuberculosis

Answer 41

can cause ocular toxicity, resulting in vision loss and loss of red-green color discrimination.

Question 42

activated partial thromboplastin time (PTT) is used to evaluate heparin

elevated activated PTT increases the risk for bleeding, and the heparin infusion would be decreased or stopped

Answer 42

aPTT = heparin eval

Question 43

prothrombin time (PT) or international normalized ratio (INR) is used to evaluate warfarin

Answer 43

PT or INR = warfarin eval

Question 44

contraindications
for thrombolytic therapy

Answer 44

Prior intracranial hemorrhage

Structural cerebrovascular lesion (eg, arteriovenous malformation, aneurysm)

Ischemic stroke within 3 months (except within 3 hr)

Suspected aortic dissection

Active bleeding or bleeding diathesis

Significant head trauma within 3 months

Question 45

digoxin toxicity

report

Answer 45

dizziness or lightheadedness
low HR(<60/min) or has skipped beats

Visual symptoms (eg, alterations in color vision, scotomas, blindness)

Gastrointestinal symptoms (eg, anorexia, nausea, vomiting, abdominal pain) – frequently the earliest symptoms

Neurologic manifestations (eg, lethargy, fatigue, weakness, confusion)

Question 46

Drugs commonly associated with orthostatic hypotension

Answer 46

Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin)

Narcotics (eg, morphine)

Vasodilators (eg, nitroglycerine, hydralazine)

diuretics (eg, furosemide, hydrochlorothiazide

Antipsychotic medications (eg, olanzapine, risperidone) and
antidepressants (eg, selective serotonin reuptake inhibitors)

Take medications at bedtime, if approved by the health care provider

Rise slowly from a supine to standing position, in stages (especially in the morning)

Avoid activities that reduce venous return and worsen orthostatic hypotension (eg, straining, coughing, walking in hot weather)

Maintain adequate hydration

Question 47

diltiazem (a calcium channel blocker)

Answer 47

Ventricular rate control is a priority in atrial fibrillation

Question 48

Digoxin (Lanoxin) is excreted almost exclusively by the kidneys

Answer 48

Decreased kidney function usually requires decreased digoxin dosage and frequent drug level monitoring

bun, creatinine

Question 49

Sildenafil and nitrates both cause smooth muscle relaxation.

Answer 49

viagra) + nitrates = hypotension

life-threatening hypotension and sildenafil use should be reported to the health care provider prior to nitrate administration.

Question 50

transdermal nitroglycerin patch that was applied 1 hour ago has peeled off

Answer 50

priority action:
for acute angina is administration of rapid-acting (1-3 minutes) sublingual nitroglycerin to restore cardiac perfusion.

patches have a delayed onset of action (40-60 minutes)

Question 51

Bronchospasm

Answer 51

rarely occurs with high doses of aspirin and metoprolol.

Question 52

HMG-CoA reductase inhibitors (“statins”)

Answer 52

myopathy with ongoing generalized muscle aches and weakness.
should be taught to call the HCP

XXXX grapefruit juice

Liver function tests

Pregnancy status: Statins are contraindicated in pregnancy.

Question 53

vancomycin flushing syndrome,

Answer 53

infusion should be slowed or stopped and restarted at a slower rate after 30 minutes.

Question 54

ACE inhibitors

Answer 54

hyperkalemia, especially in the presence of renal insufficiency.

The nurse should clarify a prescription for ACE inhibitor administration in a client with hyperkalemia

Question 55

Lactulose

for cirrhosis and hepatic encephalopathy

Answer 55

cirrhosis and hepatic encephalopathy to promote excretion of ammonia via fecal elimination

The dose is adjusted to achieve 2-3 soft stools each day.

Question 56

Adenosine

for SVT

Answer 56

first-line medication for paroxysmal supraventricular tachycardia (SVT)

half-life is <10 seconds, so adenosine should be administered rapidly over 1-2 seconds followed by a 0.9% sodium chloride flush

Repeat doses may be given twice if SVT persists

a brief period of asystole may occur due to adenosine slowing impulse conduction through the atrioventricular node

Although the medication should be administered as close to the heart as possible (eg, antecubital area), a central venous access is not required.

Question 57

Morphine

Answer 57

can cause burning during IV administration.
This can be reduced by diluting morphine with 0.9% sodium chloride and administering it slowly over 4-5 minutes

promotes the release of histamine, which can result in vasodilation and hypotension

can cause dizziness. The client should be taught to change positions slowly and call for assistance before getting up to avoid falls.

Question 58

Clients under age 18 who have recently had a viral illness should avoid aspirin

kids X aspirin, also pepto bismol

Answer 58

to prevent Reye syndrome, a condition that causes brain swelling and liver damage.

Question 59

Topical capsaicin cream (Zostrix)

Answer 59

osteoarthritis, neuralgia

wait at least 30 minutes after massaging the cream into the hands before washing to ensure adequate absorption

avoid contact with mucous membranes (eg, nose, mouth, eyes) or skin that is not intact, as capsaicin is a component of hot peppers and can cause burning

application of heat with capsaicin is contraindicated

Question 60

NSAIDs (eg, ibuprofen, aspirin, naproxen, indomethacin, ketorolac)

Answer 60

nephrotoxic and should be avoided in clients with chronic kidney disease

can cause cardiovascular side effects (eg, myocardial infarction, stroke, hypertension, heart failure exacerbation) and decrease the effectiveness of diuretics and antihypertensives

should use NSAIDs cautiously, at the lowest dose necessary, and only for a short time

Question 61

Extended-release oxycodone (Oxycontin)

Answer 61

long-acting opioid agonist prescribed to manage severe chronic pain.

teach the client’s caregiver to administer extended-release oxycodone as scheduled, even if the client does not report pain.

can be given w/ immediate-release opioids for breakthrough pain

Question 62

no opioids within 4 hours of birth

Answer 62

opioids cross the placenta and can cause newborn respiratory depression if the birth occurs within 4 hours of administration.

The length of the second stage of labor (ie, complete dilation of the cervix to birth of the fetus) varies but typically ranges from several minutes to 2 hours. Therefore, it is not appropriate to administer IV opioid analgesics to a client in the second stage of labor

Question 63

life-threatening adverse effect of opioids

Respiratory depression

Answer 63

risk factors:

Concurrent use of other sedating medications (eg, benzodiazepines, antihistamines)
History of smoking
Obesity
Opioid-naive status (ie, has not taken opioids recently on a regular basis)
advanced age (eg, >65),
history of pulmonary disease (eg, chronic obstructive pulmonary disease),
recent surgery (highest risk during first 24 hours after surgery)

Question 64

sedation scale

Oversedation can quickly escalate to fatal respiratory depression (ie, hypoxia, bradypnea) and cardiovascular collapse (ie, hypotension, bradycardia)

A client who falls asleep during conversation is oversedated and should not receive additional opioids.

Other classes of medications (eg, NSAIDs) may be used adjunctively if pain is unrelieved

Answer 64

Pasero Opioid-induced Sedation Scale

1 – Awake, alert

No action necessary
May increase sedation

2 – Slightly drowsy but easy to rouse

Acceptable, no action necessary

3 – Falls asleep during conversation

Unacceptable
Monitor respiratory status
Notify health care provider to decrease sedation by 25%-50%

4 – Somnolent, minimal or no response to verbal & physical stimuli

Stop sedation
Consider using naloxone
Notify health care provider
Monitor respiratory status